Wake Up and Smell the Sugar
My low-carbohydrate epiphany occurred 11 years ago, when I discovered I had type 2 diabetes. As a physician, I should have known better. I had a strong family history of type 2 diabetes and I was working with the First Nations population (various Aboriginal peoples in Canada), where diabetes is rampant.
Studies, such as one published in 2009 by Harvard, would eventually show that type 2 diabetes was 90% preventable (1). Nevertheless, I had neglected my health to the point where I had actually developed a florid case of diabetes, with all the usual signs and symptoms, before it dawned on me to check my blood sugar. I had not been practicing clinical medicine for a while so I felt I should brush up on the latest therapies. To buy some time, I resolved not to eat any food that would exacerbate my hyperglycemia. Much to my surprise, my self-imposed carb-free diet quickly resulted in the reversal of all my previous signs and symptoms. My blood glucose levels returned to normal and I lost weight at a rate of a pound-a-day for the next month.
Not surprisingly, I became curious as to why, during my medical training or any time since, I had never come across the concept that a low-carb diet might be an appropriate therapy for diabetes. Fortunately, my epiphany coincided with a resurgence in the well-known Atkins diet—which takes a low-carb approach—along with increased research on carbohydrate restriction. Around that time, a paper appeared in the American Journal of Medicine, authored by Dr. Eric Westman of Duke University, which reported that overweight men had lost weight and improved their lipids by following the Atkins diet (2). A slew of published studies over the next 10 years showed similar benefits. When going head-to-head with conventional, calorie-restricted weight loss diets, the low-carb subjects usually demonstrated more success and better compliance. (3)
The benefits evident in the emerging literature encouraged me to pursue my new-found therapy more arduously. In my work with the Canadian Aboriginal population, I started comparing their traditional diets with the modern low-carb diets. I suggested that the recent addition of carbohydrates to their traditional protein and fat-based way of eating could be the driver of high chronic disease rates.
During one presentation, a First Nations man announced that he was going to try my low-carb diet idea. He was an obese diabetic with metabolic syndrome and a history of stroke who was medicated with insulin and an ACE-inhibitor. He had been using insulin for 17 years but was unable to control his blood sugar. He eliminated starch and sugar from his diet, and began sending me emails to document his progress.
After two weeks on the diet, he reported a weight loss of 17 pounds and normal fasting blood sugar readings. More remarkable, however, was the fact that he had completely discontinued his insulin. Over the course of 18 weeks, he lost 46 pounds while normalizing his blood sugar, blood pressure and lipids and discontinuing all medications. We remain in contact and he reports that over the intervening years he has lost an additional 50 pounds and remains medication-free while maintaining normal cardio-metabolic markers. He achieves this by simply avoiding starch and sugar. When I was in medical school we were taught how to diagnose a food intolerance. Simply put, my First Nations friend has an intolerance to carbohydrates.
Over the years, I have become convinced that much of our chronic disease burden can be attributed to the onset of carbohydrate intolerance manifested by the many conditions associated with insulin resistance. Since we urge those who have carbohydrate intolerance to continue to eat the foods they no longer tolerate, we propel these epidemics rather than mitigate them. Our approach is to offer a multitude of medications to alleviate the consequences of continuing to consume carbohydrates after intolerance has developed. This approach, while not very effective, is the source of huge profits for the pharmaceutical industry and for the agri-food companies who produce the vast array of sugary and starchy foods that form the bulk of the standard American diet.
The cost of these rising chronic disease epidemics that are driven by dietary carbohydrates is a threat to the viability of our health systems. The human cost is one of global scale now that these epidemics have taken root in most countries of the world. When seen through the lens of this simple paradigm, it all seems quite mad. Like any other food intolerance, the answer is simple: avoids the foods you cannot tolerate and the associated problems will resolve. Eventually, the consensus will embrace this approach. The only question that remains is how much needless human suffering must occur before the new paradigm is accepted?
- Dariush Mozaffarian et al, Lifestyle Risk Factors and New-Onset Diabetes Mellitus in Older Adults, Arch Intern Med. 2009;169(8):798-807. doi:10.1001/archinternmed.2009.21.
- Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE. Effect of 6-month adherence to a very low carbohydrate diet program. Am J Med. 2002;113:30-6.
- Santos, F. L., Esteves, S. S., da Costa Pereira, A., Yancy Jr, W. S. and Nunes, J. P. L. (2012), Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors. Obesity Reviews, 13: 1048–1066. doi: 10.1111/j.1467-789X.2012.01021.