Adventist Review editor Bill Knott recently sat down with Dr. Wes Youngberg, a lifestyle medicine and nutrition specialist and occasional
Review contributor, to talk about Youngberg’s new book, “Goodbye Diabetes (Hart Research: Fallbrook, CA) For further informartion go to www.goodbyediabetes.com.”
Knott: Wes, I guess I’m going to start where I think a lot of people will start—with the intriguing title that’s been given to your book. I know that titles aren’t always the author’s invention. But yours has a novel element to it because it seems to go counter to the way many people think about the disease of diabetes. Your title proclaims, Goodbye, Diabetes, as though one can actually look at it in the past as something that has ended in one’s life.
Yes, I think we do a great disservice to someone who is being told about a medical condition when we give the impression that really they can’t do anything about it, that they really are going to be forever under the clutches of their condition, and imply that in the end they are going to suffer because of that. Many times that translates into a state of fatalism, like, OK, so I have diabetes. Well I’ve been told that I’m going to have it for the rest of my life, and I’m going to have to be on medication for the rest of my life.
So they tend to give up. They’ll go to the doctor; they’ll take their medication; but they don’t really believe that they can get back to a state they were in before. Of course, they gradually get worse and end up dying from heart disease or cancer or some other condition that is strongly related to diabetes that’s not aggressively addressed. So the title, Goodbye, Diabetes
was purposely chosen to give hope to individuals who are struggling with a condition that historically has been referred to as incurable.
Was the information you share in this book intended to put good scientific credentials behind the belief that diabetes is reversible?
Yes, absolutely. Doctors are used to seeing individuals with diabetes gradually get worse and die prematurely of a heart attack, stroke, colon cancer, breast cancer, or some type of condition. That’s what we’ve come to expect with diabetes, that it will eventually lead to some complication including blindness, amputation, pneumonia, kidney failure, etc. This book is written primarily to show people how they can avoid all of that. We can absolutely greatly minimize the complications of diabetes; and in most cases, especially if caught early, the diabetes is reversible. It is
reversible. Unfortunately, very few people have taken advantage of this because it takes a lot of effort. It takes a daily willingness to prioritize healthy eating and act on a balanced walking/exercise program. It’s not really that hard, though, once you make the decision that you’re going to give highest priority to doing the things necessary for health and healing to place.
You suggest that the data point to the fact that perhaps as many as a third of the diabetics in the U.S. don’t even know they have the disease.
Yes, the new statistics indicate that about 40 percent of individuals who have diabetes don’t know it.
What’s the issue there? Is this a challenge to the patient or to the medical profession for not diagnosing the condition?
Fortunately, the standard of care in medicine has continued to improve with regard to diagnosis. But wasn’t until 1997 that the criteria for the diagnosis of diabetes improved dramatically. Prior to that time, an individual had to have a fasting blood sugar of 140 or higher to be diagnosed as “diabetic”. Researchers in the late 1990s recognized that many people were already experiencing the complications of diabetes even before they were diagnosed.
Were they in that sense pre-diabetic, or was it the definition of diabetes that needed adjustment?
A fasting blood sugar of 140 or higher was actually the definition of diabetes. So the diabetes is defined by one thing alone, and that is the level of blood sugar or a test that relates to the level of blood sugar. It has nothing to do with anything else. But now, a fasting blood sugar of 126 or higher, or a two-hour blood sugar of 200 or higher yields in a diagnosis. More recently, the third criterion is a hemoglobin A1c reading above 6.4 percent.
Why are at-risk individuals not being diagnosed, in your opinion? Is it that they are trying to ignore what they fear could be true, and thus not asking for the blood tests and the diagnostic procedures?
Well, actually, I don’t think that’s the reason, because anybody who has a yearly physical is going to have what’s called a complete metabolic profile, or at least a basic metabolic profile. Both of those initial standard blood tests include a fasting blood glucose, a fasting blood sugar, taken first thing in the morning before eating breakfast. Also, in 1997 a new criterion was established that identified a condition that we now know as “pre-diabetes.” That is, a blood sugar that is above 99. In other words, having a fasting blood sugar level between 100 and 125, that’s pre-diabetes. Alternatively, if the two-hour blood sugar level, after a sweet drink or a carbohydrate-rich meal, goes above 140, that’s also pre-diabetes. And, of course, if the two-hour blood sugar after a meal goes above 199, that’s full-blown diabetes. We have those newer criteria to consider.
The medical problem is that the two methods used to diagnose diabetes actually operate on different physiologic principles. In other words, an elevated fasting blood sugar relates more to a problem with what’s going on in the liver. The liver is struggling to control blood sugar. And if the fasting blood sugar goes up, it’s a representation that we need to improve the health of the liver, since the liver appears to be contributing to the pre-diabetes and diabetes.
When the after-meal blood sugar goes up excessively, which is the most common problem, in a medical test called the glucose tolerance test—when they’re actually given 75 grams of sugar, equal to 300 calories of carbohydrates in a carbonated drink and they drink that—then the blood sugars are checked two hours later. If that result rises above 139, that represents pre-diabetes. That result, however, is more related to the muscles becoming less sensitive to the work of insulin. And of course, insulin is designed to take sugar from the blood and absorb it into the muscle cells or into the liver. A fasting blood sugar that’s elevated represents resistance to insulin by the liver, or insulin resistance in the liver, but after-meal blood sugar that’s elevated represents muscles that are resistant to insulin.
How widespread is the epidemic of diabetes in the Unites States?
In 1980, only 2.5 percent of the American population had diagnosed diabetes. Today the typical statistic is 8.3 percent, which represents about 26 million Americans. But there is another 40 percent of the population who are undiagnosed. So now we’ve come to realize that, actually, 12.9 percent of the U.S. population has diabetes, if you count those who have probably never been tested. So you go from a total of 26 million to 40 million—you add an additional 14 million persons! And what’s really important to know here, Bill, is that this only represents those with full diabetes. It doesn’t represent those with pre-diabetes yet. And even pre-diabetes doesn’t represent the majority of those who have insulin resistance.
With the dramatically increased incidence of childhood obesity now document, is it then possible predict that a large percentage of these children and teens are going to move rather rapidly from adolescent obesity into adult type 2 diabetes?
Absolutely. And it’s important to note here that this condition is already beginning in their system—this metabolic syndrome, this insulin resistance. It’s already present at a young age. And that’s the problem. The high blood sugars aren’t really the main problem. The main problem is the underlying dysfunctional mechanism in the body that creates all kinds of problems with circulation, problems with hormones, and increases the risk of the most common cancers. The risk of colon cancer goes up 30 percent for diabetics. Lung cancer risk goes up 20 percent. The risk of prostate cancer goes up considerably, as well as pancreatic cancer. These are matters that aren’t being commonly discussed between patients and their physicians. When I use the title, Goodbye, Diabetes,
I might do better to indicate that what this book is really talking about is saying “goodbye” to the underlying mechanisms associated with the majority of diseases. We know that people who have diabetes have a greater risk for autoimmune diseases, a greater risk for heart diseases. In fact, if you have diabetes, you’re twice as likely to die prematurely of a heart attack, and you’re just as likely to have a heart attack as somebody who’s already had a heart attack that doesn’t have diabetes. These are sobering realities and significant challenges!
The good news is that this is reversible! We don’t have to stay in that brokenness, in that dysfunction. We can actually reverse that. And the sooner we start, the greater the possibility of completely reversing the condition.
I’ve noticed, Wes, that your characteristic approach to both lifestyle diseases and lifestyle improvement focuses on the motivational issues that are often at the heart of people’s unwillingness or denial or fatalism. You’ve thought about how to present what you know in a way that actually helps motivate people to make positive change.
Human nature is such that we can get stuck in a rut, and we need to hear the “straight testimony.” Many times doctors, clinicians, will not address the full picture simply because they don’t believe that the patient is really going to do anything about it. I want to make sure that I spend a lot of time educating the patient, helping the patient understand really what’s going on. And as they better understand their circumstances, they start to recognize, Wait a minute! There are things that I could do to actually turn this around!
It’s exciting to see, even those it’s initially uncomfortable for many.
I met with a patient just this week whose wife had “strongly encouraged” him to come and see me after a new diagnosis of diabetes by his family doctor. She was with him at the appointment, and he said, “Man, I feel like I’m at a parent-teacher conference! My parent pulled me in because the teacher wanted me to be there.” And I said, “Well, that’s just the bad news part. The good news part is that we can change this around. You could be making As in no time!”
From what I know of your career, you began working with diabetics in populations that probably had a higher incidence of it than is typical of the U.S. population.
That’s certainly true. My work began in Sun City, California, which is a retirement community. I was working with the Loma Linda University faculty medical group. I eventually ended up spending 14 years on the Pacific island of Guam, which had a severe, severe, epidemic of diabetes, as was true of the majority of the Pacific Islanders. These populations had traditionally been on a very healthy diet that involved mostly local fishing and plant foods. With increased political and economic ties to the U.S., they then started choosing fast foods and processed foods from North America—and they started developing diabetes at alarming rates. What was truly scary was that the death rate from diabetes for these Pacific Islanders was five times higher than that of the U.S. mainland!
Given the scale of the problem on the mainland, that is truly at epidemic proportions!
Early in my service in Guam, the governor of Guam challenged me to head up a task force that was specifically designed to prevent diabetes on Guam. So in considering his assignment, I asked, “How can you prevent a condition that already has complications, even before it’s diagnosed?” Just about that time the new definition of pre-diabetes came out, and on Guam we identified what we called “the five stages of high blood sugar.” This simple approach helped both doctors and patients recognize where they were on this continuum with both fasting and two-hour blood sugars. That effort created a tool for individuals to recognize their risk far earlier than the standard fasting blood sugar test would indicate.
Let’s assume for a moment that a 45-year-old male walks into your office carrying blood work results from his latest physical. Maybe he’s been referred by his internist to talk with you. What is he likely afraid of, and what are you trying to accomplish in a first contact with him?
My first contact is to help him really understand his situation. If I have somebody who comes into my office, I know that I’m already preaching to the choir a little bit. They are at least willing to address their problem at that point.
But because many people who come in have just been diagnosed with diabetes or pre-diabetes, they’re naturally scared. Unfortunately, what usually happens is that the doctor says, “You just need to lose some weight,” and that’s about the end of the counsel. Weight loss is certainly a good thing—it’s even necessary—but it fails to address the underlying issue that’s also related to the weight. The evidence now shows that you can reverse diabetes and pre-diabetes well before people reach any ideal weight; in fact, even before they lose any weight, in some cases. Reversing diabetes is not primarily a weight issue. It’s an issue that relates to the choices that we make throughout the day. Of course, if we make the right choices, then eventually the weight will optimize. But health improves well before the weight changes. My book is very broad in its lifestyle approach. It doesn’t just focus on nutrition; it doesn’t just focus on weight. It gives equal emphasis to all of the other lifestyle factors and environmental factors that contribute to the blood sugar challenge.
If I’m understanding you correctly, Wes, you’re not telling patients, “This one thing you should do,” but rather “Here’s a menu of things you can do. You need to start doing some of all of these.”
Exactly. The challenge is multi-faceted, and so the strategy must be multi-faceted. I tell patients, “I’m here to help you fill in the gaps. What are the metabolic challenges that are unique to you?” I first review all their lab work and help them really understand both the numbers and what they mean. And that’s really important, because in today’s health care climate, physicians usually only have 10 or 15 minutes to spend with patients at their regular follow-up. That’s very little time. I spend an hour with every patient, every time, because my job is to really
help them understand what’s going, to fill in the gaps in their knowledge and the gaps in their motivation to make needed changes.
Many times the diabetic’s blood work study doesn’t indicate their iron level or their iron storage test, which is called a ferritin test. It’s not traditionally a standard test for individuals with diabetes, even though the research says it should be. But elevated iron or ferritin dramatically increases the complications of diabetes, including heart disease, kidney failure, nerve damage, blindness, and so forth. That’s one circumstance that then can be addressed through diet and through other medical intervention to completely reverse that condition. So we’re always looking at filling in the gaps. We ask, “What can we do to improve all the genetically unique challenges that an individual brings to the clinic?”
When someone reads Goodbye, Diabetes and candidly looks at the menu of positive choices you encourage them to make in exercise, in nutrition, and in a variety of lifestyle changes—how likely is it that that individual reader is going to be able make those changes without a coaching community, or an individual coach?
Of course, I always strongly encourage coaching to occur. What I have noticed, though, is that it is hard to coach somebody without also providing them access to comprehensive material. Because the coaching clinical visit—even in my case where I spend an entire hour—is still greatly limited in the amount of information you can communicate. I always try to engage the client or patient with something that requires their involvement at home—with homework, if you will. They can begin monitoring their own blood sugars and documenting how they are affected by such things as sweets, stress, exercise, and so forth. Then they bring that information back the following week or a few weeks later. We sit down, go over it together, learn from it, adjust our protocol, and then just keep doing that. If they maintain a healthy lifestyle for at least six months to a year, and their blood sugars are no longer in the diabetic levels or even the pre-diabetic levels, and their A1c levels are no longer even in the diabetic level, then they really don’t have diabetes anymore.
Since diabetes is only determined by blood sugar levels, then the reversal of diabetes should be determined primarily by where their blood sugar levels are. If they can do that without the use of medication, then that means that they now have reverted back to a state of health that they were at prior to developing the diabetes.
It sounds like your book could be very useful to the individual client who comes in to consult with you. You can put chapters of the whole book in their hand to help them see that menu of lifestyle changes they need to make. But do you also envision this book being used by other medical professionals who are approaching things in group environments?
Absolutely. In fact, Dr. Eric Ngo, a physician, now retired, who was the founder of the Department of Preventive Medicine for Kaiser Permanente, graciously endorsed the book. And he said, “All my life, all my professional career, I’ve been looking for a book that I can recommend to my patients to look at the broad categories of lifestyle medicine intervention.” With “Goodbye Diabetes,” he says, “I’ve finally found it.”
Is it plausible that a book like this could become the center point of sort of diabetes community-based education?
Very much so. In fact, Dr. John McDougal, who is a well-known leader in the field of lifestyle medicine and nutritional medicine, wrote me a letter saying that this book should be required reading for all physicians, dietitians, nurses, and other health professionals.
I’m just excited that this information is now available in a way that can change people’s lives. The key is putting together strategies that are easily understood and applied.
I’ve heard you say that by improving people’s physical condition, you’re also improving their hope. I’m not sure which comes first: if it’s the hope that improves conditions, or if improving conditions sparks hope.
The hope to make positive change always has to be there at the beginning, because otherwise, people won’t do it. People are not going to devote effort to something that they believe is unchangeable: “So why would I go out and walk after every meal if I believe that I can’t really reverse my condition?”
They’re going to say, “Oh, forget it. I guess it’s just getting old, and that’s just God’s will.”
People just think, “This must be God’s will.”
But this is not
God’s will—diabetes is not God’s will. It’s God’s will that we use our brains, reason from cause to effect, and then make the changes we can. Both our hope and faith increase as we see the accumulating evidence that real, life-giving change is actually happening.
For more information about Dr. Youngberg's work and articles he's written, go to dryoungberg.com.