AN INTRODUCTION TO DIABETES & PRE-DIABETES
WEB RESOURCES  Dr. Bernstein's Diabetes Solution
  
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If you clicked here you probably have recently been given the news that you have diabetes or may be on the road to getting diabetes. This site will help bring you up to speed about diabetes and what you can do to get it controlled.
Briefly, the on onset of Type One (DM1) is usually sudden when the insulin-secreting (islet) cells of the pancreas are destroyed by an autoimmune attack. Type 1 diabetics can not secrete insulin. The hormone insulin is required to permit glucose to enter cells for energy use. Without insulin around, sugar cannot be taken up by cells so blood sugar levels can rise dangerously high. DM1 typically strikes during childhood or the teen years. DM1 patients are required to take insulin by injection to replace the function of the pancreas. Now let's talk about Type Two Diabetes (DM2). It's much more common. It develops gradually over a period of years or decades. Unlike DM1, the blood levels of insulin in DM2 are very high. Yet, in spite of very high levels of insulin, glucose levels also remain high. This is because the energy consuming cells of the body, such as muscle cells, become insensitive to insulin’s effects. Greater and greater amounts of insulin are required to permit glucose to enter the cells. Insulin resistance gradually becomes more severe as time goes by. Type Two Diabetes was formerly called "Adult Onset Diabetes" because it rarely appeared before age 30. This is no longer the case. The childhood DM2 epidemic exploded during the 1990s. DM2 does occur in normal weight individuals but it occurs more commonly in those who carry excess weight. There usually are no symptoms of early diabetes and pre-diabetes. It is frequently discovered on routine blood work. The classic diabetes symptoms appear when blood glucose levels are very high. Those symptoms are constant thirst, frequent urination, blurred vision, and unintended weight loss. Frequent urination occurs because excess sugar overwhelms the kidneys' ability to prevent its loss into the urine. Water follows the sugar into the urine. Satisfying thirst with sugary drinks fuels the cycle of more sugar and water loss. DM2 causes many long-term complications. They appear when DM2 has been present for several years, and sooner if glucose control was poor, or later in the opposite case. Diabetics are at greatly increased risk for severe heart disease. It's the number one killer of diabetics. Other common complications are kidney failure, nerve damage to hands, feet, and gut, eye damage, including cataracts and blindness. Diabetics are prone to serious foot ulcers and skin infections. There are two causes of the complications that occur in DM2. 1. Very high insulin concentrations cause high blood pressure and damage to larger blood vessels in the heart and elsewhere. 2. High blood glucose concentration damages proteins in tissues by sticking to them. It's a process called glycosylation. It causes damage to the retina, lenses, kidneys and, nerves. DM2 is caused by habitually consuming easily digested sugar (fructose) & refined carbohydrates and starches. The disease usually takes decades to develop, starting in childhood. Early on, the pancreas and liver are able to manage the repeated floods of carbs, but slowly there is a loss of control and glucose levels gradually rise as insulin resistance sets in. There are two standard methods of detecting DM2. One is by measuring blood glucose concentration directly via a blood test or a finger stick. Fasting glucose above 126 mg/dl is diagnostic of DM2. Fasting glucose between 100 and 125 indicates pre-diabetes. Diabetes is also diagnosed when the blood sugar concentration is above 200 regardless if fasting or after a meal. Another test for DM2 is the Hemoglobin A1c (or just A1c). This test measures the percentage of red cells that are sugar coated and provides a general idea of what the average sugar concentration has been like within the previous three months. An A1c value of less than 5.6% is considered acceptable although lower is even better; 5.7 to 6.4% is pre-diabetic; greater than 6.5% is diabetic. Higher A1c levels indicate a greater risk of diabetic complications. Let’s next talk about the hormone insulin because it is the central problem in diabetes and obesity. Insulin prevents a diabetic coma when eating say, Cheerios, a baked potato, or a bagel. However, too much insulin causes problems. Insulin is the fat storage hormone. When insulin is present in the blood, fat cells grow by sucking glucose from the bloodstream. Insulin also shuts off fat burning and tells the body to conserve energy. Once insulin has cleared the bloodstream of energy, the brain is tricked into thinking the body needs more fuel. So we feel hunger and go looking for a snack. It's an endless cycle. In the conditions of overweight, obesity, pre-diabetes and DM2, circulating insulin levels are super-elevated and that causes super-fat storage, constant hunger, frequent eating, and lethargy. I liken insulin to a prison guard for fat, keeping it locked in fat (jail) cells. If insulin is not around, the fat escapes. The problem is, in diabetics and obese people, it's always around. The Diabetic Diet Basics: Most people want to know if their diabetes can be controlled without medications. In many people, the answer to that question is an emphatic yes! If carbohydrate consumption is drastically reduced, and fats and proteins are increased then it is probable that blood sugar will normalize without medications. Click here to check out this research article which proves it. It was written by a friend of mine from residency, Will Yancy, M.D. In sixteen weeks he managed to sharply reduce or eliminate the diabetes medications his patients had previously been taking. Take away the carbs, and we can take away the pills. There is not a cure for diabetes, but it can be put into remission with diet alone. The diabetes will return should you resume eating carbage. Historically, diabetics have been advised to consume 60 grams of carbs per meal with more carbs in snacks. Remember, people with diabetes are carbohydrate intolerant. The adverse impact of eating concentrated carbs is easily demonstrated by wearing a continuous glucose monitor. I cannot recommend consuming that many carbs to anyone especially people with diabetes. In a landmark shift in policy, The American Diabetes Association now seems to agree: "Low-carbohydrate eating patterns, especially very low-carbohydrate (VLC) eating patterns, have been shown to reduce A1C and the need for antihyperglycemic medications. These eating patterns are among the most studied eating patterns for type 2 diabetes." ---2019 ADA Consensus Report on Nutrition BECAUSE SUGAR AND STARCHES ELEVATE BLOOD GLUCOSE , DIABETICS SHOULD EAT A LOT LESS OF THEM…even whole-grains and fruit. Yes, I know everyone says they are healthy! In truth, they spike blood sugar and then insulin levels, which leads to increased fat storage and decreased metabolic rate. Go ahead, Eat More Fat! No joke. Fat does not make you fat, carbs do. Fat does not spike blood glucose and does not stimulate fattening insulin. Fat tastes great and is incredibly satisfying! It keeps hunger away for hours and suppresses cravings. I know what you are thinking. “He wants me to eat more fat? Doesn’t that doctor know that fat causes heart attacks? Everyone knows that!” What if I told you that the largest and most costly diet trials performed over the last 30 years have failed to show any harm from eating fat & cholesterol rich food. It's true. Unfortunately, the official government guidelines still tell us to avoid fat & cholesterol. Why they do is a long sad story. Not all fats are the same. Some are better than others. The best fats are real animal fat from meat (preferably with high omega-3 content), fish, dairy, nuts, and eggs. It is true that plaques in arteries are filled with cholesterol but it is insulin that puts it there, not cholesterol in food. Polyunsaturated vegetable fats cause artery wall inflammation because they convert to sticky toxic aldehydes when heated in frying. Partially hydrogenated vegetable oils and trans fats are even worse. Factory produced processed foods are usually loaded with them. Ditch margarine and Crisco. Fructose is toxic to diabetics: And it can not be recommended to diabetics: Fructose is probably the most toxic macronutrient. Sure, it is the reason fruit tastes sweet. But even in fruit, it promotes weight gain and insulin resistance. Refined sugar is the worst. It causes cavities in the mouth, then moves on to damage the liver. The liver is capable of safely processing about six teaspoons of sugar per day. Fructose in excess of that gets to converted to fat for storage in the liver itself. This is called fatty liver. Fructose overload also ends up as as belly fat, causing increased waist size. Abdominal fat causes insulin resistance and eventually type 2 diabetes. On average, Americans now consume 30-41 teaspoons of sugar daily. That is many times more than the safe amount. It comes mostly from packaged foods and sugary drinks and juices. A typical American breakfast with milk and cereal, yogurt and OJ contains toxic levels of sugar. Sugar is rewarding and addictive. That's why most people are loathed to cut back on sugar. Say No to Grains, Potatoes & Sugars: These are fattening because they all cause insulin secretion. This includes so-called "healthy” whole grains which I like to think of as the “low tar cigarette of nutrition.”: Bad for you, but slightly less so than the regular version. Stay away from “light”, “low fat” or “fat-free” versions of real foods, That stuff should stay in the grocery store. When they take fat out, they put carbs, sugar, and chemicals in. Examples include “fat-free” yogurt, “fat-free” sour cream and anything from Snackwells. Did you know Strawberry Yoplait® contains as much sugar as 8 ounces of coke? Yup. 5 teaspoons, the maximum amount of sugar you should eat all day. Eat real food. Real food does not have a long list of ingredients (usually only one or two) and doesn’t need to be labeled “Natural”. You should know that by looking at it. Beware of the center isles of the supermarket that are loaded with highly engineered food-like substances. Artificial sweeteners? They send the sweet signal to the brain which then tells the pancreas to secrete insulin thus making you store fat, feel hungry and tired. People who use them fail to lose weight; they usually gain. Treatments used in Diabetes: 1. A good low carb high-fat diet (www.dietdoctor.com/diabetes) is better than any medicine. This is super important so I'm going to say it again: The root cause of diabetes is carbohydrates so the treatment should be getting rid of them. You may only need drugs if you eat too much sugar and starches. Make sure you cut them out of your diet before going on diabetes drugs. MEDICINES USED IN DIABETES: None of the diabetes medicines below, including insulin, has been shown to reduce the risk of death or heart attacks; only diet can do that. Medicines lower blood glucose but don't fix the high insulin problem. Cutting the toxic carbohydrate load fixes both issues for free. Diabetes medicines are expensive. Most diabetes meds only hide blood sugar. It's kinda like sweeping dirt under the rug. 2. Metformin (Glucophage®): stops sugar secretion from the liver and increases uptake by the muscles. It’s the first line drug for DM2. Unlike all other diabetes medicines, it slightly lowers the death rate from diabetes. It doesn't make you gain weight. But metformin does not get rid of the sugar. Instead, it simply takes the sugar from the blood and rams it back into the liver. The liver doesn’t want it either, so it ships it out to all the other organs – the kidneys, the nerves, the eyes, the heart. Much of this extra sugar will also just get turned into fat. 3. Thiazolidinediones (Actos®): lowers blood sugar and a1c by increasing insulin sensitivity but it also increases fluid retention and risk of heart failure. I don’t think these drugs are safe.$$ 4. DPP-4 Inhibitors (Januvia®) Stimulates a hormone from your intestines that, in turn, causes the pancreas to secrete more insulin. Neutral effect on weight $$$ 5. Sulfonylureas (Glyburide®, amaryl®, glucotrol®) causes your pancreas to pump out more insulin to lower blood sugar. Side effect: occasional low blood sugar (hypoglycemia), causes weight gain. 6. Insulins: Injection medicines that force sugar out of your blood and into your fat cells. It obviously causes weight gain. $$$ 7. SGLT2 inhibitors induce your kidneys to dump excess blood sugar into the urine. This lowers blood glucose and causes weight loss. Side effects: Ketoacidosis, frequent urination, urine infections, increased risk of amputations (Yikes!).$$$ (Isn't it just a better idea to eat less glucose? Of, course it is.) 8. GLP-1 agonists- (Victoza) injectable medicine that stimulates insulin for better sugar control and reduces appetite and has the side benefit of weight loss. $$$ |
KEY POINTS
80% of Americans have insulin resistance. Diabetes should be called Carbohydrate Intolerance Disease Definition: |
Links:
http://www.dietdoctor.com/diabetes Reverse Diabetes
11 Ways to Start Reversing Type2 Diabetes Right Now- Dr Rangan Chatterjee This is a doctor in England with a TV show on the BBC. His philosophy is very much like mine.
11 Ways to Start Reversing Type2 Diabetes Right Now- Dr Rangan Chatterjee This is a doctor in England with a TV show on the BBC. His philosophy is very much like mine.
