Diabetic complications are leading causes of blindness, amputations and kidney failure. Most diabetics develop a complication within 16 years of being diagnosed. Diabetologist's waiting rooms seem to be filled with people with white canes, overweight people, amputees in wheelchairs - people suffering the agonies of the damned. The cost in human suffering is inconceivable, and, judging from my experience, totally unnecessary: The ketogenic diet brings normal blood sugar without the penalty of high insulin levels to both Type I and T ype II diabetics.
The Diabetes Control and Complications Trial followed two groups of insulin-dependent diabetics, one following a casual regime of blood sugar control, the other attempting much tighter control with more frequent insulin injections. The results showed beyond doubt that high blood sugar is associated with neuropathies and microvascular (small blood vessel) complications, but does not lessen the macrovascular (large blood vessel) complications. In other words, tight control reduces the chance of kidney failure, foot problems, leg ulcers, blindness, amputation and neuropathy, but actually worsens weight gain, causes more and more severe hypoglycemia and increased risk of coronary artery disease (on the ADA-style, low fat, high carbohydrate diet used in the DCCT).
The so-called microvascular complications are caused by high blood sugar and damage the capillaries and the organs dependent on them such as the kidneys (nephropathy), eyes (retinopathy), and the extremities which can lead to diabetic leg ulcers, gangrene and amputation. The neuropathies (nerve damage) include: itching, burning, numbness, and eventually the failure of organ systems to perform properly, as in delayed stomach emptying from damage to the vagus nerve, and eventually the progressive failure of the digestion.
The macrovascular complications - heart disease - are associated with and likely caused by high insulin levels: the so-called syndrome X. In this trial, the researchers acknowledge that high insulin levels are the price of tight control; and some of the tight control group gained weight and had increases in blood pressure and cholesterol, so they came to have an increased risk of vascular complications. The larger vessels become blocked, like the coronary arteries which feed the heart muscle (setting the stage for heart attack), and the carotid artery which feeds the brain (setting the stage for a stroke). These conditions are shared with people without diabetes, but in diabetics they progress six times faster. Further, diabetics' blood has a greater tendency to clot, so that heart attacks and strokes are more common among them. The combination of numbness in the feet and poor circulation make diabetic feet and legs terribly vulnerable - even too-hot bath water can damage them - and wounds are slow to heal and may ulcerate.
Fortunately, the way of eating I describe has lessened my risk factors for heart disease dramatically. All that really matters about complications is knowing how to avoid them. The key is to decline the commonly-prescribed high carbohydrate, low fat diet in favor of a low carbohydrate diet with protective supplements. This makes tight control quite easy and lowers heart attack risk. Dr Richard Bernstein's severe complications of long standing abated when he normalized his blood sugar with a low carbohydrate diet even without supplements, so there's no doubt in my mind that this approach is both preventative and curative.
Now, the way I eat involves avoiding sugars and the other refined carbohydrates so prominent in the American diet and it's had these phenomenally positive effects on my blood chemistry in spite of being the opposite of the conventional wisdom. Is this coincidence? An idiosyncrasy of my metabolism? Or is it that sugar and refined carbohydrates actually cause damage?