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# 2022-01-03 - Type 2 Diabetes and Fasting by Jason Fung | |
An excerpt from the introduction to The Complete Guide to Fasting by | |
Jason Fung (2016). | |
However, in my work with type 2 diabetics, I realized that there was | |
an inconsistency between the treatment of obesity and the treatment | |
of type 2 diabetes, two problems that are closely linked. Reducing | |
insulin may be effective in reducing obesity, but doctors like me | |
were prescribing insulin as a cure-all treatment for diabetes, both | |
types 1 and 2. Insulin certainly lowers blood sugars. But just as | |
surely, it causes weight gain. I finally realized that the answer | |
was really quite simple. We were treating the wrong thing. | |
Type 1 diabetes is an entirely different problem than type 2. In | |
type 2 diabetes, the body's own immune system destroys the | |
insulin-producing cells in the pancreas. The resulting low insulin | |
level leads to high blood sugar. Therefore, since insulin levels are | |
low to begin with, it makes sense to treat the problem with | |
supplemental insulin. And sure enough, it works. | |
In type 2 diabetes, however, insulin levels are not low but high. | |
Blood sugar is elevated not because the body can't make insulin but | |
because it's become resistant to insulin--it doesn't let insulin do | |
its job. By prescribing more insulin to treat type 2 diabetes, we | |
were not treating the underlying cause of high blood sugar: insulin | |
resistance. That's why, over time, patients saw their type 2 | |
diabetes get worse and required higher and higher doses of | |
medications. | |
But what caused the high insulin resistance in the first place? This | |
was the real question. After all, we didn't stand a chance of | |
treating the underlying disease if we didn't know what caused it. As | |
it turns out, insulin causes insulin resistance. The body responds | |
to excessively high levels of any substance by developing resistance | |
to it. If you drink excessive alcohol, your body will develop | |
resistance to it, up to a point--we often call this "tolerance." If | |
you use prescription sleep medications such as benzodiazepines, your | |
body will develop resistance. The same is true for insulin. | |
Excessive insulin causes obesity, and excessive insulin causes | |
insulin resistance, which is the disease known as type 2 diabetes. | |
With that understanding, the problem with how doctors treat type 2 | |
diabetes became clear: were were prescribing insulin to treat it, | |
when excessive insulin was the problem in the first place. | |
Instinctively, most patients knew what we were doing was wrong. They | |
would say to me, "Doctor, you have always told me that weight loss is | |
critical in the treatment of type 2 diabetes, yet you have prescribed | |
me insulin, which has made me gain so much weight. How is that good | |
for me?" I never had a good answer for this. Now I know why. They | |
were absolutely right; it wasn't good for them. As patients took | |
insulin, they gained weight, and when they did, their type 2 diabetes | |
got worse, demanding more insulin. And the cycle repeated: they took | |
more insulin, they gained more weight, and as they gained more | |
weight, they needed more insulin, it was a classic vicious cycle. | |
We doctors had been treating type 2 diabetes exactly wrong. With the | |
proper treatment, it is a curable disease. Type 2 diabetes like | |
obesity, is a disease of too much insulin. The treatment is to lower | |
insulin, not to raise it. We were making things worse. We were | |
fighting fire with gasoline. | |
I needed to help my obesity and type 2 diabetes patients lower their | |
insulin levels, but what was the best approach? Certainly, there are | |
no medications that do this. There are surgical options that help, | |
such as bariatric surgery (commonly called "stomach stapling"), but | |
they are highly invasive and have many irreversible side effects. | |
The only feasible treatment left was dietary: reducing insulin levels | |
by changing eating habits. | |
... | |
I gave my patients lengthy sessions of dietary advice. I reviewed | |
their food diaries. I begged. I pleaded. I cajoled. But the diets | |
just didn't work. The advice seemed hard to follow; my patients had | |
busy lives and changing their dietary habits was difficult, | |
especially since much of it ran contrary to the standard advice to | |
eat low-fat and low-calorie. | |
But I couldn't just give up on them. Their health, and indeed their | |
very lives, depended upon reducing their insulin levels. If they had | |
trouble avoiding certain foods, then why not make it as simple as | |
possible? They could simply eat nothing at all. The solution was, | |
in a word, fasting. | |
See also: | |
tags: book,fasting,health | |
# Tags | |
book | |
fasting | |
health |