Wednesday, April 24, 2013

The Nutrition Debate #102: Denial is not…

Denial is not a river in Egypt. You’ve probably heard that joke before. It may be said by a close friend/counselor, or even an enlightened physician, to not so gently make a point about the need to confront a matter. It avoids treating it as a mere “peccadillo,” the consequences of which are small and relatively unimportant. In fact, it could be said to affect a change that may be life altering. It was that way for me once. I remember it well.

While floating down a “lazy river” at a resort in Puerta Vallarta, Mexico, I began a conversation with another “floater.” I turned the conversation to my interest in nutrition for Type 2 diabetics and told my “new friend” what I had accomplished a few years before by a Low Carb Way of Eating (WOE). I followed Atkins induction. I then described how I had drifted away from that WOE for a number of years. It turns out my “friend” was one of those enlightened physicians (a Canadian) who then bluntly said to me, “You’re in denial.” Boy was I shocked!

He was right, of course. It’s easy to delude oneself. We do it all the time, every day, in many ways. It’s called rationalization, a process of reasoning, or suspension of reason that allows us to do something that we know is a “bad” option. The process is invidious. It sneaks up on us when we are unprepared. It happens in unexpected or unplanned circumstances. That is, if we are not practiced in dealing with it and if we lack total commitment.

That passing acquaintance had a lasting impact on my life. I returned to my previous WOE (after returning home, of course) and I lost another 100 pounds. I did that by eating VERY Low Carb and as a consequence was able to completely eliminate the 5mg of Micronase, a sulfonylurea drug that I was then still taking. And my blood pressure dropped further to 110/70 (on the same meds).  Sulfonylurea drugs are “the worst,” but until the mid-‘90s (when Metformin was finally allowed in the U. S.) they were the only anti-diabetes oral medications permitted here. Europe had been using Metformin for years, and today Met has been transformed here into the first line of defense (after “lifestyle modifications”) for pre-diabetics and diagnosed Type 2s.

One of Metformin’s mechanisms of action is to make our insulin resistant cells more insulin sensitive so that less insulin is needed. The sulfonylurea drugs are harmful because they force an already seriously compromised pancreas to secrete more insulin to deal with elevated blood glucose from the carbs we eat. By “seriously compromised” I mean that most of the beta cells which are formed in the Islets of Langerhans of the pancreas and produce insulin, have already been destroyed by the time a Type 2 diabetic is diagnosed. That shocking assessment is, sadly, true, and you need all you can get; they may figure something out later!

“Beta Cells in Diabetes, a website created by The Endocrine Society, describes a presentation by Dr. Ralph A. DeFronzo thus: “This article represents Dr. Ralph DeFronzo’s Banting award lecture, which he delivered as the 2008 recipient of the American Diabetes Association’s most prestigious scientific award (the Banting Medal for Scientific Achievement). It is noteworthy because in it he identifies that beta cell failure begins earlier and is more severe than previously thought. Based on this finding, he argues the need for early and aggressive treatment to preserve remaining beta cell function and to limit further disease progression.”

Dr. DeFronzo’s very technical paper, later published by the ADA, is available for free with full text and figures on PubMed here. Early in it, under the sub-heading “Prediabetes”, Dr. DeFronzo said, “In summary, individuals with IGT [impaired glucose tolerance] are maximally or near- maximally insulin resistant, they have lost 80% of their β-cell function, and they have an approximate 10% incidence of diabetic retinopathy. By both pathophysiological and clinical standpoints, these pre-diabetic individuals with IGT should be considered to have type 2 diabetes.”

The sulfonylurea drugs accelerate the destruction of pancreatic beta cells. That’s why they have (thankfully!) fallen into disfavor. They pump the pancreas dry and are one of the reasons why Type 2 diabetes is described in the medical lexicon as a “progressive disease.” It’s the medical treatment that (in part) drives the progressivity. Of course, the other equally egregious reason is that the medical establishment does not advocate modifying the diet to restrict dietary carbohydrates to cope with a disease that is defined by carbohydrate intolerance.
Denial is a touchy subject. It is touchy because it is a very personal thing. (It can also be an institutional thing.) Addressing it requires the ability to look at oneself in an objective way. That confrontation can be pretty messy if our lives are complicated. We all have family and friends who care about us but who do not know about the advances in understanding the optimal way to treat people whose damaged metabolisms cannot tolerate dietary carbohydrates. It is, to the extent possible or practicable, to not eat carbohydrates. That course of treatment works for everybody who has insulin resistance, is pre-diabetic, or is diagnosed with Type 2 diabetes. It is also a great way for anybody to lose weight. Take an honest look at your own life, and ask yourself if you are in denial. If so, are you ready to change, now?

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