The Diabetes Reset: Avoid It. Control It. Even Reverse It. A Doctor's Scientific Program

292 Pages·2015·2.45 MB·English

by  George King M.D.

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 CENTER and 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