The best way to reverse diabetes is to not get diabetes in the first place.

The standard of care for type 2 diabetes starts with one drug. Then two. Then three. Then insulin, in rising doses. Most patients assume the medication is making the disease better. It is not. It treats the symptom, the high blood sugar, while the disease, insulin resistance, gets worse every year. The complications track insulin resistance, not just glucose.

Reverse Diabetes MD, listed in our directory as Reversing Diabetes MD, treats the disease. It has been reversing diabetes for 18 years. Diet experts sell the next best thing. This program uses medicine and science.

Not sure this is your service? Tap the directory assistant (the light in the corner of the page) and it will point you to the right place. This page sits in our pain and metabolic medicine directory.

What results does the program report?

On its own figures:

• 7,000+ patients whose diabetes it has reversed
• 10+ pounds average weight loss per month
• 4+ months average time to reverse diabetes

These are the program's own reported numbers. Individual patients have varied success, and one patient's result is never a statement about the next.

Who is the protocol for?

The end result of a damaged metabolism is overweight, then obesity, then prediabetes, then type 2 diabetes. Nearly 88% of the US population is metabolically unhealthy. If you are anywhere on that path, the protocol is for you.

It is also for referring physicians who want metabolic syndrome reversed in their patients and the patient handed back.

Why does diabetes reversal need a physician?

Because the dangerous part is the medication, and a diet plan cannot manage it.

Cutting carbohydrate cuts the glucose the body has to handle. A glucose-lowering drug does the same thing. Stack the two and last week's correct dose becomes this week's overdose. Blood pressure behaves the same way: the fluid shift of carbohydrate restriction drops pressure faster than the prescription expects.

Medical supervision is required before you change your carbohydrate intake if you take:

• Glucose-lowering drugs: insulin, SGLT2 inhibitors such as Invokana, Farxiga, Xigduo and Jardiance, and drugs such as Victoza
• Blood pressure drugs: clonidine, ramipril, Lasix, lisinopril and other ACE inhibitors, atenolol and other beta-blockers
• Mental health drugs: antidepressants, anti-anxiety medication, mood stabilizers

Deprescribing on a schedule that tracks your own returning physiology is the clinical work. There is no magic bullet, because the failure is a system failure.

Who runs Reverse Diabetes MD?

The protocol is directed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, Medical Director, board certified in obesity medicine and addiction medicine among five boards. Ami Grimes is co-founder.

Dr. Padda came to metabolic medicine through pain, not endocrinology. He saw diabetic nerve pain at the far end, years later, often past the point where the damage could be undone. That is what makes the case for treating the metabolism early instead of waiting for a number to cross a line.

It is also personal. He lost his father to undiagnosed prediabetes. His father was a scientist, a statistician and physicist, highly disciplined. After arriving from India he gained about a pound a year no matter what exercise or diet he tried. He followed the federal guidelines, went low-fat, and swapped natural saturated fats for industrial seed oils. As he grew heavier and metabolically sicker, statins were added. Dr. Padda learned of his father's death on a mountain bike trip in the canyonlands of Utah, while noticing the same slow weight gain in himself despite heroic amounts of exercise. Clearly something was wrong, and it was not a lack of activity.

The board pairing matters. Highly processed food acts on the same reward circuitry as other addictive substances. That is why willpower advice fails so reliably, and why an addiction model of obesity predicts patient behavior better than a calorie model. A physician certified in both treats the eating pattern as a dependence with a physiology behind it, not a character flaw.

How does insulin resistance become diabetes?

Type 2 diabetes is insulin resistance. The body still makes insulin but cannot use it, so glucose piles up in the blood. It is a disease of the modern lifestyle, driven by the malnutrition of overconsumption. More than 95% of diabetics are type 2.

The chain runs in five links:

1. Carbohydrate arrives. Insulin answers. Insulin clears glucose into the cells and switches on fat storage. Whenever you hear "insulin," think "fat-storage hormone."
2. Fat cells overflow. Glycogen storage is small. The excess goes to fat. Overstuffed fat cells leak inflammatory signals and triglycerides into the blood. Push them far enough and they burst, which triggers more inflammation. That is metainflammation.
3. Sugar makes everything sticky. Loose glucose bonds to proteins and receptors, a process called glycation. Pour sugar into a car's gas tank: the fuel burns off and leaves a residue until the engine seizes. Hemoglobin A1C measures exactly that residue on red blood cells.
4. The receptors tire. Constant stimulation makes them down-regulate. The pancreas answers with more insulin, which drives more storage and deeper resistance.
5. The organs choke. The liver and pancreas congest with fat, blood flow to the pancreas drops, insulin output fails, and the patient ends up injecting it.

Decompensation can take up to 12 years. The fasting sugar looks normal the whole time. The metainflammation does not wait.

Why does the damage start at 5.7, not 6.5?

Most physicians wait for an A1C above 6.5. Tissue damage is already underway between 5.7 and 6.5. Cardiovascular risk climbs along a continuum well below the diagnostic cutoff. A1C also misses cases that an oral glucose tolerance test catches. A normal A1C is weaker reassurance than you have been told.

Nerves prove it. Between 10% and 20% of people already have measurable nerve involvement on the day diabetes is diagnosed. The longest nerves go first, which is why it starts in the feet. For burning or numb feet, see peripheral neuropathy treatment.

In 2015, 84.1 million American adults had prediabetes, about one in three. Most did not know. Prediabetes is a warning, not a sentence. Reversing it while it is still prediabetes is safe, cost-effective and disease-modifying.

Who pays for this epidemic?

Everyone, and some far more than others.

African Americans are 1.7 times more likely to develop diabetes than non-Hispanic whites. Prevalence among African Americans has quadrupled in 30 years. Delayed diagnosis brings more amputations, blindness, kidney failure, heart disease and stroke, and death rates 27% higher.

The practice's own clinics, which see several thousand pain patients a year, find the same thing: over 90% of patients have untreated metabolic syndrome, and over 80% have undiagnosed prediabetes or type 2 diabetes. More than half go on to expensive complications. About 20% eventually need dialysis.

The money follows the disease. Diagnosed diabetes cost the nation $327 billion in 2017, up 26% in five years. A diagnosed diabetic averages about $16,752 a year in medical spending. The program's position: the chronic disease model produces enormous revenue for the medical-industrial complex, Big Pharma and Big Food, and generational metainflammation is a primary driver of economic disparity, with a role in violence and incarceration. Medicaid does not reimburse lifestyle and dietary modification. Academic centers avoid this population until expensive complications force a hospital admission. The program warned that by 2026 Medicare would be so overwhelmed by the diseases of metainflammation that it would run out of money.

The program exists to return these patients to health without bariatric surgery, which is costly and carries real risks of organ injury, death and long-term disability.

How does the protocol work?

Three tools, delivered through a neurobehavioral approach: time-restricted feeding, dietary modification and medication management.

Time-restricted feeding

Fasting is simply the absence of eating. Some patients limit eating to an eight-hour window, a 16-hour fast. Some eat one meal a day, a 24-hour fast.

The logic is hormonal. Constant eating keeps insulin high. High insulin shunts glucose into fat and blocks fat burning. Let insulin fall and the body burns fat and turns up autophagy, the cleanup of damaged cells and organelles. Eating less often exercises the insulin system instead of exhausting it.

Snacking is new. The share of Americans eating three or more snacks a day rose from 11% to 42% between 1977 and 2002. There is no evidence breakfast promotes weight loss. Breakfast eaters consume about 260 more calories a day and weigh more.

Dietary modification

Low in added sugar and refined carbohydrate. Moderate protein. High in natural, healthy fats. Real, unprocessed food. No snacking.

For patients who are already metabolically sick, the program is definitive:

• Refined grains are unhealthy and come off the plate. Milling strips the bran and germ and leaves fast starch that spikes blood sugar and insulin.
• Vegetable omega-6 oils are unhealthy. Soybean, canola and corn oil flood the body with omega-6 fats that drive chronic inflammation.
• Red meat and fish are good for these patients. Healthy fats include nuts, real olive oil, fish oils, flax and avocado.
• Fruit juice is not health food. Some 100% apple juice carries more fructose per liter than cola. Juicing strips the fiber that slows absorption.
• Carbohydrate is not essential. The body makes the glucose it needs. That does not mean zero carbohydrate. It means half your calories do not need to come from it.

Medication management

As insulin sensitivity returns, the old dose of glucose-lowering drug becomes too much and the risk of low blood sugar rises. That is a sign of success, and it is why dosing is adjusted throughout, especially insulin, metformin, the sulfonylureas and anything taken with food. Never change a prescribed medication on your own.

Why not use rescue sugar?

Many diabetics are taught to eat sugar when they feel lightheaded. Check the meter and the glucose is often normal. The brain is insulin resistant: the sugar in the blood cannot get into the brain cell. Lightheadedness is intracellular hypoglycemia. Treating it with sugar every time deepens the resistance. The better path is fewer medications, less carbohydrate, and ketones as the rescue fuel, because ketones enter the cell without insulin.

What gets measured?

Resting metabolic rate is measured at the St. Louis clinic by indirect calorimetry, so the plan is built on how much energy your body actually burns at rest, not on an assumption. For the vascular, autonomic and small-fiber systems insulin resistance damages first, see autonomic and vascular testing.

The goal is remission, and remission is a state you maintain. With nerves, some damage recovers and some does not. The realistic aim is to stop the progression, cut the pain and protect the sensation you still have.

How does diabetes connect to chronic pain?

Pain is the final common pathway the body uses to signal tissue damage. Most patients avoid the health system until a symptom can no longer be ignored, and for most, that symptom is pain. The same insulin resistance drives diabetic nerve pain, fatty liver and PCOS, which is why the protocol treats the terrain, not one diagnosis. Dr. Padda's interventional pain practice treats the pain end. For weight as the primary goal, see medical weight loss.

How do physicians refer?

The Metainflammation Program is a partnership with you. The team advises on medications, bloodwork and screening, provides the dietary guidance, and expects the patient to keep seeing you for all medical care. Once the metainflammation is controlled, it keeps monitoring, then returns the patient to you. Office (314) 481-5000, fax (314) 481-3037.

How do you get started?

On any of the medications above, start with a visit, not a diet change.

Reverse Diabetes MD, 4477 Woodson Rd, Suite 209, St. Louis, MO 63134. Call (314) 481-5000, Monday to Friday, 8:00 a.m. to 5:00 p.m.

Frequently asked questions

Can I just try the protocol at home?

Not if you take glucose-lowering, blood pressure or mental health medication. Cutting carbohydrate on top of those drugs can overshoot, so the first step is a visit.

Why does my doctor say my A1C of 5.9 is fine?

Because 6.5 is the diagnostic line. Damage begins at 5.7, and nerve injury can start before diabetes is ever diagnosed.

Is fasting safe with diabetes?

Under supervision, yes. Diabetic medications and drugs taken with food often need adjusting during the fasting window to prevent side effects.

Is this a keto or carnivore program?

It is a physician-run protocol: low added sugar and refined carbohydrate, moderate protein, high natural fat, time-restricted eating and medication management, set to the patient.

Do I lose my regular doctor?

No. The program works alongside your physician and returns you to their care once the metabolic inflammation is controlled.