I don’t remember how, but in early
2016, I landed on South African blogger Marika Sboros’s site, FOODMED.NET. I loved it and signed up for regular
delivery. The blog’s subtitle is “Let food be your medicine,” so you can see my
affinity. The first post I read, in her “Managing Your Blood Sugar” series, was
titled “NOAKES: IT'S THE FATTY LIVER DISEASE, STUPID' PART 2,” tagged “LCHF.”
Marika explains that LCHF in her lexicon means “Low Carb Healthy Fats.”
The author of this particular post was
world-renowned scientist and University of Cape Town Professor Emeritus Dr. Tim
Noakes. Noakes introduces his subject with a discussion of the misunderstood
term “risk factors,” frequently used in epidemiology and “observational” or
“associational” studies. He delves briefly into “hazard ratios” (HRs), relative
and absolute risk, and related subjects to show how data is commonly
manipulated and misused.
“This is intellectually absurd,”
Noakes says. “How can everything be a risk factor for everything else?” he
asks. He answers, “The answer can be found in the ignored work of Dr. Gerald
Reaven, Emeritus Professor of Medicine at Stanford University.” “Reaven has
spent the past 60 years studying the condition that intellectually he now owns,
insulin resistance.” (As I rewrite this in 2020 for the Retrospective Series, I
note that Gerald Reaven died in 2019.)
Reaven’s interest in insulin
resistance was piqued by the distinction between Type 1 and Type 2 diabetes.
Type 1 is characterized by the (almost) total absence of
endogenous insulin; Type 2, insulin resistant diabetes, by “abnormally high amounts [of insulin] because
the target cells on which the insulin normally acts are resistant to its
action; hence the condition of insulin resistance or carbohydrate intolerance. Persons with insulin resistance
have blood insulin concentrations that are elevated
most of the time, a condition known as hyperinsulinemia.” (my
emphases).
Noakes says, “Reaven’s great
contribution has been to show this persistent hyperinsulinemia in insulin
resistance, whether or not associated with t2dm, produces a collection of grave
secondary consequences.”
Noakes then says, “But
Reaven’s greatest (and bravest) intellectual contribution is to suggest that
insulin resistance and hyperinsulinemia are the necessary biological precursors
definitely for four and perhaps for all six of the most prevalent chronic
conditions of our day: 1) Obesity; 2) Arterial disease (local: heart attack or
stroke; disseminated: T2DM; 3) High blood pressure; 4) Non-Alcoholic Fatty Live
Disease (NAFLD); Cancer; and Dementia (Alzheimer’s Disease, also known as Type
3 Diabetes).”
Reaven gave the keynote Banting lecture at the 1988 American Diabetes
Association annual meeting. His talk explained the underlying factor for a
constellation of abnormalities: glucose intolerance, hyperinsulinemia, hypercholesterolemia, hypertriglyceridemia, and hypertension. Reaven named it
“Syndrome X”; it was also given the moniker Reaven’s syndrome. Today
it is simply called Metabolic
Syndrome.
“The key finding from Reaven’s work,” Noakes says, “is
that these conditions are not separate – they are different expressions of the
same underlying condition. Thus, a patient should not be labeled as having high
blood pressure or heart disease or diabetes or NAFLD (or perhaps even cancer or
dementia).”
“Instead,” Noakes continues, “the patient should be diagnosed
with the underlying condition – insulin resistance – with the realization that
the high blood pressure, the obesity, the diabetes, the NAFLD, or the heart
attack or the stroke are simply markers, symptoms if you will, of the basic
condition.”
“And that basic condition,” Noakes concludes, “is insulin
resistance which, simply put, is the inability of the body to tolerate more
than an absolute minimum amount of carbohydrates eaten each day. “
Thus, we have it: Reaven’s unifying hypothesis of chronic
disease: “One disease, one cause, many symptoms.” Tomorrow’s post will offer
insight into the profound implications of this fundamental advance in medical
science.
Aside: This column was based on Noakes’s 2016 “Part 2”
in a Series. By sheer coincidence, a link to “Part 4,” recently published by
Tim Noakes, appeared on Twitter on January 13, 2020. It is a long encomium to the
late Gerald Reaven.
This comment has been removed by a blog administrator.
ReplyDelete