You Want To Know!

As a member of the LCDA, you should be proud knowing you are taking a proactive lead in healing the prediabetes or diabetes of yourself or a loved one or a patient. And, you have come to the right organization. By learning about The Eight Essentials, and how to bring positive changes to your diet, lifestyle, supplementation, you will learn information that may help you reverse prediabetes and can help you to reverse or control diabetes.

New Expert Interviews!

The low carb diet is the foundation diet for people who have prediabetes or diabetes. The LCDA promotes a nutritional, fun, tasty way to implement the diet.

The LCDA At the 32nd ADA Clinical Conference

Dr Mona Morstein (Executive Director) and Dr. Helen Hilts (Board Director) from the LCDA went to the 32nd Annual ADA Clinical Conference in Orlando, FL, May 25-28th. Since the LCDA is promoting itself as the modern more progressive diabetes non-profit, why would we go to the ADA conference?

Well, although the LCDA disagrees with the ADA about many key treatment foundations regarding diabetes, Dr. Mona Morstein (Executive Director) and Dr. Helen Hilts (Board Director) decided to attend the ADA Clinical Conference in Orlando, FL. What was unique to us this year was that a few topics at the ADA fit right into The Eight Essentials®. I’d like to highlight some lectures we heard, including those we were impressed with and those we were not.

The first lecture to note was a narrative by Rev. Richard Joyner of Conetoe. NC. Rev. Joyner joined that very poor, very poorly fed, and very sick community as an assistant to the main Reverend who was 92 years old. When the main reverend retired, Rev. Joyner was alloted to take over full care of his community. Dr. Joyner noted that in the first year of being a reverend to Conetoe there innumerable funerals, occurring most weekends, all due to poor health and chronic disease. In 2007 Rev. Joyner began a grassroots plan to encourage Conetoe children to eat better, and break out of the cycles of bad diet, bad health and premature death. The Conetoe Family Life Center has set up a large garden, where the children are integral at farming up to 50,000 pounds of product. The children learn to grow food, eat healthy food, sleep well and get regular exercise. Half the produce is given to low income families and the other is sold locally. Conetoe has also set up a bee bus, where they set up bee colonies to pollinate their plants, and the honey is collected also for sales around the state. The children learn science and math, gain self-esteem and confidence. And, the benefits to the community are real: ER hospital use is down 40%, health risks down 50%, students high school graduation rate rose from 50 to 80%, and 21 other churces in four countries have adopted a similar garden model. If this model spreads to more communities and faith based institutions around the country, the diabetic crisis may significantly reduce. This was a truly inspirational talk!

Dr. Sara Blackman spoke on “The Microbiome: Working With An Old Friend,” in which she detailed the functioning of the gut, and its microbiome. She described the importance of all the organisms making up our intestinal microbiome, and the environmental influences that affect it, from the fetus’ prenatal period, infancy continuing as we grow to adults. New evidence suggests that the appendix is actually a reservoir of healthy bacteria and reseed the intestine when it has been damaged by some microbial insult. A fascinating medical fact is that there are neurons from the brain that reach down into the cells of intestine, continuing the idea that the gut is the “second brain” or at least that there is indeed a true brain/gut connection going both ways. The microbiome is associated with nitrogen processing, vitamin creation and absorption, mineral absorption, metabolism, neurotransmitter formation and short chain fatty acid formation. She noted the cells of the large and small intestines can be functioning well or poorly, due to the health of the microbiome, and how an unhealthy microbiome may indeed cause systemic insulin resistance and may also lead to the development of auto-immunity, such as in Type 1 Diabetes. Obesity and metabolic syndrome and both T1DM and T2DM are associated with negative changes in the intestinal microbiome. As for antibiotics, studies have shown it might take up to two years for normalization of the damage caused by even 7 days of a strong antibiotic.

Dr. David Repaske, MD, PhD, a pediatric endocrinologist, gave a good talk on the problems of clearly diagnosing T1DM, T2DM and MODY in the pediatric population. Both T1DM and T2DM are significantly rising as diagnoses around the world, including in the US. It’s very rare for a child under 10 years old to develop T2DM, however. Dr. Repaske went over case studies of pediatric diabetic patients. In the first case an overweight teen with a BMI of 35 and high ethnicity and family history of T2DM, presented with polyuria (frequent urination) and polydipsia (frequent drinking), and no acanthosis nigricans (a skin condition commonly seen in T2DM patients), had a blood glucose of 278, and no urinary ketones or blood changes suggesting ketoacidosis. Yet, this child’s labs were positive for diabetic auto-antibodies showing he had developed T1DM. Thus, weight alone should not rule out either type of diabetes, as right now, 20% of adolescents are obese and obesity does not protect one from getting an auto-immune condition. This is important for physicians and parents to know, because physicians make diagnostic errors in this regard. Of 1211 T2DM diagnosed pediatric patients enrolled by pediatric endocrinologists into the T2DM TODAY study, actually 10% were found to have T1DM, showing that even endocrinologists, who specialize in hormonal conditions, can make T1DM/T2DM diagnostic errors.

In the second case study, Dr. Repaske illustrated a 13 year old African American child who had a two week history of flu-like symptoms with frequent urination and 8 lb weight loss. She was also obese with a BMI of 35 and did have acanthosis nigracans present. Her labs showed she was in diabetic ketoacidosis (DKA). However, after acute care treatment with insulin, her insulin antibodies were negative, and she was weaned off the insulin onto Metformin. This child has T2DM but her illness raised her insulin resistance so high it took her into diabetic ketoacidosis, an uncommon but possible condition in acutely sick T2DM patients. Teens are naturally insulin resistant with the elevation of their reproductive hormones during pubertal changes, and adding in the diabetic insulin resistance, plus her fever, caused the severe insulin resistance that caused the DKA.

A third case study was about a 19 year old Indian-American male college student whose father and grandfather had T2DM treated with a sulfonylurea. He discovered by chance, playing with his father’s glucose meter, that his fasting glucose was 132. He saw Dr. Repaske. He was healthy, slender and had no symptoms at all, though his A1C was 6.5%. His diabetic auto-antibodies were negative and a genetic panel showed he had Monogenetic Diabetes of the Young, or MODY. There are 13 different MODY gene defects, but only MODY 2 and MODY 3 are common. These genes reduce the ability of the pancreatic beta cells to make or secrete insulin out into the bloodstream or hinder the ability of the insulin receptor to acknowledge the insulin molecule. This is not a progressive type of diabetes and most can be treated with a sulfonylurea, helping the pancreas to overcome the gene defect and secrete appropriate insulin. MODY is found in 12% of young diabetic patients, and 3% of older diabetic patients and is very frequently misdiagnosed. It is seen when diabetes goes down through each generation. Unfortunately, genetic testing of MODY is oftentimes extremely expensive and may not be covered by insurances.

Pediatric diabetic patients may also suffer from more depression and anxiety so investigating that regularly with them is vital. A simple mental/emotional form called the PHQ-9 can be used by physicians to check in with the kids and see if they are struggling to cope.

Many medications for diabetic patients are not approved for pediatric patients, so are used “off label.” For example, Lantus/Basaglar (generic Lantus) is not approved for patients under 6 years old. Humalog is not approved for patients under 3 years old, although Novolog is approved for children 2 years old and above. In pediatric T2DM in teen years, only Metformin is approved for children at/over 10 years old. (Rosiglitazone is approved but now very rarely used due to an increased risk of heart failure). Unfortunately T2DM in pediatric patients is a very serious disease, very progressive and hard to get under control. Complications can develop very quickly. (LCDA Comment–Of course, that is because only medications are used, and many are not told to eat low carb!)

Dr. Repaske noted, as the LCDA promotes, that only half unit rapid acting pens should be used for meals and corrections in pediatric patients: Humalog Luxura Pen and the Novolog Echo pen. And for younger T1DM patients, using longer acting basal insulin should be done with a syringe and vial as the pens for those insulins only come in one unit dosing (or, of course, use a pump).

Last, the overall risk of developing T1DM is 0.4% for any child. However, if a sibling develops T1DM, the risk for siblings increases to 4%. Measuring diabetic auto-antibodies is important to see if the disease is developing in siblings. If there are no or just one antibody, the ten year risk is ~10%; if 2 or more antibodies are found, the five year risk of 44% (or faster), 10 year risk is 70%, and the lifetime risk is ~100%. If there are 2 or more antibodies and already there is elevated glucose after meals, the 5 year risk rises to 75%. will measure antibodies in siblings oftentimes for free.

There are Three Stages now established to developing T1DM: Stage 1–(+) antibodies but no elevation in glucose or symptoms; Stage 2–(+) antibodies, and elevation in glucose but no clinical symptoms; Stage 3–full on-blown T1DM.

The LCDA has a lecture on its website on the microbiome on T1DM development and how it may be possible with a very health, low carb diet, avoiding food sensitivities, analyzing imbalances in the other Essentials and healing the gut microbiome to slow down or perhaps prevent the onset of T1DM. This has by no means been proven, and is wholly theoretical, and the LCDA in the future would like to get money to research this idea. Also, since Celiac disease affects 1% of the population and 10% of the T1DM pediatric population, and since there was research showing that by catching Celiac disease early and avoiding gluten, there was a subsequent zero percent occurrence of T1DM. The LCDA feels that it is vital to screen all toddlers for Celiac disease by ages 1-2 years old at their pediatrician’s office to find Celiac disease and help prevent those children from developing T1DM.

In a similar lecture using adult diabetic patient diagnostic complications later that day, odd presentations of T2DM (lean, non-overweight) and Latent Auto-immune Diabetes of the Adult were illustrated. LADA is a T1DM that occurs in adults over 30 years old and is also, again, oftentimes misdiagnosed as T2DM.

Another valuable lecture was by Dr. John Jakicic, PhD on “Physical Activity Considerations: Individualizing Treatment.” Right along with our 2nd Essential, Dr. Jakicic discussed the value of exercise and talked about ways to help patients see the importance of it in their own views, and figure out how they can add it into their lives. Patients oftentimes see value in exercising regarding first their appearance and how their clothes fit, and then the way their body functions (being able to walk without getting tired, for example, or having good energy to get through the day), and then how it affects their health, and last how it can imporve their mental/emotional well balance. Working with patients in a positive way can help them prioritize exercise and fit it into their life. Aside from focusing on exercise, though, it’s also important for patients to focus on NOT being so sedentary and making commitments to sit less, watch TV less, be on the computer less (outside of work). In one study, for those who had never exercised and then began to, they had a decrease risk in cardiovascular disease. For those who had not exercised, did for awhile, and then stopped, they had no risk reductions, and for those who exercised and continued to exercised, there were also risk reductions. So, the key is whether you have always exercised or are just starting to, continuing to do it is what brings cardiovascular risk reduction. Starting, stopping, starting, stopping is not beneficial. Also, regarding getting those 10,000 steps a day–Dr. Jakicic said yes, getting 10,000 steps a day is helpful IF: 1) you get them in at least 10 minute segments, and 2) you get them at pace faster than normal walking. So, yes, very helpful to get up and get moving and have your Fitbit record 10,000 steps! Good for you! However, in terms of real weight loss, glucose control and cardiovascular benefits, putting a little extra oomph into those steps will really make a difference!

Neither Dr. Hilts nor I went to the “Yoga and Meditation in Practice” lecture, but I did see a whole bunch of people in the large lobby area by the conference rooms doing a quiet, meditative type of yoga led by the lecturer, Dr. Sally Sherman.

There were many other good lectures, but those are a few highlights.

A few problematic statements were made at the ADA, for LCDA advocates. First, one lecturer, discussing nutrient deficiencies in diabetes did not discern any differences between using Vitamin D2 and Vitamin D3. There are considerable differences soon to be seen in a new lecture on Vitamin D3 on the LCDA website! The LCDA only suggests using Vitamin D3 for replacement. The lecturer recommended checking homocysteine for vitamin B12 analysis but homocysteine is more related to folic acid status, and methylmalonic acid is the functional test to interpret serum vitamin B12 levels. Last, she focused on USP certification of vitamins, naming a particular brand that has been advertised lately on TV as USP certified. USP certification means the product does contain what is on the label, does not contain dangerous additional excipients, and dissolves within 45 minutes in the gut. However, it hardly verifies quality of the product! For example, a product can be USP certified to contain vitamin B12, but it is made from cyanocobalamin, a poor form of the vitamin, and the vitamin also contains corn starch and sodium benzoate as filler and preservative. That is all USP ok! It’s important to know there are better certification programs that companies can attain. NSF international and Therapeutic Goods Administration (TGA) from Australia are certification programs that hold supplement companies to much higher standards of purity than USP. Companies that are recommended by LCDA physicians usually have one or the other or both of those top notch quality certifications, making them exceedingly pure, and exceedingly well absorbed.

Another problematic lecture discussed diet in diabetic patients. This lecturer is an followerer of the US Government’s recommendations. The MyPlate recommendations look like this:

As you can imagine the LCDA completely disagrees with this Myplate plan for any patient with diabetes, since it is definitely not low carb. When the lecturer than noted that a diabetic person can easily get a Myplate meal that is not expensive by getting a burger and small french fries from McDonalds, Dr. Hilts and I had no choice but to get up and walk out!

One last problem is that the ADA really just promotes the use of prescription medications for the treatment of diabetes. One study illustrates just how narrow-minded the whole conventional care focus is. A lecturer discussed the GRADE study, whereby patients with high A1Cs are put on metformin, and when they fail (by attaining an A1C at 8 or above) they are given a second medication, one of three different drug categories. The study is then going to watch and see which category of drugs the patients are taking of fail the quickest, that is, allow the patients to get up again to a very high A1C. The drug group that rises the A1C levels the slowest is the one that wins and the one they feel will be best to qualify as the medicine to follow metformin. The lecturer, upon questioning from Dr. Morstein, clarified they are not changing any patient’s diet, exercise, sleep, anything–they are just watching what the drugs do in and of themselves. It is sad this is called “leading edge” research! We already know that in conventional care of diabetes utilizing only medications, diabetes is the main reason adults go blind, have amputations (outside of trauma), and develop kidney failure. We already know that only using drugs does not work! Yet, here is more money on a unhelpful study that could instead by used to show what a low carb diet does for lowering A1Cs in the same time. Drugs alone do not work!

One big reason they do not is that there is only one class of drugs actually designed to treat the reason for T2DM, insulin resistance. In high blood pressure, drugs are given to lower the blood pressure. In high cholesterol patients, drugs are given to lower the cholesterol. In T2DM, where the condition is caused by insulin resistance, the only drug category designed to reduce insulin resistance are the TZDs, the hard to pronounce Thiazolidinediones (briefly, the glitazones). Unfortunately, these drugs are rarely if ever used any more since medications in that category group are associated with significantly negative side effects, such as congestive heart failure, cardiovascular death, and bladder cancer. So, all the other drug categories do not treat the etiological factor for T2DM; they are simply designed to help treat the symptom of it, high blood glucose. (Metformin may have a little effect at lowering insulin resistance, but that is not its key action in the body). This is why the LCDA needs to show diabetic patients other alternative methodologies that do indeed lower insulin resistance, encourage weight loss, remove etiological imbalances to health, and help reverse diabetes.

The ADA also has little faith that people can change their diets and stick to it; on top of that it seems they also do not feel it’s right to put people on a strict diet, “it’s so difficult”, one person said. There is the valid aspect of many people in poverty with diabetes not being educated on how to eat healthy on a cost effective way, but that doesn’t mean they cannot be educated and cannot change. Rev Joyner is proving everyone can listen, act and change! That’s so exciting!

The problem is that physicians in conventional care are really just designed to dose medications. In fact, Dr. Morstein heard one endocrinologist sitting in front of her say, during the telemedicine lecture, that “Treating diabetes is easy over the phone–you’re just making a change to their medications.” Well, the LCDA doesn’t advocate that type of “easy” treatment of diabetes, because it is a failed type of treatment. The LCDA also believes that educating people on how to eat better, how to eat low carb, encourages and motivates them to do so. The LCDA believes that healing the world of diabetes will take more than an eight minute office visit and a prescription pad! It will take comprehensive integrative practitioners doing what they do best, spending more time with patients to teach, guide and support.

On top of everything, the ADA discussed that they have now added metabolic surgery to their algorithms of treatment. That means, if the T2DM patient is overweight or obese, and medications have not lowered their A1Cs, and the A1Cs are still quite elevated, having bariatric (AKA “metabolic) surgery is suggested. In bariatic surgery, the capacity to eat and digest is grossly changed due to removal or interference of digestive organs, either temporarily or permanently, depending on the type of surgery done. Examples of this include Rouen-Y surgery, Gastric Band, and Gastric sleeve. The surgery is around $40,000 (roughly, depending on the type) and a lot more money is required for follow-up, and for rehospitalizations for complications. As Dr. Morstein asked the lecturer–Is it really a positive step forward in modern medicine that physicians rely on drugs alone and when drug therapies fail, what the ADA advocates is doing substantial metabolic surgery on patients? The lecturer’s response was “What else can we do when patients are overweight, with high A1Cs, and medications done work? They can’t be left alone? What else can we do?”

Perhaps instead of recommending bariatric surgery, we set up healing centers where for a lot less money, patients can get diabetic counseling, learn to exercise, to garden, to cook healthy foods, learn to be less sedentary, get introduced to low carb meals, get appropriate supplements, learn The Eight Essentials® and so forth!

Obviously, this is where the LCDA comes in! The entire existence of the LCDA is about using The Eight Essentials® to help patients heal, and reverse their diabetes, reducing the need for medications, leaving patients’ stomachs and intestines in their bodies as they were born, making the whole of them not only healthy, but maximized in functioning.

So, in summary, there were several excellent lectures and networking connections were made. The LCDA hopes to be interviewing Dr. Jakicic and Rev. Joyner, both who seemed very willing and eager to work that way with the LCDA.

However, the foundational direction of the ADA is still problematic, and reaffirmed even more the necessity of the LCDA’s commitment to make changes in the treatment of diabetes.

Counting Protein With Insulin Dosing

There are two key methodological problems with the conventional insulin dosing paradigm: 1) the axiom conveyed, especially in pediatric T1DM patients, is to eat all the carbs they wish and then cover them with insulin, and, 2) not adding protein into the insulin dosing calculations. Through these very erroneous methods insulin dosing can be nearly impossible to accurately cover glucose levels, and constant highs and lows are usually the result. A diabetic child can be then called “brittle” when indeed it is the incorrect diet and lack of complete coverage of food in combination of insulin that causes the endless poor control and elevated A1Cs.

In this article from 1997, we learn several key points:

  1. Total carbs raise glucose levels, no matter the type of carbs eaten.
  2. Fat does not have appreciable affects on glucose levels.
  3. Protein has adequate affect on glucose levels with adequate insulin. However, with insulin deficiency, gluconeogenesis proceeds rapidly and contributes to an elevated blood glucose level.  (Gluconeogenesis is the biological term for having protein turned into glucose which occurs in the liver mostly, but also the kidneys).

As a result, it is imperative for two things to happen when dealing with any diabetic patient who is insulin dependent:

  1. Eat few carbs. The one sentence definition of diabetes is simply that a person has lost the metabolic capacity to process carbohydrates, as a result, it is best to minimize eating them. Dr. Richard Bernstein created the Law of Small Numbers–that is, considering the FDA allows nutrient labels to be up to 20% off, the higher the intake of carbs, the more impossible it becomes to dosing insulin correctly. For example, say the package of spaghetti notes that eating one serving is 100 grams of carbs. In general, one gram of carbs raises the glucose 5 mg/dL in a person who weighs 140 lbs; if you weigh less, it raises your glucose more, and if you weigh more, it raises your glucose less. If a person eats 100 grams, and it could be 20% off legally, up to 120 grams of carbs, that means, the effect could raise glucose 500 to 600 mg/dL at 140 lbs. That’s quite a spread to cover with insulin. If you inject for 500 mg/dL, but it’s a 600 mg/dL raise, you’ll wind up with high glucose after the meal. If you inject for 600 mg/dL and it’s a 500 mg/dL raise, you’ll wind up hypoglycemic after the meal. However, if the meal only contains 8 grams of carbs, and 20% more is only 10 grams (rounded up), the net effect is from 40 mg/dL to 50 mg/dL, in 140 lb person, a much tighter window and easier to inject for. This is why it is adament for all patients using insulin for meals to eat low carb; control with injecting insulin will be impossible without doing so.
  2. Cover proteins–since we scientifically know that proteins are converted into glucose in the liver and kidneys, and since most diabetic people know that if they eat protein their glucose numbers will definitely increase, it is very important to cover protein with insulin. Dr. Bernstein also led the way in figuring out how to do the math to figure out how much insulin needs to be injected per ounces of protein eaten at a meal. Doing that takes a bit of math and is a little more complicated than I wish to discuss here in the newsletter, but Dr. Morstein has created the CarbProtein Insulin App in the Google Play Store, accessible on your Android phone or via your computer or Ipad if you do not have an Android smart phone. (Unfortunately, Apple refused to let her publish her app in their store). The app is $1.99 for lifetime use, and all proceeds go to support the LCDA non-profit. This app is easy to use and is the best app out there for figuring out insulin dosing for meals, including carb and protein intake and also figuring out correction doses. It is applicable for pediatric and adult patients. The LCDA absolutely recommends you get approval and guidance from your medical practitioner before downloading or using the app, and takes no responsibility for the use of it. All insulin dosing should be monitored by your medical practitioner.

What about using your pump instead? Unfortunately, pumps are designed to figure out insulin doses only taking into account carbs eaten at a meal, so they will not lead to excellent control. The LCDA is not sure why conventional care does not include protein in insulin dosing but the LCDA will thus take the lead in doing so.

By limiting carbohydrate intake and by covering proteins with your insulin dosing excellent control of glucose can occur, without highs, without lows, without being brittle, and can help to eradicate the fear of using insulin. Look in June for a new video on counting protein for meals for insulin dosing, but in the meantime, check out the CarbProtein Insulin Calculator.

The Fat is Fit Myth

A few years ago a study occurred showing that even though patients were overweight or especially obese, they could still be considered fit or healthy. Unfortunately, a recent study done in the UK has disproven that belief. People who were obese, but who had no initial signs of cardiovascular disease, diabetes or high cholesterol were not protected from ill health in later life. Researchers at the University of Birmingham analyzed the data from millions of British patients between 1995 adn 2015 to see if this fat is fit myth was true.

They tracked people who were obese (BMI > 30) at the start of the study who had no evidence of heart disease, high blood pressure, high cholesterol or diabetes at this point. They found these people were definitely at a higher risk than normal weight people of developing heart disease, strokes, and heart failure. This is important to know as 75% of patients with diabetes die from cardiovascular disease. Although this study has not yet been published it is stirring up discussion on being overweight or obese and can one be “healthy” in that state.

Obesity is an interesting development. Being obese is not always a guarantee a person develops T2DM, but it certainly increases the risk. (And, in fact, there are indeed a significant number of T2DM patients who are not obese, or even that overweight). Why do some obese people develop diabetes and some do not? It’s a good question and there are some ideas to think about.

There was an amazing study showing once that in two groups of obese people, one that had diabetes and one that did not, the main mitigating difference between the two groups was that the group that had diabetes had much more environmental chemicals stored in their fat than those in the other overweight group. Many environmental chemicals, such as POPs, persistent organic pollutants, have been shown to increase the risk of insulin resistance and also auto-immunity. So, it really seems that for those who are overweight or obese, how many toxic environmental chemicals come with the fat seems to be a main factor. This might relate to how well any particular individual can detoxify from exposure to environmental chemicals; those who do so better, have less risk of developing diabetes even if they are significantly overweight. See the study here:

That is why the LCDA considers environmental detoxification so important, it became an Essential.

Another aspect of fat is where is the fat stored. Abdominal fat, AKA visceral fat, is much more dangerous to health than “womanly” fat stored in the hips and thighs. That is, the “apple” shape is more dangerous than the “pear shape.” For men, if they do gain excess weight it usually always appears in the apple form. For women, before menopause weight is typically distributed more in the pear shape, but after menopause weight gain will almost always occur in the abdomen. This is because estrogens help reduce insulin resistance, and after menopause, when estrogen levels fall, the area of weight gain is problematically changed, if it occurs, to the abdomen, the focal point of developing insulin resistance. It is very important for post-menopausal women to eat right, exercise and work hard to not gain weight.

Abdominal fat can also be very proinflammatory as it makes TNF-alpha and Leukotriene 6, two chemicals that promote cellular insulin resistance and aggravate fatty livers, which are common in obese individuals. Inflammation is known to be a main factor driving the development of cardiovascular disease and diabetes. It may be that some people who are overweight or obese produce less inflammatory chemicals from their fat, causing less disease occurrence as a result.

Nonetheless it is best overall for health, it seems, for people to be at normal weight. Following The Eight Essential®, and getting them all in good balance is a great place to start losing weight, reducing chemical toxicity, reducing inflammation, feeling good, looking good, and significantly reducing the risk of the development of diabetes, and getting diabetes under excellent control if it has already occurred.



  1. The Obesity Code by Dr. Jason Fung.
  2. Overdosed America by Dr. John Abramson


  1. The ADA Clinical Guidelines for Obesity


Recipe #1 | Grilled Chicken With Spinach and Melted Mozzarella


* 3 large chicken breasts slice in half lengthwise
* 1 tsp olive oil
* 3 cloves garlic, crushed
* 10 oz frozen spinach, drained
* 3 oz shredded full fat mozzarella
* 1/2 cup roasted red pepper, sliced in strips
* Kosher salt and pepper to taste


1. Preheat oven to 400 F

2. Season chicken with salt and pepper. Lightly brush a grill or grill pan with olive oil (or other oil as you wish). Cook chicken until no longer pink, about 3-4 minutes per side.

3. Heat a skillet over medium heat. Add oil and garlic and saute 30 seconds. Add spinach, salt and pepper. Cook until heated through, 2-3 minutes.

4. Place chicken on baking sheet and place equal amounts of spinach leaves on top of each breast Top spinach with 1/2 oz of mozzarella cheese, roasted peppers.

5. Bake until melted, about 3 minutes.

6. Pour the mixture into a buttered 8 x 4 loaf pan. Bake for 30 minutes. Check with a toothpick to ensure the bread is cooked through. Enjoy!

Calories: 195
Fat: 6 g.
Carbs: 3.7 g
Fiber: 1.3 g
Net Carbs: 2.4 g
Protein: 31 g

Recipe #2 | Caprese Stuffed Avocadoes


* 2 avocadoes
* 1 cup salad greens
* 1 cup tomato, diced
* 1/2 cup fresh mozzarella, diced
* 2 TBSP basil pesto
* 2 TBSP balsamic reduction

How to make basil pesto:

* 1 cup basil, packed
* 1 clove garlic
* 2 TBSP pine nuts, toasted
* 1/4 cup parmigian, grated
* 3 TBSP olive oil
* 1 TBSP lemon juice
* Salt and peper to taste

Place everything in a food processor and blend. Carbs: 0.4 g

How to make balsamic reduction:

Simmer balsamic vinegar until it reduces to 1/2 to 1/4 or the desired thickness and let cool before using. (Although balsamic vinegar is usually contra-indicated in diabetic patients, in this recipe it is very sparingly used.)


Plate the avocado on the salad greens and top with the mixture of the tomato, mozzarella and pesto, followed by a drizzle of the balsamic reduction.

*If allergic to cow dairy, can try goat cheeses.

Calories: 257
Fat: 22 g
Carbs: 11.4 g
Fiber: 7.5 g
Net carbs: 3.9 g
Protein: 6.5 g