New remedies: Testing blood sugar levels is the price of vigilance in the fight against type 2 diabetes. Speakers at Swiss Re’s conference in June criticised the traditional low-fat, high-carb dietary guidelines as contributing to global epidemics of obesity and type 2 diabetes. Picture: SOWETAN/BAFANA MAHLANGU
New remedies: Testing blood sugar levels is the price of vigilance in the fight against type 2 diabetes. Speakers at Swiss Re’s conference in June criticised the traditional low-fat, high-carb dietary guidelines as contributing to global epidemics of obesity and type 2 diabetes. Picture: SOWETAN/BAFANA MAHLANGU

You know something big is up when the world’s second-largest reinsurer, Swiss Re, has its eye on the future of diabetes treatment. And when the reinsurer hosts a global four-day conference casting serious doubt on mainstream medical treatment for type 2 diabetes.

In other words, speakers said at the June conference, conventional medicine keeps diabetic patients sick, fat and drug-dependent.

That makes messages emanating from the conference that much more groundbreaking. Among them are that type 2 diabetes is not chronic, progressive and degenerative; it can be reversed, even put into remission. Low-carbohydrate, high-fat (LCHF) diets are safe, effective methods of reversing it without drugs or invasive bariatric (stomach) surgery.

Conference speakers also slated official low-fat, high-carb dietary guidelines as contributing to global epidemics of obesity and type 2 diabetes (or "diabesity" as doctors now call the twin incidence) and need radical revision.

Obesity, prediabetes and diabetes are growing global epidemics strongly associated with heart disease, stroke, cancer and Alzheimer’s disease.

It doesn’t take a rocket nutrition scientist to work out what is in it for the company to drive dietary change.

Nor is it difficult to identify the main driver: Swiss Re’s global chief medical officer, South African Dr John Schoonbee. The reason for the reinsurer’s interest in nutrition is simple, Schoonbee said: "If more people die, we pay out more. If fewer people die, we pay out less. So, we want to keep people living longer, healthier lives."

Noncommunicable diseases now account for six of the top seven causes of death globally, he said. Obesity, prediabetes and diabetes are growing global epidemics strongly associated with heart disease, stroke, cancer and Alzheimer’s disease.

Diet is the key factor in obesity and diabetes. Fixing nutrition won’t just slow down these epidemics but can reverse these conditions, he said.

As a large global reinsurer in life and health, Swiss Re’s exposure to long-term mortality and morbidity is "significant", Schoonbee said. Improving these will lead to "very significant financial benefit" and an advantage allowing it to win new business.

The company’s vested financial interest "entirely aligns with [its vision of] making the world a healthier, more resilient place", he said. Thus, its research arm, the Swiss Re Institute, engages with stakeholders by "sharing insights, tailored services and products to enable risk-focused decision making and smarter solutions to manage risk".

To that end, at the institute’s conference delegates included nutrition scientists, endocrinologists, cardiologists, epidemiologists, psychiatrists and a South African, UK-based plastic surgeon. Among top research institutions represented were Harvard and Tufts universities in the US, Cambridge University in the UK and Sydney University in Australia.

The first two days debated Food for Thought, Science and Politics of Nutrition, a collaboration between the institute and The BMJ (formerly The British Medical Journal) to launch a series of articles under the same name. These were researched and written by nutrition experts and advised by Cambridge University and Tufts University.

BMJ editor-in-chief Dr Fiona Godlee opened by saying: "There is no miracle diet but there is a miracle meeting and this is it."

The meeting was not miraculous but it brought together experts with divergent views on optimum nutrition to treat and prevent obesity and diabetes on the same stage.

Some vigorously promoted plant-based diets as optimum to treat and reverse diabesity. Among them was Prof Walter Willett, professor of epidemiology and nutrition at Harvard TH Chan School of Public Health and professor of medicine at Harvard Medical School.

UK professor of medicine and metabolism Roy Taylor sat somewhere in the middle. He has spent more than 40 years studying type 2 diabetes and best treatment methods.

He said eating patterns vary in different populations and there is no one-size-fits-all diet. LCHF diets are "reasonable" treatment for type 2 diabetes, provided they are "not extreme". Taylor agreed that diabetes is reversible but one obstacle is doctors who are "highly trained in using drugs and hardly at all in nutrition".

British consultant cardiologist Dr Aseem Malhotra, author of The Pioppi Diet, came down firmly on the side of animal foods. He said that the huge global burden of chronic disease shows doctors and healthcare systems have failed patients.

Commercial interests have hijacked the best available clinical evidence and the root cause of obesity and type 2 diabetes is flawed science, Malhotra said.

A two-day Redefining Diabetes, Putting a Chronic, Progressive Disease into Remission conference followed.

There was consensus that dietary guidelines have contributed to the global diabesity tide and that LCHF diets can stem it.

US physician Dr Sarah Hallberg is adjunct clinical assistant professor of medicine at Indiana University Medical School and medical director at Virta Health. Virta has been described as one of San Francisco’s "hottest startups". The company recently announced that it had raised $45m funding, bringing the total equity funding to $75m to date.

Hallberg is lead author of a Virta peer-reviewed study recently published in Diabetes Review. Results are from the first 12 months of the five-year study investigating standard- of-care, low-fat and low-carb therapies. Among key takeaways, she said, data show for the first time that reversal is possible in a large-scale trial and in more than just anecdote.

Data also show high adherence to LCHF diets.

Doctors often cite adherence as a barrier to nutrition for effective type 2 diabetes reversal, Hallberg said.

At the end of a study year, 83% of patients on LCHF were still actively engaged. "That’s better adherence than with most medications". Hallberg attributed that to a study design allowing patients to self-select from three diet arms.

"Patient choice is key in diabetes treatment," she said.

Virta data show that LCHF can achieve improvements in cardiovascular disease risk factors at the same time as diabetes reversal, she said.

The LCHF group showed a significant 40% decrease in inflammation, a key cardiovascular disease risk marker.

Low-density lipoprotein (LDL, so-called "bad" cholesterol) went up by 10%.

Other markers that are better risk indicators, such as LDL B and apolipoprotein (APO) B, did not change.

"We haven’t seen anyone [with type 2 diabetes] who doesn’t improve on LCHF," Hallberg said. "LCHF makes many things better without making things worse. It’s a no-brainer," she said.

Resistance to LCHF is because many doctors are still "scared of [saturated] fat". The saturated fat debate is "over". We are pretty much done with it and we now need to get that message across, Hallberg said.

Healthy people can tolerate plant-based diets, she said. Once they enter the disease state or have metabolic issues, then the evidence shows that animal-based diets are healthier.

Hallberg welcomed financial institutions showing interest in nutrition. Healthcare and related costs for type 2 diabetes are staggering, she said. In the US, it costs well over $10,000 a year to treat diabetic patients and costs are growing.

UK diabetologist Dr David Cavan, who calls himself a recovering endocrinologist, described modern medical management of type 2 diabetes as "a lottery" and "scandalous".

Cavan in 2013 became director of policy and programmes at the Brussels-based International Diabetes Federation, a global federation representing over 230 national diabetes associations. In 2017, he set up a Diabetes Reversal Programme in Bermuda, in association with Bermuda Diabetes.

Bermuda is a diabetes factory, Cavan said.

Its diabetogenic environment ticks all the boxes for increased risk of type 2 diabetes. These include a staple diet of starch (rice and peas), high intake of sugary soft drinks, easy availability of low-cost, junk food and the high cost of healthy foods.

Of 30 participants on his LCHF programme after the first 12 months, all but four lost weight and waist circumference. Eight stopped all diabetes medications and 11 reduced some diabetes medication.

Cavan said it is now clear that type 2 diabetes results from modern lifestyles. This has led to the evolution of a new management paradigm.

He outlined the basic principles: type 2 diabetes is associated with insulin resistance or carbohydrate intolerance; it can be reversed and remission is the goal; carbohydrate restriction is vital; intermittent fasting, low-carb and ketogenic (very-LCHF) diets work.

Jeffrey Bohn, Swiss Re Institute director, said that the BMJ partnership reflects a focus on major research topics for the future of the insurance industry and wider society.

"Swiss Re Institute has established itself as a platform for unbiased debate. I was particularly pleased that the Food for Thought conference was live-streamed and viewed more than 5,700 times by people in 63 countries," Bohn said.

Schoonbee said that Swiss Re is agnostic.

"We don’t endorse any one diet. We want to know what works and we accept it as long as it is evidence-based. In that way, we are truly unbiased."

He ended with a rallying call: "Imagine if we could stop diabetes and obesity epidemics and change the trajectory for world health, and for policy makers."

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