This week’s edition of the Journal of the American Medical Association contains a commentary entitled ‘Can Diabetes Be Cured’ . It caught my eye, partly because I have some interest in diabetes as a condition, but also because the word ‘cure’ is not usually applied to a condition like diabetes. The conventional wisdom is that once a diabetic, always a diabetic. The commentary challenges this ‘wisdom’ and talks about the possibilities of curing type 1 diabetes) with pancreatic transplantation or transplantation of the cells that make insulin (the beta-cells). Other, more experimental approaches, such a stem cell therapy are also discussed.
The commentary also discusses potential for the cure of type 2 diabetes, which is far more common than type 1. The author here makes the claim that surgery, for example, gastric banding, offers most potential here.
The author also discusses the idea of a ‘mechanical’ solution to diabetes, in the form of a device which senses sugar levels and gives an appropriate dose of insulin in response. Such devices are not yet available, and even if these were, I’m not sure they would constitute a ‘cure’. They will be, if they ever come into being, another ” albeit more sophisticated – way to administer insulin. That doesn’t constitute a cure in my books.
This article also left me wondering if there might be lower tech solutions to diabetes. In my view, there are. Imagine that a 50-something man is diagnosed with type 2 diabetes as a result of blood testing. Repeat testing confirms the diagnosis. Let’s imagine that this individual, as yet, has no signs of the complications of diabetes such as eye, nerve, kidney or blood vessel damage.
Remember the primary problem with diabetes is that the body is not handling sugar well so blood sugar levels tend to be raised. The primary underlying factors here will be some resistance to the hormone insulin (insulin not working as it should) and/or inadequate insulin secretion as a result of an ‘exhausted’ pancreas. So, imagine now that this individual decides to adopt a low-carbohydrate diet. And imagine that repeat testing in, say, two months time reveals no evidence of diabetes. He continues with the low carb diet and a year later, repeat testing reveals still no evidence of diabetes. And no evidence of complications of diabetes either.
This may be a hypothetical situation, but it mirrors actual experiences had in the real world by those who advocate low-carb diets for those with diabetes.
Now, here’s the question: does this man have diabetes or not? The obvious (and correct) answer I think is ‘no’. Let’s say he’d never been tested for diabetes but took it upon himself to adopt a low-carb diet and some time later turned up his later, normal lab results. No-one would be diagnosing diabetes right? He may have had diabetes, he might even have a tendency to developing diabetes, but he hasn’t got it now.
However, you’d be surprised at just how much resistance some healthcare practitioners can have to the notion that someone can cure themselves of type 2 diabetes with something as simple and low-tech as a change in diet. Why is this?
Some of this may have something to do with the fact that many healthcare practitioners have been persuaded that the ‘right’ diet for diabetics is one with a lot of carbohydrate in it. No wonder these individuals may not have much faith in the ability of diet to ‘cure’ diabetes.
But another potential explanation for the scepticism regarding the potential of diet to cure diabetes might have something to do with the fact that there’s not really much money in it. No drugs, surgery or high-tech gadgets are required. With no industry making particularly good money out of low-carbing, who is going to push this as a viable ‘cure’ for diabetes. The fact that this approach is not particularly lucrative may help to explain how it can be that commentaries can be written about potential cures for diabetes that don’t include any meaningful discussion of the role diet might have here. I suppose it’s worth pointing out that the author of the commentary is an advisor and consultant for two companies that make glucose monitors (supposedly a potential part of the high-tech solution that might ‘cure’ diabetes).
The author actually starts his commentary with the following words: For individuals with diabetes, the ultimate hope is cure. But how will this cure ever be realized? He goes on to write: If the answer was obvious, all effort would be directed to it. If only this were true.
Saudek CD. Can Diabetes Be Cured? Potential Biological and Mechanical Approaches. JAMA. 2009;301(15):1588-1590.