"When you're a hammer, everything looks like a nail." No where is this statement more true than in medicine.  A perfect example is in the treatment of type 2 diabetes.

If a doctor suspects their patient may be diabetic, they can run an oral glucose tolerance test (OGTT), in which the patient is given a glucose load, and subsequent blood response is measured to see how effectively the glucose is cleared from the blood. In a non-diabetic, the blood sugar only rises a relatively small amount, as the intact and functional beta cells of the pancreas secrete just the right amount of insulin to reduce the blood sugar levels to normal levels. 

If a person is given an OGTT and their blood sugar spikes more than expected, then by definition they are glucose intolerant. They have failed their OGTT, and cannot tollerate carbohydrates the way a non-diabetic can.

In medical school, we are taught that the primary goal in treating diabetics is to keep blood sugar levels low, and that hemoglobin A1C levels are predictors of further disease progression. There are two major ways to control this blood glucose level, with what we put into our bodies as well as ways to control the blood glucose after it has already risen, such as insulin or other diabetes drugs, such as the alpha-glucosidase inhibitors.

Alpha-glucosidase inhibitors are a category of drug that work by decreasing the absorption of carbohydrates in your gut, resulting in a smaller rise in blood glucose. However, the unabsorbed carbohydrates need to go somewhere, causing the predicted unpleasant side effects of stomach discomfort and diarrhea.

Now instead of taking a drug that will reduce our absorption of carbohydrates, result in various side effects and and cost additional money, why not just eat less of the very foods spiking the blood sugar in the first place? In other words, why would the American Diabetes Association tell us that a diabetic diet should be 40-50% of the calories from carbohydrates, when by definition, these are the vey foods they cannot tolerate? Here is how they describe it on their meal planning page:

It seems equivalent to a person with a peanut allergy slightly lowering their peanut intake and just injecting him or herself with an epinephrine pen after each meal. Why not just stop eating peanuts and avoid the potential side effects of epi injections? Why don't they just not eat the carbohydrates in the first place? After all this was the treatment of diabetes in the pre-insulin era. Here is how Dr. Elliot Proctor Joslin described it in 1893:  

And here is how the Joslin Diabetes Center, named after Dr. Joslin above,  describes it 120 years later:

Diabetes is diagnosed by demonstrating a glucose intolerance and therefore, the first line of therapy should be a reduction in glucose. Why is this logic not the first, most obvious treatment? Of course if the patient refuses, or they reduce their carbohydrates and their blood glucose levels continue to remain elevated, then further therapy is in order.

I believe it is because food is not "a hammer" physicians are equipped with. Medical training in nutrition is essentially absent apart from outdated vitamin deficiencies,  yet doctors are expected to know it, so they default to the USDA's MyPlate for advice and information. This is seen as a constant, unchangeable  variable in treatment of any food related disease, regardless of the etiology, given the label of "diet" or "lifestyle." Just the fact that alpha-glucosidase inhibitors are used as a treatment before a low carbohydrate diet confirms this.

Furthermore, if the patient is given a low fat high carbohydrate diet (as is the standard of care today) to manage their high blood sugar and they do comply with it meticulously, they will very likely need the insulin, alpha-glucosidase inhibitors, and/or metformin to control their daily dose of 180 grams of the very nutrient they cannot tolerate.

Clinical Trials
When you look for clinical trials testing this logic, you see things like this:

The triangle lines are the diabetic patients. The dark triangles represent those on a low carb, ketogenic diet. Their blood glucose and Hemoglobin A1C is significantly lower than those eating a low fat, high carbohydrate diet. This graph also illustrates how in non-diabetics (the circle lines), there is no difference, further supporting the fact that diabetics are carbohydrate intolerant.

Treating Type 2 diabetes with food
Once you have a basic understanding of how the three major macronutrients alter your blood glucose and insulin levels, devising a plan to reduce blood sugar levels becomes simple. 

• Carbohydrates of all kinds raise blood glucose AND insulin
  
• Protein spikes insulin AND DOES NOT seem to spike blood glucose, despite the theoretical ability of the amino acids to be converted into glucose via gluconeogenesis
• Dietary fat does not raise blood glucose OR insulin

Armed with these 3 simple facts, the intuitive treatment of high blood glucose would be: 

1. A decrease in carbohydrates, which spike blood glucose 
2. An increase in protein which acts to secrete insulin and thus reduce blood glucose (essentially acting as giving a patient insulin or sulfonylureas)
3. An increase in dietary fat, which is insulin and blood glucose neutral.
   

And when people eat this way, this is exactly what you see when it is tested:

Earlier this year a friend of ours lost a tremendous amount of weight following “the caveman diet.” I had never heard of it, but it didn’t sound healthy. It is, however, hard to argue with success, and I reserved judgement until learning more.

Over the last few years both my husband and I have had difficulty maintaining a healthy weight, despite eating a diet that is pretty consistent with the government’s food pyramid (or the new MyPlate). In addition, we cooked most of our meals at home using good ingredients: olive oil, brown rice, whole wheat pasta, organic/local vegetables and pastured meat from a local farmer. Despite this, we were both overweight and on various medications. Something wasn’t working!

I started researching the Paleo or Primal way of eating, first by asking our friends how they ate and what the rational for the diet was. They were very helpful and pointed us to a few websites. In college, my initial degree program was biochemistry and I was fascinated by evolutionary biology (total Stephen Jay Gould fangirl). So when I began to understand that the underlying science of this way of eating was based on the evolution of the human species, I really got interested.

So what changes have we made? Surprisingly few. The basics of the diet are grass fed/pastured meats (already doing), vegetables (which have increased exponentially), some fruits, and healthy fats, such as coconut oil and avocado. We eat a lot more eggs (pastured, from a local farmer) and no processed foods. We seldom eat out, but when we do we avoid grains, breads, and starchy foods. We've eliminated dairy, although we eat some cheese, mostly as garnish. No breads, pastries, rice, pasta, etc.

Well, the proof is in the paleo pudding. I had my lab work done and a doctor’s appointment today. I have lost 30 pounds (just shy of 20% of my initial weight) and am in the healthy weight range for my height. I’ve also lost 6 inches (!!) off my waist. More importantly, my doctor looked at my lab work and stated “Wow! Whatever you’re doing keep it up!”

Fasting glucose 67 (down from 87)

Total Cholesterol 148 (relatively unchanged…I was still on pravastatin, which has since been discontinued)

HDL 63 (up from 54)

LDL 70 (down from 112)

VLDL 15 (down from 26)

Triglycerides 76 (down from 132!)

My vitamin D level went from 14 to 28 (still low but doubled from last time), so I’ll continue supplementation for a while, plus get my 30 minutes of sunshine daily at lunch (and much more when I’m not at work). My thyroid level has been low off and on, so we’ll continue to monitor (I have no metabolic symptoms so am not overly concerned). I’m off all medications and don’t have a follow up for 6 months!

I can’t see ANY reason to go back to the conventionally taught nutrition (eg, MyPlate). I think one of the reasons it’s working is the focus on whole foods; removing the processed garbage removes so many non-food, potentially toxic things from the diet. 

More importantly, I feel fantastic! All arthritis symptoms are gone, my sleep is even better (shorter but deeper), and I look better than I have in, well, decades. 

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
Initial carb cravings were hard; I used an Atkins bar twice to get through them. Eating out initially was hard, but I quickly learned what worked for me.

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
Be prepared for the carb cravings and have a plan. Don't focus on what you choose not to eat, but focus on the awesome food choices you have! Who needs bagels and donuts when you can eat bacon and eggs?

Link to Video Here.

Dr. Dayspring reviews the methods of SpecialtyHealth's risk assessment and treatment of a 34-year old insulin resistant police officer. He went from incredibly high cardiovascular risk with insulin resistance to low risk in four months following SpecialtyHealth's model treatment program of a low carbohydrate diet, WWGF by Gary Taubes, and a statin. A must watch!

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I have always been athletic and slim and averaged 55Kg in weight until I hit my 30s. After I got married at the age of 33 my weight increased dramatically (my heaviest being 98kg!). In my mid-30s we decided to start a family, and after a miscarriage, decided that perhaps being overweight was the cause. I went on a specific low-carb diet (Dr Cohen's 1st diet) and lost 21kg in 3 months. I felt fabulous. While I was still on the re-feeding programme, I fell pregnant and started eating "normally" again. After nearly 4 months without carbs, I literally binged on carbs. At 20 weeks, our baby girl was diagnosed with severe spina bifida and after second opinions, consultations with experts, much research and a visit to a spina bifida clinic, we decided to terminate the pregnancy - the hardest and most horrific decision I had ever been faced with. 

After a great deal of research, I found a study that linked insulin spikes to growth defects (particularly spina bifida) and I am convinced that that was the cause in my case. After a year we tried again, had another miscarriage, then I finally had a healthy baby girl who is now nearly 6 years old (after being very careful with my carb intake during the pregnancy). Then my husband discovered Gary Taubes' "Why we get Fat" and we both devoured it in days. It made total sense and caused a complete paradigm shift for me regarding health and nutrition. I have followed his recommended regimen of eating less than 20g of carbs a day and have lost nearly 15kg in 9 months. The weight came off slowly but steadily and I lost inches (I dropped three dress sizes in six months). Not only do I feel fantastic, but nearly a year down the line I am still losing and enjoying being able to wear lovely clothes again - and that's with very little exercise! 

My brain is quicker, I don't forget things like I used to and I have so much more energy and positivity! And as for the health benefits, I am far healthier than I have been in years. My friends are incredulous because I eat so much cheese, butter and cream! After following my new eating plan (I do not consider myself as being on diet) for three months, I started experiencing dizzy spells and weird leg cramps. I visited my doctor who ran a full series of blood tests, including all thyroid tests (I have been suffering from hypothyroidism for years and have been taking thyroxin for nearly 7 years). The results were astonishing - the cause of the dizziness was my thyroid. My new eating plan had kick-started my thryoid again and because I was still on medication, I was over-producing the hormone. 

My doctor immediately halved my dose of medication and retested me a month later, then the month after that. The dizziness and cramps disappeared. I am now completely off the medication and am due for a follow up test in a month's time. As for the rest of my test results - my doctor told me that my full blood count is that of an 18 year olds! Although my overall cholesterol was higher than it's ever been, there were no red flags because my cholesterol to HDL ratio is in the "ideal" category. I have also suffered with low blood iron following years of regular blood donation and marathon running - at one stage having to give up blood donation because my iron reserves were so low. My iron levels are now extremely healthy. My doctor is 100% behind me on my new eating plan. Most importantly, I do not think of myself as being "on diet" and will follow this way of eating for the rest of my life (but intend adding more fruit once I have lost more weight). Clinically, I am still obese with a BMI of 30.9, and I still have a long way to go to get to the weight that I want to be, but I know with absolute conviction that I will get there.

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
Giving up bread, cakes and sweets. I LOVE bread. Now I never crave bread at all, but I still hanker after chocolate every now and then. 

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
1. Do all the research you possibly can before starting on any eating plan - know why you are eating this way and what effects it may have on your body and mind. It will help make you better prepared for hiccups along the way. 

2. Consult your doctor before you begin - especially if you have a pre-existing health condition. If your doctor is a carb-naysayer, balance what he/she says with what you know, have experienced and read. 

3. Make sure you have the right incentive for losing weight. My experience has taught me that if you have too specific a goal, you tend to binge once you have reached it. I now intend to eat this way for the rest of my life - no pressure or anxiety if I don't lose weight for a week and no obsessing over food. If I want to take a break for a day (or more, like at Christmas time) I do, and then get right back to business afterwards. 

4. Lastly, don't be afraid to experiment and mix things up a bit. When you hit a plateau (which you will) don't panic and don't give up. Try something different - give something up or try something new. I recently discovered that I am eating way too much beef jerky and left if out completely for two weeks and my weight loss literally plummeted. I replaced it with raspberries and blue berries. What a pleasure!

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I remember starting my first “diet” and attending my first Weight Watchers meeting at age 10, and for almost 40 years, I battled constantly with my weight. I was an expert at losing the weight, but could never keep it completely off for long, and like many, found myself caught in a vicious “yo-yo” weight loss cycle. I was always at odds with the scale. Always at war with food. And always hungry.

For almost 40 years, I tried every diet that came along in search of the magic bullet that would make me thin, keep me thin, and satisfy my constant hunger. I restricted food, weighed my food, and counted calories. I attended meetings, weighed in, and kept food diaries. I popped diet pills, drank weight loss formulas, and ate protein bars to curb hunger. Over the years, I’d go for weeks at a time eating nothing but cottage cheese, or grapefruit, or rice cakes, or low-fat yogurt, or Special K cereal with skim milk, or Diet Coke and gummie bears (they’re low-fat, right??). In a final act of desperation, I signed onto a very expensive, hospital-based, medically supervised weight loss program, which required that I drink nothing but protein shakes (taking in under 800 calories a day) for six months. I did that twice. It “worked” - both times. I spent a lot of money – both times. I lost a lot of weight – both times. But consuming only protein shakes for the rest of my life was not a sustainable solution for me.

The diet gimmicks worked for a while – especially during my high school years (while in marching band) and college years (as a performer in live shows and parades at Walt Disney World for four summers). In my twenties and thirties, I fluctuated between 124 lbs. and 150 lbs. But as I reached my forties, things started to change. I couldn’t keep the weight off. And by the time I reached my late forties, I had gained 200 lbs. I reached my highest weight…at 5 feet 4 inches, I weighed 324 lbs. And I was afraid.

I continued to struggle with food and went through periods of “all or nothing”…starving myself (“nothing”), and when that wasn’t working, I would eat whatever (“all”), because it just didn’t seem to matter. I couldn’t lose the weight when I was starving. I couldn’t lose it when I was eating a low-fat diet and exercising like my physicians prescribed. I was beyond discouraged. I was exhausted from extremely stressful situations in my work environment and at home. And I was struggling to balance the challenges of being the primary caregiver for my mother (who had been diagnosed with type 2 diabetes) for eight years prior to her death in 2010. 

As I cared for my Mom during those years, I witnessed how type 2 diabetes ravaged her health and destroyed her once full and vibrant life, until complications from the disease took her life at age 74. My wonderful Mom taught me how to live. But her greatest gift to me was showing me that type 2 diabetes and the litany of complications that accompany it were not the way to die.

I knew that I had to do something, but had no idea what that “something” was. Eating a low-fat diet and exercising more – as my doctors prescribed – were doing nothing more than making me hungrier, sicker, and fatter. I was exhausted all the time. I felt like a complete failure. 

Until November 5, 2009, when I had the great fortune of finding and coming under the medical care of Eric C. Westman, MD – Founder and Director of the Duke Lifestyle Medicine Clinic at Duke University Medical Center, Durham, NC, and internationally known researcher and expert in the clinical use of very low sugar/very low starch nutrition to manage obesity and to prevent and reverse diseases – including type 2 diabetes. 

Before meeting Dr. Westman, I had no idea that everything that I’d learned about diet, food, and nutrition was wrong. I had no idea that the “low-fat diet” that the “experts” had been telling me to eat was precisely what was making permanent weight loss virtually impossible for me. Most importantly, I had no idea that low-fat dieting was silently setting me up for the very same things (type 2 diabetes, heart disease, obesity) that ultimately caused my Mom’s death.

Thankfully, my Mom’s story won’t be mine, because in the three years since implementing Dr. Westman’s very low sugar/very low starch approach (from November 2009 to current, September 2012), I have lost 185 lbs. and kept it off. Thanks to Dr. Westman, I have learned to eat a well-formulated very low sugar/very low starch diet. I enjoy beautiful, fresh foods every day – eating right at or under 20 g Total Carbs a day, comprised of optimal protein (chicken, beef, poultry, pork, seafood), good fats (olive oil, coconut oil), full-fat dairy (butter, heavy whipping cream, cheeses), eggs (yolks and whites), very low sugar fruits (blueberries, blackberries, strawberries, raspberries), and non-starchy vegetables (lettuce, kale, spinach, onion, tomatoes, green beans, squash, zucchini, broccoli, bell peppers). 

I am 51 years old, weigh 139 lbs., and have more energy than I did thirty years ago. My arteries are clear and my blood pressure, cholesterol, glucose, and A1C levels are all beautifully normal…all of which are hard to believe for those who don’t understand the science behind very low sugar/very low starch eating. But it is true. 

I have the best health of my life and my healthiest years ahead…because of Eric Westman, MD, and others who know the science and understand that very low sugar/very low starch foods are the most powerful medicine we have. We can heal broken metabolisms and prevent and reverse a myriad of health conditions by simply eating beautiful, fresh very low sugar/very low starch foods that truly nourish us on all levels. 

We can’t exercise our way out of a bad diet. But we really can heal ourselves with the right one. I am thankful for Dr. Westman and for his work with very low sugar/very low starch nutrition. To say that it changed my life is an understatement. It saved my life. And I’m thankful for finally finding a wonderful way of eating that is sustainable, healthy and right for me. I am no longer at war with food. No longer at war with the scales. No longer at war with myself.

What was the biggest challenge to adopting a carbohydrate-restricted or paleo diet?
I'll never forget the day I went to particular appointment to see my doctor (Eric C Westman, MD, MHS, (founder-director of the Duke Lifestyle Medicine Clinic, Durham, NC, and President-Elect of the American Society of Bariatric Physians (not surgeons :-). At that appointment, Dr Westman told me, "Lynne, you have to eat fat to lose fat"...I couldn't believe it! Had a hard time wrapping my head around that one...but it's true. From that point on, I made a conscious effort to include more of the good fats in my diet. And the pounds melted away. 

What advice (if any) would you give to someone interested in trying a carbohydrate-restricted or paleo diet? Were there any obstacles that you overcame that could help future dieters?
My advice would be to immerse yourself in the real science out there that supports low-carb living. Read books by authors like Eric C Westman, MD (The New Atkins for a New You), Drs Steve Phinney and Jeff Volek (The Art & Science of Low-Carb Living, and The Art & Science of Low-Carb Performance), and of course, Gary Taubes (Good Calories, Bad Calories, and Why We Get Fat & What To Do About It). 

Search the web and enjoy the myriad of low-carb websites and low-carb recipes...there is no reason in the world to be hungry or bored with food when you low-carb...check out some wonderful recipe sites and bloggers, like Linda's Low-Carb recipes, Jamie Van Eaton's Your Lighter Side blog, Chef George Stella's site and amazing success story at Stella Style. Real food is delicious!! And it's made a 185 lb weight loss sustainable and permanent for me. 

Dr Westman says that low-carb living isn't a weight-loss diet...weight loss is a nice side benefit (true!!), but that the real magic is happening on the inside...with prevention and reversal of diseases and major improvements in a number of health markers, like cholesterol,triglycerides, and blood glucose levels,to name a few. I see insulin dependent/med dependent diabetics coming completely off of meds and insulin every day when they are under the care of Dr Westman...in essence, he is curing diabetes...totally reversing it...every single day. Miracles. I just wish more in the medical community knew and understood the real science behind low-carbing. (Ironically, Dr Westman teaches the only course in an American medical school (here at Duke University School of Medicine) that addresses the use of ketogenic diet to address obesity and to prevent and reverse disease. It is an elective for our medical students. one of these days...I hope Dr Westman and other physicians like him will get the respect deserved and that courses like this will be mainstream). 

I help Dr Westman lead the Low-Carb Support Group here at Duke...as a patient, group member, and group coordinator...I know how important it has been to me to surround myself with others who "get" low-carb. We have a wonderful group here in Durham, NC, that meets with Dr Westman monthly...we'd love to have anyone coming to the area join us! Click here for more information.

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In 1944, Ancel Keys recruited 36 men into what would be known as the Minnesota Starvation Experiment, to study the physiological and psychological effects of prolonged and severe dietary restriction. He detailed his findings in a 1400 page, two volume book entitled The Biology of Human Starvation. These men volunteered to starve themselves and suffer for the altruistic goal of contributing to science and improving our understand of the detrimental effects a lack of food may have on human health.

Shortly after the start of the experiment, the men quickly how realized how difficult it may be to take part in this study, as the predictable signs and symptoms crept in: constant hunger, decreased body temperature, lack of libido, and a total inability to think of anything but food. A large part of their mental energy - even in their dreams as they slept - was inexorably devoted to food and hunger. There was self-mutilation, depression, anxiety, and in one man, a desire to be infected by tuberculosis simply for the opportunity to be fed and satiated once again in the hospital.

One man in particular, offered a chilling expose of what it was like to live on such little food:

"How does it feel to starve? It is something like this: I'm hungry. I'm always hungry - not like the hunger that comes when you miss lunch but a continual cry from the body for food. At times I can almost forget about it but there is nothing that can hold my interest for long. I wait for mealtime. When it comes I eat slowly and make the food last as long as possible. The menu never gets monotonous even if it is the same each day or is of poor quality. It is food and all food tastes good. Even dirty crusts of bread in the street look appetizing and I envy the fat pigeons picking at them. No food is wasted and the sight of people wasting it in restaurants is intolerable.

...I'm weak. I can walk miles at my own pace in order to satisfy laboratory requirements but often I trip on cracks in the sidewalk....This lack of strength is a great frustration. In fact it is often a greater frustration than the hunger. I eagerly look forward to the day when I can go upstairs two at a time or maybe run to catch a streetcar.

...Social graces, interests, spontaneous activity and responsibility take second place to concerns of food. I lick my plate unashamedly at each meal even when guests are present. I don't sit near guests, for then it is necessary to entertain and talk with them. That takes too much energy and destroys some of the enjoyment that comes from my food. I no longer have that ardent desire to help millions of starving people; rather I feel akin to them and hope that I as well as they will benefit from scientific refeeding."

So what were they eating? 

“The major food items served were whole wheat bread, potatoes, cereals, and considerable amounts of turnips and cabbage. Only token amounts of meats and dairy products were provided." But what is most striking is how much food they were given to eat: 1570 calories per day.

1570 calories a day, which is 130 calories more than the globally recommended caloric intake for a 5'3", 200 pound sedentary female with a BMI of 35.5 told to lose 1 pound per week, according to the widely accepted Mifflin-ST Jeor equation. 

How did the caloric intake of a “starvation diet” almost 70 years ago become the standard of care today?

Reading through the Biology of Human Starvation, the similarities from the Minnesota Starvation Experiment and the stories from those that have registered for AWLR are just incredible. Many of those who have registered, detailed what it was like to eat a low fat, low calorie diet before they began their new way of eating. 

Body Temperature

As one subject described in 1944: 
"I’m cold. In July I walk downtown on a sunny day with a shirt and sweater to keep me warm. At night my well fed room mate, who isn’t in the experiment, sleeps on top of his sheets but I crawl under two blankets.”

And from AWLR: 
“I was cold even in the Florida summer, I could see all the veins in my hand, and I almost passed out during a training session at the gym.” 

“I was hungry all the time; I obsessed about food to the point that I planned every meal for several days in advance. I felt cold much of the time, especially at night.”


Skin

As Ancel Keys explained: 
“At 23 weeks…19 of the 31 subjects had developed brownish patchy pigmentation of the skin" and "[a] dry and scaly skin…was reported for 15 of the 31 subjects during the twenty-third week of semi-starvation."

From AWLR: 
"AND,  MY SKIN has improved 300%.  I used to have some brown skin tags on my face and shoulder and a large one on my scalp.  Low carb diet has made them FALL off, effortlessly.”

"Even the rough skin on the heels of my feet smoothed away!"

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People are universally hungry on a low calorie diet. We need to start listening to the people consuming these diets, and how it makes them feel, instead of blaming the patient and blindly citing the USDA’s dietary guidelines, which is molded by vicious lobbying interests and political partisanship. The food industry has a direct and powerful influence on the USDA and the dietary guidelines. If you don't believe this, read Dr. Nestle's Food Politics. If you don’t believe her, you can look at what happened when the USDA recently decided to begin an interoffice “Meatless Mondays” as a way of reducing their environmental impact. What followed was an outraged president of the National Cattleman’s Beef Association condemning this idea. In response, the USDA retreated with its tail between its legs.

And why does the United States Department of Agriculture, whose mission is to “keep America’s farmers and ranchers in business,” have any say in what we are supposed to be eating? Can someone say conflict of interest?

Despite all this, in the end we can only hope that the truth will prevail.  As people register from all over the world and cast their vote for or against the potential benefits of removing grain, wheat, and sugar from their diet, the real effects (at least according to our self reported data) will slowly reveal themselves.

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