Simple Care for Diabetes
sitting across from your doctor and being told your blood sugar is
elevated and that you now have type-2 diabetes. Next you are informed
that this condition is in part due to your excess body fat and that if
you lose weight your diabetes will improve and possibly go away;
however, in the meantime, you need to take medication. The doctor
prescribes a diabetic pill (say a sulfonylurea) and hands you a sheet of
paper describing a calorie-restricted diet; which incidentally was
provided by a drug company representative selling diabetic pills to your
doctor. On your first follow-up visit, the next month, despite all of
your best efforts, you have gained 4 pounds. Because of your weight gain
your blood sugars are still no better in spite of the medication. Your
doctor doubles his efforts and adds another medication with a stern
warning to lose the weight. The next month your weight is up another 4
pounds. Your blood sugars are now over 200 mg/dL and insulin shots are
prescribed. This downhill spiral continues and after one full year of
intensive treatment you have now gained 20 pounds of weight, a bag full
of pills, bottles, and syringes, and worse health. Nearly every patient
gets the same results because the medications do nothing to fix the
illness and they compound the patient's problems by raising the levels
of insulin in his or her body
effect of insulin is to facilitate the storage of dietary fat into fat
step to turning around these events is to stop, or at least drastically
reduce, the medications. By removal of the medication-induced
"hyper-insulin-state," the body can now begin making overdue
corrections; an important one being weight loss. The second crucial step
is to change to a low-fat, animal-food-free, starch-based diet. Starchy
foods (rice, corn, potatoes, beans, etc. cause the body's own insulin to
become more powerful; insulin sensitivity is increased.1-3.
To further make the point about the benefits of carbohydrates on the
function of insulin; even pure simple sugar improves insulin
sensitivity.4 A classic experiment on people found an
improvement in diabetic control as measured by fasting blood sugar
levels, insulin levels, and glucose tolerance tests when diabetics were
fed an extreme diet consisting of 85% of the calories as simple sugar
(glucose and maltose).4 Animal proteins, like milk casein,
and animal fats and vegetable oils reduce the sensitivity of insulin.5,6
The third step is to start exercising which further lowers blood sugars
and enhances the weight loss. With these changes a simple cure is possible
for essentially everyone with type-2 diabetes.
Diabetes: From Insulin Deficiency to
(mellitus) is a disease characterized primarily by elevated sugar levels
measured by a blood test usually taken after 6 to 8 hours without food
(a fast). Normal fasting blood sugar values vary among healthy people
between 50 mg/dL to 100 mg/dL.* Levels above 100 mg/dL suggest
impairment of the body's blood sugar-regulating mechanisms (impaired
glucose tolerance = IGT) and a level above 126 mg/dL is defined as
diabetes. Blood sugar levels change rapidly, especially after eating
(they go up) and after exercise (they go down). Hemoglobin A1c is a
common blood test that reflects the average blood sugar over the
previous 2 to 3 months and is the gold standard for judging long-term
control with medication. It is not a test for diagnosing diabetes. A
normal level is considered below 6%. Some patients with diabetes run
percentages twice that high.
by 18 for a rough conversion to mmol/L.
diabetes as a spectrum of disease from insulin deficiency (type-1
diabetes) to insulin sufficiency (type-2 diabetes). Insulin is a hormone
produced by the beta cells of the pancreas. This vital hormone
facilitates the passage of glucose through the cell wall into the
cytoplasm where this sugar provides for energy for the body. Insulin
also makes possible the storage of dietary fat inside of the fat cells.
Insulin production can be permanently reduced by the destruction of the
beta cells; this is usually due to an autoimmune reaction (the body
attacks itself). Type-1 diabetes follows substantial loss of pancreatic
function. Cow's milk protein is the most common cause of immune-mediated
beta cell destruction.7 Type-1 diabetes can occur at
any age, even into adulthood. Substantial lack of insulin production is
life threatening; the only partial remedy is supplementation with daily
insulin injections. The damage is irreversible.
diabetes the pancreas is synthesizing normal and sometimes excess
amounts of insulin.8,9 However, in this case the problem is
not with the pancreas; the problem is that the cells throughout the body
have become resistant to the actions of insulin. This peripheral
resistance results in less sugar entering the cells and more remaining
in the blood. The development of
insulin resistance is a normal adaptive mechanism the body uses to
ward off extreme fat accumulation when faced with the rich Western diet.
Type-2 diabetes is known as non-insulin-dependent diabetes, meaning
there is plenty of insulin being synthesized. Therefore, eliminating the
resistance to the action of the body's insulin always cures type-2
diabetes (unless there is in addition some significant loss of beta cell
function). This cure is accomplished with substantial weight loss.10
The most healthful and long-lasting way to correct obesity and insulin
resistance is by following a high-carbohydrate, low-fat, starch-based
People with Insulin Deficiency May Need
patients requiring insulin can be divided into two categories:
Insulin Deficiency: The most severe form of insulin deficiency, seen
in the classic patient with type-1 diabetes, requires daily insulin
supplementation, otherwise the patient will become severely ill (ketoacidosis),
and often die without this vital replacement.
People with Partial Insulin Deficiency: Most people with blood
sugars above 126 mg/dL, who are also trim (not overweight or
underweight) fall into the category of partial insulin deficiency.
Doctors often refer to this as type-1� diabetes. These patients produce
enough insulin to avoid life-threatening illness, but not enough to keep
their blood sugars normal. With the elevated sugar levels they may also
develop adverse effects, such as excessive thirst and urination, and too
much weight loss. Insulin injections easily remedy these undesirable
Treating Type-2 Diabetes in the Overweight
patient I see with a diagnosis of type-2 diabetes is overweight or obese
and on a multitude of medications intended to lower their blood sugar.
Yet their sugars remain elevated in the 200 mg/dL to 400 mg/dL range;
even with their doctors' best efforts. No matter how often the blood
sugar is checked daily, or the amount and kind of medication given, the
blood sugars are never normal; they are usually way too high, and on
occasion, dangerously low, causing confusion and coma. Obviously, even
in the best professional hands, the treatments do not work.
step I take is to stop all of their oral medications on the first visit.
I do this because these medications have serious adverse effects and no
real health benefits. (Yes, they do cause the numbers - sugar and
HgBA1c - to look better.) After I explain the facts to the patient, most
of them readily agree to make this change.
Diabetic Pills Kill
Most physicians believe that better control of blood sugars
means better long-term outcomes for the patients and they
enthusiastically prescribed these medications. Research proves
otherwise. Diabetic medications are approved by the FDA for
market based upon their ability to lower blood sugar levels, not
based on any improvements in the quality or quantity of the
a major study, a popular diabetic medication, Avandia (rosiglitazone),
given at a dosage of 4 mg twice daily, on average, decreased
hemoglobin A1c levels by 1.5 percentage points, reduced fasting
plasma sugar by 76 mg/dL (4.22 mmol/L), and reduced insulin
resistance by 25%.14 These improved numbers should
have meant healthier patients, but they didn't. On May 21,
2007 the New York Times reported, patients taking Avandia
had 66 percent more heart attacks, 39 percent more strokes and
20 percent more deaths from cardiovascular-related problems.15,16
Since 1972, the Physicians Desk Reference (PDR) descriptions of
most diabetic pills have included two paragraphs in bold print
that begin with: Special Warning on Increased Risk of
Cardiovascular Mortality. This warning is given
because a very commonly prescribed class of oral medication,
called sulfonylureas, increases the risk of cardiovascular death
by 2 � times compared to diet treatment alone.
Reducing Insulin Injections
overweight patient, with a diagnosis of type-2 diabetes, significantly
elevated blood sugars, and taking insulin, I always reduce their dosage,
and most times I ask them to stop the insulin altogether. My decision is
based upon my best guess and the patient's wishes. Many patients are
understandably afraid to stop their insulin, so a reduction in dosage is
often the best compromise, say stopping all of the short-acting insulin
and continuing only the long-acting, or cutting the amount of both the
long and short acting in half. This is very safe to do (under doctor's
supervision) for those with type-2 diabetes. The greatest risk to the
patient is hypoglycemia from them still taking too much insulin,
especially after they change to a low-fat, starch-based diet and start
exercising. In almost all cases it is better to guess on the side of
less rather than more medication.
At the same
time medication changes are being made, my patients begin strictly
following the McDougall Diet and exercising daily (slowly at first). I
ask them to monitor their blood sugars (fasting) every morning with
their home measuring unit and report the results to me daily. Based on
these blood sugar numbers their insulin injection dosage is either
raised or lowered for that evening or the next day. The goal is to keep
their fasting blood sugars between 150 mg/dL and 300 mg/dL. I discourage
blood sugar measurements at any other time of the day unless they
suspect hypoglycemia (too low a sugar). The finding of elevated sugars
later in the day after eating just upsets the patient and does not add
any useful information in deciding on the next dosage of insulin to be
important change I also make is to switch them from multiple shots daily
to a single dose of long-acting insulin, such as Lantus, taken once in
the evening. (Other long-acting options are Ultralente and Levemir.) A
typical starting dose for people with blood sugars between 200 mg/dL and
400 mg/dl is 20 to 40 units of Lantus daily (roughly 10 units of insulin
for each 10 mg/dL elevation over 200 mg/dL). The reason I do not try to
more aggressively treat the blood sugar numbers to make them look more
normal by using more testing, pills, and injections is because this
commonly used approach is proven beyond any doubt to harm patients.
diabetes I do not prescribe pills; however, when needed, I use
long-acting insulin in order to:
the rate of weight loss or to cause weight gain.
2) Relieve symptoms of diabetes, such as excessive thirst and urination.
3) Help relieve the worries of the patient over the high sugar numbers.
Being treated with a little insulin makes people feel that all the bases
are being covered, especially if their blood sugar numbers look a little
lower after the insulin. However, there are possible downsides:
Introduction of insulin treatment may cause the patient to become less
compliant with their diet and exercising; turning their faith back to
the medications, in spite of the facts. Plus, I worry about the harms
caused by the medications as I have discussed.
Aggressive Treatment Harms
six major studies published over the past thirteen years show
that attempts by physicians to make the patients' blood sugars
and Hemoglobin A1c levels look more "normal" with medications
harm the patients. Three major studies published between 1996
and 2000 found more weight gain, higher cholesterol,
triglycerides, and/or blood pressure; and more heart disease,
stroke, and/or death with "aggressive" treatment compared to
2008, three landmark studies, ACCORD, ADVANCE, and VADT, were
published in the New England Journal of Medicine.20-22
All three showed aggressive treatment does more harm than good.
On February 6, 2008 the National Heart, Lung, and Blood
Institute (NHLBI), stopped the ACCORD study (Action to Control
Cardiovascular Risk in Diabetes) when results showed that
intensive treatment of diabetics increases the risk of dying
compared to those patients treated less aggressively.23 Patients
in the intensive-treatment group were oftentimes taking four
shots of insulin and three pills daily, and checking their
blood-sugar levels four times a day.20 The ADVANCE
study found no reduction in heart attacks or strokes, deaths
from cardiovascular causes, or death from any cause with
Veterans Affairs Diabetes Trial (VADT) was based on 1791
military veterans with type-2 diabetes.22 Patients
were assigned to receive either intensive- or standard-glucose
control and studied for 5.6 years. The intensive-therapy group
reduced their hemoglobin A1c levels to 6.9%; compared to 8.4% in
the standard-therapy group. A weight gain of 18 pounds occurred
with the intensive-treatment, compared to 9 pounds with
standard-therapy. There were 102 deaths from any cause in the
intensive-therapy group and 95 in the standard-therapy group. In
the intensive-therapy group, the number of sudden deaths was
nearly three times the number of those in the standard-therapy
group (eleven vs. four). More patients in the intensive-therapy
group had at least one serious adverse event, predominantly
hypoglycemia, than in the standard-therapy group.
Diet and Exercise Are the Foundations for
Proper Medical Care
therapy has consistently failed patients with type-2 diabetes, and their
well-intended doctors, making the search for an alternative treatment
imperative. Since the rich Western diet is agreed to be the cause of
this epidemic, should diet not be the first place to look for the
prevention and the cure?24 Written reports on the benefits of
a low-fat, high-carbohydrate, plant-food-based diet on type-2 diabetes
date back to at least 1930.25 Several published studies
demonstrate how type-2 diabetics can stop insulin and get off diabetic
oral medications with a change in diet.26-31 One goalpost is
weight loss to the point of normal body weight, at this time the blood
sugars of most patients diagnosed with type-2 diabetes will normal, and
then everyone will agree that no further treatment with medications is
good fortune, this same low-fat, no-cholesterol diet successfully used
for diet-therapy for diabetes has been shown to prevent and treat heart
and kidney disease, and prevent many common forms of cancer. Heart
disease accounts for 70% of the deaths in diabetics, diabetes is the
number one cause of kidney failure, and cancer is more common in
for a person with diabetes, attention should be paid to other risk
factors, such as cholesterol, triglycerides, and blood pressure. In most
cases these numbers will also improve by following a starch-based diet
and exercising, and the associated weight loss. But there will remain a
few people who will benefit from treatment of their
cholesterol with medication. Just like a few people with type-2
diabetes (with partial insulin deficiency) will need insulin.
and purposely misled, as is the case now, the patient cannot get well
and the doctor is ineffective in carrying out his or her duties.
Consideration for the truth, and the appropriate medical practices that
must follow, would change the entire healthcare system for the good,
reducing costs and improving patient outcomes substantially.
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