A sweet turn in diabetes treatment

Something significant has changed in the way the medical establishment looks at diabetes. For long described as a chronic, progressive disease with complications affecting all aspects of life, diabetes is now seen as a condition that can be reversed.

On diagnosis, patients used to get some medication, and dire predictions about what could lie in store down the years. Some of the bleakness is now being dispelled by newly introduced treatment protocols. Doctors are still wary of the term ‘cure’, but they are talking about remission, a state where blood glucose returns to normal levels without medication. The focus has shifted to lifestyle – diet, sleep, and exercise. You can imagine what a game-changer this is – at least when it comes to how diabetics imagine their future years. They are being offered a way out of a life sentence. Behave, and you will be let off based on your good conduct!

It is jokingly said that two kinds of medicine are common in India – herbal and verbal. As one who has heard the most outlandish solutions to diabetes, I can tell you they raise hopes quickly and crash them equally quickly. And we have no dearth of snake oil salesmen when it comes to problems that conventional medicine has no answers for.

Around 2004, I began to scour the Net for medical literature on diabetes, and continued my search for at least five years. I was looking for wisdom that was derived from experience and not textbooks. Among the many things that came my way, the story of Dr Richard Bernstein (1934-2025) caught my attention the most.

An engineer by training, Bernstein was diagnosed with type 1 diabetes in the 1940s, when he was a child. Despite following his doctors’ instructions diligently, his condition deteriorated, and he was plagued by complications like neuropathy. Frustrated, he took matters into his own hands in the 1960s. At a time when home glucose monitoring wasn’t available to patients – glucometers were hospital tools only – he leveraged his wife’s position as a physician to procure one.

He began meticulously testing his blood sugar responses to different foods, discovering that carbohydrates spiked his levels dramatically while proteins and fats provided stability. He mapped his findings on a graph. Much to everyone’s surprise, he started getting better. He thought he had stumbled on a new way to treat diabetes and wrote an article about his self-experimentation. No medical journal was willing to publish it. They said he was not qualified – he held no degree in medicine.

When he was 45, he quit engineering and signed up for medical school. He became an MD. He was simultaneously working on a low-carbohydrate, high-protein diet that normalised blood sugars and reversed many complications. Empowered by his results and his medical degrees, he started treating diabetics.

Emphasising strict dietary control over reliance on pills and insulin injections, he achieved considerable success in his practice. He summed up his findings in his book, Diabetes Solution, first published in 1997 and updated since, challenging mainstream advice, and arguing that diabetics could achieve near-normal blood sugars through diet alone or with minimal medicines.

It took some decades for Bernstein’s philosophy to permeate mainstream methods. His advice is easier for meat eaters to follow. Vegetarian diets are rich in carbohydrates from grains. But with some tweaks, vegetarians have also been able to try his method.

In more recent years, I have explored structured diabetes remission programmes, which align with Bernstein’s focus on diet but incorporate support with the help of apps and AI tools. These programmes emphasise carbohydrate restriction, meal planning, and tracking. They provide nutrition coaching, occasional doctor consultations, and monitoring tools.

A breakthrough came in 1921 when Canadian researchers Dr Frederick Banting and Charles Best discovered how insulin could be used to treat diabetics. Over the decades, we have heard of radical treatments in the making, but few have come into clinical practice. The recent advent of drugs like Ozempic and Mounjaro has generated much excitement, but it is still too early to say whether they will make a big impact in India, described as the world’s diabetes capital.

Remission isn’t guaranteed, and a relapse can occur with any deviation from the diet, but the silver lining motivates action. The perception began changing in 2009 with a formal definition of remission by a consensus group. In 2021, the American Diabetes Association refined it further, defining remission as an HbA1c of under 6.5% sustained for at least three months off glucose-lowering medications. This evolution has brought optimism. As for the healing, well, work on it!

The writer often sees high art in kitsch and vice versa.

Disclaimer: The views expressed above are the author's own. They do not necessarily reflect the views of DH.