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Favorite Five Articles from Recent Medical Journals
Undeniable
Evidence: Diabetes Treatments Do More Harm Than Good
Glucose
Control and Vascular Complications in Veterans with Type 2
Diabetes
by William Duckworth in the December 17, 2008 issue of the
New England Journal of Medicine found, “Intensive
glucose control in patients with poorly controlled type 2
diabetes had no significant effect on the rates of major
cardiovascular events, death, or microvascular
complications.”1This study, called the Veterans
Affairs Diabetes Trial (VADT) was of 1791 military veterans
(mean age 60.4 years) who had a suboptimal response to
therapy for type-2 diabetes. They were assigned to receive
either intensive- or standard-glucose control and studied
for 5.6 years. The intensive-therapy reduced the Hemoglobin
A1c levels to 6.9%; compared to 8.4% in the standard-therapy
group. The patients were also put on aspirin and a statin.
A weight
gain of 18 pounds occurred with the intensive-treatment
compared to 9 pounds with standard-therapy. There were 95
deaths from any cause in the standard-therapy group and 102
in the intensive-therapy group. In the intensive-therapy
group, the number of sudden deaths was nearly three times
the number as those in the standard-therapy group (11 vs.
4). More patients in the intensive-therapy group had at
least one serious adverse event, predominantly hypoglycemia,
than in the standard-therapy group.
These
pharmaceutical companies—Sanofi-Aventis, GlaxoSmithKline,
Novo Nordisk, Roche, Kos Pharmaceuticals, and Amylin—provided
medications and financial support for the study.
Comment:
This is the third industry-funded study published this year
showing aggressive treatment hurts patients. On June 12,
2008 the ACCORD* trial and ADVANCE** trials were also
published in the New England Journal of Medicine.2,3
Together, the effect of these three well-designed
randomized studies should be enough to halt aggressive
prescribing of diabetic pills and insulin to type-2
diabetics. Will this overwhelming evidence change how
doctors practice? Probably not. Drug companies have millions
of advertising dollars dedicated to emphasizing any slight
benefits their drug treatments may show and minimizing the
harms. In this manner they convince doctors to prescribe and
patients to buy useless and harmful products. Most doctors
are too afraid of lawsuits to stand up for the patients and
against the drug companies. To change current practice,
doctors need to fear being sued for too aggressively
treating patients. Even more, they need to fear being sued
for failing to prescribe the correct treatment for type-2
diabetics—a change in diet. None of these three studies
published in one of the world’s most prestigious medical
journals taught dietary and lifestyle modification to their
patients.
Currently,
Food and Drug Administration (FDA) approval for a diabetic
medication requires evidence that the drug will lower blood
sugar—not that it improves the patient’s life. The title of
my
February 2008 newsletter describes the results of such
narrowly focused therapy: “Intensive Therapy Means Dying
Sooner with Better Looking Numbers.” The FDA is as of
December 2008 recommending that all new drugs developed for
the treatment of type-2 diabetes show that they do not
increase the risk of cardiovascular events. However, this
is not a requirement, just a recommendation or suggestion to
the pharmaceutical companies.4
Eating the
rich western diet causes type-2 diabetes. My February 2004
newsletter provides details on the cause and how a
change in diet will cure essentially all type-2 diabetics—at
the same time causing them to lose weight, reverse heart
disease, and dramatically improve their overall health.
*ACCORD =
Action to Control Cardiovascular Risk in Diabetes
**ADVANCE
= Action in Diabetes and Vascular Disease: Preterax and
Diamicron Modified Release Controlled Evaluation
1)
Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven
PD, Zieve FJ, Marks J, Davis SN, Hayward R, Warren SR,
Goldman S, McCarren M, Vitek ME, Henderson WG, Huang GD; the
VADT Investigators. Glucose Control and Vascular
Complications in Veterans with Type 2 Diabetes. N Engl J
Med. 2008 Dec 17. [Epub ahead of print]
2) Action
to Control Cardiovascular Risk in Diabetes Study Group,
Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT,
Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr,
Probstfield JL, Simons-Morton DG, Friedewald WT. Effects of
intensive glucose lowering in type 2 diabetes. N Engl J
Med. 2008 Jun 12;358(24):2545-59.
3) ADVANCE
Collaborative Group, Patel A, MacMahon S, Chalmers J, Neal
B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P,
Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G,
Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B,
Bompoint S, de Galan BE, Joshi R, Travert F. Intensive blood
glucose control and vascular outcomes in patients with type
2 diabetes. N Engl J Med. 2008 Jun
12;358(24):2560-72.
4) (http://www.medscape.com/viewarticle/585593)
Brain
Impairment from the Atkins Diet
Low-carbohydrate weight-loss diets. Effects on cognition and
mood
by Kristen D’Anci in the February 2009 issue
of the journal Appetite concluded that, “The
present data show memory impairments during low-carbohydrate
diets at a point when available glycogen stores would be at
their lowest.” Women followed a low-carbohydrate diet,
similar to the Atkins diet, or a reduced-calorie balanced
diet, similar to that recommended by the American Dietetic
Association (ADA). “Results showed that during complete
withdrawal of dietary carbohydrate, low-carbohydrate dieters
performed worse on memory-based tasks than ADA dieters.
These impairments were ameliorated after reintroduction of
carbohydrates.” After about one week of severe carbohydrate
deprivation subjects demonstrated impairment of memory.
Comments:
Have you noticed any of your dieting friends
slipping with their physical or mental health? There are
scientific reasons to believe this is a real change caused
by a deficiency of “brain fuel,” which is carbohydrate.
Sugar (glucose) is the primary, preferred fuel for the brain
and it is not stored in the brain tissues. Thus, the brain
is dependent upon circulating glucose in the blood stream.
This glucose comes almost exclusively from eating
carbohydrates. Except for milk and honey, only
plant-derived foods contain carbohydrate. The body’s stores
of carbohydrate last about 24 to 72 hours after starting on
a low-carbohydrate, Atkins-type diet. Upon depletion of
carbohydrates the body metabolizes body fat into ketones,
which can be used, but less efficiently, by the brain
tissues and other body tissues for fuel.
The
popularity of low-carbohydrate diets is waning, but I doubt
they will vanish because they promise quick weight loss
while consuming familiar foods like beef, butter and Brie.
These diets work by simulating sickness. Without
carbohydrate the body turns to fat for energy. Ketones are
produced from fat metabolism and with their accumulation a
condition of ketosis develops. Ketosis suppresses the
appetite. Weight loss follows as long as ketosis-induced,
appetite-suppression, is maintained. Most dieters cannot
tolerate the unpleasantness of sickness for long and they
give up, regaining all their lost body fat.
The foods
consumed for a low-carbohydrate diet (meat, poultry, fish,
cheese, eggs) are known to cause many serious illnesses,
including heart disease, strokes, cancer, osteoporosis, and
constipation. This is not the right way to lose weight.
D'Anci KE,
Watts KL, Kanarek RB, Taylor HA. Low-carbohydrate
weight-loss diets. Effects on cognition and mood.
Appetite.
2009 Feb;52(1):96-103.
Breast
Cancers Spontaneously Disappear
The
natural history of invasive breast cancers detected by
screening mammography by Per-Henrik Zahl published in
the November 24, 2008 issue of the Archives of Internal
Medicine found, “…that the natural course of some
screen-detected invasive breast cancers is to spontaneously
regress.”1 The investigators found invasive
breast cancer 22% more often in women who had a mammography
every other year for 6 years than those who did not (1909
vs. 1564 per 100 000 women). If all cancer were to naturally
progress and none disappear then the same number of cancers
would be expected to be found in the women who received
regular screening every other year and those who only had
one exam after 6 years. Their conclusion was, “it appears
that some breast cancers detected by repeated mammographic
screening would not persist to be detectable by a single
mammogram at the end of 6 years.” The final remarks of the
investigators were, “Our findings are equally consistent
with the possibility that mammography either leads to a
reduction in breast cancer mortality or has no effect at
all. Instead, our findings simply provide new insight on
what is arguably the major harm associated with mammographic
screening, namely, the detection and treatment of cancers
that would otherwise regress.”
Comment:
Spontaneous regression of advanced breast cancer has been
reported. One recent reported identified 32 such cases, but
there are certainly many more unreported cases.2
Advanced melanoma, brain cancer (neuroblastoma), and kidney
cancer are also known to disappear without treatment.
Precancerous changes in the female uterine cervix and colon
polyps also regress.
Most of my
readers know that I am against doing “early detection”
screening tests for most cancers, including those of the
breast, prostate, and lung cancer. This study provides one
more reason to avoid mammography and even breast-self
examination—benefits of which have been seriously
questioned.3,4 The harms from these detection
campaigns are, however, unquestioned.*
I often
see women with breast cancer, men with prostate cancer, and
both genders with many other forms of cancer in late
stages. Their doctors have given them no hope—in fact, in
most cases their well-intentioned treatments add to their
misery. Hopelessness compounds the suffering. Patients
need to be told that even with advanced cancer, sometimes
there is recovery, called spontaneous remission. I believe
this miracle is more likely to happen for someone in good
health, rather than in poor health. The only way I know to
consistently improve health is by replacing destructive
habits with good ones. The most powerful of these changes
is switching from the meat-, dairy-, and junk food-based
Western diet to the McDougall starch-based diet. I have
seen what I believe to be spontaneous remissions in my
patients several times. Ruth Heidrich, reported as a
Star McDougaller, is one remarkable example of
metastatic breast cancer diagnosed over 26 years ago—and she
lives cancer free today.
*I believe
there are minor benefits to be had from PAP smears every 3
to 5 years until age 50, one routine colon exam (polyps) at
age 55 to 60, exams of the mouth (leukoplakia), and skin
exams (pre-melanoma).
1) Zahl
PH, Maehlen J, Welch HG. The natural history of invasive
breast cancers detected by screening mammography.
Arch Intern Med. 2008 Nov 24;168(21):2311-6.
2) Larsen
SU, Rose C. Spontaneous remission of breast cancer. A
literature review. Ugeskr Laeger. 1999 Jun
28;161(26):4001-4.
3) Baxter
N; Canadian Task Force on Preventive Health Care. Preventive
health care, 2001 update: should women be routinely taught
breast self-examination to screen for breast cancer? CMAJ.
2001 Jun 26;164(13):1837-46.
4)
Gřtzsche PC, Nielsen M. Screening for breast cancer with
mammography. Cochrane Database Syst Rev. 2006 Oct
18;(4):CD001877.
The
Ancient Human Diet Is Starch-based
Starch
grains on human teeth reveal early broad crop diet in
northern Peru by Dolores Piperno reported in the
December 16, 2008 issue of the Proceeding of the National
Academy of Science, found plant parts on the teeth
(dental plaque) of people who lived in Northern Peru as long
as 11,200 years ago and concluded, “Starch grain studies of
dental remains document plants and edible parts of them not
normally preserved in archaeological records and can assume
primary roles as direct indicators of ancient human diets
and agriculture.”1
Researchers examined 39 human teeth found in northern Peru's
Nanchoc Valley from six to eight individuals. Some of the
grains had been cooked. The diet of these people was
considered stable for possibly 5000 years (until 6000 years
ago). These people cultivated their crops close to their
circular houses. Starch granules from Lima beans, common
beans, peanuts, nuts, squash, grains, and fruits were
identified.
Comment:
Often the only findings reflecting the diet of ancient
people are the hard bones of animals that are found near
their ruins. Any plant material has decayed and
disappeared. Because of this many people have come to the
wrong conclusion that early people were primarily hunters
and their diet was largely of meat. However, this research
adds support for my often-stated position, that all large
populations of trim, healthy people, throughout written
human history, have obtained the bulk of their calories from
starch.
The early
ancestors of modern humans, from at least 4 million years
ago, followed diets almost exclusively of plant-foods.
Beginning at least 250,000 years ago, people survived as
hunter-gatherers with a subsistence standard of living,
eating foods that extended from one extreme to the other in
proportions of plant vs. animal foods—from the raw flesh and
fat of marine mammals; the Arctic Eskimos—to diets composed
largely of wild plants of the Western Desert; the Australian
Aborigines.2 Hunter-gatherers took advantage of
any dependable sources of food from their wild local
environments. Because of the ease and dependability
(compared to obtaining animals), gathering fruits and
vegetables was a primary source of food for most
hunter-gatherer societies. The emphasis on hunting increased
in higher latitudes because of plant scarcity.3
Examination of the dental remains of this ancient culture
provides more clear evidence that the natural human diet is
starch based.
1) Piperno
DR, Dillehay TD. Starch grains on human teeth reveal early
broad crop diet in northern Peru. Proc Natl Acad Sci U S
A. 2008 Dec 16;105(50):19622-7.
2) Milton
K. Back to basics: why foods of wild primates have
relevance for modern human health. Nutrition. 2000
Jul-Aug;16(7-8):480-3.
3) Milton
K. Hunter-gatherer diets-a different perspective. Am J
Clin Nutr. 2000 Mar;71(3):665-7.
Diet
Benefits Prostate Cancer (Another Ornish Contribution)
Clinical
events in prostate cancer lifestyle trial: results from two
years of follow-up
by Joanne
Frattaroli published in the December 2008 issue of the
journal Urology found, “Patients with early-stage
prostate cancer choosing active surveillance might be able
to avoid or delay conventional treatment for at least 2
years by making changes in their diet and lifestyle.” By 2
years of follow-up, 13 of 49 (27%) control patients and 2 of
43 (5%) experimental patients—those encouraged to adopt a
low-fat, plant-based diet, to exercise and practice stress
management, and to attend group support sessions—had
undergone conventional prostate cancer treatment (radical
prostatectomy, radiotherapy, or androgen deprivation).
Comment:
This is the second report of the Prostate
Cancer Lifestyle Intervention Trial started by Dean Ornish,
MD. Given the honest facts about standard prostate cancer
treatments, most patients would elect diet, and delay or
avoid surgery, radiation, hormone deprivation (pills or
cutting off their testicles), and chemotherapy. These
damaging treatments fail to produce consistent survival
benefits—and every doctor and patient should know the
results of a century of research. Doing nothing would be a
better option for most patients. Research also shows that
the high-fat, meat- and dairy- rich Western diet causes this
disease. Common sense says “Don’t throw gasoline on a
fire.”
Frattaroli
J, Weidner G, Dnistrian AM, Kemp C, Daubenmier JJ, Marlin
RO, Crutchfield L, Yglecias L, Carroll PR, Ornish D.
Clinical events in prostate cancer lifestyle trial: results
from two years of follow-up. Urology. 2008
Dec;72(6):1319-23. Epub 2008 Jul 7. |
