Tuesday, May 28, 2019

Retrospective #102: Denial is not a river in Egypt

While floating down a “lazy river” at a resort in Puerta Vallarta, Mexico, I began a conversation with another “floater.” I turned the conversation to my interest in nutrition for Type 2 diabetics and told my new “friend” what I had accomplished a few years before by eating Very Low Carb. I followed Atkins induction (20g of carbs a day) for 9 months and lost 60 pounds. I then described how I had drifted away from VLC for a number of years. It turns out my “friend” was one of those enlightened physicians (a Canadian) who then bluntly exclaimed, “You’re in denial!”
He was right, of course. It’s easy to delude oneself. We do it all the time, every day, in many ways. It’s called rationalization, a process of reasoning, or suspension of reason, that allows us to do something that we know is a “bad” option. It’s a lack of self-awareness. The process is invidious. It sneaks up on us.  It happens in unexpected or unplanned circumstances. That is, unless we are practiced in dealing with it and have made a total commitment.
That passing acquaintance had a lasting impact on my life. After returning home, I returned to my previous VLC Way of Eating and lost another 100 pounds. I was also able to completely eliminate the remaining 5mg of Micronase, a sulfonylurea drug that I was then still taking. And my blood pressure dropped further to 110/70 (on the same meds. I was still taking a minimum dose (500mg once a day) of Metformin. Metformin has since become the first line of defense in the U.S. (after “lifestyle modifications”) for Pre-diabetics and diagnosed Type 2s.
Sulfonylurea drugs accelerate the destruction of pancreatic beta cells. That’s why they have, in some places, fallen into disfavor. They deplete the pancreas’s secretionary power and are one of the reasons why Type 2 diabetes is described in the medical lexicon as a “progressive disease.” It’s the medical treatment that (in part) drives the progressivity. Of course, the other equally egregious reason is that the medical establishment still advocates a “balanced diet,” instead of restricting carbs, to cope with a disease that is defined by carbohydrate intolerance.
The sulfonylurea drugs are harmful because they force an already seriously compromised pancreas to secrete more insulin to deal with elevated blood glucose from the carbs we eat. Dr. Ralph A. DeFronzo, winner of the ADA’s 2008 Banting Medal for Scientific Achievement, stated that “beta cell failure begins earlier and is more severe than previously thought.” Based on this finding, he argues for “the need for early and aggressive treatment to preserve remaining beta cell function and to limit further disease progression.”
Dr. DeFronzo’s very technical paper, later published by the ADA, is available for free with full text and figures on PubMed. Early in it, under the sub-heading “Prediabetes”, Dr. DeFronzo said, “In summary, individuals with IGT [impaired glucose tolerance] are maximally or near- maximally insulin resistant, they have lost 80% of their β-cell function, and they have an approximate 10% incidence of diabetic retinopathy. By both pathophysiological and clinical standpoints, these pre-diabetic individuals with IGT should be considered to have type 2 diabetes.”
Denial is a touchy subject. It is touchy because it is very personal. Addressing it requires the ability to look at oneself in an objective way. That confrontation can be pretty messy if our lives are complicated. We all have family and friends who care about us but who do not know about the advances in understanding the optimal way to treat people whose damaged metabolisms cannot tolerate dietary carbohydrates. To the extent practicable, the optimal way is to not eat carbohydrates. That course of treatment works for everybody who has insulin resistance, is Pre-diabetic, or has been diagnosed with Type 2 diabetes. It is also a great way for anybody to lose weight. Take an honest look at your own life, and ask yourself if you are in denial. Then, ask yourself, are you ready to change, now?
Denial is not a river in Egypt. This blunt pronouncement may be said by a close friend/counselor, or even an enlightened physician, to not so gently make a point about the need to confront a matter. In fact, it could be said to affect a change that may be life altering. It was that way for me once. I remember it well.

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