Sunday, August 27, 2017

Type 2 Diabetes, a Dietary Disease #395: All my friends are dying…

I sometimes think about all my friends who are dying. Well, not all of them, but many. And in my case the usual feeling of loss that one experiences is augmented by the feeling that I could have done something about it. Again, not for all of them, but for many. And many who are still alive too. I know this sounds like I think I am a Svengali-like zealot. I plead guilty, but not to the power to save everyone – just a few.
So, I post this blog every week in the hope that someone, somewhere – personal friend or not – will heed the message: “Let food be thy medicine and medicine be thy food” (Hippocrates: 460BC-370BC). And that the food be that which enabled Hippocrates to live to the ripe old age of 90. Real foods. Whole foods, not refined “foods” designed to make you crave more. Not snack foods with flavor enhancers, deli meats embalmed with dextrose and corn syrup, and bread where the third ingredient, after flour and water, is always sugar.
Why do I think that the food we eat is responsible for the steep increase in so many of the “diseases of civilization? Assuredly, I am not alone. The evidence is now overwhelming. What else is there that can explain the precipitous rise in so many chronic diseases, starting about a century ago and accelerating precipitously about 40 years ago? It’s our diet!!!
Doctors are not trained to view diseases as syndromes. They learn to identify specific disease conditions by symptoms, and treat them by writing prescriptions. Epidemiologists look at disease differently too. They do statistical meta analyses and draw conclusions from associations of conditions and outcomes. However, correlations do not prove causality. And epidemiological findings are often flawed by bias and poorly designed analyses with myriad confounding factors.
A year ago I wrote a two-part series on Gerald Reaven’s Unified Hypothesis of Chronic Disease (see Part 1 and Part 2). Reaven was a professor of medicine at Stanford University and gave the 1988 American Diabetes Association keynote Banting lecture on his unified hypothesis, which he called “Syndrome X.” His hypothesis later came to be known as “Metabolic Syndrome.” I first wrote about in 2011 (column #9, here). If you don’t normally open and read my hyperlinks, I encourage you to find the time to read these three. They’re worth it.
Now, assuming you ignored the above advice, here are my CliffNotes, from Tim Noakes, in Part 1 of the series:
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).”
 “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.” And that’s why so many of my friends are dying. Our bodies cannot tolerate so many carbohydrates. Now, if only more of my friends (and everyone else) would follow that advice…and save themselves!

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