I am saying that there is no evidence that obesity exacerbated
type II diabetes at all.  I am saying that the effects of
diet and exercise on type II diabetes are DIRECT, and not
mediated by the presence or absence of fat.

Avoiding cooking.net">food (which has an annoying tendency to turn into
glucose at some time or another in the metabolic cycle)
reduces stress on an inadequately functioning glucose uptake
system, for the same reason that avoiding sodium helps people
who can't adequatly clear excess sodium to avoid high
{*filter*} pressure.

A lifetime commitment to semistarvation happens to be extremely
difficult in the presence of enough to eat.  The ancient Pima
dietary secret for avoiding weight gain and diabetes was having
crop failures 3 out of every seven years.  I'd rather have a
life, myself.  

Maybe one of these days the folks who advocate weight loss as
the major treatment for diabetes will start recommending hair
loss as a cure for cancer--there is, after all, a great correl-
ation between chemotherapy, cancer remission, and hair loss.

--
Martha Koester         "Some mornings, it just isn't worth

                                      --Emo Phillips

Many obese people get that way because of lousy diets and lack of
exercise.  Lousy diets and lack of exercise also make type II diabetes
worse.  When prescribed a better diet and exercise regimen to help the
diabetes, it is no wonder that these people also lose some weight.
But that doesn't mean that the weight loss has anything to do with the
improvement in their diabetes any more than the improved
cardiovascular function does.  If you did a study, you'd also probably
find that poor cardiovascular function correlates with diabetes as
well.  Yet does any doctor tell a patient to "lower your resting heart
rate and improve your stamina" in order to treat diabetes?  Why do
doctors then tell patients to "lose weight" in order to treat
diabetes?  As Martha point out, that is like telling a cancer patient
to lose their hair in order to treat cancer.  If they lose their hair
the "correct" way the cancer may be cured.  But if they go out and
shave their head, it's not likely.  Likewise, if a patient loses
weight by changing their diet and exercising, the diabetes is likely
to get better.  But if they lose weight some other way, it probably
won't.

--

By the way, someone sent me email in response to an earlier post
I made in this thread.  I deleted it without reading it (don't
ask).  My apologies and please re-email me.
--
David Rind

If on the other hand, the diabetes gets better only after some time (and
weight loss), this is an indication that weight loss is the cause.

If, after stopping the diet and/or exercise, the diabetes gets worse very
soon, this is again an indication that the diet/exercise is the cause.

If, again after stopping the diet and/or exercise, the diabetes gets worse
only after some time, and some weight gain, this is an indication that the
weight gain is te cause.

I would presume that Martha would accept a study showing this. I do not
give guarantees  about this.

From discussions with diabetics, I know that they get worse very soon after
quitting exercise, befor any weight gain occurs. this is for me a strong
indication that exercise and diet are the keys, not weight loss.

(I am a statistician, and do not therefor speak about proofs.)

Elly Jeurissen

Health and weight

I would, however, expect that in the absence of data showing that
obesity causes diabetes, that someone postulating that link would at
least have a plausible workable mechanism for how fat tissue
interferes with insulin response.  Got one?

--

: Would you care to expand on this?  For instance, are you arguing
: that if we could maintain a diabetic's body fat and weight while
: altering the diet, that the type II diabetes would go away?
: (For instance you could decrease exercise so that caloric balance
: was maintained.)   If not, please explain the experiment that would
: test your hypothesis.

David, I think Martha is referring to the fact that when placed on a
hypocaloric diet a Type II diabetic shows an IMMEDIATE response in terms
of lowered {*filter*} sugars and lowered insulin secretion, well before any
actual weight loss occurs. No, the diabetes has not gone away, but
calorie restriction clearly has a place in diabetes control.

As far as exercise, it has been shown that the GLUT transporters (which
ferry glucose down into the cell) become more active during and after
exercise, which ALSO has a role in reducing {*filter*} glucose levels, and
again, is totally independents of fat.

Both of these are short term effects, and must be maintained. So they are
treatments, not cures.

Hope this explains your questions!

Smiles,

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c-

Natalie A. Sera, with all her ducks in a row!!!!  
Proud mother of Josh, age 22                      

._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._(` ._c- ._c- ._c- ._c- ._c-

                                         Can YOU find the Ugly Duckling?

The existence of fat diabetics who reverse symptoms by exercise
without measurable weight loss demontrates the hypothesis.

It certainly does make a difference whether or not obesity is
a cause or an effect of insulin resistance. It is essential
to design a proper program for those who are diagnosed with
Type II diabetes that will work over the long term.

The King, Revers and Winn Medical Group (130-D East Romie Lane,
Salinas, CA 93901) has been successfully treating type II
diabetics without having weight loss as a goal.  They claim
superior long term medical outcomes, and would love to have
someone do a study of their patients as compared to a
control group.

Astrup et al [International Journal of Obesity Vol 11, p 51-66
(1987)] have demonstrated that it is fat people who eat the
LEAST who have abnormal insulin response.  He compared two
groups of fat people, one of which ate less than 1500 calories
a day, and the other of which ate more than 4000.  Every one of
the former group had abnormal insulin response, and none of
the latter group.  The people who are genetically at risk for
developing type II diabetes are therefore those who are LEAST
likely to lose weight.  It is not only callous and smug to
recommend weight loss to this group, but also counterproductive.
Weight training, aerobic exercise, changes in diet composition
and dividing total caloric intake into more frequent meals all
improve the health of people with type II diabetes.  Those who
do these things improve their health and usually don't lose
much weight.  Furthermore, there is ZERO correlation with of
improvements glucose tolerance with the AMOUNT of weight lost.
What kind of sense does it make to call the people who lose
less weight despite major improvements in their health
failures in order to make those who are genetically at less
risk feel better about themselves?

If fat (rather than the underlying genetic trait of insulin
resistance) is such a problem, why are fat type II diabetics
less insulin-dependent, less likely to develop the complications
of diabetes, and less likely to die from it than type II dia-
betics of average weight? [Turkington, R.W. and Weidling, H.K.,
JAMA Vol 240, p. 833-836 (1987)]  Why do diabetic Pima Indian
women (the human population with the largest known genetic
concentration of insulin resistance) experience the lowest
levels of mortality when they weigh TWICE the actuarial ideal?
[Pettitt, D.J., et al Am. J. Epidemiol. Vol 115, p. 359-366
(1982)] (Pima men with the longest life spans weigh 45% more.)
--
Martha Koester         "Some mornings, it just isn't worth

                                      --Emo Phillips

If you lose weight by dieting and reverse diabetic symptoms,
that does not prove that weight loss is the cause of the
reversal.  In studies where both are tracked frequently,
improved glucose tolerance always comes first.  If it
precedes weight loss, it is not caused by weight loss.  It
seem only logical that if your glucose uptake system is
faulty, you can avoid challenging it by reducing cooking.net">food intake, thereby reducing
the amount of glucose to be dealth with.  You also
son't have to lose hair in order to benefit form
chemotherapy.

--
Martha Koester         "Some mornings, it just isn't worth

                                      --Emo Phillips

Reducing caloric intake helps reduce insulin resistance almost immediatly
by (apparently) causing cells to express more insulin receptors or making
the existing receptors more effective.  This has been show by determining
the effect of glucose loads on {*filter*} glucose levels relative to {*filter*}
insulin levels.  On a more basic level, adipose cells can be shown to
express fewer insulin receptors directly, by radioimmunoassay and similar
methods.  The control of all of this is being worked out at the genome
level.

Ed Uthman, MD               Note: Because of my provider's lousy

Pathologist                 messages. I'm not ignoring you. :)
Houston/Richmond, TX, USA

So you are saying that someone who has lost weight and "reversed their
diabetes" can then resume their old diet, as long as they don't gain
weight?

|>Reducing caloric intake helps reduce insulin resistance almost immediatly
|>by (apparently) causing cells to express more insulin receptors or making
|>the existing receptors more effective.  This has been show by determining
|>the effect of glucose loads on {*filter*} glucose levels relative to {*filter*}
|>insulin levels.  On a more basic level, adipose cells can be shown to
|>express fewer insulin receptors directly, by radioimmunoassay and similar
|>methods.  The control of all of this is being worked out at the genome
|>level.

But how does the amount of adipose tissue a person has influence the
expression or effectiveness of insulin receptors?  By the size of the
individual adipose cells?  Or do they excrete some substance based on
how much fat they are holding that when there is so much of it, it
causes decreased expression or effectiveness of insulin receptors?
How does a fat cell tell a muscle cell in another part of the body
to lower its expression or effectiveness of its insulin receptors?

--
Mary Conner

Would it not be more useful to recommend some kind of action these patients
were actually able to follow?

If about 5 % of the patients are able to keep the lost weight off in the
long term, and all patients improve when they follow a healthy diet and
exercise, can you explain to me why only the first gets recommended, and
not the second?

And, as you are explaining, can you explain to me why weight loss is
recommended to all fat people, if they have diabetes or not?

There are indications that weight loss increases the risk to die of a
heart disease. (review study of the Dutch hearth society) They mention
one study where losing weight decreased the risk of dieing of cardio-
vascular diseases, two where losing weight increased the risk, and several
more where losing weight did not increase or decrease the risk.

Elly Jeurissen

Health and weight

Sure, I like "having a life," too, but that