lack of evidence

[firecat]

This post in JunkFoodScience examines whether there is good evidence to support the widespread belief that people with type 2 diabetes should attempt to lose weight and/or eat according to a particular food plan (low-carb or modified fat or what have you). It concludes that there is no good evidence to support weight loss or any particular food plan as a treatment for type 2 diabetes—not many studies have been done, and the studies that have been done are flawed.

http://junkfoodscience.blogspot.com/2008/08/evidence-behind-dietary-and-lifestyle.html

Comments

[karenkay.livejournal.com]

I always read JFS, but I thought this was a particularly good column. This should be required reading for anyone with diabetes.

[firecat]

More importantly, it should be required reading for people treating diabetics.

[karenkay.livejournal.com]

Well, true. Good luck with that!:)

[innerdoggie.livejournal.com]

Makes you wonder what you should eat if you have Type 2 diabetes. (Which I might have someday since Grandma had it.)

[sistercoyote.livejournal.com]

What you eat, I suspect, is less important than how well you monitor and maintain your insulin levels. Based on my understanding of Type 2 diabetes, which isn't as clear as it should be.

Note that I'm not advocating going out and gorging on anything, mind, unless you know how to keep your insulin levels balanced while doing so.

[firecat]

My anecdotal evidence is that you eat doesn't have nearly as much to do with your insulin levels as most people believe -- especially for people who have had T2 for a while. So yeah, paying attention to your insulin levels is more important. And the majority of T2s need to go on medications at some point...which I take to mean that it's a progressive disease, but some healthcare providers and laypeople will have you believe it means you have "failed" at controlling your T2 the "right" way.

[sistercoyote.livejournal.com]

Hooray! I was right about something today!

(It's been a bad day for the old self-esteem. I keep having teh dumb.)

[firecat]

You are right about many things. I'm sorry your day is trying to convince you otherwise. :(

[karenkay.livejournal.com]

The thing is, diet IS very important. I take medication for diabetes, high cholesterol, and blood pressure, but diet has a much bigger effect on my measurements than the medication alone does.

[firecat]

I said "my anecdotal evidence," and you should have too, IMO, since you're talking about yourself.

The way it looks to me, the interaction between food and the conditions you mention varies a lot. (Which is probably part of the reason there's little evidence for a particular diet being good for T2s.)

[karenkay.livejournal.com]

You're right, of course. I am only speaking for me. I do think it's a Big Personal Experiment.

[dreamalynn.livejournal.com]

This makes me wonder about the Conventional Wisdom about insulin resistance, which I believe is part and parcel of the PCOS I have. (Though I've never had this confirmed.) IR/PCOSers are constantly told to follow the low glycemic index thing, and are constantly told to lose weight (no matter how out of whack their hormones may be, and of course failure to lose weight is a personal willpower issue) and many doctors refuse to offer any sort of medication unless a patient is having difficulties trying to conceive, especially if they're deemed "noncompliant" in terms of diet. I don't get it. It seems like many with PCOS have to progress to full T2 diabetes before anyone is willing to treat the insulin related portion of the disease.

[firecat]

Some doctors prescribe metformin for PCOS. Metformin is supposed to help with insulin resistance.

I think (and vaguely recall reading about some studies, but don't know how good they were or even if they were on humans or mice) that the underlying disorders leading to PCOS and T2 diabetes also sometimes cause weight gain. I think that "treating" them by prescribing weight loss is kind of like trying to reverse aging with minoxidil.

[dreamalynn.livejournal.com]

Oh there's no question that PCOS, generic IR, metabolic syndrome and the other related ailments all have factors which cause weight gain. It's why it's particularly galling to have something which is obviously being caused/aided by a goofed metabolic system being blamed on lack of willpower/poor choices/personal failure.

And yes, Metformin and Glucophage are very successful in helping women with PCOS feel better, have fewer symptoms, reduce unreasonable carb cravings (a friend has described waking up from sleep feeling like she needed mashed potatoes) and (sometimes in conjunction with birth control pills) regulate menstrual cycles. But many women are denied the drugs until they're actively trying to concieve or until they've proven that they're good little girls by losing a significant amount of weight first. It's frustrating that there's no set standard of care, but it's an interdisciplinary ailment and most women are under the care of a doctor that only focuses on one part of the equation.

[firecat]

But many women are denied the drugs until they're actively trying to concieve or until they've proven that they're good little girls by losing a significant amount of weight

You probably know about this, but for the benefit of anyone reading who might not:

The blog First, Do No Harm documents stuff like this. It started as a result of a post on one of the fat activist blogs by a woman whose mother died because she was told by a doctor "Don't come back until you lose 50 pounds." So she never went to the doctor again, for decades.