When we reverse type 2 diabetes, hyperinsulinemia, and obesity, we are advocating for less medical intervention and more patient self-care.
Empowering the patient to manage a lifestyle disease with a lifestyle intervention does not result in a medical profit.

There is no financial incentive in the Business of Medicine, Big Pharma, or Big Food for this position.

It is obvious that big pharma and big food will not likely be supporting studies that reduce the utilization of their products over non-compensable lifestyle changes. Evidence-based academic research is also unlikely to be performed by academicians who are funded by these same interests. The entire health delivery industry seems to be geared towards medicalization of treatment rather than lifestyle improvement, which would radically disrupt the status quo. “doctors who got money from drug and device makers—even just a meal—prescribed a higher percentage of brand-name drugs overall than doctors who didn’t” and “the more money doctors receive…the more brand-name drugs they tend to prescribe.” Ornstein C, Jones RG, Tigas M. Now there’s proof: docs who get company cash tend to prescribe more brand-name meds. ProPublica. https://www.propublica.org/article/doctors-who-take-company-cash-tend-to-prescribe-more-brand-name-drugs. Published March 17, 2016. Accessed May 1, 2016.

The effects of pharmaceutical firm enticements on physician prescribing patterns. There’s no such thing as a free lunch. J P Orlowski and L Wateska. Chest 1992;102; 270-273 DOI 10.1378/chest.102.1.270

In the US, 52.3% of the adult population has either type 2 diabetes or prediabetes.

Less than 12.2% of the adult population is metabolically healthy.

Six feedings a day are a recipe for insulin resistance.

Dietary carbs are only necessary if a person is currently taking diabetes medications associated with the risk for hypoglycemia such as insulin or a sulfonylurea, otherwise, there are no essential dietary carbohydrate requirements.

Type 2 Diabetes is triggered by too much insulin, it’s not an insulin deficiency. It’s insulin resistance.

According to a “NEW” study published in Obesity, “lifestyle interventions focused on altering dietary and physical activity habits using behavioral strategies can produce sustained weight loss among African Americans and Hispanics who have type 2 diabetes (T2D)” Which ivory tower have they been living in or is this new information to their sources of funding?

Maybe some of these researchers could come to visit outpatient clinics that have been successfully doing this for 20 plus years.
Pharmaceuticals have only a short-term role in a long-term lifestyle and behavioral issue.
Bariatric surgery is an induced dietary restriction and malabsorption syndrome, patients often overheat the restriction with liquid calories or develop such significant malabsorption that they develop secondary complications .
I treat obesity, exactly the same as I treat addiction.

The only intervention I have ever found to be successful in the long term was providing the patient with behavioral management tools in altering habits (using substitution and harm reduction), and then a re-education of what was truly “healthy” (and that didn’t include starting the day with a bowl of cereal and skim milk.

In a busy clinical practice, a brief direct interaction, providing just in time information that is “doable” is the only thing that I have found useful. The more esoteric the information or the more complicated the protocol, the worse the adherence.

Download our entire protocol for free on the profile page.

Weight Loss Experiences of African American, Hispanic, and Non‐Hispanic White Men and Women with Type 2 Diabetes: The Look AHEAD Trial. Obesity, 2019; 27 (8): 1275

The longer progression to Type 2 Diabetes can be delayed, even if using oral hypoglycemics, the more cost-effective it is. Most physicians wait until someone’s HgBA1C exceeds 6.5, but this is a mistake.

The following is a cost analysis of early intervention with metformin, compared to delaying treatment until insulin supplementation is required due to B-cell fatigue, assuming similar lifestyle management:

The average wholesale cost of generic metformin is less than $0.05/1,000 mg tablet, so a 30-day supply is $6.00 a month.
The average wholesale insulin cost, when a combination of both long-acting and short-acting insulin is prescribed:
Long-acting insulin: Lantus $431/month
Short-acting insulin: Humalog $533/month
Combined cost: $964/month excluding injection supplies.

One could pay for 160 months of metformin therapy for the same cost as 1 month of insulin therapy.

The prevalence of vending machines that stock soda in schools, particularly elementary schools, is concerning for the overall health and well-being of the country. Sodas are made largely with high fructose corn syrup. Fructose activates the dopaminergic reward system more than glucose, and high fructose corn syrup is spiked with extra fructose, far beyond what the labels suggest. Additionally, reinforced behavior, accentuated by the casino-like feel of vending machines, increases consumption in vulnerable populations, such as young children.

The ability of children, not adults, to make these choices, combined with the hedonic reward of dopamine, only increases consumption. Fructose preferentially is stored as fat through first-pass hepatic effects, leading to insulin resistance and potentially diabetes.

Background:

The per capita consumption of high fructose corn syrup — the mainstay of soft drinks and other sweetened beverages — has increased from 38.2 pounds in 1980 to 868 pounds in 1998 (Chou et al., 2004). In 1942, the annual U.S. production of soft drinks was 90 8 oz. servings per person; in 2000, it was 600 servings (Jacobson, 2005). Sodas and other sweetened beverages are readily available in our nation’s schools. Vending machines are placed in almost all of the nation’s middle and high schools (Weicha, Finkelstein, Troped, Fragala, & Peterson, 2006) and are in approximately 40 percent of our elementary schools (Fernandes, 2008). Both school vending machines and fast food restaurant use have been associated with increased intake of sugar-sweetened beverages by youth (Weicha et al, 2006). When vending machines are placed in elementary schools, black children are more likely to purchase a soft drink from these machines (39 percent) compared to white children (23 percent) (Fernandes, 2008). Could it be that these machines are becoming vendors of death?

Obesity doesn’t cause metabolic syndrome; obesity is a marker for metabolic syndrome.

Pain is the leading reason why people come to my practice, and it is the common link between untreated metabolic syndrome and untreated diabetes. I personally evaluate and treat several thousand patients per year for chronic pain, in an urban setting where access to high-intensity healthcare is readily available through several large academic centers as well as government-sponsored outreach clinics. Unfortunately, despite the availability of cutting-edge medical treatment, the overall health of individuals and populations continues to decline each year. Over 90% of the patients have untreated metabolic syndrome and over 60% have undiagnosed pre-diabetes or type 2 diabetes. Pain is the final common symptom for the human body to signal impending tissue damage, and most patients avoid contact with the health delivery system until they develop a symptom that they can no longer ignore. Unfortunately, my clinical practice is not unique; pain is the leading reason for patients seeking medical care and is one of the most disabling, burdensome, and costly conditions in the United States. Overall, pain care/treatment and lost productivity costs the U.S. $635 billion per year. Hyper-inflammation is the common link between metabolic syndrome and chronic pain.

In recent years, more megafarms have begun to use monocropping, which depletes the soil of beneficial microelements in order to maximize production. The role of Big Food in increasing food production depletes micronutrients and adds artificial flavors, increasing the likelihood of someone developing obesity.

By 1967, American corn farms were growing nearly three times as much corn as thirty years earlier. The mono-cropped surplus was shared with livestock to increase production. The average dairy cow now produces more than 70 pounds of milk per day, and the top-performing Holsteins produce 200 pounds per day, a 1,200 percent increase over the 1948 average. Similarly, a typical potato farmer produced about 63 sacks of potatoes for every acre in the 1930s, but by the mid-1960s, it was up to 200 sacks.

Eating is a behavior-driven by an expectation of pleasure; we crave flavors. However, mass production reduces micronutrients, which results in bland food. Maximizing food quantity came at the cost of nutrient density and food began to get blander. The solution to this bland food was adding flavors to stimulate taste. Flavor engineering combines organic chemistry with engineering, neuroscience, psychography, psychophysics, ethnography, demography, molecular biology, finance, botany, economics, and physiology to produce flavors that specifically increase cravings.

Hyperpalatable, highly processed foods are designed by food manufacturers to activate the reward system and increase food consumption. Unfortunately, the brain’s perception of the nutrient value is distorted by synthetic flavors. Subsequently, people end up overconsuming manufactured carbohydrates and manufactured fat in a combination that is likely to result in obesity.

Sugar addiction, especially glucose, leads to obesity because of how it is metabolized. Sucrose (table sugar) is a disaccharide made of 50% fructose and 50% glucose. Sucrose is metabolized primarily in the small intestine, releasing equal parts glucose and fructose. Glucose causes insulin release and is rapidly cleared from the bloodstream by insulin-dependent channels. Fructose is independent of insulin and is rapidly taken up by the liver by a first-pass effect and is preferentially stored as fat.

Further increasing obesity risks, glucose and fructose have different effects on the addiction centers in the brain. Although glucose does not directly activate the brain’s reward center, fructose does produce activation in the brain’s “reward circuit,” and increases the desire for food.

American College of Neuropsychopharmacology. “Fructose and glucose: Brain reward circuits respond differently to two kinds of sugar.” ScienceDaily. ScienceDaily, 10 December 2014. www.sciencedaily.com/releases/2014/12/141210080734.htm

Metabolic syndrome is an early indicator of diabetes even among people of normal weight, and it’s important to take steps to prevent and treat it. During the early phase of metabolic syndrome, the body is compensating for insulin resistance by increasing insulin production to maintain near-normal blood glucose levels. However, when the pancreas and liver overflow with fat from the chronic high insulin levels (the fat-storage hormone), there is a sudden change. Hyperinsulinemia can no longer keep up with the pace of insulin resistance, and the pancreatic beta cells, responsible for insulin production, are also unable to keep up. As this compensatory mechanism fails, the blood glucose rises quickly. It takes only two years or so before the beta cells begin to fail and full-blown type 2 diabetes is diagnosed.

The diagnosis of type 2 diabetes exists on a spectrum. It goes from healthy to metabolic syndrome (with or without obesity) to prediabetes to diabetes. Almost all individuals who are type 2 diabetic for a period of time and treated with insulin become obese due to the fat storage caused by insulin and remain so until they get a secondary complication. However, the metabolic syndrome that precedes the frank diagnosis of diabetes can exist even in normal-weight individuals. The key is preventing metabolic syndrome, whether caused purely by carbohydrate overconsumption or by vegetable oil omega-6 consumption because it will eventually lead to Type 2 Diabetes.

This protocol is relevant for patients who have metabolic syndrome with or without obesity, as they are both risk factors for type 2 diabetes.