Urgent: Support the
Proposed New Law in
California Requiring Doctors to Provide Patients with
Information on Diabetes and Heart Disease. Part 2 -
Diabetes
Patients
often receive inadequate and/or incorrect information from
their doctors on diabetes and heart disease. Last month’s
newsletter was on the heart disease side of this bill.
Concerning type-2 diabetes, health professionals and
pharmaceutical companies disseminate incorrect and
inadequate information on these four important issues:
1)
Patients are told diabetic medications for type-2 diabetes
will prolong life and prevent complications of diabetes,
while extensive scientific research says otherwise for the
most commonly prescribed oral medications.
2)
Patients are told that their blood sugars (and hemoglobin
A1c levels) must be lowered as close to normal levels as
possible. However, all six major studies show intensive
therapy increases the risk of heart disease, death, and
serious side effects.
3) The
public receives almost no education about the role of the
rich Western diet in the cause of type-2 diabetes and about
the right way to eat to prevent this disease.
4)
Patients are rarely told that changing to a healthy,
low-fat, plant-food based diet, exercise, and associated
weight loss will improve their health and often cure their
type-2 diabetes.
Assembly Bill 1478
has been introduced by California state assembly member Tom
Ammiano, representing the 13th District, to require that a
physician obtain a patient's written acknowledgment
confirming the receipt of information, as specified,
regarding treatment through medical nutrition therapy prior
to delivering nonemergency treatment for type-2 diabetes. My
supporting letter on this matter is provided below. Last
month’s newsletter (March 2009) has a similar letter from me
about heart disease treatments and a request for your
support.
New Fax numbers for Assembly Members:
Write to these policymakers about the need for
change for both heart disease and diabetes
treatments.
Please send letters to members of the Business &
Professions Committee (who are initially reviewing
this bill) asking them for their support of AB 1478.
Send a CC to
jimlaw@jps.net
for an additional hand delivery of your
letter to committee members. A sample letter is
provided at the end of this article. Here are their
e-mail addresses and faxes: |
B&P consultants to the
Assembly member: |
Member |
Fax# |
For Mary Hayashi: |
916 319 2118 |
For Bill Emmerson: |
916 319 2163 |
For
Connie Conway: |
916 319 2134 |
For Mike Eng: |
916 319 2149 |
For Ed Hernandez: |
916 319 2157 |
For Pedro Nava: |
916 319 2135 |
For Roger Niello: |
916 319 2105 |
For John Perez: |
916 319 2146 |
For Curran Price: |
916 319 2151 |
For Ira Ruskin: |
916 319 2121 |
For Cameron Smyth: |
916 319 2138 |
For Sarah Huchel B&P Consultant: |
916 319 3306 |
|
|
Dr.
McDougall's Letter of Support for AB 1478:
Requirement to Inform Patients in Writing about the Adverse
Effects of Pharmaceutical Treatments and the Benefits of
Nutritional Therapies for Type-2 Diabetes.
The Patients’ Right to
Informed Consent
Informed consent is a patient
right guaranteed by the bylaws of most hospitals. California
law requires that a patient’s consent be obtained in writing
for several specific procedures and treatments, including:
sterilizations, hysterectomy, breast cancer, prostate
cancer, gynecological cancers, psychosurgery, and
electroconvulsive therapy, but not for type-2 diabetes
treatments.1 California patients with type-2
diabetes need to be informed in writing about the lack of
benefits and the real harms of current therapies with oral
and injectable medications. They also need to be told that
the cause of their diabetes is the rich Western diet and
associated weight gain, and that their condition is
reversible with a change in diet, exercise, and weight loss.
The Diabetes Epidemic
According to the National
Institutes of Health (NIH) in 2007 a total of 23.5 million,
or 10.7 percent, of all people aged 20 years or older in the
US have diabetes at a cost of $174 billion.1a
The vast majority of this diabetes is type-2 diabetes,
caused by over-nutrition from the rich Western diet, and the
associated weight gain. Eighty-four percent of diabetics are
on medications (insulin and/or oral).1a Born in
the year 2000, a male child’s lifetime risk of developing
type-2 diabetes is nearly 33%, and a female’s risk will be
39% when following the Western diet.2 The
escalating incidence of type-2 diabetes clearly indicates
that current efforts at prevention and treatment are
failing. The reason for this failure is the almost exclusive
emphasis on drug therapies, and the lack of efforts to
address the dietary and lifestyle causes and treatments of
type-2 diabetes.
The Failure of
Non-emergency Diabetic Medications
Diabetic medications are
approved by the FDA for market based upon their ability to
lower blood sugar levels, not based on any improvements in
the quality or quantity of the patients’ lives.3
In a major study, a popular diabetic medication, Avandia (rosiglitazone),
given at a dosage of 4 mg twice daily, on average, decreased
hemoglobin A1c levels by 1.5 percentage points, reduced
fasting plasma sugar by 76 mg/dL (4.22 mmol/L), and reduced
insulin resistance by 25%.4 These improved
numbers should have meant healthier patients, but they
didn’t. On May 21, 2007 the New York Times reported,
“…patients taking Avandia had 66 percent more heart attacks,
39 percent more strokes and 20 percent more deaths from
cardiovascular-related problems.”5,6 Since 1972,
the Physicians Desk Reference (PDR) descriptions of
most diabetic pills have included two paragraphs in heavy
black print that begin with: “Special Warning on
Increased Risk of Cardiovascular Mortality.” This
warning is because a very commonly prescribed oral
medication, called sulfonylurea, increases the risk of
cardiovascular death by 2˝ times compared to diet treatment
alone.
Mediations (oral and
injectable) for type-2 diabetes are prescribed aggressively
by physicians with the unfounded belief that better control
of blood sugar will result in better long-term outcomes for
the patients. All six major studies published over the past
13 years have shown otherwise. Three major studies published
between 1996 and 2000 found more weight gain, higher
cholesterol, triglycerides, and blood pressure; and more
heart disease, stroke, and/or death with “aggressive”
treatment compared to less treatment.7-9
This past year, 2008, three
landmark studies, ACCORD, ADVANCE, and VADT, were published
in the New England Journal of Medicine. All three
showed aggressive treatment does more harm than good.10-12
On February 6, 2008 the National Heart, Lung, and Blood
Institute (NHLBI), stopped the ACCORD study (Action to
Control Cardiovascular Risk in Diabetes) when results showed
that intensive treatment of diabetics increases the risk of
dying compared to those patients treated less aggressively.13 Patients
in the intensive group were oftentimes taking four shots of
insulin and three pills daily, and checking their
blood-sugar levels four times a day.10
The Veterans Affairs Diabetes
Trial (VADT) was based on 1791 military veterans with type-2
diabetes.12 Patients were assigned to receive
either intensive- or standard-glucose control and studied
for 5.6 years. The intensive-therapy reduced their
hemoglobin A1c levels to 6.9%; compared to 8.4% in the
standard-therapy group. 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 of 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.
The Efficacy of
Diet-therapy
Drug therapy has consistently
failed patients with type-2 diabetes, making search for an
alternative treatment imperative. Since the rich Western
diet is agreed to be the cause of this epidemic, should diet
not be the first place to look for the prevention and the
cure?14 Studies on the benefits of a low-fat,
high-carbohydrate, plant-food-based diet on type-2 diabetes
date back to 1930.15 Several published studies
demonstrate how type-2 diabetics can stop insulin and get
off oral diabetic medications with a change in diet.16-18
Heart disease accounts for 70% of the deaths in diabetics.
By great fortune, this same low-fat, low-cholesterol diet
(successfully used for diabetes therapy) has been shown to
prevent and treat heart and kidney disease, and prevent many
common forms of cancer.
A study recently published in
Diabetes Care found a low-fat, plant-food-based diet
improved the health of people with type-2 diabetes even more
than the American Diabetes Association (ADA) Diet did.19
Forty-three percent of the plant-food group and 26% of the
ADA group participants reduced their diabetes medications.
Reductions of hemoglobin A1c, LDL “bad” cholesterol, and
urine protein were greater in the plant-food group, than
those on the ADA diet. People following the plant-based
diet could eat unlimited amounts of food, while those on the
ADA diet were required to control their portion sizes—and
compliance was better on with the plant-food-based diet.
Exercise did not play a role in this study.20
Low-carbohydrate, high-protein
diets have also been shown to cause people to lose weight
and reduce their blood sugar levels.21 However,
these kinds of diets are also high in fat, high in
cholesterol, and very low in dietary fiber; therefore, they
cannot be recommended. The American Heart Association,
because of their disease-causing effects, has condemned
low-carbohydrate diets.22
Cost Savings to the State
of California
Over 2 million Californians
currently have diabetes, and the number of Californians with
diabetes is expected to double by 2025.23 In
California in 2003, the total direct and indirect costs of
diabetes were estimated to be more than $17.9 billion per
year.24 Obesity threatens to surpass tobacco as
the leading cause of preventable death among Californians
and obesity costs the state $28.5 billion in health care
expenses, lost productivity, and workers' compensation.23
A cost-benefit analysis published in the
October-December 2006 issue of the University of
California’s California Agriculture journal has
determined that every dollar spent on nutrition education in
California saves between $3.67 and $8.34 in future medical
costs.25 The current drug therapies for type-2
diabetes promote both obesity and heart disease—widespread
utilization of diet-therapy will reduce the costs and
incidence of all three epidemics (diabetes, obesity, and
heart disease), saving California billions of dollars.
Sample Letter to Assembly Member |
Dear Assembly Member (their name):
I
am writing to ask you to vote for AB 1478. Chronic
diseases like heart disease and diabetes are
epidemic in America and California. From my
personal experience I know that while drug
medication can be of value in emergency situations,
drugs ultimately never cure the disease – they only
suppress the symptoms of the disease. This is an
expensive way to treat diseases. Our state cannot
anymore afford the high cost of treating patients
with drugs and surgery alone. Diet and lifestyle
changes have been found to be helpful in arresting
and even curing heart disease and diabetes, and are
very inexpensive compared to drugs and surgery. I
feel doctors should give their patients the option
to be referred out for diet advice and nutrition
therapy for their non-emergency heart disease or
diabetic condition. Doctors also must be required by
law to tell the truth about the limitations of
current treatments.
Thank you very much for your support for AB 1478.
Sincerely,
Your name, address, and e-mail |
|
References:
1) http://www.calpatientguide.org/ii.html
1a)
http://diabetes.niddk.nih.gov/DM/PUBS/statistics/
2) Narayan KM. Lifetime risk
for diabetes mellitus in the United States. JAMA
2003; 290: 1884-90.)
3) http://www.medscape.com/viewarticle/585593
4) Lebovitz HE, Dole JF,
Patwardhan R, Rappaport EB, Freed MI; Rosiglitazone Clinical
Trials Study Group. Rosiglitazone monotherapy is effective
in patients with type 2 diabetes. J Clin Endocrinol Metab.
2001 Jan;86(1):280-8.
5)
http://www.nytimes.com/2007/05/22/business/22drug.html?pagewanted=print
6) Nissen SE, Wolski K. Effect
of rosiglitazone on the risk of myocardial infarction and
death from cardiovascular causes. N Engl J Med. 2007
Jun 14;356(24):2457-71
7) Purnell JQ. Effect of
excessive weight gain with intensive therapy of type 1
diabetes on lipid levels and blood pressure: results from
the DCCT. Diabetes Control and Complications Trial. JAMA.
1998 Jul 8;280(2):140-6.
8) Colwell JA, Clark CM Jr.
Forum Two: Unanswered research questions about metabolic
control in non-insulin-dependent diabetes mellitus. Ann
Intern Med. 1996 Jan 1;124(1 Pt 2):178-9.
9) Gustafsson I, Hildebrandt
P, Seibaek M, Melchior T, Torp-Pedersen C, Kober L,
Kaiser-Nielsen P. Long-term prognosis of diabetic patients
with myocardial infarction: relation to antidiabetic
treatment regimen. The TRACE Study Group. Eur Heart J.
2000 Dec;21(23):1937-43.
10) 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.
11) 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.
12) 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.
13) BMJ 2008;336:407,
doi:10.1136/bmj.39496.527384.DB
14) Bulletin of the World
Health Organization 80:952-958.
http://www.who.int/bulletin/archives/80(12)952.pdf
15) Rabinowitch I. Experiences
with a high carbohydrate-low calorie diet for the treatment
of diabetes mellitus. Can Med Assoc J 23:489, 1930)
16) Kiehm T. Beneficial
effects of a high carbohydrate, high fiber diet on
hyperglycemic diabetic men. Am J Clin Nutr 29:895,
1976.
17) Singh I. Low-fat diet and
therapeutic doses of insulin in diabetes mellitus. Lancet
1:422, 1955.
18) Barnard R. Response of
non-insulin-dependent diabetic patients to an intensive
program of diet and exercise. Diabetes Care 5:370,
1982.
19)
Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede
L, Jaster B, Seidl K, Green AA, Talpers S. A
low-fat vegan diet improves glycemic control and
cardiovascular risk factors in a randomized clinical trial
in individuals with type 2 diabetes.
Diabetes Care.
2006 Aug;29(8):1777-83.
20) Barnard ND, Gloede L,
Cohen J, Jenkins DJ, Turner-McGrievy G, Green AA, Ferdowsian
H. A low-fat vegan diet elicits greater macronutrient
changes, but is comparable in adherence and acceptability,
compared with a more conventional diabetes diet among
individuals with type 2 diabetes. J Am Diet Assoc.
2009 Feb;109(2):263-72.
21) Dashti HM, Mathew TC,
Khadada M, Al-Mousawi M, Talib H, Asfar SK, Behbahani AI,
Al-Zaid NS. Beneficial effects of ketogenic diet in obese
diabetic subjects. Mol Cell Biochem. 2007
Aug;302(1-2):249-56.
22) St. Jeor S, Howard B,
Prewitt E. Dietary protein and weight reduction. A
statement for health professionals from the Nutrition
Committee of the Council on Nutrition, Physical Activity,
and Metabolism of the American Heart Association. Circulation
2001;104:1869-74.
23)
http://gov.ca.gov/pdf/press/Governors_HC_Proposal.pdf
24)
California DHS, Fast Facts on Diabetes, August 2003. http://www.publichealthadvocacy.org/printable/CCPHA_RDiabetes.pdf
25)
http://news.ucanr.org/newsstorymain.cfm?story=875
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