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Mark Hyman, MD

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Are Diabetes And Insulin Resistance Really Reversible?

Posted: 08/08/09 09:08 AM ET

Diabetes is not reversible and controlling your blood sugar with drugs or insulin will protect you from organ damage and death.

That is what the medical profession would have you believe, but medication and insulin can actually increase your risk getting a heart attack or dying.

The diabetes epidemic is accelerating along with the obesity epidemic, and what you are not hearing about is another way to treat it.

Type 2 diabetes, or what was once called adult onset diabetes, is increasing worldwide and now affects nearly 100 million people -- and over 20 million Americans.

We are seeing increasing rates of Type 2 diabetes, especially in children, which has increased over 1,000 percent in the last decade and was unknown before this generation. One in three children born today will have diabetes in their lifetime.

Yet this is an entirely preventable lifestyle disease.

In a report in The New England Journal of Medicine, Walter Willett, MD, PhD, and his colleagues from the Harvard School of Public Health demonstrated that 91 percent of all Type 2 diabetes cases could be prevented through improvements lifestyle and diet.

Today, I want to review in detail this new way of thinking about diabetes and outline the tests I recommend to identify problems with blood sugar. Then next week I want to tell you exactly how to prevent, treat, and reverse Type 2 diabetes.

The Road to Diabetes Starts Early

Diabetes is often undiagnosed until its later stages. Insulin resistance, when the body becomes resistant to the effects of insulin, is primarily what causes diabetes.

When your diet is full of empty calories, an abundance of quickly absorbed sugars and carbohydrates (bread, pasta, rice, potatoes, etc.), the body slowly becomes resistant to the effects of insulin and needs more to do the same job of keeping your blood sugar even.

High insulin levels are the first sign of a problem. The high insulin leads to an appetite that is out of control, and increasing weight gain around the belly.

High levels of insulin are warning signs -- they precede Type 2 diabetes by decades.

Insulin resistance and the metabolic syndrome associated with it is often accompanied by increasing central obesity, fatigue after meals, sugar cravings, high triglycerides, low HDL, high blood pressure, problems with blood clotting, as well as increased inflammation.

These clues can often be picked up decades before anyone ever gets diabetes -- and may help you prevent diabetes entirely.

If you have a family history of obesity (especially around the belly), diabetes, early heart disease, or even dementia you are even more prone to this problem.

Most people know about the common complications of diabetes such as heart attacks, strokes, amputations, blindness, kidney failure, and nerve damage. Some may even know that it increases your risk of dementia and cancers and can cause impotence.

But most people don't realize that insulin resistance or pre-diabetes can be just as bad causing heart attacks, strokes, dementia, cancer, and impotence -- decades before you get diabetes.

In fact many people with pre-diabetes never get diabetes, but they are at severe risk just the same.

Living in Harmony with Our Genes

We were highly adapted to a nutrient-dense, low-sugar, high-fiber diet rich in omega-3 fats. But when we eat out of harmony with our genes, we turn on genes that promote diabetes.

Take Arizona's Pima Indians, for example.

They were thin and fit 100 years ago, living on a diet of over 70 percent carbohydrates. They ate high-fiber, unprocessed plant foods and they had no diabetes or obesity.

Now, in just one generation, they are nearly all obese and 80 percent have diabetes by the time they are 30 years old!

That's because they are eating food that turns on all the wrong gene messages -- foods like sugar, trans fats, white flour, and processed foods.

Diabetes is Reversible: Diagnose Problems as Early as Possible

Diabetes and pre-diabetes ARE reversible.

New science shows that it's possible, through an aggressive approach of lifestyle, nutritional support, and occasionally medications.

It is important to diagnose Type 2 diabetes early, but it is often not diagnosed until very late.

In fact, all doctors should aggressively diagnose pre-diabetes decades before diabetes occurs, and before any damage is done to your body. Damage begins with even slight changes in insulin and blood sugar.

Unfortunately, there is a continuum of risk from slightly abnormal insulin and blood sugar to full blown diabetes. This should be addressed as early as possible on the continuum.

In a recent study, anyone with a fasting blood sugar of over 87 was at increased risk of diabetes. The lowest risk group had a blood sugar less than 81.

Most doctors are not concerned until the blood sugar is over 110 -- or worse, over 126, which is diabetes. Therefore, I recommend early testing with anyone who has a family history of Type 2 diabetes, central abdominal weight gain or abnormal cholesterol.

Don't wait until your sugar is high.

Testing for Insulin Resistance and Diabetes

The tests I recommend include the following:

1. Insulin Glucose Challenge Test - This should be done with a 2-hour glucose challenge, 75 grams measuring fasting, 1- and 2-hour blood sugar AND insulin. Your blood sugar should be less than 80 fasting and never rise above 110 or 120 after one to two hours. Your insulin should be less than 5 fasting and should never rise above 30 after one to two hours. I recommend this test for everyone over 50, and for anyone with any risk of insulin resistance, even children.

2. Hemoglobin A1C Test - This is an important measure of glycated hemoglobin, which can be an early indicator of sugar problems. It measures sugars and proteins combining into glycated proteins called AGEs (advanced glycation end products), like the crust on bread, or the crispy top on creme brule. These create inflammation and oxidative stress throughout the body, and promote heart disease and dementia and accelerating aging. The hemoglobin A1C should ideally be less than 5.5. Anything over 6 is considered diabetes.

3. Lipid Profiles - These are also important. An HDL or good cholesterol level under 60 and triglycerides over 100 should make you suspicious of insulin resistance. An HDL under 40 and a triglyceride level over 150 usually means diabetes.

4. NMR Lipid Profile - This test is slightly different from the one above as it identifies the size of your cholesterol particles. With insulin resistance or Type 2 diabetes, you develop small LDL and HDL cholesterol particles. They are much more dangerous than larger particles and lead to increased risk of atherosclerosis or heart disease.

5. High Sensitivity C-Reactive Protein Test - This is a measure of inflammation, one of the classic conditions that is both the cause and result of insulin resistance and diabetes. It should be less than 1, and is often associated with diabetes. In fact, anyone with a high C-reactive protein has a 1,700 percent increased risk of getting diabetes.

6. Homocysteine Test - Homocysteine levels are often abnormal in people with diabetes. The test is a measure of folic acid deficiency. It should be between 6 and 8.

7. Fibrinogen Test - This measures your risk of clotting, which can cause heart attacks and strokes. It is also a sign of inflammation and is associated with insulin resistance and diabetes. It should be less than 300.

8. Check Ferritin Levels - These are often elevated in people with diabetes. It is a nonspecific marker of inflammation associated with the disease. It also can mean an overload of iron in the body. It should be less than 150.

9. Uric Acid Test - Your level should be less than 6. Higher levels indicate problems with insulin resistance. This can lead to gout, which is related to insulin resistance and Type 2 diabetes.

10. Liver Function Tests - Elevated liver function can result from insulin resistance. This is the major cause of fatty liver and elevated liver function in this country. This is entirely due to sugar and carbohydrates in our diet that cause fatty liver, liver damage, and even cirrhosis.

These are tests any doctor can perform and are covered by insurance.

That's all for today.

In next week's blog, I will tell you how to prevent, treat, and even reverse diabetes. I have seen this hundreds of times in my patients and there is no reason you can't achieve the same thing if you apply these principles.

Till then, remember what Michael Pollan said: "Eat food. Not too much. Mostly plants."

Now I'd like to hear from you ...

Have you been diagnosed with pre-diabetes or diabetes?

Have you been told that it is irreversible?

What steps have you taken to prevent diabetes?

Please let me know your thoughts by leaving a comment below.

To your good health,

Mark Hyman, M.D.

Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.

 
 
 

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Diabetes is not reversible and controlling your blood sugar with drugs or insulin will protect you from organ damage and death. That is what the medical profession would have you believe, but medicat...
Diabetes is not reversible and controlling your blood sugar with drugs or insulin will protect you from organ damage and death. That is what the medical profession would have you believe, but medicat...
 
 
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08:38 AM on 08/21/2009
I agree with most of what you are saying. But it is my understanding that the Pima Indians have been chosen in key studies because of their higher propensity to suffer from diabetes. Although there are no medications indicated to treat insulin resistance, the ADA does recommend the biguanide class (metformin) as an option. The number one way to prevent insulin resistance and ward off Metabolic Syndrome is to reduce the % of visceral fat. There is now plenty of evidence proving that visceral fat is in fact an active metabolic organ. Check out BIopharm's web page. They have free BMI, BMR and H20 intake calculators as well as free interval training routines as well as diets specific to those fighting insulin resistance or who want to learn more about metabolic disorders. WWW.VIMULTI.COM. There are also PDF files from studies published in JAMA on possible treatments for reducing visceral fat.
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Fred Hahn
Author, trainer.
08:46 PM on 08/18/2009
I agree with you doc and highly recommend that people who have diabetes, type II specifically, adopt a low carbohydrate diet. While eating plants is fine, eating mostly plants is not in accordance with our genetic heritage. Research reveals that eating mostly meats, fish, eggs and poultry along with some plants and fruits is a far better and healthier approach.
09:19 PM on 08/13/2009
I was born into a family that was Republican thru and thru. Never was there a mention of being liberal ,conservative or socialist. We were all Americans regarless of our beliefs. I am now 53 years old and have changed my affiliation to Independent and am sure that many more American citizens will change to Independent as well.
We are all getting to the point where we cant stand the two party system any longer. The people we have representing us have treated us like we are stupid long enough. Unfortunately stupid is the only way to describe it. Our country was founded on the belief of what is morally right. We need to always remember who we are and what we were meant to be. Its not what either party is concerned with and its a shame .
11:09 AM on 08/12/2009
For starters, may I recommend reading these the excellent books by Michael Pollan. After that, allow your mind, rather than your waistline to further expand by reading: The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler.

I'm currently reading the latter book, and after being shocked into realization of the crap we're offered at grocery stores for our American diet, I've doubled up my following of Pollen's advice to "Eat food. Not too much. Mostly plants." I think I now have a fighting chance for health and survival.
09:47 PM on 08/11/2009
There needs to be put in law what a Doctor charges you for service. Its not fair at all that a Doctor charge you what he likes to, talking about people getting rich its the doctors. Also same goes for car mechnic charge you for service, This kind of thing is out of control. Maybe I can charge 100.00 a hour to cut Grass, See what i'm talking about, I have told a doctor you care more about the money than the patient health care. So the money comes first and your health care come second. My wifes car broke down and she called the dr office to let them know that she could not come for the appt, the receptionists told her well ride your bike to the appt. The temp outside was in the 100's and too hot as she has heart problems, this was uncalled for as far as I am concerned. This doctor was more interested in money than my wifes welfare PERIOD.
04:18 AM on 08/11/2009
Doctor, at least put some parameters about taking a glucose tolerance test. If one is hypoglycemic, which logically could lead to insulin intolerance if you are not eating right, it can be a horrible test. I took one when I was 15 and hypoglycemia was considered "over diagnosed". My mother is a lab tech so thankfully I took it at home. (my mom took my blood every hour after giving me the nasty sugary stuff to drink). About 3-4 hours into it, I passed out . My mom sorta woke me up to do my blood, and later on when she got the results she said my glucose was so low I could have been in a diabetic coma. I don't remember the numbers, just remember how horrible the whole test made me feel and never wanted to, and never will, repeat the test.
If you fall asleep about 2 hours after eating a high carb meal, whether that is candy bars or pasta, you need to avoid carbohydrates. If you are like me but get past the test without passing out, you are already less sensitive to insulin.
if you are that sensitive to insulin (like many native people may be) than you should never, ever be eating the sweet stuff, or bread or pasta or anything that ranks high on glycemic indexes. If you do take the test and feel rotten, have some OJ handy and then fill yourself with lots of protein to fix it.
04:10 PM on 08/10/2009
To answer your question, I have never been diagnosed with prediabetes, but my family does have a history of diabetes with weight around the waist. In addition, in 2002 I was diagnosed with fatty liver and in creased liver enzymes. Subsequently I lost 60 pounds, removed sugar soda, diet soda, donuts from my diet, now my liver enzymes are normal, and I just had another liver ultrasound (in order to make it possible to get personal medical insurance if I ever need it) and I no longer have a fatty liver, so I'd have to agree that you can probably turn this stuff around.
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Mikeatle
Intelligent, Proudly Liberal Progressive!
12:55 PM on 08/10/2009
Here's what I learned a few years ago from an article in Parade magazine. I've done research online separately to corroborate the information.

Eat a diet that is mostly fruit, vegetables, beans, nuts and seeds, whole grains, and some cold water fish.

Along those lines, I've read that peanuts and peanut butter (I buy peanut butter that is made of peanuts and sea salt, with no additional ingredients) are an excellent food for keeping diabetes at bay.
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wendy82551
Rockin' the cranky.
11:21 AM on 08/10/2009
Part of the problem--which I would like to see you address--is that the information FROM doctors (and their understanding of the problem) varies WILDLY. I was diagnosed with a bg of 250. That was 20 years ago, and yet I JUST heard of someone with a 250 reading who was told by his doctor, "Don't worry about it. You probably just ate something sugary." Doctors are not educated about the impact of insulin resistance--that not only is it e
xacerbated by obesity, but it also CAUSES obesity, makes it infinitely more difficult to lose weight.
Prior to gastric bypass surgery, I was taking four shots of insulin a day and two pills and getting fatter by the minute. I was able to get rid of all that as a result of the surgery--I walked out of the hospital and was able to get rid of the needles. Unfortunately, I didn't go to my diabetes specialist until a few years later, when I just couldn't lose any more weight no matter how hard I tried. Thank God for the Joslin Clinic, where I learned what to do to manage my diabetes and my weight after surgery. I'm on the fast track now.

There's LOTS of information about diabetes that is not filtering down to the average PCP; the proposed electronic medical records and the resultant survey of best practices should go a long way in helping that.
03:25 PM on 08/10/2009
I gradually gained weight as my metabolism tanked and struggled for years. When i was diagnosed with type II, I went back and read my various random blood sugar tests from the 5 years BEFORE i was diagnosed, and bless my HMO Clinic physicians hearts, not one looked at past results and everyone concluded it was post lunch spike or whatever. I did not have 1 normal test in 5 years. At 325 lbs I was morbidly obese and an insulin dependent diabetic.

I took my health in my own hands and researched gastric bypass surgery then rumored to have a 90% type II "cure" rate.

Since gastric bypass surgery in Jan 2000 (BTW: Duodenal switch procedure-that's an important detail, btw), my weight has been a stable 185 and my HBa1c test results have never exceeded 5.6 in 10! years.

I understand the rhetoric of "cure" versus remission and aI m sure if I were sufficiently obese the symptoms would recur, But if having an excellent avg. blood sugar reading for the last 10 years us not a "cure", what would be?

Now I keep my own records and look up the normal reference range for EVERY test and ask about any results that are not within it. I counted six PCP physicians who missed the onset of diabetes plain to see there on paper and in person in my body shape and weight.
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OldTart
Let it begin with me...
09:12 AM on 08/10/2009
Frankly, taking responsibility for your own health is the only way I can see to counteract this. Diabetes runs in my family (mother and brother) and I have been diagnosed as pre-diabetic. I have been a vegetarian for years and grow most of my own food organically, so that can't be used against me. But my health care provider is herself obese and disinterested and, as is abundantly clear, health care is not aimed at prevention but at treating disease, and then often only the symptoms and not causes.

I am very discouraged over this subject because I have put on belly fat when I never had anything but flat abs, I carry weight that was never a problem in my life, and I am very physically active.

Until the medical profession is trained in prevention as a routine part of their education, I don't think we will see a reversal of a phenomenon that is so clearly the product of our American lifestyle, although I don't understand how that affects me as I am so out of the mainstream.
08:36 AM on 08/10/2009
I was diagnosed with insulin resistance about 2 years ago and am going strong. I come from a family history of diabetes and obesity, I just fall into the obese category with a BMI of 30. I eat healthily, predominantly vegetables, basmati rice, protein and high fibre bread. I am still fat. I am still insulin resistant. I could still get diabetes.

As much as Id like to believe your cure, I dont. By saying that insulin resistance and diabetes are reversible you are planting responsibility on the patient and claiming a cure that, Im sorry to say, is not original. May I ask if you suffer from insulin resistance or diabetes?

Seriously, miracle diets for diabetics didn't work in 1797 when Rollo first started the fad, and yet you still think you can reverse a disease that has plagued the human race since 1552 BCE by cutting out soda???

Also, as an aside, may I ask what the life expectancy of the 'fit and healthy' Pima Indians was 100 years ago? If it was greater than the life expectancy of the average American today I will eat my words.

I am disappointed to say that unless you plan on performing a societal overhaul removing all modern technology, then Im sorry sir but you need a better answer. I wish you all the best with your research from this point onwards. Please let me know when you have found an actual cure.
05:03 PM on 08/10/2009
Add some low pace aerobics for 1/2 hr to 1hr each day and lose the rice and bread and you will have the cure you desire. Your blood sugar monitor should show you that rice(of any kind) and bread(of any kind) raise your blood sugar enormously. Get Dr. Richard Bernsteins book.
11:06 PM on 08/09/2009
On June 1, 2003 my weight was 375, and my blood sugar was that + 100. I got scared - I didn't want to wake up in a nursing home without my feet! I threw away the crap I'd been bingeing on for the last 15 years. Removed all the clothing hanging from my antique exercise bike and rode 8 minutes before I stopped, exhausted. My A1C was 12.3, lipid obscenely high, b/p 150/110, protein in my urine, just a trainwreck waiting to happen. My Dr said "If you don't change now, then possibly you will never have a chance at health". I took Avandia for 2 months, Inderal, Lipitor, Zoloft for a year (fat because I was depressed, depressed because I was fat, take your pick). Learned the Glycemic Index, and worked out along with Margaret Richard on PBS' "Body Electric". Three years, 205 pounds, and a tummy tuck later, I am fit, drug-free, feel wonderful and am cured. My FBS was 84 today. My A1c is 4.7. But I am always looking over my shoulder, ever vigilant, for I know what lurks just around the corner should I backslide. People ask what I did, and when I say that I exercise and eat mostly vegetables, fruits, lean protein, low fat dairy, whole grains and heart healthy fats (with an occasional splurge). Their eyes just glaze over. They want the magic pill from the infomercial, the secret trick. If I can do this anyone can.
09:31 AM on 08/10/2009
Good for you Foxy!!!!!!!!!!!

The hardest thing for a human to do is change habits!!!!!

Congrats on the hard work AND for staying vigi!!!!!
04:35 PM on 08/10/2009
I am conviced that heart healthy fats are part of what turned it around for me. Much more omega 3 & and reduction of most transfats.
10:59 PM on 08/09/2009
I'am truly amazed this article is spot on. I have predinsone induced diabetes. If your using steroids especially high doses though the dose doesn't have to be high. You should moniter your blood sugar. There are things that reverse diabetes like chrysanthamum tea, taurine seems to work and greens. From collards to spinach. A balanced diet with plenty of greens at pre-diabetes level may avoid the disease altogether. Fresh baked bread without preservatives is much less chronic on diabetes than shelf bread that last on the counter for several days. Freeze or refrigerate homade bread it won't keep on the counter. If you make lasanga layer some throughly dried spinach in with the cheese layers. T ake the strained spinach juice and put it in the pasta water.
09:00 PM on 08/09/2009
I have just finished my first week eating a low glycemic diet, which means lean meats, vegetables, fruit, whole grains, legumes and no processed foods, the diet that the doctor recommends here. I did this not because I was concerned about diabetes or to lose weight but because I have ADD and I want to find a remedy besides the prescriptions drugs I have been taking.

Even though it has only been one week, I can't believe how amazing I feel. I feel calmer; my head doesn't feel like it's in a fog; I am no longer constantly looking for food to eat; plus I just feel happier. The most amazing thing is...I find myself supermotivated not to eat sugar, desserts, or other refined foods. I just don't want to mess up the great way I feel now. Even though I have dramatically altered the way I have been eating, I can't imagine eating other any other way. It will be interesting to see if this is the case.
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mlaiuppa
Pres. Sarcasm Society. Like we need your approval.
11:12 PM on 08/09/2009
After a month I'm starting to feel better too. Don't have ADD and didn't cut out bread, rice or sugar.

What I did cut out was high fructose corn syrup. I've replaced my regular foods such as ketchup and bologna with products that do not contain HFCS. I've had to buy organic, Kosher or foreign imports. But I'm feeling a bit better now.

And I don't crave sweets, despite the fact some of what I eat does have sugar in it. I've never been a nibbler nor a snacker. But I find it much easier to stop when I'm full and say no when I just don't feel like eating.

Eat food. Not to much. Mostly plants.

And read the ingredients.
06:06 PM on 08/09/2009
I have a theory about the explosion of diabetes: High fructose corn syrup. And infant formula.
I would LOVE to see the numbers of breastfed babies versus formula-fed babies, and which have higher rates of diabetes. But I bet there aren't any.
07:10 PM on 08/09/2009
I can believe that has part in the equation but believe the many toxins we've allowed in our environment factor in, big time, too.

Including & especially to blame are the many & escalating number of vaccinations which play a major role & have been altering our state of health as a whole. They have put our immune systems at risk to the point of wide spread disease in many forms we see playing out now.

As a whole we are a sick nation of guinea pigs & we'd better wake up soon to the fact.