2022-01-03 - Type 2 Diabetes and Fasting by Jason Fung
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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
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