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.’