“People with type 2 diabetes are at elevated risk for a number of serious health problems, including cardiovascular disease, premature death, blindness, kidney failure, amputations, fractures, frailty, depression, and cognitive decline.” In other words, the higher people’s chronic blood sugars are, the more heart attacks and strokes they have, the shorter their lifespans, and the higher their risk of complications such as blindness and kidney failure.
A study was designed in which 10,000 diabetics were randomized into an intensive blood sugar-lowering intervention, where they put people on one, two, three, four, or five different classes of drugs, with or without insulin, to drive blood sugars into the normal range. Of course, this is not treating the underlying cause—that is, the actual disease—but by lowering one of the effects of the disease, these high blood sugars, by any means necessary, the hope was to prevent some of the devastating complications. How did they do?
The intensive blood sugar lowering with drugs increased mortality. After reviewing mortality trends, they concluded that the harm associated with the increased risk of death outweighed any potential benefits, and they stopped the study prematurely for safety reasons. They were successful in bringing down people’s blood sugar, but in trying to push people’s hemoglobin A1c under six, they ended up pushing people six feet under, perhaps due to the adverse effects of the very drugs used to treat the disease.
Even just injected insulin itself may promote cancer, obesity, and atherosclerosis; worsen diabetic retinopathy; and accelerate aging. Insulin therapy may promote inflammation in the lining of our arteries, which may help explain the results of that drug trial and other trials like it that showed the same thing: no reduction in so-called macrovascular complications, heart attacks, and strokes with intensive blood sugar lowering. However, intensive therapy was associated with a 21 percent reduction in the development of microvascular complications like kidney dysfunction.
Any such benefits should be weighed against the increased risk of dying, increased weight gain, and increased risk of severe hypoglycemia in intensively treated patients. So, trying to normalize people’s blood sugar with drugs may not be such a good idea. “It also should be noted that these trials relied virtually exclusively on [drugs] and did not include any serious effort at [diet and other] lifestyle change…”.
A study published in the New England Journal of Medicine found that an intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events such as heart attacks in overweight or obese adults with type 2 diabetes. It did not increase their risk of death, but it didn’t seem to decrease it either. In fact, the trial was stopped after about 10 years on the basis of futility—participants lost weight, but they weren’t dying any less. And, that’s what we see across the board with these types of lifestyle interventions. It’s good that the dietary intervention wasn’t killing anyone, but why wasn’t it actually helping people live longer?
Because they didn’t actually put them on a healthier diet. They just put them on a smaller diet—a calorie-restricted diet—meaning essentially the same lousy diet, but just in smaller portions. If we eat less and exercise more, we can lose weight, get more physically fit, get slimmer, and have better blood sugar control, but if our diets continue to be so un-heart-healthy that our “bad” LDL cholesterol doesn’t improve, we’re not going to be unclogging our arteries. Whereas individuals following healthier diets may experience improved reductions in blood sugar, body weight, and cardiovascular risk. Yes, by eating a smaller quantity of food, without changing quality, we can lose weight, but the point of a lifestyle intervention is not to just fit people into skinnier caskets.
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