Reverse Diabetes MD presentation for providers

Reverse Diabetes Md Provider Info

April 18, 2019

Reverse Diabetes MD Presentation | Reverse Diabetes MD from Gurpreet Padda on Vimeo.

It’s time to look harder at the root causes of obesity, prediabetes and type 2 diabetes, because of what they mean for future public health. Reversing the obesity, prediabetes and type 2 diabetes epidemic is today’s most important public health challenge. Nearly 70% of the population is insulin resistant, prediabetic or frankly diabetic.

Kraft, J.R.:” Glucose Insulin Tolerance. A routine Clinical Laboratory Tool Enhancing Diabetes Detection”. In O.B. Hunter. Jr. (ed): Radio assay: Clinical Concepts. Skokie, IL. Professional Education Dept. G.D. Searle & Co., 1974. Pp 91-106

Data from the National Health and Nutrition Examination Survey 2009-2016 found that less than 12.2% of the US population was metabolically healthy. On the tighter criteria applied after 2021, that share fell below 7%.

“Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009-2016,” was published online Nov. 28 in the journal Metabolic Syndrome and Related Disorders.

Almost all the patients who come to our clinics are overweight. When we check their blood markers, they have prediabetes and metabolic inflammation. Pre-diabetes is known to come before type 2 diabetes (T2D). Changes in the number and function of immune cells can cause more of these inflammatory cells to move into tissue that is already inflamed. Cytokines (immune signaling proteins) are also turned up. This immune activation begins in the pre-diabetic state.

Studies published in a European journal on preventing heart disease put it this way: “The increased risk of adverse cardiovascular outcomes associated with type 2 diabetes does not begin at the diagnostic cutoff for plasma glucose (or HbA1c) at which the condition is diagnosed. Rather, there appears to be a continuum of increased microvascular and macrovascular risk that extends to levels of glycemia well below these cutoffs.”

Hopper I, Billah B, Skiba M, Krum H. Prevention of diabetes and reduction in major cardiovascular events in studies of subjects with prediabetes: meta-analysis of randomized controlled clinical trials. Eur J Cardiovasc Prev Rehabil. 2011;18:813–823. [PubMed]

A 2015 global survey by Credit Suisse found a substantial level of misinformation among doctors and nutritionists:

92% believed that fat consumption could lead to cardiovascular issues
87% believed that fat consumption could lead to obesity
54% of doctors and 40% of nutritionists thought that eating cholesterol-rich foods raised blood cholesterol
83% of doctors believed butter was worse than margarine
66% of doctors believed vegetable oils are beneficial to health.

Fat; The New Health Paradigm – Credit Suisse 2015

Prescription drugs are now the third most common cause of death worldwide, after heart disease and cancer. That should alarm us. The Academy of Medical Royal Colleges and the BMJ offer a blueprint to reduce the harms of “too much medicine” as part of the Choosing Wisely campaign. They recommend teaching the public to ask their medical professionals whether there are “simpler or safer options” to taking a medication.

Malhotra A, Maughan D, Ansell J, Lehman R, Henderson A, Gray M et al. Choosing Wisely in the UK: The Academy of Medical Royal Colleges’ initiative to reduce the harms of too much medicine BMJ 2015; 350 :h2308.

The root causes of obesity, prediabetes and type 2 diabetes are built into the food environment. Legislative efforts that push people to eat fewer processed foods and drink fewer sugary drinks will help significantly reduce the burden of diet-related disease. Diet-related disease now contributes to more disease and death worldwide than physical inactivity, smoking and alcohol combined.

Newton JN, Briggs AD, Murray CJ, Dicker D, Foreman KJ, Wang H, et al. Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015. doi:10.1016/S0140-6736(15)00195-6.

Processed foods labeled as “low-fat” or “proven to lower cholesterol” should be avoided. The flawed science behind the 1977 Dietary Guidelines pushed people to eat less fat. That opened the door to eating more carbohydrates. This shift away from natural food with animal products and fats led people to eat more processed food rich in carbohydrates, processed grains and industrial seed oils. In the United States between 1961-2011, 90% of the added calorie intake came from carbohydrates and polyunsaturated vegetable oils.

Select Committee on Nutrition and Human Needs. Dietary goals for the United States. First ed. Washington: U.S. Govt. Print. Off., February 1977.

CreditSuisse.Fat: The New Health Paradigm: Research Institute, 2015: 76

Obesity rose after these guidelines. That suggests they may be a root cause of the problem. Nutrition science was first built on human correlational studies, which are often flawed. That science has also been corrupted by commercial influence. The food industry’s undue influence on official guideline bodies and politicians has posed a significant threat to public health. “Nutritional epidemiology is a scandal. It should just go to the waste bin,” claims professor John Ioannidis, professor of medicine, health research and policy, and statistics at Stanford University School of Medicine and School of Humanities and Sciences.

Max Planck also said, “Science progresses one funeral at a time.” Nearly 50 years passed between the first published evidence linking smoking and lung cancer and effective rules to curb tobacco use. Big tobacco companies used a strategy of denial. They planted doubt, muddied the facts and even bought the loyalty of scientists. The recent likeness to big food and big pharma is uncanny.

Brownell KD, Warner KE. The perils of ignoring history: big tobacco played dirty and millions died. How similar is big food? Milbank Q 2009;87: 259–94.

The food industry has a fiduciary duty to make profit for its shareholders. Sadly, the food industry’s downstream cost to public health is bankrupting most Western societies. Sadly, academics, institutions and journals whose first duty is to patients and scientific integrity have at times colluded with industry for money. It is not credible to suggest that eating 22 teaspoons of sugar daily falls within recommended guidelines. This is despite the known science: for optimum health, the human diet has no dietary or biological need for sugar.

Malhotra, A. (2013) The dietary advice on added sugar needs emergency surgery. BMJ, 346, f3199.

Evidence from multiple randomized controlled trials shows that a higher-fat, lower-carbohydrate diet beats a low-fat diet for weight loss and for lowering cardiovascular disease risk. The Harvard School of Public Health ran a meta-analysis of 53 randomized controlled trials with 68,128 participants. It concluded that “when compared with dietary interventions of similar intensity, evidence from randomized controlled trials does not support low-fat diets over other dietary interventions for long-term weight loss. In weight loss trials, higher-fat weight loss interventions led to significantly greater weight loss than low-fat interventions.”

Sackner-Bernstein J, Kanter D, Kaul S. Dietary Intervention for Overweight and Obese Adults: Comparison of Low-Carbohydrate and Low-Fat Diets. A Meta-Analysis. PLoS One 2015;10(10):e0139817 DOI: 10.1371/journal.pone.0139817.

Bazzano LA, Hu T, Reynolds K, et al. Effects of Low-Carbohydrate and Low-Fat Diets: A Randomized Trial Effects of Low-Carbohydrate and Low-Fat Diets. Ann. Intern. Med. 2014;161(5):309-18 DOI: 10.7326/M14-0180.

Harcombe Z, Baker JS, Cooper SM, et al. Evidence from randomized controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis. Open Heart 2015;2(1) DOI: 10.1136/openhrt-2014-000196.

The Women’s Health Initiative is one of the largest randomized controlled diet trials ever done. It used 48,835 post-menopausal women, with a mean follow-up of 8.1 years. They were randomized to either a standard western diet or a low-fat, calorie-reduced diet with more exercise. The authors had expected the low-fat, calorie-reduced diet with more exercise to reduce cardiovascular disease. The intervention lowered total fat intake by 8.2% of energy and saturated fat intake by 2.9% of energy. But it did not reduce the risk of CHD (coronary heart disease) or stroke. Lowering dietary fat and total daily calories (361 calories/day reduction) failed to produce any significant weight loss over the study. So the study rejected the idea that the low-fat diet helps either cardiovascular disease or weight loss.

Howard BV, Van Horn L, Hsia J, et al. Low-fat dietary pattern and risk of cardiovascular disease: The Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA 2006;295(6):655-66 doi: 10.1001/jama.295.6.655.

By contrast, eating fat makes you feel full. Compared with protein and carbohydrates, fat has the least impact on blood glucose and insulin output. Making too much insulin, and the insulin resistance that follows, is the forerunner of type 2 diabetes. A meta-analysis of the evidence available before the 1977 US change in dietary guidelines did not support limiting dietary fat. There was no scientific consensus. Even so, these guidelines advised limiting total fat to 30% of calorie intake and saturated fat to 10% of calorie intake. That created the low-fat craze and a national experiment in diet-induced metabolic dysfunction.

Thirty years later, in 2014, a meta-analysis of 76 studies covered over 600,000 participants from 18 countries. It concluded that “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”

Chowdhury R, Warnakula S, Kunutsor S, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann. Intern. Med. 2014;160(6):398-406 doi: 10.7326/M13-1788.

A study published in the BMJ (British Medical Journal) found that “Saturated fat intake was not associated with all- cause mortality, CVD mortality, total CHD, ischemic stroke, or type 2 diabetes.”

de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all-cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ 2015;351 doi: 10.1136/bmj.h3978.

Also, The American Journal of Clinical Nutrition found that “diets with cheese and meat as primary sources of saturated fatty acids cause higher HDL cholesterol and apo A-1 and, therefore, appear to be less atherogenic than is a low-fat, high- carbohydrate diet.”

Thorning TK, Raziani F, Bendsen NT, Astrup A, Tholstrup T, Raben A. Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. The American journal of clinical nutrition 2015 doi: 10.3945/ajcn.115.109116.

Full-fat dairy may protect against obesity. A 2014 study concluded: “Participants in the highest tertile of whole-fat dairy intakes (milk, cheese, yogurt) had significantly lower odds for being obese. “

Crichton GE, Alkerwi Aa. Whole-fat dairy food intake is inversely associated with obesity prevalence: findings from the Observation of Cardiovascular Risk Factors in Luxembourg study. Nutrition Research 2014;34(11):936-43 doi: 10.1016/j.nutres.2014.07.014.

Cohort studies confirm that plasma saturated fatty acids from dairy sources such as cheese and yogurt are inversely related to the incidence of type 2 diabetes. By contrast, the plasma saturated fat palmitic acid, linked to the consumption of starch, sugar and alcohol, is strongly associated with the development of type 2 diabetes.

Mozaffarian D. Saturated fatty acids and type 2 diabetes: more evidence to re-invent dietary guidelines. Lancet Diabetes Endocrinol 2014;2:770–2

Natural, non-processed, non-refined food (meat, fish, eggs, nuts, seeds, olive, avocados) contains high levels of saturated fat. These natural foods are a portion of the ancestral human diet. People have eaten as much as they want to of these foods without adverse health consequences since paleolithic times, until 1977 when the Dietary guidelines demonized saturated fat of omnipresent natural fat, driving people away from highly nourishing, wholesome and health-promoting foods.

Reducing dietary saturated fats does not reduce cardiovascular events and death. Improvements in cardiovascular outcomes are independent of direct cholesterol lowering. Dietary trials that provide abundant natural fats such as α-linolenic acid, polyphenols and Ω-3 fatty acids found in nuts, olive oil, oily fish and vegetables exert a positive health effect, likely by reducing inflammation, atherosclerosis and thrombosis.

Chakrabarti S, Freedman JE. Review: nutriceuticals as antithrombotic agents. Cardiovasc Ther 2010;28:227–35.

Interestingly, replacing saturated fat with Ω-6 containing vegetable oils (highly processed and refined industrial seed oil) does lower LDL cholesterol but does not actually improve cardiovascular mortality, and may actually increase mortality.

Veerman J Lennert. Dietary fats: a new look at old data challenges established wisdom BMJ 2016; 353 :i1512

Total and LDL cholesterol are a poor marker of cardiovascular health. Cholesterol profile of elevated triglycerides and low HDL is a more predictive marker of cardiac risk and a reliable marker of insulin resistance. In fact, the QRISK calculator, used to estimate the 10-year risk of CVD, does NOT use LDL cholesterol, but uses total cholesterol/HDL ratio instead.

Preventing insulin resistance in young men would prevent 42% of myocardial infarctions, a larger reduction than correcting hypertension (36%), low high-density lipoprotein cholesterol (31%), body mass index (21%) or low-density lipoprotein cholesterol (16%).

Eddy D, Schlessinger L, Kahn R, Peskin B, Schiebinger R. Relationship of insulin resistance and related metabolic variables to coronary artery disease: a mathematical analysis. Diabetes Care. 2009;32(2):361–6.

Refined Carbohydrates:

Prediabetes and Type 2 diabetes are diseases of insulin resistance with initial excessive insulin production, which display the symptom of elevated blood glucose levels as the disease progresses. Treating the root cause of the disease, instead of the symptom, is the key. Eliminate all refined carbohydrates to reverse obesity, prediabetes, and type 2 diabetes.

Refined carbohydrates are known to increase blood glucose levels, increase requirements for medications and result in weight gain. It is disturbing that dietary guidelines prioritize the consumption of starchy carbohydrates for type 2 diabetics, to nearly 55% of their daily macronutrient consumption. Such diets will potentially lead to progressive worsening of disease with all its attendant complications, such as blindness, kidney failure, nerve damage, peripheral vascular disease, heart disease and stroke.

Added sugar has no nutritional value whatsoever. There are no biochemical reactions in the human body that require dietary fructose. No single study exists that demonstrates benefit associated with its consumption.

Credit Suisse – Sugar Consumption at a crossroads

Dietary carbohydrate restriction is the “single most effective intervention for reducing all of the features of the metabolic syndrome” according to Credit Suisse. It should be the first approach in diabetes management. A ketogenic diet is one that gets less than 10 percent of its calories from carbohydrates. It produces the greatest falls in HbA1C and the biggest cuts in medication use. These benefits come independently of weight loss.

Feinman RD, Pogozelski WK, Astrup A, et al. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition 2015;31:1–13.

Sugar+veg oil+grain=obesity→PreDM→T2D

Dietary sugar is strongly associated with higher risk of type 2 diabetes, hypertension and cardiovascular disease. This holds independent of its calories or its effects on body weight.

Lustig RH: Sickeningly sweet: does sugar cause type 2 diabetes? YES. Can J Diab (in press).

Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome. Lustig RH, Mulligan K, Noworolski SM, Tai VW, Wen MJ, Erkin-Cakmak A, Gugliucci A, Schwarz JM. Obesity (Silver Spring). 2016 Feb;24(2):453-60. doi: 10.1002/oby.21371. Epub 2015 Oct 26.

Added sugar intake and cardiovascular diseases mortality among US adults. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. JAMA Intern Med. 2014 Apr;174(4):516-24. doi: 10.1001/jamainternmed.2013.13563.

Vegetable Oil:

Humans have at least 2-3 million years of history. Yet only since 1917 have industrial seed oils been a significant part of the human diet, with a major jump in use in the late 1970s. Linoleic acid (the Ω-6 fat in these vegetable oils) oxidizes very easily. That makes foods rancid, and it also oxidizes in the body. In non-processed whole food (seeds, nuts, fish and eggs), linoleic acid comes packed with vitamins, minerals and antioxidants. Those protect this fragile polyunsaturated fat.

Free Radic Biol Med. 2001 Dec 1;31(11):1388-95. The stomach as a bioreactor: dietary lipid peroxidation in the gastric fluid and the effects of plant derived antioxidants. Kanner J, Lapidot T.

Curr Atheroscler Rep. 2009 Nov;11(6):403-10. Impact of circulating esterified eicosanoids and other oxylipins on endothelial function. Shearer GC, Newman JW.

A meta-analysis of almost 10,000 patients confirmed that high intake of Ω-6 oils (from vegetable oils/margarines) increases the risk of death and heart disease compared to saturated fat plus trans fat. Human research data suggest that we should remove these vegetable oils from our food supply for optimal health.

29.BMJ. 2013 Feb 4;346:e8707. doi: 10.1136/bmj.e8707. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. Ramsden CE1, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR.

Older data was confounded because it lumped in Ω- 3 polyunsaturated fatty acid intake. This misrepresented the health benefits of Ω–6. Other studies, such as the Anti-Coronary Club trial, confirm that Ω–6 PUFA increases death and coronary heart disease compared to animal fat.

Christakis G, Rinzler SH, Archer M et al. Effect of the anti-coronary club program on coronary heart disease. Risk-factor status. JAMA 1966;198:597–604

The LA Veterans trial found that cancer deaths rise with the use of Ω–6 rich vegetable oils.

Pearce ML, Dayton S. Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet 1971;1:464-7.

Animal studies have also found that Ω–6 PUFA promotes the growth of experimentally induced cancers, while Ω–3 holds back their growth. Ω–6 rich vegetable oil ( such as sunflower and corn oil) is linked to a higher risk of death, coronary heart disease and cancer in humans. It is also linked to the growth of cancer in animal models.

Am J Epidemiol. 1998 Feb 15;147(4):342-52. Adipose tissue Ω–3 and Ω–6 fatty acid content and breast cancer in the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer. Simonsen N1, van’t Veer P, Strain JJ, Martin- Moreno JM, Huttunen JK, Navajas JF, Martin BC, Thamm M, Kardinaal AF, Kok FJ, Kohlmeier L.

Cancer Res. 1988 Dec 1;48(23):6642-7. Effect of different levels of Ω–3 and Ω–6 fatty acids on azoxymethane-induced colon carcinogenesis in F344 rats. Reddy BS, Sugie S.

Why eat less, move more fails:

A calorie is a calorie only if it is burned in a bomb calorimeter and the heat given off is measured. Calories from different foods have entirely different metabolic effects on the human body. Equal calorie portions of sugar, alcohol, meat or olive oil act very differently on hormone systems. These include insulin and fullness signals such as cholecystokinin or peptide YY. It does not matter how many calories a portion of food on a plate contains. What matters is how our body responds to taking in and absorbing those calories. It matters how they are metabolized and how full we end up feeling.

The calorie-cutting plans pushed for weight loss today do not work. The standard calorie-cutting approach gives a 1 in 167 chance of reaching a normal weight. That is a greater than 99% failure rate.

Fildes A et al. Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. Am J Public Health. 2015;105: e54–e59

People wrongly assume that eating too many calories is the root cause of obesity. A calorie of food energy has different fates in the body depending on hormone signals. That same calorie may be used to make body heat or stored as body fat. Obesity is a disease of failed energy partitioning (how the body splits energy between burning and storing), not one of total energy intake. The main driver of this partitioning is the hormone insulin. Insulin is specifically a fat storage growth hormone.

Focusing on calories in and calories out builds in a bias against high-fat food. Yet high-fat food may protect against obesity and related diseases. This simple calorie focus leads to a dietary guideline that swaps fat for starch and sugar. That swap promotes insulin resistance.

We hope that shifting focus away from calories will reduce obesity, related diseases and cardiovascular risk. That means stressing a way of eating built on food quality rather than quantity.

Malhotra A, DiNicolantonio JJ, Capewell S. It is time to stop counting calories, and time instead to promote dietary changes that substantially and rapidly reduce cardiovascular morbidity and mortality. Open Heart 2015;2(1) doi: 10.1136/openhrt-2015-000273.

Yo-yo dieting, with fast weight loss and regain from fad diets, harms health. This ‘weight cycling’ adds to hypertension, insulin resistance and dyslipidemia (unhealthy blood fats). The result is a higher risk of death and worse cardiovascular outcomes.

Mann T, Tomiyama AJ, Westling E, et al. Medicare’s search for effective obesity treatments: diets are not the answer. Am Psychol 2007;62:220–33.

LC + exercise ≠ health

In the Action for Health in Diabetes trial, no cardiovascular benefits were found from a low-calorie diet plus more physical activity in type 2 diabetic patients.

(Despite the significant weight loss, even up to the longest follow-up of 13.5 years, no health benefits could be found. )

Wing RR, Bolin P, Brancati FL, et al. Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 2013;369:145–54.

Exercise is not the solution:

The public and media widely accept that eating more calories than we burn causes the obesity epidemic. So they believe the solution is to just exercise more.

Food and drink companies have pushed this exercise message to clear their own name. The very companies selling processed and highly refined foods linked to the obesity epidemic have sponsored major sporting events. This association of ultra-processed food and soft drinks with sport is troubling. Celebrity endorsements send the wrong message, especially to children.

Regular physical activity does have health benefits, but weight loss is not one of them. In fact, our levels of physical activity have changed little in the past three decades, while obesity has risen.

Luke A, Cooper RS. Physical activity does not influence obesity risk: time to clarify the public health message. Int J Epidemiol 2013;42:1831–6.

It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet . A Malhotra, T Noakes, S Phinney Br J Sports Med bjsports- 2015-094911Published Online First: 22 April 2015 doi:10.1136/bjsports-2015- 094911

The time spent not eating is more important than the time spent eating. Snacking will make you fat. The cause is the chronic high insulin from constant feeding.

There have been two major changes in our eating habits since the 1970s, before the obesity epidemic began. The first is the switch to a high-carbohydrate, low-fat diet. It is well documented and has played an important role in causing obesity. But the rise in how often we eat plays an equal if not larger role, and it has been largely ignored. In the 1970s, people ate an average of three times a day: breakfast, lunch and dinner. By 2005, that number had almost doubled. Now we eat breakfast, snack, lunch, snack, dinner and snack. More often than not, each of these contains refined carbohydrates.

Cameron JD. 6 meals per day does not result in greater weight loss. Br J Nutr. 2010 Apr;103(8):1098-101

Popkin BM. Does hunger and satiety drive eating anymore? Am J Clin Nutr 2010;91:1342–7

Eating almost nonstop from the moment we wake to the moment we sleep gives the body a chance to store food energy without a chance to burn it. Eating six times a day does not cause weight loss. It tends to increase how much food we eat overall. Snacks are made for convenience and long shelf life. They are filled with refined carbohydrates and often have Ω–6 vegetable oil added. Heavy processing of food raises its glycemic index. Grazing all day keeps insulin, the fat storage hormone, high all the time.

Eating fewer meals and cutting out snacks are simple ideas. People practiced them widely before the obesity epidemic.

Frequently asked questions

What is the biggest contributor to type 2 diabetes?

The root cause sits in the food environment. Sugar, industrial seed oils and refined grains drive obesity, then prediabetes, then type 2 diabetes. Type 2 diabetes is a disease of insulin resistance. It begins with the body making too much insulin, and high blood sugar shows up later. Eating all day, snacks included, keeps insulin high around the clock.

Can type 2 diabetes go away?

Yes, when you treat the root cause instead of the symptom. Eliminating refined carbohydrates reverses obesity, prediabetes and type 2 diabetes. Cutting dietary carbohydrates should be the first approach in diabetes management. A ketogenic diet gets under 10 percent of calories from carbohydrates. It produces the greatest falls in HbA1c and the biggest drop in medications, independent of weight loss.

What is the worst food for blood sugar?

Refined carbohydrates and added sugar. Refined carbohydrates raise blood sugar, increase the need for medication and cause weight gain. Added sugar has no nutritional value. No reaction in the human body requires dietary fructose. Dietary sugar is tied to higher risk of type 2 diabetes, high blood pressure and heart disease, regardless of its calories or its effect on weight.

Can a healthy person get type 2 diabetes?

Most people who feel healthy are not metabolically healthy. Less than 12.2% of Americans met the bar for metabolic health in NHANES 2009-2016 data. Fewer than 7% meet it on the tighter criteria applied after 2021. Nearly 70% are insulin resistant, prediabetic or diabetic. Heart and blood-vessel risk climbs well before blood sugar reaches the diagnostic cutoff.

Why doesn’t eating less and moving more work for weight loss?

Calories from sugar, alcohol, meat or olive oil act on your hormones differently. Insulin decides whether food energy is burned or stored as fat. Standard calorie cutting gives an obese person a 1 in 167 chance of reaching a normal weight. Exercise has real health benefits, but weight loss is not one of them: you cannot outrun a bad diet.

Additional references for RCTs comparing low carb and low fat for weight loss

Shai I, et al. Weight loss with a low-carbohydrate, mediterranean, or low-fat diet. N Engl J Med 2008;359(3);229–41.
Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and learn Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women. The A to Z Weight Loss Study: A Randomized Trial. JAMA. 2007;297:969–977.
Brehm BJ, et al. A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women. J Clin Endocrinol Metab 2003;88:1617–1623.
Samaha FF, et al. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. N Engl J Med 2003;348:2074–81.
Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. J Pediatr. 2003 Mar;142(3):253–8.
Aude YW, et al. The National Cholesterol Education Program Diet vs a Diet Lower in Carbohydrates and Higher in Protein and Monounsaturated Fat. A Randomized Trial. Arch Intern Med. 2004;164:2141–2146.
Volek JS, et al. Comparison of energy-restricted very low-carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism 2004, 1:13.
Yancy WS Jr, et al. A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia. A Randomized, Controlled Trial. Ann Intern Med. 2004;140:769–777.
Nickols-Richardson SM, et al. Perceived Hunger Is Lower and Weight Loss Is Greater in Overweight Premenopausal Women Consuming a Low-Carbohydrate/High- Protein vs High-Carbohydrate/Low-Fat Diet. J Am Diet Assoc. 2005;105:1433–1437.
Krebs NF, et al. Efficacy and Safety of a High Protein, Low Carbohydrate Diet for Weight Loss in Severely Obese Adolescents. J Pediatr 2010;157:252-8.
Summer SS, et al. Adiponectin Changes in Relation to the Macronutrient Composition of a Weight-Loss Diet. Obesity (Silver Spring). 2011 Mar 31. [Epub ahead of print]
Daly ME, et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial. Diabet Med. 2006 Jan;23(1):15–20.
Westman EC, et al. The effect of a low-carbohydrate, ketogenic diet versus a low- glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr. Metab (Lond.)2008 Dec 19;5:36.
Halyburton AK, et al. Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance. Am J Clin Nutr 2007;86:580–7.
Dyson PA, et al. A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects. Diabet Med. 2007 Dec;24(12): 1430-5.
Keogh JB, et al. Effects of weight loss from a very-low-carbohydrate diet on endothelial function and markers of cardiovascular disease risk in subjects with abdominal obesity. Am J Clin Nutr 2008;87:567–76.
Volek JS, et al. Carbohydrate Restriction has a More Favorable Impact on the Metabolic Syndrome than a Low Fat Diet. Lipids 2009;44:297–309.
Partsalaki I, et al. Metabolic impact of a ketogenic diet compared to a hypocaloric diet in obese children and adolescents. J Pediatr Endocrinol Metab. 2012;25(7-8):697-704.