Wednesday, April 29, 2020

Retrospective #438: Two Degrees of Separation

In Retrospective #437, “Heading toward the cliff,” I described how standard clinical practice 1) treats type 2 diabetes as a progressive disease of insufficient insulin (not unlike type 1 diabetes) and 2) typically uses both oral and injected medications to “activate your body to release its own insulin.” This is still done with sulfonylureas, which should have fallen out of favor as documented in #437. However, a new once-a-week injectable medicine promises to do the same – to “activate your within” to “release its own insulin.” That’s a bad idea!
Why? Because it is a medication that is designed to address a symptom of type 2 diabetes, an elevated blood sugar, and thus is a treatment TWO degrees removed from the CAUSE of the disease: INSULIN RESISTANCE. This treatment increases insulin either from “your within” (your pancreas) or, as the disease progresses (as you doctor believes it will), direct injections of insulin. To be sure, increasing insulin will lower your blood sugar… but at what cost? You’ve exhausted your pancreas and become an “insulin dependent” type 2. That is the WORST thing you can do!
A better treatment, just ONE degree removed, would be to take a medication that suppresses unneeded/unwanted glucose production by the liver and improves your insulin sensitivity (the opposite of Insulin Resistance). That medicine is Metformin. If the dosage is titrated (started as a low dose and slowly increased), the gut tolerates it well. It has virtually no other side effects and some salutary effects (longevity) not yet fully understood.
By lowering glucose production and facilitating glucose uptake at the cellular level, treatment with Metformin accomplishes the same goal (lowering blood glucose) without putting any stress on your already overworked pancreas. This treatment is thus one degree closer to the cause of your type 2 diabetes: INSULIN RESISTANCE. 
The best treatment, a DIRECT treatment, then, would be one that doesn’t cause your blood glucose level to rise in the first place. But, remember, if you’re a typ2e 2 or prediabetic, you have Insulin Resistance. Because of a genetic predisposition and eating for many years a diet very high (60%+) in carbohydrates, especially refined and processed carbs and simple sugars, your body developed resistance to the glucose transporter hormone, INSULIN.
Refined and processed carbs like flour and starches are the worst; they’re almost all glucose. At least cane sugar is half glucose and half fructose. But fructose is processed by the liver to become either glucose, or if your liver is full of stored glucose (glycogen), your body converts it via lipogenesis to fat. Besides added pounds, this produces its own set of problems, including NAFLD, non-alcoholic fatty liver disease, or worse, NASH, non-alcoholic steatohepatitis.
So, if you’re a type 2 or prediabetic, how do you prevent an elevated blood glucose? Clue: It’s NOT a drug, so your doctor can’t write a script for it. It’s a patient-directed treatment. Don’t eat foods that digest quickly and easily to glucose. If you don’t eat foods that digest to glucose (carbs), your blood “sugar” cannot become elevated!
Those foods would be 1) the refined and processed foods and the so-called “complex” carbohydrates (a criminal misnomer if ever there was one). They are just long-chain glucose molecules which break down to simple glucose when digested; and 2) the simple sugars, like sucrose (cane sugar), lactose (as found in milk and yogurt).
As bad as table (cane) sugar is, (and honey and maple syrup and agave), most yogurts are worse, especially the non-fat ones. In place of fat, sugars and other carbs are added, and then fruit syrup and fruit, both virtually 100% “sugar.” If you question this, ask yourself, does fruit contain any of the other two macronutrients, protein or fat? If not, it is 100% carbohydrate (sugar). And breads! Besides, flour (a highly processed carb), and water, the third ingredient in almost every loaf of bread is sugar. Even those “sprouting” breads are maltose, a disaccharide (double sugar).
So, what are your options: 1) WORST: 2 steps removed. You can beat up your pancreas by taking a sulfonylurea or a once-a-week injectable that does the same thing, or 2) BETTER: 1 step removed. You can take Metformin to suppress unwanted glucose, or 3) BEST: directly address your Insulin Resistance. You can eat fewer carbs, to keep your blood glucose level lower and stable, and avoid having to take more meds and face the “the dreaded complications.”

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