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These are the findings from an extraordinary new study that was recently published in The New England Journal of Medicine, and in this blog, the second in my three-part series on diabesity, I am going to tell you all about that study and its profound implications for the treatment of obesity, diabetes, and other related conditions.
In last week's blog you were introduced to the concept of diabesity, and learned that conventional treatments typically don't work to treat it. Today we'll see WHY those treatments don't work and look at the REAL way to treat the problem. Let's start with one of the most fascinating medical studies published in recent times ...
The ACCORD Study: Revolutionizing Our Understanding of Diabesity
In 2008, an extraordinary study was published in The New England Journal of Medicine. It is called the ACCORD study (i), and it is one of the most profound pieces of literature that exists regarding why conventional treatments for diabetes simply do not work.
In the study 10,000 patients with diabetes were designated to receive intensive or regular therapy to lower blood sugar. These patients were monitored and their risks of heart attack, stroke, and death were evaluated. The patients who had their blood sugar lowered the most had a higher risk of death.
Let me repeat that, because I really want you to understand it: The patients who had their blood sugar LOWERED the most had a HIGHER risk of death. How could this happen if, as we believe, elevated blood sugar is the cause of all the evils of diabetes? Why would lowering blood sugar lead to worse outcomes?
Amazingly, the study had to be stopped after three and a half years because it was evident that the aggressive blood sugar lowering led to more deaths and more heart attacks. This completely explodes the way conventional medicine understands and treats diabetes. It's a revolutionary study. Yet for those of us who have been working to understand the REAL causes of diabesity, it isn't all that surprising.
How could LOWERING blood sugar INCREASE your risk of death?
The reason is simple: Elevated blood sugar is actually a symptom of underlying metabolic, physiologic, and biochemical processes that are out of balance ... and lowering blood sugar with medications does not address the underlying issues that gave rise to the high blood sugar in the first place. This may surprise you, but many of the methods used to lower blood sugar such as insulin or oral hypoglycemic drugs actually make the problem worse by increasing insulin levels.
Type 2 diabetes is a disease of too much, not too little, insulin. Insulin is the real driver of problems with diabesity. That means you don't simply need more insulin in your blood to lower your blood sugar. Instead, what you need to do is treat the underlying causes that gave rise to the high blood sugar and insulin in the first place. And that is insulin resistance.
Insulin Resistance: The Real Cause of Diabesity
Insulin resistance occurs when your diet is full of empty calories and has an abundance of quickly absorbed sugars, liquid calories (ii), and carbohydrates (like bread, pasta, rice, and potatoes). When this happens, your cells slowly become resistant to the effects of insulin. You need more and more to do the same job of keeping your blood sugar even. Thus you develop insulin resistance.
High insulin levels are the first sign of a problem. The higher your insulin levels are, the worse your insulin resistance. As a result your body starts to age and deteriorate. In fact insulin resistance is the single most important phenomena that leads to rapid and premature aging and all its resultant diseases including heart disease, stroke, dementia, and cancer.(iii),(iv)
As your insulin levels increase it leads to an appetite that is out of control, increasing weight gain around the belly, more inflammation and oxidative stress, and myriad downstream effects including high blood pressure, high cholesterol, low HDL, high triglycerides (v), weight gain around the middle, thickening of the blood, and increased rates of cancer, Alzheimer's, and depression. These are all a result of insulin resistance and too much insulin. Elevated blood sugar is not the source of the problem.
Understanding this has a profound impact on the whole way we think about diabesity. It's not simply a matter of shifting our focus from one type of medication to another. This completely alters the fundamental way we understand the disease.
In fact, in some sense, diabesity isn't a "disease" at all. It's simply a continuum that stretches from optimal health to full-blown illness. Let me take a few moments to explain this, because it is essential for you to understand if you want to fully realize the potential of this new paradigm to prevent or reverse diabesity.
The Continuum Concept
Most medicine is based on clear-cut, on-or-off, yes-or-no diagnoses. Most conventional doctors are taught that you have a disease or you don't, you have diabetes or you don't. There are no gray areas. This approach is not only misguided, it is dangerous, because it misses the underlying causes and more subtle manifestations of illness.
Practicing medicine this way completely ignores one of the most fundamental laws of physiology, biology, and disease: The continuum concept. There is a continuum from optimal health to hidden imbalance to serious dysfunction to disease. Anywhere along that continuum, we can intervene and reverse the process. The sooner we address it, the better.
When it comes to diabesity most doctors just follow blood sugar, which actually rises very late in the disease process. Conventional medicine tells us if your blood sugar is 90 or 110, you don't have diabetes; if it is over 126, you do have diabetes. But these distinctions are completely arbitrary, and they do nothing to help treat impending problems.
I remember one patient, Daren, came to see me with mildly elevated blood sugar. I asked Daren if he had seen his doctor about this. He said, "Yes". I then asked "What did your doctor say?" Daren's doctor told him, "We are going to wait and watch until your blood sugar is more elevated, then we are going to treat you with medication for diabetes."
Given our current level of scientific understanding of diabesity, I find this concept of watching and waiting until more serious disease occurs unfortunate, misguided, and in some cases it's deadly.
It is also why diabesity is so woefully and inadequately diagnosed and treated. Millions of Americans are suffering needlessly from chronic symptoms. Nearly half of all diabetics are undiagnosed. Nearly ALL of the 100 million Americans with pre-diabetes are undiagnosed.
Why? Most doctors just don't know how to diagnose it, or what to do about it, because there is no good drug treatment.
The truth is the road to diabetes starts as early as childhood.(vi) We now know that there is an epidemic of type 2 diabetes in children as young as eight years old (vii), and pediatric diabetic specialists who used to only care for type 1 diabetes, now find their offices are overwhelmed with cases of type 2 diabetes.
By the time you get diagnosed with diabetes you have had problems with insulin and blood sugar that could have been detected twenty to thirty years earlier. That is, if you knew where to look, which most doctors are not trained to do.
Insulin resistance and diabesity is often accompanied by:
• Belly fat
• Fatigue after meals
• Sugar cravings
• High triglycerides
• Low HDL
• High blood pressure
• Problems with blood clotting
• Increased inflammation
These clues can often be picked up long before you ever get diabetes and may help you prevent the disease entirely. Why is this important? Because insulin resistance can cause SUBSTANTIAL health risks even in the absence of full blown diabetes.
In part one of this blog series I reviewed some of the common complications of diabetes. But what most people (including most doctors) don't realize is that insulin resistance or pre-diabetes can be just as bad and can lead to nearly ALL of these complications even in the absence of a technical diagnosis of diabetes.
In fact, many people with pre-diabetes never get diabetes, but they are at severe risk just the same. We could eliminate many of the long-term complications of diabesity if we simply addressed these symptoms and diagnosed the problem much earlier in the process--that is to say, much earlier on the continuum.
This leaves us with a couple of questions:
1. What is causing our insulin resistance?
2. How can we address the fundamental underlying problem of our bodies resisting the effects of its own insulin?
It is only by answering these questions and addressing the real causes of diabesity--the factors that are leading to this problem with insulin resistance--that we will effectively treat this terrifying disease.
Any hope we have for resolving this pandemic must use a new approach to the diagnosis and treatment of diabesity. That approach is called Functional medicine. And I am going to explain what it is and how you can use it to help you heal from diabesity in the next blog in this series.
By applying this new form of medicine to your health problems you may overcome diabesity and become vibrantly health once again.
Now I'd like to hear from you ...
Are you taking insulin and if so, how has it helped, or not, with your diabesity?
What do you think about conventional medical approaches to treating this problem?
What do you think about the continuum concept? Has your experience with diabesity reflected this continuum?
Please let me know your thoughts by leaving a comment below.
To your good health,
Mark Hyman, MD
(i) Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun 12;358(24):2545-59.
(ii) Chen L, Appel LJ, Loria C, Lin PH, Champagne CM, Elmer PJ, Ard JD, Mitchell D, Batch BC, Svetkey LP, Caballero B. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr. 2009 May;89(5):1299-306.
(iii) Bhashyam S, Parikh P, Bolukoglu H, Shannon AH, Porter JH, Shen YT, Shannon RP. Aging is associated with myocardial insulin resistance and mitochondrial dysfunction. Am J Physiol Heart Circ Physiol. 2007 Nov;293(5):H3063-71.
(iv) Ryan AS. Insulin resistance with aging: effects of diet and exercise. Sports Med. 2000 Nov;30(5):327-46. Review.
(v) Gaziano JM, Hennekens CH, O'Donnell CJ, Breslow JL, Buring JE. Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation. 1997 Oct 21;96(8):2520-5.
(vi) Nelson RA, Bremer AA. Insulin Resistance and Metabolic Syndrome in the Pediatric Population. Metab Syndr Relat Disord. 2009 Nov 29.
(vii) Silverstein JH, Rosenbloom AL. Type 2 diabetes in children. Curr Diab Rep. 2001 Aug;1(1):19-27. Review.
Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.