A few days ago the National Heart, Lung, and Blood Institute (NHLBI), the organization coordinating the ACCORD study (Action to Control Cardiovascular Risk in Diabetes), pulled the plug on the glucose lowering part of it. Why? Because in a stunning mid-trial finding, subjects in the arm of the study who were edging their glucose levels closer to normal were dying in significantly greater numbers than those whose glucose levels remained elevated.

What the heck is going on? Conventional wisdom has it that the lower (toward the normal range) the blood sugar the better. It has been the goal of diabetic management to reduce blood sugar levels as close as possible to the normal range; now comes this disastrous study presenting dramatic evidence to the contrary. Amazingly, those subjects who died in the lowered-blood-sugar group succumbed to some form of cardiovascular disease, the very condition the more aggressive blood-sugar lowering was crafted to prevent. Do these tragic deaths invalidate the sugar hypothesis of heart disease?

I don’t think so, but before we get into why, let’s summarize this experiment.

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I just read an article in the Family Practice News that shows once again that the low-carb diet is the Rodney Dangerfield of diets: it gets no respect. Especially not from the press.

The Family Practice News (FPN) is one of the so-called throw-away journals that are sent to physicians free of charge. The FPN is also one of the few of the zillions of these things that I get that I actually don’t throw away until after I’ve read it. Reporters working for the FPN seem to haunt the types of medical meetings I would attend if I could afford the time to attend every one I wanted to. Their reporting is pretty sharp and concise and for the most part honestly portrays the research it reports.

The December 1 issue contains an article on a poster presentation at the NAASO meeting a couple of months ago that I found interesting on a number of levels and wanted to pass along.

To set the stage, let’s go over a couple of things. First, NAASO stands for the North American Association for the Study of Obesity, which now goes by the name The Obesity Society. NAASO is the academic obesity research society. It’s members are primarily scientists working in academia on obesity research. But not all are academic researchers. They let me in. I have been a member since the mid 1980s and have attended numerous meetings.

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Superior doctors prevent the disease.
Mediocre doctors treat the disease before evident.
Inferior doctors treat the full-blown disease.
— Huang Dee Nai-Chang—
(2600 BC 1st Chinese Medical Text)

Truer words were never spoken. While contemplating these words, let’s take a look at what is important to our ‘superior’ mainstream doctors of today in the field of diabetes treatment. Below is a copy of an email I received today from Medscape, the folks who are kind of the WebMD to MDs. (I posted on another email from Medscape a few days back – the one with the annoying video of the two doctors telling how patients should take charge of their own health.)

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I’ve had enough questions about the glycemic index and the glycemic load that I’ve decided to take the time and explain what it all means.  If you know what the glycemic index and glycemic load are, then you might want to skip this post unless you’re just here for the scintillating writing.

If I were to bring you into my office while you were fasting and check your blood sugar, then check it again every 15 – 30 minutes over the next two hours, I would find that your blood sugar levels wouldn’t change much.  Your blood sugar would remain at about, say, 85 mg/dL over the entire two hours.  Now, suppose I bring you in fasting, measure your blood sugar, then give you a piece of cake.  You eat the cake and I measure your blood sugar over the next two hours.  Your blood sugar would rapidly rise, then fall slowly, and return (assuming you’re not diabetic or glucose intolerant) to around your normal 85 mg/dL.

Scientists have known for years that normal blood sugars follow this kind of rapid increase, slow return to normal curve.  At some point someone asked the question: do different foods cause a different curve?  In other words, if someone eats a piece of cake does that make a different blood sugar curve than if that person eats a bowl of ice cream?

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MD and I had a great time at the ASBP (American Society of Bariatric Physicians) meeting.  We ran into a lot of old friends and met some new ones.  And the Robert C. Atkins Memorial Lecture went off without a hitch.  Thanks to all of you who wished me well.

I was amazed at the change in the types of material presented at this meeting compared to that MD and I saw the last time we attended in the late 1980s.  During our early years at the ASBP everyone was pretty much deep into the low-fat movement.  All the lectures were from practitioners telling the attendees how to implement low-fat diets or, worse yet, how to implement low-fat diets and give diet pills.  Since MD and I were using low-carb very successfully in our practice at the time, we didn’t see any real need to drop the $300 or $400 each on membership fees and the money to attend meetings only to be presented with information and ideology in which we didn’t subscribe.  How things have changed.

I found myself in front of the attendees debating the merits of the minor differences between different low-carb plans.  Ron Rosedale, M.D., our former partner, agreed on virtually everything  except the amount of protein necessary–I argued for more; he argued for less.  He was, of course, wrong, but we didn’t let that interfere with our good time.

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