The Diabetes Code. Dr. Jason Fung

start on insulin injections for type 2 diabetes, they often sense they are heading down the wrong path.

      My diabetic patients would often say, “Doctor, you’ve always said weight loss is the key to reversing diabetes. Yet you prescribed me a drug that made me gain 25 pounds. How is that good?” I never had a satisfactory answer to this important question because none existed. The plain truth was that it was not good. The key to treating diabetes properly was weight loss. Logically, because it caused weight gain, insulin was not making things better; it was actually making the disease worse.

      Since weight loss is the key to reversing type 2 diabetes, medications don’t help. We only pretend they do, which is the reason most doctors think type 2 diabetes is chronic and progressive. We’ve avoided facing an inconvenient truth: drugs won’t cure a dietary disease. They are about as useful as bringing a snorkel to a bicycle race. The problem is not the disease; the problem is the way we treat the disease.

      The same principles used for reversing type 2 diabetes also apply to preventing it. Obesity and type 2 diabetes are closely related, and generally, increased weight increases the risk of disease. The correlation is not perfect but, nevertheless, maintaining an ideal weight is a first step to prevention.

      Many people paint type 2 diabetes as an inevitable part of modern life, but this is simply not true. The epidemic of type 2 diabetes really only started in the late 1980s. So we only need to go back a single generation to find a way of life that can prevent most incidents of this disease.

       FACT: TYPE 2 DIABETES IS CAUSED BY TOO MUCH SUGAR

      AT ITS VERY core, type 2 diabetes can be understood as a disease caused by too much insulin, which our bodies secrete when we eat too much sugar. Framing the problem this way is incredibly powerful because the solution becomes immediately obvious. We must lower our insulin levels by reducing our dietary intake of sugar and refined carbohydrates (a form of sugar).

      Imagine your body as a big sugar bowl. At birth, the bowl is empty. Over several decades, you eat sugar and refined carbohydrates and the bowl gradually fills up. When you next eat, sugar comes in and spills over the sides of the bowl because the bowl is already full.

      The same situation exists in your body. When you eat sugar, your body secretes the hormone insulin to help move the sugar into your cells, where it’s used for energy. If you don’t burn off that sugar sufficiently, then over decades your cells become completely filled and cannot handle any more. The next time you eat sugar, insulin cannot force any more of it into your overflowing cells, so it spills out into the blood. Sugar travels in your blood in a form called glucose, and having too much of it—known as high blood glucose—is a primary symptom of type 2 diabetes.

      When there’s too much glucose in the blood, insulin does not appear to be doing its usual job of moving the sugar into the cells. We then say that the body has become insulin resistant, but it’s not truly insulin’s fault. The primary problem is that the cells are overflowing with glucose. The high blood glucose is only part of the issue. Not only is there too much glucose in the blood, there’s too much glucose in all of the cells. Type 2 diabetes is simply an overflow phenomenon that occurs when there is too much glucose in the entire body.

      In response to excess glucose in the blood, the body secretes even more insulin to overcome this resistance. This forces more glucose into the overflowing cells to keep blood levels normal. This works, but the effect is only temporary because it has not addressed the problem of excess sugar; it has only moved the excess from the blood to the cells, making insulin resistance worse. At some point, even with more insulin, the body cannot force any more glucose into the cells.

      Think about packing a suitcase. At first, the clothes go into the empty suitcase without any trouble. Once the suitcase is full, however, it becomes difficult to jam in those last two T-shirts. You reach a point where you can’t close the suitcase. You could say the luggage appears to be resisting the clothes. This is similar to the overflow phenomenon we see in our cells.

      Once that suitcase is full, you might simply use more force to shove those last T-shirts in. This strategy will only work temporarily, because you have not addressed the underlying problem of the overfilled suitcase. As you force more shirts into the suitcase, the problem—let’s call it luggage resistance—only becomes worse. The better solution is to remove some of the clothes from the suitcase.

      What happens in the body if we do not remove the excess glucose? First, the body keeps increasing the amount of insulin it produces to try to force more glucose into the cells. But this only creates more insulin resistance, in what then becomes a vicious cycle. When the insulin levels can no longer keep pace with rising resistance, blood glucose spikes. That’s when your doctor is likely to diagnose type 2 diabetes.

      Your doctor may prescribe a medication such as insulin injections, or perhaps a drug called metformin, to lower blood glucose, but these drugs do not rid the body of excess glucose. Instead, they simply continue to take the glucose out of the blood and ram it back into the body. It then gets shipped out to other organs, such as the kidneys, the nerves, the eyes, and the heart, where it can eventually create other problems. The underlying problem, of course, is unchanged.

      Remember the bowl that was overflowing with sugar? It still is. Insulin has simply moved the glucose from the blood, where you could see it, into the body, where you cannot. So the very next time you eat, sugar spills out into the blood again and you inject insulin to cram it into your body. Whether you think of it as an overstuffed suitcase or an overflowing bowl, it’s the same phenomenon all over again.

      The more glucose you force your body to accept, the more insulin your body needs to overcome the resistance to it. But this insulin only creates more resistance as the cells become more and more distended. Once you’ve exceeded what your body can produce naturally, medications can take over. At first, you need only a single medication, but eventually it becomes two and then three, and the doses become larger. And here’s the thing: if you are taking more and more medications to keep your blood glucose at the same level, your diabetes is actually getting worse.

       Conventional diabetes treatments: How to make the problems worse

      THE BLOOD GLUCOSE got better with insulin, but the diabetes got worse. The medications only hid the blood glucose by cramming it into the already engorged cells. The diabetes looks better but actually it is worse.

      Doctors may congratulate themselves on the illusion of a job well done, even as patients get sicker. No amount of medication prevents the heart attacks, congestive heart failure, strokes, kidney failure, amputations, and blindness that result when diabetes is getting worse. “Oh well,” the doctor says, “it’s a chronic, progressive disease.”

      Here’s an analogy. Consider that hiding garbage under your bed instead of discarding it allows you to pretend that your house is clean. When there’s no more room under the bed, you can throw the garbage into the closet. In fact, you can hide it anywhere you can’t see it: in the basement, in the attic, even in the bathroom. But if you keep hiding your garbage, eventually it’s going to begin to smell really, really bad because it’s starting to rot. Instead of hiding it, you need to throw it out.

      If the solution to your overflowing suitcase and your overflowing house seems obvious, the solution to too much glucose, which leads to too much insulin, should also seem self-evident: Get rid of it! But the standard treatment for type 2 diabetes follows the same flawed logic of hiding the glucose instead of eliminating it. If we understand that too much glucose in the blood is toxic, why can’t we understand that too much glucose in the body is also toxic?

       FACT: TYPE 2 DIABETES AFFECTS EVERY ORGAN IN THE BODY

      WHAT HAPPENS WHEN excessive glucose piles up in the body over ten or twenty years? Every cell in the body starts to rot, which is precisely why type 2 diabetes, unlike virtually any other disease, affects every single organ. Your eyes rot, and you go blind. Your kidneys rot, and you need dialysis. Your heart rots, and you get heart