Non-insulin dependent diabetes mellitus is an endocrine disorder which involves the pancreas, or more importantly the 'islets of langerhans'; the beta cells that secrete the hormone insulin. In addition a common factor especially in the early stages is Insulin resistance. This is caused by the muscles and other cells, inability to take up the glucose circulating in the bloodstream, leaving it at high levels; this is hyperglycemia. Interventions by drugs and insulin is the way medicine then acts, to reduce this dangerous excess. But this is often counterproductive, as it exacerbates the problem of the insulin resistance, and pushes an already exhausted pancreas to secrete more and more insulin until it dies completely under the load imposed upon it. At that stage, insulin injections become mandatory and these are potentially life threatening and almost always cause obesity to increase, or appear, if it has not already begun.
To enable a more proactive approach to the prevention, detection and treatment of diabetes, a number of 'sacred cows' need to be taken out of the equation, preferably round the back of the surgery, and administered a fatal shot to the brain. Perhaps along with some of the physicians that promote these drugs and protocols. These are;-
- Low fat, high carbohydrate diets.
- Exercise, but with little direction as to what or when.
- Various hypoglycemic agents that have some serious side effects.
- A culture that offers a chemical fix instead of a lifestyle changes
With this initial nutritional advice, to consume low fat, high carbohydrate diets we come up against the pig headed views, about the fat-diet-heart hypothesis that have dominated dietary advice for the last thirty years. It takes no account, of numerous studies that have thrown this into the long grass, where it belongs, and I cannot see why it still prevails, as even some mainstream medics are beginning to cast doubt on it's veracity. When even simple biochemistry dictates, that any starch intake is going to be converted to glucose almost instantly in some foods, it is obvious that blood levels are going to rise with it's consumption, which will then require that level to lowered. The only conventional way for a diabetic to achieve normoglycemia from this position is to take something to lower the level and/or burn it off by exercise. Why in the name of Hippocrates would you suggest that you take a 'poison', merely so you can take the antidote ? Far better, I say not to take the damn stuff in the first place, surely ?
Exercise, is always advocated by all in Health care for, well, virtually everything. But it does little at all to reduce obesity of itself. OK it will help a little to keep you healthy, but obesity tends to make exercise an effort, so tends to go on the back burner for most. It can and does burn off excess glucose in diabetics, but has to be carefully targeted to do this at times, postprandial, that will have the maximum effect, but it will do little to reduce weight in any meaningful way. In the last few days it has been widely reported in the media that childhood obesity is not caused by lack of exercise, as reported by this study, from the Peninsular Medical School in Plymouth. Read it here , it explodes a few myths.
Hypoglycemic agents are oral drugs, generally that lower glucose absorption, increase it's disposal by the liver, help to lower insulin resistance or pressurise the pancreas to produce more insulin. They have significant and often unpleasant side effects, and whilst I would not entirely rule them out, I would always advise extreme caution in their use. With the possible exception of Metformin, they often invoke hypoglycemia, which can be more dangerous than too much blood glucose, and they almost always promote weight gain. Once you are prescribed these drugs the condition almost always worsens, and more and more are prescribed until insulin injections are needed because you will no longer have any functional beta cells.
These chemical 'fixes' are there because you will never be told to eliminate as much as possible the source of all that glucose, carbohydrates, that is largely causing the condition. It is not politically correct to consume fats, especially saturated animal fats, and proteins should only be consumed in relatively small volumes, so the bulk of the diet advised is carbohydrates, of up to 66% of intake, if you include the insane notion, of fruit and vegetables not being carbohydrates, which they largely are. So, with the connivance of the medical profession you are told to eat carbs in abundance, even some sugars (!) because the drugs you are being given will take care of the problem. You will also be told that eating fats will make you fat, except of course the awful man made vegetable types; monounsaturated and polyunsaturates, (and I do advocate some intake of the latter, in the form of Omega 3's), margarine with plant sterols, are in fact in that group. These are alleged to assist in cholesterol lowering, which you will also be told is an essential of diabetic protocols (see last post). The simple truth is that saturated fat has no insulin reaction whatsoever in it's metabolism in the human so it cannot make you fat. It will in fact help to make you thin as well as providing a food stuff you will satiate your craving for sustenance, which is a side effect of insulin resistance.
So even if you are a diabetic, even on insulin, you will benefit from the 'primitive' or 'paleolithic' diet we were eating only some ten thousand years ago. 'A blink of the eye' in evolutionary terms. Man, especially those hunter gatherer types, northern in origin, which people the USA and Europe are poorly adapted to the absorption of nutrients from grains and other carbohydrates, and as a consequence, much of that which we eat in this food group, increases our likelihood of becoming diabetic and largely is stored as fat. Abdominal fat increases our chance further of becoming diabetic and obese. Worse, the huge consumption of sugars both sucrose, which has risen from 3kgs per person in 1900, to 75kgs per person today, and more importantly, in the past few years, fructose, is complicit in this phenomena of increase in both risk and consequence.
By failing to take account of these factors, in the dietary advice given to all diabetics, by current mainstream dietitian's, nutritionists and most doctors, a considerable disservice has been perpetrated upon diabetics. By, adding to the burden of drug protocols, the need to lower all lipoproteins, and blood pressure often when these are in the normal or low risk levels; the health and well being of the diabetic is often further compromised. Often, this is founded in dogma and poorly researched science, typical of preventative measures advocacy that much of health care interventions is steeped in today. These are '5-a day'; statins lower CVD risk ( in otherwise healthy people); a (so called) cholesterol level of 4.0 mmol/L is dangerous; eating saturated fat increases CVD risk, etc,etc. These are all hypotheses that are unproven or worst proven as being untrue. The vast sums we have literally 'thrown' into these protocols and the 'bribes' given to Doctors to both advocate and invoke them is a scandal of enormous proportions. It is patently not working and we are are on the brink of an epidemic of diabetes and obesity in society, that is going to eat up more and more of our precious resources, with prospect of 4.2 million diabetics by 2025, as opposed to approximately 2.5 million today (Diabetes UK figures).
We are now faced with the prospect of GP Commissioning of all Primary care in the UK, which will include diabetes care. If this comes to pass, for which there is some inevitability, GP's will be given the budget for this area, with perhaps even more of the same outmoded beliefs and treatments inevitable. As most, if not all GP's are contractors, it will place them in the difficult position, for the patient that is, of being both the purchaser and provider of services. The situation not of 'poacher turned gamekeeper', but of them being one and the same simultaneously. That is not a scenario that bodes well for patients, and is likely to make for even more corruption of care than is currently the case. There is already vested interests at play both in the National bodies that oversee diabetic care and in those that treat us for it. To allow even more to be invoked is likely to make it worse, not better. The diabetic will once more be a pawn of those interests, with the prospect of large private 'for profit' entities bidding for their care, with their outcomes likely to suffer as a result. And society's spiral towards diabetic overload likely to result.