insulin resistance

Scientists Rediscover That Starvation Cures Type 2 Diabetes

Yes, you can reverse type 2 diabetes if you starve yourself. In fact, a medically supervised water-only fast can be a useful way to manage many different kinds of diet-related diseases. Fortunately, you do not have to starve yourself to reverse your type 2 diabetes. Instead, you could simply eat a low-fat, plant-based diet—like the populations that don’t get type 2 diabetes to begin with.

In June of 2011, some researchers from Britain published the results of a trial in which people with type 2 diabetes who went on a starvation diet (600 calories per day) ended up with normal fasting blood sugar levels. To me, that is not news. By 1841, a French pharmacist named Apollinaire Bauchardat was recommending that patients with what we now call type 2 diabetes should eat as little as possible and that they should fast occasionally to bring down their blood sugar. Since then, however, diabetes researchers have learned that it’s possible to reverse type 2 diabetes without such severe calorie restriction. In fact, I think that it’s better to teach people the diet that will enable them to cure their type 2 diabetes within a couple of weeks without limiting their food intake than to set them on a course of yo-yo dieting and possible eating disorders.

Bouchardat was one of the first clinicians to put patients in charge of monitoring their own diabetes. At first, his patients did this by keeping track of what they ate and tasting their urine to see how sweet it became. Later, Bauchardat worked out a chemical test to detect sugar in urine. From monitoring the sugar content of the urine, Bauchardat showed that when people with diabetes ate sugars or starches, large amounts of sugar passed into their urine. The sugar in the urine reflected high blood glucose levels. However, the problem in type 2 diabetes is not that the person is eating carbohydrates, it’s that the body has become resistant to the hormone insulin.

Starting in the 1930s, scientists started to realize that fatty diets made the body less sensitive to insulin, and that this insulin insensitivity was the underlying cause of the high blood sugar levels in people with type 2 diabetes. People who went on a low-fat, high-carbohydrate diet rapidly became more responsive to insulin.

Starting in the 1940s, Dr. Walter Kempner at Duke University reported astonishing success in reversing type 2 diabetes and diabetic complications with a diet based entirely on rice and fruit. Patients who found that they were losing too much weight on that low-fat diet were encouraged to add pure white sugar to get more calories. In Kempner’s report of 100 patients with diabetes who were fed his high-carbohydrate, low-fat, low-protein diet, most of the patients decreased their insulin doses and many discontinued taking insulin. (It’s likely that some of the patients had type 1 diabetes and therefore would need to keep taking insulin for the rest of their lives.)

The American Diabetes Association currently recommends that people with type 2 diabetes eat limited portions of foods from all of the four food groups. In 2006, however, a clinical trial showed that the people who were randomly assigned to eat as much as they liked of low-fat, unrefined plant foods (75% carbohydrate by calorie) found it easier to stick to their diet, lost more weight, and made faster progress in reversing their diabetes than did the people who were randomly assigned to follow the ADA’s recommendations.


Behind Barbed Wire_PrintNote: In my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2, I explain the relationship between body weight and blood sugar. French doctors have always used the term fat diabetes (diabètes maigre) to refer to the relative mild form of diabetes that occurs in people who are at least a little bit overweight and that goes away if they lose weight. Fat diabetes is the body’s way to avoid storing too much of the fat from a fatty diet. If you have fat diabetes, it means that you are a naturally thin person. It means that your body is willing to sacrifice everything—your feet, your eyesight, your kidneys, and even your life—to keep you from gaining any more weight. The solution to this problem is to switch to a low-fat, high-carbohydrate, high-fiber diet. This diet reverses type 2 diabetes and is also good for people with thin diabetes (type 1 diabetes).

insulin resistance

Only a Small Percentage of Diabetes Cases Are Truly Genetic

Lately, genes have been all the rage in medical research. Many people hope that genetic studies will unravel the secrets of many diseases that, strictly speaking, aren’t really genetic. Sometimes, people get so caught up in thinking about the genes that could be involved in a disease that they ignore the importance of diet to prevent and manage the disease. Yet even for a disease that is truly 100% genetic, dietary management can be important. The classic examples are the rare forms of diabetes mellitus that really are genetic. These forms of diabetes are called monogenic diabetes mellitus. Sometimes they’re called MODY, which stands for maturity-onset diabetes of the young. It is a form of monogenic diabetes, which means that it is due to a mutation in a single gene.

There are several different forms of MODY, each resulting from the mutation of a different gene. These disorders tend to be autosomal dominant, which means that if you inherit the gene from one of your parents, you have the disease. Clinically, cases of MODY tend to look like a hybrid between type 1 and type 2 diabetes. Together they account for somewhere between 1% and 5% of cases of diabetes mellitus.

Diabetes mellitus refers to several unrelated conditions that all result in high levels of sugar in the bloodstream. In the 1870s, French researchers noticed that there are two main types of diabetes mellitus. One is a catastrophic disease that tends to strike children and young adults. Before the discovery of insulin, these patients would rapidly lose weight, go into a coma, and die within a matter of days or weeks, regardless of treatment. The French researchers called it diabète maigre, or thin diabetes. English-speakers called it juvenile diabetes, then insulin-dependent diabetes, and now type 1 diabetes. In contrast, the most common form of diabetes is a much milder, reversible condition that occurs in middle-aged to elderly adults who are usually at least a bit overweight. The French called this condition diabète gras, or fat diabetes. English-speakers tactfully referred to this kind of diabetes as adult-onset, then non–insulin-dependent, and now type 2 diabetes.

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If left untreated, all forms of diabetes mellitus result in abnormally high levels of a sugar called glucose in the bloodstream. In cases of type 1 diabetes, the high glucose levels result from the failure of the pancreas to produce the hormone insulin. In cases of severe insulin shortage, the body goes into a state called diabetic ketoacidosis, which is a medical emergency.

Early on, doctors noticed that people with type 2 diabetes rarely get diabetic ketoacidosis. In severe cases, they might go into a coma because their blood sugar is so high that they get severely dehydrated, but they rarely get such severe ketosis that their blood pH is affected. That’s because people with type 2 diabetes are producing some insulin. In fact, they tend to have abnormally high levels of insulin in their bloodstream. The problem is that their cells have become resistant to the effects of insulin.

MODY was discovered in the 1960s, when physicians noticed that some children had persistent, symptomless high blood sugar that didn’t progress to ordinary type 1 diabetes. In other words, the condition looked like type 2 diabetes, except that it was happening in young people who weren’t overweight. The child’s pancreas was producing some insulin, just not enough to meet the body’s needs. By the 1970s, it was clear that this problem ran in families. At present, at least 10 forms of MODY have been described, each of them linked to a different gene.

The treatment for MODY depends on what type of MODY the patient has. Genetic testing is now available for MODY1, MODY2, MODY3, MODY4, and MODY5. MODY2 is a relatively mild disease that can be managed by diet and exercise. As in ordinary cases of type 2 diabetes, the goal is to avoid or reverse insulin resistance, so that the amount of insulin the pancreas produces on its own will be enough to regulate the patient’s blood sugar naturally. Maintaining insulin sensitivity through proper diet and exercise is undoubtedly also important in managing the other, more severe forms of MODY. Patients with MODY1, MODY3, or MODY4 are usually given a sulfonylurea drug that causes the pancreas to secrete extra insulin. MODY5 is a severe condition that is usually treated as if the patient has no pancreas whatsoever; the patient is given insulin injections as well as digestive enzymes that are taken by mouth.

Eventually, doctors found that a few newborns had a condition that seemed like type 1 diabetes. This condition, called neonatal diabetes, is generally inherited as an autosomal recessive trait. To get a case of infantile diabetes, the baby has to inherit a defective version of a gene from both parents.

If you think that you or someone in your family has either MODY or neonatal diabetes, contact the National Center for Monogenic and Neonatal Diabetes at the University of Chicago.


Behind Barbed Wire_PrintNote: For more information about diabetes in general and the genetic forms of diabetes in particular, see my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2.

insulin resistance

We’ve Known Since the 1930s: Fatty Diets Cause Insulin Resistance

This graph shows the glucose tolerance test results of a healthy person on a high-fat test diet as opposed to a high-carb diet. Notice that he had lower, more stable blood sugar levels after eating a high-carb diet!

Low-carb gurus have been telling people that insulin resistance, which is the underlying cause of type 2 diabetes, results from eating too much carbohydrate. Yet scientists have known since the 1930s that the problem can be provoked by a high-fat diet and reversed by a starchy, low-fat diet. You can read the research for yourself here.

This work was done in the 1930s. How long will it take before the low-carb gurus hear about it?