I don’t usually rush to report on news when I first hear about it, and in fact, there is a great deal of news that I don’t even bother discussing in my blog. When I do discuss studies, I like to have time to think about them first.
But the news this morning that indicates that diabetics who “control” their A1c levels die faster than those who don’t has me fuming. And when even friends who don’t read my blog, don’t even know that my blog exists, start shooting me e-mails with the “news,” I feel like I have to say something quick.
Here’s the article from the New York Times. I haven’t yet read the study, but the article, which is probably largely cribbed from the press release, the way so much media science coverage is, gives me pause.
One thing that really jumped out at me was the discussion of just how A1c was “controlled.”
“Many were taking four or five shots of insulin a day,” he [Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association] said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”
They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.
I love the way the article says, “This is what you must do to get normal A1c.” No, no, no! You can get normal A1c by drastically reducing carbohydrate intake - many diabetics who have tried this find they can get normal readings with little or no medication. But of course, if the guy you are consulting is a shill for the ADA, which is in turn in the pockets of the pharmaceutical companies, of course your news report is going to suggest that the only way to get good A1c control is to down lots of pills.
So, why did so many more people with tight control die? Not having looked at the study, I can’t say, but I have some hypotheses. Cholesterol-lowering medications are toxic; they cause neurological problems, muscle weakness, and stroke. Blood pressure medications are notorious for increasing insulin resistance, and conversely insulin raises blood pressure by instructing the kidneys to retain sodium - a vicious cycle. Avandia, an oral hypoglycemic, is linked to heart disease, and that’s just the one we know about.
Of course people who take all this crap die sooner. This is why it is my goal never to have to take any of it.
The safest way for a diabetic to maintain A1c levels at normal levels is carbohydrate restriction. This will also control blood pressure (because of insulin’s sodium-sparing effect), and has been shown repeatedly to raise good cholesterol and lower bad cholesterol. It also lowers triglycerides, which are a much better predictor of heart disease than pool ol’ cholesterol. A low-carb diet also reduces the production of advanced glycosylation end products (AGEs), hybrid chemicals created by the joining of a carbohydrate molecule to a protein molecule. AGEs are thought by some researchers to be the cause of the damage to small nerves and blood vessels that leads to so many complications of diabetes, such as blindness, heart disease, gangrene, kidney disease, and neuropathy. I wouldn’t expect a high-carb diet that is “controlled” with medication to reduce AGEs, because one is still consuming lots of glucose.
So the conclusion I draw from this is: put down that darn piece of bread and eat some spinach.
Unfortunately, the conclusion the press, and most of its readers, will draw from this is: don’t bother keeping your A1c (itself a glycosylated protein) under control. Irresponsible!
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