Issue link: https://eguideline.guidelinecentral.com/i/1347670
1 ABOUT THE AUTHOR DR. MARK CUCUZZELLA, MD I am a family doctor working in West Virginia, the state with the highest obesity and diabetes rates in America. I started my medical training in the 1980s, and since 1990, the incidence of both of these conditions have tripled: we now have an adult rate of type 2 diabetes close to 20% and obesity (BMI >30) well north of 40% in my state (with other states not far behind). Early in my career, until 2012, I was aware of these increasing rates but felt helpless and hopeless in how to help. The advice I was giving — eat less, exercise more, reduce fat, increase medications — often led to poor outcomes. As clinicians, we often viewed it as the patient's fault for not "complying." This was embedded in our training. The drugs I prescribed at best poorly managed these problems. I left the office fatigued and often felt as if we both had failed — myself and the patient. A six month assignment in 2012 with the U.S. Air Force to re-design the running program changed my life. Realizing that obesity was a large driver of fitness test failures, I traveled to dozens of military bases asking whether anyone in the room had lost 50 lb and kept it off for a year. Usually a handful (or two out of about 100) would volunteer, and I would query what they did. From base to base, the answer was very similar: they had given up all bread and sugar or had done a paleo-type diet, which in those days was not paleo junk food. The food was mostly eggs, meat, fish, and vegetables, and a few even had the courage to say they had done "Atkins." I started reading about the history of obesity as well as the science. The early works of Gary Taubes in Good Calories, Bad Calories opened my mind to new ideas. These ideas were confirmed by the premier scientist Dr. Timothy Noakes in South Africa as we did a couple of courses together in his country. Paradoxically, at the same time, my blood glucose was in the prediabetic range since I was developing an insulin insufficiency type of diabetes. For many years I had been a runner, eating the traditional runner's diet of high carbohydrate and low fat. So I started a low-carb lifestyle myself. A short experiment with a continuous glucose monitor showed the dramatic response my body had to any form of carbohydrate whether it was fruit, starchy veg, cereal, any bread product, and undoubtedly the low-fat frozen yogurt. At the time I did not realize they were all basically the same thing: turned into sugars once they hit my system. For the last eight years I have enjoyed every day free of medication, staying below the threshold for full diabetes.