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How Bariatric Surgery Reverses Diabetes

“Roux-en-Y gastric bypass surgery (RYGB) is one of the most successful treatment strategies for diabetes accompanying morbid obesity. Long-term diabetes remission rates of 83% have been reported.” These findings have led to the suggestion that the surgery improves diabetes by somehow altering digestive hormones, but this interpretation ignores the fact that patients are placed on a severely limited diet for a week or two after the operation just to recover from the major surgery. Severe caloric restriction alone can improve diabetes. So, is it the diet or the surgery?

To answer that question, researchers put diabetics on the exact same diet as one would eat post-RYGB surgery, with or without the actual surgery. As I discuss in Reversing Diabetes with Surgery, the researchers found that their diabetes improved rapidly on the surgery diet before they had the surgery. In fact, the improvement in blood sugar control was better on the diet alone than after the surgery.

Blood sugar control improved more in the absence of surgery.

This suggests that the whole surgical-diabetes-reversal is not due to the surgery at all, but rather because of the diet people have to go on in the hospital during recovery. So, the clinical implication is that nonsurgical interventions have just as much potential to resolve diabetes as major surgery does.

If you’re familiar with my video Diabetes as a Disease of Fat Toxicity, you’ll understand what is occurring. Namely, “[t]ype 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat”—that is, too much fat in the cells of the liver, pancreas, and muscles. Within seven days of eating about 600 calories a day by either dietary intervention or bariatric surgery, fasting glucose levels (blood sugar levels) can normalize, thanks to a fall in liver fat. If you look at CT scans, you can actually see a 35 percent reduction in liver volume as all the fat is cleared out. Then, the body starts pulling fat out of the pancreas. When the cause of diabetes goes away, the diabetes goes away.

The insulin-producing beta cells of the pancreas “had woken up!… Clearly, the [beta] cells are not permanently damaged in Type 2 diabetes, but are merely metabolically inhibited.” Studies show a reversal of diabetes up to 28 years after diagnosis.

So, diabetics motivated enough to starve themselves can regain normal health. This information should be available to all people with type 2 diabetes, even though it is unlikely many will be motivated enough to escape from the disease. It’s not easy to not eat. Diabetics should know that if they don’t reverse their diabetes, their future health is in jeopardy, although the serious consequences must be balanced against the difficulties and privations associated with starvation diets. “For many people, this may prove too high a price to pay,” as it’s hard to voluntarily restrict food intake that much.

In that case, how about involuntary food restriction? That’s what stomach stapling surgery is. When you essentially remove someone’s stomach, they’re forced into compulsory food restriction.

Of course, major surgery carries major risks—during the operation and afterwards. There can be bleeding, leakage, infections, erosions, herniation, and severe nutritional deficiencies. Surgery or starvation? There has got to be a better way. And there is!

Instead of changing the quantity of food eaten, whether voluntarily or involuntarily, is it possible to reverse diabetes by changing the quality of the food? Watch my videos Reversing Diabetes with Food and Diabetes Reversal: Is It the Calories or the Food? to get the complete picture.


For the lowdown on saturated fat, check out Lipotoxicity: How Saturated Fat Raises Blood Sugar.

Interested in taking a deeper dive into underlying causes of type 2 diabetes? You may be interested in these:

And, for an overview, see How Not to Die from Diabetes.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


57 responses to “How Bariatric Surgery Reverses Diabetes

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  1. 600 calories a day. Let’s say you ate those calories in one sitting or over a 4 hour window. Does this indirectly suggest that an intermittent fasting protocol of 23:1 or 20:4 (hours in the day not eating:eating hours) can help regulate insulin levels? Others seems to be discussing this on other forums. I just don’t think there has been enough research. When there is, I am sure Dr. G will tell us.

    1. There is lots of research on intermittent and prolonged therapeutic fasting being a solution to address insulin resistance causing type II diabetes and trigger other beneficial body functions. See any talk by “dr. jason fung” on youtube. We are all awaiting dr. greger’s review and conclusions on research results associated with use of therapeutic fasting especially as it relates to those who otherwise are eating a whole food plant based [wfpb] diet.

      1. Liisa,

        Yes, cutting the fat gets rid of it more permanently.

        But the studies he is showing are doing very low calorie with Keto shakes. It is the very-low-calorie part, which works, even if you do it Keto.

        I looked up the studies on one of the sites he posted and it was Keto Shakes and they were talking very low calories.

        My friend might be doing one of those programs now. She had done it before and lost a lot of weight. I see her once a year – one year amazingly thin. The next year she got sick of the shakes and ended up getting heavy again. This is 5 years later and she is sick of being heavy again and is doing the shakes again. Her scale contacts the people to tell her whether she loses or gains weight, so she is highly accountable to them.

        She is going to get sick of it again is what I predict. Getting used to low fat is easier than eating Keto shakes every day for the rest of your life. It is also easier than sticking with 650 calories or less for any amount of time.

        Intermittent fasting is easier than low calorie, but they recently had the study where alternating day fasting increased diabetes.

        1. Yes, but the Keto side of the equation lumps refined carbs and whole food carbs together.

          (They also don’t tend to include trans fats in their fat studies.)

          High Carb people from WFPB don’t tend to include refined carbs when they speak about carbs.

          Chances are it is both fats and refined carbs and way too much sugar causing problems

        1. Lundberg has been making these pro-saturated fat arguments for years. However the quality of his judgement is apparent from his flattering remarks about Gary Taubes’ books. Taubes’ misrepresentations of the evidence and history, and his omissions of key evidence refuting his case, should be well known by now to any medical professional with an interest in nutrition. However, they are not to Lundberg it seems. An MD who dismisses the findings of expert scientific panels from around the world in favour of sensational claims made in a popular ‘health’ book by a journalist, has got to raise eyebrows.

          High fat, low carb diets can deliver weight loss. So can most other diets for that matter. Weight loss alone can result in significant improvements to biomarkers such as those you report Greg. The question is what are the long-effects on disease risk and mortality of high fat low carb diets? Some of my other posts answer that question.

          I hope you aren’t eating a lot of saturated fat, Greg. and that your high fat low carb diet emphasises unsaturated fats.

          ‘Interestingly, while saturated fatty acids are toxic to cells, unsaturated fatty acids are not only harmless but also provide protection against the damage done by saturated fatty acids. Studies conducted on many cell lines have indicated that saturated fatty acids can cause cell death involving the “endoplasmic reticulum stress (ER stress),” a cellular process known to be involved in the development of many diseases. A new paper, “Saturated fatty acids induce endoplasmic reticulum stress in primary cardiomyocytes,” just published in open access in “Endoplasmic Reticulum Stress in Diseases” by De Gruyter Open shows that there are striking differences in the accumulation of saturated and unsaturated fatty acids in cardiac muscle cells, and that saturated fatty acids induce the death of these cells through the ER stress. In striking contrast, unsaturated fatty acids protect the same cells from such damage.’
          https://www.sciencedaily.com/releases/2015/04/150427101527.htm
          https://www.degruyter.com/view/j/ersc.2015.2.issue-1/ersc-2015-0004/ersc-2015-0004.xml

    1. Carbs are not “killing us”, only refined carbs (processed carbs without the fiber, vitamins and minerals of intact carbs) do damage, at least as long as one is not overeating.

      Reversing type 2 diabetes, if it has not gone too far, requires achieving and maintaining a low enough weight to clear out the fat from the liver and other places (the amount of weight loss required can vary with the individual). It does not seem to matter much how one does this, but some diets, e.g. ketogenic diets, are not healthful for the long term.

      By the way, I eat lots of intact carbs, usually 7 servings per day, on my 100% WPF diet and easily maintain a BMI of 19 (exercise a lot too), and at age 71, am on no medications, do not have diabetes or prediabetes, and have a total cholesterol of 137 (LDL of 80). I should add I am not on a low fat diet. I eat lots of nuts and seeds, approx 25% or more of my daily calories – seems to have no adverse affects on my cholesterol. This is consistent with Dr. Fuhrman’s claim that fats are fine as long as you maintain an optimal body weight and get them from whole foods.

    2. Greg

      Cutting out fruit, vegetables and whole grains and eating more animal fats and animal protein sounds suicidal to me.

      ‘Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.’
      https://www.ncbi.nlm.nih.gov/pubmed/30122560

    3. This what the evidence shows

      ‘This study prospectively examined the relationship between low carbohydrate diets, all-cause death, and deaths from coronary heart disease, cerebrovascular disease (including stroke), and cancer in a nationally representative sample of 24,825 participants of the US National Health and Nutrition Examination Survey (NHANES) during 1999 to 2010. Compared to participants with the highest carbohydrate consumption, those with the lowest intake had a 32% higher risk of all-cause death over an average 6.4-year follow-up. In addition, risks of death from coronary heart disease, cerebrovascular disease, and cancer were increased by 51%, 50%, and 35%, respectively.

      The results were confirmed in a meta-analysis of seven prospective cohort studies with 447,506 participants and an average follow-up 15.6 years, which found 15%, 13%, and 8% increased risks in total, cardiovascular, and cancer mortality with low (compared to high) carbohydrate diets (see figure for total mortality).

      Professor Banach said: “Low carbohydrate diets might be useful in the short term to lose weight, lower blood pressure, and improve blood glucose control, but our study suggests that in the long-term they are linked with an increased risk of death from any cause, and deaths due to cardiovascular disease, cerebrovascular disease, and cancer.”’
      https://www.escardio.org/The-ESC/Press-Office/Press-releases/Low-carbohydrate-diets-are-unsafe-and-should-be-avoided

        1. Oh dear, Greg. This is the PURE study by a team led by researchers from McMaster University, an acknoledged partner of the Canadian dairy industry.

          It has been roundly criticised as bad science by experts from the WorldHealth Organization to Harvard. Basically it compares poor people in poor countries with limited public health and medical systems who necessarily eat inadequate diets high in cheap carbs, with rich people in rich countries who eat higher calorie diets with more fats and protein, who have access to good healthcare systems and medicines. Unsurpriingly, rich people in rich countries live longer than poor people in poor countries.

          This team argues that current guidelines advising strict limits on satfat consumption should be changed. The same team also argued that current guidelines recommending strict limits on sodium consumption shou;d be changed. coincidentally, dairy foods are high in both saturated fat and sodium.

          1. What about Dr. Salim Yusuf, an internationally renowned cardiologist?

            https://youtu.be/RwGteseHyas

            A new, soon to be released study from Houston by another top cardiologist is going to agree with Dr. Yusuf. This new study should be published before the end of the year.

            I come here to get the other side of the argument but it’s just hard for me to believe that fat is so bad for you since my weight and health have improved so much since reducing carbs and eating more fat.

            1. Greg

              My impression is that mainstream science currently thinks that the amount of fat in the diet isn’t particularly important. What is important is the type of fat. See for example, the AHA’s Presidential Advisory on fats and cardiovascular disease. It’s pretty heavy going but if you are eating a low carb, high fat diet you owe it to yourself to read it
              https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000000510

              Every time a cardiologist comes out with a case for saturated fat, they are always described as ‘top’ cardiologists by the keto/low carb crowd. In fact, the real top cardiologists are the ones who write the US, UK, European etc guidelines. None of them them recommend saturated fat consumption.

              There are tens of thousand of cardiologists around the world. Very few of them promote these ideas but some of them do……… and some become very rich or famous for saying such things. Think Dr Atkins. Or Malhotra in the UK. The press and the public love that sort of thing.

              We are expected to believe that the global scientific and medical communities have got it wrong and a few mavericks have got it right. We’d need extrordinary evidence to believ that – but there is no extraordinary evidence. Just badly interpreted and confounded observational studies.

              1. Greg

                I think that I have mentioned before that McMaster University receives funding from the Canadian dairy industry and that dairy foods are high in fat and sodium. And that the leading authors of the PURE study papers that argue for lifting the recommended limits on saturated fat consumption are from McMaster University. l commented that this was probably a coincidence.

                By anotherr coincidence, Salim Yusuf is professor at McMaster University. I would add that all Yusuf’s allegations about Ancel Keys are falsehoods and this is easily demonstrated by some basic fact checking.[
                https://medium.com/thrive-global/what-to-do-when-a-leading-physician-slanders-great-scientists-e157c083bc93

  2. Willpower against an all-consuming addiction? Fat chance.

    What ever happened to aversion therapy?
    I saw an amazing transformation once the oreo and potato chip cravings were slayed.

    1. I would like to see that video.

      I have had to do serious mind re-programming to get rid of things like cheese and junk food and also to eat any fruits or vegetables at all.

      It was almost exhausting to get myself to try even one blueberry or to get myself to not crave cheese.

      Vegan cheese replacement helped with the cheese.

      Replacement sugar doesn’t help. It makes the sugar cravings worse.

      Fruit lowers the sugar cravings. Frozen fruit mixed into almost an ice cream concoction helps prevent binging on soy icecream products.

      I haven’t gotten an aversion to sweet things though.

      Just a preventative fruit intake, but I still don’t really enjoy most fruit. I just enjoy the victory of not having candy bars or cake or icecream all summer.

  3. I believe bariatric surgery has proven to be unique in that people are able to maintain their weight loss much better than people who lose weight through dieting. So in this example, the group who only does the low calorie diet is eventually going to feel ravenously hungry and probably gain the weight back, while surgery patients are much less likely to do that. It may be the only treatment that actually changes the body weight set point (this would be where the digestive hormones leptin and ghrelin come in) so that the person isn’t constantly fighting against their desire to eat more for the rest of their life. Diabetes reversal might depend on calories alone but sustainability is everything.

    Of course these studies aren’t comparing surgery to a whole food plant based diet. But even plant based dieters have to struggle with the effects of being below their metabolic set point after losing a large amount of weight.

    1. Miki,

      You are right that people who eat low calories do end up with ghrelin and leptin issues.

      It isn’t just some people.

      It is 99.9% of dieters who fail.

      Whole Food Plant Based not triggering that reaction as much is party why I chose it. I had already figured out that low calorie was banging your head against the wall and had stopped trying anything at all.

      My friends have done several diets over the years since I stopped even trying and I have watched them yo-yo, but just not to even go there at all anymore.

      Whole Food Plant Based is the first thing I have really wanted to try in the past decade.

      1. Perhaps it is a matter of perspective.

        Diets are popularly seen as short term options or fixes which are to be abandoned when the problem is ‘solved’. That would explain why most diets fail long term. However, if we consider whole food plant-based eating a permanent lifestyle choice, then perhaps the dynamics are differeet. As I understand it, in Esselstyn’s heart disease reversal patients, only one person abandoned the diet. And the scientifc literature appears to show:

        ‘However, many people report that they have successfully managed weight loss maintenance in the long term. Several factors have been associated with better weight loss maintenance in long-term observational and randomized studies. A few pertain to the behavioral area (eg, high levels of physical activity, eating a low-calorie, low-fat diet; frequent self-monitoring of weight), a few to the cognitive component (eg, reduced disinhibition, satisfaction with results achieved, confidence in being able to lose weight without professional help), and a few to personality traits (eg, low novelty seeking) and patient–therapist interaction.’
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4777230/

        A whole food plant based diet is in practice a low calorie, low fat diet ……….. unless people are living on avocados and nuts perhps.

    2. Hi, Miki, there are a lot of people who started following a plant-based diet, lost weight effortlessly without counting calories, and lost weight.
      I am one of them and you can see many of them online. I’m glad I never had to have bariatric surgery, for sure!!!

  4. As someone who has been WFPB for a few years now, I eat massive quantities of food. I eat delicious food all day, every day and never gain weight. It’s not about quantity, it’s quality. In my opinion, learning to eat a whole foods, plant-based diet is a hell of a lot easier and much more pleasant than bariatric or other surgeries, which are barbaric.

    1. Nancy,

      I agree with you.

      That being said, I do know people who were closer to 400 pounds who had Bariatric surgery and they lost weight and would never have eaten vegetables or low calorie.

      I have friends who had stomach stapling, who lost weight, but gained so much that she is almost 400 pounds with her stomach stapled and I have heard those types of fails with Bariatric surgery, too.

      Food addiction is not an easy thing to deal with and people not being raised on fruits and vegetables makes the whole issue harder.

      I honestly probably switched to entirely veggie burgers one time, because I was trying to not gain weight, but didn’t eat fruits and veggies and I did shakes other times and did chocolate bars from Slim Fast or Special K or Atkins or Power Bars. That chocolate nutrition bar was the easiest way for me to eat. Hard to go out with friends, but it was like just eating chocolate all day long.

  5. I think it’s a scary statement about our collective mindset that risky surgery has become the preferred “quick fix” for a problem caused by long term, daily habits and choices, especially sad in progressively younger children! The rational solution would be to change, or seek out help to change, the mindset and choices that got someone there in the first place. But gee, that requires effort and change. How well I know after finally losing over 100 lbs and keeping it off just learning to eat whole food plant based. The only safe, sure, cure surgery offers… is for the doctors’ finances, because even a tiny stomach doesn’t prevent more frequent ingestion of garbage edibles and subsequent regaining of weight.

    1. Vegetater,

      I totally agree with your summary. ‘Quick fix’ seems to be the distorted American way to address everything. I too lost 1/3 ( 74 lbs.) of my body weight in approx. 1 year, just by not consuming anything that came in a box, package, wrapper, container, can, tin, bottle, jar, bag, etc.

      By only consuming Whole, Fresh, Alive plant foods…am able to eat what I want, however much I want, and whenever I want, and maintain my desired healthy weight, body fat, and visceral fat/muscle ratios. Got to throw daily vigorous exercise into the equation.

      ‘P & E’…plants and exercise. Easy peasy.

      1. It has to be so discouraging to people. They get a few years of real weight loss, then by 5 years, they start creeping up.

        The percentage of surgical failure was higher in the superobese group at all times studied, reaching 18.8% at 48 months after surgery.

  6. As a person who had this surgery it would rarely be my recommendation. In 2003 I thought I had tried everything to loose the weight and had failed. I did not have type 2 diabetes however I was 100 lbs plus overweight. It certainly helped me loose 100 lbs but eventually it has cost me 80% of my pancreas and the ability to absorb vital nutrients. In my journey on the other side of bariatric surgery I struggle with blood sugar levels of 250+ that drop to sometimes 55 with in 30 minutes. It is a horribly uncomfortable ride to have your blood sugar drop this fast. I have a rare condition no one could have known about prior to the surgery. The positive side you could say is that I had to teach myself about nutrition which keeps me coming back to this valued site. I am a registered nurse and due to my issues became a certified diabetes educator. The most important thing I learned is you still need to have lifestyle change and improve the way you think of food.

    1. Cindy,

      Thank you for sharing!

      I know people who have had the surgery and I want to post the reality that most of them had the surgery because they didn’t want to die from health problems.

      I am sorry that it has caused the health issues that it has caused with you.

      That type of a drop in blood sugar has to be terrifying. Are you considered Diabetic now with the limited pancreas? That breaks my heart that you started off not Diabetic, but now have Blood Sugar problems, even with the nutritional changes.

      I am glad that you have the right attitude to turn the negative into a positive.

  7. I wish Scott was here to debate me about women’s wages again. I was listening to people who are afraid they will never get a full-time job or a career in their whole lives and who can’t afford even one college class and who don’t know whether to go $200,000 in debt when that is a house price.

    I think the younger people and blue collar class and retail workers don’t care how much professionals make anymore because their issues are so much more pressing and I think the young people and elderly and working class and skilled labor and customer service who saw their jobs go overseas and parents who have 6 kids and don’t know how in debt to go to send them to college – are where males and females are all in the same boat.

    I pondered it if I was being insensitive to professional women’s condition and I think it is just that I am so aware of everybody else.

    I remember hearing it with missionaries who were in countries where there was no clean water to drink and we are into bottled water and filters and showers with multiple heads and so many of the people of the world are so desperate for something to drink and we waste it left and right and pollute it left and right and it is almost as if we just plain aren’t going to get compassion from them and we also don’t have compassion for them.

    I have had friends who ministered to children who live in garbage dumps and she said that she came home and couldn’t get excited about materialism anymore.

    In some ways, I have come to feel that way about entertainment. Sports and movies and television people all wanted so much money that they have priced me out of caring about them. So has education and insurance and medicine and government and those are the ones where I know people getting so much money.

    The worst part is that the insurance companies doubled and tripled the wages of their people, then they couldn’t afford those wages and let them go at age 50. The schools doubled and tripled and quadrupled how much it costs to go there and society has so many people in desperate debt and the kids come out and even if they get a job they can’t afford to get married or buy a house or have children, because of the debt. My State hired my relative and her whole team for $50 an hour, but couldn’t actually afford that and ran out of money for the project after 1 year, before even one productive thing got done and the grocery store women were talking about 4 other projects where that happened.

    I see people losing their houses for medical care and I see doctors deep in debt because of education and hospitals almost going bankrupt trying to give huge salaries because of insurance and there is some ridiculous cycle of whether it will be the insurance or the medical bills that cause people to go homeless or whether it will be their kids trying to go to college.

    I say it at this Bariatric Surgery post because I see it as the same as food and materialism as unsustainable situations. It feels like we are numbing ourselves out with food and drinks and pot and entertainment and sports and pornography and sex and all kinds of things and that we have a pyramid scheme called social security and we have more jobs right now, but our employment is more like Jenga.

    WFPB saves money so you don’t have to have surgeries like this.

    1. If you work in Big Pharma you want to make as much as your coworker. If you are not in Big Pharma you want Big Pharma to not have people making millions of dollars for health-related products. If you can’t afford your medicine, you resent it when you hear someone from Big Pharma making big bucks.

      I feel like that is the cultural clash of the future.

      1. And trash collectors wanting equal wages because their job exposes them to toxic stuff all the time competes with the self-interest in the people who want to be able to afford their trash bill. And every worker in every industry wants more money and more benefits and more job security and every level of society and every generation and males and females are all in competition with each other for those resources and it is going to be harder and harder and harder to generate the type of compassion that people used to be able to generate.

  8. I am not against people pursuing wealth. It is more that industries started doubling salaries and once they doubled it for one, everybody wanted it and it turns out the very industries where women are crying out for higher wages are the ridiculously inflated wages industries.

    And I get that the people who made six figures also spent money on education or houses as if the could count on making six figures and then the schools, government, insurance companies and medical industries all cry poor and it is unsustainable because the haves are being supported by too many have nots who can’t afford to use the services.

    I don’t know if I can Google and find a WFPB equivalent of a global economy, but I am over saturated with compassion for the genuine poor and mentally Ill and have some compassion for the haves, but they want to double and triple my price to pay for everything and my salary didn’t double or triple when theirs did.

  9. And the younger generation isn’t sure whether they will be able to ever afford to have houses or cars or children and they think it isn’t fair and the poor working class thinks the same thing and they think it isn’t fair and they teach their children, “Life isn’t always fair” and it is the privileged class where they use the press and rile up people to care about whether someone making a livable wage doesn’t make as much as other people and those people use “It’s not fair” and it may not be, but third world countries say the same thing and teach their children, “You have to learn to live with the reality that life is not always fair.”

    And I would like government to spend less money and medicine to cost less and hospital emergency room visits to cost less and dentists to cost less and insurance to cost less and movies to cost less and I got rid of my phone line and got rid of cable and never got internet at home and don’t go to the movies or restaurants except for special occasions and don’t do fast food, except for one green tea latte every day and I may have to give up that eventually, but will think of generations all around the world who have lived through famine and war and dictators and slavery and by God’s grace I will not say, “It’s not fair” if I don’t get to have a green tea latte every day.

  10. Sorry for the rant.

    If I could make life more fair for everyone, I would do it, but it cannot be done, so what do we do to make it healthier and happier and more fulfilling? What are the “vegetables” we aren’t eating and what are we eating instead?

    That is what is on my mind.

    Sorry to the women because I know that women are abused and being held as sex slaves and are being exploited and there are likely companies which should be ashamed of themselves. I am not against those things being dealt with.

    I just have a “genuine need” versus something more akin to a child saying, “It’s not fair that I don’t get to go to Disneyland” when I can look at the Shriner’s children’s ads and that genuinely moves me.

    1. There was a time in history when women were denied the right to work and if they didn’t get married or have parents they were often exploited or became prostitutes out of necessity. Some of my favorite works of literature were about those times and people worked hard to lessen that and I do know that women still end up in prostitution in America because of poverty today. The statistics in America is that one out of six of those women will be murdered.

      I do care about those things.

      I just don’t want to spend my emotional investment worrying about whether some female star deserved more million dollars and I don’t think it is something worth rallying people if one executive gets $100,000 and one gets $200,000.

  11. I was walking through the grocery store tonight after writing those posts and heard Michael Jackson’s “The Man in the Mirror” and that and “Do They Know It’s Christmas?” are some of the songs I have listened to over and over and over again. There is a line in Do They Know It’s Christmas: Tonight, thank God it’s them instead of you.

    https://www.youtube.com/watch?v=WesKXdaWBq0

    That and “One Million Voices” for Rwanda.

    https://www.youtube.com/watch?v=VXevueClB44

    Anyway, it caused me to look up the global issues of real poverty and really do an inventory of my part in the world.

    http://www.globalissues.org/article/26/poverty-facts-and-stats

    Somehow I have to figure out how to measure time and energy to be genuinely helpful. Dr. Greger does that. I see it.

    Anyway, some of us try, but never learned how to measure by and that is probably the reason I am rambling on a Sunday night.

    “525,600 minutes, 525,000 moments so dear.
    525,600 minutes – how do you measure a year?
    In daylights? in sunsets? in midnights? in cups of coffee?
    In inches? in miles? in laughter?
    How do you measure a year in the life?
    How about love?
    Measure in love.”

    My dog has been alive over 100 days since the diagnosis. Almost a third of a year went by and I am not sure I accomplished anything.

    Dr. Greger, I see how productive you are for the good. I can only pray to get there somehow.

      1. Thank you Liisa, you are so sweet!

        You are also good in this forum!

        I really enjoy you!

        I am laughing because my sister-in-law just got another job in an insurance company making her six figures. She makes more than my two brothers and I put together and she gets the jobs because she is bossy and I couldn’t do the jobs even if I suddenly wanted to make money like that, which I thought about today while she was telling me that I can take her off of our insurance soon and I am happy to get her off our insurance because insurance is too expensive and there is some irony in there someplace that she is going to go to the insurance company and make our insurance more expensive at that end instead of this end.

        1. I know, we can have the doctors go work for the insurance companies. Less education and you can have it paid for, plus they wouldn’t have to pay the extreme insurance rates or worry about getting sued and they might actually approve things which the expensive insurance workers wouldn’t.

            1. Oops I ended up with Round Up needing layoffs. And the Round Up and Big Pharma workers could go to researching antibiotic resistance.

  12. You don’t have to starve. A balanced diet, such as Weight Watchers, such as worked for me, can also solve the problem. After losing 50 pounds in 8 months, not only am I not diabetic anymore, I am no longer pre-diabetic. My A1C is 5.1. Even though I am still considered obese and still have at least 50 more pounds to lose, that initial weight loss did it for me.

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