AIR DATE: September 26, 2013 at 7PM ET
FEATURED EXPERT: Dr. William Curtis
FEATURED TOPIC: “Nutrition-Based Diabetic Therapy”
According to the latest statistics from the American Diabetes Association, 26 million Americans currently have diabetes (mostly Type 2) with a whopping 79 million more who are what’s known as prediabetic where they are insulin impaired to the degree that if nothing changes they will become a full-blown diabetic in the coming years. The sad reality of these statistics is they are getting worse, not better, with an additional 2 million+ new cases of diabetes being added annually. What’s going on here to explain the explosion in the rates of Type 2 diabetes and even the more rare Type 1?
That’s precisely what we cover in this podcast featuring a former ER physician and family doctor from Corpus Christi, Texas named Dr. William Curtis from the multi-specialty clinic “Future Focus Family Medicine” who has become passionate about how healthcare must shift the way they treat patients away from disease management and more towards wellness and prevention care. His clinical experience has shown him firsthand that health does not come from the medicine bottle for the vast majority of patients but from the very foods they are putting in their mouths as well as fitness and lifestyle changes.
When it comes to the subject of diabetes, that statement is magnified many times over with the need for the right kind of nutrition and lifestyle treatment modalities as the FIRST line of defense in an overall wellness plan. Dr. Curtis doesn’t believe we should be convincing everyone they are sick and in need of a prescription medication to get better again. He contends that a whole foods-based, low-carb lifestyle that he teaches through his NRG Tribe Diet & Lifestyle Compass will provide diabetic patients with REAL encouragement and invaluable information to help them defeat this chronic health issue. That’s the topic we’ll take on directly in Episode 47 of “Ask The Low-Carb Experts” taking YOUR questions on “Nutrition-Based Diabetic Therapy.”
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Here are some of the questions we address in this episode:
ANDREW ASKS: It may just be a semantic argument, but I am wondering why the typical medical establishment position is that Type 2 diabetes is incurable. Conventional wisdom says that once you have a consistently elevated fasting blood glucose level, the “diabetic” label seems to stick for life. My doctor bestowed me with that distinction although he never even once checked my A1c, which I later discovered was low. But now my medical records show me as having Type 2 diabetes although I’ve never taken a single drug to treat it. This is such a scarlet letter on my health history that I’m wondering if I am plagued with this label for the rest of my life. What is the difference between “reversed” and “cured” in the context of diabetes? And is the term “managed” the best label one can hope for in the context of our current medical nomenclature?
DEB ASKS: I am a 48-year old female who has eaten low-ish carb for the last year and a half (~75-130g per day) and my fasting blood glucose was always nice and low (<85). In the last few months I’ve tightened up the carbs and usually consume 50 or so per day. Now my fasting blood glucose levels are regularly in the 90’s and 100’s and I’ve even seen it go as high 124 which totally freaked me out. My post-prandial numbers are fine (90-120) except occasionally if I eat some starch or sugar like a frozen yogurt, when it went to 149—it made me freak out again!
So my questions are: Can you explain why this “physiologic insulin resistance” occurs? Is it dangerous for my blood sugar levels to be lurking so high for so long? I often fast in the mornings, so that means that my fasting blood glucose tends to be high for a long time, albeit not over 140. Please tell me I’m not somehow giving myself diabetes by eating low-carb!
JANE ASKS: My aunt was eating a very low-carb diet for many years and was suddenly put on metformin. I never really thought about it until I realized that she PROBABLY was diagnosed as pre-diabetic or diabetic because she had a high fasting blood glucose level and possibly a high oral glucose tolerance test since a low-carber would show that unless they took 3 days of 150g carbohydrates daily prior to the test. I’m sure she didn’t. Even if her A1C is normal (which she reports it is now), I have a feeling that her doctor would have looked at these two “smoking guns” and labeled her diabetic when in reality she was just a good law-abiding low-carber!
Of course she LOVES being on metformin because for the first time in her life, she can eat bread and chocolate cake for dessert when we gather and it’s all solved by this newfound magic pill. I don’t want to be the stick-in-the-mud to tell her that she should be retested and suddenly give up all that sugary goodness for the rest of her life. My question for you is how dangerous is it for her to be on metformin in this circumstance and should I be that evil niece to break it to her that this sweet-fest should come to an end? She is nearly 70 years old and has had all sorts of medical issues including breast cancer, lymphoma, rapid heart rate and high cholesterol. I love her but I don’t want to ruin her twilight years! This scares the daylights out of me that innocent low-carbers might get caught in this trap if they are not informed about these abnormal test results that are actually completely normal.
PEGGY ASKS: I am looking for an answer as to why my sister has very high fasting blood sugar levels even after 14 years of low-carbing. We have a strong family history of insulin-resistance related health problems including Type II Diabetes. My siblings and I all went low-carb in 2000. My brother and I have been very successful, but our older sister who was already diagnosed with Type II diabetes has not been able to get control of her blood sugar. She sees a traditional medical doctor and has been on metformin, Januvia, and other medications. She even took insulin for a brief period because the high fasting blood sugars just didn’t come down. I’ve suggested she try a very low-carb, high-fat, ketogenic like I do and I think she has trouble with it because she doesn’t like fatty meats. I’m not sure how high her fat intake is and if she’s getting too much protein in her diet. But it just doesn’t make any sense that she can have a fasting blood glucose level in the morning as high as 300 on a low-carb diet. Food doesn’t seem to have an effect on her blood sugar levels that tend to go down throughout the day. But with those high fasting numbers, her A1c has been as high as 12! That is so frightening to me and thankfully she hasn’t experienced any complications in her health yet. She does take a beta blocker and swears that without it she gets migraines. She works very hard in her job and has a lot of stress that may be contributing to this. And, unfortunately, she is still overweight and carries it in her midsection. Got any words of advice about what my sister can do?
JAN ASKS: So what’s the deal with insulin? We obviously need to secrete SOME insulin for our body to perform as it was intended. Would a low-carb or ketogenic diet interfere in any way with the benefits that could come from insulin secretion beyond simple glucose metabolism?
I keep hearing from various sources that low-carb or ketogenic diets doesn’t “cure” the underlying metabolic issue in the diabetes pathway (i.e. insulin resistance, pre-diabetes, or Type II diabetes), they merely control the symptoms. Some people even assert that the low-carb or ketogenic diet itself causes insulin resistance, claiming that we are not “cured” unless our bodies can become insulin sensitive to handle carbohydrates like those who have a “normal” metabolism. In fact, there are those like Perfect Health Diet author Paul Jaminet and even starch-based vegan diet advocate Dr. John McDougall who claim that carbohydrates are absolutely necessary to help us become insulin sensitive. What is your opinion about this?
JEANNE ASKS: I’m 55 years old and have a family history of Type II diabetes and have been interested in eating healthy and anti-aging for over 22 years. So, I have been off sugar for a long time. Lately I’ve been hearing more and more about the ketogenic diet and I read the books by Dr. Jeff Volek and Dr. Steve Phinney. I have been eating low-carb, moderate protein, high-fat since June 1st. It was really easy for me to get into a ketogenic state since I was already grain free and sugar free. My question is this: My blood ketone readings range from .6 – 3.7 millimolar, but my fasting blood sugar levels has gone UP in the recent weeks. Initially, I was seeing blood sugar readings in the upper 80’s/low 90’s when I woke up in the morning but now it’s upper 90’s/low 100’s. I don’t see a correlation now between the ketone level and blood sugar level. Do you have any idea what might be going on? I’m almost to the point of just ignoring the blood sugar reading for a while just to see if it normalizes. I feel good and I am not eating any carbs that would raise my blood sugar like that. I do enjoy a glass or two of wine a few times a week but I include those carbs in my total. I’m 5’8″ and weigh 136 pounds. I eat an average of 1100 calories/day with 50-60g protein, 40g carbohydrate and the rest dietary fats mostly from avocado, fatty meats, macadamia nuts and coconut oil.
HEIDI ASKS: My husband may as well be considered “genetically diabetic” since his entire paternal line is diabetic, and includes both Type 1 and Type 2 diabetes. I’ve been trying to help him with his blood sugar problem for over a decade. A couple of years ago, his doctor got worried enough to issue him a blood glucose meter and recommended he take his fasting readings weekly. When his fasting readings crept up to 100, and then toward 110, I hit the panic button and started shoveling supplements at him, including fiber. When that was no longer enough, the carbs came way down to the point of Atkins Induction and then a ketogenic diet. Not much improvement came after that until I heard a podcast about intermittent fasting and tried spacing out my husband’s meals. Clearly his body has trouble clearing out the blood sugar spikes from his previous meals. The IF strategy did bring the fasting and post-prandial numbers down a little bit, but what REALLY seems to be working is the reintroduction of carbs on a weekly basis a la Kiefer’s Carb Nite Solution plan. For example, last Friday night he gorged on melon at a co-worker’s farewell party and his fasting blood sugar level the next morning was 102 and then in the 90’s all day on Sunday. A few days later he was back in the upper 80’s eating low-carb and implementing intermittent fasting. My question for you is this: WHY IS THIS WORKING? It goes completely against every bit of logic and reasoning I’ve ever heard about managing diabetes.
FRED ASKS: I started eating low-carb to control my Type 2 diabetes I was diagnosed with 15 years ago. I only eat a small amount of oatmeal and berries for breakfast and animal protein and fats with lots of vegetables for lunch and dinner. My nutritionist has suggested that I start eating 150g carbohydrates per day but my blood sugar numbers eating low-carb are in the 90’s consistently. My doctor recently increased my metformin dosage to two 500 mg tablets in the morning and at night. My last A1c level was 7.4. Here are my questions for you: How many carbs should a diabetic be eating in a day? Is it dangerous to consume less than 85g carbohydrates daily (this is what I’m currently doing)?
JEANNIE IN NORWAY ASKS: My father-in-law has been on metformin for years. His A1c has been close to 10 at times. He replaced his bread and potatoes with salad vegetables. He still eats fruit, though. He is incredibly skeptical about consuming dietary fat and refuses to add it in out of fears for his health. He swears that he tested himself after eating salad with and without oil and that his blood sugar was higher with the increased fat. His last A1c was pretty good at 5.6. When should he consider weaning himself off of metformin? I have finally convinced him to try 2-4 Tbs coconut oil daily to help prevent memory loss. Have you noticed any increase in blood sugar levels with your patients when they have added fat to their diet?
ERIK ASKS: Please ask Dr. Curtis about the use of regular insulin vs. long lasting insulin for Type 2 diabetes while following a low-carb, moderate protein, high-fat diet. I am a 5’9”, 210-pound Type 2 diabetic who has been eating a fat/protein/carb ratio of 70/20/10 for the past four months. I would like to use insulin to lower my blood sugar levels but I’m concerned it will slow down or stop my weight loss efforts. Do I need to lower my calories when taking the insulin or is there a better way to control my diabetes and achieve my weight loss goals?
PETER ASKS: I was diagnosed as a Type 1 diabetic in October 2012 and it came as a surprise to me since I considered myself to be far above average in health. I am an endurance athlete and coach and had just completed my third ironman distance event the month before. My training was off a bit and I experience high levels of inflammation, frequent colds, eye infections, and my body wasn’t responding to training as it had in the past. I still did surprisingly well all things considered. As a larger than normal athlete at 6’5”, 220 pounds and 10-12% body fat, I would consume about 5000 calories/day. I already was a fan of coconut oil and never feared fat, but I also ate more than my fair share of carbohydrates. I saved money by making my own bread, thinking that would make it healthier. I was under the assumption that I needed carbs for my exercise performance, but post dinner I’d be glued to the couch. I just wasn’t quite myself. Since becoming a Type 1 diabetic and being very sensitive to insulin (1U to 40grams initially), common sense taught me the easiest way to balance the carbs and insulin would be to use as little of each as possible. I started using an insulin pump which has allowed me to fine tune even further. For the past 7-8 months I’ve been on the ketogenic approach carefully researching all along the way and I’ve been very successful with this. I’m now planning to compete in the Ironman Arizona in just a few weeks. So here are my questions: Should I have a variable level of insulin so that my body doesn’t get used to a steady rate? I already reduce my rate while exercising, which is usually a couple of hours per day. What is the natural fluctuation the people see in a healthy body? And is there a good blood sugar range I should be shooting for being in a ketogenic state while exercising?
NICK ASKS: I work in Family Practice and find many patients cannot even consider giving up bread, rice and pasta. Do you have any tips to increase compliance with the diet when you first approach a patient about going on a low-carb plan? What has your “real life” experience been with long-term diabetes on large doses of insulin (>100 units per day) who adopt a low-carb lifestyle? Do you see problems in this type of patient particularly in achieving the blood sugar lowering you’d hope for and do you attribute that to glucagon dysfunction and hepatic insulin resistance? What other factors should be considered when low-carb just isn’t enough on its own?