Wednesday, May 6, 2020

Retrospective #445: Are doctors in denial?

When a doctor tells me that I am “no longer diabetic” – as a few have, informally – are they misinformed about what causes type 2 diabetes, or are they just small business men or women in denial and following the government’s definition which dictates a clinical diagnosis? Because they want to get paid and move on…
I mean no offense, honestly. If I seem disrespectful, well…maybe I am, but as Dr. Michael Eades said, at the end of Retrospective #406, it’s sometimes necessary for “you” (his readers) to “educate your trained professional.”
For example, at a cocktail party recently I was having a tête-à-tête with a friend, a retired MD, when a tray of shrimp was passed around. I took one, but when the doctor declined, I asked him, “Why?” He answered, “Cholesterol.” He apparently hadn’t heard that, back in 2014, the Dietary Guidelines Advisory Committee had declared that “cholesterol [was] no longer a nutrient of concern for overconsumption.” Or that Ancel Keys, the infamous creator of the “diet-heart hypothesis,” was quoted later in his life as saying, “And we've known that all along. Cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit.”
With respect to the “misinformed” possibility, and the “denial” question, we know that type 2 diabetes is caused by a metabolic dysfunction in which the body is no longer able to handle a diet high in refined carbs and simple sugars due to Insulin Resistance. The hormone insulin, secreted by the pancreas, carries glucose from digested carbs in the blood stream and, in a normal metabolism, “opens the door” by connecting to receptor cells where the glucose is supposed to be taken up for energy. When the connection doesn’t work, the glucose continues to circulate and the pancreas secretes more insulin to help out, eventually wearing itself out.
Most doctors rely on the A1c test or a fasting blood glucose to diagnose type 2 diabetes and begin a course of treatment (“diet and exercise”, and 3 months later, when this fails, prescription meds). These simple blood tests show the symptoms of a disregulated glucose metabolism and are cheap and effective as screening methods. Most people who present with an elevated FBG or A1c are pre-diabetic or frank type 2s. And the meds that a doctor prescribes to treat these symptoms will lower your FBG or A1c somewhat, at least temporarily. But your type 2 diabetes will continue to progress, because the clinician is treating a symptom, not the cause, of type 2.
The cause of type 2 diabetes is Insulin Resistance (IR). The best test for IR is the Oral Glucose Tolerance Test (OGTT). In this test, the patient drinks 75g of a glucose solution, and their blood is tested before and at half hour intervals afterwards for 2 hours. It is usually performed by an Endocrinologist and/or in a hospital outpatient setting, so it’s expensive, BUT THE OGTT WILL REVEAL DEFINITIVELY IF THE PATIENT HAS INSULIN RESISTANCE.
But the GOVERNMENT, and therefore your doctor, is only interested in treating your symptom, an elevated blood glucose (A1c). If your A1c is ≥6.5%, you are clinically designated a “type 2 diabetic.” If it is <6.5% but ≥5.7%, you are clinically designated “pre-diabetic.” If your A1c is <5.7%, you are clinically designated “non-diabetic.” If your A1c was previously ≥5.7%, but somehow is lower now, your doctor will declare you “non-diabetic” or “cured,” and by the established Standard of Care, the insurance “system” will reward the doctor financially for this favorable outcome. This totally ignores your INSULIN RESISTANCE. YOU ARE STILL INSULIN RESISTANT, and therefore STILL TYPE 2 DIABETIC. If you don’t change your diet, YOUR DISEASE WILL PROGRESSIVELY WORSEN.
So, is your doctor misinformed, in denial, or just focused on the bottom line? He or she is, after all, in business and just following government rules for treatment and payment. As far as keeping your INSULIN RESISTANCE in check, or even putting your type 2 diabetes IN REMISSION while losing weight easily and without hunger, that’s up to YOU. YOU decide what foods you eat. But don’t expect your doctor or the government to know how to “eat healthy.” FOLLOWING THEIR ADVICE IS HOW YOU GAINED WEIGHT AND GOT SICK IN THE FIRST PLACE.
If you are Insulin Resistant, your doctor can only write scripts to “control” your A1c. Eating right is up to you.

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