Retrospective #306: Type 2 Diabetes, a Dietary Disease

When this post originally appeared in 2015, I published weekly and, after #305, I decided to take a break. In this current “Retrospective Series,” I am rewriting the originals and publishing daily. And I have found a new audience.

From the time #306 first appeared, the landscape has changed dramatically. Atkins, Bernstein, Paleo and Low-carb, High-fat (LCHF) have been replaced by Keto, Fasting (IF, ADF & EF), Autophagy and Carnivory, not to mention Twitter.

The field is now crowed. Diet Doctor, the Dr. Jason Fung Fan Club and The Fasting Method with Megan Ramos are all very good online sites, all advocating effective ways of healthy eating for weight loss and good blood sugar control.

The hiatus (in 2015) gave me an opportunity for introspection. It enabled me to step back and re-examine my purpose and the best methods of achieving them. As my regulars know, I write this column for educational purposes, both mine and the readers.’ I accept no advertising. I have nothing to sell but an idea: Type 2 Diabetes is a Dietary Disease.

in 2011, in Retrospective #114, “My Insulin Dependent Type 2 Pharmacist,” I recalled an offer to write a newspaper column on any subject, without compensation. It was just “content,” or fill between ads, for the publisher.

I accepted and chose to write about Type 2 diabetes because an acquaintance of mine – a registered pharmacist – died, unnecessarily and tragically. It was when I went to buy a glucose meter that I learned that my pharmacist was an insulin-dependent Type 2. He followed “doctor’s orders” – and the advice of the American Heart Association since 1961 and the Dietary Guidelines recommended by our government since 1977 – and his disease progressed to its inevitable conclusion. His death was a waste. It didn’t have to happen. And that’s what I decided to write about it.

With that in mind I have decided to focus my efforts on a large underserved segment of the diabetic population.  I want to explore an aspect of Type 2 Diabetes care that is largely ignored by the medical and pharmaceutical communities, and the press, and therefore little understood by the people: self-management of Type 2 Diabetes.

I am especially interested in reaching what the medical community calls the “treatment-naive” patient, i.e., someone who is newly diagnosed (as Pre-Diabetic or a Type 2 Diabetic) and has never been subject to any “treatment.” Such patients are at a critical juncture, and DENIAL is an extremely tempting option. Typically, the patient is devastated by the news. He or she defaults into a dependent state and accepts their doctor’s ministrations (as we customarily do in healthcare matters). However, a diagnosis of Pre-Diabetes or Type 2 Diabetes is actually a great time to look into what this disease is really all about – to learn what you, the patient, can do about it. Your doctor will probably agree that as a well-informed patient, you CAN self-manage your diabetes care, under your doctor’s watchful eye, of course. 

Self-management of Type 2 Diabetes is a mutually beneficial arrangement. Doctor’s know that Type 2 Diabetes is largely a PATIENT managed disease. They call it “patient-oriented” care, but that leaves the impression that patient care is a collaboration that the DOCTOR manages. I’m sorry, but as far as dispensing dietary advice is concerned, most clinicians, and Certified Diabetes Educators (CDEs) and Registered Dieticians (RDs), if they want to be paid for the advice they dispense, are required to follow the government’s recommendations. And that advice, since 1961 (AHA) and 1977 (DGA) has been dead wrong, almost exactly the opposite to what “healthy eating” advice should be.

So, at this critical juncture, and in the days and months ahead between doctor’s appointments, if YOU decide on self-management, you will follow one of the dietary regimens mentioned above. And at your next office visit your doctor will order tests and monitor (NOT manage), and record, your IMPROVEMENTS in all your important medical markers.

If you default to the dietary advice your doctor and the government offers, you will embark on a path of MEDICAL management (vs. self-management) of your diabetes. After getting your blood sugar under control with drugs, your doctor WILL manage the progressive WORSENING of your condition. You’re thinking, something must be wrong with this “prescription.” Well, your doctor knows that too, but the only arrow he has left is, “More medications could be used.” That’s the road my pharmacist took– progressively worsening disease – and then a slow, premature death.