Thursday, 27 August 2015

What 2000 Calories Looks Like (2)

So let’s talk about diabetes. There are two types of diabetes. The first is what your grandmother had: an auto-immune destruction of beta cells in the pancreas that makes insulin production impossible. That is managed by injecting a substitute insulin. This is Type 1 - or as I will prejudicially call it, “real” diabetes. The “not-real” type is diabetes-by-analogy, or so-called “Type 2“ diabetes, and this arises when, for one of many reasons, the body can’t process sugar as well as it used to, and the blood-sugar rises to the point where nasty lumpy sugar molecules can start doing some real damage to various parts of the body. At one point I went along to Ashford Hospital after fasting for twelve hours, was given a litre of Lucozade to drink and had my blood sugar levels measured two hours later. I think it came out at 9 mmol per litre, which meant I had, according to the World Health Organsiation, impaired glucose tolerance, or as the PR people call it “pre-diabetes”. My levels now are around 4-5 mmol / litre. Diabetes mellitus is diagnosed at 11.1 mmol / litre. 

When my blood sugar came down, I stopped getting random infections, often in my nose, my head cleared and my emotions stabilised. Even though I was in the middle of a horrible re-organisation at work, about to be down-graded, and under stress, I felt better. Increased blood sugar isn’t funny, and it’s vaguely scary how little it needs to increase before it has a noticeable effect on my ability to function at the levels needed in today’s working world. Chronic high blood sugar is nasty and dangerous and can really, really mess up your life. But it’s not a disease, it’s a symptom.

Why don’t I want to call "Type 2 diabetes” as a disease? A disease is a chemical process in the body caused by some (usually external) agent, and the symptoms are the results of that process. Stop the process and the symptoms go away - that’s what we call ‘curing the disease’. A disease is usually cured by killing a virus or bacteria, or in some cases, by chemicals that make our own immune system back off attacking a perfectly acceptable part of us. A real condition, such as syphilis is treated with a real medicine with a real chemical effect. This will work despite our body fat, exercise regime, religious beliefs, the state of our chakras, how much exercise we do, or how mindful we are (which is the definition of technology: it works whether you believe in it or not). The only change we usually need to make to our diet is giving up alcohol for the duration. 

Calling something a disease creates the expectation that there’s a cure for it that works whether we believe in it or not. Since high blood sugar has many causes, there isn’t a single cure for it. At best there would be a medicine that reduced blood sugar to normal levels. There is, and it’s called “insulin”. But NICE doesn’t like giving it to people who aren’t Type 1 because it’s expensive… I mean, because they fear the patient will become dependent on it. Instead they hand out drugs with names that end in “formin”, which make a third of the people who take them feel nausea, while a third have problems with their, ahem, married life and stop taking the pills within a month.These drugs definitely do not work. Not like penicillin or ranitidine work. 

The pharmaceutical industry wants you to think that high blood sugar is a disease, because then you will expect to be prescribed a cure, and press your GP for one. It may not happen now, but at least a couple of years ago, there was an NHS bonus for GPs to diagnose you as having high blood sugar, get you on nasty drugs and then find your levels had dropped. That sounds more or less like a bribe to me. Despite that bribe, the NHS no more believes in “Type 2 diabetes” than I do, and suggests exercise and diet as the first approach to managing high blood sugar.

But “they didn’t push the envelope”. The NHS recommends small changes in diet and exercise regime. What the doctors will never tell the poor saps sitting in front of them is that the change must be sudden and fairly extreme. (It is of you’re very obese and get a diet from a nutritionist.) I went on a 1,500 calorie / day diet and hit the gym four times a week. That works because the body can’t adjust to the sudden and dramatic change of regime, and it burns calories and loses weight, especially fat from the abdominal region. The official advice is to make small changes, and rightly so: the parade of long-term un-exercised carb-munchers that GPs see would simply keel over if they tried to repeat what I did. 

1,500 calories is the US Army’s extreme weight-loss diet and you’re not supposed to do it for long (I can’t find a decent link to this anymore and there’s a lot of faddy looking stuff when googling “us army 1500 calories”). It works in conjunction with, oh yes, being a soldier. Not an office-worker. Being in good shape is part of a soldier’s job, as it is part of a model’s or an actor’s. They get support for it. Being in good shape is not part of an office-worker’s job, and they don’t get any support for it. Capitalism doesn’t care about your body-fat, except to sell you gym memberships and fad diets to get rid of it, and the shit that puts it there in the first place. 

As for the 2,000 calorie thing? Turns out that was a classic piece of US governmental bureaucratic fudge. 

We’ll carry on in the next post. 

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