Towards a Cure – T2D35

posted in: Health and Nutrition | 66

Protective Responses

Over 50% of American adults are estimated to have prediabetes or diabetes. The twin cycles (hepatic and pancreatic) are not simply rare metabolic mistakes leading to disease. These responses are almost universal because they serve as protective mechanisms.

Protective? I can almost hear you gasp. Insulin resistance and beta cell dysfunction are protective? Yes. Absolutely. What do they protect us from? The very name gives use the vital clue. Insulin resistance protects the liver from too much insulin. Our body is resisting the excessive insulin, which is harmful.

Imagine the liver as a balloon that can be filled with sugar and fat, the two storage forms of food energy. Normally, when we eat, insulin goes up, storing some of this food energy. When we stop eating, during fasting, insulin levels fall, releasing some of the stored energy for the rest of the body.

When insulin levels stay elevated for a prolonged period, the liver fills up with sugar and fat, like an over-inflated balloon. The pressure inside the liver goes up and up, making it increasingly difficult to move sugar into this overfilled liver. This is insulin resistance. The liver simply cannot store any, so rejects the incoming sugars, becoming resistant to insulin’s normal signal. Glucose piles up outside the cell in the blood.

This provokes a compensatory hyperinsulinemia. Like trying to inflate the over-inflated balloon, it works for a time. However, it becomes more and more difficult. Ultimately, the liver was only trying to protect itself from the damaging effects of the high insulin. The problem is not the insulin resistance, but original hyperinsulinemia.

The liver is busy trying to clear the fatty congestion by exporting this new fat. Some of it accumulates in the pancreas, eventually clogging it and lowering insulin levels. This is exactly the correct protective response. Since high insulin is the very problem that causes type 2 diabetes, reducing insulin is the most effective protective strategy.

Blood glucose surges to abnormally high levels and spills out into the urine causing many of the symptoms of frequent urination and thirst. This too can be understood as an appropriate, protective mechanism. Forcing more glucose into the over-filled liver and pancreas will eventually destroy it. The body is now trying rid itself of the toxic glucose by eliminating it through the urine.

Obesity, too can be understood as a protective response against excessive de novo lipogenesis. Adipocytes are specialized cells that store fat (triglycerides) without problem. Without fat cells to store this newly created fat, it would otherwise immediately deposit in the organs and cause type 2 diabetes. In the rare genetic disease of the Beradinelli-Siep lipodystrophy‏ syndrome there is a congenital lack of fat cells. Virtually all of these patients develop type 2 diabetes, often by their teenage years, as excess fat from both diet and de novo lipogenesis deposit directly in the liver and muscles.

Long standing fatty liver causes scarring and will soon become the leading cause of liver failure in North America. Long-standing fatty pancreas will eventually lead to scarring as well, and after many decades, the pancreas is destroyed. To protect itself, the body needs to rid itself of this excessive toxic glucose load. By forcing the glucose out into the blood, it will spill out in the urine. This causes many of the symptoms of excessive urination and weight loss, but at least the toxic glucose load is being excreted.

Implications

This new understanding carries several important implications. First, type 2 diabetes results from a single underlying, unified mechanism. It does not result from two entirely separate pathophysiologic mechanisms, one for insulin resistance and another for beta cell dysfunction. The natural history and all of the manifestations of type 2 diabetes can be explained from excessive fatty organ infiltration.

Too much de novo lipogenesis results in fatty liver and insulin resistance. Too much fat in the beta cells results in lower insulin production. But hyperinsulinemia is ultimately the root cause of the entire problem.

Secondly, both defects of insulin resistance and the beta cell dysfunction are entirely reversible by removal of the excess fat clogging the organs. Contrary to popular belief, the pancreas is not scarred and burnt out beyond repair. Instead, the pancreas is simply clogged with fat. Once you unclog the fat, the pancreas starts to work again and insulin is secreted normally.

Thirdly, and perhaps most importantly, type 2 diabetes is both preventable and reversible, not chronic and progressive. It is not a life sentence. This new dawn carries tremendous hope for those afflicted. We only need to understand the underlying disease and apply our new knowledge. Our treatments were ineffective, and so we believed progression was part of the natural history the disease itself. Instead, the culprit was our fundamental misinterpretation of this disease.

Towards a Cure

In any disease, success depends upon identifying and treating the underlying cause, not the symptoms. For example, a bacterial infection may cause symptoms such as fever. The root cause is the bacterium and fever is only a symptom. To cure the disease, you must address the root cause, in this case, an antibiotic to kill the bacteria. This also successfully eliminates the symptom of fever.

But if you simply treat the symptom, there is no benefit. In this case, you can treat the fever with acetaminophen, but the infection persists unabated and may eventually kill you. Once you stop taking acetaminophen, the fever returns because the disease has not been treated. This may seem like the disease is chronic and progressive, but only because the treatment is incorrect. Treating the fever is only symptomatic treatment, since the fever is not the actual disease.

The exact same problem exists in type 2 diabetes. The root cause is hyperinsulinemia, and the symptom is high blood glucose. Type 2 diabetes, and indeed all the manifestations of the metabolic syndrome are diseases caused by too much insulin. Yet our current treatment paradigm focuses on lowering the blood glucose, which is only the symptom of the disease, but not the disease itself. Instead of treating the hyperinsulinemia, we were treating the high blood glucose.

The currently recommended treatments for type 2 diabetes include insulin, oral hypoglycemic drugs and low fat diets. Fifty years of experience tells us that these treatments do not cure the disease and only treat the symptoms. All these therapies are directed towards lowering blood sugar, but not the underlying hyperinsulinemia. In fact, all of these treatments raise insulin.

The treatments that are known to lead to a cure – fasting, bariatric surgery and low carbohydrate diets all share one feature in common. They are all treatments that lower insulin. Here’s comes the sudden, horrifying realization. The treatments we have been using for type 2 diabetes were EXACTLY wrong. Too much insulin causes this disease. Giving insulin or drugs that raise insulin will not make the disease better. It will only make it worse!

It is no different from treating alcoholism with more alcohol. Treating alcohol withdrawal by giving more alcohol will certainly improve symptoms in the short-term. But the disease, the alcoholism will get worse.

This is precisely what happened. Type 2 diabetic patients are generally started on one medication at diagnosis. This only treats the symptoms, so over time the disease gets worse, and the dose is increased. Once the maximum dose is reached, a second, then a third drug is added. After that, insulin is prescribed in ever increasing doses in a desperate bid to control the blood sugar. But, if you require higher and higher doses of medications, your diabetes is not getter better, it is getting worse. The treatment was exactly wrong.

In type 2 diabetes insulin levels are high, not low. Injecting more insulin is not going to help treat it. Yes, in the short-term, the symptom of high blood sugar is better, but the disease, the diabetes was continually getting worse. How did we expect that giving more insulin to a patient with too much already would help? Our standard accepted treatments were precisely how NOT to treat type 2 diabetes.

 

66 Responses

  1. With a low carb, full fat diet, I have succeeded in coming off Gliclazide before Christmas and off slow release Lantus insulin a few weeks ago. I am still on Metformin. I am due to have my Hba1c test in a couple of weeks, but daily my bs levels have been volatile since coming off insulin from 5.6 to 9.1 whilst always sticking to the same diet. Is there any chance of my ever coming off Metformin if I continue with this way of eating and how can I aid this? I do sometimes do an 18:6 fast but have not tried longer than that.

    • Roger Bird

      Dear Jane, I presume that you are European by your numbers of your blood sugar. If you want Americans to understand it, multiply by 18, so your 5.6 to 9.1 becomes 100.8 to 163.8. Yikes! That is high.

      I strongly recommend that you push harder on the fasting. I just did a 7 day fast with one zero calorie (or close to it) green smoothie once a day. It was the best 1 week improvement by all markers that I have ever had, especially disposition. The longer the fast, the deeper it works. I still have 20 lbs. to go, so I still have “room” for plenty of longer fasts.

      • nathalie

        What is your recipe for your zero calorie green smoothie?

      • Lindamusician

        Roger Bird, your comment is very interesting. I would also like to know how to make your “almost 0 calorie” green smoothie, if you would be willing to share. Thanks.

    • Sounds like you are making good progress.

      There is no rush as this is a marathon, not a sprint. Our body needs time to heal itself from the years of “nutrients” overload.

      That said, I found that 18:6 fast works best when I do it over 2 consecutive days and skipping dinner instead of breakfast. That helped to lower my fasting glucose to 5.5 mmols/L (100mg/dl). Coincidentally my HbA1c had also stabilized at 5.5% from 11% and have maintained it since Dec 2015.

    • I wouldn’t even worry about Metformin. It improves insulin resistance and is the only diabetes medication to show *INCREASED* longevity. I’m not sure how much Metformin increases insulin … I’ll say it increases insulin the least out of any other diabetes medication that lowers A1c.

  2. The entire field of Type2 diabetes industry is wrong and immoral. It generates massive amount of money treating the symptom – high blood glucose. There is no money in treating the actual disease – hyperinsulinemia. They will fight hard to preserve status quo.

    But because of doctors like Dr. Fung people will know the truth and start demanding answers from organisations like ADA. Will they admit, that they were not helping and even harming patients? Maybe governments should step in?

    Any way, big thanks to Dr. Fung for another great post!

    • The government did step in and helped cause this diabetes epidemic by telling everyone “fat is the villian” and subsidizing farmers who produce corn, wheat, and soy to make those foods really cheap.

    • The truth is never widely accepted and promoted but by a few, therefore even if there is a cure to type 2 diabetes (which I believe this is) it will not be widely accepted. Of course only my opinion and I do hope I am wrong.

    • Organisations like ADA are Big Pharma funded. They will never admit anything. Step away from those.

    • But, let us face it, the cardiovascular disease and cancer industries are even worse. We live in a very corrupt society.

  3. Dr.rob

    We were just talking about that yesterday. Imagine if all obstetricians told their patients to have 2 drinks a day because it was good for the fetus or eat raw meat because it builds up the fetuses immunity! They would be sued from here to tomorrow.

    The problem is the standard of care for T2D and CAD is a low fat diet, whole grains and 60 grams of carbs per meal. You follow the standard of care, you are not liable even if there is a bad outcome, you deviate and even if your patient dies or is injured in a car accident you could be liable potentially (exaggerating).

    I really believe that many physicians mean well and while they want to support their condo in Aspen, they equally want to help people. These people want to be successful, they are used to being successful their whole lives (they were always the best in school etc). It is (I am told) very personally discouraging for physicians when they lose a patient. So how does an endocrinologist who is obviously reasonably bright to begin with, dispense such bad advice?

    I think we have been indoctrinated as a planet that a low fat especially low animal products, whole grain diet is the way to go and nothing else will work. I recently asked my husband to start eating better. Without my saying anything (despite him casually observing my diet over the last 6 weeks), he thought he would be living on dry chicken, sweet potatoes and cauliflower with oatmeal for breakfast. NO ONE HAS ANY IDEA.

    I have an older relative who has always been thin, is NOT diabetic at all. She has idiopathic peripheral neuropathy. She has been everywhere, consulted numerous top experts throughout the US and so on (she has access to the “best” care). Literally has spent days being tested, pocked and prodded. While she is reluctant to discuss it with me, when I suggested she might want to look at her diet, she got extremely upset, in a nice way said that if the experts could not find a solution then she did not want to talk about it. She said her diet was excellent and that was not the problem. I am sure her diet is chicken, egg whites and whole wheat toast with no butter but I have no idea since she would not discuss it. I figure she has nothing to lose, she lives with this pain, there is no apparent medical solution that the experts recommend so why not try something alternative?

    It does amaze me that people realize that a 50 mcg pill can make a huge difference for better or worse but it does not occur to most people that the pound of food they eat every day can as well.

    If insulin is the cause, then why not create a pill that reduces insulin instead of increasing it?

    • I like this and wonder the same thing
      (If insulin is the cause, then why not create a pill that reduces insulin instead of increasing it?)

      • Because that would be bassackward. Why would you want to
        eat CRaP and then take a pill? Lowering insulin will just cause
        your body to leave glucose in the blood. Why not just eat the
        foods that don’t give you high blood glucose?

        • Not everyone can or wants to. There is already a medicine that causes excess sugar to depart through the urine. Combine that with lowering insulin and you have something. According to what I have read, it is the insulin resistance that happens first not the high blood glucose. Not every obese person is diabetic. They eat plenty of CRaP and are ok. Why shouldn’t diabetics? If someone is diabetic WHY do they have to give up Pizza forever? Whether they do LCHF or Ornish they still have to give it up. Sorry but what passes for pizza in LCHF world ain’t no substitute.

          Plus right now people are literally dying by the CRaP diet or the SAD diet or even the ADA diet and its 180 grams of carbs a day with added insulin. At least if big pharma can make money on a drug something will save these people.

          Eating CRaP should not be considered a crime punishable by death especially when every moment on TV you are encouraged to consume all sorts of CRaP. There are people who if you give them a choice between a pill and a diet will take the pill every time. A friend has SEVERE allergies and I told her about a suggestion I had read online. Nothing extreme, one was a teaspoon of raw local honey (which I bought for her a year ago!) it is still sitting in her cabinet untouched. HONESTLY, HONEY, what could be bad (if you are not on LCHF). The other suggestion was seafood. She nixed both without even trying it.

          Think of it this way, T1 and T2 are opposites. So if the treatment for T1 is insulin, then the treatment for T2 is a pill reducing insulin other than by fasting or LCHF. Obviously if it were so simple someone would have invented it already. It makes sense especially in the pre diabetes stages

          • Some people can stand more Crap than others. If one settles for that, one will survive until old. The others won’t. Maybe that is the whole meaning. In The New Brave World all peasants will eat Monsanto’s owned grains and will be relative healthy. Only the rich ones can have animal foods.

          • Brigitte

            Lori, insulin resistance does not just happen. It is the result of chronically elevated blood insulin levels which are the results of chronically elevated blood sugar levels, usually from eating too many carbs at any one sitting or eating carbs too frequently. Insulin levels, insulin resistance and blood sugar are some of the larger cogwheels in a complex metabolic clockwork.
            The easiest way to stop this clockwork moving ever forward is not replacing one wheel with a different sized one that stops a wheel spinning but moves two or three other hitherto static ones and therefore causing unplanned movements. The easiest way is to take the battery out of the clock.
            If carbohydrates is the battery, remove them from the metabolic clockwork.
            A medication that has a desired main effect will also have undesired side effects. For this reason there is not simply a pill to reduce insulin. It would have side effects we might like even less than DM T2 and it would leave high blood sugar levels which are not healthy either.
            All human action has consequences. It is our choice to eat crap and suffer the chronic progressive T2 of textbooks, or change our eating and be free of T2 and medication. What we should all have learned by now is that we cannot do as we please and expect someone else (read: the pharma industry) to sort it out with no ill effect for us.

          • Brigitte While I agree with you for myself, the reality is many do not do as they please, instead their doctor tells them eat 60 grams of carbs at each meal and they do and keep getting sicker and are told that T2 is progressive and unstoppable and that is why. NOT the CRaP they are eating. How is that a choice? Many people I know do not have the capacity to research.

            To be honest, while LCHF and IF have really been working well for me for about 2 months, there is a part of me that wonders if this is the best and safest diet for me. If I stop LCHF, will my ability to metabolize even moderate carbs be compromised? Quinoa and Lentils for example. I have no idea. How will my lipid profile look in a few months? I need to apply for new insurance, will it appear normal? Am I healthier now than a couple of months ago? I feel better but who knows. I would like to think so but I am not an expert. I am nervous eating all sorts of cheeses, am I helping myself the right way?

            There are drugs, including insulin for T1s that have saved lives. We have grown up seeing that. It takes a lot for the average rule follower to walk away from their doctor and their drugs and claim to know better given their extensive training as a real estate broker, construction worker or accountant as in no medical training.

            I saw it for myself when an older relative was hospitalized for a heart attack. The intervention was amazing and made a ton of difference, all the coconut oil in the world would not have saved him without a triple bypass. The dietary advice in contrast was horrendous. He still sees his cardiologist but does not have an endocrinologist because he now believes none of them have a clue.

            Given the wheat and corn and soy industries and big pharma, do you really believe LCHF will ever catch on? Even if it does there are going to be people who cannot do it. So why not give them an option that will stabilize them. Let pharma advertise it so the message gets out.

            As for insulin resistance, it seems from what the Dr. and others have written, insulin resistance is the first step. Obesity follows insulin resistance, not the other way around. It has been stated time and again this is not a disease of glucose but of insulin.

            I recently read it begins in childhood for many which is very scary. Children who were on a LCHF due to seizures I THINK have problems with growth. So for example I have an overweight preteen who has not had his growth spurt yet. I have no idea what to do with him in terms of diet. Of course I would never put him on a medicine even if one existed but it does make me wonder.

            What is even stranger is he was thin until the age of 7 and then suddenly he ballooned over the course of a winter and has not lost weight since. So I believe something must have triggered it, whether it was discovering chicken nuggets, antibiotics that destroyed his biome, insulin resistance I have no idea.

            If anyone has suggestions for my son I would love to hear them!

        • Removing Insulin causes this little thing we doctors call Ketoacidosis. https://www.youtube.com/watch?v=lgqsIL29YOQ Nasty stuff. But Bill, I love your creative thinking. 🙂

  4. Marlese Wacek

    Keep up the great work and continue spreading the word on how to cure type-2 diabetes and insulin resistance.

  5. Srinath

    There is no money in fasting. I did low carb, then accidentally fasted and then I started fasting. Completely getting rid of all problems, including high BP and inflammation that I had surgery to treat. Yea, plantar fasciitis in right foot I had surgery to treat and still used to have mild pain. Left was pretty bad too, and 2 days into a fast, it all disappears. Too bad it comes back even with very low carbs. Anyway, 90% of physical problems are likely due to hyperinsulenimia. Fasting will cure it. That will make pharmaceutical and food companies broke. Simple. I like that goal on all fronts.

  6. Once again you have explained so it can be understood. That is what I truly like about your blog you write so those of us without medical degrees can get it. I appreciate your blog and look forward to each installment to keep me chugging along to the best health of my life so far. Have a ways to go but I can see the light. Thank You!

  7. Dr. Adrian

    I also wonder if the rise in eating disorders generally has been in part due to the change over to low-fat. I worried at first very much about how people with eating disorders would respond to this diet, and especially to fasting (obviously most people’s disordered eating goes in the direction of overeating or overeating and purging, and I have long believed anorexia to be a physiological response to foods the body “simply does not want to consume”)

    I believe firmly now after some months of resisting the idea (often quite angrily!), that if the stage is set correctly, the person has good medical and behavioral care (I hate the term “behavioral medicine” but most disordered eating is really in my opinion about an adaptive response to food), learns to eat properly, and eases into fasting if it would cause any kind of anxiety (not eating obviously becomes associated with “deprivation” and that’s hard enough to take with the SAD), anyone can make this transition.

    I have! 50 pounds later, no longer obese BMI category, in ketosis, and HbA1c down from 5.9 to 5.2. But I had, I believe begun the 3-year “pre-diabetic” stage after about 15 years of overweight/obesity. Now that I really *understand* the process thanks to Dr. Fung, Drs. Eades, and Dr. Eefeldt, I would no more go back to regularly eating refined carbs and sugary fruits and vegetables than I would start smoking again.

    Many thanks to everyone at the IDM for what I believe will indeed turn the tide back toward food as something we can enjoy and live on. It will be a struggle, but as Dr. Fung has said, the new day has definitely dawned.

  8. Amen, This Blog posted here today should be a mandatory read for to every medical provider and every medical student. If they want more information/proof they can read his books and previous blogs and see Dr Fung’s logic behind this issue. I am amazed how he writes in such practical terms so the laymen can understand, that is a gift. I feel fortunate to have run across his name and have purchased and read every book and blog he has written. I myself are in the Pharmacy field and see how far off we are treating Type-II diabetes. But big pharma is too embedded in academia, the FDA, and will require a massive effort to unseat their views. Get this man on as many TV shows, Blogs, and newspapers as possible, and get the truth out. Thank You Dr Fung!

    • Bob, I think that is kind of conspiratorial. As Dr Taylor stated when asked essentially the same question, it will take until Medical Schools update their text books as the ones they use now predate the work Dr Taylor and others have done proving T2D is reversible/curable. Doctors, pretty much are bound to practice medicine as they were taught. Dr Fung explained this as it related to his early days practicing medicine. He concluded what he was doing clearly was not working.

      By not effervescently praising Dr Fung over the work of Dr Taylor and others, in no way detracts from Dr Fungs work to aggregate and explain the results of others research. I think the work he is doing with IDM and this periodic blog is outstanding. I refer to Dr Taylor and Dr Kraft as these two actually did the original research and made the original conclusions. One might say Dr Fung has peer reviewed their conclusions in a practice setting vs clinical trials with subjects and controls.

  9. So is this like alcoholics in the sense they can never ever again take a drink of alcohol. Are we to stay Keto forever and never ever again taste a twinkie☺

    • Yes. You will not heal by going back to what broke you.

    • I am not a dr but I do not believe that is true, one must stay on a keto diet. I believe individuals have a capacity to tolerate carbohydrates. If you blew past your tolerance long enough to acquire T2D, which takes over a decade, yes you will become diabetic again. As Dr Taylor explains in “Reversing the Irreversible”, individuals have a set point of BMI, in all of his clinical trials once the individual drops below their BMI set point their T2D disappears as the pancreas and liver resume normal function. So long as one stays below their BMI set point they remain T2D free. Alcoholism is never cured, only managed. So, in theory, you can resume a less restrictive diet. In fact, in the work Dr Taylor et al, have done, their diet was not keto at all. My diet was not keto at all when I dropped 125lbs and A1C went from 8.5 to 5.5. I went from BMI of 43 to 25.

      • And that was well over a year ago and my A1C has stayed mid 5’s. I am trying to do keto and IDF now to get A1C to mid 4’s and BMI to 20. That should, in theory, give me far more dietary latitude for occasional excursions into ‘treats’. But I don’t want to eat like a bird for the rest of my life.

        • Nice weight loss Walt!

          My BMI was 25 at its highest twenty years ago, and I was a mess. Now @ 22 and my body is humming along with a LCHF/lazy keto approach. Maybe your A1C will normalize somewhere below 25 and you won’t have to get to 20, which as you know is quite low.

          Re eating like a bird, do you visit r/keto on reddit? There are lots of recipes and good conversations there on how to fit in treats while staying in ketosis.

        • I treat myself often, but not with food.

    • no, after you heal you will be able to eat relatively high carb, high fiber foods. I eat potatoes, carrots and beets in abundance, a lot of natto, and some beans and squash. The high fiber keeps the GI low, but additions such as apple cider vinegar in a root salad, or sauerkrauts of all sorts, will further lower the GI (Dr Fung himself states this often). Today I have chickpeas with a preserved lemon ground, and preserved olives and mixed in for lunch. Still no grains and sugar.

  10. I still think the use of ‘reversal’ as in Dr Taylor’s “Reversing the Irreversable” or as Dr Fung uses it above, and the use of “towards a cure” detracts from the notion of “CURE”. In other words either it is or it isn’t. As my ex doctor told me “good, you’re managing it with diet and exercise”. No, I believe I’ve cured it, much like an STD, it was treated and now it’s gone”. As weird as that analogy is, it’s valid as curing an STD doesn’t mean it can’t be re-acquired. But that is distinctly different than saying it’s being managed by…in that case, safer sex. Again, with that same analogy, there are some that can’t be ‘treated and gone’ only the symptoms masked. So, again, why language is important, is it ‘treated’ or is it gone? But I am not a Dr. I believe a current clinical trial being conducted by Dr Taylor is ‘how long, exactly, it remains gone”.
    Full disclosure: I’ve never acquired any STD. I toyed with using ‘common cold’ but they don’t get cured.

  11. I wonder if there are phases the liver and pancreas go through during a process of losing weight, being on low carb, and fasting? I had my insulin tested in June of 2015. It was 3.8 uIU/mL. This was a “normal” 12 hour fast. I then had my insulin tested again in September 2015, after 4.5 days of fasting (blood test Friday morning, had not eaten since Sunday evening), and it was <3.0 uIU/mL. That was lower than the test could go.

    I had another 12 hour fasting test taken in October of 2016. My insulin was 33.0 uIU/mL, and I was in KETOSIS that morning, as verified by a blood ketone test. I was shocked. I then went on vacation, where I ate a few more carbs than I normally would. I came back and had a test two weeks later (again, a 12 hour fasting test), and my insulin was lower but still high: 23.8 uIU/mL.

    What I theorize is that values for insulin must fluctuate as the pancreas (and liver) adapt to intermittent fasting and low carb diets. I had fasted quite a bit before the October 2016 test, but kept my meals stable before getting the test taken. Perhaps I caused fat to come out of my pancreas, therefore leading to increased insulin?

    I've been eating low carb for 3+ years, although I did try resistant starch for a bunch of months. I was eating very low carb for a while before October 2016, though. My weight was between 195-200 in October 2016 and is between 200-205 today. However, I learned before October 2016 that I had two torn rotator cuff muscles (both shoulders) and I had not been lifting weights for months due to shoulder pain. I had shoulder surgery in November 2016, and had my arm in a sling for 6+ weeks. I did no exercise whatsoever for 4+ weeks. I'm back to lifting weights now, and my strength has increased dramatically, literally by 5 or more times for shoulder and chest exercises, and less but significant for other body parts. For instance, for leg presses, I now have to use a different machine than the one I started out using, as I can lift the entire stack on the original machine, so I went from less than half the stack to all of it over the last few months. I'm still wearing the same size pants, with no problems.

    Unfortunately, I don't get my insulin tested enough to know what's happening. I do take blood sugar almost every day and many times multiple times per day, but I have to pay for insulin tests out of my own pocket. At $90 or so (though I've found cheaper prices now), I don't get them tested that often.

    Has anyone else experienced high insulin levels while fasting and being on low carb?

  12. Doctor Fung, thank you again for another highly instructive and informative article.

    I am convinced that after eating a low-fat high cabs diet for 25 years I worked my way toward pre-diabetes (A1C 5.9/fasting glucose 112), and things were not getting any better. I was increasingly frustrated by my inability to control my weight even while being active.

    Several years ago, I trained and ran a half marathon. Training took me around 5 months, especially since I had never run long distances. I remember trying to eat “healthy whole grains” and other carbs to ensure I had enough energy to train and to complete the event. On my long run days, I took my energy packs (pure sugar concoctions) with me and water to fuel up during my long run, which usually was over 10 miles. I was expecting my weight to go down. But the opposite happened: I gained weight!

    After evaluating the totally depressing results of such a major effort from my part, I realized that there was something wrong with my metabolism, a thing my primary care physician had not addressed. I don’t think he even had a clue. I have since fired him and went looking for another physician who understood metabolic issues and who treated without drugs but with a ketogenic diet.

    One day, I was doing research online and I came across your YouTube videos about fasting, and I thought your explanation of the condition insulin resistance, fit me to a T. I tried fasting for a 24 hour period, and I felt great. I think because I had long time ago switched to a ketogenic lifestyle (which was beginning to show its positive effects in my blood tests, albeit a bit too slow for me).

    I have continued to fast on a weekly basis for the last six weeks and have seen really wonderful results with my weight. I have lost 7 pounds, but the big difference has been in inches. I have lost a dress size already. I suspect I have gained more muscle weight which explains how much better my size is. I enjoy working out now again. I do high intensity interval training twice a week and resistance training three times a week. In general, my work outs are under 20 minutes per session. I have all the energy I need to live my life and to continue to be active.

    Being on a ketogenic state also helps a great deal, because I am not ravenous on my fasting days, which are M-W-F’s for 42 hours each time. I recommend a ketogenic lifestyle to whomever is able to do it, because if fasting is part of the overall protocol to reverse insulin resistance, burning fat for fuel makes fasting easier. I have no physical symptoms when I fast. My body is burning my excess fat and I am able to live a normal life.

    I am looking forward to my next blood test in late September. I especially would love to see A1C normalized and fasting glucose at 100 or slightly better.

    • NicoleS

      Gloria – your story is so similar to mine! After my second child, I started working out hard and lost some of the baby weight although I never got down to my pre-pregnancy weight from my first child. I was also breastfeeding a lot but I still had the pooch! Doctors told me it was because of breastfeeding and once I stopped, the weight would melt off. But when I stopped, the weight just piled on! It made no sense to me! I was doing obstacle races, lifting weights and running and while I was extremely fit, the weight kept going up! I thought I was eating better than I had ever eaten in my life!

      I went to doctors, hired nutritionists and they gave me the same meal plan which I followed to a tee. Yet nothing helped! In fact the weight kept creeping up! They just said that’s the way I am built! I wasn’t super overweight or obese so I was typically dismissed with my concerns. Finally one doctor suggested I started low carb so I switched and while I felt amazing, the weight still didn’t fall off other than a few pounds. But I kept at it because I had done some research and I knew the dangers of carbs and sugar.

      Fast forward 2 years later and my weight stabilized and although I was not losing weight, I continued testing my BG which were 5.0 – 6.0 and ketones (also high), but no weight loss. I never could IF and didn’t because everything I read said not to force it and it seemed so forced to me – I never did it or considered doing it. But coming from a family of Type 1 diabetics, I was concerned by these high BG numbers. But no one had answers and didn’t seem to concerned since they weren’t in the diabetic range. But I knew that with those numbers and the increased weight combined with my family history that it was a loud warning sign! This January, I decided I needed to do more and starting researching again. Than I read Dr. Fung’s books. I started fasting a month ago and I am shocked how the weight started coming off and how many inches are moving! I feel so much better and even though I still see high fasting BG levels, I know its my body releasing fat and I am on the path of healing. Dr Fung has explained exactly what happened to me and how come despite my excessive exercising, low calories and even with the LCHF diet I was not losing weight. I was not giving my insulin levels a break and unable to access my fat stores!

      While I want weight loss, its amazing how that isn’t my biggest goal but instead my goal is to lower my insulin and BG levels and weight loss is the perk! I look forward to seeing my A1C normalize as well and watch how now my training can further improve.

      • Stephen T

        Excellent result, Nicole. Well done.

        What a pity people get so much bad advice before finally finding something that works.

  13. Ron Hunter

    Dr. Fung – here’s my challenge to you. Joseph Kraft’s radio assay / extended glucose tolerance test needs to become a standard test. It boggles my mind this is not being done more to cut off cases of diabetes before they manifest themselves.

    • Ron, a glucose tolerance test IS a standard test. It is just far more expensive than FBG, which is why they give it instead. Likely insurance companies won’t pay for it. However, if you tell your dr you want it, you can get it just you’ll be paying for it from the tester facility.

      • Ron Hunter

        Kraft does a glucose tolerance with a radioactive assay of insulin levels. He also does a 5 hour test. It gives him an insulin response curve for a person. The insulin assay can identify people who are actually diabetic but have normal fasting blood sugar and A1C’s.

  14. Dr Fung has got it all wrong, according to this video! Hard to believe there are MD’s out their spewing this garbage and propagating the falsehoods…

    https://www.youtube.com/watch?v=1cl2IX94GCI

    • Dr. Adrian

      Joe, Dr. McDougall is one of the worst snake-oil salesmen out there (unless what you meant was ironic and the garbage coming from McD, hard to tell on a message board!). My view, if you want to get an eating disorder right this minute, follow Fuhrman or McDougall. Should do the trick.

    • Yes, it’s really hard to believe, that there are such a scientific illiterates, like Dr McDougall, that are driven more by ideology, than by what’s really happening.

  15. Stevo74

    Hi Dr. Fung,

    Thank you for another interesting post. While reviewing an article on atrial fibrillation (see link below), I noticed the quote below in the conclusions. Infiltration of fat in the heart may also be a contributing factor for atrial fibrillation.

    You may have stumbled upon a mechanism for a much large scope of obesity related diseases than you originally thought.

    Keep up the great work.

    https://www.ncbi.nlm.nih.gov/pubmed/26139051

    “…Obesity was associated with reduced posterior LA endocardial voltage and infiltration of contiguous posterior LA muscle by epicardial fat, representing a unique substrate for AF.”

  16. I was able to get off my metformin after two weeks, eating low carb, high fat. I’m drinking bulletproof coffee each morning, and I’m having some stomach issues. I’m thinking, since I’m not use to coffee, that this may be affecting my stomach, so I’m going to lay off the coffee for a few days to see if that is the cause. Coffee is acidic, so that brings me to another concern. I’ve been told for years that dairy products are extremely “acidic”, so that makes me wonder if I’m becoming too acidic. I’ve been a vegetarian for 37 years, eating very little dairy products. I saw a video by Dr Eric Berg, talking about the benefit of eating this way, and he said something I had never heard before. He said people think they are “acidic”, but they are actually “alkaline”, so eating the acid forming food is actually good for the body. Apple cider vinegar and lemons are great for the body, so I’ve often questioned that, since we are already acidic, however, I was told that even though vinegar and lemons are acidic, they change to alkaline when ingested. So now…..I’m very confuseed, since I have never heard that our bodies are more alkaline than acidic, because I was alwasy told it’s the exact opposite. What does all of this mean?? Do dairy products create more acid in the body? Or do dairy products create more alkalinity? Do we strive for more acid, or more alkaline?

    • Ron Hunter

      Coffee is pretty bad on the stomach and is one of the items that is recommended that people with reflux avoid. Two things I greatly enjoy, coffee and wine both do no favors to my reflux problem.

      • Ron, please forgive the unsolicited advice, but I have had great relief also (my reflux was treated several times with upper endocsopy dilation, so I don’t know that things will ever fully heal even with best diet) is the MedSlant pillow (pricey but cheapest on Amazon). It folds in half, has very comfortable ridges as opposed to solid foam, and I manage to stay on it most of the night.

        Coffee I limit to one 6 oz cup in the a.m. with some coconut oil, and the other 2 ounces as iced coffee with lunch. Very infrequently enjoy a small glass of wine with food at least three hours before bed.

        Chocolate seems to be my worst enemy–if I have any after noon, I’ll have more trouble at night.

        Hope any of this might help, best regards.

        • Ron Hunter

          Thanks so much. Someone else told me about slant pillows. Right now I just sleep on multiple pillows. I’ll check it out.

  17. Does dry red wine cause insulin to rise?

    • According to Dr Roy Taylor, wine is metabolized as fat as there is actually very little sugar in it, per unit volume. That is still a head scratcher for me. However, on the FastingTalk podcast with Jimmy Moore (coauthor of Complete Guide to Fasting, and Meghan Ramos, the director of IDM, wine is perfectly fine to consume on a fast. That said, even fat will raise insulin, though fat does it the least of the three mega-nutrients, carbs, protein, fat, in that order.

  18. This t-shirt says everything.
    http://amzn.to/2rKrLT4

  19. Did people see the article in the NY Times from 5/03/2017?
    https://www.nytimes.com/2017/05/03/well/eat/fasting-offers-no-special-weight-loss-benefits.html?comments&_r=0#permid=22650370

    This is their write up of the JAMA article
    http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2623528

    published May 1, 2017

    Effect of Alternate-Day Fasting on Weight Loss, Weight Maintenance, and Cardioprotection Among Metabolically Healthy Obese AdultsA Randomized Clinical Trial
    John F. Trepanowski, PhD1; Cynthia M. Kroeger, PhD1,2; Adrienne Barnosky, MD1; et al

    Key Points

    Question Is alternate-day fasting more effective for weight loss and weight maintenance compared with daily calorie restriction?

    Findings This randomized clinical trial included 100 metabolically healthy obese adults. Weight loss after 1 year in the alternate-day fasting group (6.0%) was not significantly different from that of the daily calorie restriction group (5.3%), relative to the no-intervention control group.

    Conclusions and Relevance Alternate-day fasting did not produce superior adherence, weight loss, weight maintenance, or cardioprotection vs daily calorie restriction.

    Meaning Alternate-day fasting does not produce superior weight loss or weight maintenance compared with daily calorie restriction.

    I did point out that it missed the point of metabolic adaptation.

    • Mags299

      Hello Walt,

      How do you square this phrase from the write-up?: “Participants in the alternate-day fasting group ate more than prescribed on fast days, and less than prescribed on feast days, while those in the daily calorie restriction group generally met their prescribed energy goals.”

      To me that says (along with the 25% of energy needs on fast days, ironically not in quotes in the text) that they did not actually follow a fasting regime alternate-day or otherwise. Just a alternate-day calorie restriction.

      Now I am all for starting with the little 500 calories during a fast day as the Fast Diet suggests as a way to ease into the idea, especially psychologically. It is what allowed me to start and get through the initial adjustments to getting ‘angry’ when hungry at the end of my 24hrs. But after time, my system adjusted, my fears too, and I didn’t need to do the 500 calories. This coincided nicely with plateaus in my weight loss, as I became more comfortable with fasting longer or more absentmindedly (skipping a dinner on a non-fasting day because there was nothing to eat and I wasn’t really hungry anyway–unheard of for me before where I would make random things “go together” because you have to eat, right? Nope, no not all the time like clockwork!) and just giving up breakfast as it is too time consuming and/or the easiest thing is a bowl of carbs (except on vacation, love a good full breakfast.).

      In six months I lost 27lbs, 6 cm around my waste, stopped metaformin and my blood work has never been better. I live in France so covered for ultrasounds of my liver and pancreas: not a spec of fat there. (Had to do that with my general practitioner as I “fired” my diabetes doctor who would not stop the meds despite my blood sugars being normal.

      It has been 2 1/2 years and through three xmases, multiple vacations and special occasions, I have maintained both the weight loss +/-2 lbs and the reversed diabetes. Never ever felt deprived. As time goes on the fasting gets shaken up. Started IF 5/2, went to IF 5/2, 4/3, and then36hs, 48hr, till now psychologically I find I decide to do a three day fast once a calendar month the way you might think ‘I’ll watch a movie today’. (I note that that ‘fearlessness’ on my part coincided with the reading of Dr Fung’s guide to fasting which gave me answers to my fears!) Always keeping the 5/2 as a base.

      So, on the face of it, they have told me in their summary that the Alternate-day fasting was not really fasting at all, so not swayed by the conclusion.

      • Mags299, that is really great. Thank you so much.

      • Mags299, I can’t square it. I also can’t get the full text without paying for it, which I am not inclined to do. The summary didn’t say ADF doesn’t work, just it doesn’t work any better. That, I actually believe as I lost 125lbs on the so-called CRaP diet and went from A1C or 8.5 to 5.5. The issue I have with Fung’s rhetoric is the denigration he shows for all things not in his story-line. Kevin Hall is a reearcher, endocrinologist, PhD, if not MD, and the best Dr Fung can do is “here’s $5.00 go buy yourself a clue”. I believe people on here are desperate for salvation and they will take it any way they can get it. None of this says Dr Fung is wrong, simply that he is not necessarily right. He, himself, does say “all diets work and all diets fail”. Further he states even on IDF people will hit a plateau. Further, he says the plateau is the body lowering one’s metabolism to match or drop below, one’s caloric intake. I’ve been listening to the Jimmy Moore (coauthor of Complete Guide to Fasting) and Megan Ramos and Dr Fung podcast. They routinely contradict what’s in Obesity Code and CGF. And, make no mistake, I want to believe too. It’s difficult to not doubt when you contradict your own books. As for your last sentence, that was one of the contradictions, regarding what to do on fasting days and from what Megan and Jimmy said, it should be fasting approved liquids only. That contridicts Dr Michael Mosley (5:2 and 8 week blood sugar diet fame). For myself, right now I eat supper only and it is generally under 1000 cals. I haven’t gained any weight, haven’t dropped any further either. In CGF they specifically call out a 20 hr as well as 24 hr intermittent fasting regiment. On the podcast they say, “no, that’s bad” Predating CGF the 20hr fast is called the “Warrior Diet” and, as I recall, is talked about in Eat, Fast, Eat. So it’s very confusing for me. Also, in that clinical trial it doesn’t deal with insulin or FBG at all, merely as a weight reduction strategy. Nor did they discuss metabolic adaptation.

        I thought it was an interesting data point people may not have been aware of. Up top, there is reference to sugar curing T2D. T2D is not caused by sugar, it’s caused by insulin and one responder said there is documented ‘proof’ that what the Dr said had been documented. Dr Fung talks about people on a high starch (turns to sugar) diet and virtually no weight or diabetes problems and people on all fat no carbs with no systemic problems. So that Dr is not a heretic merely not singing the “Dr Fung is my hero” song. What’s scary is not what the NYT’s wrote about on May 3rd, it’s the propensity of people to cry ‘heretic, heretic’. Dr Roy Taylor, who was the guy to prove T2D was curable and Dr Fung almost refuses to mention, proved that, over and over again, with an 8 week protocol of 3 Optifast (slimfast) packets and a small salad per day. Hardly keto and no fasting. In 8 weeks the avg weight loss was about 33lbs.

        It’s really important people not single source the information they get, either political or medical.

        • Oh, in Dr Taylor’s protocol, virtually 100% cure rate. In subsequent trials expanding length of T2D vs cure rate, the longer one has lived with T2D the less likely it is for a complete cure, but there is a consistent, regardless of length of T2D everyone improved. The cure rate drops as T2D duration increases. There were a few that had T2D for 30yrs that reversed it, but not all of them.

          • Aaron

            Hi Walt and Mags299,

            I think the point missed in the study and the article, which Dr. fun points out somewhere, is that even though both groups regained their approximate weight back, they did so with increased muscle mass and decreased body fat percentages. This with the history of lower insulin production created a situation where they were healthier.

            My wife has noted Dr. Fung’s sarcasm a few times to me also. i thank that both of you pointed out the other important factor, like not true fasting and what type of diet was returned to.

          • Aaron, I don’t recall seeing any Dr Fung comment at all. That study just wrapped up. Yes, they didn’t address several thing. They didn’t say ADF didn’t work, simply, by what they were measuring against, it didn’t work any better.

      • Mag299, ditto, congratulations. As the saying goes, how you get there is far less important than, that you got there! But, as they say, nothing succeeds like success!

  20. Is there a good link somewhere for what the various numbers in a fasting serum insulin level test are considered good/normal/bad/terrible ? – I’ve seen reference to the difference between 2 uIU/mL and 8 uIU/mL being statistically significant in correlation with insulin related disease incidence, but the provider that administered my test recommends 17 uIU/mL as the “high” cut-off, and measured mine as 36 uIU/mL (with a fasting glucose level of 80 mg/dL, so in the considered normal level) – I don’t seem to be able to find anything that discusses a number that high!

  21. Awesome explanation, as always! Very simple to understand and easy to visualize. It should help many people! Thanks for sharing your knowledge!
    Angela

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