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