The diabetes reset : avoid it, control it, even reverse it : a doctor’s scientific program

220 Pages·2014·2.21 MB·English

by  King

THE
DIABETES
RESET
Avoid It. Control It. Even Reverse It.
A Doctor’s Scientific Program
GEORGE L. KING, M.D.
WITH ROYCE FLIPPIN
WORKMAN PUBLISHING • NEW YORK
I dedicate this book to my wife, Diana, and my sons, Benjamin and Adam, for their
lifetime of support. I also want to express my appreciation to all the investigators,
health providers, and patients with diabetes at JOSLIN DIABETES CENTE Rand
everywhere for their passion and hard work in managing this disease.
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION: THE DIABETES RESET PROMISE
PART ONE—THE DIABETES RESET TOOLBOX: EIGHT ESSENTIAL STRATEGIES FOR
PREVENTING AND CONTROLLING TYPE 2 DIABETES
STRATEGY 1: The Rural Asian Diet (RAD) Eating Plan: Cut Your Fat Intake in Half and Double
Your Fiber
STRATEGY 2: Reduce Your Body Weight by 5% to 7%
STRATEGY 3: Increase Your Muscles’ Glucose-Absorbing Ability Through Aerobic Exercise and
Strength Training
STRATEGY 4: Activate Your Calorie-Burning Brown Fat—It’s Easier Than You Think
STRATEGY 5: Turn Your Body into an Inflammation-Fighting Machine
STRATEGY 6: Get Seven to Eight Hours of Sleep Every Night
STRATEGY 7: Reduce Stress and Manage Your Mental Health
STRATEGY 8: Boost Your Own Natural Antioxidants
PART TWO—PUTTING THE DIABETES RESET STRATEGIES INTO ACTION: A
TWELVE-WEEK IMPLEMENTATION PLAN
WEEK 1: Time to Get Moving!
WEEK 2: Kicking Off Your RAD Eating Plan
WEEK 3: Starting Your Weight-Loss Program
WEEK 4: Building Strength
WEEK 5: Taking Aim at Inflammation
WEEK 6: Improving Your Sleep
WEEK 7: Upping Your Aerobic Program to the Next Level (Optional)
WEEK 8: Addressing Your Stress
WEEK 9: Activating Your Body’s Antioxidants
WEEK 10: Bringing Your Brown Fat into Play
WEEK 11: Optimizing Your Vitamin D
WEEK 12: The Diabetes Reset Lifetime Plan
Strategies to Prevent or Control Gestational Diabetes
Endnotes
About the Authors
ACKNOWLEDGMENTS
I would like to thank my literary agent, Katherine Cowles, who had the original vision for this book,
and without whom The Diabetes Reset would not have been written. I also want to thank my
assistants, Daad Abraham and Karen Lau, for their extensive efforts in the research and writing of this
book. In addition, I am grateful to the Joslin researchers and clinicians who generously shared their
time and expertise, and to the administrators at Joslin for their support of this project. Finally, I offer
my special thanks to Royce Flippin, my collaborator on this project, and to the editors and production
team at Workman Publishing, especially Mary Ellen O’Neill, for their fine work in bringing this book
to publication.
(Note: Dr. King will be donating 50% of his proceeds from The Diabetes Reset to the Joslin
Medalist Study and Joslin’s Asian American Diabetes Institute.)
INTRODUCTION:
THE DIABETES RESET PROMISE
If you’re reading this book, it’s very likely that you or someone close to you is struggling with blood
glucose levels. It could be that your fasting blood glucose level was higher than it should have been at
your last checkup—perhaps in the prediabetes range of 100 to 125 mg/dL (milligrams per deciliter),
indicating you have impaired glucose tolerance and are at high risk of developing diabetes. Your
fasting blood glucose may even be more than 125 mg/dL, which is considered the threshold for type 2
diabetes.
You may also have gotten test results showing that your hemoglobin A1C levels, which measure
your average blood glucose over the past several months, are elevated—meaning they were either
between 5.7% and 6.4%, the range for prediabetes, or 6.5% or higher, signaling that you may actually
have diabetes.
Learning that your blood glucose levels are too high can be bewildering, even frightening.
Because both type 2 diabetes and its precursor, prediabetes, tend to develop slowly over many years,
it’s tempting to think that once you’ve been diagnosed with one of these conditions, there’s not much
you can do except take diabetes medication and hope for the best. As a lifelong diabetes researcher,
however, I want to assure you that nothing could be further from the truth. In reality, you can always
take steps to improve your body’s response to insulin and “reset” your ability to metabolize the
glucose in your blood—starting today.
This simple statement has profound implications. It means that if you have prediabetes, not only
can you prevent your condition from progressing to diabetes, but in many cases you can actually
reverse course and bring your glucose metabolism back to normal. Even if you’ve already been
diagnosed with type 2 diabetes, you can still significantly improve your body’s natural glucose
metabolism and dramatically reduce—and in some cases even eliminate—your need for metformin,
synthetic insulin, or other diabetes drugs.
The promise of The Diabetes Reset is equally simple: If you follow the evidence-based
approaches in this book, you will begin seeing immediate improvements in your body’s ability to
metabolize blood glucose—improvements that will continue to grow over time. At the same time, you
will also see remarkable improvements in your overall health. In addition to becoming lighter and
fitter, you will find yourself eating the types of foods that human beings have thrived on for thousands
of years. You’ll also sleep better at night, experience less stress during the day, and have a more
balanced immune system that fights off illness without overreacting. And because impaired blood
glucose control is a major risk factor for cardiovascular disease, you will be taking a major step
toward improved heart health as well.
The Diabetes Reset: Not for Type 2 Diabetes Only!
Although the diabetes-control strategies in The Diabetes Reset have been written primarily for people with prediabetes or type 2
diabetes, they will also benefit people with type 1 diabetes and pregnant women who may be at risk of gestational diabetes. By
using these approaches to increase insulin sensitivity, type 1 diabetics can enhance their glucose control and also reduce the
amount of insulin medication they require, which in turn will make it easier to control their weight. At the same time, the
recommendations contained in this book will enhance their overall health and reduce risk of vascular complications. Similarly,
pregnant women can use these approaches to reduce the risk of developing gestational diabetes.
Glucose and the Goldilocks Principle
There are only 4 grams of glucose—just enough to fill a teaspoon—circulating at any given time in
the bloodstream of an average-weight person. But keeping that small amount of glucose constant is
vitally important to your health. When it comes to your blood glucose level, the Goldilocks principle
holds—you want it to be in the “just right” range, no lower than 70 mg/dL and no higher than 100
mg/dL when you wake up in the morning, and no higher than 140 gm/dL one to two hours after eating
a meal. Normally, your body is programmed to keep glucose safely within this range. When glucose
levels rise, the body automatically produces more insulin to speed the absorption of this glucose into
the body’s tissues. When glucose levels dip toward the lower end of this range, the liver releases
stored glucose into the bloodstream, while the pancreas stops producing insulin and may instead
secrete glucagon, a hormone that induces the liver to manufacture still more glucose.
If this system falters and you become hyperglycemic, meaning that your blood glucose levels are
consistently elevated, this excess glucose will begin attacking your nerve endings and the walls of
your blood vessels. Over time, this can lead to neurological problems, damage to the eyes, kidneys,
inner ear, and other organs, and increased risk of heart attack and stroke. Although these
complications are typically associated with diabetes—defined as a fasting blood glucose of 126
mg/dL or higher or a postmeal glucose level of 200 mg/dL or above—people with prediabetes (a 100
mg/dL to 125 mg/dL fasting glucose level, or 140 mg/dL to 200 mg/dL following a meal) can also be
at increased risk for these conditions.
If blood glucose levels fall too low, on the other hand, a condition known as hypoglycemia, your
health can also suffer. Because the brain relies completely on blood glucose for fuel, and requires a
lot of it (when you’re in a sedentary fasting state, your brain consumes a whopping 60% of your total
blood glucose supply), it is quickly affected by low glucose levels. People typically begin noticing
the mental effects of low blood sugar as their glucose levels drop below 70 mg/dL. These may
include feelings of irritability, anxiety, and difficulty concentrating. Low blood sugar can also cause
headaches, fatigue, blurred vision, sweating, an elevated heartbeat, tremors, and hunger pangs. If
glucose levels drop further still, it can lead to fainting, seizures, coma, and even death. People who
take insulin medication for type 1 or type 2 diabetes are at particular risk for low blood glucose
because injected insulin can push glucose levels too low if it’s administered at the wrong time or in
the wrong dose.
If you notice signs of low blood glucose, you should immediately ingest 15 grams of fast-acting
carbohydrate, such as: 4 ounces of fruit juice, 6 ounces of regular soda, three to four glucose tablets,
one small box of raisins, 1 tablespoon of honey or syrup, or seven gummy bears.
Why Is My Blood Glucose Too High?
When your blood glucose levels start to rise, it’s an indication that several related things are
occurring inside your body. First, your body’s insulin—the hormone that has primary responsibility
for keeping your blood glucose within a normal range—is no longer working as effectively as it
should because specific tissues aren’t fully responding to its actions. This reduction in insulin
sensitivity, commonly referred to as insulin resistance, has different effects depending on where it
occurs.
In your muscles, where most blood glucose is burned or stored, insulin resistance makes it
harder for glucose to enter the muscle cells. The result is that more insulin is needed to help the
muscles absorb glucose. If not enough insulin is available, then excess glucose is left circulating
in your bloodstream while less glucose passes into your muscles to help power them. For most
people, insulin resistance in the muscles is what starts them on the path to type 2 diabetes.
In your liver, which both stores and manufactures glucose, insulin acts to suppress glucose
production. When the liver becomes insulin resistant, however, insulin’s suppressive effect on
glucose production is reduced, causing excess glucose to be released from the liver into the
bloodstream.
The third major “target” of insulin is the body’s fat tissues. Insulin works on the fat cells to
suppress the breakdown of fat stores into fatty acids for use as fuel. When fat tissue becomes
insulin resistant, this suppressive effect is reduced, inhibiting the fat storage process—which, as
we’ll see shortly, can lead to even more insulin resistance by contributing to fat buildup in the
muscles and liver.
Although insulin resistance works differently in the muscles, fat, and liver, the result is the same:
The body must pump out greater amounts of insulin on an ongoing basis in an attempt to keep blood
glucose levels under control. Insulin resistance can exist for many years without causing a noticeable
rise in blood glucose levels (although even then it places the insulin-resistant individual at increased
risk for cardiovascular disease). In a sizable percentage of people with insulin resistance, however,
there comes a time when the beta cells in their pancreas—the cells that manufacture insulin—can no
longer make enough insulin to overcome their decreased insulin sensitivity.
When this occurs, your blood glucose levels become elevated and you cross the threshold to
prediabetes. If your pancreas continues to fall behind, the next step will be type 2 diabetes. With your
body unable to manufacture enough insulin to metabolize all the glucose in your blood, your blood
glucose will remain at unhealthy levels unless you begin taking diabetes medication or start pursuing
some serious antidiabetes lifestyle strategies—such as the ones outlined in this book.
Unraveling the Causes of Type 2 Diabetes
At the most basic level, then, type 2 diabetes is a simple two-step process: First, you develop insulin
resistance, requiring more insulin to be produced to keep glucose levels under control. Second, your
insulin production begins to fall short, causing glucose levels to rise. This sounds straightforward
enough. But exactly why this two-step process occurs in some people and not others has remained a
medical mystery until fairly recently. We knew, for example, that being overweight contributes
significantly to type 2 diabetes risk (as evidenced by the fact that 80% of people with type 2 diabetes
are overweight or obese) and that getting regular exercise appears to improve glucose control and
lessen type 2 diabetes risk, but the mechanisms behind these connections weren’t clear.
That situation has altered dramatically over the past twenty years. Thanks to major advances in
our ability to understand and investigate the complex biochemical reactions that regulate our bodies,
we are starting to gain a fairly good understanding of the causes of insulin resistance—which, it turns
out, is a complex, multifaceted phenomenon. We’re beginning to unravel some of the causes of
pancreatic failure as well, which offers promise not only for the prevention and treatment of
prediabetes and type 2 diabetes, but also for the treatment of people with type 1 diabetes—an
autoimmune disorder that typically strikes early in life, attacking the insulin-producing cells in the
pancreas to the point where it can manufacture little or no insulin at all.
In The Diabetes Reset, I’ve drawn on these latest findings to provide eight evidence-based
strategies for reversing the insulin resistance process and preserving the insulin-producing function of
your pancreas. In these eight strategy chapters, I’ll describe in detail many of the exciting discoveries
being made by diabetes researchers about the importance of diet, weight loss, exercise, stress, and
other key factors. First, though, I want to share our current knowledge about the underlying causes of
prediabetes and type 2 diabetes.
The Four Drivers of Insulin Resistance
Much of the discussion around diabetes centers on carbohydrates—the nutrient that your body
converts into glucose. And it’s certainly true that persistently high levels of glucose in the
bloodstream are what actually cause many of the physical problems associated with diabetes by
damaging the nerves and the blood vessels that feed the heart, kidneys, eyes, and other vital organs.
But elevated blood lipids in the form of total cholesterol and LDL cholesterol (which are linked
mainly to dietary consumption of fat rather than carbohydrates) are also important risk factors in
diabetic patients. What’s more, we now know that elevated blood glucose levels and blood lipids are
actually driven by insulin resistance, caused in varying degrees by the following factors:
Fat accumulation in muscle and liver tissue
Mitochondrial dysfunction due to oxidative stress
Systemic and local inflammation