Type 2 Nutrition #483: “…when used with diet and exercise.”

Have you ever noticed how the TV diabetes medication ads always conclude with “…when used with diet and exercise”? That common refrain riles me a bit, but I’ve never examined why. I think it’s time I do.

First off, by self-examination I admit to being something of a curmudgeon. However, I tend to grouse only about the abysmal state of our collective health, including how we (including I) got into this mess. In other respects, I think I have a positive outlook on life, but you’d have to ask the people who know me best if that’s true. Regardless, my readers could fairly describe me as a crusty, grumpy old man. This column, however, is not about me. It’s about why the diabetes ads conclude with the caveat, “…when used with diet and exercise.”

I think it’s a government requirement. The Food and Drug Administration (FDA) has to approve all claims made by drug manufacturers. The FDA also dictates for what and when a drug may be prescribed. That includes as a first course of treatment, as well as any adjunctive therapy if the first medication fails to achieve the primary target. In the case of a drug to treat type 2 diabetes, that would be lowering the patient’s serum blood glucose, usually as measured today by a blood marker, the hemoglobin A1c (hgA1c), or simply, the A1c test.

Metformin is the first drug prescribed today for the treatment of Insulin Resistance (IR), as measured (too late)  by an Impaired Fasting Glucose (IFG). Metformin is generic, cheap and widely accepted as the standard-of-care, almost universally prescribed first after diet and exercise have failed. After Metformin, a generic drug, the clinician has a wide choice of drugs, depending on other risk factors and co-morbidities. That’s when the phrase, “…when used with diet and exercise,” usually appears. The competing drugs all have this in common.

And that’s what gets me riled. Every doc is supposed to tell their overweight and Pre-diabetic patients to “lose weight and exercise” before ANY meds are prescribed.  “Eat less and move more,” “eat a plant-based” or “Mediterranean” diet and get lots of exercise (to lose weight!). And everyone FAILS. They fail to stop or reverse the slow but inexorable slide to drug dependence, eventually “graduating” to Type 2 diabetes. So why do the diabetes ads still advise people to continue this failed strategy?

Answer: The FDA mandates it. But, what does Big Pharma care? It’s a throwaway line because so long as PATIENTS continue to eat what government and their doctor has “prescribed” as a “healthy diet,” T2D WILL BE a “progressive disease,” and the PATIENT will continue to worsen.” BIG PHARMA IS THE BIG WINNER.

There is no downside for Big Pharma. They’re not telling you how and what and when to eat. Certainly no one would say that exercise is not good for you. Besides, exercise is a well-documented way for Type 2 diabetics to slightly improve their insulin sensitivity, which is good. But for weight loss, exercise is not an effective method.

THE ONLY DOWNSIDE IS FOR THE PATIENT. By following the advice to eat what the government “prescribes” as a “healthy diet,” patients are being herded like lemmings into the hands of Big Pharma. Whether this is a corrupt cabal, I’ll leave it for you to decide. But more to the point, in your own self-interest, you might want to ask, why has the advice, “…when used with diet and exercise,” failed? And why does it continue to fail even as you take more medications. Is it because exercise, while a good thing, is not a good way to lose weight? 

Is it because the “healthy” diet the government prescribes is NOT REALLY A HEALTHY DIET? If eating lots of carbs (like corn) is a good way to fatten beef cattle in a “feed lot,” is it not also a good way to fatten people? Yet, the government’s Nutrition Facts label on all “processed” foods prescribes that the Percent Daily Value (%DV) for carbs recommended for women (on a 2,000kcal diet) is 300g, or 1,200kcal, or 60%. And for men (on a 2,500kcal diet), is 375g, or 1,500kcal, also 60%. Did you know that? Do you think, maybe, that is too many?

If you want to avoid the inevitable “graduation” to a cocktail of anti-diabetic medications, including the ones advertised on TV, you might want to consider dropping your intake of carbs, to 40, 20, 10 or even 5%, like me.