I was diagnosed a Type 2 diabetic in 1986, when the standard for diagnosis was two consecutive, office-visit tests of Fasting Blood Glucose ≥140mg/dl. And recently,* after eating Very Low Carb (VLC) for the last 15 years, now with an A1c of 5.2%, a clinician told me, I am no longer diabetic. I disagreed. I said that although my blood sugar control had greatly improved, I was and am still Insulin Resistant and Carbohydrate Intolerant. I told her that I keep my Type 2 Diabetes IN REMISSION by restricting carbohydrates. I eat Very Low Carb, with Extended Fasting as needed.
Then, a saw Megan Ramos, Director of Jason Fung’s Intensive Dietary Management program, say on Facebook that “there are a lot of ‘haters’ out there” who say that, with an A1c of ≈4.5%, she is “not really non-diabetic”; “[She’s] just controlling [her] diabetes with diet.” “Haters”? Well, I am not a hater, but isn’t that how she is controlling her blood sugar? Does she think she’s cured? I know I am NOT cured. If I ate a lot of carbs again, my A1c would skyrocket!!! I think hers would too, though she doesn’t want to, and never will, eat that way again (i.e., “pasta 5 nights a week”).
Apparently, people who tell her that she is “just controlling her diabetes with diet” have hit a raw nerve…so I won’t tell her directly, but I am not a “hater.” I just want people to understand that having Type 2 diabetes is a condition that the patient can totally manage, as she has, through diet (and fasting as needed). It’ a POV based on reality.
And it is difficult to manage a condition – in this case, Type 2 diabetes – if one is in denial that what caused that condition was a dietary practice, eating too many processed carbs (pasta) for too long. But, I’m willing to take a fresh look at the subject. Am I “non-diabetic” if a doctor who takes my blood (and doesn’t take a history) sees that my A1c is 5.2%? (In my case, besides eating Very Low Carb, I am also taking 1,500mg of Metformin to suppress unwanted glucose production and improve insulin sensitivity, but taking Metformin is not why I have a “non-diabetic” A1c.)
I am clinically considered “non-diabetic” simply because of my low (<5.7%) A1c. To the physician/practitioner, who is running a business financially dependent on payment from the patients’ insurers, the criteria for prescribing drugs (and tests even) is based on government and medical association sanctioned Clinical Guidelines. The actual Standard of Care a clinician offers can vary from that, but the patient’s medical record better show that they recommended “diet and exercise,” and a statin if your Total Cholesterol is ≥200mg/dl. A Very Low Carb diet is not part of that SofC.
In Megan’s case, age at onset of diabetes was doubtless a factor. Incipient Type 2 diabetes is undoubtedly more treatable and less intractable at an early age before some beta cell function has been lost. Megan notes that she was diagnosed at age 27 and found the right treatment immediately. Under Dr. Fung’s direction, she began to eat VLC and incorporated fasting from the get go. In 6 months, she lost 60 pounds and her A1c dropped to 4.5%. Today, 6 years later, Megan certainly takes no diabetic meds, eats LCHF and, having incorporated fasting, is now 80 pounds lighter.
I was diagnosed at age 45 but continued to eat a Standard American Diet for 16 more years until I was 61. Neither my doctor nor I knew better at the time. I continued to gain weight and my Type 2 diabetes got “worser and worser.” In 2002 I was maxed out on a sulfonylurea (Glyburide) and Metformin and starting on Avandia, a 3rd class of orals. I weighed 375 pounds. Then, in July 2002 my doctor read Gary Taubes’s “What If It's All Been a Big Fat Lie,” the New York Times Sunday Magazine cover story and suggested I try the diet described (20g of carbs a day) to lose weight!!!.
Today, 15 years later, thanks largely to eating Very Low Carb, I weigh 190 pounds. A little over a year ago, ironically thanks to a suggestion from Megan Ramos, I began Extended (full-day) Fasting. I started with alternate day, then 2-consecutive day and occasionally 3-day 300kcal fasts almost every week. I maintain my 185-pound weight loss by accepting that I have intractable Insulin Resistance and will therefore be Carbohydrate Intolerant for life. As such, while I am now clinically “non-diabetic,” I know that if I ate the way I did before, I would quickly become, clinically speaking, diabetic again. Therefore, realistically, my Type 2 diabetes is NOT cured; it is IN REMISSION, and I keep it that way with diet. I will live happily and healthily and hope to remain that way for so long as I accept that reality.* This post was written in in 2017 and is republished here, with some editing, as part of the Retrospective Series.