Sunday, October 22, 2017

Type 2 Nutrition #403: Denial is not a river…

When someone says their A1c is 6.1% and they’re doing nothing about it – not even taking Metformin – I think, what are they thinking about! Are they waiting until they’re told, as Tom Hanks was, “You’ve ‘graduated’ to full-blown, type 2 diabetes.” As though, after observing “high-normal” blood sugars for 20 years, his doctor was congratulating him! And what is their doctor thinking about? I mean, folks, denial is not a river. I know, it’s an old joke, but that behavior is just bizarre, unless, that is, the Standards of Medical Care – which to be paid by insurance for his or her services a doctor must follow – doesn’t offer a better solution.
That’s what it amounts to, though. Metformin is not generally prescribed to pre-diabetics, although in my opinion it should be. Currently, it’s occasionally  prescribed “off-label,” meaning “used in a manner not specified in the FDA’s packaging insert.” But putting pharmacotherapy aside, what else can a pre-diabetic do to “delay” the onset of frank type 2 diabetes, or as demonstrated in so many recent trials, to proactively REVERSE incipient type 2 diabetes and put this modern lifestyle scourge into complete remission?
Well, the first thing you have to do is acknowledge that you are pre-diabetic. What does that mean? It means that 1) you have a genetic predisposition, 2) you’ve eaten, per nutritional guidelines, a diet unnaturally high in carbohydrates in order to avoid eating saturated fat and cholesterol, and 3) your body has “expressed” an intolerance for so many carbohydrates. Being “pre-diabetic” means you are now carbohydrate intolerant. The condition, Insulin Resistance (IR), is a continuum. And the sooner you address it, the easier it is to manage.
Insulin Resistance is part of Metabolic Syndrome, a constellation of symptoms that put you at much higher risk of heart disease (CVD and CHD) as well as several other chronic diseases of Western Civilization, including Alzheimer’s disease (“type 3” diabetes) and many types of cancer. But Insulin Resistance can be managed by lifestyle changes. You modify your diet so the pancreas does not secrete too much insulin. The only way to do that is to restrict your dietary intake of carbohydrates.
The object of self-management of your Insulin Resistance is to keep your blood insulin level low. There is not a common lab test to measure blood insulin, but a good surrogate is your blood sugar level, either fasting (FBG) or A1c. And there is no drug to lower blood insulin although anaerobic exercise can help.  If you’re Insulin Resistant, the consitent way to lower your blood insulin is to restrict carbohydrates. It is not a “therapy” that will enrich Big Pharma, or Agribusiness, so you’re not likely to hear about it from them. And to avoid financial penalties and sanctions, your doctor is not likely to go against what the Standards of Medical Care dictate.
So, self-management of your pre-diabetes is just something you’re gonna have to do yourself. Perhaps that’s why you’re surfing the web and how you came across this site. If so, we hope you’ll come back. We encourage you to try carbohydrate restriction on your own. Test your blood before and after a meal and see how much it improves when you eat fewer carbs. Do it for 3 months and see your A1c improve and your weight plummet!
Or…here’s an idea. Forget about how much carbohydrate restriction will help your pre-diabetes or type 2 diabetes. Don’t even think about asking your doctor for “permission” to go on a carbohydrate restricted diet to help control your pre-diabetes or type 2 diabetes. Ignore the fact that type 2 diabetes is a dietary disease.
Instead, if you would like to lose a few pounds, and you think your doctor would like that as well, ask if he or she thinks a carb-restricted diet would be a good way to lose weight? Safely! I’ll bet you that you’ll get a “yes.”
Better yet, don’t ask. Help your doctor avoid the risk of financial penalties and sanctions from Medicare. And then, when you next have bloodwork done and your weight and cholesterol – especially triglycerides and HDL-C – and blood pressure and inflammation have all improved, it’ll just be our little secret how you did it. 


  1. What a wonderful introduction.You sound like a really motivated serious no-non sense guy. Good to see that you have been fighting so bravely with your diabetics since so long. Hats off to you