We are committed at Start Clinic to reversing diabetes when we can. For the last ten or more years after retiring from a nearly thirty year career in sports medicine I began doing nerve tests of injured workers in California followed by testing of patients in pain management clinics in Arizona. I would test diabetics almost every week with neuropathy who were completely unaware of their neuropathy as well as weekly make a probable diagnosis of diabetes in adult patients who were also unaware they had peripheral neuropathy or adult onset type II diabetes. Prior to this I was Medical Director of a mobile Medicare-certified independent testing lab that did nerve tests in primary care and podiatry clinics in seven states. I interpreted over 16,000 nerve tests over the span of about four years. In our experience over 90 percent of diabetics we were testing had evidence for motor and/or sensory neuropathy. This is in contrast to textbooks on nerve disease erroneously stating that about fifty percent of diabetics have peripheral neuropathy.
Diabetes Can Be Reversed
This was one of the primary reasons I launched a new medical weight loss practice to help overweight individuals lose weight and either reduce their risk of becoming diabetic or if already diabetic, to make the necessary lifestyle changes to reverse diabetes. It can be done! I am unfortunately also an expert in diabetes by default—at the age of 45 I had an autoimmune illness that included a viral pancreatitis and I became an insulin dependent diabetic literally overnight after a flu like illness. I have been on insulin now for 23 years and I hate this disease! I was a very physically fit runner and body builder with 2 clinics and 44 employees and all of a sudden I was diabetic—my life was forever changed! I won’t burden you with other details but at one time I was told my life expectancy based on a predicted viral infection of cardiac muscle was less than a year. I have overcome a lot to get where I am today and I hope to share some of that with you when you become one of our patients. If you are diabetic and overweight we can help because I have walked in your shoes and I have also overcome—now it’s your turn!
What Are the Risks of Diabetes?
The term “diabesity” was coined in 1994 by Shape Up America, an organization formed by former United States Surgeon General C. Everett Koop to raise awareness about the alarming increase in both obesity and type II diabetes in America. The incidence of both diabetes and obesity are increasing each year, a testimony to our failure in modern medicine to stop this epidemic with its horror of adverse side effects including heart disease, cancer, dementia, chronic pain, peripheral neuropathy, carpal tunnel syndrome, retinopathy, blindness, renal disease, gangrene, impotence, and gastroparesis. And what I experienced in my nerve testing practice merely confirms those concerns—many type II diabetics are not even aware they have the disease. The onset of neuropathy, heart disease, and changes in renal function are insidious and initially silent. It is incredibly sad to note that in spite of those efforts in 1994 to promote a healthy lifestyle, we continue to get fatter and increase our risk for diabetes and other medical conditions that threaten our vitality and our longevity. Type II diabetes, once primarily a disease of middle age, is now affecting younger adults and even children. In 1997 the American Diabetes Association recommended we no longer refer to type II diabetes as “adult-onset diabetes” because of the number of children and teenagers developing type II diabetes directly related to increasing obesity among our youth.
Diabetes is the leading cause of blindness, leg amputation, and kidney transplant. Every year over 20,000 people go blind because of diabetes. Renal failure related to diabetes affects nearly 30,000 others. Over 80,000 people with have amputations this year alone due to the vascular effects of diabetes. If you develop diabetes prior to age 40 you will reduce lifespan in men by an average of eleven years and in women by an average of fourteen years. If you are African American, Hispanic, or Native American you are 1.5 to 2 times more likely than Caucasians to develop diabetes.
How Are We Doing This to Ourselves?
Behind this mess is quite simply carbohydrate addiction. We are inundated with advertising inviting us to experience ultimate scintillating pleasure from our “supersized” diets of sugar, sugar and more sugar. Fast food is a killer! Almost everything in a box, a package, or a bottle is a killer! (The only exception to that may be red wine—many studies tout the benefits of the French Paradox, why wine drinkers appear to have lower rates of heart disease due to the benefits of phytochemicals from grapes that are antioxidants and vascular wall protectors.)
What is the common denominator between diabetes and obesity? Insulin! The most common cause of adult onset (and now childhood onset) diabetes is insulin resistance. Insulin is the hormone responsible for reducing blood sugar levels after a meal. Insulin is manufactured in the pancreas by islet beta cells. The more sugar you eat the more insulin you release. Insulin is a storage hormone and all the extra sugar that you are unable to burn off for energy is stored—the primary storage area for insulin is belly fat. Over time the pancreas gets tired and is unable to produce enough insulin to meet the demands of a high sugar diet. And over time your body becomes less sensitive to insulin. More sugar, more insulin and eventually your body is unable to handle the sugar overload. Sugar levels remain elevated and the process of widespread damage to blood vessel walls and cells in every system in your body begins—this process of gradual and then accelerated damage to your cells is called glycosylation. Basically free radical damage causes premature aging and contributes to all those terrible side effects of diabetes that you read about: heart attack, neuropathy, retinopathy, kidney disease, loss of limb and so on.
Belly fat created by too much insulin makes your diabetes even worse and increases your risk for that big list of other health problems. Belly fat also is a toxic hormone factory manufacturing pro-inflammatory hormones (cytokines and leukotrines) that inflame blood vessel walls, making them more susceptible to the damaging effects of high blood sugar. These hormones contribute to insulin resistance, actually making your diabetes worse, as well as setting the stage for accelerated aging of all organs.
What is the Cure?
The best way to break this cycle of insulin resistance and hormonal inflammation is to lose weight and in particular, to lose belly fat. That is why waist size is now regarded as an independent risk factor in addition to BMI and percent body fat. When you reduce waist size in women to less than 35 inches and in men to less then 40 inches you will observe remarkable changes in health risk factors begin to take place.
Here at Start Clinic we talk all the time about your numbers. Waist size is a critical number. BMI is a critical number. Blood pressure, cholesterol, triglycerides, hemoglobin A1c, C-reactive protein, fibrinogen, insulin levels, and homocysteine are all numbers that matter. If you change your numbers you can change your life!
Unfortunately, one of the problems with blood sugar control in type II diabetes is this—insulin makes you fatter! And fat makes your diabetes worse. So guess what? Your doctor may keep increasing your dose of insulin to combat the rise in blood glucose only to discover over time your weight keeps going up, your waist keeps getting bigger, and your diabetes keeps getting worse. So add more insulin?
Likewise, oral medications for diabetes also contribute to weight gain. Diabetic medications that may cause weight gain include the popular sulfonylureas (Micronase, Diabeta, Glucatrol) and thiazolidendiones (Avandia). Large studies indicate the oral diabetic drug least likely to cause weight gain is metformin.
Numbers don’t lie. In spite of all we know, the incidence of diabetes and obesity are not decreasing. I believe one critical reason is because we are not properly addressing the underlying cause of our health problems including diabetes. Modern medicine is frequently criticized for treating symptoms rather than the underlying cause of disease: We lower blood sugar with oral diabetic drugs and/or insulin. We lower blood pressure with anti-hypertensive medications. We lower cholesterol with statins. We thin blood with aspirin. We treat situational life stress issues with powerful antidepressant medications. If you look online you will find extensive information on how to approach any if not all these real health issues without drugs. Some of the information is legitimate and some is not, in fact some is quackery. But with diabetes the evidence is clear—we can reverse type II diabetes or at worse, reduce the associated health risk factors, but treating the cause—excess visceral fat.
Physician members of the Obesity Medical Association and other preventive health groups have legions of patients who have responded favorably. Since our clinic is new I can only give you a summary of the real science. But I promise you that if you keep following my blog I will have some really terrific stories to share with you of restored health, not just mine. Stay tuned as we share how you too can safely lose weight, reverse diabetes, reduce risk for serious disease, and avoid being another countless victim of our number one health problem in America if not the world.
If you have co-morbidity conditions due to being overweight, your medical insurance may pay for your medical weight loss program at Start Clinic. Call 602-795-3649 to schedule a consult today.
We encourage primary care physicians to send us their diabetic patients for lifestyle management because the science clearly shows the most successful way to lose weight if you are diabetic is with diet and exercise in combination with medical management. All of this takes hard work and may be beyond the time constraints of a busy primary care medical practice. At Start Clinic we focus on whatever it takes to change those lifestyle habits. We do leave management of diabetic medications to the patient’s primary physician; however, we may make recommendations about changing medications if the diabetic is taking a medication notorious for increasing rather than decreasing weight. We believe with proper guidance and a firm commitment to lifestyle changes, type II diabetics can reverse their disease and may even be able to discontinue medication for blood sugar control all together. To do so means losing the body fat, reducing BMI to less than 25, shrinking waist size, and committing to regular exercise. It may also require the support of appetite suppressants. We also have options for those for whom stimulant medications are medically contraindicated such as severe hypertension or known heart disease.
This may include injections of amino acids and B vitamins that boost metabolism as well as non-drug appetite suppressants. Our gym provides an opportunity for diabetics to learn exercises under medical supervision that minimize risk of musculoskeletal injury while maximizing burning of body fat. We may be the only medical weight loss clinic that has vibration plates to help those with neuropathy improve proprioception in lower extremities for better balance and safer gait.
According to the CDC (Center for Disease Control) the number of diagnosed diabetics in the U.S. in 2014 had risen to 22 million, a fourfold increase from 1980.
The CDC also reports that more than 1/3 of the U.S. population is obese and roughly another 1/3 is overweight–over 150 million people carrying too much fat!
These are frightening real numbers. Our goal is to help change these numbers!