Now, for something completely different. I had to break the streak of vaccine articles, especially since I am interested in all parts of science denial – evolution, GMOs, climate change, and, of course, vaccines. But today, we’re going to focus on diabetes myths. Why, well my academic field of study was focused on insulin and insulin-like growth factors effects on aging – and I continued to keep up with the literature on insulin and diabetes ever since then.
What troubles me about diabetes is that the quacks have decided to make it a business opportunity for their fake potions, lotions, herbal medicines, and magical foods. Now, I don’t have time to cover every single one of those diabetes myths, but I’m going to cover the ones that annoy me the most.
All about diabetes
I know I criticize those who try to sum up complicated science with an hour or two of research on the internet, and then claim that they’re an expert. But I’ve probably far exceeded Malcolm Gladwell’s 10,000-hour rule in the study of diabetes, which states that the key to being an expert in a field requires over 10,000 hours of work, study, or experience. Using my knowledge, I’ll try to simplify everything down to a few paragraphs, which should give you the scientific consensus on diabetes. If I get something wrong, I’ll be sure to fix it.
There are several diseases that many people lump together as “diabetes.” In general, there are three that are known as diabetes mellitus – type 1, type 2, and gestational (see Note 1). They are all metabolic diseases that cause an increase in blood glucose levels.
Glucose is the primary energy source for cells in the body, and is controlled in tight range by two key hormones, insulin and glucagon. I’m over-simplifying here, but when insulin is signaled to be released (usually after eating and raised blood glucose levels), it causes cells to store glucose.
Glucagon, the antagonistic hormone to insulin, is released when blood sugar levels are low. It simultaneously up-regulates glucose producing engines (gluconeogenesis) in liver and other cells. In well functioning physiology of mammals, glucagon and insulin work effectively to regulate blood glucose levels within a relatively narrow band.
Now one may think, “what’s wrong with glucose levels that are out of that narrow range, it’s just glucose.” Hyperglycemia, or high blood glucose, can cause both short- and long-term problems.
On the other hand, chronic high blood sugar can lead to serious issues that can also lead to death, or a serious impairment to quality-of-life:
- Microangiopathy, damage to small blood vessels, can lead to a long list of diseases from diabetic retinopathy to diabetic nephropathy.
- Macrovascular diseases, which can lead to cardiovascular and peripheral vascular diseases.
- Abnormal immune responses, which can lead to immune deficiency or inflammation.
Without a doubt, diabetes mellitus is a dangerous disease which kills. And it is not a trivial disease, and it should be treated with respect and evidence-based medicine. Looking for alternative treatments on the internet is a quick way to disabilities and death.
OK, I used too many words to describes diabetes generally. But let’s take a look at each of the different types of diabetes mellitus that are only broadly linked, but the underlying pathophysiology for each of these diseases is different. And that will take us to the diabetes myths, since you now have a strong grounding in the disease.
Type 1 diabetes mellitus
And yes, here we go with more science. Type 1 diabetes is an autoimmune disease characterized by the destruction of pancreatic islet cells, which produce insulin, by autoreactive T cells. These lymphocytes mistakenly attack pancreatic islet cells as if they were a foreign body, like a viral or bacterial infection.
In addition, regulatory T-cells (which are often called Tregs) modulate the immune system and would generally reduce the effect of an autoimmune attack. Tregs act like brakes that normally prevent the mistaken attacks, like on the pancreatic islet cells, without affecting the whole immune system. A branch of diabetes research has suggested that Tregs could be the key to treating type 1 diabetes. Once the pancreatic islet cells are damaged, they no longer produce hormones, especially insulin, that help regulate the levels of blood glucose.
It is not known what causes this autoimmune disease, although there is strong evidence that genetics is the most important factor. However, other things may be implicated, like vaccine-preventable diseases, which could be important co-factors in the development of the disease.
Currently, there are no known cures for type 1 diabetes. The only treatment for the disease are regular injections of human insulin, manufactured from genetically engineered E. coli cultures. In addition, careful diet and lifestyle management helps regulate blood glucose levels, although it cannot replace insulin injections.
However, there is some potentially good news, although it’s still very early, that the BCG vaccine, for prevention of tuberculosis, may “cure” or at least reverse type 1 diabetes. I think within 5-10 years, we’ll get some news, either positive or negative, about whether the BCG vaccine would work.
Type 2 diabetes mellitus
Type 2 diabetes is superficially similar to type 1 diabetes, including high blood sugar and similar chronic complications. However, its underlying pathophysiology is substantially different than type 1.
Mostly, type 2 diabetics continue to produce insulin, just an insufficient amount to regulate glucose levels, or their cells have become resistant to insulin. Generally, it is believed that type 2 diabetes is caused by lifestyle choices, such as obesity, sendentary behavior, and poor diet. However, there is an underlying genetic component that is exacerbated by the poor lifestyle. There are individuals who are active, not obese, and have a healthy diet, but will contract type 2 diabetes (see Note 2).
Type 2 diabetics are treated with various medications help reduce insulin resistance, decrease production of glucose (not all glucose comes from diet), or increase insulin production. In addition, as insulin resistance increases, some individuals are required to begin regular insulin injections.
There is no magical way to “cure” type 2 diabetes – a complete and radical change in lifestyle will reverse the disease. That means significant weight loss to normal ranges, increase in exercise and activity, and a change to a better diet. And if you revert to your old lifestyle, your type 2 diabetes will probably return.
Type 2 diabetes has become an “epidemic” in the USA and many other developed countries as our populations become more obese, more sedentary, and less concerned about our diets. And with respect to diabetes myths, type 2 is the focus of more pseudoscientific nonsense than we see with type 1 diabetes.
Those diabetes myths
- Pronunciation. This really isn’t really one of the diabetes myths, but it makes me want to yell. The word is dye-a-bee-teez. Not dye-a-bee-tus. I just heard a real life MD use that word, and I was going to discount everything she said from that point on.
- Vaccines. Let’s be extraordinarily clear, vaccines are not linked to type 1 diabetes. Vaccines do not cause the autoimmune disease that causes destruction of the islet cells that produce insulin. And it seems biologically implausible to hypothesize that any vaccine could lead to damage to those pancreatic cells.
- Conflating type 1 and type 2 diabetes. Although this is typically not one of the numerous diabetes myths, it leads to very confusing questions and comments. They are two different diseases with two separate management and treatments.
- Diet and exercise will cure diabetes. This may help manage type 1 diabetes, but it will not cure it. The patient will still require insulin to manage the disease, although long-term outcomes are better with insulin injects plus diet and exercise. Now, if done properly, diet and exercise can reverse type 2 diabetes, but as I said above, if the patient returns to their old behaviors, the disease will return.
- Magical foods, fruits, vegetables, smoothies. No, there are no top-secret exotic tropical fruit that will magically cure type 1 or type 2 diabetes. Sure, a diet higher in certain fruits (high sugar ones are to be avoided) and vegetables could be part of a plan to help manage your blood glucose levels – that’s a good thing. But it will not cure these diseases.
- Supplements. There are no supplements to treat either form of diabetes supported by robust clinical evidence. There are some people who insist that cinnamon can reduce blood sugar, but the evidence is quite weak – better systematic reviews show that cinnamon has no effect on blood glucose levels or long-term outcomes. Other supplements that are popular with type 2 diabetics have shown no improvement in glucose levels.
- Insulin causes cancer. There is simply no robust evidence that the genetically engineered human insulin used today to treat type 1 or 2 diabetics is causally linked to any cancer. And once again, it is biologically implausible to think that it might.
- Insulin is a Big Pharma scam. Yes, I keep reading that. Big Pharma blocks the “cure” to type 1 diabetes (if the writer actually understands the difference between diabetes types), so that it can sell expensive insulin. Just a couple of things – there is a boatload of research underway to find a cure for type 1 diabetes, and it’s been going on since before I was in grad school studying it (which was before most of the readers of this blog were born). We are only now getting a handle on the autoimmune disease, and there are lots of directions which may lead to prevention of it. But autoimmune diseases are notoriously difficult to control. And even if there is a cure, that doesn’t mean that the disease will disappear – about 18,000 children are diagnosed with type 1 diabetes every year in the USA, and probably a similar number in Europe and other countries. If Big Pharma had a cure, it would want it on the market.
- Only obese people get diabetes. This is one of those diabetes myths that are similar to the “people who are depressed are just lazy” myth pushed by a lot of people. Type 1 diabetes risks are probably not very closely linked to childhood obesity, though I won’t discount it. And yes, obesity does increase risks of type 2 diabetes, though it is not the only risk factor. Like I mentioned above, someone with type 2 diabetes could be a skinny athlete!
- Homeopathy cures diabetes. No, no, no. If you’re a newbie here, maybe you don’t know that homeopathy is pure water or a sugar pill. Neither of which will help treat any form of diabetes, and, in fact, could be deadly. You think I’m making this up? Check out the Tweet below:
— HomeopathicAssoc (@HomeopathicAsso) February 19, 2018
Yes, this homeopathy quack is trying to convince people that water or sugar can cure diabetes. Apparently, he wants to end diabetes by killing patients.
Ok, I’m sure there are other diabetes myths out there. These are the ones that make me pull out the keyboard and start typing away. Just follow diabetes questions on Quora, and you’ll run into these all the time. Well, except for the pronunciation issue – I don’t know how most people pronounce it, except on TV. Thank you Wilford Brimley.
By the way, if you run across a new myth, or one I overlooked, post it in the comments. I might want to take a look.
- For the purposes of this article, we’re going to overlook gestational diabetes, which is a somewhat common type of diabetes that afflicts pregnant women but differs from type 1 and type 2 diabetes, as it is usually temporary. It generally resolves itself after the birth of the baby. Unfortunately, gestational diabetes is linked to development of type 2 diabetes in both the mom and the child, and high blood sugar can cause harm to the developing fetus.
- A recent article published in Lancet Diabetes and Endocrinology has proposed that there are actually 5 “clusters” of diabetes, including cluster 2, which is a type of diabetes where the patient fails to produce sufficient insulin but not as a result of an autoimmune disease, which would be cluster 1. This new cluster 2 might account for individuals who are otherwise healthy, but develop what we used to call Type 2 diabetes. I’m not sure when or if this new classification will gain traction in the world of diabetes, but I think it’s something to consider strongly.
- Ahlqvist E, Storm P, Käräjämäki A, Martinell M, Dorkhan M, Carlsson A, Vikman P, Prasad RB, Aly DM, Almgren P, Wessman Y, Shaat N, Spégel P, Mulder H, Lindholm E, Melander O, Hansson O, Malmqvist U, Lernmark Å, Lahti K, Forsén T, Tuomi T, Rosengren AH, Groop L. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018 Mar 1. pii: S2213-8587(18)30051-2. doi: 10.1016/S2213-8587(18)30051-2. [Epub ahead of print] PubMed PMID: 29503172.
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