Diabetes is Track Your Plaque's Kryptonite!


If there's one thing I truly fear from a heart scan score reduction/coronary plaque regression standpoint, it's diabetes.

I saw a graphic illustration of this today. Roy came into the office after his 2nd heart scan. His first scan 14 months ago showed a score of 162. Roy started out weighing well over 300 lbs and with newly-diagnosed adult diabetes.

Roy put extraordinary effort into his program. He lost nearly 70 lbs by walking; cutting processed carbohydrates, greasy foods, and slashing overall calories. His lipoproteins, disastrous in the beginning, were falling into line, though HDL was still lagging in the low 40s, as Roy remains around 60 lbs overweight, even after the initial 70 lb loss.

Unfortunately, despite the huge loss in weight, Roy remains diabetic. On a drug called Actos, which enhances sensitivity to insulin, along with vitamin D to also enhance insulin response, his blood sugars remained in the overtly diabetic range.

Roy's repeat heart scan showed a score of 482--a tripling of his original score.

Obviously, major changes in Roy's program are going to be required to keep this rate of growth from continuing. But I tell Roy's story to illustrate the frightening power of diabetes to trigger coronary plaque growth.

Like Kryptonite to Superman (remember George Reeves crumbling and falling to his knees when the bad guys got a hold of some?), diabetes is the one thing I fear greatly when it comes to reducing your heart scan score. As you see with Roy's case, diabetes can be responsible for explosive plaque growth, more than anything else I know.

The best protection from diabetes is to never get it in the first place. (See my earlier Blog, "Diabetes is a choice you make".)
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The Great Low-Carb Connector

The Great Low-Carb Connector

The effusive Jimmy Moore of Livin' La Vida Low-Carb asked me to help get the word out about his new podcast subscription service, The Livin' La Vida Low-Carb Show Fan Club.

Jimmy has been The Great Connector for the low-carb discussion, from his ubiquitous online and social media presence, to his annual low-carb cruise. He has also broadcast first class interviews of nutritional notables like Gary Taubes, Dr. Robert Lustig, and blogger Stephan Guyenet. His Fan Club expands listener involvement in the podcast process and, potentially, greater access to his guests:

My faithful listeners have long been asking me about how they can become even more engaged in the behind-the-scenes workings of the show to get the inside scoop about what’s coming next. I’ve heard people ask specifically for access to transcripts of the most popular podcasts, a listing of the interviews I’m currently working on with the ability to ask questions of those guests, to have sneak peek of audio from not-yet-released interviews and more. My amazing podcast producer, Kevin Kennedy-Spaein, and I have been discussing how to best do this for a while in an effort to meet the demands of our biggest fans and we think we’ve got just the answer for you. Introducing The Livin’ La Vida Low-Carb Show Fan Club!

This is for all intents and purposes the quintessential destination for people who can’t get enough of this podcast that goes much deeper than discussion about the low-carb lifestyle. Yes, I speak with a lot of people who are supporters of carbohydrate-restricted diets, but I also talk with fitness gurus, people who support alternative eating plans, those who have interesting theories and beliefs regarding health and much more. Wouldn’t you love to have a chance to know who’s coming up in my schedule to be able to ask them questions BEFORE I interview them? Keep in mind that my interviews are pre-recorded and air sometimes as much as 5-6 months afterwards. Members of the “fan club” would know all about who’s coming and likely will have their question asked on the air just for signing up to be a part of this exciting new addition to “The Livin’ La Vida Low-Carb Show.”


Jimmy is the guy who is bringing this disparate and widely-spread community together. He's the guy we all know, he knows "everybody." I'm looking forward to seeing how this new project makes a more involved, personal delivery of interaction possible.

Comments (15) -

  • Anonymous

    10/28/2010 12:54:06 PM |

    Is Jimmy still eating eggs for every meal in order to lose weight?

  • kris

    10/28/2010 2:37:00 PM |

    Dr. Davis, How true is this statement?
    "before resorting to muscle tissue, the body will burn fat. If you have no body fat, (or even very little of it), then eating carbohydrates is a good idea. If there is fat to burn, it will be burned first. Our entire body runs on sugar, but you can turn fat into sugar and sugar into fat, depending on the current needs of the body"

  • Anonymous

    10/28/2010 4:02:20 PM |

    No - he is off the eggs, but somewhere up around 282lbs.  Jimmy is indeed a great connector and does well with podcasts and interviews but his own diet - and as a consequence his weight - remains a problem.  He remains obese and as such is not a great advert for low carb.

  • Jimmy Moore

    10/28/2010 6:04:17 PM |

    THANKS for the plug for my new "Fan Club" associated with my podcast, Dr. Davis.  I certainly hope to indeed connect fans of "The Livin' La Vida Low-Carb Show" with more of the behind-the-scenes happenings to get them involved in the interview process, share transcripts of past episodes, and even let them hear sneak peak audio of not-yet-aired podcasts.  I'm excited to make this little something extra available to those who want more.

    As for the the anonymous criticism about my weight, yes I weigh more than I would like to at this moment.  This is not a secret and I've been quite candid about this publicly because there are many who face the same frustrations of doing everything right and yet seeing very little progress on the scale.  While I'm seeking to rectify those issues by lowering my calories to 1800/daily and engaging in regular exercise, the fact remains my health is immaculate.

    High HDL, low triglycerides, low percentage of Small LDL particles, stable blood sugar, normal blood pressure, a heart scan score of ZERO, abundant energy and so much more.  While the focus tends to be on weight as the key measurement in someone being healthy, I think that's as shortsighted as telling someone a low-fat, high-carb diet is the only way to lose weight and be healthy.  Again, I'd like to weigh less than I do now but it's difficult to argue that the way I'm eating isn't making me healthier than when I weighed 400+ pounds in 2004 on three prescription medications.

  • Jamie Scott

    10/29/2010 12:17:43 AM |

    Re: Jimmy's weight - it's Jimmy's business!  The guy does a massive amount of work, as highlighted by Dr Davis' post, promoting the many and varied strains of low carb eating, and he does so because he has first-hand experience of the benefits of doing so.  Sure HE might not want to be where HE wants to be with HIS weight, but it isn't like he is ht eonly guy pushing the low carb mantra and peddling snack oil is it?

    Jimmy, I'd have no doubt you could get to where you wanted to be (or closer to it at least), if you gave up on the stuff that you do.  But the rest of us would be poorer for it.  A run a very small and very much part-time blog in this field and if I put in the amount of time Jimmy does with all his work, I doubt I would be able to maintain the other aspects of my life that I enjoy so much.  It is a sacrifice Jimmy makes.

    One last thing, and Jimmy may disagree with me on this... At one point in time, Jimmy's lifestyle lead him down the obesity pathway.  One aspect of this, and one that I try to promote in my line of work, is if you go down that road, there is no guarantee you can come back out of it.  Things like the consumption of industrial seed oils can lead to fat cell hypertrophy & hyperplasia... size AND number of fat cells increase.  Stay in this state long enough, and there is high chance you will never fully undo the damage done.  You can certainly imporve your health biomarkers as Jimmy has obviously done.  But you might not necessarily be able to return to an ultrathin body, no matter how much you desire it.  There is a degree of ingorance from people who just automatically assume that because one is eating low carb, they should look like a Crossfitter all the time and failure to do so means that low carbing is a failure also.

  • Jimmy Moore

    10/29/2010 2:16:34 AM |

    Well said Jamie!  I totally agree.

  • Lori Miller

    10/29/2010 4:29:01 AM |

    Nothing measures up when compared to perfection. It's better to compare real-life choices and their likely consequences whenever possible.

    If someone was 400+ pounds and on medications on their old diet, and 120 pounds lighter, energetic and off the medications on a different diet, the different diet must have some benefits. I prefer to think in terms of progress, not perfection.

  • Susan

    10/29/2010 5:24:31 AM |

    Jimmy, Jamie and Lori


    AMEN !!!!


    Sue

  • Dr. William Davis

    10/29/2010 12:01:08 PM |

    I know Jimmy personally and he is a sincere, hard-working nice guy.

    We are all learning new lessons in nutrition and how to manage diet, navigating all the landmines in the commercial food that we are sold.

    Jimmy's unquestioned role in this has been to facilitate the discussion, bringing differing viewpoints from interesting people like Gary Taubes and Jeff Volek.

    Personally, I am grateful that we have someone like Jimmy Moore who acts as amiable host to our discussions.

  • ben

    10/29/2010 1:20:41 PM |

    i love Jimmy's podcasts. In fact i subscribe via itunes. He never fails to have intelligent guests. Especially in the last year or two he has had many paleo people which is great. I like to see the focus on good-health-all-around entering into his lowcarb world, rather than the sole goal of weightloss that i feel many atkinsers etc have. Anyway, he's doing a great job. and he has been for quite some time now. His weight? Who cares. Jimmy, dont sweat it! you've lost all that, your health numbers look great and you are leading a life that benefits many. I think you can be satisfied.

  • Anonymous

    10/29/2010 6:20:42 PM |

    Train wreck/drama queen. Needs to lift free weights or join a cross fit gym…quit making excuses..

  • Anonymous

    10/30/2010 1:22:10 AM |

    "Train wreck/drama queen...quit making excuses..."

    You got that right!

  • Anonymous

    10/30/2010 4:28:00 PM |

    Thank you so much Jimmy for the help you provide to all of us.
    I am an uruguayan and follow your podcast from Uruguay LA.
    Thanks again.
    Jose.

  • Anonymous

    10/30/2010 9:37:25 PM |

    If not for Jimmy Moore I would never have heard of Dr Davis, Mark Sisson, Stephan Guyenet, Robb Wolf, Dr Briffa, Fred Hahn and so many others.  I would never in a million years have thought to include strength training in my lifestyle.  I wouldn't have learned about the impact of sleep on health and mood.  Without the information Jimmy Moore brought into my life, I'd still be Vitamin D deficient, undermuscled, underslept and unhealthy.  Instead I've grown strength and muscle, ditched lifelong allergies and have had only one cold in the last three years.  (I work in healthcare and get coughed/sneezed upon constantly, so this is no insignificant fact.)

    Jimmy is humble, funny, candid and generous.  Sure, we'd all like to include "stunning physique" in our list of personal qualities, but some of us just have to be satisfied with excellent health and an ongoing commitment to pursue optimal body composition.

    For me, Jimmy Moore is a treasure.

  • e4e

    11/1/2010 6:16:54 PM |

    Kudos to Jimmy for all his good work. I completely agree with Jamie above.

    Anonymous trolls, just go away, or at least show a little spine and put your name.

    Tony K

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Name that food

Name that food

What common food can:

• Cause destructive intestinal damage that, if unrecognized, can lead to disability and death?
• Increase blood sugar higher and faster than table sugar?
• Trigger an autoimmune inflammatory condition in the thyroid (Hashimoto’s thyroiditis)?
• Create intestinal bloating, cramps, and alternating diarrhea and constipation, often labeled irritable bowel syndrome?
• Trigger schizophrenia in susceptible individuals?
• Cause behavioral outbursts in children with autism?
• Cause various inflammatory diseases such as rheumatoid arthritis, ulcerative colitis, dermatitis herpetiformis, systemic lupus, pancreatic destruction, and increase measures of inflammation like c-reactive protein?
• Cause unexplained anemia, mood swings, fatigue, fibromyalgia, eczema, and osteoporosis?


The food is wheat. Yes, the ubiquitous grain we are urged to eat more and more of by the USDA (8-11 servings per day, according to the USDA food pyramid), American Heart Association, American Dietetic Association, and the American Diabetes Association. Wheat is among the most destructive ingredients in the modern diet, worse than sugar, worse than high-fructose corn syrup, worse than any fat.

What other common food can result in such an extensive list of diseases, even death?

Celiac disease alone, a severe intestinal inflammatory condition from wheat gluten, affects an estimated 3 million Americans (Celiac Disease Foundation). The medical literature is filled with case reports of deaths from this disease, often after many years of struggle with incapacitating intestinal dysfunction and the sufferer's last days plagued by encephalopathy (brain inflammation).

What happens when you remove wheat from the diet?

The majority of people quickly shed 20-30 lbs in the first few weeks, selectively lost from the abdomen (what I call “wheat belly”); blood sugar plummets; triglycerides drop up to several hundred milligrams, HDL increases, LDL drops (yes, wheat elimination is a means of achieving marked reduction in LDL cholesterol, especially the small, heart disease-causing variety); c-reactive protein plummets. In addition to this, intestinal complaints improve or disappear, rashes improve, inflammatory conditions like rheumatoid arthritis improve, diabetes can improve or be cured, and behavioral disorders and mood improve.

Along with the ill-fated low-fat dietary advice of the last 40 years, the advice to eat plenty of "healthy whole grains" is responsible for untold disease and suffering. Yes, if you start with a fast food and junk diet and replace some of the calories with whole grains, you will be better off. (That was the logic--the Nutritional Syllogism--of the studies that established the benefits of whole grains over processed, "white" grains.)

But eliminate wheat grains and health takes a huge leap forward. And, no, there is no such thing as wheat deficiency--B vitamins, insoluble fiber, some protein--can easily be replaced by other foods.

Comments (30) -

  • Peter

    10/13/2009 12:40:15 PM |

    I stopped eating wheat when I read Gary Taubes's book Good Calories, Bad Calories.  However, I haven't noticed any changes.  My blood sugar is still a little high, and my weight is about the same.  Could you cite a study that shows that blood sugar and weight often go down when you stop eating wheat.

  • Anonymous

    10/13/2009 1:12:56 PM |

    Yes, yes!  Great post!  However, I think there is a huge mssing link here, and that is the source of wheat.  Sure, wheat (or gluten in many cases) causes problems.  I totally agree.  But my theory is that people who drop weight and improve their health by eliminating wheat were not eating the ocassional slice of home-made sourdough.  Nope.  I'd be willing to bet that most of the "wheat" elimination that leads to a better lipid profile and decreased body fat is from the elimination of packaged and processed foods like cereals, bars, crackers, store breads and buns, and other snack foods.

    Avoiding wheat due to a sensitivity or allergy is one thing.  But gorging oneself on processed foods and so-called healthy whole grain products only to later marvel at the results of a "wheat" elimination diet is a bit ridiculous.

    Eat from the earth.  And if for you that means no wheat, then great!  Just don't go eating all that "gluten free" stuff.  One can still eat a ton of junk without eating wheat.

  • Allison

    10/13/2009 1:58:16 PM |

    I love that you're pursuing this matter. Smile  It's not just wheat, though.  It's all the gluten grains related to wheat: barley, rye, spelt, kamut, etc.  In those of us sensitive to gluten, even the tiny bits of gluten in most processed foods cause problems.  So do oats, even gluten-free oats, in some Celiacs.

    Keep up the anti-wheat campaign, but please add the other gluten grains to your target.

  • Catherine (Santa Fe)

    10/13/2009 5:55:01 PM |

    Dr. Davis,
    I started the gluten-free diet 2 months ago after reading all your blogs. The one thing I did not think it would influence is thyroid. You stated so confidently that it influences Hashimotos, I wondered how you came to that knowledge---articles, research, personal observation?
    For 8 years my TPO antibodies have been very high in 700-800 range even with meds and good T4, T3 numbers. All tests came back negative for celiac although with high IGA. I have never been able to get Hashimotos numbers down, so would love to know how/where you heard about this. I will report back if after being wheat free my IGA and TPO numbers go down.
    Warmly,  Catherine

  • I Pull 400 Watts

    10/13/2009 6:40:50 PM |

    Fantastic post.


    I have been looking into a lower wheat (or gluten?) diet for a bit now, and recently purchased The Paleo Diet for Athletes. As soon as a finish In Defense of Food, that is next on my list.

    A quick question if you have a second. Maybe you can simply directly me to a page with the answer, as I have not been able to clearly find it.

    Is the key avoiding grains as a group, or would eating gluten free products be partially sufficient?

  • woly

    10/13/2009 8:47:33 PM |

    Do you have any references you could post for those claims?

  • Dr. William Davis

    10/14/2009 1:15:19 AM |

    In answer to several questions to clarify what I mean by "wheat":

    1) For celiac disease or marked wheat sensitivity, including "wheat addiction," all grains that immunologically cross-react with wheat should be eliminated--barley, spelt, oats.

    2) For those with extreme carbohydrate sensitivity--meaning diabetics, pre-diabetics, or marked small LDL, then even spelt, bulghur, sorghum, quinoa, barley, etc. can present excessive carbohydrate loads.

    For everyone else, I believe that these whole grains can play a role.

    Re: references. Just go to Pubmed.gov and enter your relevant search terms. It's quite easy.

  • Peter

    10/14/2009 10:07:13 AM |

    It's hard for me to separate out the effects of wheat, gluten, flour, grains, carbs.  

    Probably, nobody really knows yet., which is what it's like in 2009: lots of clues but nothing definitve.

  • Jonathan Byron

    10/14/2009 2:40:16 PM |

    My wife has hashimoto's thyroiditis, and cutting out the gluten has led to tremendous improvements. Her T3 and T4 levels are back to normal, and her anti-thyroid antibodies dropped significantly, to nearly undetectable. And she feels normal, not cold and lethargic.

    I am not convinced that all people with Hashimoto's benefit from cutting out gluten - some studies showed only about 30% to 50% of the group improved (but many people show amazing improvement). A change of diet should be the first thing tried IMO. It was not something the endocrinologist discussed. When my wife asked if there were any dietary or lifestyle changes that might help, she was told there were none.

  • Dr. William Davis

    10/14/2009 4:47:40 PM |

    Hi, Jonathan--

    Yes, wheat exposure probably requires years to trigger the Hashimoto's reaction. Unfortunately, to my knowledge, the precise trigger and "dose" or duration required is not well sorted out.

  • Christine Anderson

    10/14/2009 5:19:18 PM |

    I find the statement “don’t go eating all that ‘gluten free’ stuff” rather silly – the implication being that it’s full of junk.  Most of the gluten free food I’ve found is wonderfully free of the usual high-fructose corn syrup and the like.  It’s a real blessing, to be quite frank.  And by the way, all my food comes from Earth.

  • Anonymous

    10/15/2009 12:58:54 AM |

    Dr. D, correct me if I am wrong but quinoa is not a grain (it's a seed) and should not be grouped with wheat, spelt, barley, etc.

    My understanding is that its impact on the body is significantly more positive compared to grains.

  • Anne

    10/15/2009 1:06:24 AM |

    I have both gluten sensitivity and insulin resistance. Gluten free means I avoid wheat(includes spelt, kamut and other related grains), barley and rye. Oats are available that are certified gluten free. Removing gluten eliminated my GERD, gas and bloating, improved my neuropathy, lifted my depression, stopped my joint pain and the list goes on.

    When I discovered my blood sugar issues, I dropped all the gluten free grains that caused spikes in blood glucose. OK, I have not found a grain that does not spike my blood sugar so I am now grain free. The only problem I noticed when eating the GF grains was the blood sugar effect.

    Gluten/wheat and carbs/sugar are two separate issues for me.

  • Sue

    10/15/2009 11:01:24 AM |

    Is it full of soy?  That's junk.

    Peter, you probably have to reduce your carbs to see improvement in your blood sugar levels.

  • Anonymous

    10/15/2009 2:39:19 PM |

    To clarify: My point was that most products tha are labeled as "gluten free" are processed, and largely a part of the food industry's marketing tactics.  They are not there for your health, but rather to make profits.

    You can buy gluten free cookies, cereal, and other snack foods.  These foods are far from being close to the earth, and IMHO, not to be a regular part of a healthful diet.

  • Anonymous

    10/15/2009 3:15:27 PM |

    The sentiment is valuable, but I worry about hyperbole.  If an individual cuts out 1000 calories a day of wheat-related foods (a generous estimate), and doesn't replace those calories with any other foods, then they would lose about 2 pounds a weeks, not 10 or 15.

  • Anonymous

    10/19/2009 2:50:23 AM |

    I agree with Anon., who on the 15th wrote it's about reducing calories.

    1lb fat = 3,500 cals; hence 2lbs/week is practical weight loss. Getting fat does not happen overnight, or a week for that matter so why would anyone expect to loose weight magically within a week.

    If by not eating wheat you get there, I say go for it. For me, I feel much better since doing mega-dose K2/D3/B3/C which I learned here on the Heatscanblog and I will be forever grateful for those who aid Dr Davis in sharing their knowledge such as Ted Hutchinson who takes the time to post links to scientific papers supporting the cause of improved heart health.

  • Caballaria

    10/29/2009 10:43:40 PM |

    Question - how about rice? Is it just as bad?

  • Michael

    12/6/2009 12:32:14 AM |

    I take wheat grass tablets from Pines.  I have stopped eating wheat and reduced all grain consumption dramatically.  However, I still take the wheat grass tablets.  Is wheat grass a problem, like wheat?

  • Anonymous

    12/28/2009 4:27:15 AM |

    Well I acquiesce in but I contemplate the list inform should have more info then it has.

  • Anonymous

    12/31/2009 5:08:59 AM |

    Again a gentle post. Thanks your also pen-friend

  • Term Papers

    1/29/2010 7:49:30 AM |

    I think there is a huge missing link here, and that is the source of wheat.

  • Term papers

    6/8/2010 1:59:54 PM |

    I just bookmarked your blog and will come back in the future. Keep up your great job, I hope you have a nice day!

  • Anonymous

    3/26/2011 3:12:34 PM |

    Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon.



    Web Design

  • auto insurance quotes

    3/28/2011 8:22:55 PM |

    I study carried out in China proved conclusively that wheat was the major cause of heart attacks. I am quite sad to read these reports because I love bread. The question is that do I love it to death?

  • Study in UK

    5/9/2011 6:14:45 AM |

    This is generally a wonderful website i should say,I enjoyed reading your articles. This is truly a great read for me. I have bookmarked it and I am looking forward to reading new articles. Keep up the good work.


    Education

  • Julie

    10/20/2011 1:01:55 AM |

    I'm new here but looking for answers on systemic inflammation.
    Can eliminating wheat or gluten reduce the inflammation in my system?

  • Jaime M

    12/27/2011 7:34:37 PM |

    Hey Dr. Williams,
    My mom stumbled across this article a year ago in attempt to help me explain some unusal blood work and severe contipation issues that the gastro doc called IBS after a negative celiac test. At the time my c-reactive protein was elevated, my T4 was elevated, I was chronically tired, cold intolerant, constant constipation, stabbing pain in my abdomen (hurt to touch my toes and put shoes on),had eczema, and mood swings. More then ten years ago I had thought I was a celiac and had gone wheat free, went to a gastro doc but was told it was just IBS and now looking back my symptoms were worse after I began to eat wheat again.
    So, I have now been wheat free for a year now because of your article!.... my constipation has been reduced dramatically (no more miralax everyday) and my eczema only flares when I have accidently eaten something with wheat in it!
    Here's my delima now.. I thought that being wheat free for a year would change the unusal blood work, but I just got results back and my c-reactive protein has elevated slightly more, my T4 has elevated more, but the strange thing is my TSH is on the higher end too. Hashimoto's usually has high T4 and low TSH, plus all my symptoms are that of someone with a hypothyroid.  I'm still chronically tired, cold, and getting more moody. Any ideas?

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Diabetes is a choice you make

Diabetes is a choice you make

Tim had heart disease identified as a young man. He had his first heart attack followed by a quadruple bypass surgery at age 38. Recurrent anginal chest pain and another small heart attack led to several stents over three procedures in the first four years after bypass.

Tim finally came to us, interested in improving his prevention program. You name it, he had it: small LDL, low HDL (28 mg/dl), lipoprotein(a), etc. The problem was that Tim was also clearly pre-diabetic. At 5 ft 10 inches, he weighed 272 lbs--easily 80 or more pounds overweight.

Tim was willing to make the medication and nutritional supplement changes to gain control over his seeminglly relentless disease. He even turned up his exercise program and lost 28 lbs in the beginning. But as time passed and no symptoms recurred, he became lax.

Tim regained all the weight he'd lost and some more. Now Tim was diabetic.

"I don't get it. I eat good foods that shouldn't raise my insulin. I almost never eat sweets."

I stressed to Tim that diabetes and pre-diabetes, while provoked acutely by sugar-equivalent foods (wheat products, breads, breakfast cereals, crackers, etc.), is caused chronically by excess weight. If Tim wants to regain control over his heart disease, he needed to lost the weight.

Unlike, say, leukemia, an unfortunate disease that has little to do with lifestyle choices, diabetes is a choice you make over 90% of the time. In other words, if you become diabetic (adult variety, not children's variety) as an adult, that's because you've chosen to follow that path. You've neglected physical activity, or indulged in too many calories or poor food choices, or simply allowed weight to balloon out of control.

But diabetes is also a path most people can choose not to take. And it is a painfully common choice: Nearly two-thirds of the adults in my office have patterns of pre-diabetes or diabetes when I first meet them.

Let me stress this: For the vast majority of adults, diabetes is a choice, not an inevitability.
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