If I had a flood in my house . . . I would not spend day after day, week after week, & year after year buying buckets, mops and towels. I would not be inventing different types of buckets and more expensive mops or drainage systems to ensure the water drained away quickly. I would find the source of the water and turn it off! DR. VERNER WHEELOCK
IN 2015, NEWSPAPERS reported that a three-year-old Texan girl had become the world’s youngest person to develop type 2 diabetes.1 Yes, three years old.
At birth, she weighed 3.2 kg (7 pounds).
At three-and-a-half years old, she weighed 35 kg (77 pounds) and presented to the hospital with the classic symptoms of diabetes: frequent urination and thirst.
Given her age, medical staff naturally assumed she had type 1 diabetes, the so-called early onset or juvenile diabetes.
However, her obesity suggested type 2 diabetes, and further testing confirmed it.
There was no family history of diabetes.
Instead the problem was her diet, which consisted mostly of candy, sugary drinks, and fast food.
The toddler was initially placed on medications.
But with the proper diet, she lost 25 percent of her original weight and was able to stop taking all her medications as her blood glucose levels returned to normal.
Two years later, this little girl’s diabetes was cured.
Here’s another heart-warming story.
My friend Betsy (not her real name) was a twenty-seven-year-old medical researcher in a local academic hospital.
At her yearly checkup, she was overweight but otherwise felt well.
She was shocked to learn that screening blood tests
revealed a hemoglobin A1C of 10.4, which meant she had severe type 2 diabetes.
Alarmed, her physician immediately prescribed three different medications in line with the Canadian Diabetes Association guidelines.
Betsy was further warned that she would likely need medications for the rest of her life and, eventually, insulin.
She heard that type 2 diabetes is chronic and progressive, a disease without hope of a cure.
Horrified, Betsy rejected this dire prediction and took none of the medications.
She did some research, started a very low-carbohydrate diet called a ketogenic diet, and immediately noticed a difference.
Her weight dropped.
Her waist size shrank.
Three months later, her A1C level was only 5.5 percent without any medications at all.
She looked and felt great.
By definition, she no longer had type 2 diabetes.
Again, Betsy’s diabetes was cured.
So much for a chronic and progressive disease!
In both cases, dietary changes addressed the root cause and reversed the diabetes.
That’s no surprise.
All diabetes associations throughout the world recommend starting treatment with diet and lifestyle changes before prescribing medication.
But what’s the best diet to follow for type 2 diabetes?
Unfortunately, that’s a more difficult question.
THE FAILURE OF THE LOW-FAT DIET
THE WORLD HEALTH Organization released its first Global Report on Diabetes in 2016 but it only provides vague, general dietary guidelines for treatment.2 It says that added sugars should be reduced to less than 10 percent of total calories but mentions nothing about optimal macronutrient composition.
There is no guidance to follow a low- or high- carbohydrate, low- or high-fat, low- or high-protein diet.
Similarly, the American Diabetes Association 2016 standards of care document, Diabetes Care,3 declined to recommend any particular diet.
Both of these organizations have quietly backed away from the ineffective low-fat, calorie-restriction dietary advice they had promoted for forty years, tacitly acknowledging its futility.
Fatty but delicious foods such as butter, full-fat cheese, and cream were said to “clog arteries” and cause heart disease, so the Dietary Guidelines for Americans in 1977 recommended that people eat 50 to 60 percent of their total daily calories as carbohydrates, in order to lower dietary fat.
Even as recently as 2008, the American Diabetes Association
position paper recommended a minimum daily carbohydrate intake of 130 grams.4 In North America, these carbohydrates tend to be highly refined wheat and corn products such as sugar, bread, and pasta.
In 1999, at the height of the low-fat mania, the landmark Lyon Diet Heart Study sent shockwaves through the medical community.5 Patients who had suffered heart attacks were randomly assigned to the American Heart Association’s low-fat diet or the high-fat Mediterranean diet, which was full of olive oil, nuts, and avocados.
The results were almost unbelievable.
The Mediterranean diet reduced heart disease and death by a jaw-dropping 75 percent.
It should hardly have come as a surprise, as it confirmed what used to be called the French paradox.
In the 1980s and 1990s, people in France were eating saturated fat like it was going out of style, yet their death rate from cardiovascular disease was less than half what it was in the U.S.
If saturated fat clogged arteries and led inexorably to heart disease, then how could the French possibly eat more fat and have less heart disease?
The answer, in hindsight, is pretty obvious.
Eating saturated fat does not lead to cardiovascular disease.6 The cardiovascular benefits of the relatively high-fat Mediterranean diet have since been replicated many times.
Most recently, the 2013 PREDIMED study confirmed that patients on the Mediterranean diet reduced their rate of heart disease and death.7 Further comparison of different dietary habits in the countries of Europe in 2012 shows that higher saturated fat intake is associated with less heart disease.8 A 2009 meta-analysis9 demonstrated that saturated fat had no correlation to heart disease and offers slight protection against stroke.
In Japan, this protection against stroke has also been noted.10 Slowly but steadily, the realization that diets high in natural fats are intrinsically healthy is gaining ground.
Figure 14.1. Higher dietary fat = lower risk of stroke and heart attack11
WHY TO EAT HEALTHY FAT
THE NUTRITIONAL LANDSCAPE began to change in the mid-2000s, as foods high in monounsaturated fats began to be recommended for heart health.
Avocados, once regarded as dangerous due to their high fat content, are now highly valued as a healthy superfood.
Similarly, eating more nuts is routinely linked to better health outcomes.
Daily nut consumption is associated with a 35 percent decreased risk of heart attack.12 Fatty cold-water fish, which are rich in omega-3 oil, are also considered extremely protective against heart disease.
Northern communities where native people have eaten a traditional diet full of whale and seal blubber as well as fatty fish have had virtually no cardiovascular disease or type 2 diabetes.13 The town of Upernavik, Greenland, for example, reported only a single case of type 2 diabetes between 1950 and 1974; in comparison, about 13 percent of Americans currently suffer from this disease.
High blood levels of trans-palmitoleic acid from full-fat dairy are associated with a 60 percent reduction in the incidence of type 2 diabetes.
It also improves HDL triglyceride levels and lowers markers of inflammation, such as high-sensitivity C-reactive protein.14 Egg yolks, once reviled as being high in cholesterol, have been vindicated.
Studies now conclude that eating eggs, even daily, does not raise the risk of heart disease.15 In fact, consuming lots of eggs reduces the risk of diabetes by 42 percent.16
Why is fat useful in preventing and treating type 2 diabetes? Remember that of the three macronutrients, dietary fat stimulates insulin the least. Pure fats, such as butter and olive oil, stimulate almost no insulin release. Therefore, replacing refined carbohydrates with natural fats is a simple, natural method of reducing insulin.17
WHY TO REDUCE REFINED CARBOHYDRATES
IN 2001, in a critical review of dietary fat and cardiovascular disease, Dr. Walter Willett of Harvard’s School of Public Health noted that, “It is now increasingly recognized that the low-fat campaign has been based on little scientific evidence and may have caused unintended health consequences.”18 Furthermore, as shown by Figure 14.2 from the Nurses’ Health Study, a very large, long-term observational study from Harvard University, he found a clear correlation between high glycemic load in the diet and the risk of heart disease.19 Sugar and refined carbohydrates have a high glycemic load, which raises blood glucose and the risk of type 2 diabetes. This, in turn, significantly increases the risk of heart disease.
Figure 14.2. Higher glycemic load = higher risk of heart disease20
A comprehensive 2013 review concluded that certain diets provide superior glycemic control.21 Specifically, four were found beneficial: the low-carbohydrate diet, low glycemic-index diet, Mediterranean diet, and high-protein diet. All four diets share a common trait: they reduce dietary carbohydrates to varying degrees. Low-carbohydrate diets have proven more effective at reducing body weight, waist size, and blood glucose.22
Figure 14.3. U.S. Macronutrient Consumption 1965, 201123
Data from the National Health and Nutrition Examination Survey (NHANES) show that between 1965 and 2000, as the twin epidemics of obesity and type 2 diabetes unfolded, Americans primarily ate more carbohydrates and less dietary fat as a percentage of diet, just as the dietary guidelines recommended.24