Diabetes: We’re doing it wrong.
My father was diagnosed with type 2 diabetes in December. Starting a family-wide, low-carbohydrate diet at Christmastime was no easy feat, but to say it’s working would be an understatement. Check out these results.
From 12/11/15 to 3/7/16:
- Fasting blood glucose fell from 292 mg/dL to 133 mg/dL. Normal is below 100 mg/dL.
- Hemoglobin A1c fell from 12% down to 6.6%. Normal is below 5.7%.
- Total cholesterol fell from 263 mg/dL to 171 mg/dL. Normal is below 200 mg/dL.
- Triglycerides fell from 791 mg/dL to 144 mg/dL. Normal is below 150 mg/dL.
- HDL cholesterol rose from 34 mg/dL to 50 mg/dL. This is the type of cholesterol that’s considered protective against heart disease. The more the merrier!
- LDL cholesterol was incalculable in December due to his extremely high triglycerides, but we can assume it was high since his total cholesterol was high and his HDL cholesterol was low. In March it was 92 mg/dL. Below 100 mg/dL is optimal.
- He lost 5 pounds.
- After years of hypertension, his blood pressure normalized.
In less than three months, he has completely reversed hypertension and dyslipidemia and is actively reversing diabetes at an impressive rate. Subjectively, he reports his golf game has improved and my mother reports he’s far less grouchy. It’s a win-win-win.
My intention for him is that by his next follow-up, he will have completely reversed the disease and his medications will be discontinued. At that point, we’ll liberalize his diet a bit to include…get this, legumes and maybe, occasionally, some whole grains if he tolerates them. Wild, I know.
As a clinician, I can say this type of transformation is virtually unseen. Yes, it is the goal, and it’s what we all advocate for, but it just doesn’t normally happen.
We’re managing the disease all wrong.
We seem to have forgotten that type 2 diabetes is induced by diet. It’s a carbohydrate intolerance, plain and simple. The commonsense approach to managing it is to restrict dietary carbohydrate.
Stop feeding the body that which it cannot tolerate.
That is, in fact, how it used to be treated but not any longer. Today, new diabetics are prescribed medications and are taught to eat pretty much the same high-carbohydrate diet as the general public. The disease only progresses. The patient requires more and more medication to control it. Then the serious complications start creeping in.
So why have we forgotten that diabetes is diet-induced and can be diet-reversed? There are countless reasons.
We really buy into prescription drugs.
We’ve come to expect that first comes disease, then comes medication. We bet on pharmaceutical solutions rather than addressing the cause of disease.
One reason we’re so accepting of medication is that taking a pill is simplistic compared to overhauling our life. It’s also an easier solution for clinicians who can’t move in with you and police your food.
There are vested interests at play.
There’s money to be made in drugs, devices, and the medical management of diabetes. Pharmaceutical companies, for example, believe there is so much money to be made that they invest heavily in a salesforce trained to waltz right into your doctor’s office and educate (a.k.a. sell) them on the benefits of their wonder-drugs.
You know who isn’t in your doctor’s office hocking their product? Cauliflower farmers.
I’m not saying industries are intentionally exploiting the disease for profit. It’s just that there isn’t nearly as much money to be made in organic farming as there is in devices or pharmaceuticals. Food, real food, is the often overlooked treatment plan.
Lack of knowledge
Every physician has experience treating diabetes, but that is not to say their knowledge is either exhaustive or up-to-date. Physicians traditionally receive very little nutrition education in their training — sometimes as little as a few hours. Most are not nutrition experts and will outright admit that.
Dietitians and Certified Diabetes Educators are experts on the relationship between diet and diabetes, but many subscribe to out-dated industry practices. And, not every patient is referred to one. My father wasn’t.
Dietary interventions fail.
We have a learned helplessness when it comes to dietary interventions. We’ve been preaching diet and exercise to the masses for decades to no avail. Society just keeps getting sicker despite all of the well-intentioned advice.
Patients feel helpless because they’ve never been able to meet their goals despite real effort. And physicians feel like they’re banging their own heads against the wall advocating for a healthy lifestyle that no one can or will follow.
I get that, both personally and professionally, but our diet advice has failed not because it’s futile, but because we’ve simply been giving the wrong advice.
We got it wrong.
The low-fat, low-saturated fat, low-cholesterol, “heart-healthy” diet first recommended in the 1970s morphed into a high-carbohydrate, high-sugar, low-fiber processed food diet that is precisely what’s making us sick.
If we focused on the right advice — real food, fewer grains, and for those with type 2 diabetes, a low-carbohydrate diet— we would see more impressive results.
We assume obesity causes diabetes.
It doesn’t, and this one is really slowing us down because it’s still such a commonly held belief. Steve Jobs said “If you define the problem correctly, you almost have the solution.” We’ve defined the problem incorrectly. It’s no wonder our attempts to solve it have failed.
We assume that obesity causes diabetes, because the two are so commonly observed together. A more progressive way of thinking about it is that obesity and diabetes are both symptoms of the same problem: our food. Address the food and you’ll solve both problems.
What it all means
Type 2 diabetes is preventable and reversible, but we treat it like it’s inevitable.
We expect the patient can’t control diabetes with diet. We expect the disease will progress. We expect complications. We expect poor quality of life. We expect there’s not much we can do except “manage” it, which really means adding new medications, amputating limbs, and starting hemodialysis.
That explains why, despite his obvious progress, my father sometimes forgets that reversing the disease is an option. For example, his targets for fasting blood glucose and hemoglobin A1c are not normal levels. Rather, they’re the values that indicate well-controlled diabetes, because those are the values his physician told him to aim for. He was taught to manage rather than reverse, and now he has a hard time thinking differently.
It also explains why, when my father asked his physician if his diabetes had anything to do with the “out of control” way in which he had been eating, his physician responded with “Nah, it’s genetic.”
By assuming diabetes cannot be undone, we are creating a self-fulfilling prophecy. We need to challenge the assumptions about diabetes and remember what we’re all taught in the beginning: Diabetes is a carbohydrate intolerance. Start there.