Sunday, July 3, 2016

Type 2 Diabetes, a Dietary Disease #335, Implications of Reaven’s Unified Hypothesis: Part 2

Last week’s column was heavily cribbed, with attribution, from Dr. Tim Noakes' recent post on South African Marika Sboros’s excellent blog FOODMED.NET. This week I’m going to continue it with an almost verbatim extraction. It is so well written, and so profound in its implications, I don’t want to botch it by editing a thing!
We left off with Noakes explaining how endocrinologist and Stanford professor Dr. Gerald Reaven presented at the 1988 ADA annual Banting lecture a unified hypothesis of chronic disease, which he called Syndrome X but which thereafter became known as Reaven’s Syndrome. Today it’s simply called Metabolic Syndrome.
Noakes continues, To determine whether nutritional factors contribute to the development of the metabolic syndrome, beginning in the 1980s, Reaven completed a number of RCTs of the effects of low-carbohydrate diets in patients with this condition. Without exception his studies showed that removing carbohydrates from the diet uniformly improved all measures of health in those with insulin resistance and metabolic syndrome.
“So besides establishing the fundamental role of insulin resistance in these chronic diseases, Reaven also discovered the optimum treatment – carbohydrate restriction. By any measures, Reaven should be a shoe-in for the Nobel Prize in Medicine.  But perhaps not.  For he failed subsequently to emphasize the curative effects of low-carbohydrate diets in insulin resistance.
“Why not,” Noakes asks?
“I suspect that during his daily work at Stanford Medical School, Reaven was in close contact with some of the more important cardiologists in the USA and perhaps in the world. They would not have taken kindly to their colleague’s suggestion that, to prevent heart attacks, cardiologists should be prescribing high fat diets instead of the low fat diet dictated, then as now, by the American Heart Association.
“Had he chosen that route, Reaven’s colleagues would have excommunicated him, his research funding would have dried up, and his career would have been over, exactly as happened to Dr John Yudkin in England for his (correct) suggestion in the 1970s that sugar, not saturated fat, causes heart disease.
“So it seems to me that Reaven kept quiet, choosing rather to continue researching insulin resistance without paying much attention to how a low-carbohydrate, high-fat diet might – simply, effectively and at low cost – prevent and reverse all the medical disguises through which insulin resistance reveals itself.
One disease, one cause, many symptoms:” Reaven’s unified hypothesis of chronic disease.
“Reaven’s problem is not unlike that faced by Darwin and Galileo whose findings estranged each from religious orthodoxy.  For Reaven’s unifying hypothesis of chronic disease must offend not just his colleagues in cardiology.  For his hypothesis strikes at the very heart (pun intended) of the pharmacological model that we practice in modern medicine.
“For if obesity, diabetes, heart disease, NAFLD and high blood pressure (and perhaps also cancer and dementia) are in fact all symptoms of the same underlying condition, insulin resistance, then our current model of medical management must be wrong, requiring as it does, specific but different pharmacological treatments for each separate condition, overseen by different hierarchies of medical specialists.
BUT WHAT IF THE CORNERSTONE FOR THE TREATMENT OF ALL THESE CONDITIONS IS A LOW-CARBOHYDRATE DIET – the very diet that has now been vilified by my profession for the past 50 years?  That must be an extremely frightening thought for very, very many.  How does one come to terms with the possibility that, by following medical orthodoxy, one may have harmed very many patients?”
What indeed?! Think about it…
Thank you, Dr. Tim Noakes, for the courage to speak out. Note: all CAPS, bold and italics added by this blogger.


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