Retrospective #160: Letterman to Hanks: “…through diet, mostly.”

On the David Letterman show in late 2013, Tom Hanks blurted out that his doctor had told him that after 20 years of having high-normal blood sugars, “You’ve graduated. You’ve got Type 2 diabetes, young man.” All the media coverage the next day was about how Hanks had “performed an important role in raising awareness.” All I heard everywhere was banal generalities about how a “regular guy,” who “doesn’t appear to lead an unhealthy lifestyle,” can develop Type 2 diabetes. And that “Diabetes is a very treatable disease with good guidelines for effective treatment.” Really? Don’t get me started on those “good guidelines,” but that’s another story.”

Nobody in the press – medical or lay – covered the most important utterance in the Letterman interview. It was Letterman’s response to Hank’s, “It’s treatable…” Letterman said, “…through diet, mostly.” Letterman then added, “I suffer from high blood sugar – had to go on a special diet myself.” LETTERMAN GOT IT RIGHT, AND NOBODY COVERED IT. Nobody reported that Letterman’s doctor had told him, if he did treat it “right,” “through diet mostly, he would get back to his high school weight and essentially be healthy and would not have Type 2 diabetes.”

In a BBC interview, Hanks said that he “gets regular exercise, eats right, takes certain medications, and, so far, feels fine.” It sounds to me like he’s making the same mistake as Paula Deen. They’re both leaving the control of their diabetes health in the hands of a medical practitioner.  Tom Hanks (and Paula Deen) should listen to David Letterman instead: Type 2 diabetes is “controllable…through diet, mostly.”

But I don’t think either of them will listen to Dave, or me either. If Hanks had high blood sugars for 20 years and hadn’t figured out what to do about, I don’t expect he will now. But I was in a similar – actually, identical situation for the first 16 years after my Type 2 diagnosis in 1986. Of course, I know better now, and that’s why I work hard today to try to persuade others If you are Pre-diabetic, you don’t have to develop full-blown Type 2 diabetes; you can TREAT it… through diet, mostly. But if you do develop it, you can CONTROL it “…through diet, mostly.

I know I’m “beating a dead horse.” I persist because I know it’s hard not to, by default, leave your health care in the hands of your doctor. We presume that doctors know what’s best for us. Unfortunately, though, that’s not always the case, especially with respect to nutrition. They’re not educated in nutrition. They know that, but they also know that, in order to gain and hold your trust, they must preserve and maintain the appearance of omniscience.

They are constrained by a multitude of factors. Most older doctors were trained in the era of Ancel Keys’s diet/heart hypothesis in which they were taught that saturated fat and dietary cholesterol were “killers.” How can they now do a 180 degree turn and tell you that saturated fat is good for you and that, in the words of Ancel Keys himself later in life, “cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit.”

They are also constrained by the standards of practice of their medical specialty. It takes a long time for research findings to influence clinical practice through updated guidelines. Not to follow those standards would risk professional sanction and possible loss of license. They are also constrained by the reimbursement rules of Medicare and the insurance companies; they are constrained by limited time with patients and limited time for continuing education. And, sadly, they and their medical associations are so influenced by the big pharmaceutical companies that conflicts of interest are pervasive. So, it’s tough to be a doctor these days, but from the patient’s point of view, there’s a workaround: SELF-CARE. YOU can decide what to eat and not eat.

If type 2 diabetes is controllable… through diet, mostly, Tom Hanks can do as David Letterman did and “go on a special diet” himself. Wake up, Tom! Take responsibility for your own health. Take charge of your own nutrition. Stop being in denial. You’re carbohydrate intolerant, Tom. For whatever reason, including a combination of genetic predisposition and past eating patterns, over many years you developed Insulin Resistance. Insulin Resistance = Carbohydrate Intolerance. Accept it, Tom. Don’t act like a victim. Show some character. Show me some grit, Tom.  Show the world that you can be a positive role model. Show us you’re a good man, Tom, like old James Ryan…