Put Diabetes In Remission – Introduction
As we have all heard, more and more Americans are becoming obese which in turn is leading to increasing rates of Type II Diabetes Mellitus (high blood sugar). In response to this epidemic, patients are told by their doctors, the newspaper, radio and TV shows, and public health campaigns that they have to lose weight in order to reverse Diabetes and regain their health.
This advice isn’t necessarily wrong, it’s just becoming out of date. Patients with who develop Diabetes do so because they develop a metabolic condition called insulin resistance. Conventional thinking holds that insulin resistance and diabetes are primarily due to becoming overweight. This is only partially true.
It’s The Carbs, Not The Pounds
While patients who become overweight have a greater chance of becoming diabetic and patients who have diabetes tend to be more overweight, their weight isn’t the primary problem. The primary problem is the large amount of carbohydrates they’ve consumed while becoming overweight.
Patients who weight more tend to eat more carbohydrates. It’s the carbohydrates and not the weight gain per say that is the driving force behind the development of diabetes. Conversely, those with diabetes who reduce their weight, see an improvement in their diabetes because they have reduced a disproportionate amount of carbohydrates from their diet. Not simply because they now weight less.
If carbohydrates are the true driving force behind the development diabetes, then one would expect to see an improvement in diabetes in patients who reduce their carbohydrates but don’t significantly lose weight. Well, that is exactly what researchers found.
There are several studies (here as well as this nice review as well as this one) that have examined this and all find generally the same thing. A reduction in carbohydrate intake alone leads to significant improvement in blood sugar control, improvement in triglycerides and cholesterol and the requirement of fewer medications.
This study demonstrated that after 6 months on a low carbohydrate diet, 95% of participants reduced or eliminated their diabetes medications.
An added bonus is that patients who also reduce their carbohydrate intake will begin eating less and loss weight without even trying; it occurs spontaneously.
Cutting Carbs Is Easier Than Losing Weight
Understanding that the carbohydrates are the main driving force in the development of diabetes changes the focus from the patient’s perspective.
Instead of thinking, “I have to lose weight although I feel hungry all the time” to “I need to simply reduce my carbohydrate intake and if I’m still hungry just eat more meat, beans and dairy products”.
In my experience working with patients, it is much easier for them to switch to eating less carbs and more protein and fat than to try to simply eat less of everything. The other benefit is that most patients spontaneously reduce their calorie intake and lose weight without even trying. Although patients will tend to eat more fat as they do this, their cholesterol levels surprisingly tend to improve overall.
Don’t Forget About Exercise
You can also increase your exercise to 30-60 minutes of mild to moderate cardiovascular or resistance exercise per day. I counsel patients to not exercise with an intensity in excess of a brisk walk.
The exercise intensity and extent of your exercise is not meant to “burn off” the fat. This low level of exercise actually changes your cellular metabolism and results in a reduction of your insulin resistance. It’s the metabolic changes, not the energy burning effect of exercise that reduces your abdominal fat.
A recent study demonstrated that resistance vs cardiovascular exercise have the same impact on reversing the insulin resistance in older patients with diabetes.
What Should My Goal Be For Carbohydrate Reduction?
Reducing your daily intake of carbohydrates (sugars and starches) to 100-125 grams/day will lead to a consistent and steady reduction in your blood sugar, cholesterol and triglycerides as well as your blood pressure.
The average American female and male consume 250-300 and 300-350 grams per day respectively. The human body was not designed to handle this amount of carbohydrate and the result of this excess is the development of insulin resistance and diabetes.
As I’ve noted in my other writing, try to eliminate most of your carbohydrate from the least psychologically important meals of the day. For many of us, it’s breakfast and lunch. Focus instead on eating high protein/low-carb or carb-free meals at these times and saving your carbohydrate allowance for your most psychologically/socially important meal, dinner. Dinner is often the meal that involves eating with friends or family and has a great deal of emotion connected with eating and food.
By saving your carbohydrate allowance for this meal, the reduction in carbohydrates won’t seem so intrusive and difficult. You’ll still be able to enjoy some of your carbohydrate comfort foods and not feel as if cutting back on carbs is such a sacrifice. There is no metabolic importance to eating carbohydrates at dinner, its only a psychological trick that I have found has helped me as well as many of my patients.