Gina Kolata wrote a series of articles that appeared in today's New York Times. One of them, "Obesity only part of the puzzle" cites two findings that have been published on my web site for 3 years--that there's an 80% concordance among identical twins for Type 2 diabetes--strong evidence that it is genetic, and that only a very small fraction of the obese ever develop diabetes. Kolata says 10%. I written at least 5 letters to the Times over the years protesting their articles stating as a fact,"Obesity causes diabetes," so this was very good news.
Unfortunately, the good news ended there. Instead of featuring the "Diabetes NOT caused by obesity" news, the paper chose to give most of its attention to another article by Kolata that reads like an advertisement for statin drugs. The article states as if this were a proven fact that "But no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation."
The article then goes on to state that people with diabetes are guaranteed to develop heart disease unless they take statin drugs.
"Looking past blood sugar to survive with diabetes."
There's only one problem with this. It isn't true.
People with diabetes can and do get normal blood sugars. In my years online I've met many of them. They do it with all different approaches but in general the strategies that give them normal blood sugars do NOT rely on oral drugs. They use any or all of the following: carb restriction, exercise, and carefully dosed insulin calculated with carb/insulin ratios and a very good understanding of the difference between basal and bolus insulin.
And because there is a lot of evidence linking A1c to heart attack risk, these people with diabetes who have A1cs in the normal range have a normal risk of heart attack, just like anyone else with that A1c.
High blood sugars in the range most doctors tell patients is "good control" glycosylates the receptors on your LDL molecules--i.e. glues them all up with glucose--which makes it tough for the body to remove that LDL and leads to clogged arteries. If your blood isn't full of glucose, your LDL gets removed from the body the way it is supposed to be. That is why most people who low carb see dramatic drops in their LDL. And they ALSO see dramatic drops in their trigycerides, the other lipid fraction associated with heart attack which Statins do NOT lower.
The other thing high blood sugars do is create neuropathy in the vagus nerve that regulates heart beat and blood pressure, which probably also contributes to heart attack by leading to abnormal heart behavior.
So promoting the idea that people with diabetes should try to avoid heart attacks by taking statins is like saying people who smoke in bed drunk should be sure to have a fire extinguisher in the house. Yes, it's better than nothing, but why not get them to stop smoking instead! Statins, do NOT prevent heart attacks in people who haven't already had one, and even in that group lots of people who take statins go on to have heart attacks. In fact, one half of people who have heart attacks have normal LDL. People with diabetes who settle for A1cs or 7% or higher will only cut their risk of heart attack by some modest amount. Not eliminate it.
But lowering blood sugar to normal levels CAN prevent heart attack by getting the sticky glue-cose out of your arteries and restoring normal function to the vagus nerve!
I've cited the research backing up these statements here: "A1c Predicts Heart Attack"
And who knows, maybe one day Ms. Kolata will discover that research too, as she finally did the "obesity doesn't cause diabetes" research!
But if I ever pick up a mainstream media report that tells people they can regain normal health by cutting back on their carb intake rather than taking expensive drugs I'll probably have MY heart attack from the shock!
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
August 20, 2007
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7 comments:
I am even more troubled by the Wall Street Journal's Health Blog, which today suggested that statins should become another class of "diabetes drugs". I don't think that was an appropriate recommendation, in part, because the cardiovascular risk models do not even apply to all forms of diabetes. Plus, I am not convinced that statins are the benign cure-all they are promoted as. Pfizer may love the fact this attitude has made Lipitor the world's best selling drug, but so far, the clinical evidence that these drugs reduce cardiovascular disease are not causal. The jury is still out on them, and the side effects of statins are now becoming more prevalent.
About this comment - "And because there is a lot of evidence linking A1c to heart attack risk, these people with diabetes who have A1cs in the normal range have a normal risk of heart attack, just like anyone else with that A1c." - couldn't it be the case that diabetics with normal A1C have a different level of heart attack risk to non-diabetics with normal A1C?
To put it another way, it would seem surprising if heart attack risk could all be boiled down to one number, in people with quite different conditions of health.
Of course there are other causes of heart attack--so a normal person's risk isn't zero.
The biggest problem, to me, with statins is that they have been found to cause cognitive impairment, sometimes permanent, especially for older folks (and I am rapidly turning into one of those!)
I saw a statin cause a major deterioration in my dad's mental state and it isn't something I'll ever forget.
My endo told me she has seen that happen among her patients too.
The belief this article was promoting was that every person with diabetes should be on a statin. And it is a belief, not backed up by solid research from sources other than the makers of the drug who have been known to fudge results and spin studies.
In fact, this is far from proven. What IS proven is that high blood sugar correlates very closely with observed heart attack INCIDENCE in huge populations so instead of writing stuff that says, "You'll never control your blood sugar, just take this pill" wouldn't it be nice if they said, "No pill will control your blood sugar, but there are ways of doing it. Let's work on them!
Honestly, I got as far as
And even though blood sugar levels are the diagnostic hallmark of diabetes, the central fact of diabetes is that patients are not making enough insulin.
and realized there was nothing here of use. The struggle continues. :P
Well I agree with you that it's a bad article, it reads like a statin ad. It doesn't top the recent pronouncement of a senior UK government health spokesman that all men over 50 should take statins (no I'm not joking) but it's in the ballpark.
By the way, you misunderstood my comment. I wasn't saying that there are no other causes of heart attack, I was saying that it doesn't automatically follow that when diabetics achieve normal A1Cs, that they then have the same risk of heart attack as non-diabetics.
Paul,
It doesn't follow automatically, but once you eliminate blood sugar caused heart disease, you eliminate actual "diabetes" related issues.
Diabetes really is a symptom--high blood sugar--caused by a variety of physological problems, NOT two well-defined diseases, because there are so many completely different underlying disorders that cause high blood sugars.
Someone with an inflammatory disease that has inflamed the pancreas, causing failing beta cells doesn't have the same disease as someone with defective mitochondria, or someone (like me) with a defect that causes insulin not to be secreted in response to raising blood sugars (though that response can be restored with drugs.) And someone who is severely insulin resistant with sky high insulin levels causing tissue overgrowth has an entirely different disease than someone who has defective beta cells but a very high sensitivity to tiny amounts of insulin.
So prescribing ONE drug for all these different conditions just shows how little people really have looked into what diabetes really is!
The best evidence is that statins prevent heart disease by being anti-inflammatory, and NOT because they lower LDL.
For someone like me with normal CRP and no other markers for systemic inflammation, they'd be a complete waste.
"So prescribing ONE drug for all these different conditions just shows how little people really have looked into what diabetes really is!"
... or it shows that health initiatives are driven by marketing of profitable drugs, not by what makes people healthy. That's the most likely explanation for me for the original article. Thanks anyway for a great fact-based blog and web-page.
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