Diabetes: Better than hedge funds

Diabetes is where the action is.

While, for virtually all of history, type 2 diabetes was an uncommon condition of adults, the disease has spread so much to all levels of American society that even kids are now developing the adult form. Researchers from the Center for Disease Control and Prevention predict that, by 2050, one in three adults will be diabetic.

The diabetes market is booming, handily surpassing growth of the oil industry, the housing market, even technology. It makes Bernie Madoff’s billions look like small potatoes. In health, few markets are growing as fast as diabetes—-not osteoporosis, not heart disease, not cancer.

Americans are getting fat from carbohydrate consumption, becoming diabetic along with it. While kids hanging around the convenience store gulp down 26 teaspoons of sugar in 32-ounce sodas and 56-grams-of-sugar in 16-ounce frozen ices, health-minded adults are more likely eating two slices of 6-teaspoons sugar-equivalent “healthy whole grain” bread, wondering why last year’s jeans are too tight.

The U.S. is not the only nation affected. Globally, 2.8% of the world’s population are diabetic, a number expected to double over the next 20 years.

Pharmaceutical companies boast double-digit growth for diabetes drugs, growth rates that keep profit-hungry investors happy. Merck’s Januvia, for instance, introduced in 2006, recently catalogued 30% growth in sales, with annual sales approaching $1 billion. Recently FDA-approved Victoza, requiring once-a-day injection, is expected to reap $4 billion in sales per year for manufacturer Novo Nordisk. Such numbers can only warm a drug company CEO’s heart.

Most diabetics don’t just take one medication, but several. A typical regimen for an adult diabetic after a couple of years of treatment and following the dietary advice of the American Diabetes Association includes metformin, Januvia, and Actos, a triple-drug treatment that costs around $420 per month. Two forms of insulin (slow- and fast-acting), along with two or three oral medications, is not at all uncommon.

“Collateral” revenues from the other health conditions that develop from a diet rich in “healthy whole grains,” such as drugs for hypertension, drugs to slow the progression of kidney disease in diabetes, drugs for “high cholesterol,” and drugs for high triglycerides, and you have a pharmaceutical drug bonanza. You, too, would throw all-expenses-paid, fly-the-entire-sales-force-to-the-Caribbean sales meetings.

The global diabetes market has already topped $25 billion and is growing at double-digit rates. Forget the Internet, gold stocks, or solar energy—-diabetes is where the money is. This fact has not been lost on the very market-savvy pharmaceutical industry. As with any successful business, they have devoted substantial resources to develop and grow this booming business.

Comments (23) -

  • Kurt

    3/7/2011 5:19:04 PM |

    Since I changed my diet to lower my cholesterol, my fasting blood sugar went from 98 to 82.

  • praguestepchild

    3/7/2011 5:51:32 PM |

    I'm not sure the pharmaceutical industry is any more market-savvy than any other industry, less I would say. They spend quite a bit of their time and money influencing politicians and doctors in an extremely distorted feedback loop of regulation, regulatory capture, and lots of sleazy baksheesh.

    I'd prefer to invest my money in a company that really is market-savvy in an unfettered market. Like Apple.

  • Patty

    3/7/2011 6:10:53 PM |

    I'm floored.  I had no idea that diabetics took so much medicine and spend so much money on it.

  • Might-o'chondri-AL

    3/7/2011 7:54:30 PM |

    285 million diabetics worldwide is a lot. There are also 100 strains of entero-virus ( a sub-group of picorna-viruses).

    Type 1 diabetic children show 60%with entero-virus in their pancreas beta cells. Type 1 is usually said to be an auto-immune destruction of beta cells.

    Type 2 diabetic adults show 40% entero-virus infection in beta cells; whereas, the general non-diabetic rate is 13% infected.

    4 genetic variants of the gene IFIA-1 enzyme inducing an immune response were identified. It affects how the immune reaction to picona-virus RNA inside a cell cytoplasm plays out; some get over-reaction of interferon Beta.

    Another genetic factor recently discussed involves the human inability to make the sialic acid NeuSGc. Gene CMAH enzymes aren't able to produce this sialic acid on the outside of our cells; it limits human, as opposed to other mammals, control of blood sugar.

    Some individual genetics have both less number of pancreatic beta cell and diminished size of the islets. They don't put out enough insulin to meet the demand.

    Maybe we'll see a vaccination program for specific non-polio entero-virus; it's worthwhile, even if not relevant to all diabetes. If I could patent reversal of fatty liver to overcome genetic pancreatic insufficiency riches would be mine.

  • Henry Lahore

    3/8/2011 1:47:18 AM |

    Vitamin D appears to both prevent and treat diabetes.
    http://www.vitamindwiki.com/tiki-index.php?page_id=339

  • Paul

    3/8/2011 3:54:25 AM |

    You know when an industry is growing by leaps and bounds by the amount of TV ad space they buy... it's startling how many commercials there are right now targeting the diabetic consumer.

    The one advertisement that I find most disturbing though is the one for Onglyza.  The ad says, "you exercise and eat right but your blood sugar may still be high, so you need extra help."

    This specific medication is designed to prevent after meal blood sugar spikes.  But, right there in the middle of the ad it shows a man (with a large wheat belly) eating a sandwich with what looks like two slices of "healthy whole wheat" bread.  This explains a lot (to me) when it comes to what kind of message this company is trying to send.

    It's a kin to producing an advertisement for Nicorette gum while showing young, attractive teens enjoying themselves smoking cigarettes.

  • Dr. William Davis

    3/8/2011 4:05:51 AM |

    Hi, Prague--

    Please don't mistake my tongue-in-cheek comments for investment advice.

    In fact, outsized profits or no, I wouldn't think of investing in what I feel is an industry governed by greed and the pursuit of perverse profits.

    Hi, Paul--

    Yes. It seems to say, "It's not your fault. We can help. Go ahead and enjoy your sub sandwich."

    50 years from now, they will look back and laugh at our dietary disasters, wondering why we never got it right.

  • Daniel A. Clinton, RN, BSN

    3/8/2011 4:09:47 AM |

    I suspect Vitamin D's role in protecting against diabetes is multifactorial. I suspect that viruses that may infect the Vitamin D deficient bounce off those with optimal Vitamin D. I suspect Vitamin D also plays a direct role in the beta cells of the pancreas. I don't know how restorative Vitamin D is, but I strongly believe Vitamin D has huge preventative effects, which is part of why we have such absurd Vitamin D recommendations.

  • Anonymous

    3/8/2011 6:24:18 AM |

    brilliant viewpoint doctor. lots of love.. Smile)

  • Anonymous

    3/8/2011 6:35:51 AM |

    The whole diabetic thing is astonishing to me. It's an epidemic and will cost us gazillions in health care money, and the pain and misery is going to be horrible. I have been a RN for 35 years and otherwise intelligent people just look at you blankly when you suggest changing their diet or even just walking. They say, "oh, my doctor is happy with my A1C of 7" or "he added another medication and now things are fine." Their lights are on but no one is home!!!

  • Anonymous

    3/8/2011 8:43:57 AM |

    I found an interesting page regarding Vitamin D and diabetes (among other things):

    http://www.vitamindwiki.com/tiki-index.php?page_id=339

    The conclusions from the available research are as follows:

    - It appears that > 2000IU VitD3 will prevent diabetes
    - It appears that > 4000IE VitD3 will treat (but not cure) diabetes
    - It appears that calcium and magnesium and needed both for prevention and treatment.

    Pretty interesting summary.

  • Kris @ Health Blog

    3/8/2011 8:50:51 AM |

    Those are really terrible news, I wonder if all those profits have something to do with how slow governments seem to be in waking up to the fact of how easily those diseases are preventable.

    It's incredible that all of this is so easily fixed with a simple change in lifestyle, yet nothing seems to happen.

    -Kris

  • Anonymous

    3/8/2011 8:59:44 AM |

    From an article on the Physorg.com website with the title: Researchers at the University of Saskatchewan have discovered, after a two-year investigation, that diets high in carbohydrates are a probable mechanism for the skyrocketing rates of Type 2 diabetes

    "The work by Kaushik Desai and Lily Wu, professors in the U of S College of Medicine’s Department of Pharmacology, focused on methylglyoacal (MG), which is produced naturally as the body metabolizes glucose consumed in carbohydrates.

    They found that high levels of MG produce all the features of Type 2 diabetes, including damage to insulin producing cells in the pancreas, insulin resistance and impairment of body tissue to use glucose properly. Their finding are set to be published in the American Diabetes Association journal Diabetes in March."

    And I thought the ADA wouldn't allow such findings to be published because they go against the ADA's "dietary" advice.

  • praguestepchild

    3/8/2011 12:16:08 PM |

    Dr Davis wrote: "Please don't mistake my tongue-in-cheek comments for investment advice.

    In fact, outsized profits or no, I wouldn't think of investing in what I feel is an industry governed by greed and the pursuit of perverse profits."

    I understood the irony. But the perverse profits are, IMO, a result of regulatory capture, and many other market distorting incentives like the unequivocal government acceptance of the diet-heart hypothesis.

    As far as greed goes, if you don't like "greed" perhaps you shouldn't invest in anything but simply donate it all to charity ;)

  • Stargazey

    3/8/2011 1:34:00 PM |

    This discussion is all very idealistic, but don't forget the fact that our government is totally and completely in the pockets of Big Food.

    Think of all the political contributions made by ConAgra, General Mills and Cargill. If the government started preaching against sugar, wheat and industrial oils, there would be hell to pay. It's much easier for our politicians to nurture an antidiabetes pharmaceutical industry than it is for them to go up against the massive clout of Big Food.

  • JEAN

    3/8/2011 4:08:40 PM |

    That's why, Stargazey, voting with your pocketbook is the only way, and blogs like this. Every time I come here, and to other similar sites, there's usually one poster who's so thankful they've found this information. And Paleo-Primal diets are now on the evening news, five years ago, that life style was considered to be fringe, nutters only accepted.
    So, one person at a time, but you've got to start somewhere.

  • Margaret

    3/8/2011 11:08:54 PM |

    I don't go for all these conspiracy theories.  I think it is just terribly difficult to get people to change their foodways and get exercise.

  • fatfree

    3/9/2011 4:18:04 AM |

    And fingerstick tests are also part of industry. Hm...

  • Might-o'chondri-AL

    3/9/2011 5:55:49 PM |

    http://www.pnas.org/content/early/2011/03/03/1019007108.full.pdf.+html.

    In utero epigenetics (& age) influence diabetes....
    ? Are you what your mother ate as well as what you eat ?

  • Might-o'chondri-AL

    3/9/2011 5:59:27 PM |

    Link got chopped; so, after second ".../03/" put this:

    1019007108.full.pdf.+html.

  • Might-o'chondri-AL

    3/10/2011 3:09:32 AM |

    http://www.ajcn.org/content/71/5/13445/T1.expansion.html

    Control may very well be via Doc's method. Diabetes progression may be individual.

    Epigenetic vulnerabilites chart
    includes glucose/insulin, insulin resistance, glycolysis in exercise, etc. Free full article link chart from is at right.

  • Might-o'chondri-AL

    3/10/2011 3:11:45 AM |

    Again chopped link; end reads "... T1.expansion.html"

  • body lift

    3/22/2011 11:33:21 AM |

    Really nice post. Thanks for share it.

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Oil-based vitamin D

Oil-based vitamin D


As time passes, I gain greater and greater respect for the power of restoring vitamin D blood levels to normal, i.e. 50-70 ng/ml. Just yesterday, I saw several people with blood levels of <10 ng/ml--severe deficiency.

Vitamin D deficiency this severe poses long-term risk for osteoporosis, arthritis, colon cancer, prostate cancer, inflammatory diseases, diabetes, and heart disease. Vitamin D appears to make coronary plaque reversal--reduction of your heart scan score--easier and faster.

But it is important that you take the right kind of vitamin D. Several of the people I saw yesterday with vitamin D levels of somebody living in total darkness were taking vitamin D, but they were taking tablets. Tablets are the wrong form. Powder-based tablets, in my experience, yield little or no rise in blood levels. Some preparations generate a small rise but the dose required is huge.

If you're going to take vitamin D, take a preparation that yields genuine and substantial rises in blood levels. This requires an oil-based capsule. I commonly see blood levels of 25-OH-vitamin D3 rise from, say, 10 ng/dl to 60 ng/ml when oil-based capsules are taken.

The most common dose I prescribe to patients is 2000 units per day to females, 3000-4000 units per day to males in non-sun exposed months. Ideally, your dose is adjusted to blood levels.

The Vitamin Shoppe preparation pictured here is one I've used successfully and generates bona fide rises in blood levels. And it costs around $5. Just be sure the preparation you buy is oil-based.

Comments (2) -

  • Cindy

    1/6/2007 5:15:00 PM |

    Just went to Vitamin Hsoppe, but unfortunately theirs is made with soy, which I am intolerant to.

    I did buy some Carlson't, which is made with Safflower oil.

    Label reads: Vitamin A (from fish liver oil) 1600 IU and Vitamin D3 (from fish lever oil) 1000 IU.

    So, as a woman I should take 2 caps each day?

    Price was twice the cost of the Vitamin Shoppe brand, about $10 for 250 caps, but for me to avoid soy the increase in price is worth it.

  • buy jeans

    11/3/2010 3:05:57 PM |

    If you're going to take vitamin D, take a preparation that yields genuine and substantial rises in blood levels. This requires an oil-based capsule. I commonly see blood levels of 25-OH-vitamin D3 rise from, say, 10 ng/dl to 60 ng/ml when oil-based capsules are taken.

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90% small LDL: Good news, bad news

90% small LDL: Good news, bad news

Chris has 90% small LDL particles.

On his (NMR) lipoprotein panel, of the total 2432 nmol/L LDL particles ("LDL particle number"), 2157 nmol/L are small, approximately 90% (2157/2432).

Bad news: Having this severe excess of small LDL particles virtually guarantees heart attack and stroke in Chris' future.

Good news: It means that Chris potentially has spectacular control over his lipoprotein and lipid values, achieving statin-like values without statin drugs.

Typically, extravagant quantities of small LDL particles are accompanied by low HDL, high triglycerides, and pre-diabetes or diabetes. Chris' HDL is 26 mg/dl, triglycerides 204 mg/dl; HbA1c 5.9% (a reflection of prior 60-90 days average blood glucose; desirable 4.8% or less), fitting neatly into the expected pattern.

Chris' pattern tells me several things:

1) He overconsumes carbohydrates, since carbohydrates trigger this pattern.
2) He likely has a genetic susceptibility to this effect (e.g., a variant of the gene for cholesteryl ester transfer protein, perhaps hepatic lipase). Only the most gluttonous and overweight carbohydrate consumers can generate this high a percentage small LDL without an underlying genetic susceptibility.
3) Provided he follows the diet advised, i.e., elimination of all wheat, cornstarch, oats, and sugars, he is likely to have an extavagant drop in LDL particle number. Should he achieve the goal I set of small LDL of 300 nmol/L or less, his LDL particle number will likely be around 500 nmol/L. This translates to an LDL cholesterol of 50 mg/dl . . . 50 mg/dl.

In many people, this notion of taking statin drugs for "high cholesterol" is an absurd oversimplification. But it is a situation that, for many, is wonderfully controllable with the right diet.

Comments (11) -

  • Might-o'chondri-AL

    3/4/2011 5:10:09 PM |

    Patient dropping total LDL particles from 2432 nmol/L to 500nmol/L is an impressive goal. The posting is a prediction however.

    It would be instructive to hear
    clinical data on ratio of patients who have actually achieved that degree of LDL reduction. A busy private practise isn't a research project, so that's probably impractical to compile.

  • Anonymous

    3/4/2011 6:09:15 PM |

    FWIW, my NMR lipid profile following about 16 months of Eades/Harris protocols (more the latter than the former).

    My doc almost had a heart attack Smile She is focused exclusively on the LDL-C and the TC #'s. I have of course refused any statin.

    LDL-P 1450  Borderline-High 1300-1599

    LDL-C  208   Very High > 189

    HDL-C   85

    Trigs      65

    Total    306

    HDL-P   47.6

    Small LDL-P   131

    LDL size   21.9

    HDL-P  of 47.6 >34.9 (probably on the order 99%ile = lower CVD risk)

    Small LDL-P 131 estimated 33%ile (lower CVD risk)

    LDL size of 21.9 large (Pattern A = 23.0 lowest CVD risk)

  • Dr. William Davis

    3/4/2011 6:49:31 PM |

    Hi, Might--

    Actually, we've accomplished drops like this many, many times.

    As you point out, the experience is retrospective and therefore difficult to attribute (in a scientific way) to any one treatment strategy. But I can tell you, having done this many times, wheat elimination in the setting of a low-carb restriction accomplishes such drops as a rule.

  • Anonymous

    3/4/2011 11:18:09 PM |

    I believe I fall into this category relative to wheat products.  I have started eating oat bran rather than oatmeal for my morning hot cereal and avoiding carbs.  

    While the scale doesn't reflect any real weight loss I am less bloated and actually feel slimmer after a few weeks of wheat elimination.  I was a strict WHOLE WHEAT person prior as that was what the AHA recommended.  I have been told that I have a hereditary condition which causes high LDL and low HDL.  Statins give me such muscle pain and fatigue that I have stopped them.  I do take Enduracin daily and will get my levels checked again.  I wondered about OAT BRAN and what the thoughts are regarding consumption of OAT BRAN.  I have a 1/2 cup of hot oat bran each morning.

    Suggestions or comments welcomed.

  • Craig Newmark

    3/5/2011 2:57:16 PM |

    Question for Dr. Davis:

    I'm 54 and have labs similar to Chris, including a very high proportion of small LDL particles.

    But I recently had a cardiac calcium test at a reputable facility and the score came back . . . 0.

    I have been, and expect to continue, doing better on my diet and exercise. But if the LDL doesn't change much--all of my other results have responded at least some to my change in lifestyle--am I still virtually guaranteed to have a stroke or heart disease?

    Thanks in advance.

  • Might-o'chondri-AL

    3/6/2011 5:56:02 PM |

    Small LDL has to get acted on by an "immunological complex" to become an actual problem. Inflammation is a non-precise way of describing how the immunological complex gets to form.

    My understanding is that
    small LDL does not "guarantee" a
    cardio-vascular disaster. Blood tests for specific inflammation markers are a way to monitor the degree to which the body might
    be generating the immunological complex risk factor.

    Magnesium is absolutely vital to prevention in this dynamic. It is capable of disassociating the molecule of oxidized small LDL from absolutely locking with any circulating immunological complex.

    But, the magnesium has to be on the scene shortly after the two "bad" parts first connect (bond). Magnesium can't come along too much later and neutralize (sunder) the undesireable bond described above.

    Of course keeping down the "inflamation" (immunological complex) in the first place is also important. This is where having robust circulating levels of active vitamin D on the job, all of the time, is relevant.    

    A low level of calcium laid down indicates, in my premise, that magnesium has been doing it's job (knocking down problem reaction). It does not neccessarily mean the body is free from risky inflammation (immunological complex).

    Age re-models most of us; our health is not a steady state with constant variables. Risk factors Doc's deals with clinically, and warns us about, become more relevant.

  • Anonymous

    3/10/2011 12:06:28 PM |

    Dr. Davis, what would be a reasonable time frame for Chris to achieve the goal of LDL-P = 500?

    Also, if Chris meets his goal(s), correct to think that the guarantee of a stroke or heart attack has been stymied?

  • High LDL

    5/3/2011 7:50:01 PM |

    I've just received my lipids back:
    Total cholesterol : 357
    Trigs:                            63
    HDL                              93
    LDL                              251
    Apo-B                         165

    I am hypothyroid and my T3 is low on the range.  Also am on an extremely low carb diet (following Dr. Richard Bernstein's way of eating) and am Type 2
    (no meds/no insulin).

    Any suggestions how to get the LDL down?  Also do you have a list of lipid panel blood work that I could have done?

    Thank you so much.

    Maxie55

  • Damien

    5/14/2011 8:54:30 AM |

    Hi,

    like Maxie55,

    I too follow Dr Bernstein and am Type one diabetic.. my lipip panel is almost identical to yours Maxie55;  fantastic TG/HDL ratio but LDL over 200...

    very interested how i may be able to get the LDL down....?

  • Frustrated

    8/23/2011 8:04:22 PM |

    Dr. Davis,
    I have spent the last 5 months eating a diet that completely eliminated all wheat products. It was very low carb, and consisted of relatively high protein (eggs, grass fed beef, grass fed raw cheese, oily fish, chicken), good level of olive oil, walnuts, fish oil (3 mg per day), raw vegetables, little bit of fruit.  So I had good amount of monounsaturated fat as well as saturated fat from eggs and grass fed products. My recent NMR showed:
    LDL-p. 2,800
    Small LDL particle 1700
    Small HDL particle 20
    HDL-C 40
    LDL-C 114
    Trigs. 224
    Total chol 208
    So I was disappointed. Where have I gone wrong?  No wheat and sky high LDL-p and 1700 small LDL paticles.

  • Dr. William Davis

    8/24/2011 1:50:39 AM |

    Hi, Frustrated--

    Why don't I make this post the topic for a full discussion?

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