DIABETES – IS NOT NECESSARILY PERMANENT
The likelihood of becoming diabetic increases in parallel with our ever expanding waistlines. Once diagnosed with Type 2 Diabetes or simply diabetes, the condition almost always persists forever. Currently the remission rate averages less than 0.2% basically signifying a lifetime of misdirected attention to diet along with a steadily growing number of oral medicines followed by various injections and typically culminating with insulin treatment after about ten years.
Until relatively recently, the incidence of diabetes hovered at very low levels where it still remains but only in underdeveloped nations. Along with changing dietary habits coupled with a decrease in physical activity, the prevalence of diabetes soared to well in excess of 1 in 11 adults. A recent phenomenon couples the burgeoning waistlines of children with a dramatic surge in diabetes among the pediatric population.
Traditionally a different form of diabetes referred to as Type 1 Diabetes was the major affliction of childhood. This condition originates with autoimmune destruction of insulin producing cells embedded within the pancreas. Type 1 diabetics lack insulin and their survival requires multiple daily injections of this essential hormone. Until the mid-1900s, this remained the dominant form childhood diabetes.
Unfortunately our regular dietary indiscretions allow an ever increasing rate of Type 2 Diabetes in both children and adults. The principal difference between the two types of diabetes relates to insulin production – absent in Type 1 and present in Type 2. Type 1 diabetics remain thin while Type 2 diabetics tend to be overweight or obese.
Type 2 Diabetes basically involves resistance of the tissues to even the more generous production of insulin than normal. Early in the disease, the body attempts to compensate for the lack of response to the action of insulin by producing greater quantities than in those of similar weight but with normal blood sugar concentration. Only late in the course, the overburdened insulin producing cells begin to decrease in number.
Unfortunately diabetes control remains suboptimal which leads to a vast array of devastating complications that strike ten to twenty years after disease onset. Problems generally relate to incompetence of the large and small vessels. Macrovascular complications include heart attack and stroke. Actually the increased death toll among diabetics stems from these vascular issues – not the diabetes itself.
Abnormalities of the peripheral nerves rank among the most frequent complications and lead to numbness and tingling of the toes and feet. This neuropathy associated with diminished sensation raises the risk of ulcers and infection in the skin and bone which may precipitate the need for amputation.
STILL MORE COMPLICATIONS
For a variety of reasons most diabetics eventually develop high blood pressure. This leads to further deterioration in the vascular system and compounds issues related to decreased circulation in the legs. The precarious combination of inadequate blood supply also known as peripheral artery disease together with diminished sensation from peripheral neuropathy further increases the likelihood of amputation and serves as a potent omen of shortened overall survival.
Equally problematic are the small vessel or microvascular changes that impair kidney function and often result in kidney failure, dialysis or transplantation. Eye disease or retinopathy causes a decrease in vision and may lead to blindness.
Life expectancy in diabetics averages five to ten years less than among those without the condition. In spite of this, people with diabetes see more doctors and take more medicine yet appear considerably less healthy than non-diabetics. Diabetics require more blood tests but are burdened with a significantly greater incidence of associated medical complications. The financial cost of treating diabetes with all of the latest medicines exceeds $1 billion a day.
Faced with an elevated blood sugar in an overweight individual, most busy practitioners simply reach for a prescription pad and perhaps suggest some rudimentary dietary manipulation as recommended by the American Diabetes Association. Unfortunately this scenario all but ensures the never ending decent into the maelstrom of progressive weight gain, worsening diabetes control and additional therapy.
Everyone agrees diabetes represents an overabundance of improper nutrition / calories rather than a genetic condition. Prior to the 1950s obesity was uncommon. Now as we export McDonalds, Burger King, Pizza Hut, Coca-Cola, Pepsi Cola, KFC, Oreos and more, our national disease appears to be making inroads overseas. Obesity, once unheard of, now affects wide swaths of Brazil, China, Japan and even many countries in Africa thanks to “modernization” and an overabundance of empty calories. Overweight parents beget pudgy kids not as a result of recent genetic mutations, but rather due to shared environmental issues.
With this as an introduction, diabetes can easily be cured in a large number of individuals whose disease appeared within the past 5-10 years. Disease of longer duration remains to be evaluated. And for those who seem at risk, diabetes remains largely preventable. More amazingly these goals can be regularly achieved without the need for any medication. Diet caused the problem and diet can eliminate the problem.
Unfortunately the diets championed by the American Diabetes Association and the guidelines established by most medical organizations fail to correct the situation. History clearly informs us that our current approach, our medicines and our advice simply perpetuate the problem.
A hint that diabetes could be successfully reversed without medicine appeared in 1992 with the advent of bariatric surgery for weight reduction. Originally the concept was that any of several different procedures would lead to weight loss and perhaps some beneficial internal chemical change. Interestingly it appears by the time of patient discharge from the hospital, blood sugar normalizes. This occurs long before any substantial loss of body mass.
Currently the least invasive procedure, the gastric band, is associated with a 50% success rate in reversing diabetes. This number increases to 85% with gastric bypass and nearly 100% with even more dramatic rearrangement of food’s route through the gut. Generally diabetes does not return in the absence of significant weight rebound.
SURGERY NOT NECESSARY
Obviously of necessity this invasive approach must be limited to a relatively small number of individuals, however similar outcomes are available without surgery. The major issues involve events happening in the hospital between the time of surgery and discharge or shortly thereafter. Why do the sugar / glucose levels plummet so rapidly? How can we achieve similar results without the risk of short and long term complications associated with surgery?
Interestingly studies of surgery on severely obese individuals with diabetes demonstrate the immediate benefits relate to the drastic reduction in caloric intake immediately after surgery. The surgery itself seems unnecessary for the benefits.
ORIGIN OF BLOOD SUGAR
First, some basics. Dietary intake supports blood glucose only for a short time after eating. Throughout the remainder of the day most of the circulating blood sugar actually results from production by the liver.
When caloric intake exceeds the metabolic demand – in other words we simply eat too much – storage of the excess energy occurs as fat. Triglycerides remain the preferred type and deposit under the skin as subcutaneous fat as well around the intestines, kidneys and other organs as visceral fat. But more importantly some people actually deposit fat within the various organs and even inside the cells of the heart, kidney, pancreas and liver. Specifically these deposits within the liver and pancreas appear to precipitate development of diabetes.
Chronic caloric overconsumption commonly leads to fatty liver. Individual liver cells maintain the ability to internalize fatty acids from the blood stream and combine them with a molecule of glycerol. Adding one part fatty acid to one part glycerol produces monoglyceride. Two fatty acids added to a glycerol result in diglyceride while three fatty acids and a glycerol creates the well known triglyceride.
Triglycerides accumulate within the liver and pancreas only in people susceptible to diabetes. Those without this predisposition experience bulging waistlines and fat around the visceral organs but not within the liver or pancreas.
LIVER METABOLISM MALFUNCTION
Once inside the liver fat can be sent to the energy producing mitochondria but unfortunately this escape hatch fails to work due to production of a blocking chemical. This results in two other pathways available for the liver fat: continued storage in the liver or conversion to VLDL which acts to raise levels of triglyceride in the blood stream.
Interestingly it appears that manufacturing diglycerides either from fatty acids or by metabolizing the triglycerides prevents the liver cell from responding to circulating insulin. These diglycerides or diacylglycerols interfere with the action of the insulin receptor on the surface of the liver cells. Under normal circumstances this insulin receptor transmits it’s message to a chemical known as insulin receptor substrate 1 (IRS-1) in the cell’s interior. Blocking this first step in insulin activity prevents insulin from turning off production of glucose by the liver cell.
In the presence of insulin resistance within the liver, the organ continues synthesizing glucose and storing fat which results in an enlarged fatty liver. This viscous cycle of increased fat and greater insulin resistance ultimately affects the pancreas.
Accumulation of fat both within the pancreas and inside the Langerhans or islet cells that manufacture insulin lead to a situation where insulin production continues apace. In Type 2 Diabetes insulin production actually exceeds normal levels; but no matter how high the levels rise, the tissues remain resistant. Additionally the normal immediate spurt of insulin after a meal fails to develop which further compounds the problem since the food related rise in blood sugar can not be minimized.
PASSAGE OF TIME
This entire process usually requires years during which time routine tests may be normal or alternatively there may be a mild elevation of either blood triglycerides or liver enzymes such as ALT also referred to as SGOT. After a lag time the sugar levels rise over a several month period and diabetes results. The interval varies between people due to genetic, epigenetic and environmental factors.
In order to restore order and turn down production of insulin, the pancreas awaits an all clear signal from the liver. But this will only occur with loss of the accumulated fat within the liver cells and not in the absence of a dramatic sustained decrease in calorie intake.
FAILURE OF CURRENT TREATMENT
So for the most part in America, the number of people affected by diabetes continues to climb. And treatment with the popular drugs only amplifies the problem since these medicines decrease sugar loss in the urine which retains calories and translates into greater storage of fat as triglycerides. Exercise within practical limits fails to overcome the situation. Serious dietary manipulation must be undertaken in order not to fall victim to the unpredictable and potentially devastating consequences of simply ingesting too many calories.
Demonstrating the ease of reversing diabetes first appeared in general practice clinics in relatively small municipalities in England and Scotland. Amazingly specialists in diabetes were not involved in direct care of these patients. In a study lasting 12 months known as DIRECT or Diabetes Remission Clinical Trial participants either received standard care according to the current guidelines or entered into the experimental group.
Individuals following the special dietary protocol avoided traditional foods and were fed a formula containing about 850 calories a day. Basically this equates to a commercial Optifast diet and was maintained for 3 months with the possibility of continuing it for an extra 2 months if appropriate. Afterward structured reintroduction of food occurred over 2 – 8 weeks. This in turn was followed by a combination of suggested diet and behavior modification to guard against resumption of an inappropriate diet.
WEIGHT LOSS NECESSARY
Participants in the special diet portion of the study discontinued their diabetic medications as well as their high blood pressure therapies on day one. The likelihood of remission paralleled the amount of weight loss. Overall among these diabetics weighing around 225 pounds at entry, almost 90% were able to maintain normal blood sugar without the need to restart anti-diabetic drugs with loss of only 30 – 35 pounds. Close to 60% achieved success with weight loss ranging between 20 – 30 pounds and even 1 in 3 avoided medication with a loss of 10 – 20 pounds.
Overall at 12 months about half of the diet group remained free of diabetes even though their body weight still remained far in excess of normal.
BLOOD PRESSURE IMPROVES TOO
Blood pressure readings in both groups appeared similar. However in the diet group, almost 3 out of 4 participants maintained normal levels without restarting anti-hypertensive treatment. Among those treated according to traditional guidelines, 2 out of 3 continued on blood pressure medicine with half taking at least 2 different pills each day.
A similar study evaluated an even more stringent diet including only 600 calories a day for 8 weeks. At entry participants weighed an average of 225 pounds. By the end of the study liver fat had dramatically decreased, hepatic glucose production fell to normal and the immediate response of insulin to food intake rose substantially.
REVERSING FATTY LIVER
Diet rapidly interrupts the cycle of fat storage in the liver and pancreas. Drastic dietary restriction can reduce liver fat content by 30% within one week. This loss averages nearly 80% by 12 weeks of continuing calorie restriction. Similar findings occur in the pancreas although both fat accumulation and shrinkage appear most prominently in the larger liver. Rapid restoration of normal metabolism of these organs accompanies this reduction in stored fat.
LIFELONG DIET – NOT PILLS
So it appears type 2 diabetes does not require lifelong treatment with expensive drugs and all of their attendant adverse reactions. Instead a diet, perhaps rigid and unpleasant for a short period of time, offers the potential for complete reversal while simultaneously improving general health. Within only a few days, dietary restriction offers major health advantages and freedom from so many of the unpleasantries of diabetes.
Reasonable people face a dilemma: current diabetes care forever with all of the potential complications so customarily associated with the disease or the alternative of a strict diet with freedom from expense, complications, needles and uncertainty. A rational individual might not find this a difficult decision. Unfortunately we Americans choose the default path toward continued weight gain and the advancing spiral of diabetes and its complications.
CHANGE OF HABITS
Why do we fail? Remember, the sudden meteoric rise in incidence of diabetes accompanied changes in our society not in our genetic constitution. Prior to the 1950s, the incidence of obesity and diabetes remained minimal. Currently greater than 2 in 3 Americans weigh too much. Obviously all of the popular diets, weight loss pills and exercise schemes fail to improve our overall health.
Unless we collectively break the chain of excess calories as exemplified by fast food, fried chicken, pizza, cookies, cake, candy, sugar laden cereal and submarine sandwiches our health outlook will remain cloudy at best. If it’s not diabetes, remember an improper diet still leads to the increased probability of heart disease, cancer, arthritis, dementia and stroke.
And to end on a bright note, once you succeed and take back control of your health, maintaining it becomes rather painless. And so many other benefits arise from weight loss and freedom from diabetes. You will be rewarded with a much lower possibility of arthritis, cancer, heart disease, stroke, kidney disease, high blood pressure, vision loss, nerve damage and more. Sleep will be more refreshing, you will be less fatigued and you will have more energy.
So onward and upward.