For those of us not entirely familiar with this medieval Jewish philosopher, his life and works deserve some attention. He wrote of many things, including physics and health. One of his more famous admonitions, at least in some medical circles, has to do with a straight-forward approach to many of our physical maladies—known eight or nine hundred years ago and still true today. His words were simple but wise. “Let nothing which can be treated by diet be treated by other means.”
Think about that for a moment. If we can manage a medical problem by altering what we eat, why would we look elsewhere for relief? And yet we do, don’t we? Ours is a society looking for the ever-elusive “quick fix.” We reach for the medicine cabinet when faced with any discomfort or illness, preferring a pill, capsule, or magic elixir to something as simple (and admittedly difficult) as changing our lifestyle and potentially destructive habits. As physicians, we are quick to comply. We reach for the prescription pad rather than taking the time to educate, collaborate, and advise. We sense our patients have heard too many times about diet, exercise, adequate sleep, not smoking, and so we chose the path of least resistance. That’s a well-worn highway by now, and Maimonides must be shaking his head, because he was right.
Nowhere is this more evident than in the growing plague of diabetes. Some prefer the gentler term “epidemic,” but we need to call it what it is. As you read these words, one in eight of us have this disease, whether we know it or not. That’s a lot, and the numbers are increasing. Some of us develop this problem through no fault of our own, brought on by defective genetics, bad luck, or the result of as yet undefined causes. We may have type I diabetes, usually insulin dependent, with an onset at an early age. But the majority of us have type II diabetes we’ve had a part to play with our ever-increasing blood sugars and the havoc that wreaks within our bodies. Harsh words, but reality none-the-less.
But what does that have to do with Maimonides’ advice and what makes it so special? We all know we need to eat right and exercise. Tell us something new.
Just be patient. I’m going to do just that. And this “something new” comes from a couple of recent studies. It has to do with the low-carbohydrate diet—more specifically the “ketogenic diet.” This term refers to the production of ketones, a chemical that we produce naturally when fat is broken down for energy, rather than sugar (carbohydrates). In order for ketones to show up in our urine, we need to significantly limit our carbohydrate intake, to the tune of 20-50 grams/day. As a point of reference, a breakfast bagel and glass of orange juice gets us started with more than 70 grams of carbs. And our pancreas starts humming, pumping out insulin until it finally gives up and we become diabetic.
But there’s good news—great news if you’re one of the millions of type 2 diabetics in our country. This low carb diet—actually the diet that our hunter-gatherer forefathers and mothers consumed—does a lot of great things. People who stick with this diet lose weight, lower their blood fats (triglycerides), and dramatically improve their ability to handle their blood sugar. For many, this can mean reducing the number and amount of medications needed for control of their diabetes, and for some of us, it can result in the reversal of this disease. That’s right—I said reversal. We no longer have to carry the diagnosis of type 2 diabetes, with all of its attendant complications. Just by adhering to a simple diet. It takes some work, but the results will be worth the effort.
Maimonides would ask, “What are you waiting for?”
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