evidence-based medicine in diabetes treatment

“The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines.”   The entire abstract of the recent scientific paper by Dr. Richard David Feinman and his team

I’ve shown you before that Type II Diabetes is literally exploding here in America (30,000,000), with between two and three times that number dealing with pre-diabetes, otherwise known as CARDIO-METABOLIC SYNDROME.  The root cause of this problem is so out of control that our government recently commended us for lowering our per-capita consumption of soda to the lowest levels since my freshman year in college — 1985 (HERE) — over 81 gallons.  Like I said, out of control.

About a month ago, a group of almost thirty MD’s and Ph.D researchers published a paper in one of the Science Direct / Elsevier journals, Nutrition (Dietary Carbohydrate Restriction as the First Approach in Diabetes Management. Critical Review and Evidence Base).   Thinking that this was likely another misguided attempt at “EVIDENCE-BASED PRACTICE,” my interest was piqued when I saw this statement by one of the paper’s lead authors, Richard David Feinman, a medical researcher and professor of biochemistry at State University of New York. “Dietary carbohydrate exacerbates hyperglycemia, the most salient symptom and the cause of downstream sequelae. The resistance of the American Diabetes Association and other agencies and individuals physicians to this approach which has help many patients is incomprehensible to many people and will be equally hard to understand in the future.  Doesn’t it strike you as a terrible scandal that carbohydrates are given to people with diabetes. Isn’t this one of the worst scandals in the history of medicine.”  

For a very long time — most recently HERE — I’ve been saying that the “it” Feinman speaks of above (physicians failing to treat people who have DIABETES with LOW CARB DIETS, instead telling them to eat more carbs) is incomprehensible.  But then again, there isn’t much money to be made by suggesting dietary changes and watching people actually get healthy instead of prescribing more DIABETES MEDICATION.  That’s right; according to this paper, “carbohydrate-restricted diets reduce or eliminate medication and there are no side effects comparable to those seen in intensive treatment with drugs.”  Considering that the government has severely cracked down on individuals for saying the exact same thing (HERE), this paper may prove to be a major break thru.  You will never be able to accuse the authors of this paper of mincing words; “We present major evidence for low-carbohydrate diets as first approach for diabetes.  Such diets reliably reduce high blood glucose, the most salient feature of diabetes.”  But before we continue, I would like to take a moment to talk about the, “downstream sequelae” spoken of in the first paragraph. 

It is important to understand the definition of “sequelae” — a word commonly seen in the medical field.  If you look at the word, it’s base is the word “sequel“.  When we think of a sequel, we generally think about the natural progression of a story — particularly a movie.  According to Webster’s, however, the word “sequelae” means something slightly different; “an aftereffect or secondary result of a disease, condition, or injury“.  In other words, this study largely pertains to the “downstream sequelae” or consequences of hyperglycemia (JACKED UP BLOOD SUGAR).  Needless to say, I have not only written about these consequences or ‘sequelae’ numerous times, but I’ve told you time and time again that most health problems and diseases have their origins in blood sugar dysregulation. 

The paper starts out by saying, “The benefits of carbohydrate restriction in diabetes are immediate and well-documented. Concerns about the efficacy and safety are long-term and conjectural rather than data-driven.”  Think about what the authors are really saying here.  They are telling us (as I have in the past) that even though there are mountains of data to support the use of Low Carb or “carbohydrate restricted” diets with diabetics, our medical community is not doing so.  And for those of you who would argue that these sorts of diets are dangerous, the authors have this covered as well. I have included the author’s Twelve Points along with a bit of my own commentary. 

• “Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels”.  This is fairly simple and straightforward.  The very definition of Diabetes means that you have higher blood sugar levels than what’s considered normal (read THIS if you are consuming mass amounts of sugar and starch, but have ‘normal’ blood sugar).  Furthermore, the best way to attack this problem is a Low Carb diet (my favorite is PALEO but the KETOGENIC DIET has gained steam in recent years).  If you want to understand why this is true, take a moment to understand INSULIN RESISTANCE. 

• “During the epidemics of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrate”.  What have we been told by our own government for the past generation?  Besides being told that RED MEAT, SALT, BUTTER, were bad for you, we were told that HIGH FAT DIETS are the real killers, and to avoid dietary fat like the plague.  If you think I am over-exaggerating, take a moment to go back and look at the older Heart Association or Diabetes Association diets.  They were basically a low fat / no fat, carbohydrate free-for-all (I have an old handout from them saying that fat-free saltine crackers make a good snack for diabetics).  By the way, this bullet point would be equally true if with substituted the word “cancer” for obesity and type 2 diabetes (HERE).

 

• “The benefits of dietary carbohydrate restriction do not require weight loss”.  In other words, you don’t have to LOSE WEIGHT to see the benefits of a Carbohydrate-Restricted Diet.  However, listen to what the authors say (this is actually their fourth point).  “Benefits do not require weight loss although nothing is better for weight reduction.”  In other words, if you go on a Low Carb diet, you will almost not be able to help but lose weight (*disclaimer at bottom of page).

 

• “Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good as adherence to any other dietary interventions and is frequently significantly better.”   There are all sorts of diets that will, over the short term, help you get to where you want to be.  However, there is nothing better than Low Carb for the long haul — that includes our government’s questionable DASH DIET.

 

• “Replacement of carbohydrate with protein is generally beneficial.”  If you want to understand why, read one of the books that started it all for me, PROTEIN POWER. This is particularly true for those of you who realize you have a SUGAR / STARCH ADDICTION.  The truth is, Dr. Atkins really was way ahead of his time (HERE).

 

• “Dietary total and saturated fat do not correlate with risk of CVD (Cardiovascular Disease).”  Wow, it seems I have heard this one before (HERE).  Do not ever let people fool you into thinking that the best way of eating involves giving up animals or animal fats (HERE or HERE).  Their next point (“Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids (fats)”) goes right along with this.  In other words, blood fats and CHOLESTEROL are regulated far more by the sugars and starches you consume than by eating red meat.  This is not tough to grasp once you realize that farmers fatten their beef not by feeding them saturated fat, but by feeding them GRAIN — often sweetened with sugar or molasses. 

 

• “The best predictor of microvascular and, to a lesser extent, macro-vascular complications in patients with type 2 diabetes, is glycemic control (HbA1c).”   America’s physicians have put untold millions of patients on STATIN DRUGS because they had blood lipid profiles that were not normal (see previous point).  However, it’s the A1c test above that is truly best.  Although a fasting blood sugar gives us an idea of the situation, the A1c test is better because it tells us what has been going on with blood sugar over the past several months, as opposed to what it is doing at this particular moment in time.

 

• “Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum triglycerides and increasing high-density lipoprotein (HDL).”  We’ve mentioned that Statin Drugs are a dangerous bust.  So what’s a person to do?  According to this statement, Low Carb diets are the best thing going for both lowering blood fat levels and getting your Cholesterol levels in order.  And when you EAT THIS WAY you never ever have to be hungry again!

 

• “Patients with type 2 diabetes on carbohydrate-restricted diets reduce and frequently eliminate medication. People with type 1 usually require lower insulin.”    Getting your body’s physiology regulated to the point where you can get off drugs is good — it’s a state of being known as “HOMEOSTASIS“.  Any doctor who tells you otherwise is lying to you.  Just remember that even though drugs can sometimes cover symptoms, they never change underlying physiology.  The truth is that drugs kill, whether pushed OR PRESCRIBED. The last point sort of follows this train of thought.  “Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment”.  In other words, don’t let anyone scare you into not doing a Low Carb diet because it’s ‘dangerous’.  Nothing is safer.  Regulate your blood sugar and control your health!  In fact, it’s so safe you don’t need a doctor’s orders to get started (HERE).

Understand that first and foremost, diabetes is not so much as blood sugar problem as it is an “inflammation” problem.  Some of you may have to hunt for the hidden source of your INFLAMMATION, while for many of you it’s right in front of your face (HERE).  For those of you, however, who are not losing weight or regaining normal blood sugar values after going Low Carb, you need to look to other sources of Inflammation besides blood sugar.  After all, it is important to remember that Diabetes is not simply a blood sugar problem, but first and foremost an INFLAMMATORY PROBLEM.  To see what sort of things have the potential to drive inflammatory processes in your life, take a peek at THIS POST.