The further a society drifts from the truth, the more it will hate those who speak it. ... In a time of deceit, telling the truth is a revolutionary act. George Orwell

Thursday, September 15, 2016

Lack of benefits from blood glucose-lowering diabetes treatment, doctors confused

This is the key conclusion from the recently published study.

Glycemic Control for Patients With Type 2 Diabetes Mellitus
Our Evolving Faith in the Face of Evidence


...We searched in top general medicine and specialty journals for articles referring to glycemic control appearing between 2006 and 2015 and identified the latest practice guidelines.
We identified 16 guidelines and 328 statements. The body of evidence produced estimates warranting moderate confidence. This evidence reported no significant impact of tight glycemic control on the risk of dialysis/transplantation/renal death, blindness, or neuropathy. In the past decade, however, most published statements (77%–100%) and guidelines (95%) unequivocally endorsed benefit. There is also no significant effect on all-cause mortality, cardiovascular mortality, or stroke; however, there is a consistent 15% relative-risk reduction of nonfatal myocardial infarction. Between 2006 and 2008, most statements (47%–83%) endorsed the benefit; after 2008 (ACCORD), only a minority (21%–36%) did.

Conclusions — Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications.

And journalistic commentary, from the CBC:

New study questions Type 2 diabetes treatment
No evidence glucose-lowering drugs help ward off long-term complications, researchers say

It's a curious case of missing evidence. When a diabetes specialist searched the medical literature looking for proof to support the use of glucose-lowering drugs for Type 2 diabetes, he couldn't find it.

His conclusions challenge the conventional wisdom of many medical specialists, and contradict most clinical practice guidelines.

"Over 90 per cent of experts were saying that controlling blood sugars tightly was associated with a reduction in your risk of going blind or of needing dialysis or having to undergo an amputation," Montori said. "But when we looked at the evidence for that, we could not see any signal that would suggest that is true despite the question being asked at least since the 1970s."
The finding reveals a divergence in professional opinion based on the same set of facts, and it exposes a dilemma in the science of Type 2 diabetes — that doctors don't completely understand the relationship between blood sugar and the disease.

My comments:

1) The lack of benefits from glucose lowering therapies may be explained by the primary cause of the damage being the total carbohydrate overload (Glycemic Load) rather than the blood glucose level.

2) The results are consistent with the research published by R.W.Stout (Lancet, 1969) demonstrating arteriosclerotic plaque production stimulated by glucose and insulin. Reduction of carbohydrate consumption therefore reduces both glycemic load and insulin secretion, reducing the overall risk, especially cardiovascular. Some glucose level controlling drugs only push glucose from one location (blood) into another (tissues) without generally affecting insulin secretion and therefore unchanging the risk, while some other drugs that do increase insulin would also increase the risk.

3) Confusion among medical professionals stems from their attachment to the Western food and lifestyle, unable to consider a possibility that the high carbohydrate nutrition may by itself be the main trigger (if not the cause) of diabetes. In my personal opinion, best remedy would be to allow more free play and competition in the medical field, enabling doctors trained in other countries that may not be subject to the above described mind blocks, to practice legally world-wide, as it is already being widely accepted in other professions such as engineering, scientific research and art.

Stan (Heretic)


JC said...

I buy the meds don't help but disagree with your comments about carbs being the problem.Before the Asians started with processed carbs they did not get diabetes on a diet of 99% carbs.

My own fasting blood glucose went from 136 to the upper 70s-mid 80s after I changed to a diet of vegetables,fruit, and starches like brown rice and potatoes. JC

JC said...

I do think the starch diet has a number or problems but I don't see blood sugar (or blood pressure) as one of them.The benefits of a vegan diet are greatly exaggerated.


Stan Bleszynski said...

Hi JC,

Re: Before the Asians started with processed carbs they did not get diabetes on a diet of 99% carbs

Not 99% carbs, plant based diets have about 10% protein or more since beans and green vegetables do contain some protein, albeit of poor quality.

Yes they did get diabetes. India about 4% diabetes in rural areas, 13% in the cities. The first figure would have been probably more representative to the pre-industrial society. Europe 19-th century about 2%.

Regarding blood glucose control, in your case, my guess is that your previous high carbohydrate diet contained too much vegetable oils per carbs, as is typical in the Western countries. People with metabolic syndrome don't seem to tolerate a diet with a mixture of fats and carbohydrates. Specifically, the worst seems to be 40-45% of calories out of fat and equal amount out of carbs.

When you went low fat vegetarian you moved away from that zone but I personally do not believe that such diet is healthy. I think it can be called "less harmful", at best.

With the metabolic syndrome, when you reduce fat contents and keep it high carb (but not overcaloric!) your body is dealing with carbohydrates better, that is the same amount (relatively high) of insulin results in lower blood glucose. However the damage caused by excessive insulin, if you do have high insulin, may be still going on in spite of lower glucose. That was the true reason, IMHO, behind the results published in that paper!

Better solution is to reduce the carbohydrates and up the fat (saturated and mono-unsaturated only!) because fat is just modulating the effect of the carbohydrates upon the insulin and overall metabolism. Carbohydrates (glycemic load) is the driving factor while fat is a secondary modulator.

Note that this only matters to people with metabolic syndrome, it might not matter for everyone.


Stan Bleszynski said...

Re: I do think the starch diet has a number or problems but I don't see blood sugar (or blood pressure) as one of them.The benefits of a vegan diet are greatly exaggerated.

A theory that diabetics develop diabetes only because of sugar alone, is dubious. Burkitt's studies from British Africa (1940-ties) showed that diabetes shows up in 100% cases of consuming about a lb of cane sugar only after 18 years on average - that is huge amount!

I think one should add starch to sugar and use "Glycemic Load" concept rather than separately, because human digestive system converts all that into simple sugars anyway.

Vegetarian diet is easier not because it has more of the supposedly less harmful starch but because it has lower glycemic load, in most cases. It is harder to overeat carbs on a vegetarian diet. You can calculate your total caloric intake and you will see (and use correction for the digestion rates of vegetables which is less than 100%).

Not all diabetics I knew were eating sweets, not any more than I did. But they all did a lot more starches than I did! I will pass on potatoes, thank you very much.


Stan Bleszynski said...

I have another comment. I find it strange that the medical scientists gloss over the data like in the paper I quoted, without stating an obvious: if lowering glucose does not make much of a difference then may be it is not blood glucose but something else that causes most of the damage? What could that be? I can identify a natural candidate:
- excessive consumption of carbohydrates and a related factor - the total daily secretion of insulin! This is why I suggested that you look at the Glycemic Load concept (GL).

It's the carbohydrates ...


JC said...

My fasting insulin level is 4.3 as of 7/13/16 the highest its been in years but still way below avg....its usually in the 1-2 range.IGF-1 was 87,and fasting glucose was 85 up from 78 last year.LDL 82,triglycerides 76,HDL 46,total c 143,homocystine 11.3,A1C 4.9...............PSA 14.71

Except for the PSA I don't have bad blood work. JC

Stan Bleszynski said...

Looks good. What is your thyroid status and bone density?

JC said...

Thyroid appears OK from blood work but I take 150mcg of iodine each day since I do not eat any salt.I don't know about bone density...never had it tested.

Stan Bleszynski said...

Good idea! I found that iodine ("Lugol Solution" consisting of iodine dissolved in potassium iodide and water) has amazing anti-inflammatory properties against skin and joint inflammation, tendonitis, fungal and bacterial infections. I cured my fascitis in my right foot after one bath in a 1oz 2.5% bottle dissolved in a bowl. It took only one bath for 10 minutes and its gone for good! Prior to that I was trying to get rid of it, for over a year, using various traditional techniques like foot massage massage over hard bumpy surface, ice-cold compresses etc. Nothing really worked until iodine!

I wonder if it could also be used in other chronic inflammatory conditions. Have you heard of such use of iodine?

I also noticed, curiously that the local drugstores keep only two small bottles of iodine at all time on any one shelf. If I need more for a full body bath you need to go to a shop sever times. Incidentally I found that taking it orally is not the best idea, it is much safer to absorb it through the skin, if you need to supplement with iodine.

"If you don't know where and why give the patient K and I"


(This was supposed to be doctors' saying in the old days)

JC said...

Thanks for the tip.I'll try it topically.