November 9, 2015

ITIS -- It's the Insulin, Stupid (pt 8/8)





Well, here we are, folks! The 8th and final installment of the crazy journey that began way back when we looked at Dr. Joseph Kraft’s 5-hour glucose tolerance tests with insulin assay. You remember those, right? The ones that suggested far more people are in the early stages of diabetes and insulin resistance than anyone ever would have guessed, based on their “normal” fasting glucose and hemoglobin A1c results.

In case anyone’s stumbling upon this series for the first time, here are links to the seven posts that preceded this one:

  • Part 1: Introduction to insulin resistance and the work of Dr. Kraft: What is diabetes in-situ?
  • Part 2: Health consequences of hyperinsulinemia & hyperglycemia unrelated to body weight.
  • Part 3: Deep-dive into the pancreas and the balancing act between insulin and GLUCAGON.
  • Part 4: The role of insulin in the gain & loss of body fat.
  • Part 5: More on insulin & the regulation of body fat—how do different eating patterns (such as intermittent fasting and carbohydrate reduction) affect insulin, and what does that mean for body fat and energy levels?
  • Part 6: The concept of “normal weight obesity” or TOFI—thin outside, fat inside, and what this means for overall health. (Summary: “thin” doesn’t automatically mean healthy.) Also: how come some people don’t become overweight when they’re insulin resistant?
  • Part 7: “Calories in, calories out” and “eat less, move more.” Are these sound bytes the least bit helpful? In a word, no. If you have even the smallest appreciation for the complexity of the biochemical regulation of human metabolism, in general, and body fat, in particular, then you will agree that these phrases are laughably simplistic and one step shy of being completely meaningless.

Okay! Let’s get down to business.

Having covered some of the gnarly health conditions and debilitating downstream effects of insulin resistance (IR), hyperinsulinemia, and hyperglycemia—which can affect your eyes, your ears, your brain, your kidneys, your heart & blood vessels, your nerves, and your man parts or lady bits, not to mention make you the three Fs: fat, fatigued, and foggy-headed—it’s time to address perhaps the most important questions of all...


What causes insulin resistance, 
and what can we do about it?


Insulin resistance served up
for breakfast?
Maybe not…
Let’s take care of the low-hanging fruit first. Here’s what does not cause IR: consuming carbohydrates, per se. As I have mentioned in past posts, I called this series “It’s the Insulin, Stupid,” and not “It’s the Carbs, Stupid.” Because it’s not just the carbs. Exceeding your own individual level of carbohydrate tolerance is a big factor in this, for sure. But it’s not the only one, and I don’t even know if, by itself, it’s sufficient to cause IR. Like I said in part 6, it’s more likely that a confluence of factors is required before the “wheels start to fall off the wagon,” as Robb Wolf likes to say. Maybe just eating tons of carbs isn’t enough to induce IR. Maybe IR only creeps up when regularly gorging on carbs is combined with a high omega-6 intake, long-term inadequate sleep and poor stress management, a sluggish thyroid, heavy metal toxicity, exposure to environmental “obesogens” and endocrine disruptors, micronutrient deficiencies (vitamin J, anyone?), Mercury in retrograde, and/or factors we don’t even know about yet.

Anyone who’s been reading this blog for any length of time knows I am most definitely a proponent of low-carb and ketogenic diets. (But I am also a firm believer in individualization and there being no one-size-fits-all approach when it comes to feeding ourselves.) So maybe it’s surprising to hear me say that I truly believe eating lots of sugar & starch is not the only way to induce IR. (And no, this has absolutely nothing to do with the Kitavans. As I have written about many times, the Kitavans likely remain lean and free of chronic degenerative illness on their high-starch and fruit diet because they are the Kitavans, and they are evolutionarily/dietarily conditioned to thrive on that type of diet. This does not mean that everyone else, everywhere else on the planet, will do equally well on the same diet. I will quote myself here, because I think it’s one of the most important things I’ve written in the history of this blog: “Human beings can thrive on a wide variety of diets. But that does not mean that all humans can thrive on all diets.” [Never mind that the Kitavans don’t consume venti caramel macchiatos, chocolate-frosted breakfast cereal, bottomless baskets of breadsticks, sugary granola, and other fare that has become the norm in the U.S. The Kitavan version of a “high-carb diet” is a world apart from that of the U.S.]) So, no, the Kitavans are not proof that eating a high-carbohydrate diet is safe for all other population groups. What the Kitavans do prove is that, at least in some populations, in the absence of several other potential contributors to insulin resistance, a high intake of whole, unprocessed, nutrient-rich carbohydrate foods does not cause IR or other forms of metabolic dysfunction. (Let me reiterate: They are not proof that donuts, bagels, soda, and 64-oz slushies do not contribute whatsoever to metabolic illness.)

I swear, if I hear one more freaking thing about the Kitavans…

I have already mentioned some other issues that might be at play when it comes to the development of IR. There are many more, some of which are under our control, and some of which are not. If/when necessary, we can all find ways to better manage stress, get more sleep, build more muscle, maintain adequate vitamin & mineral stores, and even—with the guidance of a knowledgeable physician or clinical nutritionist—chelate or “detoxify” heavy metal buildups, optimize thyroid function, and address other hormonal imbalances that might be affecting glucose & insulin disposal. We can also tinker with our gut flora, but to be honest with you, I don’t think anyone knows enough just yet about what constitutes a “healthy” microbiome, and it's possible people loading up on resistant starch and probiotics could end up doing themselves more harm than good.

All that being said, there are yet other factors that might contribute to the development of IR—factors we have zero control over. If any of you are familiar with the research of Weston Price, DDS, then you know that the diet of our parents—and our grandparents, and maybe even their parents—influence our own physical development, and we have no reason to suspect they don’t also influence our physiological or endocrinological development. That is, maybe our carbohydrate tolerance, or our caffeine tolerance, or FODMAP sensitivity, or liver detoxification capacity, or methylation efficiency, or whatever else, is out of our hands. We can manipulate all of these things to some extent, but overall, some of the wacky things our bodies do might simply be the hand we’re dealt. We already know for sure that maternal hyperglycemia can predispose offspring to some pretty serious health issues down the road. Maybe it doesn’t outright cause them, but it certainly makes them harder to avoid, particularly in the context of the modern American diet and lifestyle. (For an updated but equally impactful version of Dr. Price’s findings, I recommend the book Deep Nutrition. Be warned, though: reading these works may lead you to start scrutinizing the faces of strangers—particularly children—and jump to conclusions about their ancestors’ dietary habits. Happens to a lot of us!)

I could go on and on (and on!) regarding my theories on why some people tolerate carbohydrate, or stress, or short sleep, better than others—and why some of us tolerate these things just fine when we’re young, but less so as we age—but let’s stay on message here.

Having acknowledged that there are several routes to the same destination of insulin resistance, I will defer to the experts to explain the details on the multiple inputs that are currently hypothesized to contribute to IR. The people at Meridian Valley Lab have put together a fantastic 3-part video lecture series on the causes of insulin resistance, how to test for it, and how to treat/reverse it. As it relates to this post, regarding the causes and what to do about them, you’ll want to watch parts I and III. (Part II looks at the glucose & insulin assays the lab uses to assess IR, and they are pretty much the same ones Dr. Kraft used. It is worth watching, for reasons I’ll get to in a minute. If nothing else, it’s worth it just to hear the speaker say that the result that puzzles them—the one they almost never see and can barely make sense of—is likely due to someone following a low-carb diet. [Approximately 30 minutes into the video.])
Part I will give you an appreciation for how far beyond “carbz” this all goes. Part III presents several answers to the “what to do about it” question.

Now back to part II. Part II provides answers to the question you might have after reading all these posts and being skeer’d of developing insulin resistance, and maybe being especially skeer’d of developing any of the conditions associated with IR, such as Alzheimer’s or cardiovascular disease. This question, in particular, is driven by what we saw way back in the first post in this series, with Dr. Kraft’s insulin assays. Remember: Dr. Kraft showed that, in many people with normal glucose tolerance, normal fasting glucose, and normal A1c, hyperinsulinemia, or “diabetes in-situ” was lurking behind the scenes. As I explained, the reason those measurements were normal is because of sky-high insulin, which, as we saw in the second post in this series, has very serious implications for health all on its own, apart from anything going on with blood glucose.

What should we be on the lookout for
in our various & sundry bodily fluids?
So what is this burning question? (And do they make a cream for it?)  The question is, until insulin assays become standard protocol at your annual physical, or until testing insulin at home is as simple as using a handheld glucometer, what other markers can we keep an eye on in order to make sure we don’t have a date with disaster?

I don’t have any groundbreaking answers for you. Most of them are pretty old news if you read other blogs and listen to podcasts about this stuff. (If you don’t, then, congratulations. You are not the gigantic nerd I am, and you are probably way too busy having fun and living life to immerse yourself in this stuff like I do.) Okay, back to what matters: if we can’t measure insulin directly (many doctors don’t want to, even some of the LCHF-friendly ones), what else can we look at to see how we’re doing?

Pretty much the usual suspects: If your glucose & A1c are elevated, then you’ll know you’re already in dangerous territory. Beyond that, there’s triglycerides, blood pressure, HDL, LDL particle size (but not necessarily number), C-peptide, uric acid, and fructosamine. (Possibly also CRP or hs-CRP [C-reactive protein and high-sensitivity C-reactive protein, respectively], which are markers of inflammation. I think they can be surrogate indicators of IR as well, since chronically elevated insulin is pretty damn inflammatory.)

For more on the markers to watch, and what are currently believed to be the optimal ranges, part II of the video lectures is your best bet. (You don’t have to watch part I first. I recommend watching all of them in order, but each part stands alone just fine.)

I’m sorry if this post is a somewhat anti-climactic end to what has otherwise been a pretty good ride. I guess I just feel the videos explain the nuances better than I can, and there’s no point in reinventing the wheel.

HOWEVER, just so I don’t leave you completely disappointed, allow me to share some thoughts on the strategies that might help us protect ourselves from the horrible outcomes detailed in part 2, or, if we already have some of those issues, how we might stop them from progressing, and possibly even reverse or cure them.
Can insulin resistance be reversed?
Can it be cured?


Those two words are quite interesting: reverse, and cure. Can insulin resistance be reversed? Dr. Fung seems to think so. He routinely uses that word in his videos and tweets.


Can it be cured? Probably not, but really, it’s just semantics. Dr. Fung has taken some harsh criticism, even among the LCHF community, regarding his claims of “curing” type 2 diabetes (and, for our purposes here, we can lump IR together with T2D). Is it cured, or is it merely managed?

Well, it’s managed, in the sense that an alcoholic who’s been sober for 20 years isn’t “cured” of alcoholism, but as long as they avoid the triggering element, there’s no problem. If they were to start drinking again, then boom: problem. It probably works the same way with eating excess carbs, or chronically undersleeping, or being stressed out, or exposed to environmental obesogens, or whatever other factors are contributing to someone’s insulin resistance. Avoid the triggering factors, and you avoid the problem. For example: If you go swimming in the ocean and get stung by a jellyfish, then take medication to counteract the poison, you are cured. But are you “cured” in the sense that you are immune to any and all future jellyfish stings? Are you impervious to jellyfish stings henceforth? No, of course not. Dr. Fung gave a similar example regarding antibiotics: If you develop a bacterial infection and take antibiotics, when the pathogenic organisms are gone, you are cured of the infection. But that doesn’t mean you are immune to getting infected again if you come into contact with the organism again.

I suspect it’s the same with frequently exceeding your individual carbohydrate tolerance and playing fast & loose with the other contributing factors: you are “in the clear” as long as you continue to avoid the triggering substances and/or behaviors. But that doesn’t mean IR isn’t reversed. Like alcoholism, by sticking to certain behaviors and avoiding others, we manage the condition. We keep it in check. And there’s nothing wrong with that. The fact that someone is an alcoholic is irrelevant if they abstain from alcohol. The fact that someone had a past diagnosis of T2D or insulin resistance is irrelevant if they control their diet and lifestyle, right now and going forward. For some people, maybe that means an ultra-low-carb diet. For others, maybe it means a moderate-carb diet as long as they’re getting good sleep and have time to relax and do lots of walking. Maybe it means berberine and chromium supplements, or occasional fasting.

So yes, I think we can “cure” T2D and IR, provided we keep on top of the things we think may have contributed to developing those conditions in the first place. And you know what? The nifty thing about all this is that we can keep on top of things. Even if we start to slide—maybe an 80/20 diet drifts precariously toward 60/40, or you’ve been gunning for a promotion at work or maybe are the parent of a newborn, and your stress levels are at an all-time high, while your quality sleep is at an all-time low—whatever the interfering circumstances, we can get back on track as soon as we choose to. Many of the presumed causes of IR are firmly within our control, and when we start to see or feel things getting out of whack—or objective lab values tell us they’re out of whack—we can take corrective measures immediately. It might take a few weeks or months for the effects of those measures to be reflected in the bloodwork, but we can take control as soon as we decide to. (Kind of like gaining weight: we don’t have to wait until we’re 50, 100, or 200 pounds overweight before we do something about it. You’d probably notice if you gained 20 or 30 pounds, and you can start doing something about it before it becomes 50 or 150.)

If I want to be a real stickler for semantics (and I usually do), then I guess we really are better off saying insulin resistance/T2D is “managed,” rather than cured. Or perhaps a better word is remission: “Thanks to a reduced-carbohydrate diet, more sleep, weightlifting, occasional fasting, and appropriate supplements, my type-2 diabetes is in remission.” I think that sounds pretty great, actually.

So no, none of us is “immune” to diabetes or insulin resistance. Frankly, just by being 21st Century inhabitants of industrialized nations, I’d say we’re all “at risk.” Those of us who have never been officially diagnosed with T2D or insulin resistance are at just as much risk as those “in remission,” right? If they screw up their diet & lifestyle, those things come back, and if we screw up our diets & lifestyles, there’s a good chance we’ll develop those things, too. (Or, if not T2D, then maybe heart disease, or a stroke, or PCOS, or BPH, or one of the myriad other manifestations of insulin resistance that are not diagnosed via elevated blood glucose.)

Of course, the funny thing about this is, conventional doctors and dietitians will insist that IR & T2D are progressive and irreversible. They will say it’s not possible to put T2D into “remission,” because people only ever get worse and worse; no one ever gets better. But that’s only because those practitioners have never seen it stopped in its tracks, let alone reversed. Why not? Because they prescribe insulin and a high-carb, low-fat diet, to be eaten in the form of several small meals per day. (As we showed in part 5, this is an absolute metabolic disaster.) Like we covered in part 1, giving insulin to individuals who are hyperinsulinemic (most T2 diabetics) is pouring fuel on the fire. T2D is not an insulin deficiency, and in many ways, more insulin actually makes things worse. So, yes, IR is abso-tively, posi-lutely reversible. It does NOT need to be progressive, and tailspin into an unmanageable sh*tstorm of neuropathy, kidney failure, blindness, and amputation. Knowledgeable MDs, such as Ted Naiman, Rakesh “Rocky” Patel, Jeff Gerber, and Andreas Eenfeldt, reverse diabetes in their clinics all the time. They get their patients off medication, rather than on ever-increasing amounts of increasing numbers of drugs, and they do it with a low-carb high-fat diet, intermittent fasting, lifestyle recommendations, targeted supplementation, and, when necessary, yes, pharmaceutical medication. 

For the note I’d like to close on, I came across a comment on someone else’s blog recently that I thought was pretty awesome. My apologies for not remembering where I saw it, but the gist was something like this: we should stop using the phrase “pre-diabetes” and call it what it is: stage-1 diabetes. Don’t you agree that calling metabolic syndrome and pre-diabetes “stage 1 diabetes” would scare the shit out of wake people up? Hearing that they ARE DIABETIC, albeit in the early phase, would probably have people leaving doctors’ offices far more determined to do something about it than if they were simply told that their blood glucose, A1c, triglycerides, CRP, and uric acid are “kinda on the high-ish side,” and their HDL is “kinda on the low-ish side,” but they’re not diabetic yet, so just keep an eye on things. [AYFKM?!] Now, granted, if their physician is a total moron not well-versed in the science of carbohydrate reduction and ancestral health, they might walk away with nothing more than a semi-useless platitude about eating less and moving more—with emphasis that eating less pertains only to high-fat foods, because you absolutely must—MUST!—be sure to eat lots of whole grains. But we can hope that, in the age of the internet and social media, in looking for information to help dig themselves out of the hole they’re in, those stage-1 diabetics might stumble across the low-carb, Paleo, and/or Primal communities, and it just might save their lives.

And that, my friends, is the end of this brief foray into insulin! It’s time for me to work on some posts I’ve had on the backburner for a while. (Topics include: why fat loss doesn’t always happen like magic on a low-carb diet; the difference between being “in ketosis” and being fat-adapted, and why people need to STOP FREAKING OUT ABOUT THE COLOR OF THEIR KETOSTIX; and, of course, the cancer series.)

Do you have any questions about anything you’ve read here? Is there something I missed but you were hoping I’d cover? I can guarantee you I don’t have all the answers, and if there were some other aspect of this that I thought was essential to address (without turning this blog into a graduate seminar in biochemistry [like this one]), I’d have written about it. But I’m happy to take requests. If there are additional topics related to this that you’d like me to write about, let me know in the comments, or contact me directly at tuitnutrition [at] gmail [dot] com. Or you can send me a tweet! @TuitNutrition  

In the meantime, check out this post by Georgia Ede, MD. It's a fantastic primer on all this for newbies, and would be a great thing to show people in your life who are curious about this stuff.




P.S. Regarding tracking bloodwork: I’m not a doctor (and I don’t even play one on TV), but if I were one, I would try to avoid becoming alarmed based on any one-time snapshot. I think it’s more important to pay attention to how things are trending over time. This is especially true when it comes to prescribing side-effect riddled medication. This is completely different from the current standard of care, which would have everyone with a total cholesterol over 200mg/dL on statins (which we know are disasters), and similarly demands that other drugs be prescribed for other single measurements that are out of the normal range. Obviously, many of us in the LCHF/Paleo worlds are better educated in some of this stuff than the average patient. But we’re not immune to freaking out if something in our bloodwork surprises us. SO: what I said above, about keeping an eye on trigs, HDL, CRP, etc.? The same thing holds true. Don’t get overly alarmed if one or two things seem out of whack, particularly if they’ve been fine in the past and you haven’t made any dramatic changes (for the worse) to your diet & lifestyle. Some of the markers we keep an eye on—fasting glucose and blood pressure, for example—can be affected by things that happen just days—and sometimes minutes—before the blood is drawn. Did you get stuck in a traffic jam on the way to the lab or doctor’s office? Your BG could easily be 20 points higher than it would otherwise be. Did you have an intense workout the night before, or do you have a mild infection somewhere, or have you had dental work recently? Any of those things can temporarily elevate serum cholesterol. So yes, we should keep an eye on these things, but we should keep an eye on how they’re moving over time, and not scare ourselves silly over one marker at one point in time.





Remember: Amy Berger, M.S., NTP, is not a physician and Tuit Nutrition, LLC, is not a medical practice. The information contained on this site is not intended to diagnose, treat, cure, or prevent any medical condition.

28 comments:

  1. This was an awesome series, thank you so much!

    A couple of thoughts:
    1. Some of us have a genetic predisposition toward IR, I have no doubt that is the origin in my family. But I HATE it when a doctor says "it's genetic" because what they are really saying is "it's genetic therefore you are stuck and there's nothing we can do about it except give you ever increasing doses of medication". I wouldn't say I've necessarily even reversed it with an LCHF diet, but I have certainly backed it up to an earlier stage and held it steady for some time now. If I had listened to doctors, it would have been "Oh well, nothing I can do about it so pass the chocolate cake." It's important to remember the adage--"genetics loads the gun, but our own actions pull the trigger."

    2. Thank you so much for posting Dr. Kraft's work. I was listening to an older podcast where the interviewee was debunking the "insulin theory" because Insulin responses are (according to her) transient and don't remain elevated all day long." (I won't invoke the interviewee's name here). She even claimed that the half life of insulin is mere minutes, ignoring that some people just keep secreting it in large amounts all day long. Dr. Kraft's charts show her contention is true if you have "normal" insulin metabolism, but it's a very different story for people with varying degrees of insulin resistance who spend most or all of the day with elevated insulin levels.

    3. Denise Minger has had an interesting series of the effects of a very low fat, HIGH carbohydrate diet primarily from starches and claims that kind of diet DOES cure diabetes. And perhaps it may, in some limited percentage of the people who can tolerate that diet for any length of time. It seems to reverse IR in certain cases. I'd be interested to see the cases where it is effective parsed out a little more--e.g. would it work with someone who has a genetically induced IR??? Anyway, it's interesting food for thought. It doesn't contradict your theories, IMHO, but just goes to prove that every body is different and there may be multiple causes and treatments for IR.

    4. I wholeheartedly agree with the "stage 1 diabetes" name instead of "pre-diabetes". My dear SIL is a case in point. She told me that she has a high fasting blood glucose so she is "pre-diabetic" but it was OK because her doctor was "watching it" (said as she reached for a piece of cake). Watching it for what??? Watching it until she becomes officially "diabetic" at which time they can throw drugs at her and tell her that she should lose weight by eating less and exercising more. Which is what she thinks she is doing right now (she can tell me the calorie count for every bite of food she puts in her mouth, but has no clue what its metabolic effect is and is in shock when she sees me put real, actual butter on my veggies). I wonder if her attitude would have been so blasé if her doctor instead told her that she had "stage 1 diabetes" (though the doctor's advice likely would not have been particularly helpful)? I think until we have more doctors educated about the role of insulin and how diet influences insulin levels, just telling someone they have "stage 1 diabetes" is going to be of limited benefit. It needs the whole package--scary diagnosis plus education in how diet and metabolism influence that state. But I still think it's better than "pre-diabetes".

    Again, thank you--great job on this series.


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    1. SO TRUE on points 1, 2 & 4. I love your description of "my doctor is 'watching' it." You're exactly right -- watching until it becomes full-blown diabetes and things *really* spin out of control. (And what do they expect -- that pre-diabetes might magically "go away" without active, deliberate changes on your sister's part to *make it* go away?) The level of ignorance in the medical profession just *stuns* me. I am *so* grateful for the doctors (and nurses, dietitians, nutritionists) who GET IT. I honestly don't know how any of them *don't* get it -- don't they see that NONE of their patients ever gets any better on all that medication? Don't they ever stop to question things? I mean, jeez, when I have clients who don't get good results, I question myself left and right...what can I do better? Why are things not going well? What can we change?

      And I agree completely with "genetics." My blue eyes -- now *those* are genetic. My tendency to get chubby when I eat too much carbohydrate and slack off on exercise? Maybe the *tendency* is genetic, but whether it actually *happens* is mostly within my control.

      As for Denise Minger, Dr. Fung had two very good blog posts in response to super-low fat/high-CHO diets. You've probably already seen them, but just in case (and for other readers):
      https://intensivedietarymanagement.com/thoughts-on-the-kempner-rice-diet/
      https://intensivedietarymanagement.com/thoughts-on-the-pritikin-diet/

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    2. Love your posts! Learning a ton.

      I am really lucky, in that the doctor who is treating me with HRT - peri-menopausal and severely progesterone deficient - spotted my Ha1c, which was 5.8, and told me: This is a problem, you have to work on it and get it down, otherwise you WILL develop type 2 diabetes. So... LCHF for me, together with fasting and (thank you Jason Fung) and my BG averages on a daily basis are down.

      As I say, attentive doctor. Not all of them are that way. My own physician said: "Dont worry about it"

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  2. Great series. I agree Stage 1 would be a better name but then Pharma would just make drugs for stage 1 and 2 and 3...
    I try to get patients to eat low carb, give them a simplified diet, counsel them but they would rather shoot insulin and eat their cake. Not all of course but about 98%. It's a mindset. That is where we have to get the wedge driven in. We can do this and it will take time. Thanks for all you do.
    Lauren Romeo, MD

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    1. Thanks, doc! I've seen you post as Larcana on other sites...never knew you were an MD. Thank you for reading!

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  3. Excellent close to the series Amy; I was nodding my head in agreement one paragraph after the other. As you already know my Doctor told me I was pre-diabetic over a year ago. As luck would have it, I worked with “the best nutritionist in the Pentagon" at the time so I was able to get all the free advice I needed from you. Thanks to your guidance and examples, despite my often chocolate binges, I've been able to reduce my carbohydrates, cut the sodas, incorporate weightlifting and some supplements as part of my weekly routine. I'm feeling better, my triglycerides level plummeted and my Doctor told me to keep doing what I was doing because I was no long considered "pre-diabetic" or Stage 1 as you call it.

    Keep spreading the word!!!

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    1. Thank you for the great comment! But don't give me more credit than I deserve. If I recall correctly, you had pretty much reversed your pre-diabetes all on your own, before we even had a consultation. ;-) Either way, you're doing awesomely!

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  4. Hi Amy
    Another excellent post. I can only imagine how much time and effort has to go in to a post a series such as this one with so much detail. The cancer one as well , which is very interesting and so I'm waiting for the next part with much anticipation .

    Now onto my question
    I have lost about 40kg's in weight over a few years and everything ( according to the numbers ) was OK , but after reading through this series I'm starting to wonder if I"m one of those people who look OK on the outside and with good Hba1c test (4.8 at last test ) but is actually insulin resistant on the inside . I have just purchased a new blood monitor, and I must say some of the numbers I have been seeing are not filling me with much encouragement.

    So what I need to know is what tests to ask for on my next DR visit ( which is soon ) too find out what is actually going on inside and from those tests what kind of numbers should I be looking for ?

    Thanks in advance Stuart

    P.S. Nothing in the reply will be taken as medical advice

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    1. Hey Stuart, thanks for reading. :) Please don't worry yourself. How have your tests been in the past? Sounds like they've been fine. With an A1c of 4.8, I'd be surprised if you had any problems with insulin. (Yes, even having written this series, I'd be surprised.) I'm assuming you now follow a low-carb diet. If you also get regular exercise (even just walking), manage your stress, and get adequate sleep, you're probably fine. If you're concerned and want to do some testing, I would recommend the tests I've mentioned in this post: triglycerides, C-peptide, CRP, and a comprehensive cholesterol panel -- not just total/LDL/HDL, but a breakdown of the particle numbers and subfractions, if possible. Honestly, though, if you're doing "all the right things," I'd be surprised if things were out of whack, especially since you've lost so much weight. 40kg -- that's a big accomplishment! Give yourself credit for that.

      If anything, go back to part 1 (http://www.tuitnutrition.com/2015/09/its-the-insulin-1.html) and re-read the section down toward the bottom, with the sub-header: "If your A1c and fasting glucose are normal,
      are you in the clear?" The people whom I think have reason to suspect insulin resistance is an issue are the people with "normal" BG and A1c, but who eat a lot of junk, are very sedentary, have high-stress lives and don't get enough sleep. I mean, it makes no sense that those people should have "normal" looking numbers. They "should" be showing up as metabolically damaged, but since that is *not* reflected in their BG & A1c, I think *they* have reason to suspect super-high insulin, which might be reflected in some of those other tests.

      Get some bloodwork done if you want to see where things are for you, but please don't get overly worried. Chances are you're healthier than 98% of the people out there.

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  5. Thanks for the great series on insulin and glad to see your site listed on the dietdoctor blog page. I look forward to additional posts and catching up with the rest of your site. I have slowly but steadily reduced my bellyfat (>15 lbs!) over several months through: LCHF, intermittent fasting, and resistance training. I think the fasting has given me the biggest bang for the buck but that has been easier via eating low carb. I'm glad that I found something that is working for me but will continue to study health/nutrition and try to keep an open mind as I think there is much we still don't understand. My diet is mostly carnivorous now - no complaints but uncertain whether that will be best over the long term.

    "I could go on and on (and on!) regarding my theories on why some people tolerate carbohydrate, or stress, or short sleep, better than others—and why some of us tolerate these things just fine when we’re young, but less so as we age..."

    I hope you will go on (and on) with your theories. While I plan to continue doing what I'm doing as long as it works, I expect there will be times when I will ingest too many refined carbs (special occasions, holidays, etc). I'd be interested in thoughts/strategies on how to minimize or at least reduce the impact of those times when I may eat/drink things I know I shouldn't (although those times should now be few and far between for me). Cheers!

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  6. Again an excellent series. Thank goodness for the few enlightened nutritionists. Keep up the good work:)

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  7. Your [AYFKM?] placement was perfect and joyful in its shared frustration. I cannot put a number on how many times my inner voice has repeated such a phrase while on my obsessive quest to grasp and understand what was happening to me both mentally and physically over the past few years or so that I believe was all tied into my T2 diagnosis earlier this year.

    My astonished AYFKM?'s began with my first fasting blood test lab results at 462 with my primary doc prescribing 1000mg Metformin daily and my ironically T2 diabetic endocrinologist telling me I'm "60 days away from injecting insulin".

    I got so much AYFKM? silly advice about my newly discovered "chronic and progressive disease" from many "health professionals" that NEVER ONCE mentioned or asked WTF was I eating! It was all about "managing and treatment" with drugs.

    But I was perhaps in a full-on diabetic fog brain, with foot neuropathy, excessive joint pain, stress-filled tension, lack of sleep, hypertensive BP, and bouts of depression for perhaps several years. I was really a zombie-like dysfunctional mess who dismissed seeing a doctor because I was just far too busy for such nonsense over a little foot numbness.
    But then the numbness went to my fingers. My eyesight was bothering me and I started to feel like my eyes were burning.
    And then I remembered something I had selectively and completely blocked out of my memory. A brief time of meeting and slightly getting to know my biological mother so many years ago.
    The eagerness and sudden jolt of not ever knowing someone biologically connected to me happened very quickly as I searched for her over about a year in the mid 1980's.
    Finally, I was about to literally open a door and meet my bio-mother that one fine day. A dream held silently inside of me for decades that consisted of only knowing her name.

    And there she was as I opened that door. A woman who actually resembled my facial features, my blue eyes, and even my smile. I never met anyone directly and biologically related to me. It was a monumental moment.
    I tried to withhold or buffer any shock of identifying multiple facial resemblances as I wanted to just be respectful and dignified hoping to someday hear the circumstances of why she gave me up to foster care.
    But before I could even say, "Nice to finally meet you!", I noticed she was a double amputee in a wheelchair. She even had a few amputated half-fingers.
    She died not very long after that in her late 60's of multiple strokes. She was a 30plus year head nurse who cared and saved many lives, but her own. And she warned me of the possibility of diabetes being passed on to me.
    And she once described the horror of her doctor explaining the need to amputate one toe and waking up from surgery to see her one leg on a gurney fully detached surgically from her body and that she could somehow still "feel" it still attached, yet it was physically six feet away from her.
    They took her other leg a month later.

    Somehow the human brain, or at least MY human brain, selectively stored away or denied me these memories that might actually come to haunt me as I went on my merry way of what was perhaps a fate for me. And I ignored her warning and didn't take care of myself. I was always in fine shape at 6' 2" at 225-230lbs and active. But consuming junk, and an overwhelming sweet tooth, and gallons upon gallons of soda while being stressed out as a building contractor.

    cont...

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  8. But the urgency and re-realization sent me on a fact-finding mission of aggressive knowledge consumption about what this T2 was and rejecting the notion of this "chronic disease" being a part of me. I desperately wanted to reject the projections my health care pro's were telling me of increased insulin injections and other complications.

    I only know that the past three months of eliminating processed foods, sugars, and wheat based products and pasta and breads along with intermittent fasting has dropped my levels to 90 to 110-ish fasting glucose levels with absolutely no joint pain, much milder foot neuropathy, eye burning pain completely gone, and a much healthier and clearer thinking brain.

    Your 8 part series has been an absolute joy to read. It sums up, and demystifies so much of the scattered information and biologically confusing info that lend itself to more AYFKM? moments.
    I read your heart-wrenching post concerning your own Mom. It really affected me. You're what I would call a "fixer", much like me. You have this overwhelming urge to "fix it", understand why it's broken, and so caringly explain why it's broken in the most compassionate and non-condescending way. With humor, facts, and a gently guiding and simultaneous teaching ability. It is such a remarkable gift you have, and a joy to discover you.

    I also listened to the podcast you linked us to. Your voice and ability to clearly explain so perfectly matches your teaching personality and connective writing style.
    I can't help but wonder if you ever considered auditioning a TEDtalk. There simply needs to be more help and clearer guidance for any T2 freaked out newbies who need to navigate through so much misinformation to get to some clarity.
    I, for one, could have done without so many AYFKM's along my "reversal" pathway?

    One of your sincere fans,
    Tom :)


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    1. Tom, YOU WIN THE BEST COMMENT AWARD! (Perhaps in the entire history of this blog!) Thank you so much. I'm glad you "found" me, and that my writing is helpful. I love translating the science-speak into plain English that people can understand and put into action. And thank you for taking the time to read the post about my mother. Her doctors were *useless.* In fact, they were *worse* than useless, because they actually made her *worse* than she would have been if she had never sought treatment for anything, ever. Like your own medical team, no one ever said anything to her about her diet. I swear, you can't make this stuff up. But how fortunate that you found out how much control *you* have over diabetes and your own health destiny. It must have been quite a shock to see your mother that way. (And you know what? Even watching my own mother, I still eat some things I know I "shouldn't." I'm not a robot, and once in a while I have come cookies, or a piece of cake, or whatever. But I've been at this long enough that I know how much "wiggle room" I have, and I try to keep things in check. Compared to the average person out there, I eat extremely well, but compared to others, who never, *ever* indulge in something delicious just for the heck of it, I'm certainly not perfect. Nor would I want to be.

      I don't think of myself as "a fixer." (But I see what you mean.) In fact, I'm doing some soul-searching that is leading me to believe nutrition counseling is not the right path for me. Nutrition in some form, yes, but helping people one-on-one is difficult for me. I'm absolutely not a "hand-holder." I'm an introvert to the extreme, and often find myself drained after interacting with people. (It's situationally dependent, though. I can be downright scintillating in the right setting and with the right people.) I've been wondering if maybe teaching at a community college would be a good fit for me. (I don't have a PhD, so a university is probably off-limits to me, for now.) I do love seeing the light bulbs go on over people's heads, and the "a-ha" moment when things *click,* and they understand *why* they feel a certain way, or *why* their body does the strange things it does.

      I would love to give a TED Talk about the Alzheimer's research I've done. Not sure how to make that happen, but I can probably look into it.

      Anyway, thanks again for the really nice comments. Very much appreciated. I also recorded a podcast with Jimmy Moore that you might be interested in (and no bad sound quality!) It's more about Alzheimer's than diabetes, but since Alz is now called "Type 3 diabetes," you might find it eye-opening. http://www.thelivinlowcarbshow.com/shownotes/12494/967-amy-berger-examines-the-ketogenic-antidote-to-alzheimers-disease/

      You'll probably also love Dr. Fung's videos, if you haven't watched them yet.

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    2. Just listened to your Jimmy Moore podcast.

      And at the risk of possibly minimizing the importance of "teaching at a community college", I am convinced there are much higher peaks for you to climb.
      I suspect you feel "drained" in more one-on-one-ish "handholding" because you are not a personal nutrition coach. It's not challenging you enough, or possibly not at all. We introverts often find when people need our attention or guidance just becomes a draining nuisance. Dare I say some people are "life-suckers" whose needy energy can just drain the life out of others. I often enjoy running and hiding in solitude. :) Even from the people I care most about. I seem to prefer the negative guilt of hiding from them over the more positive willingness to hand hold sometimes.

      But maybe the introvert you enjoy being, might just be the solitary writer that you are at the most peace with. It seems, if I may be so bold, that there's an extrovert writer inside of you that is "downright scintillating to the people" you write to, aligned with the subject or path you're drawn to.
      And the extrovert you may believe you are not, or is uncomfortable with being, is the educated and conflicted "natural" that I hear on that podcast. The dilemma of engaging communication skill, knowledge, and brilliance is often minimized by those who possess it.
      The introverted and researching writer can always hunker down and enjoy perhaps as much as 90% of their time writing, researching, and further educating themselves with the solitude they enjoy. The less comfortable extrovert might need to succinctly and passionately write an 18 minute-ish TED talk on the much needed discussion of Type 3 diabetes that you've already invested so much of your time and energy in with "The Alzheimers Antidote".
      The "clicks" and "a-ha's" needed in an already massive vacuum of missing dialogue and a misinformation baggage carrying populace, including the woeful medical/health industries, is desperately needing a coherent voice, an instigator, a decipher of technical/biological/medical jargon, for the eager-to-know, Alzheimer-affected family member and open-minded health care professional.

      The uber-educated, PHD-shingled schmucks, have mostly failed us all through the last three decades or more. And the digital age has propelled some of the finest introverts to challenge and rattle many an archaic health care fool.

      "The Power of the Introvert" by Susan Cain is a Tedtalk you might like on Youtube..
      She also wrote a great book called "Quiet: The Power of Introverts in a World that Can't Stop Talking"

      Your tweets are often more knowledge-filled than my "highly regarded" yet woefully informed, T2 afflicted, endocrinologist who thought insulin was my future. :)

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    3. And alas, a Dr. Jason Fung video was my first sort of haphazard find after having enough common sense to know I needed to eliminate a lot of the obvious sugar and processed carbs I was living on. I'm embarrassed to admit how much soda I was drinking per day. But I think there might have been a dip in Pepsi stock once I dumped that stuff.
      But I started thinking practically after functioning in probably a pre- "Mild Cognitive Impairment" state and went on a sort of aimless fruit and vegetable intake. It took me a month to realize I needed to get a glucose meter. I had no fricken clue and no guidance other than "take the Metformin and prepare for insulin".

      Imagine my shock of thinking eating my fave vegetable of healthy and tasty carrots would help lower my glucose digits! Duh!
      I was clueless. I could have consumed chocolate cake and probably got the same result!
      And after that foray into aimlessness, I found a single Dr. Fung video and slowly, the AYFKM's? and OMFG's! started. He was somewhat boring, but fascinating in a lecture hall/clinical way. And I was still in a T2 dysfunctional fog so I would often watch the same video over and over to try to comprehend WTF? he was so casually saying without me ever hearing it. To "EAT LCHF!". I needed to still meander about and read and click and listen to Lustig and back to Fung and Gary Taubes and ...I just started to have "A-Ha!" moments.
      I cannot honestly say I took more joy in repairing myself, or joyfully watching my primary care physician literally drop his jaw in astonishment as I reversed my glucose levels through LCHF/intermittent fasting and maybe some obsessive exercising. Introversion (and copious amounts of narcissism) can propel tons of motivation in solitude to consume information I had absolutely no background or education in.

      Simply put, your 8 part series is "the digestible meat on the bones" of all the bits of scrap of info that I clumsily gathered in my earlier T2 "cognitive disarray", yet didn't quite fully click with along the way for me. Your writing skills are simply exceptional and were needed, and connected a lot of the dots I was struggling to comprehend and explain. I still am not fully grasping most all of it. But I'm much more "edumacated" than I was. Maybe it's the coconut oil and butter I put in my coffee instead of heaping amounts of sugar?

      And I sincerely believe Type 3 diabetes desperately needs more of your input. Nursing homes and health care facilities are filled with catatonic, wheelchair-bound, or bedridden Alzheimers patients appearing younger and younger. I witnessed scores of them while visiting my bio-mother back in the late 1980's. The health care staffs at her higher end nursing facility would line them up in wheelchairs in the hallways while bed linens were being changed in their rooms.

      I would occasionally bring my bio-mother flowers at her very upscale nursing facility. And the gauntlet of Alz patients lining the hallways would try to reach out for the cut flowers in my hands. It was disturbing to me in almost a "zombie-like" way because I thought I was upsetting them all as I passed them by in the halls. They were always so motionless on previous visits, sans flowers. But the sight (or presence?) of flowers would get an almost disturbing, incoherent moaning-like scream in a frightening way to me. Even the "nursing staff" would react disturbed to their patients reaction.

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    4. But then my very clever bio-mother casually explained to me that most all of these Alz patients had slowly faded into their more severe and closeted Alz-state while tending their home flower and vegetable gardens.
      She explained that to most all Alz patients there, it was their last active and cognitive state or connection to "being present" before they could no longer care for themselves, or extended family members could no longer care for them. She had conversations with occasionally visiting family members of most all the Alz patients. And most all had paintings they had painted, or photographs on their room walls, of their well tended flower and vegetable gardens. And the sight of living flowers would catch their eye almost waking them from their dazed and motionless, or even drugged state.
      I once brought tiger lilies and their strong scent filled the hallway. And most all of them would take deep breaths while closing their eyes. Like a famished person might breathe in the scent of a summer barbeque.
      The visual or maybe even the very scent of those flowers, was perhaps so "connective" to their last link to their final "Vitamin J". But I was just not mature enough to comprehend such a concept at the time. But it all seems so clearly connected in hindsight now.
      It's no wonder I blocked most of those memories of visiting my bio-mother. I wasn't prepared for experiencing such overwhelming illness and felt so relieved every-time I left that facility. I had never been exposed to such an environment filled with people trapped within themselves.
      I remember visiting her once on a Christmas morning. She was a double amputee but had the sharpest mind. All of the extended family members of these countless Alz patients would come and do their "once-a-year visit" to their Alz-mother in a wheelchair towing the little grandkids along, plopping a fully wrapped Christmas gift, ribbons and balloons and all attached, into the lap of a catatonic Alz-patient who could barely move a finger, let alone have the dexterity to open a fully wrapped gift!

      Such a horrible "disease". And if it's primarily nutritional and dietary, then it desperately needs more diligence, expertise, and attention from someone still eager to research it.

      Methinks a beautiful sunset is wondrous to observe, take in, relish, and remember.
      But I can't help but think the vastness of a beautiful sunset is ultimately somewhat of a distraction of shiny minutiae. And I am left to wonder of the power of the visual and even aromatic scent of one intricate flower that apparently dwarfs such an immense scale of beauty as a multi-colored sunset in the imprisoned senses of an apparently T3 atrophied human brain, and somehow be frightening or disturbing to witness. Even by their own caretakers and family members.

      Someone brilliant once said:
      "There’s a reason gardening is so good for mental health, and for sure, it goes beyond the pride of raising pretty flowers or producing awesome, homegrown vegetables to use in your cooking. What about getting close to the soil? The literal earth. What about digging your hands deep into that soil—teeming with minerals, with microbes, with life? Again—sights, sounds, and smells we’ve likely come to expect, if not outright require for good health—emotional/psychological far more so than physical. (This is why I love visiting farms so much. Small farms don’t smell like manure lagoons like the big feedlots do. They smell like grass, and soil, and nature, and renewal, and life. There’s “stuff” in the air there—stuff that you breathe in and feel better without being able to identify exactly why.)"

      (This might sound like spacey hippie nonsense, but I really do think it’s a huge missing piece of things.)

      I encourage such brilliance. And sincerely hope not to read like a presumptuous fool.

      Just a sincere and verbose fan,
      Tom :)

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    5. Quiet is one of my favorite books. I dare say she wrote it while directly inside my head, and speaking directly to ME. Seriously, I learned so much about myself -- things I didn't even know, but which explained so much about why I am the way I am, and why certain people and situations affect me the way they do. I already had a lot of insight about myself, but that book brought it to an entirely different level. Fantastic stuff, and it has helped me navigate through the world much more smoothly.

      And you made it all the way through "Vitamin J," too? Add that to the post about my mother, and the insulin series, and you, sir, are a champ!

      I can't imagine walking through a dementia ward, or a home that specializes in Alzheimer's. Absolutely heartbreaking, especially because I feel so strongly that it is something that can be prevented. Or, at the very least, it's something that is more understandable when it occurs in someone who's 95+ years old. But not in ever younger people. We now have people in their fifties being diagnosed with "early onset," yet I guarantee you, NONE OF THE NEUROLOGISTS are telling their patients that it is type 3 diabetes, and there's a good chance that the very best thing they can do to stop it in its tracks, or at the very least, delay further progression for as long as possible, is to adopt a low-carb diet. :`( I would love to get my book into the hands of some Alz specialists who are OPEN-MINDED.

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  9. Enjoyable and informative series. Thank you. I'd like to drill down on the "cure" vs. "remission" question for just a moment. I don't think it needs to be left as "just a semantic matter."

    1. Most human beings are susceptible to becoming progressively insulin resistant until classifiable as diabetic. And diabetes is just an arbitrary threshold in the march toward complete insulin resistance. So, as many have argued, all levels of IR constitute a disease state.

    2. If, through some protocol, dietary or otherwise, insulin sensitivity is restored, then, I would argue, whether such resensitization constitutes a "cure" depends on the level of sensitivity restored.

    3. If one is returned to a prior level of sensitivity, below, say, the threshold for being considered pre-diabetic... is it the case that one is more susceptible to becoming increasingly insulin resistant after this resensitization? Or is it basically the case that insulin sensitivity is insulin sensitivity? In other words, the proclivity to become insulin resistant was there before and there after in equal measure. So, either we were never "healthy" even before we had the disease state (because we were always susceptible to becoming IR), or we are in fact cured after "remission" because we have restored a prior sensitivity of the non-diseased state which is as healthy as we could have been in the first place?

    4. All this would be affected by the question of irreversible damage. Is it the case that all insulin resistance is accompanied by irreversible beta cell death, or some inability to return to a non-disease state level of sensitivity in some kinds of cells? Or can a disease state be reached and retreated from without major loss of beta cells and without having made one's self more like to become IR again? Maybe some people are more likely to sustain irreversible pancreatic damage from an IR state than others? Maybe some people's cells, once they become IR, can never return to a perfectly healthy level of sensitivity?

    5. These questions still remain open, as far as I know. However, if one can return to a prior sensitized state from a disease state without significant loss of beta cells or no net loss of beta cells, then why wouldn't this constitute a "cure" in any sense of that word?

    6. On the other hand, if there's no way to return from some levels of IR to a prior sensitivity level or a healthy beta cell population, then from those levels no cure is possible.

    The question is, then, does Dr. Fung have evidence that in 95% of the DM cases he has worked both a prior level of sensitivity and a healthy beta cell population can be reached? If not, what is the real percentages of actual cures versus partial cures (a.k.a. Remission) For instance, remission examples might include to reach a prior level of sensitivity but with significant beta cell loss, or to reach a prior level of sensitivity but with a greater tendency to become IR again.

    Thanks again,
    Kev Ferrara

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    1. Lots to tackle here. Not sure I can do so intelligently. I agree with a lot of what you've said here.
      As for "beta cell death," I'm not sure about that, in the context of insulin resistance or T2 diabetes. (In type 1, yes, obviously.) Absent an autoimmune assault, our cells renew and regenerate...that's how we heal broken bones, torn ligaments, etc. I'm not sure how long it might take "dead beta cells" to be replaced -- if it even happens at all.

      I think insulin sensitivity can be restored to a certain degree through various interventions. But restored to the point where someone can regularly consume upwards of 300g of carbs per day and not fall into IR/T2d once again? Doubt it.

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    2. Beta cells regenerate very very slowly after childhood. I think studies of just how slow are still ongoing. If a diabetic who has lost considerable beta cell function from mass "burn out" of those cells (due to long term over-demand of insulin production, a common problem in diabetes) manages to keep glucose low enough for long enough, one can imagine that significant pancreatic cell restoration could take place. The question is just how long until that health is restored? 6 months? 6 years? Two decades? We really don't know. (It seems likely that in a few years time a lot more will be known about regenerating these types of cells.)

      There's lots of evidence that even kids will start to get diabetic with 300g of carbs on a daily basis. Very few adults won't. So, the thought I was trying to express was that being susceptible to diabetes after being exposed to 300gs of carbs day after day makes one "just a normal healthy person." So being restored to a state where you are still susceptible to that dosage/bolus is actually being cured.

      best wishes,
      Kev

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    3. ..."being susceptible to diabetes after being exposed to 300gs of carbs day after day makes one "just a normal healthy person." So being restored to a state where you are still susceptible to that dosage/bolus is actually being cured."

      Yes, I know this is what you meant -- and I agree completely. (I had a lot to say in response to your comment...so much, in fact, that I decided to table it and just write something short.) Even if beta cell function is restored, it's going to go right back down the tubes if someone participates in the same dietary & lifestyle triggers that caused them to die in the first place. It's not really a "cure"...more like a reprieve. A reprieve, however, that will last a lifetime IF one is careful about what they eat and how they live. If not, it's back to living in Diabetesville.

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  10. Perhaps Diabetes is a lot like Celiac Disease, remission vs. cure. I have the disease but I'm not in a diseased state. I can quickly return to it if I eat gluten. This could be the case for those Dr. Fung has placed into remission. I struggle with this like he does, as I'm a physician. We are taught the Pharmaceutical approach is the only way to treat this disease process.
    I know this is the current method as I am taking my Board recert exam this coming weekend. And my required study materials from the ABFM is loaded with Pharma and the obesity lectures misstate that LC diets only work in the short run ( 6 months) this is exasperating to me as I have placed patients in remission with LC diet and exercise to increase insulin sensitivity. This battle is not over for me. I have to remain in the system to continue my work. So, I have to regurgitate this not helpful advice to pass the exam. Sigh...

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    1. Right. This is largely the reason I chose not to do a dietetics program (RD). I didn't want to have to learn/memorize information I knew to be patently incorrect. I didn't think I had the patience and intestinal fortitude to sit through two years of that, plus an internship. There are some low-carb/Paleo oriented RDs out there, but they're in the minority, just as with like-minded physicians. Unfortunately, not having the RD credential means many employment doors are closed to me, and even the ability to work at all in some states, depending on the laws.

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  11. Hello Amy... I want to thank you for this excellently written series on Insulin. A little of my background: I was officially diagnosed as Type 2 back in 2000, but I suspect I'd been borderline for a long time prior to that as I had the symptoms for a few years and just overlooked them. At that time, I also weighed 307 lbs. Over the course of the past 15 years, I have managed to lose 70 lbs via various diets (strict ADA, vegetarian, raw, low fat/low carb, etc.), but I noticed that with that weight loss, two things occurred: 1) my legs, arms, and butt got very thin and 2) my stomach has remained quite large. Also, even though I lost a good deal of weight, my BGLs and my A1c were remaining extremely high (9s and 10s). I must also add that in 2008, I was put on insulin to help "control" my high BGLs. It has not helped at all. In August of this year, I went on a Low Carb Healthy Fats diet. My A1c did initially drop, as did my BGLs during the day. After viewing Dr. Fung's talks on Insulin, I took myself off of the insulin (my doc would have nothing to do with this, not even lowering it some). I honestly believe this is the best route for me. However, now my BGLs will NOT come down. They range from 170 to 230 all the time now. I eat a very low carb diet that consists of only non-starchy vegetables and the occasional dairy. I have noticed that when I eat too much protein, this also causes my BGLs to stay high. I am at my wit's end. Can I possibly live almost completely off of fat as it is the only thing that does not raise my BGLs? I have done fat fasts periodically and my BGLs will go down to around 140, but the moment I introduce protein or carbs in even small amounts back into my diet, up goes my BGLs again. I've lost 20 lbs since August 28th and I am worried that even weight loss will not reverse these high BGLs and insulin spikes. I would appreciate any advice or guidance to other areas I can read and research about this besides what you've included in this 8-part presentation (I AM researching all of those links!). I have a pill-pusher for a doctor, so I get no advice from him at all. In fact, my last tests on triglycerides, HDL and LDL all showed improvements and he still wanted to put me on a statin. Then when I told him I was eating low carb, he said, fine just watch your sodium intake... which of course made no sense! I am beside myself trying to know what to eat, when to eat it, and how to get this over-abundance of insulin out of my body.

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    1. Thanks for reading! Obviously, I am not a doctor and cannot and do not provide any medical advice. Even as a nutritionist, I'd be uncomfortable giving you any advice without knowing a lot more about your history & current situation. That being said, first, let's start with the good news: you've lost 20 pounds (in less than 3 months!), and your blood lipids are improving. That's great! YAY, RAVYNE! Clearly, you're doing something right. :) As for the BG still being high -- especially since you stopped the insulin -- maybe it would help to go back on insulin, but a very low dose. Chronically high insulin is not good for health, but neither is chronically high blood sugar! So it's a balancing act. Insulin is not necessarily a bad thing. If you need it, you need it. Consider speaking to your doctor about your options regarding very low doses of insulin or maybe instead, oral blood glucose-lowering drugs. (Pills.) If it were me, that would be *my* way to go...pills, rather than insulin, and I'd see how that went for me. Have you ever been on metformin? That has worked wonders for some people.

      Again, I am not giving medical advice. Just some suggestions about things to talk with your physician about. If your doctor is not willing to work with you on these issues, find a new one! There are tons of LCHF/keto/Paleo-friendly healthcare providers out there. Check out the Paleo Physicians Network, Primal Docs, and Low Carb Doctors:
      http://paleophysiciansnetwork.com/
      http://primaldocs.com/
      http://lowcarbdoctors.blogspot.com/

      As for dairy & "too much" protein, yes, some people are more sensitive to those things than others. You might do all right with high-fat dairy, like butter and heavy cream, but cheese, yogurt, sour cream, cottage cheese...maybe you're just very sensitive to those.

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  12. I had remembered the phrase, "It's the Insulin, Stupid!", so I googled it and found this series in your archives, written before I discovered your blog. I had started looking into health through nutrition many years ago, and one of the first books I found in the '90's was Stop Aging Now! by Jean Carper. She had an entire chapter devoted to the dangers of insulin in excess and how it promotes premature aging. Of course she was still under the influence of the "fat is bad" theory, but I thought it was interesting that she recognized the dangers of too much insulin back then, 20 years ago. Whenever I see articles on the havoc insulin wreaks, I think of the chapter in that book, and marvel that the mainline medical system still doesn't have a clue. Though the volume of blogs, posts and articles on HCLF seem to be growing all the time in what appears to be a burgeoning grassroots movement away from carbs. I just wonder how long it will take to turn this monster around? Thanks for contributing your part!

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