Despite the fact that diabetes has been known to medicine for thousands of years, what exactly causes it remains a mystery. Let's try to figure out why it is so difficult to understand this disease and whether humanity has a chance to get rid of it.
We are already accustomed to the almost omnipotence of modern medicine. Dangerous infectious diseases are pressed to the nail, although a few hundred years ago, one epidemic could claim 70 million lives, like a couple of world wars. Even patients with HIV, thanks to effective treatment, in recent years have received the same life expectancy as their healthy peers - and this disease has been known for less than 40 years.
The most dangerous diseases now remain those that, most likely, are not directly related to any infections. We have already written about one of them - cancer. The second, not so dangerous, is diabetes. Moreover, the incidence of the disease is growing even faster than for cancer.
In 2013, there were 382 million diagnosed diabetics in the world, and in 2016 there were 425 million (+10.8%, every 18th person on Earth). Direct deaths from diabetes alone in the world 1.5 million a year, from indirect deaths another 2, 2 million. In the next ten years, according to a number of scientific groups, deaths from it will increase by one and a half times. We are talking about a full-fledged epidemic, more than 90% of cases of which are diabetes of the second type ("mellitus", although this name is rather misleading).
It is known exactly how it manifests itself about diabetes. The body does not react correctly to the hormone insulin, the level of glucose in the blood rises sharply. Thirst, frequent urination, vision problems, high fatigue, in men - problems with potency. We will omit the long list of possible and sometimes fatal complications, moving on to the main problem. No one knows exactly what causes diabetes.
Need to eat less?
The scientific journal Diabetologia recently published another article by the supporters of the first hypothesis about the causes of the expanding global epidemic with millions of victims. The idea behind the first hypothesis is simple: being overweight is the most important risk factor for type 2 diabetes. Since the weight is to blame, it means that you have to think - and the fight against this disease is through its reduction.
The authors of the new work took the results of a long-term study of 11,192 Australian women in 1996-2015 and tracked how changes in body mass index correlated with the likelihood of type 2 diabetes (and during the observation period 162 of these women, 1.5%, fell ill with it). As you might expect, people with obesity (normally this means a body mass index above 30) are more likely to develop "diabetes".
What's more interesting: the later in a woman's life obesity appeared, the lower her chance of getting sick. For each year of later onset of obesity, the likelihood of the disease fell by 13%, which is quite a lot.
Researchers do not deliberately articulate a vision of the causes of illness. But they conclude that preventing obesity or combating it after it has occurred can significantly reduce the risk of illness.
Earlier, supporters of the first hypothesis - that diabetes is associated with overweight / improper lifestyle or heredity - spoke more frankly. Now in scientific journals it is no longer accepted to write this way. But on the websites of large Western clinics you can still find statements like this: "Type II diabetes has several causes, genetic and lifestyle are the two most important."
Why try so hard not to write v scientific journals - it is understandable. The fact is that genes change slowly, and diabetes spreads quickly.Lifestyle is a loose concept, and nowadays, in relation to diabetes, it is often the politically correct form of denoting obesity and low physical activity. Nevertheless, this explanation is also lame. In the United States, only obese adults - 93, 3 million, and three times less diabetics. If it were the years spent with obesity, the masses of such people would not approach retirement without a similar illness, as we see it in real life.
At first glance, it is not clear: why should we even know the causes of this disease? The answer is simple. Medicine often believes that it understands the causes of a particular disease and, accordingly, treats it based on them.
For example, the cause of pneumonia has long been considered stale air, therefore, back in the 1910s, medical reference books, by inertia, recommended cold baths to patients with it (which, as it is now clear, carry great risks for the patient). As soon as the bulk of doctors understood the real cause of the disease, it became possible to influence it.
Cutting to hell without waiting for peritonitis?
It all began for almost a hundred years, when medical practitioners began to notice that after a series of operations, the symptoms of diabetes in people went away without return. Such cases have become widespread since the 1980s. Then they began to treat extreme obesity with gastric bypass surgery. With such an operation, only a small part of the stomach is left available for food, which quickly causes feelings of fullness and stops overeating. Many obese patients had type 2 diabetes, and they had it after the operation - for good. True, this helped only in 83, 7% of cases, in the rest - the disease remained.
A little later, another method of dealing with extreme obesity began to gain momentum: "biliopancreatic bypass surgery with the shutdown of the duodenum." Technically, this is just an exception from the actively working digestive tract of a part of the duodenum. And with him it turned out that already 98, 9% of patients stopped suffering from type 2 diabetes.
At that time, medicine was dominated by the "fat-centric" hypothesis of the causes of diabetes. According to her, everything seemed to be clear: operations reduce the absorption of food, people lose weight - so diabetes goes away. Therefore, for a very long time, tens of years in a row, no one paid special attention to the results of such operations.
There is nothing new in this story. Back in the 16th and 17th centuries, English admirals knew that fresh fruit in a sailor's diet would prevent scurvy. Physicians in the United States in the 1950s noticed that regular aspirin users were less likely to have thrombosis as well as heart attacks. But until the mechanisms of the therapeutic effect are clarified, most scientists and doctors are inclined to attribute them to some unaccounted for factors.
However, over time, scientists did establish: "The mechanism for the disappearance of diabetes after surgery to bypass part of the gastrointestinal tract remains unclear, but it is definitely not associated with weight loss alone."
The main sign that it's not a matter of weight was time. Diabetes symptoms disappeared in days, rarely weeks, but weight loss during this period often did not have time to occur. In addition, after the operation, patients often continued to eat a lot, but they did not show any symptoms of the disease anyway.
Finally, some doctors began to try (in fact, at their own and the patient's fear and risk) similar operations on people with a slight overweight, or even without it (there are many such diabetics). And their symptoms also went away - although there might not have been any weight loss at all. The same thing was observed in experiments on diabetic rats. Over the next 15 years, quite a lot of such operations on diabetics were carried out - and they had the same effect.
It would seem that this is the solution. Yes, surgery costs money, but more than a quarter of a trillion dollars a year are spent on diabetes care worldwide. To operate on all 422 million means, over time, to recoup the costs of their surgical treatment. But it was not there.
First, the mortality rate from such operations is 0.28%.True, one must take into account that they are now carried out mainly on people with a large and very large weight. And this is a serious risk factor that greatly increases the risk of death after surgery. Again, only direct deaths from diabetes annually claim the lives of 0.9% of those suffering from it.
More importantly, it takes dozens of years to live with diabetes (and each year there is a chance of dying from its consequences), and surgery is a one-time risk. Statistical studies have shown that, over seven years of observation, the operated diabetics show a mortality rate 92% lower than the control group, which had the same severity of the disease and the same overweight. It turns out that the operation is, on average, much safer than its absence.
There is, however, also the second. Some people after such an operation cannot eat too sweet or fatty foods: they are sick of it in the truest sense of the word. Someone has an increased incidence of diarrhea. Someone shows a reduced level of vitamins in the blood, and they are prescribed multivitamins. The reasons for this are obvious: the human gastrointestinal tract was not formed by chance, there are no "extra" spare parts at all.
Chopping down roots: while in the dark
The ideal way out of the situation would be some kind of non-surgical treatment method that does not force a part of the gastrointestinal tract to be turned off. Then not to donate periodically blood to control the vitamins in it and so as not to turn out from sweets. But such a method cannot be developed without understanding what exactly happens in diabetes and what mechanism it has.
Based on the fact that diabetes - contrary to what was previously believed - is reversible, it is obvious that it is controlled by some constantly acting factor associated with the intestine and / or stomach (the greater efficiency of operations with the duodenum shows that, most likely, it is in the intestine) …
To date, there are three hypothetical mechanisms that explain diabetes cure. The first, and the most vague, is that surgery causes the intestines to alter the production of hormones associated with food. The second mechanism: after the operation, the level of some bile acids increases, affecting the reaction of cells to insulin and, in the case of cells of the intestinal walls, their absorption of glucose.
The third hypothetical mechanism is the influence of the microbiome, bacteria and archaea living in our intestines as beneficial inhabitants. As in 2014, a group of Israeli researchers found out, sugar substitutes like the same aspartame cause serious changes in the species composition of the microbiome in the intestines of mice. Some bacteria and archaea are replaced by others, which previously constituted a smaller part of the intestinal microflora. However, these mice develop impaired glucose tolerance, a process followed by type II diabetes in humans.
At the same time, the transfer of fecal material from such mice to others showed that they immediately developed impaired glucose tolerance. Even when the intestinal microbiota of the mouse was isolated from the animal and grown separately from it, the introduction of such microflora into a healthy mouse would disturb its glucose tolerance. A similar mechanism has been shown for humans.
Of course, this does not mean that aspartame is to blame for everything: diabetes appeared long before sugar substitutes. But it is obvious that something in what we eat is "out of sync with evolution." The inhabitants of our gastrointestinal tract from this begin to wage interspecific wars. And when such a war ends, we start having problems with blood sugar levels.
Probably the ideal approach to non-surgical treatment of diabetes would be to study what exactly is wrong with our diet - and either eliminate it from the diet, or some other way to maintain a normal species balance of intestinal microflora.
It remains only to wait until these discoveries are finally made.