The End of Diabetes (17 page)

 

Step #6: The Exercise Prescription

It cannot be overemphasized that if you have diabetes, exercise is your prescription of choice. In place of dependency-inducing drugs, the proper medical intervention for this disease is to focus on the aggressive use of diet and exercise.

I always ask new type 2 diabetic patients, “How many days a week do you forget to take your medication?” They most often say, “Never.” Then I ask, “Why don't you just take it sometimes?” They look at me like I am crazy. Then I say, “Which do you think is more important to your long-term health, taking your medication daily or exercising daily? The answer is exercise—it is much more effective and more protective of your future health and survival than the medication. If you want to neglect yourself or forget to care for yourself, then forget the prescription drugs, but never forget to exercise.” Too many people suffering from diabetic conditions believe that drugs are their savior. In reality, drugs can discourage us from taking the right steps toward good health, and the dependency on medication can be a downfall, not a savior.

Diabetes is a disease whose inherent causation is too little exercise and too much fattening food. The two key goals for anyone with type 2 diabetes are to get slim and fit. So why are more and more of us getting sick each year? As we discussed earlier, too many people are addicted to unhealthy foods and vicious toxic eating cycles. And too many are told by well-meaning physicians that diabetes is safely and effectively managed with drugs, not diet and exercise. Diabetics typically think (falsely) that their medication is life saving. They wouldn't dare miss it. The truth is that doing daily exercise is the real life-saving prescription. I make this clear to my patients and emphasize, “From now on,
never
miss your exercise. That is so much more important. It is critical to your recovery. You must be physically fit if you are going to beat diabetes.”

In fact, according to large studies, diabetics who become fit can lower their risk of premature death by 40 to 60 percent depending on their body weight. One study, reported at the 2008 European Society of Cardiology Congress, showed that those diabetics who were highly fit had a 65 percent reduced risk of death in the seven years following the study compared to those with a low level of fitness.
1
Performing daily exercise and building up exercise tolerance are the most effective ways to enhance survival—their results are not matched by any medications to any degree.

There is no excuse for not exercising. Time is not an excuse. If you have time to take a shower, brush your teeth, and go to the bathroom daily, you can put aside ten minutes twice a day to exercise. Poor fitness is not an excuse. Even bodily injury rarely involves the entire body, so you can usually do some kind of physical activity. Even people in wheelchairs can exercise. And if you have poor exercise tolerance, that is even more reason to start.

If your blood sugar is running high, get it down quickly; address this right away with what goes in your mouth and how often you exercise. You must de-emphasize the role of medications and address your condition head-on. If you did not have medications, if they had never been developed, what would you do to bring your glucose down? You would exercise more and eat less, a much safer and more effective option than medication.

 

How to Exercise When You Have Diabetes

Okay, you are committed to getting healthy and fit to get rid of your diabetes. You are going to eat the right foods and exercise every day because you have finally decided to beat this disease once and for all. Now you know you should eat only when you're hungry and not eat so much that you are not hungry again for the next meal. My basic exercise rules for my diabetic patients work hand in hand with the understanding of true hunger. Generally if you eat three times a day, you should exercise three times a day. If you eat twice a day, you should exercise twice a day. Eat only when you are hungry, and that usually means eat only after you have exercised to work up an appetite.

Ideally, calories should be expended via exercise or physical activity in between meals so that before food is eaten, you have earned it. Exercising two to three times a day is usually necessary to achieve true hunger before a meal. The point is that you should not be eating food unless hunger demands you do. And then when you see how much better food tastes when you are truly hungry, you can appreciate that eating less and exercising more increases the pleasure of the food you do eat.

A good place to start your exercise regimen is with walking. The ultimate goal is working up to thirty minutes three times a day. Of course if you have not been walking regularly, we don't start out at that level. I recommend beginning with ten minutes three times a day. These short intervals make the exercise very easy to fit into our busy lives, and they allow us to quickly build up stamina over a few short weeks. If ten minutes is too easy, extend to fifteen minutes three times a day.

 

TEN EASY EXERCISES YOU CAN DO ANYWHERE

1. Walk briskly.

2. Put on some music and dance with a bouncing motion, transferring your weight from leg to leg.

3. Make-believe jump rope—jump in place as if holding a jump rope.

4. Get up and down from your chair 50 to 100 times.

5. Walk up and down a flight of stairs (or much more than one flight).

6. Do jumping jacks.

7. Hop around the room in a circle or back and forth in a line first on one foot, then on the other. Start out with 30 seconds per foot.

8. Rise up and down on your toes.

9. Stand on one leg and hold on to a chair or a wall for balance. Extend your free leg in front of you so the heel stretches out about 12 inches in front of your standing leg. Now, bend your standing leg knee so you lower your body about 6 inches, and then come back up. Do this 25 times and then switch legs. Repeat X times on each leg, depending on your fitness level and exercise tolerance.

10. Jog in place. Pick your knees up higher as you get in better physical condition.

 

Modify your exercise prescription to your individual capacity abilities and needs. Jumping is more vigorous than walking, so start out with only one minute of jumping or hopping if this is new for you. Also use a variety of the above exercise techniques (and many others) at each exercise session so that you involve a variety of skills and muscles. Start slowly, but do as much as you can handle comfortably.

 

The worse your physical condition and exercise tolerance, the more frequently you need to exercise.

If you are overweight and poorly conditioned, fatigue and soreness from exercise can be a limiting factor. The objective is to work up your exercise tolerance gradually. Walk, do a few flights of stairs, and then if you can't do anymore, wait a few hours and try again. The more out of shape you are, the more trouble you'll have doing much exercise, so the more frequently you'll have to exercise. If you can't exercise much at one time, you have to engage in shorter periods of regular but more frequent exercise. If you can only do a little exercise, such as five minutes or less, then plan on doing something at least four times a day. Exercise in spurts throughout the day. As time goes by, you will be able to increase the intensity and duration of the exercises. When you can spend an hour or more in the gym exercising vigorously, you can exercise less frequently.

You can burn calories, lower your blood sugar, and melt away fat with a variety of calorie-burning activities and exercises. However, calorie-burning activities such as walking, stair-climbing, biking, swimming, and using the elliptical machine are not sufficient. Weight training to increase muscular strength is also important. So often, diabetics complain it is difficult for them to lose weight even if they cut back significantly on their food intake. The way to address this is by combining the right diet with an assortment of exercises, especially muscle- strengthening exercises. Invariably, people who complain that their metabolic rate is low and they have trouble losing weight no matter what they eat have weak muscles and are poorly conditioned. Increasing their strength by weight training and doing other weight-bearing exercises creates an increase in muscle density, which helps to metabolize more calories. This critical increase in muscle density will help normalize metabolism, and as a result will address the problem that's causing diabetes.

Walking up flights of stairs is the very best exercise. Walk up as many flights of stairs as you can each day, and keep track of the total number of flights you do. Walking twenty to thirty flights a day is an effective way to meet your fitness goal. Most of my patients have a health club in their home—that is, a stairway. Many even have a second stairway going down to the basement. I ask them to walk up and down the two flights ten times in the morning and ten times at night. It takes only ten minutes, but it really works.

I also encourage patients to join a real health club and use a variety of equipment that uses many body parts for maximum results. The more muscle groups that are exercised, the more metabolically active players you have on your team to help you meet your goals. It is definitely helpful to have access to an assortment of exercise equipment, such as elliptical machines, treadmills, stair steppers, recumbent bicycles, and numerous resistance machines. When you tire of one machine, you can move on to a new one.

Strength-building exercise should be done daily too. However, the muscle groups exercised should be rotated so the same muscles are not exercised two days in a row. For example, on Monday, do exercises to strengthen your chest, shoulders, and middle back (latissimus dorsi). On Tuesday, do abdominals, lower back, and thighs. Wednesday, do biceps, triceps, forearms, upper back (trapezius), and calves. Thursday, start with chest, shoulders, and middle back again.

Of course, this is done in coordination with the other walking, running, jumping, climbing, stairs, swimming, tennis, racket ball, incline treadmill, biking, or other calorie-burning activities so as not to work the same muscle groups heavily two days in a row. For example, avoid stair climbing, elliptical, or biking the day after doing thigh-strengthening exercises. However, walking, treadmill walking, jogging, swimming, continuous dancing, and rowing machine exercises can be done every day in addition to strength training because these exercises will not make your thighs too sore. Ideally, I recommend my diabetic patients walk at least a mile every morning, exercise for ten minutes or so before lunch, and then exercise vigorously with jumping and strength training in the late afternoon or early evening before dinner.

It is also helpful to minimizing sitting during the day. If you work at a desk, consider purchasing a draft table which has a work surface at a height convenient for standing. Or work part of the day with your laptop or papers on an elevated counter so you can stand. Nowadays, you can purchase computer stands that rise up so you can work standing. If you're talking on the phone, stand up and walk as you talk. If you sit all day, you will make this program more difficult. Sitting all day is unhealthy, even if you exercise regularly. If you work standing and then sit for a bit, then work standing again, you will be more alert and efficient on the job while you're also training your body to be more fit.

 

Is Exercise Essential for Success?

Exercise is extremely important, but if your ability to be active and to exercise is limited, do not despair. My menu plans will still enable you to lose weight. People who are unable to exercise just require a stricter diet. Some people have health conditions that preclude them from much exercising. However, an exercise prescription can be devised to fit your capabilities. Almost everyone can do something; even those who cannot walk can do arm, abdominal, and back exercises with light weights or use an arm cycle. You can listen to upbeat music and rhythmically bounce up and down for a full song. Even if your full body weight does not lift off the ground, see if you can do some mild bouncing and hopping as you are dancing. Try to keep dancing for a full five minutes or more.

Exercise will facilitate your weight loss and make you healthier. Vigorous exercise has a powerful effect on promoting longevity. If you have the will to adopt this plan and take good care of yourself, you will find the will to exercise. Start slow and gradually work up, so you do not injure yourself. But immediately begin to do more than you are doing now.

You now know the nutritional science behind diabetes and why drugs are not the solution. You understand the ins and outs of what you should eat, and you have the six critical steps for preparation and achieving your health goals. It is now time to get slim and fit to prevent or reverse diabetes for good.

CHAPTER TEN

For Doctors and Patients

When Ricardo Pacheco started this program sixteen years ago, he had a fasting blood sugar of 175 and weighed 256 pounds. His blood pressure was 155/85, and he was taking 20 milligrams of Accupril daily for blood pressure as well as 15 units of insulin and 500 milligrams of metformin twice daily. At the first visit, I cut his insulin to just 10 units that first night and then just one more dose the following night with 5 units. The insulin was stopped after the two-day taper. Two weeks later, he weighed 237, a drop of nineteen pounds. His fasting blood sugar was 115, and his blood pressure was 125/80. About a month after that, he weighed 221, a loss of thirty-five pounds in fifty-two days. He had a fasting blood sugar of 80, which allowed us to stop the metformin at that time. His blood pressure was 88/70, so I discontinued his Accupril, which actually could have been cut out sooner. Luckily, he was not fatigued or lightheaded. He could have fainted or injured his kidney from the unnecessary medication. Ten months after the first visit, Ricardo weighed 190, a loss of sixty-six pounds since starting the program, and his HbA1C was 5.3 with a total cholesterol of 134 and a blood pressure of 112/76. He was on no medication. He has been doing well, medication-free for over fifteen years.
*

A
s we have discussed, diabetes mellitus is a tremendous financial and health burden on an already overstressed health care system. Diabetes and its complications contribute to an estimated total (direct and indirect) cost of $174 billion in the United States on an annual basis, including $116 billion in medical expenditures and $58 billion in lost productivity.
1
In 2011, according to the National Institutes of Health, the prevalence was 25.8 million, or 8.3 percent of the population.
2
It complicates the issue that approximately two-thirds of the U.S. population is overweight and/or obese, increasing the possibility of exponential growth in diabetes due to the higher likelihood of insulin resistance among this population.
3

It is generally assumed that a combination of failure to lose weight, poor glucose control, and poor management of other risk factors increase the complications and risk of diabetes. Currently, medical care for type 2 diabetes consists of attempts to lower risk and achieve better metabolic control. Successful treatment outcome, however, is not consistently achieved with current drug-based recommendations.

In the 2009 consensus statement of the ADA and the European Association for the Study of Diabetes, the organizations recommend starting a nascent diabetic patient on lifestyle changes plus metformin. According to the authors, for most individuals with type 2 diabetes, lifestyle interventions fail to achieve or maintain the metabolic goals either because of failure to lose weight, weight regain, progressive disease, or a combination of factors.
4
Only about 36 percent of type 2 diabetics have achieved the ADA's recommended goal of a HbA1C <7.0, which means about 64 percent are still not reaching even the basic (suboptimal) therapeutic goal.
5
These percentages are worse than in 1988 through 1994, when 44 percent reached the ADA goal.

Also disappointing is the finding of two large clinical trials, each with over ten thousand patients, that intensive medication therapy to tightly control glucose to near normoglycemic levels may not be the most effective treatment approach.
6
One trial was halted when data showed an increase in all-cause mortality (257 vs. 203) and no benefit in cardiovascular complications.

The problem is that the modern diet is so diabetogenic that most patients with type 2 diabetes do not achieve target glycemic levels with traditional therapies, and these agents are also associated with weight gain and poor tolerability.
7
Insulin therapy or intensification of insulin therapy commonly results in weight gain. Weight gain associated with insulin therapy is believed to be primarily due to the anabolic effects of insulin, an increase in appetite, and the reduction of glucose excretion in the urine. This weight gain can be excessive, adversely affecting cardiovascular risk profile.
8
These less-than-satisfactory results create a quagmire for the medical community. Diabetic care without substantially motivating patients to eat more carefully and do more exercise is suboptimal.

 

Heart Disease and Diabetes Have an Unbreakable Bond

Diabetics develop atherosclerosis early in life. They develop it even before the diagnosis of diabetes is entertained. Atherosclerosis, or the buildup of cholesterol and plaque inside of the blood vessels, is a disease created by excess caloric consumption. We can't separate the discussion about diabetes and heart disease completely from weight loss. Heart disease and heart attacks were exceptionally rare occurrences in human history until the explosion of commercial food manufacturing and processed food exposure in the 1900s. The low-micronutrient diet people eat today contributes to atherosclerotic plaque deposition in two basic ways. First, low micronutrient consumption promotes excess calorie intake, and second, low micronutrient intake increases oxidative stress and inflammation in the body, which further promotes atherosclerosis.

It is well-established that atherosclerotic plaque development and the factors that contribute to the instability of plaque that promotes clot formation are linked to inflammation-prone tissue. From the initial phases of fatty streak formation to the evolution toward plaque instability and rupture, the SAD, which gets its majority of calories from low-micronutrient processed foods and animal products instead of vegetables, beans, fruits, seeds, and nuts is the cause of this disease process. Circulatory disease, the leading cause of death in the modern world, is a dietary-caused disease that is most effectively dealt with from a dietary standpoint.

The impact of low-micronutrient eating takes its toll, promoting an inflammatory cascade underlying most diseases that plague the modern world. It is this combination of excess calories, fat deposition, and inadequate phytonutrients that creates a nation of cardiovascular-diseased individuals. It is possible, but much less likely, for thin people to develop atherosclerotic heart disease when eating a disease-promoting diet, but even most of these people still have significant amounts of abdominal adiposity and visceral fat.

In addition to my twenty-plus years of experience in treating advanced cardiac patients and diabetics with aggressive nutrition, my main scientific contribution to this body of knowledge is the explanation that the same underlying buildup of free radicals, AGEs, and other toxic agents caused by inadequate micronutrient intake not only create disease and promote tissue damage and aging, but they also promote overeating behavior, food addiction, and food cravings. The underlying drive to overconsume calories is just too difficult to address while addictive symptoms drive overeating behavior. This physical need for more frequent and concentrated calories creates emotional and thought rationalizations that seek to justify bizarre and illogical eating behaviors, leading almost everyone to overconsume calories. When a micronutrient-deficient diet is consumed, we desire an excessive amount of calories just to feel normal. There is no longer the connection between satisfying hunger and a normal body weight. So becoming overweight is due not just to easily obtainable calories and sedentary jobs but also to unhealthful eating that leads to addictive food-consuming behavior, resulting in overly frequent eating and overeating. The result is that the vast majority of Americans become overweight, atherosclerotic, and—now more and more—diabetic.

Using medical and surgical interventions while the underlying nutritional, biochemical, and lifestyle factors that caused the problems continue to percolate is doomed to failure. Medical care is expensive and futile compared to nutritional interventions which are remarkably effective for:

 

•  Lowering cholesterol and lipid risk markers

•  Improving vascular remodeling to facilitate oxygenation and to relieve and resolve angina

•  Losing weight and glucose intolerance, reversing the diabetic process

•  Reducing inflammatory and clot-promoting tendencies without incurring a risk of bleeding

•  Reducing the tendency toward arrhythmia, sudden cardiac death, heart attack, and stroke

•  Reducing all-cause mortality in all patients with all medical conditions

 

It can't be reinforced enough that the goal is a low body-fat percentage, not a low dietary-fat percentage. The low body-fat percentage is best achieved by prescribed regular exercise and nutritional excellence, and bringing back the connection with true hunger so recreational eating and eating outside of the demands of true hunger can be reduced.

Keep in mind that lowering cholesterol and losing weight do not adequately explain this high-nutrient diet's protective effects against cardiovascular disease. This prescribed diet effectively lowers high-sensitive C-reactive protein. This protein found in the blood has been proven to increase the risk of heart disease. In addition, this powerful diet offers vital anti-inflammatory protection and other beneficial biochemical effects. Even though drugs may lower cholesterol, they cannot be expected to offer the protection against cardiovascular events that superior nutrition can. The aggressive use of cholesterol-lowering drugs does not prevent most heart attacks or strokes and does not decrease the risk of fatal strokes.
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In clinical trials, a significant percentage of patients who are taking the best possible statin therapy still experience cardiovascular events, such as heart attacks, sudden cardiac death, and strokes. Lowering cholesterol with nutritional excellence, however, can be expected to offer radically more protection and disease reversal than drug therapy can, without the risk or expense of prescription medication. I have seen the results in patients for more than twenty years, and now finally we are beginning to see the research results catch up and support my experience.

The reward for treating patients in this manner is to see improvements and disappearance not only of diabetes but so many other medical conditions as well. Headaches resolve, asthma episodes often go away, fatigue and body aches improve, digestive issues resolve, and most importantly, atherosclerosis and chest pains resolve without invasive procedures or surgeries.

 

Heart Disease Case Studies

The interesting part of the results achieved with excellent nutrition on this nutritarian diet style is that many of these participants were already on so-called healthy diets and were worsening before they followed my nutritional protocols to reverse heart disease. Some were even worsening on vegetarian diets. The other notable achievement is that people on this regimen do not see just a small reversal of atherosclerosis with excellent nutrition; they get a dramatic amount of reversal.

 

Case #1: David

David was a sixty-year-old man who had read the 1980s runaway bestseller
Fit for Life
over ten years ago and was following its recommendations for a starch-based Mediterranean-type diet. David ate mostly vegetarian foods with brown rice, potatoes, and whole wheat, fruits and vegetables, chicken only a few times a month, fish once or twice a week, and some olive oil on salads. He began an exercise program in June of 2006 and was surprised to find that he had chest pain with exertion.

His weight had been stable at 158 pounds for years. A thallium stress test indicated a significant coronary artery disease with an LDL cholesterol of 126. His CT angiogram done on June 30, 2006, showed near total obstructive disease in the proximal left anterior descending artery due to low-density plaque.

David began my careful dietary protocol for the reversal of heart disease and did not have an angioplasty or bypass as was suggested by the cardiologists. After following my nutritional advice for one month, the chest pains resolved. His weight dropped to 140 in the first eight weeks. One year later, a repeat of the CT angiogram showed the left anterior descending artery with a non-obstructive mixed-density plaque with a stenosis estimated at 50 to 70 percent. David's weight has remained around 138 to 140 since following my dietary suggestions. In August of 2008, the last evaluation of his coronary arteries was performed, showing normal cardiac blood flow and no evidence of heart disease.

 

Case #2: Stan

Stan was a middle-aged male who had been on the strict version of a popular low-fat diet program that included meat but was largely based on vegetables, grains, and fruits for over three years while his carotid artery disease continued to worsen. After the first year on this seemingly healthy diet, the results showed no or very slight improvement. Stan continued on this very strict program for two more years to improve his disease. But it got significantly worse! The radiologist said, “The lesion on the left side is stable. There is some early buildup on the right side that has worsened, and I got a nice picture of a lipid [fat] inclusion in the artery wall.”

Stan was then referred to me by the dietician at the health center that was monitoring his progress. After twenty months on my program, he saw great results. The radiologist's comments this time were: “Borderline evidence for atherosclerotic burden.” He was no longer talking about a lesion or early buildup. There was barely any sign of atherosclerosis.

In twenty months on my dietary protocol, Stan lost ten pounds and is now 157 pounds. He is now running two miles per day, whereas he was running four miles a day during the last two unsuccessful years on his former low-fat flexitarian diet. “I just changed the emphasis off of lots of whole grains and onto high-nutrient foods. I felt lots better, I dropped my abdominal fat girdle without effort, and I enjoyed it,” he said.

 

Case #3: Susan

Sixty-six-year-old Susan had a history of occasional irregular heartbeats noted to worsen with the ingestion of caffeine, alcohol, and sometimes even heavy exercise. She changed her diet first to vegetarian and then to low-fat vegan. After a little more than one year on the very low-fat vegan diet, her arrhythmias worsened, and she then developed atrial fibrillation.