What is this diet?

March 16, 2007 7:50 AM

What sort of strange diet has my doctor put me on? Is this the new and accepted way to treat diabetics now?

I was diagnosed as type 2 diabetic this week by my regular doctor - he's older (experienced) but progressive. The treatment he's outlined for me, for the next 30 days at least, is a shot of Byetta before each meal, and a diet that I find odd.

He started off by telling me that people need to remember that they're animals and should eat more like animals (more proteins in the winter, more carbs in the summer) because you rarely see an overweight or diabetic animal. Then he said that I should eat only 2 meals a day for 4 days, either breakfast & lunch or lunch & dinner. Then 1 meal a day (lunch) for 3 days. He didn't tell me which kinds of food to eat or avoid - but he did say I could make those 3 days easy on myself by going to Sonic or Burger King and ordering a double hamburger, no fries.

He also said to not listen to anyone who tells me I should be eating 5-6 times per day. He said that's an old way of thinking and those people will die (from diabetes & related complications).

Is there a name for this diet? Did he make it up? My doc has recently lost weight, and he looks great & healthy, but I'm still in shock over getting the diabetic diagnosis and this diet seems to go against everything I read on the web.

Any thoughts? Thanks!

posted by LadyBonita to health (42 comments total)

Maybe he's on to something, but I'd say this calls for a second opinion from another GP, or else a visit with a nutritionist to be sure.
posted by hermitosis at 7:58 AM on March 16, 2007

Sounds like he's telling you to do the typical Atkins induction thing.
posted by briank at 8:00 AM on March 16, 2007

I'd get a second opinion. IMHO, he sounds like a crackpot.

My dad controls his type II diabetes through diet - working with his endocrinologist and a nutritionist - and his diet most certainly is not a double hamburger from Sonic twice a day. It is more similar to the South Beach type of diet - focusing on lean proteins, low glycemic complex carbs, and lots of green vegetables. It's true that he usually only has coffee for breakfast, so he eats 2 meals a day, but I really have to question the integrity of someone who suggests eating greasy fast food as a great way of controlling diabetes.
posted by tastybrains at 8:16 AM on March 16, 2007 [1 favorite]

This is not standard. I'd get a second opinion because this is counter to the guidelines put out by the american diabetes association. It's definitely not the new and accepted way to treat diabetes.
posted by selfmedicating at 8:20 AM on March 16, 2007

This sounds NOTHING like Atkins induction briank. Please don't spread misinformation.
posted by FlamingBore at 8:22 AM on March 16, 2007

IANAD but I'm glad your alarm went off. I really can't speak to what this doctor was thinking about, but I'd suggest getting a second opinion, and in the meantime carefully reading the recommendations of the American Diabetes Association's Nutritional Guidelines. (You should of course learn about Byetta.)

But learn about your new diagnosis and ask your doctor why he recommended this new diet.
posted by ruwan at 8:26 AM on March 16, 2007

Wow! A close friend of mine was diagnosed with type 2 diabetes within the past few years, and this sounds nothing like the prescribed diet her doctors gave her. Perhaps your doctor is right; I am certainly not medically trained. However, i would agree with the advice that a second opinion can't hurt. When she was diagnosed as type 2 diabetic, her insurance carrier covered a diabetic nutrition. You should call your insurance carrier and see if the same is possible for you.
posted by theantikitty at 8:32 AM on March 16, 2007

Diabetic nutritionist, that is.
posted by theantikitty at 8:33 AM on March 16, 2007

This is absurd. Go to another doctor.
posted by chinston at 8:43 AM on March 16, 2007

He also said to not listen to anyone who tells me I should be eating 5-6 times per day. He said that's an old way of thinking and those people will die (from diabetes & related complications).

That sets off my alarm bells. I would see a diabetes educator. Even if you have to pay, you usually get a very decent blood glucose meter and a few strips out of it. And it should be covered by insurance.

Are you already monitoring? How are your numbers?

Although I only had gestational diabetes, not type 2 [yet], I ate 6 times a day and within two weeks, my numbers were absolutely stellar. Now, I wouldn't say anyone can eat six MEALS a day, but that's not what any sane person means anyway.

I continued that diet through the end of pregnancy, and my numbers just got better and better.

I certainly can't offer you any medical advice, but if you want to talk, my email's in my profile.
posted by peep at 8:45 AM on March 16, 2007

Sounds like a quack to me. Find an endocrinologist that works with a nutritionist. Things like controlling fat and cholesterol are even more important to diabetics than they are to the general populous.

My SO is a type 2 diabetic and keeps her blood glucose very well under control with several small meals throughout the day, no sugar, no processed wheat, lean proteins etc... Fast food has no place in her diet.
posted by hilby at 8:47 AM on March 16, 2007

Oh, and using Byetta while eating very little could be EXTREMELY dangerous. This guy is a douchebag. The more I think about this, the more pissed I get.
posted by peep at 8:48 AM on March 16, 2007

I don't know anything about Byetta, but the meal timing is known as intermittent fasting (IF). You can google/pubmed it but here's a quick description from Art De Vany's website. I don't think I've ever heard anyone promote IF with fast food, though. The whole "eat like animals" is great advice, but contradictory to a double hamburger. Eat lots of meat and veggies, some fruit, nuts and seeds. Think whole, natural foods; nothing processed.
posted by Durin's Bane at 8:59 AM on March 16, 2007

Sounds nutty to me.

If you're concerned go to the American Diabetes Association website and obtain an ADA diet and guidelines to follow in the meantime.

I failed my first gestational diabetes screening while pregnant with my second child. I'm a nurse, I grabbed some literature on ADA diets at work, spoke with the dietician at the hopsital. I followed the diet perfectly and passed the second test. I probably never had gestational diabetes, but I never felt better and lost five pounds safely. I should go on it again. It's a common sense, healthy diet for any person, diabetes or not.

Hamburgers from Sonic and two meals a day with a diagnoses of Type II diabetes doesn't make sense to me, but I'm not a doctor.
posted by LoriFLA at 9:00 AM on March 16, 2007

Oh, I forgot to mention that I don't think meal timing is as important as food choices and quantity. I think 5-6 meals a day is fine if you're still eating whole, unprocessed foods like I mention above _and_ you adjust portion sizes so that overall intake is the same. Intermittent fasting supposedly offers benefits on top of this but can be hard to implement permanently. For further reading, check if your library has The Paleo Diet, The Protein Power Lifeplan, and Lights Out.
posted by Durin's Bane at 9:11 AM on March 16, 2007

Just another voice chiming in to say at the very least, get a second opinion and at best, see a nutritionist. My mom and several other members of my family have diabetes, and NONE of them follow this diet. What kind of doctor tells anyone to eat fast food?!

Also, another resource to consult with is your local pharmacy. Some offer diabetes consultations and classes, like Walgreens for instance.
posted by geeky at 9:14 AM on March 16, 2007

"rarely see an overweight or diabetic animal."

Huh? I'd walk out right there. I've seen plenty of fat animals and the diabetic ones refuse to carry ID. He sounds wacky to me. I'm guessing he's on a similar diet and it works for him so he has found religion and is just sharing the love. Get a 2nd opinion. And consider not going back to him.
posted by chairface at 9:25 AM on March 16, 2007

you rarely see an overweight or diabetic animal.

Yes, except for animals raised by humans, who tend not to need to hunt or forage for food and as a result can adopt a sedentary lifestyle like many humans. Or, in other words, diet may not be the only reason animals are rarely diabetic or overweight.

My alarm bells would go off just at the realization that my doctor was making sweeping generalizations and drawing unexamined conclusions from them. Here's another voice urging a second opinion.
posted by Tuwa at 9:27 AM on March 16, 2007

Type II here, diagnosed 4 years ago.

He's wacked. Run, do not walk to a second opinion and a real doctor.

Read the book The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed.

Also, check out the exchange diet.

Byetta is new and can be a really great thing, but prepared for some nauseous at first, which varys in instensity from person to person. It should subside after a while.

Email is my profile if you want more advice. But please, get a new doctor. Diabetes is very treatable and there are proven methods that work. This is not one of them.
posted by Brandon Blatcher at 9:27 AM on March 16, 2007

jinks. Should preview.

And none of that takes into account animals which go through heavy and lean periods, such as bears, or even pigs, which definitely have a high fat content.

Ah ... I think this fellow is not a scientist. I like doctors to be scientists. I hope you do too.
posted by Tuwa at 9:31 AM on March 16, 2007

We're kind of derailing here, but the doctor is right about there not being overweight/diabetic animals in the wild, not pets, zoo/farm animals, or animals scavenging from human food sources. Yes, animals build up fat stores for the winter (often by eating carbs in the summer, as mentioned by the doc), but they use/lose those stores over the course of the winter and don't become diabetic or sick from it.

This also applies to humans. Native hunter-gatherer tribes that eat their traditional foods don't get overweight or diabetic. They are dwindling throughout the world as Western, processed food is taking over everything. Read Nutrition and Physical Degeneration by Weston Price for evidence of this.
posted by Durin's Bane at 9:47 AM on March 16, 2007

I'm not sure about the whole 2 meals a day / 1 meal a day thing, but any doctor who tells a diabetic that a double cheeseburger from Burger King is an acceptable part of their healthy diet is full of shit. Get a second opinion.
posted by chundo at 9:52 AM on March 16, 2007

Another note:

As a diabetic you should educate yourself that it IS all about you. Don't be snotty about it obviously, but keep in mind that the doctor is there to help and educate you. So if you smell bullshit, call'em on it and make'em explain stuff. And get copies of your lab results. If they're difficult about this or insist that they're right and you should ignore everything and everyone else about diabetes, then find a another doctor.
posted by Brandon Blatcher at 9:54 AM on March 16, 2007

There are docs who specialize in treating diabetics. See a nutritionist also to help change your diet.
posted by i_am_a_Jedi at 10:08 AM on March 16, 2007

Yet another note:

Do bookmark http://www.mendosa.com/. It's a pretty good resource of all things diabetic(check out the links in the upper left),run by a writer who is himself diabetic and writes about diabetes.
posted by Brandon Blatcher at 10:22 AM on March 16, 2007

"Eat like animals" is the stupidest thing I've ever heard, and could only come from someone who doesn't know much about "animals." I mean, which animals are we talking here: carrion-eaters? Grass-eaters? I don't think coyotes or deer (or most animals) can provide much of a model for human diet.

Okay, so maybe he means eat like animals who are like us. If you look at our three closest primate relatives we have chimps/bonobos: they eat fruit and bugs, and the occasional monkey or dead chimp infant. They pick through their faeces to get extra meat bits that haven't fully digested.

Gorillas eat a vegetable diet that our guts can't handle.

Orangutans eat anything. Things my primates prof witnessed an orangutan eat include bars of soap and a radio with batteries--with no discernible consequences. I doubt that anyone would accept the fact that an orangutan could eat a battery as a good argument that you or I could (or should) eat a battery.

All of these animals eat on an as-it-comes basis, basically spending the whole day scavenging on and off and eating whatever looks good whenever they can get it. This is, I believe, where the idea that we should eat lots of small bits over the course of a day came from.

Finally, the whole "you don't see sick animals" argument neglects the fact that an animal with diabetes or any other of a number of treatable-but-otherwise-deadly diseases are going to die of them. Part of the reasons humans have more diabetics is because they can treat diabetics. (My grandfather's dog was a diabetic, and he received an insulin shot before every meal with my grandfather, who had the same condition. Needless to say, the dog would not have survived in the wild.) And while you rarely see overweight animals "in the wild," you often see starving (and starved-to-death) ones.

But the key point here is that if you find this advice suspect or uncomfortable, you should go to someone else. There have been a lot of different diets prescribed for diabetics over the years. What I've learned from my grandfather's experience is that if you eat moderately based on a diet that you enjoy following and allows you to maintain good insulin levels, pay attention to how you feel, and stay educated about research on diabetic diets, then you'll live through a few fads in diabetic eating (at least) without too much harm.
posted by carmen at 10:30 AM on March 16, 2007 [3 favorites]

Definitely sounds like B.S. for the reasons everyone has mentioned.

RE: the frequency of meals, I've heard recently that the 5 or 6 small meals a day idea is being challenged - it doesn't necessarily speed the metabolism as claimed. I've heard that the real trick is finding whatever works for the individual to lose weight (e.g. eat fewer total calories). For some, skipping meals works bc they have fewer opportunities to overeat, for others eating many small meals works because they don't get absolutely starving and binge. Here's a better explanation.

I don't know how this fits in with diabetes, though, other than that losing weight is good.
posted by Amizu at 11:01 AM on March 16, 2007

Any doctor that would recommend someone eat fast food for any reason is off their rocker.
posted by zackola at 11:04 AM on March 16, 2007

Please go see an endocrinologist and a nutritionist who specializes in diabetes.
posted by radioamy at 11:20 AM on March 16, 2007

5 or 6 small meals a day idea is being challenged

I can see the 5 or 6 small meal thing working for a diabetic. You could compare diabetes to a transmission, where normal folks have an automatic, while D's have a manual: we constantly have to be aware of where our body is and where we want it by and adjust for best performance.

I've tried the 6 small meals a day thing and it tends to work, but since the rest of the world goes by 3 meals a day, it gets a bit hard. Having a mid morning and mid afternoon snack works better.
posted by Brandon Blatcher at 11:28 AM on March 16, 2007

I can't speak for the plan he's trying to get you on, but any doctor who would even utter the words Sonic or Burger King and recommend that you actually eat there should be ran away from and ignored as quickly as possible.
posted by RoseovSharon at 11:37 AM on March 16, 2007

If he didn't say anything about AVOIDING SUGAR, CORN SYRUP, and OTHER REFINED CARBOHYDRATES then find a new doctor, one who understands that all three of those things make blood sugar go up. If he had said to eat like a caveman, that I would have understood. Evolutionarily speaking we're not so far from cavemen. But an animal? What kind of animal?

Remember, diabetes is a disease of carbohydrate metabolism, not a disease of fat metabolism. IANAD, please consult someone who is.
posted by ilsa at 11:55 AM on March 16, 2007

I read a bizarre diet book a couple of years ago whose author said much what your doctor said - change the macronutrient balance from winter to summer, don't eat frequently in winter, look at animals changing diets through the year.

The author in fact argued that ignoring these principles led to obesity and... diabetes!

It didn't strike me as credible at the time. I'm sorry I can't remember the name of the book.
posted by i_am_joe's_spleen at 12:21 PM on March 16, 2007

Maybe consider reporting the kook to the medical association, too. But it's been a funny thread. Good luck with your new doctor.
posted by Listener at 12:33 PM on March 16, 2007

I agree with everything else said about the diet but consider an additional piece of info about the doctor. I spent a bit of time reading about Byetta when it first came out and decided that there were very few times that it would make sense to prescribe it. As monotherapy in a new diabetic when there are other great, non-injectable, generic alternatives with proven track records? Seems very weird IMVHO.
posted by Slarty Bartfast at 2:16 PM on March 16, 2007

This is where I go WTF, like everybody else. I was diagnosed as Type II about 9 months ago. My doctor put me on metformin (Glucophage) and recommended a crapload of exercise and diet changes. I don't know anything about Byetta, but from what I've read it's for people who have not received satisfactory results with metformin or sulfonylureas. From what my RN told me, they (standard efficacy and treatment guidelines, I guess) usually start you out on metformin. And if that doesn't work, they step you up to a sulfonylurea. If that still doesn't work, then they start putting you on insulin shots. So my (very) uninformed opinion is that you have to have crazy high blood sugar uncontrollable by other means to even consider starting out with Byetta first, or your doctor's getting hella kickbacks from Eli Lilly.
posted by calistasm at 5:38 PM on March 16, 2007

My husband was dx'd with Type II early this year. We consulted with a highly recommended diabetic nutritionist, who ultimately kept pushing her vegan lifestyle. Mr. Adams was not amenable to a no-meat or eggs or milk diet. However, just by cutting carbs (not following a strict Atkins diet, but eliminating a lot of potatoes and white bread) and taking his Glucophage, he's managed to keep his numbers within the normal level ever since.

She did mention (as did our regular doctor who dx'd him) that they always start with Glucophage first, and then switch to something like Byetta if it doesn't work. Definitely seek a second opinion!
posted by Oriole Adams at 7:07 PM on March 16, 2007

IAAD, and while I hesitate to offer pointed advice without having detailed knowledge of your medical history, I will say that this certainly doesn't sound like the standard of care for diabetes management.

However there may actually be a small nugget of wisdom in some of his recommendations, and there are a few misstatements above.

Firstly, Byetta should NOT be a first-line agent for the treatment of diabetes. If you are ONLY on Byetta, in the absence of metformin, a sulfonylurea, or a thiazolidinedione, then this is diverging from standard of care. The bulk of studies validating the use of this agent compared placebo to Byetta in combination with one of the above first line agents. The insert even describes the drug using the word "adjunct" treatment.

Secondly, at least based on the controlled trials, Byetta independent of a sulfonylurea does NOT cause increased episodes of hypoglycemia as compared to placebo. It is unclear if the hypoglycemia noted in combination is due entirely to the sulfonylurea in combination therapy, but sulfonylureas are known to cause hypoglycemia. Moreover, in combination with metformin, an agent unlikely to cause hypoglycemia, Byetta did not cause hypoglycemic episodes. Take that for what it's worth.

The small bit of sense in his dietary recommendations may well be two meals a day. There's certainly no consensus on this one, but if you're managing blood sugar with Byetta twice daily, it does make some pharmacodynamic sense. The half-life of Byetta is a few hours, so taking it with meals may actually optimize your insulin profile as the burst of insulin it theoretically provides would overlap your meal. But that's really hand-waving at best, in the setting of what sound like some otherwise kooky recommendations. Remember, Byetta IS NOT A FIRST LINE AGENT IN THE TREATMENT OF DIABETES.

As a side-note, many of the first line agents, which are oral by the way, are the only ones that have shown long term benefits with respect to the micro-vascular and debatably macro-vascular complications of diabetes. These benefits are untested with Byetta.

Finally, going to the ADA site should give you a good deal of insights regarding dietary recommendations. A few simple points: Yes, simple and refined sugars are not your friend in the sense that they will spike your glucose level. But the key is to find a combination of diet and medications which minimize hyperglycemic episodes without the risk of hypoglycemia. That's the plain and simple of it. Moreover, the best thing you can do to stay healthy and live a normal life is to eat a HEART-HEALTHY diet. Heart disease is the enemy of the diabetic. That means low fat, low cholesterol, no trans-fats, minimizing salt particularly if you have high blood pressure.

This speaks to the last issue. Which you haven't mentioned anything about, but if your doctor hasn't done a detailed evaluation of your kidney function, blood pressure, and lipid profile, checked your urine for early signs of diabetic nephropathy, and made sure you have regular ophthalmologic evaluation, then I'd be quite concerned.

If you have any further questions, my e-mails in the profile.
posted by drpynchon at 8:21 PM on March 16, 2007 [1 favorite]

I'll go out on a limb and say "possibly cutting edge", not a crack. There has been a bunch of quite recent research linking intermittent fasting to everything from improved insulin response to shrinking the size of melanomas.

See, for example, Effect of intermittent fasting and refeeding on insulin action in healthy men. Halberg N, Henriksen M, Soderhamn N, Stallknecht B, Ploug T, Schjerling P, Dela F. Dept. of Muscle Research Centre, The Panum Institute, University of Copenhagen, Denmark. [e-mail] (the gist - intermittent fasting increases insulin-mediated glucose uptake rate).

See also Intermittent fasting dissociates beneficial effects of dietary restriction on glucose metabolism and neuronal resistance to injury from calorie intake. Anson RM, Guo Z, de Cabo R, Iyun T, Rios M, Hagepanos A, Ingram DK, Lane MA, Mattson MP. Laboratory of Neurosciences, Gerontology Research Center, National Institute on Aging, 5600 Nathan Shock Drive, Baltimore, MD 21224, USA (the gist - for reasons we don't understand, Dietary restriction has been shown to have several health benefits including increased insulin sensitivity, stress resistance, reduced morbidity, and increased life span.)

The idea is that you restrict your eating to a six or eight window each day, or eat more often, but fast for longer when you do fast. It's only very, very recently in our evolution that human beings have been able to wake, then graze non-stop til we go to bed, mostly on refined carbs and saturated fat. Is it surprising that your insulin / leptin is foobar'd when your blood stream is always, always swimming with sugar?
posted by obiwanwasabi at 12:30 AM on March 17, 2007

Thanks very much everyone. I will get a 2nd, even 3rd opinion. Looks like I have a lot to learn!
posted by LadyBonita at 5:20 AM on March 17, 2007

Dr. P is right, Byetta is not at all a first-line drug. Yikes. If you doc is a drug-rep junkie, he/she might start you on it. Be careful of a doctor's office that has more drug reps in it that patients. Good luck.
posted by skepticallypleased at 9:00 AM on March 17, 2007

Yikes. I'm glad you're getting another opinion.

My advice:
- Be your own advocate
- Educate yourself (Diabetes for Dummies is a good place to start for the basics, really!)
- Surround yourself with good medical personnel
- Take diabetes education classes
- There are good threads here at AskMe about dealing with diabetes; read them
- Diabetes.org and Diabetes.ca are good resources no matter where you live

I was diagnosed with Type II February 2001. Good luck with this LadyB. My email is in my profile.
posted by deborah at 2:28 PM on March 19, 2007