End Organ Damage – T2D 17

posted in: Diabetes, Health and Nutrition | 82

Hyperglycemia may be the hallmark of diabetes, but does not cause most of the morbidity. Blood glucose is fairly easily controlled by medication, but this does not prevent the long-term complications. Despite blood glucose control, damage occurs to virtually every organ system. It would be difficult to find a single organ system NOT affected by diabetes. These complications are generally classified as either microvascular (small blood vessels) or macrovascular (large blood vessels).

Certain organs, such as the eyes, kidneys and nerves are predominantly perfused by small blood vessels. Chronic damage to these small blood vessels causes failure of these organs. Damage to larger blood vessels results in narrowing called atherosclerotic plaque. When this plaque ruptures, it triggers an inflammatory reaction and blood clots that cause heart attacks and strokes. When blood flow is impaired to the legs, it may cause gangrene due to reduced circulation.

There are other complications do not fall neatly into this simple categorization. A variety of diabetic complications are not obviously caused by injured blood vessels. These would include skin conditions, fatty liver disease, infections, polycystic ovarian syndromes, Alzheimer’s disease and cancer.

Microvascular Complications


Diabetes is the leading cause of new cases of blindness in the United States, according to the Center for Disease Control in 2011.retinopathy-condition

Eye disease, characteristically retinal damage (retinopathy) is one of the most frequent complications of diabetes. The retina is the light-sensitive nerve layer at the back of the eye that sends its ‘picture’ to the brain. Long standing diabetes weakens the small blood vessels in the back of the eye. Blood and other fluids leak out causing visual disturbances. This damage can be visualized with a standard ophthalmoscope during routine physical examinations. Bleeding into the retina appears as ‘dots’ and is therefore called ‘dot hemorrhages’. Lipid deposition at the margins of the bleeding is seen as ‘hard exudates’. The retina is the only place where this damage to the blood vessels can be directly visualized.

Over time, new blood vessels begin to form in the retina, but these are fragile and tend to break. This proliferation of new blood vessels leads to more bleeding inside the eye (vitreous hemorrhage) and/or formation of scar tissue. In severe cases, this scar tissue can lift the retina and pull away from its normal position. This detachment of the retina may lead to eventual blindness. Lasers are often used to prevent the formation of these new blood vessels.

Approximately 10,000 new cases of blindness in the United States are caused by diabetic retinopathy. The development of retinopathy depends upon the duration of diabetes as well as the severity of the disease. In type 1 diabetes, the majority of patients will have some degree of retinopathy within 20 years. In type 2 diabetes, retinopathy may actually develop up to 7 years prior to the diagnosis of diabetes itself.


Diabetic kidney disease (nephropathy) is the leading cause of end stage renal failure (ESRD) in the United States accounting for 44% of all new cases in 2005. ESRD is defined as kidney failure requiring dialysis or transplantation, but many more are diagnosed with lesser degrees of chronic kidney disease. In the United States, more than 100,000 patients are diagnosed with chronic kidney disease annually. In 2005, it is estimated that care for kidney disease cost the United States $32 billion. The cost of this burden is enormous, both in financial and emotional terms.

One of the kidney’s major functions is to clean the blood of various toxins. As the kidney starts to fail, toxins build up in the blood leading to loss of appetite, weight loss, persistent nausea and vomiting and eventually to coma and death if untreated.

Dialysis is an artificial procedure to remove the accumulated toxins in the blood. It is only used when the kidneys has lost over 90% of their intrinsic function. The most common form of dialysis is hemodialysis where the blood is removed, cleaned through a dialysis machine, and then returned to the patient. Patients typically undergo dialysis three times a week for four hours each.dialysis

Diabetic kidney often takes 15-25 years to develop. Nephropathy, like retinopathy may actually be present before the diagnosis of type 2 diabetes is made. The first detectable sign is the finding of trace amounts of leaked protein called albumin in the urine. This stage is called micro-albuminuria. Approximately 2% of type 2 diabetic patients develop micro-albuminuria each year with a 10-year prevalence after diagnosis of 25%. The amount of leaked albumin continues to increase relentlessly over years. Eventually, the cleaning function of the kidney becomes impaired, and patients develop worsening kidney disease. When the kidney function falls below 10% of normal, dialysis is often required.


Diabetic nerve damage (neuropathy) affects approximately 60-70% of patients with diabetes. There are many different types of diabetic nerve damage. Once again, the duration and severity of diabetes correlates with the occurrence of neuropathy.

The most common type of diabetic neuropathy affects the peripheral nerves. The feet are affected first, and then progressively, the hands and arms as well in a characteristic ‘stocking and glove’ distribution. Symptoms include:

  • Tingling
  • Numbness
  • Burning
  • Pain

Symptoms are often worse at night. The incessant pain of diabetic neuropathy is often one of the most debilitating aspects of this disease. Even powerful painkillers such as narcotic medications are often ineffective.

But the lack of symptoms does not mean that there is lack of nerve damage. Rather than pain, patients may experience complete numbness, with no sensation at all noted in the affected areas. Careful physical examination reveals decreased sensations of touch, vibration, temperature and loss of reflexes.

While loss of sensation seems innocuous, it is anything but. Pain protects against damaging trauma. Charcot foot is the progressive deformation caused by repeated trauma. Where most people would sensibly adjust their position when their feet start to hurt, diabetics cannot feel these damaging episodes. Repeated over years, destruction of the joint ensues.neuropathy

Carpal tunnel syndrome, caused by compression of the median nerve as it runs through the wrist, is a common ailment. In one study, 80% of patients with this syndrome had insulin resistance. Large muscle groups may also be affected in diabetic amyotrophy, characterized by severe pain and muscle weakness of the thighs.

The autonomic nervous system controls our body functions that are not generally under conscious control, such as breathing, digestion, sweating, and heart rate. These nerves may also be damaged causing nausea, vomiting, constipation, diarrhea, anhidrosis (lack of sweating), bladder dysfunction, erectile dysfunction, and orthostatic hypotension (sudden, severe drop of blood pressure on standing). If cardiac innervation is affected, the risk of silent heart attacks and death is increased.

No current treatment reverses diabetic nerve damage. Drugs may help the symptoms of disease, but do not change its natural history. Ultimately, it can only be prevented.

Macrovascular disease

Atherosclerosis is a disease of the arteries whereby plaques of fatty material become deposited within the inner walls of the blood vessel. This causes the narrowing and hardening of arteries of all sizes. Diabetes greatly increases the risk of developing atherosclerosis. Atherosclerosis of the large blood vessels of the heart, brain and legs are the standard cause of heart attacks, strokes and peripheral vascular disease respectively. Together, these diseases are known as cardiovascular diseases and are the main cause of the death for diabetics.

The amount of death and disability resulting from cardiovascular diseases is an order of magnitude greater than from the microvascular disease. It is popularly imagined as cholesterol slowly clogging the arteries, much as sludge might build up in a pipe. However, this theory has long been known to be false.

Atherosclerosis results from injury to the endothelial lining of the artery. This allows infiltration of cholesterol particles into the lining of the artery wall causing inflammation. Smooth muscle proliferates and collagen accumulates in response to this injury, but this further narrows the vessel.

The end result is the development of the plaque, also known as the atheroma, covered with a fibrous cap. If this cap erodes, the underlying atheroma is exposed to the blood, triggering a blood clot. The sudden blockage of the artery by the clot prevents normal blood circulation and starves the downstream cells of oxygen. This causes heart attacks and strokes.

Atherosclerosis results from injury to the arterial wall rather than simply the buildup of cholesterol. Many factors contribute to this problem, including age, sex, smoking, physical activity, family history, stress, and high blood pressure. However, diabetes is one of the greatest risk factors for atherosclerosis.atherosclerosis

Heart Disease

Heart disease is the most well-recognized and feared complication of diabetes. The presence of diabetes increases the risk of cardiovascular disease at least two to four times higher. Complications develop at a younger age. According to the American Heart Association, at least sixty eight percent of diabetics aged 65 or older will die of heart disease compared to sixteen percent who will die of stroke. Because more than eighty percent of diabetics will die of CV disease, reducing macrovascular disease is of primary importance, even above those of microvascular concerns.

The Framingham studies of the 1970s established the firm association between heart disease and diabetes. The risk is so high that having diabetes is considered the equivalent of having had a previous heart attack. Diabetic patients have over three times the risk of heart attack compared to non-diabetics. Over the past three decades, there have been significant improvements in treatment, but the gains for diabetic patients have lagged far behind. While overall death rates for non-diabetic men have decreased by 36.4%, it only decreased 13.1% for diabetic men. In non-diabetic women, death rate decreased by 27% but increased 23% in diabetic women.


The devastating impact of stroke cannot be underestimated. In the United States, it is the third leading cause of death and the biggest contributor to disability. Diabetes is a strong independent risk factor in stroke, increasing risk by as much as 150-400%. It is estimated that approximately ¼ of all new strokes occur in diabetic patients. The risk of stroke rises 3% for each year of diabetes. The prognosis of stroke in diabetics is also worse than non-diabetics.

Peripheral Vascular Disease

Peripheral vascular disease (PVD) is caused by the blockage of blood vessels going to the lower extremities. It may happen in the hands and arms, too, but this is uncommon. The progressive narrowing of the blood vessels starves the legs of much-needed oxygen carrying hemoglobin.

Intermittent claudication, pain or cramping that appears with walking and relieved by rest is the most common symptom. As circulation worsens, pain may appear at rest and is especially common at night. Diabetic foot ulcers may occur and progress to gangrene in severe cases. At this point, amputation is often necessary.

Diabetes, along with smoking, is the strongest risk factor for PVD. Over a 5 years period, approximately 27% of patients will have progressive disease and amputation will occur in 4%. PVD significantly reduces mobility leading to long-term disability. Intermittent claudication results in reduced mobility. Patients with gangrene and those requiring amputation may never walk again. This may result in a ‘cycle of disability’ with progressive deconditioning of muscles. Severe unrelenting pain impairs quality of life.

Other complications


Many common cancers are related to type 2 diabetes and obesity. This includes breast, stomach, colorectal, kidney and endometrial cancers. This may be related to some of the medications used to treat diabetes. Survival of cancer patients with pre-existing diabetes is far worse than non diabetics.

Skin and Nails

Type 2 diabetic patients commonly manifest some form of skin disease. Acanthosis nigricans is a gray-black, velvety, thickening of the skin, particularly around the neck and in body folds. High insulin levels stimulate the growth of keratinocytes to produce the thickened skin.

Diabetic dermopathy, also called shin spots, are often found on the lower extremities as hyperpigemented, finely scaled lesions. Skin tags are soft protrusions of skin often found on the eyelids, neck and under the arms. Over twenty-five percent of patients with skin tags have diabetes.

Nail problems are common in diabetic patients, particularly fungal infections. Nails become discolored to a yellowy-brown color, thicken and separate from the nail bed (onycholysis).


In general, diabetics are more prone to all types of infections, which tend to be more serious than those in non-diabetics. Simple bladder infections are increased, but also the more serious kidney infection (pyelonephritis). This risk is increased 4-5 fold in diabetics and tends to involve both kidneys. Complications such as abscess formation and renal papillary necrosis are also more common in diabetics.

All types of fungal infections are more common in diabetic patients. This includes oral thrush, vulvovaginal yeast infections, fungal infections of the nail, and athlete’s foot.

Diabetic Foot Ulcers

Foot infections are quite rare except in diabetics and often lead to hospitalization, amputation and long-term disability. These infections can involve multiple different microorganisms, making broad-spectrum antibiotic treatment necessary.GangrenousFoot

Despite adequate blood glucose control, 15 % of all diabetic patients will develop non-healing foot wounds during their lifetime. Diabetics have a 15-fold increased risk of lower-limb amputation, and account for over 50% of the amputations done in the United States excluding accidents. The financial cost of these diabetic foot problems cannot be underestimated. It is estimated that each case costs upwards of $25,000 to treat.

Erectile Dysfunction

Community based population studies of aging males age 39-70 years found that the prevalence of impotence ranges between ten and fifty percent. Diabetes is a key risk factor, increasing the risk is more than three fold. Erectile dysfunction affects diabetics at a younger age than non-diabetics.

Fatty Liver

Non-alcoholic fatty liver disease (NAFLD) is the storage and accumulation of excess fat in the form of triglycerides exceeding 5% of the total weight of the liver. When this excess fat causes damage to the liver tissue, detectable on standard blood tests, it is called non-alcoholic steatohepatitis (NASH). This is not a trivial issue as NASH is expected to be the leading cause of liver cirrhosis in North America.

In type 1 diabetes, there is a very low incidence of fatty liver disease. By contrast, the incidence is very high in type 2 diabetes, often estimated at upwards of 75%.

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is characterized by irregular menstrual cycles, evidence of excessive testosterone and ultrasound findings of cysts. PCOS patients share many of the same characteristics as type 2 diabetics, including obesity, high blood pressure, high cholesterol and insulin resistance. It is commonly considered part of the metabolic syndrome and an earlier manifestation of the insulin resistance that is characteristic of type 2 diabetes.

Alzheimer’s Disease

Alzheimer’s disease is a chronic progressive neurodegenerative disease that causes memory loss, personality changes, and cognitive problems. It is the most common form of dementia totaling 60-70% of all cases. The links between Alzheimer’s disease and diabetes continue to grow stronger. Many have argued that Alzheimer’s disease can be called ‘type 3 diabetes’ given the central role of insulin resistance in the brain.


Every single organ system is affected by diabetes. Diabetes has the unique malignant potential to devastate our entire body. But why? Virtually every other disease is limited to a single organ system. Diabetes affects every organ in multiple ways. It is the leading cause of blindness. It is the leading cause of kidney failure. It is the leading cause of heart disease. It is the leading cause of stroke. It is the leading cause of amputations. It is the leading cause of dementia. It is the leading cause of infertility. It is the leading cause of nerve damage.

Why are these problems getting worse, not better, even centuries after the disease was first described? We assume that complications arise due to damage caused by hyperglycemia. But as we develop newer, better medications to control hyperglycemia, why do complications rates not improve? We expect that over time, as our understanding of diabetes increases, that the rates should decrease. But they don’t. We are in the midst of a worldwide epidemic of type 2 diabetes. Worse, rates are accelerating, not decelerating. We must face the cold and hard-as-steel fact that our current path leads to failure.

If the situation is getting worse, then the only logical explanation is that our understanding and treatment of type 2 diabetes is fundamentally flawed. We may be running hard, but in the wrong direction. Even a cursory glance at our treatment paradigm reveals the problem. The unspoken premise of our current treatment paradigm is that the toxicity of type 2 diabetes develops only from high blood glucose. Therefore, drug treatments are all directed towards lowering blood glucose.

However, we also know that insulin resistance causes the hyperglycemia in type 2 diabetes. If our drugs do not correct the underlying insulin resistance, then they only treat the symptoms of hyperglycemia. The underlying disease (high insulin resistance) remains completely untreated. We have no hope of eradicating this disease without addressing the root cause.


82 Responses

  1. This is how doctors should be speaking to their patients. Our doctor was very matter a fact about it. “You have diabetes. Go to this nutritionist (and she’s going to tell you how to completely eat wrong), lose some weight and oh yea, take this pill”. When you read about all the complications we are ever so thankful to your Dr. Fung for providing the true answer to this terrible disease.

  2. Dr Fung’s explanations are refreshingly direct, yet accessible, and make sense at a non professional level. As a result, although I do not believe I have any version of these terrible afflictions, I am changing my habits to try and be consistent with his general approach. In my experience, it seems that the profession is better with acute situations, than preventative recommendations, which surely applies also to most of us as individuals. It’s a human condition, or one of them anyway, so his outline looks like one that could help.
    I am certainly interested in pursuing this further.

    • Roger Bird

      Check your yellow pages in the “Physicians” heading for “Prevention”. It is pretty freaking small compared to all of the pathology categories. Even worse, I found that most of the MDs listed in the “Prevention” section were just there in order to get some business; they weren’t really into prevention. They were into cash flow.

  3. Thank you for increasing my awareness everyday with you blog Dr Fung. In case you have not seen it, there is now a serious move to keep people on metaformin : “The new clinical trial called Targeting Aging with Metformin, or TAME, is scheduled to begin in the US next winter. Scientists from a range of institutions are currently raising funds and recruiting 3,000 70 to 80 year olds who have, or are risk of, cancer, heart disease and dementia. They are hoping to show that drug slows the ageing process and stops disease.” http://www.telegraph.co.uk/science/2016/03/12/worlds-first-anti-ageing-drug-could-see-humans-live-to-120/
    I am sick of hearing of the benefits of metaformin yet it does nothing to address the root cause. I am really trying with ketogenic diet and fasting to get things under control. Not easy to make the lifestyle change but the alternative you describe above give me motivation everyday. They don’t tell you all of this when you become Type 2 – they just say take the drugs and you believe it until you really open your eyes to quality of the medical advice you have been given.

    • Roger Bird

      Hm, I encourage you to keep at ketogenic diet and fasting. I am much better.

      You might also check out ozone and oxygen therapy. It is something that you can also DIY, do it yourself.

    • J Lance De Foa, MD

      Actually, Metformin is one drug which does work at the root cause – insulin resistance. The product monograph states:
      “(metformin HCl) is a biguanide derivative producing an antihyperglycemic effect … only when there is insulin secretion. Metformin, at therapeutic doses, does not cause hypoglycemia when used alone … . Metformin has no effects on the pancreatic beta cells. The mode of action of metformin is not fully understood. It has been postulated that metformin might
      potentiate the effect of insulin or that it might enhance the effect of insulin on the peripheral receptor site. THIS INCREASED SENSITIVITY SEEMS TO FOLLOW AN INCREASE IN THE NUMBER OF INSULIN RECEPTORS ON CELL SURFACE MEMBRANES.”
      So it helps one’s own insulin work better, so one’s pancreas doesn’t need to make as much for the same effect, so it can reduce hyperinsulinemia, particularly between meals. There were other biguanide medicines that had more adverse effects. Wikipedia has a good article about metformin.

      Now that I have a better understanding of its action I prescribe the maximum tolerated dose (500 mg 4 times daily) rather than pussyfooting around. I want my patients to replace their receptors faster, rather than slower.

      The glitazones also work by reducing insulin resistance, but have some unwanted adverse effects.

      • https://jonbarron.org/herbal-library/herbs/banaba-leaf-extract


        J Lance De Foa, MD, I would be interested in your thoughts about these supplements. (Or anyones?????) When my husband was first diagnosed we did take banaba leaf with very good and immediate results. But once we understood that metformin might keep the liver from releasing the excess sugar we stopped. We are so scared to take ANYTHING that might impede the complete reversal of diabetes.

        • J Lance De Foa, MD

          Whenever I see someone SELLING a product they recommend, I’m sceptical. However, apparently the active ingredient in banaba leaf is corosolic acid. A quick Google Scholar search shows it may have more promise as an anti-cancer or anti-inflammatory agent. The one study I saw about its glycemia lowering effect was very small. Until it is studied more thoroughly I couldn’t prescribe it. Many of our medicines come from plants, so it may well come to something. I couldn’t find much to say what compound(s) in berberine were active in doing what. So it looks even less well studied. Phytochemistry, Phytomedicine, and Phytotherapy Research may be good basic science journals, but I don’t know them. So I can’t really comment on their reports.

          I agree with Dr. Fung’s emphasis that the way to normoglycemia isn’t a matter of what to put in one’s mouth, rather it comes from NOT PUTTING SO MUCH IN ONE’S MOUTH, at least on an intermittent basis. I tell my patients “If you don’t want it on your hips, don’t put it in your mouth.” To reverse your hyperglycemia stick with an intermittent fasting routine. Make it your life. Get your insulin sensitivity back.

          Metformin has been very extensively studied. It helps liver cells respond to insulin. Insulin tells the liver “don’t make glucose for the brain & muscles, we have a load of it coming in from the intestines.” Fasting blood glucose reveals whether the liver gets the message right. A 2h 75g oral glucose tolerance test (after an 8-12 h fast) reveals how much pancreatic reserve one has. A fasting insulin level (with or without a HOMA2 calculation) gives a rough measure of insulin resistance. Anyway, this is Dr. Fung’s blog, not mine. So I’ll stop now.

          • Thank you for your time and effort in your reply. I agree 1000% in being sceptical when someone is selling something. I will say however, we had remarkable success with the banaba leaf extract in the very beginning when my husbands numbers were HIGH! We are strict LCHF and his numbers are GREAT now but sometimes I wonder if extra support would benefit him in the long run since clearly he has a sensitivity to carbohydrates. And yes…. less is more. Unless it’s butter. Then more is less. 🙂 And now back to Dr. Fung …. 🙂

          • Really and True thank you for your input.

  4. honeycomb

    I just wonder how much of this is reverseable?

    It seems .. some .. but not all of these conditions can be self-repaired with I.F. .. but most conditions occur before an official T2D die’ag’nos’us.

    To bad Doctor’s aren’t looking for these early signs.

    • It’s possible most of the damage could be averted by taking ginger and following a nutrition oriented keto diet.

      Ashwaganda may be able to heal some of the nerve damage.

  5. https://intensivedietarymanagement.com/reverse-type-2-diabetes-the-quick-start-guide/

    For any newbies out there.

    • Elaine in Big D

      Thanks much, Sue…and is there a support blog for peeps doing longer fasts? I’m on day 7 but it’s not water only, power coffee with collagen then whole organic lemon, 4T avocado oil, 1T baking soda, 1/4t cayenne, 4c water in high speed blender, drinking 1c twice AM and twice PM then 1T collagen night. Various supps, carnitine, acetyl carnitine, carnosine, taurine, arginine, lysine, alpha lipoic, NAC, quercetin, mk7, TMG, p5p, choline, opti zinc, silversol, lutein.

      Can’t find definitive best practice to break fast. HFMPLC. Am thinking small amount sauteed in avocado oil cauliflower, couple T wild salmon, quarter of an avocado.

      Your opinion if you have time.


      • Hi Elaine, sounds like you’re an advanced faster! I was curious too about support groups. I just want to do a 4-day water fast but I have nobody (friends or family or associates) in my life who is interested in this and I could use a fasting buddy! Is there a facebook group or somewhere we can support and encourage each other? (PS I have done shorter fasts but it’s hard! Would love some moral support.)

        • Elaine and Becky , join this group: https://www.facebook.com/groups/459769974182105/ It’s very supportive!

          • Elaine in Big D

            Thanks, Agnes! I don’t have the FB…I need like a forum board for fasting. If I find one I’ll advise.

            Thanks again for your time and your caring!


          • Joined it! Thanks a lot, it looks like just what I need. Yay!

          • This is what happens when I click on your link to the facebook group

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        • Elaine in Big D

          Hi, Becky, I’m so not social media. Is there a way for us to email? Or just stick here? You’ll know more about that than I will.

          I have done strictly water fasts of 10 days back in the 70s…there was a book out back then concerning the benefits. And I met the wife of a friend of mine who was regular Army who did 30 day fasts twice a year. Then of course the media blitz against it began with bogus unsupported info about how you start cannibalizing your organs after the third day in and I dropped it. I’ve been researching this right at a year. I’m back to five day fasts and now this first seven day. The Eat Stop Eat guy, Brad Pilon, has all the research with notes…his book is 10.00 during October and although it’s zip and epub, they worked with me and I now have it .pdf and in my Kindle app plus audio. Really, it’s 4.00 extra for kindle and audio but I’m on a Samsung droid so I needed the Kindle format. It included a guide. And his site for the book is one of those long don’t pass this up kind of marketing ploys that I abhor but the book is very detailed and footnoted. It is well worth the investment if you want to ruin down the supporting research. And he speaks knowledgeabley concerning how fasting is good not bad and how we’ve been duped by disinformation. He’s advocating short fasts.

          When I louse up, it takes a 5 day fast to get my levels under control. You feel cured, numbers in the 70s and 80s but you’re not cured yet. It appears that maybe two years under this kind of fasting with no diabetic meds can lead to a cure…as in, eating starches on occasion not a regular basis.

          Even tho I’m doing the whole lemon concoction right now, I still have the hardest time the first two days. Then I get an occasional gnaw alert but avoid food by eating Kerry Gold butter or just drinking a glass of water. I find if I can get through about 30 minutes of discomfort, I’m good for at least another day. Five of these seven days have been excellent. I’m considering going for 10. The cauliflower salmon is a real winner for me in that my levels stay in the 70-80s after a five day fast. It’s only after a fast that my control stays consistent as long as I’m faithful with HFMPLC.

          I’m hunkering down, backing my ears, jutting out my jaw and refusing to accept less than triumph over this subversive, insidiously deadly syndrome.

          Maybe the site admin can hook us up.

          • Hi Elaine, thanks for all the info. Maybe the admins can hook us up. Meanwhile, if you want to create a free yahoo or gmail email address you can use it to create a quick facebook profile with that. You don’t have to use your real name just call it (Elaine T. Faster or something!) I think you’re missing out on all the supportive boards, groups and resources out there. BTW I was a slow joiner of facebook but finally gave in and see why it is tremendously useful.

          • Elaine in Big D

            Becky, the reply to you is not showing so I’m using the one by my name…

            I did NOT know that abt FB. I’m fixn to roll but I’ll look into it tonight. Oh even the old peeps in my family (I’m 67 so old means OLD) are all into FB…I’m like the commercial with the old lady sticking photos on her living room wall and the other old ladies are saying “It doesn’t work like that”…cracks me UP

        • /r/fasting and /r/keto Read the FAQ

          • Yes Reddit is the place

          • Elaine in Big D

            Thanks Jim and Lynn…without your comment Lynn, I wouldn’t have been able to decipher Jim’s, having no clue as to /r/anything. I wondered if he was growling at me. Hahahahahahaha

            I did go there and found good faq.


        • Get Dr. Jason Fung’s book, The Complete Guide to Fasting. He talks about how to transition. Also the book The CR Way talks about having a very small transition meal to gently ‘awaken” your insulin response, but not overload it, then wait about 45 minutes for a more substantial but not-too-large meal.

      • Elaine ~ sounds like the perfect way to break your fast. You just want to eat something small to start. My husband and I have done a couple of 4 -5 day fasts and we’ve never had a problem breaking it when we eat something small and fatty. Job well done!! And I belong to the FB page that Agnes gave to you. and she’s right everyone is very helpful and supportive.

        • Elaine in Big D

          Thank you, thank you, Sue!

          I’ll go with your confirmation on the eats!


      • Elaine in Big D

        Becky and Agnes, I created FB account, joined the Fung Schweigh group but dunno perzackly what to do next. I don’t see anything, just a list of 4K some odd members…

        • I had trouble with this too and finally gave up on it. For me it is like Fung Schweigh has disappeared from Facebook altogether.

      • Wenchypoo

        Hang on…Dr. Fung’s latest book on fasting is coming out VERY soon ( a little over a week away). https://www.amazon.com/Complete-Guide-Fasting-Intermittent-Alternate-Day/dp/1628600012/ref=sr_1_1?ie=UTF8&qid=1475832202&sr=8-1&keywords=jason+fung

        • Elaine in Big D

          Hi, Wenchypoo!

          Yay and I been waiting plus gigging Amazon to make it available for Kindle preorder.

  6. If anyone here has experience with long-term (4+ days) water-only fasts, I have a couple queries:

    1) Is it ok to eat 100-200 calories a day? Alan Goldhammer, in one of his lectures, says it to takes a tiny amount of food to stop the cellular healing process. However, Goldhammer pushes fructose since he’s a vegetarian. I’m thinking of a small cup of bone-broth soup at night, just before bed, might be ok, and help maintain electrolytes and water weight.

    2) I’ve done fasts of 1, 2, or 3 days. By the 3rd day I’m usually somewhat dizzy and faint and tired. I do drink a lot of water. Does it really become better by days 4 and 5?

    I would like to try one long water-only fast, it’s hard to schedule. I’m thinking 7-14 days.

    3) Is the healing process of long fasts remotely understood? There are anecdotal reports of healing from everything from Parkinson’s to myopia to cancer. Some people say their hairline improves.

    • https://www.dietdoctor.com/complete-guide-fasting

      We have ordered this book. Also Dr. Fung does have a lot of info about fasting on his blog. We have fasted 5 days (twice) and I will say for sure that day 4 got a lot easier! Like you, we could certainly go longer but it’s hard to schedule that! Personally I would only have the water and bone broth during a fast…

    • I have done several (at least three) 4.5-5.5 day fasts, and many 3 day fasts. Initially, I would add a small amount of cream to my coffee, have bone broth at night, etc. Now, I usually have none of those (just black coffee, “black” tea, water). The bone broth I found made me hungry. If it doesn’t make you hungry, then it’s probably not bad. I felt it made me warm, especially while sleeping. I’m not sure why.

      Dizzy and faint is usually a sign of lack of sodium (perhaps also magnesium) for me. I usually drink dill pickle juice if necessary, although I also also add salt (and magnesium, if you think that’s a problem) to coffee or water. The detriment to these is they can make me hungry.

      I find day 2 is the worst, and then it gets better. However, lately I haven’t been able to make it that long, because of hunger. It may be that I have to take pills three times a day, and perhaps they’re causing a bit of stomach upset. It’s unclear. It’s also difficult when you come home and the wife has just made the kids something that smells and tastes great. I made it two days, then my wife accidentally left out dinner. I looked at it and lost my willpower. If that was in the fridge (which she meant to do–with kids you forget some things sometimes), I likely could’ve made it, as if I make to to 8pm, it’s much easier.

      I have not yet been able to schedule a 7 day fast. I find it hard to not eat over the weekend (I’m a dad with a family and two kids). I also find it hard not to eat with the kids on the few days I get to be at dinner with them. The weekend is definitely the hardest, though. The only way I can think of doing it is to start Friday after dinner and make the weekend be the first thing you do, and try to keep busy those two days. I find the week to be much easier. If the first two days are the weekend and are over, the rest won’t be as bad. Like you, I’m still scheduling the 7 day fast.

      Though I often wonder, what’s the big deal with 7 days? Isn’t 3 or 4 or 5 days, or even fasting multiple 24+ periods in one week, almost or just as good? Why 7 days? It’s like my desire to get under 200 pounds. Why? No reason, although than 200 is a clean number. (Who cares if you get under 202 pounds?) I think 7 days is like that. It has no real basis in reality, other than it’s a week.

      • Bob, there’s no magic to “7 days”, but a lot of claims online that healing only begins on day 4.

      • sten bjorsell

        Bob, Sunday night to Friday evening is 5 days, which I did 3 weeks in a row.
        Got rid of arrhythmia and a heart strain problem that way, apart from losing nearly 10 cm around the waist!
        One has to inform the family well before fasting and they must get on with dinners early an leave out no plates and that it is a serious matter done to cure health issues so they all respect it and help during the week. Then great dinners in the weekend. Fasting and feasting !
        Day 3 or 4 some broth is best started , one bowel a day. I squeeze the juice form half a lemon in one -two liters of the water I drink during the fast, as it has the effect on my that the water then quenches any hunger. Also unrefined sea salt is a great source of all trace minerals and electrolytes. The salt also makes it easier for the body to adjust its pH as it is easily broken up in acid and base (proton pumps) and excess acids if more alkaline required is excreted, and v.v. Next time I will also try epsom salt baths or sauna preceded by epsom salt body spray to supply both magnesium and sulfur through the skin, the latter to bind heavy metals like mercury, lead and cadmium exposed when the fat burns off during the fast (like stones in snow in the spring sun ?). Has anyone combined with epsom salts through the skin ?

        • Elaine in Big D

          Hi, Sten,

          I use magnesium chloride flakes, 1:1 with good water and spray on topically. I’m going to make up a separate bottle with Epsom to gain sulphur advantage. I sea salt my water, 1/8 tsp to 16 oz. Twice a day I use baking soda instead of sea salt.

          Do you mind sharing which arrhythmia and if you use any supps specifically for your heart?


      • Elaine in Big D

        Hi, Bob, we’re all so different and I don’t know your specifics but if you need the five dayer regularly, you could continue it during your work week and have a nice sparkling water with the family those evenings then flip to one meal per day on the weekends for family enjoyment. Depending on your target, be sure to stay HFMPLC even for family dinners. It doesn’t take many starchy carbs to wreck your progress back to square one.

        • I don’t know if I need the 5 day regularly. I fast so much now (no breakfast, often eating during short windows per day, even on the weekends (doing a 40 hour fast right now), that I’m not sure I do. However, it’s always good to try one. I will try one next week to see what happens. Dinners are always the toughest, but if I make it passed dinner, I can make it.

          I’ve been on a ketogenic diet for the last several month, so I haven’t had any carbs to speak of. And before then, I was low carb, just wasn’t actively testing for ketones.

    • Axel de France

      Did the same type of fast with 200kcal for 6 days.
      I felt tired After 3 days without recovery all along the fast.
      I have known that metabolism shuts down After 3 days.
      Seems to be true.
      But found it very hard to go through 6 days.
      3 days is long enough to start with.

      I .

      • sten bjorsell

        Metabolism is not shutting down during fasting until body weight becomes critical which means fat stores are exhausted. To make it easier, eat low carb dominated meals at least a few days before fasting. But if any carbs or insulin raising calories are consumed during the “fast” , one cannot call it fast. These cheating calories push up insulin every time taken and fat burning and then metabolism reduce. Read about he Minnesota starvation trial from 1946, and you see how metabolism shuts down with a calorie reduced standard high carb diet. The participants in their 20’s froze in the middle of the summer, and felt generally miserable all the time.
        Once insulin is allowed to reduce through true water fasting, shut down only takes place after all fat and lots of muscles consumed which may take an abnormal 40 day fast for an average weight person.

    • Just have a spinach/mushroom/nutritional yeast shake in the morning. Add a small amount of Himalayan salt for the sodium.

      Fasting is about caloric restriction and clearing out your gut. Not nutritional depravity.

    • David. Get Dr. Fung’s book, The Complete Guide to Fasting. Ingesting any food breaks the fast and may be why you are not feeling great. His book covers his exact protocol. Anyone doing any kind of caloric intake is on a diet, but not a true fast, in my view.

  7. sten bjorsell

    Very little if anything is written in main stream media about this. Why is main stream media corrupted, bought off by big pharma ? A massive corruption or blackmail by advertisers of our “independent” media it seems to be.
    The fact that diabetes itself is nearly always cured “by” gastric bypass operation procedure in less time than a week is an awful indictment of our standard diabetes treatment, that never cured a single patient!
    At a gastric operation patients fast a few days before , during and after operation, as stomach be empty and then must heal after being cut down and stitched up, resulting in typically 5 days fasting, usually enough to normalize both insulin and blood sugar all the way back to a none diabetic status! Just one week and pains and cries and death 10 year earlier can be avoided! One week! Note well that the operation has at that point done absolutely NOTHING. The normalization is a natural result of fasting alone.
    The weeks following operation very little can be consumed resulting in good weight loss without metabolic derangement, as insulin has become very low induced by the 5 day fast.

    Imagine now instead that large number of diabetics were housed in a hospital without food for on average 10 days for fasting preparation, fast supervision and fasting recovery plus advise what they must avoid to EAT not to raise their blood sugar later, then walked out into their new life without medications like getting a second life, still fearing what Jason wrote above, very few would return to same old eating.

    Using the otherwise mental resting during the 10 days to education about above, and what to eat and what to avoid and learn from excellent ketogenic diet cook books would close the loop leaving very few to return to the SAD, the villain diet that put them in the place they are today.
    The longer term failure rates of gastric bypass ops were very high but now reduced by (off the record ? advise to reduce carbs..) Why could the trusting people have been told this before ?
    GBP seems to me be a totally useless mutilation for most when such simple and low cost alternatives can be implemented with minimal cost. How many diabetic-2 can be cured by fasting for the cost of a single GBP ? Being a taxpayer, it is our money.

  8. ashley jones

    Well this really cheered me up when it popped into my inbox…newly diagnosed type 2 but probably had it for years, some symptoms as listed, and will be doing everything I can to reverse using the protocols here.

    Thanks to Dr Fung I will not sleep tonight..but that’s no bad thing!

    • Ashley ~ It is an eye opener isn’t it?? My husband and I have been LCHF + IF since February 1st. Changing your eating habits is not easy but I want to say to you and everyone that might just be starting, it gets easier and easier as you go, plus we feel soooo good we never want to go back to where we were! There are many, many delicious low-carb recipes online and I ton of support on FB pages. If you follow what Dr. Fung says, diabetes will be a distant memory….

    • I at first didn’t like getting the diagnosis, but now I am glad I did. I had a name for it and now could research what to do. Problem was it took me 5 years to find Dr. Fung’s info. I stumbled upon his book last April on Amazon and my life has changed for the better, be glad you found the info sooner than later. I am a devoted follower of Dr. Fung.

  9. Blair Thedinger

    Thanks Dr. Fung. I am a primary care physician and I am proud to say that I have helped several patients reverse their diabetes through dietary change and fasting. Dr. Fung’s latest post about complications from DMII is a great summary. This is a devastating disease about our current medical therapies are inadequate. We need intensive dietary management program in every community. We need the insurance reimbursement models to change so that payment actually promotes effective dietary counseling, instead of rewarding the 15 minute individual visit with ever increasing medication doses. I work at a free health clinic so I have the luxury of not being concerned with reimbursement as much. I just focus on what is best for the patient, but I don’t think private offices are going to treat diabetes differently (or effectively) until we change how reimbursement works. But I supposed the drug companies and probably most doctors would not like that…. $$$ 🙁

  10. Roger Bird

    Jason Fung is to holistic health as Johann Sebastian Bach was to music.

    I thank God for giving my an extremely painful herniated disk about 3.5 years ago. I was a health nut slowly falling down the diabetes hole. The pain of that herniated disk woke me up and I started doing things that helped heal the diabetes I was too much in denial about to do anything about. When I started to get real about my diabetes symptoms, then I could do something about it. From Jason’s list above, I feel like I have dodged so many bullets that I can’t keep track.

    With regard to diabetic neuropathy, the numbness on the outside of my right knee has not gotten better at all, even though I am making great progress with the diabetes per se. I am hoping that ozone/oxygen therapy will help with that. But, the pain is completely gone. In fact, once I had some really bad pain and doing push-ups made the pain go away completely. But I have had no pain for perhaps 6 months, so the pain can be healed. The numbness I am not sure about.

    • sten bjorsell

      You may add epsom salt baths as the sulfur in it helps to clear any calcifications that may be involved. In any case it is the cheapest and best way I know of to detox.

    • Try taking Ashwaganda at least 1000mg/day.

  11. Here is a pathologist, Dr. Joseph Kraft, that studied this very issue, that of damaged micro-vascular blood vessels caused by chronic high insulin levels, by looking at them under the microscope for years and wrote a book about it – specifically in the heart and eyes. He says an ophthalmologist with the right equipment can see the T2D damage in the eye long before T2D is diagnosed by regular doctors. Unfortunately you can only see the damage in the heart after the patient dies, since the only way to see it is to slice it up and look at it under the microscope. Dr. Kraft did this for years and documented his findings. He hypothesizes that the heart vessel damage is what causes irregular heartbeats and even heart failure in some T2D sufferers, which is of course in addition to problems caused by insulin to the blood vessels in the rest of the body

    Kraft says the insulin is what causes the damage, not the sugar, thus giving T2D patients insulin to lower their sugar makes the problem worse. The only answer, as Dr. Fung knows, is to stop the sugar. Dr. Fung needs to add heart micro vessel damage to his list.

  12. Dr. Fung, your website and lectures have been life changing for me, thank you for leading this revolution to better health! I have to ask: Have you personally seen any significant T2D damage REVERSAL with fasting therapy in your patients? My neuropathy is pretty bad (can’t feel my feet anymore) and my left eye is quickly losing sight. Stopping organ damage in its tracks is a huge benefit, but very curious if you’ve seen actual reversal or recovery with your patients who have cured their diabetes through fasting and LCHF. Thanks for your time (wishing for a glimmer of hope!)

  13. Thank you Dr. Fung for this article. I am a victim of both severe retinopathy and nephropathy from un-diagnosed Type 2. I was only diagnosed with diabetes as a result of severe retinopathy (retinal hemorrhages in both eyes). If only I had been more pro-active 3 -5 years ago I would not be in the situation I am in with my vision and kidneys. Doctors have done all they can to keep my eyes stable but I now have a permanent disability. I will be sharing this!

  14. Vilma Williams

    Good day doc. I live in Trinidad, I have been suffering with diabetes for over twenty years it so happened. Today I went for
    A. Check up the diabetes is so bad. I now have. To take two different kinds. Of insulin .my eyes are going. Sir. As I. Write this note to you I am in tears I have tried so. Hard to get control today after hearing I have to use two different kinds of insulin I give up but as I go to the computer looking for foods that I can have there I found your program telling me what no doctor has ever said. And it it make a whole lot of sence please please tell how can I start your program. You have given me hope I want to say thank you in advance I eagerly wait your reply.

    • Elaine in Big D

      Hi, Vilma, I’m not the doc but this blog has the answers you are looking for. Try this as a beginning point:


      I feel your pain, Vilma. Most of us were caught flat footed by this debilitating disorder. There is no good education in the mainstream medical community. Take heart, you can begin to get control with diligent research and application of the precepts laid down by Dr. Fung. You can do it! Please don’t be discouraged.

  15. No grains, no sugar (including fruit), no starches. Within four weeks most pre-Type 2 diabetics are back to normal. But that would mean one and done (one blood exam to confirm your blood sugar is back to normal, and your all set).

    But there’s no money in “one and done” for Big Pharma, Big Grain, Big Packaged Junk Food, Big Doctor, Big Hospital, Big Drug Store, and most of all, the Number 1 villain in this rape of the American taxpayer – THE AMERICAN DIABETES ASSOCIATION.

    • Is there any empirical confirmation that fruits are bad, or just theoretical conjecture due to it being sugar?

      • Elaine in Big D

        From The Paleo Leap:

        It’s common knowledge in Paleo diet circles that sugar, especially the sugar fructose, should be limited and that it can cause a multitude of problems like those categorized under the metabolic syndrome umbrella term. Unlike other major unhealthy foods and non-foods (grains, soy, vegetable oils), sugar is also in foods that are natural and healthy like fruits and vegetables. This can make it hard for us to really understand the dangers of consuming too much sugar and reminders are often a good idea.

        The problem comes from the amount of sugar consumed in today’s diets. We were probably never in contact with as much sweet fruit before in history, let alone fruit juices, sodas, sweeteners and candies. If some of our ancestors were ever in contact with high amounts of sweet fruits, it surely wasn’t year round.

        In sucrose (table sugar) and in sugary fruits, the fraction that is problematic is the sugar fructose. The other main fraction is glucose, which can be used by all our cells for energy and is the main fuel for life on earth.

        Because glucose is the good sugar, can be used by all our cells for energy and is essential for some parts of our bodies, the best sources of natural carbohydrates are starchy vegetables. Starch is a complex polymer of glucose molecules that are disassembled in our digestive systems and absorbed as glucose. Starchy vegetables have been demonized in the past by Paleo practitioners, but science has shown that starchy vegetables are not only generally healthy, but have also been consumed for a very long time already by our ancestors as a dense source of energy. Of course, many sources of starch like grains and legumes are very unhealthy and over consumption of total carbohydrate is also problematic, especially for the already metabolically challenged.

        It’s good to keep in mind though that fructose, in small amounts, has been in our diet for a very long time as a species and that we usually handle small amounts very well. Of course, the amount where fructose becomes toxic and damaging varies for everybody depending on a multitude of factors, but a good rule of thumb for most healthy people is ataround 50 grams of fructose per day. Keeping in mind that most fruits are half glucose and half fructose, consuming over 100 grams of sugar from fruits every day can become problematic.

        We should also keep in mind that by eliminating the other toxic agents in our diets like grains and vegetables oils our bodies probably become more tolerant to a little excess sugar. This shouldn’t become an excuse to indulge in high amounts of fruits and natural sweeteners though, but only as a reminder not to stress over your diet if you find yourself eating higher amounts of sugar from natural sources from time to time. The real damage is when the high sugar habit becomes chronic and is repeated day after day.

        Without further ado, here are 10 reasons why excess consumption of the sugar fructose, whether it comes from apples or high-fructose corn syrup, is damaging to our health:

        Reasons to limit fructose consumption
        Fructose can only be metabolized by the liver and can’t be used for energy by your body’s cells. It’s therefore not only completely useless for the body, but is also a toxin in high enough amount because the job of the liver is to get rid of it, mainly by transforming it into fat and sending that fat to our fat cells.
        Excess fructose damages the liver and leads to insulin resistance in the liver as well as fatty liver disease. In fact, fructose has the same effects on the liver as alcohol (ethanol), which is already well known as a liver toxin.
        Fructose reacts with proteins and polyunsaturated fats in our bodies 7 times more than glucose. This reaction creates AGEs (advanced glycation end-products), which are compounds that create oxidative damage in our cells and ultimately lead or contribute to inflammation and a host of chronic diseases.
        Fructose increases uric acid production, which, in excess, can cause gout, kidney stones and precipitate or aggravate hypertension.
        While most of your body’s cells can’t use fructose as a source of energy, the bacteria in your gut can and excess fructose can create gut flora imbalances, promote bacterial overgrowth and promote the growth of pathogenic bacteria.
        In part because of the damage done to the liver, chronic excess fructose causes dyslipidemia, which means that your blood lipid markers tend to shift towards numbers that indicate a risk for heart disease.
        Fructose rapidly causes leptin resistance. Leptin is a hormone that controls appetite and metabolism to maintain a normal weight. Leptin resistant people tend to gain fat and become obese really easily.
        Excess fructose alone can cause all the problems associated with the metabolic syndrome (diabetes, obesity, heart disease).
        Cancer cells thrive and proliferate very well with fructose as their energy source.
        Excess fructose also affects brain functioning, especially as it relates to appetite regulation. It has also been shown to impair memory in rats.


  16. Wenchypoo

    How about restless leg syndrome–microvascular?

    Thank you for participating in the Keto Summit–it was like a giant doctor blitz! I hope it comes back next year.

    • I have/had restless leg syndrome. I’m not diabetic or pre-diabetic (not that I think there is such a thing…. I prefer to call it 1st stage diabetes). Restless leg syndrome runs in our family but since beginning this WOE my restless leg symptoms have all but disappeared! I had a very severe case of it and took medication for it everyday, could NOT sit at my desk for long periods of time without being forced to get up and walk around and sleeping was very difficult. My husband and I will never go back to the SAD diet!!

  17. Mikeissimo

    Am borderline t2d. In july, my bg a1c came in at 7. About that time, I discovered your work on youtube and followed it thru to this web site. With 18:6 fasting and low carbs, Ive gone from 226 pounds to 209 pounds and my aic has dropppd to 6.0.
    My area of concern is the dawn effect. About 50% of mornings my bg is above 7.0, as low as 6.2 as high as 7.6. I read recently that even prediabetes can be accompanied by peripheral neuropathy, which has been the case with me. The article stated that post prandial bg spikes are a likely culprit in causing the neuropathy in prediabetics.

    I believe my dawn effect bg’s could contribute to neuropathy. Would it be feasible to take a dose of metformin at 2:30 am to head of the dawn effect. It seems that my liver is quite happy to squirt out gobbs of glucose and I’m a sitting duck for hyperglycemia during the wee hours.
    I’d appreciate comment from you,Dr. Fung or your informed readers or moderators.
    Thank You, I believe you have set me on a path to getting control over this potentially horrible affliction.

    • @Mikeissimo

      Let me state what I have done in similar situation. I started take Metformin -SR 1000 MG around 2 PM when my feeding window starts & again I take another tablet of Metormin SR 1000 MG around 7 PM when I am about to end feeding window, This has been very effective in managing Dawn Phenomenon. Your FBG may varies with the quality of sleep-& Dreams & Nightmares & indigestion. In my case if I get into deep sleep around 6 AM…..my FBG will be high. I have also seen that If I eat only once a day & take one Metformin SR MY FBG will be under 5.00 but I need to maintain my healthy weight range too.

  18. Mario O'BANNON

    Dr. Fung thanks for sharing your knowledge about the disease of diabetes and how to treat the problem and not the symptoms of diabetes. Dr. Fung my sister has had this disease since the age of 13 and now she is 36. It’s really really really has taken a toll on her body but she is one hell of a FIGHTER. She has experience a lot of the illustrated experiences mentioned above if not all of them along with non related diabetic experiences with her house now burned down to the ground on October 2. I am her brother and personal care taker of her and my nephew. We saw a video of you yesterday morning doing a presentation and it blew us away with all the shared information exspeacially about insulin can cause more damage to her problem. We are fighting to get better at understanding this thing and I myself is a health nut (lol) and is careful about what I eat but for her situation it’s not just about the food in take we need a dietary guide for a diabetic. Dr. Fung if at all possible I ask for your help and knowledge to give to my sister. Thanks Mario.

  19. J Lance De Foa, MD

    Dr. Fung, I love your blog. I’m recommending it to all my insulin resistant patients (i.e. almost every Canadian over the age of 25). However, in regards to PCOS, your mistaking zebras for horses.

    PCOS affects about 1 in 15 women.
    About 1 in 2 are overweight or obese.
    All have elevated Luteinizing Hormone (LH).
    ALL have insulin resistance, but the degree increases with increased BMI.
    All have increased Free Testosterone which arrests follicle development, produces hirsutism, acne, etc.
    Perhaps 1 in 3 develop impaired glucose tolerance.
    Perhaps 1 in 10 will be chronically hyperglycemic by age 40.
    So I in 2 have NORMAL BMI.
    And 9 of 10 do NOT develop T2DM (Which really is just insulin resistance with pancreatic decompensation. It’s kind of like saying a metapslastic polyp isn’t cancer just because it isn’t an obstructing rectal mass.)
    (I’m sure a few with normal BMI do have IGT and “T2DM”. To every rule there is an exception.)

    Aninsulinemia produces hyperglycemic glycosuria. (aka T1DM)
    Insulin Resistance eventually produces hyperglycemic glycosuria. (aka T2DM)
    Sharing the common clinical sign of glycosuria (in Greco-Latin “διαβαίνειν MELLITVS” – or “honey-sweet pee”) doesn’t make them the same disease. They have different etiologies.
    So with PCOS, androgen excess with insulin resistance doesn’t make it the same as BMI elevation triggered insulin resistance.

    Only some with PCOS develop hyperglycemia. Most hyperglycemic women don’t/didn’t have PCOS. Many hyperglycemic women have HIGH BMI. Most women with PCOS who develop hyperglycemia have HIGH BMI. Excess carbohydrate consumption is a reliable way to achieve elevated BMI and insulin resistance and hyperglycemia.

    Warm Regards.

  20. Suman Banerjee

    It would be great if an explanation can be provided as to why does increase in blood glucose and/or high levels of insulin lead to tissue damage. I have not been able to find this information.


  21. Mark Luxton

    Thank you for all your free information Dr. Jason Fung. I had multiple symptoms of type two diabetes and insulin resistance for 2 to three years. I did not know what was causing various changes to my health. I thought perhaps magnesium deficiency was most of the cause. This year I had not felt right, developed a major thirst and peeing every hour or two this summer, eventually my eyesight went blurry, I lost all ambition, fell asleep after eating, etc. etc.. Beginning of Sept. I began to search for answers and suspected diabetes. Turned out most of my symptoms were due to insulin resistance and full blown diabetes. I immediately stopped eating any sugar and carbohydrates; I kept drinking a lot of water. Sept. 2nd, already feeling quite a bit better, I tested my blood glucose at 30.7mmol/L. I went for a 2 mile walk and brought that down to 26.6mmol/L within 4 hours. I have always known that industry lies about health, so I began to do intensive research. I already had some fairly good knowledge of nutrition and natural medicine, but also had a sweet tooth and loved pasta. Thanks to Dr. Jason Fung and others that figured out much truth about what is healthy for a human being, I now have my blood sugar remaining within the normal range, generally below 6 mmol/L. I no longer eat breakfast or snacks before or after lunch and supper time. The last spikes I noticed were around 10 mmol/L and were after eating whole grain bread or pasta. I am removing wheat from my diet bit by bit. IMO what we call “wheat” is bio-innappropriate for any animal, especially humans. SEVEN WEEKS! passed from my first reading of 30.7. I could have died, as I was feeling much worse for a month before that initial reading. I could not see my doctor for 18 days, but got his receptionist to give my doctor my findings, and have a prescription for a glucose meter and supplies sent to the local pharmacy. 7th. Sept had my own meter. On the 20th. my doctor was very puzzled at my vast improvement and asked ” how did you do this?…exactly what did you do”. I told him what I did and why, and that doctors are being kept ignorant of proper treatment of insulin resistance. He checked my blood pressure, and looked up my last cholesterol readings(waste of time) and found that everything was fine. Still puzzled he said “I see no reason for you to take any diabetes drugs”. I had no intention of taking drugs. I didn’t become diabetic because of a deficiency in drugs. A month later I saw my doctor again. My blood sugar levels were not only improved again, but were normal. Again somewhat puzzled, he checked my blood pressure again, normal too. Again he said I see no reason for you to take any treatments, see you in a year or so. I plan to drop off some information for my doctor to look into so he can learn the truth about diabetes. Most doctors first impulse is to prescribe something, and I could tell my doctor was trying to find something off enough to sell some drugs. It is a damn shame and travesty that the medical profession is trained to treat symptoms and sickness but never to treat the actual problem and aim for a cure. Congratulations Jason for breaking through this foolish paradigm.

  22. Mark Luxton

    I must also mention something else I discovered to be true and had suspected for many years. A lot of people are easy for doctors to take advantage of(intensionally or not), because they do not want to take responsibility or control for their health. They don’t want to stop eating what they always have eaten so they use the drugs as a crutch.
    Four family members living a mile from me are diabetic. All of them have seen what I have done and I have sent them most of the same information I used to bring my blood sugar levels to normal. Still they eat refined carbohydrates, sweets, snacks, etc.. They even have the nerve to brag that their sugar levels are nearly as good as mine. I actually have to point out to them that I am not taking dangerous drugs, that I am healing and they will continue to get sicker if they do not make changes and get off the drugs. I guess I have more will power, or perhaps a greater desire to live and live as a healthy person.
    You can lead a human to knowledge, but you can’t make them think.

    • Mark, My prediabetes diagnosis threw me into high gear, research wise. But my next visit was a diabetes diagnosis. I signed up for Kaiser’s four-part education class. After starting the New Castle protocol a few days before, I had already lost 10 pounds and my readings were mostly normal. I was afraid to even share what I was doing in the face of canned nutritional advice. One woman asked if she could still have cookies and the dietician said yes! I wanted to tell her, “You are looking at a death sentence, get your priorities straight.” Since then I have read Dr. Fung’s book, am on day three-of-seven of a true fast. My readings have been all normal, except some slightly low, which I am not going to panic about yet. I don’t think I can get through these classes without sharing, but I fear the skeptics. Seems futile.

  23. Love Dr. Fung’s candid style! I’m binge reading everything. I’ve been drinking a water enhancer made out of organic honeybush which is loaded with antioxidants and has other natural blood sugar and anti-inflammatory properties. The studies on this herb from South Africa are very exciting. #sweetbynatureinc

  24. Dr. Fung, With fasting and the return to healthy glucose levels, do you see these complications:

    * Continue to worsen?
    * Plateau- that is, not get worse?
    * Improve/get better?
    *Reverse/go back to a healthy state?


    • I am really anxious for his answer, as well. I just get a diagnosis, have mild symptoms and took drastic action with both the New Castle protocol before finding Dr. Fung’s book. Here is a bit of hope, many who went through the New Castle approach (lose 20 percent of pre-diagnosis weight within and 8-week deadline on 8oo calories a day) found lasting results, basically went back to normal, and depending on severity improved or reversed the associated health problems.

      Here is one story of pretty significant reversal:

      Here is the New Castle information:

      From what I can tell, all of this is consistent with Dr. Fung, and he mentions the study in his book.

  25. I think Dr. Fung should be awarded the Nobel Prize

  26. Dr. Fung, so if some of the nerve pain at night started prior to the diagnosis, will it subside at all after improving insulin resistance? Same for eye damage, ED, etc.

  27. outstanding article .

  28. Ever Learning

    Hello, Dr. Fung: I have a question. I have bought your 2 books and have been reading some of your online articles, as well as viewing some of your YouTube interviews. Thank you for trying to make such a difference to people through your sharing your clinical experience, through your knowledge of and communication of the pertinent academic literature, and through your sharing your hopes through your writing and interviews.

    I am hoping to use your writings to radically change my life, by allowing the designer of the human body which is actually “designed to heal” to work miracles in me from head to toe, from outside to inside. I would like to do a 40-60 day extended, water-only (no supplements) fast now. I’ve done intermittent fasting and LCHF for a few years.

    [I’m of average weight. I have never been diagnosed with insulin resistance, high blood sugar, metabolic syndrome, diabetes, or prediabetes. But for many years I have been experiencing most of the signs listed on the websites of physicians, university hospitals, well known, mainstream offline medical organizations, as well as naturopathic doctors and medical doctors who practice “functional medicine.” Decades of chronic sleep issues and elevated stress hormones. My physician just retired. So I’ll be at the mercy and availability of drop-in, long-waits medical clinics.]

    I deeply wish to maximize my health and well being, as well as absolutely minimize all likelihood of Alzheimer’s and related microvascular complications and macrovascular disease. I plan to end the fast only after I have stopped seeing improvements for several days, which I expect will be after at least 40 days of the fasting.

    My question, Dr. Fung, is:

    Would you expect that a 40-60 day extended, water-only (no supplements) fast would repair microvascular complications and macrovascular disease, including: Peripheral Vascular Disease, atherosclerosis, neuropathy, retinopathy, carpal tunnel, and a couple decades of being freezing cold?

    Thank you, Dr. Fung, for any consideration to sharing your expectation with me. Good luck with spreading your word to Canadian governments, and then hopefully to American ones once they notice the unprecedented results.

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