Retrospective #4: Big Government, Big Pharma, and Poor Little Dr. Atkins

In 1972 Dr. Robert Atkins published his “Diet Revolution” advocating a Very Low Carbohydrate diet. In response the AMA attacked Atkins calling his “high fat” diet a “dangerous fraud.” When Atkins was called before a Congressional Committee to defend himself, he was publically ridiculed and humiliated. Meanwhile, just two years later (in 1974), The Framingham Study reported that there was no association between high cholesterol and sudden death, but men with low cholesterol had a strong association with colon cancer and premature death. The water was muddy, but nobody outside the research community paid attention to the research findings and nuanced data.

Enter Senator George McGovern, chairman of a U. S. Senate Select Committee on Nutrition and Human Needs (“the McGovern Committee”). He had been a staunch supporter of agriculture since beginning his Congressional career. He was also convinced that fat made us fat and was responsible for “killer diseases” like cancer and heart disease. In 1977, after only two days of very contentious hearings, his committee published the “Dietary Goals for the United States,” aka “The McGovern Report.” The first “Dietary Guidelines for Americans,” published jointly by HHS and USDA, followed soon after in 1980. It has since been revised and reissued, with only incremental changes, every 5 years. The die had been cast. There was now no going back, in spite of mounting evidence. Government appointed scientists and processed food industry representatives would henceforth decide what to recommend we eat. What we eat had become Big Government’s business, and the province of Agri Business and Big Pharma.

In that same year as The McGovern Report (1977), the National Institutes of Health (NIH) reported on five diet-heart studies suggesting that a depressed level of HDL was the most reliable predictor of heart disease for men and women at all ages, but this went virtually unnoticed. This finding was studied further by the NIH, but only after a substantial delay. It wasn’t until 1999 that a large scale, long-term study confirmed that increasing HDL lowers CVD risk. This old link from 2009 indicates that it also lowers cancer risk, approximately 36% with every rise of 10 mg/dl.

In the meantime, NIH’s MRFIT study (1982, 13,000 men followed for 6 years) studied a low-fat, high-carbohydrate diet with a focus on vegetable fat, which effectively lowered total cholesterol. Participants had more heart disease deaths than their “usual care” cohort. In addition, the lowest cholesterol levels were associated with mortality levels equivalent to the highest cholesterol levels. They were also associated with significantly more strokes, digestive diseases and cancers. This study was also ignored, but the focus did shift to lowering LDL-C instead of Total Cholesterol, perhaps due to the desire for a simple public health message.

Now, enter Big Pharma. By the late 1980’s sales of the first LDL cholesterol lowering statin drug had begun. As a result of public advertising campaigns, people became familiar with their cholesterol numbers, and the difference between “good” and “bad” cholesterol entered the public consciousness. These campaigns were very effective. A recent AMA editorial suggested that world-wide sales of statins may approach $1 trillion by 2020.; they are the most successful drug of all time. However, there is no evidence that statins help women or anyone over 65.

Meanwhile, Ancel Keys, father of the lipid hypothesis, retired to Southern Italy, coming home to die in 2004 at age 100. However, according to Malcolm Kendrick, author of “The Great Cholesterol Myth,” Keys admitted in 1997 that cholesterol in the diet has no effect on cholesterol levels in the blood. Keys is said to have said, “There's no connection whatsoever between cholesterol in food and cholesterol in blood. And we've known that all along.”

What is that he said, you ask? Is it then possible that dietary cholesterol does not have to be limited at all? That Total Cholesterol is irrelevant? That high LDL-C is not a critical metric, and that high HDL-C and lower triglycerides are more important for heart health? And finally, that higher HDL-C and lower triglycerides are achievable, with weight loss, by eating low-carb, with fish oil supplementation (to lower triglycerides), and without taking statins?

Yes, it is, and when my doctor saw my most recent blood tests, including my lipid panel, he called me to tell me the results. He concluded, exultant: “You’re going to live to be 105!” Hmmm, I thought, that’s longer than Ancel Keys.

Retrospective #3: Ancel Keys and the Lipid Hypothesis

Ancel Keys, a prominent University of Minnesota physiologist who was keenly interested in diet and nutrition, was attending a medical conference in Rome in 1951 where he learned that “heart disease was rare in some Mediterranean populations who consumed a lower fat diet.” He noted, too, that “the Japanese had low fat diets and low rates of heart disease. He hypothesized from these observations that fat was the cause of heart disease.”¹ These observations and associations about dietary fat have since come to be known as the Lipid Hypothesis.

Just two years later, Keys, now convinced that dietary fat was the cause of heart disease, published his “Six Country Analysis” (1953), an epidemiological study. Years later, with his hypothesis now firmly entrenched, he published an updated version (Harvard University Press, 1980) as the “Seven Countries Study.” In this study Keys points out an association between dietary fat and mortality from heart disease. Critics pointed out then, and with increasing traction today, that Keys had data for 22 countries, but selected data from just 6 (later 7). As an example, Keys excluded France, a country with a high fat diet and low rates of heart disease. His detractors then and now claim that Keys had selected only data to support his hypothesis, and that that was bad science. Further, his was a retrospective analysis, not a prospective study, and thus did not prove causality. This distinction is an important and fundamental precept of scientific investigation, but one that is often overlooked by the media and lay public.

Meanwhile, the American Heart Association (AHA), founded in 1924 by cardiologists, had “re-invented” itself in 1948 as a fundraising organization. In 1956 their TV fundraiser on all three networks (that was all there was at the time) urged Americans to reduce their intake of total fat, saturated fat, and cholesterol. Then, when President Eisenhower had his first heart attack in 1958, the AHA recommended Americans eat “heart-healthy” margarine, corn oil, breakfast cereals and skim milk, a diet that the President (and millions of us) unhappily complied with.

Today, most “health-conscious” Americans still largely follow this diet, perhaps with the exception of margarine, which was basically a partially hydrogenated vegetable oil made with trans fats. We are now told, and I certainly agree, that trans fats are really bad for us.  But, we still (many of us) largely avoid eggs, butter, marbled beef and other fatty cuts of meat, and high-cholesterol-containing foods like liver and shrimp (and eggs, butter and cream!).

Meanwhile, by 1961 Ancel Keys was on the Board of the AHA, the AHA had adopted Keys’s low-fat diet, and Ancel Keys made the cover of Time Magazine under the banner “Diet and Health.” Fat became public health enemy #1.

That same year the famous Framingham Heart Study, another epidemiological study of 5209 people begun in 1949, noted that men under 50 with elevated serum (blood) cholesterol were at greater risk of heart disease. However, these men were also more likely to smoke, be overweight, not exercise, and, although not noted, have high blood sugar. These first three observations became the famous “risk factors” that, to this day, are the mantra of the the public health establishment, the medical community, and the media who trumpet it. Little noted was the finding that for men over 50 there was no association between elevated serum cholesterol and heart disease.

There were, of course, opposing voices in the medical community, including senior researchers at Rockefeller and Yale and the U. of Pennsylvania. They and others pointed out that elevated triglycerides (and low HDL) were associated with increased risk of heart disease and that low-fat, high-carbohydrate diets caused elevated triglycerides, but their findings were disregarded and their voices ignored. By 1972 the federal government’s WIC program only allowed skim or low-fat milk for kids over age 2. The die was cast. We had started down the road of government Dictocrats intervening in what we eat. Still more ominous interventions were to come. Stay tuned.

¹ The Timeline History of Heart Disease in this and succeeding columns draws heavily from a piece by the same title published by Diet Heart Publishing  at http://dietheartpublishing.com.

Retrospective #2: Nutrition 101: A Primer on the Fundamentals of Nutrition

Food has three principal nutrients, called Macronutrients. They are: Fat, Protein and Carbohydrate, hereafter sometimes referred to as “carbs.” All of the energy derived from food comes from these three components.

Foods also have non-caloric nutrients, namely vitamins and minerals, or Micronutrients, as well as water and ash. In addition, foods have essential but not yet well understood (or discovered) Phytochemicals, such as antioxidants.

The energy content of either a gram of protein or a gram of carbohydrate is four (4) calories. The energy of a gram of fat is nine (9) calories, making it thus more than twice as “dense” in calories as either protein or carbs. A gram of ethyl alcohol in an alcoholic beverage has seven (7) calories but, alas, no nutrient value, hence “empty” calories.

Most “sugar-free” candies and “energy bars” contain “sugar alcohol,” which does not elevate blood sugar levels, making them tempting to diabetics. They do, however, raise blood insulin levels, because the body senses sweet.

The total available energy of a food is therefore the sum of the products of the weight (in grams) times the calories per gram of each of its macronutrients. If you wanted to do the math (or use a software program) you could calculate how many calories of each macronutrient, and the total percentage energy in calories, are contained in each portion of food. But for this primer, it is only necessary to establish an understanding of the basic science.

If you are interested in healthy eating and a long life, you should be informed about the macronutrient distribution and balance of your diet. It was not so in the Paleolithic Era, referenced in the 1^st installment. It was then just about survival. It was through “survival of the fittest” and that we learned what to eat to be healthy and evolve.

Almost half a century ago in the U. S., some big-government advocates thought that heuristic learning (by trial and error) was fraught with too much risk. That’s when politicians and public health officials decided to get involved in establishing Dietary Goals (1977), and later Dietary Guidelines (1980) for Americans. The HHS/FDA created these standards and later the “Nutrition Facts” panel that is on all manufactured and processed food.

This is known today as the “Standard American Diet,” or SAD, for short, prophetically. It contains a “% daily value” (previously the “Recommended Daily Allowance”) for carbs, for an adult woman, of 300 grams (x 4 calories per gram = 1,200 calories, or a whopping 60% of a 2,000-calorie diet). The “daily value” for protein is 50g (x 4 = 200 calories or 10% of 2,000 kcal). And the “daily value” for fat is 65g (x 9 = 585 calories or +/- 30% of a 2,000 kcal. diet.

This means that our government currently, to this day, recommends that an American woman eat a diet comprised of 60% carbs, all of which break down to “sugars” in the blood. Simultaneously, beginning in 1980, most of us have become fatter, and many of us have become Type II diabetics (like me). Does anyone see a correlation here? Does anyone think maybe this is a vast public health experiment gone wrong? Many people now agree. It was a mistake.

But I don’t blame our doctors. For more than 50 years – longer than the entire time that virtually any doctor still in practice has been working – the prevailing wisdom passed down from the powers-that-be has wavered but little. The sources of information that the medical practitioner has relied on are, writ large, our public health officials and, derivatively, the practitioner’s medical community, through their specialty practice standards, medical journals and conventions, and the ubiquitous pharmaceutical salesperson. For the most part, practicing physicians were not trained much (if at all) in nutrition, except for basic biochemistry; they have had little time to “bone up” on an area that isn’t being pushed by big pharma because there is no money to be made in nutrition. So, I do not blame the clinician for treating symptoms of disease by prescribing medications. I sympathize with (most of) them. They are stuck in the status quo of the mainstream mantra and, and the dictates of government regulations, insurance, and reimbursement policies. They are unable to turn around in the face of these compelling drivers.

This suggests to me that it may be time for the patient to assume some responsibility and take charge of his (or her) own health.  What you eat is up to you. It’s in your hands. You can do it, if you take the trouble to “bone up.”

Retrospective #1: A Very Brief (and Necessarily Selective) History of Human Nutrition (and Dieting)

In the beginning, there were the hunters and the gatherers. In the History of Nutrition this was the Paleolithic Era, hence the Paleo Diet. In most cultures, men hunted and women and children gathered food as it was available to them. Early humans adapted to periods of feasting and starvation (fed and fasting states, in dieting terms).

We humans were of necessity omnivorous. It was a survival thing. We ate every part of the animals we were lucky or skilled enough to trap, club or impale. Every part of the animal (or fish), including the organ meats (offal), the blood, and even the marrow within the bone cavity, was eaten. Some of us still enjoy these foods today.

We also ate the things we could gather from in-season fruit trees and vines, and the leaves, roots and fungi that didn’t kill us. It was a trial and error thing. We learned that to survive we had to take risks, both in hunting and gathering, and to make the most of what was available. This is why children have a natural aversion or “distaste” for “new” foods and only increase the scope of what they will eat as they mature. Remember when you wouldn’t eat x – fill in the blank. For me, it was Brussels sprouts, which today I love, especially tossed in olive oil and roasted.

Then, as we became more “civilized” and gathered together for socialization and protection, we wandered about less. This undoubtedly fostered the beginnings of agriculture. We saw that cereal grains, that is, the seed heads of grasses such as corn, wheat, and rice, grew naturally where nature planted them. We reasoned, why wander about when we could plant our food supply and water and cultivate and harvest it where we lived? This also enabled us to build more permanent shelters and live in fertile places with good fresh water supplies and abundant game and vegetative life. We also learned that we could catch certain animals and domesticate them for a steady food supply as they multiplied naturally in captivity. Wunderbar! Surely, this was a milestone of human evolution.

Could life get any better? Perhaps. But, in the view of many students of these developments, this was also the beginning of mankind’s downfall, nutritionally speaking. It was the dawn of the onset of the age that was to bring us the dreaded Diseases of Civilization. It was the advent of the Neolithic Age, and it began about 10,000 years ago.

Fast forward to about 150 years ago. William Banting¹, in 1863 a retired London undertaker, wrote and published a 16-page pamphlet titled Letter on Corpulence – Addressed to the Public. In it, the 5-foot 5-inch, 200-pound Banting – surely a fat man – described a program of eating in which he “scrupulously avoided eating any…food that might contain either sugar or starch.” On Banting’s diet, he ate 5 or 6 ounces of meat or fish at each of three meals every day, together with a fair amount of wine and spirits, avoiding altogether “bread, milk, beer, sweets and potatoes.”  Banting lost about 50 pounds in 18 months. His pamphlet became a best seller in England and on the Continent.

William Banting credited his diet to William Harvey, an aural surgeon in London who had recently been to Paris where he had heard the great French physiologist Claude Bernard debate on diabetes. Voila! So, there you have it.

Now, fast forward again to about 50 years ago, to include the impact of the Industrial Revolution, the new roller-milling technology for making flour, trans-fat-loaded Crisco and “vegetable” oils made from soy beans and corn.  

On January 13, 1961, Ancel Keys, an assertive University of Minnesota physiologist (after whom WWII’s K-Rations were named), was on the cover of Time Magazine. Since the 30’s Keys had been interested in the influence of diet on health. His epidemiological work on the etiology of heart disease would later be published in his 2nd seminal tract, the “Seven Countries Study” (Harvard University Press, 1980). In it he advanced his hypothesis associating saturated fat and dietary cholesterol with heart disease. This was the genesis of the Diet-Heart (Lipid) Hypothesis.

Keys’ Lipid hypothesis led the nation and the world to the Low-Fat diet. Lamentably, the study was later discovered to have been “cherry picked.” It will be the subject of the third essay of this series, but first will be a primer for non-scientists (and physicians) on “The Basics of Nutrition: Macronutrients, Vitamins, Minerals and Phytochemicals.”

¹ “Prologue: A Brief History of Banting” from Gary Taubes’ Good Calories – Bad Calories, 2007, Alfred A. Knopf

Type 2 Nutrition #472: Is the Vedda Blood Sugar Remedy Credible?

A friend of 40 years, who used to follow my blog, thenutritiondebate.com, recently emailed me to ask, “Does the Vedda Blood Sugar Remedy have any credibility?” I’d never heard of Vedda before so I looked it up. It’s a Sri-Lanka herbal product and diet program that’s being promoted here in a new book.

The website Contra Health Scam says the Vedda Blood Sugar Remedy is a scam. Quoting from their conclusion, “Vedda Blood Sugar Remedy is nothing but a well-produced scam, complete with paid actors, stock photos, stock videos, twisted scientific studies and outright lies.” So, I sent the link to my friend and suggested instead that he look up the Virta Health program (see the name similarity?) for managing his weight and blood sugar.

My friend thanked me and later emailed me, “The Keto rage sure evidences your research! The weight loss results are phenomenal. This is totally counter to the food pyramid we grew up with, or Michelle Obama’s new school she tried to promote.” I replied, “Yes, that’s all true,” and asked if he would like to be added back to my distribution list.” He replied, “Yes, I am definitely still struggling to get to my goal weight. Thanks.”

Later, while working in the garden I got to thinking about this “conversation.” I found it very depressing. I’ve been proselytizing about how to manage weight and blood sugar about ten years and have written almost 500 columns (472 published with this one), and even my long-time friends (and my own wife!) pay no attention to me. How frustrating is that? So, I told my wife about the conversation and she said, “You have no bona fides.”

I understood what she meant, of course. I’m not a medical doctor. But, with exasperation, I replied, I have personally lost 170 pounds (and maintained most of the loss) BY DIET ALONE, WITHOUT EXERCISE, AND WITHOUT HUNGER. Not only that but I have turned my diabetes health around, from a progressively worsening disease to the point where, from a clinical standpoint, I am “cured,” and in complete remission.

In addition, my lipid (cholesterol) profile is also completely reversed, I’m no longer on a statin, my blood pressure is “normal” (with meds), and my inflammation non-existent (hsCRP ≤1.0). I am so full of energy and so much healthier and happier than I was 17 years ago when my doctor first suggested I try a Very Low Carb diet to lose weight. He didn’t call it LCHF or Keto, but that is what is was and IT WORKS!

So, it seems, my personal example only works for me – “you’re not like other people,” my wife says – until you read somewhere in the mass media about “the Keto rage” with “weight loss results [that] are phenomenal.” And then you realize that it’s “totally counter to the food pyramid we grew up with,” the one our government has been promoting for more than half a century.

My wife said I should be grateful that my friend has come back into the fold. I said I was, but still, I was stunned at the resistance of some people…by which I mean most people, not my friend in particular…to rational change. We just don’t want to change, until perhaps we reach a tipping point in our personal life. For me it was the shock of learning that I weighed 375 pounds. My doctor’s scale only went to 350, so one morning before an appointment, I stopped at the Fulton Fish Market in New York City and weighed myself on a commercial scale. I thought I was going to die. I looked around and I didn’t see any really fat, old people. I didn’t want to die.

What will it take for you? What combination of fear, courage, and a glimmer of a chance that changing your diet could work? That it might be easy to lose weight and improve all the markers associated with death?

What will it take for you to realize you became overweight because of what, you ate? To realize the way to reverse that condition is to change what you eat – to eat in a way “totally counter to the food pyramid we all grew up with,” that we’ve been following our whole lives and that got us into this mess in the first place. Think about it. If that’s what it takes, then maybe you’ll become a follower too, and we can grow old together…

Type 2 Nutrition #471: “You mean, sugar is a carb?”

I was sitting at the bar in an upscale restaurant, having dinner and chatting with the co-owner about nutrition, when she said, earnestly, “You mean, sugar is a carb?” I’m not kidding. This woman, who is seriously obese, blames it on her “lack of discipline” and being “married to a chef.” “I work in a restaurant,” she says. Sheez…

“I know sugar is the enemy,” she continued. But for someone in her position – she clearly has an influence on the menu– to know virtually nothing about nutrition, is shocking. I’m tempted to go into another rant about how we got into such a state of affairs, but you’ve read enough of those. Instead, let me illustrate the point with further evidence of her thinking, and how that influences her and their business.

I hadn’t been to this neighborhood restaurant in a while, so I took a good look at the menu: Two soups, seven appetizers, and eight or nine entrees. One soup was a creamed squash, the other a chowder, by definition loaded with potatoes. I was interested in the creamed soup so the wife checked to confirm that it contained no flour. But I wasn’t hungry enough for such a filling and calorie loaded starter.

Then, to my surprise, the first appetizer listed was a plate of fried potatoes. Five of the other six appetizers were salads. The seventh was calamari, dredged in flour, dipped in cornmeal and deep fried – three good reasons not to order it. Some of the salads looked good though, especially hearts of artichoke and a burrata.

Several of the entrees were also appealing: two fish entrees, an osso bucco, and a pork chop. All the entrees were accompanied by a vegetable and a starch, which of course could be switched out for extra vegetables. However, since I was not hungry, I settled on just the artichoke salad…and it was very good.

The young amiable bartender made me a good drink and I settled in. That’s when the co-owner joined me and we got into conversation about nutrition. I told her about how I had lost over 170 pounds, starting in 2002, and was still down 150. She said that was very good, but she didn’t ask how. It was a sign she didn’t want to change her way of eating. I told her anyway: VERY LOW CARB. I started on Atkins INDUCTION.

She told me she did Weight Watchers. When I asked her, rudely, why she was not successful, she explained that she was married to a chef. I let that pass and instead mentioned that she and I – both of us – were at a disadvantage to many in the population, like the bartender, who was skinny.  She and I were victims, I said, thinking that would appeal to her. We, like millions of others among us, had a bundle of genes in our makeup that had been “expressed” over the years by our eating too many processed and refined carbs and sugars.

Her response was, “I think that’s up for debate.” She averred that a meal had to be “balanced.” Her problem, she said, was “discipline.” I countered that when you eat a meal of mostly protein and fat, your hunger is satisfied. She responded that a large serving of broccoli satisfied her for hours. We were going nowhere.

“Potatoes have a lot of fiber in them,” she continued. “I like potatoes.” I now understood why the potatoes were the first item listed on the menu, offered as an “appetizer.” And I now also understood why the seat I took at the bar had a half-finished plate of potatoes in front of it that the bartender removed. I had taken the co-owner’s seat and had interrupted her dinner.

I had another drink and another salad, the burrata – which was also very good. That was all I could salvage from the night’s foray into re-educating the world, one person at a time. But I did get subject matter for another blog on the state of nutrition in this world, and my fasting blood sugar next morning was 87mg/dl. That’s good. But what’s going to become of us if we’re not even interested in knowing about nutrition. If we’re so fixated on a “balanced” diet, getting lots of “fiber,” and blaming others for the food choices we make?

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.