Understanding Joseph Kraft’s Diabetes In Situ- T2D 24

posted in: Diabetes, Health and Nutrition | 62

Joseph Kraft is a medical doctor who measured over 14,000 oral glucose tolerance tests in his lifetime. This is a standard test to measure the blood glucose response to a standardized amount of glucose over 2 hours. The difference is that he measured over 5 hours and included blood insulin levels. A summary of his work is here and Prof Grant also reviews it nicely here. Ivor Cummins, The Fat Emperor, has also reviewed it nicely here

What Dr. Kraft had discovered is that you can make the diagnosis of type 2 diabetes much earlier than the standard OGTT by measuring insulin. The OGTT itself is meant diagnose T2D earlier than blood glucose by measuring the blood glucose response to a 75g load of ingested glucose.

But people with normal OGTT may still have an abnormal insulin response. Those people who respond with excessive secretion of insulin to 75g of glucose are at very high risk of eventually developing T2D as well. So the insulin response is even earlier, which means you can diagnose ‘diabetes in situ’, which means incipient diabetes.

Let’s think about this for a second. This makes a lot of sense. If you simply wait until blood glucose is elevated, then you have T2D, no question. But if you have normal blood sugars, then you may still be at risk of diabetes (pre-diabetes). So, we give a big load of glucose and see if the body is able to handle it. If this is negative as well, this does not yet mean everything is normal.

If the body responds by very high secretion of insulin, this will force the blood glucose into the cell and keep the blood glucose normal. But this is not normal. It’s like the trained athlete who can easily run 10K in 1 hour and the untrained athlete who must dig deep and use all his effort to do so. Those people who need to produce prodigious amounts of insulin to force the glucose back to normal are at high risk. This makes perfect physiologic sense. But there’s a much deeper implication to this:

HYPERINSULINEMIA PRECEDES HYPERGLYCEMIA

This is very important. Consider our two different paradigms of insulin resistance – the ‘internal starvation’ model and the ‘overflow’ model. In the standard ‘internal starvation’ model, some unknown thing (inflammation, oxidative stress etc.) causes IR, which blocks glucose from entering the cell. It looks like this.

IR –> hyperglycemia –> hyperinsulinemia

This is completely incorrect because this model assumes that the hyperglycemia PRECEDES the hyperinsulinemia, which Kraft showed to be untrue. According to the this theory, we still need to find the mysterious boogeyman that causes IR. There are those, for example that claim dietary fat causes IR, others say vegetable oil, inflammation, oxidative stress, genes etc. But it simply is not correct because the high insulin comes first. So therefore the high blood glucose cannot CAUSE the high insulin.

But according to the ‘overflow’ model, things look like this.

Too much sugar –> hyperinsulinemia –> fatty liver and IR –> hyperglycaemia

The implication of Krafts pioneering work is this – The ‘Internal Starvation’ paradigm is completely backwards. Think about this. If we think that T2D is the result of internal starvation, would we expect internal starvation to look like it does? (Large waist, obesity, fatty liver) What part of that looks like internal starvation of cells? This means that the high insulin causes the high blood glucose (symptom of the disease). Therefore, the proper treatment of T2D is to LOWER INSULIN. How? Drugs don’t do this, in general. It would require dietary changes – LCHF and Intermittent Fasting. What Kraft demonstrated was that the disease is NOT insulin resistance. The disease is HYPERINSULINEMIA.

This is ‘internal starvation’?

Overflow paradigm

Picture a subway train in the middle of rush hour. Each train stops at a station and upon getting the ‘all clear’ signal, opens its doors. Some passengers leave but most go into the train on their way to or from work. All the passengers go into the train without problems and the platform is empty as the train pulls out.

A cell works in an analogous method. When insulin gives the proper signal, the gates open and glucose enters the cell in an orderly fashion without much difficulty. The cell is like the subway train, and the passengers are like the glucose molecules.

When the cell is insulin resistant, insulin signals the cell to open the doors, but no glucose enters. Glucose accumulates in the blood, unable to get inside the cell. In our train analogy, the train pulls into the station, receives the signal to open the doors, but no passengers enter the train. As the train pulls out, many passengers are left on the platform, unable to enter the train.

Why does this happen? There are several possibilities. Under the ‘lock and key’ paradigm, the interaction of insulin with its receptor fails to fully open the gate. This leaves glucose outside in the blood while the cell experiences internal starvation. In the train analogy, the conductor’s signal fails to open the subway doors fully so passengers are unable to pass through. They are left outside on the platform, while the inside of the train is relatively empty.

But that’s not the sole possibility. What happens if the train is not empty, but already jam-packed full of passengers from the previous stop? Passengers are crowded and waiting on the platform. The conductor gives the signal to open the door, but passengers cannot enter. The train is already full, so passengers are left waiting on the platform. Not because the door failed to open, but because the train is already overflowing. From the outside, it appears that passengers are not able to enter the train when the door opens.

The same situation can happen in the cell, particularly the liver. If the cell is already jam-packed full of glucose, then more cannot enter despite the fact that insulin has opened the gate. From the outside, we can only say that the cell is ‘resistant’ to insulin’s urging to move glucose inside. But this is not a gummed up ‘lock and key’ mechanism. This is an overflow phenomenon.

In the train analogy, what can you do to pack more people into the train? One solution is simply to hire “subway pushers” to shove people into the trains. This was implemented in New York City in the 1920’s. While these practices died out in North America, they still exist in Japan, where they are called “passenger arrangement staff”.

Insulin is the body’s “subway pusher”, shoving glucose into the cell, no matter the consequences. As glucose is left outside the cell, in the blood, the body produces more insulin for reinforcement. This extra insulin helps push more glucose into the cell, but it becomes ever harder to put more and more glucose inside. In this case, insulin resistance causes compensatory hyperinsulinemia. But what was the initial cause? Hyperinsulinemia. It’s a vicious cycle. Hyperinsulinemia leads to insulin resistance, which leads back to more hyperinsulinemia.

Let’s think about the liver cell. At birth the liver is empty of glucose. When we eat, glucose enters the liver cell. When we don’t eat, or fast, glucose leaves. With persistently high insulin levels, glucose keeps entering the liver cell. Over decades, glucose slowly fills the cell until it is now overflowing like the congested subway train. When the gate opens for glucose to enter, it is unable to do so. The cell is now insulin resistant. Hyperinsulinemia creates the insulin resistance.

To compensate, insulin levels increase and like the Japanese Subway Pushers, tries to push more glucose into the cell by force. The insulin resistance creates hyperinsulinemia, the very thing that created it. This works, but only for a short while, because eventually there is no more room for the glucose. The vicious cycle goes round and round, worsening with each iteration.

The cell is not in a state of ‘internal starvation’, but rather, it is overflowing with glucose. As it spills out of the cell, blood glucose levels increase. Insulin’s action on glucose is being resisted. But what happens to insulin’s other major job to increase new fat production or DNL? If the cell is truly resistant to insulin, DNL should decrease.

But the cell is overfilled with glucose, not empty, so there is no reduction of DNL. Instead, the cell is producing as much new fat as possible to relieve the internal congestion. The action of insulin to increase DNL is not being resisted, but enhanced. This paradigm perfectly explains the central paradox.

On the one hand, the cell is resistant to insulin’s effect on glucose. On the other, insulin’s effect on DNL is enhanced. This happens in the liver cell, with the same level of insulin and the same insulin receptors. The paradox has been resolved by understanding this new paradigm of insulin resistance. The cell is not in a state of ‘internal starvation’, but rather a ‘glucose overload’ one.

As the liver ramps up DNL to deal with its internal congestion, more new fat is created than can be exported. Fat backs up in the liver, an organ not designed for fat storage. This disease of fatty liver is intimately related to the overflow problem of insulin resistance.

Understanding this new paradigm is critical. According to the old ‘lock and key’ paradigm, the treatment of T2D involved hiring more subway pushers to shove even more passengers into the crowded train. This is analogous to giving more insulin to patients, even though we already know that insulin is too high.

If we understand the ‘overflow’ paradigm, we see that the logical treatment of type 2 diabetes is to empty out the train. How? LCHF diets, intermittent fasting. In other words, type 2 diabetes is essentially just a disease of too much sugar in the body. The only logical treatments, therefore are to

  1. Stop putting sugar in (LCHF)
  2. Burn the sugar off (Intermittent Fasting).

That’s all you need to know to reverse type 2 diabetes.

62 Responses

  1. I was discussing medical problems with a doctor years ago, and he told me that “there’s no such thing as pre-diabates”.

    Oh. I guess there is.

    • http://www.mayoclinic.org/diseases-conditions/prediabetes/home/ovc-20270022

      Your doctor needs to get hit with a cluestick. It’s not controversial AT ALL.

    • Actually, he might have been right. “Pre-diabetes” might as well just be called Diabetes. Calling it “pre” makes people think the the pathology is sometime in the future, whereas it’s already upon them.

    • In the 1960’s two separate doctors told me that exercise was bad for my health.

    • Not defending the doctor, but these terms, ‘diabetes’ and ‘pre-diabetes’ are nothing more than relatively arbitrary figures that are applied in response to demographic statistics.

      We’re all on the diabetes continuum to some point, either at the low end with good insulin sensitivity and energy partitioning capabilities or at the other end, with full blown diabetes and such damage to the beta cells in the pancreas that we can only ever manage the condition, not reverse it.

      The only reason you become ‘diabetic’ or ‘pre-diabetic’ is because someone decides what those numbers are. You obviously are not pre-diabetic if your numbers are even 1 below the threshold. 1 above it…wow, you’re diabetic.

      Now of course, I suspect those threshold numbers have changed a lot over the years, as poor blood sugar control and increased insulin resistance has started to show in more of the population.

      It’s the same with cholesterol numbers. what was once normal cholesterol is now high cholesterol, what was once norma blood pressure is not pre-hypertension.

      I’m not saying the concept of pre-diabetes is wrong at all, but what does that make me? Pre-pre-pre-diabetic? I don’t know 🙂

      I kinda understand the rational though. Either you are diabetic or you’re not, but as I mentioned, that threshold number will probably change in the coming years, so normal today becomes pre-diabetic in 5 years etc.

    • Years ago I had a doctor say that pre-diabetes is like being almost pregnant. A woman can have a fertile body that enhances the chance of pregnancy–but fertility does not equate to pregnancy. He added if you want to avoid pregnancy take the necessary steps and if you want to avoid TD2 take the necessary steps. I am sorry to say that I never asked him what those steps are. But to my credit I know now– LCHF and IF.

  2. Joseph Kraft have conclusion that much more people have diabetes disease than is known now. No one wanted to buy that. What if we say that the diabetes type 2 is not a disease att all? It could be said that it is bodys natural way to react to too many sugars like skin is reacting to too much scratching. Some people can stand up it longer and some not so.

    To say that diabetes 2 is not a disease moves responsibility back to people themselves and away from Big Pharma and their drug pushers. Doctors job would be consulting people like you are already doing.

    • There’s plenty of responsibility with doctors — anytime they’ve given misguided advice to patients, or prescribed the wrong medicines.

  3. And to think, the common advice to newly-diagnosed diabetics is “eat frequently, eat carbs.” Mind-boggling.

  4. The only thing I would add is to your very last sentence…
    “That’s all you need to know to reverse AND PREVENT type 2 diabetes”
    You hit another one out of the park, doc!!

  5. Freeman Brown

    “This is completely incorrect because the hyperglycaemia PRECEDES the hyperinsulinemia.” I think that you wrote this backwards.

    Dr. Jason Fung: I’ve tried to clarify in the text. I meant that the ‘lock and key’ paradigm, which assumes hyperglycaemia precedes the hyperinsulinemia, is wrong.

    • sten bjorsell

      The text above is fine: “This is completely incorrect because this model assumes that the hyperglycemia PRECEDES the hyperinsulinemia,…”

      You got it backwards by not reading/including “this model assumes”:

  6. Without a doubt we completely buy into LCHF + IF for completely reversing T2D. Which is why, on Feb 1st, 2016 we began this WOE. We did this for my husband only. Almost a year later, his T2D is completely reversed symptom wise. He had very bad gall bladder issues, and was going to have his gall bladder removed and this has been completely resolved. I had very bad indigestion and was taking Nexium constantly for it. That is completely gone. I had terrible, life debilitating Restless Leg Syndrome. This is 95% gone. A true miracle for me. We have both lost over 50 pounds and probably are withing 20 – 30 pounds of our ideal weight. We will never go back to the SAD way of eating!!!! But what I would really like to know is if my husband (who has had normal blood glucose readings for 6 months now ~ he was at 11.5 A1C mid-January 2016) had an OGTT along with having his insulin tested, would all of that be normal now? Although the thought of him pouring that much sugar into his body after spending the last year vehemently rejecting all forms of sugar is a bit repulsive to me. Any volunteers??? LOL Has anyone done these test after reversing their T2D??

    Here’s to all our Health and Well-Being in the coming New Year!

    • Sue, I’ve been on low carb for three years and LCHF + IF for about a year and a half. I have lost about 55 pounds. I want to have this test done, but I can’t find a place that would give it. No one is familiar with this test.

      I will have some carbs at times. I plan on having chocolate pudding and some bread (home made, sourdough, using Einkorn wheat) on Christmas. But I get right back on track using IF. Also, three years of eating low carb except for infrequent splurges means that I don’t get as affected by sugar/carbs as I used to. If I had sugar/carbs (eg, bread/pizza) for even one day or meal two years ago, I would overeat (LC foods) for days afterward and have cravings. Now, it’s not like that. I’m slowly losing my ability to be affected by carbs.

      • Hi BobM ~ I’ve read a lot of your responses over the last months and always find your advice good and honest! If you don’t mind refreshing memory, were you T2D? And I’m not surprised you can’t find someone to do this test. We can’t even find a doctor willing to do a fasting insulin test yet alone, do this test. I will say this, on the rare, rare occasion we having something high carb (had Asian about a month ago with rice noodles to celebrate the engagement of our son) and when we came home my husband and I tested and his sugar was a low as mine and I’m not diabetic, so that was comforting. In a way the question is mute because we will always eat like this now, but…. just curious. Thanks for you response, Happy New Year!

        • Hi Sue, I was probably close to being type 2 but was never diagnosed. I ate very low fat for many years, thinking fat was horrible and would kill me. I used to count calories and would keep my fat intake under 10% by calories, thinking that was healthy. I couldn’t understand why I could eat a large bowl of rice and beans (or pasta) and be starving 30 minutes later. I had mood swings, which lead to depression. When I was young and in college and biking, walking, lifting weights a lot, it wasn’t too bad. But when I got injured and couldn’t do any of those things, I blew up like a balloon. And even when I could exercise, I still gained weight. I’ve ridden many 60+ mile bike rides, and even that barely kept my weight in control, and as soon as I stopped for the winter, I’d gain more weight.

          I went on the Atkins diet on a lark, and after two weeks or so of hell, woke up one morning and felt fantastic. I wasn’t hungry, I had tons of energy, etc. I couldn’t believe it was true, though. The “experts” said we NEEDED carbs, especially for exercise (I’ve always exercised, no matter what, except when injured). So, I dabbled in low carb but would eat high carb after bike rides, would eat before workouts, etc., because I believed I had to. It wasn’t until I read a bunch of books in this area that I decided to try LC for good.

          I found Dr. Fung’s website about 1.5 years or so into low carb. I’d lost 30 pounds, but still felt something was missing. I was eating a bunch of times per day (again, the “experts” tell us to do this), but I still thought I was insulin resistant. I started intermittent fasting, missing breakfast two days a week. Then I tried a bullet proof coffee in the morning and missing lunch. Then I tried missing lunch and dinner, again only two days per week. I was afraid to do more. Then, I started longer fasts, 3.5 days, 4.5 days, 5.5 days. I’ve now done many 3-4 day fasts. There was definitely a transition period. I would get angry after workouts for instance. I think that was a sign of my body always being used to having energy from food. But I no longer have those.

          I never took my blood sugar or ketones in the beginning, so I don’t know what these were. General practitioners where I live do not give you HbA1c or insulin tests. I’ve had to pay for those myself. Everyone is concerned about cholesterol and ready to give you a prescription for statins, but no one cares about insulin resistance. I think it should be the other way around, but it’s not.

          I started taking my blood sugar and ketones this year. I bought the meter to test ketones, but since it tests blood sugar, too, I decided I would do that. It’s enlightening. I’ve learned that vinegar (apple cider) on an empty stomach decreases blood sugar about 10 points. An herbal tea I drink seems to increase blood sugar slightly (maybe 5 points). I usually eat similar low carb lunches, and I’ve experienced anywhere between -5 points to +25 points for basically the same meals. I rarely get over the 120s with the low carb meals I eat.

          I plan on testing before and after my Christmas meal (with sourdough bread, maybe potato pancakes, and chocolate pudding, all home made). To see what happens. I’ll try to remember to report back.

          By the way, when do you take your blood sugar after eating? I’ve heard different theories — 1 hour after finishing, 2 hours after starting. I’ve taken my blood sugar every 15 minutes after eating a low carb meal, and it seems as if 2 hours after the start is the highest readings, but the spike isn’t big enough (could be 15 points max) and the strips I find to be not that accurate, so I’m not sure. What I’d like to do is eat some sugar, and test using that. That should provide a better spike and I might be able to see what’s really happening.

          Anyway, I wish you luck.

        • BobM! Thank you for your detailed reply. My husband was diagnosed with T2D, I’m just along for the ride but love the health benefits for sure!

          We have taken our blood sugar (I am the “control group” in more ways than one my husband would say….lol) at all kinds of different times. If we are trying a new processed low carb food (like LC bread) we will test every 1/2 to see if he reacts differently than me or if our BG goes up higher than we think it should, but we are not happy at all with the accuracy of the test strips. We will test, and maybe get 119 and then using the same prick, immedicately after, squeeze more blood and get a reading of 107…. maddening! Well, again surely appreciate your response. Happy New Year to all!

      • Hi BobM,
        I want to thank you for your contributions to the comments section. I was diagnosed as pre-diabetic in June 2016 and started reading Dr. Fung’s book. But I was hungry for more information and actual stories on how people were incorporating this solution in real life – so I went through Dr. Fung’s blog and also read all the comments over time. This was very helpful – and your commentary was particularly helpful. Since June, I have lost 70 lbs doing LCHF and IF – it has been an incredible journey – my lipid profile has improved greatly, and I am no longer pre-diabetic (at least according to my A1C). I still have another 30 lbs to go, but I feel confident that I will be successful.
        Thanks!
        Shelly

        • And, of course, I also owe a HUGE THANK YOU to Dr. Fung as well!!!! Your book connected everything in a way that finally made sense to me!! Thanks for everything you do and all the time you put in to help us all!!

          Shelly

    • Sue,

      having lost 75 pounds and moved my A1C from 9.2 to under 6, I can honestly say this about OGTT: I don’t care 🙂
      I know my body reacts to carbs much better than it used to. Even without taking measure I can feel it by absence of sleepiness after an occasional carb-rich meal. I make sure I apply protective measure when I do have those occasions, by taking protein with it, by scheduling physical activity around that time, taking resistant starch a few hours before, having some apple cider vinegar later that day. It all works, I stay at my ideal weight, my A1C remains fine… so OGGT result remains kind of hypothetical curiosity for me and I feel almost nauseous just of the thought of putting all that in my body

      • And I agree to all of that. Like I said, we’re not interested enough to do the test and ingest all that sugar…. it really does matter not since we are not looking for an “out” to the LCHF, WOE. It would just be fun to know if we are really curing T2D or managing it. I believe this is a cure… might take a few months or a few years, but I do believe if you are vigilant, it is a cure. Happy New Year! Cheers!

        • I know what you mean 🙂 I for myself settled on this answer: if my current lifestyle maintains healthy blood sugar level and I can maintain this lifestyle without being miserable, for all practical intents and purposes my diabetes is essentially reversed. Both of these are true: my BG stays steady, and my lifestyle is far from miserable, it’s in fact enjoyable.

          Some advance this argument: but if you start eating all that sugar and refined carbs again, and snack every 2-3 hours, and your diabetes return, then you are not cured. I don’t buy it. If I fixed broken table’s leg and then hit it with an ax, it will break again – how does it indicate that it was never fixed? 🙂

          Detractors can argue fine points all they want; for you and me it’s a real reversal of potentially debilitating condition. Happy New Year!

    • Sue, you may not need another OGTT. Not sure if you’ve seen this video, but Dr. Ted Naiman basically echoes your misgivings about ingesting that much glucose. In his practice, he determines IR through other markers that don’t require an OGTT.

      https://www.youtube.com/watch?v=193BP6aORwY

      • Great video ChrisW, thank you so much for sharing! Happy New Year to you and yours!

        I will be sharing this video as well!

    • sten bjorsell

      Sue and Bob, if you do a sugar challenge make sure you use glucose = dextrose which is free of the liver damaging fructose, half of standard sugar. Easier is to measure waist. Healthy target is half the body length. Then continue IF while above !

  7. Dr.Fung!!
    What an AMAZING article!! So, so simple and easy to understand.

    I have a question….After eating…What is considered high glucose levels. What number am I to aim for in order to keep my insulin low?

    Thank you!

  8. Standing O, Dr. Fung. Best and clearest explanation I have read!

  9. If you simply wait until blood glucose is elevated, then you have T2D, no question.

    Yep, and the AMA tells doctors to wait until the fasting blood sugar reaches 140 before stepping in with armloads of (bad) literature, a meter + test strips, and a vial of insulin. THEN comes the instructions of how to shoot yourself–they like to use an orange for patient practice.

    Yeah–I’D like to stab an orange right about now…

  10. It seems that insulin is truly the lynchpin of the whole T2D problem. I guess the big question that comes right up is: why do some people have a much higher insulin response than others when they ingest the same ratio of macronutrients? I.e., why do different patterns show up in Dr. Kraft’s diagram. If the answer is genetic programming (afaik nothing can be done about that so far), then for those unlucky people with a high insulin response, LCHF and IF is the path to take for life. Any consistent deviation from that one-way street, will only bring them closer to diabetes.

    • Richard S Stone

      Yes, but I think the point is that really, it’s kind of the other way around: maybe only a few can manage the SAD and NOT ultimately get diabetes. Otherwise we would be looking at an entirely different medical/public health situation. And it’s not just the “obesity” issue, because some people can have “diabetes” and still be reasonably shaped.

      What also seems to be the implication of Dr. Fung’s view on this is that when people are young their cells are not yet full of the fat pushed into them by insulin. So they eat what they want and stay slim. For a while.

      And this article suggests that there is no period where you are “about to get diabetes,” because the idea is that pre-diabetes is diabetes. Your cells are either stuffed full of fat or not. The moment they are full of fat your insulin production has to be increased to get the sugar out of the blood. And then very bad things start to happen. The trick is to get the fat out of your cells so that the body can react properly to a diet with some carbs in it, produce the proper amount of insulin, and move on. LCHF and IF does that.

      And yes, it would seem reasonable, given what we know about bell shaped curves, that some people are more (or less) sensitive than “average.” And in a sense we are all N=1 sorts of experiments. But before we decide we are exceptional, do we need to take a difficult medical test, or can we just look a the number on the scale or look in the mirror?

    • Oxapodo,
      If you are familiar with any of Dr. Robert Lustig’s work, there are likely other factors than genetics to blame for the insulin resistance. High amounts of sucrose (fructose + glucose) in the diet can be both addictive and have significant impact on subsequent insulin sensitivity.

  11. An issue that I am trying to understand is – what happens next?
    You follow an LCHF diet and, lose weight and blood glucose normalises.
    But insulin does not.
    Even after 18 months .
    What do you do?

    • sten bjorsell

      Without IF it is almost impossible to lose the belly = the insulin resistance. In my case it had to be water fasting minimum 24 hrs at a time.

  12. My parent has been overweight most of their life. They eat candy everyday all day long and yet their blood glucose is normal. I on the other hand who was not overweight until after age 40 and never ate anywhere near the coca cola and candy bars they ate have high blood sugars. Not fair

    • Not fair indeed. Hate to say it, but you may have “inherited” your carb intolerance because of your mother’s poor diet (assuming that’s who you mean when you say “parent”). If you were talking mother, there’s some research that suggests that it’s possible for the mother to give birth to an insulin resistant child simply by virtue of poor diet during pregnancy.

  13. carolyn anne

    Just read the letter to Health Canada-You are a true champion!!
    I feel that the tipping point has arrived here-Am a Canadian living in London,Ont.-
    and that the importance of nutrition and diet in good health will once again be primary.Thanks to my mother we were raised onLCHF food real,garden fresh and home preserved and prepared food!
    The 200 health care providers that signed that with you should know there are thousands like me that support and follow you advice with gratitude.
    Happy New Year

    • Hi Carolyn Anne, would it be possible for you to provide a link to that letter to Health Canada? I am a lay person an have written many letters to my MP to Health Canada and the Ontario Ministry of Heaelth. I have received almost no response, except for one letter patting me on the head for “taking responsibility” for my “own health”, while otherwise ignoring the issue. To me, writing a letter to our politicians is like dropping something in a well so deep that you can’t even hear the splash when it hits the water. The I Colle ge of Physicians and the Canadian Diabetes Association have also basically ignored my letters. Perhaps it is because of my poor letter writing skills?

  14. Doug Gardiner

    Hi Jason

    Thank you for your continued sharing of your research and ideas on this subject.

    I have benefitted greatly from implementing your recommended LCHF and IF protocols

    If the overload theory is correct, why then, when the cells are emptied of sugar via LCHF and IF, does IR and type 2 diabetes remain? The bio markers for type 2 are corrected only while the LCHF and IF protocols are adhered to. Blood glucose is normalised only because none is ingested. The ability to cope with dietary sugar is still compromised after the full carriages are completely emptied. Why is the condition permanent regardless of the amount of stored sugar present? What damage to the system has been done to prevent the cells from ever returning to insulin sensitive? Many people have gained good blood glucose control with diet and exercise like myself however I have yet to hear of a single case of full insulin sensitivity being restored to a type 2 diabetic

    regards

    Doug Gardiner

    • Hi dough,

      Just to share my personal experience on lchf and if.

      I use to have metabolic syndrome and after 6 moths, my blood glucose is 5.1, my blood pressure is Std 110/70 my cholesterol is down to almost normal and Uris acid and fatty liver problem resolved.

      What 9 have done are experiments on my own using food as a medicine. I am following 2 Nobel prize wining ideas. Dr ignarto nitric oxide and auto-Nagy achieved thru fasting.

      This is my personal experiments as I understand doctors cannot claim or advise anyone without medical proof. I took it upon myself to do this wxperment on myself.

      Nitric oxide, repairs our enthodelial cell membrane. In short, my translation is it heals badically almost all of our damage cell lining. Also our damage cells are got rid off thru autophagy.also, most diabetics lack potassium and magnesium plus they are seventy dehydrated.

      So I take foods that can help me achieve these plus if.foods like watermelon, spinach, almonds, sweet potatoes, potatoes, spinach, tomatoes, seaweeds.

      And when my blood sugar goes up a bit Hugh, I just do a 20 hour fast, for a few days and I am back to normal.

      The result of my experiments are getting more and more encouraging. My recovery from fasting due to high carbo in take is getting faster. Recently my blood glucose was 6.8 and in a 20 hour fast it drop to 4.6.

      I have been binging on carbo for the last 3 months, albeit carbo that have a lot of nutrition that help my recovery from metabolic syndrome. So far, so good. In fact I have also discover I can binge on beers or wine and it has no effect on my blood glucose but affect my after bp

      Only a few times in the last 3 months have my blood glucose spike above 6.0 and it usually happens after a week of binging on carbo.

  15. Mathieu Clément

    You write that LCHF / IF will “reverse” T2D, so you mean it will “cure” it ?

    And it means that these person can then go back to a normal diet ?

    By “normal” I mean with carb intake according to their activity (probably medium-carb then), from good a natural source (no sugar) and no IF ? Which is a diet that doesn’t lead to T2D for healthy persons.

    If not, then LCHF/IF is the natural (no drugs) treatment, but not a cure.

    • sten bjorsell

      LCHF removes symptoms but wont cure metbolic syndrome. Combined with IF it is a cure when it reduces insulin resistance enough. LCHF alone did not do it for me. After normalised insulin levels (fasting insulin at least below 5), only revert to medium carb diet, not too high carb as it seems to be key cause of DB-2.

    • I am not saying that lchf and if or long term fast can cure diabetics. I am taking myself as an experiment to reverse metabolic syndrome. Thru autophagy, nitric oxide and thru upping my intake on potassium and magnesium.

      I also take vinegar and am very sensitive to the incretin effect i.e., stress. This I try to achieve thru meditation nad having. A let go attitude in life. According to researchers on the telomere length, so far the best answer is to accept what life brings you nad base on what is available studies at this point in time, this distress actually lengthen the telomerase.

      So I have combine, dr fung, telomase research nad 2 Nobel medicine prize winners into my personal experiment.

      Some may say I am grave, but we are at the frontiers of confirming this research. By the time it goes mainstream, I may be unsalvageable. So it is a risk I take. So far the results from my blood test have been steadily progressing well.

    • Richard S Stone

      Mathieu: I wonder if your question/comment is more about definitions than results? Maybe before we talk about a cure, or the meaning of “cure,” we should discuss the nature of the disease? If we are talking about measles, as a disease, that is one thing. Time alone, and proper rest, will likely cure measles. Or are we talking about something like alcoholism (and whatever that term means), as a disease? Is diabetes contagious? Or is it a function of some pattern of behavior? I obviously would argue the latter. What Dr. Fung has proposed, as I understand from his various posts and lectures, is that diabetes has a lot in common with drug dependency and drug addiction, particularly in the sense that increasing doses (of the drug) create a higher level of drug tolerance and then increasing doses for the “drug” (in this case the hormone insulin) to be “effective.”

      With that paradigm in mind the answer to the problem, the “cure,” if you will, is to greatly reduce the production of the hormone (insulin) and allow the body to recover to, and regain, its natural sensitivity to the hormone. Part of that process is going to be the gradual release and consumption of the fat stored in the various cells. That course of action I think deserves to be called a cure.

      I have to tell you that in my reading on this subject, particularly in regard to LCHF diets, many people claim that they could not live without bread and rice or cookies and cakes, etc. Sad to say, that “issue” or craving, sounds a lot like an addiction. I don’t think that people get addicted to insulin, but I simply do not know the answer to that. On the other hand, a lot of people get very determined, in a kind of strange way, to eat, or defend their consumption of, refined grass seed based carbs. If we are going to “cure” diabetes one aspect of the course is going to have to be re-defining the meaning of a normal diet.

      • Richard S Stone!!! This was so very well written! I’ve never quite thought of it like that, but I have been AMAZED at the resistance from people to change their diet who are very, very sick with diabetes. I’ve met people grossly overweight, having trouble with their eyes, pain and numbness in their feet but suggest giving up bread and you’d think someone told them you were taking their first born. So when you frame it as an addition that makes so much sense!

        My husband was diagnosed with T2D last January so it has been a year now. We IMMEDIATELY switched to a low carb diet and then shortly after found Dr. Fung and started LCHF + IF. I am not for a moment suggesting that the switch wasn’t hard and that we didn’t feel sad and deprived… we kind of did. 🙂 But not only did my husband do remarkably well (11.5 A1C ~ 4 months later 6.0 and by 6 months 5.4 with zero medication) our overall health, weight and well-being is the best it has ever been! And now that we have “perfected” this WOE we actually feel like we eat decadently. So if people could just get past the initial “pain” of switching they would be so happy!

        All of that being said, when you look at alcoholism, people lose their whole lives and sometimes their actual life to alcohol even when they know if they just quit drinking all would be fine. Diabetes is no different. Give up processed foods, sugar and starches and you’ll be fine.

        For the good of all people your last statement says it all. We need to re-define the meaning of a normal diet. Thanks for sharing.

  16. A year ago I was told that I was overweight, diabetic, poor kidney function and high blood pressure. Over the last year I have gone ketogenic and lost 15 kg (down to 80 kg at 6ft tall). My HbA1c is down to 5.6 , i.e. no longer diabetic. My HDL is 1.3. My kidney function is now normal. However my BP is still averaging 150/80, which doesn’t seem that bad for a 75 year old man, but my doctor wants to put me on medication. I am worried that the medication will adversely effect my weight and insulin levels and I’m dubious whether it will actually improve BP.

    • Stephen T

      Barry, I wouldn’t touch blood pressure (BP) medication in your case. I think there has to be a clear benefit before even considering taking a drug.

      Last November I had an above average BP reading and was advised by my doctor to take medication. I was prepared for this and quoted evidence from Dr Malcolm Kendrick’s article on this subject (spacedoc.com). My doctor’s response was simply that I met NICE guidelines (in the UK) for BP medication. I told her the evidence seemed to be clear that I would not benefit from these drugs and that there was a 1 in 12 chance that I might be harmed. She didn’t argue and made no attempt to persuade me. I got the impression that she felt obliged to follow NICE guidelines, but was quite content for me to ignore them.

      The following extracts are from ‘Does Treating High Blood Pressure Do Any Good?’ by Dr Kendrick:

      “Nine thousand people were treated for raised blood pressure for five years. At the end of the study five more people were alive in the treatment arm than the placebo arm. A result so deeply unimpressive that it fitted comfortably within the possibility of it being purely a chance finding. Or, to put it another way, this study failed completely to reach the holy grail of medical studies – statistical significance.

      “It seemed from this very large, long-term study, that lowering mild/moderately raised blood pressure was of no benefit. Certainly not when you set it against billions of dollars it costs, and years of potential side-effects. I do remember thinking at the time. Well, that should cause a massive re-think in the whole area. But it did not. Not even slightly. This result was basically swept aside and ignored.

      They went on (in the European Heart Journal, 2000) to make the following statement: ‘No randomized trial has ever demonstrated any reduction of risk either overall, or cardiovascular death by reducing systolic blood pressure to below 140mmHg.’

      • Hi Stephen.

        I agree with your general premise that medication should be a last resort. Having said that, there is now, however, a randomized trial showing benefit to controlling blood pressure below 140 (SPRINT trial). Here is a link to PubMed. https://www.ncbi.nlm.nih.gov/pubmed/26551272

        Personally, I would only consider using medication if IF, LCHF, and high intensity interval training in combination have failed. While I’m not convinced of the benefits of HIIT to reduce weight, I have personal experience that it does a very nice job reducing systolic blood pressure.

        • Stephen T

          Thank you, Stevo, but I remain highly sceptical. I’m afraid I’ve got to the point that I trust almost nothing a drug company has to say (and one of the authors has links to drug companies) because they will say anything to increase the pool of ‘patients’.

          One of the responders to the paper referred to a “near tripling of the rate of acute kidney injury or acute renal failure in the intensive-treatment group”.

          They haven’t go anywhere near passing my test before taking a drug. We all have to make our own decisions

      • That you for that Stephen. Problem is that my GP is putting a lot of pressure on me to take medication. I have already resisted statins but he is adamant that I should take BP medication or I will be at serious risk of stroke or heart attack.

        • Barry, we do all make our own decisions. There is no way I’m taking a drug to keep my doctor happy. I suppose it depends on whether you think artificially lowering a symptom (a BP number) with a drug actually does any good. I don’t think it does, so it gets nowhere near passing my ‘clear benefit’ test for taking a drug.

  17. sten bjorsell

    “Overflowing cells”. Cells may well be full of glucose for different reasons. Lack of materials for instance. One material from this abstract: https://www.ncbi.nlm.nih.gov/pubmed/15319146
    “Magnesium is required for both proper glucose utilization and insulin signalling. Metabolic alterations in cellular magnesium, which may play the role of a second messenger for insulin action, contribute to insulin resistance.”
    It is well known that increased carbohydrate metabolism demands more magnesium “to work”. At the same time our food contains less magnesium due to less recycling in modern agriculture at the same time as magnesium is important to bind and excrete toxins, which increase in both environment and modern foods. LCHF reduces magnesium demand, and when we go organic another step is taken. “IF” can reduce toxicity by cell cleaning through autophagy. No surprise people “recover their lives” through just doing a few good things from this blog! Thank you Jason Fung!

  18. How come more doctors don’t measure insulin response along with glucose response? Is that historical? Is it still people on the lock and key paradigm?

  19. David Magnus

    This study makes your theory invalid
    https://examine.com/nutrition/really-low-fat-vs-somewhat-lower-carb/
    even though the insulin went down, low fat lost more fat.
    Please answer.

    • I didn’t read every word in the link but if this is the study I think it is, Dr. Fung has already addressed it by pointing out that the low carb folks maintained their metabolic rate and the low fat people didn’t. As the commentary in the link points out what works in the real world is not what appears to work in the lab when the end point is loss of fat, since in the real world loss of fat without hunger or meaningful deprivation or significant reduction in metabolic rate is what determines long-term success. Further, Dr. Fung has pointed out in many different venues that insulin is an important factor but by means the only factor for success. And you link is not addressing the point of this blog entry either, which is that rising insulin which appears to create “healthy” blood glucose levels is still a big problem. So no, the “study” (which has major problems pointed out elsewhere) you cite does not invalidate that theory.

  20. This is a wonderful revelation, a fantastic protocol and I am very grateful to have found my way to this site and Dr Fung.

  21. thebigpicture

    I cannot emphasize enough that there is a social aspect to eating and to obesity. Quite simply, we eat what others eat, and we gain weight when others are doing so. During the holidays this is especially true.
    If you think about it, this must be true. If you are say, thin, active, or deny yourself certain foods or periods of eating in order to maintain your health, and then you find yourself among others who are enjoying all the food they can eat, your willpower may begin to break down. You may decide to heck with it, and to enjoy food as others seem to be doing.

    To be fair, extremes of obesity might provoke an opposite reaction. You might look around at really obese people, or yourself have had a problem, and then determine to change.

    But, in general, I think my social hypothesis is true. If it is, that means unfortunately that you must begin to shun obese people. This is not as bad as it sounds. It’s no different than an alcoholic who has sobered up and then declines to spend time with his friends when they are drinking.

    The people around you will determine your reality. Obese people will make you obese, I definitely know this happened to me. You will have to make the changes and then disassociate yourself from the overeaters, and unfortunately this does to a certain extent mean being asocial. Thereby it can only be cured by associating yourself with healthy and normal weight people.

    • Hey ‘thebigpicture’

      I do agree with your idea that we tend to be the sum of the people around us, but I think my agreement kinda stops there.

      Being around obese people doesn’t necessarily make you obese. Many obese people don’t eat huge amounts of food (perhaps they did once), they don’t all spend there time eating pies, cakes, drinking full fact Coke 🙂 and lying around all day of the sofa.

      We don’t all respond to food in the same way, either the hormonal or the psychological effects of it. Sure, if you spend your time around lean, fit, health conscious people, you are more likely to make better health and fitness decisions, but depending on you, your history etc, medical issues, eating the same as your peers won’t necessarily make you look like your peers.

      And even if it did, with practice, good food choices etc, it becomes very easy (over time) to NOT make the decisions that you feel are bad for your body, even when everyone around you is.

      I’ve been a personal trainer and nutrition coach for years, I’m about to embark on a post grad diploma and then a masters degree in obesity and weight management. I’m suffered myself with binge eating, making poor decisions, and so have many of my clients.

      My family like sweets , they eat chips and chocolate. I don’t. I go to parties, I eat the meat and salad, not the sausage rolls and trifle.

      It takes time, but there are PLENTY of unhealthy food cues all around you, in advertising, supermarket layout, cafes, restaurants. Ultimately you have to work to get yourself to a position when YOU are in control and not blaming others for your decisions.

      It’s not easy, but it is doable.

  22. I see the value of the “glucose overflow” analogy to explain hyperinsulinemia and its onset as a result of chronic overfeeding. However, “internal starvation” also seems to be going on in the sense that in the presence of heightened levels of insulin, the body is unable to access lipid stores (if anything, increasing them). Certainly something is going on systemically in terms of ongoing hunger in the obese that doesn’t square well with “overfull cells” — somehow the signal that cells are full is not translating into reduced eating on the part of the organism.

    I’m not so sure that the two interpretations are completely incompatible. Perhaps one is leading to the other?

    Certainly, my n=1 is that the body responds better to fat as a fuel, and that this is only possible in the (relative) absence of carbohydrate. So, LCHF and IF it remains for me, thanks.

Leave a Reply