Type 2 Nutrition #412: “Cover” Story

With idle time in my wife’s doctor’s waiting room, I picked up WebMD Magazine’s June 2017 issue. The cover appeared to feature an article asking, “Trouble reaching your A1c goals?” Next to a photo of a middle-aged man, the caption invited the reader to: “See how Jerry does it.” I’m always interested in seeing how other people lower their A1c’s, so I eagerly and naively turned the page…to a 3-page ad for Trulicity.

Somehow I missed the disclaimer on the “cover.” It said (on a black banner), “Special advertising section. This Trulicity promotional cover has been placed on a limited number of WebMD magazines” – just the ones in doctor’s offices, I’d bet. It continued, “It does not constitute an endorsement by WebMD Magazine and no endorsement is implied.” Okay, WebMD gets big bucks for the fake cover, but how about the doctor’s office? Are they not complicit in this non-endorsement endorsement? I think so, and they don’t even get paid for it!

I also missed the small red-type Lilly at the bottom of the false cover. But it was impossible to miss the 3 full pages of information about “non-insulin Trulicity, a once-weekly injectable pen for type 2 diabetics to help [your body] release its own insulin.” They’re careful to say it’s not the first pharmacotherapy med for type 2s. That would be Metformin, introduced in France in 1957 and the UK in 1958. But Metformin works on the liver to suppress unwanted glucose production and improve to insulin sensitivity (glucose uptake), and it’s safe.

As Lilly implies, Trulicity works on the pancreas, an organ that is already overworked, to counter the insulin resistance that is the cause of type 2 diabetes. Does it make sense to put an added burden on the one (and only) pancreas you have to secrete the insulin on which your life depends? Trulicity makes the pancreas work harder; it “helps the body release its own insulin,” to use their own words. Lilly’s not worried, though. When the pancreas eventually wears out, you will graduate to another injectable drug made by Lilly: daily insulin. Have you seen the price increases for insulin lately?

But Lilly and all the other drug manufacturers do not intend you harm. Their drugs are all approved by the FDA for the uses intended, and the uses all conform to the American Diabetes Association's Standards of Medical Care. What’s wrong with this picture? The treatment plan! The treatment treats the symptom of type 2 diabetes—an elevated blood sugar – by forcing the pancreas to produce more insulin. More insulin is what your pancreas has been producing for years before and since your impaired insulin response was discovered (by an elevated fasting blood glucose, or an A1c test).

Your impaired insulin response, aka Insulin Resistance (IR), is the cause of your type 2 diabetes. What caused your IR? Answer: On the government’s advice, in order to avoid eating saturated fat, for 60 years you ate a diet of 55% to 60% carbohydrate, composed of simple sugars and processed, refined, long-chain glucose molecules, euphemistically called “complex” carbohydrates. Over time, you became Carbohydrate Intolerant.

So what’s the best treatment for IR? That’s simple too: reduce your intake of carbs, especially the refined, processed ones, and the simple sugars of course, particularly the liquid ones. From 60% there’s lots of room for lowering. For the generic woman’s 2000kcal/day diet, 60% is 300 grams of carbs/day. Lowering it to 20% would be 100 grams/day. For a man (2500kcal/day = 375 grams/day), lowering it to 20% would be 125 grams.