A Letter
to the Editor in my online Lancet subscription contained the comment: “Physical
inactivity should be considered as a
modifiable risk factor. IMPROVING OF POPULATION HEALTH SHOULD NOT SIMPLY
BE MADE THE WORK OF DRUG COMPANIES.” “Bravo!” I say. And this advice is
especially apt for OBESITY AND T2 DIABETES too!
But not
through exercise! Obesity is also “a modifiable risk factor,”
and “improving of population health” – both through weight loss and the
concomitant remission of type 2 diabetes – is achievable simply
by modifying the macronutrient composition of the diet. It
stands to reason, doesn’t it, that if carbohydrates increase the amount of
glucose in the blood, particularly among those who have become Insulin
Resistant and thus Carbohydrate Intolerant, then reducing the carbs in the diet
will reduce the glucose in the blood? I mean, who doesn’t get this?
For our
government to ignore this “obvious truth,” with a “one size fits all” prescription
in its Dietary Guidelines for Americans, amounts to gross negligence and, for
clinicians, medical malpractice on a humongous scale.
I say
“concomitant” because remission of type 2 diabetes is a phenomenon that
naturally accompanies or follows adoption of a Very Low Carb diet. In
2002, my doctor, who had been trying to get me to lose weight for years, read
about a Very Low Carb (20g/day) diet program in the New York Times
Sunday magazine. The story, “What If It’s All Been a Big Fat Lie,” was written
by the acclaimed science writer Gary Taubes. What attracted my doctor to the
story, though, was the photo of the ribeye steak on the cover. As a
cardiologist, he hewed to the “company line” to avoid saturated fats. But the
visual image got his salivary juices started, so he decided to try the diet himself.
He lost 17 pounds in a month and decided to suggest it to me…TO LOSE WEIGHT, NOT TO TREAT MY TYPE 2 DIABETES!
He did
suggest, as an afterthought as we walked down the hall of his office to make an
appointment for another visit in a month (to monitor me closely), that the
low-carb diet “might be good for your [Type 2] diabetes too.” In retrospect, I
have to say, how clueless could he
be?!!!!! Anyway, he didn’t have to wait a month to see how the dramatic
reduction in carbohydrates affected my diabetes; within a day, I had my first hypo. A hypo (hypoglycemia) is a
dangerously low blood glucose condition. When I felt the sweating, I went to
the newsstand and bought a candy bar. This was perhaps a bit of an
overreaction, I admit, but this was my first ever hypo, and I was
scared.
Next,
after the sweating stopped, I called my doctor. He told me to immediately drop
one of the oral anti-diabetic medications he had prescribed for me. Next
day late afternoon I had my 2nd hypo, another candy bar, and called
my doctor again. This time he said to cut the other two oral anti-diabetes
meds I was on (at maximum doses) in half. I did, but
then a few days later, I had my 3rd hypo. This time my doctor told
me to cut both meds in half AGAIN.
I’ve
been following a Very Low Carb diet now for 17 years, and I’ve never had another
hypo. I eventually titrated off one of the two remaining meds (Micronaise, a
sulfonylurea), and lost 170 pounds. I still take Metformin though, to improve
insulin sensitivity and suppress unwanted glucose production by my liver.
Along
the way, my blood pressure improved from 130/90 to 110/70 on fewer meds. My
triglycerides dropped from about 135 to 54 average, and my HDL (good)
cholesterol more than doubled from 39 to 84 average. My total cholesterol is
under 200 while my latest LDL was 92. And my fasting blood glucoses are usually
under 100 and my A1c’s under 5.7% (lowest 5.0%). You would never know I was
diagnosed a Type 2 diabetic 33 years ago.
So, obesity is “a modifiable risk factor” and the
concomitant benefits of losing weight on a Very Low Carb diet are 1) remission
of type 2 diabetes, 2) improved lipid profiles and 2) improved blood pressure. Indeed,
“Improving of population health should not simply be made the work of
drug companies.” This eloquently stated and obvious truth has been
ignored by health-care professionals for many years. But, just as the obvious
truth that eating fewer carbs will lower serum glucose levels in the insulin
resistant patient, it is also a very effective way to lose weight in
the patient whose glucose metabolism is normal. The blood lipid
and blood pressure benefits will follow, even where blood glucose regulation is
not required, “improving…population health” concomitantly. No Rx
required!
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