Health Journal Online

Tag: Diabetes

  • Potatoes and Diabetes: It’s Complicated

    Potatoes and Diabetes: It’s Complicated

    Does the link between white potatoes and diabetes extend to non-fried potatoes without butter or sour cream?

    The trouble for white potatoes began in 2006, when the Harvard Nurses’ Health Study, which had followed the diets and diseases of tens of thousands of women for 20 years, found that greater potato intake was associated with a greater likelihood of getting type 2 diabetes. However, of the hundred or so pounds of potatoes Americans eat every year, most are in the deep-fried forms of potato chips, french fries, or other processed products. What happened when they looked specifically at mashed or baked potatoes? They found the same link with diabetes. Okay, but what might potato eaters eat more of? Maybe I should rephrase that: What might meat-and-potatoes people eat more of? Indeed, people who ate more potatoes ate more meat, and we know that animal protein may be associated with increased diabetes risk. But the researchers tried to statistically adjust for that and still found increased risk with potatoes.

    Well, what do people put on baked and mashed potatoes? Butter and sour cream. Again, the researchers tried to adjust for other dietary factors like these as well as effectively looking at the ratio between plant and animal fats and whether potato eaters drank more soda or maybe skimped on other vegetables. Yet, still, there seemed to be this association between potatoes and diabetes.

    Okay, but that was just one study. By 2015, Harvard researchers had also looked into other cohorts, including the all-male Health Professionals Follow-up Study to complement the all-female Nurses’ studies, and they continued to find a small increased diabetes risk associated with baked, boiled, or mashed potatoes, though french fries do indeed appear nearly five times worse. The authors concluded that potatoes are considered to be a healthy vegetable in dietary guidelines, but the current evidence “casts serious doubts on this classification.” Walter Willett, the chair of Harvard’s nutrition department at the time, went a step further, suggesting potatoes should be siloed up there with candy, as you can see below and at 2:18 in my video Do Potatoes Increase the Risk of Diabetes?.

    A meta-analysis of potato consumption and risk of type 2 diabetes published in 2018 combined all six of the prospective studies that had been done to date, and the researchers found about a 20% increase in diabetes risk associated with each serving of potatoes a day, concluding “[l]ong-term high consumption of potato…may be strongly associated with increased risk of diabetes.” But, again, the great majority of the potatoes consumed were fried, and we know deep-fried foods contain all sorts of nasty things, like advanced glycation end-products. The researchers weren’t able to assess french fries versus non-fried potatoes. Even just three servings of fries a week is associated with nearly 20% greater risk of type 2 diabetes, whereas there was only a tiny associated risk with potatoes in general, and that included the fries mixed in.

    The world’s largest manufacturer of frozen french fries took issue with this conclusion. Claiming to make one in three fries eaten on planet Earth to the tune of billions of dollars, the company has the money to fund reviews to cast doubt on the science. One review said that the scientific literature should be read with caution because the impact of potatoes on disease risk factors may depend on the foods they’re grouped with as part of a dietary pattern. Indeed, they do have an actual point. Observational studies can never prove cause and effect, and maybe potato consumption—even baked potato consumption—may just be a marker for an unhealthy diet in general. As much as researchers try to adjust for these other factors, as the journal of the Potato Association of America is quick to remind us, it’s not possible to separate the effects of potatoes and fries from the effects of the overall crappy Standard American Diet.

    Is there a country where potato consumption is associated with a healthy diet? If potato consumption was still associated with diabetes there, then that would be concerning. Enter a seventh study, but this time out of Iran, where most potato consumption is of boiled potatoes. In fact, those who ate potatoes had the healthiest diets and ate the most whole plant foods—fruits, vegetables, legumes, and whole grains. And though the researchers tried to tease out those other dietary factors, those eating the most boiled potatoes had only half the odds of developing diabetes. This supports the notion that it may be hard to completely separate out just the potatoes. The bottom line, this systematic review concluded, is that we really don’t have “convincing evidence” that the intake of potatoes in general is linked to type 2 diabetes, but we should still probably hold the fries.

    Doctor’s Note

    This is the first in a five-part series on potatoes. Stay tuned for:

    Interested in a sampling of diabetes videos? Check out the related posts below.



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  • Diabetes Reversal Roadmap

    Diabetes Reversal Roadmap

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  • Is Fasting an Effective Treatment for Diabetes?

    Is Fasting an Effective Treatment for Diabetes?

    By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

    Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

    More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

    Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

    “Poor diabetic people’s medicine
    He should live like a saint (Munni);
    He should walk for 800–900 miles.
    Or he shall dig a pond;
    Or he shall live only on cow dung and cow urine.”

    That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

    Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

    Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

    As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

    When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

    The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

    With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

    Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

    To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

    Doctor’s Note

    Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

    For more on fasting for disease reversal, see:

    Fasting is not the best way to lose weight. To learn more, see related posts below.

    What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.



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  • Is Surgery Necessary to Reverse Diabetes?

    Is Surgery Necessary to Reverse Diabetes?

    Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

    The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

    After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

    One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

    The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

    Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video. 

    The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

    Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

    Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

    What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

    Doctor’s Note

    This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)



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  • Early Diabetes Symptoms Years Before Diagnosis

    Early Diabetes Symptoms Years Before Diagnosis

    Prediabetes is a condition where blood sugar levels are elevated, but not yet high enough to qualify as diabetes. Many people remain unaware they have prediabetes because early warning signs are often subtle or easily dismissed. Recognizing prediabetes signs early—when the body first begins to struggle with glucose regulation—can give individuals a chance to reverse the trend before full-blown diabetes develops.

    Spotting early diabetes symptoms and blood sugar warning signs can lead to timely lifestyle changes, better monitoring, and professional intervention. This awareness becomes especially important as uncontrolled blood sugar levels, even in prediabetes, can quietly damage the body over time.

    Common Early Diabetes Symptoms to Watch For

    Some of the more noticeable early symptoms of elevated blood sugar mirror those of diabetes itself. These include:

    • Increased thirst and frequent urination — When blood glucose rises, the kidneys work harder to filter out excess sugar, causing the body to excrete more water. This imbalance leads to dehydration, prompting frequent urges to drink and urinate. According to the Mayo Clinic, people with prediabetes may notice persistent thirst and frequent urination even before a diabetes diagnosis.
    • Fatigue and blurred vision — Because cells become less responsive to insulin, glucose can’t enter cells efficiently for energy. The resulting energy shortage triggers fatigue, even after normal rest. Blurred vision can occur as elevated glucose affects fluid levels in the lens of the eye.
    • Unexplained hunger and weight changes — Insulin resistance can impair the body’s ability to use glucose properly, leading to persistent hunger despite adequate food intake. Some people may gain weight, while others might experience unintended weight changes.

    Recognizing these as early diabetes symptoms is important—especially if they occur together or persist.

    Blood Sugar Warning Signs That Indicate Prediabetes

    Beyond the more obvious symptoms, prediabetes can also manifest through less obvious—but still significant—physical changes. Watch for the following blood sugar warning signs:

    • Darkened skin patches (Acanthosis Nigricans) — This condition causes velvety, darkened skin on the neck, armpits, groin, or other folds. Because it signals insulin resistance, it’s one of the more visible prediabetes signs.
    • Tingling or numbness in hands or feet — Early nerve irritation or damage may occur due to chronically elevated blood sugar levels, even before full diabetes develops. This can feel like tingling, “pins and needles,” or numbness.
    • Slow-healing wounds and increased infections — High blood sugar can impair immune function and circulation, slowing down wound healing and increasing susceptibility to infections or skin problems.

    Based on information from the Cleveland Clinic, several physical changes can reveal that blood sugar has been elevated for months—or even years. Because these symptoms may appear years before any formal diagnosis, they offer an early window for intervention.

    Prevention, Early Detection, and When to Seek Medical Help

    Because prediabetes often has no obvious symptoms, regular screening is important if risk factors are present — such as overweight/obesity, sedentary lifestyle, family history of diabetes, or metabolic syndrome. According to the National Institute of Diabetes and Digestive and Kidney Diseases , early detection and preventive strategies significantly reduce the risk of progressing to type 2 diabetes.

    Preventive measures start with lifestyle changes. A balanced diet rich in vegetables, lean protein, whole grains, and low-sugar foods helps stabilize blood sugar. Exercise—particularly walking, strength training, or cycling—improves insulin sensitivity and helps the body use glucose more efficiently. Maintaining a healthy weight also plays a crucial role in regulating blood sugar levels.

    Monitoring symptoms is essential. If individuals notice signs such as fatigue, increased thirst, dark skin patches, or slow-healing wounds, they should request a blood test. The most common tests include the A1C test, fasting glucose test, and oral glucose tolerance test. These tests help confirm whether someone is experiencing prediabetes. Knowing when to seek medical help can prevent serious complications. If symptoms worsen or persist, or if an individual has risk factors such as obesity, family history, or gestational diabetes, early evaluation is recommended. Health professionals can also guide patients through lifestyle changes and, in some cases, prescribe medications to help control blood sugar.

    Conclusion

    Prediabetes often develops quietly, with prediabetes signs and blood sugar warning signs appearing years before diagnosis. By paying attention to early symptoms — increased thirst, frequent urination, fatigue, skin changes, slow healing, or tingling — individuals can catch metabolic changes early. Regular screening and timely early diabetes symptoms detection give a critical window for lifestyle intervention. Adopting healthier habits — a balanced diet, regular exercise, maintaining weight, managing stress — can often reverse prediabetes and prevent the onset of full-blown type 2 diabetes. The sooner you act, the better your chances of staying healthy, avoiding complications, and protecting your long-term well-being.

    Frequently Asked Questions

    1. Can prediabetes be reversed with lifestyle changes?

    Yes — many people with prediabetes can reverse glucose abnormalities through healthy eating, regular exercise, and weight loss, preventing progression to type 2 diabetes.

    2. How often should blood sugar be tested if prediabetes is suspected?

    If you have risk factors or experience warning signs, it’s wise to get tested annually or more frequently, as advised by your healthcare provider.

    3. What diet and exercise routines help prevent progression to diabetes?

    A diet high in vegetables, fiber, whole grains, lean protein, and low in processed foods and sugar helps stabilize blood sugar. Pairing that with regular moderate-intensity exercise (e.g., brisk walking, cycling, swimming) for at least 150 minutes per week is highly effective.

    4. Are there medications recommended for prediabetes management?

    Lifestyle interventions remain the first-line approach, but some doctors may prescribe medications to help control blood sugar if lifestyle changes alone are insufficient — especially for individuals at high risk or with additional health conditions.



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  • Diabetes Symptoms and Prediabetes Signs Most People Overlook — Early Warnings for Type 2 Diabetes

    Diabetes Symptoms and Prediabetes Signs Most People Overlook — Early Warnings for Type 2 Diabetes

    Diabetes is a chronic health condition affecting millions globally. Early recognition of diabetes symptoms and prediabetes signs is crucial to prevent progression to type 2 diabetes and avoid serious complications. Many warning signs are subtle and often overlooked, leading to delayed diagnosis. This article highlights overlooked diabetes symptoms, prediabetes indicators, and type 2 diabetes early symptoms to watch for.

    Commonly Overlooked Diabetes Symptoms

    Some diabetes symptoms are easy to miss due to their mild or gradual onset:

    • Frequent urination and increased thirst indicate elevated blood sugar, causing kidney stress and dehydration.
    • Extreme hunger despite regular eating signals an impaired ability to use glucose.
    • Fatigue and reduced energy occur when cells struggle to absorb glucose.
    • Blurred vision results from fluctuating fluid levels affecting the eyes.
    • Slow healing of cuts and wounds reflects a compromised immune response.
    • Tingling, numbness, or pain in hands and feet (diabetic neuropathy) develops from nerve damage.
    • Unintentional weight loss despite increased appetite can be a warning.
    • Dry skin, itching, and frequent infections, including gum problems, may be signs.
    • Changes in sweating patterns, either excessive or reduced perspiration, can occur.

    These symptoms indicate elevated blood sugar and require medical evaluation.​

    Prediabetes Signs to Watch For

    Prediabetes occurs when blood sugar levels are higher than normal but not yet diabetic. Often symptomless, some signs include:

    • Darkened skin patches on neck, armpits, or groin (acanthosis nigricans).
    • Increased thirst and frequent urination.
    • Fatigue and irritability, resulting from blood sugar fluctuations.
    • Tingling or numbness in extremities indicates early nerve damage.
    • Slow wound healing and frequent infections.

    Recognizing these signs can prompt early lifestyle changes to prevent type 2 diabetes.​

    Early Symptoms Specific to Type 2 Diabetes

    Type 2 diabetes symptoms often develop slowly and may be unnoticed initially:

    • Increased thirst, frequent urination (especially at night).
    • Persistent fatigue, sometimes after meals.
    • Blurred vision.
    • Numbness or tingling in hands or feet.
    • Unexplained weight loss.
    • Frequent infections and skin conditions.

    These symptoms are the body’s signals that blood sugar regulation is impaired.​

    Why These Warning Signs Are Often Missed

    Many diabetes symptoms overlap with common health issues or aging effects. Mild symptoms are often misattributed to stress, fatigue, or lifestyle factors. Lack of routine blood sugar screening contributes to underdiagnosis. Awareness and education are key to identifying these signs early for timely intervention.​

    When to See a Doctor

    Individuals experiencing any combination of these symptoms should seek medical evaluation, including blood sugar testing. Early diagnosis allows for lifestyle modifications and medical treatments to prevent progression and complications. Regular screening is essential for those with risk factors like obesity, family history, or a sedentary lifestyle.​

    Long-Term Complications of Diabetes

    If unnoticed or unmanaged, diabetes can lead to serious long-term complications affecting various organs and systems:

    • Cardiovascular Damage: Diabetes increases the risk for heart attack, stroke, and peripheral artery disease by damaging large blood vessels (macrovascular complications).
    • Kidney Disease: Diabetes may damage the kidneys’ filtering ability (nephropathy), potentially leading to dialysis or transplant.
    • Eye Problems: Diabetic retinopathy can cause vision loss; cataracts and glaucoma are more common in older age.
    • Nerve Damage: Neuropathy causes numbness, tingling, pain, and loss of sensation, often starting in the feet and hands, increasing the risk of infection.
    • Foot Problems: Reduced sensation and blood flow can lead to ulcers, infections, and, in severe cases, amputation.
    • Other Effects: Diabetes can impair immune function, increase risk for gum disease, sexual dysfunction, gastrointestinal issues, and is linked with depression and dementia.

    These complications underscore the importance of early detection and consistent management to minimize damage and maintain quality of life.​

    Preventing Progression and Managing Diabetes

    Early identification of symptoms can lead to proactive management:

    • Lifestyle Changes: Healthy diet, physical activity, and weight management can delay or prevent the progression from prediabetes to type 2 diabetes, according to the Centers for Disease Control and Prevention.
    • Medication: When appropriate, medications help control blood sugar and reduce risks.
    • Regular Monitoring: Routine blood sugar, blood pressure, cholesterol checks, and screening for organ damage.
    • Patient Education: Awareness of symptoms and risks helps patients seek timely care.

    Effective management reduces risk of complications and improves long-term outcomes.​

    Recognizing overlooked diabetes symptoms, prediabetes signs, and type 2 diabetes early symptoms can save lives and reduce complications, according to the World Health Organization. Increased thirst, frequent urination, fatigue, numbness, and slow healing should never be ignored. Early medical consultation and proactive health management provide the best outcomes in diabetes care.

    Frequently Asked Questions

    1. How do diabetes symptoms in children differ from those in adults?

    Diabetes symptoms in children, especially type 1 diabetes, often appear suddenly and more intensely than in adults. Children may show rapid weight loss, increased appetite, extreme thirst and frequent urination, including bedwetting in previously dry children. Fatigue and mood swings are also common. In contrast, adults, particularly with type 2 diabetes, tend to develop symptoms gradually over years, making early detection more difficult. Early recognition in children is critical to prevent serious complications like diabetic ketoacidosis.​

    2. Can type 2 diabetes occur in children, and if so, how are the symptoms different?

    Yes, type 2 diabetes is increasingly diagnosed in children, often developing gradually. Symptoms resemble those of type 1 diabetes, such as increased thirst, urination, hunger, fatigue, blurred vision, and darkened skin patches, but may be less noticeable. Unlike type 1, unintentional weight loss is less common in children with type 2 diabetes. Early diagnosis in children is essential to initiate lifestyle changes and medical treatment.​

    3. What role does diabetic neuropathy play in overlooked diabetes symptoms?

    Diabetic neuropathy, or nerve damage caused by high blood sugar, can start with subtle symptoms like tingling, numbness, or mild pain in the hands and feet. These sensations might be dismissed as normal aging or minor injuries. Over time, neuropathy can lead to loss of sensation, increasing risks of unrecognized injuries and infections, especially in the feet. Recognizing early nerve-related symptoms is essential for preventing severe complications.​

    4. How does early fatigue associated with diabetes differ from regular tiredness?

    Fatigue linked to diabetes results from the body’s impaired ability to use glucose for energy, even if a person has eaten enough food. This fatigue is persistent and may occur alongside other symptoms, such as increased thirst and frequent urination. Unlike typical tiredness that improves with rest, diabetes-related fatigue can be chronic and unrelenting until blood sugar levels are controlled. Awareness of this difference can aid earlier diagnosis.



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  • Sonu’s Diabetes Secret

    Sonu’s Diabetes Secret

    Product Name: Sonu’s Diabetes Secret

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  • What About Millet and Diabetes? 

    What About Millet and Diabetes? 

    What were the remarkable results of a crossover study randomizing hundreds of people with diabetes to one and a third cups of millet every day? 

    How does millet come to the help of people with diabetes? A substantial portion of the starch in millet is resistant starch, meaning it’s resistant to digestion in our small intestine so it provides a bounty for the good bugs in our colon. Below and at 0:28 in my video The Benefits of Millet for Diabetes is a table showing how the various millets do. As you can see, they’re all much higher in resistant starch than more common grains, like rice or wheat, but proso and kodo millets lead the pack. 

    What’s going on? The protein matrix in millet not only acts as a physical barrier but also partially sequesters our starch-munching enzyme, and the polyphenols in millet can also act as starch blockers themselves.

    Millet has markedly slower stomach emptying times than other starchy foods, too. When we eat white rice, boiled potatoes, or pasta, our stomach takes about an hour to digest it, before it begins to slowly release it into our intestines, and it takes about two or three hours to empty about halfway. When we eat sorghum or millet, though, stomach emptying doesn’t even start for two or three hours and it may take five hours to empty just halfway, as you can see below and at 1:22 in my video. 

    Note that this was the case with both a thick millet porridge and a millet couscous. “The non-viscous millet couscous meal was also equally slow in [stomach] emptying. This suggests that there is an intrinsic property” of millet itself that helps slow down the rate of stomach emptying, which should blunt the blood sugar spike. What happened when it was put to the test? 

    Indeed, millet caused about a 20 percent lower surge in blood sugar than the same amount of carbohydrates in the form of rice. Remember how excited I was to show you how it only took the body about half the insulin to handle sorghum compared to a grain like corn? Well, millet did even better, as seen here and at 2:07 in my video.

    When a group of prediabetic individuals were given about three quarters of a cup of millet a day, within six weeks, their insulin resistance dropped so much that their prediabetic fasting blood sugars turned into non-prediabetic blood sugars, as shown below and at 2:22 in my video. 

    This “self-controlled clinical trial,” with the same subjects before and after, is just a sneaky way of saying it’s an uncontrolled trial. There was no control group in which participants either didn’t add the millet or added something else, and we know that just being under scrutiny in a study can cause people to eat better in other ways. So, we don’t know what role, if any, the millet itself played. What we need is a randomized, controlled, crossover trial where the same people eat diets with and without millet so we can see which works better. And here we go: a randomized, crossover study with hundreds of patients following an American Diabetes Association-type diet with and without about one and a third cups of millet every day. Researchers found that the millet-based diet lowered hemoglobin A1C levels, meaning there was an improvement in long-term blood sugar control, as well as the achievement of some side benefits like lowering cholesterol. 

    The target for good blood sugar control recommended by the American Diabetes Association is an A1C of less than 7. The participants started out at 8.37, but after a few months on millet, their A1C dropped to an average of 6.77, as seen here and at 3:35 in my video. 

    Is it just because they lost weight? No, which suggests it was an effect specific to the millet. The researchers didn’t just give them millet, though. They mixed the millet with split black lentils and spices, and we know from dozens of randomized, controlled experimental trials in people with and without diabetes that consuming pulses—beans, split peas, chickpeas, and lentils—can improve long-term measures of blood sugar control like A1C levels. So, while the researchers “concluded that millets do have a potential for a protective role in the management of diabetes,” a more accurate conclusion might be a mix of millets and lentils can be protective. The spices may have helped, too. The researchers didn’t say which spices were used, and I couldn’t get in contact with the authors, but a similar study done by one of the same researchers included about a daily tablespoon of a mixture of fenugreek, coriander, cumin, and black pepper, with a fifth spice, perhaps cinnamon or turmeric. 



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  • What About Diabetes, Blood Pressure, Blood Sugar, and More?

    What About Diabetes, Blood Pressure, Blood Sugar, and More?

    There are so many ways we eat potatoes—baked, mashed, hashed, fried, scalloped, roasted, and more—but should we be eating them at all?

    Potatoes and Diabetes

    In 2006, the Harvard Nurses’ Health Study, which had followed the diets and diseases of tens of thousands of women for 20 years, found that greater potato intake was associated with a greater likelihood of getting type 2 diabetes, but of the hundred or so pounds of white potatoes Americans eat every year, most are deep fried and consumed as potato chips or french fries, and deep-fried foods are known to contain advanced glycation end products (AGEs), which we know are unhealthful. Researchers have found that just three servings of french fries a week is associated with a nearly 20 percent greater risk of type 2 diabetes, whereas there was only a tiny associated risk with potatoes in general, including fries.

    There was still a diabetes link with mashed or baked potatoes, but people who eat more potatoes may eat more meat, and we know that animal protein is itself associated with increased diabetes risk. However, when researchers statistically adjusted for that, they still found an increased risk with potatoes.

    Looking deeper, butter and sour cream are often put on mashed and baked potatoes, but when researchers tried to adjust for those and other such dietary factors, as well as effectively looking at the ratio between plant and animal fats and whether potato-eaters drank more soda or skimped on other vegetables, there still there seemed to be a potato-diabetes association.

    By 2015, Harvard researchers had also looked into other cohorts, including the all-male Health Professionals Follow-Up Study to complement the all-female Nurses’ studies, and continued to find a small increased diabetes risk associated with baked, boiled, or mashed potatoes––though french fries appear nearly five times worse. The authors concluded that potatoes are considered to be a healthful vegetable in the Dietary Guidelines, though current findings cast serious doubts on that classification. (Walter Willett, the then-chair of Harvard’s nutrition department, went a step further, suggesting potatoes should be siloed with candy.)

    Then, in 2018, a meta-analysis published on potato consumption and risk of type 2 diabetes combined all six of the prospective studies that had been done to date and found about a 20 percent increase in diabetes risk associated with each serving of potatoes a day. The researchers concluded that long-term, high consumption of potato may be strongly associated with increased risk of diabetes.

    Does the story end there? If only there were a country where potato consumption was associated with a healthy diet. If potato consumption was still associated with diabetes there, then that would be concerning. As I discuss in my video Do Potatoes Increase the Risk of Diabetes?, a study out of Iran found that those eating the most boiled potatoes had only half the odds of developing diabetes. In Iran, not only is most of the potato consumption in the form of boiled potatoes, but those who eat potatoes have the healthiest diets and eat the most whole plant foods, such as fruits, vegetables, whole grains, and beans.

    The bottom line is we don’t have convincing evidence to date that the intake of potatoes in general is linked to type 2 diabetes, but we should still probably hold the fries.

    Potatoes and High Blood Pressure

    What about potatoes and hypertension? And death? I dive into those topics in my video Do Potatoes Increase the Risk of High Blood Pressure and Death?.

    Harvard researchers found that individuals who, on most days, ate potatoes—baked, boiled, or mashed, and not just french fries and potato chips—appeared to be at higher risk of developing high blood pressure. As mentioned above, salt and butter are often added to potatoes, but when they attempted to tease out the effects of salt and saturated fat, there still seemed to be a link between potato consumption and high blood pressure.

    Again, though, what about the “meat” in “meat and potatoes”? The same Harvard researchers found that meat, including poultry alone, appeared associated with an increased risk of hypertension, as did a moderate amount of canned tuna. So, in the potato study, they endeavored to factor out any effects from the consumption of all types of meat yet still found an increased risk of hypertension associated with potato intake.

    Two similar studies performed in Mediterranean Europe did not find any association between potato consumption and high blood pressure, though. Perhaps this is because, in that area of the world, potatoes aren’t typically smothered in butter and sour cream, and potatoes are often eaten with other vegetables.

    So, Are Potatoes Bad for Us?

    A primary reason we care about blood pressure is because we care about the consequences. In two studies done in Sweden, where they primarily eat their potatoes boiled, no evidence was found that potato consumption was associated with the risk of major cardiovascular disease; no relationship was found between potato consumption and risk of premature death in Southern Italy either. In the United States, though, potato consumption has been associated with increased mortality: a 65 percent increased risk of dying from heart disease, a 26 percent increased risk of fatal stroke, a 50 percent increased risk of dying from cancer, and increased risk of dying from all causes put together. However, all of that disappeared after adjustment for confounding factors. In other words, it wasn’t the potatoes at all. People who eat potatoes must just smoke more, drink more, or eat more saturated fat, for instance. Once all such other factors are considered, the link between potatoes and death disappears.

    This was confirmed in the NIH-AARP study, the largest such study of diet and health in human history. If you just separate out the potatoes, researchers find they are not associated with increased risk of death—with the possible exception of french fries, which are associated with an increased risk of dying from cancer. Put all the studies together—20 in all—and no significant association has been found between potato consumption and mortality, though, again, fried potatoes may be the exception. Even if eaten just twice a week, fries may double one’s risk of dying prematurely, independently of other factors, but the consumption of unfried potatoes seemed to be neutral. (In terms of mortality, fried potatoes may not be as bad as fried meat—think fried chicken and fried fish—but that’s not saying much.)

    Other whole plant foods—nuts, vegetables, fruits, and legumes (beans, split peas, chickpeas, and lentils)—are associated with living a longer life and significantly less risk of dying from cancer, dying from cardiovascular diseases like heart attacks, and 25 percent less chance of dying prematurely from all causes put together. However, no such protection is gained from potatoes for cancer, heart disease, or overall mortality. So, the fact that potatoes don’t seem to affect mortality can be seen as a downside. Remember, though, that potatoes aren’t like meat, which may actually actively shorten lifespan, but there may be an opportunity cost to eating white potatoes, since every bite of a potato is a lost opportunity to eat something even healthier—something that may actively enhance our lifespan.

    So, potatoes are kind of a double-edged sword. The reason that potato consumption may just have a neutral impact on mortality risk is that all the fiber, vitamin C, and potassium in white potatoes might be counterbalanced by the detrimental effects of their high glycemic index, which I discuss in my video Glycemic Index of Potatoes: Why You Should Chill and Reheat Them. Not only are high glycemic impact diets robustly associated with developing type 2 diabetes, but current evidence suggests that this relationship is cause-and-effect.

    The Potato Glycemic Index

    Foods with a glycemic index (GI) above 70 are classified as high-GI foods, and those with a GI lower than 55 are low-GI foods. Pure sugar water, for example, is often standardized at 100, and white bread and white potatoes are high glycemic index foods.

    Is there any way we can lower the glycemic index of potatoes? When potatoes are boiled, then cooled in the refrigerator, some of the starch crystallizes into a form that can no longer be broken down by the starch-munching enzymes in our gut. When put to the test, researchers actually saw a dramatic drop in glycemic index in cold versus hot potatoes. So, by consuming potatoes as potato salad, for instance, we can get nearly a 40 percent lower glycemic impact. The chilling effect might, therefore, also slow the rate at which the starch is broken down and absorbed. So, individuals wishing to minimize dietary glycemic index may be advised to precook potatoes and consume them cold or reheated. The downside of eating potatoes cold is that they might not be as satiating as eating hot potatoes, but we may get the best of both worlds by cooling them and then reheating them, which is exactly what was done in a famous study I profiled in my book How Not to Diet. The single most satiating food out of the dozens tested was boiled then cooled then reheated potatoes.

    There’s an appetite-suppressing protein in potatoes called potato protease inhibitor II, but the way potatoes are prepared makes a difference. Both boiled and mashed potatoes are significantly more satiating than french fries. That was for fried french fries, though. What about baked fries? Individuals had a big drop in appetite after eating boiled mashed potatoes, compared to white rice or white pasta, which is right where fried french fries were, as well as baked french fries.

    Do Potatoes Spike Our Blood Sugar?

    White potatoes have a high glycemic index, as I mentioned, and consumption of high glycemic impact foods may increase the risk of diabetes. Normally after a meal, we’d like our blood sugars to just gently, naturally rise and fall, but with high glycemic foods like potatoes, we can get an exaggerated blood sugar spike. That leads our body to over-compensate with insulin, forcing our blood sugars lower than when we started, which results in negative metabolic consequences––such as a rise in triglyceride fats in the blood. However, potatoes are a good source of potassium, vitamin C, and polyphenols, which may counterbalance the glycemic impact. This may explain why potatoes appear to have a neutral effect when it comes to lifespan, unlike other whole plant foods that have been associated with actively living longer.

    How to Reduce the GI of Potatoes

    Aside from the chill-and-reheat method to dramatically lower the glycemic index of white potatoes, is there another way? Yes, and it’s the same way we make everything better in our nutritional life: Add broccoli. As I detail in How to Reduce the Glycemic Impact of Potatoes, the co-consumption of two servings of cooked broccoli with mashed potatoes immediately cuts the insulin demand by nearly 40 percent. In contrast, adding chicken breast makes matters worse, and adding tuna fish is even worse still, nearly doubling the amount of insulin our body pumps out.

    Why does plant protein make things better, but animal protein make things worse? Because decreased consumption of branched-chain amino acids improves metabolic health. I cover this in my book How Not to Diet, as well as my video on the topic.

    Something else can help, too: vinegar. Simply chilling potatoes may cut down on blood sugar and insulin spikes, but to get significant drops in both, just add about a tablespoon of vinegar (even plain white distilled vinegar) to drop levels by 30 to 40 percent. Just one to two tablespoons a day of vinegar diluted in water can significantly improve both short- and long-term blood sugar control in people with diabetes, which is why clinicians may want to incorporate vinegar consumption as part of their dietary advice for their patients with diabetes.



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  • Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Obesity’s Impact on Back Pain, Blood Pressure, Cancer, and Diabetes 

    Losing weight can reduce sciatica, hypertension, and cancer risk, as well as reverse type 2 diabetes.

    In the ABCs of the health consequences of obesity, A is for Arthritis, as I discussed in my previous blog post, and B is for Back Pain. Being overweight is not just a risk factor for low back pain, but it is also a risk factor for sciatica (a radiating nerve pain), as well as degenerating lumbar discs and disc herniation. Similar to what we learned in the arthritis story, this may also be due to a combination of the excess weight, high cholesterol, and inflammation associated with being overweight. Why cholesterol? Studies of autopsies and angiographies show that the lumbar arteries that feed our spine can get clogged with atherosclerosis and starve the disks in our lower back, as you can see below and at 0:47 in my video The Effects of Obesity on Back Pain, Blood Pressure, Cancer, and Diabetes. 

    B is also for Blood Pressure. Excess visceral fat—for example, internal abdominal fat—can physically compress our kidneys. The increased pressure can effectively squeeze sodium back into our bloodstream, increasing our blood pressure. Together, the combination of obesity and hypertension can have “disastrous health implications,” but the good news is that just a few pounds of weight loss can help take off the pressure. Losing excess weight has been described as “a vital strategy for controlling hypertension.” In fact, researchers found that losing around nine pounds (4 kg) may lower blood pressure about as much as cutting salt intake approximately in half can.

    C is for Cancer. As many as three-quarters of people surveyed “were unaware that being overweight or obese increased a person’s risk of cancer,” when, in fact, based on a comprehensive review of more than a thousand studies, excess body fat raises the risk of most cancers, including esophageal, stomach, colorectal, liver, gallbladder, pancreatic, breast, uterine, ovarian, kidney, brain, thyroid, and bone marrow (multiple myeloma) cancers, as you can see below and at 2:00 in my video.

    It could be the chronic inflammation of obesity or perhaps it is the high insulin levels due to insulin resistance. (Besides controlling blood sugars, insulin is also “a potent growth factor” that can promote tumor growth.) In women, it could also be the excess estrogen.

    After the ovaries shut down at menopause, fat takes over as the principal site of estrogen production. That’s why women who are obese have up to nearly twice the estrogen levels circulating in their bloodstream, which is associated with an increased risk of developing breast cancer and dying from it. The data on prostate cancer aren’t as strong, though obesity is associated with increased risk of invasive penis cancer. 

    One of the reasons we’re confident the link between obesity and cancer is cause-and-effect—and not just an indirect consequence of eating poorly—is that the overall risk of cancer goes down when people lose weight, even through bariatric surgery. Researchers found that those experiencing a sustained weight loss of about 40 pounds (19.9 kg) after surgery went on to develop around one-third fewer cancers over the subsequent decade, compared with matched individuals in the nonsurgical control group who continued to slowly gain weight over time. The exception, though, is colorectal cancer. 

    “Colorectal cancer is the only known malignancy where the risk of being diagnosed with disease seems to increase after obesity surgery.” Indeed, after bariatric surgery, the rate of rectal cancer death may triple. The rearrangement of anatomy involved in one of the most common surgeries—Roux-en-Y gastric bypass—is thought to increase bile acid exposure along the intestinal lining. This causes sustained pro-inflammatory changes even years after the procedure, which is thought responsible for the increased cancer risk. In contrast, losing weight by dietary means has the potential to decrease obesity-related cancer risk across the board.

    D is for Diabetes. As presented in a consensus statement from the International Diabetes Federation, obesity is considered the single most important risk factor for the development of type 2 diabetes, which is the leading cause of kidney failure, lower-limb amputations, and adult-onset blindness. Ironically, many of the leading drugs used to treat diabetes (including insulin itself) cause further weight gain, creating a vicious cycle. 

    So, again, using lifestyle medicine to treat the underlying cause is not only safer, simpler, and cheaper, but can also be most effective.

    If you missed my previous video, check out The Best Knee Replacement Alternative for Osteoarthritis Treatment.

    Coming up next? See related posts below.

    I continue the topic of weight control with these videos that may be of interest to you: Is the Obesity Paradox Real or a Myth? and Friday Favorites: What’s the Ideal BMI and Waist Size?.

    For more on back pain, blood pressure, cancer, and diabetes, check out their topic pages. 



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