Type 2 Nutrition #470: A Tale of Two Paradigms

Sitting next to a good friend – waiting for a memorial service to begin – I asked her if she was pre-diabetic. Huffily she replied that she was not! Her fasting blood sugars were all in the “low hundreds,” she said, which her doctor told her was okay. She’s happy because she thinks she’s avoided the dreaded T2 diagnosis and the drugs. But she’s “a little” overweight, like most of us, so I supposed she might also be a little Insulin Resistant.

This is how the Medical Treatment Paradigm for Type 2 Diabetes works, historically and for the most part as it exists today.  The doctor might have told a patient with blood sugar in the “low hundreds” to “lose weight and move more.” But my friend is in her mid-eighties, still working hard, and no doubt very glad to be alive and declared “well.” A good doctor might also have counseled my friend to take Metformin and eat fewer carbs, but given her age and the new, very lax ADA Standards of Medical Practice for older folks, she probably didn’t.

Doctors are taught to diagnose disease and treat symptoms by prescribing medicine. But almost all of us are “a little” overweight, and everyone is getting older, so what’s a doctor to do? Prescribe Metformin for every one? Ironically, that’s not a rhetorical question. There’s evidence that Metformin extends longevity even in a non-insulin resistant population. It's been suggested that maybe everyone should take Metformin. It’s cheap and, except for brief intestinal distress in about 20% of those who start on it, it has no other side effects.

But even in the best of circumstances, in our 40s when we start to develop Insulin Resistance and put on a few pounds, a doctor today would still counsel “diet and exercise,” and when that fails – as it invariably does – initiate drug therapy. Metformin is the first line of pharmacotherapy recommended almost universally. In the clinical world the debate these days is what should be the 2^nd and 3^rd course of oral medications, before the doctor begins a more advanced drug like an injectable GLP-1 incretin mimetic, and finally, insulin therapy.

This is how the Medical Paradigm dominates the treatment of Type 2 Diabetes. We all wait too long to start, think of losing weight as a personal responsibility, and consider treating disease (like T2D) as something doctors do. Ironically, it is totally lost on us (and the doctors) that the reason we gained weight was a due to a medical condition called Insulin Resistance, whose best MEDICAL treatment is a CHANGE in DIET. Weight gain and Type 2 Diabetes both arose because for years we ate way too many refined carbohydrates and simple sugars.

The Dietary Treatment Paradigm for Type 2 Diabetes is rarely suggested in the doctor’s office. There are many reasons for this, but suffice it to say it is both “safe and effective.” And so long as YOU follow this dietary “treatment” (eating Very Low Carb), you will lose weight (a lot of it, if you want) and your blood sugars will get much better. Many people report A1c’s below the pre-diabetic threshold (5.7%). My first A1c, taken by an endocrinologist more than 25 years ago, was 8.9%. Last December it was 5.0%, rock solid normal.

So, the question arises: What will it take to bring about a revolution in the basic principles and practices of medicine to make this Paradigm Shift, a shift from the Medical to the Dietary Treatment for Type 2 Diabetes? It does not require a shift in all the “principles and practices of medicine.” It is only because Type 2 Diabetes is caused by diet that a change of diet is needed. Until doctors make this shift, patients must learn Type 2 Diabetes is reversible through diet and take responsibility for their own health at every meal. Treating an elevated blood sugar with drugs, because “that is something doctors do,” is “old school.” Until that day, the framework for diagnosing Type 2 Diabetes and treating it with drugs will continue to be the model.

Doctors likewise need to be reminded that Hippocrates, the Father of Medicine, said, “Let food be thy medicine and medicine be thy food.” If you have fasting blood sugars in the “low hundreds,” you have Insulin Resistance. You’re “Pre-diabetic” (actually a Type 2; see #469 ). And if you want to avoid the clinical Dx, now is the time to change what you eat. Don’t wait before you graduate to finger sticks and a cocktail of drugs.