25 Things I Want My Patients to Know About Diabetes

  1. Diabetes = carbohydrate intolerance

Type 2 Diabetes is a metabolic disorder characterized by carbohydrate intolerance, in that your body does not process carbohydrates properly, and thus eating carbohydrates results in excess glucose in your blood (i.e. hyperglycemia).

Normal fasting glucose (i.e. when you wake up after not eating all night) is 70 – 100.  Diabetes is defined as a fasting glucose of 126 or greater, or a glucose over 200 with characteristic symptoms (excess thirst and urination).  In a normal state, your glucose should never go above 140, even after a meal rich in carbohydrates/sugar.

Unfortunately, diabetes is a potentially deadly disease, but it is also potentially reversible, even without medication.

Diabetes causes damage to every cell in your body; the higher and longer your glucose is elevated, the more complications will result.  Complications include heart attack, stroke, blindness, kidney failure, nerve damage, and gangrenous infections or vascular disease that requires limb amputation.

Hyperglycemia (high glucose) is associated with increased death and disability.  In addition, if you are hospitalized, hyperglycemia is associated with a prolonged hospital stay.

  1. Eating a low-carbohydrate, high-fat (LCHF) diet can reverse diabetes

Just as a person with lactose- or gluten-intolerance should not eat lactose or gluten, a person with carbohydrate intolerance (e.g. diabetes) should not eat carbohydrates.  Since dietary carbohydrate intake is the main dietary determinant of your blood glucose, restricting the amount of carbohydrates in your diet is effective at decreasing glucose levels and thus preventing these complications in the long-term.

  1. All carbohydrates are composed of sugar

There are 3 main macronutrients – fat, protein, and carbohydrates.  Carbohydrates are the sugars, starches, and fiber that are commonly found in produce, grains, and milk products.  Common foods that are high in carbohydrates are bread, pasta, rice, potatoes, pancakes/waffles, fruit, flour-containing products, sugar-containing products, etc.

All carbohydrates in your diet break down into sugar, primarily glucose.  There may be some fiber, such as in vegetables, fruits, and whole grains, that does not get absorbed and thus does not affect bloods glucose.  Despite their fiber content, however, whole-grain bread and cereals still contain large amounts of carbohydrates that turn into sugar.  The fiber content may slow down the absorption of sugar to a small degree, and thus whole-grain products are only marginally better than their white counterparts.

  1. There is no need for carbohydrates in our diet

Though are bodies have an absolute requirement for dietary fats and proteins (to provide essential fatty acids and essential amino acids – things that our bodies cannot produce on their own), there is absolutely NO physiologic requirement for carbohydrates in your diet.  (i.e. there is no such thing as an essential sugar/carbohydrate).

  • “The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are available.” – Institute of Medicine, Dietary Reference Intakes, 2008.

Many cultures have survived (and thrived!) on diets consisting of no carbohydrates, for example, the Inuit traditionally eat whale meat and blubber (protein and fat) while living in areas devoid of all vegetation.

Our bodies are incredibly versatile at using various fuel sources for energy – if glucose is available, it’s preferentially used for energy.  If, however, there is not a steady supply of glucose, our bodies transition to ketosis, a harmless physiologic state whereby fat (stored energy) is broken down into ketones that can be used as fuel. Nearly every part of our bodies is remarkably efficient at using ketones for fuel.  For the small portion of metabolism that is dependent on glucose only for fuel, we are able to convert proteins into glucose via a process known as gluconeogenesis.

  1. Eating fat can be healthy

Dietary fat is a perfectly normal part of a human diet, and fat intake has never been shown to cause cardiovascular disease or diabetes – whether saturated fat or unsaturated fat.

Despite what you’ve been taught the past 40 years, it’s okay (and probably best) to eat fat.  Your ancestors certainly didn’t worry about fat intake, and they did not suffer from cardiovascular disease or diabetes, diseases that have become epidemic since the US government started warning the public against fat intake.

It’s a complicated story about how fat became inappropriately demonized by the 1977 US Dietary Guidelines based on a committee headed by a vegan politician.  For those interested, I encourage reading The Big Fat Surprise by Nina Teicholz for a thorough analysis of nutritional research and the follies of the anti-fat campaign.

Despite the warning by the Dietary Guidelines, there is no good scientific evidence that fat intake causes cardiovascular disease.  In fact, the Women’s Health Initiative study included a study arm looking at the effects of a low-fat diet that showed no reduction in rates of cardiovascular disease or stroke for those following a low-fat diet over an 8-year period.

Two caveats about fat intake:

  • High fat intake is likely harmful in the setting of high carbohydrate intake. It is important to eat low-carb when eating high-fat.
  • Avoid all artificial trans fats – hydrogenated vegetable oils – which are highly processed and toxic – one of the few things in nutrition that everyone agrees about.
  1. Calories In/Calories Out does not fully explain weight gain/weight loss

Because fat contains more calories per gram (9) than carbohydrates or protein (4), the traditional teaching has been to eat low-fat in order to lose weight.

For decades, we have blindly accepted the notion that our weight is simply a function of the difference between Calories In and Calories Out.  If that were the case, however, someone eating at a calorie deficit over many years would eventually vanish into nothing!  Thus, it’s easy to recognize that it’s much more complicated than how many calories are in the food we eat and how many calories we burn.

It is clear that one needs an excess of calories in order to gain weight.  If you’re not eating enough energy to fuel your basal metabolism, your body won’t have adequate material to store any excess energy as fat or produce lean tissue.

However, an excess of calories does not necessarily cause fat accumulation/weight gain.  Fat storage is driven by insulin, and insulin levels are most responsive to carbohydrate intake.  Therefore, as demonstrated in many scientific studies, many people are able to lose weight while eating a low-carbohydrate diet without a caloric restriction.

  1. Metabolic Syndrome – all symptoms of the same disease process.

The metabolic syndrome is a set of 5 risk factors for cardiovascular disease – large waistline (obesity), high glucose (diabetes), high blood pressure (hypertension), low HDL cholesterol, and high triglycerides.

Each of these conditions is caused by excess carbohydrate intake and is characterized by insulin resistance.

Furthermore, a low-carbohydrate diet improves all markers of the metabolic syndrome. [Another reference demonstrating the same]

  1. Insulin Resistance – the key to understanding diabetes and obesity

Simply put, when your glucose level is high, your insulin levels increase.  Insulin is the signaling hormone that lowers the level of glucose in the blood by directing excess glucose into the tissues of the body, e.g. muscle, liver.  Insulin is produced by the pancreas and released in response to elevated levels of glucose.

When excess glucose is directed into these other tissues, it is stored as fat, and thus insulin causes fat accumulation.   Insulin is also a signal to stop utilizing fat as energy (because now there’s plenty of glucose in the blood available for energy).  Thus, insulin turns off fat-burning and turns on fat storage.

If your muscles are sedentary and not utilizing the glucose that is already stored in them, they will eventually become ‘resistant’ to the insulin signal, thereby leaving excess glucose in the blood.  In a persistent effort to lower the glucose level in the blood, however, the pancreas then responds by secreting more and more insulin to produce a stronger signal to the body’s tissues (muscle, liver, etc.) to take up more glucose.

This process of increasing insulin resistance is akin to developing tolerance to a drug, needing more and more of the drug on subsequent exposures to match the original effect – to get the same “high”.  The hallmark process that causes diabetes (type 2) is insulin resistance.  Insulin resistance is also the predominant mechanism of obesity and the other markers of the metabolic syndrome.

  1. Using insulin to treat diabetes actually worsens your diabetes.

The fundamental problem causing diabetes is insulin resistance, which is characterized by high insulin levels produced by the pancreas that is desperately trying to lower the elevated glucose levels in the blood.  Though administering insulin may lower glucose in the short-term, it will likely increase your insulin resistance and thus worsen your diabetes in the long run.  Some oral medications, specifically sulfonylureas (e.g. glipizide, glyburide, gimepiride), have an insulin-like effect and thus have the same problem.

Giving insulin to a diabetic is equivalent to giving IV fluids to someone who is already fluid overloaded, as in congestive heart failure.  More of the offending agent will only make the problem worse.

The logical approach to fixing fluid overload is to prevent excess fluid accumulation.  Similarly, in insulin overload (diabetes), the equivalent solution is to prevent high levels of insulin.  In the absence of carbohydrate consumption, blood insulin levels decrease, thereby creating a more favorable physiologic condition.

It is preferable to manage hyperglycemia with diet rather than insulin.

  1. The current standards of care for diabetes are tainted by politics and do not reflect good science

It is quite unfortunate that a low-carb diet is not presented as a safe and effective option for managing (and even reversing) diabetes.

Unfortunately, the reasons for this failure are quite complicated but may well come down to:

“Follow the money.”

Nutritional guidelines are unfortunately heavily influenced by “Big Food” – the manufacturers whose products line the shelves of grocery stores and are full of substances that make you crave more highly processed food and are associated with obesity, such as ‘high fructose corn syrup’.  These kinds of subsidized “foods” are relatively cheap due to government subsidies for corn production – a situation that does more harm than good.

Any carbohydrate you eat breaks down into glucose and raises your blood glucose levels.  Thus, it makes no sense that the ADA (American Diabetes Association) advocates high carbohydrate intake (over 200 grams of carbohydrates per day – ~60 gram of carbohydrates per meal plus snacks) – unless they are actually in the business of ensuring that you will always have diabetes.  [The ADA accepts an extraordinary amount of financial support from companies that benefit from you being sick, i.e. pharmaceutical companies that want you to buy their insulin or other diabetes drugs, and companies like Coca-Cola and Dannon Light & Fit Yogurt who want you to buy their sugar-laden products.]

If your goal is to lower your glucose (which it should be), then carbohydrate restriction is imperative.  Do not trust the ADA to provide advice for managing diabetes.

  1. How to Reverse Diabetes

The fewer carbohydrates you eat, the lower your glucose, and thus the lower your insulin levels and better the control of your diabetes.

Despite what you have likely been told, diabetes is not necessarily a chronic, progressive disease.  If you keep eating a high-carbohydrate diet, it may well be.  If, however, you cut carbohydrates from your diet, you can decrease your dependence on diabetes medications and even put your diabetes into remission . . . if it’s not too late.  In some situations, diabetes may have progressed to the point that one will always require some medication for optimal control.  Still, carbohydrate restriction is beneficial by reducing the fluctuations of your glucose and reducing your need for medications.

A low-carbohydrate/high-fat (LCHF) diet is optimal for reducing hyperglycemia and thus decreasing your need for medications to artificially lower your glucose.  Fat intake should be at approximately 70% of your daily calorie intake, and your protein intake should remain at a moderate level, at about 20-30% of daily calories.  Carbohydrate intake should be at most 5-10% of daily calories, or less than 50 grams of carbs/day.

In addition to these dietary modifications, increasing physical activity is certainly beneficial, although the emphasis should be on correcting your diet first.

A word of caution: If you decrease your carbohydrate intake while taking medications for diabetes, you may be at risk of hypoglycemia (low blood glucose) which is potentially dangerous.  Talk with your physician about your plans in relation to your individual circumstances before making significant changes.  When in doubt, check your fingerstick glucose often, especially at the first sign of something unusual with your body.

  1. How to Lose Weight

Weight loss (fat loss) is relatively easy on a low-carb/high-fat (LCHF) diet.  Since insulin drives fat accumulation (and thus weight gain), your goal is to reduce your insulin levels as much as possible so that your body starts to burn fat as a fuel source.  As long as you are eating carbohydrates, however, your body will have a steady supply of glucose that will be preferentially used by your body as an energy source and your body won’t tap into your fat stores.

If you greatly restrict carbohydrate intake, your body will eventually be forced to mobilize fat as fuel.   This process can be expedited by burning your glucose stores with vigorous physical activity, but the 80-20 principle in this situation is that 80% of the results are obtained by diet modifications, whereas only 20% of the results are yielded by the greater effort of exercise.

  1. My 2 Commandments of Eating

Acquiring food for nourishment is a fundamental drive by all organisms.  However, what once was a relatively simple process of selecting whatever edible food was available nearby (e.g. Inuit eating seafood; forest-dwellers eating rabbits and deer, etc.) is now a profoundly complicated process in the modern-day world of mass-produced food.

The challenge is to select food that actually contributes to, rather than detracts from, health.

Healthy eating is as simple as these 2 principles:

  • Eat Real Food
  • Eat only when hungry

In nature, ‘real food’ is all there is.  Animals hunt and forage for food – what they find is what they get.  We humans, however, have lost touch with what food should be.  It’s ironic to note that the human race has developed in such complex and sophisticated ways over hundreds of thousands of years while fully subsisting on simple food sources available on earth, and now we are burdened with an epidemic of diseases associated with factory-produced products that we call “food”.  Our bodies and brains thrive on animal and plant products in their simplest forms, directly from the Earth.  The modern-day transition to processed foods, however, correlates closely to the advent of large-scale heart disease and obesity-related diseases such as diabetes.

As important as the quality of food is the quantity of food.  Why then, can one desire too much of a good thing? [Shakespeare]  Eating is pleasurable, but there needs to be a limit on our food intake.  Consider this problem in Nature: If a wild animal overeats, there is great risk, as it may be sluggish following a large meal or it will gain weight over time, placing it at a distinct disadvantage over other fitter individuals.  Since we no longer have to fight for our meals, we humans are now spoiled by a seemingly unlimited supply of food and have lost the appreciation of fitness inherent to the survival of our species.

An important corollary to my 2nd commandment of food stating that you should eat only when hungry is to stop eating when you are no longer hungry.  The Okinawans in Japan, known for the longest life expectancy in the world, abide to a concept they call Hara Hachi Bu.  This Confucian teaching is a rule that states simply to stop eating when their stomachs are 80% full.  Obviously, one cannot know when the stomach is 80% full, but that mindfulness of avoiding overindulgence is the important takeaway from this teaching.

  1. Real Food comes from animals and plants

Real food is simply the animal and plant products that can be obtained from the land that are readily available and digestible.  Real food is what Nature provides us – raw, unprocessed materials that are edible and safe for consumption in their natural states.  A helpful way to think of real food: If we lived in prehistoric times, what would we eat?  Real food has only one ingredient – itself.  Perhaps most important is that real food can be made by hand.  It does not require extensive milling, bleaching, purification, or fortification in order to make it edible, palatable, or nutritious.  It is a quality source of nutrition just as it is.  There is no packaging, no significant refining required to make it edible, and no chemicals added.

For example, butter is a real food.  It is derived from a single ingredient – cream.  In contrast, margarine is a highly-processed conglomeration of vegetable oil with emulsifiers, colorants, and other artificial ingredients.  Furthermore, in order to keep it solid at room temperature, margarine is hydrogenated, which produces the harmful trans fats.  Bottom line: Eat butter; don’t ever eat margarine.

Surround yourself with real food, and you won’t have the temptation to eat bad/fake food.  Real food is obtained from gardens, farms, local markets, etc.  Real food is also available at grocery stores, but you must pay attention to labels in order to ensure you are buying quality products.

Things to avoid: Processed food, food with multiple ingredients, food that came from a factory – unfortunately most of what you see in the grocery store.

  1. How to eat Real Food

What to eat: Eggs, meat, fish, full-fat dairy, cheese, vegetables, fruit

What not to eat: bread, pasta, anything with sugar, anything with flour

What about . . . ?

  • Fruit: small amounts – preferably seasonal and local. Recall that fruit contains fructose, a sugar, which will increase your blood sugar.  [See #23 for more]
  • Nuts: mostly okay, but beware of the carbohydrate content of some nuts, particularly cashews. Keep in mind, also, that nuts are an adornment to our meals, not a main course.
  • Rice: If you have diabetes, then no. If you don’t, keep it limited to a fairly small amount.  There is no benefit to eating brown rice over white rice.
  • Potatoes: Very limited, preferably only sweet potatoes/yams. If you have diabetes, you’re better off avoiding them entirely, but small amounts can be okay.
  • Yogurt: Beware . . . most yogurt is sweetened. Find a Greek yogurt with no added sugar.
  • Grains: The vast majority of so-called “whole grain” foods are still highly processed, and thus the proclaimed benefits of their fiber content are lost.  Flours are stripped of any nutritional value they originally had during the processing of the grains, so much so that they are “fortified” and “enriched” with vitamins and minerals in order to have any nutritional value. Grains increase blood glucose as much (and sometimes more) than pure sugar, thereby causing an insulin spike.

“Consumption of whole grains has not been associated with improved glycemic control in persons with diabetes; however, as for the general population, individuals with diabetes should consume at least half of all grains as whole grains.  Large prospective cohort studies, but not randomized controlled trials, report that consumption of whole grains is associated with a reduced incidence of type 2 diabetes.”

Diabetes Metab Syndr Obes. 2014; 7: 65–72. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938438/>

Other problems with grain consumption: 1) Wheat contains phytic acid, an antinutrient, that impairs the absorption of minerals such as iron and zinc.  2) A plant-based diet is devoid of vitamin B12, which can be obtained only from animal sources.

  1. Low-carb high-fat is similar to but not the Atkins Diet

Not quite, but close.  The Atkins Diet specified a low-carbohydrate diet with high protein and high fat.  The diet called for an induction phase with less than 20 gm carbs daily followed by reintroducing carbs slowly until they adversely affected one’s weight.

In contrast, I am simply advocating a ‘real food’ dietary approach as described in section 15.  By its very nature, it ends up being low-carb and high-fat, but protein intake should not change drastically from what you are accustomed to eating.  Typically, people eat about 20-25% of their daily calories from protein sources.  If you’re diabetic, you should swap out nearly all the carbs for fat sources and avoid reintroducing carbs as in the Atkins Diet.  Diabetes = carbohydrate intolerance.  Following a low-carb lifestyle indefinitely is perhaps the best thing you could do for your health if you have diabetes.

  1. Cholesterol

Your health is not defined by a single number.  You know better than that, and yet the medical establishment continues to emphasize total cholesterol as THE ONE TEST that defines you.  Unfortunately, the pharmaceutical companies that market their cholesterol-lowering drugs have played a huge role in perpetuating that myth, and yet studies now demonstrate that lower cholesterol is actually associated with higher rates of mortality.

Interpretation of cholesterol values is complicated.  Perhaps the only consistently supported notion is that higher HDL’s are good and higher triglycerides are bad.  LDL, however, the so-called “bad cholesterol”, is almost always a calculated value and not actually being measured.  What your doctor doesn’t tell you (or doesn’t know) is that the size of your LDL particles is far more important a predictor of cardiovascular disease than the calculated LDL number.

Small, dense LDL’s are likely to cause harm to the arteries (like little bullets that penetrate the artery walls), whereas big, fluffy LDL’s are harmless (picture big beach balls that bounce off the artery walls).  The standard Lipid Panel does not assess the size of these particles and thus is relatively meaningless.

An LCHF diet has favorable effects on all aspects of the lipid measurements: lower triglycerides, higher HDL, and a shift towards the big, fluffy LDL’s.  Conversely, a low-fat, high-carbohydrate diet has the opposite (unfavorable) effects on these values.

  1. Other factors affecting weight loss

The important goal, initially, is to reduce insulin resistance, the mechanism causing diabetes.  Weight loss should happen as a pleasant side effect of eating LCHF.  It does take time to overcome insulin resistance, the most likely barrier to initial weight loss.   There are a few other factors that may be impeding your weight loss, assuming you are truly eating LCHF and have been doing so for a reasonable period of time, i.e. at least 3-4 weeks consistently.  Probably the 2 most common barriers to weight loss are stress and inadequate sleep.  Granted, there is usually no easy fix for these factors, but efforts to improve sleep and stress are important not only for weight loss but also quality of life, in general.

If you still find it difficult to lose weight despite having all other factors dialed in, I recommend experimenting with intermittent fasting.  By waiting longer periods of time between meals, you allow your insulin levels to drop further and thus allow your body to further reduce insulin resistance and to tap into your fat stores for fuel when no other energy source is available.

  1. Nutritional Ketosis – ketones as the optimal fuel for your body

Most people, and everyone who is diabetic, are carbohydrate-adapted, meaning that your body is accustomed to using carbohydrates for energy.  Glucose is readily available for energy, and there is an abundant supply of glucose in the muscles known as glycogen.  When you restrict your carbohydrate intake, however, your body uses up its glycogen stores much sooner than normal and then must convert to utilizing fat as an energy source.  The process of breaking down fat for fuel produces ketones.

Our bodies run very efficiently on ketones; we are not dependent on glucose or carbohydrates for energy.  The vast majority (~80-90%) of our metabolic processes can be driven by ketones alone.  For the remaining processes that require glucose, our bodies are able to produce plenty of glucose by a process in the liver known as gluconeogenesis (gluco = glucose, neo = new, genesis = synthesis).

  1. Ketosis vs. Ketoacidosis

There is a profound difference between nutritional ketosis and diabetic ketoacidosis.  It takes rather significant carbohydrate restriction just to get to nutritional ketosis.  Ketoacidosis occurs in severely uncontrolled diabetes in the setting of inadequate insulin, not by carbohydrate restriction.

“During very low carbohydrate intake, the regulated and controlled production of ketone bodies causes a harmless physiological state known as dietary ketosis” (Manninen, 2004).

Manninen, A. (2004). Metabolic effects of the very-low-carbohydrate diets: Misunderstood “villains” of human metabolism. Journal of the International Society of Sports Medicine, 1(2): 7-11.

  1. Eating LCHF will reduce your need for medications

If you sufficiently restrict carbohydrate intake, you will not need as much medication to manage your diabetes, and hopefully will be able to stop taking medications, as has been demonstrated in multiple research studies on the LCHF diet.

It is imperative that you monitor your glucose closely when you are making substantial changes to your dietary habits while taking diabetes medications.  Insulin is especially dangerous, as it may have a rapid and dramatic effect on your glucose levels.  Very simply . . . The fewer carbohydrates you eat, the less insulin you will need.

In addition to reducing the medications needed to manage diabetes, eating LCHF will improve all markers of metabolic syndrome and thus reduce your need for medications being used to treat other medical conditions, such as high blood pressure and abnormal cholesterol.  Furthermore, most people who transition to a LCHF lifestyle note significant improvement in any other areas including GERD (reflux) symptoms and fluid retention.

  1. Real food is cost-effective

Buying real food rather than processed food may, in some situations, be more expensive upfront, but that lifestyle will inevitably result in improved health in the long run.  Higher quality protein sources such as wild salmon or grass-fed beef are indeed more expensive, but a low-carbohydrate diet does not call for high protein intake.  Protein intake should still be moderate, with protein comprising 20-30% of your daily calorie intake.

In the long run, a Real Food diet will allow you to realize much more significant cost savings in the form of:

  • Fewer medications
  • Fewer hospitalizations/clinic visits/procedures/surgeries
  • Less need for diabetic testing supplies
  • Shorter hospital stays

Quality food is cheaper in the long run.

  1. Fruit is Nature’s Dessert

While there are certainly some beneficial nutrients available in fruit, there is no absolute requirement for fruit because those nutrients can be obtained from other foods.  As a diabetic, you are still intolerant of sugars, including fructose which is what gives fruits their sweet taste.  Fruits should be thought of as “Nature’s dessert” – to be enjoyed in small amounts and best when local and seasonal.

I contend that there is an intelligent design to Nature by making sugar-laden fruits available in the warmer months, i.e. Summer.  Animals (including humans) are naturally more physically active in the warmer months and thus more metabolically active.  This revved-up metabolism can better tolerate the consumption of sugar compared to when we are more sedentary – using the readily available sugar in the fruit to fuel one’s increased physical activity.

Furthermore, the consumption of fruits in the late Summer and early Fall appears to be the ideal method for animals to fatten up for the ensuing Winter, i.e. bears preparing for torpor (note: bears don’t truly “hibernate”).  Humans fatten up in response to fructose intake, just the same.

  1. Healthcare is slow to embrace the potential of low-carbohydrate diets

Many reasons exist for the slow acceptance of low-carb diets as an important treatment option.  There still remains fear around the consumption of fat despite increasing evidence against the claims that it causes heart disease, and physicians receive profoundly little training in nutrition through medical school and residency, let alone after training.

The culture in medical training regarding nutrition was that of leaving it to the dietitians to handle any questions regarding nutrition.  There is far too much medical knowledge and experience to acquire already, and thus deferring to a “specialist” in a particular field is the easy way out.  Ironically, a great deal of effort goes into understanding the science and use of pharmaceutical products (medications), the very things that good nutrition can render obsolete.  As stated in this famous quote attributed to Hippocrates:

Let food be thy medicine and medicine be they food.

I don’t believe that physicians remain ignorant of nutritional knowledge on purpose, but rather that they simply have faith that their expensive medical education provided them with the highest quality information at the time and that dietitians will forever be a reliable resource.  With continued research demonstrating favorable outcomes from a low-carbohydrate diet, I believe there will be a gradual shift in healthcare towards the LCHF lifestyle for managing not only diabetes but also many other medical conditions.

  1. Other resources