The Diabetes Gold Rush

Lou came into the office. Clearly, his program had gone sour.

Lou had initially obtained wonderful control over his heart scan score of 1114, having reversed modestly in his first three years of effort through correction of his multiple causes (including low HDL, severe small LDL, Lp(a), and a diabetic tendency).

But Lou now came into the office red-faced and sporting a big bulging abdomen. Blood sugar? Now in the overtly diabetic range. Lou said that his primary care doctor had suggested that he start on three new medications (glucophage, injectable Byetta, and Actos) to control his blood sugar. His doctor also told him to increase his intake of fibers by eating more "healthy" breakfast cereals like Cheerios.

Lou had apparently done just that (added "healthy" fiber-rich foods) even before his doctor had suggested it. (Lou failed to remember the several conversations we'd had about healthy eating.) Unfortunately, Lou also failed to connect his increased intake of "healthy fiber-rich foods" and his growing abdominal girth (his "wheat belly").

Here's the dirty little secret: Much of the world wants you to be diabetic. It is the health gold rush of this century. "Go West, young man!"




To find out what I mean, you need only ask: Who profits when people become diabetic? That's easy:

The pharmaceutical industry--Diabetes is a booming growth industry, a source of tens of billions of dollars of revenue, poised for enormous growth as the population ages and gets fatter. It is common for a newly-diagnosed diabetic to be given new prescriptions for two or three drugs with a monthly cost of $300. Of course, the chronic nature of the disease make this far more profitable than, say, a two week course of antibiotics. Presently, 70 new drugs are under development.

Diabetes drug maker Novo Nordisk reported a 25% increase in revenues in 2007 from diabetic agents in the North American market, along with near $2 billion increase in profit for the year. Merck's recently-released DPP-4 inhibitor, Januvia, has already sold $668 million in 2007 and is growing rapidly.

The medical device and supply industry. Take a look at the Medtronic quarterly earnings report, detailing the breakdown of their record-setting quarterly revenue of $3.7 billion:

Diabetes revenue of $269 million grew 12 percent driven by sales
of consumables, the accessories required by insulin pump users, and
continuous glucose monitoring products. Revenue from international
sales grew 31 percent over the same quarter last year.


That's what I call a growth industry.

The processed food industry. The food industry is as big or bigger than the drug industry. ADM, Kraft, General Mills all have annual revenues in the $12-50 billion range. There are plenty of others.

When we're told, for instance, that Cheerios reduces cholesterol, we're not told that it skyrockets blood sugar or triggers small LDL. When we're sold whole wheat crackers, Cocoa Puffs (which the American Heart Asscociation says is heart-healthy), or granola bars, hunger is stimulated, impulse to eat more grows, blood sugar escalates, we get fat, we get diabetic. It's a simple formula.

So be aware that there is little incentive among corporate giants in the food, medical device, or drug industries to encourage behaviors that decrease the incidence of diabetes. In fact, there is enormous financial incentive to make sure that diabetes continues to grow at the startling rate it has over the last decade.

To be sure, the drug and medical device industry will also develop better tools to deal with diabetes and its complications. But the very best way to deal with diabetes is to not develop it in the first place.

Comments (9) -

  • Anonymous

    9/11/2008 11:53:00 PM |

    while you mention a low fat diet in your book, you now seem to speak of a higher sat fat diet, but how high?  also, it appears that oatmeal and oat bran are recommended by you to be good.  Is this correct?  I thought grains should not be consumed

    It would be helpful to those of us who have read your book to have a current picture on your diet recommendations as they currently stand.  thank you for the fine blog you produce.

  • Dr. William Davis

    9/12/2008 1:03:00 AM |

    Hi, Anon--

    The new Track Your Plaque Diet will be coming out in both the www.trackyourplaque.com website, as well as the revised version of the book, likely out in 2009. This will include all the new strategies we've been employing.

  • Anna

    9/12/2008 3:53:00 AM |

    Have you thought about an e-book?  Would make updates much easier.  I'd get it and recommend it (I do have the TYP book).

  • Ricardo Carvalho

    9/12/2008 3:53:00 AM |

    Dear Dr. Davis, I believe your post demonstrates a lot of courage and personality by recognising that the pharmaceutical, medical and food industries are more worried about their profits than about promoting health among our society. We already knew this, of course, but it is different when it’s said by a doctor. In Portugal, in 2006 an estimated 6.5% of the population was diabetic. In the last 7 years, the number of diabetics increased an amazing 40%! Also, it is estimated that there are thousands more undiagnosed cases, so the total number today can be around 1 million (10% of the population). This is the 4th cause of death in Portugal and cardiovascular disease is 1st. Some of these cardiovascular deaths might be related to diabetes, isn’t it? In my opinion, this is a total catastrophe requiring urgent mobilization from all sectors of our society! But, unfortunately, most authorities don’t seem worried at all about preventing this. After all, their profit is proportionally higher to people’s ignorance. I also notice that some, or most(?), doctor simply don’t have a clue about what is healthy food, glycemic control, low-carb or paleolithic diets, etc. Also, total cholesterol is still considered the number one problem, when perhaps glycaemia is much more relevant to public health. The spouse of a friend of mine, who is a nephrologist, says that “doctors are just mechanics”, so I assume they really don’t care about avoiding the engine’s damage, but only about repairing it. I think this shouldn’t be like this. We want preventive medicine! I once made a rough estimate of diabetic related deaths in Portugal - and this can be far from reality -, and it was about 5.000 people/year. Too many deaths and human suffering that could be avoided! How many people will die in our country because of terrorism, carjacking, assaults, and so on, the major concerns in the media? I don’t have the statistics but certainly very few. Metabolic disorder induced diseases, like cardiovascular disease and diabetes, will kill many thousands and should be world’s priority number one. People perhaps think this is inevitable, something decided by the external forces of destiny. But it’s not, proper lifestyle changes can make a tremendous difference. I personally believe in emulating the traditional and ancestral ways of living: something like a paleodiet, caloric restriction, unprocessed foods, no refined sugars, minimal amount of cereals & dairy, being active, walking & running, etc., the so called Primal Blueprint (www.marksdailyapple.com). I don’t want to make this comment be larger so I’m stopping here. I finish this comment with a few book suggestions from my Amazon Listmania: http://www.amazon.com/lm/R3HD91CU3D7QOO/

  • Anne

    9/12/2008 10:49:00 AM |

    And don't forget all the gold in taking care of diabetic complications from inadequately controlled blood glucose. What would happen to that industry if people followed guidelines of Dr. Bernstein or read Blood Sugar 101?

  • steve

    9/12/2008 7:26:00 PM |

    glad to hear there will be a revised edition of the track your plaque book updated for current knowledge.  Will that be early '09 and in the meantime other than elimination of grains where in the low carb universe is best for fighting heart disease; sat fat matters, and should be low, or don't worry about it.  Thank you.

  • Anonymous

    9/13/2008 1:00:00 PM |

    I'll wait for your new book but I am perplexed that a vegetarian diet, by implication, would be unhealthy.

  • Peter Silverman

    9/17/2008 3:19:00 PM |

    I can't understand why people who ate the traditional Asian diet, mostly rice, had such low rates of diabetes and heart disease.

  • Steve Cooksey

    2/7/2010 8:40:14 PM |

    Dr.  Davis,

    This post means SO MUCH to me.

    I am a paleo diabetic... no meds, no insulin (lost 75 lbs) .

    I have been saying the same thing ... and now I know I am on the right track.

    Steve

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Fat and fiber composition of nuts

Fat and fiber composition of nuts



From Mukuddem-Petersen J, Oosthuizen1 W, Jerling JC. J Nutr 2005.



If you haven't yet done so, adding raw nuts to your health program yields a broad panel of health benefits.

Contrary to conventional advice, nuts can be eaten in unlimited quantities. Provided they are raw--unroasted, unsalted (since salting only accompanies roasted nuts), not roasted in unhealthy oils like hydrogenated cottonseed or soybean (very common)--they do not make you fat, regardless of the quantity consumed. Beer nuts, honey-roasted nuts, mixed nuts roasted in unhealthy oils with salt added are either fattening or exert other unhealthy effects (e.g., hypertension, rise in Lp(a), and cancer from the hydrogenated fats).

Some notable observations from the chart:

--Hazelnuts and macadamians are the richest in monounsaturates
--Walnuts are the richest in the omega-6 linoleic acid, while also richest in the "omega-3" linolenic acid.
--From a fat composition standpoint, raw cashews and dry roasted peanuts aren't so bad.
--Pistachios figure pretty favorably in this analysis, rich in monounsaturates.
--Coconuts are unusually rich in saturated fat, though about half is lauric acid--an issue for future conversation.



Here's a listing of the fiber composition of nuts per 1 oz serving (about a handful):

Almonds (24 nuts) 3.5 g
Brazilnuts, dried (6-8 nuts) 2.1 g
Cashew nuts, dry roasted, with salt added (18 nuts) 0.9 g
Hazelnuts or filberts 2.7 g
Macadamia nuts, dry roasted, with salt added (10-12 nuts) 2.3 g
Mixed nuts, dry roasted, with peanuts, with salt added 2.6 g
Peanuts, all types, dry-roasted, without salt 2.3 g
Pecans (20 halves) 2.7 g
Pine nuts, dried 1.0 g
Pistachio nuts, dry roasted, with salt added (47 nuts) 2.9 g
Walnuts, English (14 halves) 1.9 g

Data courtesy USDA Nutrient Database


Note that almonds are the winners with 3.5 grams fiber per ounce, pistachios a close second. Pine nuts and cashews place last on the fiber content chart.

Not addressed by the charts is protein content of nuts, as well as the low sugar content, all additional beneficial aspects of nuts. Nuts are also a moderate source of magnesium (though seeds like pumpkin and sunflower shine in the magnesium content area).

Rather than micromanage the specific fat and fiber content of your diet, why not get a little of the good of everything on the list and just mix and match the nuts? (Mixed and matched on your own, of course, not a hydrogenated cottonseed oil nut mixture).

Comments (16) -

  • Anna

    12/1/2008 4:00:00 AM |

    Great chart!

    But it's getting hard to find truly raw nuts anymore, unless one has or knows someone with a nut tree (cashews, even when labeled raw,  are always heat treated to remove their toxic skin).  

    Industrially produced almonds in California's Central Valley had some food-borne illness contamination problems a while back and now must be pasteurized by steam or gassing, with a  few exceptions for very small producers.  Driving through that area and seeing the trees trimmed straight across for mechanical harvesting machines and the mountains of almonds by the side of the road waiting for pickup, it's a far cry from way our hunter-gatherer ancestors sourced their nuts.  

    For the freshest nuts (least damaged PUFA oils), buy them in the shell and shell them at home.  It's hard to overindulge in nuts when one has to shell them.  

    Additionally, nuts contain substances that inhibit digestion and nutrient absorption (these prevent the nut germ from sprouting prematurely).  The best way to prepare raw nuts for consumption is to soak them in salted water for hours or overnight (depending on the nut variety) to activate the sprouting enzymes and neutralize the anti-nutrients, then drain and dry.  A food dehydrator is very efficient for drying nuts, but it can also be done in the oven.  I soak and dry about 4 pounds at time, using sheet pans and setting the oven on the lowest possible temp (170°F on my oven), then cracking the door open with a wooden spoon to keep the temperature no higher than 150°F and allow for moisture evaporation.  It varies on how long the nuts must be dried, but 24 hours is a good average.  For safety I turn the oven off overnight or if I leave the house (keeping the door cracked open) and turn it back on when I am around and can keep an eye on things.  Otherwise, it is very passive hands off  "work" and can easily fit into other activities at home.  

    The resulting nuts are not roasted, so the delicate oils aren't damaged, and are easier to digest than plain raw nuts, as well as being tasty and crunchy.  My husband and son love these "crispy nuts".  We always have a few pounds of several varieties on hand for snacking, school lunches, salad toppings, etc.

  • Anonymous

    12/1/2008 5:49:00 AM |

    Ornish, McDougall, et al., advise not eating nuts if you have atherosclerosis. Why the disagreement?

  • Zbig

    12/1/2008 10:36:00 AM |

    dear doc,
    apart from nuts(some of which, btw, are always in my fridge and I eat them daily)
    - what do you think about the Pauling's protocol - could you spare a post on it some time?

  • Micawber

    12/1/2008 1:15:00 PM |

    Dr. Davis,

    I absolutely love your blog - thank you so much for such an invaluable source of information.  

    I'm wondering whether dry (& lightly) roasted (trader joes) almonds are okay?  Or if it's essential to eat them raw?  

    Thanks!

  • Gretchen

    12/1/2008 2:27:00 PM |

    This is a little confusing: "Provided they are raw--unroasted, unsalted (since salting only accompanies roasted nuts), not roasted in unhealthy oils like hydrogenated cottonseed or soybean."

    If they're unroasted, obviously they're not roasted in unhealthy oils.

    Please clarify your position on dry-roasted nuts. Is it the heat of roasting that is the problem? Or just the oils they're roasted in.

    BTW, I find that almonds, which I dry roast myself, are a great antidote to the constipation that often accompanies low-carb diets.

  • steve

    12/1/2008 3:12:00 PM |

    interesting, but not to those of us allergic to nuts!  We lose out. I for one can eat peanuts which are really legumes, but raw peanuts i have heard are not good for you.  Hard to tell what oil it is roasted in as well.

    Is non hydrogentated peanut butter with no salt ok?

  • IggyDalrymple

    12/2/2008 12:22:00 AM |

    This physician claims that coconut oil improved her husband's Alzheimer's.

    http://www.tampabay.com/news/aging/article879333.ece

  • Anonymous

    12/2/2008 12:26:00 AM |

    I also am curious about dry-roasted vs. raw nuts and hope for some clarification on this subject.

  • Healthy Diet for Quick Weight Loss

    12/2/2008 9:14:00 AM |

    Great post......I like your blog so much...... Thanks for your valuable efforts. Good Job.....

    Quick Weight Loss


    Thanks!

  • stephen_b

    12/2/2008 10:55:00 PM |

    Instead of peanut butter which is roasted, try raw almond butter. I don't miss peanut butter now.

    StephenB

  • Andrew

    12/3/2008 8:28:00 PM |

    I enjoy salted nuts, but I am a bit concerned about the hypertension effects.  As stated in the chart, lots of salt is bad.  So, I was wondering about doing some home-roasting of raw nuts in something like peanut oil or palm oil and mixture of salt and potassium chloride salt substitute.

  • Scott Miller

    12/5/2008 12:16:00 AM |

    Here's what I do, as a nutty nut fan:

    Buy several types of raw nuts at a local market and/or whole foods.  Also include Brazilian nuts, pine nuts, sunflower seeds and pumpkin seeds (none of these on the chart, but each has a healthy fat profile).

    I mix all of these in roughly equal quantities in a large bowl.  Then I add several tablespoons of olive oil.  Why, to make the nuts sticky for what comes next: seasonings!  I'll add black pepper, cayenne (chili) pepper, and sea salt -- all to taste, but I use a lot of sea salt.  (Note, sea salt is not like table salt, which is 99% sodium chloride and not healthy. Sea Salt is a composition of numerous mineral salts, and not only healthy, but required for longevity.)

    I also throw in about 50 grams of unflavored egg white protein powder, which, when everything is all shaken up, helps keep the nuts from feeling oily to the touch.

  • Dr. B G

    12/6/2008 3:56:00 PM |

    Scott,

    Thanks for the delish recipe!

    We just switched to sea salt (for the Mag and electrolytes) -- GREAT TYP!!

    What an interesting way to use egg white powder (besides making royal icing).

    -G

  • Pablo

    11/6/2009 9:00:39 AM |

    Dr. Davis,

    I'm wondering about your comment that "Contrary to conventional advice, nuts can be eaten in unlimited quantities. Provided they are raw..."

    You see, 100 grams of Cashews has approx. 550 calories. While I'd love to eat a pound of 'em, that'd be over 2,000 calories.

    Your thoughts, sir?

    Paul

  • Anonymous

    10/20/2010 2:54:05 AM |

    I can't eat nuts, they are too high glycemic and give me headaches. Almonds are supposed to be low glycemic, but my headache after eating almonds is proof that nuts spike my blood sugar. I hope to mix nut butter with a fiber complex to lower the glycemic response in the future. I'll stick with seeds for now, like sesame.

  • buy jeans

    11/3/2010 3:41:47 PM |

    Not addressed by the charts is protein content of nuts, as well as the low sugar content, all additional beneficial aspects of nuts. Nuts are also a moderate source of magnesium (though seeds like pumpkin and sunflower shine in the magnesium content area).

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