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.
If you want specific details on the trial itself, you can check out the ACCORD website where you can find the study purpose, protocol, etc.
In short the study personnel selected diabetic patients who had pretty well established type II diabetes. All were on some kind of medication, many were on insulin injections as well. All had HbA1c levels in the range of 7.5% to 11% (the upper limit of normal is 5.9%) and all had either a history of cardiovascular disease (CVD) or a number of risk factors for CVD. Researchers wanted to find out if aggressive therapy to reduce HbA1c levels to under 6% in these subjects would reduce CVD events more than less aggressive therapy designed to reduce HbA1c to an average of 7.5% (still pretty high). The conventional wisdom was that the lower the blood sugar the better, so when it was discovered that the subjects in the lower-blood-sugar group were dropping like flies as compared to their peers with higher sugar levels, the study was halted, and the head scratching began.
Here is a sampling of what many well-known physicians had to say about the results:
Said Dr. William Friedewald, chair of the ACCORD steering committee:
The simple and honest answer is that we have done extensive analyses and not identified a cause for the increased mortality. We will now do even more extensive analyses with all of our investigators, who are now unblinded to the results, and prepare a paper with the data and our best impressions of the possible causes.
Dr. John Buse, a member of the ACCORD steering committee, suggested (as paraphrased by Heartwire):
…three basic possibilities that would explain the higher mortality rate in the intensively treated group: it could have been a spurious observation, and it might have disappeared with further follow-up; it could have been due to adverse effects of a particular drug or drug combination that has not yet been teased out; or it could be that the observation is true, that lowering blood-sugar levels too much in older diabetics with heart disease is a bad thing.
He also said
The patients enrolled in this study were quite vulnerable in that they were relatively old (average age 62) and had heart disease or at least two or more other risk factors for heart disease. Maybe we just flogged them too hard to get their sugar levels down. The intensive group had extremely rigorous treatment, with some patients taking four shots of insulin and three pills and checking their blood-sugar levels four times a day. Perhaps this was just too many drugs at too high a dosage, and the effort required just stressed them out too much. I think our conclusion is therefore that we should not be zealots about lowering blood sugar at all costs. We must understand that there are risks and benefits and one size probably does not fit all patients.
As reported by Heartwire, our old friend Dr. Steve Nissen commented:
“This result really does defy conventional wisdom.” Noting that benefit has been seen in lowering blood sugar in terms of diabetic complications but the effect on major cardiovascular events and mortality is not known, he added: “I suppose it wouldn’t have been a major surprise if there was no effect, but to show harm is really a big surprise. This effect could have been due to some of the drugs being used to lower glucose levels, which may have other effects that cause harm. We know that rosiglitazone increases MI risk, so others may do this too.” He said not enough data on rosiglitazone use in ACCORD had been released to establish whether it could have played a role in the adverse outcome. “We don’t even know what percentage of people in each group were on rosiglitazone. So we can’t answer that question yet. All in all, this trial has raised a lot more questions than it has answered.”
These comments pretty much summarize the thinking of all the diabetes experts I’ve heard opine on this study. Let me give you my views. Before I do, though, you’ve got to understand that just as is true of those commenting above, my views are speculative. And just like the others, I haven’t been able to dig into the actual data to see what makes sense. My views are derived from looking through the lens of my own years of experience, my reading and analysis of a lot of medical literature, my knowledge of how most doctors go about treating their diabetic patients (which I think borders on malpractice) and my experience with big-name, mainstream physicians and their thought processes.
First, I think the lowered blood sugar levels are a red herring.
To see why, let’s look at how the typical doc treats his/her type II diabetic patients.
The patient gets a diagnosis of type II diabetes, is scared to death, and needs help. Most docs put these newly diagnosed patients on a low-fat, low-calorie diet. And they give them some kind of drug to help lower blood sugar. They make an appointment for a recheck in a month or six weeks.
The patient comes back and gets a retest of his/her HbA1c. If the HbA1c is lower, the doc says, You’re looking good. Keep it up. If – as is more common – the HbA1c is the same (it’s already elevated or the patient wouldn’t be a diabetic), the doc increases the medication dose.
The patient leaves, takes the higher dose of meds, which usually drops the blood sugar. A falling blood sugar is a strong stimulus to eat. The patient (if trying to be compliant) eats from the low-fat, high-carb list of foods given by the doc. The patient’s blood sugar comes back up, the patient feels better, and this cycle repeats.
On the next visit, the patient’s HbA1c is the same or higher than before. The doc views this as failure of the medication to lower the patient’s blood sugar. The doc raises the dose and/or adds another medication. The patient takes the increased dose/added drug and repeats the above cycle. Lowered blood sugar, feeling lousy, eating more carbs to compensate.
The next visit finds the HbA1c the same or higher, and the doc increases or adds medications, sometimes even insulin injections. And on and on and on.
Patients on this regimen typically gain weight, feel like crap, and don’t control their sugars all that well. And that’s the standard treatment for type II diabetes in this country today. These patients are actually ‘treating’ their over medication with carbohydrates. I’m confident that many commenters who have undergone this regimen will back me up.
Happily, there is a better way.
Newly diagnosed type II diabetic comes in. Doc says, Let’s give this diet a try before we fool with medications. Doc gives patient instructions on how to follow a low-carb diet.
Patient comes back in a month or six weeks, finds HbA1c is lower than before. Doc says, Good job, let’s keep on the diet and see what happens. Patient comes back in a couple of months, weighs less, sleeping better, and HgbA1c is almost normal. Doc says, Good job, let’s keep working with the diet.
Ultimately, the patient’s HbA1c is normal on diet alone. Doc tells the patient, Your type II diabetes is gone, but the propensity for it is still there, so it’s important to remain on your diet, although you can lighten up a little on the carbs now and then. But if you go back to your old way of eating, your diabetes will return.
(Unfortunately, sometimes in certain patients with type II diabetes, a low-carb diet isn’t enough. Small doses of medications are required to normalize blood sugar. But it’s typically one medication only and in fairly low doses.)
Sadly, only one patient gets treated this second, more effective, less harmful way for every thousand patients (if not more) who get treated the first way.
In my opinion, here’s what happened in the ACCORD study.
The doctors running the study tried to aggressively lower blood sugar levels by increasing dosage levels or by adding more drugs to the patients’ regimens. The goal was to treat the HbA1c, not to treat the patient. The docs taking care of the patients in the aggressive treatment group pulled out all the stops to get HbA1c into the normal range using drugs and insulin, which was the study protocol.
All the strategies used to aggressively lower HbA1c – whether increased insulin dosing or using medications designed to wring the last drop of insulin from the pancreatic beta cells – ends up increasing insulin levels in these patients. And insulin itself is a major risk factor for heart disease.
I think that in their focus on reducing blood sugar in an effort to decrease risk for CVD, these researchers ran insulin levels up and increased another more potent risk factor for CVD. In other words, researchers traded one risk factor (high blood sugar) for an even more potent one (elevated insulin). The result was that more people died in the aggressively treated group.
Had the aggressive treatment been with a rigorous low-carb diet instead of a rigorous drug/insulin therapy, I believe the results would have been the opposite. But that is simply speculation on my part. But it’s speculation seasoned with a dose of good sense. And I think it solves the conundrum of what happened to these unfortunate victims.
Dr. Eades, the content link ads that your webmaster recently added to your posts on your site are very tacky and not worth the damage they will do to your reputation going forward. Those familiar with your blog and your books trust you, but for new arrivals it makes it look as if this is one of those sites where the copy has been twisted to jam in lots of pay-per-click opportunities.
I agree. I promised my guy I would give them a few days just to see what happens. But I hate them, too. They will be gone soon.
Thanks for the feedback.
Hi Dr. Mike. I suppose I should stop being surprised by results like this, but I have a hard time shaking the feeling that the approach to the ACCORD study was amazingly short-sighted. Given what is known about the atherogenic effects of insulin, the outcome should hardly be a surprise. It also amazes me that anyone thinks that Type II diabetes (fundamentally a disease of excess insulin) should be treated by adding MORE insulin to the system. Another example of treating a number (blood glucose, HbA1c, etc.) instead of the cause.
And even after getting stomped on by the “elephant in the living room”, people are busy waving their hands blaming everything but the obvious cause. Incredible.
Pitiful, but true.
I agree we can’t really speculate fruitfully without all the data, but I envision another possible scenario.
All the patients were told to keep fat below 30%. But the intensive-treatment patients might have had more consultations with idiotic dietitians who gave them more tips on how to get the fat down and the carbs up, so even without the medication, they would have had higher insulin levels.
We also have to remember that, as with the Vytorin study (scandal), the differences between the two groups were small. And in the ACCORD study, both groups had cardiac mortality rates significantly lower than those in the general population. What astonishes people in both cases is that the differences were the opposite from those expected.
Agreed. But they did have medications. It was part of the protocol. And having cared for as many diabetics as I have who have come from other physicians, I can tell you that most doctors will try to control blood sugar by increasing meds, not by decreasing carbs.
Treating a symptom rather than the problem will often lead to a worse problem I believe. It seems likely that the patients would be better off if they treated the insulin insensitivity problem rather than the high blood sugar symptom, which would have also given the lower blood sugar result they were after.
It seems amazing that they are so puzzeled by the result. As you say, it was actually rather predictable from a different point of view. Taubes book reviews this problem a quite often.
My father-in-law (a chemistry PHD) was put on high blood sugar meds and hated how they made him feel. Instead he cut out the six slices of toast he ate during the day, which got him off the meds and he lost some weight. He also got a blood sugar reading device so he could understand the relationship between what he ate and his blood sugar.
I’m sure those drugs drove them to drink! Sugar Drinks!
Just wanted you to also know that thanks to your comment to me many months ago about 30 units of insulin being enough for anyone, my life is really changed. That comment led me down many paths that taught me many things.
This moment I sit here with my new insulin pump which has me taking about 13 units a day instead of the 52 I was on before and watching my new Continuous Glucose monitor do it’s thing, getting ready to sit down to a nice low carb meal of less than 15 carbs.
Life is good
Thank you from the bottom of my grateful heart with it’s clear arteries. Oh and Mad Scientist aka dh says thank you also because I guess I am not so crabby lately… He also says that I should say thanks for the new clothes cause the ones from last year don’t fit.
Thanks for the feedback. I love to hear stories like yours. Keep up the good work.
“We don’t even know what percentage of people in each group were on rosiglitazone”.
Is he saying he doesn’t know which patients where on rosiglitazone – if so, that’s just amazing. They should know everything about the study participants.
Studies like this one are done in many locations. It takes a while to gather all the data.
They did succeed in getting the patients’ blood glucose down, judged by the HbA1c. So the therapy did what they intended, proximally speaking.
I like the elevated insulin explanation best, since the mechanism is so simple and established. But I also like the possibility that the drugs were toxic at high doses and/or in combination. I’ll be really interested to see the data and their analysis of it.
I can’t say I’m shocked by this result. The body has glucose homeostasis mechanisms for a reason, and driving glucose up or down doesn’t address the reason why the homeostatic set-point is off target.
Same with blood cholesterol. Your body makes most of the cholesterol in your blood, and the process is tightly regulated. So high blood cholesterol is not due to excess cholesterol consumption, but to a high set-point (not that I believe total blood cholesterol means much). What changes the set-point? That’s the big question.
The sad part is that it took people dying to make the researchers question things,
Just add this to the list of recent failures in treating surrogate markers to target numbers. What’s really sad is that millions of patients are being over treated daily well before the results of clinical endpoint trials come in demonstrating no benefit or worse, negative benefit. Yet the researchers scratch their heads and blame everything but their precious failed paradigm and keep following the same road. It’s maddeningly frustrating. Let’s see – in the past year we’ve seen the failure of the lo-fat diet in the Women’s Health Study, the failure of vytorin, the failure of torcetrapib, the failure of Avandia, what did I miss? I don’t see any evidence that any of these negative findings that should result in the slaying a beautiful hypothesis doing anything of the sort.
The only logical explanation for this has to be that there is too much ego, vested interest and money involved to admit that they are wrong. I can’t imagine that all these researchers and experts are truly as stupid as they seem on the surface, they have to see what’s going on.
It all makes perfect sense to someone who accepts the carbohydrate hypothesis as explained by Taubes in his book, but to someone whose thinking is still mired in the current concept of dietary fat causing heart disease, it will be a puzzle. Expect all sorts of contortionary, laborious explanations from these so called experts who cannot and will not embrace the principle of Occam’s Razor.
Dr. Mike, I agree with what you say and kind of cut loose into ranting about it lately — won’t bother to link, nothing you don’t know in it. It just makes me sad. Of course the press doesn’t hesitate to trumpet this evidence that normalizing blood sugar kills. (Naturally, I looked at it and came away with the suspicion that drowning people in diabetes meds kills. But I already suspected that, so I’m biased.)
Really I’m commenting to say thank you (and thanks to Jenny of the Blood Sugar 101 site, and Dr. Bernstein) for helping me be the 1 in 1000 or more. A year and a half under 6% and I haven’t touched a diabetes med ever. And hopefully never will.
I think that you should give a plug here to Dr. Bernstein and his book the Diabetes Solution. He clearly explains in his book that lowering blood sugar aggressively is most important to avoid many of the long term consequences of diabetes. He is also clear that you must keep your insulin levels down. He only gives small doses. He seeks to establish natural physiological levels of insulin in the patient at all times. He of course is rigorously strict in having a low carb diet and in exercise. He personally is a weight lifter which is the best kind of exercise for all people and especially diabetics. He has proved his regime in many patients over many years and is himself a type I diabetic of I believe 60 years duration with none of the long term consequences of diabetes.
Dr. Bernstein is a good friend of mine, and everything you say is true. I recommend his book often on this blog. And I recommended it to all my diabetic patients.
Dr. Eades, I’ve got a love/hate relationship with your blog. The well-written and interesting posts are truthful accounts of relevant topics. But so often I come away with hatred for so many people; it usually ruins my day.
Sorry about that. I don’t hate any of the people I write about. I don’t think they’re malevolent. Based on their training, knowledge base, and perspective on things, they are acting appropriately in most cases. I simply think their training, knowledge base and perceptions are faulty.
I even bought George Blackburn a drink once, and sat and chatted with him for an hour or so. We discussed nothing scientific, and he was a perfectly nice guy.
I read the report on the study with interest and found myself perplexed by the results. Then, about 4/5 of the way through, the writer reveals that the low blood sugar was achieved by aggressive interventions and I said, ‘of course’. I have no medical training, though have been keeping up to date with low-carbing science and practicing it since reading PP about 10 years ago. Just that level of involvement in all this allowed me to see the probable problem in this study. And the specialists scratch their heads!
Keep up the good work Doc(s).
Thanks Dr. Mike. I suspected this is what you would say and it makes perfect sense.
I just saw this new story this morning about “good carbs” (indigestible starches) and would like to know your take on it.
What she says does make some sense, to a point, but without any specific studies to look at its hard to know if the “hundreds of studies proving it” are any good. And I now that you recommend eating some of these foods in small quantities once on maintenance level.
When you have the time to comment it would be appreciated.
Thanks for sending the link. See today’s post (Feb 12, 2008)
That was exactly my thought when I read this news in the NYT: Occam’s Razor.
Can you tell me if there is any information out there that addresses intermittent fasting (combined with low-carb diet) for mild Type II diabetics? I have had amazing success with weight lifting, low-carb eating, and especially intermittent fasting in addressing about 50-60 lbs of excess body fat (I’m about half way there). People around me are taking notice and are interested, but some are also mildly type II (I’m not), so there is some concern over how/if they should fast intermittently and I don’t expect they’re going to get sound advice on that score from anyone in the “eat six times a day, high carb, low fat” world.
I haven’t seen anything specific to the effect of intermittent fasting (with or without a low-carb diet) for typr II diabetics. Maybe some readers who have been more diligent in combing the IF literature than I can help you out.
Mike, as usual, thanks for your views on this. More than speculation, I think your argument is a well-founded hypothesis, which testing is long overdue. After all, a while back you (and others… me included) also speculated on why cholesterol is lowered also by adopting a carbohydrate-control. You kindly offered a post on that not too long ago.
The problem I see with all these protocols is that very few people are willing to put their reputations on the line by testing ‘a diet’, which by current standards may even be qualified as ‘unethical’. That alone makes no sense since there is evidence of normoglycemia and normoinsulinemia after a period of carbohydrate control (Mary Vernon’s work on diabetics comes to mind).
As speculative as it may sound, your hypothesis fits the data and not the other way around, which is what I normally see in studies like the ACCORD, ATPIII… etc, based on a fundamentally flawed observation.
Hi, Mike —
Several vegatarian-oriented websites tout this study, which claims that beef, cheese, and fish cause a greater insulin secretion than pasta:
If the results are correct, what would be the explanation? Doesn’t pasta produce more blood sugar than beef? Or is insulin secretion affected by something other than blood sugar alone?
I don’t eat pasta because I seem to have a bit of an arthritic response to the gluten, but I found this study interesting nonetheless.
I’ve got an entire post lolling around in my head over this subject. Let me say this: don’t give up your beef, cheese and fish just yet.
Hi, Dr E,
A couple of posts back, I made a comment about a paper calling into question current dietary guidelines, but neither you nor I could find the actual paper.
Here it is:
Here is the (attempt at a) refutation by Woolf and Nestle:
and the authors’ response to the refutation:
So, I thought it best to post this in the current thread, rather than comment on the older post.
All the Best,
P.S.: now to cure my addiction to the Deutsche Grammophon web site! It’s got to be the best music site on the web, including the Naxos website which is awesome.
Great paper and interesting discussion. Thanks for sending it.
During the appointment at which newly diagnosed type II diabetics are told by their MD that laboratory tests show they have diabetes the doctor typically reaches for his or her prescription pad and says in a voice brimming with confidence, “Now, let’s get you started on some medication”. Most patients interpret this to mean that their MD knows exactly what he or she is doing and will prescribe medications that will correct their diabetic condition. The MD makes little, if any mention of any need to make changes in the patient’s lifestyle and especially to their diet. If any dietary information is provided to the patient it is typically the official ADA or CDA high carbohydrate, low fat diet.
This starts the process to which you have alluded wherein the patient’s BG either fails to improve or even worsens resulting in an escalation of the doses of medication. Sadly, most patients accept this outcome as the normal progression of diabetes in spite of the best treatment available. Few ever question the obvious ineffectiveness of such an approach. I have yet to encounter a single type II diabetic who I have spoken to about the low carbohydrate approach who has been willing to try it. To the contrary, many have told me that they simply could not exist without their daily dose of carbs even as they succumb to diabetic complications.
Sad, sad, sad.
I have just had an AH! moment while reading various articles about the most overlooked historical mysteries, including the Tarim Mummies of China and all the government suppression of information that has occurred in China regarding them. (For those of you who don’t know about them, the Tarim Mummies are caucasian mummies found in China dating at least as far back as 4000 years. You’ve probably seen pictures of them in the news sometime, white mummies with blonde or red hair wearing colorful wool clothing, a female mummy with a very tall “witches hat”, etc…)
Getting back to my Ah!, I just realized the fatal flaw in the formation of the U.S Constitution. Our Founding Fathers neglected to include separation of Science and Medicine and The State! Just think, if the government stayed out of the realms of science and medicine how much healthier we all might be. No lobbying by drug companies, no spending on studies that are pointless, no food pyramid…
Maybe while we’re at it, for archeology’s sake we should add separation of Church and Science too. So many ancient artifacts and so much ancient information have been lost because of religions.
I’m with you whole heartedly in both ideas.
Reading the ACCORD web site, it appears to me as though the “Lipid Trial” portion of the study is comparing the use of fibrate plus statin to the use of statin (alone), with no “untreated” control group. That seems… odd. Or maybe I am misunderstanding?
I haven’t read this part of the study critically, but in my once over that seems to be the case. It’s a trial comparing more aggressive therapy to less aggressive therapy. But both arms get therapy.
There has just been another study reported in the BMJ “Sugary drinks, fruit and increased risk of gout: dietary fructose could be a contributing factor.”
Martin Underwood BMJ 2008;336:285-6
Consuming two or more glasses of fruit juice each day increased the risk of gout by 81% and eating an apple or an orange a day increased the risk by 64%…..free fructose has an adverse effect on urate metabolism. This in turn might have a causal effect on the development of the metabolic syndrome. …..on the other hand increased fruit and vegetable intake is generally thought to reduce the risk of cardiovascular disease.
Another little nail in the high carb/low fat coffin?
A little one, maybe, But a whole lot of little ones can ultimately do the job.
Hey Dr. E.,
No need to post this comment as it adds nothing to the discussion. I have a question regarding your RSS feed. It looks like you’ve gone to using the “More” link, which forces subscribers to come to the site to read the entire post. I generally try to stay in my reader as much as possible unless I have a comment to make. Is there any chance you can go back to running the entire post in your RSS feed?
I’m working on it. Thanks for the feedback.
The protocol for the ACCORD study included giving the patients both fibrates and statins.
The combination of fibrates and statins has been shown to cause rhabdomyolisis. This fact isn’t unknown or unusual – in fact, it is listed in the PDR as a warning. Yet physicians persist in frequently putting their patients on this combo. Rhabdomyolisis is the breakdown of muscle protein, a situation that can over task the kidneys and, not uncommonly, bring about kidney failure. Either Statins or fibrates alone, in my opinion, are pretty much worthless, but together, can be disastrous.
Great post that helped me work through some of the confusion I was having with these results. Dave Dixon has a similar post about these results that goes more deeply into the effects of insulin at Spark Of Reason: http://sparkofreason.blogspot.com/2008/02/insulin-insanity.html
Like other commenters here, I get very frustrated with all the stupidity, special interests, and blind dogma that the medical community seems so infected with of late. Although with information that you provide it really is kind of fun to irritate my GP when he tries to instruct me in a “healthy” diet. 😉
As always, I appreciate the work you do.
Any way I can talk you into switching your blog feed from partial back to full posts? I usually read your articles from Google Reader and just as I’m getting into your post I run into the “(more)” link and I have to come to to the website to finish the story.
I’ve been subscribed to your feed for a while now and have really been enjoying it. It was quite surprising when the feed changed recently to partial.
Thanks for listening.
My web guy did all kinds of things late one night. I woke up the next morning, and I had banner ads and all kinds of stuff. I haven’t been able to get in touch with him since to figure out exactly what he did and why. I’ll pass along your complaint.
My internist has prescribed four medications for me as preventative measures and I could not tolerate any one of them. At one point I was on Actos, and a few days after having started it, I found myself in front of a client discussing a large sale involving many products. All of a sudden, I had to excuse myself very quickly and practically run to the restroom to avoid an embarrasing situation.
Nobody in business can afford to interrupt a client in the middle of ironing out details, and no human being should be put through such pain as I was. Every med prescribed has had the same result. I have discontinued every one of them. Without low carb and paying attention to every starch and sugar that gets put into my system, I have no way to prevent the onset of full blown diabetes. I fear that my doctor prescribes these meds as much to cover her liability as to try to help me. It’s too bad she has no incentive to try low carb as a measure.
It doesn’t surprise me that these meds would contribute to worsening CVD considering how much pain they caused me. I can’t believe that anything with such terrible side effects can be good in the long run.
I might add this is a good place to link to Adam Campbell’s very informative article:
A CURE FOR DIABETES in menshealth.com
I almost missed that there was 5 pages, so be sure to click NEXT at the bottom to view all the other sections of that article, including:
-Eliminate Foods that Raise Blood Sugar
-In Favor of Vegetables
-Our Data-Driven World
-Stay Off the Starch
Thank you, Dr(s) Eades
Another great article. Thank you.
Just wanted to mention that when I click on the section of your website that says “About” Dr Eades, I always get a 404-Page not found message. Could this be corrected on your end?
It says that because the theme of the blogging software has that section, and I haven’t gone to the trouble to fill it in. I’ll do it sooner or later.
Hi Dr. Mike,
Thanks for all of the great information. I check in everyday and enjoy reading your posts.
I was wondering if you have ever written a post on arthritis medications such as Humira (Adalimumab) or Enbrel (Etanercept).
Another thought: If you try to lower the average blood sugar down to the “normal” range when the body’s natural regulating mechanisms have been put out of action, how low do the inevitable low levels go? Do those sudden deaths come at times when the blood sugar levels are just too low? what if an infarction hits at an unnaturally low bg – will it be deadlier than otherwise?
Usually the lower levels are into the normal range – they typically don’t fall drastically. I don’t think these lowered blood sugars have anything to do with sudden death from heart attacks. Sudden death is usually caused by the infarct hitting an area of the heart that is important in the conduction of the electrical impulse that stimulates the heart to beat in a rhythmic and coordinated fashion. When this impulse is short circuited, the heart fails to beat properly (ventricular fibrillation), leading to loss of blood to the brain and everywhere else and often death
I saw that same article about this study in the paper, and when I got to the “we used lots of drugs” part, I knew that was probably the problem.
My fiance introduced me to Protein Power last June, and since then, I’ve lost weight, I’m sleeping better, my nails are stronger, my skin is better … low-carb is such good medicine! And I would not be diagnosed as diabetic, either, even though I have a family history of it. I’ve given away 4 sets of PP and Lifeplan to people I love who need to read them … and none of them have. (sigh) I’ll just have to go on being a good example, along with my fiance. Thanks for disseminating all the good info, Dr. Eades.
And thank you for buying all the books.
Dr. Mike, Something hit me after reading this. The doctors don’t believe their patients will make a life style adjustment or stay on the adjustment. So why not give them a pill that a sales rep has told them will work? Generally, I bet they are right, lifestyle change is difficult to do and maintain, especially in the US (Sugar is everywhere!). I don’t want to switch the blame here, I think I want to add more, there is enough to go around. The Gov., food industry, lawyers, doctors, advertising… How can the common man survive?!
By using his brain.
I posted a comment earlier, but it has not shown up. It says “awaiting moderation,” but other comments have appeared since then. I’d like to be a commenter and contribute, but I’d like to have some confidence I won’t be wasting my time.
I wrote a post a couple of weeks or so ago stating that I wasn’t going to be able to answer comments individually as I had been doing. The time commitment is too much now that I’ve got a book contract to deal with. What I’ve started doing is posting comments that are comments as they come in. Questions go to the back of the line until I have the time to deal with them. I could simply post all comments, whether comments or questions, as they come in without a response to either. Which would you prefer?
I’ll ditto what Dave Dixon says. After reading Taubes’ book, I say that the answer to the “surprising” results of the ACCORD study lies in Chapter 10 about the role of insulin. Insulin in and of itself can be a harmful substance. What I don’t understand is why so few people seem to be aware of this…especially in the media. I just read an article in the Economist discussing the ACCORD study (usually they are a fairly serious bunch) and not one mention was made regarding insulin as the culprit. Wonder what the explanation of these results will be in 6-8 weeks after they get a chance to write up their hypotheses.
I wonder myself.
I do respect the fact that you are a real doctor and have to deal with the stresses of giving patients answers and quickly.
I’m sorry for the trolling. Some things are too serious to troll about. I don’t know enough to comment about the existence of a Metabolic Advantage.
Also I wish they would make progress as to the REAL cause of CHD. I certainly don’t want to get it. I wish the corruption of the national health organizations agendas would stop preventing the doctors who have something to offer to get their message out and the real results of these trials out.
The real cause of CHD could be something Anthony is missing, Orthodoxy is missing , and the Taubes camp is missing.
My trolling before was all in good fun. I’m sorry.
No problem. Apology accepted.
Of course: ACCORD wan’t testing just the effects on CHD deaths of normal or near normal bloodsugar it was equally testing the effects on CHD deaths of the ACCORD program for lowering bloodsugar.
What is stunning is that I hadn’t seen the hyper-insulin hypothesis before I arrived here while hunting for explanations for what went wrong in ACCORD.
But my impression is that none of the posters here had panicked about ACCORD, that no one had decided they’d better raise their A1c to ADA levels AND that no one here has reached normal through ACCORD-like measures.
What I wonder is, on the one hand, WILL anyone “out there” be frightened away from normalizing by ACCORD, especailly those following a non-ACCORD path and, on the other hand, do many people reach normal using ACCORD-like measures who weren’t in ACCORD? In other words, is ACCORD likely to have a real effect on real people’s goals and methods?
Ironically, I didn’t know this site before my search for ACCORD explanations brought me here, because I have been low carb only since late October, so the ACCORD debacle has at least that as a silver lining — but we can hope that it shakes up the paradigm (in the right direction).
I don’t think there is a big worry about the vast unwashed masses of people being put off by the ACCORD results. Most will never hear of them. I’m more worried about physicians being put off of helping their patients work to achieve closely controlled blood sugars.
Please do not blame the dietitian for high carb diets. Most people forget that a diet order is a legal prescription and dietitians have to follow the doctors order. Not all dietitians believe in the high carb diet approach to diabetes. It is however hard to buck the system when insurances and Medicare will only pay for the “evidence based diabetic protocol”.
I understand. Point taken.
Wow, I give firm Kudos to the censors who deleted the statistics from this article:
First: THREE out of ONE THOUSAND people died. This number was ONE-THIRD LESS then what ACCORD expected. Real epidemic on our hands.
Second: For those THREE people who died we do NOT know what their blood sugar numbers were because this is a BLIND study.
Lastly: For those people who claim that Insulin is harmful, it may be for people WITHOUT diabetes, but for those people with diabetes…READ MY LIPS: THEY CANNOT MAKE ENOUGH INSULIN TO LIVE. They have TWO Choices: A. Die without Insulin or B: Live a normal life WITHOUT any problems due to insulin because they are not taking excess of it.
And your point is?