Reversing Type 2 Diabetes with a Low-Carb Diet

Dr. Sarah Hallberg, one of my Health Sherpas, says patients who want to reverse type 2 diabetes have three medically proven options, backed by multiple published studies:

  • Bariatric Surgery
  • Very Low Calorie Diet
  • Low Carbohydrate Diet

Bariatric Surgery works for many people, with 30% or more able to achieve long-term remission. It also has the obvious downsides of surgical risk and expense. But it should be presented as an option, and some people will find it right for them.

A Very Low Calorie Diet, depending on the study, ranges from 300 to 1,800 calories per day. While these work really well in the short term, there is an issue with weight gain after the period of calorie restriction ends. It’s difficult to maintain the weight loss: the faster you lose weight, the faster you tend to regain it, and progress on diabetes can be lost too.

Low Carbohydrate Diets – Dr. Hallberg points to 22 randomized controlled trials (RCTs), 10 meta-analyses and 10 non-randomized trials, including six studies of two years or longer, including the Virta Health/Indiana University Health study she leads.

I think it’s worth watching the video below in its entirety for context, but if you want to skip ahead, she starts describing her results at about the 16:00 mark:

These results are phenomenal: Half of patients maintaining diabetes reversal at two years.

As she says, can you imagine if a drug had that kind of sustained effectiveness?

Here’s how the methods compare in blood sugar control:

Comparison of sleeve gastrectomy, gastric bypass, very low calorie diet and low-carbohydrate diet.

In HbA1c, low carbohydrate is better than sleeve or very low calorie at two years, and equal to bypass.

And here’s how they compare from a weight loss perspective:

As Dr. Hallberg pointed out, the patients in her study (the purple line) started at a higher weight, and the average time with diabetes before the study was 8 years. Shifting the purple line’s starting point down 10 kg would make it pretty similar to either of the surgical options.

I greatly admire Dr. Hallberg and her collaborators, and I think the work Virta Health is doing is outstanding. Their results are great, and I think their intensive coaching intervention is valuable for people adopting this new way of eating.

I would add a fourth approach that I think will be the most effective, however: a combination of a low carbohydrate diet with intermittent fasting.

It conceptually combines the effects of the purple and orange lines in the graphs above.

Dr. Jason Fung calls fasting “medical bariatrics.” It has the benefits of bariatric surgery without the surgical expense and risk. It’s a lot easier to undo, too: You simply resume eating.

In fact, you have unlimited flexibility in adjusting the dosage of fasting. You can start with a 12-hour eating window each day, or you can fast for 16 or 18 hours and only eat from noon to 6 p.m. or noon to 8 p.m.

You can even consider alternate-day fasting, as in the #July4Challenge.

Low carbohydrate eating makes those fasting periods much less difficult, because fat and protein are more satiating than carbohydrates.

It’s kind of magical how these two strategies work together.

One final observation: At about the 23-minute mark of the video, Dr. Hallberg makes a really important point about the misplaced emphasis on randomized controlled trials in gauging efficacy.

RCTs are important when you have a drug intervention, because you’re typically testing a drug vs. a placebo, and the only thing you’re asking of the patients in the study is to just be sure they take whichever pill is assigned.

Diet is different. Motivation matters.

So does belief. If you’re randomly assigned to a diet for purposes of a study, even if you’re really motivated to change, you may not have really bought into the rationale behind the diet.

More on belief in a bit.

Dr. Hallberg in the U.S. and Dr. David Unwin in the U.K. have each demonstrated that a significant portion of patients under their care (as many as half) are able to reverse type 2 diabetes, going off diabetes medications, through a truly low-carb diet.

They’re not alone. Dr. Eric Westman at Duke, Dr. Tro and Dr. Brian Lenzkes, Dr. Ken Berry and scores or even hundreds of others are doing the same, although perhaps not quite at the same scale or with rigorous comparative studies.

They’re just helping patients who are motivated to get healthy and lose weight, and who are willing to try a low-carb approach.

For type 2 diabetes reversal (and prevention) and for weight loss, low-carb works.

I believe low carb + periodic fasting works even better.

I can’t “prove” it by the RCT standard, and the people I’ve mentioned above may not all agree with the combination.

They each have their own emphases: Dr. Fung’s is mainly on fasting, while I think some of the others who promote low-carb think it’s most important to eat healthy fat and moderate protein meals to satiety. They say the key is avoiding hunger, which makes compliance easier.

My experience has been that combining both perspectives has led to the best result for Lisa and me.

Now back to what I said about belief.

There’s plenty of evidence that if you will adopt a low-carb eating pattern you can eat until you’re full, rarely feel hungry, improve your metabolic health and lose weight.

But as long as you toy with the idea instead of taking the plunge, you’ll never really know. As one of the great Christian theologians put it in a different context:

“Understanding is the reward of faith. Therefore, seek not to understand that you may believe, but believe that you may understand.”

St. Augustine of Hippo

Give low carb with periodic fasting a try.

Embrace the journey. Take the plunge.

If it doesn’t work for you, you can always have bariatric surgery later.

In the next few days I’ll have a post describing a new free community we’re setting up to support people in making these changes and swimming against the societal dietary currents. I look forward to telling you about it.

It will be another installment in the series about my health journey. You can follow along on FacebookTwitter and LinkedIn or subscribe by email

If you’re ready to get started yourself, use my #BodyBabySteps.

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Is Cancer Caused by Sugar?

That’s the question posed in this discussion featuring one of my top Health Sherpas, Dr. Jason Fung, in an interview related to his new book, The Cancer Code, with Dr. Mark Hyman, a functional medicine physician and host of The Doctor’s Farmacy podcast.

Dr. Fung is among the five physicians who have been most influential for Lisa and me. From The Obesity Code to The Diabetes Code to The Complete Guide to Fasting to Life in the Fasting Lane, his books share common themes:

  • Insulin is the hormone that causes your body to store fat.
  • While other macronutrients cause some insulin response, sugar, starches and highly processed carbohydrates cause blood sugar (and insulin) spikes, and our continuous snacking means blood insulin levels are perpetually high.
  • This condition, called hyperinsulinemia, causes weight gain, often leading to obesity and Type 2 diabetes.
  • Giving patients with Type 2 diabetes increasing doses of insulin to manage blood sugar causes them to gain even more weight, making the problem worse.
  • Obesity increases the risk of many cancers, including breast, prostate and colon cancer. Insulin, with its growth-promoting properties, seems to encourage the uncontrolled growth of cancer cells.
  • Intermittent fasting, time-restricted eating or even fasts of a day or more create periods of lower insulin levels in the blood, which enables your body to begin burning the fat you’ve stored. Fasting regimens may have some cancer-prevention benefits, too.

I have spent hours listening to Dr. Fung’s books on Audible, many of them more than once, and we also have the print edition of some of them. He has had great insight into dietary and lifestyle contributors to disease, and also is an excellent communicator to a lay audience.

Setting aside one hour to watch this video would be a great investment for you.

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The Other Side of Fasting

Dr. Jason Fung calls fasting “medical bariatrics.” For patients with type 2 diabetes it has the same benefits (under proper medical supervision) as bariatric surgery, but it’s totally reversible.

And compared to surgery or medications, it has radically fewer side effects. It’s been used by literally billions of people throughout history and has been part of every world religion.

And it’s even better than free. It actually saves money.

The other major positive aspect of fasting is its flip side. Fasting isn’t a continual pledge of self-denial. It’s a decision to forego eating for a time. And when the fast is over, it’s time for…

The Feast.

It’s not a great idea to break an extended fast (2-3 days or more) with a huge meal. That can be a shock to your system. But if you regularly maintain a narrow feeding window of perhaps 8 hours or less, and occasionally throw in a 24-48 hour fast, it frees you to really enjoy occasional excess without guilt or fear.

So as Dr. Fung says, “Enjoy that birthday cake!” Relish those holiday meals.

For me, another big application is when I travel to our Mayo Clinic locations in Phoenix and Jacksonville. I get to each of them perhaps twice or thrice per year, and so I make sure to visit my favorite gluten-free restaurants in each city.

When I’m in Phoenix, I make sure to eat once at Picazzo’s Healthy Italian Kitchen, where I get the Meaty Meaty pizza with gluten-free crust:

The Meaty Meaty at Picazzo’s

I also eat at Zinburger, where in addition to gluten-free burgers and double-chocolate milkshakes they have a separate fryer where they prepare French fries loaded with cheese and bacon.

Thankfully, when I visit I’m usually there a couple of nights, so I can make it to both places.

As I write this, I’m in the Sky Club in Atlanta on the way home from a couple of days in Jacksonville. That meant on Thursday night I got to visit V Pizza in Jacksonville Beach, where I had the Carnivora with gluten-free crust:

The Carnivora at V Pizza in Jacksonville.

The great part about fasting is that I can look forward to meals like this because I know I will have them a few times a year at most. So I couldn’t develop a habit of visiting these restaurants more frequently even if I got a sudden craving.

When I do eat there, I typically have fasted since dinner the night before, and will fast the next morning as well.

So even though I’m eating 10-15 times the carbs I usually have, within a day or two of my feast I’ll have burned the sugar and starch and be back to gluconeogenesis and maybe even moving toward ketosis.

If you haven’t tried fasting, I’d encourage you to investigate its benefits. Read about our 10-week alternate daily fasting experience. And again, if you’re on diabetes medications or insulin you absolutely do need medical supervision to prevent hypoglycemia.

Once you’ve developed a time-restricted feeding or intermittent fasting pattern or mindset (especially a low-carb diet), you’ll not only be free from the tyranny of cravings and having food seem so important.

You’ll also really enjoy the times when you do feast.

If you want to explore why intermittent fasting works, this video featuring Dr. Fung is a great way to start.

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Our 10 Weeks of Alternate Daily Fasting

As I mentioned in this post, when I heard Art De Vany say he eats “two meals a day, sometimes one, sometimes none” I thought that was unfathomable.

But after reading The Obesity Code and The Complete Guide to Fasting, in which Dr. Jason Fung described his experience with his Intensive Dietary Management clinic and how he would get many patients with type 2 diabetes off insulin and diabetes medications within just a few weeks through extended fasting, Lisa and I were ready to give it a try.

Neither of us had even been diagnosed as prediabetic, but Lisa’s fasting blood sugar had been 102 in October 2016, which is what got us started on this dietary and lifestyle journey.

In The Obesity Code, Dr. Fung cited a study of 70 days of alternate daily fasting in which body weight was decreased by an average of 6%, while fat mass decreased by 11.4%, with no loss of lean mass. He also said

Studies of eating a single meal per day found significantly more fat loss, compared to eating three meals per day, despite the same caloric intake. Significantly, no evidence of muscle loss was found.

The Obesity Code, p. 243, Jason Fung, M.D.

It’s important to note that with alternate daily fasting, you’re still eating every day. Typically you eat dinner every evening, and skip breakfast and lunch every other day.

So on Sunday you would eat all three meals, but then on Monday skip breakfast and lunch, limiting yourself to water, black coffee or tea. Then repeat the cycle.

Two Three important additional points:

  1. If you are taking insulin or medications for diabetes, you absolutely need to have medical supervision while fasting to prevent dangerous low blood sugar episodes.
  2. If you’re eating lots of carbohydrates, you will be miserable on an all-day fast. It’s best to get at least somewhat converted to fat metabolism before starting fasting. Eggs, meat, avocados, nuts and other foods relatively high in fats and with moderate protein, combined with limiting carbs to 25-40g per day, will help convert your body to burning fat.
  3. I’m not a doctor. I’m not giving medical advice. Check this out for yourself and make your own decision in consultation with medical professionals you trust.

One more tip: a good way to start is with time-restricted feeding, just skipping breakfast every day and eating lunch and dinner during a 6-8 hour window. This still gives you an extended period of lowered insulin levels, and isn’t quite as extreme as going 24 hours without food.

With all of those caveats, here are my weekly bluetooth scale readings from our 10 weeks of alternate daily fasting. I weighed every day, but for simplicity am just sharing the Wednesday morning readings.

With the caveat that the body fat and muscle percentages seem to be calculated by some voodoo electrical signals running through the soles of my feet, at least all of those readings were coming from the same scale.

So the bottom line is that I lost about a pound of fat per week while essentially preserving muscle mass. (The other 4 lbs. lost, according to the scale, were water weight .)

Note also that when we started the 10-week experiment I was already down 37 lbs. from Peak Lee, as demonstrated in my “before” pictures. So presumably I had already lost the “easy” weight.

And in keeping with the study cited by Dr. Fung, my body weight was reduced by 6.2%, while my body fat was reduced by 18.1%, during the 10-week period.

Have you tried intermittent fasting or time-restricted feeding?

If so, how did it work for you?

If not, what questions do you have?

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