To reverse diabetes, weight loss and a low-carbohydrate diet must be combined. These are independent factors for reversing diabetes.
Weight loss can achieve diabetes reversal through decompressing (decongesting) the liver and pancreas, improving blood flow, and reducing adipocyte hormonal responses.
As the worldwide epidemic of obesity continues to worsen, the epidemic of type 2 diabetes follows, and 1 out of every 2 Americans born today is predicted to get type 2 diabetes. Clinically, we observe a progression of obesity to eventual type 2 diabetes through the lens of insulin resistance and metabolic syndrome.
In a recent study at Ohio State University, obese patients with metabolic syndrome ate a low-carbohydrate diet but maintained their weight. A four-week low-carb diet resulted in the reversal of the metabolic syndrome, even though there was no weight loss. Reversal of metabolic syndrome is key to reversing prediabetes and type 2 diabetes.
Parker N. Hyde, et al. Dietary carbohydrate restriction improves metabolic syndrome independent of weight loss. JCI Insight, 2019; 4 (12)
A low-carbohydrate diet can achieve diabetes reversal through reduced insulin requirements (reduced insulin production), a reduction in glycated lipids, proteins, and receptors, reduced lipid storage, and increased lipid mobilization
The clinical relevance of this is that patients can become rapidly insulin sensitive again, well before they have returned to normal weight. Explaining this to patients provides the encouragement they need to continue a long path to ultimate success. The only way we will know a patient’s insulin sensitivity is to actually check the insulin level.
Have you had your insulin level checked?
Weight loss is clearly of primary concern to Americans, but the healthcare industry doesn’t seem to have a good solution. America doesn’t have a healthcare system; we have a sick maintenance cabal.
Between 1989 and 2016, the average American gained 29 pounds and spent more than $1 trillion on weight loss products. In 2016 alone, chronic diseases driven by the risk factors of being overweight or obese accounted for $480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity. The total cost of chronic diseases due to obesity and overweight was $1.72 trillion, equivalent to 9.3 percent of the U.S. gross domestic product (GDP). Obesity as a risk factor is by far the greatest contributor to the burden of chronic diseases in the U.S., accounting for 47.1 percent of the total cost of chronic diseases nationwide.
Obesity has become such a significant independent disease that over the past 20 years, a completely new sub-specialty of obesity medicine has developed. Obesity affects more than one-third of the population, but less than 2 percent of obese individuals in the United States are actively treated, and of those treated, less than 10 percent manage to maintain weight loss.
Despite the fact that widespread obesity is a relatively new disease, associated with multiple reversible lifestyle factors, most of the clinical research funding and physician education has been geared towards medication management rather than lifestyle intervention. Using this standard of care approach, only 1 in 167 patients maintains weight loss.
Recommending dietary changes, as well as not prescribing medications, both erode profit margins for Big Food and Big Pharma. There is no money for them in a healthy population; all the money is in sick care.
Why do we care so much about food and diet and its impact on your health? We own and operate chronic care health-related companies, but also own and operate restaurants. We have been fascinated with the intersection of health, dietary intake, and lifestyle. We view nutrition as a program, or a subroutine, that informs and instructs the body to specific action. A corrupted program leads to a corrupted outcome.
Our clinics evaluate and treat several thousand patients per year for chronic and acute 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 health of individuals and populations continues to decline year over year. Over 90% of our patients have untreated metabolic syndrome, and over 80% have undiagnosed prediabetes or diabetes type 2. The symptom of pain is the final common pathway 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, our 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 US. Overall, pain care/treatment and lost productivity costs $635 billion per year. The commonality in metabolic syndrome and chronic pain is the hyperinflammatory state or metainflammation.
As we have treated this patient population over the last 20-plus years, we have discovered some common threads that trouble us. About 80% of the patients have either obesity, prediabetes or diabetes, with the vast majority remaining undiagnosed. More than half of these patients go on to have significant expensive complications and about 20% eventually require dialysis. By 2026, the Medicare system will be so overwhelmed with the diseases of metainflammation that it will literally run out of money. We must engage individual patients in improved health outcomes in order to change the community. We have fewer than seven years.
We are passionate about returning this patient population to health, and avoiding bariatric surgical procedures, which are costly and carry significant risks of organ injury, death, and long-term disability. We have found that academic institutions avoid this population until extraordinary and expensive complications set in, requiring hospitalization. It is our opinion that there is a fundamental cultural disconnect between the ivory tower of the institutions and the actual communities where these patients reside. This cultural disconnect prevents patient engagement in lifestyle changes. Additionally, the Medicaid system does not reimburse for lifestyle and dietary modification for obesity but does reimburse for bariatric surgery. The overwhelming marketing from processed food manufacturers targets the urban minority communities with disingenuous messaging, suggesting health benefits for obesogenic foods. This combined with supplemental nutrition benefits and game theory promotes the hyper-consumption of farmer-subsidized high fructose corn starch as well as industrial seed oils. It is our opinion that the overconsumption of hyperpalatable, nutritionally deficient food is a major contributor to reduced academic success, reduced employment opportunities, increased incarceration rates, and progression of metabolic dysfunction. It is a root cause of the social and economic disparity.