Wisdom Wednesday: Therapeutic Fasting Could Be an Alternative to Insulin for Some Diabetes Patients

Medically supervised fasting could eliminate the need for insulin in some patients with type 2 diabetes, according to findings in BMJ Case Reports.

Three men who'd had type 2 diabetes for 10 to 25 years — and who were taking various pharmacotherapies, including insulin — underwent nutritional training and were instructed to fast for 24 hours three times a week for several months. On fasting days, they ate just dinner. On nonfasting days, they ate lunch and dinner. Low-carbohydrate meals were advised, and participants were seen twice a month for lab testing.

Among the findings:

• All three patients were able to discontinue insulin within 5 to 18 days. Two ultimately stopped all diabetes medications.
• All participants saw reductions in hemoglobin A1c, and none experienced symptoms of hypoglycemia.
• All three lost weight (10%–18% of body weight) and reduced their waist circumference.
• Patients described feeling "terrific" and "excellent" on fasting days.
• The researchers write, "Educating patients on the benefits of fasting ... may aid in the remission of (diabetes) and curtail the use of pharmacological interventions."

My Take:
As you know from previous blogs, I have been recommending intermittent fasting for a few of my patients. Most commonly, I recommend the 18-6 fast where you eat from noon to 6 pm and fast the rest of the day and night. In this case study they used the intermittent 24 hour fast. I typically limit this fast to two non-consecutive days a week. However, extreme health issues like chronic, insulin dependent type II diabetes often calls for extreme measures. In this scenario, fasting three days per week is warranted.

Wisdom Wednesday: The Pancreas

The pancreas is the last organ in the endocrine system that we evaluate. We began with the endocrine system as a whole – adrenal, pineal/pituitary, thyroid, and reproduction. Then we looked at hidden adrenal issues. Last week we reviewed liver function; now finally, the pancreas.

The head of the pancreas secretes digestive enzymes. Digestion will be discussed next week. The tail of the pancreas secretes insulin and other hormones. Insulin binds to glucose in the blood stream and facilitates entry to most cells of the body.

Over the course of our lives, most of us become insulin resistant. Excess refined carbohydrates and just eating too much in general tax the system. Insulin receptors in the cells of the body become less responsive to insulin so the pancreas must produce ever increasing quantities of insulin to force sugar into the cells. This is early stage Type II Diabetes.

Eventually, the pancreas just wears out, insulin production falls and the body becomes dependent on insulin injections to maintain some semblance of glucose control.

There are four tissues that do not require insulin to absorb glucose – the small capillaries, the kidneys, the nervous system and the eyes. These tissues are saturated with excess glucose for years prior to the diagnosis of diabetes. The result is progressive degeneration of these tissues resulting in neuropathy, blindness, amputation of the lower extremities, kidney failure, and ultimately death.

It is estimated that by the year 2050, 50% of the US population will be diabetic. Diabetes is an epidemic that is preventable and often reversible just by making good choices in diet and exercise.

When evaluating the pancreas, we correlate function with the remainder of the endocrine system. Sometimes pancreas dysfunction is secondary to an adrenal issue or a thyroid problem. However, most commonly, the problem begins with general inflammation.

When the body is inflamed, from just about any cause, it produces arachidonic acid. This most frequently results in the production of prostaglandins (PG2), primarily from the liver. (Please review my first Wednesday Wisdom blog on QA evaluation, “Inflammation – part 1”, posted on March 19, 2014) Adequate intake of omega 3 and omega 6 fatty acids should produce PG3 and PG1 respectively, which counterbalance the inflammation from PG2. However, early on in insulin resistance, the conversion of healthy omega 6 fatty acids from the diet is shunted into the arachidonic acid pathway creating more inflammation rather than less.

Supplementation with sesame seed oil prevents this shunting and restores the omega 6 to PG1 pathway. This simple change in body chemistry often dramatically improves glucose metabolism, even in drug dependent diabetics.

In resistant cases, the herb Gymnema can be most effective. Gymnema actually helps restore the beta cells of the pancreas that secrete insulin. In Ayurvedic medicine, Gymnema means “sugar destroyer”. For thousands of years, it has been used to eliminate the sickly sweet smell of urine produced when diabetics spill glucose into the urine in an attempt to reduce blood levels.

THE BOTTOM LINE:
If you are not yet diabetic, the odds are quite good that you will become one. Have your glycohemoglobin A1c checked yearly. It will detect problems in glucose metabolism years before the fasting glucose is out of control and the diagnosis of diabetes is given. Maintain a regime of regular exercise and reduce the refined carbohydrates in your diet.

If you have a blood sugar issue, no matter how advanced, consult with a qualified nutritionist. The damage begins long before you are aware you have a problem. However, it can be reversed with proper guidance.

Wisdom Wednesday: Inflammation – Part 4

Insulin, the hormone produced by the pancreas to escort glucose into the cells of the body, can stimulate inflammation. It is the most insidious inflammatory pathway and very difficult to reverse.

Most cells in the body require adequate insulin in the blood stream to facilitate glucose absorption. However, a majority of Americans are now insulin resistant. They eat too much and too much of the wrong foods – refined carbohydrates. As the pancreas increases the output of insulin to control glucose levels, the body slowly becomes insulin resistant. This occurs long before the eventual diagnosis of Type II diabetes. It is estimated that by the year 2050, over half of all Americans will be diabetic.

Today, many of these young Americans are already insulin resistant and pre-diabetic. The systemic inflammation caused by excess insulin production is evidenced by our inability to process omega 6 fatty acids, like olive oil.

Most nutritionists recommend against supplementing omega 6 fatty acids. They claim that the omegas 6’s are abundant in our diet and that they can be pro-inflammatory. Although both of those claims are true, I disagree with their recommendations. First, the omega 6 fatty acids in our diet need to be converted to GLA (gamma linolenic acid) and many people can not make that conversion. Secondly, it’s only the people who are insulin resistant that take healthy omega 6 fatty acids and convert them to inflammatory compounds. I recommend fixing the chemistry rather than denying the body an essential fatty acid. Essential means just that, your body can not make it, it is essential to the diet.

The key, of course, is cleaning up the diet, reversing all the factors associated with metabolic syndrome – central obesity, high blood pressure, low thyroid function, high serum lipids, and insulin resistance. In the meantime, the addition of sesame seed oil, and possibly GLA, to the diet will support healthy utilization of omega 6 fatty acids and effectively block the conversion to inflammatory compounds.

I have seen uncontrolled type II diabetics, on multiple medications, cut their medication by 75% with the simple addition of sesame seed oil and GLA, while reducing their blood sugar levels from over 250mg/dL to 85mg/dL in less than 3 weeks. Simultaneously, their inflammatory complaints – IBS, musculoskeletal pain, headaches, etc. also improve markedly.

In my office, as soon as I see impaired chemistry on the omega 6 fatty acids, I suspect insulin resistance as the cause. Fortunately, the glycohemoglobin A1c is a simple blood test that tells us what your blood sugar has been averaging for the past 60 days. I mention this test often in my blogs and I advise you to have this test run annually.

THE BOTTOM LINE:
Diabetes is epidemic in our county and is not only preventable, but often time’s reversible. The vast majority of pre-diabetics are undiagnosed. The odds are at least half of you reading this blog are pre-diabetic. Get an A1c performed. If you have any of the characteristics of metabolic syndrome and you suffer from inflammation, chances are your pain is being driven by insulin.

Tom Hanks Could Reverse His Diabetes

Type II diabetes is simply caused by a poor diet. In Tom’s defense, his dramatic weight fluctuations to meet the various roles he has played required terrible dietary practices. In gaining, or losing 30 pounds or more over relatively short spans of time, he has highlighted an exaggerated form of SAD (the Standard American Diet).

Americans just eat too much, too much of everything – protein, carbohydrate, and fat. Obesity rates, currently at 37 % nationally, are skyrocketing. Type II diabetes is also at epidemic levels and scientists predict about half the adult population of the United States will be diabetic by 2050, unless our eating habits change. Only one diet has been shown to increase longevity – reduced caloric intake. So Tom, you and the rest of the country have to start eating less.

Now let’s talk about food quality. It is estimated that early man, the hunter-gatherer, ate a bushel basket of fruits and vegetables per day. That seems like a lot of food, but it was not a lot of calories. These foods were high in fiber and much of the material passed through as undigested bulk. Today, the bulk of our diet is refined carbohydrates, devoid of insoluble fiber, and loaded with calories. These simple sugars rush into our blood stream and tax our pancreas and liver, dismantling our ability to manage blood glucose levels.

The solution is quite simple – I recommend 5 servings of vegetables each day, 2 fruit servings, and 3 servings of protein. If Tom (and the rest of the nation) would just meet these simple goals daily, there is little room for the refined foods and they drop away from the diet. Unfortunately, when I review food journals in my practice, I often find diets that average less than one serving of fruits or vegetables per day. The protein intake is usually adequate, unless the patient is trying to lose weight, then they typically will restrict the protein intake as well, piling on more refined carbohydrates. Then they wonder why they can’t lose weight.

Early detection of diabetes is where you need to start. It is not enough to test your fasting glucose. That just shows how well your body manages glucose without the stress of adding any calories from eating. Everyone should have a glycohemoglobin A1c performed yearly. This test measures what percentage of your RBCs (red blood cells) are saturated with sugar. The A1c tells us what your blood sugar has averaged over the course of the past two months. Tom Hanks A1c has been elevated for years prior to his diagnosis of Type II Diabetes. Yours may be elevated as well. Every week I see young adults with early signs of diabetes, all undetected, all unaware of the devastating disease they are creating by eating SAD.