The Times on Type 2 Diabetes: Part I

I pointed out in my book The First Year: Type 2 Diabetes, first published in 2001, that type 2 diabetes has a strong genetic component and the weight gain that so many people with type 2 diabetes see may not be their fault.

Many of us have pointed out, as Kolata did in the Times, that not all overweight people have type 2 diabetes, so obviously obesity alone does not cause the disease. Again, no one listened.

Patients have also pointed out that without any change in their diet, they suddenly began to put on weight, especially in their stomach, before they were diagnosed with diabetes, suggesting that some metabolic defect was causing the weight gain, rather than the weight gain causing the metabolic defect. But no one listened. People thought, "Yeah, yeah. They're probably cramming themselves with doughnuts when no one is looking."

Recent research, which I described in this blog in late July, has provided support for the patients' observations. Research showed that the apple shape doesn't cause insulin resistance. Rather, insulin resistance causes the apple shape.

A metabolic defect that shows up years before people are diagnosed with metabolic syndrome or diabetes means that people with this defect are unable to store carbohydrates correctly. Instead the carbohydrates are converted to fat, and this extra fat is deposited in the stomach.

Then this extra fat causes insulin resistance, and in those without the pancreatic reserves to increase their output of insulin, the insulin resistance causes type 2 diabetes.

Thus obesity is associated with type 2 diabetes, and sometimes reducing weight can reduce insulin resistance and improve blood glucose levels. But obesity is not the real cause of type 2 diabetes.

The fact that a prestigious newspaper like the New York Times is trying to spread the word is encouraging. But will it have any effect?

Probably not right away.

Gary Taubes, in an oft-cited article in the Times in 2002 -- What If It's All Been a Big Fat Lie -- argued that the currently popular low-fat diets were not helping people, and might even be causing the "obesity epidemic."

Did anyone listen? Yes, for a few minutes, and then they went back to the old dogma, urging patients and clients to cut back on their fat and eat a lot of "healthy complex carbohydrates."

So I don't imagine the latest Times article is going to turn diabetes care around in a heartbeat. But each little bit helps. Each time someone gives support to the idea that people with type 2 diabetes shouldn't be blamed for "bringing it on themselves" it helps.

Next: Blood Glucose Levels and Heart Disease