Foreword: If you are prediabetic (A1C between 5.7%-6.4%; fasting blood glucose between 100-125 mg/dL) or have full blown Type 2 diabetes (A1C greater than 6.5%; fasting blood glucose greater than 126 mg/dL) I suggest that you consider the GLVE protocol to reverse this deadly condition which is linked Here.
Want to Reverse Type 2 Diabetes? Ignore the ADA Standards and go Keto!
“Type 2 diabetes (T2D) has long been identified as an incurable chronic disease based on traditional means of treatment. Research now exists that suggests reversal is possible through other means that have only recently been embraced in the guidelines.”
–Dr. Sarah Hallberg et. al. 2019
A little over two months ago I was diagnosed with prediabetes. My fasting blood sugar was 109 mg/dL and my A1C was 5.8%. When I opened the email from my doctor I experienced a tightness in my gut, a sense of impending doom. After all, the complications that accompany diabetes are horrendous: stroke, kidney disease, amputation, blindness, etc.
My doctor made the recommendation that I follow the Mediterranean diet in order to improve my A1C and blood glucose levels. For the readers convenience I have quoted the American Diabetes Association 2019 standard of medical care below (4):
“Based on intervention trials, the eating patterns that may be helpful for those with prediabetes include a Mediterranean eating plan (8–11) and a low-calorie, low-fat eating plan (5). Additional research is needed regarding whether a low-carbohydrate eating plan is beneficial for persons with prediabetes (12). In addition, evidence suggests that the overall quality of food consumed (as measured by the Alternative Healthy Eating Index), with an emphasis on whole grains, legumes, nuts, fruits and vegetables, and minimal refined and processed foods, is also important (13–15).”
The purpose of this presentation is to argue against the American Diabetes Association’s 2019 standard of medical care as an effective way to achieve remission from prediabetes or Type 2 diabetes. I want to emphasize two points about the standard of care quoted above.
First, both the Mediterranean and the low-calorie, low fat diets include between 45%-65% carbohydrates (4, see % recommended carbs) in their meal plans and carbohydrates are the main driver of diabetes.
Secondly, the low carbohydrate option is presented in a way that questions its effectiveness in treating diabetes. There is good reason to be concerned about this bias. The citations did not include a non-randomized investigation where participants were on a well formulated ketogenic diet with carbohydrate loads at, or below, 50 grams per day where participants achieved a 60% reversal of Type 2 diabetes (3).
Over 50% of the adults in the US are prediabetic or already have Type 2 diabetes (1). If you have been diagnosed with prediabetes or full blown Type 2 diabetes you are probably trying to understand what you can do about the situation besides buying insulin and preparing for eventual complications to occur. Furthermore, based on the doctors recommendations, do you blindly go forward eating a diet rich in carbohydrates—the very macronutrient that drives diabetes—or do you try something else?
First, you need to understand that the genetic origin of the disease is not well understood. Gene expression in humans is complicated and dependent on the expression of gene families—that means there is not a single gene that causes the diabetic condition but rather there are many genes (possibly over 60 genes) that work together in response to our metabolic environment—the carbohydrates, proteins, and fats that we eat.
The environment that drives diabetes is also based on our fitness level. Of the millions afflicted with this deadly disease, 80% are overweight or obese and 19% are thin and within their normal BMI (1). In both populations there are underlying genetics that operate in response to the food environment that contribute to the diabetic condition. However, adipose tissue is an endocrine machine that promotes insulin resistance and inflammation and contributes another layer of complexity to this situation (9).
In past presentations I have already spoken about the need to exercise so if you fall in the category of the 80%, and are overweight, you must start to exercise at least 150 minutes per week. Exercise is no less important for the 19%—if you are inactive, you may be as bad off as someone who is super overweight and suffering from the same disorder. Obese individuals will likely see an improvement in their blood glucose levels as soon as they start to shed adipose tissue and both groups will see improvements in their cardiovascular condition which will help with their diabetic condition.
In any case, the main purpose of this presentation is to focus on the other major environmental factor which is what you eat. There are three macronutrients in our diet: carbohydrates, proteins, and fats. The main driver of diabetes is the carbohydrates because of their effect on insulin secretion. Proteins also stimulate insulin secretion but to a lesser degree than carbohydrates. The protein effect is not immediate and takes longer because the protein must first be converted to glucose by the liver. Finally, fats do not stimulate insulin secretion—this is an important fact to remember.
The standard of medical care differentiates carbohydrates into two categories: good carbs and bad carbs. The bad carbs are refined foods that contain sugar: glucose and fructose. In contrast, good carbs (also called quality carbs) are complex and come from whole foods like whole grains, legumes, nuts, fruits and vegetables.
Understand that when complex carbohydrates are broken down by the body the major product is glucose which stimulates insulin secretion. There is an argument that complex carbohydrates do not cause the same insulin response as bad carbohydrates because they are absorbed more slowly by the gut due to the increased fiber. Whether this is true or not, doesn’t matter because the rise in blood glucose is substantial from complex carbohydrates and like it or not, carbohydrates are the driver of diabetes.
Remember that there are different glucotypes in our population which means that we don’t respond to glucose in the same way and in diabetics those differences are probably exacerbated. Moreover, whether you are diabetic or not, your insulin sensitivity is most likely not the same as another individual’s. Therefore, the only way to know what your response is to different carbohydrates is to test your blood after meals using a blood glucose meter—see the GLVE protocol and Keto-Mojo.
After a diabetic diagnosis the first thing you can do is buy a glucose meter (Keto-Mojo) and start testing your blood. You need to test your fasting blood glucose in the morning before you eat or drink and then at one hour and again two hours after meals as a minimum. The fasting blood glucose should be between 65-99 mg/dL if you are normal, 100-120 mg/dL if you are prediabetic, greater than 126 mg/dL if you are a Type 2 diabetic.
After meals the one hour value should be less than 140 mg/dL and the two hour value under 100 mg/dL. Spend a few days taking measurements based on your current diet and record the values in a logbook. The idea here is to begin to understand what your individual patterns of glucose are over the course of twenty-four hours.
Once you know the situation with your blood glucose levels then you can start the diet recommended by your physician which is most likely going to be the Mediterranean or the DASH—both diets include approximately 45-65% carbohydrates (4). The doctor may suggest cutting the carbs down, or not. Try to limit each meal to only one type of carbohydrate so that when you test your blood you can see the effect of that particular carbo-type. I spent two weeks in this mode and could not stabilize my blood glucose levels. The worst offenders were potatoes, whole grains (such as farrow), and black beans—these carbs caused glucose spikes that influenced my values for many hours after digestion and, in addition, elevated my fasting glucose the next day.
I want to emphasize that I reduced the portion of the specific carbohydrate down to a single serving and actually measured out the whole grains or beans. My numbers were not improving under the standard of medical care and did not improve until I eliminated carbohydrates from my diet. I have been on a carbo-restricted Ketogenic diet for the past 52 days (at the time of this writing) and have normalized my blood sugar and reduced my A1C from 5.8% (prediabetic) to 4.8% (normal).
The reader needs to understand that I established a high bar for myself with the goal of normalizing my blood glucose (fasting 65-99 mg/L). I am not willing to accept a simple reduction in the numbers that keep me designated as prediabetic because that will simply delay the onset of the disease along with the eventual complications. This inevitability is confirmed by the literature which shows remission of diabetes is rare under the current standard of medical care (4).
As a counter to my argument some individuals may have an elevated tolerance to blood glucose and may be successful in normalizing their blood sugar maintaining a Mediterranean diet since we all have different glucose responses. This assumes that these individuals eliminated sugary drinks, refined sugar and processed foods and are eating whole food and perhaps restricting their intake of carbohydrates below 45%.
If you are overweight or obese and are eating a calorie restricted Mediterranean diet you will most likely see an improvement in your numbers as you lose weight. This is because you are losing adipose tissue which produces factors that stimulate insulin resistance and therefore, high blood sugar (9). Be aware that once your weight stabilizes your numbers may plateau above normal levels which means that you may never reach a point where you are in reversal of diabetes on a diet that includes elevated carbohydrates. Again, consider going on a diet that restricts carbohydrates and provides for weight loss without calorie restriction—the Ketogenic diet.
The bottom line is that carbohydrates are the driver of diabetes and you can’t expect to reverse diabetes if you don’t restrict them. I recommend using a well-formulated Ketogenic diet (www.virtahealth.com) that restricts carbohydrates: 30-50g carbohydrates and includes moderate protein, and high fat (no insulin response).
To monitor how you are doing on the Keto diet you need to measure blood ketones which can be done at the same time that you measure your blood glucose using the same meter (Keto-Mojo). The blood ketone levels should be between 0.5-3.0 mM in order to be in mild ketosis which is a metabolic condition that favors burning fat instead of carbohydrates. Under this diet my blood glucose values started to normalize within a few days and those values have settled to an average of 90 mg/dL and my A1C shifted from 5.8% to 4.8% over a 52 day period. At this point I am no longer pediabetic.
If I can do it, you can too!
For an action plan see the GLVE protocol Here!