Q:I was interested to read your articles on diabetes in WDDTY vol 3 No 7, though I certainly cannot agree with some of the content. I think it is very intersting that the initial article on diabetes refers to several excellent studies on diabetes and its causation from reputable journals like the BMJ and Lancet. Unfortunately, the article is then sidetracked into chromium and zinc, along with vitamin supplements.
Interesting as these areas are, I note that no papers are quoted to support any of the suggestions made. Having recently reviewed the issue myself and discovered that the negative papers outnumber the positive papers by 5 to 6 to 1, I think it is a pity that the article moves from established fact into anecdote and unproven theory without making clear to a non expert reader the difference between the two issues.In the pregnancy article I would comment that it is unlike ly that one can reasonably extrapolate from eight patients managed without infusions (2.3 per cent of the total) to imply that this is appropriate for everyone. It is, in addition, true that many diabetic physicans (and obstetricians managing patients with diabetes) will recommend induction of labour at 38 weeks rather than waiting to term. As someone who has seen a diabetic mother reach 38 weeks, only to have the baby suddenly die in utero at 39 weeks, the knowledge that earlier intervention would avoided the tragedy of the loss of this baby obviously influences my judgement.
In general I am not averse to anything which discusses health inssues and raises interests and awareness, and I would certainly never pretend that health professionals have a monoply on correct answers but I do think there is a tendency to believe the enthusiastic amateur rather than the perhaps more cautious experinced professional, perhaps not to the benefit of the patient. K R. Paterson, consultant physician, Diabetes Centre, royal Infirmary, Glasgow.
A:Thank you for your letter. Let us respond to some of your comments, one by one.
First, there is substantial research, conducted by diabetic specialists here and in the States, to show that if allergies, lifestyle factors and certain genetic predilections cause diabetes, then lifestyle changes that is, dietary manipulation is the most positive way forward in controlling this disease.
Dr James W Anderson, professor of medicine and clinical nutrition at the University of Kentucky in Lexington and author of Diabetes: A Practical New Guide to Healthy Living (Warner Books, New York, 1983) has pioneered a low fat high fibre, high carbohydrate diet for diabetics. In a variety of controlled studies, two thirds of his patients have been able to come off insulin.( Postgraduate Medicine, August 1990188(2):157-168).
Dr William Philpott of St Petersburg Florida, another researcher with a good deal of clinical experience in treating diabetic patients, has shown a correlation between food intolerance and diabetes; when allergies have been identified, two thirds of his patients also have been able to manage their condition without insulin.
Numerous animal and human studies have been done on the beneficial effects of chromium and zinc which increase glucose tolerance. Dr Stephen Davies refers you to just a few ("Chromium depletion in the pathogenesis of diabetes and atherosclerosis", Boyle et al, South Medical Journal 70:12 (1977), 1449-53, Am J Clin Nutr., 34(1981), 2670-8; Diabetes, 29 (1980): 919-25; Practical Cardiology, 8:9 (1982), 145-56.
In the pregnancy article, we were not suggesting that all diabetic patients be managed without infusions; only that technological births not be decided upon as a matter of course, since technological interventions may be riskier than a natural birth.
You assume that the baby of the mother you cite died only because the labour was not induced. Of course you are aware of the myriad of papers published recently showing a relationship between insulin dependance among pregnant women and adverse pregnancy outcomes. So it could well be that the baby in question died from medical intervention.
By "enthusiastic amateur", which of the two physicians quoted most frequently in our article are you referring to? Stephen Davies, internationally respected, practitioner, author and editor for some 20 years? Or Michel Odent, probably the most important pioneer of natural birth in this century?