Op-Med is a collection of original articles contributed by Doximity members.
Ninety five percent of diabetes is Type 2 — patients make enough insulin but it cannot deliver glucose inside the cells. This called insulin resistance occurs as fats deposit inside the liver and muscle cells. Unless we help patients get off saturated fats (meats, cheese, eggs), we insist they stay insulin resistant and all we can do to keep down their blood glucose is to restrict carbohydrate intake.
When we limit not just flour and sugar, but also fruits, grains, legumes, and starchy vegetables, we seriously limit the glucose available for energy, leaving the body no alternative but to rely on calorie dense foods high in protein and fats (meats, nuts, and oils).
With few carbohydrates to metabolize into glucose, of course blood sugars fall — a falsely reassuring numbers game. The fat deposits in muscle and liver which caused insulin resistance in the first place go unchecked and diabetes stays alive and well.
A low carbohydrate diet is by definition high in protein and fat — picture a seesaw, if one goes down the others must go up. On a meat and oil rich plan people are not aware of eating fewer calories than before. What the patient and practitioner do notice is the resulting weight loss — a happy short term development for people who might have been struggling unsuccessfully.
At the same time blood lipids tend to go up, blood pressure often rises, and some degree of blood inflammation ensues — but encouraged by the above short term results many patients press on — assured there is always medication for those pesky side effects.
What happens when this unsustainable eating pattern is abandoned? Or is palatable no more? Or serious side effects become evident? Or the cost of monitoring and drugs is untenable? Or when more medications can no longer support the patient?
Insulin resistance type 2 diabetes is a man-made disease, therefore reversible. Why not help patients revert to insulin sensitivity? We know this can be done in relatively short time (two to three weeks). Why not spend time educating patients on the practice of a success proven diet and then how to sustain it? Can we responsibly afford not to? What is our plan?
In 2003 after years of practice, I noticed my diabetes patients were not getting better. Their numbers were acceptable but their medication list grew longer each year, with no sign that they would ever come off. Their diabetes was often accompanied by weight gain, high blood pressure, high cholesterol, gallstones, painful joints, constipation, and erectile dysfunction — an epidemic — what was going on?
I had adopted a whole foods plant-based lifestyle in 1987, a personal ethical decision, but slowly became aware of the overwhelming scientific evidence that this way of eating was a preventive and therapeutic intervention capable of lowering heart disease mortality and diabetes — a significant risk factor for heart disease. So I began cooking with my patients, increasing their greens and grains food literacy. Much to their surprise, they liked the food and their body chemistry began to change — reducing inflammation at the root of their condition and the need for many medications
I can say that to this day cooking continues integral to my practice. The health results are consistent and expected; but the obstacles are many and serious. For example, children are developing their taste buds on school lunches absent of greens, whole grains, legumes, and fresh fruits. Served processed meats, cheese, and other refined foods, they are robbed of crucial developmental nutrition not to mention the stressful dinnertime at home when they ask for the all too familiar pizza and nuggets over their tired parents protest and best intentions.
In the U.S., eventual “patienthood” is norm — people expect to get sick with man-made conditions such as diabetes and heart disease especially as they age. Too many undergo invasive procedures or take on a life of medications without much of a fight. We are complicit.
Most of the people I ask are unaware that “Forks Over Knives” (a 2011 documentary) is a call to avoid the surgical scalpel by eating a healthy plant-based diet.
There is ample evidence that the longest and most exhaustively studied dietary pattern which consistently results in reduced cardiovascular disease mortality (the number one killer) as well as many other chronic illnesses is a whole foods plant-based diet.
This is a scientific fact in need of no more studies to prove it. We should not spend more money and resources on the obvious. What we do need now are studies showing and leading us on how to make this lifestyle easy to choose, how to make it the default.
Born and raised in Puerto Rico, Ana M. Negrón is a bilingual board certified family physician and author of the book Nourishing the Body and Recovering Health: The Positive Science of Food published by Sunstone Press. She owns a nutrition consultation solo practice, volunteers at The Clinic free for the uninsured in Phoenixville, Pennsylvania, and teaches young family doctors the role of food in medicine.