Wednesday, November 13, 2013

The Nutrition Debate #160: Letterman to Hanks: “…through diet, mostly.”


On the David Letterman show recently, 57-year old Tom Hanks blurted out that his doctor had told him that after 20 years of high-normal blood sugars, “You’ve graduated. You’ve got type 2 diabetes, young man.” And all the coverage the next day was about how Hanks had “performed an important role in raising awareness.” In the medical news, as in this piece, “The Tom Hanks Effect: Diabetes Diagnosis Great for Awareness,” in M­­edscape Medical News, all I heard was banal generalities about how a “regular guy,” who “doesn’t appear to lead an unhealthy lifestyle,” can develop diabetes. And that “Diabetes is a very treatable disease with good guidelines for effective treatment.” Boy, don’t get me started on those “good guidelines.”

Nobody…I mean nobody covered the most important utterance in the Letterman interview. It was Letterman’s response to, “It’s controllable…” to which Letterman added, “…through diet, mostly.” Letterman then said that, “I suffer from high blood sugar – had to go on a special diet myself.” Now, I’m not a fan of Letterman, but he got it right, and nobody covered it. It’s true, Hanks is the news, and Hanks did smother what Dave said with his funny rejoinder about getting back to his high school weight. But his doctor had said, if he did, “he would essentially be healthy and would not have type 2 diabetes.

In a BBC interview, Hanks said that he “gets regular exercise, eats right, takes certain medications, and, so far, feels fine.” It sounds to me like he’s making the same mistake as Paula Deen, except that she concealed her diagnosis until she had lined up a pharmaceutical endorsement. They’re both leaving the control of their diabetes health care in the hands of medical practitioners.  Tom Hanks (and Paula Deen) should listen to David Letterman: type 2 diabetes is “controllable…through diet, mostly.”

But I don’t think either of them will listen to Dave, or me either. If Hanks had high blood sugars for 20 years and hadn’t figured out what to do about it in that time, I don’t expect he will now. Of course, I was in a similar – actually, identical situation for the first 16 years after my type 2 diagnosis in 1986. So if I put myself in Hanks’s shoes, I can be sympathetic. But I know better now, and that’s why I work hard to try to persuade others not to follow in my footsteps. If you are pre-diabetic, you don’t have to develop full-blown type 2 diabetes. And if you do, you can control it “…through diet, mostly.

I know I’m “beating a dead horse.” I persist because I know it’s hard not to, by default, leave your health care in the hands of your doctor. Doctor knows best and what is best for us, presumably. Unfortunately, though, that’s not always true. They are human and fallible. They know that, but they also know that, in order to gain and hold your trust, they must preserve and maintain the appearance of omniscience.

They are constrained by a multitude of factors: most were trained in the era of Ancel Keys’s diet/heart hypothesis in which they were taught that saturated fat and dietary cholesterol were killer foods. How can they now do a 180 degree turn and tell you that saturated fat is good for you and that “cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit,” in the words of Keys himself later in life. And virtually no MDs have training in nutrition.

They are also constrained by the standards of practice of their medical specialty. It takes a long time for research findings to influence clinical practice through updated guidelines. Not to follow those standards would risk professional sanction and possible loss of licensure. They are also constrained by the reimbursement rules of Medicare and the insurance companies; they are constrained by limited time with patients and limited time for continuing education. And, sadly, they and their medical associations are so influenced by the big pharmaceutical companies that conflicts of interest are inevitable. So it’s tough to be a doctor these days, but from the patient’s point of view, there’s a workaround: self-care also known as patient-centered care.

If type 2 diabetes is controllable through diet, mostly, Tom Hanks can do as David Letterman does and “go on a special diet” himself. But it sounds to me like he doesn’t want to. “Hey, you gotta live, you know?” Hanks has tweeted. He’s decided he’s going to just “eat right,” exercise and take some meds. If he follows this course, I don’t have to tell my readers that his disease will be progressive, just as it was for the last 20 years that he followed his doctor’s advice. And look where that got him: he “graduated.”

What does he expect? To be congratulationed? Wake up, Tom. Take responsibility for your own health. Take charge of your own nutrition. Stop being in denial. You’re carbohydrate intolerant, Tom. For whatever reason, including genetic predisposition, or body type if you like, or past eating patterns. Don’t act like a victim. Show some character. Show me some grit, Tom.  Show the world that you can be a positive role model, Tom. Show us you’re a good man, Tom, like old James Ryan…

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