Cure and prevent diabetes mellitus with diet, not drugs

Part 3: Conventional Treatment mens a progression to ill health

Introduction

Conventionally, as diabetics are more at risk of heart disease and other cardiovascular complications, they are advised to eat 'healthily' and treated with a diet based on carbohydrates — bread, pasta, cereals and "five portions of fruit and vegetables a day". They are also told to cut down their fat intake.

Conventional wisdom also says that 80% of Type-2 Diabetes is associated with obesity which in turn is said to be directly related to the increasing weight and decreasing physical activity of the population. It is believed by DiabetesUK that their low-fat, carbohydrate-based diet will help diabetics lose weight as this has enormous benefits.

So let us look at what a newly diagnosed diabetic patient can expect from following the advice of DiabetesUK and the American Diabetic Association.

Conventional Risk Factors for Type-2 are:

Increasing age
Physical inactivity
Greater obesity
Longer duration of obesity
Unfavourable body fat distribution
hyperinsulinaemia

(Note hyperinsulinaemia for later)

There is little we can do about the first 'risk factor' as the alternative to getting older is dying young. Most of the rest are concerned with overweight.

Aim of Diabetes Treatment

It is the complications brought on by diabetes that are the real problem. Most of these involve the cardiovascular system through the glycosylation of haemoglobin (the coating of haemoglobin in the blood with sugar). Diabetics know this as HbA1c — it is not a desirable condition and the lower its measurement the better.

As most diabetic complications concern the cardiovascular system, the aim is to:

Control hyperlipidaemia
Control hyperglycaemia
Control 'risk factors' to prevent diabetes

Lose weight — lose diabetes

If you are overweight, and most diabetics are, weight loss is normally the first concern for, if maintained, the potential benefits of weight loss are remarkable. ⁽¹⁾ A weight loss of 10 kg:

Reduces HbA1c more than Metformin (the most commonly used anti-glycaemic drug)
Reduces diabetes-related deaths
Improves blood lipids, without drugs
Improves blood pressure, without drugs

Conventional Method

In the last century, diabetics were treated with a high-fat, low- or no-carbohydrate diet. But that regime was revised when 'healthy eating' was introduced by the COMA report of 1984.

Diabetics are more likely to suffer from ischaemic heart disease than people without diabetes. Under these circumstances, it seemed unwise to continue the high-fat recommendations. And so DiabetesUK recommends a 'healthy' diet based largely on carbohydrates and low in fat.

Conventional Advice — American Diabetic Association

For most people with diabetes, diet control is the key to managing this complicated disease. It is also extremely difficult. The current state of the diabetic diet is in flux, and at this time, there is no single diet that meets all the needs of everyone with diabetes. There are some constants, however. All people with diabetes should aim for healthy lipid (cholesterol and triglyceride) levels and control of blood pressure. People with type 1 diabetes and type 2 diabetics on insulin or oral medication must focus on controlling blood glucose levels by coordinating calorie intake with medication or insulin administration, exercise, and other variables. Adequate calories must be maintained for normal growth in children, for increased needs during pregnancy, and after illness. For overweight type 2 diabetics who are not taking medication, both weight loss and blood sugar control are important. A reasonable weight is usually defined as what is achievable and sustainable, rather than one that is culturally defined as desirable or ideal. And the general rules for healthy eating apply to everyone: limit fats (particularly saturated fats and trans-fatty acids), protein, and cholesterol, and consume plenty of fiber and fresh vegetables. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs.

Conventional Advice — DiabetesUK:

In a similar way, DiabetesUK say:

"The healthy diet for people with diabetes is the healthy diet recommended for everyone."
"Foods can be divided into five main groups. In order for us to enjoy a balanced diet we need to eat foods from these groups."

And like the American Diabetic association they lay things out in groups — this time on a plate (left)

But note that in both these two pictures the foods recommended to form the basis of all meals are predominantly carbohydrates — starches and sugars in the form or bread, pasta, breakfast cereals, rice, fruit and vegetables.

These between them fill two-thirds of the plate. At the bottom, in the smallest section we have fats and sugars — although fruit is mainly sugar and, thus should, presumably be there as well. As we will see in Part 4, I believe that this is really nonsensical.

Glucose tolerance test To test for diabetes, patients are often given a glucose tolerance test. In this test, they drink a quantity of glucose and then their blood glucose is checked to see:

How high it rises and
How long it takes for their blood glucose to return to a normal level.

At the right you can see a typical glucose tolerance test for a healthy person.

Note that a similar tolerance test using fat does not raise blood glucose

The effect on insulin

If we look at the effects of the two tolerance tests on blood insulin, we see a similar pattern. Because high levels of glucose in the blood are harmful, this rapid release into the bloodstream causes the pancreas to dump a large amount of insulin into the bloodstream to bring that level down. As you can see, insulin is produced very quickly — but it stays high much longer than necessary. This means that when the blood glucose is down to a normal level, after about 80 minutes, insulin is still near its highest point.

The consequence of this is that blood glucose is driven abnormally low, you become hypoglycaemic, soon feel hungry, and so need to snack. In this way, you eat more than your body needs, while the excess is stored out of the way as fat.

And, just as fat doesn't raise blood glucose, it also doesn't raise insulin. This is why fats are so much healthier than carbs for a diabetic.

Are carb meals yo-yo tolerance tests?

But 100g of glucose is not dissimilar to the amount of carbohydrate — starches and sugars — that would be consumed in a 'healthy' meal. And their effect on blood glucose levels would be similar to that of the glucose tolerance test.

This means that every time you have a 'healthy' meal of pasta, and fruit, with mid-morning and mid-afternoon snacks of biscuits and/or sweets, your blood glucose level will be continually rising and then brought down again by your body's insulin — a form of yo-yo dieting by the hour, with your pancreas working overtime. What actually happens is that Carbohydrate Meals:

Raise blood glucose levels.
This in turn elevates levels of insulin on the blood
That insulin takes excess energy (glucose) out of bloodstream.
And that energy stored as fat.
THE RESULT is: weight gain!
But insulin also inhibits use of energy from fat cells.
THE RESULT IS: no weight loss!

But, of course, weight loss is one of the major aims of the exercise.

And it gets worse:

Consequences of High Insulin Demand

As the pancreas is continulally being called uponn to produce large amounts of insulin, the following sequence of events takes place:

Body demands for more insulin to reduce excessive blood glucose increase,
Beta cells in the pancreas up-regulate or increase in size or capacity to meet that demand.
Continual carb meals and insulin production leads to hypersensitivity.
This leads to an exaggerated insulin response to even small carbohydrate loads. The flatter curve in the graph on the left demopnstrates that for the same stimulus far more insulin is produced.
Hyperinsulinaemia (high levels of insulin in the bloodstream) leads to insulin resistance in fat and muscle cells.
This increases glucose intolerance and insulin resistance.
The pancreas has to produce even more insulin to be effective
Until eventually, the pancreas is no longer able to cope and it gives up.

A senior NHS diabetic dietician, who must remain anonymous for obvious reasons, admitted that she had NEVER seen ANYONE with type 2 diabetes able to control blood sugar on the standard high carb diet!

So Bring on the Drugs!

As dietary control fails, drugs are employed to reduce glucose levels.

There are basically four classes of drug used to reduce levels of glucose in the blood:

1. Alpha-glucosidase inhibitors — retard glucose uptake from the intestines (Acarbose)

2. Biguanides — augment muscular uptake of glucose (Metformin)

3. Sulphonylureas — stimulate insulin production by pancreas (Glimepiride)

4. Prandial glucose regulators — stimulate insulin release from pancreas

The first class of drugs slow down the rate at which glucose enters the bloodstream and the second takes it out of the bloodstream for storage in the muscles as glycogen. But the body can only store so much glycogen. So other drugs (3 and 4) are used to increase the amount of insulin in the blood. This increases the removal of glucose but, as it does so by storing the excess glucose as fat, this results in weight gain — the exact opposite of what doctors are trying to achieve.

Polypharmacy May Be Unavoidable

And weight gain is not the only problem. Because of the increased risk that diabetics have of complications, polypharmacy, (the use of many drugs together) is a real concern. A paper published in the British Medical Journal pointed out that: ⁽²⁾

Given the cardiovascular risk profile of type 2 diabetes, up to 10% of patients could require:

Two or three hypoglycaemic agents (ultimately including insulin),
At least three antihypertensive agents,
Two hypolipidaemic agents,
And aspirin.
"A high proportion will also require treatment for coexistent cardiovascular disease and coincidental unrelated chronic disease."

"It is difficult to see how we can realistically expect patients to comply for long with such a draconian regimen requiring so many separate drugs."

ID-NIDDM?

Polypharmacy is only part of the deterioration in quality of life a diabetic on conventional treatment can expect.

As conventional low-fat diets and drugs fail and glycaemic control deteriorates, eventually insulin is prescribed. Over time, therefore, some non-insulin dependent diabetics end up requiring insulin injections. So they are now insulin dependent, non-insulin dependent, diabetics! This elevates insulin levels in the blood even further — it's a condition called hyperinsulinaemia. And it is not a healthy progression as it increases the risk of even more serious disease.

And remember that hyperinsulinaemia is also a risk factor for diabetes!!

The complications of Insulin

Firstly, insulin puts on weight. Its purpose is to take energy out of the bloodstream and store it as fat — the very thing that conventional treatment is aimed at stopping. For this reason:

Insulin is the most fattening hormone.
Diabetics who have to inject insulin find it almost impossible to lose weight.

But weight gain is not the only complication of insulin use, as insulin:

Increases risk of thrombosis
Increases plaque formation
Prevents plaque regression
Stimulates connective tissue synthesis
Stimulates IGF-1 ⁽³⁾

Insulin elevates blood pressure by:

Kidney Na+ retention
Enhancing flow of Na+ and Ca++ to vascular smooth muscle cell
Fasting and postprandial insulin levels have significant positive associations with systolic and diastolic BP ⁽⁴⁾

Hyperinsulinaemia (high blood insulin level) is also known to be involved in:

Polycystic ovarian syndrome (PCOS)
Prostate cancer,
Endometrial cancer,
breast cancer.

And it is suspected in relation to:

Gestational hypertension
Preeclampsia
and Osteoporosis ⁽⁵⁾

Insulin increases heart disease risk

The most important complication of diabetes is the large increase in risk of a heart attack.

A recent study of subjects in Framingham, Massachusetts demonstrated that a blood clot is much more likely to occur if insulin levels are increased. This effect was present in individuals who did not have diabetes, but was more profound in individuals who did have diabetes. ⁽⁶⁾

Blood clots (thromboses) are a recognised cause of heart attacks, strokes, blockages in other arteries and deep vein thrombosis.

Insulin increases cancer risk

Breast cancer patients with high levels of insulin in their blood seem to be more likely to die of their disease. Researchers found that insulin may predict whether a woman's breast cancer recurs after therapy and whether she will die.

In a study of 535 breast cancer patients followed for up to 10 years, those with the highest insulin levels were more than eight times more likely to die and were almost four times as likely to have their cancer recur at a distant site. ^⁽⁷⁾

Although many of the women in the study were obese, and obesity is known to affect both breast cancer prognosis and insulin levels, obesity alone did not completely explain the link between insulin and poorer cancer survival. Insulin normally helps promote cell growth. Researchers hypothesize that in the breast, insulin can spur the growth of both normal and cancerous cells.

The insulin/cancer risk found confirmation in another study conducted at the Samuel Lunenfeld Research Institute, Mount Sinai Hospital. This study demonstrated that patients with the highest levels of insulin in their blood were twice as likely to have their cancer spread and more than three times as likely to die of the cancer compared to patients with low levels of insulin in their blood. ^⁽⁸⁾

Recap on Conventional Approach

Major aims are:

Weight loss.
Control of cardiac risk factors.

BUT:

The conventional high-carb, low-fat diet results in hyperglycaemia.
Hyperglycaemia causes hyperinsulinaemia.
Excess energy is stored as body fat.
Weight gain is the norm and cardiac risks are increased.

Thus conventional treatment for diabetes, using a diet based on breads, pasta and fruit is likely to do the exact opposite of what is aimed for — and make the condition worse. Why that happens is explained in detail in Part 4: Why carbs are the wrong foods for diabetics

References

1. Jung RT. Obesity as a disease. Br Med Bull 1997; 53: 307-21.
2. Winocour PH. Effective diabetes care: a need for realistic targets. BMJ 2002;324:1577-1580
3. DeFronzo RA, Eleuterio F. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-91. and Meigs JB, Mieeleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglyceima, and impaired hemostasis. The Framingham offspring study. JAMA 2000;283:221-229.
4. DeFronzo RA, Eleuterio F. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-91.
5. Bachman JM The low-carbohydrate diet in primary care ob/gyn. Prim Care Update Ob/Gyn. 2001; 8: 12-17
6. Meigs JB, Mieeleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglyceima, and impaired hemostasis. The Framingham offspring study. JAMA 2000; 283: 221-229.
7. Annual meeting of American Society of Clinical Oncology, New Orleans, 23 May 2000
8. Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2002; 20: 42-51

Introduction
Part 1: The scale of the problem
Part 2: What is diabetes -- Are you at risk?
Part 3: Conventional treatment for Type-2 diabetes — and why it fails
Part 4: Why carbs are the wrong foods for diabetics
Part 5: The evidence
Part 6: The correct diet for a Type-2 diabetic, (or treatment without drugs)
Part 7: Treatment for Type-1 diabetes
Suitable foods for diabetics

Last updated 6 February 2008

another website, Diabetes Diet spells out in easy to read terms just what causes diabetes and how best to treat diabetes.

"One must attend in medical practice not primarily to plausible theories but to experience combined with reason." Hippocrates

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