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April 11, 2014

If I say it once, I say it 15 times a day to patients, “Diabetes starts at birth.” This is one of the biggest paradigm shifts that needs to occur in medical science today. This article points directly to this in several ways.

First, it shows that earlier recognition of people at risk of Polycystic Ovary and Diabetes type II (I would argue are one and the same) and subsequent intervention decreases the severity of the disease!! What a novel concept. Unfortunately though, our medical system is stuck in “Damage Control Mode,” where diseases are identified late and treated when little can be done. Through simple observation and patient experience, I can go to my grade school child’s play and pick out the 3-5th graders who have this gene. Knowing their parents makes it very obvious. Yet what is obvious to me in regards to diabetes is not at all part of current day medical thought. Diabetes is so rigorously defined [by history] that we MUST follow guidelines to the detriment of progress. This has impaired our ability to truly help people overcome this most devastating disease.

Secondly, the inclusion criteria of “very low birth weight (VLBW)” children adds support for the theory that Insulin Resistance causing Type II Diabetes may be “turned on” in the pregnancy. This is why I spend so much time on nutrition in pregnancy with our patients. It is my firm belief that besides VLBW, which affects only a small portion of our population, that there is a signal to the fetus based on the nutrition of the mother that points to inadequate food supply in the environment. Insulin resistance and obesity would then protect this person from starvation. We all know that most people are not starving but natures “mechanisms” are directed at the cave man environment where starvation was much more common. I believe the stimulus is male hormones produced by the pregnant woman’s ovary in response to insulin stimulation. Carbohydrates cause the insulin stimulation. Therefore, high carbohydrate intake in pregnancy is likely the stimulus for this problem. Babies are bigger and C-section rates are much higher in this process.
Actually using metformin (glucophage; diabetes drug) in 8 yr olds is a radical idea yet perfectly demonstrative of the physiology. I’m sure many pediatricians would jump up and down at this idea. As we’ve found in infertility treatment, metformin improves insulin function some and makes the overall metabolic picture better. Unfortunately, as we found in fertility treatment, the metformin effect pales in comparison to the low carbohydrate nutrition effect. I would put nutrition at 80% and metformin effect at 20% or less.

In summary, I take away the concepts above and would extrapolate associated concepts, which would lead me to recommend very low carbohydrate diet to these 8 yr olds and reserve drugs for those who don’t respond or the most severe of cases. Severity can be easily measured by BMI and simply taking a good family history. Parents would have to be scared into really adopting this nutrition approach with their children and as we see in our practice, the parents have the same gene and need to be observing the same treatment.

I’m very excited to see such novel research and see it in the mainstream media.
Best wishes,
Dr. Michael D. Fox

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