Diabetes is a chronic, progressive disease characterized by elevated levels of blood glucose. As a medical student back in the Dark Ages – circa 1975-78 – diabetes was a troubling, rare phenomenon.
From 1980 through 2014, the number of Americans with diagnosed diabetes increased fourfold (from 5.5 million to 22 million). In 1980, an estimated 30 million people had diabetes, worldwide. In 2014, this figure climbed to 422 million. At the current rate of growth, unless a massive intervention takes place in the healthcare landscape, the World Health Organization estimates that there will be 552 million victims.
This series, like our in-depth look at thyroid disease that published in the July 2015 through July 2016 issues of Healthy Beginnings Magazine, will explore all things diabetes. This month, we explain the definition of diabetes, describe how diabetes became a worldwide crisis, share conventional wisdom and treatment options, and propose a metabolically sound, peer-reviewed approach to remedy (and possibly reverse this modern-day scourge).
Diabetes comes in two forms. Type 1, juvenile-onset diabetes, primarily affects children and young adults. Juvenile diabetes results from the death of insulin-producing cells, creating a severe deficiency of insulin. The result is high blood sugar and rapid weight loss. Type 1 diabetics – 10 percent of the diabetic community – require daily, life-long access to insulin.
Type 2 diabetes results from inadequate use of insulin. Type 2 diabetics are typically middle-aged, overweight-to-obese individuals with many comorbidities including hypertension and elevated lipid panels.
Pre-diagnostic diabetic symptoms include extreme thirst, uncontrollable urinary frequency, blurred vision with a tendency toward nearsightedness and profound fatigue.
A “normal” fasting blood sugar ranges from 65 to 99 mg/dL, less than 140 mg/ dL one hour after a meal, and less than 120 mg/dL two hours after a meal. A fasting blood sugar greater than 100 mg/dL and less than 125 mg/dL is “pre-diabetes.” Anything over 125 is considered pathologic.
It wasn’t always this way. According to my first hospital internal medicine mentor, Dr. L, “As long as they’re under 200, tell them they’re the Mary Poppins of Philly, practically perfect in every way. Just watch it. If it gets to say, 225 or more, we will do something about it.” (Thus, the standard of care for diabetes at Metropolitan Hospital in 1978, which today is a condominium.)
We “watched” our patients develop advanced atherosclerotic heart disease and suffer from blindness, kidney failure, dementia, (often regarded as Type 3 diabetes), non-healing cuts and wounds, amputations of fingers, toes and whole limbs, and premature death.
When we did “something” we did lower the patient’s blood sugar, but the underlying disease process marched on. Food intake received, at best, lip service.
Before the days of insulin and oral hypoglycemic agents, little was available to diabetic patients other than dietary advice.
If touched upon by the patient, we informed them that diet didn’t matter. We physicians, of course, never brought the subject up. If pressed, the “standard of care” of the day was the newly discovered “cause” of diabetes and heart disease – dietary fat. The cure? A low fat, high carbohydrate, “heart smart” diet.
The diabetic associations of many Western countries, including the United States, Britain, Canada, Australia and Finland, affirmed the importance of diet in the management of diabetes and recommended an increase in fiber-rich carbohydrates with a reduction in the fat intake.
The unspoken truth among us interns: A diagnosis of diabetes meant the person in front of us would never be healthy again. We were managers of their decline. We started with one drug, and then added a second, a third, sometimes up to five. When the drugs inevitably failed, we administered insulin.
If a patient’s blood glucose dropped too low, common with the medications of the day, we recommended Snickers, Mounds, Almond Joy or Hershey’s chocolate bars. The patients were encouraged to keep some handy in case of a hypoglycemic episode.
Unless the patient took matters into their hands, the above-noted scenario was the expected outcome. A small number of patients seek out medical “mavericks,” especially one Robert Atkins.
Dr. Atkins, a New York City cardiologist, appeared on The Tonight Show touting a low-starch, low-sugar, high-fat diet to control weight, blood sugar, and heart disease. He claimed that high carbohydrate intake caused the body to overproduce insulin. Insulin metabolized blood glucose increasing, not decreasing, hunger – as was the popular notion at the time. His “Dr. Atkins’ Diet Revolution” was mocked by the supposed medical experts.
For his troubles, Dr. Atkins was called before Congress in 1973, labeled a menace to America’s health, and impudent to boot. How dare he “impugn the reputation” of noted doctors who told America that the healthy way to lose weight was to avoid fatty foods? Asked one senator.
The fly in this ointment, we observed, was that Dr. Atkins’ patients lost weight, stabilized their blood sugars and improved their exercise capacity. In short, Atkins’ patients got better. The medical “experts’” patients became sicker and sicker, needed more and more medication, and continued to deteriorate and died prematurely.
Big medicine, of course, explained away this phenomenon as anecdotal, a coincidence. Coincidentally the direct and indirect cost of diabetic care in the U.S. increased from $17.9 billion in 1980 to $245 billion in 2012.
Excess carbohydrate intake begets obesity, leading to hyperinsulinemia, along with with genetic factors, and a sedentary lifestyle, which are the chief drivers of the diabetes health crisis.
Next month we look at the diagnosis and treatment of diabetes from a traditional medical standpoint. Future episodes will cover peer-reviewed methods to ease the diabetic burden with an eye toward answering the question, “Can diabetes be reversed?” Hint: If I must spell out the answer, you missed the point of the article. Stay tuned.
For more information, call Clearfield Medical Group at 775-359-1222, visit our new website at www.DrClearfield.net or email at drbill@rejuvenatereno.com.
References
- Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics,https://www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm
- Chan, M, Global Report on Diabetes, World Health Organization, Geneva, Switzerland, 2016:25
- Nestle, M, Food Politics. Weighing in on Paula Deen. (n.d.). Retrieved from http://www.foodpolitics.com/2012/01/weighing-in-on-paula-deens-type-2-diabetes/
- Mann, J, “What Carbohydrate Foods Should a Diabetic Eat?,” British Medical Journal; Oxford, G.B. 1984; 288: 1025.
- Huttunen JK, Aro A, Pelkonen R, Puomio M, Siltanen I, Akerblom HK. Dietary therapy in diabetes mellitus. Acta Med Scand 1982; 211:469-75. https://www.ncbi.nlm.nih.gov/pubmed/7113763
- Leith, William (February 9, 2003). “What the doctor ordered.” The Observer. London. Retrieved 2009-10-29.
- Fishman, S, “The Diet Martyr.” New York Magazine. New York. http://nymag.com/nymetro/news/people/features/n_10035/ Retrieved January 1, 2017.
- American Diabetes Association, Economic Costs of Diabetes in the U.S. in 2012, Diabetes Care. 2013 Apr; 36(4): 1033–1046.
