More supporting evidence for the sugar hypothesis
The sugar hypothesis of heart disease triumphs yet again over the lipid hypothesis. A study presented recently in Rome and published in the New England Journal of Medicine demonstrates that efforts to lower blood sugar pay off better in lower rates of heart disease and longer life than do efforts to lower cholesterol. In fact, to be ruthlessly honest about it, efforts to lower blood sugar do seem pay off whereas efforts to lower cholesterol don’t much at all.
Researchers presented data from a long-term study (almost 30 years long) showing that subjects who lowered their blood sugar levels with drugs for a period of 10 years reaped large rewards in terms of reduced incidence of heart attack and reduced incidence of all-cause mortality long after the end of the study.
Here is how the study was done:
From 1977 through 1991 patients were enrolled in a study to determine the benefits (or lack thereof) of intensive glucose lowering with medications (insulin or sulfonylurea) compared to conventional glucose control achieved through diet (more about which later). Researchers randomized the subjects into the drug-treated, intensive-glucose-control arm or the diet arm of the study and waited and watched for ten years. At the end of the ten years, the subjects on the intensive-glucose-control arm demonstrated a reduced risk of microvascular complications, a nonsignificant reduction in incidence of heart attack and no improvement in all-cause mortality. (There was a subset of obese patients in this study who were treated with metformin who showed significant reductions in incidence of heart attack and all-cause mortality by the end of ten years.)
Other than the improvement shown in the obese diabetic patients on metformin and the decrease in microvascular complications, there was no real advantage to the strict glucose control within the ten year study period. After the study was completed, the subjects were no longer followed regularly for their disease and were returned to the care (or lack thereof) of their own physicians.
Researchers then performed a 10-year post study monitoring just to see what had happen, and were surprised to learn that those patients who had undergone the strict glucose control experienced fewer heart attacks, fewer diabetic symptoms, and lower all-cause mortality. The reductions in risk were, in my opinion, extraordinary. There was a 15 percent reduction in heart attacks and a 13 percent reduction in the most important statistic of all: all-cause mortality.
Said one of the directors of the study in a comment that beggars belief and is worthy of the Reckless Award for a stupid statin statement as reported on HeartWire:
UKPDS [United Kingdom Prospective Diabetes Study] has definitively shown today that early glucose-lowering in the longer term really does impact on cardiovascular disease in people with type 2 diabetes. We’re talking about a 13% reduction in all-cause mortality and a 15% reduction in MI. Now, that may not be as big as what we see with a statin or something, but given the millions of people with diabetes, this is a very substantial change, and it is over and above the other treatments that patients are getting.
“Now, that may not be as big as what we see with a statin…” Are you kidding me? This guy must be another one who has drunk way too much of the statin-laced cool aid. If the companies that make statins could get even half… half, hell, if they could get even a third or a fourth of these results, there would be dancing in the streets in statin land.
I’m putting the following in bold so that it will stand out.
As I’ve written countless times in this blog, randomized, placebo-controlled studies (the only kind that matter) have shown that statins provide no decrease in all-cause mortality (the only statistic that really counts) in women of any age whether they’ve ever had a heart attack or not. These same studies have shown that statins provide no decrease in all cause-mortality in men over the age of 65 regardless of whether or not they have ever had a heart attack. The only group of people for whom statins have shown any benefit in terms of a decrease in all-cause mortality is men under the age of 65 who have already had a heart attack. And even in these men, the decrease in all-cause mortality is minuscule. So minuscule in fact, that some authorities don’t even think the expense of statins is worth the tiny risk reduction.
A 13 percent reduction in all-cause mortality is pretty huge, and seems to be a ‘legacy effect’ of the strict blood sugar control these subjects experienced during the ten years they were on the study. To be completely accurate, it could be said that the drugs these subjects took are what is bringing about their decreased risk of death, but given the side effects of these drugs, I kind of think that is doubtful.
Chronically elevated blood sugar, even when elevated just a little, is toxic to the blood vessels. Knowing this, it makes sense that if blood sugar is kept tightly regulated for ten years, less damage should accrue to the vascular systems over this period. And, since heart disease is the major killer of people worldwide, and since heart disease is a manifestation of vascular damage, it also makes sense that if you minimize vascular damage for ten years, you will have less risk of heart disease and earlier death. At least that’s the way I see it.
From the hindsight of today, it’s really easy to see why those with tightly controlled blood sugars would have fared better than those on the conventional diet, when you realize what the conventional diet was at the time of this study. From the original paper in The Lancet (1998) 352(9131) 837-853:
The patients were advised to follow diets that were low saturated fat, moderately high fibre and had about 50% of calories from carbohydrates…
That pretty much tells us all we need to know. Ten years of a high-carb diet verses ten years of tightly-controlled blood sugar. Which do you think caused the most vascular damage?
Almost three years ago I wrote another post on the subject of the sugar hypothesis, but that was at a time that this blog had about 12 readers. Those of you who weren’t readers way back then might want to give this one a look now. It shows that variations even within the normal range of blood sugars are correlated in a dose-response fashion with mortality.
The take home lesson of these studies is that blood sugar is much more closely correlated to health and longevity than are cholesterol levels. Yet everyone is focused on cholesterol. Why? Because the drug companies want us to be focused on cholesterol. The pharmaceutical industry has brainwashed the public and, even worse, has brainwashed most of the doctors out there (as evidence, see the quotation above by the director of the UKPDS, who is an academician and should know better).
The nice thing is that it’s pretty easy to tightly control your blood sugar levels without drugs. How? By taking blood sugar control out of the hands of your pancreas and turning it over to the liver. You can do this by keeping your carbohydrate intake low enough to ensure that your liver has to produce glucose. When the liver gets into the glucose production business, it turns it out in a slow, steady fashion, making just the amount necessary. Blood sugars stay low, and glucose-induced damage to the vascular system is minimized. If you follow a good-quality, whole-food, low-carbohydrate diet, your blood sugar will stabilize. If you’ve already got type II diabetes, following such a diet might not completely solve your problem, but it will make it a lot better. I have never seen any kind of therapy that works better than a low-carb diet to lower and stabilize blood sugar levels. It truly is amazing. If you do have type II diabetes, you must work with your physician to regulate your medications because you will need to reduce your dosages or eliminate the medications very quickly or your blood sugar will fall too low too fast. As one of my colleagues says when telling other physicians about this therapy: nothing in your medical experience heretofore will have prepared you for how quickly this will work. And, unlike some other therapies it works everytime
I’m wondering what other people think. I’ve been doing some research on healthy eating and low carb diets in particular and came up with this one site called OpposingViews.com where there are debates by experts on various subjects. There is one debate called: “Are Low Carb Diets Healthy?”.
I like the idea that these people are experts in their fields, but this one guy says something that gives me pause. He says something to the effect that eating whole plant foods is associated with having good health but diets high in animal protein and fats are not. He also says that in a global sense, a sustained low carbohydrate diet which comes mainly from animal foods creates significant challenges for the planet and also other health issues for people such as antibiotic resistance.”
What do you think he means when he says that a diet which comes primarily from animal proteins is bad for the planet? That’s the first time I ever heard that. If you have time, take a look and let me know what you think by posting your comment. Thanks! http://www.opposingviews.com/questions/are-low-carb-diets-healthy
I think the idea that the eating meat “creates significant challenges for the planet” is absolutely absurd. As is the idea that eating meat causes antibiotic resistance. This idiocy has almost become a religion for some. I will have to post at length on this in due course.
The antibiotic concern is due to the belief that cattle are given antibiotics and as a result we ingest them making us more resistent to them in general.
The concern for the planet is related to the enormous amount of cattle raised and how their waste breaks down into chemicals that end in rivers and water tables that upset the eco balance in a negative way. I believe this was explained in a book called “diet for a small planet”, a book from the early 80′s i believe, promoting vegetarianism.
Btw, I was a vegetarian for around 10 years and now trying to fight the obesity it caused by low carbing.
I think the antibiotic concerns and the planet-related concerns are total hogwash. But that’s just me. Others may think differently. I’ll try to do a post on my perspective on all this in due course.
Hi DrEades,
Can you comment on the soon-to-be-released diabetic medicine Liraglutide(GLP 1- glucagon like peptide 1) that promises to regenerate(to some degree) beta cells?
Also, what are your parameters for blood sugar and HbA1C?
Thank you for your great blog.
I don’t know enough about the new medicine to comment intelligently. I do know that a lot of good work has been done on GLP-1, but I don’t know exactly what this drug does. I’ll give it a look. Thanks for pushing me.
I like to keep blood sugar levels in the 75-85 level and HgbA1C as low as possible, somewhere below 5 if possible.
I’m glad to see your support for relying primarily on breastmilk for the first year of a baby’s life in a comment above. My son wasn’t big on solids until more like 15 months (ate a wide variety of tastes, textures, but small quantities). My daughter is approaching 2 and still enthusiastically nursing along with eating solids (she has always been more interested in them than DS, but prefers meats, cheese, sour cream, etc. to sweet tastes or carbs, funny enough). Neither child started on any solids until 6 months and we skipped rice cereal altogether.
I did want to add that while I am thrilled to see you actively encouraging moms to rely on breastmilk for the first year of life, many *non* primitive moms nurse their babies into toddlerhood (2-3 years or later), LOL. The AAP recommends a minimum of one year of breastfeeding (with no “upper limit” established), and the WHO recommends a minimum of 2 years of breastfeeding, including in industrialized nations.
Anyway, kudos for the overall support for BFing
Any chance you could do some posting on PCOS in the near future? I’m a woman without weight issues but with PCOS…I lowcarb and take metformin. Past tests for IR haven’t shown IR, but metformin helped me get pregnant with DD which was a pleasant surprise
It may not have come through in my response to the comments, but I am a proponent of breast feeding until at least age 1, but for however long beyond that mother and kid are happy with it. And you are right, many primitive cultures do breast feed until toddlerhood. I don’t see a problem with it – it’s probably the way our ancient ancestors did it, which means that’s the way we’re hard wired.
I’ll see if I can come up with a post on PCOS in the future.
Thanks for the suggestion.
MRE
Thanks for sharing this post! Very informative!
A sorry state of affairs it is. I wonder why Kirschenbaum thinks that those same 75 percent of genes didn’t cause kids to be obese 40 years ago when the percentage of fat in the diet was a lot higher than it is today?
$6350/month will help you think *anything*
Is this guy a financial genius or what? He has developed a reversible diet thus guaranteeing plenty of repeat business.
Give a man a cure and you have an income for a day. Give a man an incurable but treatable condition and you have an income for life.
I was in the eye dr.’s office today, and she had some sort of diabetes magazine published by Better Homes and Gardens. The cover photo was of some sort of apple cake, about 5 inches high. Inside it said (I swear) that to control your diabetes it is important that you eat a low-cholesterol, low calorie, low saturated fat diet. No mention of carbohydrates? How do they even have the gall to get away with that?? I have no concept of how the system could be THAT broken.
In other news I have been eagerly awaiting the posting of minutes from the 2010 Dietary Guidelines meeting from 29 Jan, and they have not yet been posted. http://www.cnpp.usda.gov/DGAsMeeting2.htm Hopefully they are having a tough time incorporating the low carb research that I sent them. Dare to dream eh?
Dare, indeed.
I am thinking seriously about the carnivore connection and was wondering …what caused the death of the hunters…how long did they live…how active were they?
Dr. Eades,
I am 61 yoa, had 6 gestational diabetic pregnancies, and upon looking back have never had an acceptable blood glucose level. My fasting insulin is less than 1 and my HA1C about 13, I have never taken insulin, my BG stays in the 200′s unless I eat simple carbs. Would the no carb/low complex carb regimen work for me. I want to heal my pancreas and would like to contact you by phone for a consultation. Thank you
For medico-legal reasons I can’t do phone consults. Given your history as presented in your comment, I think a no-carb/low-carb regimen would work fine for you. As low as your insulin is, you may not be making a lot. You should find a physician who understands low-carb diets and work with him/her to get you going.
Just saw a compelling lecture by Dr. Robert Lustig in which he said that glucose is actually not the problem, since it is the life energy giving force and all living organism uses glucose. What we need to watch out for is FRUCTOSE. According to him. fructose is metabolised in the body the exact same way as ethanol, except that the brain doesn’t recognise fructose and only the liver can handle fructose. In his exact words, fructose is poison. You can watch the video here and interview here.
You wrote, “To be completely accurate, it could be said that the drugs these subjects took are what is bringing about their decreased risk of death, but given the side effects of these drugs, I kind of think that is doubtful.”
While not really disagreeing in any way with the main points of this post, I think you might be too hasty in concluding conclusively that some significant part of this lower mortality could be a direct side effect of medications. There is significant evidence that metformin activates some of the biochemical pathways believed to be responsible for the benefits of caloric restriction, and therefore it could be partly responsible, apart from its effects on blood sugar.
Thanks for the blog!