Diabetic Amputations: More Dangerous Than Keto? I

[Don_Q]

This article blew me away this morning. A study was conducted in California to better understand the epidemic of diabetic amputations. Apparently, between 2011-2017, there were 82,000 amputations performed on diabetics just in California! Roughly 75% of patients died within 5 years of the amputation procedure.

I checked that stats for the US as a whole and found that there are roughly 170,000 diabetic amputations annually in the US! That means in that same time period, roughly 1,020,000 Americans had a diabetic amputation. According to the article, the average cost was around $100,000 for procedure and postcare. That’s $102,000,000,000 just on amputations. The upside was that 765,000 Americans died within 5 years of the treatment. WTF???

Diabetic Amputations A ‘Shameful Metric’ Of Inadequate Care

Diabetic Amputations May Be Rising in the United States

How this is not a major political issue boggles the mind. The cost of Diabetes is staggering. The American Diabetes Association estimates that the annual cost of diabetes to be $327 billion dollars. To put that in context, the US spends a total of $668 billion on all K-12 education. It’s insane. This is to say nothing of the human suffering caused by 170,000 annual amputations. I’m an amputee myself (fingers) and I promise you the rehab and post-care is not something anybody wants to experience.

The Cost of Diabetes

I’m not really sure what the solution to the problem is, but the claim that we’re not spending enough on the problem is laughable. The claim that people lack access to or the financial ability to purchase healthy food is also ridiculous. Since I started eating keto and doing extended fasting, my grocery bills have dropped 60%. Fat is cheaper than sugar and carbs. They give the stuff away. Type 2 diabetes is a voluntary disease; you’ve got to work to maintain it several times per day. Kind of like smoking.

I don’t know what the solution to the problem is, but the fact that nobody is even proposing one politically is somewhat shocking. I suppose the problem is that Type 2 diabetes is a voluntary disease. The only real solution is for people to take responsibility for their own health. That’s probably not going to happen so long as healthy people pick up 90% of the tab for voluntarily sick ones.

I don’t pretend to know how to solve the problem, but shifting the costs from the victims (healthy folks) to those responsible (voluntary diabetics) seems like an interesting idea. It worked for cigarettes. The economics of it are similar. The demographics of smoking mirror the demographics of type 2 diabetes as well. As a former cigarette and sugar addict, my experience is was that quitting cigarettes was easier than quitting sugar. I quit when cigarettes went from $2.00 a pack to $10.00 (NY State).

I think that a $0.20/g tax on sugar would be an interesting start. A snickers bar has 20g of sugar. It costs 75 cents. If you added a $4.00 sugar tax to it, and it cost $4.75, I’d bet they’d sell a lot less of them. A 10lb bag of sugar costs $5.50 cents at my Walmart. It has 4,536g of sugar. It’s basically a DIY diabetes kit. If that same 10lb bag cost $913.00, do you reckon they’d sell fewer of them?

That will never happen of course. I’m curious to hear what other folks think might be a viable solution to the diabetes epidemic. Increasing health care premiums for type 2 diabetics like we do for cigarette smokers? Subsidizing avocados? I don’t have a clue what would work or be feasible, but I’d love to hear some ideas!

[AuntJane]

I’m an addictions counselor and have a client who is a brittle diabetic and has already lost a few fingers to the disease. I should tell him “listen to your doctor” but I finally said the hell with it and gave him a list of keto-friendly foods!

I think sugar should be regulated as a drug. I feel like when kids especially are exposed to sugar, always on those low shelves in the store, it’s like they’re pushing addiction. It’s disgusting. How much evidence do we need to show that sugar is harmful? That grains are nearly as bad?

[Carolus_Holman]

I was on my way 2 years ago, then the 2keto dudes podcast saved me! This article outlines some of the struggles poorer people face fighting diabetes, WARNING Some photos of people without limbs - some folks have sensitivities to these types of pictures.

Diabetic Amputations A ‘Shameful Metric’ Of Inadequate Care

[Nomoreweighting]

Thank you for sharing, very upsetting.

[Jody2]

I’m sad, I’m angry, and I’m scared this could have been me eventually if I had never found Dr Fung’s work.

[jessOTR]

Simple policy updates to organizations like the American Heart Association (who we know will never endorse keto) and the American Diabetes Association would be a start. Diabetics are told they need more drugs, not to cut out sugar. The diabetic I work with keeps all sorts of carbs on her desk in case her blood sugar goes too low. If the policy of those organizations and the medical staff who serve these people changed, I think a lot of the “epidemic” would fade. I have an uncle who ate keto for a while and had good results. He quit and is now diabetic. He 100% believes there’s nothing he can do about it because it’s a chronic condition. Why try?

[PaulL]

I suppose the problem is that Type 2 diabetes is a voluntary disease.

I wouldn’t phrase it quite like that, I don’t think. Yes, it’s a behavioral disease, but I don’t believe people choose it, any more than the worst smoker chooses lung cancer, or the worst alcoholic chooses brain damage and cirrhosis of the liver. Part of the issue is that nicotine, ethanol, and carbohydrate (especially sugar) all have an addictive effect on a significant percentage of the population.

Also, since the whole CICO/a-calorie-is-a-calorie way of looking at obesity is intended to fasten blame on the obese patient (“eat less, move more” means that if you don’t get thinner, you’re a glutton and a sloth), I am wary of the phrase “voluntary disease” simply because it is probably not a helpful way to think about what is really going on. The hormonal model of weight gain and loss makes much more sense to me, in any case.

On the other hand, your phrase does imply a certain amount of control lies in our hands, and I do like that part! I must say that, as a sugar addict, it was very hard to come to terms with the addiction, but once I did, the necessary behavior change became possible. As long as I avoid sugar and keep my total carb intake minimal, I don’t have to binge on food anymore. Who knew?

Be very careful about identifying victims. I would tend to say that the “victims” in smoking are the cigarette customers who were told for centuries that cigarettes were harmless. And the tobacco companies, last I heard, were still claiming that “nicotine is not addictive,” when every heroin addict of my acquaintance can testify that getting off nicotine was far more challenging than getting off heroin (when it was introduced, heroin was supposed to be a non-addictive alternative to morphine, ironically). And if you don’t believe that carbohydrate is addictive, take a gander at all the threads on these forums posted by people who dream of being able to eat carbohydrate again, the way alcoholics dream of someday being able to drink again (the smart ones know it ain’t gonna happen, but knowing that doesn’t kill the dream).

A big step towards eliminating Type II diabetes would be for the government to stop recommending a diabetes-inducing diet, stop subsidising the production of high-fructose corn syrup, and stop subsidising the growing of grains. Dr. Robert Lustig also recommends a tax on sugar-sweetened beverages. Nina Teicholz’ Nutrition Coalition is working on getting the dietary guidelines changed, and Dr. Lustig’s Eat Real organization is working on the rest. You might want to check out those two organizations and see if their programs make sense to you.

As a last comment (sorry to go on so long), Peter Ballerstedt, the forage agronomist, has some compelling arguments to the effect that raising ruminants on our grasslands actually helps the environment and reduces global warming by sequestering carbon. He has figures to show that growing crops is actually far more harmful to the land, as well as to all the small (and not-so-small) animals who live on it, than ruminant agriculture is.

[David_Stilley]

Okay, I have to say amputation is just the tip of the iceberg with diabetes. I spent many years on dialysis because of loss of my strong kidney to cancer, and quickly went below acceptable renal function with the remaining kidney three months later.

I was shocked when I had to stop home dialysis and started going to a clinic for my last two years. I live in central California and we have a pretty large Latino community. Maybe 30%+, the dialysis clinic was about 60% Latino clients. A fairly significant number of them had single or double amputations (one guy was a blind double amputee in a wheelchair who sat outside the clinic smoking while he waited for his ride, probably in his late 30’s. Dialysis costs are a few thousand dollars per month on top of nephrology doctors and lab costs. Obesity was part of the deal for most of them too. It always shocked me that some people were having supersize Burger King meals in their chair during treatments. I wasn’t the perfect example of a renal patient either but I tried to keep it in rein. If someone is getting amputated because of diabetes renal failure and loss of eyesight are around the corner if they haven’t already started to manifest. I asked about why there was such a large percentage of diabetic Latino patients with renal failure and was told it’s because of their love of sugar and fried foods that are part of their culture. They make up the largest demographic of diabetic and dialysis patients in California.

[Don_Q]

Simple policy updates to organizations like the American Heart Association (who we know will never endorse keto) and the American Diabetes Association would be a start. Diabetics are told they need more drugs, not to cut out sugar.

Well, on the bright side, we’ve had a major keto victory with the American Diabetes Association just recently. They’ve made a big shift towards low carb as an evidence based dietary treatment for diabetes!

American Diabetes Association endorses low-carb diet as option — Diet Doctor

[anon2571578]

This sort of reminds about how health officials keep trying to blame the high blood pressure on average for African Americans on soul food consumption; rather than it being a combo of factors largely outside of the individual’s control, everything from food manufacturing to #existingwhileBlack in America.

Like of course they would blame the prevalence of diabetes on the Latinx cultures themselves, rather than the outside factors and lack of resources.

[PaulL]

We saw a similar blaming of victims with the AIDS epidemic, especially in the early days.

Actually, given what my relatives all eat, I’m surprised that the indicidence of diabetes is not far higher in the lily-white portion of the population. Except of course that the rich tend to be white and can afford to eat better, so they skew the figures. The view is far different from my end of the economic scale.

[Don_Q]

I wouldn’t phrase it quite like that, I don’t think. Yes, it’s a behavioral disease, but I don’t believe people choose it, any more than the worst smoker chooses lung cancer, or the worst alcoholic chooses brain damage and cirrhosis of the liver.

I draw a distinction between Type 1 diabetes and Type 2 diabetes. Type 1 diabetics have no choice. They are born with it, and it is incurable. Type 2 diabetics make thousands of bad choices to cause their own disease, and must choose not to fix it daily. The former is involuntary, the latter is voluntary.

Put succinctly, there is no cure for type 1 diabetes; the cure for type 2 diabetes is better choices.

Whether or not it’s hard to make better choices, or the degree to which addiction plays a role in the poor choices isn’t really relevant to the question of whether or not the root cause is daily choices that only the individual can make. I’m a recovering addict, and every recovering addict I know made the choice to change. Continuing to make the choice every day is my definition of recovery. It’s a debatable point certainly.

Spending more healthcare money won’t solve the problem. Spending healthcare money differently won’t solve the problem. We either incentive better choices, and penalize detrimental choices, or the epidemic continues to spiral out of control. That’s what it looks like to me anyway.

If that’s not true, the only solutions are pharmaceuticals. That’s our default treatment option now. It’s not working. If what Dr. Fung says is true, insulin and metformin only treat the symptoms, and make the disease worse, not better.

[PaulL]

Put succinctly, there is no cure for type 1 diabetes; the cure for type 2 diabetes is better choices.

The distinction is that Type I is an autoimmune disease, occurring at any stage of life, of which we don’t know the cause (could also be the result of people’s choices, who knows?), whereas Type II has a genetic predisposition, but is affected by environmental factors. So yes, Type II is avoidable, if you know what you are doing, but my point was that we have to stop subsidizing the production of diabetes-inducling foods, in particular by eliminating the subsidy of the U.S. corn (maize) crop.

High-fructose corn syrup is so much less expensive than sucrose because of this subsidy, that it drives down the cost of foods rich in sweeteners, practically driving poor people into a diabetes-inducing diet (in combination with the dietary guidelines, of course), because they can’f afford better food. It’s not purely a matter of “choice.” Watch some of Dr. Lustig’s lectures on the topic; his economic analysis, while not as nuanced as it could be, is actually pretty decent.

The sort of thing that can be done, however, is an educational effort similar to that undertaken by the Noakes Foundation among the poorest South Africans. They have had quite a bit of success coaching people to buy higher-quality food, and they have been able to show that, once past the initial hump, people actually save money on the “Banting” diet, because they no longer have the high medical costs, lost work income, and travel expenses getting to the doctor that they had been experiencing when sick.

[Robert_Johnson]

Put succinctly, there is no cure for type 1 diabetes; the cure for type 2 diabetes is better choices.

Except the victims of our medical industry are being told an outright, lie. “Eat a ‘healthy’ diet”. To which they are told is a diet of 45% carbs?!?! How are we suppossed to make better choices when given fraudulent information. Information by design to keep a T2DM in that state? Heads need to roll. Higher management needs to go to prison. A low carb aproach may not fit 100% of T2DM patients, for whatever reasons, but surely a majority! Even if it was 50%, that would be MILLIONS of patients getting out of diabetes. Which would be a boon to the ones that are the poorest seeing as a ketogenic diet is by far the cheapest way to it. My grocery bill dropped about 75%. And I wasnt eating high end food stuffs. Just the cheapest things I could get to continue eatling healthily into the diabetes trap. Maybe the poor are at a disadvantage because big pharma is able to keep the wool pulled over their eyes because they dont self educate as easily as a middle income person who can afford internet access?

[anon2571578]

That lack of empathy has reached Ronald Reagan levels here. We don’t get to blame the poor for these issues when literally everything diet related is stacked for them to lose. They’re told eating high-carb diets are healthy, even by diabetic associations. Good quality food is largely inaccessible to them. They’re worked so hard that most of the time they don’t have the time or energy to spend cooking healthy meals from scratch.

It’s no coincidence that poor communities are disproportionately effected by bad diets, just like they are by addiction; it’s by design.

[DiMo]

Have a ! Have lots of ’s!

_{I’m out of likes again, already.}

[PaulL]

You forgot to add
_{stupid software!}

[Pasiviking]

Type 2 diabetes is a voluntary disease; you’ve got to work to maintain it several times per day. Kind of like smoking.

This statement crushes in truth and painful to realize. I’ve never considered SAD as something you have to work towards but you’re right. It takes effort to consume copious amounts of sugar and starches multiple times a day. MINDBLOWN

[DiMo]

Thank you for responding to the OP in a nuanced and succinct fashion. I personally want to be very careful about blaming individuals who are operating with the deck stacked against them by many factors including terrible economic policies (eg corn subsidies) and terrible nutritional advice provided by governments which IS IN NO WAY evidence based.

When I followed the generally accepted nutritional advice, it led me down a path (exacerbated by my genetic tendencies [MTHFR genetic mutations and others which inhibit my livers’ ability to detoxify my blood], a history of prolonged severe caloric restriction and repeated severe viral infections) to extremely impaired ability to produced ATP. This resulted in restricted ability to take care of myself and severe brain fog. I feel very fortunate to have finally discovered the health benefits of low carb eating for myself. I think it likely that many people who are eating carbohydrate heavy diets also operate under some version of brain fog and… yes… addiction which complicates the probability of finding a better way to nourish their bodies and brains.

All that said, I think everyone who is commenting here wants better solutions and support for all these people who are suffering horrible, debilitating conditions which could very likely be alleviated or reversed with better dietary choices.

[Don_Q]

The distinction is that Type I is an autoimmune disease, occurring at any stage of life, of which we don’t know the cause (could also be the result of people’s choices, who knows?), whereas Type II has a genetic predisposition, but is affected by environmental factors. So yes, Type II is avoidable, if you know what you are doing, but my point was that we have to stop subsidizing the production of diabetes-inducling foods, in particular by eliminating the subsidy of the U.S. corn (maize) crop.

I think we probably agree on way more than we disagree.

I think that we need to stop subsidizing sugar and high fructose corn syrup asap. I think we should tax the hell out of added sugars the way that we tax cigarettes now. Sugar is every bit as deadly and addictive.

I sounds like we even agree that individual choice plays an important role, and that we can improve those choices with better education, and better research into dietary treatment of diabetes. The recent shift of the American Diabetes Association towards low carb diet as a treatment option is really encouraging.

I think you’re right that it’s important to be careful when identifying “victims”, or in applying that label. There is a matter of degree of culpability as well. Big agriculture, and the pharma industry share some portion of the blame.

The way I look at it, I’m powerless to change big AG or pharma, but I have 100% control over what I eat. I caused my own diabetes with choices, and I can fix it with choices. Eating keto is an easy choice because it’s cheaper and it works!

If I’m truly a victim of big AG, pharma, and the FDA, I’m powerless to fix it. So far, I’ve found it’s easy and delicious problem to solve.

I think the extent to which I am a victim is commensurate to the ease with which I can solve the problem; in this case it’s 100% within my power, and not particularly difficult.