Thursday, March 19, 2020

Retrospective #397: If Type 2 diabetes is defined as an A1c of ≥6.5%…

If Type 2 diabetes is defined as an A1c of ≥6.5% (which is it), and the goal of the American Diabetes Association (ADA) is to manage your blood sugar such that it does not exceed 7.0%, then it follows, ipso facto, that it is ADA’s goal to maintain you in a perpetual disease state. What do you think about that?
Two explanations for this non-sensical, upside-down goal are possible. I’m not so cynical that I would buy into the first: that your doctor, and the health care industry that comprises about 1/6th of the U. S. economy, needs to keep you sick for their business practice to prosper. I understand the temptation to think that way, but I really don’t think that there is such a sinister conspiracy. There has to be another, probably much more complex reason.
The second explanation for the low expectation (A1c = ≤7.0%) of the healthcare community is that, in their clinical experience, it is difficult, under the terms of the ADA’s Standards of Medical Care, to achieve an A1c of ≤7.0%, even with all the pharmaceutical options, both oral and injected, they have at their disposal. Big Pharma has expended vast resources over the last half century to develop new, effective drugs, to little avail.
Insulin, discovered in 1921, can achieve that goal, but most patients do not want to inject themselves multiple times a day while monitoring and counting the carbs (and protein) in everything they eat to maintain “tight control.” Besides, the ADA and most clinicians do not advocate or practice tight control because of the serious risks of hypoglycemia (dangerously low blood glucose!). The medical establishment is reluctantly content to let their diabetic patients remain in a perpetual disease state rather than risk having them pass out and be transported to hospital.
But the main reason that the ADA’s goal of an A1c of ≤7.0% is difficult to achieve began with the American Heart Association’s 1950’s recommendations with respect to eating a diet low in saturated fat and dietary cholesterol. The U.S. public health establishment’s, compounded the effect in 1977 with the “Dietary Goals for the United States” produced by the Senate Select Committee on Nutrition and Human Needs, aka “the McGovern Commission.”
This was followed in 1980 and every 5 years thereafter by the “Dietary Guidelines for Americans” to “govern” what we eat. We followed it, the food manufacturers followed it, and so did the media and medical associations. We ate low fat, low cholesterol, low salt, lean meats, and low-saturated fat dairy (milk, cheese and yogurt).
Simultaneously starting in 1980, by eating this low-fat (consequently high-carb) diet, we got sicker and fatter and started to develop Insulin Resistance and Type 2 diabetes at increasing rates. This reflects an aging population, but cannot explain the soaring rates of childhood diabetes. Just look around you on the street, or maybe in the mirror.
The “ship of State,” however, has begun to change course. In 2015 the Guidelines dropped the limit (30%) on total fat and the limit on dietary cholesterol (300mg/day). I’ll bet you, and your doctor, don’t know that! Eggs and butter are now healthy again. Margarine, made from partially hydrogenated vegetable oils (trans fats) is now taboo.
But these little-known changes, while really significant – seminal, really – are in themselves not sufficient for the Type 2 diabetic to reverse his or her disease state and achieve an A1c of less than 6.5%, much less, lower than the 5.7%, threshold for a diagnosis of pre-diabetes. To reach this A1c goal, or even a lower, healthier A1c, Pre-diabetics need to change the foods they eat. They need to limit carbohydrates, and not eat the same, one-size-fits-all diet that the government still insists everyone should eat. They need to follow a Low-carb, High-fat (LCHF) Way of Eating.
When you start to eat Low Carb, you will feel better. You will lose weight, and your blood sugar will stabilize. You will feel less tired and less hungry.  And your A1c will come down. I’ve been a diagnosed Type 2 for 34 years and have been eating LCHF for 18. On LCHF I’ve lost 180 pounds, and managed to keep off 150. My A1c has gone from 8.9% to as low as 5.0% (currently 5.3%). With no Cardio Vascular Disease or other Macro or Microvascular complications. It’s still a challenge, but if I hadn’t made this Lifestyle Change, I probably wouldn’t be here today to write about it today. 

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