Benjamin Franklin famously wrote “Nothing is certain except death and taxes.” In today’s world, one might be tempted to add the progression of type 2 diabetes to that list. Adding diabetes to Franklin’s list would be ironic, since in his time, the disease was largely unknown. It was occasionally discussed in medical texts, but rarely seen in clinics or ‘on the street.’1
However, recent diabetes epidemiology data provides fairly strong support of diabetes progression as unavoidable. Diabetes prevalence has tripled in the last 20 years, and increased eight-fold since 1960.2 Indeed, a variety of medical authorities characterize the disease as chronic and progressive,3 emoting a sense of inevitability to its worsening. One can even find predictions of diabetes progression timelines, suggesting for example that eye damage occurs by 10 years after disease incidence.4
But is diabetes progression really inevitable, either at an individual or population level? The answer to that question is, in reality, a resounding no. The key is blood sugar control, but ironically not in the way that the American Diabetes Association (ADA) espouses.
The ADA promotes ‘good control’ for individuals living with type 2 diabetes as an HbA1c of 7.0% or less, with postprandial blood glucose concentrations of less than 180 mg/dL.5 This is actually sub-par control at best, when one considers that non-diabetic individuals have HbA1c’s below 5.7%, the pre-diabetic threshold. And although achieving truly normal HbA1c scores is challenging for individuals with diabetes, it is possible if a low-carbohydrate diet is followed. Indeed, people who eat a lower-carbohydrate diet can keep even their post-meal sugar below the 140 mg/dl level, where blood vessel damage is believed to start.6
So, two changes in society’s approach are needed. First, we need an adjustment in our perception of what success looks like when it comes to blood sugar control. The problem here may be, in part, one of terminology. Many endocrinologists follow the ADA to suggest that while 7.0% is a “good” HbA1c reading, a lower reading is “excellent.” But if HbA1c’s of 6.0% are both better and achievable, why do we lead individuals with type 2 diabetes, especially those with meaningful remaining potential for insulin sensitivity, to believe that they are doing even a “good” job with HbA1c’s of 7.0%? Given the right information and tools for improving health, I believe that patients will rise to the challenge.
The second change required to challenge the inevitability of type 2 diabetes progression is broader and deeper adoption of low-carbohydrate nutrition. Although I am a big believer that correlation is not causation, it is difficult to imagine that the growth of diabetes from Franklin’s time to today is not driven, at least in part, by sugar consumption. Indeed, in 1776, Americans ate about 4 lbs of sugar annually, whereas in 1994 that figure was 120 lbs!7
The challenge to proliferation of low-carbohydrate nutrition is providing patients with appropriate education – and technology-driven behavioral nudges over time – to eat ‘low carb.’ This of course is where Virta comes in, as the first online diabetes reversal clinic. Virta provides full-service metabolic medical care to its patients, and has world-class expertise in helping its patients achieve sustainable and satisfying low-carb eating habits. A key part of Virta’s approach involves promotion of fat-based macronutrient calories as a substitute for carbohydrates, which is both satisfying as well as supportive of the proven biochemical strategy of nutritional ketosis. Virta’s clinical trial results show that low-carb is both possible and incredibly beneficial for individuals living with type 2 diabetes, having demonstrated diabetes reversal in 56% in just 10 weeks.
I like to think that if Franklin were alive today, he would see through the myth of diabetes’ inexorability. After all, in addition to opining on death and taxes, he is also famous for saying that “An investment in knowledge pays the best interest.”
1. The Case Against Sugar
2. Long-term Trends in Diabetes
3. Type 2 diabetes is a progressive disease
4. Stanford University Virtual Labs: Diabetes Module
5. American Diabetes Association: Tight Diabetes Control
6. Diabetes Self-Management: “Reversing” Type 2 Diabetes
7. Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?