The End of Diabetes (18 page)
Read The End of Diabetes Online
Authors: Joel Fuhrman
Unsatisfied with the results of following the extremely low-fat vegan diet, she changed her diet to my nutritional recommendation. Susan improved the nutritional quality of her diet and added back nuts and especially seeds. Within three months, her cardiac arrhythmias completely disappeared.
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Case #4: Debra
Debra arrived in my office as a seventy-two-year-old female type 2 diabetic at five-foot-one and weighing 160 pounds. She had been on insulin for twenty years. She was using 30 units of Lantus insulin at bedtime and 5 units of Lispro insulin before each meal, with blood sugar running between 125 and 175. Because Debra was taking under 50 units of insulin a day and the dietary intervention can account for at least 30 units of insulin, I discontinued all the insulin at that first visit and started her on 250 milligrams of Glucophage (metformin) three times a day. As it turned out, she did not feel well using even the low dose of Glucophage, and since her glucose levels were running between 110 and 130 in the few days after her initial visit, we decided to manage the diabetes without medications. In this case, we essentially stopped 50 units of insulin per day, and her blood sugar was better controlled without it.
Debra reported at her two-week follow-up visit that she felt much better off of the insulin. Her appetite was no longer ravenous, and she felt immediately lighter and more comfortable with walking and exercise. She lost nine pounds in those first two weeks. Debra is now safely off all medication and showing no signs of diabetes.
My high-nutrient-density diet is designed to be diabetic favorable, to reduce body fat, and to promote the regression of atherosclerosis. It accomplishes these goals for multiple reasons:
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â¢Â No refined carbohydrates, neither sugars nor starches
â¢Â Minimal grains (intact grains only), 1 serving daily
â¢Â Very high fiber (over 50 grams per day)
â¢Â High viscous fiber (flax, oats, beans)
â¢Â High percentage of resistant starch
â¢Â Moderate fat from seeds and nuts
â¢Â Very low saturated fat
â¢Â Zero trans-fatty acids
â¢Â Sufficient omega-3 fatty acids
â¢Â High phytochemicals and antioxidants
â¢Â Low glycemic load
â¢Â Very low sodium (less than 1,200 mg/day)
â¢Â Low caloric density per food volume
â¢Â Minimal animal products, 3 servings a week (few ounces maximum) or less
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It is designed as a therapeutic intervention for diabetics who want the most effective dietary regimen for maximizing health protection. Because the results have been so impressive, patient compliance has been favorable.
Results are aided when diabetic patients make a firm decision to attack their medical issue with complete dedication and effort to a high-nutrient diet.
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Managing Insulin Use for Type 1 Diabetes
Nutritional excellence is critically important for type 1 diabetics. The combination between the disease and the SAD or even the ADA recommended diet results in needless medical tragedy in all type 1 diabetics. My type 1 diabetic patients wind up using approximately half the insulin dosages they required before working with me. They obtain favorable glucose and HbA1C levels, and get rid of the swings in glucose that require varying dosages of insulin. They are able to stick to an insulin dose without monitoring nightmares and constant adjustments. They have fewer fluctuations in numbers and avoid hypoglycemia, as their insulin requirements are now physiological, not pathological.
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After adequate discussion, let patients know how much more rewarding and exciting it is for you as a physician to watch people getting well and beating diabetes and their other medical issues. After all, did we get into medicine to watch people deteriorate, or did we do it to help people get better?
Make a goal with the patient to shoot for at the next visit. Make it absolutely clear to the patient that diet and exercise are now the main means of glucose control, not drugs. Without an explanation and understanding of the futility of the drug-only approach and the absolute necessity of using diet and exercise to protect against further damage, patients are not given the proper opportunity to protect themselves. High glucose readings can be treated with enhancements in exercise and dietary adjustments much in the same manner doctors use medications. Medication used in the interim period until sufficient weight is lost should be limited to those drugs that are not counterproductive to losing weight or to saving and restoring pancreatic function, or at least moving in this direction.
This protocol essentially rules out the use of sulfonylureas and insulin, except considering insulin in very small amounts when the pancreatic beta reserve is unusually depleted. When the proper eating style is combined with the proper exercise program, medications are rarely needed, and even then only in small amounts. We also want to discontinue or at least reduce medications that can cause hypoglycemia since caloric reduction and increased exercise can reduce glucose so dramatically. Glucophage (metformin) and Januvia (sitagliptin) do not cause hypoglycemia and are safe medical options when medications are needed. Byetta (exenatide) is an option when the glucose is running too high on metformin and something stronger is needed, as it does not cause weight gain.
At the first visit, when patients begin this protocol, insulin and sulfonylureas should be reduced by at least one-half and discontinued in the weeks that follow, if possible. A very low dose of 250 milligrams of Glucophage three times daily can help people who experienced indigestion from higher dosages in the past. If the dose is increased slowly, the side effects are minimized. Byettaâinjections of 5 milligrams twice a dayâcan be used in place of insulin in the initial phase if the glucose levels are unfavorable. In most cases, the oral medications such as Glucophage, Prandin (repaglinide), and Januvia can be used because they do not induce hypoglycemia or weight gain.
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Less Likely to Cause Hypoglycemia or Weight Gain | |
Glucophage (metformin) | Januvia (sitaglitin) |
Byetta (exenatide) | Prandin (repaglinide) |
Starlix (nateglinide) | Precose (acarbose) |
Glyset (miglitol) | Â |
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More Likely to Cause Hypoglycemia and Weight Gain | |
Insulin (various types); ultra-long-acting Lantus and Levemir cause less weight gain | |
Amaryl (glimpiride) | Diabenese (chlorpropamide) |
Glucotrol (glipizide) | Diabeta, Glynase (glyburide) |
Actos (pioglitazone) | Avandia (rosiglitazone) |
The goal is to avoid having a hypoglycemic event in the first week of dietary change. The glucose readings in the first few days of dietary adjustment should run 125 to 175; do attempt tight glucose control.
It is safer to allow the patient to run a little high than to risk a hypoglycemic event when they start a diet this aggressive. I always give the first-time diabetic patients my cell phone number and ask them to call me every day for the first three days after their visit. On the third call, I determine when the next call will be or if they can wait until their follow-up appointment in two weeks.
I also instruct the patients who are reducing their insulin dose to cut back their dose considerably each time they get even one reading below 120. I emphasize strongly that if they don't, the next reading may have them in a dangerous hypoglycemic episode. I write out exactly which insulin to cut back on and by how much, reducing both the long-acting (Lantus or Levemir) and the short-acting meal-time insulin (usually Lispro). I carefully watch their morning fasting readings for guidance on the reduction of the long-acting insulin dose.
The most physiological insulin regimen is to use four shots a day: one of the long-acting, twenty-four-hour insulins (such as Levemir or Lantus) before dinner or at bedtime, and one short-acting insulin immediately before each meal. This most accurately mimics what a normal, nondiabetic pancreas would supply. Long-acting and short-acting insulins cannot be combined in the same shot, thus four shots are required per day, not three.
The nighttime long-acting insulin dose is usually cut back by 40 percent at the first visit, and the pre-meal (quick-acting) insulin is reduced by 30 percent. Because regular insulin extends its action beyond mealtime needs and can lead to hypoglycemia, it is no longer recommended as the medication of choiceâespecially for my patients, whose mealtime insulin requirements are even shorter lived.
Reviewing the morning fasting and preprandial insulin levels will help the physician adjust the bedtime long-acting dose, and the two-hour postprandial insulin readings will help further adjust the mealtime quick-acting insulin dose.
For type 1 diabetics, adjust the long-acting dose so the morning and preprandial glucose readings range from 80 to 120, and adjust the preprandial insulin dose so the two-hour postprandial glucose readings hit in the 130 to 175 range.
The only way to safely achieve these results without hypoglycemic reactions is not by conventional carbohydrate counting but by stability in the diet and stability in the insulin dosage. For example, a sample dietary skeleton for a type 1 diabetic woman with a daily intake of 1,500 calories would be:
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Breakfast | 400 calories | Two fruits, oats and oat bran, almonds, ground flax, walnuts |
Lunch | 500 calories | Salad with nut/seed-based dressing, veggie/bean soup, one fruit |
Dinner | 500 calories | Salad with hummus/bean/salsa dip, steamed greens, veggie stew, tofu or flavored beans or fish, one fruit |
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The consistency is in the food choices, as the carbohydrates used and the overall GI of the meal is low and the fiber is very high. The secret to the excellent control is the use of greens, beans, seeds, and nuts all together in the meal at both lunch and dinner.
This hypothetical type 1 patient will now require only 3 to 5 units of insulin before each meal and 15 to 25 units of long-acting insulin at night. Whereas under the standard carbohydrate-counting ADA regimen, the average type 1 diabetic would take 6 to 9 units before each meal and 40 to 50 units at night.
With consistency in diet and medication, precise management of type 1 diabetes is possible without highs or lows. Patients are no longer at high risk for heart disease, stroke, or other tragic complications of the condition. They are no longer overusing insulin. They are no longer destined to be overweight. Their lipids come under control, and they get better glucose management, without the risk of being hypoglycemic. Their condition is managed more physiologically, and they feel better.
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Diabetes During Pregnancy
Gestational diabetes is a pregnancy-related condition affecting over 5 percent of pregnancies in which women without previously diagnosed diabetes develop high blood glucose in the diabetic range.
Because the early stages of diabetes have no symptoms, gestational diabetes is most commonly diagnosed by screening with a glucose challenge test (GCT) or a three-hour glucose tolerance test (GTT). American women are subject to intensive screening to identify gestational diabetes. Their blood is checked for an elevated glucose early in pregnancy; and then, at twenty-four to twenty-eight weeks, they are given a 50 gram GCT to test their blood sugar under the high glucose stress. If that test is suggestive, the glucose is elevated above 130 one hour later, a more definitive GTT is offered. The GTT is a longer test conducted over three hours, with blood drawn for glucose each hour. Only about a third of women who have an abnormal GCT are found to have gestational diabetes with the GTT. However the higher the number is on the GCT, the more likely the GTT will be positive.
Of course if a woman was already diagnosed with diabetes before pregnancy, she would not need to be screened, but it is more important than ever for her to adopt a diabetic reversal diet and begin to reverse her diabetic condition immediately. In the United States, where we have the most obese and diabetic-prone population in the world, this extensive and elaborate screening regimen is set up by obstetricians because gestational diabetes is more prevalent compared to other areas of the world where the diet is not so excessive and unhealthy people do not carry so much diabetes-promoting body fat.
Women are more prone to gestational diabetes if they are overweight before becoming pregnant. Then the placenta-produced pregnancy hormones, in conjunction with the increasing body fat, make the body more and more insulin resistant. People prone to diabetes in general are those with a more limited beta cell reserve in the pancreas. Gestational diabetes develops for reasons similar to type 2 diabetes development in later adult life. As the insulin needs of the body increase during pregnancy, the beta cells can't produce sufficient insulin to keep up anymore. In this case, the heightened needs of pregnancy emulate the insulin needs in an overweight person. So diabetes diagnosed during pregnancy is predictive of an increased risk of developing diabetes in subsequent pregnancies and later in life, if the standard (disease-causing) diet is continued. One long-term study followed a group of women diagnosed with gestational diabetes for thirty years and found that half developed type 2 diabetes after six years and more than 70 percent had diabetes after twenty-eight years.
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