“Strange is our situation here upon earth. Each of us comes for a short visit, not knowing why, yet sometimes seeming to a divine purpose. From the standpoint of daily life, however, there is one thing we do know: That we are here for the sake of others…for the countless unknown souls with whose fate we are connected by a bond of sympathy. Many times a day, I realize how much my outer and inner life is built upon the labors of people, both living and dead, and how earnestly I must exert myself in order to give in return as much as I have received.”
- photo: Alias Rex
I ran across an interesting post today on the Scientific Blogging site, which acts to rekindle the question (debate?) of genetics as destiny. Specifically here, the identification of a genetic variation that seems to impair the ability of the body’s muscle cells to use insulin to help them make energy.
The post in question is a summation of an article published in Nature Genetics titled, “A multistage genome-wide association study detects a new risk locus near IRS1 for type 2 diabetes, insulin resistance and hyperinsulinemia” (6 September, 2009).
This is highly interesting stuff, no doubt — however, it does beg the question of environmental influence. In other words what is the environmental impact of diet type and fitness level on the expression of this genetic variant?
Case in point: Chris, of the wonderful blog Conditioning Research, recently highlighted Michelle’s story of surmounting diabetes with no more than the intelligence and wherewithal to adhere to a strict Paleo lifestyle. In Michelle’s case, I suspect that she was wrongly diagnosed as being a Type I diabetic — an increasingly common mistake as the incidence of “adult onset” diabetes increases among the young (Michelle is 21). That’s mere hair-splitting, though, with the real story being Michelle’s new-found health as a result of her adherence to the Paleo lifestyle. Check out Michelle’s testimonial, here, at her blog. And please encourage her to continue keeping us informed of her progress.
Remember, genes are not destiny, they are merely signposts. Environmental influence counts for much in the ultimate genetic expression.
And speaking of environmental influence, I’d like to point out this little tid-bit, as highlighted in the Scientific Blogging post:
Professor Philippe Froguel, one of the corresponding authors of today’s study from the Department of Genomic Medicine at Imperial College London, said, “We are very excited about these results – this is the first genetic evidence that a defect in the way insulin works in muscles can contribute to diabetes. Muscle tissue needs to make more energy using glucose than other tissues. We think developing a treatment for diabetes that improves the way insulin works in the muscle could really help people with type 2 diabetes.
“It is now clear that several drugs should be used together to control this disease. Our new study provides scientists developing treatments with a straightforward target for a new drug to treat type 2 diabetes,” added Froguel. (emphasis mine).
Ugh! I guess we should have seen that one coming, huh? Now, I’m certainly not a Luddite when it comes to pharmacological intervention, but how about let’s promote Michelle’s method first and foremost, then proceed from there, if even necessary at that point, via the pharmaceutical route?
Unfortunately, we already know that answer. It’s not about health, folks, — it’s about profits.
In health,
Keith
Theory to Practice 
I find it interesting that we are trying to identify the ‘abnormality’ that makes someone prone to sickness when eating a standard American diet. Perhaps the abnormality is actually to be found in those who can eat such a diet and NOT get sick.
The rest of ‘us,’ those ‘prone’ to type II diabetes, may actually be the norm. (I think I might be included in this due to the weight gain and blood sugar instability I used to have).
Saying someone has a genetic predisposition to get diabetes when eating 150lbs of sugar a year seems a bit like claiming someone could have a genetic predisposition to catch hypothermia when submerged in freezing water.
Good analogy. And yes, I do believe science looks at this from the wrong end of the gun, so to speak.
I am all in favor of treating DM2 (and even DM1) primarily through diet, but I think you’re being a little unfair to the medical profession. When I was diagnosed with OSA, the MD immediately started to write me a prescription for a CPAP. I tried talking to him about treating it through weight loss. He said I could try if I wanted and that it would be effective but that he didn’t even broach the topic with patients anymore because there was such poor compliance with behaviorally-related treatments.
Hey, I couldn’t agree more, Chris — don’t let my last two ” rants” leave you with the impression that I think the general public (the “sheeple” portion, at least) is not to be implicated in this morass. far from it. And I can certainly feel for the front line medical troops in this battle. They really are in a lose/lose situation. And I just want to be clear — my ire is mostly directed at the so-called “experts” and “policy makers”.
Nutritional bricolage participatory partnership between patients and medical professionals provides a possible way to improve on poor patient compliance: ‘n=1’ clinical trials empower patients with self-directed agency, embedding their experiences within a larger mythological context and background. We need better health financing and delivery models, though, to operationalize this form of medical practice (*see Hello Health — http://www.hellohealth.com — as one possible iteration aimed at creating an ‘alternative healthcare system’).
This plays back to Chris’s point; the problem also rests on the shoulders of the public, who must remain informed and engaged. The general public, unfortunately is not — not at this point, at least — and it may take a generation or more to turn the tide. I think in some small way that has begun (as evidenced by this and other engaged conversations), but much work and attitude-shifting remains.
I’ve done quite a bit of work for pharmaceutical companies, but have become discouraged and disillusioned at their approaches to curing diseases of late. There will always be people who are disabled or otherwise too ill to exercise, who have food allergies or other idiosyncracies and require drug interventions. So I hope the pharma companies will keep looking for cures. However, I think their model is completely wrong- they rely on simplistic associational thinking and design drugs based on the effect on surrogate markers (you know- you need a drug to lower your cholesterol or CRP or glucose), never mind figuring out what actually causes the disease. Who cares when we can sell a drug to treat associated signs of the disease… Hunting for genes associated with a disease also doesn’t address the role of epigenomics, modifications of the genes that affect their activity, but aren’t mutations. Maybe that is where the environmental affects of chemicals and diet composition come into play.
It’s certainly more profitable to treat symptoms for the remainder of a lifetime than to cure. I’m not at all a pessimist by nature, but I am a “questioner of all”; the answers I’ve received when the subject turns to business, profit motive and the acquisition of power…well, you know how the story inevitably ends.
I am a “questioner of all”
–> ‘Learned Amateurs’
http://evidenceanecdotal.blogspot.com/2009/09/learned-amateurs.html
Nullius in Verba — `Nothing upon Another’s Word.’” The Society’s web site translates Horace’s Latin more colloquially as “Take nobody’s word for it,” and elsewhere I’ve seen “On the words of no one” and “Nothing in words.” In other words, trust experimentation, not authority.
(Sounds like epistemocracy?): I like the sound of “learned amateurs,” intrepid autodidacts. It describes the better class of independent bloggers, those who live by Nullius in Verba.
Sometimes it shames me to be in the medical profession. Heaven forbid someone have some sense and do what this doctor does: http://www.menshealth.com/cda/article.do?site=MensHealth&channel=health&category=other.diseases.ailments&conitem=4a935e4e40fae010VgnVCM20000012281eac____
Awesome find, Ryan.
This is very Richard Feynman (the physicist) like:
“They’re contradicting themselves,” says Richard Feinman, Ph.D., director of the Nutrition & Metabolism Society and a professor of biochemistry at SUNY Downstate medical center, in New York City. “They want diabetics to take medication to lower their blood sugar, but recommend a diet that has the opposite effect.”
Nutritional bricolage:
” Dr. Vernon instructed Long to adopt a low-carbohydrate, high-fat diet instead of the ADA’s well-established dietary guidelines. His condition reversed — and fast. In just 3 months, he was no longer diabetic. And this was without ever taking a single dose of metformin or injecting insulin.
“My treatment didn’t seem like a treatment,” says Long. “All I had to do was change my eating habits.”
This turnaround may have amazed Long, but Dr. Vernon is more matter-of-fact about the remedy and the results. “I believe in addressing the cause, not the symptoms,” she says. “That’s why I first eliminate the foods that raise blood sugar. It’s only logical.”
So logical, in fact, that Elliott Proctor Joslin, M.D., a Harvard- and Yale-educated physician, used it more than a century ago. According to carefully documented patient logs he kept from 1893 to 1916, Dr. Joslin successfully treated dozens of diabetic patients — including his own mother — using a diet made up of 70 percent fat and just 10 percent carbohydrates. ”
Fructose got a cursory passover in the article, with a focus on starch, but fructose is quite a hepatotoxin.
‘Men’s Health’ is one general public health outlet …
“…That’s why I first eliminate the foods that raise blood sugar. It’s only logical…” Ah, but unfortunately, not very profitable. Kudos to the likes of Dr’s Feinman, Vernon, and McGuff for speaking out and, I’m sure, undertaking substantial financial risk for bucking “the machine”.
Not profitable for most; but, is profitable under integrated systems like Kaiser Permanente and others (like Hello Health) that eliminate the ‘three-body’ agency problem in healthcare.
To be sure there are some wonderful models out there, which makes what the ultimate, politicized outcome of this debate will be, all the more difficult to stomach. One can only hope that we will eventually inch toward such a model.
Definitely, and business models is only half the battle. More importantly, the practice practiced trumps most everything, hence the real need for health reform, not healthcare reform.