Tom was eager to learn more about my approach to diabetes reversal. I explained that 15-20 percent weight loss was usually sufficient to achieve remission of type 2 diabetes, and a 10% weight loss was usually sufficient to reduce the A1c about three-quarters of the way toward remission. In his case a 20% weight loss would be 44 pounds, a reduction from 220 pounds down to 176. He agreed that would be an appealing weight. If he was fortunate, even a 30 pound loss might be enough for remission but we would not know until he got that far. To lose the weight he would obviously have to change his eating and exercise, and to find the right balance between effectiveness and sustainability. Too strict and he would not be able to sustain. Too lax and he would not achieve sufficient weight loss.
I described the approach that worked best for me – 90% dietary adherence plus 7 hours of exercise per week. Up to 10% of the amount of food he ate each week could be “treats” which I consider to be unhealthy food, and the remainder should come from the healthy food list. We went down the list of healthy foods together so I could get a good understanding of his food preferences, and so he could understand what I considered to be healthy. I explained I did not intend to push him to eat any foods he disliked, but wanted him to know all the foods I considered to be healthy and would help him achieve weight loss and diabetes reversal. We spent about 30 minutes discussing the food, and we brainstormed together to identify a few examples of breakfasts, lunches, dinners, and snacks that would probably work for him. He said his wife wanted to help him and was interested in finding new approaches to cooking for the whole family. He explained that 7 hours of exercise would be extremely challenging, given his other obligations and time constraints, and I asked him to spend the next week thinking it over. I also asked him to keep a food record, including food amounts and calories. I explained how to estimate food portions without using measuring cups or a food scale, by comparing the food volume to his palm diameter and thickness (6 ounces) or to his clenched fist (1 cup). I recommended getting a calorie counting book. I explained that patients who follow this plan typically reach weight losses of around 10% in 3 months, and in his case, I predicted such a weight loss of around 22 pounds would drop his A1c from 7.3% to 6.4%. Another 10-20 pounds beyond that, at the 6 to 9 month point, and he’d likely be in remission.
He left the office exuding an optimism that was sorely lacking when we first met. I had encouraged him to simply prepare, psychologically and logistically, during the 7 days until our next appointment. He discussed everything with his wife and she enthusiastically agreed to support his efforts. She read the diet materials I had given him, and she helped him think through some meals he could eat and she could make. She made arrangements to accompany Tom at the next visit.
They told their children about how important it was to keep their bodies healthy by eating the right foods and exercising. That weekend, instead of going to a restaurant for lunch, the family went on a half-hour walk together to the park and had a picnic lunch and walked home. They cleared the kitchen of as much unhealthy food as possible, and filled it with healthy food. Tom and his wife knew their children would complain about not having treats, such as ice cream, every night after dinner, but they both felt strongly that they had to be better role models and start teaching their children that treats that are unhealthy must be reserved for special occasions and not every meal is a special occasion. It would be hard, but they knew their united approach would stick if they remained focused on keeping themselves and their family healthy. They explained to their children that the doctor reminded them how important it is to keep healthy by eating right and exercising, and that everyone in the family would be expected to do their part to set a good example for the others. There would still be treats, but they would have to get used to eating unhealthy food only at special occasions. Most of what they would be eating would be healthy food. The children were not enthusiastic, but they did seem to respect the reasons why and the united front their parents projected.
Will Tom’s efforts succeed? Will chaos ensue? Stay tuned next week for the final chapter of “A Diabetes Reversal Story”.
—Michael Dansinger, MD
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