October 19, 2019
Honourable Tyler Shandro
423 Legislature Building
10800 – 97 Avenue NW
Dear Mr. Shandro
RE: Type II Diabetes
You may recall that I wrote to you about two months ago stating that the ability to balance the Alberta budget lies with you and you alone. I stated at that time that I could show you more than enough incompetence, obsolete thinking, and badly misguided treatment to save enough money to balance our budget rather quickly. I received your reply letter and I must say that it is one of the nicest and most thorough replies that I have ever received from a politician. Thank you. I am certainly disappointed that there will not be an opportunity for us to meet but I am sure that you are busy and there are certainly a lot of more qualified people than me that can help you. A lot of hard working men and women worked hard last spring to rid this province of in competent government. Nothing needs more change than our healthcare system. It is an awful mess. I am sure that your bureaucrats are telling you that we have the best healthcare system in the world and it just needs a little more money, that is all. The truth is that our system is about 35th best in the world which puts it just about dead last among first world countries. During the months ahead, I will write to you every month or so with a new topic, each one darker than the one before. Let’s start with something light and simple. Let’s start with Type II diabetes.
The theme of our discussions going forward will always be that today we know the causes of most diseases. When we know the cause of a disease, more often than not we can consider the disease to be, “Mostly Preventable,” and in many cases very treatable and even curable in some cases. That was not always the case. When I started in healthcare nearly a half century ago, we did not know what caused most disorders and we desperately grasped at anything that would make our patients more comfortable. More often than not it was Big Pharma that had a quick fix. They had a “Pill for every ill,” as the saying went. We were grateful for this when we had nothing else but it allowed our healthcare system to fall into the trap of just treating the symptoms and not treating the cause. This is a very costly way of doing things. Our healthcare system labeled many disorders as chronic diseases which implies that they are not treatable and not curable. That may have been true at one point but today we do know the root causes of many different disorders but still we continue to simply treat the symptoms rather than tackling the root cause. This works very well for Big Pharma and the medical establishment but it is bankrupting the taxpayers and does a tremendous disservice to the poor patient who will never get better if we just treat the symptoms and not the root causes of the problem.
There is no better example of this type of misguided treatment than in the case of Type II Diabetes. The causes of Type II Diabetes are very well known and understood but we hardly use what we know when we treat this disease. I have included the diagram of the causes and results of diabetes which was also included in my first letter. Just look at all the problems that result from improper treatment and control of diabetes, a completely preventable and completely curable disease. Consider all the costof all the heart failure, liver failure, kidney dialysis, blindness, dementia, and amputations that could have been prevented if only the patients with Type II Diabetes were properly treated and cared for. This saving alone would probably be enough to balance Alberta’s Budget.
So how did we get it so wrong? I remember one of my professors nearly fifty years ago stated in no uncertain terms that the cornerstone to the treatment of diabetes was through diet alone! Period. End of discussion. He was dead right then and this statement is truer than ever today. The problem was that fifty years ago my professor’s main focus was on sugar and he did not realize that other refined carbohydrates played as big a part as they did. It was not until patients got their own testing equipment that we realized what a big effect that other refined carbohydrates such as breads, cereals, and pastas also played into the overall problem.
Simply stated, Type II Diabetes occurs when a person consumes more glucose than his body can handle. Everybody’s capacity to handle glucose is different and is unique to that person. So, what does a diabetic have to do to be cured? Answer, whatever it takes to get his glucose consumption down to a level that his body can handle. This will mean seriously cutting back carbohydrate consumption in all cases and in some cases it will mean complete abstention. Complete abstention may seem extreme but if that is what it takes, so be it .Carbohydrates are not essential. Our bodies do need some glucose but our liver has the capacity to produce enough glucose. This is the process that the drug Metformin blocks. So you give a patient a drug to block the production of glucose and then you tell the patient that he can consume up to 40 grams of carbohydrates at each meal. Brilliant!
All foods fall into one of three categories: proteins, fats, and carbohydrates. Fats and proteins are essential for life, carbohydrates are not. Our North American natives lived on foods high in fats and proteins and nearly no carbohydrates for tens of thousands of years and were far healthier than they are today on our modern American diet.
So, what diet does our Canadian Diabetic Association recommend? Oddly enough they recommend a diet with up to 40 grams of carbohydrates per meal. Sheer madness! Their diet is loosely based on the latest version of the Canada Food Guide which is a political creation focused mostly of creating harmony with a bunch of lobby groups and it really has no basis in science so it is not worthy of further consideration. There are several good diets which could work for diabetics. The Keto diet is a serious fat and protein(Carb free) diet that has worked well for many. The Paleo Diet is also good. It is mainly a meat and vegetable, no refined carbohydrates diet that also works well. There are all plant based diets that can be good as long as you get all your essential amino acids, fat soluble vitamins and minerals such as iron, zinc, and magnesium. (There is more to being a vegan than just stopping consumption of meats.) Then there is the Mediterranean Diet which can be good as long as you avoid all breads and pastas which are loaded with carbs.
So, what you might ask is the practical application of all this information and how can we save a ton of money without spending much money? The answer is simple. You tell the Alberta Medical Association to adopt as the “Standard of care for diabetes”, that when treating a patient with diabetes, that first you most address the cause of the disease which is a high carbohydrate diet. This must be thoroughly and vigorously addressed before resorting to treating the symptoms and the results of poorly controlled diabetes. Treating the cause involves a high level of personal responsibility and personal sacrifice and this is not for everyone so we shouldn’t be too harsh. But still, “Treating the cause of the disease rather than the results of the disease is the foundation of good healthcare.”
There is also a matter of informed consent at play here. Anything short of informing the diabetic patient of all the aspects of this complex disease does not satisfy the patient’s right to informed consent before the patient is asked to decide how he chooses to proceed with treatment. I fear that a lot of patients are not properly and thoroughly informed and therefore the practicing physician does not have informed consent. Starting treatment without informed consent is unprofessional conduct which is punishable by suspension of licensure. The department of health could help the medical association to standardize the minimum information necessary for informed consent by producing pamphlets and videos that provide the necessary information.
One closing thought is that we must cut our diabetic patients some slack because there is one more factor to consider. Many diabetics will simply not be able to quit all carbs cold turkey and that is because carbohydrates do have an addictive component to them. This will be explained in January when we examine all addictions in depth. This element of the problem must also be discussed and appropriately addressed.
Thank you for reading my letter. No need to reply. Next month we will deal with dementia which is also largely preventable and somewhat treatable and again there is a ton of money to be saved. If at any time you wish to discuss any of these problems in greater depth please feel free to get in touch with me.
Dr. Murray Hennings, DMD