Myths about Diabetes
washingtonpost.com
washingtonpost.com
* My diabetes controlling diet is high in fat. I have found that without the presence of carbs, fat is the safest macronutrient in terms of keeping my blood glucose level down. I can eat fat and protein while barely budging my levels.
* Sweet desserts are not okay, not even once in a while. They make my blood glucose soar, and it can take days to get it back under control. I get some of my diabetes symptoms and carb cravings back within hours of indulging. This is not about sugar though, it's about all of the carbs I've tested, including fruit. Sugar seems to act just as a concentrated carb.
* Yes too many sweets can give you diabetes. I believe that's how I earned it, by indulging my sweet tooth for year after year.
It seemed like an extreme change for me to go low carb, but as a result I have a reasonable blood glucose level without any drugs. And the actual change was more joy than slog. I now love this way of eating and don't (much) miss the high carb foods. I'm afraid this myth buster needs some of her myths busted.
I found this very interesting I just haven't seen or heard anyone trying it
https://www.bbc.com/news/health-42154666 https://www.bbc.com/news/health-47456418
Someone just reading your comment here might not realize that the article has a reasonably nuanced discussion of this.
The paragrpah in question is:
The story for Type 2 diabetes is a bit more complicated. Obesity and inactivity play huge roles in the risk for the disease, but genetics are also a factor, even more so than for Type 1. "
If you go to the link she references, theres a lot of statistics about gentic factors on Type 1, but very little in Type 2.
Type 1 has:
"If you are a man with type 1 diabetes, the odds of your child developing diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child was born before you were 25, your child's risk is 1 in 25; if your child was born after you turned 25, your child's risk is 1 in 100.
Your child's risk is doubled if you developed diabetes before age 11. If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.
There is an exception to these numbers. About 1 in every 7 people with type 1 diabetes has a condition called type 2 polyglandular autoimmune syndrome. In addition to having diabetes, these people also have thyroid disease and a poorly working adrenal gland. Some also have other immune system disorders. If you have this syndrome, your child's risk of getting the syndrome—including type 1 diabetes—is 1 in 2."
And Type 2 has:
"Type 2 diabetes runs in families. In part, this tendency is due to children learning bad habits—eating a poor diet, not exercising—from their parents. But there is also a genetic basis."
It seems that Type 1 genetic factors are much more understood, and there is a correlation in Type 2.
So insulin is a necessary component of treatment for Type 1, whereas the first line treatments for Type 2 improve cellular response to naturally produced insulin.
I don't see anything you've written than contradicts the article author?
If you don't take insulin before a dessert, then of-course it will take days to get your sugars back to normal. That's a reason to take insulin if you can/want, not necessarily a reason to avoid sugars.
The author doesn't assert that too many sweets give you diabetes. Only that there are a complex set of factors, among which are sweets. The myth here is that it's as simple as "too many sweets give you diabetes".
There is an enormous range of experiences covered by diabetes 1 and 2. It's no surprise that general myth busting doesn't tally exactly with N=1 individuals, especially someone who has made such an extreme change to their diet to manage their sugars.
Here were some A1c numbers about 15 years in, at which point I was on four different diabetes pills and most of those at fairly high doses:
2014-12-12 7.8
2015-03-13 8.9
2015-06-18 8.2
2015-09-18 8.1
2015-12-16 5.9
2016-03-11 5.5
2016-06-06 5.3
2016-09-07 5.2
2016-12-08 5.0
2017-03-03 5.1
2017-06-12 5.0
2017-09-08 4.8
2018-03-13 5.0
My "low carb" was simply to try to keep carbs below 40% of calories. Astronomically high compared to your goal, but quite a bit lower than the average American diet.
For 2016, I ended up averaging 2200 calories a day, which came from 185 g carbs (34%) and 126 g proteins (23%).
2017 was 33% carbs, 25% proteins. 2018 was 36%/23% carbs/proteins.
I'd recommend that people eat what the normally do for a while before making a diet change and keep a record of everything eaten. Look up the nutritional information on it all, and figure out what percent of calories are from carbs.
If like many people that is 60% or more, I'd recommend trying a cut to 40% first before trying a cut to something very low. 40% should be a lot easier for most people to actually stick with.
40% can reasonably be reached without cutting out whole categories of food. Even if you mostly eat at fast food places, 40% can be achieved at those places reasonably. 40% is also easy to check on the nutritional information: take calories, divide by 10, and cast that result to grams. If the number of carbs is above that, more than 40% of calories are from carbs.
A lot of this article is just playing "gotcha", where she's pointing out technically a lot of cultural glosses about diabetes only applies to type-2 diabetes. However type 2 diabetes occurs at a rate >10x as much as type 1 diabetes [1], and it's the type that is more preventable by behavior and diet change.
Statements close to the "myths" she's debunking is approximately true, while her "technical facts" if not handled with care will lead to far worse wrong beliefs.
Approximate myth that we want: "Generally, diabetes is strongly related to high BMI and bad diet which often includes diets high in sugar". Technical truth that muddies the conversation: "Actually the above relationship excludes T1D, which is a vast minority of diabetes."
Approximate myth we want: "Many diabetes is preventable by eating well." Technical truth that muddies the conversation: "Actually some T1D is adult onset 2-3%, so you may not be able to prevent those!"
Approximate myth we want: "Bargain hunting for medications when medically equivalent is good, especially generics." Technical truth: "Actually there are medical differences between different insulin formulations, because unlike small-molecule drugs, different formulations are not biologically equivalent. Some expensive modern formulations are good."
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A doctor with knowledge about public health and has good writing skills should reconsider writing an article like this. Why not go after real harmful myths like anti-vaxxers? Or how about rewording the article so that the myth is actually approximately bad, like "Bad diets are okay for diabetes as long as you avoid sugars".
I once had an obese friend of mine tell me I was going to give myself diabetes -- despite the fact that I'm not even remotely overweight -- because I regularly drank soda. To him, his diet was good, because he ate salad for lunch and snacked from the office fruit bowl, whereas my diet was bad, because I drank soda.
There are likely many people out there who believe that because they eat salad for lunch they're "eating well" and reducing their risk of diabetes, when actually they're putting themselves at risk by being overweight.
A salad is better for diabetes than almost any alternative, and does reduce risk all else equal.
My point is that an underweight person who consumes sugary beverages is at a lower risk than an obese person who eats salad for lunch, whereas the general public is likely to believe the opposite.
So you can get diabetes from an unhealthy diet, like a diet with too many sweets.
> Type 1 diabetes develops as a result of genetic risk and an unclear trigger; it’s not caused by eating sugar — or anything else... The story for Type 2 diabetes is a bit more complicated.
For example: A "healthy" serving of plain corn flakes with a serving of plain milk has lots of sugar in it. Foods can have low added sugar, or low some-kind-of sugar, and still lead to type 2 diabetes. Focusing on sugar will lead to the same health disaster that came from focusing on salt or fat.
The anti fat crusade was a marketing lie sponsored by sugar /corn syrup manufacturers.
No one's confused into thinking sugar is good, they just like eating junk food.
You eat food because you are hungry. Food doesn't not cause hunger.
I am not an endocrinologist, but the idea that habitual abuse of the body's insulin system causes a pathology in that system - at least in vulnerable individuals - is much more plausible than the idea that we're all getting diabetes from the water or something and that's why we're drinking soda and eating unhealthy foods.
If there is some plausible alternate theory, or some contradicting evidence I would be very interested to hear it.
This is all made worse because health science is heavily influenced by the same industries that profit enormously off of processed foods.
People don't eat boxes (but perhaps they should, because the actual danger in processed foods is removing fiber.)
Fruit juice is terrible but not heavily processed.
Sugar is not heavily processed.
Baking cakes and deep frying everything at home is not heavily processed.
If you then add refined sugar to your diet in a big way, you would likely start seeing symptoms, and might seek diagnosis and claim eating lots of candy caused diabetes, but it could have already been there.
My understanding is that there’s a pretty clear well-understood progression from obesity to pre-diabetes (which is measurable in terms of resting blood glucose, but usually not symptomatic) to diabetes. Insulin resistance is also reversible to some extent via dietary changes.
So I am having difficulty understanding how it could be that diabetes would proceed dietary changes in this scenario.
Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person.
If they changed their diet, and began to show symptoms of diabetes, and led to a diagnosis of type 2 diabetes, would you say the change in diet caused the disease?
If glucose tolerance tests were regularly administered to (apparently) healthy people, we could have some data or anecdotes about people having good insulin response, then changing their diet and no longer having good insulin response as 'eating too much candy gives you diabetes' suggests.
I 100% agree that there's a correlation between obesity, increased carbohydrate content in diets, and increased diagnosis of insulin resistance. I'm just not convinced that there's a correlation between those things and insulin resistance. I suspect that without the increased carbohydrates, many people would have asymptomatic insulin resistance and go undiagnosed -- after all, dietary changes are a preferred treatment once insulin resistance is diagnosed.
> Their blood sugar (fasting or otherwise) would most likely look fine, and you wouldn't subject them to a glucose tolerance test, because it's unpleasant to drink the glucose solution, and you have to sit in the lab for two hours before the second blood sugar test --- you wouldn't do that for an apparently healthy person.
Why do you think this test is never performed on apparently healthy individuals? Do you think they never established a baseline for these tests using a large number of healthy individuals?
> These findings suggest that the vast majority of Pima Indians susceptible to diabetes were already developing the disease in the early years of the study, and the increasing obesity in youth combined with a nearly 4-fold increase in the frequency of exposure to diabetes in utero [7] simply shifted the onset of diabetes to younger ages in the most susceptible individuals [6].
This wording suggest to me that while diet (and changes in diet), can change the onset of diagnosis, it does not cause the disease, it's a trigger for the disease in people that are susceptible.
This is a big difference in my mind, because it can change blanket advice of 'don't eat too much candy or you'll get diabetes', into 'if you're susceptible to (type 2) diabetes, don't eat too much candy or you'll show symptoms of diabetes'. The first option undermines trust in the advice giver, because there are many examples of people who eat too much candy and don't get diabetes; the second example isn't super actionable, because it's hard to know if you're susceptible, but a history of diagnosis in your family or other genetic grouping is a sign.
This is the same with the blanket war on obesity as a health risk. A large portion of the comorbidity with obesity comes from type 2 diabetes; but the distributed health advice is that all persons with obesity have higher risks, despite evidence that persons with obesity but not type 2 diabetes have pretty similar risks to those without both obesity and type 2 diabetes.
Metabolic syndrome is definitely multifactorial and causation is difficult to establish. Not saying you're wrong, but nobody has ruled out its causes.
Long to short, yes food can (indirectly) cause hunger.
A quit google, shows that ~40% of americans are obese, and around 9% of americans have type 2 diabetes. If eating poorly lead to diabetes (and didnt just expose the symptoms) then those numbers would be much closer.
I don't think this is really a useful distinction. If you eat a lot of sugar and "get diabetes", i.e. it becomes clinically significant, then it would be just as correct to blame your sugar intake as to blame your genetics.
It's quite known that sugar intake is strongly correlated with diabetes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584048/
People with type 2 diabetes, genetically, have trouble removing glucose from cells, this is a fact, eating too much sugar, means that the cells become full sooner, and the body shows that it can't deal with it.
The "per se" makes it plenty clear (to me at least) that their point is that sugar does not DIRECTLY cause diabetes.
What this means is that you can't authoritatively state that sugar is the cause of diabetes. It does not mean that sugar has been proven to not be the cause.
type 2 diabetes - cells that hold glucose are resistant to insulin produced by the body.
As in, Sugar almost certainly doesn't cause type 2 diabetes but causes the symptoms to surface because of the inability to remove the excess glucose from the cells.
Epistemologist2: As a physician myself, with Type I diabetes for the past 56 years, I have lived through quite a lot of change in the management of my diabetes. I am particularly concerned about the discussion in Myth #2. The inexpensive insulin, U-100 Regular Insulin, is readily available and it is just as potent, unit for unit, as the newer synthetic insulins. What is different is the rate of onset of action. Regular Insulin does not "turn on" as quickly as the others, but if taken in advance of a meal will do the job sufficiently well that you can maintain reasonable blood sugars. The over-riding intent with insulin therapy is to mimic natural insulin production/action in one's body. The expensive modified insulins become active much faster and consequently will more closely mimic natural insulin release, but it is critical to note that once injected, those insulins do not turn off as promptly as naturally produced insulin from the pancreas, and this can be a serious problem!
In my case, I had had my diabetes for about twenty years and was adequately controlled using those "old" insulin products extracted from beef and pork pancreas after which we got the now inexpensive Human Insulin, chemically identical to that from the human pancreas, and it did not "turn on" any faster than the predecessor products. It was not until 1996, 33 years into my own diabetes, that we saw the introduction of a synthetic insulin with much faster onset of action.
Bottom line is that the price of the fancy new insulins should not be such a barrier that it leads to one's death. The inexpensive older products work, just like you old "dumb" phone works to do its basic job. Newer is better, but not critical, and neither doctors nor patients should forget that using older techniques and products is a viable option. It is the doctor's failure to think outside the box to adequately educate the patient that causes death.
Insulin-N (NPH, neutral protamine Hagedorn insulin) and protamine zinc insulin (PZI) are the first generation crystalline insulins. They have longer lasting (baseline) effects as well as peaking effects that allow them to be given easily on schedule based on the sizes of meals.
There’s a variety of modern insulins now, which are substituted with different amino acids to give them different effects. Insulin glargine and insulin detemir are the most popular. They are supposed to have blunted peaks and are given at regular intervals such as every 24 hours. They mimic the baseline insulin secretion.
Insulin pumps are also available that monitor blood sugar and secrete insulin to keep it controlled. There are also experimental “artificial pancreases” that will also secrete glucagon.
Another comment mentions that cheap insulin can be just as good. This is true but it requires a careful lifestyle. Messing up is more common and if you’re on your own you may be unable to help yourself, e.g. comatose.
Currently, insulin-N and -R are cheap. Detemir and glargine are constantly going up in price despite the existence of multiple suppliers of glargine. (This sort of implicit agreement without actual price fixing is common in the pharmaceutical industry). Essentially, the competitor is a small fraction cheaper, can take some of the market, but most people will continue writing and filling scripts for the incumbent because it’s what they know, on the formulary, etc.
I’m not sure of the use of PZI in human medicine. It’s popular in my patients, as is glargine.
When I was diagnosed with t1d at the age of 24, I can't count on 1 hand how many people told me that I can "reverse" it by (going low carb/eating gluten free/eating cinnamon). I know we are talking about type 2 diabetes in this case, but
Do you "cure/reverse" bradycardia and heart block by getting a pace maker? no you treat it.
By your definition you cure/reverse any condition by taking a medicine/getting a treatment for the rest of your life.
Also...Clinically, most people who can treat type 2 diabetes with diet when they are younger, still have to go on some sort of medication (metformin) when they get older, even if their diet stays clean.
Virta Health has had some excellent success in reversing Type 2 with carbohydrate restriction.
https://blog.virtahealth.com/with-sustained-type-2-diabetes-...
The following article describes research for substances that appear to protect pancreatic beta cells. It mentions that one of the substances, adipsin, is correlated with subcutaneous fat.
https://news.cornell.edu/stories/2019/11/protein-finding-cou...
Likely, many people with T2D have excess fat regardless of where it's distributed in the body, but in places like Japan, which is claimed to have a 10% rate of T2D despite an obesity rate of 3% (probably more relevant if measured as subcutaneous fat, i'm not really sure how they measured it), it could make for interesting speculations for some of the mechanisms leading to development of T2D.
1. Only kids get type 1 diabetes
2. Wal-mart insulin is just as good as expensive insulin
3. Eating sugar gives you diabetes
4. You can't eat sweet foods if you have diabetes.
5. You can treat type 1 diabetes without insulin.
That column in the post is very size constrained and has a very specific format- I would have loved to expand on some areas. Second- this is really written to educate those without diabetes about the disease. A lot of the subtext, which was more explicit but edited out, is that everyone’s diabetes is different. People with diabetes get a lot of blame and unsolicited advice, but each person has their own way of managing their disease and we should accept that.
Maricopa County Jail did a A1C test on him on intake, and decided this passenger needed a daily time-release insulin injection. If he tried to refuse the injection, he would be sent to solitary confinement.
When combined with the jail's starvation diet, this forced use of insulin is a form of torture: I understand insulin without carbohydrates -> low blood sugar -> cortisol release -> muscle wasting. When he got out he told me he'd developed an intestinal blockage that required surgery.
When he was locked up again 2 years ago (on account of missing a drug court hearing, 2.5 years before), I took pity on him and deposited some funds on his jail account so he could buy snacks to sort of keep himself out of stress-induced deterioration. I have a postcard that said it was incredibly helpful knowing someone on the outside cared about him. He supposedly sent me three postcards, but I only got one.
"Do the most expensive thing possible" seems to be the guiding philosophy for the American approach to Medicine. The doctors quoted in my recent submission [1] pointed out that they can do expensive things for their patients, but have no ability to provide what their patients actually need.
My step-sister's husband is a type 1 diabetic. I just learned he had a bad case of the chicken pox just before he was diagnosed as a 3 year old child. A friend's 2 year old daughter became a type 1 diabetic soon after her first weekend at her biological father's house -- this was the first interaction with her birth father; I'm sure the kid was like "who the hell are you and where is my mother????".
I bet in 20 years the new myth of Diabetes will be that it's a chronic condition that can only be treated palliatively. "Stress" seems to be the cause behind the symptoms of diabetes. If doctors treated stress instead of the end result of stress (pancreas dysfunction / insulin resistance -> high blood sugar levels), people would certainly have much better outcomes.
How would doctors treat stress?
Bodies can recover if they're given a chance.