The morning that Bob MacEachron went to meet his new weight-loss doctor, the one he hoped would help him shed some of his 370 pounds, he sat down to what he thought would be a breakfast of lasts. The last time he would eat three jumbo eggs fried in butter. The last time he would enjoy bacon. He poured heavy cream in his coffee, girding himself for what he feared would be the last time he would whiten the drink with anything other than skim milk.
And then he met his doctor, who asked what he had eaten at his last meal.
“Perfect breakfast!” responded Dr. Sarah Hallberg to MacEachron’s surprise.
Hallberg, medical director and founder of the medical weight-loss program at Arnett IU Health Lafayette, is a big proponent of low-carb, high-fat diets. But not just for weight loss. She also believes this diet can treat Type 2 diabetes, a disease affecting almost 10 percent of American adults.
The former exercise physiologist took her message to the Internet last spring in a TEDxPurdueU talk that has drawn about 325,600 viewers online, more than any other video from the college speaker series’ three years. She packages her message with a strong jab at the American Diabetes Association, whose guidelines do not embrace the low-carb concept.
“This really makes us question a lot of these recommendations that we have been getting. Clearly they are not working. We keep getting fatter and sicker in this country,” Hallberg said in a recent interview with IndyStar. “Do we want to just continue throwing medications at people? Or do we want to get down to the root cause of their problem, which is the food that we’re eating?”
When Hallberg started the weight-loss clinic about three years ago, she at first focused on helping people shed unwanted pounds. She embraced a low-carbohydrate plan because she says evidence has shown it works best — not just at helping people lose weight but also on keeping it off.
The hallmarks of the diet Hallberg endorses emphasize fat over carbohydrates. People should eat no more than 75 total grams of carbohydrates or 10 to 15 teaspoons of sugar a day. To achieve this, Hallberg advocates eating no processed foods as well as no grains, potatoes or sugar.
So what can people who do away with carbs eat in their place?
“My patients eat fat and a lot of it,” Hallberg says in her TedX talk. “‘What?’ you say. ‘What’s going to happen when you eat fat?’ Let me tell you: You’re going to be happy because fat tastes great and it’s incredibly satisfying.”
That means nothing low-fat, fat-free or light. Plenty of proteins such as meat, eggs, nuts and seeds. Minimal fruits, if at all.
Within six months of a year of opening the weight-loss clinic, Hallberg noticed that her patients not only lost weight but that those who took diabetes medicines no longer needed to do so.
“Weight loss I consider a secondary goal at this time,” said Hallberg, who herself follows this diet and says that her weight — she was always slim — has not fluctuated on it. “Weight can be harder than the metabolic changes. We will see people who have lost very little weight but have a dramatic turnaround in their metabolic health.”
The program worked for MacEachron, 67, who originally saw Hallberg to lose about 80 pounds so he could have hip surgery safely. Within 30 days of his first visit, MacEachron stopped taking all his diabetes medicine. In nine and a half months, he lost 120 pounds — and did not cheat once, he said.
Buoyed by anecdotal evidence from patients like MacEachron, Hallberg partnered with a Purdue University nutrition professor on a pilot study, comparing 50 people who followed her method with 50 people who stayed on standard diabetes treatment, including medicine.
After six months both groups improved their hemoglobin A1C levels, a measure of how well diabetes is controlled in the long run. Those in the first group, however, had to take less medicine to achieve the result; those in the latter group took more medicine.
Such statistics leave Hallberg baffled as to why more health care providers don’t support a food-based approach to treating diabetes. Instead, she said, most diabetes doctors prescribe medicine after medicine to control the condition, buying into a billion-dollar pharmaceutical industry.
“What we’re choosing instead is to medicate people. … It boggles my mind,” she said. “I would say the goal for everyone is to go off medicine. It is a complete routine occurrence. We see multiple patients every day going off medicine
About 29.1 million people have diabetes, according to the Centers for Disease Control and Prevention, and 8.1 million of those do not even know they have the disease. An additional 86 million Americans have prediabetes, according to the American Diabetes Association.
Once a person has been diagnosed, medications and care for associated health problems such as heart or kidney disease can prove quite costly. Caring for those with diagnosed diabetes came to about $245 billion in 2012, according to the American Diabetes Association. About 18 percent of that number stems from the cost of medications.
Not everyone is as staunch of an advocate of Hallberg’s low-carb, high-fat approach.
Diabetes specialists can focus too much on medicine and ignore the role of food in managing diabetes, acknowledges Maggie Powers, president-elect of healthcare and education for the American Diabetes Association. That does not mean, however, that the answer lies solely in low-carb, high-fat diets. Rather than prioritizing one eating plan, the Association encourages treatments tailored to individuals.
“If she’s asking for the Diabetes Association to have all people limit their carbohydrates, that’s not going to happen because there’s no proof that that’s a healthy diet,” said Powers, a registered dietitian with the International Diabetes Center at Park Nicollet in Minneapolis. “It’s easy to say that someone or an entire organization is wrong. The American Diabetes Association … does not dictate a one-size-fits-all plan. We just don’t do that. There’s millions of people with diabetes, and they all cannot follow that food plan.”
Even Hallberg’s collaborator from Purdue expresses some reservation that the healthiest diet consists of low-carbs, high-fats. Wayne W. Campbell, a professor in Purdue’s nutrition science department, has studied many different diets, looking to see which one is healthiest in the long run.
A low-carb, high-fat diet has proved effective in the short term, Campbell said, but that does not necessarily mean that it’s the only way to achieve these results.
“There is no magical diet,” said Campbell, who describes his diet as healthy but not low-carb, high-fat. “The low-carb diet has been shown to be particularly effective at least in the short term because it is such a dramatic difference from what people eat.”
Low-carb diets work largely because of the way insulin, a fat storage hormone, operates in our bodies, Hallberg says. Insulin drives glucose or blood sugar into the cells. The more insulin we have, the more glucose we have. The more glucose over time, the more likely we are to develop diabetes.
Carbohydrates spike our insulin and glucose levels, Hallberg said. Fat, however, has no impact.
“At its root, diabetes is a state of carbohydrate toxicity,” Hallberg says in her TedX talk. “When our patients decrease their carbs, their glucose goes down and they don’t need as much insulin. So those insulin levels drop and fast.”
Now the question becomes what happens if a person sustains this diet in the long term.
Hallberg and Campbell are embarking on one of the largest studies of this diet ever to try to answer this. In the coming months, they will enroll 400 people, half in Lafayette and half in Indianapolis, who will follow the low-carb, high-fat approach. An additional 100 people will have standard care, which may include medication and dietary modifications that are not limited to low-carb, high-fat regimens.
The 200 people in Lafayette will come into Hallberg’s office regularly for assessments. The other 200 will be followed remotely. The trial is sponsored by a company involved with health technology, Hallberg said.
“The improvement she sees in lipid profiles, blood pressure, hemoglobin A1C are clinically significant, but they are well documented to occur with other types of weight loss programs,” Campbell said. “Is there a superiority to one program? At this point … we can’t answer that question.”
Some people who try the rigorous diet find that sticking with it can be tough.
Barbara Davies started in January of 2014 after her doctor told her she was at risk of developing diabetes. She stayed on to the diet for months even though she kept cooking foods like mashed potatoes for Jim, who also needed to lose weight but wasn’t ready to do so. Still, it was not easy.
“It’s very difficult to get the mindset. Fat’s not the enemy; it’s carbs. It’s not the butter; it’s the bread,” said Davies, 65, who is now on the diet with her 67-year-old husband, Jim.
When last Thanksgiving came, however, Barbara’s willpower left. Through the holidays and the start of this year, she went back to her old eating ways. She canceled two appointments with Hallberg and put back on 30 of the 55 pounds she had lost.
Four months ago, Jim decided that he would go on the diet with Barbara. They’ve been on it together ever since.
Barbara’s blood sugar levels are no longer in the danger zone for developing diabetes. And Jim, who has had the disease since he was 50, has lost 50 pounds. When he first started seeing Hallberg, he took six medicines to treat his diabetes. Now he’s down to three.