Discovering the Truth

In July of 1990, I completed nine years of medical training at the University of Southern California. The last two years of my training were focused on endocrinology – the world of hormones. I left USC steeped in the complexities and nuances of various endocrine disorders such as hypothyroidism, adrenal, and pituitary problems. Much less attention was given to more “pedestrian” problems such as diabetes and menopause that were more typically handled by internal medicine, OB/GYN, and family practice doctors.

That fall I accepted a position at a prestigious medical center in Santa Barbara, California. I was hired to rejuvenate their diabetes clinic, which had once been the premier diabetes center in the United States. While I would be treating both type I and type II diabetes, more than 80% of my patients would have type II diabetes traditionally referred to as “adult diabetes” because it happens over a period of years and, at that time, generally didn’t occur until adulthood. In this story, my references to “diabetes” refer to type II diabetes.

I saw my new assignment as a real challenge because in my experience at that time people with diabetes didn’t get better. Diabetes wasn’t something that got reversed or cured; it was only “managed.” At that time, medical practitioners believed that diabetes was genetic and that the most and the best we could do for our diabetic patients was merely to slow the inevitable progression of this disease.

Drawing on my own experience as a young adult when I was told my health problems were genetic and I just had to accept and live with them — a pronouncement I proved wrong (see My Healing Journey) — I was unwilling to accept this limiting, conventional thinking. My patients deserved better. I dug in.

To start I spent a full hour interviewing each patient. I will never forget the angst I felt when nearly every patient said, “I hope you won’t tell me the same thing all the other doctors have said. It just doesn’t work for me.”

Back in 1990, the “standard of care” for managing diabetes was simply to keep patients’ blood sugar under control by having them adhere strictly to the American Diabetes Association (ADA) diet and using insulin and other blood sugar controlling medications as needed to regulate their blood sugar levels.

But my patients complained, “When my other doctor gave me insulin, I gained weight and my blood pressure went up.” That made sense to me since insulin is a fat-storing hormone. And the patients’ weight gain along with high insulin levels led to increased blood pressure. Many had then been prescribed drugs to lower blood pressure, which in some cases actually made their blood sugar levels worse.

It was a vicious circle. Consistent with the standard of care for diabetes at that time, they took their prescribed medications, injected themselves with insulin, and followed the ADA high-carb, low fat diet. Yet their blood-sugar levels did not improve. Their blood pressure went up and their cholesterol levels got worse. They gained weight and required more insulin. After listening to their stories I thought, “My God, we are making these patients worse!”

Truly able to empathize, I told them, “I understand your frustration, but to be honest I would have told you the same thing. That’s what we are taught to do in our training. At this moment, I don’t know what else to tell you but I’m going to figure it out and help you get better.”

Reminding myself that one definition of insanity is to continue doing the same thing and expecting a different outcome, I began analyzing the standard of care – the “conventional wisdom” around treating diabetes.

I started by focusing on the ADA diet which was at that time a low-calorie, high-carbohydrate, low-fat, low-protein program that featured fruit, milk, bread, and very little fat. For instance, the “by-the-book” ADA breakfast consisted of a bowl of shredded wheat with non-fat milk, a banana, and a glass of orange juice. Essentially, sugar, sugar, and sugar.

I was alarmed. To me, it was illogical to give sugar to diabetics whose blood sugar levels you were trying to suppress with insulin. How could this be? The ADA diet was designed and refined over a period of years by a team of experts who understand diabetes far more than I do. What’s wrong with this picture?

I decided to find out. I met again with each of my patients and told them to check their blood sugar levels seven times a day — before they ate, an hour after they ate, and at bedtime. “Write everything down,” I told them, “everything you’re feeling, everything you eat, activities, blood-sugar levels, and any other observations. I’ll see you in a week.”

When they returned after monitoring their habits, my patients all told me, “It’s the food I’m eating!” They were absolutely right. From their blood sugar monitoring, I could see that in the morning their blood sugar was normal. Then they ate the high-carb, ADA recommended breakfast and saw their blood sugar spike 100 to 200 points — 10 to 20 times what a normal, healthy blood-sugar response to any meal should be!

These patients had religiously followed this diet, only to see their diabetes worsen. But no one blamed the diet because, as I mentioned, back in 1990 type II diabetes was considered genetic. The fact that these patients had gotten worse was attributed to the inevitable, relentless, progressive nature of this genetic disease.

Well, as far as I was concerned, those days were over! I decided to see what would happen to my patients’ blood-sugar levels if I put them on a “zero” carbohydrate diet. I asked them to eliminate all obvious carbs, such as potatoes, rice, legumes, cereals, breads, fruit, low-fat yogurt, milk and, of course, refined sugar. No more shredded wheat, bananas, and orange juice!

Instead, I put some protein and healthy fats back in their diet. I also educated my patients about insulin levels. Virtually eliminating carbohydrates for one week would rapidly lower their insulin levels, and they would have to reduce their diabetes medicines and/or insulin accordingly to avoid low blood-sugar reactions.

One week later, the first group of patients returned for an evaluation. I looked at the blood sugar numbers they had recorded throughout each day. Their progress was astounding. In fact, some of my elated patients confessed, “Dr. Schwarzbein, I’ve been cheating. I love red meat and when you said I could have some, I ate it every night for a week.”

The “cheaters” were eating real mayonnaise, real cheese, real eggs and steak every day — foods that had been forbidden for so long they could not resist them. Their blood-sugar numbers had fallen dramatically. In fact, the biggest improvements were seen in the patients who “cheated” the most.

By cutting carbohydrates from their diets and adding proteins and fats, most patients (after an initial body-water loss) started losing one to two pounds of body fat per week. They ate healthy fats and lost body fat. All came back to me and said, “I don’t understand. I got fatter when I didn’t eat fat. Now I’m eating fat and I’m losing weight.”

Clearly, I was onto something. So I continued. I tweaked the diet a bit and had my patients continue to systematically track what they ate and record their blood sugar levels. Previously, these patients experienced high blood sugar levels, abnormal cholesterol levels, high blood pressure, weight gain, fatigue, and constant hunger.

As they followed my new eating plan, their blood sugars normalized; many were able to stop injecting insulin and/or taking other blood sugar medications. Their cholesterol levels improved; I stopped their cholesterol-lowering medication. Their blood pressure came down; I stopped their blood pressure medication. I was able to eliminate most of their drugs. They lost body fat and gained muscle mass. Their energy improved. They were not going hungry anymore. They felt great! So did I!

My diabetic patients were so happy with the improvements in their health (and their expanded range of food choices!) that they began to refer family members to me. Although these referred patients were not necessarily diabetic, they similarly suffered from fatigue, excessive body fat with decreased muscle mass, cholesterol problems, high blood pressure, and even heart disease. I treated them with the same program. Body fat decreased and muscle mass increased, cholesterol levels normalized and blood pressures came down. They, too, felt great and their blood test results backed it up.

Word of my successful “diet” spread. I started treating patients who had the same symptoms as the first two groups but no family history of diabetes. These patients all related histories of poor eating habits and chronic dieting, including low-fat dieting. The program worked for them as well.

I began to see people with isolated conditions: bad cholesterol profiles, high blood pressure problems, or excessive body fat. I put them on my eating plan, which by then I had refined to include more oils, real eggs, real butter, etc. I was amazed that the same program I used for my diabetic patients worked for all these people. Regardless of the patient’s problem or illness, a properly balanced diet produced the same results — better health and decreased body fat.

Today, from the experience and scientific insights gained from the last 30 years, no one who is informed still believes that type II diabetes is a “genetic disease” whose progression is inevitable, a disease that can only be “managed.” We now know that it is really a “lifestyle disease” that can absolutely be reversed or at least arrested depending on how soon it is correctly treated. I’ve done it hundreds and hundreds of times!

There is a lot more to this story. Through my scientific and clinical research over the next several years, by challenging and examining conventional thinking, I reached the breakthrough conclusion that became known as The Schwarzbein Principle. I determined that degenerative diseases, which are now the cause of death of over 90% of people in the developed world, are not caused by genetics. They are caused by our lifestyle, our daily habits, including, fundamentally, our diet.

The same research that led me to change the way I treated my diabetic and numerous other patients also led me to reject the current thinking regarding the treatment of both menopause and adrenal compromise. It led to the publishing of my three Schwarzbein Principle books that have been read by over three-quarters of a million people. And, in large measure, it led me to create this website for you.

But before you go, there’s a punch line to this first part of my story that I think you will find to be somewhere between amusing and alarming.

Word of my successful approach had spread to a number of physicians within the medical center where I was working. These doctors were the primary care doctors who worked with my patients and had referred them to me for the management of their diabetes. They were impressed and intrigued by the lab test results they were now seeing and by their patients’ markedly improved health and sense of wellbeing.

“What could this young, newly-minted endocrinologist be doing? What did she learn in her training at USC that we don’t know?” they wondered. I was asked to give an “in-service” presentation to a group of these internal medicine doctors to share my knowledge. I started the presentation by telling them what I just told you about how I had changed my patients’ diet and the results we had seen. They were truly impressed and complimentary.

But then one doctor in the audience asked me if I had been taught this new approach at USC. I explained that I had not, that they still taught the conventional approach. I was then asked for the data that validated my approach. Doctors love what’s called “longitudinal data” — data from years-long studies of large numbers of people using a particular drug or treatment modality. I told them there was no such data. In developing my program I relied on my knowledge of biochemistry, of how the body really functions and, of course, my clinical results from working with now hundreds of patients for nearly a year.

The room became silent. Uncomfortably so. Then one of the “elder statesmen” in the group stood up and made a speech. He said there was no possible way they could support my approach in the absence of well-accepted longitudinal data that justified departing from the current standard of care. “It’s irresponsible,” I recall him saying.

Needless to say, the in-service ended with a thud. What happened next may or may not surprise you. These doctors stopped referring their patients to me and resumed treating them themselves using the conventional methods that I had concluded were harming people.

“Primum non nocere” is a Latin phrase that means, “First, do no harm.” It’s implicit in the oath we take when we become doctors. I take that oath very seriously. Typically, this aphorism is invoked when doing something to try to fix a problem may cause a further problem. Be cautious, is the message. I agree. But I don’t agree that the adage gives doctors an excuse to not do the right thing just because it bucks clearly wrong-headed “conventional wisdom.”

Within months of my in-service presentation, I left the clinic. I started my own private practice. Within a few weeks, I had a line at the door, which has been the case, consistently, ever since that day nearly 30 years ago. My practice is now closed to new patients. I’m now developing ways to help people with the same issues and challenges I help my patients with. That’s what I’m all about and what this website is all about.