© Whole Foods Magazine
January 2008

Stop Prediabetes Now:

An interview with Dr. Ron Hunninghake and Jack Challem

Richard A. Passwater, Ph.D.


Readers are well aware of the fact that pre-diabetes is a growing epidemic. In November, I had the opportunity to share a podium in New York City with my friends, Dr. Ron Hunninghake and Jack Challem. They spoke about their recent finding about prediabetes. Their book on the subject (Stop Prediabetes Now: The ultimate plan to lose weight and prevent diabetes, John Wiley and Sons) was just about to be released and the audience was very interested in the subject.

I have mentioned “Dr. Ron” as Dr. Hunninghake is fondly called in this column a few times and I will be chatting with him about vitamin C in the future. Many readers are well familiar with Jack Challem as we have chatted with him in these pages many times before. I have known Jack, a.k.a. “The Nutrition Reporter,” for about thirty years, but I didn’t meet Dr. Ron until a couple of years ago. I was surprised to find that they had known each other since the late 1990s and had been researching prediabetes together.

First, let me introduce you to Dr. Ron, and then we’ll find out how Dr. Ron and Jack Challem pooled their resources to write their book.

Passwater: Before we get into the growing epidemic of prediabetes and overweight, let’s discuss where you, Dr. Hunninghake, work and how you came to collaborate with Jack Challem on Stop Prediabetes Now.

Hunninghake:  I am the chief medical officer at the Center for the Improvement of Human Functioning International, more commonly known as the Bright Spot for Health, in Wichita, Kansas. The center is the largest nonprofit nutritional medicine center in the United States and very possibly the world. It was founded in 1985 by the late Hugh Riordan, M.D., a pioneer in nutritional medicine. We have a staff of about 50 people, including three full-time physicians, researchers, nurses, and so forth. We have an analytical laboratory on site for measuring vitamin and mineral levels and for more conventional medical tests. The physical structure of the center is also distinctive; it consists of eight geodesic domes and a pyramid. All of this is on 92 acres, which also include a nature preserve, an organic garden, a pond, and a gratitude trail. Readers can find out much more about the center at brightspot.org

            I’m board certified in holistic medicine, and I’ve been practicing nutritional medicine at the center for 19 years. I met Jack during his first visit as a patient and journalist in 1997. Over the past 10 years, we’ve become doctor and patient, good friends, brain stormers in nutritional medicine, and now coauthors. Jack is usually ahead of the curve with his ideas, with such books as Syndrome X, The Inflammation Syndrome, and Feed Your Genes Right.

Challem: When I visited the center in 1997 and saw my blood test results, I realized I was prediabetic. This experience became part of my motivation for writing Syndrome X, which is a form of prediabetes. In my subsequent visits to the center, Dr. Ron and I spent more and more time talking, which led to a friendship and to the collaboration on Stop Prediabetes Now. Dr. Ron is unlike any other physician I’ve known — he is completely open to new and good ideas. He is also strongly nutritionally oriented and holistic in his thinking. Dr. Ron promotes the center’s concept of co-learning, the idea patients and physicians learn from each other, and that patients must be active participants in the process of regaining and maintaining their health. By the way, I am no longer prediabetic. Using supplements, diet, and exercise, my numbers are actually better than so-called normal.

Passwater: How is Stop Prediabetes Now different from Syndrome X?

Challem: We know a lot more today about what happens in prediabetes than my coauthors and I knew in 1999, when we were writing Syndrome X. The Syndrome X book was also a little ahead of the curve. Today, there is widespread understanding of how serious and common prediabetes is as a disease. Of course, Syndrome X is one manifestation of prediabetes. Impaired glucose tolerance, insulin resistance, and hypoglycemia all have similar underlying problems.

Hunninghake: Stop Prediabetes Now is a much more practical book in terms of what to do about prediabetes, full-blown diabetes, and overweight. We begin with the idea that overweight and prediabetes and two intertwined health problems. When you improve one condition, the other will almost always improve. We recommend specific blood tests to get the full picture of glucose intolerance (or tolerance, as the case may be), explain how to safely shop in supermarkets and natural food stores, read food labels, recommend foods that stabilize appetite and blood sugar, and suggest a number of beneficial supplements. It’s really a much more integrated approach, because the solution isn’t just taking a lot of supplements. Reversing prediabetes and overweight involves changing eating habits, getting more active physically, and controlling stress. When people start getting their blood sugar problems under control, they notice a lot of “side benefits” in their health.

Challem: The standard American diet is perfect for creating prediabetes, overweight, and diabetes. It’s difficult for people to navigate the market aisles and restaurant menus and to eat safe and healthy foods. In many ways, Stop Prediabetes Now is a manual for how to eat healthy and to prevent and reverse these health problems.

Passwater: How serious of a problem is prediabetes?

Hunninghake: It may be “ground zero” in the many degenerative health problems people now face. Look at the situation this way: People with prediabetes have glucose intolerance problems, and they usually have nutritional deficiencies that impair how they process carbohydrates. Both glucose intolerance and nutritional deficiencies set the stage for many other health problems.

The single major risk factor for prediabetes and full-blown diabetes mellitus is being overweight. Two-thirds of Americans are now overweight, and four out of five men are overweight. Depending on whose numbers you use, 40 to 100 million adults are prediabetic. They are turning diabetic at a rate of about 1 million people a year. Because of the increases in overweight, prediabetes, and diabetes, related health problems will increase and life expectancy will likely start decreasing in the next few years.

            If someone is prediabetic and doesn’t do anything to change the course of the disease, he will likely become diabetic within a few years. Being overweight, prediabetic, or diabetic significantly increases the risk of heart disease, Alzheimer’s, many types of cancer, and other health problems. People develop more of a prediabetic health profile with normal aging; it’s part of how the body breaks down with age. Poor nutrition can accelerate the process, and good nutrition and slow it.

Passwater: What are some of the symptoms of prediabetes?

Challem: I think two of the most common symptoms are feeling tired and mentally fuzzy, especially after eating. Many people have traditionally attributed this post-meal tiredness to hypoglycemia, or low blood sugar. But blood tests have never really confirmed this, which is why conventional doctors have often argued that they don’t see many cases of hypoglycemia.

Blood sugar levels go up after a meal, and recent research has clearly shown that higher blood sugar levels increase mental fuzziness and feeling tired. There is a family of brain chemicals called “orexins,” which enable us to feel alert. However, as blood sugar levels increase, production of orexins shuts down, making us feel less alert and more tired. So, people who get tired after eating lunch are actually experience hyperglycemia, or blood sugar that’s too high. That’s a pretty clear sign of prediabetes.

Hunninghake: There are many clinical signs that point strongly to prediabetes. One is insulin resistance, that is, the inability to efficiently use insulin to process blood sugar. Another is elevated triglyceride. Still others include elevated cholesterol, hypertension, and abdominal obesity. These are the symptoms that make up Syndrome X, but they’re all related to excess insulin, which itself is related to consuming too many sugars and sugar-like carbs.

There is also an inflammatory component of prediabetes. When the body is stressed, and blood sugar problems are a stress, the body secretes a number of inflammation-promoting cytokines, including interleukin-6 and C-reactive protein. These are communication molecules that, in a manner of speaking set off the red lights and sirens in the body. There is a cascade effect, so inflammation becomes a bigger and bigger problem. People who are prediabetic, diabetic, or overweight tend to have higher levels of these inflammatory signs.

            It’s almost important to recognize that “normal” blood sugar levels may not be ideal. The standard reference range is between 65 and 99 mg/dl of blood, but this range is far too wide to be of any real value. The best fasting blood sugar level seems to be right around 80 mg/dl of blood. Some research has shown that people with “high normal” blood sugar levels are more likely to develop diabetes within a few years, compared with people who have “low normal” blood sugar levels. Normal does not necessarily mean healthy.

Passwater: What are the major dietary causes of prediabetes?

Challem: The dietary causes are the usual problematic eating habits and foods, the ones most people hear about. They include: Too many sugary and sugar-like carbs, regardless of whether you count them in grams or calories, too many trans fats, too many refined omega-6 oils, too many deficiencies of nutrients involved in insulin function and glucose control. There are also the non-dietary factors, such as not getting enough physical activity and not protecting against stress. Stress increases insulin and the stress hormone cortisol, which promote the formation of belly fat.

            Like a lot of people, I took plenty of supplements (and still do), but for years gave only lip service to diet and exercise. Many of the retailers I see at the trade shows are not the picture of health — they don’t set a good example for their customers. They’re fat and stressed and prediabetic. They get caught up in the pressures of running a business and forget to take care of themselves. They don’t have to be perfect, but I think they should do their best to set a good example for their customers. Otherwise, their credibility is hurt.

Huninghake: There’s also a genetic aspect with prediabetes and overweight, but not the one most people think of. There hasn’t been any significant change in the genetics of Americans, yet obesity has ballooned over the past 30 years. Increasingly poor eating habits raise insulin levels, which in turn activate genes involved in fat storage and inflammation. In other words, Americans have been doing a better job of turning on undesirable genes in recent years than they did in the past.

            There is also a multigenerational effect from eating unhealthy foods or having nutritional deficiencies. I think we’ve all seen multiple generations of families in which the grandparent is thin, the adult child is chubby, and the adult grandchildren are seriously overweight. The science of epigenetics looks at how nutrients and nutrient deficiencies affect the activity of genes. In animal studies, an absence of B vitamins leads to overweight offspring, whereas B-vitamin supplements lead to normal-weight offspring. The implications for people are intriguing: too many sugars and sugarlike carbs may be part of the problem, but a lack of B vitamins may be another part of the problem — if the animal research holds true for people.

Passwater: What are the foods that improve blood sugar and help people reduce weight?

Challem: First on my list is quality protein, namely fish and organic chicken. Protein stabilizes and often lowers blood sugar levels, helping people avoid the extreme blood sugar swings that invariably lead to hunger and overeating. By controlling blood sugar levels, protein suppresses appetite, so people tend to eat fewer calories. Even when people eat more protein calories, the body responds to those calories in a healthier way. In contrast, eating sugars and sugar-like carbs — breads and pastas, regardless of whether they’re whole grain or refined — stimulates insulin secretion. Excess insulin increases belly fat, cholesterol, triglyceride, and blood pressure.

            High-fiber vegetables are next on my list. The fiber helps stabilize blood sugar. When you are eating quality protein and high-fiber veggies, you’re eating a balanced diet. If you’re relatively sedentary, you don’t need any more carbs than those in the veggies. If you’re very active physically, you can probably tolerate more pure starch, such as bread and pasta.

            The irony is that much of the health food industry was built on the idea of whole-grain goodness, which now doesn’t appear to be so good after all. Around the turn of the century, Dr. John Kellogg used whole grains to treat a lot of people at his sanatorium in Battle Creek, Michigan. Americans weren’t eating much in the way of vegetables then. But when you look at the Paleo diet data, humans seemed to do better, historically, with just protein and veggies. When grains became dietary staples, a lot of illnesses, including bone problems, arthritis, and birth defects, suddenly became common.

Hunninghake: From a clinical perspective, people who are overweight and or prediabetic generally respond best to a low-carb diet built around quality protein and high-fiber vegetables. Such people tend to be carbohydrate sensitive, or they are outright carb addicts. They’re almost always sedentary. They just don’t need the carbs, and when they eat carbs, they almost always go back to the eating habits that made them sick. We’re not advocating an extreme high-protein diet. If you’re sedentary, you just don’t need a lot of starches in your diet, and you can get sufficient carbs from vegetables.

            This is probably a good time for me to talk about the “co-learner” concept at the Bright Spot for Health in Wichita. In a conventional medical practice, patients go to a doctor and want a quick solution, which is usually a prescription. It may be a pill to improve blood sugar or lose weight. At the Bright Spot, we coach patients on their role as a co-learner. They have to take some responsibility for their health, and they have to realize that doing so is part of a life-long process of staying healthy. In other words, they have to learn about what makes them healthy and keeps them healthy.

            Doctors at the center are also co-learners. I’ve certainly learned more from my patients than I ever did in medical school. Being a co-learner is a journey doctors and patients share. Jack and I have learned plenty from each other. But in a conventional medical practice, the doctor is regarded as the fount of knowledge, and he often gets testy when patients know more about vitamins than he does.

Passwater: What roles do supplements play?

Hunninghake: First of all, all new patients at the center have an initial meeting with one of the physicians. This meeting typically lasts a little over an hour, something that’s pretty rare in conventional medicine. Based on the patient’s health issues and a dietary workup, the doctor orders blood tests for measuring various nutrient levels, hormones, and more standard blood work. It’s amazing how many patients have zero levels of vitamin C or selenium or other nutrients. No wonder they’re sick!

            This blood testing gives us a solid scientific — evidence based, is the current buzz phrase — assessment of the patient’s nutritional status. Once we know what the patient is low in, we can make some sound recommendations. I think this approach is better than a trial-and-error approach to supplementing.

Challem: When I first visited the center, my dietary analysis found that I had good intake of most nutrients. But the blood tests showed that some nutrients, such as vitamin B1, just weren’t getting absorbed very well. In addition, my antioxidant levels were great, but all of the minerals involved in glucose tolerance were a disaster. No wonder I was prediabetic at the time.

Passwater: Specific supplements?

Hunninghake: There are many that are helpful in glucose tolerance and insulin function, and they’re all supported by published scientific studies. Chromium is very important, and both the niacin-bound and picolinate forms seem to work well. Alpha-lipoic acid has been used as a prescription drug for years in Germany. The omega-3 fish oils often help with glucose tolerance, and some research suggests that they might also help a little with weight loss. Two clinical trials have found that silymarin supplements improve most markers of diabetes.

            Vitamin D and L-leucine are needed to make new muscle, and of course physical activity stimulates muscle synthesis. Muscle is where most of the body burns glucose, so the more muscle you have, the better off you are. In the book, we recommend many other supplements for specific purposes.

Challem: We’re very big on supplements, but supplements by themselves are not likely to reverse prediabetes, diabetes, or overweight. Supplements work best with better eating habits. Let’s not forget about whole, fresh foods.

Passwater: Any final comments?

Hunninghake: It important to remember that prediabetes is as much of an opportunity as it is a disease. Most people who are prediabetic can still reverse the condition. If they let it become actual diabetes, then they are largely limited to trying to control the damage. Prediabetes is a wake-up call that your health is going in the wrong direction. We will have more information and some excerpts from the book at www.stopprediabetesnow.com.

Challem: If I hadn’t made the changes in my eating habits, supplements, and exercise that I did — mind you, I didn’t do them all at once — I have no doubt that I would now be a full-blown overweight diabetic. My thought back in 1997, when I saw my blood sugar numbers, was how embarrassing they were. After all, I was a health writer, and what right did I have to tell other people how to stay healthy when I couldn’t even stay healthy myself. These days, I feel better — and have more energy — than I did even in my twenties. I’m 10 years older and I feel better, look better, and have far better energy levels. It is possible to reverse prediabetes. The alternative is to do nothing, and the outcome from doing nothing isn’t very pretty.

Passwater:        Thanks once again for chatting with us about pre-diabetes and nutrition. I am sure that you book will help many people.


© 2008 Whole Foods Magazine and Richard A. Passwater, Ph.D.

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