Before I answer that question, a little background information will help. When I started practicing internal medicine in Brentwood, I started the practice from scratch; that is to say, no patients followed me from a prior practice. I managed to pay the rent by doing what is called locum tenens. Locums are temporary employment assignments in various settings. Some were emergency medicine opportunities, while others were substitutions for physicians going on vacation or taking maternity leave.
One of these jobs consisted of replacing an endocrinologist in the South Bay area. I had always enjoyed endocrinology and the office was a very nice setting in which to work.
On my first day there, I met a patient named Dino. He was in his early sixties and was nearing retirement. Before entering the examination room, the practice manager gave me a little background on Dino. He said, “Dino is a very nice person. He has been a patient for many years and is very compliant with his medications. His blood work today is very good. His hemoglobin A1c is in good range and his cholesterol is well controlled on Lipitor ”.
I entered the room and was taken aback. As I was introducing myself to him, a loud voice was shouting in my head, “How could this be? He must weigh over 300 lbs. How could his numbers be in normal range at that weight? Does it even matter?”
Because I was just substituting, I had rehearsed a whole speech to the patients to minimize disruption in the office routine. I couldn’t do it. As I began to speak to Dino, I could hear my wife tell me, “Can’t you just leave well enough alone? Can’t you just leave things the way they are and just do the job that was asked of you?” Obviously, I couldn’t. So I asked Dino, “Dino, where do you see yourself five years from now?” He told me, “Doc, I am retiring after working at the same place for forty years. I have a heck of a retirement pension coming my way and life is going to be great.” To that I replied, “Dino, at the rate you are going, you will be barely functional in five years. Most likely, your wife will enjoy your pension with someone else. You are close to three hundred pounds and climbing, seriously where do you think this is going to go?” He looked at me perplexed. “Doc I am doing everything I am told. I take all of my medications. I show up to all of my appointments, what else can I be doing?” I told him, that the insulin he was taking was acting like a growth hormone. The more he uses it, the hungrier he gets, and the more he eats, the more insulin he needs. It’s a vicious cycle. “Are you willing to try something new?” He said sure. I stepped out of the room and hand wrote the first version of the diet. It was limited to lean protein, zero or near zero calorie vegetables and eliminated all traces of carbohydrates.
I returned to the room and explained to him what I needed him to do. He would start right away and would return in one week. I gave him my cell phone number and instructed him to call me should he have any questions or concerns. He called me on Saturday morning, almost two days after meeting him, and he told me, “My sugar level this morning is 70, what should I do?” Celebrate? “No seriously Doc, how much insulin do I take?” I told him to stop all of his diabetic medications and let’s see what happens tomorrow. The rest of the day he kept checking his sugar before each meal, and he called me on Sunday with the results. His sugars had normalized and he did not need to take his Avandia or insulin. I had instructed him to continue taking Glucophage, as there is no risk of hypoglycemia with this medication, but all others had to be stopped. I waited anxiously for the week to pass to see him again. As I was about to walk into the room, the practice manager told me, “You won’t believe this, Dino lost 12 lbs this past week.” I stepped into the room and asked Dino “How do you feel?” I feel really tired but I can’t believe that I lost 12 lbs. Do you think that you can do this for another week I asked him? He said sure. The following week, he lost an additional 8 lbs and his blood pressure had dropped so low that I had to stop his blood pressure medications as well. He felt a little better, but still a bit tired. Again, I asked if he could continue another week, and he did. He returned the following week, wearing shorts and reported that he had walked the length of the Strand in Redondo Beach, approximately one and one half mile each way with his wife on Sunday. He told me that it had been over fifteen years since he felt like doing anything like that. He had lost another 5 lbs and looked like a completely different person.
Diane was the next patient to try this program. She became angry that no one had ever suggested to her that she there was an alternative approach to treating her diabetes, hypertension and dyslipidemia. This combination of diabetes, high blood pressure and elevated cholesterol is also known as Metabolic Syndrome. Diane is an engineer, and until her move to Arizona, she kept meticulous spreadsheets of her blood pressures, and glucose levels. We still e-mail each other and she has continued her new lifestyle ever since.
It is easy to get people who are very sick to make dramatic changes, but how do we succeed with individuals who are not yet sick, but who will inevitably get there on their current path?
Many patients come to me after trying the diet on their own, but to a great extent, it is the advice I give them in the office that facilitates their success. You are more than welcome to try this program on your own, but please, have your physician monitor your progress, your renal and liver function, as well as your lipid profile.
Who should not be on this diet? This diet will trigger an Atkins-like state of ketosis, a state of high fat burning. Ketosis needs to be closely monitored in patients with heart problems, especially arrhythmias. Individuals with renal failure should be monitored closely with regular renal function studies. Type I diabetics would not need to consider this diet as they tend to be lean. But if tempted to try it for nutritional purposes, Type I diabetics, need to be followed by their endocrinologist. Pregnant patients should avoid ketosis mainly because we do not know the effects this would have on the fetus, although my bias is that it wouldn’t be harmful, but I do not know this with certainty.
It is my intention and my hope that with this blog, I will help a greater number of people than I am able to see in the office.