low-fat vegan diet safely and quickly aids diabetics, John A McDougall
critique of Gina Kolata diabetes article, New York Times, based on
recent studies by Neal D Barnard, David JA Jenkins et al: Murray
2007.08.21
http://groups.yahoo.com/group/aspartameNM/message/1465

John A. McDougall, MD mcdougall@lava.net
McDougall Wellness Center P.O. Box 14039, Santa Rosa, CA 95402
http://www.drmcdougall.com

Dr. McDougall's response to: Looking Past Blood Sugar to Survive With
Diabetes by Gina Kolata in the August 20, 2007 New York Times

This article reads like a multimillion dollar sales promotion for the
pharmaceutical industries by telling diabetics that they are being
inadequately treated by their doctors who are focusing only on
medications to lower their blood sugar. To make matters right,
primary medical attention must be shifted to the addition of even more
drugs. She quotes an expert, '"We already have the miracle pills' -
statins and blood pressure medications..."

Kolata overlooked the scientifically established and well-accepted
fact that type-2 diabetes, high cholesterol, and high blood pressure
are all three due to eating the rich Western diet, and the obvious
treatment used by responsible physicians would be to correct the
patient's diet.

There is an epidemic of diseases of over-nutrition-worldwide more than
1.1 billion people are overweight and 312 million obese, 197 million
have diabetes, 1 billion have hypertension, and 18 million people die
of heart disease annually.

Over the last two decades, there has been a 10-fold increase in the
incidence of type-2 diabetes in children in the USA, because of the
rapidly growing numbers who are obese from an escalating exposure to
rich foods, compounded by a lack of exercise.

The few references to diet she makes in this article are focused on
the importance of counting carbohydrates, as if these were the "evil
calories" that caused diabetes.

The truth is populations who consume diets highest in carbohydrates,
like the people of rural Japan eating rice, Peru eating potatoes, and
Mexico eating corn are essentially free of type-2 diabetes-and
hypertension, obesity, and high cholesterol. When these people migrate
to the USA or Europe and eat fewer carbohydrates and more fat, they
lose their immunity to these illnesses.

Commonly, patients at our live-in clinic with type-2 diabetes will
stop taking 30 to 120 units of insulin and a bag full of "anti-
diabetic pills" daily, and their blood sugars will become normal in as
little as 7 days, as a result of eating a diet based on whole plant
foods with a little exercise. They also lose weight, reduce their
cholesterol, and their blood pressure comes down.

Any well-read scientist or science writer would understand the
benefits of carbohydrate. As far back as the 1920s experiments showed
carbohydrates make the body's insulin work more efficiently, while fat
paralyzes insulin's actions.

A recent thorough review of the use of high carbohydrate diets in the
treatment of type-2 diabetes, published in the September 2003 issue of
the American Journal of Clinical Nutrition, reported improvements in
blood sugars in diabetics, with 39% stopping insulin and 71% stopping
diabetic pills after three weeks of therapy.
[ 25) Jenkins DJ, Kendall CW, Marchie A, Jenkins AL, Augustin LS,
Ludwig DS, Barnard ND, Anderson JW. Type 2 diabetes and the
vegetarian diet. Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S-616S. ]

To her credit, Kolata did point out several things: blood sugar
control with medications is difficult and expensive and has not been
proven to save lives.

With further study she can learn that the benefits from medications to
treat cholesterol and high-blood pressure are also of limited value,
especially when compared to those seen after a change in diet and
lifestyle.

Kolata writes that diabetes has little to do with an out-of-control
diet and sedentary lifestyle and with the resulting overweight.

Furthermore, she believes patients are unable to control their
disease, no matter what they do. Essentially they are trapped by
genetics. Their only hope is to buy drugs.

Fortunately, she is wrong. I believe people, if given the chance,
would choose the most effective, least toxic, and most economical
therapies - those focused on non-profit lifestyle medicine.
Unfortunately, "cash is king," and the drug companies rule.

To learn more about diabetes, see my Hot Topics, diabetes.
www.drmcdougall.com/med_hot_diabetes.html

John McDougall, MD
© 2007 John McDougall All Rights Reserved


www.ajcn.org/cgi/content/full/78/3/610S free full text

Am J Clin Nutr. 2003 Sep; 78(3 Suppl): 610S-616S.
Type 2 diabetes and the vegetarian diet.
David JA Jenkins,
Cyril WC Kendall,
Augustine Marchie,
Alexandra L Jenkins,
Livia SA Augustin,
David S Ludwig,
Neal D Barnard
and James W Anderson.

Based on what is known of the components of plant-based diets and
their effects from cohort studies, there is reason to believe that
vegetarian diets would have advantages in the treatment of type 2
diabetes.

At present there are few data on vegetarian diets in diabetes that do
not in addition have weight loss or exercise components.

Nevertheless, the use of whole-grain or traditionally processed
cereals and legumes has been associated with improved glycemic control
in both diabetic and insulin-resistant individuals.

Long-term cohort studies have indicated that whole-grain consumption
reduces the risk of both type 2 diabetes and cardiovascular disease.

In addition, nuts (eg, almonds), viscous fibers (eg, fibers from oats
and barley), soy proteins, and plant sterols, which may be part of the
vegetarian diet, reduce serum lipids.

In combination, these plant food components may have a very
significant impact on cardiovascular disease, one of the major
complications of diabetes.

Furthermore, substituting soy or other vegetable proteins for animal
protein may also decrease renal hyperfiltration, proteinuria, and
renal acid load and in the long term reduce the risk of developing
renal disease in type 2 diabetes.

The vegetarian diet, therefore, contains a portfolio of natural
products and food forms of benefit for both the carbohydrate and lipid
abnormalities in diabetes.

It is anticipated that their combined use in vegetarian diets will
produce very significant metabolic advantages for the prevention and
treatment of diabetes and its complications.
PMID: 12936955

1 From the Clinical Nutrition & Risk Factor Modification Center (DJAJ,
CWCK, AM, ALJ, and LSAA)
and the Department of Medicine, Division of Endocrinology and
Metabolism (DJAJ), St Michael's Hospital, Toronto;
the Department of Nutritional Sciences, Faculty of Medicine,
University of Toronto (DJAJ, CWCK, AM, and LSAA);
the Department of Medicine, Children's Hospital, Boston (DSL);
the Physicians Committee for Responsible Medicine, Washington, DC
(NDB); and the VA Medical Center, Graduate Center for Nutritional
Sciences, University of Kentucky, Lexington (JWA).

2 Presented at the Fourth International Congress on Vegetarian
Nutrition, held in Loma Linda, CA, April 8-11, 2002. Published
proceedings edited by Joan Sabaté and Sujatha Rajaram, Loma Linda
University, Loma Linda, CA.

3 Supported by the British Medical Research Council,
the British Diabetic Association,
the Canadian Diabetes Association,
the Natural Sciences and Engineering Research Council,
the Canada Research Chairs Endowment of the Federal Government of
Canada,
Loblaws Brands, and the Almond Board of California.
DJAJ is funded by the Federal Government of Canada as a Canada
Research Chair in Nutrition and Metabolism.
ALJ holds a doctoral research award from the Heart and Stroke
Foundation of Canada.

4 Address reprint requests to DJA Jenkins, Clinical Nutrition & Risk
Factor Modification Center, St Michael's Hospital, 61 Queen Street
East, Toronto, Ontario, Canada M5C 2T2. E-mail:
cyril.kendall@utoronto.ca


http://groups.yahoo.com/group/aspartameNM/message/1361
McDougall low-fat vegan diet, no meat or dairy, hugely helps 49
diabetics in 4 month study by Neal D. Barnard: Murray 2006.07.30

http://care.diabetesjournals.org/cgi/content/full/29/8/1777
free full text

Diabetes Care 29: 1777-1783, 2006 August 1.
A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular
Risk Factors in a Randomized Clinical Trial in Individuals
With Type 2 Diabetes.
Neal D. Barnard, MD 1,2, nbarnard@pcrm.org
Joshua Cohen, MD 1,
David J.A. Jenkins, MD, PHD 3, contact cyril.kendall@utoronto.ca
Gabrielle Turner-McGrievy, MS, RD 4,
Lise Gloede, RD, CDE 5,
Brent Jaster, MD 2,
Kim Seidl, MS, RD 2,
Amber A. Green, RD 2
and Stanley Talpers, MD 1

1 Department of Medicine, George Washington University School of
Medicine, Washington, DC
2 Physicians Committee for Responsible Medicine, Washington, DC
3 Department of Nutritional Sciences, Faculty of Medicine, University
of Toronto, and the Clinical Nutrition and Risk Factor Modification
Center, St. Michael's Hospital, Toronto, Canada
4 Department of Nutrition, School of Public Health, University of
North Carolina, Chapel Hill, North Carolina
5 Private practice, Arlington, Virginia

Address correspondence and reprint requests to Neal D. Barnard, MD,
5100 Wisconsin Ave., Suite 400, Washington, DC 20016. E-mail:
nbarnard@pcrm.org

The study was supported by grant R01 DK059362-01A2 from the
National Institute of Diabetes and Digestive and Kidney Diseases
www2.niddk.nih.gov/ 301-496-3583
and by the Diabetes Action Research and Education Foundation.
www.diabetesaction.org/ info@diabetesaction.org
426 "C" Street, NE Washington, DC 20002
202-333-4520 fax 202-558-5240
www.diabetesaction.org/site/PageServer?pagename=About#advisory
Medical Advisory Board


OBJECTIVE:
We sought to investigate whether a low-fat vegan diet improves
glycemic control and cardiovascular risk factors in individuals
with type 2 diabetes.
RESEARCH DESIGN AND METHODS:
Individuals with type 2 diabetes (n = 99) were randomly assigned
to a low-fat vegan diet (n = 49)
or a diet following the American Diabetes Association (ADA)
guidelines (n = 50).
Participants were evaluated at baseline and 22 weeks.
RESULTS:
Forty-three percent (21 of 49) of the vegan group
and 26% (13 of 50) of the ADA group participants
reduced diabetes medications.
Including all participants,
HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group
and 0.56 points in the ADA group (P = 0.089).
Excluding those who changed medications,
A1C fell 1.23 points in the vegan group
compared with 0.38 points in the ADA group (P = 0.01).
Body weight decreased 6.5 kg in the vegan group
and 3.1 kg in the ADA group (P < 0.001).
Body weight change correlated with A1C change
(r = 0.51, n = 57, P < 0.0001).
Among those who did not change lipid-lowering medications,
LDL cholesterol fell 21.2% in the vegan group
and 10.7% in the ADA group (P = 0.02).
After adjustment for baseline values,
urinary albumin reductions were greater in the vegan group (15.9 mg/
24h)
than in the ADA group (10.9 mg/24 h) (P = 0.013).
CONCLUSIONS:
Both a low-fat vegan diet and a diet based on ADA guidelines
improved glycemic and lipid control in type 2 diabetic patients.
These improvements were greater with a low-fat vegan diet.
PMID: 16873779


Comp Biochem Physiol A Mol Integr Physiol. 2003 Sep;136(1): 141-51.
The Garden of Eden--plant based diets,
the genetic drive to conserve cholesterol
and its implications for heart disease in the 21st century.
Jenkins DJ,
Kendall CW,
Marchie A,
Jenkins AL,
Connelly PW,
Jones PJ,
Vuksan V.
Clinical Nutrition and Risk Factor Modification Center,
St. Michael's Hospital, 61 Queen Street East, Ont.,
M5C 2T2, Toronto, Canada.

It is likely that plant food consumption throughout much of human
evolution shaped the dietary requirements of contemporary humans.
Diets would have been high in dietary fiber, vegetable protein,
plant sterols and associated phytochemicals,
and low in saturated and trans-fatty acids
and other substrates for cholesterol biosynthesis.

To meet the body's needs for cholesterol,
we believe genetic differences and polymorphisms
were conserved by evolution,
which tended to raise serum cholesterol levels.

As a result modern man, with a radically different diet and lifestyle,
especially in middle age, is now recommended to take medications
to lower cholesterol and reduce the risk of cardiovascular disease.
Experimental introduction of high intakes of viscous fibers,
vegetable proteins and plant sterols in the form of a
possible Myocene diet of leafy vegetables, fruit and nuts,
lowered serum LDL-cholesterol in healthy volunteers by over 30%,
equivalent to first generation statins,
the standard cholesterol-lowering medications.

Furthermore, supplementation of a modern therapeutic diet
in hyperlipidemic subjects with the same components
taken as oat, barley and psyllium for viscous fibers,
soy and almonds for vegetable proteins
and plant sterol-enriched margarine produced
similar reductions in LDL-cholesterol as the Myocene-like diet
and reduced the majority of subjects' blood lipids concentrations
into the normal range.

We conclude that reintroduction of plant food components,
which would have been present in large quantities
in the plant based diets eaten throughout most of human evolution
into modern diets can correct the lipid abnormalities
associated with contemporary eating patterns
and reduce the need for pharmacological interventions.
PMID: 14527636


www.drmcdougall.com/med_hot_diabetes.html

Diabetes

Elevated blood sugar is the hallmark of diabetes, but even more
feared then the sugar should be the complications - heart attacks,
kidney failure, loss of vision, etc. - that follow within a few years
after diagnosis. Type-1 diabetes is due to destruction of the insulin-
producing cells of the pancreas (in many cases this permanent damage
is from an autoimmune reaction involving cow's milk). Type-1 diabetes
is not curable (insulin therapy is required), but risk of
complications can be greatly reduced with the McDougall Program.
Type-2 diabetes is due to overnutrition from the rich Western diet -
medication is not required and is usually inadvisable. The McDougall
Program cures this form of type-2 diabetes by correcting the
malnutrition with a plant-food based diet and exercise - and
associated weight loss.

Related Newsletter Articles (articles open in a new window)

February 2004:
Type-2 Diabetes - the Expected Adaptation to Overnutrition
www.nealhendrickson.com/mcdougall/040200pudiabetes.htm

September 2006: Sugar, Coated with Myths
www.drmcdougall.com/misc/2006nl/sept/sugar.htm

August 2006: Vegan Diet Benefits Diabetes
www.drmcdougall.com/misc/2006nl/august/fav5.htm

July 2006: Glycemic Index - Not Ready for Prime Time
www.drmcdougall.com/misc/2006nl/july/glycemic.htm

March 2006: Diabetic Pills Kill
www.drmcdougall.com/misc/2006nl/march/fav5.htm

July 2002: Type-1 Diabetes: The Pancreas under Attack by Cow's Milk
www.nealhendrickson.com/mcdougall/020700puthepancreas.htm

May 2005: Dairy and Type-2 Diabetes - Wrong Conclusion
www.drmcdougall.com/misc/2005nl/may/050500pufavfive.htm

July 2005: Vegetarians Don't Have Insulin Resistance or Metabolic
Syndrome www.drmcdougall.com/misc/2005nl/july/050700fav5.htm

Cases of Star McDougallers:

Scott Raphael www.drmcdougall.com/stars/scott_raphael.html
Logan Ginger www.drmcdougall.com/stars/050308starlogan.html
Jason Wyrick www.drmcdougall.com/stars/jason_wyrick.html


www.nealhendrickson.com/mcdougall/040200pudiabetes.htm

February 2004 The McDougall Newsletter
Vol. 3 No. 2

Type-2 Diabetes - the Expected Adaption to Overnutrition

Sixteen million people in the United States have type-2 diabetes,
which shortens lifespan by up to 15 years, leads to almost 300,000
deaths annually, and costs about $100 billion annually.
Since 1980 the incidence has increased by 30%.

Born in the year 2000, your male child's lifetime risk of developing
type-2 diabetes is nearly 33%, and a female's risk will be 39% when
following the Western diet.1
Worldwide, 135 million people have type-2 diabetes and by 2025 the
incidence is predicted to reach 300 million people worldwide.

This form of diabetes was once referred to as "adult-type diabetes"
because in the past, type-2 diabetes was rare in children.
However, over the last two decades, there has been a 10-fold increase
in incidence of type-2 diabetes in children, because of the rapidly
growing numbers with obesity from an escalating exposure to rich
foods, compounded by a lack of exercise.2

The general state of poor health of Westerners, as reflected by
diabetes, escalates unchecked for 3 important reasons:

1) This growing epidemic of type-2 diabetes and obesity is fueled by
huge profits generated by a food industry super-sizing everything by
stuffing their irresistible morsels with fat, sugar, refined flour,
and calories.

2) Medical doctors continue to prescribe remedies that have never
cured a single case of diabetes. Furthermore, the usual "poly-
pharmacology" of medications they rely upon promotes weight gain,
heart disease, and hypoglycemia, along with other serious adverse
effects. From all these expensive medications there is a small
reduction in complications, such as kidney and eye damage, which still
fails to offset the tremendous harm done by their efforts.

3) The American Dietetic Association has remained steadfast in their
recommendation of a portion-controlled version of the Western
(American) diet - an impossible diet to follow (because of its complex
rules and semi-starvation nature) - made up of ingredients, like fat,
sugars, refined foods, and cholesterol, that caused the patients'
problems in the first place.

In 1927 Dr. E. P. Joslin, founder of the famous Joslin Diabetic Center
in Boston, suspected a high-fat, high-cholesterol diet might favor the
development of diabetes and its major complication, atherosclerosis.3
He prophetically wrote: "I believe the chief cause of premature
atherosclerosis in diabetes, save for advancing age, is an excess of
fat, an excess of fat in the body (obesity), an excess of fat in the
diet, and an excess of fat in the blood. With an excess of fat
diabetes begins and from an excess of fat diabetics die, formerly of
coma, recently of atherosclerosis." And now, 75 years after Joslin's
farsighted message, diabetes is the fastest growing disease in the
world.

Type-2 Diabetes: A Runaway Epidemic Caused by Rich Foods

The cause of this skyrocketing health tragedy is easily seen by
observing everyday people striving for the "good life."4-6
Feasting from the king's table brings on the diseases of royalty, like
obesity, gout, and diabetes.
Worldwide, the incidence of type-2 diabetes increases in direct
proportion to the consumption of meat, dairy products, sugars, fats,
and calories by the residents.
Type-2 diabetes has taken the greatest toll on "minority" populations
brought to the Western diet by migration to cities and giant
industries providing cheap fast food.

Native Americans, for example the Pima Indians of Arizona, introduced
to the Western diet over the past 75 years, are now afflicted so
severely that as many as one-half of them has diabetes.7
However, their genetic cousins, the Tarahumara Indians of Mexico,
following a diet consisting of 90% corn and pinto beans (chili), and
vegetables (like squash), are free of type-2 diabetes - as well as
obesity and heart disease.8,9

Similar dramatic rises - from immunity to epidemic proportions - of
type-2 diabetes have been seen in other people like Africans, African-
Americans, Mexicans, Chinese, and Polynesians, as they adopt the
Western diet with enthusiasm.10-12

There are no exceptions to this observation that when populations of
people following a starch-based diet (rice, corn, potatoes, sweet
potatoes, etc.), switch to a diet of rich foods - meats, dairy
products, added oils, and refined foods - they become overweight and
diabetic, and develop heart disease, breast, prostate and colon
cancers, gallbladder disease, arthritis, multiple sclerosis, and bowel
problems.
No exceptions!

Diabetes Is an Adaptive Response to Overnutrition

The malnutrition caused by the high-fat, low-fiber Western diet places
serious burdens on the body and requires it to make adaptions in order
to survive under adverse conditions.
The calories consumed in excess of our needs cause us to gain fat -
this is a natural, expected change.
Soon a point is reached when this accumulation becomes
counterproductive - a point when any further excess body weight is
likely to cause serious physical harm.
When this hazardous excess is reached, the body puts "the brakes on"
in order to slow the rate of gain.
This is accomplished by a variety of changes that cause the hormone
insulin to become less potent. 13,14
In other words, our cells become resistant to the actions of the fat-
gaining hormone, insulin - a state referred to as "insulin
resistance."


One of insulin's primary jobs is to push fat into the fat cells - thus
saving fat for the day when no food is available (which for Westerners
never comes).
If it were not for the adaptive mechanisms which allow for the
development of "insulin resistance," people would commonly expand
until they became so large that they could not get out of bed or fit
through a doorway - a very rare condition that does occur in 1000-
pound sized people who need a forklift to move them to the hospital.
(They make headlines in the newspaper.)

One of insulin's other important jobs is to let sugar into the body's
cells - with a state of "insulin resistance" the sugar cannot get into
the cells easily - so it rises in the blood.
The hallmark of the diagnosis of diabetes is an elevated blood sugar
above normal (usually normal is below 115 mg/dl fasting).
With impotent insulin, the calories of fat and sugar we consume cannot
easily enter the cells; the body is essentially starving itself from
the inside in a desperate attempt to compensate for the overfeeding
coming from the outside.
To further reduce the burden of obesity, the body eliminates calories
by allowing sugar to spill over into the urine, like water falling
over a dam.
At this stage sugar is found with a urine test - another common way to
diagnosis diabetes.
Most doctors and patients view the elevated blood sugar as the enemy
to be beaten down with medications - the result is a fat, sickly
patient with a slightly lower blood sugar.

The Reason Medical Therapy Should Be Your Last Choice

Diabetic medications have never cured anyone of diabetes and actually
compound the patients' problems.
The patient goes to the doctor, is diagnosed with diabetes, placed on
medication, and told to lose weight.

Unfortunately, these medications make insulin more effective, causing
more fat to be stored in the fat cells.
The average initial weight gain when diabetic medications are started
is 8 to 20 pounds - due to partially counteracting the protective
effects of "insulin resistance."
Thus the well-behaved patient takes the medications as directed, but
then gains weight, and as a result of the added weight his diabetes
becomes worse.
The patient returns to the doctor, is given a firm scolding for
gaining weight, and then more medications are prescribed because his
sugars are even higher than before - this additional medication makes
the patient even fatter and the diabetes more out of control.
The vicious cycle continues - and the patient and doctor are left
guilt-ridden and confused about their obvious medical failure.
After all, they followed the pharmaceutical company's instructions
exactly.
Worse yet, the patients are not one bit healthier from all this effort
and expense.

More than 30 years ago, when I was in medical school, I remember
doctors arguing about the benefits from aggressive use of medication
to make the blood sugars lower, a practice referred to as "tight
control."
Ideally, keeping the blood sugars close to normal makes sense, but in
real life more harm than good is done for type-2 diabetics.

First of all, no matter how hard the patient and the doctor work at
their goal, the blood sugar readings are all over the place - one test
shows 60 mg/dl and the next 260 mg/dl.
Soon it becomes obvious to the patient that the short-term goal of
"normalizing" the blood sugar levels is impossible using medications.

The next carrot held out is for long-term benefits:
preventing complications later in life.
In truth, studies have shown there is some benefit for the eyes and
the kidneys with better control of blood sugar (especially for type-1
diabetics).15-17

However, the major threat to the life of a diabetic is from heart
attacks and strokes - diseases of the large blood vessels.
Intensive medical therapy using the most high-tech drugs to lower
blood sugars has failed to reduce the risk for, and improve survival
from, these two major killers.
In fact, the medications used to combat sugar will actually create
more sickness and death from heart disease.

Since the early 1970s every single edition of the Physician's Desk
Reference, found in every doctor's office, has carried this warning in
heavy back print for their diabetic medications: "SPECIAL WARNING ON
INCREASED RISK OF CARDIOVASCULAR MORTALITY."

The most commonly prescribed diabetic medications, known as
sulfonylureas,* cause fundamental changes in the function of cells
that increase the risk of heart attacks.18

These drugs, which are called "antidiabetic agents" by the
pharmaceutical companies, have recently been shown to more than double
the risk of heart attacks and almost triple the risk of early death in
patients after an angioplasty.19
I never prescribe this type of diabetic pills, and always ask my
patients to stop them.
All diabetics should be actively looking for a better approach - and
so should any doctor interested in his patients' welfare.

The Treatment of Type-2 Diabetes with a Low-Fat, Plant-Food Diet

Multiple studies dating as far back as the 1920s have shown the
benefits of a high-carbohydrate, low-fat diet in the treatment of
type-2 diabetes.23

For example, studies from the University of Kentucky Medical School
reported as many as two-thirds of diabetics were able to discontinue
insulin and almost all stopped oral agents.24

A recent thorough review of the use of a vegetarian diet in the
treatment of type-2 diabetes was published in the September 2003 issue
of the American Journal of Clinical Nutrition.
In this review article Dr. David Jenkins reported on research showing
improvements in blood sugars in diabetics with 39% stopping insulin
and 71% stopping diabetic pills after three weeks of therapy.25

Relief of diabetic neuropathy pains, reduced lipids (cholesterol and
triglycerides), and weight loss have also been reported with a low-
fat, pure-vegetarian diet.

Another recent research paper has reported similar findings with a low-
fat vegetarian diet.26

Many of these people with type-2 diabetes are cured of their disease
within three weeks, and most will be cured of their diabetes over time
as they adhere to a low-fat, high carbohydrate diet, exercise, and
lose all of their excess body fat.

This same kind of diet (in large part because of the restriction of
animal protein) has been shown to dramatically improve the health of
the kidneys of diabetics (protein in the urine, a sign of diabetic
kidney damage, decreases and disappears).27,28

Research has also shown diabetic damage found in the eyes
(retinopathy) can be reversed with a low-fat diet.29,30 It's
interesting how kidney and eye damage, the two purported benefits from
drug therapy, are actually better treated with diet than with
medications, at no cost and no side effects.

A low-fat vegetarian diet has also been shown to reverse heart disease
(atherosclerosis), the number one killer of diabetics.31

Many other researchers have praised a low-fat vegetarian diet as the
best approach to prevent and treat most diseases that plague people in
modern societies, including people with diabetes.32-35

Possibly the most important effect of this dietary approach (combined
with exercise) is the scientifically established fact that this is the
easiest and most effective way to lose weight permanently.36-39

Obesity is the underlying cause of diabetes.40

Practical Steps to Cure Type-2 Diabetes

If you are one of the millions of diabetic patients facing a hopeless
future of worsening diabetes, obesity, loss of vision, kidney failure,
heart attacks, strokes, gangrene, and early death and disability -
even though you have visited your doctors regularly, and taken your
medications faithfully - then it is time to break this downhill spiral
by changing your diet and exercise program.

At the same time ask your doctor to provide you with sensible,
conservative, care. I do the following with my patients:

1) Stop diabetic pills and reduce or eliminate insulin.
In most cases, I have my patients stop all of their diabetic pills the
day they start the McDougall diet and exercise program and/or at least
half of their insulin.
If this reduction is not made in a timely manner, then they run a real
risk of developing hypoglycemia (too low blood sugar).
I increase or reduce medications based on the patient's response and
as a general guideline I try to keep their blood sugars between 150 to
250 mg/dl while I am trying to adjust their medication needs.
Stopping and/or reducing the medications reverses the weight gain
immediately.
(Insulin cannot be stopped in type-1 diabetes, but the dosage is often
reduced.)

2) Change them to a low-fat, high-fiber, plant-based diet: the
McDougall diet.
The diet should be based around starches with the addition of fruits
and vegetables - there are no added vegetable oils.
Sample foods are: oatmeal, whole wheat pancakes or potatoes for
breakfast.
Lunch can be soups, salads, and sandwiches.
And dinner may be thought of in terms of ethnic dishes, like Mexican
burritos, Chinese Mu Shu vegetables, Thai curried rice, or Italian
whole grain pasta.

3) Ask them to exercise. Start at a comfortable level and
gradually build up.
Exercise should be increased to the equivalent of at least a half hour
of walking a day.

4) Check their other risk factors for indications of serious
disease, such as cholesterol, triglycerides, and blood pressure.
Then make diet and lifestyle modifications to correct these (for
example, fewer fruits and juices with high triglycerides and
cholesterol, and less salt with high blood pressure).

5) Have them take appropriate medications only.
For example, I prescribe:

Small doses of insulin for too much weight loss or if my patient
develops symptoms of diabetes, like too frequent urination or
excessive thirst.
Cholesterol (and triglyceride) lowering medications in order to
reach ideal levels of 150 mg/dl, especially for patients at high risk
for a stroke or heart attack. (See my September 2002 and June 2003
Newsletters.)
Blood pressure lowering medications, are sometimes indicated in
high-risk patients whose blood pressure remains at 160/100 mm Hg or
greater for months. (See my August 2002 Newsletter.)

A prescription of a low-fat diet and exercise can be taught by any
interested physician or dietitian.

Most diabetics respond within days - and with continued weight loss,
most can be expected to stop all diabetic medications - and regain
lost health and appearance.

The most difficult task for people with diabetes is to break from
tradition - the following words may help.

"The diet recommended by the American Diabetic Association virtually
guarantees all diabetics will remain diabetic," claimed the pioneer
nutritionist, Nathan Pritikin, 30 years ago.

His experiences from treating thousands of people with this disease
convinced him that type-2 diabetes is largely curable by following a
healthy diet and moderate exercise.

Obviously the failure of modern diabetic management has been known
long before most diabetics developed their disease - yet nothing
changes for the better.

Your only chance is to rebel against commonly accepted advice.

Don't you think a revolt is long overdue based on the poor results you
have experienced so far?

References:

1) Narayan KM. Lifetime risk for diabetes mellitus in the United
States. JAMA 2003; 290: 1884-90.

2) Ludwig DS, Ebbeling CB. Type 2 diabetes mellitus in children:
primary care and public health considerations. JAMA. 2001 Sep
26;286(12):1427-30.

3) Joslin EP. Atheroscleriosis and diabetes. Ann Clin Med
1927;5:1061.

4) Hinsworth HP. Diet in the aetiology of diabetes. Proc R Soc Med
1949;42:323-6

5) West KM, Kalbfleisch JM,. Influence of nutritional factors on
prevalence of diabetes. Diabetes 1971; 20: 99-108.

6) Rao RH. The role of undernutrition in the pathogenesis of
diabetes mellitus. Diabetes Care 1984; 7: 595-601.

7) Lee ET, Welty TK, Cowan LD, Wang W, Rhoades DA, Devereux R, Go O,
Fabsitz R, Howard BV. Incidence of diabetes in American Indians of
three geographic areas: the Strong Heart Study. Diabetes Care. 2002
Jan;25(1):49-54.

McMurry MP . Changes in lipid and lipoprotein levels and body
weight in Tarahumara Indians after consumption of an affluent diet. N
Engl J Med. 1991 Dec 12;325(24):1704-8.

9) Briceno I, Barriocanal LA, Papiha SS, Ashworth LA, Gomez A, Bernal
JE, Alberti KG, Walker M. Lack of diabetes in rural Colombian
Amerindians. Diabetes Care. 1996 Aug;19(:900-1.

10) Foliaki S. Prevention and control of diabetes in Pacific
people. BMJ. 2003 Aug 23;327(7412):437-9.

11) Ring I. The health status of indigenous peoples and others.
BMJ. 2003 Aug 23;327(7412):404-5.

12) Ko G. Rapid increase in the prevalence of undiagnosed diabetes
and impaired fasting glucose in asymptomatic Hong Kong Chinese.
Diabetes Care. 1999 Oct;22(10):1751-2.

Mann JI. Diet and risk of coronary heart disease and type 2
diabetes. Lancet. 2002 Sep 7;360(9335):783-9.

13) Fujimoto WY. The importance of insulin resistance in the
pathogenesis of type 2 diabetes mellitus. Am J Med. 2000 Apr 17;108
Suppl 6a:9S-14S.

14) Goldstein BJ. Insulin resistance as the core defect in type 2
diabetes mellitus. Am J Cardiol. 2002 Sep 5;90(5A):3G-10G.

15) UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-
glucose control with sulphonylureas or insulin compared with
conventional treatment and risk of complications in patients with type
2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.

16) DCCT Research Group. The effect of intensive treatment of
diabetes on the development and progression of long-term complications
in insulin dependent diabetes mellitus. N Engl J Med.
1993;329:977-986.

17) Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy
prevents the progression of diabetic microvascular complications in
Japanese patients with non-insulin-dependent diabetes mellitus: a
randomized prospective 6-year study. Diabetes Res Clin Pract.
1995;28:103-117

1 Engler RL, Yellon DM. Sulfonylurea KATP blockade in type II
diabetes and preconditioning in cardiovascular disease. Time for
reconsideration. Circulation. 1996 Nov 1;94(9):2297-301.

19) Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR
Jr. Sulfonylurea drugs increase early mortality in patients with
diabetes mellitus after direct angioplasty for acute myocardial
infarction. J Am Coll Cardiol. 1999 Jan;33(1):119-24.

20) Purnell JQ. Effect of excessive weight gain with intensive
therapy of type 1 diabetes on lipid levels and blood pressure: results
from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998
Jul 8;280(2):140-6.

21) Colwell JA, Clark CM Jr. Forum Two: Unanswered research
questions about metabolic control in non-insulin-dependent diabetes
mellitus. Ann Intern Med. 1996 Jan 1;124(1 Pt 2):178-9.

22) Gustafsson I, Hildebrandt P, Seibaek M, Melchior T, Torp-Pedersen
C, Kober L, Kaiser-Nielsen P. Long-term prognosis of diabetic
patients with myocardial infarction: relation to antidiabetic
treatment regimen. The TRACE Study Group. Eur Heart J. 2000 Dec;
21(23):1937-43.

23) McDougall J. McDougall's Medicine - A Challenging Second
Opinion. New Century Publication 1985.

24) Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high
carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J
Clin Nutr. 1976 Aug;29(:895-9.

25) Jenkins DJ, Kendall CW, Marchie A, Jenkins AL, Augustin LS,
Ludwig DS, Barnard ND, Anderson JW. Type 2 diabetes and the
vegetarian diet. Am J Clin Nutr. 2003 Sep;78(3 Suppl):610S-616S.

26) Nicholson AS, Sklar M, Barnard ND, Gore S, Sullivan R, Browning
S. Toward improved management of NIDDM: A randomized, controlled,
pilot intervention using a lowfat, vegetarian diet. Prev Med. 1999
Aug;29(2):87-91.

27) Raal FJ, Kalk WJ, Lawson M, Esser JD, Buys R, Fourie L, Panz
VR. Effect of moderate dietary protein restriction on the
progression of overt diabetic nephropathy: a 6-mo prospective study.
Am J Clin Nutr. 1994 Oct;60(4):579-85.

2 Cupisti A. Vegetarian diet alternated with conventional low-
protein diet for patients with chronic renal failure. J Ren Nutr.
2002 Jan;12(1):32-7.

29) Van Eck W. The effect of a low fat diet on the serum lipids in
diabetes and its significance in diabetic retinopathy. Am J Med.
1959; 27:196-211.

30) Kempner W. Effect of the rice diet on diabetes mellitus
associated with vascular disease. Postgrad Med. 1958; 24:359-71.

31) Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT,
Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. Can
lifestyle changes reverse coronary heart disease? The Lifestyle Heart
Trial. Lancet. 1990 Jul 21;336(8708):129-33.

32) Segasothy M, Phillips PA. Vegetarian diet: panacea for modern
lifestyle diseases? QJM. 1999 Sep;92(9):531-44.

33) Fraser G. Ten years of life. Is it a matter of chance? Arch
Intern Med. 161:1645-52, 2001.

34) Key TJ, Davey GK, Appleby PN. Health benefits of a vegetarian
diet. Proc Nutr Soc. 1999 May;58(2):271-5.

35) Sabate J. The contribution of vegetarian diets to health and
disease: a paradigm shift? Am J Clin Nutr. 2003 Sep;78(3 Suppl):
502S-507S.

36) Nicholas P. Hays; Raymond D. Starling; Xiaolan Liu; Dennis H.
Sullivan; Todd A. Trappe; James D. Fluckey; William J. Evans. Effects
of an Ad Libitum Low-Fat, High-Carbohydrate Diet on Body Weight, Body
Composition, and Fat Distribution in Older Men and Women: A Randomized
Controlled Trial. Arch Intern Med. 2004;164:210-217.

37) Jequier E, Bray GA. Low-fat diets are preferred. Am J Med. 2002
Dec 30;113 Suppl 9B:41S-46S.

3 Astrup A, Astrup A, Buemann B, Flint A, Raben A. Low-fat diets
and energy balance: how does the evidence stand in 2002? Proc Nutr
Soc. 2002 May;61(2):299-309.

39) Wing R. Successful weight loss maintenance. Annu Rev Nutr.
2001;21:323-41.

40) Pinkney J. Prevention and cure of type 2 diabetes. BMJ. 2002
Aug 3;325(7358):232-3.
////////////////////////////////////////////////////////////


http://www.nytimes.com/2007/08/20/health/20diabetes.html?em&ex=1187841600&en=f7b182684c4d472d&ei=5087%0A

August 20, 2007
Six Killers: Diabetes
Looking Past Blood Sugar to Survive With Diabetes
By GINA KOLATA

Dave Smith found out he had Type 2 diabetes by accident, after a urine
test.

"Whoa, look at the sugar in here," his doctor told him. Mr. Smith's
blood sugar level was sky high and glucose was spilling into his
urine.

That was about nine years ago, and from then on Mr. Smith, like so
many with diabetes, became fixated on his blood sugar. His doctor
warned him to control it or the consequences could be dire - he could
end up blind or lose a leg. His kidneys could fail.

Mr. Smith, a 43-year-old pastor in Fairmont, Minn., tried hard. When
dieting did not work, he began counting carbohydrates, taking pills to
lower his blood sugar and pricking his finger several times a day to
measure his sugar levels. They remained high, so he agreed to add
insulin to his already complicated regimen. Blood sugar was always on
his mind.

But in focusing entirely on blood sugar, Mr. Smith ended up neglecting
the most important treatment for saving lives - lowering the
cholesterol level. That protects against heart disease, which
eventually kills nearly everyone with diabetes.

He also was missing a second treatment that protects diabetes patients
from heart attacks - controlling blood pressure. Mr. Smith assumed
everything would be taken care of if he could just lower his blood
sugar level.

Blood sugar control is important in diabetes, specialists say. It can
help prevent dreaded complications like blindness, amputations and
kidney failure. But controlling blood sugar is not enough.

Nearly 73,000 Americans die from diabetes annually, more than from any
disease except heart disease, cancer, stroke and pulmonary disease.

Yet, largely because of a misunderstanding of the proper treatment,
most patients are not doing even close to what they should to protect
themselves. In fact, according to the federal Centers for Disease
Control and Prevention, just 7 percent are getting all the treatments
they need.

"That, to me, is mind-boggling," said Dr. Michael A. Brownlee,
director of the JDRF International Center for Diabetic Complications
Research at the Albert Einstein College of Medicine in New York. "It
makes me ask, What is going on? I can only conclude that people are
not aware of their risks and what could be done about them."
brownlee@aecom.yu.edu

In part, the fault for the missed opportunities to prevent
complications and deaths lies with the medical system. Most people who
have diabetes are treated by primary care doctors who had just a few
hours of instruction on diabetes, while they were in medical school.
Then the doctors typically spend just 10 minutes with diabetes
patients, far too little for such a complex disease, specialists say.

In part it is the fault of proliferating advertisements for diabetes
drugs that emphasize blood sugar control, which is difficult and
expensive and has not been proven to save lives.

And in part it is the fault of public health campaigns that give the
impression that diabetes is a matter of an out-of-control diet and
sedentary lifestyle and the most important way to deal with it is to
lose weight.

Most diabetes patients try hard but are unable to control their
disease in this way, and most of the time it progresses as years go
by, no matter what patients do.

Mr. Smith, like 90 percent of diabetes patients, has Type 2 diabetes,
the form that usually arises in adulthood when the insulin-secreting
cells of the pancreas cannot keep up with the body's demand for the
hormone. The other form of diabetes, Type 1, is far less common and
usually arises in childhood or adolescence when insulin-secreting
pancreas cells die.

And, like many diabetes patients, Mr. Smith ended up paying the price
for his misconceptions about diabetes. Last year, he had a life-
threatening heart attack.

The Heart Disease

Just after returning from church last October, Mr. Smith had a
discomforting sensation. Deciding to focus on something else, he went
to a local newspaper office where he was weekend editor. But the
strange feeling persisted and intensified.

"I felt a pain in my chest," Mr. Smith recalled. "It wasn't sharp - it
was more of a kind of pressure, a feeling like something is
contracting."

The pain spread, to his neck, along his shoulder, down to his biceps.
Mr. Smith, alone and frightened, looked up heart attack symptoms on
the American Heart Association's Web site. They were exactly what he
was experiencing.

An hour later, Mr. Smith was at the Mayo Clinic in Rochester, Minn.,
in the throes of a major heart attack, transported by helicopter while
his wife and two young sons frantically drove two and a half hours to
be with him. A main artery to his heart was 90 percent blocked. If he
had waited to seek help or if his local hospital and doctor had not
acted quickly and sent him to the Mayo Clinic, he probably would have
died.

Mr. Smith thought his biggest risk from diabetes was blindness or
amputations. He never thought about heart disease and had no idea how
important it was to control cholesterol levels and blood pressure. He
said his doctor had not advised him to take a cholesterol-lowering or
blood pressure drug and he did not think he needed them.

Most people with diabetes are equally unaware of the danger that heart
disease poses for them.

A recent survey by the American Diabetes Association conducted by
RoperASW found that only 18 percent of people with diabetes believed
that they were at increased risk for cardiovascular disease.

Yet, said Dr. David Nathan, director of the Diabetes Center at
Massachusetts General Hospital, "when you think about it, it's not the
diabetes that kills you, it's the diabetes causing cardiovascular
disease that kills you." dnathan@partners.org

Dr. Brownlee said he was stunned by the results of the diabetes
association poll. "If you are one of those 82 percent who don't think
you are at increased risk," he said, "finding out that you are and
that you can decrease that risk substantially could literally change
your life."

The science is clear on the huge benefits for people with diabetes of
lowering cholesterol and controlling blood pressure. After multiple
studies, costing hundreds of millions of dollars and involving tens of
thousands of subjects, national guidelines were rewritten to reflect
the new data, and professional organizations issued recommendations
for diabetes care.

With cholesterol, the guidelines say that levels of LDL cholesterol,
the form that increases heart disease risk, should be below 100
milligrams per deciliter and, if possible, 70 to 80. Yet, Dr. Brownlee
said, diabetes patients with LDL cholesterol levels of 100 to 139
often are told that their levels - ideal for a healthy person without
diabetes - are terrific.

"Many practicing doctors just don't know that an LDL cholesterol
number that is normal for someone without diabetes is not normal for
someone with diabetes," he said.

Mr. Smith found all that out too late. The heart attack, he said,
"really blindsided me."

He also did not know the other measures proven to prevent
complications in diabetes. He was correct that high blood sugar is
dangerous. It can damage the small blood vessels in the eyes, leading
to blindness; the nerves in the feet, leading to amputations; and the
kidneys, leading to kidney failure.

But no matter how carefully patients try to control their blood sugar,
they can never get it perfect - no drugs can substitute for the body's
normal sugar regulation. So while controlling blood sugar can be
important, other measures also are needed to prevent blindness,
amputations, kidney failure and stroke. Mr. Smith was doing none of
them.

He also made the common assumption that Type 2 diabetes is simply a
consequence of being fat. And that losing weight will help cure it.

Obesity does increase the risk of developing diabetes, but the disease
involves more than being obese. Only 5 percent to 10 percent of obese
people have diabetes, and many with diabetes are not obese. To a large
extent, Type 2 diabetes is genetically determined - if one identical
twin has it, the other has an 80 percent chance of having it too. In
many cases, weight loss can help, but, as Mr. Smith has learned, most
who lose weight are not cured of the disease. He lost 40 pounds but
still has diabetes.

"Everybody in the act of losing weight will have a pretty dramatic
improvement pretty quickly," said Dr. C. Ronald Kahn, a diabetes
researcher and professor of medicine at Harvard Medical School. Blood
sugar levels drop precipitously and the disease seems to be under
control. But that is because the metabolic process of weight loss
lessens diabetes. Once weight is lost, he added, and people stabilize
at a lower weight, their diabetes may remain.

When it comes to weight loss, Dr. Kahn said, "there is a range of
susceptibilities in how people react."
c.ronald.kahn@joslin.harvard.edu

Complex Regimens

Before he left the hospital, Mr. Smith's doctors told him about his
new diabetes regimen: a statin to drive his cholesterol level very
low, two drugs to lower his blood pressure, an aspirin, insulin and
two drugs to reduce his blood sugar levels. That new list of drugs was
what he should have been taking all along.

Mr. Smith is taking them now, terrified that his heart disease will
progress.

"I'll never be out of the woods," he said. "I've got to face that."

Diabetes researchers say stories like Mr. Smith's are all too
familiar.

The statistics are grim: A quarter to a third of all heart attack
patients have diabetes, even though diabetes patients constitute just
9.3 percent of the population. Another 25 percent of heart attack
patients are verging on diabetes with abnormally high blood sugar
levels.

Most worrisome are diabetes patients who already have symptoms of
heart disease, like chest pains or a previous heart attack. "That is a
terrible situation," said Dr. James Cleeman, coordinator of the
National Cholesterol Education Program at the National Institutes of
Health. Those patients, Dr. Cleeman said, are set up for a fatal heart
attack and should be stringently controlling their cholesterol and
blood pressure. (301) 496-4236

And it is not just that many diabetes patients are overweight, as
people with Type 1 diabetes, who often are thin, also have a high risk
of heart disease. There is something about diabetes itself,
researchers say, that leads to high levels of LDL cholesterol and a
form of LDL cholesterol particles that is particularly dangerous.
Diabetes also leads to increased levels of triglycerides, which are
fats in the blood that increase heart disease risk, and in diabetes is
linked to high blood pressure.

Being obese or overweight, in contrast, are "weak contributors to
heart attack risk," Dr. Nathan said.

Type 2 diabetes "does not exist in isolation," Dr. Nathan said.
"Underlying diabetes are all these cardiovascular risk factors."

Somehow, though, it has taken quite a while for the alarm bells to go
off.

One reason might be that it was heart disease researchers, not
diabetes researchers, who conducted the seminal studies.

The key to saving lives is to reduce levels of LDL cholesterol to
below 100 and also control other risk factors like blood pressure and
smoking. The cholesterol reduction alone can reduce the very high risk
of heart attacks and death from cardiovascular disease in people with
diabetes by 30 percent to 40 percent, Dr. Cleeman said. And clinical
trials have found that LDL levels of 70 to 80 are even better for
people with diabetes who already have overt heart disease.

Studies of blood sugar control have been more problematic than those
of cholesterol lowering.

In Type 2 diabetes, the most ambitious effort was a huge study in
Britain. It found that rigorous blood sugar control could lower the
risk of complications that involved damage to small blood vessels, a
list that includes blindness, nerve damage and kidney damage. But
there was no effect on the overall death rate. There was a small
decrease in the number of heart attacks but it was not statistically
significant, meaning it could have occurred by chance.

The National Institutes of Health is trying again, with a larger study
of blood sugar control that includes enough patients to detect more
subtle effects on the heart attack rate if they exist. For now,
though, the answer simply is not known.

In Type 1 diabetes, a large federal study did find evidence that
rigorous blood sugar control could reduce heart disease risk. But the
effect emerged 12 years after the study ended and most of the
patients, in those years, had not been able to sustain the blood sugar
control that they had had during the study. Did the short period of
rigorous control exert a delayed effect on heart disease or was the
effect caused by some other factor during the study or afterward, some
asked? While most think it was caused by blood sugar control, it is
impossible to know for sure.

The result, notes Dr. John Buse, president-elect for science and
medicine at the American Diabetes Association, is that for people with
Type 1 and, especially, for those with Type 2 diabetes, there are
still questions about whether and to what extent blood sugar control
protects against heart disease and saves lives.

That leaves cholesterol lowering, for patients with Type 1 and Type 2
diabetes, as the most effective and easiest way by far to reduce the
risk of heart disease and the only treatment proven to save lives. But
doctors say achieving the recommended cholesterol levels usually means
taking a statin. Some patients resist, wary of intense drug company
marketing to patients and afraid of side effects like muscle or liver
damage which, although extremely rare, have frightened many away from
the drugs, Dr. Brownlee and other diabetes specialists said. (Dr.
Brownlee said he had no financial ties to statin makers.)

Others point to drug company advertising itself.

Statin advertising, said Dr. Irl B. Hirsch, a professor of medicine
and director of the diabetes clinic at the University of Washington,
is all about heart disease, and the advertisements do not mention
diabetes. The diabetes advertisements are all about blood sugar. Dr.
Hirsch has seen few that put the two together.
ihirsch@u.washington.edu,metab@u.washington.edu

Yet lowering cholesterol with statins, Dr. Hirsch and others said, is
much simpler than anything else diabetes patients are asked to do.
And, he added, the drugs are among the best studied and the safest on
the market. (Dr. Hirsch said he had no financial ties to statin
makers.)

Dr. Hirsch has a message for diabetes patients: If he had to rate the
different regimens for a typical middle-age person with Type 2
diabetes, the first priority would be to take a statin and lower the
LDL cholesterol level.

Dr. Brownlee agreed, but added that the two other measures to protect
against heart disease, blood pressure control and taking an aspirin to
prevent blood clots, should not be neglected.

"Right now, without waiting for lots of exciting things that are
almost in the pipeline or in the pipeline, starting tomorrow, if
everyone did these things - taking a statin, taking a blood pressure
medication, and maybe taking an aspirin - you would reduce the heart
attack rate by half."

The Burnout

Even when patients do take the right steps to control diabetes, the
grueling process can simply wear them down.

Virgil Umbarger learned that he had Type 2 diabetes when he was 39 and
had a medical exam for a life insurance policy.

That was 25 years ago, and the start of a journey that diabetes
specialists say ends up fundamentally changing a person's world.
Unlike Mr. Smith, who has just awakened to the danger he is in, Mr.
Umbarger, a funeral director in Yakima, Wash., has lived with diabetes
and its increasingly complex regimen for decades. And, as happens with
most diabetes patients eventually, he feels he is reaching a point
where he just cannot continue to do all that he should to protect his
health.

In a sense, Mr. Umbarger said, he was not completely surprised when he
learned he had diabetes, because it runs in his family. But he never
thought it would happen to him. At 6 feet tall and 195 pounds, he was
not heavy.

Still, Mr. Umbarger's first thought was to lose weight. "I starved
myself," he said, and lost 15 pounds. But he still had diabetes and
the pounds crept back on.

Dr. Buse said his patients knew how important it was to diet and
exercise, but most could not do it enough to make a difference, and
some were also thwarted by medications to control blood sugar that
make patients gain weight.

In the end, Mr. Umbarger decided to seek care from a diabetes
specialist. He chose Dr. Hirsch, even though it meant driving nearly
three hours each way for an office visit. There was no one nearby with
that kind of expertise, Mr. Umbarger said.

On his first visit, Dr. Hirsch gave him a fistful of prescriptions,
including a statin, blood pressure medications and one for the drug
Mr. Umbarger dreaded - insulin. He also told Mr. Umbarger to have
regular checks for eye, nerve and kidney damage. And he has to watch
what he eats and count carbohydrates.

Dr. Hirsch and other diabetes specialists say they are well aware of
how daunting the program can be.

"Many come here once or twice and walk away saying, 'I don't want to
do this,' " Dr. Hirsch said.

Not Mr. Umbarger. For years, he tried to do all that was required. He
can cope with the medications and the long drives to see Dr. Hirsch.
The problem for him, as for most diabetes patients eventually, is the
blood sugar monitoring. He is supposed to prick his finger six or more
times a day to measure his glucose levels and adjust his insulin dose
accordingly.

Every time he checks his blood sugar is like getting a report card -
was he eating too many carbohydrates? Did he get the insulin dose
right?

"I don't want to look," he said.

"Pricking your finger, seeing that number day after day, it wears on
you," Mr. Umbarger said. "It's like a ball and chain." He confesses
that he has only been checking his blood sugar once or twice a day,
guessing at many of his insulin doses. His blood sugar levels have
been rising and guilt hangs over him.

Meanwhile, no matter what they do, most people with Type 2 diabetes
get worse as the years go by. Patients make less and less insulin and
their cells become less and less able to use the insulin they do
produce.

"That is why it is not uncommon to start initially with diet therapy,
then after a few years we need to add a drug that improves insulin
sensitivity," Dr. Kahn said. "Then when that drug isn't enough, we add
a second drug that improves insulin sensitivity by a different
mechanism. Then we add a drug that stimulates that pancreas to make
more insulin."

Then, he added, patients with Type 2 diabetes may need insulin itself,
but when that happens they have to take even more than a person with
Type 1 diabetes - two or even three times as much - because their
cells no longer respond adequately to the hormone.

While it is not easy to re-energize burned-out patients, Dr. Hirsch
said, at the very least, doctors and patients should know what is
important.

"We already have the miracle pills" - statins and blood pressure
medications, he said. And they are available for pennies a day, as
generics.

"We need patient education and physician training that this stuff is
out there and this is what we should be focusing on to make a
difference in lives."

Copyright 2007 The New York Times Company

www.mindfully.org/Reform/Gina-Kolata-Dowie6jul98.htm

MARK DOWIE The Nation July 6, 1998 critique of Gina Kolata
for usually toeing the corporate line

www.sourcewatch.org/index.php?title=Gina_Kolata
Center for Media and Democracy [ selection ]
bob@sourcewatch.org

" Too Much Fat in Kolata's Coverage?

Writing for the Columbia Journalism Review's CJR Daily, Felix Gillette
criticizes a February 2006 story by Gina Kolata on a major study
examining a low-fat diet for postmenopausal women and finding little
positive impact. Gillette says Gina Kolata's article in the New York
Times hyped the study: "[T]he warnings about the potential
shortcomings of the study were surrounded by quotes from doctors
pumping up the study's 'Holy Geez!' index." [17]

The third paragraph in Kolata's front page story reported: "These
studies are revolutionary," said Dr. Jules Hirsch, physician in chief
emeritus at Rockefeller University in New York City, who has spent a
lifetime studying the effects of diets on weight and health. "They
should put a stop to this era of thinking that we have all the
information we need to change the whole national diet and make
everybody healthy." [18]

"So revolutionary, in fact, that over at the Wall Street Journal,
editors found the perfect spot to highlight their story on the same
study -- deep, deep, deep inside the paper. Specifically, under a one-
column headline on page D5. And even though the Journal's article
about the federal study was less than half as long as the Times'
piece, it managed to bring to the topic twice the skepticism,"
Gillette wrote. [19]

Gillette compliments other reporters, saying "perhaps the best article
of the bunch was penned by one of the skeptics quoted in Kolata's
story," low fat diet proponent Dr. Dean Ornish. [20]

Ornish pointed to a number of major limitations in the study:

* The study participants did not reduce their dietary fat very
much--29 percent of their diet was comprised of fat, not the study's
goal of 20 percent. Even this may be an overestimation, since it's
very common for people to report that they're following a diet better
than they really are.

* They did not increase their consumption of fruits and vegetables
very much.

* The comparison group also reduced its consumption of fat almost as
much and increased its consumption of fruits and vegetables, making it
harder to show between-group differences. Neither group significantly
changed its consumption of grains.

* As a result, LDL-cholesterol ("bad cholesterol") decreased only 2.6
percent more in the low-fat diet group than in the comparison group,
hardly any difference at all. Blood pressure decreased hardly at all
in either group, by only about 2 percent in both groups.

* The study did not last long enough to expect to see a difference in
preventing cancer.

Also, this study didn't distinguish between fats that are beneficial
and ones that are harmful," he wrote. [21].

On Newsweek's web site Ornish "provided a clear and nuanced take on
the study. 'The real lesson of the Women's Health Initiative study is
this: if you don't change much, you don't improve much. Small changes
in diet don't have much effect on preventing heart disease and cancer
in those at high risk. Fat is only part of the story. What we include
in our diets is at least as important as what we exclude.' Ditto for
good journalism -- what a paper such as the Times chooses to include
on its front page is at least as important as what it excludes. On
this one, we recommend a little less Kolata in the diet, and a few
more caveats." [22] "
////////////////////////////////////////////////////////////


http://groups.yahoo.com/group/aspartameNM/message/1464
13 mainstream research studies in 24 months showing aspartame
toxicity, also 3 relevant studies on methan...(message truncated)

Archived from group: alt>support>diabetes