By Marika Sboros
Can you conquer your diabetes? Sure you can. However, conquering it is a journey, not a destination. Fortunately, as the ancient Eastern saying goes, even a journey of a thousand miles begins with a first step.
Diabetes is, of course, a journey over a lifetime. Therefore, the best first step you can take is to equip yourself with up-to-date scientific information about this common and serious metabolic disorder. You also need the right medical specialists as guides.
You don’t have to go far to find two of them.
US endocrinologist Dr Martin Abrahamson and hepatologist (liver specialist) Dr Sanjiv Chopra are distinguished professors of medicine at Harvard Medical School. They are also authors of a brave new book. It is appropriately titled Conquer Your Diabetes, Prevention, Treatment, Remission, available from today on Amazon, Barnes and Noble and elsewhere.
It is the fruits of the authors’ remarkable, never-ending, professional journeys. Between them, they have nearly 100 years of clinical and teaching experience on diabetes and its related life-threatening conditions. They share their accumulated knowledge, wisdom and practical insights from those years generously with readers.
Their aim, they write, is to “inform and empower people with diabetes, those at risk for (it) and all their loved ones affected, to help them live full and fulfilling lives”. To that end, they are patient-centred throughout.
The book’s opening quote by Dr Elliot P Joslin points to that mission: “The diabetic who knows the most lives the longest.”
Joslin was the first doctor in the US to specialize in diabetes and founder of the world-renowned, eponymous Joslin Diabetes Center in Boston, Massachusetts.
Must-read for physicians
Abrahamson, a graduate of the University of Cape Town Medical School, was Senior Vice President and Chief Medical Officer at Joslin for 10 years. Chopra served as Faculty Dean for Continuing Education at Harvard Medical School for 12 years.
Their book is well-written, easy to read and beautifully crafted. Although primarily aimed at the lay reader it is a must-read guide for physicians as well. It contains everything patients, family, friends and doctors could need or want to know about diabetes.
It is jam-packed with survival strategies and “tips, tools and tricks”, as one reviewer put it. The authors deliver on all promises and hopes.
They have dipped their toes into the turbulent waters of the current COVID-19 pandemic. But, wisely, only a little. They say that there is “no evidence that having diabetes increases susceptibility to COVID-19 infection”. There is evidence that people with diabetes who become infected “may have a more severe form of infection”.
Some might say that the evidence suggests more complexity in risk but that’s not for this book.
The authors dispatch the vexed COVID-19 vaccine debate with one pointed sentence: “Vaccinations simply save lives, from the newborn to old age.”
Never was this book more needed.
Diabetes is a common and an extremely serious metabolic disease. It is characterised by hyperglycemia (high blood “sugar” – glucose – levels in the blood) from defects in secretion and/or action of the hormone insulin.
Epidemic or pandemic?
Researchers have variously called diabetes the “epidemic” and “pandemic” of the 21st century. The numbers tell the sobering tale. Currently, it afflicts close to half a billion people worldwide. The vast majority (95%) have type 2 diabetes. Most of the rest have type 1 and a smaller number with gestational (pregnancy-related) or other types.
The most recent estimates are that there are almost 375 million people with prediabetes. Conservative estimates put global health expenditure on diabetes at $760 billion. That’s excluding related costs from productivity losses, absenteeism, premature disability and death.
There is currently no cure for diabetes, claims to the contrary notwithstanding.
As with many scientific discoveries, the understanding of diabetes “has evolved significantly from older observations and knowledge”, the authors say. Advances allow people to conquer diabetes and live full, longer, healthier lives but their path is riddled with obstacles. These include ignorance, myth, misinformation and fake news that bedevil optimum diabetes treatment and maintenance. There’s also the lucrative industry and purveyors of snake-oil products and “cures” that have popped up.
This book is firmly rooted in orthodox medicine and science to dispel myths and misinformation about diabetes. It is also multimodal and embraces complementary and alternative medicine (CAM) as adjunctive where appropriate.
And – dare I mention the “S” word – it is spiritual in approach. A sign of that from the get-go is the foreword’s author: Chopra’s brother, US endocrinologist Dr Deepak Chopra. That choice is not just fraternal.
He is founder of The Chopra Foundation, a non-profit organisation devoted to research on well-being and humanitarianism. He also founded Chopra Global, a health company at the intersection of science and spirituality.
No boundaries for diabetes
In the foreword, he says that “no matter which side of the stethoscope you find yourself on, diabetes respects no boundaries”.
Abrahamson makes precisely that point. Diabetes doesn’t discriminate. It has no social, economic, or political boundaries, he writes. It affects all ages and increasingly, younger children. In clinical practice, Abrahamson has seen the “illiterate rural laborer with type 1 diabetes who has no access to electricity take superb care of himself and maintain excellent glucose control; and … a highly intelligent and wealthy entrepreneur unable to adhere to a treatment regimen of primarily diet and exercise and develop multiple complications”.
The authors’ balance between head, heart and mind makes this book an idea whose time has come.
They take readers on a journey through time, from the first record of a disease similar to diabetes in ancient Egypt to the present day. All the basics of diabetes are there – the different kinds, causes, symptoms, diagnosis, treatment options (medical and surgical) and its killer complications. The latter are legion and arise when diabetes is not properly treated and managed.
Diabetes is a major cause of blindness, limb amputation and heart, kidney, liver disease. There’s a chapter on each in the book. However, diabetes of any kind affects multiple bodily and organ systems, as the authors show. Thus, they cover other serious problems, including cancer, neurological, declining cognitive function (and increased risk of dementia diseases), psychological and sexual issues.
Erectile dysfunction in men with diabetes is common. So is its effects on female sexuality.
The authors punctuate each chapter with patients’ inspirational life and case histories. One is American explorer and educator Will Cross, presumably the inspiration behind the book’s title.
Doctors diagnosed Cross with type 1 diabetes in 1976, aged just nine. In 2006, he became the first American with type 1 diabetes to summit Everest. He has since summited the peaks of the highest mountains on all seven continents.
Among this book’s many strengths is the focus on prevention as much as treatment and remission. The key, the authors say, is tight blood sugar levels. They are unequivocal on how best to achieve it: “Lifestyle modification: weight loss through diet and exercise.”
That’s backed up by solid science, they say. They stress the need for individualised treatment. And they say that conventional treatment only becomes necessary if – or when – lifestyle changes don’t work well enough.
Another clear message is that obesity is the “single most important driver of the type 2 diabetes epidemic”. Therefore, addressing obesity through prevention and treatment holds “one of the keys to reducing the personal and population burden of diabetes”.
Even small amounts of weight loss can make a big difference in lowering glucose (HbA1c), blood pressure and serum cholesterol, the authors say. In doctors’ parlance, that’s the “ABCs” of diabetes management.
Diet and diabetes
Thus, they cover diet and nutrition in depth. That makes sense as diabetes is a diet- and nutrition-related disorder of carbohydrate (glucose) metabolism. Therefore, it makes sense to try diet- and nutrition-related solutions before drugs and surgery.
And no, they don’t promote any one-size-fits-all diet to conquer diabetes. As they show clearly, there isn’t one.
They present the pros and cons of a wide variety of diets, including vegetarian and vegan. They say that low- and very low-fat diets contribute to weight loss and reduced diabetes risk. The authors also say the same about low- and very-low-carbohydrate (ketogenic) diets. These have become one of the biggest trends in diabetes dietary management.
Which works best?
Both support the evidence for a low-carb approach and complex carbs only for those with diabetes.
Overall, they say that the so-called (my word) Mediterranean Diet has been “studied the most. It is also shown to improve glucose control, facilitate weight loss, and reduce cardiovascular risk”. I call it so-called given ongoing controversy on just what constitutes a Mediterranean diet. And because there is robust and growing clinical evidence for benefits of low-carb diets these days.
Even the conservative American Diabetes Association’s consensus statement in 2019 accepts that low-carb (and low-fat) Mediterranean diets have “the most robust evidence”. Diabetes Canada said something similar in the Canadian Journal of Diabetes in 2020 but wrapped in caveats.
The authors support another growing dietary trend for diabetes management – intermittent fasting. They say that there’s evidence for benefit of regular, short fasts for common health conditions. Not just for diabetes but also obesity, cardiovascular disease, cancers and neurological disorders.
They take a deep dive into drugs to treat diabetes and note that none currently has FDA (Food and Drug Administration) approval in the US for prevention. Even Metformin, while the most established, is “less effective than lifestyle modification”, they say.
They acknowledge research showing that statins, cholesterol-lowering drugs, can increase diabetes risk. However, they also say that the risk is “very modest”. And that “all experts agree that the benefits of statin therapy outweigh this side effect”.
I’d say that not all experts agree.
Abrahamson and Chopra take a long, hard look at bariatric (stomach) surgery. It is an invasive procedure to treat morbid or recalcitrant obesity. It is also controversial as some critics say its success rate is low and complication rate high.
The authors say that in good hands, bariatric surgery has an “inordinately low mortality”. It is recommended as part of the treatment of type 2 diabetes and obesity. But only when non-surgical strategies to incur weight loss fail.
They devote a chapter to the microbiome as “one of the hottest topics of investigation in medicine”. They explain what it is: a conglomeration of 100 trillion bacteria and around 1000 different species in the human gastrointestinal (GI) tract. It is also a “massive and dynamic collection of organisms and their DNA” with a reputation as the “Second Human Genome” and the “Inner Bacterial Rainforest”. It might also be “a newly discovered organ”.
The composition of the microbiome has “implications in obesity, diabetes, cancer, arthritis, liver disease, mental health and even perhaps in autism”, they write.
While they devote a chapter to CAM treatments and products, the authors are mindful of inbuilt research limitations. With any CAM modality it can “be difficult to pinpoint exactly which aspect is improving a person’s glucose control”, they say.
They look at herbs and spices with purported blood-sugar benefits. Top of their list is cinnamon, although they say that more research is needed. In the meantime, it’s “reasonable for a person with diabetes to add cinnamon (1 to 3 grams daily) to their diet for six to eight weeks” to check effects on their blood sugar levels.
A strategic way to get enough cinnamon, they say, is simply to add it to your coffee. Their book contains a whole chapter on coffee. It’s a paean to my favourite brown brew and one of Chopra’s side fields of interest.
Along with all the other evidence, they say that coffee is helpful for those with diabetes and can favourably alter the gut “microbiome”.
Another strength of this book is its broad horizons. Strategies to ameliorate or reverse type 2 diabetes in “the not-too-distant future” will likely include ways to alter the composition of the gut microbiome favourably. These may include stool (faecal) transplants, they say.
They also look at technological advances and transplant developments, with the holy grail of a “cure” hovering ever in the wings.
For those with end-stage kidney disease from type 1 diabetes, SPK (Simultaneous Pancreas and Kidney) transplantation is “looking good”. Survival for seven years following surgery is currently at 77%. That’s “significantly better” than the 40% survival in patients who remained on dialysis. Up to 90% of people have optimal blood sugar levels a year after an SPK transplant, they say. Crucially, some patients have been able to do without insulin altogether.
Stem cell research also looks promising as a “cure” for type 1 diabetes. However, the authors say that researchers are having to work hard to address the problem of beta-cell destruction.
Not surprisingly, their book garnered glowing advance praise from top medical specialists across the US and globally.
Dr Shlomo Melmed, Dean and Professor of Medicine at Cedars Sinai Medical Center in Los Angeles, calls it a “clearly articulated patient-focused tour de force”. Dr John Wong, Professor of Medical Sciences at the National University of Singapore says it “needs to be translated into as many languages as possible for all to benefit”.
Ultimately, this is a remarkable book about a remarkable journey with two remarkable men as readers’ guides.
The authors close it with a lyrical quote by revered Buddist monk and teacher Thích Nhất Hạnh, who died last Saturday:
“Allow the teachings to enter you as you might listen to music or as in the way the earth allows rain to permeate it.”