Wednesday, August 7, 2013

The Nutrition Debate #132: Why I Despair for the Type 2 Diabetic Patient

Chatting with an MD Internist friend of mine, my hopes for the future of the medical care of his diabetic patients sunk to an abysmal low. Admittedly it was a social situation, and in fairness my friend did not express much interest as I proselytized about my self-treatment (VLC dietary) regimen for my own type 2 diabetes. However, the pain and despair I felt for his patients, when referring to how he treated them, was in his use of the terms “good diet” and, referring to blood sugar, “under control.” I rudely interrupted him on both phrases since I was sure he and I had a totally different concept of the meaning of these terms. I must have seemed insufferable to him.

This is a problem of immense dimension and import. Until the entire public health and medical establishment comes to see these two terms in a different context, I fear that the world-wide epidemic of obesity and diabetes (“diabesity”) will continue to worsen. The small town practitioners are not the root of the problem. They just follow what they have been taught and continue to learn on an on-going basis from their medical societies. And the patient accepts the scripts his or her doctor writes, as well as the assurances he or she gives the patient, because it conforms to the messaging from the corrupt Government/Big Pharma/Agribusiness/Media consortium. This is not conspiracy theory. Just follow the money.

I challenged “good diet” when my internist friend mentioned it since I was sure he meant a “balanced” low fat diet. In other words, the one-size-fits-all diet the government recommends: 60% carbohydrate, 30% fat, and 10% protein. It’s on the HHS/FDA/USDAs Nutrition Facts label. The fat category subdivides into only 10% “solid” (saturated fat) and more unsaturated fat, especially vegetable and seed oils (corn and soy bean oil, among others). These are unstable and inflammatory. See The Nutrition Debate #21, here. This is not a healthy diet for anyone.

“Under control” is the other phrase over which I became exercised. By this point my friend was backing away from the conversation so I didn’t get a chance to explore whether he was referring to an A1c of 7.0% (the ADA standard), or 6.5% which has for a few years now been the standard of the AACE, the endocrinologist’s society. If I had had the opportunity I would have mentioned that “good control” should be defined as an A1c <6.0%, as Dr. Ralph DeFronzo, MD, stated in his Banting Award lecture at the 2008 ADA convention in San Francisco: “Further, a more rational goal of therapy should be an A1c <6.0% …” His “Treatment Summary” in the published paper is as follows:

“Although this paradigm shift, which is based upon pathophysiology, represents a novel approach to the treatment of type 2 diabetes, it is substantiated by a vast body of basic scientific and clinical investigational studies. Because this algorithm is based upon the reversal of known pathophysiological defects, it has a high probability of achieving durable glycemic control. If the plasma glucose concentration can be maintained within the normal nondiabetic range, the microvascular complications of the disease, which are costly to treat and associated with major morbidity and mortality, can be prevented. Most importantly, this will enhance the quality of life for all diabetic patients.”

And Dr. Richard K. Bernstein, a type 1 himself, believes that diabetes patients (both type 1s and type2s) should be entitled to “normal” A1c’s, in the 4.0% to 5.0% range. Remember, heart disease risk rises steadily with an A1c above 5.5. 

“Good Control,” of course, from a doctor’s perspective, means controlled with medications, either oral or injected. And good control as defined by the associations (ADA and AACE) assures that the patient will take progressively more and more said medication as the disease “progresses.” Type 2 diabetes is defined as a “progressive disease,” due entirely to the treatment regimen that these same associations advocate. Why is that?

“That’s a very hard question to answer,” replied Dr. Jay Wortman, MD, a Canadian low-carb blogger, to Dr. Andreas Eenfeldt, MD, a Swedish doctor known as the Diet Doctor, in a recent video interview. You can watch the entire 25-minute video, but the 2 minute excerpt from 19:20 to 21:25 is particularly riveting. Here are parts of that dialogue:

(Wortman) “I think there’s a multiple answer to that question. I think there’re a lot of people in organizations and positions that are funded by the drug industry, and the drug industry doesn’t want people doing this (“a simple dietary change”). They’d get off the drug.” (Eenfeldt) “Bad for Business.” (Wortman) “Yeah. Bad for business – totally bad for business. And these big organizations (ADA, AHA, etc.) depend on drug industry funding.” (Wortman, later) “The other problem is there’s nothing to patent there. There’s nobody going to get wealthy from patenting this (simple dietary change). Our system runs on something that can be patented and marketed, and turn a profit, and that’s how the funding goes through the system in terms of both the research agenda and also how recommendations are generated, and there’s nothing to patent.”(Eenfeldt) “Right. It’s all free information, right?” (Wortman) “It’s freely available.”

What does your doctor consider “good control”? What do you aim for?


  1. I am past being simply disillusioned with the Medbiz and have progressed to avoiding them as much as possible. I think it should be illegal to advertise prescription drugs in magazines and on TV. Except for confronting doctors one on one, as you did, I don't have a clue how to get them to actually learn anything. I did get good advice from a doctor who retired from Kaiser. He was a T2 diabetic and had learned for himself that the standard treatment did not work. The best advice he gave me? Don't do anything your doctor says until you check it out for yourself. When he left Kaiser, he and two nurse practitioners were trying to get the endo department to learn about low carb strategies. They got nowhere. Meanwhile I see so many diabetics try very hard to be "good" patients. They eat the carb-loaded diet, they take the pills, and they get worse and worse. They blame themselves when they fail. It's so sad, and such a waste. Keep up the good work, every diabetic who stumbles across your blog is one more who might be saved.

    1. Thanks, Jan. Your last sentence is what keeps me going. I've written 4 new columns in the last 2 days and have sent them on to my editor. She been a loyal supporter, just as you've been. And the column is getting more and more play. In January I passed the 1,000 a month mark. This week I passed the 3,000 a month mark. But, I am reminded that the Diet Doctor (Andreas Eenfeldt) got 58,000 hits in one DAY recently, so I have to keep my 'rising star' in perspective.