The causes of Dupuytren's disease are not known (for the most complete information see Dr Eaton's excellent webpage "Dupuytren's Disease: Frequently Asked Questions and Links to Published Studies: FAQs and Facts"), though various risk factors are known: for example, diabetes, heavy smoking, trauma to the hand, etc.

An article (by Gudmundsson et al.) based on a study of 287 Icelandic people with Dupuytren's disease reported: "In men elevated fasting blood glucose (P < 0.04), low body weight and body mass index were significantly correlated with the presence of the disease (P < 0.001). Dupuytren's disease was common among heavy smokers (P = 0.02) and those having manual labor as occupation (P = 0.018)." According to Dr Eaton, diabetics are five to ten times more likely to develop Dupuytren's disease than other members of the population.

Although there are some risk factors (e.g. ancestry) which we can do nothing about, it is still worth examining the others, since there is a hope that if the underlying cause can be removed, it might be possible to slow down or halt the progression of Dupuytren's, or even reverse it. (Not many people have reported a reversal of Dupuytren's, but at least two posters on this Forum have claimed that their nodules cleared up after they stopped taking glucosamine/chondroitin supplements. The similar nodules that form in Peyronie's disease have also been known to clear up of their own accord.)

Following a lead from Kevin's interesting website "www.dupuytrens-a-new-theory.com", I would like to examine the connection between blood sugar and Dupuytren's - the "elevated fasting blood glucose" mentioned in the Icelandic study. Under this heading we should include not only diabetes, but also the pre-diabetic condition known as "insulin resistance syndrome", which appears to be connected.

What could be the connection between blood sugar and Dupuytren's? One answer is to be found in an article by Dr Ron Rosedale entitled "Insulin and its Metabolic Effects", in which he describes the process of "glycation". In this process, glucose molecules attach themselves to protein molecules and damage them. Often (according to Dr Rosedale) the damaged protein is gobbled up by white blood cells. He continues: "That is the best alternative; the worst alternative is when those proteins get glycated that can't turn over very rapidly, like collagen, or like a protein that makes up nerve tissue. These proteins cannot be gotten rid of, so the protein accumulates." Dr Rosedale's article does not mention Dupuytren's, but the relevance is obvious. The whole article, by the way, is very well worth reading.

What happens when a healthy person eats is that some of the blood sugar produced is used up as fuel for the brain and muscles and other cells, and the rest (under action of insulin) is converted by the liver into starch. But what if the liver is damaged in some way or has become insensitive to insulin? Obviously the excess glucose continues to circulate through the blood stream, causing damage. If this line of reasoning is correct, then a Dupuytren's sufferer should aim to keep the excess blood sugar to a minimum - that is, to have a steady, necessary amount to keep the body and brain functioning well, but to avoid huge surges such as might be caused by eating a large sugary meal. As far as I can see this could be done in three ways:

(a) Eat less. This was the system advocated by the Italian nobleman Luigi Cornaro (1467-1565) in a book written in his 90s (it was republished a few years ago under the title "How to live 100 Years"). Having indulged himself up to the age of 40, he became ill, and realised he could only be healthy by eating less. He ate a great variety of foods, but in very small quantities. It is well known from modern studies on different species of animals that calorie restricted diets cause them to live longer.

(b) Avoid foods that cause a rush of blood sugar, too much for the body to deal with at one time, that is to say foods like starches (bread, potatoes, pastry), sugar and sweet things, caffeine, and alcohol.

(c) Avoid foods and activities that cause a surge in insulin production (since excessive insulin floating round the body is known to cause insulin resistance syndrome as well as other problems). The foods which cause excessive insulin production are exactly the ones mentioned in the paragraph above. Other things which provoke insulin production are smoking, lack of exercise, and not sleeping enough.

The way forward for Dupuytren's sufferers is therefore clear. It is to eat a healthy modified Atkins/South Beach/Mercola 'no-grain' style diet, sleep regular hours, and exercise daily. One might say the motto should be: "If you want to avoid surgery, choose foods which aren't sugary".

Speaking for myself, I have been following this regime for a month. It is too early to say if it is going to have an effect on my Dupuytren's disease (though the nodule certainly feels less active and bothersome). On the other hand, I feel a lot fitter and have lost nearly a stone in weight.

I hope these ideas will be helpful to readers with Dupuytren's. If you think so, and think that others might benefit, do please feel free to add a comment at the top, to keep this posting from sinking too far down the list.

Andrew Goodson

Andrew,

Your posting is very well thoughtout in regard to controlling insulin resistance. I would only like to add that your advice is useful only for those persons who have an insulin/glucose dysfunction due to lifestyle (ie eating habits, sleeping habits, smoking, etc.)

As I have theorized in my web site (www.dupuytrens-a-new-theory.com), there are many different paths that can lead to a dysfunction in the insulin/glucose metabolism. The first that comes to mind right now would be a deficiency in vitamin D. But there are many other ways to develop to a dysfunction, other than vitamin D deficiency.

With this in mind, I believe that many people actually do develop Dupuytren's disease because of insulin resistance. But the question is, why are they insulin resistant? I think that many are insulin resistant due to some kind of root cause other than lifestyle. And for those persons, the only totally effective solution would be to treat the root cause rather than the just lifestyle issues. But even if the actual root cause is not addressed, I do think it can be beneficial to make lifestyle changes in order to lower one's insulin resistance.

Dear Michael,

I think the point about caffeine is that although caffeine drinks (e.g. black coffee without sugar) may not contain sugar themselves (although some do), they nonetheless raise blood sugar levels by indirectly stimulating the liver to release its stored sugar. This rise in blood sugar then in turn causes the pancreas to produce insulin. Dr Paavo Airola writes in his book "Hypoglycemia: a better approach":

"Studies demonstrate that coffee raises the blood sugar level in diabetes, but drastically lowers the blood sugar level in victims of hypoglycemia. This is not as contradictory as it may seem. Sugar does the same: it raises the sugar level in diabetes and lowers it in hypoglycemia because of the hypoglycemic's over-reacting pancreas. Dr. E.M. Abrahamson tells of patients whose hypoglycemia was controlled by proper diet, but who had violent blood sugar reactions when they took as little as one cup of coffee. Coffee has a stimulating effect on the adrenal glands which, in turn, encourages the liver to release more sugar into the blood."

This also goes for cola (see the earlier thread on colas).

Smoking also raises the blood sugar. Dr Airola again:

"It has been shown in actual human studies that smoking causes a rapid blood sugar rise with just as rapid a drop in blod sugar level shortly after the cigarette or cigar is put out. A Swedish study, reported in the prestigious British medical journal, Lancet, showed that in some study subjects, the rise of blood sugar was as high as 36 percent. Nicotine in tobacco was isolated as the culprit, since a comparable test with denicotinized cigarettes did not produce the same effect as regular cigarettes. The Swedish researcher concluded: "The rapid fall of the blood sugar level after the smoking throws further light on the habit of chain smoking - the craving for another pick-me-up..."."

It may be for this reason that heavy smokers are more prone to Dupuytren's than non-smokers (according to the Icelandic study).

Kevin (see posting below) is no doubt right that in some people an insulin/glucose dysfunction (if this is indeed the cause of Duypuytren's) may not be due to diet and lifestyle. However, in others it surely is. In my case Dupuytren's developed after a period of exercising too little and eating and drinking too much, so it wouldn't surprise me if correcting those unhealthy habits might halt the Dupuytren's. Let's try it and see.

One puzzling thing about Kevin's excellent website is that in several places he connects Dupuytren's disease with hypoglycemia, that is *low* blood sugar; whereas it is known that very often Dupuytren's is associated with diabetes or else (as in the Icelandic study) with *high* fasting blood sugar. At any rate, in either case there is an insulin connection. In type 2 diabetes (the commonest type) the pancreas often produces an excess of insulin, but ineffectively because the cells are insulin-resistant; in hypoglycemia the pancreas produces an excess of insulin, often because it is overstimulated by the excessive use of caffeine or sweet foods. Either way the treatment should be to adopt a lifestyle and diet that reduce the amount of insulin produced.

One useful informational website on diabetes type 2 says:

"Although the pancreatic beta cells of patients with NIDDM [non-insulin-dependent diabetes mellitus] usually continue to produce insulin, for some reason the body does not respond to the insulin effectively. Beta cells are the cells of the pancreas that regulate glucose levels in the body by producing insulin. The first step towards type 2 diabetes is insulin resistance, a condition in which the key target tissues for insulin (muscle and fat) do not respond normally to that hormone. Both genetic traits and acquired factors (such as aging, diet and obesity) play a role in the development of insulin resistance. Beta cells compensate for insulin resistance with increased insulin secretion resulting in hyperinsulinemia. In this compensated, insulin-resistant state known as impaired glucose tolerance (IGT), blood glucose remains normal throughout most of the day, but may become high after meals. IGT (insulin resistance) is very common in Western society, afflicting an estimated 20 million individuals in the United States alone. Over time, beta cells are unable to continue to secrete the high levels of insulin needed to maintain normal glucose levels in the face of chronic ingestion of simple sugars and refined carbohydrates. When this occurs, the patient develops elevated blood glucose throughout the day, indicative of type 2 diabetes."

There is also a condition called "dysinsulinism" in which the blood sugar rises very high (to diabetic levels) after a meal, but a few hours later falls very low (to hypoglycemic levels). It would be interesting to know whether any Dupuytren's sufferers who are reading this recognise these symptoms to a mild or severe degree.

Incidentally, the 'modified Atkins/no-grain'-style diet recommended by some doctors for the treatment of insulin resistance is not recommended by all of them. For example, Hart and Grossman in their book "The Insulin-Resistance Diet: How to turn off your body's fat-making machine" recommend a low-fat diet which contains a greater amount of carbohydrate. (There is an abstract of their ideas on the Internet.) An article by Gregory S. Kelly entitled "Insulin Resistance: Lifestyle and nutritional interventions" (also on the web) summarises studies comparing the two types of diet. A low-fat, even vegetarian, diet is also usually recommended for diabetics. The low-carbohydrate, high-protein diet has for many years been recommended for hypoglycemia, except by Dr Airola, who though he admitted it works in the short term, thought it unhealthy in the long term. (Unfortunately Dr Airola died in 1983, aged 64, from a stroke.)

Andrew Goodson
agdg@supanet.com

Andrew,

I have not heard about thin people being more likely to get DC than fat people. Where did you get this information? My case and family history would support this. I'm the relatively thin one with agressive DC.

Interesting points on diet.

Andrew,

Thank you for the response. Its very interesting and may be clue as to why I have this and other family do not. I'm trim and exercise regularly, whereas family members are in good health, but rounder.

Not sure what to do, but the earlier postings on diet make sense and I'll reconsider my dietary habits.

Thanks again.