Everything We Know About Diabetes is Wrong

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sugar causes diabetesBy Matt Stone

Everything you know about Diabetes is wrong. Or at the very least it’s a half truth, taken out of context, assumed but not proven, or worse. When I say Diabetes I’m referring primarily to the most common form of Type 2 Diabetes (there are several types of diabetes sometimes classified as type 2 that aren’t really type 2, such as LADA). The following are some common myths that have become deeply embedded into the collective psyche of both the average Joe and his doctor.

If you are left scratching your head and confused after reading this, that’s good. We humans still have much to learn before we fully understand Diabetes. Those who portray Diabetes as a simple disease while singling out a food item or lifestyle factor as its cause are probably the same people that think that legalizing pot will solve the debt crisis, that obesity could be stopped dead in its tracks if people just ate more fruits and vegetables, that driving a hybrid will change the global air temperature, and that abstinence holds the power to eradicate teen pregnancy.

Jeez. I was just trying to introduce a list of stuff, but now this post has more tangents than Miami beach. Get it? Tan gents! Woo-sha! Okay, on to the Beetus…Intracellular glucose

  1. Sugar does not cause Diabetes. In fact, many academic conversations about sugar (glucose, sucrose, fructose, lactose) are about whether or not it protects against Diabetes and by how much, as you can see in this review. Considering sugar’s ability to decrease some of the hallmarks of Diabetes, such as elevated lactate and others it would be no surprise if it, in the end, was found to actually be medicinal in some sense. Or at least in certain contexts.
  2. Grains do not cause Diabetes. Again, the question is not whether or not they are causative of Diabetes, but how protective are they, what types are protective, and for whom are they protective.
  3. Dieting does not improve Diabetes. There was a big headline story a while back showing that extreme calorie restriction can reduce or even eliminate Diabetes. Sure, reducing food intake can temporarily improve the biomarkers for many health conditions. It is not a lasting cure, and repeated dieting is associated with higher rates of obesity and type 2 Diabetes, perhaps even causing the conditions it is purported to cure as I have asserted for many years both on this blog and in my books.
  4. Lowering your blood sugar doesn’t necessarily improve your health. Uh oh Scooby. In fact, one study showed good glucose control led to worse health outcomes. This one too. In my experience, when diabetics and prediabetics reduce food intake or carbs to lower blood glucose levels, health problems ensue equal or greater to the problems caused by high blood sugar. Starving oneself of glucose is not a solution to a very complex and multi-faceted disease. When it comes to improving any health problem, you cannot chase a number or numbers with disregard for all the other markers of proper function (hair, skin, sleep, sex drive, digestion, etc.).
  5. Diabetes is not a disease of glucose excess. Well sure, it is if all you are focused on is the blood. But glycogen storage and intracellular sugar are reduced in Diabetics when compared to normal people. Diabetes should probably be thought of as a disease in which sugar can’t get to where it’s supposed to go (cells and muscles), and blood levels rise to compensate, which is perhaps why lowering blood glucose levels can cause even more harm. More discussion on this can be found in 12 Paleo Myths.
  6. Carbohydrate consumption does not damage beta cells in the pancreas that are vital to insulin secretion. There’s not much evidence that glucose, singlehandedly, plays a role in damaging beta cells. There is a great deal of evidence that free fatty acids, uncoupling protein-2, free radical oxidation, inflammation, and many other factors are involved in beta cell dysfunction.

diabetes glycogen storageThis is just scratching the surface. There’s no need to be exhaustive here. All this should do is demonstrate the far greater complexity that lies beneath the superficial beliefs and opinions of those less informed. For more interesting reading, Andrew Kim (who will be guest posting here on Wednesday) has shared some very interesting and more in-depth thoughts on diabetes, as has Ray Peat. As always, be open-minded and don’t be too quick to jump to conclusions, thus forming strong opinions about things you know little about. Unless you like being an idiot. After nearly a decade of studying human health, I’m proud to say I’m not sure what the cause of and solution for diabetes is anymore in any simple sense. I hope this helps you get there, too, and reopen the case on Diabetes.

When I communicate with diabetics, the first goal is simply to try to get more carbohydrate into the cells and muscles. The ultimate goal is to see blood glucose levels come back down as carbohydrate intake increases. Reducing stress, increasing the number of hours of nightly sleep, and increasing the intake of carbohydrates and salt usually prove to be the most effective interventions. There are exceptions. No two cases of diabetes are exactly the same in my experience.


  1. SWEET

  2. When I took my first (totally mainstream) nutrition class, I was very interested to learn that sugar intake has never been shown to have an association with diabetes type 2 onset. High fat diets, however, have been associated with type 2 onset. Association does not equal causation, but for people familiar with the research, fat is much more suspicious than sugar.

    • What types of fat?

        • When they talk about “saturated fat” In studies, they usually mean lard ans not Burt, coconut oil, beg tallow, and other tropical fats. Lard is usually 60% unsaturated and 12% PUFAs, which is 20% more than palm oil which is far more unsaturated than ruminant fats, dairy fats, and other tropical oils. So don’t believe their lies or take their claims at face value. Don’t eat lard and fatty pork, esp fresh or nitrate-cured meats which are ofteb pushed by low carb and paleo gurus as some kind of super foods. Study the free fatty acid issue and other suspects argued by Ray Peat, Andrew Kim, Matt & others.

          • As far as I know, these studies are comparing fatty acid profiles, not whole fats. Also, the higher PUFA content of lard shouldn’t be an issue, since both PUFAs and MUFAs have been shown to increase insulin sensitivity in comparison to SFAs.


          • Thanks for that link, Christal. Since dairy is probably my chief source of fat, that was good to read!

          • I’m not sure these studies indicate anything about the ability of saturated fat to lead to diabetes. They don’t appear to be longterm from the abstracts. I didn’t think the type of fat had really been established. Monounsaturated like olive oil is pretty in the clear, I think.

            Interestingly, the countries that consume the most saturated fat are not the ones with the highest rates of diabetes:


            Countries with high saturated fat consumption like France, Switzerland, Sweden, Denmark are all low on the list. Iceland is all the way at the bottom. They do all take in saturated fat mostly from dairy however, not meat. I would not be surprised at all if that made a huge difference. In France, duck fat is considered healthy (which is less saturated), but beef tallow is not.

          • I think this is great advice. There’s no need to worry about fat or sugar or any other type of food, as long as we practice moderation. I notice that although she eats full-fat yogurt, she also considers a piece of dark chocolate a weekend reward. She clearly watches what she eats, even though she eats what she likes.

            To stay slim, she heeds her doctor’s advice to “eat smaller amounts, walk more, cook her own food and drink more water.”

          • Traditionally, Swedes get a fair bit of saturated fat with their meat. Pork is the staple meat for most of the population (more red meat up north, but not many people up there). I believe that’s still the case today even with the anti-pork propaganda gaining ground. Chicken might be more popular.

          • I think saturated and mono-unsaturated fats are safest from ruminants and tropical fats. The opinions for / against dairy (or dairy fat) have gone back and forth for decades and do not mean a thing. My health declines if I go a while without eating fatty beef, but it’s slow and subtle. I feel colder and more irritable. My body temperature is higher and I do not feel cold hands or feet if I have fatty beef at least once or twice a week (does not have to be too often). Like many, i have felt worse from eating pork, esp fresh pork or nitrate-cured meats, however I will have them on occasion. I think “uncured” bacon, sausage, ham, and proscuitto are better (only salt, sugar, and spices added), as well as long-marinated pork (like 24 hours with raw apple cider vinegar). Based on a variety of information from WAPF, Food Renegade blog, Perfect Health Diet blog, and others about pork.

          • I’m not actively avoiding saturated fat or anything. In fact, I had sausage and pepperoni pizza for dinner last night.

            My point, in posting those links, was not to indicate that they were the infallible truth, but to follow up on your comment that in orthodox medicine, fats (and especially saturated fats) are more likely to be implicated in diabetes than any form of carbohydrate.

          • I doubt they tested each fatty acid individually. The second link you give says “Consumption of energy-dense/high fat diets is strongly and positively associated with overweight that, in turn, deteriorates insulin sensitivity, particularly when the excess of body fat is located in abdominal region.” That is talking about people eating PUFAs, trans fat, HFCS, etc (SAD). I’ve lost 24 pounds so far eating high-SFA, high-MUFA, low-PUFA and trans fat, high-calories, high-sugar, high-starch, 10-20% protein, low-fiber, high-reward foods, and one or two drinks (potato vodka, pure agave tequila, sugarcane rum, apple ale, honey brown beer, and good gin mostly). The claim that eating high fat or high energy is strongly associated with overweight proves nothing. I think it’s also associated with dieting and restricting macro-nutrients or calories, then returning to eating PUFAs and trans fat and HFCS.

            They say “the ability to oxidize dietary fat is impaired in some individuals genetically predisposed to obesity. Insulin sensitivity is also affected by the quality of dietary fat, independently of its effects on body weight.” That is probably due to eating toxic fats, rancid fats, lipid peroxidation, inflammation, etc.

            They say “Epidemiological evidence and intervention studies clearly show that in humans saturated fat significantly worsen insulin-resistance, while monounsaturated and polyunsaturated fatty acids improve it through modifications in the composition of cell membranes which reflect at least in part dietary fat composition.” THAT IS BASED ON SHODDY STUDIES THAT CALL LARD A SATURATED FAT, or BEEF TALLOW MIXED WITH SAFFLOWER OIL. They do things like that all the time, changing the meaning of words to make SFAs look bad. Unless you know what fats they used or were eaten, I am pretty sure they are talking about lard or diets that include PUFAs mixed with saturated fats, which I agree are bad. Saturated fatty acids aren’t the problem. They need to isolate the variables better.

            “A recent multicenter study (KANWU) has shown that shifting from a diet rich in saturated fatty acids to one rich in monounsaturated fat improves insulin sensitivity in healthy people…” Beef and lamb fats are high in MUFAs compared to SFAs, but studies call them SFAs. I’d look for studies that use coconut oil, palm kernel oil, butter, cocoa butter, beef SUET (fat around kidneys), and maybe good palm oil if it has 50% SFAs or more.

            “There are also other features of the metabolic syndrome that are influenced by different types of fat, particularly blood pressure and plasma lipid levels… shifting from saturated to monounsaturated fat intake reduces diastolic blood pressure.” MY BLOOD PRESSURE was around 90/60 in the past, a level seen mainly in children and elite athletes. I ate lots of saturated fatty acids, low PUFAs, high sugars, moderate starch, low to moderate protein. My blood pressure was consistently below 110/55, like 108/54, but occasionally it spikes to below 200/100, maybe due to alcohol or PUFAs, not sure.

            “Substitution of unsaturated fat for saturated fat not only reduces LDL cholesterol but contributes also to reduce plasma triglycerides in insulin resistant individuals.” THIS IS A TOXIC EFFECT, from it driving cholesterol into cells. We should ask “what is the mechanism?” Ray Peat thinks a high pulse (like 85+) and blood pressure are healthy, it has just been demonized because of shoddy science and unfounded assumptions that were made (like calling lard, or beef tallow mixed with safflower oil, a saturated fat). Look deeper.

            “Therefore, prevention of the metabolic syndrome has to be targeted: (1) to correct overweight by reducing the energy density of the habitual diet (i.e., fat intake) and (2) to improve insulin sensitivity and associated metabolic abnormalities through a reduction of dietary saturated fat, partially replaced, when appropriate, by monounsaturated and polyunsaturated fats.”

            This dietary pattern will cause and exacerbate all kinds of diseases. High energy density or “high-reward foods” are not the problem. I’ve lost weight and look slimmer and am stronger by eating high-reward foods with abandon, not counting or limiting anything except PUFAs, trans fats, HFCS, invert sugar, glucose-fructose syrup, etc. Scientists today are like the Ministry of Truth in 1984, they use Orwellian new speak and double-think. They call lard a saturated fat when it’s 60% UNSATURATED and 12% PUFAS, higher than palm oil which is usually half saturated fat and 10% PUFAs (lard is 20% more). Palm oil allows liver cirrhosis to heal even with continued alcohol consumption, as lard makes the damage worse. That difference may seem small, but palm oil is clearly healthier than most lard, IMO. Ray Peat, Andrew Kim, and others have come to the same conclusion.

          • Glad to hear you’re having success with your diet. I know there’s plenty of disagreement with the mainstream on the role of saturated and unsaturated fats in the etiology of disease, particularly among the paleo, peatarian, and wapf communities. To be honest, I’m basically agnostic about it and will eat my turkey sandwich with both cheese and mayo (horrifying both camps!). My own opinion is that exercise and controlled weight are the most important factors that we can control, when it comes to diabetes.

            My main point with my posts was that, when it comes to mainstream research on diabetes, saturated fat is the most implicated. I’ll happily acknowledge it’s an open case. For me, it seems prudent to keep fat calories under 30% of the total, but I know many people have success with much higher levels of fat intake.

            Thanks for sharing your thoughts. I enjoy the controversy. The only part I really disagreed with was the comparison of scientists to the Ministry of Truth from 1984. I’m not claiming that our modern institutions of science are perfect, but I don’t see any intent to misinform. It may be that in some studies lard is the representative saturated fat, but I don’t think that’s part of some conspiracy to silence the truth about SFAs.

          • Part of the problem with studies on Saturated fat is that they typically use lard, one of the highest sources of AA. When butter or coconut oil is used the outcomes are markedly different in rodents and in humans.

          • Ah yes, I see Mercury has thoroughly pointed this out. Thanks Merc!

          • If you are eating deli sliced turkey, it probably has very little fat. I eat Oscar Meyer Honey Roasted Turkey Breast often, as that tastes the best of the (many) cold cuts I’ve tried. I have Kraft low-fat olive oil mayo sometimes with it (the only one I’ve seen with olive oil as the first ingredient, not soybean – though it still has traces of soybean oil and canola oil). I do try to minimize USA foods with soy and corn a lot on kind of general principle, because of the subsidies.

            Studies rarely use anything more saturated than lard or lower PUFAs than lard, even though we know animals don’t need all those PUFAs (and neither do non=pregnant adult humans). My view is that obesity and disease result more from restricting food (or food groups, macro-nutrients, meals, etc). I’ve been reading Chief Rok’s blog and think he has a lot of things right but you don’t have to fast and eat buffets. Simply eliminating television and reducing stress and eating a large food variety instinctively with no restrictions would work. Chief does not isolate his variables, but blames obesity on people eating 3+ meals a day, despite lean people who do that. I think it’s far simpler than Chief, just eat with balance and don’t restrict a thing, don’t count anything, learn to go by instinct. You don’t have to eat buffets and most buffets suck, IMO.

            I disagree with Matt about thinking frequent urination always implies you have a low metabolism or diabetes (or any other health problems). it’s a function, like Ray Peat says, just like high blood sugar is a function. Calling that symptom a disease is unscientific and doesn’t make sense, esp if someone doesn’t have other significant problems like cold hands & feet, poor energy, poor healing, macular degeneration, muscle wasting, gangrene, etc. I am drinking more fluids than I was before in the form of sugar sodas mostly, because I’ve seen benefits to them that things like 100% fruit juice, fresh fruit or sun-dried fruit never gave me. I think I just need more solid foods and salt to balance the liquids. Maybe other things would give me the same benefit, like maple syrup or honey, but I just need to eat more so it’s like a soda (35-40g of carbs).

          • Correction: Honey SMOKED turkey breast, not roasted…

            Here is a good quote from Ray Peat on diabetes:

            I have known adults and children who were diagnosed as diabetic, and given insulin (and indoctrinated with the idea that they had a terminal degenerative disease) on the strength of a single test showing excessive glucose. When I taught at the naturopathic medical school in Portland, I tried to make it clear that “diabetes” (a term referring to excessive urination) is a function, and that a high level of glucose in the blood or urine is also a function, and that the use of insulin should require a greater diagnostic justification than the use of aspirin for a headache does, because insulin use itself constitutes a serious health problem. (And we seldom hear the idea that “diabetes” might have a positive side [Robinson and Johnston], for example that it reduces the symptoms of asthma [Vianna and Garcialeme], which get worse when insulin is given. Normal pregnancy can be considered “diabetic” by some definitions based on blood sugar. I got interested in this when I talked to a healthy “diabetic” woman who had a two year old child whose IQ must have been over 200, judging by his spontaneous precocious hobbies. Old gynecologists told me that it was common knowledge that “diabetic” women had intellectually precocious children.)

            I would appreciate any thoughts from Matt or others with regards to this quote or the rest of the article. Thanks.


          • Mercury, you say you need to eat more. If you don’t mind me asking, about how many calories are you up to? I was at 5-6k daily when I was eating the most.

          • I know that Chief’s practice of intermittent fasting works for many people, and I think a big part of that is because it’s difficult to overeat when you only get one meal a day. Another great benefit is that it saves time and money if you only visit the Ponderosa once a day. Orthorexia should also disappear. You can’t worry about PUFAs and fructose or MSG or any other “scary” additives, since just about everything is cooked in oil, margarine, corn syrup, and “flavorings.”

            I think Peat’s concerns about PUFAs are exaggerated. Worldwide, there are plenty of healthy populations that use vegetable oils in their cooking, and I’m not just talking about the tropical oils. And before the vegetable oils became predominant, lard was most common, which as you’ve pointed out is not so low in PUFAs. Pork fat, with all its PUFAs, is about as traditional as it gets.

            One of the reasons I choose turkey meat is because it’s low in fat, but that’s not really about the individual fatty acids. Generally speaking, I prefer lean meats because they’re lower in calories, which allows me to eat more. I’m not particularly concerned about the disease-causing properties of PUFAs, MUFAs, SFAs, fructose, glucose, galactose, sodium, etc., etc., etc., but I do worry about the diseases associated with obesity, and I take a very traditional view that obesity is, for the most part, a function of calories consumed versus calories expended. America has an obesity problem because we eat too much and don’t do manual labor or walk anymore. Big Gulps and the “oiling of America” are significant only to the extent that they have given us cheap calories to consume, that we don’t burn off.

            That Ray Peat quote about diabetic mothers giving birth to geniuses should be taken with great caution by any expectant mothers. There are a host of health problems for both the child and mother associated with high blood sugar during pregnancy. Gestational diabetes has real risk factors associated with it, despite an anecdote about a child who “seemed” to be smart based on precocious play.

          • I almost included some discussion of gestational diabetes in this article as well. There are some complications in women with elevated blood glucose during pregnancy. The problem is that artificially controlling blood glucose levels by restricting carbohydrates usually makes the problems much, much worse. Elevated blood glucose is just a sign of problems and high stress. Taking carbs away just adds to the stress. For example, one woman I communicated with hit 180mg/dl on her OGTT. Then she was sent down to a dietician and put on a low-carb diet. Her postmeal glucose then fell down to around 130 or lower on the low-carb meals, but she promptly had her severe insomnia (that was fixed with adding carbs) emerge, and other problems. Many people are making the mistake of chasing numbers and not looking at the function of all the body’s systems together. There is a reason that blood glucose becomes elevated, and removing carbohydrates does not get to the root of why that’s happening. Ray Peat’s radical common sense about that is refreshing.

          • I’m no friend of low-carb, and I agree with you on principle that chasing numbers is not the same thing as pursuing health. But it still true that high blood sugar during is more likely to cause problems than create a baby genius.

            My understanding is that doctors will advice obese women who are planning to have children to lose weight, because a high bmi is associated with several risks such as gestational diabetes and preeclampsia.

          • *during pregnancy

          • I agree with you, David. I don’t think PUFAs are evil, I eat mayo because I like it and don’t want to make the home made stuff.

            GD is nothing to mess around with, especially if it goes undiagnosed because you think you’re smarter than your doctor and refuse the test. Untreated GD can cause macrosomia, more difficult delivery, and hypoglycemia at birth (very dangerous for an infant).

          • While I understand the theory behind avoiding pork consumption (PUFA), I’m curious why so many peoples have eaten pork products regularly and are healthy. Where I grew up, pork has traditionally been the preferred meat. In my dad’s native country, it’s the same.

          • IIRC, pork fat is the most responsive to the animal’s diet among the animals commonly eaten by humans. Hell, feed pigs coconut flour and tubers and you can get the pufa’s to ruminant fat ranges. Also, I believe that societies that commonly eat pig also boil the crap out of anything involving the animal and/or cure the hell of the pig, which supposedly helps with some of the other problems with pig consumption.

            Don’t ask “why go through all the effort?” though, ancestral societies also jump(ed) through hoops to make legumes and grains digestible and the lack of which in SAD foods could single-handedly explain why processed foods are so god awful digestion wise for an increasing amount of people.

          • Here are some links about the problems with pork, which go beyond PUFAs & include nitrates, parasites, viruses, allergies, and so on. The traditional cultures who eat pork used uncured meats (only salt, sugar and spices added) or they marinated it for a long time with acid like raw apple cider vinegar) which breaks it down and eliminates some of the bad things. I would select “uncured” bacon, sausage, ham, and prosciutto if possible, esp if I was eating a lot of pork. I had a good long marinated pork roast recently and didn’t notice any problems, I even felt fine going on a binge of pork for about a week after that. I know Matt Stone and Chief Rok are against pork (and alcohol in the case of Chief), maybe they just haven’t healed as much as I have. (I USED TO have bad chest pain from pork like Matt talks about.)




          • You’re absolutely right about this. You can’t get any more traditional than pig farming, and for many populations pork would have been the only affordable source of meat. Pork was hugely important for the Romans, and it’s been consumed historically all across Europe, Asia, and Africa. The only caveat would be that most of traditional populations wouldn’t have been rich enough to eat a pack of hot dogs every day. The pork was a supplement (albeit an important supplement) to a diet based on grains.

          • If you are to believe RBTI (which I have some major skepticism about), people who eat food from good, healthy, nutrient-rich soil have no problems with pork. It’s just when they are eating pork as part of their nutrient-poor diet that it becomes a big problem. I do agree with them on the importance of soil health, maybe there is something to this theory, who knows.

          • So much hype around ‘healthy’ polyunsaturates, but are they?

            If you have ever tried to scrape congealed vegetable oil off a fryer you will be well aware of the fact that heated PUFAs turn into little short of varnish. In fact, traditional varnish was always made from boiled linseed (flax) oil.

            But what the heck is that doing to the cells in our bodies?

            I never got onto to ‘fat is bad, fat makes you fat’ train, I love my butter too much, but I did use polys for cooking and frying. Did that clog my cells up and give me diabetes? Has the exponential rise in diabetes simply occurred due to the huge promotion of PUFAs over the last 30+ years? Are we all being ‘varnished’ in to diabetes?

            Time was your typical corner chip shop/greasy spoon/cafe fried with lard or coconut oil, but then the drive to use ‘healthy’ PUFAs came along and coconut oil went out da winda. Back then it literally was ‘cheap as chips’. Since it’s become the ‘healthy’ option you have to take out a mortgage to afford it! The junk varnish oils however are now ten for a penny….

        • Most human trials show that saturated fat has no effect on insulin sensitivity. Only one study showed an effect (the oft-cited KANWU study) and the difference between the two groups wasn’t even statistically significant –

          By contrast In the Rose Corn Oil trial, there were three arms – a normal diet arm, a high corn oil arm, and a high olive oil arm. The normal dieters were expected to eat “fried foods, fatty meat, sausages, … ice cream, cheese, … milk, eggs, and butter” while the oil arms were supposed to restrict these foods and replace them with corn or olive oil.
          Guess what happened? Two patients developed diabetes, one from the PUFA arm and one from the MUFA arm. Another two patients developed thromboembolisms, again one from the PUFA arm and one from the MUFA arm. It turns out the reason was that SAFA rich foods are also rich in choline, which protects against insulin resistance (as well as heart disease and fatty liver disease). The groups eating the MUFA and PUFA diets were deficient in choline.

          The animal studies linking SAFA to insulin resistance are essentially meaningless. Scientists use a number of manipulations to make render rodents susceptible to disease on a high fat diet that would be innocuous under normal conditions. For example they may use genetic mutants that are sensitive to high fat diets and prone to disease, they may use ‘knock out gene’ studies that effect the rat’s fat metabolism or response to high fat diet. They may use choline or methionine deficient diets which make high fat diets dangerous and the list goes on.
          A couple of these problems are covered by chris masterjohn here – http://www.westonaprice.org/blogs/cmasterjohn/fat-and-diabetes-bad-press-good-paper-and-the-reemergence-of-our-good-friend-glutathione/

          They also tend to use purified diets, which have completely different effects to real food. For example REAL food high SAFA diets protect against fatty liver disease in rodents but high fat PURIFIED diets have the opposite effect.

          Another point, the ‘saturated fat’ usually used is lard. As it turns out the lard fed these rodents is actually TWICE as high in PUFAS as previously estimated – the lard is actually 32% PUFA.

          Contrary to claims otherwise there is no evidence that PUFA improves insulin sensitivity whatsoever. There is evidence however, that PUFA increases inflammation and lipid peroxidation; and there is also strong evidence that inflammation and oxidative stress contribute to insulin resistance.

          • I have always found it quite amusing that lard is usually used as the fat for studies on the effects of “saturated fat.” That’s like using a fruitarian diet to determine the effects of a low-carb diet. Lard is the richest source of Arachidonic Acid. Studies need to be more specific. They need to study things like butter, coconut oil, lard, sunflower oil, sesame, etc. etc. separately. Even then, the tiniest little differences in context can produce wildly different outcomes, which is why all studies shouldn’t be taken to heart. For example, in a post about to come out by Vladimir Heiskanen, you’ll see that sucrose can cause metabolic syndrome or not depending on how much glycine is present in the diet, of all things.

          • Good point matt, context is everything.as another example fructose overfeeding induces fatty liver in rodents but not when adequate choline is present in the diet.

  3. And this is a great article. I wish more people with diabetes would be informed about these things instead of just hearing what their doctors tell them. Hopefully as the Internet age progresses people will start to value knowledge and experience and critical thinking more than formal titles and credentials. I still can’t get that image out of my head of being at the mental hospital and asking a psychiatrist what the medication they wanted me to take did, and she just looked at me and said, “I’m an M.D.”

    My dad’s diabetic, and I also suspect he has a mutation of the MTHFR gene, since I tested compound heterozygous for it (C677T and A1298C). Since methylation is so important in general, I can only imagine it has to have an influence on diabetes. And even in the absence of a mutation of the MTHFR gene, adequate levels of B-vitamins are important. Since I have two mutations I supplement with active B-vitamins.


    Metanx is made of:

    L-methylfolate: 2.8 mg (vitamin B9)
    Pyridoxal-5-phosphate: 25 mg (vitamin B6)
    Methylcobalamin: 2 mg (vitamin B12)

    You can get these supplements without a prescription at just about any health food store. And speaking of B-vitamins, Ray Peat has also written a bit about niacinamide, and that might prove especially valuable to diabetics.

    “Niacinamide, used in moderate doses, can safely help to restrain the excessive production of free fatty acids, and also helps to limit the wasteful conversion of glucose into fat. There is evidence that diabetics are chronically deficient in niacin. Excess fatty acids in the blood probably divert tryptophan from niacin synthesis into serotonin synthesis.”


    At the Ray Peat forum in a thread on niacinamide, haidut made an interesting comment (the post with the orange background):


  4. Best advice for someone with recently diagnosed type 2 diabetes, on Metformin for 2 months now, still having fasting blood sugars of around 145, and facing a mastectomy for very aggressive breast cancer in the next few days? Ready, set, go:
    Oh, and said person has been following the principles espoused on this site for about 2.5 years, i.e. eating the food, reducing stress, improving sleep, etc.

    • Also, said person has read much of Andrew Kim’s writing about diabetes and has been taking aspirin, niacinamide, vitamin e and including more fruit in diet for about 4 months.

    • Said person feels pretty helpless.

      • Hugs!!

      • Yeah that’s pretty sucky Danyelle. Have you considered speaking with me?

        • I would like that. How does that happen?

      • Danyelle,

        I’m so sorry to hear about your ordeal. I’ve been an ‘independent health researcher’ on cancer in particular — though I don’t keep a site– it’s the great mystery to this nancy drew wannabe. I’m not sure what stage you areare my 2 cents:

        I am a little at a loss about your blood sugar, but I think the two must be connected and the first thing I would want to know is your Vitamin D level and your calcium intake. I would be sure to spend as much time as is comfortable outside in the sun w/out glasses or contacts in full spectrum light– it can’t hurt and it could really help. And walk for at least 30 minutes– it shows more promise than chemotherapy.

        Also, The aspirin is great and you don’t have to rely on Peat (or Kim) to feel confident about that — though you won’t hear it said by most doctors– aspirin reduces carcinomas (not blood cancers) significantly and for those already diagnosed it has a powerful anti-metastatic effect.

        Finally, dessicated liver is something that Peat says has curative effect on cancer though I can’t find the original paper he refers to. Again, something that won’t hurt and may help a great deal.

        I’m fairly certain, after all my reading, that Ray Peat (and others) is right that a cancer is not an errant cell that starts multiplying but a systemic malfunction. The cancer is a survival mechanism for an organ that is under stress– sometimes that is genetic or environmental– sometimes it’s what we’re eating. But obviously, reducing environmental and dietary stress to the extent possible is advisable. It sounds like you already are.

        I wish you the very best in your healing (it’s not a fight). Take good care of yourself.

        • I take Vitamin D every day, go outside and walk most days, and blood tests show satisfactory D, if not great high levels. A lumpectomy and sentinel node biopsy last month showed no lymph node involvement – maybe the aspirin a day helped that to happen. But the cancer is very aggressive and has already set up new nodes, thus the mastectomy coming soon.

          Also, I agree about the “not a fight” thing. I was just starting to realize how I’ve demonized my body before I was diagnosed. So when they told me it was cancer, I vowed not to “fight” it, but to heal, like you said. My body is not the enemy. That’s difficult for me to completely embrace because I’ve been hating it for so long.

          Still scared. Trusting in God, trying to listen to other intelligent resources beyond just my doctors.

          Thanks for your thoughtful response.

          • Sorry you are going through this, Danyelle. I think the truth is that we don’t know all the causes of cancer at this point and sometimes it just happens. It sounds like you have the right approach, and I hope all goes well with the mastectomy and treatment.

          • Could this help? Don’t know if it’s wise to raise ph so high. There are 2 protocols to choose from I think.

            My Dance With Cancer http://phkillscancer.com/

          • Danyelle,

            I’m so sorry to read what you are going through.

            If you don’t mind me asking, have you ever had your estrogen and progesterone levels checked? If you get the chance, google “estrogen dominance” and the product Progest-E and definitely check out Ray Peat’s articles on his website about breast cancer, estrogen and progesterone and female hormones in context if you haven’t already done so. Here’s one of his articles on breast cancer. http://raypeat.com/articles/aging/breastcancer.shtml

            I think you will gain a wealth of knowledge like I have from reading Ray Peat’s research on female hormones. Honestly, his research is really eye opening and informative.

            Lastly and I believe most importantly, check out the book “Dying To Be Me” by Anita Moorjani. I promise you, you will not be disappointed. Her story is about her near death experience with end stage cancer. I’ve been through hell and back due to illness and her book changed my life. She even has a website anitamoorjani.com where she shares her story along with interviews she has done. I think after reading her book, you will finally be able to truly believe that your body is not your enemy. Not even close! :)

            Love and Blessings!

    • Blood glucose feeds cancer so I would reduce your carbohydrate intake including fruit to try to get those levels down.

      • Ughhh no. Sugar feeds cancer cells in Petri dishes. Our bodies are not Petri dishes, and cancer is much more complicated than eat less sugar = kill cancer cells.

    • Wouldn’t Peat recommend progesterone, such as progest-e? His books are far more readable and informative than what’s available on his website, and plus he answers his emails right away.

      According to the Melvin Page cancer is due to the overactive anterior pituitary gland. I haven’t read enough of his work, but i think he used some sex hormones and just a bit of insulin to counteract the anterior pituitary. I think he really understood endocrine system and managed to solve health issues using minute amounts of glandular, but most often he found people deficient in posterior pituitary.

      • Also, i think lipase enzyme can be helpful for high blood glucose.

        • If anyone can point me to further information over this point, I would appreciate it, thanx

          • You mean the lipase for diabetes?

            There’s lots of info online…also, i think Lita Lee is quite informed and experienced with the enzyme therapy.

          • Thanx, I did not know this info was out there until now.

      • Page also stated that poor glucose control and cancer were always seen together, and that he never saw a case of cancer where blood glucose was normal. Definitely hints at similar mechanisms at the root. Of course lactate is but one theme in both cancer and diabetes.

        • As far as i can tell he was quite accomplished with his method of treatment. Later on he even discovered that depression and bipolar disorder were due to severe posterior pituitary deficiency, and was able to correct this with just a bit of post. pit. glandular. He discovered that post. Pituitary was directly opposing the adrenal cortex.

          And when he found that thyroid was low, he was able to correct the condition with just tiny amount of thyroid glandular, something like 1/50th of a grain.

          Why is no one looking into this?

          The only person i am aware of that utilized Page’s work is late Dr. Ray Forbes. Hal Huggins goes in there too, with his book Who Makes Your Hormones Hum.

    • Magnesium? Turmeric? (Proven to help prediabetics stay prediabetic rather than become diabetic, see http://www.greenmedinfo.com), and did you ever take the Oral Polio Vaccine? You could have SV40 (simian virus 40) which causes cancer – in which case, take antiviral supplements?
      Good luck, hope something there helps.

  5. “As always, be open-minded and don’t be too quick to jump to conclusions, thus forming strong opinions about things you know little about.” Wise words there. It’s soooo easy to read a headline or short article or even a whole book and think “oh, that’s the answer!”. Then you don’t get the results that were supposed to come, so you look for the next simple answer. I have been on that similar journey.

  6. Do you still recommend most of the advice in your Diabeetus book?

    • Somewhat. It is an old book and sort of a menu of options in troubleshooting insulin resistance. I hope to revise it at least a little bit eventually.

  7. “When I communicate with diabetics, the first goal is simply to try to get more carbohydrate into the cells and muscles.”

    Nothing could be further from the truth. Diabetes is the relative inability of the body to process carbohydrates. The simple solution is to avoid exogenous carbohydrates. Your body produces endogenous carbohydrates, and it is enough. High fat, adequate protein, and very low exogenous carbohydrates. It’s not easy; but, it is simple. I would be happy to provide sources at anyone’s request.

    • How do you explain some changes, including increasing carbohydrate intake, that improve the ability to process carbohydrates in the manner you describe? For example, I have worked with people whose postprandial glucose went from 300+ eating a high-carb meal to as little as 110 after the very same high-carb meal.

      • I’d say they still had insulin function. Keep giving them that high carb meal and eventually they will lose whatever insulin function they have left. Best wishes… – lc

        • Actually fructose is one of the best things you can give a diabetic. Diabetes is much more about fat metabolism than it is sugar metabolism. The fact is that diabetics are skewed toward a metabolic state where free fatty acids are being used as a fuel source instead of proper sugar metabolism. In fact sugar IS getting into cells, but it’s not being oxidized correctly, instead being converted to lactic acid. Ray Peat has some great articles talking about this. The big issue is all the omega-6 fatty acids in the western diet which is impairing proper utilization of sugars.

        • well…..I know it is just one anecdote, but I know for sure from blood tests, that after several years of carbohydrate restriction and generally too low calories, I developed insulin resistance and ‘PCOS” like symptoms and had to be on Metformin. 4 months of aggressive refeeding- no exercise and including LOTS of sugar- and my insulin resistance nigh on resolved, along with most of the PCOS symptoms. Why on earth would exposure to carbs reduce the body’s ability to deal with them? Does activity reduce the body’s ability to exercise or lactose consumption reduce the amount of lactase enzyme the body produces no… lactose presence causes the switching on of lactase enzyme production. endogenous carbohydrates are primarily produced in the liver, and have to be shuttled into other body cells with the same mechanism as exogenous carbs through the blood stream.

        • My fastings fell 20 points to mid to low 80’s going from the diet you describe to a higher calorie and much higher carb diet. My energy also increased and many health issues disappeared.

        • I personally experienced that my sugar normalized on a potato diet and went through the roof when I ate almost exclusively meat, eggs and cheese. Avoiding exogenous carbs is certainly not a solution for me, and I am probably not the only one.

    • I guess you could go that route. But if a person has diabetes or is on the verge, foremost, there has to be a reduction in excess body fat, bearing in mind excess is relative here, to relieve the stress imposed on all the interconnected systems in the body — like the intestines, gut microflora, fat tissue, endocannabinoid system, liver — as a result of the excess body fat. Since we don’t have the physiology of a bird or a rat, we don’t efficiently convert carbohydrate to fat, as once up until recently thought, so, per calorie, low-fat diets are more slimming than high fat diets, while helping to relieve some of the burden associated with having excess body fat.

      • Andrew,

        Considering all of the psychological, social, and metabolic barriers people experience when attempting to lose weight, and the high failure rate of attempts at dieting, the reduced metabolic rate and increased appetite of those who have lost fat (regulated by the loss of fat itself), and the known negative consequences of weight cycling, what can a person do to lose weight?

        • The golden question! If I diet for even a day or even THINK about dieting I have a problem eating too much directly following the event or thought. Does anyone have the answer????

  8. High blood sugar is actually a compensation for a dehydrated state.

    • Now that rings true to me. I have long felt that my diabetes is somehow linked to dehydration, but didn’t know what to do about it.

      Doesn’t matter how much water or fluid I drink, it just seems to pass straight through. I just hope refeeding with potatoes will address it.

  9. Off topic – but what’s your opinion of Anthony Colpo’s Fat Loss Bible?

  10. 1 & 2 are irrelevant, no-one knows what causes T2D, although it is widely acknowledged that it is a disease of civilization, and that those cultures that do not eat large amounts of refined carbohydrate have much lower incidences of T2D.

    (3) Not by your peculiar definition of “diet” (extreme calorie restriction), but there is lots of anecdotal evidence that a low-carbohydrate “diet” is very effective in treating T2D.

    (4) The definition of “good glucose control” in these studies is not “good” at all (HbA1c > 7). All these studies show is that by maintaining relatively poor control, then you’ll increase the likelihood that you’ll experience complications. My HbA1c < 5% (down from 10.9% at diagnosis). It's difficult to see how glucose control that is probably better than yours could lead to complications.

    (5) Diabetes is pretty much defined as a disease of Glucose Excess. Whether you are Hypoglycemic because you eat too much carbohydrate, or because your metabolism is unable to process it is largely irrelevant. If you eat less carbohydrate you are much less likely to become hyperglycemic.

    (6) Maybe, maybe not. By the time you get diagnosed as a T2D, it's largely irrelevant, your pancreatic function is diminished enough that your ability to process carbohydrates is damaged for life.

    Almost everything that I know about diabetes is contained in this article:

    I suggest you read it too.

    • Stephen, iirc my hba1c was 4.8 the last time I had it checked while eating lots of sugar and carbs but avoiding pufa oils and trans fats. since I feel even better now and my energy us more stable, it’s probably lower now. Low carb diets so not cure anything, any more than avoiding high places cites Aajonus. They paint you into a corner. They worsen glucose control, it rises over tune, see Owsley Stanley (Bear) and Lex Rooker among others for evidence. PUFAs are tozic and they mess up the body’s abilitu to use and generate energy. Read some more yourself.

      • Correction: “Low carb diets DO not cure anything, any more than avoiding high places CURES ACROPHOBIA.” (not “cites Aajonus.”) Sorry for any other typos…

    • “(3) Not by your peculiar definition of “diet” (extreme calorie restriction), but there is lots of anecdotal evidence that a low-carbohydrate “diet” is very effective in treating T2D.”
      For how long?

  11. What B.S. Clinically I’ve helped many people completely reverse diabetes with diet alone. This article is dis-info and flat out wrong.

    I used to like Matt Stone an 180dergeehealth but there out of there depth here or have become bought and sold.

    • Dr. Motley

      You need to lift your game, son.


      Dr. Spellgood

      • Big points for the 80’s reference there Tanya. Nice work.

    • You haven’t “reversef” anything unless those patients can eat like the Kitavans or other healthy high-carbers in Asoa and around the wotld. Their hormones and gut bacteria, appetites, energy, and weight will never be the same as a “naturally thin person.” Their appetite and weight will increase unless they limit carbs more and more with age, not a sustainable solution. Loren Cordain and Michael Eades lool obese. Restricting things and fighting the body just makes problems worse, imo.


  12. I meant hyperglycemic in (5).

  13. My husband was diagnosed with type 2 diabetes five years ago. He started running and biking, but wasn’t taking any diabetes meds. He got into great shape and was able to run the Chicago marathon four years ago. Four months ago he went in for a physical and his doctor sent him to the hospital because his blood glucose was 550. They got it under control and he started taking Metformin faithfully and lowered his carb intake.
    His blood glucose has been anywhere from 70 to 140, not fasting. Two months ago he tore his left lateral meniscus. He has lost 35 pounds since he went on the Metformin and is extremely thin. 5’11 and 157 pounds. He can’t seem to stop loosing weight. The doctors don’t seem to be concerned.
    He is having surgery on his knee tomorrow. I am hoping he will be able to start exercising again and gain some weight back, but I am concerned that something else is going on. More so since I read this.
    Please …any advice?

    • Read Ray Peat’s articles on diabetes, sugar, starch, fructose, glucose, etc. if you can understand just the gist, they punch a lot of holes in mainstream diet dogma.

      Nurse, nobody said diet and exercise weren’t involved, the typical mainstream junk diet and what doctors blindly suggest makes the problems worse, imo, and keeps them in business by never fixing the problem without drugs or unwanted exercise like jogging and running marathons..

    • I would get him to a real endocrinologist, and have him tested LADA, its sort of a late onset, slow onset juvenile diabetes that frequently get misdiagnosed or lumped with type 2, as Matt said in the article “(there are several types of diabetes sometimes classified as type 2 that aren’t really type 2, such as LADA).”

    • The weight loss should be very concerning. Doctors aren’t concerned about it because they almost always think weight loss is good. He probably needs more carbs and more insulin.

    • Is he tracking his food? How many calories is he eating? It sounds like he was not eating for his athletic performance, common with distance work. This will cause th body to become insulin resistant to try and save what it can IMO. He probably needs a minimum of 3,000 calories a day, easily more to gain.

  14. We know enough that diet and exercise affects diabetes. Just reading one study per point is really not adequate to come up with those conclusions. A very poorly studied and misinformed article.

    • Who said that diet and exercise don’t affect diabetes? That is certainly not stated in any way in the article. Perhaps the article was not poorly written, but poorly read.

  15. “Dieting does not improve Diabetes. There was a big headline story a while back showing that extreme calorie restriction can reduce or even eliminate Diabetes. Sure, reducing food intake can temporarily improve the biomarkers for many health conditions. It is not a lasting cure, and repeated dieting is associated with higher rates of obesity and type 2 Diabetes, perhaps even causing the conditions it is purported to cure as I have asserted for many years both on this blog and in my books.” /end quote

    I read about this at the carb-sane asylum. This diet is apparently showing results under controlled conditions and is only meant to be a very short term diet. There is speculation that it may work by getting rid of the ectopic fat that interfers with the body’s metabolism as long as the damage isn’t irreversible.

    I think that you have conflated this with diets designed to lose subcutaneous fat or to improve lifestyle or the irresponsible claims made by diet gurus, especially low carb diet gurus. This is not a diet to improve lifestyle or lose weight; after starving the regained weight was not ectopic. This is not an endorsement of extreme calorie deprivation, as the diet is under medical supervision for a specific medical outcome.

  16. What do we agree on?

    Even on a low carb diet, you can still include:

    -Saturated fat, e.g. coconut oil, as the preferred fat source, and avoiding PUFAs as much as possible
    -Niacinamide and aspirin to lower the release of free fatty acids
    -Natural dessicated thyroid, pregnenolone, progesterone
    -L-methylfolate, methylcobalamin and P-5-P for aiding methylation if the person has a mutation of the MTHFR gene
    -Fat soluble vitamins A, D3, E and K2
    -Adequate levels of sodium, potassium, calcium, magnesium, and trace minerals such as zinc, selenium and chromium
    -The use of gelatin or gelatin rich meats on a regular basis
    -Bright light therapy during the day, and using low blue-spectrum lights at night, e.g. amber lights, or blue-spectrum-blocking amber glasses, to normalize the circadian rhythm and help to ensure regular and high quality sleep
    -Regular exercise such as walking and strength training
    -Regular socializing and interaction and affection and having fun

    Agree or disagree with any of that advice. The point I’m making is that we should be looking at what game plans most people *do* agree on, even if it only boils down to a handful of things.

    One major focus that most people seem to agree on more and more lately is that saturated fats are generally protective and preferable to unsaturated fats. I’ve been trying to get my mom to use coconut oil for cooking for herself and my diabetic dad for years to no avail. Just that one step alone for most people would probably have huge benefits, especially considering how few people in the general population have chosen to make that shift.

    Although I did see coconut oil in big tubs at Sam’s Club the other day, so there’s still hope.

    • P.S. I don’t mean that we *shouldn’t* be debating about the more controversial things concerning diabetes like carbohydrate consumption. Those things should absolutely be discussed.

      To clarify, I just mean that it’d be nice to highlight some common ground between different ideologies so people struggling with diabetes firsthand could have more of a solid foundation to build on. Basically, while the carbohydrate thing seriously needs to be re-evaluated, there are still a lot of approaches that could potentially help diabetes that have nothing to do with carbohydrate consumption or a lack of it, and that people on either side of the carbohydrate fence could take advantage of.

  17. This is the most absurd load of cow dung I have ever heard. Not ONE source was cited. Really, wow, your 180 degrees of health should be called, moronic lame turd logic.

    • The sources are hyperlinked so you just click on the red words and they will take you directly to the pertinent article.
      A credible source to your suggested load of cow dung is not cited or further elaborated on. ;)

  18. I noticed an interesting correlation in one of Matt’s links (http://care.diabetesjournals.org/content/26/4/1008.full). The conclusion of the study was that moderate sugar intake does not increase the risk of diabetes, but the authors also noticed that increased sugar consumption was associated with increased consumption of carbohydrates (duh) and with a lower level of fat consumption. Notably, the sugar-eaters were also thinner and exercised more:

    “At baseline in 1993, women who consumed more sugars were slightly older, smoked less, were thinner, and drank less, although these differences were not statistically significant. Low consumers of sugar in our cohort ingested slightly higher levels of total fat and cholesterol, both of which have been postulated to contribute to insulin resistance (28,29). High consumers of sugar in this cohort appeared to consume less protein and more carbohydrates, and exercised more.”

    I’m not sure how strong these correlations are, but they would seem to suggest that sugar is associated with higher levels of activity, while higher fat consumption is associated with the opposite. This fits my personal experience. I’m more likely to want to exercise after a “light” meal that includes some sweet stuff, while I tend to get drowsy after a pizza.

  19. I avoided sugar for many years and then topped that off with low, then no carbs for years more. all of which left me with high blood sugar (120s fasting). It took ages to correct but after adding back carbs it normalized in the 80s. Lots of carbs I might add, largely sugar. Explain that, low carbers!

    • They can’t explain that Sue. And because, in their view, what I have been explaining for years and what you just described is literally an impossibility. So they really think I’m pulling their leg with this stuff and just trying to clamor for attention. They also think I’m endangering people with posts like this. They have the wrong idea about me for sure.

  20. my brother is on team type 1 (a world class diabetic cycling team). there is an associated team type 2. once i saw them standing side-by-side at a race. the body types were SO different. and even though they both train an awful lot, and i’m sure take very good care to try to nourish themselves (hard with the crap put out by media)–team type 1 is lean while team type 2 still have guts. interesting that every guy/gal who joins the team isn’t cured right off it by exercise, isn’t it?

  21. Matt,

    I know some people who have Type 2 Beetus and alomostyall of them have metioned to me that when they were initially diagnosed, their Doctors told them to go on a Low-fat diet. Is this because some MD’s are aware of fat being causative in the development in diabetes? Is this due to a discovery made in the early ’60s known as the “Randle Cycle”?

    As a side note: Since Iam what doctors would consider to be Morbidly Obese, should I go on a low fat diet since I would be at risk of developing diabetes die to obesity? I have been “experimenting” with my diet lately to make it more like a McDougall style diet but with a little “Peaty” in it.

    • The McDougall diet has worked for a lot of people, but it’s extremely difficult because it’s so restrictive. Personally, I think a McDougall base (meaning starch) can be excellent as a foundation for a healthy diet, but it’s a lot easier and more sustainable if you allow a little fat, protein, and sugar. The protein would also protect you from the muscle wasting that seems common in vegans.

      The research I have seen on diabetes suggests that a low fat diet is indicated, but it doesn’t need to be as drastically low fat as McDougall’s. McDougall plus a bit of dairy might work pretty well.

      • Thanks David. Actually my diet the past week has been more like McDougall with low fat Dairy. Yeah, I think he goes to extremes with his Vegan anti-sat fat, anti-animal protein views which is a shame because I think if he allowed some added coconut oil or dairy fat and maybe some shrimps or oysters with his potatoes/rice/sprouted bread centric diet would be a fantastic eating plan.

        • I couldn’t agree more. I respect the basics of McDougall’s philosophy, and I think he’s been been one of the strongest advocates over the last several decades for starch-based diets–and there’s no doubt in my mind that a starch-based diet is THE diet that humans are most biologically adapted to. I’m interested in ancient history, and starch has been the basis of civilization for as long as we’ve had records–with only minor exceptions that account for less than 1% of the population. Unfortunately, McDougall ignores that all these civilizations also supplemented their diets with animal products. With just a bit of meat or dairy added daily, the McDougall diet changes from extreme to just about perfect, in my opinion.

        • By the way, I also like that McDougall isn’t totally against refined starches. I think he’s gotten stricter lately, but in the early days he accepted that white rice was perfectly fine, if a person didn’t like brown rice or wouldn’t eat it for cultural reasons.

  22. Me reading 180Degree Health blog post: Confusion.
    Me reading comments on 180Degree Health blog post: Confusion squared.
    Me eating lunch afterwards: Fuck it. Gonna keep eating whatever.

  23. Low carbing will definitely control your blood sugar. You can control your hyperglycemia with low-carbing. However, if could stil become diabetic on a low-carb diet. If you’re already diabetic, VLCing and going on a hare-brained ketogenic diet a la Dr. Bernstein will worsen your health. Some of the Bernstein drones you’re seeing above are completely missing the boat. You could have triglycerides under 50, and an HbA1c of 4.5. But that doesn’t necessarily mean you’re healthy. You may have excellent lipids, liver enzymes, BG markers, but serious problems may have kickstarted due exactly to low-carbing.

    You’ll never know because when you develop an immune deficiency, if the autoimmune process gets kickstarted, if you develop gut dysbiosis or your hormones are either skyrocketing or plateauing … you won’t feel a thing. The long-term side-effects of VLCing are latent and asymptomatic. So you may not feel it until 2-5 years down the road. This is why so many people are hoodwinked by their stellar lipids and BG markers. They think that’s all there is to health: Health = Lipids + BG Control + BMI

    What I am seeing is that most VLC/ketogenic crowds are developing immune dysfunction and hormonal dysregulation. Immune dysfunction usually appear as an immunodeficiency or autoimmune pathogenesis. Hormonal dysregulation shows up as low T3/Ft3, high cortisol, low leptin, low T/FT and others. Dr. Bernstein admits during his telecasts that 100% of his patients have autoimmune diseases, 90% are hypoghyroid, 80% have Raynauds (cold fingers and toes), and get this … 33% have a severe form of immune deficiency called common variable immunodeficiency. He attributes this to diabetes but deep down, he knows that this was caused by severe carb restriction; I know this because he becomes defensive and uncomfortable when confronted by ketosis. ealth crisis emerging and I know this will become an issue and a scandal for anyone associated with the low-carb movement.

    ean you’re really healthy. Why? Because

  24. If there ever was a clean sample of people who stuck to a VLC diet for duration, it would be Dr. Bernstein’s patients, who are on 30 grams of carbs per day. That’s total, not net, carbs. That would push you into ketosis if you’re reasonably active and weigh more than 150 lbs. and you eat protein ad libitum. In the past, I used to defend VLCing in the name of blood sugar control. But it now appears that VLCing is not safe even for diabetics.

    Diabetics and their health would be better served on a moderate carb diet that steers clear of ketosis, one that is infused with safe starches a la PHD. BG control may suffer a little but you will not compromise your immune function or hormones. Some of these low-carb doctors who are Johnny-Come-Latelies to the low-carb movement will be completely discredited. I’m talking about guys like Perlmutter, Feynman, Attia, Volek and Phinney, Westman, et al.

    Some of them don’t even know that low-carbing has a severe leukopenic effect. For some, this may be healthy. But we’re seeing some of these peoples’ WBCs falling under 3.0, immediately upon low-carbing, triggering lymphocytopenia or neutropenia. I have no doubt that these hematologic effects are caused by an immune deficiency, which also leads to, or is caused by, autoimmunity. And the anecdotal accounts of those who became ANA positive or TPO/TG positive after low-carbing are beginning to mount. Wait until Dr. Oz or the vegetarians get a hold of this. The low-carbers should feel lucky that they’re still under the radar.

    • Wow, had not heard about there being an auto-immune connection but it does make sense. I assume you’re referring to the good folks over at diabetes update who claim that low carbing cures their diabetes and then they all end up on insulin anyway. It’s interesting that very low carbers are having auto-immune issues because something I’ve really started to see in the alternative thyroid community, many of whom may or may not have hashimoto’s or gluten intolerance, is a push toward no starch, no sugar, no dairy diets, claiming that severe carb restriction reverses or prevents further autoimmunity or that potato starch is a nutritionally empty brain rotting poison. Usually they start with gluten and when that doesn’t solve all their problems they start down the path of dietary restriction, elimination diets, food allergy tests, and finally very low carb, or maybe they get diagnosed with candida, they read Grain Brain or Wheat Belly or Dr. Karrazian, and suddenly they’re convinced that having one’s blood sugar spike to 110 after a meal will give them Alzheimers. Similar trends are also occurring in M.S. circles, all the while many paleo adherents have jumped ship or changed their tune all together after suffering the metabolic destruction brought on by vlc. Obviously these are internet trends that show up on message boards and in self published tomes, and as you say are under the radar of mainstream endocrinologist, although a lot of them are big fans of Lustig, who seams to be gaining traction and funding. I can’t help but wonder if low low carb will make there immune problems food allergy worse in the long run because of the same leukopenic effect you’re seeing, where? on message boards, personal experience or are their studies showing such changes.

  25. It’s sad if you read posts from these diabetic forums. These Bernstein drones have taken over all diabetic forums and try to dominate all discussion on BG control. But when they end up with an autoimmune condition, they think they’re better off becauase, well, at least my BG is under control. I’m not losing an eye. I’m not losing my foot. My kidneys are not compromised. But they don’t get this autoimmune/immune deficiency/hormone connection. They almost have this Panglossian attitude toward low-carbing: I have Lupus, RA, and Hashimoto’s but at least I don’t have diabetic complications! So I’m better off! That VLC diet courtesy of Dr. Bernstein you undertook may well have kickstarted autoimmune pathogenesis, pal. They also don’t know that dry, snake-like skin, gut dysbiosis, dry eyes, constant anemia-like symptoms, eczema/psoriases, being frigid, and the rabbit droppings they’re emitting as BM are side effects of eating not enough carbs. They tell those who’re having problems, “You’re not keto-adapted yet.” It’s false hypoglycemia! Really, false hypoglycemia for 3 years?

    It’s such a sad story, if you think about it. We have a good and well-meaning doc in his 80s who thought that limiting carbs is a solution for BG control. He’s invested all his life to it. And we have his simpleton followers who’re brainwashed into thinking that all carbs are bad. They’re totally convinced that Health = HbA1C @4.5 and FBG=83 = Excellent Health, No Questions Asked. Some of these people have trigs under 30 and they’re high-fiving each other in forums. You know that cholesterol serves an immune function and when your trigs fall that low, you will compromise your immunity. Jimmy Moore keeps telling everyone that the lower the trigs, the better. He’s never heard of the J curve.

    The VLC/ketogenic enclave is still obscure and small enough that it could escape mainstream scrutiny indefintely. But what these morons have wrought cannot be measured in terms of human suffering. It’s not just autoimmune issues. These guys all have cold fingers and toes — Raynauds, which is suspected of being autoimmune. All are either euthyroid or subclinically hypothyroid. Many have low WBCs. Some into the 2s; they get infections easily and are constantly sniffling around with sinusitis or bronchila infections. Flu shots won’t help them. Some of them have to have globs of immunoglobulins injected to fight infections on a monthly basis. Guess who has this done every few weeks.

    Yet being righteous and indignant, they’re mad at their endos who won’t approve of their ketogenic diet! The whole mess of a story will probably have to come out posthumously after their cult leader passes. But it’s a mess of a story.

    • Damn, I just find this so fascinating, thanks for the response. This sounds so much like many of the hypo forums, where these “Stop the Thyroid Madness” drones encourage people to take unnecessarily high doses of desiccated thyroid ( a drug that just ain’t right for everyone) and when these poor fools start suffering from really obvious symptoms of hyperthyroidism, they’re told that that their intolerant to the t4 in the aurmor or that, they have adrenal fatigue( a well documented long term consequence of hyperthyroidism) or that they need to be on t3 only in these huge non physiological doses, that no healthy human thyroid actually makes, and they end up on prednisone because their adrenals tank, anti-anxiety drugs, their hair falls out etc. But suggest that a person lower their dose or god forbid try some regular old t4 drugs and you get flamed with vitriol. Granted mainstream treatment solutions for many of these long term chronic conditions are often seriously wanting, but the alternative web movements that supposedly champions better care are run by reactionary radicals who haven’t really been on their new treatment plan long enough to have suffered the consequences of their experimental protocol, while feckless ideologue doctors and “patient advocates” advance their own financial and ego interests with new books, web sites and supplement sales; moderate reforms are seen as concessions to big pharma or to some other medical society and when traditionally trained docs see the consequences of all this holistic handy work from the interwebs they become even less likely to explore small changes that may help many of their patients.

        • Yeah, I remember seeing that, and thinking I’m gonna try this overfeeding thing, unfortunately it made just as sick as being on desiccated thyroid did, plus panic attacks, which I had not experienced on desiccated. Otherwise I felt extremely hyperthyroid. When I finally went to a Dr. I had clinically hypothyroid labs, I was sporting a 99. 4 temp, had a heart rate of 110; Yeah, overeating messed me up really bad, (Dude I was sleeping like 2 hours a night, shaking and crying, I literally felt like I was going to die). I guess I could have contacted you but at that point I was having like 20 or 30 svt episodes an hour with my heart rate spiking up to 160, I wanted someone to tell me that I wasn’t going to die, and sorry but I wasn’t gonna pay you to tell me to see a Dr. over the phone. Of course I had to go back on thyroid but it wasn’t no magic bullet, doctors have very little training in thyroid issues and No training in whatever the 3 months of eating beyond beyonds does to a person whose body is incapable of meeting the challenge of that many calories. It’s taken me over a year and a half to reach a point of relative homeostasis; I saw over half a dozen incompetent physicians right left and center, had to take a leave of absence from my job, I was popping benzos just to sleep an hour, at one point I started sleeping in my mothers bed, OK no not sleeping sobbing in misery, and she had no way of helping. My body was physiologically living in a war zone, seriously a sabbatical in Afghanistan would have been more relaxing. So, yeah you’ll be proud to know that you didn’t do me any favors either, although some of the things you have to say are right on the money, and I can say that I dodged a few bullets thanks to some of your musings about “adrenal fatigue,” so I’m not really as angry as I sound,(anger leads to hate and hate leads to suffering), I just think that your understanding of thyroid metabolism is um.. immature… “You must unlearn what you have learned.” There’s just a whole nother layer of complexity that I basically had to learn about the hard way, but I’m a whole lot better then I was in fact most of the low metabolism complaints that drove into the rabbit whole of internet healthdom have vanished thanks to just a tiny dose of thyroid med and sensible eating habits. That said I’m not out of the dark yet, I’m still sporting a weirdly high tsh which by the way promotes the excess conversion of t4 to t3 (funny Ray Ray never talks about that one) so I still have episodes of relative discomfort and anxiety, and the change of seasons has thrown me a bit too so my dosage may change, but almost all better. So, where I was going with this? Guess I’m just saying, don’t get too smug buddy, you have much to learn.

          • Sure. And there are always exceptions and circumstances that go beyond the norm. You are the just the 2nd person in many years who has reported signs of hyperthyroidism that severe. When I write I can’t divulge into every possible exception or scenario. It has to be written for a general audience, and when I write to large groups of strangers I speak in terms of what is most probable. When I speak to real people on the phone they often get opposite recommendations from my general guidelines, as I’m sure you would have gotten. Are your TPO counts high? Sounds like they could be.

          • You know what, I’ve been meaning to get in touch a long time, but I wanted to have a handle on what was actually happening and why before doing so. I mean that I think my case is actually instructive, I mean to those who want to learn something, but then maybe I’m guilty of universalizing my experience.
            That said I really wasn’t planing on going postal with my experiences right here on an unrelated comment thread. I know, not too classy on my part, but when I saw your comment I and reread that “Jamie” post it really chapped my ass. Did you even reread that post? That was 2010, do you even know the person that wrote that? I doubt that you really believe that things are so simple now. This is why I’m glad I don’t have a blog, I don’t have to answer to the embarrassing specter of a past self that thought they knew it all.
            So I’ll tell you what, when I get around to it, I’ll send off a lengthy explanation of what was really happening, or at least what the available tests actually showed (it was/is not autoimmune) and I’ll learn you some thyroid physiology at the same time. No, forget it, I’ll send it off to Rob, he seems like a nice guy, and he can decide weather I have a unique case or weather there’s something that may shed some light on more general metabolic problems, if he deems it valuable he can forward it to you.

          • Mehh… whether

          • Oh yeah, my “I know everything” dickishness has been dramatically bred out since 2010. I’m happy to look back and see how much I’ve progressed, although it is embarrassing and Janie will forever think of me as an ass for writing that. Would love to hear your thoughts about your situation. I too have been through phases where I had overdone the metabolism thing and had trouble sleeping and was too hot with twitchy legs and had to reel things back in with a higher fluid intake and less salt. So I’m definitely not oblivious to the other side of the spectrum either.

    • Oh, one more thing, low carb has become wildly popular with the auto-imune crowd, I’m referring to diets like this http://www.terrywahls.com/the-wahls-protocol , and probably at least a dozen other diet paleo auto-immune books that show up in my in-box from Amazon. Are you suggesting that such a diet may make things even worse for such followers?

      • Christal, Dr. Wahl is more sensible than your typical low-carb advocates, who are one-trick ponies. Her diet consists of colorful vegetables and antioxidants. Her mantra is “nutrient density,” which is fine if you’re focusing on foods like kale and grass-fed cow liver. But you don’t need everything you eat to be nutrient dense. You would only be eating egg yolks and spinach, if that was your goal; you still need a fairly steady and uncontaminated source of glucose, i.e., starches, which aren’t typically nutrient dense. But she’s not comfortable with starches. She allows some blueberries in and that’s about it.

        She does not understand the long-term impact of her diet: it is not just lipids, weight loss and BG control. That’s not all there is to health. There are such things as hormones, the adaptive immune system, CBCs, gut flora, the microbiome, which are all interconnected. The so called clinical trial for autoimmune patients that she’s asking for support is tailored to MS and neurological conditions that benefit from extreme diets like ketosis. Perlmutter is cut from the same cloth and hopped on the same bandwagon thinking there can’t be anything wrong with cutting carbs with impunity.

        Wahls has designed her trial after prior rodent and epilepsy studies where they reduced seizures and neurological complications. Studies like hers were done before. Who’ll argue that low-carbing won’t straighten out lipids and BG for most people?

        But there’s more to health than that. And the ill effects of a VLC diet creep up unawares and are longer-term rather than the short-term measured in clinical trials. And autoimmune diseases tend to come in clusters. How will she test if one has piggybacked on another? You’ll need to test for hundreds of antibodies and that would be unwieldy. How will she test for incipient immune dysregulation and deficiency: she’ll need T cell subclasses, immunoglobulins, complements, secretory IgA, etc. You need to be a specialist; immunology is not really an area that’s the purview of these low-carb intellectuals, if you wanna call them that. Most barely know what an ANA is.

        You need to test for and interpret general and specific antibodies for those diseases that are proximate to the autoimmune conditions afflicting your subjects. You also need hormonal biomarkers (T3/T4/FT3/Rt3/IGF-1/cortisol/T/FT/leptin) which may portend dysregulation. But you know that these things move glacially and stealthily. So she’ll probably declare victory and say that her subjects lowered their “inflammation.”

        That’s easy to do. And the layfolks will be hoodwinked by the results. Amazing lipids and A1c. What do I have to lose? They won’t have a foggiest idea that an extreme diet like that turn against you eventually and deliver a comeuppance. As I said in another post regarding Wahls, it’s like taking out your car’s exhaust system to maximize engine performance. Your car might accelerate quicker but you’ll be done in by carbon monoxide poisoning.

        Here’s the problem: there are at least 4-5 pathways that a VLC diet will culminate in autoimmunity and immune deficiency: (1) triglyceridemia; (2) low leptin and T lymphocyte dysfunction via thymus; (3) secretory IgA deficiency which leads to intestinal permeability (this is basically the mucin deficiency that Jaminet talks about in his glucose deficiency series); (4) selective immune deficiency and CVID that develop upon ketosis and leukopenia; (5) the gut dysbiosis resulting from microbiome evisceration through carb restriction (many low-carbers become bunny rabbits after being in ketosis for a year, when their stool becomes Bristol Chart Type 1 which is hard to pass) – the microbiome-immune connection is just emerging and is reviving the infection pathogenesis theory of autoimmunity once again.

        • Hey Ketosis- tried to reach you but your email address wasn’t working. Would you send me an email: rob at 180degreehealth dot com. Would love to be in touch with you.

          • Perhaps Ketosis Halitosis is a double agent.

  26. Don’t know if anyone will get back to the bottom of this thread, but I find this article fascinating.

    My mom family is plagued with Type 2. Her mother and AFAIK all her mother’s siblings had Type 2. My mom has Type 2 and so do her surviving 2 sisters. Her other sister had MS.

    I had WLS in part to try and avoid diabetes as I’ve always been overweight/obese, have PCOS, and obviously a big family history for the disease. I had VSG because it is less extreme, doesn’t require as much supplementation, and seems likely to have less chance of negative effects long term. I seriously considered have Duoedenal Switch because it has something like a 99% cure rate for Type 2. DS has a malabsorbtion component.

    What does the DS stop you from absorbing? Fat, protein, vitamins, and minerals are not absorbed as well. It does not stop the body from absorbing carbs and sugar. It does usually create some bowel discomfort when large amounts of carbs are consumed, but you do still absorb the carbs.

  27. Interesting info…about a week ago I met with a Naturopath and one thing she wanted me to work on was controlling my blood sugar by reducing sugar and carbs. So I eliminated sugar and limited my grains to one slice of bread per day. With each passing day my energy levels have been going down and I can barely make it through the day. Finally yesterday I said screw it…let me get back to my typical diet and let’s see what happens. Sugar in my coffee, Friday night pizza. I’ve unloaded the kids on their dad and I”m doing nothing but resting for the day…curious to see how my body responds. Prior to the restricted diet I had some unusual stomach problem which ended up with my body reducing it’s food intake…so I think this in combination with no sugar and grains has me out of sorts. Also a nugget to pass on that doesn’t seem to be well discussed. Heavy metal toxicity, specifically mercury, may be correlated with high blood sugar. Something about the mercury blocking the receptor sites (i’ve had a mouth full of amalgams most of my life).

  28. I think this post is a bit misleading. It’s important to distinguish between sugar consumption and carbohydrate consumption in general. For one thing, sugar (unlike starch) is 50% fructose. Even moderate consumption of fructose can cause hepatic insulin resistance in humans and has been shown to increase circulating free fatty acids – http://www.ncbi.nlm.nih.gov/pubmed/22933433
    Increasing circulating free fatty acids in humans appears to induce insulin resistance –
    while reducing circulating free fatty acids restores insulin sensitivity in obese and diabetic subjects – http://www.ncbi.nlm.nih.gov/pubmed/10480616

    Insulin resistance has also been associated with fructose consumption in adolscents – http://www.ncbi.nlm.nih.gov/pubmed/22190023

    Fructose overfeeding (but not glucose overfeeding) can induce insulin resistance in humans in as little as a week, albeit that is an unnaturally high intake of fructose – http://www.ncbi.nlm.nih.gov/pubmed/6986758

    Fructose (but not glucose) exacerbates insulin sensitivity in overweight/obese humans – http://www.ncbi.nlm.nih.gov/pubmed/19381015

    It’s also important to note that added sugars increase caloric intake via their effects on food reward / palatability. Cellular calorie overload induces cellular insulin resistance – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2764908/
    and excess calorie consumption contributes to obesity and type 2 diabetes – http://www.ncbi.nlm.nih.gov/pubmed/20547978

    Since added sugars promote overeating, and since both overeating and fructose overfeeding can induce metabolic syndrome, I think it’s quite likely that the huge intake of sugar in the standard western diet is contributing to the pathogenesis of type 2 diabetes.

    • I have reviewed this research extensively and preached the anti-fructose gospel for many years, pointing out some of the exact things that you did in your comment in my book on diabetes (since unpublished because I had overlooked many counterpoints and alternate contexts to the references above).


      But I later changed my perspective, especially once I began seeing so many people (myself included) derive an almost medicinal effect from adding fructose, and sometimes fructose in particularly large quantities, back into their diets.

      As for your beliefs, I think you would find in real-world experimentation, that increasing the fructose intake of Americans (especially in the form of fruit), and decreasing the intake of everything else, would decrease the development of type 2 diabetes and obesity. It also would greatly reduce the food/reward palatability of the food, which is really a relative term. Saying that maple syrup, for example, is more palatable than a bacon cheeseburger is false as there are dozens of factors involved in food reward, the greatest of which is calorie density (but even that, in isolation, isn’t true as Coca Cola is a lot more palatable than maple syrup and a lot less calorie dense).

      • I agree with you on those points matt. In the context of whole foods fructose doesn’t appear to be harmful, both fruit and honey have contradictory effects to refined sugar in the studies I’ve read. That’s why I was careful to refer to it as ‘added sugars’ and not sugary foods. Nonetheless, most people will interpret your post to mean that they can eat as much refined sugar as they like and have no effect on their risk of diabetes.


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