How Diabetes became an Epidemic – T2D 10

The World Health Organizations earlier this week released new statistics on the global epidemic of diabetes. Diabetes mellitus has been recognized as a disease throughout human history for thousands of years. The ancient Egyptian medical text Ebers Papyrus, written around 1550 B.C. first described this condition of ‘passing too much urine’. Around the same time, ancient Hindu writings note the disease of madhumeha, loosely translated as honey urine. Patients were mysteriously wasting away, but curiously, ants were attracted to their urine. By 250 B.C. Greek physician Apollonius of Memphis (I should start referring to myself as Jason of Toronto, so cool…) termed the condition ‘diabetes’ which, by itself connotes excessive urination.

Thomas Willis added the term ‘mellitus’ meaning ‘from honey’ in 1675. Another much rarer form of diabetes was termed diabetes insipidus, meaning ‘bland’. This disorder is also characterized by excessive urination, but the urine is not sweet. The primary cause of diabetes insipidus is brain injury, most commonly from trauma or neurosurgery. Commonly, the term diabetes refers to diabetes mellitus. We will also use the term diabetes to mean diabetes mellitus.

A more complete description of diabetes mellitus would wait until the 1st century AD when Greek physician Aretaeus of Cappacdocia wrote the classic description of type 1 diabetes as a “melting down of flesh and limbs into urine”. This captures the essence features of this disease in its untreated form. There is excessive urine, but also complete wasting away of all tissues. Patients cannot gain weight no matter what they eat. He further comments that “life (with diabetes) is short, disgusting and painful” as there was no effective treatment. Lovely.

The classic method of diagnosis was to taste the urine of the afflicted patient for sweetness. In 1776 Matthew Dobson (1745-1784), the English physician identified sugar as the sweet tasting substance in the urine. Like that was really hard to figure out. He also figured that the sweetness of the blood (oh, that is sooo gross) was also due to sugar.

In 1797, Dr. John Rollo a Scottish military surgeon was the first to apply a dietary solution. He observed improvement in a diabetic patient treated with an all meat diet. This would be the first dietary treatment of its kind. By contrast, French physician Pierre Priorry (1794-1879) advised diabetics to eat large quantities of sugar to replace that lost in the urine. A diabetic colleague unfortunate enough to follow this advice died. Needless to say, history only laughs at the good Dr. Priorry.

Apollinaire Bouchardat (1806-1886) sometimes called the founder of modern Diabetology, established his own diet based upon his observation that periodic starvation during the 1870 Franco-Prussian war resulted in less glucose in the urine. His book De la glycosurie ou diabète sucré, laid out forbidden foods such as sugars and starches.

In 1889, Joseph von Mering and Oskar Minkowski finally identified the pancreas as the culprit organ. Experimentally removing the entire pancreas from dogs rapidly led to identical signs and symptoms of diabetes. In 1910, Sir Edward Sharpey-Schafer proposed that deficiency of a single hormone he called insulin was responsible. The word insulin derived from the Latin insula, meaning island as this hormone was produced in the islets of Langerhans in the pancreas.

In 1910, Frederick Madison Allen (1879-1964) developed the “Allen starvation treatment” which was widely considered the best dietary therapy until the discovery of insulin. This diet was very low in calories (1000 calories per day) and very restricted in carbohydrates (<10g per day). Mason’s book “Studies Concerning Glycosuria and Diabetes” revolutionizes diabetes treatments.

Patients admitted to hospital are treated with whiskey and black coffee every two hours from 7 am to 7 pm. This is continued until the sugar disappears from the urine. Why whiskey? Not really sure, but I have the feeling that back in the day, they though whiskey could cure just about everything. At least it’ll keep their minds off the fact that they’re not getting anything but whiskey and coffee. While type 2 diabetics do well, type 1 diabetics often die. Since the disease was otherwise fatal, this was not the tragedy it may initially appear. But the response of type 2 diabetics was a stunning improvement, unlike anything seen previously, and Allen soon becomes director of diabetes research at the Rockefeller Institute.

He and Dr. Elliott Joslin were considered the pre-eminent diabetic specialists of their era. Dr. Joslin writes in 1916, ‘That temporary periods of under-nutrition are helpful in the treatment of diabetes will probably be acknowledged by all after these two years of experience with fasting”.

Frederick Banting, Charles Best and the other guy (John MacLeod) made the breakthrough discovery of insulin at the University of Toronto in 1921. They isolated and purified insulin from bovine pancreases and gave it to the first patient in 1922. Leonard Thompson, a 14-year-old boy was only 65 pounds when he started insulin injections. His symptoms and signs rapidly disappeared. Six more patients were quickly treated with equally stunning success. The average lifespan of a ten-year old at diagnosis increased from 1.3 years to 35 years!

Eli Lilly and Company partnered with the University of Toronto to commercially develop the product. Banting and Best made the patent freely available so that patients worldwide could benefit. By the fall of 1923, 25,000 patients were being treated with injected insulin. Banting and MacLeod received the Nobel Prize in 1923 to commemorate their historic discovery. Later, Sir Frederick Sanger would receive a 1958 Nobel Prize for his work decoding the amino acid structure of insulin.

Euphoria ensued. It was widely believed that the cause of diabetes had been discovered and a cure now existed. Urine testing for glucose is refined. New types of insulin are developed. Insulin’s discovery completely overshadows the dietary treatments of the previous century.

But it is clear that two groups of diabetics exist. In 1936, Sir Harol Percival Himsworth (1905-1993) divides diabetics based on ‘insulin sensitivity’. By 1948, Dr. Joslin speculates that large numbers of people have undiagnosed diabetes and that insulin cannot solve all their problems. By 1959, two types of diabetes were now formally recognized. These were called type 1 ‘insulin-dependent’ and type 2 ‘non-insulin dependent’ diabetes. With further understanding, the names insulin-dependent and non-insulin dependent are formally dropped in 2003. Previously, the names juvenile and adult-onset diabetes were also used. However, since type 1 diabetes may occur in adults and type 2 diabetes is increasingly prevalent in children, this classification has also been abandoned.

What is ironic is that despite the wealth of knowledge accumulated in the last two centuries, we are arguable worse off with diabetes than in 1816 (8). In the 1800’s, type 1, or severe insulin deficiency dominated the landscape. While almost uniformly fatal, these cases were still relatively rare and diabetes was not in the top 10 causes of death.

Fast-forward to 2016, and type 1 diabetes only makes up 10% of the total cases. These cases are efficiently treated with insulin. Type 2 diabetes dominates and is growing to epidemic proportions. Almost all these patients are overweight or obese and will suffer complications related to their diabetes.

Worse, the prevalence of T2D is a recent phenomenon, having occurred only in the last 30 or 40 years. In China, the prevalence has skyrocketed from less than 1% in 1980 to 11.6% in 2010. That’s over a 1160% rise within a single generation!

Both the total numbers of diabetics and the percentage of the population (age adjusted) are rising. What’s worse is that there seems to be no end in sight.

The problem is not trivial. In 2012, it is estimated that diabetes cost $245 billion in the United States due to direct health costs and lost productivity (10). 14.3% of US adults have T2D, but the problem is even worse than it seems. A full 38% of the population has prediabetes, so the total of prediabetes + diabetes is 52.3%. This means that for the first time in history, there are more people with the disease than without. Unbelievable.

Part of the increasing prevalence results from the fact that we are seeing T2D in younger and younger populations. Pediatric clinics, once the sole domain of T1D, are now overrun with an epidemic of T2D patients – often obese adolescents. This is a worldwide phenomenon. In Japan, 80% of all new cases of diabetes are T2D.

But the question still remains WHY? Why are we powerless to prevent the occurrence of T2D? Why are we powerless to prevent its spread to the pediatric age groups? Why are we powerless to stop the ravages of T2D on our bodies? Why can we not prevent the heart attacks, strokes, blindness, kidney disease, and amputations that accompany T2D? More than 3000 years after its discovery, WHY IS THERE NO CURE?

The only possibility is that we have fundamentally mis-understood the disease called T2D. We must understand the causes of the disease to cure it. In medical terms, this is the aetiology. What is the aetiology of T2D? Once we understand that, we can begin to design rational treatments that have a chance of success.

 

 

2017-10-27T18:43:20+00:0039 Comments

About the Author:

Dr. Fung is a Toronto based kidney specialist, having graduated from the University of Toronto and finishing his medical specialty at the University of California, Los Angeles in 2001. He is the author of the bestsellers ‘The Obesity Code’ and ‘The Complete Guide to Fasting’. He has pioneered the use of therapeutic fasting for weight loss and type 2 diabetes reversal in his IDM clinic.

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Tony
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Tony
Steph
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Steph

Retoric question !
You, Dr Fung gave an answer to aetiology, but so many people (meaning MDs) are not understanding it, or they refuse to understand it

S
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S

Love your blog Dr Fung! Well I have just come across the great work of Dr Kraft on insulin assays and if we were to follow his way of testing the population for diabetes we would find majority of the population would have diabetes in situ even prior to the rise in blood glucose. I now can see that T2DM, particularly the symptom of hyperglycaemia is secondary to hyperinsulinaemia and the treatment of some cases with insulin is like treating a gangrenous wound with more gangrene. Doesn’t make sense to me! If only the medical community could see this too.… Read more »

honeycomb
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honeycomb

I’m very pleased with your book Jason.

Keep up the, necessary, good work.

Jonathan Wexler RN
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Jonathan Wexler RN

The question “How?” would seem to be answered by “When” and “What”. If you compare the chart of incidence in T2D and world population, you will find they run parallel. Simple numbers does not answer “why”, so look at the dates both population and T2D took off. Both parallel the industrial revolution, urbanization of populace and mechanization of transport, agriculture and industry. I do not think this is coincidence. Prior to industrialization world population was at a relatively steady 500,000,000 world wide for thousands of years. T2D was likewise stable. Do a simple search for “world population level graph” and… Read more »

Jin
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Jin

Here are a few more factors to add into the mix Jonathan, Convenience, because we lead such busy lives, snacking between meals, the rise of seed oils since the late 70s, the rising use of antibiotics with the resulting decimation of gut bacteria, increased stress, cheap food produced on an industrial scale, cleanliness taken too far resulting in low levels of diversity in our guts, enriched wheat, bad scientific advice regarding diet, advising people to stay out of the sun, the rise of low fat i.e. high sugar foods. I am sure I am missing several more. in the maybe… Read more »

Walter
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Walter

In addition antibiotics poison mitochondria exacerbating metabolic problems.

Charlotte
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Jason of Toronto, excellent as usual. I have read your book and brought 4 more copies to give to patients. So when are you going to bring out the “Jason of Toronto Diet, I mean lifestyle” Book? I am amazed at how many people still think that fasting will harm them. I have been trying to explain your concepts to patients but it is way easier just to direct them here or give them a copy of your book. The only problem is that their GP (Medical Doctors) won’t get on board and keep insisting they take insulin. Even though… Read more »

Susan
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Susan

The answer to why this is happening is obvious….our food supply. Today, the foods that most people like are loaded with carbs. Just read the labels of the foods you are buying, and check out the carb content. The only aisles in the food store that have good food are the perimeter aisles. Those aisles contain the fresh vegetables and meats, all of the interior aisles contain high carb, processed foods. The human body isn’t built to handle that many carbs every day, and if you keep flooding it with carbs, it breaks down the metabolic system so that your… Read more »

Crystal Haynos
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Crystal Haynos

Coming in late here, but bingo. Agreed. It’s also interesting that when diabetes doubled in China, it did so about the time the sad diet (haha) (standard American diet) introduced itself to China. Also interesting is that Our bodies can use ketones (not the kind that happens to uncontrolled diabetes) if little to no carbs in diet, which means our bodies can thrive without carbs. I believe the food pyramid is a disaster and should be flipped.

Joan Day
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Joan Day

Thank you , their is no doubt in my mind, you will be referred to as [that brilliant Dr. Jason Fung from Toronto. ] That is how I refer to you. I love your blogs, book, [waiting for the next one] videos–and follow anything you comment on. You are a great teacher. It is one thing to know something, but you have the ability to put it in way patients and the general public can grasp it. Your blogs and lectures, are like your approach to treatment I find–if it gets too complicated, or technical, many people will not follow… Read more »

Apicio
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Apicio

Medicare recently authorized a creative new diabetes prevention benefit that leads to better health results and significantly lower costs.  The core technological driver is talking and coaching at the YMCA.  The Incidental Economist/New York Times has details.

Now, if only a few of these coaches have ever heard of Jason of Toronto.

Wenchypoo
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Wenchypoo

I should start referring to myself as Jason of Toronto, so cool… In about 100,000 years, when they’re digging up our bones to try to examine our lives in archaeology, you may indeed be known as Jason of Toronto, and Jimmy Moore will undoubtedly be called James of Spartanburg. I would advise both of you to start thinking about what forms of media storage will be used in the future, and move your books over to it (for future–WAY in the future–readers). Remember how Voyager included a sort of CD-Rom made out of gold, loaded with music and other sounds… Read more »

Wenchypoo
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Wenchypoo

Why are we powerless to prevent the occurrence of T2D? Why are we powerless to prevent its spread to the pediatric age groups? Why are we powerless to stop the ravages of T2D on our bodies? Why can we not prevent the heart attacks, strokes, blindness, kidney disease, and amputations that accompany T2D? More than 3000 years after its discovery, Due to the ubiquity, the misunderstanding, the economics, and the politics of sugar. It isn’t called the “opiate of the masses” for nothing. It is being used to enslave us, and now only a select few know how to undo… Read more »

Wenchypoo
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Wenchypoo

As to why we are powerless to prevent the spread to pediatric groups, read this: http://consumer.healthday.com/pregnancy-information-29/pregnancy-risks-news-546/moms-obesity-diabetes-may-speed-early-fetal-growth-709804.html I believe you were the one who said we are marinating our unborn in insulin–epigenetics takes it from there. Until we circumvent the insulin in pregnant mothers, epigenetics will rampage on. Mothers with high insulin give birth to babies who are programmed to become obese and insulin resistant, and so on. When the mothers-to-be start cleaning up their nutritional act BEFORE they become pregnant, the babies will start coming out cleaner at birth, and the epigenetic pre-programming will be short-circuited. When this goes on… Read more »

Allison Townsend
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Hi Jason, for the first time in my life I’ve stopped having any sugar, except what is in the fruit I have with yogurt in the morning and on my oatmeal at lunch… I’ve completely stopped snacking… still I’m finding my weight loss has plateaued… I’m not eating any grains besides oatmeal and twice weekly i might have a whole wheat bun… mostly I eat meat, veggies, fruit, eggs… oh, and a glass of red wine, coffer with cream…I’ve skipped breakfast a few times and am often so hungry. .. I hear your voice saying hunger is a wave and… Read more »

Laurie
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Laurie

When i went primal/paleo 3 years ago i lost 8 pounds and then got stuck too. I had to go low carb, quit eating fruit, be strict with no cheese, nuts and dairy (even plain full fat greek yogurt has a lot of carbs) and up the fat to ketogenic levels. In addition to that, i weight train and do a few shorter metcon workouts a week plus some fun stuff like biking and rowing outdoors on the weekend. I have to stay under a certain weight or my sculling shell sinks too much and my butt hangs over the… Read more »

Allison Townsend
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Thank you for your reply… Good to know your experiences… Thanks!

seebrina
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seebrina

Allison, Fruit is sugar and most yogurts are full of it. I couldnt find a yogurt without carbs so had to give it up. check the carb content. If i ate fruity yogurt and oatmeal my first two meals i would be starving all day. Eliminate those and have bacon and eggs for breakfast. If you get your body into fat burning mode by cutting carbs you wont be hungry.

Wolfram Alderson
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Let’s call it what it is. Processed Food Disease.

kfacwpup
Member

….or overeating disease

kfacwpup
Member

cured by not eating (fasting)

Michelle
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Michelle

Just a question for you Doc or anyone who may know…. If reducing daily food intake leads to reduced metabolism and muscle breakdown in the long term and IF is the answer to high metabolism and weight loss in the long term, when does it stop being reduced daily calorie intake or carb intake and start being being IF? I have been on LCHF now for all this year. I have done 24hr, 36 hr and 2 seven day fasts and tried both net carbs at 20g and total carbs at 20 g in between and I am struggling to… Read more »

Jin
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Jin

Hi Michelle, I think a more pragmatic approach should be taken. I have seen some people who despite getting little or no results sticking dogmatically to one approach. Low carb is great for a reason, it works for lots of people but it does not work for everyone. Low fat may not work for many people but it has worked for some. The potato hack is getting results for some people. I have seen youtube videos of people beating diabetes with a raw vegan diet. If its not working try changing your approach. Dr Fung himself said if somethings not… Read more »

kfacwpup
Member

I do not understand the potato hack diet. 5lbs of potato is 1769 calories and 390 grams of carbs. For me eating just 100gr will bring my sugar up for half a day (cannot imaging what 5lbs would do to my BS). For me eating under 1000 calories a day with less 20 grams of carbs is the way to go.

Jin
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Jin

I don’t get it either Lena, but when I read about it I was willing to give it a go. I doubt if I have had even 3lb per day as I go by hunger rather than weighing everything. Last week I had two days of potatoes along with 4tbs potato starch, two cups of tea with honey and I still managed to lose two pounds and my blood sugars came down from the 10s down to 7s. I am not knocking low carb I had good success with it however the benefits tailed off slowly for me. I am… Read more »

kfacwpup
Member

Hi JIn, so everyday way of eating is low carb and you added some interruptions of a day or two of only potatoes? How many calories in a potato day compared with a low carb day? How many potato days in a week?

jeff k
Guest
jeff k

michelle, are you getting enough sleep? is your sleep quality good? might you have apnea? are there significant stresses that might be raising your cortisol levels? do you have truncal obesity and thin limbs? [this could be cushing’s disease] has your tsh [thyroid stimulating hormone] level been checked?

Jin
Guest
Jin

Hi Lena, What happened was I did 600 calories or less per day for 6 weeks. I then I did two weeks water fasting. In Joel Fuhrman’s book, he says you should either do 0 calories or 1200 calories or more per day. He says otherwise the brain and the body compete for the available glucose. So I did another two weeks of water fasting. It affected me by making me dizzy and weak. After climbing one flight of steps I would have to sit down for a minute before attempting the next flight. Getting up from the couch would… Read more »

BobM
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BobM

You really have to watch with potatoes and potato starch in particular. You can get extreme gas with too much starch. Personally, I built up to over two tablespoons of potato starch (along with some plantain) per day, on the days I ate. I tried that for several months. I lost no weight during that time. I stopped taking the potato starch and immediately lost weight. I also really did not notice much if any benefit to the starch and a lot of detriments (a lot of gas — was farting constantly; I couldn’t be around myself). Your mileage may… Read more »

Jim Vance
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Jim Vance

I’m new to this blog so a bit on my experience. At age 60 my weight had crept up to 205 lbs (I’m 5″9″). I ate too much but a lot of good stuff mixed in with the trash. I was moderately active but did no exercising as such. I was otherwise healthy but my BP was up. Through diet which was largely a reduced carb diet without being planned as such and increased moderate exercise I lost 25-30 fairly rapidly in three to four months. I then took up cycling and (over the spring and summer) another 10 lbs… Read more »

matt
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matt

Why whiskey? Not really sure, but I have the feeling that back in the day, they thought whiskey could cure just about everything.

—-

It turns out that gin (similar to whiskey) has the lowest insulin index.

” gin produced the lowest FII (1 ± 1) ”

file:///Users/matt/Downloads/Bell_KJ_thesis_1.pdf (see page 56)

honeycomb
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honeycomb

I couldn’t read it due to it being behind a login wall.

Diet for a year to keep the weight off for good
http://www.thetimes.co.uk/edition/news/diet-for-a-year-to-keep-the-weight-off-for-good-ljp0lvspc

Jin
Guest
Jin
honeycomb
Guest
honeycomb

Thanks Jin.

They (i.e. mainstream media / medical profession) just can’t see the forrest for the tree’s.

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jeff k
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jeff k

when i was in medical school, it was still called “adult onset.” now there are 8 year olds getting diagnosed with type ii diabetes. i was at a conference of the american society of bariatric physicians [the internists and pediatricians, not the surgeons, and now called “obesity medicine” society] and a speaker asked for a show of hands of docs who’d been called to e.r.’s to rule out heart attacks in teenagers. there were 6 in the room.

Kevin Bond
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Kevin Bond

Relax! – The Diabetes Epidemic can be eliminated very fast on a global scale – Diabetes (any type of) and any other diseases can be wiped out in less than a month and everybody will become Infinitely Healthy and by that even Immortal – By doing my discovery (just an exercise for a minute a day) – My WVCD – The Weapon of Virus and Cancer Destruction, that cures and prevents any diseases, known on Earth, even Aging and Radiation disease, for every cell of our bodies is shielded 100% from any external/internal (genetic) detrimental impact – My blood sugar… Read more »