It is no surprise to physicians of any discipline or many patients within the current health care paradigm that the way chronic metabolic diseases are both prevented and managed, here in the United States is nowhere near awe-inspiring. As a matter of fact, we have all heard time and time again that out of all modern societies in the world our healthcare system is barely making the top 50 list. Ouch!
Let’s start with one of the biggies; Type II Diabetes
Diabetes is known to be many things; on its progression, it is known to have the ability to completely devastate a human beings health, organs, metabolic and physiologic functions leading to some of the most horrific complications known to the world of healthcare. These include but are not limited to Amputations, Blindness, Dementia, Kidney Failure (Dialysis or Transplant), Increased Risk of Cancers, Neuropathy, Cardiovascular Disease, Autoimmune Disease, Arthritis, Gastrointestinal Disease, Hepatic Disease, Pancreatic Disease, Immune-compromise, Neurological Disorders, etc. Even those that have not reached such end stage consequences, many Type II Diabetics report their disease causes moderate to severe limitations in their lives. For some, it is a very frustrating experience to see their condition worsen with time regardless of their efforts and sometimes even their physician’s best efforts.
Currently, there are 26 Million diagnosed Type II diabetics in the US, not counting the approximate 70 million diagnosed as pre-diabetics and discounting probably millions more that have developed the precursor to this problem described in the literature as metabolic syndrome (early insulin resistance). It is estimated that in the next 10 years approximately 33% of the entire US population will be diabetic. That is not only alarming, it is Horrific on the impact it will have on us as a society financially, socially, emotionally, anthropologically it is bad news.
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We have known for a very, very long time that type II Diabetes can be both preventable and in some cases where the diagnosis has been made reversible. We know this disorder of human physiology and metabolism responds fantastically to a comprehensive approach that includes detailed lifestyle changes that include but are not limited to clinical nutrition, functional medicine, stress management, and in some cases that are healthy enough, exercise. By no fault of their own many physicians walk out of their Medical Training with no more than 12 hours of very general knowledge in some of these subjects, yet more than 90% of them admit very openly that these are essential things in the management of chronic illness.
The truth is that as a society we have erroneously placed the blame of Type II Diabetes on the patients themselves for what many believe to be leading inadequate lifestyles, we have blamed the Food Industry for hiding so many damaging ingredients under obscure names, we have blamed technology for setting the stage for a more sedentary lifestyle, we have blamed the pharmaceutical companies for their giant push to medicate chronic conditions indeterminately, we have blamed genes, we have pointed the finger everywhere except in the most critical and valuable direction. Inwardly at ourselves as physicians.
Many of us in the frontline of healthcare had been unwilling to admit our essential role in the severity of the current health crisis. Many of us had felt unprepared for the level of confronting, knowledge and clinical expertise that are required to help many of these chronically and co-morbidly ill patients.
You see most of us all are trained in a very heavily evidence based influence model where the RCT cohort study is king. We learn to identify the validity of these studies and learn how applicable many of the treatment methods these studies test are to our daily encounter with patients.
With time and experience, many of us start making a profound but very important realization. The great majority of RCT’s are created on the foundation of eliminating all possible variables that could influence the hypothesized outcome. One of these steps is the elimination of patients suffering from co-morbidities additional to the condition being tested in the study. This is great to attempt to obtain a pure result from the study but it is a major pitfall for daily clinical practice.
The Reason: The great majority of chronically ill patients have co-morbidities. It is very rare to find a diabetic that is also not suffering from one of the following: High Blood pressure, Dyslipidemia, Decreased Hepatic Function, Decreased Kidney Function, Chronic Inflammation, Some auto-immune process, neurologic degeneration, some infectious process and so on and so forth.
Most chronically ill patients possess or are in the process of developing more than just one problem. That is why a uni-faceted approach where the RCT test for the magic bullet that will make it all better is truly flawed. It by no means accounts for the possibility and many times the reality that the treatments being tested could be making the co-morbidities progress or even worse perpetuating the underlying mechanisms of the disease being treated. This has been shown to be the case for many a diabetic. Of course don’t get me wrong, the use of many of these approaches can save a person’s life. Especially in the acute and early phases of a disease. But what we are talking about here is something very different. It is the lifelong management and support of a person’s physiology for them to have the best possible outcome as it relates to their illness.