So far in this thread we have mainly discussed cases where Dupuytren's is a complication of diabetes or is found in individuals who, if not diabetic, have a higher than normal fasting blood sugar level (as the Reykjavik study found). If this is one route to Dupuytren's, then the culprit may be either an excess of glucose in the blood or an excess of insulin, or both. (For even in people with type 1 diabetes, whose body does not produce enough insulin of its own and who have to take daily injections, it is hard to get the dose exactly right: sometimes slightly too much insulin is given, and sometimes not enough, so at times the blodstream is awash with excessive glucose and at other times with excessive insulin.)

Kevin in his website www.dupuytrens-a-new-theory.com, on the other hand, discusses the possible connection between Dupuytren's and hypoglycemia, that is *low* blood sugar, the opposite of diabetes. He points out that "Research has shown that those persons who descended from the Vikings have the highest incidence of hypoglycemia, as compared to the rest of the world". He also points out that alcoholism and epilepsy (which have both been associated in some studies with Dupuytren's) are also frequently associated with hypoglycemia. (It is possible that there are other routes to Dupuytren's too, for example through taking glucosamine/chondroitin supplements, or through trauma.)

Let us consider for a moment the life of a typical person with (mild) hypoglycemia (me, for example). In their youth these persons can eat and drink enormous quantities without getting fat; often they suffer from hayfever and asthma (to which diabetics are usually immune); they can easily do without breakfast or eat just an apple; a small cup of coffee makes them go haywire; at times (e.g. if a meal is late) they get ravenously hungry or bad-tempered; they like bread and beer. However, in some of these people, around middle age a change occurs: they start putting on weight, especially round the waist; they fall asleep on the sofa after a large meal, and their hayfever and asthma attacks become less frequent. In other words their constitution becomes more like that of a diabetic. Do any of you who are reading this recognise anything in this description, either in the first or the second half? If so, we may have a clue to what causes Dupuytren's and what diet or lifestyle to follow to prevent it from getting worse.

Andrew Goodson

Michael - What you say may be true - or it may not. East Asians may not be prone to Dupuytren's, but they are also (I read somewhere) not prone to diabetes either. Perhaps they are protected by their ancestry or diet from both diseases. In any case it doesn't prove or disprove very much.

It would indeed be interesting to know if the rate of Dupuytren's is increasing in western countries. Since the rate of diabetes is rising (in America) and a certain proportion of diabetics also get Dupuytren's, one would not be surprised if it is rising.

As for 'low body mass' etc and 'significantly less fat tissue', I don't think that the studies implied that the Dupuytren's sufferers in their surveys were scrawny, merely that they were thinner on average than the control group. I myself (and other people I know with Dupuytren's) am on the thin side, compared, say, with my brother, but I certainly wouldn't describe any of us as scrawny or suspect that we suffered from nutritional problems in the womb or in infancy. So that argument can be rejected.

Anyway, thinness aside, I have outlined a theory to explain why diabetics (and non-diabetics with high fasting blood glucose) are prone to get Dupuytren's, and Kevin has produced one to explain why there may be a link between hypoglycemia and Dupuytren's (such a link is not normally posited in the FAQ sites on Dupuytren's, but it is perfectly feasible). Have you got a different theory as to why diabetics are prone to get Dupuytren's? Perhaps YOU are unconsciously selecting facts to fit your arguments because you don't want to give up coffee!

Andrew,

I don’t claim to have a theory explaining the link between diabetes and Dup’s, and if I were to come up with one, people would very justifiably wonder why they should believe a guy with zero medical training. Sometimes the most difficult, but most aaccurate conclusion to draw is: I don’t know.

But I do know that both diabetes and smoking have many malign biochemical effects apart from excesses or deficits in blood sugar. It could very well be that one of these effects is a contributing or causal factor for Dup’s. Human biochemistry, as I’m sure you’re aware, is incredibly complex, maybe the most complex thing in the universe.

It would be amazing to me if Dup’s could be controlled by diet, and yet no one has noticed it by now. But as you say, for many of us in middle or old age (certainly for me) it would be a good thing to lose some weight in any case. So go ahead - diet, exercise, get skinny again, and let us know how it goes. But I bet that it won’t change the progress of your Dup’s one bit.

As for your point about my coffee drinking – well, I have to admit, you’ve hit close to home there. But I’ve tried very hard to compensate for my bias. - MML

Michael,

Ah yes, true! A fool can easily ask a question which a wise man cannot answer! Kevin is also right that there are often no doubt several factors together that cause Dupuytren's. However, you don't have to be an automechanic to know what kind of fuel to put in your car, nor an electronics expert to know how to switch on a computer. So maybe there is hope for the non-expert to make a contribution to this discussion, using the facts which the experts have provided.

Here the question is quite simple. Leaving aside differences between races, why is it that, given two people of similar upbringing, occupation and genetic background (e.g. me and my brother), it will usually be the thinner of the two who gets Dupuytren's? The answer would seem to be that the fat cells of the fatter person are in some way protective against Dupuytren's. Now put together these two pieces of information: (a) Dupuytren's is more common in people with high blood sugar (either those who have diabetes or who, if not diabetic, have higher than normal fasting blood sugar) (b) the chief function of fat cells is to remove excess blood sugar from the blood. Does it not seem probable that in some cases at least Dupuytren's has something to do with excess sugar in the blood? (For a mechanism whereby this might happen see the article by Dr Rosedale which I quoted in the first posting in this thread.)

It is also a fact that, given the same genetic background, men are more likely to get Dupuytren's than women. (In Iceland, according to the Reykjavik study, Dupuytren's is 4.4 times commoner in men than women.) In his website Kevin suggested that this is because men tend to have rougher occupations and use their hands more roughly than women. This may be partly true, since trauma is one of possible causes of Dupuytren's. However, I suggested a simpler explanation, namely that women have more fat cells than men. And fat cells, as we have seen, are in some way protective against Dupuytren's.

But, Michael, what makes you think it unlikely that Dupuytren's can be treated by dietary means? After all, we know that in some people at least, Dupuytren's is a consequence of diabetes; and that type 2 diabetes (the commonest type) is a consequence of poor diet. Therefore, if in some cases Dupuytren's can be caused by poor diet, does it not seem probable that in some cases at least, Dupuytren's can be halted or prevented by good diet?

Again you might object, "But I am not diabetic! If anything, I am slightly hypoglycemic." (I don't know if you are hypoglycemic, but given your addiction to coffee - a factor which often leads to hypoglycemia - it would not surprise me. Do you fit the profile of a hypoglycemic which I outlined in my posting of a couple of days ago?) If so, I quote from Dr Seale Harris, the doctor who first described the condition of hypoglycemia back in 1924 and proposed the "Seale Harris diet" (a kind of early forerunner of the Atkins/South Beach/Mercola/paleo diets) to treat it, who said: "The low blood sugar of today is the diabetes of tomorrow". In other words, though for many years your youthful and healthy body can deal with the excessive sugar load which it is subjected to, there comes a time (usually about middle age) when it can no longer cope.

For the benefit of those who have not read anything about this subject, let us say that, in addition to the healthy person with normal levels of blood sugar there are three other conditions:

(a) diabetic: After a meal the blood sugar rises to dangerously high levels and stays there for a long time. In a true diabetic there is so much blood sugar that some of it spills out into the urine.

(b) hypoglycemic: After a meal the blood sugar does not rise particularly high, but after a few hours it drops below normal, leading to fatigue, hunger, irritability, and other symptoms.

(c) dysinsulinemic: After a meal the blood sugar rises very high, like a diabetic, but after a while the insulin mechanism kicks in and it sinks to below normal, like a hypoglycemic.

Perhaps Dupuytren's is connected not only with condition (a) but also with a mild version of condition (c) - the tendency to become comatose and fall asleep on the sofa after a heavy meal. Does this apply to you? It would be interesting to know if any of you other Dupuytren's sufferers out there experience similar symptoms.

Andrew Goodson
agdg@supanet.com

I found everyone's posted messages interesting and somehting to think about. I, however, am a woman who is not thin and no none person in my family has Dup's. I am a type diabetic who runs 120 blood sugar or below. Although I have been a type 1 for 26 years and haven't always had the best of blood sugars.
If anyone has suggestions and possible help for Dup's, could you please email me.
Thank you,

Sheri G~