Sunday, September 23, 2018

Type 2 Nutrition #451, Is Very Low Carb like the South Beach Diet?

When I describe my Way of Eating (WOE), I’m frequently asked, “Is Very Low Carb like the South Beach Diet?” Definitely not! Here’s a point-by-point comparison, from my (biased) perspective as a strong advocate of the Very Low Carb approach. For reference, I’ve used this description of the South Beach Diet from Wikipedia.
SBD: “high in fiber,” “low glycemic carbs,” “unsaturated fats (mostly monounsaturated),” “lean protein.”
VLC: Very low in fiber. All fiber is carbohydrate. You cannot eat “high fiber” and Very Low Carb because, to get any fiber, you have to eat carbs, and to get high fiber you would have to eat too many carbs. The only fiber you eat in Very Low Carb is the incidental content in some of the low carb vegetables at some meals (supper, mostly), and the occasional snack (e.g. celery with anchovy paste). Typically, I eat maybe 5g of fiber a day.
SBD & VLC: Low glycemic carbs. Generally, both diets advocate “low glycemic carbs.” This would include many above ground vegetables and leafy greens. VLC would exclude corn, beets, peas and carrots (too sugary) and squash. My favorites are broccoli, cauliflower, asparagus, green beans and salad greens. More caveats below.
SBD: Unsaturated fats (mostly monounsaturated): This suggests the “fruit” oils, avocado and olive oil (mostly monounsaturated), but the SBD would necessarily include all processed and refined seed oils: corn, sunflower, Canola, soy bean, etc, all polyunsaturated, all highly processed, and all bad. It would explicitly exclude saturated fat: butter, ghee, coconut oil, tallow, lard, the latter two found in animal meats.
VLC: Includes monounsaturated fats (avocado and olive oil) and saturated fats as found in meats and dairy and used in cooking. No margarine. It is a refined seed oil and may contain trans fats (partially hydrogenated oils). We love to cook with bacon fat. My wife makes pie crusts with lard (not Crisco). I brown meats in ghee.
SBD: “lean protein.” Wikipedia doesn’t even mention the words “red meat” in the SBD piece! Or dairy either.
VLC: For us, the fattier the meat, the better, including ground meats, chicken with the skin on, and pork roast. Salmon and sardines too, and full-fat yogurt (if you can find it!), heavy cream, and full-fat cream cheese.  All saturated fat! It will raise your HDL-C. My last HDL-C was 92mg/dl, my TC 189, my LDL-C 83 and my trigs 56.
SBD: “3 steps,” “emphasis on carbs,” “exercise included”, “3 meals + 2 snacks a day,” a “high-fat” diet.
VLC: The best way to do Very Low Carb is to go all in, “cold turkey.” In 2002, I started on 20g of carbs a day. My motivation, and the reason my doctor suggested it, was to lose weight. But within the first week I had a few hypos and, by telephone my doctor stopped one med and cut the other two in half TWICE. I later stopped one of those and today just take Metformin. And by the way, over a period of years, I lost 170 pounds.
SBD: “with emphasis on carbs.” Wikipedia says Phase 1 includes “many carbs,” and Phase 2 includes “complex carbs” such as “brown rice” and “100% whole grain bread.” I can only imagine what Phase 3 allows you to eat!
VLC: Very Low Carb also emphasizes carbs, but just the opposite: you eat as few carbs as you can, but when you do you eat carbs choose ‘low-carb’ carbs and definitely no rice or bread (or pasta or potatoes, etc.).
SBD: “choose the right fats and the right carbs,” “a ‘high-fat’ diet, not a ‘low-carb’ diet”
VLC: If you are a type 2 diabetic, you are insulin resistant and therefore carbohydrate intolerant. You need to make a permanent change. Very Low Carb is not a temporary diet where you return to eating the foods you ate before. You’re not doing this to lose weight – although if you follow it strictly, you will. You’re doing it to self-treat (through diet) your type 2 diabetes and avoid the dreaded complications.
 When you eat VLC, your body will burn body fat, so it won’t be sending you hunger signals, and you will be able to eat fewer meals (1 or 2 a day), with NO snacks – and you won’t have to exercise if you don’t want to.
VLC  & SBD: Both are “high-fat,” but saturated fats taste much better than those refined “vegetable” oils.

Sunday, September 16, 2018

Type 2 Nutrition #450, When and what to eat, and not eat

In #449 I described how I met and began to mentor a newly diagnosed type 2 (A1c 7.0%) who was prescribed a long-acting basal insulin after he was unable to tolerate or had a counter-indication for three classes of oral anti-diabetic meds. My student was motivated because he didn’t want to be a life-long, insulin- dependent type 2. I thought he was the ideal candidate for a “dietary solution.” I knew that if he followed the precepts of Very Low Carb eating, he would quickly reverse his diabetes and get off insulin.
His healthcare provider’s goal was to mediate or offset his high blood sugar (a symptom of Insulin Resistance from eating a diet high in sugars and refined carbs) with exogenous insulin injections. My goal was to get him off injected insulin by lowering his blood sugar and endogenous (pancreatic) insulin response through diet. Eating Very Low Carb will lower his blood glucose and therefore his endogenous insulin response. Thus, this lower blood insulin will reduce and quickly eliminate the need to inject exogenous insulin.
Aside: I counseled my student to be prepared to learn and to test his blood regularly and whenever he had symptoms of a “hypo.” “What’s a hypo,” he asked? Incredulously, his “doctor,” the NP – the one who “prescribed” insulin injections for him – forgot to mention hypoglycemia. Neither did they discuss an A1c goal, but the American Diabetes Association’s Standard of Care is ≤ 7.0%. His typical fasting blood glucose (with a starting dose of 10 units of basal insulin) is 170mg/dl, so he’s expecting she will soon have to raise his dose.
Insulin, endogenous or exogenous, causes weight gain. When your blood insulin level is elevated, your body cannot access body fat for fuel. Once off exogenous insulin, a LCHF diet will enable him to lose body fat, if he wants or needs to, without hunger. Principally, by burning visceral fat around and within the liver and pancreas), he will ultimately restore beta cell function and endogenous insulin production.
WHEN AND WHAT TO EAT, AND NOT EAT
If you eat a Very Low Carb, High or Healthy Fat diet, sometimes referred to as a LCHF or Keto diet, you will not feel hungry very often because your body is being fed by body fat. It won’t signal you to eat food by mouth as long as when you do eat, you eat Very Low Carb. If you have a lot of body fat to lose (he doesn’t), then you don’t have to eat a lot of fat. Your body will “eat itself” (your stored fat). Without a lot of body fat to lose, he can eat more fat (saturated and monounsaturated) than others. So, my advice when you eat Very Low Carb is, eat only when you’re hungry. After a while, when you always eat this way, your body will be “fat-adapted.”
What does this mean in terms of meals and timing? Mealtimes are cultural and social habits. My student likes to eat a small breakfast: one egg and some Canadian bacon. That’s good. He doesn’t drink coffee. For many years I ate eggs and bacon for breakfast. Now, since I’m not hungry at breakfast, I just have a cup of coffee. It’s a habit. I take it with a little pure powdered stevia and a dollop of heavy whipping cream.
If you’ve got nothing better to do at “lunchtime,” and you’re hungry, eat a small lunch. When I eat the occasional lunch I prefer something portion controlled. It’s usually a can of some kind of fish. I like kippered herring in brine or Brisling sardines in EVOO or water (not packed in refined “vegetable” i.e. seed oils). Salmon, smoked or canned, would be really good too. Some days I’ll have a hardboiled egg, or two. Low-fat cottage cheese and any yogurt are not good choices. But if you do, eat full-fat. Avoid fruit, sugar and all starches.
Supper is just a fatty protein like beef, veal or lamb, fish, pork and chicken, and one low carb vegetable tossed in real butter or roasted in olive oil. Of course, no bread, potatoes, pasta, rice, wheat flour, or root vegetables. I also avoid corn, peas, carrots and beets. They’re all high in natural sugars. And no candy, dessert or snacks. Trust me. If you can control your neurotic cravings (not hunger; you won’t be hungry), you’ll be just fine.

Sunday, September 9, 2018

Type 2 Nutrition #449, “I thought salads were good for you.”

Don’t get me wrong. Salads are okay, but maybe not for the reasons you thought. I recently began mentoring a newbie who was diagnosed a few months back as a frank Type 2 (A1c 7.0%). He was prescribed a long-acting insulin, glargine, when he wasn’t able to tolerate Metformin and then Januvia (a DPP-4 as monotherapy!). Another physician had prescribed a SGLT2, but cancelled it when he saw a counter-indication. So, I started by asking him what he ate, and when he got to lunch, he said, “chicken tenders and a small salad.”
When I said that the chicken tenders were dredged in flour, then breaded and deep fried in oxidized seed oils high in Omega 6’s, he nodded his understanding that I thought there might be a problem. But then I told him that salads were virtually all carbohydrates. That’s when he said, “I thought salads were good for you.”
And herein lies the problem. When I said, “Think about it. Not including ethyl alcohol (spirits), there are only three macronutrients.” “What’s a macronutrient?” he asked. That’s the state of our nutrition education! I told him, “The three macronutrients are protein, fat and carbohydrate. Everything in nature that you eat is essentially a combination of one or more of them, mostly of more than one. Let’s start with the basics.
The only “foods” I can think of that are 100% fat are the manufactured, refined, “vegetable” or seed oils (PUFAs) that I try hard to avoid. Most animal foods are a combination of mostly protein and fat. Most plant-based foods are almost 100% carbohydrates, although some contain some protein and even fat.
Of course there are exceptions. A Haas avocado, for example, is a plant food that is rich in “good” fats and high in fiber (non-digestible carbs). The fats are distributed as monounsaturated 71%, polyunsaturated 13%, and saturated 16% (15% total fat), 9% carb (mostly  fiber), 2% protein, 2% ash, and 72% water. Avocados are a very good plant-based food. So is olive oil (EVOO), another so-called “monounsaturated” fat.
But a salad of leafy greens is almost 100% carb, albeit low-carb; but if your “small salad” had avocados, or hard-boiled eggs, or shredded cheese, or bacon bits, or all of the above, I would say it was a very good salad, because of the protein and fat. But watch out for the dressing. Unless it is just olive oil and vinegar or your own vinaigrette, it is made from one of those refined PUFAs, the manufactured “vegetable” oils – which are all bad for you. Store bought often has sugar added as well. . So, make your own vinaigrette or just use OO & V.
Returning to my mentee, I gave him three books to read while he took a vacation: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney, “The Obesity Code,” by Jason Fung, and “Diabetes 101,” by Jenny Ruhl. Since he apparently has a sensitivity to the oral anti-diabetic medications he had tried, and he really didn’t want to be an insulin-dependent type 2 for the rest of his life, I wanted him to understand the concepts and the logic behind the science of treating type 2 diabetes as a dietary disease. I knew that if he followed the precepts of low carbohydrate eating, he would quickly reverse his diabetes and get off insulin.
He was motivated, and he seemed to me to be the ideal candidate for a “dietary solution.” We agreed we’d meet again when he returned from vacation to talk about when and what to eat and not eat.
This is my area of expertise. I was never on insulin, or any of the new injectables that are frequently prescribed before insulin, but (in 2002) I was simultaneously on three different classes of oral anti-diabetic medications and would soon, my doctor and I both knew, be injecting insulin. My T2 diabetes was progressing (sadly, as mainstream and establishment medicine still says it will). Little did I (we) know that there is another way.
 Interestingly, my student said his caregiver (a NP masquerading as an MD) and her colleague, in another town (an internist masquerading as an endocrinologist), hadn’t mentioned a low carb diet as a self-management treatment. The NP just wanted him to follow orders, take his insulin, and return in 2 weeks for more tests.

Sunday, September 2, 2018

Type 2 Nutrition #448: How “science” gets it wrong

A “basic” scientist proffers an hypothesis and then attempts to prove it wrong. If by experiment it is unable to be proven wrong, it can then be offered as “true.” At this point it is open to other disinterested scientists to prove it “wrong.” If they fail, the hypothesis gains acceptance and eventually becomes “received wisdom.”
Applied science is the application of the “knowledge” discovered in basic science. The search for this “truth,” wherever it is to be found, requires an inquiring mind that is open and skeptical of all such “received wisdom.”
I am just a humble blogger, but I have noticed that the “Insulin Hypothesis” has gained a degree of acceptance in the mainstream media. I began to eat Very Low Carb after my doctor read Gary Taubes’ “What If It's All Been a Big Fat Lie?” in 2002. In 2008, after reading “Good Calories-Bad Calories” (“The Diet Delusion” in the UK), I accepted Taubes’s Insulin Hypothesis as “true.” I had totally reversed my type 2 diabetes, achieved an A1c of 5.0%, and over a period of years lost 170 pounds. “Clinically speaking,” that A1c means that I am now considered (erroneously) to be “non-diabetic.” I will always be Carbohydrate Intolerant.
Mainstream science, though, has yet to get the message. This article, published in The American Journal of Clinical Nutrition, describes a study about a different “received wisdom.” It is predicated on the premise that losing weight by eating a restricted calorie diet (800kcal/day), over a period of time, should improve insulin sensitivity; put another way: that the driver of improved insulin sensitivity is weight loss.
Gabor Erdosi, on his Facebook group Lower Insulin, was skeptical. He wrote, “The general advice to improve insulin sensitivity is to lose weight. However, it doesn’t look like the proper advice when put to the test. In this study, 55% of the participants turned out to be non-responders, meaning that even after similar weight loss on an 800 kcal/d diet, and following weight maintenance, their insulin sensitivity didn’t improve much.”
Erdosi doesn’t need to explain why to his erudite readers, but, for the uninitiated, I will.  It isn’t weight loss that improves insulin sensitivity; it is lower insulin that improves insulin sensitivity. The body doesn’t have to resist being besotted with insulin and so is more receptive. Lower blood insulin, from eating Very Low Carb (VLC), and/or Intermittent Fasting (IF), also permits the body to access its fat stores and lose weight easily, and also maintain weight loss without hunger. Eating an 800kcal/day “balanced” diet does neither of these things.
When you eat a “balanced” (high carbohydrate) diet – one that includes processed carbs and simple sugars in every meal – whether you are non-diabetic, pre-diabetic or a diagnosed type 2, your body will elevate the level of insulin flowing in your blood. Insulin is both the transporter of glucose and the cellular gatekeeper. It signals cellular receptors to open to receive the glucose energy. If you have insulin resistance, the cellular gate is stuck, so your pancreas sends more insulin into your bloodstream. This begins a vicious cycle.
So, to improve your insulin sensitivity, you need to lower your blood insulin. If you have less insulin flowing in your blood, whether you’re non-diabetic, pre-diabetic or a diagnosed type 2, your body’s receptor cells will become more sensitive to the insulin it “sees.” And, if you have less insulin flowing in your blood, your body will also have access to energy from the food you previously ate, and stored as fat, and you will lose weight.
Thus it’s not lower weight that improves insulin sensitivity. It’s lower insulin that improves insulin sensitivity.
But mainstream science continues to ignore the Insulin Hypothesis because government doesn’t fund the kind of research that would test it and accept it as “true.” There are too many corrupting influences. For example, the research cited above was conducted by the Nestlé Institute of Health Sciences, Lausanne, Switzerland. Nestlé makes the 800kcal meal-replacement product (Modifast; Nutrition et Santé) used in the study. In U.S. markets, Nestlé sells Optifast, Boost and Carnation, among many other HIGH-CARB “health science” products.

Sunday, August 26, 2018

Type 2 Nutrition #447, What’s happening to medicine today?

Lots of things are happening to medical practices today, and at an accelerating pace. I remember 40 years ago when my GP quit medicine, giving up a nice practice in an upscale community because of Medicare’s onerous reporting burdens. He was independently wealthy, and had a nice social life, but he was only in his early 40s!
Today, independent private medical practices are disappearing at an even more alarming rate, being sucked up by hospital conglomerates. In my area Health Quest and CareMount are cutthroat competitors. A search on CareMount redirects to “Medical Outsourcing.” Wikipedia explains: “Some small practices have outsourced business functions to management services organizations” (MSOs). “Business functions” includes all office staff. My urologist told me that the benefit to him was that he can now “just practice medicine.”
Two specialists I have seen in the last year now work for one of these MSOs. So does my wife’s GP. My internist in NYC is the exception. He resists the trend and recently, while maintaining a very busy private practice, joined a boutique medical group where he offers his patients, for a fee, more personalized attention. I declined. I told him I wanted to see him 3 times a year for blood work. He suggested I come just once a year.
On a recent final visit to an orthopedic, his receptionist asked me if I wanted to receive an updated printout of his clinical notes. I told her “no.” After unexpectedly receiving and reading an earlier version, they upset me. I thought that they did not fairly reflect what I had told him or his nurse; instead, they read to me like they were written to be read by the MSO or some clinical practice reviewer at HHS (Medicare).
I had a similarly eerie experience in Florida several years ago. I had to fire one physician, who was peddling statins and claimed to be a lipidologist.  Another, an endocrinologist, had justly fired me when I told him he needed to go back to school. They both worked for a large group that dominated that part of Florida where I spend the winter. Their MSO is part of HCA Healthcare based in Nashville, Tennessee. The network includes “178 hospitals and 119 independent surgical centers in 20 states and the UK.” The UK!
The orthopedic – remember, his specialty is skeletal issues, in my case a torn tendon – asked me if I was eating a “mostly plant-based diet.” Earlier, his nurse, recapitulating notes from the previous visit, asked me if I was still walking for exercise. I told her I had NEVER told her that I walked for exercise. I have NEVER walked for exercise. The only exercise I do is garden work. Where, or more to the point, why was it in their clinical notes that I walked for exercise? And why would an orthopedic counsel me to eat a “mostly plant-based diet”?
I protested the counsel to eat a mostly plant-based diet. I replied that I eat a Very Low Carb diet and would be a carnivore if my wife would not go apoplectic. I said the body had a zero requirement for plant-based foods and can make all the glucose it needs via gluconeogenesis from protein and fat. I also told them that I drink a pint of collagen-filled bone broth from pasture-raised beef every day to help repair my torn Achilles tendon (as my brilliant editor had suggested). Tendons are made of collagen. My ortho appeared to listen attentively and replied simply that he admired a person who held such passionate beliefs.
My conclusion, I’m afraid, is that to practice medicine today your MSO MD needs to follow the MSO’s and the government’s “formulary,” not just with respect to medications, but for lifestyle (“diet and exercise”) as well. And if those recommendations are not in your clinical notes, the MD’s medical practice is penalized by lower reimbursement rates from Medicare and thus with a lower rating by the bean counters at the MSO….because the MD is not pushing the government’s “lifestyle formulary.” To not push it risks lower profits for the MSO and even job security for the MD, based in part on “job performance.” That’s the price a doctor has to pay today to “just practice medicine.” And that’s what happening to medicine today. 

Sunday, August 19, 2018

Type 2 Nutrition #446, “Docs’ Beliefs” prevail in 14 of 17 Primary Care practices

Thank goodness for the headline in this Medscape Medical News story by Miriam E. Tucker: “Docs’ Beliefs Guide Prescribing of Glucose Monitoring in Type 2 Diabetes.” It means they still prescribe routine self-monitoring of blood glucose (SMBG) in patients who aren’t treated with insulin (or a sulfonylurea). The danger from insulin or a sulfonylurea (e.g.: micronase, glyburide, glipizide) is hypoglycemia (low blood sugar).
That doctors still do this is enormously encouraging to me, a type 2 for 32 years who takes a fasting reading every day and recently had an A1c of 5.0%. It is troubling to me, however, that several said that they prescribe SMBG less than they did 10 years ago, when their professional societies were encouraging the practice.
The evidence to stop prescribing SMBG, described as “qualitative data,” was presented here in The Annals of Family Medicine by a medical student at the Cleveland Clinic. The student told Medscape that “for patients who do not take insulin, the preponderance of evidence shows it increases cost without improving HbA1c.”
Duh! If you don’t do something with the information. If you don’t use it to make wise choices about what to eat. If you think the only way to treat T2D is with drugs, and that self-management actions have no educational or motivational value. The opponents of SMBG also cited the cost of test strips as barriers. The medical student does say “our study addresses the physician perspective, but there’s also the patient perspective.” Her team’s next step will be to assess patient’s perspectives of SMBG. Brava, I say. There’s hope.
But the abstract, co-authored by half a dozen MD/MPHs at the Cleveland Clinic, make it clear where this study is going. It states, “The majority [of primary care physicians] continue to recommend routine self-monitoring of blood glucose due to a compelling belief in its ability to promote the lifestyle changes needed for glycemic control. Targeting physician beliefs about the effectiveness of self-monitoring of blood glucose, and designing robust interventions accordingly, may help reduce this practice.” This is what medical students are being taught today. That’s been the problem with these damn studies. They’re myopic and, worse, narcissistic. One physician said, “I try to steer non-insulin dependent patients away from testing at home, mainly because it doesn’t change what I do. I monitor their diabetes based on the HbA1c and occasional sugar checks.” It’s me, me, me, me, me… No thought or consideration to what the patient can do to control their blood sugars.
Okay, if you believe that your patient has “low health literacy or physical or cognitive impairment,” then it goes without saying the patient’s diabetes care should be in the hands of a health care provider. This may include those who have daily home health care, are hospitalized or institutionalized. But for the rest of us? Are we not capable of participating in the management of our own health care, especially with a condition that is entirely dependent on what we eat for optimized management? But therein lies most of the problem…
Most physicians to not accept that type 2 diabetes is a dietary disease. Nor do most patients. Doctors know it, or should know it, given their training in human biology and physiology, but to admit it would require that they repudiate everything they have been telling their patients about nutrition for 40 years. I don’t blame them for following the guidelines of their medical associations and the prescribed Standards of Practice. It would be hard to look the patient in the eye and say, “It's all been a big fat lie.” (apologies to Gary Taubes)
However, under the circumstances, wouldn’t it be best to leave the options open for patient-centered care? After all, the clinician only sees the patient a few times a year to monitor their T2D condition, but the patient has the opportunity multiple times every day to make wise choices that will change their condition. Self-Management of Blood Glucose (SMBG) is thus the best way for patients to educate and motivate themselves. If by prescribing SMBG the doc’s beliefs contribute to the patient’s self-care, that’s a good workaround! Bravo!

Sunday, August 12, 2018

Type 2 Nutrition #445: Are doctors in denial?


When a doctor tells me that I am “no longer diabetic,” as a few have informally told me, are they misinformed about what causes type 2 diabetes, or are they just small business men or women in denial and following the government’s definition which dictates a clinical diagnosis? Because they want to get paid and move on…
I mean no offense, honestly. If I seem impudent, well…maybe I am, a little, but as Dr. Michael Eades said, at the end of #406 here, it’s sometimes necessary for “you” (his readers) to “educate your trained professional.”
For example, at a cocktail party recently I was having a tête-à-tête with a friend, a retired MD, when a tray of shrimp was passed around. I took one, but when the doctor declined, I asked him, “Why?” He answered, “Cholesterol.” He apparently hadn’t heard that, back in 2014, the Dietary Guidelines Advisory Committee had declared that “cholesterol [was] no longer a nutrient of concern for overconsumption.” Or that Ancel Keys, the infamous creator of the “diet-heart hypothesis,” was quoted later in his life as saying, “And we've known that all along. Cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit.”
With respect to the “misinformed” possibility, and the “denial” question, we know that type 2 diabetes is caused by a metabolic dysfunction in which the body is no longer able to handle a diet high in refined carbs and simple sugars due to Insulin Resistance. The hormone insulin, secreted by the pancreas, carries glucose from digested carbs in the blood stream and, in a normal metabolism, “opens the door” by connecting to receptor cells where the glucose is supposed to be taken up for energy. When the connection doesn’t work, the glucose continues to circulate and the pancreas secretes more insulin to help, eventually wearing out.
Most doctors rely on the A1c or a fasting blood glucose to diagnose a type 2 and begin a course of treatment (“diet and exercise”, and 3 months later, when this fails, prescription meds). These simple blood tests show the symptoms of a disregulated glucose metabolism and are cheap and effective as screening methods. Most people who present with an elevated FBG or A1c are pre-diabetic or frank type 2s. And the meds that a doctor prescribes to treat these symptoms will lower your FBG or A1c somewhat, at least temporarily. But your type 2 diabetes will continue to progress, because the clinician is treating a symptom, not the cause, of the disease.
The cause of type 2 diabetes is Insulin Resistance (IR). The best test for IR is an Oral Glucose Tolerance Test (OGTT). In this test, the patient drinks 75g of a glucose solution, and their blood is tested before and at half hour intervals afterwards for 2 hours. It is usually performed by an Endocrinologist and/or in a hospital outpatient setting, so it’s expensive, but the OGTT will reveal if the patient has Insulin Resistance.
But the government, and therefore your doctor, is only interested in treating your symptom, an elevated blood sugar (A1c). If your A1c is ≥6.5%, you are clinically designated a “type 2 diabetic.” If it is <6.5% but ≥5.7%, you are clinically designated “pre-diabetic.” If your A1c is <5.7%, you are, clinically speaking, “non-diabetic.” If your A1c was previously ≥5.7%, but somehow is now lower, your doctor will declare you “non-diabetic” or “cured,” and by the established Standard of Care, the “system” will reward the doctor financially for this favorable outcome. This totally ignores your INSULIN RESISTANCE. You are still Insulin Resistant, and therefore still type 2 diabetic. If you don’t change your diet, YOUR DISEASE WILL PROGRESSIVELY WORSEN.
So, is your doctor misinformed, in denial, or just being callous? He or she is, after all, in business and just following government rules for treatment and payment. As far as keeping your INSULIN RESISTANCE in check, or even putting your type 2 diabetes in remission while losing weight easily and without hunger, that’s up to YOU. YOU decide what foods you eat. Don’t expect your doctor or the government to know how to “eat healthy.” Following their advice is how you gained weight and got sick in the first place. Your doctor can only test your blood and write scripts to “control” your A1c. But you are still INSULIN RESISTANT and therefore CARBOHYDRATE INTOLERANT!