If you look at articles about East Asian countries in issues of National Geographic from the early 20th century, you will notice two things. One is that many of the people in East Asia were eating a lot of white rice. The other is that only the rich people and the sumo wrestlers were overweight. That’s because the rich people and the sumo wrestlers were eating something besides rice and vegetables.
Dr. George Lundberg, the former editor-in-chief of JAMA, graciously invited me to coauthor this editorial on how starchy, low-fat diets reverse insulin resistance!
During the Siege of Paris in 1870, a French pharmacist named Bauchardat noticed that the health of diabetics was improving while everyone else was suffering as a result of food shortages. That’s because the most common form of diabetes is type 2 diabetes, which the French call diabète gras, or fat diabetes. Type 2 diabetes represents the body’s attempts to resist gaining too much weight on a fattening diet. If the weight gain is solved by eating fewer calories, then the type 2 diabetes improves.
World War I provided insight into another way to deal with type 2 diabetes. Even though Denmark was neutral during the war, its grain supply had been cut in half by the Atlantic Blockade. To prevent the grain shortages from causing widespread starvation in Denmark, the Danish government developed a rationing plan. Instead of people feeding the available grain to animals and then eating the animals, the government decreed that most of the food animals should be slaughtered immediately and the grain be fed directly to the people. It also decreed that grain should not be used to make alcohol. The Danes could eat as much bread and potatoes and cabbage as they wanted; but their intake of meats, fats, and alcohol was severely restricted. Not only did this rationing plan prevent starvation, it improved the overall health of the Danish population so much that Denmark enjoyed the lowest recorded death rate in its history.
I don’t know how much of the lower mortality in Denmark during the war was due to a decrease in the rate of diabetes specifically and how much to a lower risk of heart attack or stroke among nondiabetics. All of those diseases result from the same cause, which is a rich, fatty diet. Fortunately, I do have data on how wartime rationing affected the risk of death from diabetes in England and Wales during the first half of the twentieth century.
Notice that the risk of diabetes went up during times of peace and prosperity and dropped like a stone during wartime rationing. It stayed low during the Great Depression, when many people simply couldn’t afford to overeat. The effect of dietary changes was so powerful that it completely obscured the impact of the introduction of insulin therapy in the early 1920s. That’s because the most common form of diabetes is type 2 diabetes, which results from eating a fattening diet. Less than 10% of diabetes cases result from failure of the pancreas to produce insulin.
Low-carb gurus keep telling me that a diet based on grains causes obesity and diabetes. It’s true that the low-carb diets seem to provide some short-term benefit for diabetics. Depriving a person of carbohydrates does make high blood sugar go down immediately, even if makes the diabetes worse in the long run. If the low-carb diet suppresses the person’s appetite enough to cause weight loss, the diabetes could improve. However, this improvement would be due to weight loss, not to eating fat and protein instead of carbohydrates. At the same time, the low-carb diets provide an overload of fat and protein, which is particularly bad for people with diabetes because they are so prone to heart and kidney problems. The heavy load of animal protein in low-carb diets would also promote osteoporosis and cancer, but those problems might not show up immediately.
The low-carb gurus ignore an obvious fact: diabetes and many other chronic diseases are rare in populations that eat a diet that’s heavily based on grains or other starchy staples, such as potatoes. Diabetes is common only in societies that base their diet heavily on animal products. When a population shifts from an animal-based diet to a diet based on grains and other starchy staples, such as potatoes, the rates of obesity and diabetes come tumbling down. Fortunately, there doesn’t have to be a war for people to make this change in diet. It only takes awareness and a new set of recipes.
The good news is that we don’t need to starve ourselves or suffer the horrors of war to cure type 2 diabetes. All we need to do is go ape, go wild, and eat plants. Peace on earth!
Photo by Kylie_Jaxxon
Note: In my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2, I explain why a high-carbohydrate diet is good for people with any kind of 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.
Note: 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).
Diabetes is the number 1 cause of nontraumatic amputations in the United States. What’s truly outrageous is that most of these amputations are happening to people with the form of diabetes that can easily be cured, sometimes within as little as a week, by a simple change in diet. Just eat unrefined plant foods instead of animal-based foods and processed foods and cut your fat intake to 10% or less of calories.
Here is an interesting article that was published in the Proceedings of the Royal Society of Medicine in 1949. It points out that type 2 diabetes is common in places where people eat a fatty, low-carb diet and rare in places where people eat a starchy, low-fat diet. When a population that had been eating a fatty diet switches to a starchy diet, such as under rationing in wartime, the number of people who die of complications of diabetes falls off dramatically. See the graph on page 324 to see the effects of rationing, economic slump, and the introduction of insulin therapy on the number of people who died of diabetes in England and Wales in the early 20th century.
The author pointed out that you can see the same relationship between high fat consumption and deaths from diabetes all over the world:
There thus seems to be a universal relation between diet and diabetic mortality. The dietetic factor most closely related is fat consumption.
It may seem odd that the introduction of insulin therapy didn’t make a dent in the graph. That’s because most people with diabetes have type 2 diabetes, which used to be called non–insulin-dependent diabetes. You’d see a different picture if you looked at a graph of deaths from type 1 diabetes, which used to be called insulin-dependent diabetes.
Note: For a clear explanation of why high-carbohydrate diets are good for people with any type of diabetes, see my book Thin Diabetes, Fat Diabetes: Prevent Type 2, Cure Type 2.
Most people with type 2 diabetes are at least pleasantly plump, so why do so many severely obese people have no trouble with their blood sugar? I’ve known for decades that unexplained weight loss is a common sign of diabetes. A few years ago, I began to suspect that type 2 diabetes is what happens when one of the body’s natural defenses against further weight gain gets out of control. These suspicions were deepened when I realized that the drugs that are used to treat type 2 diabetes often cause weight gain as a side effect. The drugs are disabling the body’s natural resistance to further weight gain!
This interesting article from Endocrine Reviews argues that in type 2 diabetes, the problems with fat metabolism start long before the person starts having abnormal blood sugar levels. It explains how too much fat in the body and too much fat from the diet could end up causing type 2 diabetes. It explains how eating less and exercising more could solve the underlying problem.
The idea that type 2 diabetes starts off as a problem with fat metabolism makes a lot of sense. It helps to explain something that scientists have known since the 1930s: that you can cause insulin resistance in healthy volunteers by feeding them a high-fat diet for a week. You can restore their insulin sensitivity by feeding them a starchy diet for a week. A switch to a low-fat, high-fiber, high-carbohydrate, purely plant-based diet produces a dramatic improvement in people with type 2 diabetes, even before they have had a chance to lose much weight.
The traditional cure for type 2 diabetes was to eat less and exercise more. A more sensible approach is to start off by eating as much high-fiber, low-fat, plant-based food as you feel like eating. This kind of diet will rapidly correct your insulin resistance. As your insulin resistance improves, you’ll feel more like exercising.
Of course, if you have any major health problem or are taking prescription medications, you need to talk to a registered dietitian and your prescriber before making any major change in diet. You may need to have your dosages adjusted, and you may be able to stop taking some of your prescription medication.
Note: I explain this topic in more detail in my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2
Photo by 95Berlin