Crash Course Diet Reverses Type 2 Diabetes in a week.
It is yet another example of the tragically flawed pseudo-science that damages the health of people with diabetes.
There's no mystery here, nor is the effect reported a result of "reducing fat in the pancreas" as the doctor who came up with this "cure" suggests. All he has done is craft a "balanced" diet that has so few calories it is also low in carbohydrates.
As all my readers know, most people with Type 2 diabetes--especially those recently diagnosed--can recover normal blood sugar control simply by cutting back their carbohydrate intake to somewhere between 30 and 100 grams of carbohydrate a day. The actual number varies with the size of the person, their gender (men can usually tolerate more carb), and the ability of the individual's beta cells to secrete insulin.
But a low carb diet with normal calories is a high fat diet, and doctors have been brainwashed to believe that high fat/low carb diets cause heart disease. They don't. You can read the research that has proven this HERE.
But doctors don't have the time to keep up with nutritional research, so they still believe it. And because of their fat phobia, the only way doctors can feel comfortable prescribing a very low carb diet is by pretending they aren't prescribing one--which they do by prescribing "balanced" diets, one like the one reported here, where the calories are so low that a diet that includes 33% of calories in the form of carbohydrate becomes a low carb diet.
Starvation Diets Like This One Are Dangerous
In fact, there's nothing new or healthy about the low cal diet this doctor has come up with. The starvation diet is well understood--and very expensive. It can only be pursued under the supervision of paid medical staff that includes trained nutritionists because cutting calories that low on your own can be extremely dangerous both to your body and your mind.
The classic research on ultra low calorie diets, the starvation research conducted by Dr. Ancel Keys during WWII showed that people eating very low calorie diets developed psychoses (i.e. severe mental illness) at a surprisingly high rate, as well as many other important health problems. Poorly crafted medically supervised low fat starvation diets have caused deaths in the past.
Very low calorie diets of all kinds are extremely hard on the heart because they can't supply enough protein to repair muscle, so the body ends up cannibalizing the heart muscle.
Even with careful nutritional supervision, when calories are that low, the thyroid and other parts of the system that regulate metabolism slow in order to make the best use of every available bit of energy and the result is that after a month or two on the very low calorie diet, the person who dieted so unwisely will find themselves gaining weight on a caloric intake so low that it should be a weight loss diet for someone their size.
Partially this is because some metabolic slowdown occurs in anyone who loses a significant amount of weight on any diet. I discussed this in a blog post that highlighted Dr. Liebel's research about metabolic slow down with weight loss.
But extreme calorie deprivation seems to intensify this effect. Some years ago, many denizens of the Low Carb Friends diet discussion board fell for scam diet, the so-called Kimkins diet, which was a low carb, low fat diet which was effective in taking off weight fast (and cutting blood sugar) because starvation diets WILL do that, but which also left quite a few of them with metabolisms so damaged that they started gaining weight eating as little as 1200 calories a day, their hair fell out, and they developed mood disorders and other severe deficiency problems. It took several years for some of them to get their health back.
The Gastric Bypass Model For the Diet is Misunderstood
The doctor in this study purporting to "reverse diabetes" justifies his approach by explaining that it duplicates what people eat when they have had gastric bypass, but what is forgotten is that people with gastric bypass often develop long lasting and severe nutritional deficiencies. The restricted diet enforced by weight loss surgery also appears to cause an unexpectedly high rate of suicide which goes along with what we know about severe calorie restriction causing severe mood disorders. This, sadly, is a subject you won't learn about in the enthusiastic plugs for it you read in the media which are supplied by press agents working for bariatric surgeons. Details HERE. Note that this important epidemiological study, published last September, got NO play in the health media.
What is also forgotten is that the research suggests that the real reason some people "reverse their diabetes" after gastric bypass is that they can no longer tolerate carbohydrates and will experience projectile vomiting if they eat enough carbohydrate to raise their blood sugar. Weight Loss Surgery therefore forces them to eat a very low carbohydrate diet and THAT is what "reverses" their diabetes.
Starvation Diets Like This One Are Unnecessary: It's All About The Carbs
What most doctors don't know and won't be told by the surgeons who are profiting so mightily from weight loss surgery is that people who "reverse" or "cure" their diabetes with weight loss surgery get their diabetes right back as soon as their stomachs stretch out to where they can eat enough carbohydrates to raise their blood sugar again. (You'll find studies proving this HERE.)
Clearly, there isn't any magic in the surgery or in calorie restriction that is what is supposedly "reversing" diabetes. Blood sugars come down only because these approaches remove the one component of the diet that raises blood sugars into the diabetic range: carbohydrates.
But as thousands of people with diabetes have learned, you can get the same effect by eating a diet that contains normal amounts of calories if you are willing to removed carbohydrates and replace them with healthy fats and protein. And when you do this you don't risk developing nutritional deficiencies or the possibility of developing a severe mood disorder.
It's Time for the Annual ADA Conference. Vendor-Sponsored "Research" Will Be Swamping the Health Media
It's not accidental that this study was published yesterday, tomorrow marks the beginning of the American Diabetes Association's so-called "Scientific Sessions". This is the annual conference where those who make their living selling goods and services to people promote their wares to doctors using poorly designed corporate-funded studies that twist the data to prove whatever will make the sponsor the most money.
High profile doctors the drug companies call "thought leaders"--each of whom receives huge fees from the drug companies--will give talks to their peers that purport to explain the mechanics of diabetes but which really do nothing but convince other doctors that the only treatments they should give people with diabetes are the most expensive new drugs.
So over this next week expect to see a lot of media reports about miraculous new drugs. You'll probably also be hearing a lot of praise for the miraculous effects of weight loss surgery, since the weight loss surgeons seem to have paid "charitable contributions" to the ADA to have bought a seat at the table previously dominated by drug merchants.
You'll see headlines suggesting that high fat diets cause diabetes in humans--all of which will have been conducted in rats bred to develop diabetes on high fat diets. (You can read more about this questionable methodology HERE.)
You'll read about dozens of "cures" of diabetes--all conducted in mice whose diabetes is caused by everything except the genes that cause diabetes in humans.
What you won't find at the ADA Scientific Sessions, ever, is any significant participation by people who HAVE diabetes and who have controlled it using strategies that don't cost an arm and a leg. Like carbohydrate restriction. The ADA has been fighting for decades for the right of its corporate food company sponsors to sell starchy breakfast cereal, soups, bread, and over processed juices to diabetics as "health food" for diabetics, and it will keep on doing it.
But the truth for most of us real people with diabetes who have maintained normal blood sugars for years without resorting to radical surgery or diets is that cutting way back on the carbohydrates we eat at meals will dramatically lower our blood sugars.
You can easily test this proposition at home. If you are new to this blog I urge you to read this page HERE and try the technique it suggests.
NOTE: Please click on the Comments link below to read more information and discussion based on the full text of the published study.
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29 comments:
Jenny, I love your posts, but your site, out of all the sites I read, have contributed the most to making me lose faith in the medical establishment. And I don't even have diabetes. It's depressing.
But you are providing an incredibly useful service to the diabetic community. I salute you.
Since I posted this, another pre-ADA press release has hit the mainstream media claiming that Weight Loss Surgery "Cures" diabetes. Did I call it or what.
But yes, one's faith in medicine is sorely tested. If you want to read something REALLY scary, try this:
http://www.sciencedaily.com/releases/2011/06/110622115324.htm
It says that when intensive care doctors have someone to NAG them to do what is already listed on a checklist they are supposed to follow deaths drop by 50%.
In other words, doctors too conceited to follow the kind of checklists that pilots use kill half their patients. And no one intends to change this system any time soon. Too expensive.
The study on suicide by patients who've had bariatric surgery is interesting, but would be more useful if they also compared it to the suicide rate among similarly obese folks who didn't have bariatric surgery.
Noah,
You are right, but this isn't the first study that has found a surprisingly high rate of suicide among people who have had WLS.
Here's an older one: Medscape: Higher than Expected Suicide Rate Following Bariatric Surgery.
Mood disturbances are known to be caused by starvation and WLS is all about creating starvation, so this shouldn't be a surprise.
Jenny, what's your take on the newly approved DDP-4, Tradjenta?
Tradjenta does a poorer job of lowering blood sugar than Januvia, has a higher rate of dangerous side effects, and because it inhibits DPP-4, like Januvia and Onglyza, it suppresses an important tumor-fighting gene making it very dangerous to anyone who has a small number cancer cells in their body.
Needless to say, just because it is new, I expect to see doctors prescribing it to all their newly diagnosed patients. Most doctors already have switched the new patients to Onglyza which is also less effective and which has a higher rate of dangerous side effects than Januvia.
There's a book on the Ancel Keys study called The Great Starvation Experiment. During World War II, a few dozen nice, young, mentally healthy, hardworking men--conscientious objectors who grew up in the historic peace churches--signed up for the year-long experiment.
During the experiment, a budddy system had to be used to keep the men on the diet. Even so, a few men went off plan, one of them admitting to digging for food in trash cans.
Two of the young men hung out at a diner one day, and one of them yelled at a young woman for leaving food on her plate.
Two of the pacifists got into a fistfight over a piece of macaroni.
One man, perhaps acidentally, perhaps deliberately, cut off one of his fingers.
Mostly, the men were tired, weak, couldn't concentrate, and thought of nothing but food.
As I recall, though, none of the men had lasting mental health problems.
The calories and macronutrient level of the diet, in general, is what is recommended on many popular diet plans today.
Lori, Yes, that book is where I learned about the study. It's well worth a look. The men were starved on a diet that contained the number of calories I have to eat to maintain my weight, but that is because they were young males in their 20s who do need to eat twice as much as an old lady like me to maintain the same weight.
There are indeed long term effects of starvation--there are studies of actual populations in Europe who starved during WWII that showed a higher rate of Diabetes in the starved group, if I recall correctly. Psychologically there may be long term effects, too. The Keys study did not do 10 year follow ups as I recall which would be where you'd see changed feeding patterns manifesting as perhaps a raised incidence of obesity.
I don't trust any diabetes report in the mainstream media so of course the newspaper article made me as spitting mad as you.
But I wondered if you still felt the same after reading the actual article, not the misleading, sexed up version reported in the press?
www.diabetologia-journal.org/lim.pdf
As always, would be interested in hearing your thoughts.
Lila, Reading the full study report doesn't change a thing. The diet is described as " ...a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day."
This means their diet provided 70 grams a day of carbohydrate and was therefore a ketogenic low carb diet--but sadly, because of the peculiar worship of the "balanced" diet, it was a ketogenic low carb diet that did NOT provide anywhere near enough protein, as protein was only 48 grams a day.
This means that the subject's hearts were being cannibalized to produce the glucose needed to run the brain and the protein needed to repair muscle.
My ketogenic diet protein calculator, (you'll find it HERE suggests that a 30 year old male 5' 9" tall who weighs 200 lbs --a typical subject--would need 142 grams of protein to avoid cannibalizing muscle during the first three weeks of a ketogenic diet. After that, he'd need to eat 73 grams of protein a day.
So yes, this is a dangerous diet. Beyond that, the only finding here despite the fancy technology described seems to conforms to what we already know: on a low carb diet triglycerides will drop dramatically as blood sugar normalizes. That is because the triglycerides that clog the liver come from the metabolizing of dietary carbohydrate.
Also, as blood sugars drop into the normal zone secondary insulin resistance vanishes so insulin sensitivity improves.
Calorie restriction is not required to explain this result. Cutting carbs alone will do it.
The interesting part of this study is the 12-week follow-up.
"...a 2 h OGTT plasma glucose of 10.3±1.0 mmol/l. Three participants had recurrence of diabetes as judged by a 2 h post-load plasma glucose >11.1 mmol/l." (Page 6)
Translation: All 11 people on average had OGTT results of 185 mg/dL, while 3 of these 11 had OGTT results >200 mg/dL.
According to my definition of diabetes, the entire population of this study is still diabetic.
Jenny, I'm also of the opinion that carbohydrate restriction is a far better way of controlling blood sugar than long term starvation. But it seems that this study is doing something more than simply controlling diabetes by not letting people ingest any carbohydrate. Figure 2 shows clear increases in insulin secretion. 7 of the 10 participants passed OGTTs at the end. No doubt this cure may not apply to people with distinct (genetic) forms of diabetes or reverse beta cell death.
My first reaction to reading about this study was, there was certainly NO Type 2 diabetes in the concentration camps. After reading your article, it explains the extreme muscle-wasting seen in the survivors when the Allies first took pictures of them.
But what I'm most curious about is that the study said that the subjects returned to a "normal" diet after a number of weeks, and maintained the normalized glucose levels, but I really wonder how long that will last. At the very least, this study needs long-term follow-up, because NO ONE can subsist on a concentration camp diet for very long!
David,
That increased insulin secretion could very well be due to the lowering of the blood sugars which because it eliminates glucotoxicity would lead to better functioning of the beta cells.
That's speculation, but so it the conclusion they draw in the article that it is due to the calorie level rather than the carbohydrate restriction.
The only way to settle this would be to run the experiment using two groups who ate the same amount of carbohydrate with differing levels of protein and fat.
Also, at diagnosis people with Type 2 (most of whom have SOME genetic issue contributing whether inherited or acquired through exposure to environmental toxins) have lost a great number of their beta cells (usually due to prolonged exposure to glucotoxicity.)
It just shocks me that the same people who caution that despite a decade of research showing NO negative impact on heart disease from lowering blood sugar with a low carb diet "More research is needed" because it MIGHT be dangerous are willing to promote a starvation diet that we know MUST be dangerous to the heart. This, once again is religion, not science, because it is based on a belief that can not be shaken by evidence.
Here's a functioning link to the calculator that estimates how much protein you need to eat on a ketogenic diet.
http://www.phlaunt.com/lowcarb/DietMakeupCalc.php"
The assumptions used in the calculations are explained at the bottom of the results page.
Dr.Prof, what should be your BG level in order to be classified as not diabetic in a 2 h OGTT?
Jenny,
You are absolutely right, it's all about carbs!
Dr. Jan Kwasniewski and his "Optymalni Association" doctors have been curing t2 diabetics (and some t1 cases) in the "Arkadia" affiliated network of spa clinics in Poland since the 1980-ties. The most notable diabetic patient of his is the former Polish president Lech Walesa. Another former Polish president (Jaruzelski) is also on the same diet, for a different health reason.
I remember a story reported in the Polish media about 10 years ago when medical association of diabetic doctors in Silesia (southern Poland) requested from the Polish minister of health to ban Kwasniewski's books because their diabetic patients were signing off and deleting themselves out of their hospital diabetic registers in large numbers. Around the same time (late 1990-ties) the sale of insulin in Silesian pharmacy shops declined by 70%. 8-:)
Regards,
Stan (Heretic)
In a way it's too bad that people instantly identify "low carb" as a weight loss approach, since it's hard to achieve lasting weight loss any way you try. But lowering blood sugar by eating low carb is easy, and not a lot of people realize that.
Hi Jennny,
thank you for dealing with the article from the media. What I took from it was first that after two months of very low calorie diet their diabetes was cured, because of loss of fat deposits in the pancreas and second, that disturbing the energy balance by eating more than you expend leads to diabetes. I think the first was not proved and the second is wrong.
You wouldn't like to be told that your overindulgence led to your diabetes.
By doing low carb you can manage/control your diabetes successfully but you don't cure it. The question was for me if this study is correct, their conclusion and interpretation is correct (which it seems is not) doing a two months very low cal diet might help.
Why would your body cannibalise your heart? Why wouldn't it use protein from somewhere else? It obviously does, as brought up by the commenter who mentioned the camps' survivors.
What about intermittent fasting (once a week) to get rid of excess liver glycogen stores or fat in the liver? Not necessary?
It takes years to get rid of excess fat in the liver no matter what you do, based on the only accurate way of measuring liver fat, which is biopsy. Noninvasive scanning is not anywhere near as accurate.
The mulitimillionaire diet doctors who tell you you can get rid of liver fat (and belly fat) in a few weeks or months of any diet are using a few cherry picked studies of poor quality to sell their snake oil. I've discussed that HERE.
Fasting is often a poor choice of strategy for people with diabetes as many will see their blood sugars climb when they don't eat. It can also result in eating more on the days when you aren't fasting if you have an abnormal glucose metabolism.
Intermittant fasting strikes me as yet another of those fads that sweep the internet. People love to believe that some dramatic, extreme and not-what-they're-used-to way of eating will solve all their health problems. The truth about what it takes to restore health is not so simple and varies from person to person. You can usually tell you've found a real, workable health technique because:
1. It works slowly and doesn't cure everything.
2. It doesn't work for everyone.
3. It's moderate enough that you really can stick with it for 20-50 years without having to exert enormous amounts of willpower. Any solution based on willpower will almost inevitably fail within five years.
Re: fatty liver
If it takes years of excessive alcohol or fructose, or transfats with high carb diet , to produce fatty liver, then logically, a diet low in the above, ought to reverse it, not true?
Why would you then consider low carb diet promotions to be fads (as per your linked 2009 post)?
Did you experience some difficulty, personally?
Most of the low carb diets I am familar with, do fullfill your criteria 1,2 and 3. Most of them do work as far as I know.
Do you know of any reasonable alternatives for diabetes reversal other than a LC diet for life?
Regards,
Stan
Stan,
Read the link.
Years of eating low carb may very well reduce intracellular liver fat, but the fad book doctors promise you that you can do it in a few weeks or months. That's a fantasy.
The main thing that the low carb diet is stop the accumulation of more, but the fad books confuse the shrinkage of liver tissue which happens when you flush out the glycogen stored there with the loss of liver fat. Measuring your abdomen around the liver will show a gratifying loss of "inches" after two weeks on a low carb diet, but it is all due to glycogen and comes back within a day if you carb up enough to refill the liver.
True fat loss of all kinds does NOT come back after a single carb up. The biopsy studies make it clear that after six months of ketogenic dieting you will lose a very small amount of liver fat, but it probably does take many more years to get back to anything near normal, and I have never read anything that suggested this actually happens.
Very few people with diabetes who eat ketogenic diets get down to their desired "normal" weights either. Most stall well above it, so that might also happen with the liver fat.
And yes, I know a few people do, usually younger men. But they are outnumbered by those who do not. Most of us are very happy to settle for a 20% weight loss and normal blood sugars.
First disclaimer -- I'm not clearly either Type 1 or Type 2 -- somewhere in between. I DO have some insulin resistance, but not severe -- I average about 35u of insulin a day.
But I'm intrigued that you say that most people who go on low-carb ketogenic diets remain well above their "ideal" weight. When I started low-carbing, I weighed 168, 2 lb. short of formally obese, and after 6 months was down to 138, down to BMI 24.5, which is considered normal. Am I an outlier, or is it really more likely that I'm actually some weird form of Type 1?
Natalie,
You lost about 18% of your starting weight, which is close to the 20% of starting weight most people with diabetes report losing.
But most people with diabetes would need to lose a lot more than 20% of starting weight to get to a normal weight. For example, a person who starts out at 225 lbs who wants to get to 125 lbs would have to lose 45% of their starting weight.
It's worth noting that even with gastric bypass surgery many people still don't get to their weight loss goal.
Jenny I stumbled on your book and website sometime ago and find it brilliant. You indeed are an avid follower of Dr Bernstein, who's books I have read too. Low carb dieting indeed works although it is very tough and everyone falls off the wagon, tough to stick to. There is so much info and so many medications out there and doctors themselves have so many opinions that the whole subject can be bewildering to the average person, who do you believe who do you listen to? Very overwhelming for most people. To think that the ADA gives false advice that doesn't work blows most peoples minds. But sadly this is true. Dr Bernstein in particular really despises what the ADA preaches. Having tried many things from fancy vitamin formulas, to a large array of meds, weight loss, excercise, etc etc the one thing I see that makes the absolute biggest difference is Carb reduction, period! If you can master it, you can reduce your BG significantly. But it is NOT easy for most people, in fact its very very difficult. Thanks for your great site.
Great post and comments.
I'm a type 2, don't take insulin or any medication and have been water fasting recently. I feel fine and better after 2 to 3 days, when blood sugar stabilizes at 90 (down from 160). After 9 or 10 days on only water, I noticed that my blood sugar goes above 200, but I still feel fine.
Why do blood sugars rise in a water fast ? It's essentially a zero carb diet, afterall. Maybe insulin levels are still too high ?
Paul,
Blood sugars go up when a person with diabetes fasts because the liver is creating glucose from your muscle tissue which it is breaking down. This is an unhealthy state and can make you very sick. Don't do it!
Jenny, thank you for this timely and frank post. This story got a huge run on news headlines here in Australia. We are real suckers for the low fat high carb story. Your website and book are the best thing I have discovered since I was diagnosed with diabetes - my membership of the 5% club, and even my knowledge that it is possible, is entirely down to the information you have provided. Many many thanks.
forinfo
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