IF YOU ARE DIABETIC, overweight, or suffer from insulin resistance, metabolic syndrome, or any of the other conditions conventional medicine associates with “elevated blood sugar,” I want to share a startling new discovery with you: Lowering your blood sugar may increase your risk of death.
These are the findings from an extraordinary new study that was recently published in The New England Journal of Medicine, and in this blog, the second in my three-part series on diabesity, I am going to tell you all about that study and its profound implications for the treatment of obesity, diabetes, and other related conditions.
In the last blog you were introduced to the concept of diabesity, and learned that conventional treatments typically don’t work to treat it. Today we’ll see WHY those treatments don’t work and look at the REAL way to treat the problem. Let’s start with one of the most fascinating medical studies published in recent times …
The ACCORD Study: Revolutionizing Our Understanding of Diabesity
In 2008, an extraordinary study was published in The New England Journal of Medicine. It is called the ACCORD study (i), and it is one of the most profound pieces of literature that exists regarding why conventional treatments for diabetes simply do not work.
In the study 10,000 patients with diabetes were designated to receive intensive or regular therapy to lower blood sugar. These patients were monitored and their risks of heart attack, stroke, and death were evaluated. The patients who had their blood sugar lowered the most had a higher risk of death.
Let me repeat that, because I really want you to understand it: The patients who had their blood sugar LOWERED the most had a HIGHER risk of death. How could this happen if, as we believe, elevated blood sugar is the cause of all the evils of diabetes? Why would lowering blood sugar lead to worse outcomes?
Amazingly, the study had to be stopped after three and a half years because it was evident that the aggressive blood sugar lowering led to more deaths and more heart attacks. This completely explodes the way conventional medicine understands and treats diabetes. It’s a revolutionary study. Yet for those of us who have been working to understand the REAL causes of diabesity, it isn’t all that surprising.
How could LOWERING blood sugar INCREASE your risk of death?
The reason is simple: Elevated blood sugar is actually a symptom of underlying metabolic, physiologic, and biochemical processes that are out of balance … and lowering blood sugar with medications does not address the underlying issues that gave rise to the high blood sugar in the first place. This may surprise you, but many of the methods used to lower blood sugar such as insulin or oral hypoglycemic drugs actually make the problem worse by increasing insulin levels.
This may surprise you, but many of the methods used to lower blood sugar such as insulin or oral hypoglycemic drugs actually make the problem worse.
Type 2 diabetes is a disease of too much, not too little, insulin. Insulin is the real driver of problems with diabesity. That means you don’t simply need more insulin in your blood to lower your blood sugar. Instead, what you need to do is treat the underlying causes that gave rise to the high blood sugar and insulin in the first place. And that is insulin resistance.
Insulin Resistance: The Real Cause of Diabesity
Insulin resistance occurs when your diet is full of empty calories and has an abundance of quickly absorbed sugars, liquid calories (ii), and carbohydrates (like bread, pasta, rice, and potatoes). When this happens, your cells slowly become resistant to the effects of insulin. You need more and more to do the same job of keeping your blood sugar even. Thus you develop insulin resistance.
High insulin levels are the first sign of a problem. The higher your insulin levels are, the worse your insulin resistance. As a result your body starts to age and deteriorate. In fact insulin resistance is the single most important phenomena that leads to rapid and premature aging and all its resultant diseases including heart disease, stroke, dementia, and cancer.(iii),(iv)
As your insulin levels increase it leads to an appetite that is out of control, increasing weight gain around the belly, more inflammation and oxidative stress, and myriad downstream effects including high blood pressure, high cholesterol, low HDL, high triglycerides (v), weight gain around the middle, thickening of the blood, and increased rates of cancer, Alzheimer’s, and depression. These are all a result of insulin resistance and too much insulin. Elevated blood sugar is not the source of the problem.
Understanding this has a profound impact on the whole way we think about diabesity. It’s not simply a matter of shifting our focus from one type of medication to another. This completely alters the fundamental way we understand the disease.
In fact, in some sense, diabesity isn’t a “disease” at all. It’s simply a continuum that stretches from optimal health to full-blown illness. Let me take a few moments to explain this, because it is essential for you to understand if you want to fully realize the potential of this new paradigm to prevent or reverse diabesity.
The Continuum Concept
Most medicine is based on clear-cut, on-or-off, yes-or-no diagnoses. Most conventional doctors are taught that you have a disease or you don’t, you have diabetes or you don’t. There are no gray areas. This approach is not only misguided, it is dangerous, because it misses the underlying causes and more subtle manifestations of illness.
Practicing medicine this way completely ignores one of the most fundamental laws of physiology, biology, and disease: The continuum concept. There is a continuum from optimal health to hidden imbalance to serious dysfunction to disease. Anywhere along that continuum, we can intervene and reverse the process. The sooner we address it, the better.
When it comes to diabesity most doctors just follow blood sugar, which actually rises very late in the disease process. Conventional medicine tells us if your blood sugar is 90 or 110, you don’t have diabetes; if it is over 126, you do have diabetes. But these distinctions are completely arbitrary, and they do nothing to help treat impending problems.
The truth is the road to diabetes starts as early as childhood. By the time you get diagnosed with diabetes, your problems with insulin and blood sugar could have been detected twenty to thirty years earlier.
I remember one patient, Daren, came to see me with mildly elevated blood sugar. I asked Daren if he had seen his doctor about this. He said, “Yes”. I then asked “What did your doctor say?” Daren’s doctor told him, “We are going to wait and watch until your blood sugar is more elevated, then we are going to treat you with medication for diabetes.”
Given our current level of scientific understanding of diabesity, I find this concept of watching and waiting until more serious disease occurs unfortunate, misguided, and in some cases it’s deadly.
It is also why diabesity is so woefully and inadequately diagnosed and treated. Millions of Americans are suffering needlessly from chronic symptoms. Nearly half of all diabetics are undiagnosed. Nearly ALL of the 100 million Americans with pre-diabetes are undiagnosed.
Why? Most doctors just don’t know how to diagnose it, or what to do about it, because there is no good drug treatment.
The truth is the road to diabetes starts as early as childhood.(vi) We now know that there is an epidemic of type 2 diabetes in children as young as eight years old (vii), and pediatric diabetic specialists who used to only care for type 1 diabetes, now find their offices are overwhelmed with cases of type 2 diabetes.
By the time you get diagnosed with diabetes you have had problems with insulin and blood sugar that could have been detected twenty to thirty years earlier. That is, if you knew where to look, which most doctors are not trained to do.
Insulin resistance and diabesity is often accompanied by:
- Belly fat
- Fatigue after meals
- Sugar cravings
- High triglycerides
- Low HDL
- High blood pressure
- Problems with blood clotting
- Increased inflammation
These clues can often be picked up long before you ever get diabetes and may help you prevent the disease entirely. Why is this important? Because insulin resistance can cause SUBSTANTIAL health risks even in the absence of full blown diabetes.
In part one of this blog series I reviewed some of the common complications of diabetes. But what most people (including most doctors) don’t realize is that insulin resistance or pre-diabetes can be just as bad and can lead to nearly ALL of these complications even in the absence of a technical diagnosis of diabetes.
In fact, many people with pre-diabetes never get diabetes, but they are at severe risk just the same. We could eliminate many of the long-term complications of diabesity if we simply addressed these symptoms and diagnosed the problem much earlier in the process–that is to say, much earlier on the continuum.
This leaves us with a couple of questions:
- What is causing our insulin resistance?
- How can we address the fundamental underlying problem of our bodies resisting the effects of its own insulin?
It is only by answering these questions and addressing the real causes of diabesity–the factors that are leading to this problem with insulin resistance–that we will effectively treat this terrifying disease.
Any hope we have for resolving this pandemic must use a new approach to the diagnosis and treatment of diabesity. That approach is called Functional Medicine. And I am going to explain what it is and how you can use it to help you heal from diabesity in the next blog in this series, Diabesity Epidemic Part III: Treating the Causes Versus Symptoms.
By applying this new form of medicine to your health problems you may overcome diabesity and become vibrantly health once again.
Now I’d like to hear from you …
Are you taking insulin and if so, how has it helped, or not, with your diabesity?
What do you think about conventional medical approaches to treating this problem?
What do you think about the continuum concept? Has your experience with diabesity reflected this continuum?
Please let me know your thoughts by leaving a comment below.
To your good health,
Mark Hyman, MD
References
(i) Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59.
(ii) Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Mitchell D, Batch BC, Svetkey LP, Caballero B. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr. 2009 May;89(5):1299-306.
(iii) Bhashyam S, Parikh P, Bolukoglu H, Shannon AH, Porter JH, Shen YT, Shannon RP. Aging is associated with myocardial insulin resistance and mitochondrial dysfunction. Am J Physiol Heart Circ Physiol. 2007 Nov;293(5):H3063-71.
(iv) Ryan AS. Insulin resistance with aging: effects of diet and exercise. Sports Med. 2000 Nov;30(5):327-46. Review.
(v) Gaziano JM, Hennekens CH, O’Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.
(vi) Nelson RA, Bremer AA. Insulin Resistance and Metabolic Syndrome in the Pediatric Population. Metab Syndr Relat Disord. 2009 Nov 29.
(vii) Silverstein JH, Rosenbloom AL. Type 2 diabetes in children. Curr Diab Rep. 2001 Aug;1(1):19-27. Review.
You need to update your discussion of the Accord study. Follow-up analysis showed that the increased mortality was in the group that tried to get strict control but failed. Those who aimed at lower A1c’s and actually achieved them had lower mortality. It wasn’t the low BGs that were killing them.
I have had nothing but one thing after another. Depression dx 1997, high blood pressure 1998, Diabetic retinopathy 1999, cataract surgery 2003, more laser surgery on my eyes than I can count,severe peripheral nmeuroathy in feet and hands, carpral tunnel relief both hands 2006, TIA 2007, tractional retinal detachment surgery in 2008, chronic renal failure 2008 then cancer in 2009 weith surgery in 2010. Obviously traditional treatments have not worked but I have found that since I have cut back on my insulin I feel better and am probabvly throwing ketones like crazy but I’m tired of being fat and tired.
Thanks – Cathy C.
Hello,
I am 44yo M 73″ , 290lbs. I was dx’d 2 years ago w/type2. Sugars conventionally controlled w/500 mg metformin and exercise. I cheat a few times and spiked over 250 and A1c has gone from 6.4 to 7.1 to 7.4 over the course of a year and a half. Currently, my NP has taken the metformin and replaced it with 5mg glipizide and scaring the heck out of me. My Cr went to 1.6 and that is why my NP switched meds. My concern is, we have limited Beta cells and glipizide uses them up and then BAM, I am insulin dependent. I love to exercise. I know I need to get my fat but on the road, and there is no way around that, but I love cereal, my wifes cookies, and the occasional doughnut. Is Glucerna a good substitute? I see Alcohol Sugar? What is that and is it ok to eat when the “sweet tooth” hits?
Thanks for reading
Stan
Thank you for your message and your interest in Dr. Hyman’s work. Your question and the constellation of symptoms you describe represents a complex medical condition. Though the issue of what sugars to eat may seem simple, questions like this cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
My husband has always been robust. But once he started the medication, he is constantly fatigued – still hungry and still having difficulty loosing that belly fat.
I was never diagnose immediately by several doctors30 years ago. One day I got a phone call, I was told my blood sugar is very high.Still, I had no idea that I was diabetic. After some time I was given the bad news that I was diabetic (type 2).
After 30 years, I started gaining weight, belly fat became worst, the symptoms of of ocassional drops of blood sugar made me dizzy and I had to take some orange juice to bring it up. My readings have been climbing upwards now despite the use of 10 mg of glipizidex daily and metformin 1000 mg 2x daily.
I feel this contributed to my heart disease that ended with a 3x bypass on the left side plus 2 stents on the right side. I’m becoming weaker and losing this battle. I am now 71 years old and becoming sedentary.
I was never diagnose immediately by several doctors30 years ago. One day I got a phone call, I was told my blood sugar is very high.Still, I had no idea that I was diabetic. After some time I was given the bad news that I was diabetic (type 2).
After 30 years, I started gaining weight, belly fat became worst, the symptoms of of ocassional drops of blood sugar made me dizzy and I had to take some orange juice to bring it up. My readings have been climbing upwards now despite the use of 10 mg of glipizide 2 x daily and metformin 1000 mg 2x daily.
I feel this contributed to my heart disease that ended with a 3x bypass on the left side plus 2 stents on the right side. I’m becoming weaker and losing this battle. I am now 71 years old and becoming sedentary.
Thank you, Tony, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
I’ll be 80 years old Tuesday. I have to follow my doctor’s advice…… TAKE THE STATINS…… Keep the A1c down. Google is confusing.
My doctor told me 9 years ago that I was a diabetic. He gave me metform for three years. I felt bad all the time. I gained weight. A doctor friend told me that those pills would kill me. I had to go on insulin for a year. I always felt bad and I gained even more weight. Then a doctor told me to throw all of my insulin away and to start taking ORGANIC APPLE CIDER VINEGAR three times a day. This has changed my life. I lost weight and I feel great! I take no pills and no insulin. I just put 3t of vinegar in a large glass of water three times a day. I use a straw so that it does not ruin my teeth. My doctor can’t believe how great I am doing. I walk 3 miles every day and I feel great. That insulin will kill you!! I try to stay away from sugar and bad carbs. My AC1 was 5.2 last month. I feel GREAT!!!
My A1C’s have been good for the last couple years around 5.7. The problem I’m having is with going low without knowing I’m low. Over time my body has failed to react and since my mind is always busy with something the web,TV or reading something and I loose track of time and forget to eat.(I’m retired and 63) For your info I take for my diabetes a basal and a fast acting, mixed with a basal insulin plus Metformin. My question to you is are these Hypo-events Hurting me in some way. Also they are very unpleasant because even though my body doesn’t warn me any more like it use to prior to going low but after I eat then I go through the hypo event and sweet profusely, my whole body will be soaking wet. My body always develops tolerances to everything I take over time. If I take say X mg’s of something, it will have to be increased to achieve the same results till eventually it wont work at all. I’ve had this problem my whole life. Back when I started on insulin, if I had a hypo event I thought I was going to die. I even called the ambulance to the house once but by the time they got there I was better and didn’t go to hospital, but now I can hardly tell.
How do I access your products from NEw Zealand
Thank you, Lyn, for your message and your interest in Dr. Hyman’s work. You can look at the website: http://store.drhyman.com/
Wishing You the Best of Health!
I have had diabetes type 2 for over twenty years with treatments of vayring
success. I have neve used insulin but being treated by conventinal oral medicines e.g. metformin, glucophage with varying results. I particularly
find your statement of diabetic readings to be less than helpful in determining
the seriousness of the disease on the individual. I was taught to aim for readings
in the 120-130 range in the morning but when i reach those readings it has the effects of hypoglycemia and I get very weak. My readings are now in the 150-16o
range but I don’t feel any serious side effects, but I do have a problem with insomnia. Would appreciate any comments on this.
Thank you, Paul, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
Insulin just dont work for me, i was taking up to 60 units 3 times a day along with 60 units of slow acting all it did for me was put weight on i went off it and lost 20 kgs the doctor put me back on it and i gained 20 kgs in less than 6 months. I am also on tablets my sugars rarely get below 10. I find if I want to keep my sugars low I need to stay away from any type of bread rice or pasta it doesnt matter if it is refined or not it makes no difference with me, I need to get my carbs from fruit, I spoke to a diabetes educator about this and she practically called me a liar. If i eat rolled oats for breakfast it puts up my levels to 20! I had all the classic signs belly fat etc when I was young and no amount of diet and exercise would get rid of it, it really seems just not fair!!!
I have been diagnosed with diabetes type 2. Ever since I have started taking insulin and oral medication, I have gained 10 pounds. The weight gain has been almost around my belly.
The insulin and oral medication has not really helped in controlling my blood suga. Readings fluctuate from 43 to 315. My doctor has prescribed another medication — the symlan pen.
I feel that my doctor is not really listening to what I am saying — especiallt my weight gain.
THE DOCTORS SAY I HAVE THIS SO CALL DISEASE BUT I DONT CLAIM IT NOR DO I TAKE THEIR MEDS I AM IN THE PROCESS OF LOSING THE WEIGHT. WHICH I KNOW IS THE PROBLEM. IVE DECIDED TO TAKE THE NEXT YEAR AND LOSE THE WEIGHT. ALSO I AM WORKING ON HOW I HANDLE EMOTIONAL ISSUES IN MY LIFE. I WOULD LOVE TO HEAR YOUR COMMENTS.
There was a time when it was thought that aerobic exercise actually supported pancreatic function and made the beta cells more sensitive to blood glucose levels.
Is there any evidence that that idea was correct?
Also, there are times when a sugar craving is only reduced by a simple carbohydrate. Is that a sign that diabesity is progressing? In other words the good effect comes from raising blood glucose or lowering the insulin level of your blood?
I am 53 and I have so much ambition mentally, but physically I don’t. My sugar is out of control. I am frustrated my Dr. says I have to work harder to get it under control, but I am so frustrated. The insulin is not working and I m afraid they will increase the medication. I do get depressed, my hair has thinned out, etc. I know I need to take control. I don’t want to be hungry so much, but it’s difficult. My weight is 218. Im so unhappy. I need help. I do want to live a long life.
Thank you, Lischa, for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
I have 32 units of insulin every morning and 16 units every night. My BGLs are not much different from when I was on metformin (which gave me the trots). I refused to take the metformin and wound up in hospital with 30mmol/L BGL. Then I was put on mixtard 30/70. I want to be off all the diabetes meds .. I hate injecting twice a day. I hate feeling sick all the time. No one understands how tired I get and they call me lazy. I think diabetes is diabolic.
H i every one. I became a full blown diabetic 24 yrs ago with the pregnacy of my first son. But I ‘m sure I had high blood for years before that. but it went away beytween pregnacies came back stronger with second son 3yrs later. I walked ran my legs off and ate aclean diet but it got so thats all I was doing I was depressed all the time never had much of a period I was told my hormones were screwed as a young girl. My thyroid has been screwed since a young age. So now for 20 yrs I’ve been a full blown high numbers dieabetic. The doctors seem not to be able to help me they put me in the hospital but they can’t seem to get me to stay low. I know if I lived on oatmeal they would be low. I have a hobby farm and every morning its something different so my scedual is up and down just like me. If I get my sugurs in good standing then I go low all the time specialy at night I have been rushed into town 45 min to the hospital with being in coma. so then they put me on lancet long lasting but within 2 yrs I could no longer have any reason to stay on this earth if it wern’t for my animals and not being able to find homes I’d probably comitte suicde. I stopped taking the Lanset for 6 months now and my sugars are still high but then I could breck chains on the fridge door to get to the junk. and my cubbards are full of healthy foods but if I want to get into something bad I will do it. instead of 1 cup of popcorn I’d make 7 cups ….. every single night for 25 years I have said sheila tommorow you’ll start eating good. I’m 134 lbs 5 ‘ 3 ” 50 years old. I know that all my organs are in trouble and serioulsly in trouble. But I just keep doing it I wonder what will happen to me before I change. I’d love all the help
Thank you for your message and your interest in Dr. Hyman’s work. Your question and constellation of symptoms represents a complex medical condition. Questions regarding conditions like these cannot be answered in a responsible manner via the Internet.
If you would like information on becoming a patient at The UltraWellness Center please see “How to Become a Patient” at http://www.ultrawellnesscenter.com. That site is designed to give prospective patients a comprehensive source of information about The UltraWellness Center. You may also feel free to call The UltraWellness Center at (413) 637 9991.
Regardless of becoming a patient at The UltraWellness Center, it sounds like you need to consult with a doctor. Please seek medical attention for the issues that you outlined in your message.
Wishing You the Best of Health!
My doctor started me on 60 units a day – Novalog – since taking insulin I gained 40 pounds in5 months, blood pressure went from normal to 140/90, and my LDL cholesterol is too high – doctor wants to put me on statin and add metformen.
I have recently reduced my insulin to average of 20 units a day – had my doctor prescribe Lantus & Aphidra – and now I am going to gradually quit doing insulin so my blood pressure and LDL stabilizes again. Sick of the drugs and sick of spending $45 every other month for tests and to see a specialist.
I was healthier with a 15% AC1 (other than malnutrition) before doing insulin than I am today.
Really bugs me – I’ve seen 2 endocrinologist – neither one can define if I’m a type 1 or type 2 diabetic – just prescribe drugs and lots of them.
These doctors are too busy to help – not even enough time to go over blood work. Diabetics who want to get better are usually on their own – internet and other online diabetics seem to be the answer right now.
I really don’t know what to look for in a holistic doctor. I thought I had one advertises as one. But he knows very little about herbs – he just doesn’t prescribe many pills. How do you know?
Hi Carolyn
Thank you for sharing your concerns about finding an authentic physician who practices similar to Dr. Hyman. Go to http://www.functionalmedicine.org and scroll down to find a practitioner. Enter your zip code and find a professional who best fits your needs. All these doctors had to pass a legit screening in order to be on the site so you can trust who you see. Check the site out for more info and best of luck. We truly hope you find the care you need! Stay tuned for Dr. Hyman’s upcoming book to be relased this winter called The Blood Sugar Solution. It sounds like you will appreciate the information and diet plan in there tremendously!
In good health!
Lizzy
I really don’t know what to look for in a holistic doctor. I thought I had one (this is my regular doctor – not the endocrinologist) advertises as one. But he knows very little about herbs – he just doesn’t prescribe many pills and absolutely NO pain killers. How do you know?
Hi Carolyn, please take a look at the “Find a Functional Medicine Practitioner” link at the Institute of Functional Medicine’s website for more information.
Wishing You the Best of Health!