Category Archives: diabetes mellitus type 2

Action in diabetes and vascular disease

Jean Sterne: the first to trial metformin on humans. According to Diabetologia, Sterne was an army medic. ‘Taken prisoner, he escaped to Morocco, where he worked as a musician. He returned to France to assist in the liberation of Toulouse. In 1956, after several years working in a Casablanca hospital, he took a post at Aron Labs in Suresnes.’

Much of what doctors do, writes Dalrymple,

is less than scientifically sound or justified, and some of it is downright harmful.

He cites an item from the back of a recent edition of the British Medical Journal. It comes from a column called ‘Minerva’,€ which supplies very short summaries of papers in other medical journals. It reads:

If patients knew how little the drugs they were taking were likely to benefit them, would they bother to carry on? In type 2 diabetes, tight blood pressure control is probably only of value above a certain threshold of cardiovascular risk, as shown by the ADVANCE trial, among others. But an analysis of the ADVANCE data shows that even if you select the patients at the highest risk, you would need to treat 200 for five years to prevent one adverse event.

What this paragraph is saying, Dalrymple explains,

is that untold thousands, possibly even millions, of people are being treated with drugs with actual or potential side effects, at enormous expense and effort, all to no benefit whatsoever to themselves. They do not know or appreciate this, even if they have been told of the logic and statistics on the basis of which they are being treated: for patients often fail to listen to, understand, or retain the information given them by their doctors. (And some doctors give no information.)

He points out that the actual situation is worse than the paragraph conveys,

for when trials such as the ADVANCE are carried out, the test patients’€™ compliance with their medication — the degree to which they take what they are prescribed€ — is usually much better than in normal conditions.

A half of patients prescribed antihypertensive pills

stop taking them within twelve months; the rest rarely take them precisely as prescribed. And most of the patients given the drugs in the first place will not even fall into the category at highest risk, two hundred of whom have to take the drugs for five years to prevent one stroke or heart attack.

Only one conclusion is possible:

the principal beneficiaries of this medical endeavour are the drug manufacturers, with the doctors a poor second.

You bet your sweet life

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Entering a supermarket in Nauru, Dalrymple finds that there is a large supply of Sauternes wine

The wages of sin — gluttony

Dalrymple is delighted to read in a paper published in a medical journal that those who consume disgusting sweet fatty mass-produced muck

are more likely than others to develop type 2 diabetes—the type that is increasing throughout the world at an alarming pace, and in some countries threatening to reverse the increase in life expectancy to which we have grown accustomed as part of the natural order of things and now think of almost as a human right.

Such diabetes, he writes,

is not only the wages of sin—gluttony—but of something that affects our everyday lives even worse, namely mass bad taste.

Sweetened drinks are an æsthetic abomination

Screen Shot 2015-08-06 at 07.44.34Their consumption, writes Dalrymple, is

consequent upon a mass outbreak of childishness. I want people to suffer ill-effects from their bad taste.

Micronesian pioneers of the diabetogenic diet

Dalrymple pays a visit to Nauru, where half the population has type 2 diabetes. Thanks to phosphate rock,

from a life of subsistence on fish and coconuts they went straight to being millionaires. They abandoned their traditional diet and started to eat, on average, 7,000 calories per day. They liked sweet drinks and consumed Fanta by the case-load. For those who liked alcohol as well there was Château d’Yquem. They were unique in the world in being both rich and having a short life expectancy.

Screen Shot 2015-08-06 at 07.55.12Type 2 diabetes is

a threat to public health that dwarfs Ebola virus in scale, but kills slowly and undramatically, rather by stealth than by coups de théâtre. No one ever walked around in spacesuits because there was a type 2 diabetic on the ward.

Mass-produced muck

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Splendidly titled

To an infantilised people, it has a strong appeal

Dalrymple detests soft drinks and

the plastic bottles in which they come; to see people carry them around with them as if they were dolls infuriates me.

These drinks, he points out,

don’t relieve thirst, they create it: a perfect recipe from an unscrupulous commercial point of view.

Dalrymple is delighted to read in a paper in the British Medical Journal

that those who drink these disgusting concoctions are more likely than others to develop type 2 diabetes. Such diabetes is not only the wages of sin—gluttony—but of something that affects our everyday lives even worse, namely mass bad taste.

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Abominably written

The peoples of the US and Britain,

having no proper culinary tradition, are childishly attracted to mass-produced muck. Only in such countries could you sell industrially prepared doughnuts with blue icing; people eat with their eyes, not with their mouths.

In what kind of culinary culture, Dalrymple asks, could a product advertise itself as a Whopper? A crude and childish one, he answers. More self-control in food consumption is needed than ever before,

just as self-control has been derided as an oppressive or even ridiculous notion.

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Only for the US and UK markets

Dalrymple comes across a book called Fat Chance (2013), which, though

abominably written,

comes,

persuasively enough, to the conclusion that John Yudkin came to in the neglected, splendidly titled Pure, White and Deadly (1972).

Dalrymple notes that the author of the 2013 book, Robert Lustig, blames

the food companies and farming subsidies for the epidemic of type 2 diabetes (they are, of course, guilty as charged), but never the people. This is because it is regarded as proper to blame only the rich for anything and never ‘ordinary’ people, including the fat, though where the sins of the rich come from then becomes a little mysterious unless it is assumed that they are a caste biologically apart from the rest of humanity.

Screen Shot 2015-07-25 at 08.21.09As for those who swear by organic carrots and the like, this is only because

in Anglo-Saxon countries, meals tend to be regarded as medical procedures. If it were proved that industrial doughnuts with blue icing were the very thing for health, queues of joggers would form to obtain them.

Dalrymple urges that it be made a criminal offence to take a child to a fast-food restaurant.

If someone were to tell me that children love those restaurants, I should reply, ‘But that is precisely why it should be a criminal offence.’

Pessimists, despair not!

Screen Shot 2013-12-11 at 13.26.38Creutzfeld-Jakob disease, AIDS and the Ebola virus have proved disappointing and dementia rates are falling but

there are grounds for thinking that improvement may not last. The increase in obesity and type II diabetes may reverse the trend. The fatties of today will be the dements of tomorrow. That is, of course, if no treatment is discovered in the meantime that cures type II diabetes or prevents its deleterious effects, so that people will be able to have their cake and not suffer the consequences.