WHAT DO WE DIE OF WHEN WE DIE OF DIABETES?

The obituaries in the Great Falls Tribune, a Montana newspaper reporting on a population high in grain farmers and Indians, increasingly attributes death to diabetes or “side effects.” Were these deaths by heart attacks, strokes, amputations, blindness... what? I’m being told that most diabetics die of heart attacks and therefore I should keep my blood glucose scores in the eighties or nineties -- 100 presumably being “normal.” But I’m also being warned that a score too low (I dip as low as 70.) will cause me to slip into a seizure which can be fatal. Is this what’s causing the deaths in the obits? Death by hypoglycemic seizure, which is more common in old people? I suspect that it is more likely the fact that there is a lot of attention to diabetes and a wish to impress upon people that not taking action can kill them. Something like the insistence on seat belts.

My diabetic friend and I have noticed that increasingly our doctors get angry when we ask questions or if we don’t respond to our meds the way they think we ought to. As my friend puts it, “They have this little routine set of answers and protocols, and if you don’t fit, they get mad.” Even my pharmacist, a cool guy who seems open to ideas, became impatient the last time I asked too many questions. I think this is because increasingly the realization is dawning that the problem is not being solved and authorities are indulging a tendency to “blame the victim” again. The assumption is that if dieting doesn’t work, it’s because the patient is shirking the diet. After all, if “she” [sic] weren’t such a sugar pig, she wouldn’t have gotten diabetes in the first place. (Illness as retribution for sin.)

Gary Taubes, author of “Good Calories, Bad Calories,” is a science writer who explores issues we have taken for granted. He comes to the conclusion that much of what we “know” is wrong. We DO know that: “The obesity epidemic starts between 1976, say, and 1986. We're fairly confident about that because there're these series of National Health Examination surveys, and we know that in the third NHANES survey, obesity rates are still 14 percent.... And then somewhere in that period between the late '70s and late '80s, they shoot up to 22-25 percent. That's known as the obesity epidemic, and the idea is: What explains it?

“From my fat research, I already knew that there were two major changes in the country during that period. One was, high-fructose corn syrup came in as sort of the primary caloric sweetener in America, which was my personal bias. I thought that it was high-fructose corn syrup because I'm allergic to high fructose corn syrup. “…[Local ag newspapers are beginning to actively oppose this now, so it must be having some impact!]

The other factor is highly processed sugars and starches. This fits with the glycemic index approach best explained by Aussies who are not dominated by the US’s Industrial Diabetes Cartel. You can get to them through Google. This is the way I lost fifty pounds in a hurry when I was diagnosed with Diabetes 2.

Taubes is open to the idea of “metabolic disorder” rather than just “high sugar.” He points out that insulin (and estrogen) are traffic directors that help to set points at which weight stabilizes, that guide different sugars and fats to different places in the body and help transform one into another. In other words, he’s willing to look at the major associated metabolic feedback loops that should be monitored by each person: high blood glucose, lipids, and high blood pressure. It seems clear that some mechanism under ALL of them is the REAL problem. We are only addressing symptoms.

In 1990 in Great Falls, I went to a gynecologist without the guidance of my internist, because the latter was on vacation and it was a sort of hurry-up situation. When my wise doc found out to whom I had been assigned (it was a clinic), he sighed, and soon I sighed, too. This was an angry gynecologist who declared I MUST lose weight, who scolded that it was just a matter of decent moderation, and who prescribed premarin (for menopause troubles) in an amount that made my pharmacist raise his eyebrows. This gynie was a younger version of a Sixties gynecologist (same town) who had insisted I lose weight and prescribed both thyroid extract and amphetamines. I took them, ruined my equanimity and did not lose weight, which made him very angry. (I have a suspicion that too many men who hate women go into gynecology. I have theories about why.)

In the Nineties I was beginning to really wonder about weight gain (I weighed just a little more than I do now -- about 200 when my ideal should be more like 150. But this seems to be a set point.) and to accumulate books about the issue. Not diet books, but physiology and metabolism books about stuff like cell membranes and ion pumps. I gave my best anthology of essays to that gynie to try to smarten him up and now I wish I hadn’t. That book seems highly relevant and I may have to scout for replacements. Maybe the research has moved along now anyway, maybe helped by genome information since much seems related to a sort of subtle ethnic adaptation to region. And maybe Google will work better than any book at this point.

It’s possible that this metabolic syndrome is due to more than the kind or amount of food one eats or to one’s heredity. Some have suggested a virus, and certainly we’re beginning to realize how much double-helix code is floating around the world, looking for a cell to call home. Or it’s possible that there is an environmental contaminant that is slow-acting and pervasive. It seems clearly related to wealthy countries: life-style issues as they say. Or possibly there is an actual genetic mal-mutation or a prion floating around.

Taubes again: “One of the things I had always tried to understand, the orthodox wisdom is [to] cut back. Just eat less, and yet people eat less and they don't lose weight. I've eaten less and I've not lost weight. I mean, it doesn't seem to work, and I kept saying to myself: Why can you tell people over and over again [to] eat less, and yet they don't lose any weight?

“The thing they never pay attention to -- and I've interviewed probably 300 or 400 researchers in the obesity/heart disease field in the past four to five years, and in obesity in particular -- they do not consider hunger a physiological phenomenon. They will talk about hunger hormones, hunger genes ... But hunger to them has always been something that's purely psychological on some level, so they could put people on a diet.

“But [now] everyone agrees that insulin is the hormone that controls the deposition of sugar and carbohydrates and fat in your body. They agree that if insulin levels are high, you'll preferentially store calories as fat; and that as long as insulin levels stay high, you won't be able to get to that fat to use it for fuel. They agree that carbohydrates will raise insulin levels more than fat -- fat doesn't have an effect on insulin, although if you force-feed enough calories, you can [raise] it. All of that is given....

“It's not just the calories. That's the point. It's the effect of the calories on the hormones, and the effect of the hormones on how your body decides to use the calories you're eating -- is it going to burn them as fuel or store them as fat -- and that effect on hunger.”

Is it possible that in rich countries many of us are dying of hunger? I think so. And not just hunger for food either: hunger for attention, hunger for intimacy, hunger for achievement, hunger for understanding, hunger for control of our own lives, hunger for safety. We have a lot of work to do and angry docs won’t help, even if we hungry folks are fouling up the ten-minute interval schedule that guarantees their income.