This week’s edition of the Journal of the American Medical Association contains a commentary entitled ‘Can Diabetes Be Cured’ [1]. It caught my eye, partly because I have some interest in diabetes as a condition, but also because the word ‘cure’ is not usually applied to a condition like diabetes. The conventional wisdom is that once a diabetic, always a diabetic. The commentary challenges this ‘wisdom’ and talks about the possibilities of curing type 1 diabetes) with pancreatic transplantation or transplantation of the cells that make insulin (the beta-cells). Other, more experimental approaches, such a stem cell therapy are also discussed.
The commentary also discusses potential for the cure of type 2 diabetes, which is far more common than type 1. The author here makes the claim that surgery, for example, gastric banding, offers most potential here.
The author also discusses the idea of a ‘mechanical’ solution to diabetes, in the form of a device which senses sugar levels and gives an appropriate dose of insulin in response. Such devices are not yet available, and even if these were, I’m not sure they would constitute a ‘cure’. They will be, if they ever come into being, another ” albeit more sophisticated – way to administer insulin. That doesn’t constitute a cure in my books.
This article also left me wondering if there might be lower tech solutions to diabetes. In my view, there are. Imagine that a 50-something man is diagnosed with type 2 diabetes as a result of blood testing. Repeat testing confirms the diagnosis. Let’s imagine that this individual, as yet, has no signs of the complications of diabetes such as eye, nerve, kidney or blood vessel damage.
Remember the primary problem with diabetes is that the body is not handling sugar well so blood sugar levels tend to be raised. The primary underlying factors here will be some resistance to the hormone insulin (insulin not working as it should) and/or inadequate insulin secretion as a result of an ‘exhausted’ pancreas. So, imagine now that this individual decides to adopt a low-carbohydrate diet. And imagine that repeat testing in, say, two months time reveals no evidence of diabetes. He continues with the low carb diet and a year later, repeat testing reveals still no evidence of diabetes. And no evidence of complications of diabetes either.
This may be a hypothetical situation, but it mirrors actual experiences had in the real world by those who advocate low-carb diets for those with diabetes.
Now, here’s the question: does this man have diabetes or not? The obvious (and correct) answer I think is ‘no’. Let’s say he’d never been tested for diabetes but took it upon himself to adopt a low-carb diet and some time later turned up his later, normal lab results. No-one would be diagnosing diabetes right? He may have had diabetes, he might even have a tendency to developing diabetes, but he hasn’t got it now.
However, you’d be surprised at just how much resistance some healthcare practitioners can have to the notion that someone can cure themselves of type 2 diabetes with something as simple and low-tech as a change in diet. Why is this?
Some of this may have something to do with the fact that many healthcare practitioners have been persuaded that the ‘right’ diet for diabetics is one with a lot of carbohydrate in it. No wonder these individuals may not have much faith in the ability of diet to ‘cure’ diabetes.
But another potential explanation for the scepticism regarding the potential of diet to cure diabetes might have something to do with the fact that there’s not really much money in it. No drugs, surgery or high-tech gadgets are required. With no industry making particularly good money out of low-carbing, who is going to push this as a viable ‘cure’ for diabetes. The fact that this approach is not particularly lucrative may help to explain how it can be that commentaries can be written about potential cures for diabetes that don’t include any meaningful discussion of the role diet might have here. I suppose it’s worth pointing out that the author of the commentary is an advisor and consultant for two companies that make glucose monitors (supposedly a potential part of the high-tech solution that might ‘cure’ diabetes).
The author actually starts his commentary with the following words: For individuals with diabetes, the ultimate hope is cure. But how will this cure ever be realized? He goes on to write: If the answer was obvious, all effort would be directed to it. If only this were true.
References:
Saudek CD. Can Diabetes Be Cured? Potential Biological and Mechanical Approaches. JAMA. 2009;301(15):1588-1590.
I had a good laugh when I read “If the answer was obvious, all effort would be directed to it…” The answer is obvious, and there are a number of doctors out there (yourself included) telling everyone the answer (low-carb diet), but they get shot down as quacks. I just don’t get how Doctors X, Y, and Z can be saying “here’s how I reverse diabetes in my patients” and Doctors A, B, and C don’t perk up and say, “That’s fantastic, tell me how you’re doing that!” And upon learning that reversal can be achieved through diet alone, they don’t get excited and decide to inform themselves about it and try it with their patients.
I’m not wild about using the word “cure” in the context of the low carb diet, though I do think the Low Carb diet is the best way to treat diabetes ( and the pre-diabetic conditions). The person can’t ever go back to high carb diet or the diabetes will come back, unless the underlying reason for the failure to regulate glucose is addressed and reversed (treatment for diabetes is usually about treating the high BG symptoms than reversing the underlying conditions).
So I look at the LC diet as a management treatment (perhaps the most important management treatment), not a cure.
In general, I think the word cure is used a it too liberally anyway. But nonetheless, I do agree a truly low carb diet is the best way to manage hyperglycemia in the long run.
First, you make an all-too-common error in speaking about diabetes as if it was a single condition, even though from an etiology standpoint, there are few (if any) similarities in the cause, treatment of, or “curing” the two diseases. Dr. Saudek quite obviously has no personal experience of what life with diabetes is actually like, and as an endocrinologist, his function is to treat the symptoms of the disease while ignoring the cause. One could make a fairly compelling argument that type 1 diabetes should probably be treated by immunologists rather than endocrinologists, since it is the immune system that needs repair, not the endocrine system in patients with type 1 diabetes.
You are absolutely right when you quote him “If the answer was obvious, all effort would be directed to it …” and your conclusion “If only this were true” is a genuine understatement!!
I question one of your premises: where you say, “And imagine that repeat testing in, say, two months time reveals no evidence of diabetes,” what do you mean by that? Do you mean that his fasting glucose is now at a normal, non-diabetic level? Or do you mean that he can have an oral glucose tolerance test and his responses are non-diabetic responses? If you mean the latter, does that ever actually happen?
That would certainly be at odds with my personal experience. I am a Type 2 diabetic; with a low-carb diet, I have lost 20% of my starting body weight and now maintain a normal weight for my age and height, and my fasting blood glucose and post-meal blood glucose remain within non-diabetic levels. This is only true, however, as long as I remain on the low-carb diet without deviation. A single significant carb excursion, such as the consumption of 50g carb in a single meal (which is not an especially carb-heavy meal) will put my post-meal blood glucose back into diabetic ranges; I certainly couldn’t pass an OGTT with non-diabetic numbers. For that matter, while my fasting blood glucose would still test normal on the following morning after a single carb excursion, if I went above 100g carbs on as few as 3 consecutive days, I’d be back into the diabetic ranges on fasting blood glucose as well.
Low-carb keeps my diabetes in excellent control, and I feel confident that it puts my risk of cardiovascular and other complications at or near the levels experienced by a non-diabetic. This is VERY important, and I’m pretty proud of achieving it. But am I cured? I really don’t think so. I can’t ever let up. My diabetes may be permanently in remission, if I stay permanently on low-carb, but it’s not gone. I completely agree with you that low-carb eating is a remarkably effective TREATMENT for diabetes, but I don’t agree at all that it’s a CURE.
http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=other.diseases.ailments&conitem=4a935e4e40fae010VgnVCM20000012281eac____
This is the only article i’ve ever seen that talks about a cure for diabetes.
I don’t usually post, but I just could not resist this time ! I am extremely curious as to what prompted this example ” it was spooky to say the least. But let’s just put it down to coincidence. A hypothetical 50 something man etc etc ? I’m 53. I also had no symptoms ( well, just one minor embarrassing one which we won’t go into here ( ! ) which actually prompted a BG test ) and no complications. I was also not overweight ( BMI 25 ), though my waist was 37 inches. 18 months ago I was diagnosed with Type 2.
You just described me ! 🙂 Just for once, the acronym LOL really is justified, since I did just that, as I read the post.
After a lot of research, ( what is type2, the effects, how is the body supposed to work normally, what sort of diet is best, what type of exercise, and so on, and on, and on…… ) I adopted a low(ish) carb diet, regular – typically intense – exercise and used a meter to monitor the effects of this.
The result of all this? After just a couple of months, my average BG was 5.0 mmol/l and was down to 4.8 when I stopped testing recently, other than rarely – and that more to reassure my wife than because I expected to see anything. I also lost about 12 pounds over 6 to 8 months, and dropped a few inches from my waist
At the nurse’s suggestion, around 5 weeks ago I had another OGTT, though not before doing a couple of trial runs at home before; I was curious. The result was normal i.e. towards the low end of the normal range, and I now have recorded on my notes ” officially ! ” that I am no longer diabetic. Yet am I though ? Diabetics are continually told that Type 2 is permanent and progressive. Which is at best hyper-pious cant and at worst, simply robs people of hope. My take on it is similar to yours: there are objective tests which measure whether someone has it or not. I had the tests and was indeed diagnosed as having Type 2. Subsequently, they were repeated and these same tests now show that I do not. I know which I believe, and also the nurse, who encouraged me to be re-tested.
Not wishing to tempt fate, I should stop here, but care was mentioned also. My experiences of care were pretty good ” the diabetes nurse smiled quietly and merely noted what dietary guidelines for diabetics were >50 years ago when I described my diet and observed that most dietary advice from the NHS et al simply amounted to what a cynic might say was ‘Eat what you want and we’ll cover it with drugs’. Let’s say there was tacit approval for my diet. My GP was excellent also and said I should write up what I did, though he may have been thinking of it as something helpful for insomniacs.
But I do miss jam doughnuts. ……..
I’m another one (of thousands) who has normalised my BG and lipids and improved my BP through eating a diet with non-toxic levels of carbs, and reversed several other symptoms.
But CURED??? No I am a *controlled* diabetic, as that recent pub lunch or that cake I couldn’t resist is only too ready to demonstrate.
You can greatly improve insulin resistance to the point your pancreatic output now becomes sufficient to cover the odd minor indiscretion, which may look like a “cure” until you test it. I suspect tanstaafl was lucky to be caught early and treated sensibly, which doesn’t happen as often as it should.
I think you are right – I am sure I was caught early. My GP was very supportive when it came to SMBG, and other things I requested. Yet the official dietary advice I was given was the standard high carb stuff; health care people I met do toe the party line on this I’m afraid. It was only after I’d learned a lot about diet for myself, put it into practice with good results and started questioning this standard advice, that I got the impression that not everyone in the NHS actually believed it – I did say ‘tacit approval’. You really are on your own when it comes to diet and diabetes. Sad, isn’t it ? What ever happened to ‘informed patient choice’ and ‘evidence based medicine’ ?
Stay on low carb and it is like a cure. You don’t get progressively worse requiring a few limbs to be chopped off.
I was diagnosed diabetic after a stroke just on a year ago and put on metformin and gliclazide (sp), I wasn’t really in any fit state to refuse these drugs and took them for about 3 months. I did though, go on a strict low carb diet and have had normal blood sugars ever since, I had an A1C about a month ago which was normal much to the amazement of my GP. This craze for high carb diets is not normal for humans, we still live in hunter/gatherer bodies, bread is poison to us and all those cakes and potatoes etc do us no favours. I look at the people in the streets and see very fat parents with equally fat children all eating doughnuts and other rubbish and I despair. I watched my mother lose a leg to diabetes, she trusted what the doctors told her, eat plenty of carbs and it ended up killing her. I feel healthier and weighing a stone and a half less, I can walk for miles, something I couldn’t do a year ago………
Dr Briffa,
I agree with you but cannot understand why other doctors and dieticians don’t get it. If you reduce your carbs and need less medication as a result (or none) is this not a simple equation? So why all the antagonism to it? Is it that they are all in cahoots with Tate and Lyle?
Hilda, I think its the fact that if you remove the carbs you have to up the other macros. You can only up protein so much and then you need to up the fat. Doctors are still too scared of fat – particularly sat fat. Usually diabetics have heart issues – high cholesterol, trigs and for these issues docs put them on low fat.
Kristine, what a fantastic turn-around. I’m saddened by the story of your mum.
My GP has to toe the Party Line – high carb diet and no test strips – but it’s pretty obvious she doesn’t actually believe it herself. Some of the nurses seem able to get away with mentioning low carb diets without fear of losing their jobs.
I agree with Sue, that paranoia about fats which “cause” heart disease and the protein which “causes” kidney disease means they have little alternative but to recommend carbs. Which curiously enough actually DO cause cardiovascular disease and damage kidneys through generating high BG and high levels of insulin (sigh) my lipids on a Heart Healthy diet were a heart attack waiting to happen, now they are better than many nondiabetics. GP approves of the improvement but freaks out when I tell her how I achieved it . . .
“GP approves of the improvement but freaks out when I tell her how I achieved it . . .”
That always makes me laugh – if you achieved improvements with that type of diet then surely the diet caused the improvements.
I think my GP is significantly more intelligent than the accountants permit her to be. Nevertheless she has been bombarded with endless propaganda
http://www.bmj.com/cgi/eletters/338/mar05_2/b800
I keep meaning to respond but have not yet managed to be polite enough . . .
another new convert. sort of diagnosed in February by my wife as we have a testing kit in the house (grandaughters). My wife is a long time fan of Dr Briffa and low carb for weight control – I was off the scale with ketones. Double vision and funny hands. Wthin three weeks of low carb my sugars were in normal ranges, eye sight ok and fingers improving day on day. Absolutely sure I wouldn’t do that under normal NHS teatment. I do have an advantage, I love meat and dont like bread etc in quantity. I was eating too much chocolate, biscuits, icecream and cake. I am guilty of not taking enough exercise.
I am a vocational (Heavy Goods) license holder. I have also been diagnosed type2 diabetic. To retain my license I must undergo a private medical examination and questionnaire every five years.
Five years ago, I truthfully answered the question on diabetes to say that I had been diagnosed type 2 diabetic but had not to date been prescribed oral or intravenous mediacation. The Doctor correspondingly completed the form and the out come was that it generated a letter from the DVLA acknowledging the condition and informing that I must notify changes in my prescription, or such like.
A couple of months ago, the process came around again and I paid my £60 (highly discounted on the GMC suggested rate) for a private form filling consultation with a GP. I reaffirmed my diabetic status but in this instance the GP checked the negative box on the form. Anecdotal evidence indeed that diabetes can be cured!
I am not implying any misconduct on the part of the second GP, but perhaps his interpretation was that if I had managed for 7/8 years without medication then my condition ought to be re-diagnosed as insulin resistance? The opportunity to ask him has passed.
Nonetheless, it shows that one can defer or limit the need for medication if one takes some responsibility for managing it. As has been suggested by others, our health service does not always provide the correct kind of support to encourage this.
‘The Diabetes Cure’ (Dr Vern S Cherawatenko and Paul Perry, 1999) inspired me to take responsibility to manage my condition. It may be a little dated now but could still prove a useful starting point. Check with your library service, they ought to have it or be able to source it, perhaps on the inter-library service. I am not wholly sold on the need for supplements, but Vit D, Chromium, and HCA are useful lines of inquiry for anyone interested. HCA, I feel, may have kick started some metabolic recovery, I can’t be certain and in case I did not subscribe to dosage in the quantity suggested.
The things I found most helpful were to routinely exercise, I used to think that should be aerobic but vigourous to overcome muscular glycosylation, and to incorporate lower GL foods into the diet.
I used to pass an hour every Sunday evening making salads based upon lentils, chick peas, and the like to pack into a cooler. These would last me the week while I tramped around the country delivering cars off the back of my transporter. I faired quite well with HbA1c results routinely in the region of 5.8.
I’m not advocating anyone live entirely off legumes, but reducing ones dependency upon the high GL staples, such as bread, rice, potatoes, pasta etc. is an essential step, as those who successfully manage their condition will attest. Bulk out with a selection of fresh veg. Sugary soft drinks and confections should become a thing of the past. Personally, I exercise my choice to avoid (increasingly difficult) artificial sweeteners of any kind.
If you are heavily into alcohol or coffee you may surprise yourself by taking a break. (Doc?) Incorporating foods high in soluble fibre, green leaves, nuts, seeds, and legumes, certainly aided my management. There is no need to be drawn to the proprietary foods targeted at diabetics, that is playing into the hands of the enemy, what is needed is real food and of the right kind.
In short it is possible to achieve a lot but it is necessary to wise up, and in the presence of so much bull$/it it is not easy to recognise the pertinent stuff. Heed the advice of your GP but do not rule out the possibility that you may become better informed, and do your level best not to become heavily dependent upon medication, but not at the expense of poor test results. If necessary prove your GP wrong; if you are really determined consider that your rite of passage but the sobering thought is that your GP and other health practioners are trained and better placed to spot the potential complications should they arise. They are not perfect but they deserve our respect, nonetheless. Good luck.
New breakthroughs in science have come up with interesting products. I have been considering trying a product that I heard about called Syntra5. Has anyone heard of this or perhaps tried it?
Thing is one needs fibre, and much fibre is in carbs. One thing that will screw your bloods up is wheat, It is a fact that both a US university and a Norwegian one with separate tests and monitoring found that everybody that had wheat intolerance when younger became a type 2 diabetic.
Apparently this is allied to “hard” wheat both red and white whilst the “soft” wheat does not create intolerance. Try oats and brown pasta, they do not seem to “blow my bloods out of the water” like aforesaid wheat and sugars.
Intolerance:- consume wheat products and get a reaction eg falling asleep, severe fatigue and so on. Me, whisky malt all night long, no effect and lowers BS, one glass of blended using wheat, fall asleep in 20 minutes for up to 3 hours, same for cheap breads BS goes stupid. A prominent physician in France where I live said that that maybe the reason for so many lorry drivers falling asleep at the wheel in the early mid afternoon. 30% of all europeans eventually become type 2 diabetics, much of it hereditary as in my case.
I was diagnosed T2 diabetic,told it was incurable an irreversible,prescribed metformin,which I never took.I do not exercise but eat a low carb,non white food diet.I consider myself healed,but allergic to carbs.If I eat to many carbs,I will gain weight and become diabetic.In a sence T2 diabetes I feel is a food allergy.
I’m not a doctor,just a healed diabetic.