Tuesday, June 28, 2011

What Will It Take to Reverse Type II Diabetes?

My father Dr. Khursheed Jeejeebhoy spoke at the BIST (Brain Injury Association of Toronto) meeting last night on diet and exercise in prevention of disease. His main points: you can change your genetic propensity to type II diabetes and reverse diabetes through aerobic exercise; you can keep yourself upright as you age through weight training; and you can increase your life span and keep it a healthy one by eating a diet of complex carbohydrates and low fat.

One person put up her hand to inform him that the doctor has said that her father will have diabetes for the rest of his life. Period. He had been diagnosed at age of 64. (Only type I diabetes is immutable. He has type II; the doctor is wrong.) Because she knows the doctor, she is more likely to believe him over some speaker. And that got me to thinking: we have an obesity and diabetes epidemic, but our efforts to counter it seriously suck.

About fifty percent of us inherited the insulin-resistance gene that would let us survive famine, but in an age of plentiful food, of never having to go without, that gene is killing us. Basically, this gene ensured that when we, as a species, ate food, as much as possible of it went into fat stores so that during the invitable famines, we could live off our fat stores and survive. This is why the aboriginal population has such problems with diabetes and why I have the gene. Only in the last fifty years or so have our peoples not had to worry about food supply.

Today, we don't have famines. We have too much food and poor food choices. And so we have to somehow change the expression of the insulin resistance or diabetic gene so we don't develop diabetes.

Medicine has developed drugs and surgeries that counter the cardiovascular effects of this gene, but they don't work as well as diet and exercise. The problem is that drugs and, for many, surgery (though I can't imagine choosing surgery over any non-invasive procedure, yuck) is easier than moving and eating differently. "I want to eat what I want eat, and don't ask me to exercise."

So how to change that? A good education program can help. But the only way is hands-on care. And right now, doctors are not being paid or educated to do that. The government has not trained and hired community workers to do that either. We can have all the obesity programs we want, but unless our doctors understand the science and are paid to spend the time with their patients, it ain't going to work over the long term. A doctor telling a patient "your diabetes is permanent, take the drugs" is a powerful anti-motivator to eating and moving differently.

The physician associations, provincial and federal, must get real about educating our doctors on good diets and effective exercise. Our medical schools must add a year to their program so as to cover physiology and anatomy properly (it really is pitiful how little medical students, unlike arts & sciences students, learn about the human body itself) and do more than wave a wand in the air when it comes to nutrition and exercise. Those subjects must be studied over a half term, at the very least. When we know how much food and exercise can affect us, way more than drugs can, it is sinful that medical schools pay so little attention to them. And it is sinful that the bodies in charge of continuing physician education don't insist that every family doctor, every specialist get educated on these subjects.

But once doctors know better and no longer toss a bunch of drugs at patients and tell them that they have type II diabetes for life, the government still has to compensate doctors fairly for their time. It takes less time to write a prescription for insulin than to talk to the patient about the emotional, food, and non-exercise factors that got them to their weight and/or to the pre-diabetic condition. Most doctors aren't going to donate their time pro bono -- and it's extremely selfish of us to ask them to do so -- when the key word is "epidemic." Giving time pro bono for a rare case is one thing; giving it for half the population is another.

Lastly, once doctors are educated and compensated fairly so as to spend the time with the patients diagnosing and monitoring over the long term, there is still the problem of where to get help when you have no money. If you have money, you can hire a trainer, see a nutritionist, visit a psychologist, join Weight Watchers or some other group (because everyone needs community support to succeed). But if you don't, you could get the kind of book I did out of the library and hope that's sufficient. Not. Good books tell you the whys and hows of the low-glycemic way of eating (complex carbs and/or low fat), but who will help you with the exercise program? Who will help you make the drastic changes in your eating, to ensure your questions are answered and you receive the kick in the pants when you need it? Who will help you navigate the emotional minefields that will rise once the food-stuffing has stopped? Not too many of us have the motivation and determination to go it alone.

One study showed that trained workers could help people make lasting changes to their diet and exercise regimes, which increased their longevity, reversed their diabetes, and unclogged their arteries. But in Ontario, I know of no such program for the general population. The government has to hire lots of these workers, inform every doctor of how to refer patients to them, and educate the public on how to self-refer. And they can't make them available for some piddling, ineffective three sessions. It has to be a year at least, preferably two, and for as frequently as they need. It costs money.

But frankly a $100,000 stent operation to open one unclogged artery adds up to way more.

And the drugs and debilitation of diabetes add up to less income, fewer tax dollars, a tired population, parents dying too young, children getting sick instead of playing and learning, adults retiring early from jobs, a tired population. Did I mention that already? A tired population will not have the energy to innovate, to drive themselves to achievements, to help others, to share their expertise. In short if governments don't spend real dollars and if physician assocations don't demand every physician and surgeon educate themselves and if medical schools don't radically change their curriculum and if people don't get real with the danger of diabetes and be prepared to work, nothing will change. We will get fatter and sicker.



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