I don’t remember
how I landed on South African blogger Marika Sboros’s site, FOODMED.NET; but I love it, and I have signed up
for regular delivery. Her blog’s subtitle is “Let food be your medicine,” so
you can readily see my affinity. I first read a post in the “Managing Your
Blood Sugar” series titled NOAKES:
"IT'S THE FATTY LIVER DISEASE, STUPID' PART 2, tagged “LCHF.”
Interestingly, Marika explains, LCHF in her lexicon means “Low Carb Healthy Fats.” I like it. It’s time to
take on the PUFAs!
The author of this
particular post is world-renowned scientist and University of Cape Town
Professor Emeritus Dr. Tim Noakes. Noakes introduces his subject via the
misunderstood term “risk factors” as taken from epidemiology and
“observational” or “associational” studies. He delves briefly into “hazard
ratios” (HRs), relative and absolute risk, and related subjects to show how
data is commonly manipulated and abused.
“This is
intellectually absurd,” Noakes says. “How can everything be a risk factor for
everything else?” he asks. He answers, “The answer can be found in the ignored
work of Dr. Gerald Reaven, Emeritus Professor of Medicine at Stanford
University.” “Reaven has spent the past 60 years studying the condition that
intellectually he now owns, insulin resistance.”
Reaven’s interest
in insulin resistance was piqued by the distinction between Type 1 and Type 2
diabetes. Type 1 is characterized by the total absence of endogenous insulin;
Type 2, insulin resistant diabetes, by “abnormally high amounts [of insulin] because the target cells on which the
insulin normally acts are resistant to its action; hence the condition of
insulin resistance or carbohydrate
intolerance. Persons with insulin resistance have blood insulin
concentrations that are elevated most of
the time, a condition known as hyperinsulinemia.”
Noakes says,
“Reaven’s great contribution has been to show this persistent hyperinsulinemia
in insulin resistance, whether or not associated with T2DM, produces a
collection of grave secondary consequences.”
“But Reaven’s
greatest (and bravest) intellectual contribution is to suggest that insulin resistance and hyperinsulinemia are
the necessary biological precursors definitely for four and perhaps for all
six of the most prevalent chronic conditions of our day: 1) Obesity; 2)
Arterial disease (local: heart attack or stroke; disseminated: T2DM; 3) High
blood pressure; 4) Non-Alcoholic Fatty Live Disease (NAFLD); Cancer; and
Dementia (Alzheimer’s Disease, also known as Type 3 Diabetes).”
Reaven gave the
keynote Banting
lecture at the 1988 American Diabetes Association annual meeting. His
talk explained
the underlying factor for a constellation of abnormalities: glucose intolerance, hyperinsulinemia,
hypercholesterolemia, hypertriglyceridemia, and hypertension. He named it “Syndrome X; it was
also given the moniker Reaven’s syndrome. Today it is simply called Metabolic
Syndrome.
“The key finding from
Reaven’s work,” Noakes says, “is that these conditions are not separate – they
are different expressions of the same underlying condition. Thus a patient
should not be labeled as having high blood pressure or heart disease or
diabetes or NAFLD (or perhaps even cancer or dementia).”
“Instead,” Noakes
continues, “the patient should be diagnosed with the underlying condition –
insulin resistance – with the realization that the high blood pressure, the
obesity, the diabetes, the NAFLD, or the heart attack or the stroke are simply
markers, symptoms if you will, of the basic condition.”
“And that basic
condition,” Noakes concludes, “is insulin resistance which, simply put, is the
inability of the body to tolerate more than an absolute minimum amount of
carbohydrates eaten each day. “
Thus we have it: Reaven’s unifying hypothesis of chronic disease: “One
disease, one cause, many symptoms.” Tune in next week for a glimpse at the
profound implications of this fundamental advance in medical science.