Dissecting an MD’s Argument – Part II

Dean Jenkins – Enjoy the exchange too.1) I have not seen a Type 2 diabetic on treatment with oral meds and insulin who has managed to wean themselves off all medication with a vegan meal plan. If I do I will suggest they look you up. I have seen patients at an earlier stage of their disease come off oral medications because of calorie restriction (mostly through portion control) and a smaller number who have adopted a low-carb diet. All of these have lost a considerable amount of weight – perhaps 5 – 10 % body mass and they were, on the whole obese to start with – BMIs of 35+. I have known a small number of extraordinarily healthy and elderly Type 2 diabetics who have been stable on a small dose of oral medications for maybe 40 years. They were invariably thin and I wondered if they probably had MODY rather than Type 2 DIabetes. I, with many of my colleagues, have seen a number of patients with obesity and Type 2 diabetes who have managed to wean off all medication (in fact we stop them) when they have bariatric surgery.2) I’m afraid we’ll have to differ on this. I see plenty of patients who are either not willing or capable of maintaining a diet. In fact that is a big area of ongoing research – how best to give patients self-efficacy in changing their lifestyle. You may want to look at the Transtheoretical Model of behaviour change –http://en.wikipedia.org/wiki/Transtheoretical_model – people with diabetes are at different stages of change and they need different tactics for moving them along to successful change. Just telling them to do so or showing them the evidence doesn’t work since there are factors other than cognitive ones that are preventing them doing so.Also we’ll have to agree to differ on whether there is an industry conspiracy to feed people with diabetes high carbs plus medication for their diabetes. There may be a grain of truth in that (pardon the pun) but on the whole I don’t see it that way.3) We also differ on aiming for a ‘normal life’. The vast majority of people with diabetes that I meet would rather not have the disease and would just like to get on as normal. Whatever physicians can do to help them achieve that should be used. If a vegan diet and high exercise regime works for some then great but it won’t for everybody. For many they need to take medication. Think of those, for example, with other medical conditions such as bowel disorders, malignancy, arthritis, neuromuscular disorders, stroke etc. who are unable to significantly alter their diet or perhaps increase their amount of muscle mass through exercise.

Aug 7, 2011

Dean Jenkins – Oh the bariatric surgery patients I mentioned above are almost always on insulin treatment for their diabetes and this is stopped when they undergo surgery. However, they then have very particular and often complex nutritional needs after bariatric surgery so this is not a solution for everyone either.

Aug 7, 2011 (edited)

steve cooksey – 1) … so you finally admit you do not know a Type 2 Vegan who has weaned off drugs and insulin… see how easy that was? :)I REALLY DO want to speak to someone who has done it. I will gladly post their story on my blog and then I will try it.Just not convinced that the science of Increased Carbs = Increased Glucose = Increased Drugs & Insulin can be suspended simply by a reduction in animal products. Especially when I know those animal products have helped me wean off drugs and insulin.Re: Bariatric Surgery … I know, I’ve read studies showing that as well. The problem is … if you do not ‘fix’ the diet… the lifestyle… they will become obese again and Insulin Resistance will return. Must reduce carbs… as painful as that may be.2. Doctor … <sigh> … please read my words, I am capitalizing for emphasis, not anger…. I AGREE NOT MANY WILL CHANGE…. we differ on why and what to do about it.

Medical Industry says, “don’t tell them about LC Paleo since not everyone can do it.”

I say, “Tell them ALL about Low Carb Paleo FIRST. Choose treating the disease FIRST… if they can’t do LC Paleo, then … suggest a more moderate lowER carb plan designed to reduce carbs/grains over time.

The Drug first option with high carbs is unpardonable… it benefits only the Big Pharma, the Medical Industry and Big Food Companies…. it does NOT benefit the diabetic.

… your ‘reason’ for not telling them is … because not ALL can/will do it?

A) YOU are saying , “let’s keep this a secret since not everyone can do it’. You are harming the many because some won’t do it???

B) More would and could ‘stick to it’ if they were supported in their low carb quest … instead LC Paleo is ridiculed as are it’s adherents.

C) Not sticking to a ‘diet’ as a reason not to promote it??? ALMOST no one sticks to ANY diet… you know this… so let’s promote ‘no diet’ … eat what you want as long as you take enough insulin and drugs…. UGH!

3) We definitely disagree here.

Because of Low Carb Paleo … I am normal. I have normal blood sugar and I live a normal life.

My NORMAL… no drugs, no insulin… just living and THRIVING.

Your ‘normal’ is a lifetime of drug use, soaring high and crashing lows … and the resulting neuropathy is VERY COMMON… and you know this. You also know that loss of eyesight, loss of organ function and limbs is too common as well.

That’s not normal ‘human’ life… that is sadly the high carb diabetic life….

Think about this… ALL who go low carb paleo … reduce drugs and insulin… 100%.

All have better blood sugar control… especially for type 2’s the reduction is almost immediate. Obviously for T1’s there are many more variables.

Additional Resources

http://www.trackyourplaque.com/blog/ Authored by Dr. William Davis, a diabetic who’s a cardiologist…and yes he’s anti statins too.

http://drbganimalpharm.blogspot.com/ This lady is a Paleo, a CDE and a PhD in Pharmacology

Yesterday 6:56 AM (edited)  –  Edit

Dean Jenkins – Thanks for the links. The Animal Pharm blog especially is a very interesting debate.It all makes for an intriguing hypothesis but that is all the level of the science is. It is not 100%.To be certain you should perhaps randomly assign people with Type 2 diabetes to a high protein / low carb diet or a ‘standard’ high carb diet and see how they get on. To avoid bias make sure it is not funded by wheat or drug industry and ensure it is run by academics and your aims for the study are published in advance. Perhaps if the meat industry fund it then all the better.There was such a study that was reported this year (I included it in my #diabjc summaryhttp://storify.com/dean_jenkins/diabjc ) and it failed to show a benefit.Larsen RN, Mann NJ, Maclean E, Shaw JE. The effect of high-protein, low-carbohydrate diets in the treatment of type 2 diabetes: a 12 month randomised controlled trial. Diabetologia 2011 Apr;54(4):731-740. Available from:http://www.ncbi.nlm.nih.gov/pubmed/21246185Now, it maybe that the exact type of diet, or the way it was taught, was not the right one. Maybe the study was flawed. In which case it neither supports or disproves the diets used. Maybe we need to undertake a meta-analysis of all such studies. However, it is these issues of the specifics of how you put together a dietary recommendation that need to be sorted, and proven, before wider use.

My view remains the same:

“Conclusions are limited by study design and small numbers, but it appears that reduced carbohydrate diets are safe and effective over the short term for people with type 2 diabetes.” Dyson PA. A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes. J Hum Nutr Diet 2008 Dec;21(6):530-538. Available from:http://www.ncbi.nlm.nih.gov/pubmed/18759958

“There are no high quality data on the efficacy of the dietary treatment of type 2 diabetes, however the data available indicate that the adoption of exercise appears to improve glycated haemoglobin at six and twelve months in people with type 2 diabetes. There is an urgent need for well-designed studies which examine a range of interventions, at various points during follow-up” Nield L, Moore HJ, Hooper L, Cruickshank JK, Vyas A, Whittaker V, Summerbell CD. Dietary advice for treatment of type 2 diabetes mellitus in adults. Cochrane Database Syst Rev 2007;(3):CD004097. Available from:http://www.ncbi.nlm.nih.gov/pubmed/17636747

Whilst I understand the evidence that low carb paleolithic diets suggests they may work I’m yet to be convinced that they should be recommended main stream. There needs to be more evidence of their effectiveness first.

Yesterday 1:12 PM

steve cooksey – You really should stick to one line of reasoning.One thread comment you admit it works and would be ideal in a “perfect world”… now you change your reasoning to ‘it’s un-proven’ …You can continue to push a high carb meal plan that keeps the MAJORITY of your patients on an ever increasing amount of drugs and insulin… while their blood sugar readings reach soaring highs and crashing lows … that is your choice.You know there is a better way … sleep well at night I do.Do you know why? Because ever single person that goes low carb paleo … reduces drugs and insulin and improves their blood sugar readings.Can you say that?

We could have a real debate regarding diet for ‘non-diabetics’ … but for diabetics… can you as a ‘man of science’ argue that reduced carbohydrates = less glucose = less need for drugs and insulin??? … no, you can not…. not with a clear conscience.

Yesterday 1:38 PM  –  Edit

steve cooksey – Re: Biased studies… yes… indeed.Who do you think taints more studies???Big Pharma, Big Food Companies & Monstanto… or the Cattleman Association??? LOL!

Yesterday 1:46 PM  –  Edit

Dean Jenkins – I accept there may be publication bias. I accept that low carbohydrate diets = less glucose excursions = less need for drugs and insulin and that they are effective and safe in the short term.However, I don’t accept that there is sufficient evidence for recommending low carb diets to all people with diabetes. From a science perspective I’m ambivalent about ‘low carb paleo’ diets. They work for some (clearly), there’s a good hypothesis why they should work and they MAY work for many but, then again, they may not. Should a patient be on a ‘low carb paleo’ diet, they are doing well and have the support of their family then I would encourage them to stay on it and monitor them. However, I’d remain sceptical about its wider use in all my patients.That’s not being inconsistent or being an ADA minion. That’s just trying to make sensible recommendations from the incomplete scientific evidence that is available to us.

3:29 AM (edited)

steve cooksey – I urge you to read the two resource links I posted. Not only does Low Carb Paleo best for diabetes… it’s also best for heart health….Here a lifelong vegetarian runs a study using low carb to high carb diets and in between. Dr. Gardner from Stanford…. I salute his unbiased report. The Battle of the Diets: Is Anyone Winning (At Losing?)As for a lack of long-term studies… How about the last forty years… since the war on sat fat was declared and governments began to push low fat eating? In the last forty years, there has been an explosion of diabetes and obesity… how’s that working out?Answer: Quite well for those in the medical industry, big pharma etc.We ,,, you and I, see the damage done by the high carb, grain based meal plans EVERY DAY. You can not deny that… can you?

YOU can choose to improve patients health today! … you can reduce neuropathy, reduce organ damage, reduce amputation in your patients… TODAY!

… or you can say that you are concerned because there are no long term studies…. and hide it from patients.

No…wait… you can hide it from patients because some may not be able to go low carb.

… the choice is yours.

Treat disease or treat the symptoms with a presciption pad.