Dr. Mariela Glandt’s father, who has lived with type 1 diabetes for over 50 years, inspired her to become an endocrinologist. She trained at Harvard and Columbia University and for almost two decades she had great success treating people with diabetes using the medications at her disposal. About two years ago, however, something changed. Dr. Glandt’s eyes were opened to the concept of food as medicine. “I had always recommended a low carb diet, but didn’t understand what a powerful tool it is,” she said. I ran a very successful clinic without talking about food because I’d always thought that food was the dietitian’s domain.”
Then, all at once, three patients in succession told Dr. Glandt they preferred to treat their type 2 diabetes with diet, and had managed to stop medications. They sent her to the Ted Talk by Sarah Hallberg and she started to listen. She learned that there’s a different way of doing things, and that the science is there to support it.
I talked to Dr. Glandt about her revolutionary practice, and her drive to change the way we eat.
Was nutrition part of your medical school curriculum? Were you ever taught to use diet as medicine?
I never had a nutrition class in medical school, in residency, or during my endocrinology fellowship.
Do you treat both type 1 and type 2 diabetes with a low carb diet?
I do treat both type 1 and type 2 with a low carb diet. For patients with type 1 diabetes a low carb diet means stability. No more of the roller coaster of highs and lows. For patients with type 2, I use it as a means to stabilize the condition. My patients are able to improve their diabetes management tremendously by just cutting out the carbohydrates. For some patients the change is immediate, for other patients it takes longer.
What do you think about the rule of thumb taught to most people with type 1 diabetes: eat whatever you want and cover it with insulin?
I think that it’s a choice. You can eat whatever you want and cover it with insulin, but the truth is that – diabetes or no diabetes – no one should eat the high-carb, processed foods that most of us consume daily.
The therapeutic window of insulin is so small and there is a lot room for mistakes, which puts people with diabetes on the roller coaster of highs and lows. We also know that high levels of insulin in the body can lead to many illnesses.
Why is it better for a patient to use less insulin?
Insulin is crucial for life, but too much insulin is associated with all the main chronic diseases of our time- heart disease, stroke, Alzheimer’s, Parkinson’s, PCOS, cancer… it’s a long list. In addition, higher insulin levels on their own lead to more insulin resistance. So, when we eat foods that don’t require insulin, we are able to bring down the overall levels of insulin in our body. Other ways to reduce insulin are to pay attention to the timing of food (it’s not usually necessary to eat every three hours), getting enough sleep, and reducing stress.
How did you explain your change to your patients? Did they hesitate?
Many patients were in shock at first- Add fat to the meals? Don’t eat for 16 hours? For some patients it was very dramatic, but once they started seeing the results, and slowly internalizing the reasoning behind the changes, then they dove right in. Now most patients who come to my clinic know that diet is a main part of the treatment. Since I’ve now treated many patients who have a lost significant amount of weight, and have stopped many medications, new patients seem to be less hesitant.
What kind of results have you seen?
In patients who commit to a low carb diet we consistently see weight loss, dramatic improvements in A1c, improvements in fatty liver, triglycerides decrease, and HDL increases. The LDL can go up, stay the same, or go down. The reassuring part is that we know that the biggest predictor of heart disease is the triglyceride to HDL ratio, much more so than LDL. And when this ratio improves we also know that the quality of the LDL particle improves.
Do you think a strict ketogenic diet is necessary, or is eating low carb enough to get results?
It depends on the patient. Patients who are recently diagnosed can do quite well on a low carb diet. However, those with long-term diabetes may require a more extreme diet in order to see significant results.
Why do you think mainstream medicine is reluctant to embrace and recommend a low carb lifestyle for all people with diabetes?
I think it’s hard to appreciate just how engrained the diet-heart hypothesis is. People still believe that eating fat clogs your arteries, and it’s not a shock that they believe it. After all, this is what we’ve been taught for the last 50 years. As a doctor, it’s hard for me to swallow the fact that I’ve have been fooled to such an extent. I really had it all wrong? It’s very humbling. I was lucky to stumble into this low carb world. I am so grateful for the grassroots movement that has been showing me the way, including ASweetLife, the diabetes magazine that has been promoting a low carb lifestyle since 2009. I think most doctors have not had exposure to this information. They learn what’s presented at conferences, which are always sponsored by industry.
What would you like other diabetes practitioners to know about your work?
There’s no longer an excuse to be ignorant. I often say that if we called diabetes ‘carbohydrate intolerance disease,’ no doctor would ever suggest eating carbs as part of the diet. Just like no one would tell someone with a gluten intolerance to eat gluten. The correct treatment is so obvious, I can’t believe it’s taken me/us this long to get here. Dr. Bernstein is the ‘low carb diet for diabetes’ pioneer, and diabetes practitioners should know his work.
Would you like the American Diabetes Association to change its dietary recommendations for people with diabetes?
I work at a hospital in the Bronx part-time. Last month I walked into a patient’s room at breakfast time. The patient’s A1c was 13%. I was mortified to see that he was being served pancakes. When I asked the team to look into how such a thing could happen, they told me that the hospital was simply following the American Diabetes Association’s (ADA) guidelines for dietary recommendations.
The key is to understand that patients do want to be better. We need to give them the benefit of the doubt. We need to educate them with the right information so that they know how to stand up for themselves and say, “I’d prefer not to eat pancakes because they raise my blood sugar.”
I feel it is imperative for the ADA to change their dietary recommendations. People with diabetes deserve better than this. The ADA’s recommendations are, simply-put, making us sicker.