The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally

by Jason Fung

drugs won’t cure a dietary disease. They are about as useful as bringing a snorkel to a bicycle race.

A mere 4 percent decrease in body weight reduced their liver fat by 25 percent. Fatty liver is a completely reversible process. Emptying the liver of its surplus glucose and dropping insulin levels returns the liver to normal. Hyperinsulinemia drives DNL, which is the primary determinant of fatty liver disease. Normalizing insulin levels reverses the fatty liver. Refined carbohydrates, which cause large increases in insulin, are far more sinister than dietary fat.

All the conditions we thought were problems—obesity, insulin resistance, and beta cell dysfunction—are actually the body’s solutions to a single root cause—too much sugar. And when we understand the root cause, the answer to all of these problems—and to type 2 diabetes—becomes immediately obvious. We need to get rid of the sugar and lower insulin.

Important

Intensive treatment was killing people. Completely contrary to expectations, intensively

treated patients were dying 22 percent faster than the standard treatment group, in spite of—or perhaps because of—the intervention. This equaled one extra death for every ninety-five patients treated. The study could not ethically be allowed to continue. Many similar studies finished around the same time.

There was no reduction in heart disease, stroke, eye disease, peripheral vascular disease, or any measurable health benefits. The classic medications for type 2 diabetes, including insulin, metformin, TZDs, and SUs, had utterly failed to improve health.

But, in either type 1 or type 2, if you continually raise the dosage of insulin to lower blood glucose, you simply trade higher insulin toxicity for less glucotoxicity. And over time, insulin toxicity becomes the key determinant for survival because it leads to metabolic syndrome and its sequelae, cardiovascular disease and cancer.

More insulin leads to more resistance, and more resistance leads to more insulin.

The key to the proper treatment of type 2 diabetes is to get rid of the excess sugar, not just move it around the body. The problem is both too much glucose and too much insulin.

Excessive insulin is toxic, particularly in a setting of type 2 diabetes, where baseline insulin is already very high. Giving more insulin will lower the blood glucose, but worsen the underlying hyperinsulinemia. Trading insulin toxicity for glucotoxicity is not beneficial.

Lowering blood glucose with medications, as opposed to diet and lifestyle, is not necessarily beneficial. Consider two type 2 diabetic patients with an identical A1C of 6.5 percent. One takes no medications and the other uses 200 units of insulin daily. These might seem like identical situations, but they’re not. The first situation reflects mild diabetes while the other reflects severe diabetes. The use of insulin does not change severe type 2 diabetes into mild type 2 diabetes. The cardiovascular risks are completely different. Indeed, insulin may not have any benefits at all.

SULFONYLUREAS STIMULATE THE pancreas to produce more insulin, thereby effectively reducing blood sugars. The sulfonylurea (SU) drug class was discovered in 1942 and has been widely prescribed since then.

starting treatment with SUs instead of metformin carries a 21 percent higher risk of cardiovascular disease.10 Studies from the U.K. and elsewhere estimate the use of SUs increases the risk of heart attack or death by 40 to 60 percent.

thiazolidinediones (TZDs). These drugs bind to receptors in the fat cells, making them more sensitive to insulin and thereby amplifying insulin’s effects. So TZDs such as rosiglitazone, sold under the brand name Avandia, and pioglitazone, sold as Actos, lower blood glucose but do not raise insulin levels; instead, they help the body use the available insulin more effectively.

Metformin METFORMIN, THE MOST powerful of the biguanide class of medications, was discovered shortly after insulin and described in the scientific literature in 1922. By 1929, its sugar-lowering effect was noted in animal studies, but it was not until 1957 that it was first used in humans for the treatment of diabetes. Biguanides work by blocking gluconeogenesis and thereby preventing the liver from producing glucose. This effect lowers the risk of hypoglycemia and weight gain because it does not increase insulin levels in the body.

Since metformin does not raise insulin, it does not cause obesity and therefore does not worsen diabetes. So metformin sounds pretty good. The problem is that metformin (and other biguanides) does not take away the root cause of the illness—that is, they do not rid the body of excess sugar. Remember, hyperinsulinemia causes type 2 diabetes. While these drugs target blood glucose, they do little to relieve the underlying hyperinsulinemia. They take care of the symptom but, since they do not eliminate the cause, insulin resistance continues to rise and diabetes is managed but not eliminated.

metformin may manage the disease for a while, but eventually, the patient will require higher and higher doses. The underlying disease process continues progressing, solemn as a clergyman.

dipeptidyl peptidase-4 (DPP-4) inhibitors. These drugs are designed to lower blood glucose by blocking the breakdown of incretins, which are hormones released in the stomach that increase insulin secretion in response to food. High incretin levels stimulate insulin release; however, this insulin response is not sustained and therefore these drugs do not cause weight gain. The risk of hypoglycemia is also low.

sodium-glucose cotransporter 2 (SGLT2) inhibitors, block glucose reabsorption in the kidney, allowing glucose to escape in the urine, which replicates the protective mechanism used by the body during severe hyperglycemia. What happens if you don’t block this protective mechanism, but enhance it? Where the classic diabetes drugs increase insulin, the SGLT2 inhibitors lower it21 by forcing the excretion of glucose outside the body.

The SGLT2 inhibitors simultaneously lowered both insulin toxicity and glucotoxicity, and the results were nothing short of amazing. Weight loss is one of the most noticeable side benefits of this class of medication. Not only did patients lose weight, unlike virtually every other dietary trial, they kept the weight off even after the two years.

Alpha-glucosidase inhibitors DESPITE THE HOOPLA, the SGLT2 was not actually the first oral hypoglycemic agent to show proven cardiovascular benefits. Another now largely forgotten drug was previously shown to have similar benefits. Acarbose is an oral diabetes medication first introduced in the United States in 1996. It blocks the enzymes alpha-glucosidase and alpha-amylase, both of which are required for proper digestion of carbohydrates. Blocking these enzymes prevents complex carbohydrates, which are chains of glucose, from breaking into smaller glucose molecules, thus reducing absorption. Acarbose is essentially the drug equivalent of a low-carbohydrate diet.

GLUCAGON-LIKE PEPTIDE 1 (GLP-1) analogs are diabetic medications that mimic the effect of the incretin hormones. Normally, the incretins secreted by the stomach have several physiological roles when you eat food. They increase the release of insulin but also slow down the motility of the stomach and increase satiety. The DPP-4 inhibitors also enhance incretin levels, but the GLP-1 analogs reach levels that are many times higher than normal. Incretins increase the insulin response to food, so blood glucose decreases after meals. This transitory rise in insulin is not enough to cause weight gain, but incretins slow the movement of food through the stomach, causing satiety, decreased food intake, and weight loss. It also accounts for the main side effect of nausea and vomiting.

STANDARD MEDICATIONS FOR type 2 diabetes represent a trade-off between glucotoxicity and insulin toxicity. Insulin, TZDs, and SUs all increase insulin or its effect to reduce hyperglycemia. The effect of the increased insulin becomes clinically obvious as weight gain. The price of better glucose control has been higher insulin dosage, so there is no net benefit. These medications simply trade lower glucotoxicity for higher insulin toxicity. Metformin and DPP-4 medications use mechanisms other than raising insulin to lower blood glucose. But they do not lower insulin either, so the result is neither weight gain nor weight loss. Reducing glucotoxicity while keeping insulin neutral produces minimal benefits. Clinically, these medications are weight neutral, but also neutral with regard to cardiovascular risk or benefits.

Dr. Victor Montori of the Mayo Clinic discovered that 95 percent of published guidelines endorsed the use of diabetes drugs despite their nonexistent benefits.31 Why would you take medications that have no benefits? Worse, why would you take medications that have no benefits and make you fat? The classic medical treatment, which relies almost exclusively on pharmaceuticals to reduce blood glucose, can therefore best be described as how not to treat type 2 diabetes. By contrast, newer agents, which can reduce both blood glucose and insulin levels, show proven benefits to reduce heart and kidney complications of type 2 diabetes. Nevertheless, these medications, while an important step forward, are clearly not the answer; they do not reverse the root cause of type 2 diabetes—our diet.

Following a low-fat, calorie-restricted diet and increasing exercise have long been the recommended lifestyle treatment for type 2 diabetes. There is only one problem with this seemingly common sense advice. It doesn’t work at all.

The “bread, rice, cereal, and pasta” group, of which we were supposed to eat six to eleven servings daily, comprise the exact foods that cause the greatest increase in blood glucose. This is also the precise diet that has failed to halt the greatest obesity and type 2 diabetes epidemics the world has ever seen.

facts: 1.Type 2 diabetes is characterized by high blood glucose. 2.Refined carbohydrates raise blood glucose levels more than any other foods.

The most common cause of death in type 2 diabetes is cardiovascular disease, which had been falsely attributed to dietary fat.

studies, all exercise programs produce substantially fewer benefits than expected. There are two main reasons: First, exercise is known to stimulate appetite. This tendency to eat more after exercise reduces expected weight loss. Second, a formal exercise program tends to decrease non-exercise activity. For example, if you have been doing hard physical labor all day, you are unlikely to come home and run 10 kilometers for fun. On the other hand, if you’ve been sitting in front of the computer all day, that 10-kilometer run might sound pretty good. These compensation effects are a well-described phenomenon in exercise studies. As you increase exercise intensity or duration, you may find that you eat more or do fewer other non-exercise activities. These compensations directly reduce the beneficial effects of the exercise program.

Exercise can only improve insulin resistance of the muscles. It does not improve insulin resistance in the liver at all. The fatty liver is the key to developing type 2 diabetes, and you cannot exercise your liver to health. Reversing type 2 diabetes depends upon treating the root cause of the disease, which is dietary.

Let’s juxtapose two facts: •Type 2 diabetes is a largely reversible disease. •With the standard treatments of low-calorie, reduced-fat diets and medications (including insulin), type 2 diabetes progresses. The only logical conclusion here, as bizarre as it may sound, is that most cases of type 2 diabetes are being treated incorrectly. That is why type 2 diabetes has become an epidemic. The problem is not the disease but our treatment and understanding of it.

Pure fats, such as butter and olive oil, stimulate almost no insulin release. Therefore, replacing refined carbohydrates with natural fats is a simple, natural method of reducing insulin.

1.Stop putting sugar in (low-carbohydrate diets, intermittent fasting). 2.Burn remaining sugar off (intermittent fasting). In short, a natural, drug-free solution to type 2 diabetes now lies within our grasp.

Bread raised blood glucose more than table sugar. Disbelieving, I found to my utter

amazement—it’s a fact! Starchy foods like bread, cereals, rice, or potato are

THE MOST IMPORTANT rule, without exception, is to eliminate all added sugars from your diet.

Pure fructose is not commonly available, but may be found in some processed foods. Some obvious foods to eliminate are sugar-sweetened beverages, including sodas, iced tea, sports drinks, mixed alcoholic drinks, juices, smoothies, coffee drinks, and “enhanced” water. These liquids are loaded with sugar. Cookies, cakes, desserts, muffins, cupcakes, and ice cream are other obvious sources. Virtually all processed foods contain added sugars for the simple reason that they enhance flavor and texture at virtually no cost. Check the labels on meat products, where sugar is often added to the sauce or during processing. Sugar is often hidden in condiments (ketchup, relish), spaghetti/tomato sauces, flavored yogurts, salad dressings, barbecue sauces, applesauce, and spice mixes. Cereals and granola bars are usually very high in sugar too. And ask about your restaurant meals; sugar is often included in savory dishes because it’s a cheap way to make all foods taste better.

advise patients to avoid all sweeteners, whether they contain calories or not. The logic is simple. If non-caloric sweeteners could truly reduce diabetes and obesity, then we would not have an epidemic on our hands. We have used these chemicals extensively in our food supply for decades and the empirical evidence is clear: artificial sweeteners are no better than sugar. Avoid them all.

Most processed products made with wheat, corn, rice, and potatoes belong in this group. Reduce or avoid refined wheat products such as bread, pasta, waffles, muffins, cupcakes, and donuts. Limit processed corn products, such as popcorn, corn chips, and tortillas, and refined potato products, particularly french fries and potato chips. And eat white rice, which is also a refined carbohydrate, in small amounts. High-fructose corn syrup contains 55 percent fructose, which means it’s sugar, not corn. It’s found in many processed food products and should be avoided.

Replace those refined carbohydrates with fatty fish, olive oil, avocados, and nuts. The natural saturated fats found in beef, pork, bacon, butter, cream, and coconuts are also healthy fats. Eggs are an excellent choice, as are most seafoods.

However, not all fats are benign. The industrially processed, highly refined seed oils that are high in omega-6 fat are not recommended because they can cause inflammation and adversely affect human health. These oils include sunflower, corn, canola, safflower, and vegetable oils. In particular, do not use these vegetable oils at high heat because they release harmful chemicals called aldehydes when heated. Stay away from deep-fried foods and all hydrogenated (trans) fats.

The diet I recommend has been called a low-carbohydrate, healthy-fat (LCHF) diet. It is designed to keep blood glucose low, decrease insulin, and therefore burn more fat. The result? W...

low-carbohydrate, healthy-fat diet reduces the incoming glucose load but does little to burn it off. Exercise may help, but the impact of compensation also limits its effectiveness. Further, exercise only benefits the skeletal muscles and not the fatty liver that is the cornerstone of this disease. Intermittent fasting, though, can help simultaneously with both facets of diabetes reversal. Quite simply, it is the most powerful natural therapy available for type 2 diabetes. But can’t you simply reduce your daily calorie intake to get the same effect? It sounds good, but the simple answer is no. Continuous mild calorie restriction is not at all the same as intermittent, severe restriction.

restricting calories causes a compensatory increase in hunger and a decrease in the body’s metabolic rate. This effect derails weight-loss efforts and ultimately ends in failure.

Intermittent fasting succeeds because it produces beneficial hormonal changes that chronic caloric deprivation does not. Most importantly, it reduces insulin and insulin resistance.

Intermittent fasting prevents the development of insulin resistance by creating extended periods of low insulin that maintain the body’s sensitivity to insulin. This is the key to reversing prediabetes and type 2 diabetes.

Simply put, fasting provides beneficial hormonal changes that are entirely prevented by the constant intake of food, even when the calories in that food are reduced. It is the intermittency of the fasting that makes it so much more effective. If we want our bodies to burn off the sugar that is causing type 2 diabetes, we need the fire of our basal metabolism to remain stoked. We can forge our new diabetes-free bodies in the crucible of fasting.

IF YOU ARE taking medications, then you must speak with your physician before starting a fast. Diabetic medications are prescribed based on your current diet. If you change your diet without adjusting your medications, then you risk triggering hypoglycemic reactions, which are extremely dangerous. You may feel shaky, sweaty, or nauseated. In more severe cases, you could lose consciousness or even die. Carefully monitoring and adjusting your medications is essential.

They raise insulin. And in fact, using these treatments worsens diabetes over time.

Fact #1: Type 2 diabetes is a reversible disease. Fact #2: Virtually all conventionally treated patients get worse. Unfortunately, there is only one conclusion. The conventional treatment recommended by virtually every doctor in the world is not correct. This is terrific news! Why? Because it means we can change its natural history. It means the doorway to a diabetes-free world has just opened.