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Summary
On episode 321 of 40+ Fitness, Coach Allan sits down with Megan Ramos, who co-founded the Intensive Dietary Management clinic with Dr. Jason Fung and co-hosts the Obesity Code podcast with him, to discuss Dr. Fung’s book The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally.
Megan explains that diabetes actually starts in the liver, and that body weight alone is a poor gauge of health: some very thin patients carry dangerous fatty liver and visceral fat while looking perfectly healthy.
The conversation covers three simple rules for reversing type 2 diabetes, how metformin fits in, and the fasting protocols Megan’s clinic uses to bring blood sugar and blood pressure down quickly under physician supervision.
Links
- https://idmprogram.com
Key Takeaways
- Being thin doesn’t mean being metabolically healthy. Megan describes a 98-pound patient with over 40 percent body fat and diabetes, a “TOFI” (thin outside, fat inside) case where organ fat around the liver and pancreas caused disease despite a low number on the scale.
- Diabetes originates in the liver, not the pancreas first. Excess fructose overwhelms the liver’s ability to process it, so the liver converts it straight to fat, which builds up as fatty liver disease and eventually impairs insulin production.
- You can’t burn sugar and fat for fuel at the same time. Megan cites the Randle cycle: a cell uses either glucose or fat, not both simultaneously, so a high-carbohydrate diet actively blocks fat burning regardless of total calories consumed.
- Fructose hides from a glucose meter and skews how “healthy” foods look. Fructose doesn’t register on a standard blood glucose test, which is why a chocolate bar (half fructose, half glucose) can rank as moderate on the glycemic index while a slice of bread, all glucose, ranks worse, even though the fructose is quietly doing more damage to the liver.
- Natural dietary fat requires little insulin and is highly satiating. Fat sends a fast fullness signal to the brain before the stomach even expands, while carbohydrates trigger insulin (a “fat-trapping” hormone) and require the belly to physically stretch before the brain registers fullness, which leads to overeating.
- Metformin has a narrow, specific role in Megan’s clinic. They typically hold off prescribing it until blood sugar exceeds 180 or A1C exceeds 9, and in 20 years Megan says she’s never seen it meaningfully drive weight loss; patients who commit to diet and lifestyle changes are often able to come off it within a couple of months.
- Three rules can reverse type 2 diabetes for most people: avoid fructose, reduce refined carbs while embracing natural fats, and eat real food. Megan says these rules apply whether or not someone is diabetic, and that even patients on limited budgets can follow them by prioritizing whole foods like legumes and lentils over processed, “diet-friendly” branded products.
- Therapeutic fasting can rapidly lower blood sugar and blood pressure, but only with physician supervision. Megan’s clinic uses structured 24, 36, or 42-hour fasts three times a week, since medications often need fast adjustment as numbers improve and patients can feel dizzy or unwell as they adapt.
- Fasting is introduced gradually, starting with cutting evening snacking. Patients move from three full meals with no snacking, to dropping one meal (usually breakfast, since morning blood sugar runs highest regardless of what was eaten the night before), before progressing to longer structured fasting protocols.
“You can’t be a sugar burner and a fat burner simultaneously.”
Megan Ramos
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Episode 389 – Wave goodbye to type 2 diabetes with Dr Nicki Steinberger