Ask The Doctor: Diabetes
Question: I am a 67-year-old retired white male with a history of diabetes for about 4 years. I have high blood pressure (in the 160/95 range), diminishing eyesight and tests are now showing of protein in urine. I’m probably 35-40 pounds overweight, and have been experiencing increasing fatigue and lethargy. Can you talk about my situation?
Answer: Yours seems to be the classic presentation of type II, or non-insulin-dependent diabetes. The typical story is onset in the 50s to 60s in a person who is significantly overweight. Diabetes often goes along with high blood pressure, both as a direct consequence of being overweight and as a result of the fact that excess insulin (the hallmark of type II diabetes) itself causes high blood pressure because it stimulates the retention of fluid in the body. The protein in the urine is a sign that the diabetes is affecting your kidneys and that they are starting to leak protein. This is usually a harbinger of advanced diabetes and if not corrected will eventually lead to compromised kidney function and the misery of regular dialysis treatment. The eyesight problem is also a direct consequence of the diabetes because diabetes leads to a deterioration of the small blood vessels everywhere in the body. This includes the retina, where one begins to see exudates or leaking of blood from the blood vessels of the eye into the retina. Eventually, this process will lead to further impairment of the vision, if it is not reversed. I have also found that many of my patients with this kind of advancing diabetes also complain of not feeling well in a non-specific sort of way. Often the complaint is fatigue, lethargy, or just a decreased joy in life.
Let me share a case history that is similar to yours. As is usual in these cases, my patient was on a number of drugs to address his health concerns. He was on an oral hypoglycemic agent to lower his blood sugar, a beta-blocker to lower his blood pressure (which incidentally raises the blood sugar), and an ACE inhibitor to lower the blood pressure and protect the kidneys. He believed that these drugs were contributing to his feeling unwell.
On his initial visit to me, in spite of these drugs, his blood pressure was 165/95, and his HgbA1c (a measure of the average blood sugar over the past six weeks) was 8.1 (normal is 5.5-6.5). He had been instructed in the American Diabetes Association diet which is calorie-restricted and fat-restricted and also universally reviled by the patients. Clearly, in spite of the best that Western medicine had to offer, he was not doing well.
I suggested a strict 60-70 gram per day carbohydrate intake while implementing a nourishing traditional diet to guide his food choices and food preparation. He was to eat plentifully of all the good fats and non-starchy vegetables without overeating protein (e.g., eat egg yolks in preference to egg whites, fatty fish instead of lean fish, cream instead of milk, etc.). He was not to limit his total food intake, but rather to strictly limit his carbohydrate consumption to the amount listed above. The patient also began taking a number of medicines which are my staples for treating patients with his constellation of troubles stemming from diabetes, including diaplex, gymnema, bilberry, and birch leaf tea, along with cod liver oil to supply 20,000 IU vitamin A daily.
In six months of strictly following this program the results were nothing short of remarkable (though actually predictable). He had lost 35 pounds without increasing his exercise, he felt much more energetic, he loved his food again, and he was off all conventional medicines. When I saw him at 6 months his blood pressure was 135/80, and there was no protein in his urine. The HgbA1c was 6.7 (almost normal) and he could sense his eyesight improving. Confirmation came when he had his checkup with his eye doctor, who produced an after picture showing that his retinal hemorrhages had healed considerably over the previous six months. The doctor commented that he had never seen such a thing.
This story shows that there is hope with diabetes and that with sound thinking and sound intervention much of the ravages of this illness can be prevented and treated.