February 2004    
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Type-2 Diabetes – the Expected Adaptation to Overnutrition

Sixteen million people in the United States have type-2 diabetes, which shortens lifespan by up to 15 years, leads to almost 300,000 deaths annually, and costs about $100 billion annually.  Since 1980 the incidence has increased by 30%.  Born in the year 2000, your male child’s lifetime risk of developing type-2 diabetes is nearly 33%, and a female’s risk will be 39% when following the Western diet.1   Worldwide, 135 million people have type-2 diabetes and by 2025 the incidence is predicted to reach 300 million people worldwide.


This form of diabetes was once referred to as “adult-type diabetes” because in the past, type-2 diabetes was rare in children. However, over the last two decades, there has been a 10-fold increase in incidence of type-2 diabetes in children, because of the rapidly growing numbers with obesity from an escalating exposure to rich foods, compounded by a lack of exercise.2


The general state of poor health of Westerners, as reflected by diabetes, escalates unchecked for 3 important reasons:

1) This growing epidemic of type-2 diabetes and obesity is fueled by huge profits generated by a food industry super-sizing everything by stuffing their irresistible morsels with fat, sugar, refined flour, and calories.

2)  Medical doctors continue to prescribe remedies that have never cured a single case of diabetes.   Furthermore, the usual “poly-pharmacology” of medications they rely upon promotes weight gain, heart disease, and hypoglycemia, along with other serious adverse effects.  From all these expensive medications there is a small reduction in complications, such as kidney and eye damage, which still fails to offset the tremendous harm done by their efforts.

3)  The American Dietetic Association has remained steadfast in their recommendation of a portion-controlled version of the Western (American) diet – an impossible diet to follow (because of its complex rules and semi-starvation nature) – made up of ingredients, like fat, sugars, refined foods, and cholesterol, that caused the patients’ problems in the first place.


In 1927 Dr. E. P. Joslin, founder of the famous Joslin Diabetic Center in Boston, suspected a high-fat, high-cholesterol diet might favor the development of diabetes and its major complication, atherosclerosis.3  He prophetically wrote: “I believe the chief cause of premature atherosclerosis in diabetes, save for advancing age, is an excess of fat, an excess of fat in the body (obesity), an excess of fat in the diet, and an excess of fat in the blood.  With an excess of fat diabetes begins and from an excess of fat diabetics die, formerly of coma, recently of atherosclerosis.”  And now, 75 years after Joslin’s farsighted message, diabetes is the fastest growing disease in the world.


Type-2 Diabetes:  A Runaway Epidemic Caused by Rich Foods


The cause of this skyrocketing health tragedy is easily seen by observing everyday people striving for the “good life.”4-6  Feasting from the king’s table brings on the diseases of royalty, like obesity, gout, and diabetes.  Worldwide, the incidence of type-2 diabetes increases in direct proportion to the consumption of meat, dairy products, sugars, fats, and calories by the residents.  Type-2 diabetes has taken the greatest toll on “minority” populations brought to the Western diet by migration to cities and giant industries providing cheap fast food.


Native Americans, for example the Pima Indians of Arizona, introduced to the Western diet over the past 75 years, are now afflicted so severely that as many as one-half of them has diabetes.7  However, their genetic cousins, the Tarahumara Indians of Mexico, following a diet consisting of 90% corn and pinto beans (chili), and vegetables (like squash), are free of type-2 diabetes – as well as obesity and heart disease.8,9  Similar dramatic rises – from immunity to epidemic proportions – of type-2 diabetes have been seen in other people like Africans, African-Americans, Mexicans, Chinese, and Polynesians, as they adopt the Western diet with enthusiasm.10-12  There are no exceptions to this observation that when populations of people following a starch-based diet (rice, corn, potatoes, sweet potatoes, etc.), switch to a diet of rich foods – meats, dairy products, added oils, and refined foods – they become overweight and diabetic, and develop heart disease, breast, prostate and colon cancers, gallbladder disease, arthritis, multiple sclerosis, and bowel problems.  No exceptions!


Diabetes Is an Adaptive Response to Overnutrition

The malnutrition caused by the high-fat, low-fiber Western diet places serious burdens on the body and requires it to make adaptions in order to survive under adverse conditions. The calories consumed in excess of our needs cause us to gain fat – this is a natural, expected change.  Soon a point is reached when this accumulation becomes counterproductive – a point when any further excess body weight is likely to cause serious physical harm.   When this hazardous excess is reached, the body puts “the brakes on” in order to slow the rate of gain.  This is accomplished by a variety of changes that cause the hormone insulin to become less potent. 13,14  In other words, our cells become resistant to the actions of the fat-gaining hormone, insulin – a state referred to as “insulin resistance.”


One of insulin’s primary jobs is to push fat into the fat cells – thus saving fat for the day when no food is available (which for Westerners never comes).  If it were not for the adaptive mechanisms which allow for the development of “insulin resistance,” people would commonly expand until they became so large that they could not get out of bed or fit through a doorway – a very rare condition that does occur in 1000-pound sized people who need a forklift to move them to the hospital. (They make headlines in the newspaper.)


One of insulin’s other important jobs is to let sugar into the body’s cells – with a state of “insulin resistance” the sugar cannot get into the cells easily – so it rises in the blood. The hallmark of the diagnosis of diabetes is an elevated blood sugar above normal (usually normal is below 115 mg/dl fasting).   With impotent insulin, the calories of fat and sugar we consume cannot easily enter the cells; the body is essentially starving itself from the inside in a desperate attempt to compensate for the overfeeding coming from the outside.  To further reduce the burden of obesity, the body eliminates calories by allowing sugar to spill over into the urine, like water falling over a dam.  At this stage sugar is found with a urine test – another common way to diagnosis diabetes.  Most doctors and patients view the elevated blood sugar as the enemy to be beaten down with medications – the result is a fat, sickly patient with a slightly lower blood sugar.

The Reason Medical Therapy Should Be Your Last Choice


Diabetic medications have never cured anyone of diabetes and actually compound the patients’ problems. The patient goes to the doctor, is diagnosed with diabetes, placed on medication, and told to lose weight.  Unfortunately, these medications make insulin more effective, causing more fat to be stored in the fat cells. The average initial weight gain when diabetic medications are started is 8 to 20 pounds – due to partially counteracting the protective effects of “insulin resistance.”  Thus the well-behaved patient takes the medications as directed, but then gains weight, and as a result of the added weight his diabetes becomes worse.  The patient returns to the doctor, is given a firm scolding for gaining weight, and then more medications are prescribed because his sugars are even higher than before – this additional medication makes the patient even fatter and the diabetes more out of control.  The vicious cycle continues – and the patient and doctor are left guilt-ridden and confused about their obvious medical failure.  After all, they followed the pharmaceutical company’s instructions exactly.  Worse yet, the patients are not one bit healthier from all this effort and expense.

More than 30 years ago, when I was in medical school, I remember doctors arguing about the benefits from aggressive use of medication to make the blood sugars lower, a practice referred to as “tight control.”  Ideally, keeping the blood sugars close to normal makes sense, but in real life more harm than good is done for type-2 diabetics.  First of all, no matter how hard the patient and the doctor work at their goal, the blood sugar readings are all over the place – one test shows 60 mg/dl and the next 260 mg/dl.  Soon it becomes obvious to the patient that the short-term goal of “normalizing” the blood sugar levels is impossible using medications.

The next carrot held out is for long-term benefits: preventing complications later in life.  In truth, studies have shown there is some benefit for the eyes and the kidneys with better control of blood sugar (especially for type-1 diabetics).15-17 However, the major threat to the life of a diabetic is from heart attacks and strokes – diseases of the large blood vessels.  Intensive medical therapy using the most high-tech drugs to lower blood sugars has failed to reduce the risk for, and improve survival from, these two major killers. In fact, the medications used to combat sugar will actually create more sickness and death from heart disease.


Since the early 1970s every single edition of the Physician’s Desk Reference, found in every doctor’s office, has carried this warning in heavy back print for their diabetic medications: “SPECIAL WARNING ON INCREASED RISK OF CARDIOVASCULAR MORTALITY.” The most commonly prescribed diabetic medications, known as sulfonylureas,* cause fundamental changes in the function of cells that increase the risk of heart attacks.18  These drugs, which are called “antidiabetic agents” by the pharmaceutical companies, have recently been shown to more than double the risk of heart attacks and almost triple the risk of early death in patients after an angioplasty.19    I never prescribe this type of diabetic pills, and always ask my patients to stop them.  All diabetics should be actively looking for a better approach – and so should any doctor interested in his patients’ welfare.



The Treatment of Type-2 Diabetes with a Low-Fat, Plant-Food Diet 


Multiple studies dating as far back as the 1920s have shown the benefits of a high-carbohydrate, low-fat diet in the treatment of type-2 diabetes.23   For example, studies from the University of Kentucky Medical School reported as many as two-thirds of diabetics were able to discontinue insulin and almost all stopped oral agents.24  A recent thorough review of the use of a vegetarian diet in the treatment of type-2 diabetes was published in the September 2003 issue of the American Journal of Clinical Nutrition. In this review article Dr. David Jenkins reported on research showing improvements in blood sugars in diabetics with 39% stopping insulin and 71% stopping diabetic pills after three weeks of therapy.25  Relief of diabetic neuropathy pains, reduced lipids (cholesterol and triglycerides), and weight loss have also been reported with a low-fat, pure-vegetarian diet.  Another recent research paper has reported similar findings with a low-fat vegetarian diet.26  Many of these people with type-2 diabetes are cured of their disease within three weeks, and most will be cured of their diabetes over time as they adhere to a low-fat, high carbohydrate diet, exercise, and lose all of their excess body fat.


This same kind of diet (in large part because of the restriction of animal protein) has been shown to dramatically improve the health of the kidneys of diabetics (protein in the urine, a sign of diabetic kidney damage, decreases and disappears).27,28   Research has also shown diabetic damage found in the eyes (retinopathy) can be reversed with a low-fat diet.29,30  It’s interesting how kidney and eye damage, the two purported benefits from drug therapy, are actually better treated with diet than with medications, at no cost and no side effects.  A low-fat vegetarian diet has also been shown to reverse heart disease (atherosclerosis), the number one killer of diabetics.31  Many other researchers have praised a low-fat vegetarian diet as the best approach to prevent and treat most diseases that plague people in modern societies, including people with diabetes.32-35  Possibly the most important effect of this dietary approach (combined with exercise) is the scientifically established fact that this is the easiest and most effective way to lose weight permanently.36-39 Obesity is the underlying cause of diabetes.40


Practical Steps to Cure Type-2 Diabetes

If you are one of the millions of diabetic patients facing a hopeless future of worsening diabetes, obesity, loss of vision, kidney failure, heart attacks, strokes, gangrene, and early death and disability – even though you have visited your doctors regularly, and taken your medications faithfully – then it is time to break this downhill spiral by changing your diet and exercise program.  At the same time ask your doctor to provide you with sensible, conservative, care.  I do the following with my patients: 


1)   Stop diabetic pills and reduce or eliminate insulin. In most cases, I have my patients stop all of their diabetic pills the day they start the McDougall diet and exercise program and/or at least half of their insulin.  If this reduction is not made in a timely manner, then they run a real risk of developing hypoglycemia (too low blood sugar).  I increase or reduce medications based on the patient’s response and as a general guideline I try to keep their blood sugars between 150 to 250 mg/dl while I am trying to adjust their medication needs.  Stopping and/or reducing the medications reverses the weight gain immediately.  (Insulin cannot be stopped in type-1 diabetes, but the dosage is often reduced.)


2)    Change them to a low-fat, high-fiber, plant-based diet: the McDougall diet.  The diet should be based around starches with the addition of fruits and vegetables – there are no added vegetable oils.  Sample foods are: oatmeal, whole wheat pancakes or potatoes for breakfast.  Lunch can be soups, salads, and sandwiches. And dinner may be thought of in terms of ethnic dishes, like Mexican burritos, Chinese Mu Shu vegetables, Thai curried rice, or Italian whole grain pasta. 


3)    Ask them to exercise.  Start at a comfortable level and gradually build up.  Exercise should be increased to the equivalent of at least a half hour of walking a day.


4)   Check their other risk factors for indications of serious disease, such as cholesterol, triglycerides, and blood pressure.  Then make diet and lifestyle modifications to correct these (for example, fewer fruits and juices with high triglycerides and cholesterol, and less salt with high blood pressure).


5)   Have them take appropriate medications only.  For example, I prescribe: 

  • ·     Small doses of insulin for too much weight loss or if my patient develops symptoms of diabetes, like too frequent urination or excessive thirst.

  • ·     Cholesterol (and triglyceride) lowering medications in order to reach ideal levels of 150 mg/dl, especially for patients at high risk for a stroke or heart attack.  (See my September 2002 and June 2003 Newsletters.)

  • ·     Blood pressure lowering medications, are sometimes indicated in high-risk patients whose blood pressure remains at 160/100 mm Hg or greater for months.  (See my August 2002 Newsletter.)

A prescription of a low-fat diet and exercise can be taught by any interested physician or dietitian.  Most diabetics respond within days – and with continued weight loss, most can be expected to stop all diabetic medications – and regain lost health and appearance. The most difficult task for people with diabetes is to break from tradition – the following words may help. “The diet recommended by the American Diabetic Association virtually guarantees all diabetics will remain diabetic,” claimed the pioneer nutritionist, Nathan Pritikin, 30 years ago.  His experiences from treating thousands of people with this disease convinced him that type-2 diabetes is largely curable by following a healthy diet and moderate exercise.  Obviously the failure of modern diabetic management has been known long before most diabetics developed their disease – yet nothing changes for the better.  Your only chance is to rebel against commonly accepted advice.  Don’t you think a revolt is long overdue based on the poor results you have experienced so far? 



1)  Narayan KM.  Lifetime risk for diabetes mellitus in the United States.  JAMA 2003; 290: 1884-90.

2)  Ludwig DS, Ebbeling CB.  Type 2 diabetes mellitus in children: primary care and public health considerations.  JAMA. 2001 Sep 26;286(12):1427-30.

3)  Joslin EP.  Atheroscleriosis and diabetes.  Ann Clin Med 1927;5:1061.

4)  Hinsworth HP.  Diet in the aetiology of diabetes.  Proc R Soc Med 1949;42:323-6

5)  West KM, Kalbfleisch JM,.  Influence of nutritional factors on prevalence of diabetes.  Diabetes 1971; 20: 99-108.

6)  Rao RH.  The role of undernutrition in the pathogenesis of diabetes mellitus.  Diabetes Care 1984; 7: 595-601.

7)  Lee ET, Welty TK, Cowan LD, Wang W, Rhoades DA, Devereux R, Go O, Fabsitz R, Howard BV.   Incidence of diabetes in American Indians of three geographic areas: the Strong Heart Study. Diabetes Care. 2002 Jan;25(1):49-54.

8)  McMurry MP .  Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet.  N Engl J Med. 1991 Dec 12;325(24):1704-8.

9)  Briceno I, Barriocanal LA, Papiha SS, Ashworth LA, Gomez A, Bernal JE, Alberti KG, Walker M.  Lack of diabetes in rural Colombian Amerindians.  Diabetes Care. 1996 Aug;19(8):900-1.

10)  Foliaki S.  Prevention and control of diabetes in Pacific people.  BMJ. 2003 Aug 23;327(7412):437-9.

11)  Ring I.  The health status of indigenous peoples and others.  BMJ. 2003 Aug 23;327(7412):404-5.

12)  Ko G. Rapid increase in the prevalence of undiagnosed diabetes and impaired fasting glucose in asymptomatic Hong Kong Chinese.  Diabetes Care. 1999 Oct;22(10):1751-2.

Mann JI.  Diet and risk of coronary heart disease and type 2 diabetes.  Lancet. 2002 Sep 7;360(9335):783-9.

13)  Fujimoto WY.  The importance of insulin resistance in the pathogenesis of type 2 diabetes mellitus.  Am J Med. 2000 Apr 17;108 Suppl 6a:9S-14S.

14)  Goldstein BJ.  Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol. 2002 Sep 5;90(5A):3G-10G.

15) UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.

16)  DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med. 1993;329:977-986.

17)  Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28:103-117

18)  Engler RL, Yellon DM.  Sulfonylurea KATP blockade in type II diabetes and preconditioning in cardiovascular disease. Time for reconsideration.  Circulation. 1996 Nov 1;94(9):2297-301.

19)  Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR Jr.  Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction.  J Am Coll Cardiol. 1999 Jan;33(1):119-24.

20)  Purnell JQ.  Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998 Jul 8;280(2):140-6.

21)  Colwell JA, Clark CM Jr.  Forum Two: Unanswered research questions about metabolic control in non-insulin-dependent diabetes mellitus.  Ann Intern Med. 1996 Jan 1;124(1 Pt 2):178-9.

22)  Gustafsson I, Hildebrandt P, Seibaek M, Melchior T, Torp-Pedersen C, Kober L, Kaiser-Nielsen P.  Long-term prognosis of diabetic patients with myocardial infarction: relation to antidiabetic treatment regimen. The TRACE Study Group.  Eur Heart J. 2000 Dec;21(23):1937-43.

23)  McDougall J.  McDougall’s Medicine – A Challenging Second Opinion. New Century Publication 1985.

24)  Kiehm TG, Anderson JW, Ward K.  Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men.  Am J Clin Nutr. 1976 Aug;29(8):895-9.

25)  Jenkins DJ, Kendall CW, Marchie A, Jenkins AL, Augustin LS, Ludwig DS, Barnard ND, Anderson JW.  Type 2 diabetes and the vegetarian diet.  Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S-616S.

26)  Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning S.  Toward improved management of NIDDM: A randomized, controlled, pilot intervention using a lowfat, vegetarian diet.  Prev Med. 1999 Aug;29(2):87-91.

27)  Raal FJ, Kalk WJ, Lawson M, Esser JD, Buys R, Fourie L, Panz VR.   Effect of moderate dietary protein restriction on the progression of overt diabetic nephropathy: a 6-mo prospective study.  Am J Clin Nutr. 1994 Oct;60(4):579-85.

28)  Cupisti A. Vegetarian diet alternated with conventional low-protein diet for patients with chronic renal failure.  J Ren Nutr. 2002 Jan;12(1):32-7.

29) Van Eck W.  The effect of a low fat diet on the serum lipids in diabetes and its significance in diabetic retinopathy.  Am J Med.  1959; 27:196-211.

30) Kempner W.  Effect of the rice diet on diabetes mellitus associated with vascular disease.  Postgrad Med. 1958; 24:359-71.

31)  Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL.  Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.  Lancet. 1990 Jul 21;336(8708):129-33.

32)  Segasothy M, Phillips PA.  Vegetarian diet: panacea for modern lifestyle diseases? QJM. 1999 Sep;92(9):531-44.

33)  Fraser G.  Ten years of life.  Is it a matter of chance?  Arch Intern Med. 161:1645-52, 2001.

34)  Key TJ, Davey GK, Appleby PN.  Health benefits of a vegetarian diet.  Proc Nutr Soc. 1999 May;58(2):271-5.

35)  Sabate J.  The contribution of vegetarian diets to health and disease: a paradigm shift? Am J Clin Nutr. 2003 Sep;78(3 Suppl):502S-507S.

36)  Nicholas P. Hays; Raymond D. Starling; Xiaolan Liu; Dennis H. Sullivan; Todd A. Trappe; James D. Fluckey; William J. Evans.  Effects of an Ad Libitum Low-Fat, High-Carbohydrate Diet on Body Weight, Body Composition, and Fat Distribution in Older Men and Women: A Randomized Controlled Trial. Arch Intern Med. 2004;164:210-217.

37)  Jequier E, Bray GA.  Low-fat diets are preferred.  Am J Med. 2002 Dec 30;113 Suppl 9B:41S-46S.

38)  Astrup A, Astrup A, Buemann B, Flint A, Raben A.  Low-fat diets and energy balance: how does the evidence stand in 2002? Proc Nutr Soc. 2002 May;61(2):299-309.

39)  Wing R. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-41.

40)  Pinkney J.  Prevention and cure of type 2 diabetes.  BMJ. 2002 Aug 3;325(7358):232-3.

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