SMOKINCHOICES (and other musings)

August 26, 2013

Truth – Pre-diabetes test

(I rescued this article out of Dr Wright’s archives.  It dates back to August 2001, but what the hell – – who do you know who is really giving you current, up-to-date stuff that truly helps us?   This works for me.  This article makes so much sense  and I am wondering if maybe this is one of the mysteries behind my elevated blood pressure.  Medicine claims not to know why it happens.  But diabetes and or HBP will both do anybody in and for much the same reasons.  My numbers are all pretty good, so I dunno.  But then Medicine said my “thyroid numbers” were always in normal range too — until they weren’t and said my gland was toxic.  Point is, who and what can you believe?   

Don’t have diabetes in my family  and no doc ever asked me to be tested per my numbers and health profile.  But this is an insidious thing. I’ve had a couple of skin tags [Dr wright is speaking of], so that’s not too good.  And I’m a lifelong chocoholic and have been known to cheat with ice-cream, so I am going to try to cut it out and shape up.  Maybe I ‘can’ get my blood pressure down and lower my odds a bit.  Thank God for my juicing, I’m quite sure it has saved me from much (including myself). Isn’t Dr Wright just a prince among doctors?   Jan)

Detect and prevent diabetes NOW

— years, even decades in advance!

By Jonathan V. Wright, M.D.

Type 2 (also called “adult-onset”) diabetes is an extremely common problem with potentially serious consequences. Individuals who suffer from it have increased risks of heart attack, vascular disease, kidney failure, cataracts, retinal damage, and accelerated aging. And, even more frightening, it’s estimated that at least one-third of us have a genetic tendency to develop the disease.

Although abnormally high blood sugar is a hallmark of this form of diabetes, it’s really only one aspect of a much bigger picture in predicting it. In fact, it isn’t necessary to wait until high blood sugar is actually detected: In the large majority of cases, it’s possible to use other factors to determine whether you’re at risk.   If the tendency is there, the next step is to have a glucose-insulin tolerance test done. The glucose-insulin tolerance test, although it has been available since 1975, is often overlooked, despite being a very precise indicator of adult-onset diabetes. This test can predict type 2 diabetes years-even decades– ahead of its actual onset.

Do you need to prevent type 2 diabetes?

There’s no point in trying to prevent a problem not likely to develop, so the first step you should take is to evaluate your personal risk factors.

  • If even just one of the following conditions applies, have the glucose-insulin tolerance test done.

Family history: As with any other health problem, it’s important to consider family history. If another member of your family has type 2 diabetes, your own risk is higher than that of someone with no family history of the problem. The risk is even higher if there are occurrences of type 2 diabetes on both sides of your family.

Skin tags: Over 20 years ago, a group of astute researchers wrote to the editor of a medical journal about their observations regarding skin tags and diabetes: They had noticed that a significant number of diabetic patients also had skin tags (pouches of skin that look like little tags and tend to grow in the neck, armpit, and groin regions). This coincidence fueled them to do further research. First, the researchers checked individuals newly admitted to the hospital to see if they had skin tags. When they discovered skin tags, they checked those patients’ records for known diabetes. A significant proportion of those patients did have existing diabetes. The patients with skin tags who didn’t have known diabetes were given a glucose tolerance test. The glucose test showed that a large percentage of these patients were indeed diabetic, although the condition had been previously undiagnosed.   Five years later, the researchers contacted the remaining non-diabetic patients and persuaded them to undergo another glucose tolerance test. Many more were found to have diabetes. When all the figures were added, the researchers reported that 80 percent of the patients they had studied who had skin tags either had existing diabetes or developed it later.

Excess weight: There’s a phrase I hear over and over from individuals who visit the Tahoma Clinic: “I’ve been on a strict low-fat diet for months [or even years], and I’m still gaining weight!” Every time I hear this complaint, I know to start looking for a family history of diabetes, skin tags, and other clues. While this common problem does not always indicate a tendency toward type 2 diabetes, a combination of diet trends has made it a more distinct possibility than ever before. These diet trends are, namely, the “politically correct,” low-fat, high- complex carbohydrate diet recommended (for nearly everyone) by mainstream physicians over the last 15 to 20 years and the several centuries old trend toward ever-increasing consumption of refined sugar. This combination makes it difficult for diabetes-prone people to lose weight.

Decades ago, Professor John Yudkin performed a simple experiment that illustrates this point. He recruited university students in their 20s to live in a dormitory for one month, eating only the food provided there. One group of students had absolutely no family history of diabetes, while the other group had positive family histories. At the beginning and end of the month, the students were weighed and had their insulin, cholesterol, and triglyceride levels measured.
A (very) brief lesson in sugar and carbohydrate metabolism

Carbohydrates are chains of much smaller sugar molecules arranged in many diverse ways. When we consume sugars (in the form of simple sugar or carbohydrates), our bodies respond by making more insulin, which regulates sugar levels in the bloodstream, preventing them from rising too high. The insulin response to carbohydrates is slower than it is to sugar, as they are metabolized into sugars more slowly. But whether the stimulus for insulin secretion is simple sugar or carbohydrates, the effect is the same: The more sugar and carbohydrates we eat, the more insulin our bodies must make.
The average American consumes between 150 and 200 pounds of refined sugar per year. Add to that the relatively large amount of carbohydrates found in a high complex carbohydrate diet. Now consider how much insulin your body must produce to regulate that much sugar.

For those of us with a genetic predisposition to type 2 diabetes, the insulin response is greater than in others. Overeating carbohydrates and simple sugars day after day (and consuming more than a tiny amount of simple sugar each day truly is overeating) causes the body to develop “hyperinsulinism,” or oversecretion of insulin. Oversecretion of insulin contributes to driving one’s blood-sugar level too low, causing hypoglycemia. Hypoglycemia is associated with “insulin resistence,” a condition in which the cells that receive insulin begin to resist its action.  For the record, this explanation of the insulin response is an oversimplification. Researchers have found dozens of genetic variants, each causing a different defect in sugar and carbohydrate metabolism–all of which can ultimately lead to type 2 diabetes. This likely explains why not everyone responds to treatment in the same way.

All of the students were given exactly the same food to eat for the entire month. The daily diet contained 14 ounces of refined sugar, an amount easily consumed in two to three “soft drinks.”

At the end of the month, the students with no family history of diabetes had gained an average of 3 pounds each. The students with a positive family history of diabetes had gained an average of 9 pounds each. After the month, these students had also developed significantly higher insulin, triglyceride, and cholesterol levels than the students with no family history of diabetes.

For now, we’ll focus on the weight gain. Why the variance of 9 pounds versus 3 pounds in one month, with exactly the same diet?

All carbohydrates (including refined sugar and sucrose) are metabolized to blood sugar (glucose) in the same way. This is why those of us with a tendency to develop type 2 diabetes gain weight much more easily than others and have a much harder time losing it.

Low blood sugar: Low blood sugar is also known as hypoglycemia, and is usually the result of over-secretion of insulin. Symptoms of hypoglycemia include shakiness, a rapid heartbeat, sweating, irritability, confusion, blurred vision, headaches, numbness or tingling sensations in the mouth or lips, pale skin, and sudden hunger.

High blood pressure, elevated cholesterol and triglyceride levels: If you’ve been following a low-fat diet but continue to have elevated total cholesterol and triglyceride levels, it’s probably the result of excess insulin on the liver.   High blood pressure can be attributed to excess insulin that causes the kidneys to retain more sodium and the adrenals to secrete too much adrenaline.

Predicting potential diabetes with the glucose-insulin tolerance test

You’ve probably heard of the “glucose tolerance test,” which is used to diagnose existing cases of diabetes. To perform this test, a practitioner draws blood from a fasting individual and measures it for glucose levels. The individual is then given a specific amount of a sugar solution to drink. A succession of timed glucose tests is performed for the next four to six hours.

  • The glucose-insulin tolerance test is performed in exactly the same way except that every specimen is tested for insulin levels as well as for glucose.

The pioneer in performing and defining this test was Dr. Joseph Kraft, a pathologist in Chicago, who published the results of 3,650 glucose-insulin tolerance tests in a prominent medical journal in 1975.

Enter “Syndrome X”

In the 1980s, the symptoms resulting from too much circulating insulin in conjunction with “insulin resistance” were grouped under the vague label “Syndrome X.” Again, these insulin-related symptoms include:
· elevated total cholesterol (coupled with lowered HDL, “good,” cholesterol)
· elevated triglycerides
· high blood pressure
· excess weight
The biochemistry of “Syndrome X” explains the very common combination of type 2 diabetes, high blood pressure, high cholesterol, and high triglycerides observed in all too many individuals.   Keep in mind, however, that it’s quite possible to have two or more symptoms of “Syndrome X,” but not all of them. For example, there some normal -weight or even underweight individuals with high blood pressure that actually have hyperinsulinism/insulin resistance.  If nothing is done, in time the overwhelming majority of those people with symptoms of “Syndrome X” will develop type 2 diabetes.

Unfortunately, in too many cases, the wrong things are done, and “Syndrome X” proceeds to diabetes anyway. These “wrong things” include the wrong diet plan and/or “treating the symptoms” (high blood pressure, high cholesterol) with patent medications–which do nothing to correct the underlying biochemical insulin-response problem.

Of the 3,650 tests performed, Dr. Kraft reported that 1,973 showed abnormal blood-sugar results as defined by the criteria of the American Diabetes Association. On the basis of the blood sugar tests alone, the other 1,713 individuals tested would have been told their tests were normal.

But when Dr. Kraft analyzed the data from the serum insulin tests, he found that only 568 (33 percent) of the “normal” 1,713 were completely normal. Another 64 percent (including the “borderline” cases) of those who would be judged as “normal” based on the glucose tolerance test alone could actually be shown to be “on the road” to type 2 diabetes when the insulin part of the test was included.

Remember, this test can tell you whether you’re likely to develop type 2 diabetes as much as two decades ahead, giving you plenty of time to “turn it around” and prevent it from occurring in the first place! I’ve been using the glucose-insulin tolerance test (GITT) since 1975, and I’ve seen dozens of individuals change their diets, exercise, take their supplements, and normalize their test results.

How to have the glucose-insulin tolerance test done

Nearly any clinical lab can now perform the GITT, so I can’t explain why a test with so much potential for helping to prevent a health problem that has so many potentially serious complications is so infrequently used-even by “natural medicine” doctors. I act as a consultant for the Meridian Valley Laboratory here in Washington, so I’ve insisted that they do the test. As far as I’m aware, Meridian still does serum insulin testing at the lowest price available anywhere, and, of course, they’ve had a lot of practice. After blood specimens are drawn, they can be mailed in for serum insulin testing. (As there’s no price advantage in blood sugar testing, that’s usually done locally.) You can contact Meridian at (253)859-8700 or http://www.meridianvalleylab.com. But the entire test can be done in many local clinical labs. If you can’t get your mainstream physician to order the test, contact the American College for Advancement in Medicine (ACAM) at (800)532-3688 for a referral to an alternative doctor near you.

Next: Preventing type 2 diabetes (what to do if your glucose-insulin test is abnormal)

We’ve discussed the risk factors for type 2 (adult-onset) diabetes, as well as a very specific test, the glucose-insulin tolerance test (or GITT), which can tell years in advance whether you’re “on the road” to developing this extremely common problem. Before moving on to steps for diabetes prevention, here’s a brief recap.

Predictive testing for type 2 diabetes was first established in the 1970s, but it is underutilized even today. However, any physician can order a GITT test (usually performed for a four- or five-hour duration) through most clinical testing laboratories. When judged by the standards published by Dr. Joseph Kraft, the GITT can predict type 2 diabetes literally decades before it occurs.

If you have this test done and the results are abnormal, it’s decision time! Do you want to prevent type 2 diabetes and all it’s potential complications-cataracts, retinal damage, atherosclerosis, heart attack, kidney failure, accelerated aging-or not? If you do, the following steps should do the trick.

Eliminate refined sugar!

No matter what else is done in terms of diet, eliminating (not just reducing) refined sugar is absolutely essential. Unfortunately, mainstream medicine still ignores this basic principle, preferring to concentrate on total calories or saturated fat.

Individuals with a genetic tendency toward type 2 diabetes react to elevations of blood sugar by secreting too much insulin. As previously discussed, chronic over-production of insulin (a condition called hyperinsulinemia) over many years is a primary cause of type 2 diabetes. So elimination of anything that abnormally elevates blood sugar (which in turn brings out the very worst insulin elevations) is extremely important. Refined sugar is enemy #1 here and must go!

Metabolizing refined sugar also strips the body of many of the elements essential for preventing (and treating) type 2 diabetes, including chromium, magnesium, and many B-complex vitamins. The bottom line here is that if you have a genetic tendency toward diabetes, the more refined sugar you eat, the more rapidly you’ll develop the disease.

For many people, refined sugar is literally an addiction and is incredibly hard to give up. But it’s necessary for preventing type 2 diabetes.

Weight reduction

In mainstream medicine, this is the “holy grail” of type 2 diabetes prevention. The New England Journal of Medicine recently published a report covering observations of 522 “middle-aged, overweight” individuals with already-abnormal but not-quite-diabetic blood sugar levels.2 These individuals were randomly assigned to one of two groups: One group participated in a weight-control program that encouraged the fairly typical and very politically correct “low-fat, high-complex-carbohydrate” diet and exercise. The other group followed neither a weight-control nor an exercise program.

By the end of the second year, the members of the weight-control group had lost an average of approximately 8 pounds each, while participants in the other group had lost an average of approximately 2 pounds each.

After four years, the incidence of actual diabetes was 11 percent in the weight-control group and 23 percent in the other group. Obviously, weight control was helpful in preventing type 2 diabetes.

  • In my opinion, however, concentrating on weight control in and of itself “puts the cart before the horse.” Keep in mind that excess weight is just one symptom of potential for existing type 2 diabetes — it isn’t the actual problem. But, as is all too usual, the approach of mainstream medicine is to treat the symptom instead of the problem itself.

Designing the right diet to deal with the individual metabolic quirks of type 2 diabetes (and pre-type 2 diabetes) will not only increase your chances of preventing diabetes but will also automatically result in weight loss.

The right diet

The best diet is not the same for everyone. Unfortunately, with the exception of a very few diseases, mainstream medicine is presently stuck in the politically correct “low-fat, high-complex- carbohydrate” rut. While it’s true that this type of diet is best for many people, it’s usually counterproductive for individuals seeking to prevent (or treat) type 2 diabetes.

Although researchers state that there are dozens, if not hundreds, of possible genetic variations that can ultimately result in type 2 diabetes, it appears that what nearly all of them have in common is an abnormal insulin response (hyper- insulinism) to elevations of blood sugar. Sooner or later, this is associated with insulin resistance, as the body resists the excess insulin. (As explained, the insulin resistance ultimately becomes so strong that insulin can no longer control blood sugar, which then goes too high. At that point it becomes actual type 2 diabetes.) If you can avoid overstimulating insulin secretion, it’s also likely you’ll slow-if not stop-the development of insulin resistance and prevent type 2 diabetes.

Carbohydrates, not fats, overstimulate insulin secretion in type 2 diabetes and pre-type 2 diabetes. (Actually, carbohydrates stimulate the strongest insulin response in all of us, but if we don’t have a genetic tendency toward type 2 diabetes, carbohydrates usually don’t overstimulate the insulin response.) As noted above, refined sugar and other refined carbohydrates (mostly white flour products) are the worst offenders, but carbohydrates in general are also a problem.

If your glucose-insulin tolerance test is abnormal, a low-carbohydrate diet is your best bet to prevent the actual onset of type 2 diabetes. Working with a nutritionally-oriented doctor or a certified clinical nutritionist (CCN) is best, but if this isn’t possible, some good reference books include Dr. Atkins’ Diet Revolution, Dr. Atkins’ New Diet Reolution, Protein Power, and The Carbohydrate Addict’s Diet. People with type 2 diabetes and overweight people with abnormal glucose-insulin tolerance tests are often surprised by how much weight they lose (and how rapidly) when they follow one of these diet plans.

  • But what about my cholesterol on a high-protein, (higher) fat, low-carbohydrate diet?

Low-carbohydrate diets “automatically” contain much more fat. Won’t that drive cholesterol levels too high? The answer is almost always no, if you have an abnormal glucose-insulin tolerance test or actual type 2 diabetes. Remember, in hyperisulinemia, excess insulin causes our livers to manufacture more cholesterol and triglycerides. A low-fat diet won’t help, because “high fat” isn’t the cause!

Ron’s story

Ron was 55 and more than 100 pounds overweight. For several years, his cholesterol had been over 400 and his triglycerides over 700. He’d been told that a low-fat diet was a “must,” so he followed one strictly for three years with no improvement. By the time he came to the Tahoma Clinic, he’d tried nearly every vitamin, mineral, and herbal supplement said to lower cholesterol and triglycerides with virtually no effect. When he mentioned type 2 diabetes in his family, I recommended the glucose-insulin tolerance test. Not surprisingly, Ron’s GITT turned out to be abnormal.

After talking to a nutritionist and looking through various high-protein diet books, Ron chose the Atkins program. He was as strict about it as he had been about the low-fat diet, but this time, after a year, he lost 80 pounds. His cholesterol went down to 220, and his triglycerides dropped to 160. His follow-up glucose-insulin tolerance test wasn’t entirely normal but had improved, showing that he was further away from actual type 2 diabetes.

Supplements to help prevent type 2 diabetes

Chromium appears to be the most useful mineral in the prevention of type 2 diabetes. Chromium and niacin are components of glucose tolerance factor, a molecule that improves insulin’s ability to lower blood sugar levels. Animal studies have shown that chromium deficient diets result in high blood sugar levels. Chromium deficient diets are extremely common: One survey estimated that over 90% of Americans consume less than the so-called “minimum daily intake.” Although the best food sources of chromium are mushrooms, brewer’s yeast, and eggs, chromium supplementation is advisable when a glucose-insulin tolerance test is abnormal. In my experience, the common commercially available 200 microgram quantity is inadequate for either prevention or treatment of type 2 diabetes.

Researchers have shown that 200 micrograms of chromium daily is ineffective in lowering blood sugar in actual type 2 diabetes. But when levels are raised to 1,000 micrograms daily, blood sugar, serum insulin, and cholesterol levels all decrease. Chromium supplements have also been shown to raise HDL (“good”) cholesterol. My recommendation for prevention is 500 to 1,000 micrograms (1 milligram) daily, depending on the patient’s individual needs.

Niacin and niacinamide, both forms of vitamin B3, are necessary in a type 2 diabetes prevention program. Niacin is another crucial component of glucose tolerance factor. Niacinamide helps protect pancreatic islet cells against the ultimate exhaustion that can be created by years of insulin overproduction.

Fortunately, many good multiple and B-complex vitamin combinations contain at least 15 to 25 milligrams of niacin and 50 to 100 milligrams of niacinamide, so separate supplementation of these items isn’t usually necessary. (As the rest of the B-complex group is also involved in blood sugar metabolism, it’s just as well to take all the B-vitamins together anyway.)

Biotin helps metabolize blood sugar once it gets into the cells. Daily quantities of 9 to 16 milligrams have been shown to significantly lower elevated blood sugar in both type 2 and type 1 diabetes. In experimental animals, extra biotin reduces insulin resistance and improves glucose tolerance.

For preventive purposes, considerably less than these “therapeutic” quantities would be necessary. One or, at most, 2 milligrams daily should be sufficient. Although biotin is found in many multiple vitamin formulations, quantities are usually extremely low, so separate supplementation is usually necessary. There have been no reports of overdose or serious side effects from biotin.

Alpha-lipoic acid has been shown to improve insulin sensitivity and resistance in individuals with existing type 2 diabetes. Since insulin resistance occurs both before and after the onset of actual diabetes (actual diabetes just represents a much worse stage), it’s very likely that alpha-lipoic acid will help in the pre-diabetes stages too. At present, I recommend 100 milligrams daily.

Coenzyme Q10 is synthesized in every cell in our bodies, but like most other things, the rates of synthesis decline as we get older. One study of 59 individuals with coronary artery disease, high blood pressure, high triglycerides, elevated fasting blood sugar, and elevated fasting insulin compared the effects of 120 milligrams of coenzyme Q10 daily to the effects of a placebo. After eight weeks, both fasting blood sugar and fasting insulin levels dropped very significantly in those taking co-enzyme Q10 as compared with the placebo group. Although this is only one published study, natural medicine doctors, including myself, have observed these coenzyme Q10 effects for years. At present, for those at risk for type 2 diabetes, I recommend 30 to 60 milligrams of coenzyme Q10 daily, and more if other manifestations of “syndrome X” are present. (See page 3 of the July 2001 Nutrition & Healing issue for more on syndrome X.)

Vitamin K may protect the body from both insulin resistance and abnormal insulin response to sugar. Although the research is still in the early stages, it appears that insufficient levels of vitamin K are associated with these problems. The research has also shown widespread “subclinical” vitamin K deficiency. Green vegetables are excellent sources of vitamin K, so if your glucose-insulin tolerance test is abnormal, make sure to eat plenty of broccoli and spinach (as well as other green veggies). For added insurance, take an extra 2 to 3 milligrams of vitamin K daily.

Other supplemental nutrients useful in a diabetes prevention program include the minerals magnesium, vanadium, zinc, copper, and manganese. At present, the amounts present in a good multi-mineral supplement appear sufficient.

Add to the “type 2 diabetes prevention list” vitamin E (400 IU of “mixed tocopherols”), vitamin C (2 to 3 grams daily), L-carnitine (100-250 milligrams daily), and a good high-potency multiple vitamin containing the entire B-complex.

Knowing your risk for type 2 diabetes is half the battle…preventing it is the other half!

The most important requirement for preventing type 2 diabetes is knowing you’re at risk, and then making a conscious decision not to let it happen to you! Review the risk factors discussed and if you’re suspicious, have a glucose-insulin tolerance test done. If your results are abnormal, eliminate all the refined sugar from your diet, and cut back on the carbohydrates, which “bring out” the problem. Make sure to exercise, take the supplements mentioned above, and it’s very likely that you’ll never suffer type 2 diabetes and all its possible complications!
– See more at: http://wrightnewsletter.com/2001/08/01/preventing-type-2-diabetes/#sthash.M6MDoyg2.dpuf
/#sthash.UFVC6qqJ.dpuf

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2 Comments »

  1. I value the knowledge on your internet site. Much thanks!

    Comment by Click This Link — August 26, 2013 @ 1:33 pm | Reply

    • Thank you Suzette, that’s why I’m here — plus, it is the passion of my heart. Jan

      Comment by Jan Turner — August 26, 2013 @ 3:12 pm | Reply


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