Thursday, December 5, 2019

Retrospective #292: Type 2 Diabetes: Doctors in Transition

I am not angry at doctors, in general. Neither am I an apologist for them. Let’s face it: clinicians who treat Type 2 diabetics are in a tough spot. They are like passengers on the Titanic, cruising along in the dark, comforted by thinking that the treatment protocol they were taught in medical school, combined with new drugs streaming onto the market, is the best course currently available. They are also aware, however, that the Standard of Care that they are required to use, “will trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.
The Nutrition Debate #12, “Turning the Titanic,” written almost 9 years ago, was a flop (only 135 pageviews). I guess patients aren’t interested in abstract metaphors and allusion. Type 2 diabetics want concrete solutions. Well, folks, please don’t wait for the medical establishment to substantially change the Standard of Care for Type 2 diabetes. There are too many forces in play now. Suffice it to say the field of “healthy eating” today is dominated by the influence of powerful food processors and manufacturers (“Agribusiness”) and drug manufacturers (“Big Pharma”). They in turn influence public health policy and corrupt drug research. To close the loop, their ads enrich the media.
There were, of course, notable exceptions. In the modern era, Robert Atkins, MD, raised awareness of the benefits of low carbohydrate nutrition. He was attacked by the medical establishment as “a dangerous fraud” (The Nutrition Debate #4). Then, on July 7, 2002, the NYT published Gary Taubes’ earth-shaking Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie.” My internist read it and suggested I try Atkins Induction (20g of carbs a day). That’s how it all started for me.  in 2008, Taubes, by then a 3-time Science in Society award winning journalist, wrote, “Good Calories – Bad Calories” (“The Diet Delusion” in the UK). That book had a huge impact, although less than he’d hoped for on medical practitioners. But one, Kurt Harris, MD, publicly acknowledged the influence that GC-BC had on him.
Dr. Harris was the creator of the “Archevore” protocol, but he has since taken down his websites. Interested readers, however, can find some of Harris’s writing at Psychology Today and in The Nutrition Debate #19. Another early book favorite of mine was Volek and Phinney’s “The Art and Science of Low Carbohydrate Living.” Stephen Phinney, MD, has since started VIRTA, a fee-based, on-line practice that guarantees remission of T2DM, or your fee is rescinded.
Then, in 2014, the American Diabetes Association (ADA) issued a Position Statement: “New Nutritional Guidelines.” In it they state, “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.” It concluded, “This Position Statement was written at the request of the ADA Executive Committee, which has approved the final document.” My response was #155, “Cowabunga, the ADA makes the turn.” This “patient centered manifesto” will change everything, I thought. One problem: the paper was written by and for the ADA’s Medical Nutrition Therapists, not the ADA’s doctor members. I wonder if they even read it?
Attempting to escape the current treatment protocol and reach a wider audience via individual practice is difficult. Blogs and other media do reach more people but are not very remunerative. Some have tried and failed. However, Andreas Eenfeldt, MD, a Swedish doctor, created “Diet Doctor” (subscription required) and is today the world’s most popular and successful low carb resource. Another with a large and growing following is Jason Fung, MD, a Toronto nephrologist and author, among other books, of “The Obesity Code.” Megan Ramos runs his popular site (clinic and online group) advocating various fasting protocols. The many, many success stories seen there are truly inspiring.
Today there are lot of other emerging practitioners who have seen the light, most of whom have now written books, some reviewed here. Another favorite book, and an easier read than GC-BC, is Nina Teicholz’s “The Big Fat Surprise,” obviously a riff off Taubes. Teicholz is now Executive Director of the Nutrition Coalition, a Washington, DC based organization working hard, without much success I’m afraid, ttying to shape the upcoming 2020 Nutrition Guidelines.
So, what will it take for more doctors to make “the turn”? If the Titanic is going to “stay the course,” would there not be a business opportunity for enterprising doctors and entrepreneurs to chart a different course? A course that will NOT “trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.” I think there is.

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