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Why Drugs and Diet Can Sometimes Fail in Diabetes

“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, which I discuss this in my video When Drugs and Diets Don’t Lower Diabetes Deaths.

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 by any means necessary, these high blood sugars, 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. They speculated that this may have been 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 eye disease, 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 medications alone may not be the best  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. 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 not only improved reductions in blood sugar and body weight, but cardiovascular risk as well. 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.


What kind of diet does help diabetics? See How Not to Die from Diabetes and Plant-Based Diets & Diabetes. You’ve probably heard that Diabetics Should Take Their Pulses. Why is that the case? See Why Is Meat a Risk Factor for Diabetes? and How May Plants Protect Against Diabetes?.

Healthier diets can even reverse some of the complications of diabetes once thought irreversible. See Can Diabetic Retinopathy Be Reversed? and the part of my annual review From Table to Able: Combating Disabling Diseases with Food that discusses the remarkable reversal of painful diabetic neuropathy.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


36 responses to “Why Drugs and Diet Can Sometimes Fail in Diabetes

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  1. Wow, you are hitting it out of the park with these blogs now!

    Standing ovation

    Clap Clap Clap Clap Clap Clap Clap Clap

    Great job!

    You are a fly on the wall for all the conversations I am having with my Diabetic friends!

    They start of doing the futile dieting. End up on mutilple drugs plus insulin and their numbers are still too high and they are eating nothing but meat now. Then they are terrified because they went too low, so low they thought they might have died if someone hadn’t noticed. So now they are eating some junk food with the meat. That same cycle plays agsin and eventually they can’t handle the food cravings from just living on meat and they add back in things like lasagna and other comfort food carbs and then lower the portion sizes and they gained 100 pounds after going on insulin, so it is back to keto, but this time thry are trying moderation. Keto will be next agsin, because at least they lose a few of the pounds. Futility is better than death.

  2. The sentences:

    I am doing so well, I haven’t been eating any sugars at all.

    My sugars are through the roof and I haven’t eaten any sugars at all.

    I had a terrifyingly low blood sugar in the middle of the night two nights in a row, so I have started eating a small piece of candy at bedtime.

    They don’t know what to do at all.

  3. And I am saying, “Dr Barnard gets them off their medicines in two weeks…,”

    And they are listening to some skinny mammas or something like that right now and backed up so much from our friendship that I am not the one getting most of the phone calls right now, but I checked in and they still love me. They just find vegan threatening.

  4. I had very good success in lowering extremely high blood sugars down to low normal ranges and maintaining by tweaking my already vegan diet, and introducing intermittent fasting as recommended by Dr. John Mercola’s articles and Dr. Jason Fung’s book. It worked!

    My GP had been pushing hard to put me on lifelong glucose monitoring and 2 medications offering up dire stories of amputations and blindness if I refused. I refused anyway and got a new GP who was more open to the holistic approach. She was as thrilled with my results as I was. It is a lifestyle I am happily and easily maintaining.

    1. Very interested in your results. How long was your fasting period? Was it daily? Did you prescribe a set number of hours during which you could eat? Would love the details and wondering if this might also help lower blood pressure.

      1. Thanks for the positive support! I read 3 books – Dr. Neal Barnard’s “Reversing Diabetes”, Dr. John Mercola’s “Fat for Fuel”, and most importantly Dr. Jason Fung’s “The Complete Guide to Fasting” I do a daily 16 hour fast 5 days a week, one day a week I got to 20 hours, weekends are a bit looser. Most of all was my understanding what was wrong with my system and how conventional meds would only make it worse. Mercola is not a vegan and I am committed to it, so I just took what made sense from him and did a blend. I limited carbs initially but am back with them now my system is working better. He recommends cycling in and out of “nutritional ketosis” — see his website for a more detailed explanation. Dr. Fung in a kidney specialist (!!!) and now treats all his patients like this. I had my doubts but the proof is in the bloodwork and I can maintain this lifestyle very happily. I still have more weight to lose, but it is coming off slowly but surely, and I feel great! I recommend to anyone that they do the research and give it a go.

        1. J thanks for replying. I wish more people were open-minded like you because I think the world would open up to them. i particularly like this statement you made: “Mercola is not a vegan and I am committed to it, so I just took what made sense from him and did a blend.”

          1. thanks so much for the support Julie! I got a LOT of heat from my doctor, my friends, and even diabetics! Doubtful sad head-shaking…… I just went with what “felt right” to me and what resonated with me. I was so pleased that it worked….
            Love Dr. Gregors stuff too!

    2. J: I’d love to know how you tweaked your vegan diet to get results!

      Congratulations on your success. i love intermittent fasting too (i fast18 hours out of every 24) and feel really clean and energized.

  5. Being mostly vegan for five years I have encountered none of the chronic diseases of metabolic syndrome and take no prescription medications. However I am also persuaded by the scientific logic of Dr. Robert Lustig, whose boogey man is refined sugar including carbs, who stops short of vegan when it comes to recommended food preferences. I would love to hear these two giants of medicine discuss health and a best food “lifestyle.”

      1. Frances,

        As part of The Cheese Trap interviews, Dr. Barnard has a chart with the skyrocketing rates of obesity and disease and he linked it to cheese and saturated fats and vegetable oil and animal product intake.

        He showed that America’s intake of sugar stabilized in the 1990’s, when many people started drinking bottled water, instead of soda, but the obesity and disease rate continued to climb, even after the sugar intake rates stabilized.

        That being said, I can go to Keto Pet and they cured Cancer in dogs getting rid of the sugar and carbs.

        I can also go to a vegan dog owner’s site and he got rid of his dog’s liver cancer just putting him on a vegan diet.

        I am tossing a note to the WFPB researchers and I am saying, the reason a lot of people go Keto is related to the success with Cancer with the animals. It is so hard for my vet to think anything other than Keto and can I ask someone like Alicia Silverstone, could you fund a WFPB reversing Dog Cancer study? We need the animal studies to have that evidence.

        I believe their Keto Pet diet is capitalizing on the raw vegetables, which is part of their diet.

        Purdue already showed that adding raw vegetables to the dish prevent Cancer 90% of the time in animals. Does that simple step reverse Cancer?

        I feel so sure that I am reversing my dog’s cancer using vegan dog food and he finally is feeling better enough that now, his bowl is overflowing with raw fruits and vegetables and he is loving it.

        Today, he got blueberries, blackberries, watermelon, pineapple, broccoli sprouts, broccoli, carrots, cauliflower, brussel sprouts, cabbage, tri-colored peppers, and cardamom with some dandelion root extract and Maitake Mushroom Pro 4x, Nutritional yeast, Hempseed, Flax seed and pomegranate and I laugh, because I started pre-chewing his fruit and vegetables, because he doesn’t have a long digestive tract and can be a fast eater, and it was easier than chopping every single thing up in tiny pieces.

        He LOVES it and that silly Cancer is going to be gone pretty soon.

        1. And, yes, I bought organic Dandelion Greens at Whole Foods.

          The Maitake Pro 4X is a crutch, but the supplements are going to be going away with the Cancer and I will be able to afford the organic super foods again.

    1. Frances Morey don’t be fooled…
      https://robertlustigsugarbittertruthinfo.wordpress.com/tag/dr-robert-lustig/
      Even the sources he cited don’t back him up!

      For further info, see Dr Greger’s video on the Kempner rice diet, which was created in the 1930’s before the advent of drugs to treat malignant hypertension and kidney failure, and is often still used today. It consisted of only white rice, fruit and fruit juice, and white table sugar. Can’t get much sweeter or high carb than that, yet…
      https://nutritionfacts.org/video/kempner-rice-diet-whipping-us-into-shape/

      1. After reading this thorough debunking of Dr. Lustig’s “logic” I am sorry for how many times I recommended his books and lectures. I agree with him about the dangers of refined sugars and HFCS, yet his denial of the danger of sat fat is dangerous.

    2. Frances

      Lustig is not primarily an expert on nutrition and health. He is a paediatrician and endocrinologist. However, he has published a number of works on obesity and sugar

      Unfortunately, he has also made public statements which display embarrassing ignorance of basic nutritional facts. Whether these indicate genuine ignorance on his part or whether he is simply targeting the lucrative ‘low carb/saturated fat is harmless’ market for his book sales, isn’t clear. That latter market wouldn’t be aware of such facts or much care if they did.

      As Vegetater has pointed out, his claims are highly debatable. As well as Vegetater’s excellent link, you might also want to watch these videos by PlantPositive:
      http://plantpositive.com/display/Search?searchQuery=lustig&moduleId=19496100&moduleFilter=&categoryFilter=&startAt=0

      As Wikipedia politely puts it – ‘The suggested link between obesity and excess fructose consumption, as opposed to the excess consumption of any high-calorie food, is controversial’

      and

      ‘Lustig’s opinions on fructose metabolism and weight gain have been challenged by some systematic reviews of clinical research and some experts on sugar metabolism and metabolic diseases.[‘
      https://en.wikipedia.org/wiki/Robert_Lustig

  6. I just read the study and I am reaching a different conclusion: Change that resulted from the intervention were just not significant enough.

    That is a flaw that Dr. Greger has pointed in other studies – which is different than the what is presented in this blog.

    Participants in the intervention group lost weight, lowered A1c etc. but only in year 1 of the study. After year 3 they were pretty much where they started from.

    And, hence no difference in the long term outcomes in the two groups.

    1. Dr. Greger has given the conclusions of the researchers themselves.

      “The trial was stopped early based on a futility analysis when median follow-up was 9.6 years.”

      “In our study, intensive lifestyle intervention focused on weight loss did not reduce cardiovascular events in overweight or obese adults with type 2 diabetes. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT00017953.)”

    2. Hi Ashok- May I ask which study you refer to? He discusses the Accord Trial along with others. I’d be happy to review in order to address your understandable concern. -Dr Anderson Health Support Volunteer

  7. How can these drugs be so ineffective after going through the testing that they go through to be vetted? Maybe representatives from the drug company will troll this or TG can answer.

    1. I am going to suggest that the drugs are tested for “toxicity” and for whether they affect blood sugar properly.

      They don’t do a “Do they fix the actual problem” test.

    2. Jumping to conclusions and hurling abuse are probably excellent exercise.

      However carefully studying what has been written in the blog and thinking it through can also be rewarding.

      In this case, what I took away from it was that higher than normal drug dosing (ie intensive blood sugar lowering with drugs) using multiple drugs increased mortality. This is unsurprising. Take higher than normal amounts of aspirin and paracetamol and you are likely to see increased mortality too, especially if you take them every day and mix them together as appeared to be the case here.

      On the other hand, benefits have been found with intensive blood pressure lowering and LDL cholesterol lowering using multiple drugs, so perhaps it was important to trial intensive blood sugar lowering using multiple drugs.

      I always thought that it was only conspiracy nuts who believed that drug company trolls obsessively monitor the comment boards of the thousand of websites discussing health and nutrition issues. Personally, I find that highly unlikely but I suppose it is nice to think that someone somewhere is reading your words and thinks that they are important enough to respond to.

  8. The health of a person is an open system. If you surround a healthy person with many sick persons for a long time, like in an unhealthy gradient of fluid, the sickness will penetrate the healthy person. It is like a fish living in dirty water. The newly sick person will be normalized to the environment. But if you were to jump to another part of the planet, where the problem does not exists, the problem disappears. So, if all else fails, maybe a relocation of place could be medicine. Otherwise, it is a struggle that would require discipline and constant control.

  9. Husband finally believes! As a birthday present to me, he adopted my vegan low-oil lifestyle for 2 weeks, last October…..and just kept going. No more diabetes or insulin, after 23 years. No one believed I could get my husband to give up cheese and meats but he was FORCED to watch many Dr. Greger’s videos, listen to podcasts, read transcripts. 66 lbs lost later, he’s no longer obese and so much more active. A grace, a miracle, thanks to Dr. Greger.

    1. Sandy Rubin, congratulations to you both! That is truly an amazing success story! Thank you so much for sharing and I wish you all the best.

    2. Sandy,
      — Thank you for sharing about your husband’s experience of how he became a vegan and lost 66 lbs and that he no longer needs insulin shots. I am turning 51-years old in a few days, and I have eaten meat for almost every day of my life, but I have been watching a lot (a whole lot !!!) of Dr. Greger’s videos that he posted on YouTube for the last 3-weeks and they have convinced me that a low-oil plant based/vegan diet (along with being more active) significantly reduces the risk of all the major health diseases (diabetes, strokes, cancer, high blood pressure, heart conditions, etc.) and can add quality years (or decades) to a person’s life and help preserve a person’s mental sharpness as he/she ages (& mitigate the risk of getting Alzheimer’s)
      — I also like how his videos have helped me to understand what to eat and what to avoid (& why). His recommendations are based on scientific research instead of on ‘fads’. I have learned that some of the things that I thought were healthy for me are not, and I have also learned that a few of the things that I thought were unhealthy are actually good for a person. I look forward to reading his book, “How Not To Die”. I am very grateful for what I have learned from Dr. Greger’s videos and have been telling family members and close friends about what I have learned and have encouraged them to go to YouTube and watch his videos.
      — Thanks again for your post and I hope you and you husband have many more healthy/happy/quality years together enjoying life, family, friends, great food, and each other!

  10. Dear Doctor

    Thank you for what you do. You display the true meaning of Doctor/healer. I love your articles. I love the way you convey your info with humor and wit!!! You make me strive to eat better every day!
    M

  11. https://robertlustigsugarbittertruthinfo.wordpress.com/tag/dr-robert-lustig/

    After reading this link, a lengthy critique of Dr. Lustig’s assertions, I am embarrassed that I recommended his pronunciamentos to so many people. I won’t make that mistake again.
    Much of what he said in his two books and numerous lectures didn’t add up but I thought it was just me not being able to understand it. Now I realize he was just spouting nonsense. I do agree with him about refined sugar and HFCS being bad for us though. Yet his denial of the dangers of sat fat are faulty logic.

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