Don’t manage diabetes — reverse it
By Dr. James P. McCarter
That’s how much diabetes cost the United States last year. Despite all this spending and lost productivity, the disease still does tremendous damage: It’s one of the nation’s top three causes of death, killing more than 80,000 people each year.
Diabetes takes a particularly large toll here in Houston. More than 15 percent of adults have the condition. All told, diabetes costs the state more than $12.5 billion annually. And that figure will only go up. By 2040, it is projected that 1 in 5 residents will have diabetes.
Shockingly, a huge reason for these high figures is the way our medical community treats the condition: Conventional wisdom suggests that diabetes can only be “managed.”
But this thinking is now outdated. A growing body of research clearly demonstrates that Type 2 diabetes can be reversed. To protect the health of Texans, we must put that knowledge into practice.
Diabetes comes in two varieties. One in 20 patients have Type 1. For these patients, the body’s own immune system attacks the cells that generate insulin. A full 95 percent of those living with diabetes have Type 2, which usually develops in adulthood. For these patients, the body’s cells become resistant to insulin. Both types make it difficult to process glucose — sugar — in the blood. Without proper treatment, diabetes is life-threatening: Elevated blood sugar can damage nerves, blood vessels and other vital tissues.
Currently, patients are instructed to manage blood sugar levels with the help of medication. So much of the debate within the medical community centers on how to best manage diabetes.
Consider a recent disagreement between two high-profile medical organizations. In March, the American College of Physicians issued new targets for the acceptable level of blood sugar in patients with Type 2 diabetes. The group said doctors should keep most patients’ A1C levels — which measures the percentage of red blood cell hemoglobin with glucose attached to it — between 7 and 8 percent.
Within days, the American Diabetes Association fired back, condemning the ACP targets as too high and making the “radical” recommendation that A1C levels be kept below 7 percent.
This is the staid status quo: two highly influential medical organizations quibbling over modest differences in treatment for an epidemic that is considered chronic and progressive.
There’s an evolving alternative to all this. A novel treatment approach now enables doctors to directly address insulin resistance itself. But that requires reducing the use of expensive medications and helping patients adapt to meaningful lifestyle changes.
A 2008 study published in Nutrition and Metabolism, for instance, found that more than 95 percent of Type 2 diabetes patients who successfully ate fewer than 20 grams of carbs per day for 24 weeks were able to reduce or eliminate their reliance on medication.
In a small, 2014 study led by University of California San Francisco researchers, 44 percent of 16 patients with Type 2 diabetes or prediabetes stopped using at least one diabetes drug after just three months of carbohydrate restriction.
Building on that research, my colleagues and I developed a treatment regimen combining individualized, low-carbohydrate nutritional guidance with continuous, remote health coaching and telemedicine. The aim is to shift the patient into nutritional ketosis, a metabolic state in which the body is predominantly fueled by fats, either from the diet or stored in the body, rather than carbohydrates.
Achieving ketosis isn’t easy in our modern environment of processed and fast food. Patients need to adopt comprehensive and sustained changes in diet. But here’s the breakthrough: Ketosis can help reverse Type 2 diabetes by restoring insulin sensitivity. In a recent study published in Diabetes Therapy, we report reducing or eliminating entirely injected insulin use in 94 percent of Type 2 diabetes patients. And after one year, fully 60 percent of our patients experienced a reversal of their diabetes.
If widely adopted, our treatment could generate major cost savings while markedly improving blood glucose control. The average patient beginning our study on insulin saved $4,300 a year in medication costs.
Reducing medications also reduces the risk of a “hypoglycemic” event, as hypoglycemia can occur when medications drive blood sugar down.
The medical establishment has come to view lifestyles changes as insufficient. That’s largely because much of the research on diabetes has examined the effectiveness of low-fat diets, not low-carb ones.
Consequently, the phrase “diet and lifestyle modifications” appears just once in that March report from the American College of Physicians — and not at all in the response from the American Diabetes Association.
Instead of debating the best way to manage Type 2 diabetes, the medical community should aim to reverse the disease. Behavior change with the right nutritional guidance works. And if widely adopted, it could help millions of Texans live better lives.
(Note: Links that were incorrect in the Chronicle piece have been corrected here.)