Retrospective #483: “…when used with diet and exercise.”

Have you ever noticed how all the type 2 diabetes medications advertised on TV conclude with “…when used with diet and exercise”? That common refrain riles me a bit, but I’ve never asked myself why. I think it’s time I do.

First off, by self-examination I admit to being something of a curmudgeon. However, I tend to grouse only about the abysmal state of our collective health, including how we (including I) got into this mess. In other respects, I think I have a positive outlook on life, but you’d have to ask the people who know me best if that’s true. Regardless, my readers could fairly describe me as a crusty, grumpy old man. This column, however, is not about me. This column is about why the diabetes ads conclude with the caveat, “…when used with diet and exercise.”

It’s obviously a government (FDA) requirement. The Food and Drug Administration (FDA) has to approve all claims made by drug manufacturers. The FDA also dictates for what and when a drug may be prescribed. That includes as a first course of treatment, as well as any adjunctive therapy if the first medication fails to achieve the primary target. In the case of a drug to treat type 2 diabetes, that “primary target” would be lowering the patient’s serum blood glucose, a SYMPTOM of type 2 diabetes, as measured today by a blood marker, hemoglobin A1c (hgA1c), or simply, A1c.

Metformin is the first drug prescribed today to “treat” type 2, and sometimes pre-diabetes. But type 2 diabetes is CAUSED by Insulin Resistance (IR), as measured (too late)  by an Impaired Fasting Glucose (IFG). Metformin is generic, cheap and widely accepted as the standard-of-care, almost universally prescribed first after diet and exercise have failed. After Metformin, which is now generic, the clinician has a wide choice of drugs, depending on other risk factors and co-morbidities. That’s when the phrase, “…when used with diet and exercise,” usually appears.

And that’s what gets me riled. Every doc is supposed to tell their overweight and Pre-diabetic patients to “lose weight and exercise” before ANY meds are prescribed.  “Eat less and move more,” “eat a plant-based” or “Mediterranean” diet and get lots of exercise (to lose weight!). And everyone FAILS. By following the FDA’s and their doctor’s advice, hey fail to permanently lose weight or stop or reverse the slow but inexorable slide to drug dependence, eventually “graduating” to type 2 diabetes. So why do the diabetes ads still advise people to continue this failed strategy?

Answer: The FDA mandates it. But, what does Big Pharma care? It’s a throwaway line because so long as PATIENTS continue to eat what government and their doctor have “prescribed” as a “healthy diet,” type 2 diabetes WILL BE a “progressive disease,” and the PATIENT WILL continue to worsen.” And BIG PHARMA IS THE BIG WINNER.

There is no downside for Big Pharma. They’re not telling you how and what and when to eat, and certainly no one would tell you that exercise is not good for you. Besides, exercise and Metformin are well-documented ways for type 2s to slightly improve their insulin sensitivity, which is good. But for weight loss, exercise is not an effective method.

THE ONLY DOWNSIDE IS FOR THE PATIENT. By following the advice to eat what the government “prescribes” as a “healthy diet,” patients are being herded like lemmings into the hands of Big Pharma. Whether this is a corrupt cabal, I’ll leave it for you to decide. But more to the point, in your own self-interest, you might want to ask, why has the advice, “…when used with diet and exercise,” failed? And why does it continue to fail even as you take more and more medications. It is because exercise and eating a balanced diet are not good ways to lose weight? 

It is because the “healthy” diet the government prescribes is NOT REALLY A HEALTHY DIET? If eating lots of carbs (like corn) is a good way to fatten beef cattle in a “feed lot,” is it not also a good way to fatten people? Yet, the government’s Nutrition Facts label on all “processed” foods prescribes that the PERCENT DAILY VALUE (%DV) FOR CARBS RECOMMENDED FOR WOMEN (ON A 2,000KCAL DIET) IS 300G, OR 1,200KCAL, OR 60%. AND FOR MEN (ON A 2,500KCAL DIET), IS 375G, OR 1,500KCAL, ALSO 60%. DID YOU KNOW THAT? DO YOU THINK THAT IS TOO MANY?

If you want to avoid the inevitable “graduation” to a cocktail of anti-diabetic medications, including the ones advertised on TV, you might want to consider dropping your intake of carbs, to 40, 20, 10 or even 5%, like me.