2.
Burn remaining sugar off.
A low-carbohydrate, healthy-fat diet reduces the incoming glucose load but does little to burn it off.
Exercise may help, but the impact of compensation also limits its effectiveness.
Further, exercise only benefits the skeletal muscles and not the fatty liver that is the cornerstone of this disease.
Intermittent fasting, though, can help simultaneously with both facets of diabetes reversal.
Quite simply, it is the most powerful natural therapy available for type 2 diabetes.
But can’t you simply reduce your daily calorie intake to get the same effect?
It sounds good, but the simple answer is no.
Continuous mild calorie restriction is not at all the same as intermittent, severe restriction.
Let me explain.
INTERMITTENT FASTING VERSUS CONTINUOUS CALORIC REDUCTION
DEATH VALLEY, CALIFORNIA, has an average temperature of 77 degrees Fahrenheit (25°C). Sounds perfect, doesn’t it? Yet most residents would hardly call the temperature idyllic. Summer days are scorching hot and winter nights are uncomfortably cold.
Consider that jumping off a foot-high wall a thousand times is far different than jumping off a thousand-foot-high wall once.
The difference between the two is literally the difference between life and death.
Would you prefer to experience seven gray, drizzling days with an inch of rain each, or six sunny, gorgeous days followed by a day of heavy thundershowers with 7 inches of rain?
The point, as Figure 15.1 shows, is that averages don’t tell the whole story.
Figure 15.1.
Averages don’t tell the whole story
In all these examples, it’s obvious that averages represent only one facet of the story.
The frequency of the event is of paramount importance.
So why would we assume that reducing 300 calories per day over seven days is the same as reducing 2100 calories over a single day?
Constant caloric restriction is not the same as intermittent fasting.
Each scenario provokes profoundly different hormonal responses in our body.
The difference between the two is literally the difference between success and failure.
The portion-control strategy of constant caloric reduction is the most
common dietary approach recommended to treat both weight loss and type 2 diabetes.
For example, the American Diabetes Association’s main dietary recommendation is “focus on diet, physical activity, and behavioral strategies to achieve a 500, 750 kcal/day energy deficit.”2 It further advises patients to spread this reduction consistently throughout the day rather than all at once, and dieticians following this approach often counsel patients to eat four, five, or six times a day.
In support of this reduction strategy, calorie labels are everywhere, on restaurant meals, packaged foods, and beverages.
And if that’s not enough, there are charts, apps, and hundreds of books to help us count calories.
Even with all these aids, successful weight loss using this approach is as rare as humility in a grizzly bear.
After all, who hasn’t tried the portion-control strategy?
Does it work?
Just about never.
Data from the United Kingdom indicate that conventional advice succeeds in only 1 in 210 obese men and 1 in 124 obese women.3 That is a failure rate of 99.5 percent, and that number is even worse for morbid obesity.
So whatever else you may believe, portion control does not work.
This is an empirically proven fact.
Worse, it has also been proven in the bitter tears of a million believers.
But why doesn’t it work?
Because restricting calories causes a compensatory increase in hunger and a decrease in the body’s metabolic rate.
This effect derails weight-loss efforts and ultimately ends in failure.
Intermittent fasting succeeds because it produces beneficial hormonal changes that chronic caloric deprivation does not.
Most importantly, it reduces insulin and insulin resistance.
Remember the boy who cried wolf?
Not crying wolf for a while will make the villagers listen.
Crying wolf constantly but a little softer does not work.
Resistance depends not only upon high insulin levels but also upon the persistence of those elevated levels.
Intermittent fasting prevents the development of insulin resistance by creating extended periods of low insulin that maintain the body’s sensitivity to insulin.
This is the key to reversing prediabetes and type 2 diabetes.
Studies have directly compared daily caloric restriction with intermittent fasting, while keeping the weekly calorie intake similar.4 Subjects ate a Mediterranean-style diet that included 30 percent fat, but some restricted a portion of their calories every day whereas others severely restricted their calories only two days a week and ate the full
diet the rest of the time.
That is, the groups differed only in how often they ate, but not in how many total weekly calories they consumed or the types of food they ate.
Over six months, the two groups showed no difference in the amount of weight and body fat loss between them, but an important difference between their insulin and insulin sensitivity levels.
Remember, in the longer term insulin levels are the key driver of insulin resistance and obesity.
Those on a daily calorie-restricted diet saw their insulin levels drop but quickly reach a plateau.
The intermittent fasting group, on the other hand, continued to reduce their fasting insulin levels, a key marker of improved insulin resistance, despite similar total caloric intake.
Since type 2 diabetes is a disease of hyperinsulinemia and insulin resistance, the intermittent fasting strategy succeeded where caloric restriction did not.
It was the intermittency of the diet that made it effective.
A recent thirty-two-week trial compared the portion-control strategy directly with intermittent fasting in obese adults.6 The caloric reduction strategy was designed to subtract 400 calories per day from the estimated energy requirements of participants.
The fasting group ate normally on eating days, but ate zero calories every other day.
Figure 15.2. The impact of fasting on insulin resistance5
The most important conclusion was that fasting was a safe and
effective therapy that anybody could reasonably follow.
The fasting group not only lost more weight, but also almost twice as much of the more dangerous visceral fat.
The portion-control group lost lean mass in addition to fat, but the fasting group did not.
Lean mass percentage increased by 2.2 percent with fasting compared to only 0.5 percent with portion control.
In other words, fasting is four times better at preserving lean mass. (So much for that old “fasting burns the muscle” myth.) So why isn’t fasting more popular, despite its proven success?
One of the biggest deterrents is the starvation myth.