Clues to aging maladies found in study of diabetes


After his heart attack, Bill Clinton followed a diet program devised by Dr. Caldwell Esselstyn. The retired surgeon in September spoke to a large audience at Whitman College.

I respect most of Clinton’s choices, while allowing there were some slip-ups. I’ll leave it up to you to find a category for this one.

This series of POV Science articles deals with longevity. Today’s focus was planned to show how diabetes fits into the metabolic syndrome, a group of diseases that appear to be related and which deprive us of years of good quality living.

I’ve expanded on the subject to include some thoughts about diets.

Diet plays a role in longevity, but there are different opinions about critical issues. I have written that Seventh-day Adventist vegetarians live healthier lives than non-vegetarians, and that the typical American diet is associated with the metabolic syndrome.

Esselstyn eliminates foods that have “eyes or a mother,” and he forbids all oils, including olive oil.

His claims are based on his practice and the results with 22 patients. Six of those suffered no cardiac events after 10 years.

His papers express seemingly reasonable suggestions about diet interventions, but it isn’t possible for me to find out how many patients dropped out of the program. If we don’t count and evaluate our losses, our data is bound to look good.

Controversies include:

Evidence that sugar, not fat, promotes insulin resistance, the hallmark of type 2 diabetes.

Meat contributes to creating unstable plaques and heart attacks by producing a chemical, carnitine. Carnitine changes the bacteria in our gut.

Muscle affects metabolism and reduces insulin resistance.

Some clues to the diseases of aging can be uncovered by studying diabetes. I’ll start with highlights. As usual, I’m able to expand the discussion on Facebook.

In the 1960s, I was taught that insulin saves lives by preventing acidosis and coma. When our body becomes resistant to insulin, it burns fat and turns acidotic. Adding insulin prevents that process.

We were uncertain, in those days, whether tight control of blood sugar protected our patients from widespread organ damage. It’s now clear there are health advantages in achieving good control, measured by blood glucose and glycated hemoglobin.

Eleven classes of medications are approved to control blood sugar. Diet and exercise, as well the drug metformin are old standards.

Some newer drugs have different mechanisms of action, including increasing the excretion of sugar.

Sugar, specifically fructose, drives the process that leads to type 2 diabetes. Fructose comprises half of the sucrose in your sugar bowl or your glass of orange juice.

Fructose is metabolized by the liver. Excesses make visceral fat, and we end up with a fatty and dysfunctional liver, the same as one that is overtaxed by alcohol.

Fructose also inactivates an enzyme and leads to insulin resistance. Insulin resistance leads to a demand for more insulin. We are driven to eat more and store more fat. That fat manufactures adipokines, chemicals that do many things, including promoting inflammation.

Inflammatory responses may fight infections, but they also contribute to arthritis, destabilize plaques leading to heart attacks and contribute to other illnesses, possibly including Alzheimer’s disease.

The fat hidden inside our abdomen tells us more about health risks than we learn from cholesterol levels. Most of us have a lot of fat cells that make adipokines like leptin and visfatin.

Leptin helps control appetite, but also promotes insulin resistance. Visfatin contributes to many of the disorders of the metabolic syndrome. It regulates insulin pathways and is linked to many of its negative effects. The inflammatory effects on cartilage strongly imply connections with osteoarthritis and rheumatoid arthritis.

The diets proposed by Esselstyn and Dr. Dean Ornish appear to have beneficial effects on vascular health and may be the best answer for the limited number of people who can follow their programs. You might want to read Ornish’s reports. He uses the word “moderate” to describe his results.

Did Clinton make the best choice? I don’t know. His diet is based on the experience of one physician.

Esselstyn’s advice is at odds with many experts. We need to know whether he undervalued the apparently important role of fructose and the generally recognized effects of exercise. Any future study should report on patients who drop out and on other outcomes, including dementia and longevity.

Next time, I want to look at the way hormones fail with age and whether replacing them is likely to help or harm.

After that, let’s consider current science of dementia. Can we protect our brains by limiting sugar and booze, or are we dealing with prions and an infectious process?

Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at and other online book retailers. He can be reached at


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