As a patient, much of the health advice around type 2 diabetes seems absurd to the point it might be funny if so many of us weren’t dying young.
For example, although we suffer from too much blood sugar, they tell us to eat carbohydrates (sugar) – the very thing that causes high blood sugar. Why? To keep our blood sugar high enough so that our medicine doesn’t cause our blood sugar to go too low. As if we should help our medicine, not the other way around.
In case you think high fat diets, etc., are brand new, here’s Tomás O’Crohan, the Blasket Island writer, talking about how seal meat, a traditional food for the area, went out of fashion in the late 1800s.
‘No one knows what is good for them to eat; the people who used to eat those things (seal meat & fat) were twice as healthy as those around now. The poor people out in the country used to say that they believed they’d have a heavenly life if they had the food that the people of Dingle had. But the truth of it is that the people who had ‘good’ food are in the grave long since, and the people of the famine are still alive and kicking.’
PS. Mind you, I’m glad we’re not eating seals anymore.
If you have Amazon’s Prime Video (included with Amazon Prime), Fat Fiction is definitely worth a watch and is an eye-opener as to the real reasons for diabetes and obesity and why the advice has been so wrong for so long.
Today, a year ago, I received my blood results, confirming that I had put my diabetes into remission. Finally, I could start to recover from the fear and shock of the diagnosis.
Here are some things I have learned:
2. Most of the battles are mental. Not eating sugar seemed impossible until I did it. I found a sixteen-hour fast impossible until I did it. Then it seemed totally normal and a 24 hour fast impossible until I did it, and so forth. It also seemed impossible to give up wheat bread until I did. Keeping focused on what I wanted to accomplish (remission) and also why I wanted it (to be there for my daughter and wife) were key for me.
3. Stress is a killer and makes losing weight far more difficult. I learned to meditate, practise gratitude and find other ways to keep stress at bay. When stress crept back in, I found everything harder to do.
4. Contrary to what people say, I don’t feel like exercise helped me lose weight or even keep it off, but there are many health reasons to exercise. It certainly makes me feel much better, both physically and especially mentally. For this reason, I keep it up as part of my lifestyle and suggest it to anyone… I do think, however, that it should be done for the joy of doing it rather than to punish yourself for any perceived lapses.
6. I have stayed with the low carb diet, even though from my studies, it seems like I probably could up the carbs a fair bit. There are two reasons for this – 1. I figure carbs made me sick in the first place, and I don’t want to go back there, and 2. I hardly ever crave them anymore. When I do, it’s the memory of eating experiences rather than the need to eat any given item. When I have eaten whatever it was I craved, it hasn’t given me satisfaction.
7. I believe enough fat is the key to success with low carb. Not only is it filling, but it is luxurious and makes food more enjoyable. I love food, so I had to find ways to enjoy it to keep going. Fat really helps. Spinach tossed in a pan with a pile of Irish butter is better than spinach. Cauliflower whipped with obscene amounts of cream and then baked with a cheddar layer on top is better than plain cauliflower. You get the idea…
8. Sweet things are WAY too sweet for me now. My daughter is an avid baker, and I’ve tasted some of her efforts. Even a small tastes unpleasantly sweet to my adjusted palate. The sweetness of cream or 90% dark chocolate is about right for me now, and I can enjoy them without worry.
10. There are many benefits for being in remission besides the obvious avoiding of the terrible diabetes outcomes. These include feeling happier, more energy, better sleep (no longer snoring or waking up to pee), less anger, exercise is easier (don’t have to carry around excess weight), head is clearer, etc. I feel better all around and want to keep it that way.
I wrote an article in the Irish Times about my experience of remission. In case you can’t access it via the link above, I’ll reprint it here.
‘Hope’ is a beautiful word, with a soft start, an assertive end, and cosy roundness in the middle – round in the middle like middle-aged me. In the ice cream profession, portliness could be considered appropriate and even reassuring. If my paunch betrayed excess consumption of sugar and a fondness for cream, that luxurious, white emulsion permeated with the goodness of our Irish farming heritage, what harm? Did my expanding waist and extra chin (or two) not intimate culinary zeal – the crème de la crème, the cream of the crop, the cat that got the cream? I thought so until I was diagnosed with Type II Diabetes. Then, for the first time, I felt fat. On the scale, I felt ashamed.
Anyone with a dire diagnosis knows that words can change everything. One day last November, I breezed into an examination room for blood test results and a top-up of my hypertension medication. Sun flooded through the skylight, warming the white walls. I was thinking about new flavours and not expecting the word ‘diabetes.’ Weighed and measured like a foreign object, my body began to sag under the accumulation of the ensuing words: ‘obese,’ ‘disease,’ ‘degenerative,’ and ‘medication.’ Finally, I heard, ‘serious, progressive, and incurable, I’m afraid.’ I stumbled home, prescription in hand, feeling emotional and hopeless.
An internet search didn’t cheer me up – Type II diabetes is the leading cause of non-traumatic amputations, with a million legs lost a year, and it is the leading cause of adult-onset blindness. We are more than twice as likely to die of heart, liver, and kidney failure, and we suffer a greater incidence of stroke, cancer, dementia, and Alzheimer’s. COVID-19 is lethal for us, especially if we are obese. We have a life expectancy 13 years less than the general population. The numbers afflicted are astonishing – more than 400 million people worldwide, including 200,000 in Ireland. At least double that number are pre-diabetic. I spent the next day in bed, too depressed to move.
Luckily, I’m not the type to stay down, and since the antidote for angst in Dingle was often found in the camaraderie of O’Flaherty’s pub, I arranged to meet a friend there. Perched on a stool, I gazed mournfully at my pint, trying to accept that water would likely be my lot from now on. I had read that diabetics shouldn’t drink. The talk ranged from politics to Kerry football to local history, and my friend raised a hand to order another round. He is a doctor, and while I don’t like making things awkward by discussing personal medical issues, I had to explain my sudden abstemiousness.
‘I have diabetes,’ I blurted out. The conversation paused, moved on. Later, he leaned in.
‘It can be reversed, you know.’ Just like that, the world looked brighter.
Unfortunately, not everyone has such a friend. The self-fulfilling paradigm that Type II diabetes is incurable informs the usual treatment – drugs, a dose of scare tactics and blame, and outdated, contradictory advice on eating (such as, ‘Carbohydrates raise blood sugar. Include them with every meal.’) Studies such as the ACCORD trial show that lowering blood sugar with drugs doesn’t help outcomes, and contradictory advice doesn’t help either. As frightened patients do as they are told and deteriorate, as they are blamed every step along the way, their clinicians don’t seem to question the failure of the treatments. Instead, with circular logic, it reinforces the paradigm.
The next morning, I searched ‘diabetes reversal.’ It didn’t take long to find testimonials of people who had achieved remission. According to the incurable paradigm, reversing diabetes is impossible. Yet patients are doing it by rapidly losing weight, and trials, including DIRECT (sponsored by Diabetes UK), show a success rate of 50% is possible. The ramifications of this are staggering – 100,000 people could be saved in Ireland, just for starters, as could almost a quarter of a billion worldwide. Half a million legs could remain attached to their owners.
We could gain 2.6 billion years of human life while also saving a fortune in drug and other health-related costs.
I kept studying – lectures by Dr Sarah Hallberg, the excellent Diabetes Code by Dr Jason Fung, work by Dr David Unwin, Dr Malcolm Kendrick, Dr Roy Taylor, Dr Michael Mosely, and Tom Jelinek, PhD. I learned about the futility of the ‘eat less, exercise more’ mantra. I learned how carbohydrates convert to sugar and how excess fructose is dangerous since only the liver metabolises it. I learned how hormones drive behaviour and how insulin and cortisol (the stress hormone) impact body fat. I learned about insulin resistance – the real cause of both obesity and diabetes. Too much sugar causes too much insulin, which eventually causes insulin resistance.
I learned three methods seem to work best for losing weight quickly – a low carbohydrate diet, a severely restricted-calorie diet, and intermittent fasting. I decided to combine two of them – low carb and fasting, as suggested by Dr Jason Fung. The fat melted away so quickly that I don’t know why health professionals don’t offer this as the first course of treatment. In just three months, I lost 21kg and brought my blood sugar into the normal range. I even lost a chin (or two). Since then, the weight has stayed off, my hypertension resolved, and my subsequent blood tests have been excellent.
Now and then, I still feel emotional. I miss ice cream, for I have taken a break from making it. I miss pastries, cake, rice, bread, pasta, and many other foods I loved. On the other hand, my culinary zeal remains, and I’ve become more mindful about eating. With dark chocolate, raspberries, butter and lobster on my list of low carbohydrate foods, I don’t feel too sorry for myself. I probably shouldn’t admit this, but I continue to enjoy a pint with my friend when I can, to keep the angst in check. Best of all, I learned that cream has an undeserved reputation for being unhealthy. I still consume it liberally. Each luxurious taste reminds me that there is always hope.
I love food, and I love eating. I am a food professional, and cooking earned me a living. Well brought up, I never turned down the offer of food. Loving a challenge, I never surrendered when faced with a prodigious plate. I never refused chocolates, pastries, and other sweet treats when they tempted in a cafe or supermarket. Over time, I grew large, and then I became diabetic. The shock of the latter still resonates in my life, though I have reversed the disease. I did it with the advice of Dr. Jason Fung. If you are in a similar situation, I suggest two of his books, The Diabetes Code and The Guide to Fasting. Thanks in large part to him, I am thin again, and my blood glucose is healthy.
There were two parts to Dr. Fung’s advice. The first was to stop putting sugar in my body, which meant a low carb diet, for starches convert to sugar. That meant bidding farewell to a very long list that included cakes, cookies, candy, pizza, potatoes, corn, rice, pasta, sugar, wheat, honey, and most fruit. The second part was to get the sugar out of my body, and that required fasting. Although the idea of giving up many of my favourite foods depressed me, it was the second part that worried me. I had never fasted, and the thought of doing without food, the love of my life (don’t tell my wife), scared me silly. Fasting seemed alien and impossible. Could I do it?
Even a cursory study shows fasting is an ancient practice, and it is a part of most religions. If it were harmful, surely we would have heard by now.
I am writing these words on Friday. This particular Friday is the Friday before Yom Kippur. Yom Kippur is the day of atonement, the holiest day of the year for the Jewish faith. Observant Jews spend the day fasting and in prayer, repenting and atoning, and their 24 hour fast, from sundown to sundown, is strict – no food or water. As a child growing up in New York, my fasting friends amazed me with their fortitude. Half Irish/half German people like myself had no such fasting tradition, and we weren’t able for it, or so I thought.
In Hebrew, Friday is יוׄם שִׁשִּׁי which means ‘the sixth day,’ or the last day before the Sabbath. The English word ‘Friday’ comes from ‘Frigga’ or ‘Freya’ – the Germanic/Norse goddess of married love. Christians traditionally fasted on Friday, a practice still observed by some (my wife’s devout mother fasted from Thursday evening to Saturday morning each week – a 36 hour fast). Fasting on Friday is also half-remembered by other Christians who eat only fish.
King Henry VIII, known for his appetites and his girth, brought in the Reformation so he could divorce. A secondary benefit for the king was the ability to eat anything (and as much as he wanted) on Fridays, for Martin Luther wasn’t keen on fasting:
‘…with this fasting we serve the pope and the papists— and the fishermen.’
Martin Luther, Candlemas Sermon on Luke 2:33-40
An Irish (and German) Tradition
Here in Ireland, ‘Friday’ is ‘Dé hAoine,’ pronounced ‘day heena.’ Growing up in New York, I didn’t know that ‘Dé hAoine’ means ‘the fast.’ That’s not all. ‘Dé Céadaoin’ (Wednesday) means ‘the day of the first fast’ and ‘Déardaoin’ (Thursday) means ‘the day between the fasts.’ As far as I know, Ireland has the only days of the week that reference fasting. So much for Irish people having no fasting tradition. I find the two days of fasting per week interesting, especially now that Dr. Michael Mosely’s 5:2 diet has become popular.
Germans were more severe – they had a tradition of fasting for 40 days before Christmas that eventually shrank and became Advent. ‘Martinstag’ or ‘St. Martin’s Day,’ in honour of St. Martin of Tours, preceded the Christmas fast. The saint was a Roman soldier who cut his cloak to share with a beggar in a snowstorm. He may have also liked goose, for Germans stuffed themselves with that fowl before the privations began. In case you are wondering, the fast at Christmas was in addition to the 40 days fasting during Lent. So much for the German people having no fasting tradition!
Wisdom in a Widely Practiced Tradition
Across the world, fasting is more usual than unusual. Observant Coptic Christians fast for 200 days of the year. Muslims fast during Ramadan for daylight hours, and fasting is one of the five pillars of the faith. Buddhist monks abstain from food before daybreak and after lunch, which makes them an early adopter of intermittent fasting. Hinduism has regular fasting periods for various festivals and lunar phases.
I found fasting difficult to start and eased into it, simply not eating between supper and a late breakfast. Knowing that more than a billion Muslims can manage Ramadan, that Jews get through Yom Kippur each year, that some Christians still fast for up to 200 days of the year, and that Buddhists manage intermittent fasting just fine made my little struggles seem insignificant. I was also well aware that most of the struggle was mental. After I managed a fourteen hour fast, a fourteen hour fast soon didn’t seem so difficult. The same was true when I stretched it to sixteen.
Eventually, emboldened, I fasted for a full day (supper to supper the next day). 24 hours is a magic number, for it takes 24 hours for insulin to drain completely from the body, and insulin is the hormone responsible for fat. With insulin low, the body can use the sugar stored in the cells, and it starts burning fat. Sure enough, my excess weight melted away, and my next blood test confirmed my diabetes was in full remission.
Since I started fasting, I feel more clear headed, and I sleep better. I have saved quite a bit of time and money from all the meals I didn’t eat. My cravings no longer dictate my behaviour. In fact, it’s a relief to feel that now I can choose when to eat and when to skip a meal or two. It’s liberating. Best of all, fasting has reawakened my senses. Smells are more powerful, and food tastes so much better that sometimes I stop and marvel. As a foodie, I’ll say ‘Amen’ to that.
Everyone can perform magic, everyone can reach his goals, if he is able to think, if he is able to wait, if he is able to fast.”
― Hermann Hesse, Siddhartha
Disclaimers: 1. I am a patient, not a doctor or medical professional, and I do not write medical advice. 2. Anyone with health issues, and all those on medication, should consult their doctors before embarking on a fasting regime. 3. Eating disorders are serious illnesses that require medical supervision, and I didn’t write this for those suffering the same. 4. Many people are going hungry around the world, especially at the moment, and there is nothing acceptable societally about involuntary fasting. I’m writing about voluntary fasting.
2.7 billion years of human life could be saved for 211 million people by reversing Type II diabetes. Why are we slow to act on a proven solution?
I am nothing special. Or I am very special. Depending. Like you, perhaps. I’m an ordinary person. I’m a father, son, husband, brother, and lover of family. I’m an impatient patient. I’m a businessman, which means I’m practically minded and a questioner of things, or so I like to think. I’m a man with Type II diabetes or a man without diabetes, depending. I say this because most people believe Type II diabetes is a life sentence – an incurable, progressive disease with inevitable, grim outcomes. This defeatist paradigm informs the usual treatments – an ever-increasing amount of drugs, half-hearted, often contradictory attempts to modify what patients eat, and a dose of scare tactics and blame. Studies show the drugs don’t work, and the half-hearted changes to diet don’t help much either. As demoralised patients progress to grim outcomes, the failure of their treatments isn’t questioned. Instead, with circular logic, the failure reinforces the paradigm.
Is Type II diabetes a life sentence? Incurable? If so, why are an increasing number of patients reversing the disease? According to the paradigm, that is impossible. Yet trials, including DIRECT (sponsored by Diabetes UK), show a remission rate of up to 50%. The ramifications of this are staggering, for an estimated 422 million people worldwide suffer diabetes. The financial cost is $825 billion per annum. The human cost is higher. It is the leading cause of non-traumatic amputations, with a million legs lost a year, and the leading cause of adult-onset blindness. Diabetics have a 50% greater chance of depression. Men suffer more erectile dysfunction. Diabetics develop cancer, stroke, dementia, and Alzheimer’s in higher numbers. We are twice as likely to die of heart, liver, and kidney failure, and are more likely to die from COVID-19. We are more likely to die of all causes, with a life expectancy 13 years less than the general population. That’s 5.486 billion years of lost life and a world of heartache for loved ones.
I was diagnosed eight months ago and heard the usual, ‘Diabetes is a life sentence (but don’t lose heart, it’s not a death sentence – with a bit of luck you can push off the worst parts for a good few years).’ I was given the usual prescription and contradictory advice. I was informed that carbohydrates raised blood sugar, then I was told I should eat them at every meal. I was warned about sucrose (white sugar) but encouraged to enjoy desserts (in moderation). I was admonished to switch from white bread to brown bread, even though carbohydrates are similar in both and brown bread often is made with sugar or molasses. I was instructed to eat less and get off the couch, even though I was already exercising daily. I was told to lose weight (but not too fast) as if I hadn’t tried. I was warned about strokes, heart attacks, and ulcers and urged to inspect my feet every night for wounds that could lead to amputation. I was given an appointment for retinal screening to check whether I was going blind. I asked a few questions, but not many. I felt too dispirited and pinch-faced with worry to do so.
When I came home, I sulked for two weeks. I am, however, an impatient patient, and questions I didn’t ask began to bother me to the point that I stopped sulking and started researching. I soon discovered online a chorus of joyful individuals who had put their diabetes into remission. How did they avoid the life sentence? Simple. By rapidly losing weight, especially fat around the abdomen. ‘Ha, ha,’ you might laugh. ‘Losing weight simple? Have you tried? Everyone knows how hard it is.’ What if it was simple, though? What if our failed attempts were due not to our shortcomings but incorrect advice? Dr Jason Fung starts his book The Obesity Code as follows:
‘The art of medicine is quite peculiar. Once in a while, medical treatments become established that don’t really work. Through sheer inertia, these treatments get handed down from one generation of doctors to the next despite their lack of effectiveness. Consider the medicinal use of leeches (bleeding) or routine tonsillectomy. Unfortunately, the treatment of obesity is also one such example.’
Jason Fung, MD, The Obesity Code, Greystone Books, 2016
The treatment of Type II diabetes is another example.
Dr Fung also wrote The Diabetes Code, and both books are among the most carefully argued and thoroughly researched I have ever read. For diabetics, he suggests a high fat, low carbohydrate diet combined with intermittent fasting to reverse the disease. It worked for me. I lost 21kg of weight and brought my blood sugar into the normal range in three months. Most surprisingly, I didn’t find it especially difficult. Of course, I missed the sugar, especially in the first weeks as my body adjusted. Of course, I missed the pasta, bread, rice, and all the other delicious foods with which I used to stuff myself. However, I’m practically minded, so I set about finding, preparing, and enjoying foods I could eat. When I wobbled, I thought of the thirteen additional years of life I’d have to love my family if I persisted. I would have a higher chance of walking with them with both my legs and seeing them with eyes that could still see. I’d have a better chance of avoiding dementia, and I wouldn’t wish that on anyone.
There weren’t many wobbles, though, especially once the fat started melting away. Again, I didn’t find it especially difficult. The numbers back that up. As stated earlier, studies show that significant changes to diet (very low calorie, low carb, fasting, or a combination of the three) put up to an astonishing 50% of diabetics into remission. That means they maintain healthy blood sugar without the need for medication, just as they did before their diagnosis. ‘Wow!’ you might say. ‘50% of 422 million is a potential of 211 million people whose health could be transformed for the better. It’s a potential savings of up to 2.743 billion years of human life and $413 billion in medical costs. Surely that has galvanised the entire health community? Surely they are rapidly rolling out an entirely new way of treating diabetes?’ Well…no. Why? Vested interests, perhaps. Or inertia, as Dr Fung says. Habits become entrenched, and paradigms can prove resistant to evidence, leading to denial.
Jason Fung points to another possible reason – that we view obesity (and, by extension, diabetes) as a defect of character. Since it’s a moral failing, perhaps we don’t deserve better outcomes. That makes sense to me, for I was the first to blame myself for getting fat and for my diagnosis, and I have heard the disparagement and judgement in the language surrounding Type II diabetes. It’s a ‘lifestyle disease’ for ‘ignorant’ people who make ‘bad’ choices. You’re ‘lacking in willpower.’ You ‘let yourself go.’ You can’t ‘resist’ sweets or alcohol or both. You must be eating the ‘wrong’ things and not doing the ‘right’ things. You’re ‘unwilling’ or ‘too stubborn’ to exercise more or eat less. You ‘don’t try’ hard enough. You ‘give up.’ Such talk shifts the blame for poor outcomes from the dietary advice and medical care to the patients. After all, the treatments and dietary advice might work if we weren’t so lazy/stupid/weak/unmotivated/gluttonous/dissolute.
Of course, such language creates a problem in understanding lazy/stupid/weak/unmotivated/gluttonous/dissolute people like me who do improve their lot – who manage to lose weight and reverse diabetes. The answer, for those who don’t fit a paradigm, is usually that we must be exceptional. Special. That keeps the model intact. When I told friends and relatives how my blood test came back normal, several complimented my ‘exceptional willpower.’ Others said the same when they saw how much weight I lost. I shrugged, annoyed. Doesn’t calling me ‘exceptional’ by definition exclude and demoralise the many who might wish to try to reverse their disease? I don’t think I have exceptional willpower. Otherwise, wouldn’t I have lost weight earlier and avoided diabetes completely? I’m an ordinary person. I’m both lazy and industrious. I’m weak and strong, depending. I’ve been thin and fat and thin again. I developed and reversed diabetes. I didn’t become a better person to achieve remission. I didn’t solve any character defects to do so.
I succeeded simply because I found good advice and explanations that made sense. I learned from Dr. Sarah Hallberg, Dr. David Unwin, Dr. Malcolm Kendrick, Dr. Roy Taylor, Dr. Michael Mosely, and Tom Jelinek, Ph.D. I learned about the futility of the ‘eat less, exercise more’ mantra. I learned about how counting calories makes little sense – 100 calories of spinach equals 100 calories of candy. Really? I learned that too much protein is problematic. I learned that dietary fat is healthy and necessary. I learned about ketosis. I learned about the harm of snacking since it keeps insulin high and doesn’t give the body a chance to recover. I learned about how carbohydrates convert to sugar and how excess fructose is especially dangerous since only the liver metabolises it. I learned how hormones drive behaviour and how insulin and cortisol (the stress hormone) impact body fat and blood sugar. I learned about insulin resistance – the real cause of both obesity and diabetes. Insulin resistance is caused by too much insulin, which itself is caused by too much sugar.
Once I knew all of this, and once I knew what to do (put less sugar in the body through diet and get sugar out through intermittent fasting), the solution was simple. Not easy, but not especially difficult. I went from sulking to feeling lucky – lucky that my diagnosis came when it did. If I had been diagnosed five years earlier, I’d probably still be dispirited and pinch-faced with worry, on medication that doesn’t help, following half-hearted, contradictory diet advice, and wondering which leg I’d lose first. Instead, books and online sources with clear guidelines on how to reverse Type II diabetes appeared just before I needed them and offered an alternative to the life sentence. The pioneering patients who came before me, the chorus of joyful individuals in remission, gave me hope. My love of family gave me the motivation I needed. Now, I’m lucky I can add my voice to the others who succeeded. I hope our clamour soon becomes so loud that every diabetic in the world hears it.
I also hope more government officials and health professionals begin to drive the changes needed. Health professionals see first hand the ravages that Type II diabetes brings. Surely, as scientists, more will question the paradigm as evidence continues to mount. For those who are open-minded, I ask, ‘Why wouldn’t you test it for yourself and see if you can help a patient or two?’ Instead of inspecting deteriorating bodies of patients pinch-faced with worry, wouldn’t it be satisfying to help people like me lose 21kg in less than three months and help them achieve remission? Instead of writing prescriptions that don’t help, wouldn’t it be more fun to save 2.43 billion years of life and ease a world of heartache? Picture your patients and millions of other patients around the world, surrounded by loving families, joyful after normalised blood tests. Imagine them shrugging, modestly, and saying, ‘Every one’s doing it. I am nothing special.’