Wednesday, 30 September 2015

Diabetes Australia asked to see my junk

I started typing a post with a plan in my mind to take an approach I’d not seriously attempted before – to write about a topic without swearing, being sarcastic, negative and, basically, not being a complete smart arse. I figure that every now and then I should be brave and try out new things.

The topic was type 2 diabetes and how it related to the Australian dietary guidelines. I'm familiar with the guidelines because I had a fairly close look at them a couple of years ago and I knew there was no way the advice was appropriate for Type 2 diabetics. 

I thought the post was going quite well, but then I made the mistake of looking up the local diabetic authorities, Diabetes Australia, to see if they had anything to say that was different from the maniacs that publish the dietary guidelines. 

I soon found myself in a state of bewilderment. I was dumbfounded and stupefied, stunned to the point of confusion. The statements they made were figuratively hitting me in the face with repetitive accuracy and I was left punch drunk and staring off in to space. 

You see, visiting the DA website is like being at a social gathering and getting in to a conversation with someone, who on first impressions seems quite nice, but then out of nowhere they drop inappropriate comments one after the other: 
  • They bitch about “dark-skinned foreigners” moving in next door. 
  • They say Asylum seekers are all wealthy economic tourists that have come to steal our jobs and our women. 
  • They say starving kids in 3rd world countries should blame their parents for not having a decent job and providing better care and clean water.
  • They tell you a story about the time they performed an exorcism on their son after he announced he was gay. 
  • They blame his gayness on being circumcised by a male surgeon who wore an earring and looked a bit suss.
  • They ask me if I'm circumcised. 
  • And if I will prove it.
Imagine being a party to that conversation, and that's roughly the feeling I had as a visitor to the land of inappropriate advice. 

Suffice to say I gave up on my plan to be serious and curb the swearing, but I’ll post my attempt anyway and see if you can spot the point where I visited DA website.

Slow-moving authorities

Despite the so-called ‘epidemic’ of obesity and type 2 diabetes that has evolved over the last few decades, it is perhaps a little surprising that the subject of nutrition is still so divisive. Like religion and politics, views on what constitutes the path forward are diverse and tightly held on to. In a world where all the information is widely available to anyone with an internet connection, opinions change rarely, or not at all, and new ideas are labelled as dangerous fads that will never last or will simply make things worse.

Perhaps the most resistant to change are the nutritional authorities themselves, who, after at least 30 years of proclaiming the same solution, and finding ourselves with the opposite of what was promised, are left with nothing but the claim that humans are lazy gluttons who decided all those years ago to stop listening to sound advice.

There are not many other fields where an authority would dare claim something so obviously ridiculous. Any competent institution that proclaimed to hold the ultimate truth on how to swim, would logically change their advice if a significant percentage of their customers drowned or failed to tread water without placing floaties around their arms. To not do so would be inherently unconscionable.

Given the polarised beliefs on nutrition and the overarching Government-authorised advice that remains unmoved, let’s instead look for what can be agreed upon and go from there. I am not diabetic, that I know of, and I'm clearly not a biochemist, so what follows is a lay-person's simplistic summary of a very complex and multifaceted process.

What is Type 2 Diabetes?

Type 2 diabetes (T2D), the non-genetic version that used to be called ‘adult-onset’ diabetes, is now presenting itself in children. Type 2 diabetics have an increased risk of heart disease, organ failure, dementia and circulation problems that can lead to drastic surgery such as amputation. It is clearly a condition a sane person would choose to avoid.

Looking at T2D from a very high and simplistic level – it is essentially a condition where the human body is failing to normalise blood sugar levels. This happens, in part, because the body's cells have become resistant to the hormone insulin. 

Insulin and Glucagon are the two key hormones that play vital roles in regulating blood sugar. Glucagon, secreted by pancreatic cells and also the stomach, ensures blood sugar levels do not get too low. Low blood sugar is not a good thing, clearly, because if it gets too low, you will drop dead. No joke. 

Insulin, secreted by the pancreas, has the opposite effect, suppressing glucagon and ensuring the removal of glucose from the bloodstream, delivering it to the cells that require it for energy, or storing it for later use.

If the blood stream is subjected to regular high levels of glucose, the pancreas tries to keep up by producing more insulin, but eventually the body’s cells say “sorry, I'm not listening any more” and become what is referred to as ‘insulin resistant’. 

Due to the inability of insulin and glucagon to play the game they were designed to play, the blood glucose levels remain high and you end up with T2D.

So you now have a typical Type 2 diabetic, whose body has almost given up on trying to clear glucose from their bloodstream. Clearly they would benefit from reducing the intake of foods that result in increased glucose in their blood stream. This is not just my opinion, it is both logical and reasonable.

You are not what you eat...but

You are not what you eat, but if you you base your diet on food that breaks down into glucose and then wallows in your blood stream, you are in dire need of a diet adjustment. So, what are the nutrients that break down into glucose? Common table sugar is the most obvious answer, but what about on a higher level, the macronutrients of protein, fat and carbohydrate? 

Protein can be broken down into glucose in a process called gluconeogenesis. Digested fat, despite what a lot of people seem to think, won't magically move from your stomach to your arteries, rather it is broken down into fatty acids and glycerol. Eating fat does not make you fat, but that's a whole other story.

Carbohydrates of any kind, be they bread, table sugar, pasta, wholegrains, beans, fruit – will all break down into glucose in the blood stream. There are no exceptions, that is what happens.

Of all the macronutrients, dietary fat, is clearly not the enemy of Type 2 diabetics.

Advice for Type 2 Diabetics.

Given the simplicity of this overview, and trying to ignore all of your pre-existing ideas on what is 'healthy food', what do you think the nutritional authorities recommend that type 2 diabetics eat? 

Pretend you are now an expert (go on, I do it all the time and it's loads of fun) - what would you personally suggest that a T2D eat to minimise the glucose that enters their blood stream after a meal? 

Would your advice involve eating meals that comprise at least 60% carbohydrates

A yes or no answer, please. There is no room for discussion of what you think are healthy/complex/low-glycemic carbohydrates. Remember they all end up as glucose and we’re talking about a person who’s internal organs are not coping well with glucose.

Put another way, would you recommend to your friend or family member, people you love, that despite their inability to metabolise this sugar, that they eat food that is going to increase their blood sugar levels, exacerbate their condition and make them sicker?

Of course you wouldn't. Just like you wouldn't hand your lactose-intolerant child a chocolate milkshake or a bowl full of cheese. Or your celiac child a bowl full of weetbix. It makes no sense.

I'm not advocating a diet totally void of carbohydrates, that clearly doesn't suit a lot of people. But there is a world of difference between restricting carbohydrates and basing your diet on them.

This is what the Australian national body for diabetes infor…oh,...wow.
Lower in what?

I'm confused. If only a quarter of  your plate is carbohydrates, and fat is to be avoided, diabetics need to eat at least 70% protein?

Note the last sentence - that is clearly sound advice, because your brain would die a horrible death without the goodness of carbohydrates.

Holy fucking crap
It's a 'fact', but curiously, also incorrect that you must be fat to get T2D.

And from the Queensland diabetic website:
Christ on a bike, what the hell are these people on?
Timmy says too much sugar does not equal "a poor diet"

All this madness makes me very glad I do not have diabetes, and equally glad I have a functioning brain to be able to immediately see that the authorities' advice amounts to one massive pile of steaming vegan shit.

Which leads to the equally sad and bizarre situation that Jennifer Elliot finds herself in.

Summary

I am not a doctor, biochemist or Associate Professor in Nutrition like young Timmy Crowe, so please do not take your advice from me. If you are keen to avoid developing type 2 diabetes, and who isn't, please research the facts, compare those facts with what your doctor or diabetic expert is advising, and act accordingly. 

My brains hurts. It must be craving more glucose.


9 comments:

  1. Another great rant!

    Even more entertaining than Verner Wheelock's (and it was classic too) :-)

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    1. Thanks, Indy Jill. Have a good one.

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  2. Hi Chips,

    good ranting there, welcome to my world - I am an official T2DM. I completely avoid consulting with any diabetologists or dieticans and it is quite a struggle to educate my own GP who has every appearance of being severely insulin resistant himself.

    You'll just make yourself sick with worry if you read the advice those idiots are handing out and if you ever were to believe what they say then you'd just make yourself sick, fullstop.


    Have you been following the facebook comments at the (American) ADA site where they stupidly asked everyone to tell them their latest bg readings?

    https://www.facebook.com/AmericanDiabetesAssociation/posts/10153140618374033

    It's been a non-stop condemnation of their official line and a fantastic endorsement of the LCHF & Bernstein approaches with hundreds of comments like this: "I Couldn't believe the diet that was suggested by the ADA, was a more carb laden diet than the old Weight Watchers"; "readings used to average between 180 and 250. Used to. Once I dumped the ADA diet recommendations they don't even come close to that."

    Meanwhile if you watched Four Corners this week you would have enjoyed the spectacle of Norman Swan claiming that we would save multi-billions of dollars from the Au healthcare budget if we stopped funding eg prostate screening, mri scans for lower back pain, arthroscopic knee surgery and other treatments proven to be ineffective or harmful. Imagine if he abandoned his ridiculous pro-statin, anti-cholesterol anti-fat position how much more money could be saved?

    Any idea how much money the PBS actually forks out for statins?
    C.

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    1. Sounds like hard work, C. The ADA thing was funny.

      Re the PBS, I assume the answer is 'shitloads' - and is possibly in here somewhere - http://www.pbs.gov.au/statistics/2013-2014-files/expenditure-and-prescriptions-12-months-to-30-june-2014.pdf

      Seems fairly clear statins are both the highest volume and highest cost drug. Page 5 says Gov cost is $1.7B? Not sure if I'm reading that correctly.

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  3. LOVE your sense of humor! Or maybe it's outrage. Hard to tell them apart sometimes, just like in my own writing, hehheh. ;-) I think it's going to take a couple more decades, but some time in the future, medical and nutrition "authorities" will look back on these kinds of recommendations and cringe, knowing full well that they were literally killing people. (My mother included, God dammit.)

    Honestly, whenever I hear or read a dietitian or doctor saying some nonsense about carbohydrates being required for energy, or that the brain needs a certain amount of (dietary) carbohydrate to get from one second to the next, lest you die from a whole grain deficiency, I have to shake my my head and wonder if they have ever, ever looked in a freaking biochemistry textbook. Do any of these "certified diabetes educators" (as they're called in the U.S.) know anything -- anything at all -- about human metabolism? It appears not. (And truth be told, the sad fact is, biochemistry textbooks can show the beauty of beta-oxidation, what happens when insulin levels are low, etc., and then *still* prattle on about the dangers of fat, and how we "need" a certain amount of carbohydrates.) Even in my nutrition graduate classes, there were very few others who looked at things the way I did and "got it."

    You made a great point when you wondered whether these people would recommend high-carb diets to their mother/husband/son/friend if they had diabetes.

    I think my favorite part is when all these "experts" are insisting it's not about the sugar & carbs in the diet, but more about being overweight, especially in the mid-section. Funny, isn't it, that none of them elaborate on the role of sugar & carbs in putting that extra weight there? Wankers.

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    1. Thanks, Amy. It felt a bit awkward writing about a condition I only know a bit about due to other sites like yours, but the shock of my first visit to 'their' website had me up and about.

      And cheers for putting it on your T-feed. I was wondering why the view count was so high.

      Keep up the good work.

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  4. Hi Amy, Chips,

    I found myself in the loudly-swearing-disbelief-lizard position this morning ( #335b in the manual) after listening to another dietician clone being co-interviewed with a famous chef on national radio with both of them making the case that MSG is perfectly alright to eat after all, add it freely, and much less harmful than salt and sugar and fat. etc etc etc ---- you can fill in the details by rote after that. I guess if I was in the business of either making or prescribing bland unsalted low-fat food for a living I might also feel the need to justify adding chemicals which make it taste interesting and hang the consequences but I wouldn't shout it out in public.

    To relax afterwards I headed over to Malcolm K's blog to catch up with the politics of study 329, and then the story of Dr Healy

    http://davidhealy.org/wp-content/uploads/2012/11/2008-Healy-Academic-Stalking.pdf


    THEN I was good and ready for my blood pressure medication - oh wait, I've stopped taking it because it made my ears throb and the food gag in my mouth.


    Chips, I don't know how you stay so calm and level headed.
    C.

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    1. After seeing bags of MSG for sale at a local Asian food store, I'm glad I'm not so desperate for flavour that I'd consider putting it in my food. Poor buggers.

      Thanks for the Healy link.

      Have a good one.

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  5. Actually, there is SFA lactose in cheese- It is very low carb so I love eating cheese on LCHF. The body has very limited carb stores, so If you have a high calorie intake, Insulin directs both the fat in the diet and the carbs to- visceral fat- the bad stuff. Giving your digestive system a rest (Intermittent fasting) and eating a LCHF diet CURES TYPE 2 Diabetes.With no drugs, no patent, not even SCIENTIFIC GLORY (It was standard medical practice- Check Osler's internal medicine published in the 19th century!).

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