Retrospective #119: “Lifestyle Intervention is Great Therapy.”

Ralph A DeFronzo, MD, Director of the Diabetes Division at the University of Texas Health Science Center, made this comment at the May 2013 American Association of Clinical Endocrinologists (AACE) meeting. His presentation got my attention since Dr. DeFronzo is a favorite of mine for his Banting award lecture at the 2008 ADA convention. In it he said, “By the time that the diagnosis of diabetes is made, the patient has lost over 80% of his/her β-cell function, and it is essential that the physician intervene aggressively with therapies known to correct known pathophysiological disturbances in β-cell function.”

At the AACE meeting he said, “There’s no doubt – when you look at diabetes prevention – if you can get people to lose weight and exercise on a regular basis, lifestyle intervention is great therapy.” “The issue is not whether diet and exercise works. It works. The issue is can you get people to do it on a long-term basis. I think it’s time to face reality. The reality is, it doesn’t work long-term.”

Obviously, I was expecting more, but I shouldn’t have. He is just a physician, albeit a leading one. He is a pill peddler; when pills fail or something better comes along, he’ll push that. He is a prescriber. Whatever big pharma comes up with to treat the “pre-diabetic” or diabetic patient, he’ll prescribe. That’s what doctors do.

There is also the real question of what can a physician do to get you to lose weight. There is no magic pill. If he and you view him as being in charge of your health, that’s a problem. He’s in charge of your healthcare; you’re in charge of your health. You have it in your power to lose weight, and you can do it with the right dietary “prescription.”

I do not deny that lowering the goal posts for diagnosis of pre-diabetes and diabetes to new markers – lower FBG thresholds and adding the A1c’s to the diagnostician’s quiver – are steps in the right direction. I applaud these changes. It’s just that they’re shooting at the wrong target. The target for weight loss should be a Low Carb diet. And the bull’s eye should be Very Low Carb. But, what does a doctor know about nutrition? Nothing! Ask them. They usually are the first to acknowledge they just follow “practice guidelines.” That’s all they’re qualified to do.

Except my doctor went rogue. He went “off label” and “prescribed” Atkins Induction (20g/d of carbs) for weight loss. He did it after reading Gary Taubes’s “What If It’s All Been a Big Fat Lie?” in a 2002 New York Times story. He tried it himself and lost 17 pounds in 6 weeks. Unfortunately, as Dr. DeFronzo said, he didn’t stick with it long term.

But it worked for me. And it still works for me. I lost 170 pounds and put my Type 2 diabetes in remission. It could do the same for you too, if you don’t listen to everyone who tells you it “doesn’t work long-term.” It does work long-term, if you stick to it. What they mean is that people don’t stick to it. Not that it doesn’t work long-term.

Part of the problem is that “Lifestyle Intervention” is intentionally vague. It could be defended as being “inclusive” but is more likely intentionally undefined to avoid controversy and going against the prevailing dogma. It is convenient as a phrase as it includes the idea of exercise. Exercise is good, I suppose, but I don’t do any formal or regular exercise. What works is lowering serum insulin by eating Very Low Carb. That also raises insulin sensitivity.

Because Lifestyle Intervention is so vague, it is left to everyone to interpret it in the way they chose, along with the meaning of the word “moderation.” Government still pushes the Aristotelian virtue of moderation. And that a healthy lifestyle includes a restricted calorie, low-fat “balanced” diet, as the standard “one-size-fits-all” approach.

That this “standard” therapy doesn’t work is what Dr. DeFronzo is talking about. He’s primarily an academician, but he’s right. Many patients don’t stay on a low-carb diet long-term, and the minute they leave the diet, it ceases to work because they have become, are still, and will hereafter always be, carbohydrate intolerant. By eating that “Standard American Diet” for many years, being genetically predisposed, they were susceptible to and underwent an epigenetic change. THAT is the reality it’s time to face. NOT that eating Very Low Carb doesn’t work long-term.