Does the present approach of the medical fraternity to diabetes make patients fatter and sicker? Investigative reporter and medical scientist, Dr Maryanne Demasi, looks at the latest evidence.
It is ‘World Diabetes’ day and the rise in rates of diabetes is showing no signs of arrest. Globally, over half a billion people will have diabetes by 2035. With each worsening projection of diabetes rates, come calls for urgent action, but little changes.
Type-2 diabetes (distinct from autoimmune type-1) makes up the vast majority of cases (~90 per cent) and is predominantly linked to bad lifestyle choices. The complications range from eye and kidney disease, amputations and death.
In Australia, diabetes educators tell their patients that the condition is “chronic and progressive” and requires lifelong management. But there is increasing evidence that this advice is misguided. Many experts now believe that type-2 diabetes can be reversed and that the current dietary advice to patients is actually making their condition worse.
The problem is two-fold.
Problem 1 – the treatment
Type-2 diabetes is characterized by high blood glucose levels. The body tries to restore glucose levels to normal by releasing the hormone ‘insulin’. But over time, the action of insulin becomes ineffective (known as insulin resistance). The treatment is usually to inject more insulin.
And herein lies the problem. The more insulin that gets pumped into the body, the higher the risk of becoming ‘desensitized’ to its effects. Once blood glucose levels begin to creep up, doctors respond by prescribing more insulin.
Insulin not only manages blood glucose levels, it is a ‘fat storing’ hormone. Therefore, the more insulin you inject, the more weight you’re likely to gain and the more insulin resistant you become. The treatment (injecting insulin) ultimately exacerbates the problem (weight gain and insulin resistance).
Problem 2 – the dietary advice
The dietary advice for people with Type-2 diabetes is to follow the Australian Dietary Guidelines, i.e. to eat a low fat diet based on carbohydrate rich (starchy) foods.
But carbohydrates are problematic because they are broken down to glucose in the body and dramatically influence blood sugar levels.
Diabetes educators even encourage ‘between-meal snacks’ of bread, cereal, frozen fruit juice and scones with jam (all glucose rich foods which escalate insulin demand).
This will only exacerbate the disease. Someone with type-2 diabetes cannot tolerate this amount of carbohydrate (they are carbohydrate intolerant). It is akin to telling someone with lactose intolerance to drink lots of milk, containing lactose.
Instead of telling patients to restrict their carbohydrate intake, patients are told to medicate themselves with a bolus of insulin. This takes you back to problem 1 – excess insulin promotes weight gain and insulin resistance – and the vicious cycle continues.
The safest and simplest way to break the cycle and lower the demand for insulin is to eat a low carbohydrate diet. Put simply, restricting carbohydrates is removing the major contributor to high glucose levels and insulin resistance.
The solution is so evidently simple, yet scientists have been resistant to accept it.
The evidence for restricting carbohydrates
Restricting dietary carbohydrates (a low carb diet) was actually used to treat diabetes in the early 20th century. However, it fell out of favour once insulin (injectable hormone) was developed in 1922.
US researchers at the Lifestyle Medicine Clinic at Duke University Medical Center have been using the low carb diet for over ten years. The clinic reports that diabetes medications were discontinued or reduced in most participants involved in a low carb dietary intervention trial.
A critical review of the literature suggested that low-carb diets should be the first treatment option in diabetes because of the consistently good control of blood glucose and the reduction, or elimination, of diabetes medication.
Similarly, Dr Osama Hamdy, Medical Direct at the world famous Joslin Diabetes Center, has strongly urged for a nutrition revolution. “This [carbohydrate] era should come to an end if we seriously want to reduce the obesity and diabetes epidemics. Unfortunately, many physicians and dietitians across the nation are still recommending high carbohydrates intake for patients with diabetes, a recommendation that may harm their patients more than benefit them”, writes Dr Hamdy in a recent publication.
In recent years, the low carbohydrate has been criticised as a ‘fad’ by defiant health experts who vigorously defend the ‘status quo’ and current dietary guidelines.
This has raised concerns about the independence of health authorities and scientific research. For example, ‘Coke’ bought the loyalty of influential scientists in order to deflect criticism about the role sugary drinks have played in the spread of obesity and Type 2 diabetes.
Patients are often told by diabetes educators to eat high-carbohydrate foods and then manage the influx of glucose with medications. The manufacturers of these medications are the corporate sponsors of these advisory bodies.
The way forward
The dramatic rise in rates of type-2 diabetes within a generation cannot be explained by changes in genetics, but most likely a change in the food environment. Recent data shows more than 100 million U.S. adults are now living with diabetes or pre-diabetes, a large proportion of them are undiagnosed.
It is baffling that, in the face of overwhelming evidence, diabetes educators continue to give people advice that is making them fatter and sicker.
The current approach to treating type-2 diabetes has been a huge disappointment and has achieved vanishing low remission rates. Recently, the US National Academies of Science, Engineering and Medicine (NASEM), reported that the current dietary guidelines are ‘flawed’ and lack scientific rigour.
In Canada, over 700 physicians and allied health professionals have written an open letter to Health Canada, calling for radical change to the nutritional food guidelines.
The low carbohydrate diet should be a legitimate therapy for the treatment of type-2 diabetes. Lets start the change today.
Dr Maryanne Demasi is an investigative medical reporter with a PhD in Rheumatology. Follow her on Twitter @Maryanne Demasi