August 29, 2007

If Bill Gates Got Diabetes . . .

We'd all be better off.

No, this isn't another "I hate Bill Gates" diatribe. It's just that until someone who has the kind of moola Mr. Gates has, combined with an engineering frame of mind, gets diabetes, we are never going to see the studies funded that we NEED to have funded to make official the findings those of us who have normal health with diabetes have learned anecdotally.

It all comes down to hard cash. Right now almost all the money researching diabetes is coming from drug companies, and the only thing the drug companies research is, surprise, surprise, how wonderful their drugs are.

The truth is there is no pharmaceutical drug besides insulin that reliably lowers A1c more than 1% in ALL people with diabetes. And the average American with Diabetes, according to NHANES III has an A1c near 10%.

But you would not know that if you reviewed the various publications exploring "evidence based medicine" like the latest AACE practice recommendations (just published this week) which make it sound as if the only treatment for diabetes is pharmaceutical drugs. And for Type 2 diabetes these "evidence based" recommendations recommend doctors ONLY use oral drugs and a high carb/low fat diet until people's A1cs are high enough to have taken out their kidneys, retinas, and nerves.

So clearly what we need is for someone to fund research that collects some serious "evidence" about something OTHER than oral drugs!

It's not going to be coming from government--which is who USED to fund this research until the Republicans added a clause to the Constitution that said that American business had the right to do whatever it could in defense of its profits, including cutting all taxes that sent funds to non-industry funded medical research.

So folks like Mr. Gates are our only hope. If Mr. Gates should end up diagnosed with Diabetes--like so many of use who diet, exercise and still end up with abnormally high blood sugars--and decides he would like to do something to help the millions of us who don't have his resources--here are a few projects he might like to fund:

1. A twenty year study examining the impact of maintaining truly normal blood sugars on the progress of diabetic complications in people with Type 2. Think of this as UKPDS on steroids.

Participants in one arm of this study--at least 10,000 of them--will maintain blood sugars of 5.5% or less, using carb restriction, exercise, metformin, and both basal and bolus insulin where needed. Whatever it takes! Participants will be advised to cut their carbohydrate intake down to the level which produces blood sugars after meals that do not go over 140 mg/dl--the level associated with the beginning incidence of microvascular complications.

The control group for this study will be the entire diabetic population of a randomly chosen county treated with the standard treatments.

Participants will test blood sugars fasting and 1.5 hours after every meal and upload readings from their blood sugar meters monthly. They will be given a CGMS and long-use sensor once a year and instructed how to use it, uploading the data and detailed information about the food they eat and the drugs they take to verify their blood sugar patterns.

2. A ten year study testing the safety and efficacy of very low carb dieting for people with Type 2 diabetes.

All participants at the beginning of the study will be freshly diagnosed and will have been screened so that there are NO people with any early diabetes complications in either group. Again, we want 10,000 or so participants in each arm.

The control group is people given the standard dietary advice given diabetics, which is still, sadly, a diet of at least 125 g of carbs a day but usually much higher and a fat intake of under 30% of total calories.

The test group will limit their carbohydrate intake to 100 grams a day or less. Triglycerides, HDL, LDL, blood pressure, microvascular complications, thickness of carotid arteries and other cardiac health tests etc will be monitored every three months to track development of early complications.

Various expensive prizes will be offered every three months to participants to keep motivating them to participate. It is amazing what people will do for the chance of winning an iPod! At the end of 20 years one lucky person who stuck with the study gets a Maserati or a world cruise--something along those lines. Bill can afford it.

This study is particularly important. Despite the fact that a whole series of short term dietary studies have established the superiority of low carb dieting for people with diabetes, every single review of their data concludes "caution is required as we still do not know the long term effects of this diet" and then goes on to suggest they are probably bad. This study would answer that.

Both these studies would cost a lot of money because they would require large populations to be followed for many years. But "a lot of money" when you are discussing medical studies is something like $30M over ten years, which is lunch money for Microsoft Bill.

For now, this is our only hope of seeing ANY research that doesn't "prove" that oral drug A makes a tiny but not clinically significant (as opposed to statistically significant) change in the diabetes patient's health as it makes its lemming-like way over the cliff!

Don't YOU hope Bill joins "the club no one wants to join?"

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.


Scott S said...

Its worth noting that although the massive Gates Foundation is seen as focused more on health outside the U.S., in 2004, Bill Gates personally contributed $400,000 to support California's Proposition 71, which was used to pay for some of the large-scale advertisements needed for most California propositions to be passed.

I have often said that having any public figure (especially politicians) or someone Bill Gates or Warren Buffet join the "club" might go a long way towards getting some of the much-needed type of attention this disease really need as far as research funding and public policy funding.

mollie said...

Oh Bill---I don't want you to have to join our club...but if you must join a club...I do hope it is ours-

Well put...I wish I had and extra 30M sitting around.

Anna said...

The study wouldn't last that long. Once it became abundently clear that the treatment group (lower carb diet, with metformin & insulin if necessary) is vastly superior to the conventional advice the control group is following, the study would have to be stopped so the control group could reap the benefits of the treatment group. It would be inhumane to do otherwise. :-)

Are you ready for Gary Taubes new book out in late September? Good Calories, Bad Calories: Challenging the Conventional Widsom on Diet, Weight Control, and Disease.

I can't wait. I've preordered it on Amazon but if I find it in the bookstore first, I might give a copy to my doctor or some other worthy individual. I'm pinning my hopes on this book finally pushing the low fat paradigm shift into oblivion (a Herculean task, I know). Interviews with Taubes are already starting to show up on blogs. The Knopf publisher has deep pockets for publicity, which I hope they put to good use. This book has tremendous potentional to reach beyond the usual "diet book readers" and open the minds of health professionals and the masses, much like Michael Pollan's The Omnivore's Dilemma.

Bix said...

Hi Jenny,

I'm fairly new to your blog, so please forgive me if you've discussed this. I wanted to ask you ... in your experience, can a vegetarian or vegan get their carbs low enough to stay below 140 mg/dl after meals?

And that NHANES III A1c statistic of near 10%! Wow.

Jenny said...

A person who eats cheese and eggs can do a low carb diet very successfully.

But it is very tough to get your carbs low enough to bring blood sugars into the safe zone using a vegan diet since almost all the protein sources are very high carb.

So if they cut way back on carbs vegans end up having to eat a lot of soy to get enough protein to do the diet safely.

Soy turns out to be thyrotoxic--a real problem for people who already have endocrinological problems. It also can cause mood disorders because of its hormonal mimic effect, and the phthylates in it cause yet more problems.

The soy-poison mood problem has been reported by a few people posting on the newsgroup over the years. I experienced it.

More on soy problems here: Dangers of Soy

Bix said...

Thank you, Jenny!
I've recently been working at getting my post meal sugars down and wondered how people who don't eat meat do it. I've never eaten much meat and, well, I've been eating more now.

Anonymous said...

Actually, a vegan diet is recommended for people with diabetes. Carbs aren't all the same and are definitely not the only factor to consider in controlling diabetes.

From CBS News regarding a study subscribers can check out on WebMD:

"(WebMD) Eating a low-fat vegan diet may be better at managing type 2 diabetes than traditional diets, according to a new study.

Researchers found 43 percent of people with type 2 diabetes who followed a low-fat vegan diet for 22 weeks reduced their need to take medications to manage their disease compared with 26 percent of those who followed the diet recommended by the American Diabetes Association (ADA).

In addition, participants who followed the vegan diet experienced greater reductions in cholesterol levels and weight loss than those on the other diet. "


The fat content of our diets plays an important role in glucose regulation. Advising someone on a vegetarian diet to stick to dairy and eggs to keep carbs low is a very bad idea.

Here's a bit more information as to why:

"Fat is a problem for people with diabetes. The more fat there is in the diet, the harder time insulin has in getting glucose into the cells.2 Conversely, minimizing fat intake and reducing body fat help insulin do its job much better.

Newer treatment programs drastically reduce meats, high-fat dairy products, and oils. At the same time, they increase grains, legumes, fruits, and vegetables. One study found that 21 of 23 patients on oral medications and 13 of 17 patients on insulin were able to get off of their medications after 26 days on a near-vegetarian diet and exercise program. During two- and three-year follow- ups, most people with diabetes treated with this regimen have retained their gains. The dietary changes are simple, but profound, and they work. Low-fat, vegetarian diets are ideal for people with diabetes."

Jenny said...

The vegan diet is better than the ADA diet only because the ADA diet is so extremely high in fast carbohydrates that it guarantees amputation, blindness, kidney failure and heart attack.

Compare your vegan diet to a healthy low carb diet and all the benefits disappear.

It is extremely hard to get normal blood sugars eating a vegan diet because it has many more than the 100 grams of carbs a day, total, that is the top of what most people with diabetes can handle.

Beyond that, the high soy content of most vegan diets is toxic to the thyroid gland which is a huge issue for people with diabetes.