Saturday, June 22, 2013

The Nutrition Debate #119: “Lifestyle Intervention is Great Therapy.”

Ralph A DeFronzo, MD, Director of the Diabetes Division at the University of Texas Health Science Center, made this comment at the May 2013 American Association of Clinical Endocrinologists (AACE) meeting. His presentation in the “Diabetes Update – 2013” session got my attention since Dr. DeFronzo is a favorite of mine for his Banting award lecture at the 2008 ADA convention. That full paper was published in the ADA’s Diabetes. In it he said “By the time that the diagnosis of diabetes is made, the patient has lost over 80% of his/her β-cell function, and it is essential that the physician intervene aggressively with therapies known to correct known pathophysiological disturbances in β-cell function.”

So, I eagerly read a digest of his recent remarks in "Diabetes in Control." The paragraph that “set me off” was this: “There’s no doubt – then you look at diabetes prevention – if you can get people to lose weight and exercise on a regular basis, lifestyle intervention is great therapy,” he stated. “The issue is not whether diet and exercise works. It works. The issue is can you get people to do it on a long-term basis. I think it’s time to face reality. The reality is, it doesn’t work long term.”

Obviously, I was expecting a lot more than I got, but I shouldn’t have. He is just a physician, albeit a leading one. He is a pill peddler; when pills fail or something better comes along, i.e., an injection, he’ll push that. He is a prescriber. Whatever big pharma comes up with to treat the “pre-diabetic” or diabetic patient, he’ll prescribe. That’s the modus operendi of the MD.

There is also the legitimate question of what can a physician do to get his patient to lose weight if there is no magic pill to “pop.” If he and you view him as being in charge of your health, therein lies the problem. He’s in charge of your healthcare; you are in charge of your health. You have it in your power to lose weight, and you can do it with the right dietary.

I also cannot deny that moving the goal posts for diagnosis of pre-diabetes and diabetes to new markers (like lowering FBG thresholds and adding the A1c’s to the diagnostician’s quiver, of which DeFronzo has been a leading proponent, are steps in the right direction. I applaud these changes. It’s just that they’re shooting at the wrong target. The target for weight loss is dietary. And the bull’s eye is a Low Carb diet. But, what do you expect a doctor to do? What do they know about nutrition? Nothing! Ask them. They usually are the first to acknowledge that they just follow “practice guidelines.” And it isn’t getting any better. This NIH article, “The Status of Nutrition Education in Medical Schools,” concludes the range is 2 to 70 hours! 2!!

So, if “lifestyle intervention is great therapy,” but “it doesn’t work long term,” what’s the problem? If one pill doesn’t work to lower blood pressure, what would my doctor do? He’d prescribe another one! Why don’t doctors do this for weight loss? My doctor did. He “prescribed” Atkins Induction after reading Gary Taubes’s “What If It’s All Been a Big Fat Lie?”, the July 7, 2002 New York Times Sunday Magazine cover story. He tried it and lost 17 pounds in a month. Unfortunately, he didn’t stick with it long term. He regained all that weight and more when he went back to his old ways of eating.

But it worked for me. And it still works for me. And it could work for you too, if you don’t listen to everyone who tells you it doesn’t work long term. What they mean is that people don’t stick to it. Because it does work, I’m telling you, it does, if you try it and like it and stick to it, as I do.

Part of the problem is that “Lifestyle Intervention” is intentionally vague. It could be defended as being “inclusive” but is more likely intentionally undefined to avoid controversy and going against the prevailing dogma. It is convenient as a phrase as it includes the idea of exercise. Exercise is good, I suppose, but I don’t do any formal or regular exercise. I am active, working in my garden in New York and kayaking in the winter in Florida, but I do no formal exercise. It is said to increase insulin sensitivity, but I would bet that lowering serum insulin, by eating Very Low Carb, is more effective at raising insulin sensitivity, and doesn’t involve sweating. Besides, my “exercise” is all outdoors. You should see my Vitamin D levels!

Because Lifestyle Intervention is so vague, it is left to everyone to interpret in the way they chose, along with the meaning of the word moderation. We think of moderation as the way we prefer to approach the way we eat or exercise. And a healthy lifestyle is thought to include the restricted calorie, low-fat “balanced diet,” which is still the standard therapy for weight loss. And don’t forget low-salt and low-sugar. No mention of protein, but everybody knows, don’t they, that eating too much protein is bad for you.  

That this “standard therapy” doesn’t work is what Dr. DeFronzo is talking about. He’s primarily an academician, but he’s right. Many patients don’t stay on a low-carb diet long term, and the minute they leave the diet, it ceases to work because they are still carbohydrate intolerant. That some don’t stick with it is irrelevant for you and your long term health. “It works,” remember. See the quote in paragraph two above. And I know plenty of diabetics and a few non-diabetics who’ve eaten low carb for over 10 years.  They tend to be on the quiet side, unlike me.
Do you know anyone who has eaten low carb for a year, or five or ten years, or more?

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