For years, we have been given the message that we get diabetes because we overeat, are couch potatoes and we are just fat. In a surprising turn of events a recent intervention trial aimed at having some 5,000 obese patients lose weight and become more fit has been halted because it is clear that weight loss and fitness is not protective against heart disease. Although the establishment clings to the belief that weight loss and fitness "prevents" diabetes, it is now clear that it doesn't reduce the number 1 killer of us type 2 diabetics (heart disease).
The study as reported in the NYTimes, found that these interventions " lowered blood sugar levels, blood pressure and cholesterol levels," but as Dr. David Nathan is quoted "We have to have an adult conversation about this,” he said. “This was a negative result.”
A discussion of this event by the AHA announces the result, but quotes the well known Dr. Anne Peters saying that although weight loss, fitness and improved cardiovascular biomarkers didn't result in any improvement in heart disease rates, "We do know that weight loss and exercise can prevent diabetes." Personally, I don't believe this for a minute. I've not seen any study that suggests that T2 diabetes can be prevented. The Diabetes Prevention Program (DPP) showed that patients could delay the diagnosis of outright diabetes, but without follow up and careful consideration of diagnostic criteria, it is inappropriate to declare that T2 diabetes can be "prevented."
This event dismantles one leg of the argument that the epidemic rise in diabetes is cause by overeating and obesity, but I think it will take years for the concept to actually be understood and absorbed.
What are your thoughts about this study result? Will you stop starving yourself in a valiant attempt to avoid heart disease? Do you still believe that diet and exercise makes a difference? What will you do?
I continue to tell my friends and family members to watch their carbs even though they dont have diabetes. Personally i think high BG is one of the causes of cancer. As to the heart, brushing your teeth and keeping bacteria out of the mouth is a link to the heart health and I think there is more to come on that.
Well Brian, At least they had the honesty to admit it was a failed experiment. Even though their goals were not realized some good did come out of the study. Those that did lose weight ended up with fewer meds and in some cases T2 problems were delayed.
I agree with you that T2 cannot be prevented only delayed. If you are what they call pre-diabetic you are still diabetic it is just that you have a chance to treat it without medical intervention. I have never understand the pre-diabetic term, I equate it with the old saying that says a woman can't be just a little bit pregnant.
Delaying T2 symptoms is a worthy goal. I and most T2's would be better off if we had employed the necessary delaying tactics from the beginning.
Thanks for bringing this study to our attention.
I think you are right, I do commend the scientists such as Dr. David Nathan who showed integrity by making what was obviously a hard decision to terminate a decade of hard work.
I think all of us T2 diabetics do better with diet and exercise interventions, and delaying the progression of our condition is important. I just believe that the key is tight blood sugar control and to do that we need to worry about the carbs, not the amount of fat and the portion control.
There seems to be two reports here. One talks about the results of the AHEAD study which, as far as I can tell, shows that people already diagnosed with Type 2 diabetes do not show decreased incidence of macrovascular related incidents afer lifestyle changes involving diet and exercise and a concomittant decrease in weight along with other markers associated with cardiovascular disease.
This one I wonder about because the report says that the peak weight loss was around 10% and the average weight loss over the course of the study was 5%. The report calls these changes significant, which they can be if you're talking about a statistically significant change from the base weight. Certainly, any improvement is good, but without details it's difficult to see what's going on. It the average participant weighed 250 lbs at the start of the study, the peak weight loss would be down to 225 lbs with long term staying at around 240 lbs. I just wonder if that's really enough of a change to really make much long term difference. I wonder how much body composition changed for one thing.
The second report is on the prevention of Type 2 diabetes through diet and exercise. I'm not even sure how that discussion is relavent to the study itself because that doesn't appear to even be addressed through the AHEAD methodology.
i dont know about the AHEAD study and am type 1, but read taube´s "good fat bad fat" and was very surprised by facts about t2 and genetics, obesity, overeating and exercise. making sure to eat less carbs and worry less about fat may be what it is all about. and for people to realize it is not just a lifestyle disease brought on by the patient!
You are right, the link is not obvious. According to a paper by Delahanty and Nathan "The Diabetes Prevention Program (DPP) and its followup, the Diabetes Prevention Program Outcomes Study (DPPOS), and Look AHEAD (Action for Health in Diabetes), are long-term randomized clinical trials that have potential to direct diabetes care and medical nutrition therapy for obesity, prediabetes and type 2 diabetes (T2DM) now and in the future".
It was Dr. Anne Peters, quoted in the AHA article that said "We do know that weight loss and exercise can prevent diabetes." Look Ahead showed nothing about preventing diabetes, that was the DPP.
The Look-Ahead study was an effort to place the Diabetes Prevention Program (DPP) on a stronger evidential footing, and it failed. The DPP is our governments sole killer program to defeat diabetes, it is based on having patients lose weight by eating a fat and calorie restricted diet and exercising. An initial controlled study found that pre-diabetics who followed this regime were less likely to be diagnosed with outright diabetes by the end of the study. This was interpreted as "preventing" diabetes. But I call it bull.
All these patients already had diabetes since they were pre-diabetic. Some of them may have "managed" their condition better by losing weight and exercising, but proving that the diabetes didn't progress quickly is hardly evidence that diabetes was prevented. I suspect that pretty much everyone that entered the study having abnormal glucose metabolism left the study still with an abnormal glucose metabolism.
So, the NIH in alliance with the ADA and other pharmaceutial and agribusiness companies started this study. Heart disease is the number one killer of diabetics, rather than measuring surrogate outcomes, if you could prove that heart disease was reduced by using the DPP protocol, then the DPP program would be on a strong evidentiary foundations.
Ooops. It didn't work out so well. This is a "huge" event. I expect a web of lies and deceptions over the coming months as everyone tries to backpedal. It will still take years to undo the damage from the DPP, but the cracks in the foundation are starting.
Actually, the results are ominous for T1s. The study after all showed that a low fat calorie restricted diet which lowered blood pressure and lipids did not reduce heart disease in diabetics. What does this mean about all the pressure we get to take statins and reduce cholesterol? Does taking a statin and lowering cholesterol make a difference to any of us?
I am deferring comment until I know more except to say that I thought that vo2max and insulin sensitivity both increase (improve) with exercise in obese people who otherwise do not exercise. The extent to which that translates into age of DM onset, presumed change in risk of CVD, mortality/survival time, or measured obesity is not strong (I thought) but moderate at best. Now we are told any evidence for a causative relationship is very weak or completely absent(if I understand correctly).
What am I going to do? I don't know. Maybe err on the side of caution which means to do the thing that is least risky.
Don't expect any less misinformation than we already see repeated in every corner for the next generation. It may take forever to sort out.
Now let's watch the experts squirm their way out of this. What will they claim next?
This is very interesting. I am interested to see if this study will have any impact to the practice of prescribing statins as BSC elluded to. I feel more confused than ever when it comes to prescribing Statins to diabetics?
I wish the improvement on A1c that presumably resulted from weight loss and exercise had been included in the articles. Every chart I've seen of the occurrence of CVD in relation to A1c says that its occurrence is close to normal until 5.5, then it rises at an ever increasing rate. This study does not negate those statistics. So I think keeping my A1c as low as possible is still the best bet to avoid CVD. It would also seem to vindicate my choice not to take statins.
The results of this study go contrary to my personal experience and beliefs.
My main belief is that there are two factors that come to play when we develop a condition like diabetes. One is our genes that determine how susceptible or vulnerable we are to the condition. The second is the choices we make, and whether we let our guard down or do what is required to protect ourself.
In a way it's similar to the discussion about lung cancer. On the one hand we hear about someone who's 75 and has been a chain smoker their whole life and are still healthy. (obviously they don't have the genes that make them vulnerable to lung cancer.) On the other hand you hear of a young person who gets lung cancer after being exposed to second hand cigarette smoke in their workplace for a few years (e.g. a restaurant waitress who did inherit the genes that make her susceptible to lung cancer).
I'm originally from Norway and come from a family where a blood disorder that makes people very vulnerable to diabetes (hereditary hemochromatosis - HH) is rampant. My paternal grandmother had diabetes and went blind before she died and two uncles succumbed to heart attacks before age 50. I was diagnosed with HH at age 40.
However, my parents are both in their late 80s and still very healthy with no sign of diabetes. My sisters and nephews and nieces are also in good health. What they have in common in that they've always lived healthy lifestyles, gotten lots of exercise and are slim. That was also the case for me until I left Norway for Canada in my lste 30s.
After a decade of driving instead of using my old Norwegian bike, and too many visits to Macdonalds and too much other junk food in place of the healthy fare we ate in Norway, I'd put on 60 lbs. At that point I was diagnosed with diabetes type II.
I have since (for 14 years) managed my diabetes withour medications by reverting back to a healthy diet based on the Glycemic Index and no junk food as well as three daily walks. The best results came after I'd managed to lose 40 of the 60 lbs I had gained. For the past 10 years my hba1c has been stable in the 5.2 - 6.5 range.
So regardless of this study and the results, nobody can tell me that there is not a strong and definite link between lifestyle/weight and diabetes type II and the compliations that often follow with that disease.
I don't think anyone would question the idea that diet and exercise are a very powerful way of managing diabetes and I congratulate you on being able to manage your condition so well. But managing is different than preventing. I suspect that if you stopped your diet and exercise you would shortly be back with high blood sugars. That is not preventing diabetes, it is managing it.
I'm well aware of the distinction between prevention and management, and I realize that I will have diabetes for the rest of my life.
My point was that the rest of my immediate family, who presumably have the same genes as me, have not developed diabetes. Unlike me, they've all taken very well care of themselves, e.g. with good weight control, including my parents who are in their 80s.
I'm the 'odd one out' who developed diabetes, and coincidentially, the only one that didn't take proper care of my health and was overweight for a number of years.
I rest my case.
You are the odd one out because you won (or lost?) genetic roulette. Not evedrybody related to us is doomed, just like not everybody relatd to your d relatives is doomed. I suspect that being engaged with your health may help but I don’t think it’s guaranteed either. There’s plenty of fit, active people who get clobbered by T2 anyway, e.g. Steve Redman!
The people in the study probably already had damage, and there was no mention if age was a big factor. I bet they did not spend the money to test all of the participants and evaluate there cardiac health. It would have cost Millions $ to do a complete exam including Nuclear stress and then a cardiac cauterization on those that needed a closer look. My wife was told she was a strong healthy 50 year old woman buy several outstanding cardiologists at UTSW but when she went for a Nuclear stress test before a scheduled thyroid surgery they saw a small glitch and said you possibly have a problem we would recommend a cardiac cauterization that is the only way we will know "but it's probably nothing". The doctor who did the cauterization said her heart had bad blockages on the right side and she was walking around in the jaws of death and had no idea ( was clueless).
I think the study was flawed, Kinda like the Romans putting people in the arena with lions and saying we think the skinny ones will be OK they can probably out run the big cats if they really, really, really, try hard....;-)
In the study protocol, they describe the cardiovascular fitness test as a standard stress test using the Bruce Protocol, but they didn't use a nuclear stress test. The study cost $20M of gov funds, I suspect that matching funds probably made it about $100M. Yes, a big waste.
Sorry to hear of your wife. I worry with these sorts of things that if doctors root around looking for something wrong, they can always find something. I've probably walking around in the jaws of death for years. Hope you wife is ok tho.
You never really know if the doctors are exhausting their resources or have decided the cost out weighs the risk.
I do think diet and exercise make a difference, but they probably are not be the only factors involved—I've thought so for a long time, and it generally drives me bananas to see the message in the mass media that says "eat right, exercise, and no more diabetes!" Such BS. It's plain that a lot of what drives type 2 diabetes is genetic; the key question is, what flips on the genes we'd rather have flipped off and vice versa? Some of the triggers for heart disease & diabetes are environmental, but it can't all be just the high carb/fat content of the standard American diet, because plenty of people who don't eat that way still get or have diabetes, and plenty more who do eat that way live to be 90 with no sign of heart disease. I've heard arguments that the other factor relates to the amount of chemical crap ingested, and heaven knows, unless you grow all your own food, you have no way if knowing what's truly in it at the molecular level. I do not think this finding in any way refutes the concept of environmental factors leading to heart disease; I think it simply shows that we've been oversimplifying a very complex problem, which anyone who has really studied the matter already knows. But it's nice to have some solid evidence of that fact.
Though a bit of statistics can be misleading, they can also be helpful in understanding the connection between different things.
It is a fact that the obesity rate in America is among the highest in the world and also that America has been a world leader when it comes to the rise in diabetes and in heart disease. Is there a connection? Common sense says yes.
Also, it's a safe presumption that the genetic makeup of Americans has not changed significantly over the last generation, though the frequency of diabetes most certainly has.
So we're left with the question of what has affected that change? There are two plausable explanations: the environmental factor/toxins in our food, air and water as pointed out by the previous poster, and the obesity epidemic, brought on by a generation of dieticians being guided more by propoganda by government agents promoting agriculture/grains than science.
I personally think it's a combination of both of the above. What's for sure is that there has to be a reason why family members with the same genes, over one or two generations have gone from generally being healthy to generally unwell.
Research studies that seem to indicate otherwise, are certainly not helpful at a time when it's important that people start taking responsibility for their own health rather than incessantly blaming illness on their 'bad genes'.