Friday, August 16, 2019

Retrospective #183: My New “Lipidologist” and Me

I had an appointment recently with a “new” doctor – new to me, that is. He’s an established physician in a large group that is part of a larger consortium of groups. He practices “Family Medicine,” which means he’s a generalist.
I met my new doctor in a bar. He was having broiled salmon, and I was having a drink (while my wife shopped). Anyway, he told me he was a physician, and he mentioned the group. I told ­­­­­­­him I had just been “fired” (for being rude) by an endo in that group. His suggested I call his office the next day to make an appointment, so I did.
The appointment didn’t go well. In the clinic I told him I had been off my Very Low Carb eating plan off almost 2 months and had gained more than a few pounds. I expected my A1C would probably go up from 5.7% to +/- 6.0%. “My goal is to get it back to 5.6% or below,” I said. He replied, “That would be ‘non-diabetic.’” He added that if I lost 40 pounds, “You would be non-diabetic.” I replied that a few years ago I was 50 pounds lighter than I was now, and I added, with emphasis, “believe me, I was still diabetic,” because I would still be Insulin Resistant.
I then mentioned that when I am “on” my program, I eat between 10 and 15 grams of carbohydrates a day. He responded with a tone and air of certitude, “Twenty grams of carbohydrate a meal is what you should eat.” This really set me off. My new doctor knew everything there was to know about me without even taking a history. I had been a Type 2 diabetic for 28 years, the last 12 of which I have managed to get off virtually all my oral meds and keep (for the most part) good glucose control by diet alone, and now he was telling me how to manage my diabetes his way. I know. I know. He was just following clinical guidelines, as set down by the ADA, the AHA, etc., etc.
He then brought up the subject of statins, declaring he was a lipidologist. I told him I would refuse a statin if he ordered it, and I told him why. I mentioned my latest lipid panel (at the time): TC: 217; LDL: 122: HDL: 85; TG: 49; TC/HDL ratio: 2.6). I said I considered that stellar. He replied that the National Cholesterol Education Program (NCEP-4) Guidelines recommend a TC < 200 and an LDL < 100 (which was true; those were the old guidelines). The new ACC/AHA guidelines (see Retrospective #181) no longer set LDL targets in absolute numbers. I called the NCEP guidelines pure BS and said the gurus and guidelines that I follow are very happy with my lipid (cholesterol) panel.
Actually, I later recalled that one of my favorite books, Paul and Shou-Ching Jaminet’s “Perfect Health Diet” says, “The ideal serum lipid profile – the one that produces the best health and minimum mortality – looks like this:
·         Total Cholesterol level between 200 and 260 milligrams per deciliter
·         LDL Cholesterol level above 100 milligrams per deciliter
·         HDL Cholesterol level above 60 milligrams per deciliter
·         Triglyceride level around 50 to 60 milligrams per deciliter
I then repeated my exceptional HDL (85) and TG (49) numbers and added that my LDL (122) was Pattern “A.” His response was: “Define ‘Pattern A.’” I replied, “large, buoyant, fluffy, rather than small dense, to avoid having oxidized, small dense LDL particles get stuck in the eroded endothelial layer of my arteries. I added that my very low hs C-Reactive Protein scores suggest that my arteries were not inflamed. I showed him my history of CRPs, and he did admit it was “impressive.” They had gone from 6.4 when I started very low carbing to a recent low of 0.1.
But then he said something that shook my faith that my new doctor and I were going to work out. He said, “The latest science is that all LDL are alike. They all get stuck. I asked him for a citation for that. I said I read a lot of medical journals and scientific papers – probably more than he did. He didn’t like that, and replied I did not. How can he know? Anyway, when I asked him later for the “LDL are all alike” citation, he replied, “Give it up!”
What I gleaned from this appointment is that Family Medicine MDs are trained to diagnose “incipient” Type 2 diabetes and treat it with pharmacotherapy. They’ve learned by rote the clinical definition of “diabetic” and “non-diabetic.” They know what Insulin Resistance (IR) is and believe it can be reversed, and “non-diabetic” status achieved, by weight loss alone. But this one doesn’t understand that THAT DOES NOT REVERSE Insulin Resistance

Retrospective #182: Avoiding “incident” Type 2 diabetes

What is “incident” Type 2 diabetes? The medical definition is the diagnosis and first intervention for the medical condition Type 2 diabetes mellitus. In clinical practice, “incident” diabetes is generally still defined as two successive office visits with fasting blood glucose (FBG) readings of ≥126mg/dl or a single A1c ≥6.5%.
The American Diabetes Association standard for diagnosing incipient Type 2 diabetes has changed over the years and continues to be controversial. In 1997, the FBG threshold was lowered from 140mg/dl to 126mg/dl. In 2009, the inexpensive A1c test, which measures the percent sugar on the surface of red blood cells (whose life is 2 to 3-months), became the new standard, and the A1c incident diagnosis criterion was lowered from 7.0% to 6.5%.
The A1C blood test is now the preferred method because it simulates the continuous level of glucose circulating in our blood, including the “excursions” (spikes) in postprandial blood sugar levels after eating meals and snacks. This “averaging” method is a more accurate measure of insulin resistance (IR) when “challenged” by a carbohydrate load. Insulin Resistance is the underlying mechanism responsible for high blood sugar (Type 2 diabetes).
Most clinicians still follow the guidance of the American Diabetes Association and strive, initially thru “lifestyle intervention” and then pharmacotherapy, to maintain a patient’s A1C at 7.0mg/dl. That translates to an estimated Average Glucose (eAG) of 154mg/dl and assures that the disease, and the pharmacotherapy, will be progressive. That means, eventually, that complications and co-morbidities like cardiovascular disease, kidney disease, neuropathy and retinopathy, are inevitable. In clinical practice most practitioners are complicit in the sense that their hands are tied by “Guidelines.” I don’t mean self-interest, but the trail of breadcrumbs tells a cautionary tale.
Quest Diagnostics lab reports state the current A1C “reference intervals,” as published annually in Diabetes Care, the Journal of the American Diabetes Association, are a guide to the diagnosis of incident Type 2 diabetes. They are:
< 5.7%           Decreased risk of diabetes
5.7-6.0%       Increased risk of diabetes
6.1-6.4%       Higher risk of diabetes
≥6.5%            Consistent with diabetes
A plain speaking translation of this very lax ADA standard for “incident Type 2 diabetes” is : ≥6.5% = You’ve got Type 2 Diabetes, period; 6.1-6.4% = You’re Pre-Diabetic; 5.7-6.0% = You’ve got “impaired glucose tolerance” (IGT); and <5.7% but rising = you’ve got “impaired fasting glucose” (IFG). In each case, it is telling you that you are Insulin Resistant (Carbohydrate Intolerant), and you’ve lost beta cell function, i.e., your ability to make your own insulin.
These stages are the “Natural History of Type 2 Diabetes.” They are described more fully in Retrospective #99, which is based on Dr. Ralph A. DeFronzo’s Banting Award Lecture at the ADA’s 2008 convention.
In the full paper published in the ADA Journal, Diabetes, Dr. DeFronzo says, “In summary, our findings demonstrate that, at the stage of IGT, individuals have lost over 80% of their β-cell function…” In the next section, “Pre-Diabetes,” he adds, “The clinical implications of these findings…are that the physician must intervene early, at the stage of IGT or IFG, with interventions that target pathogenic mechanisms known to promote β-cell failure.”
As a physician/researcher, Dr. DeFronzo cannot be faulted for advocating that “the physician must intervene early.” But how about the patient? The intervention that best targets the mechanism that kills beta cells is dietary. Eating carbs forces the pancreas to work. As you reduce carbohydrates, you spare your pancreas. It’s that simple, folks.
“Lifestyle interventions” can work, but not if the dietary message is wrong. Dietary changes, if initiated and continued by the patient, if the changes are the right ones, will work. If you eat right, in a way that spares your pancreas, it will allow you to burn body fat for energy and maintain stable blood sugars. That “right” Way of Eating is Very Low Carb. Reading this blog, for your amusement/edification, is a far better “lifestyle intervention,” IMHO.

Retrospective #181: The AHA/ACC Statin Guidelines and Type 2 Diabetes

In Retrospective #180, the 3rd category for individuals who should be on a statin, according to the American Heart Association/American College of Cardiology cholesterol guidelines, are the following individuals:
“Those with diabetes aged 40 to 75 years with LDL between 70-189mg/dL and without existing heart disease.”
That’s me, sort of, although I’m now 78 years old. My most recent LDL cholesterol (Martin Hopkins calculation) was 92. Never mind that my HDL was 80 and my triglycerides (TG) 56 and my total cholesterol (TC) was 186mg/dL.
As an important aside, though, I wonder, at my age (>75yo), with the Medicare budget cuts (+/-$750 Billion over 10 years) that were required to fund the Affordable Care Act, aka “Obamacare,” does the medical establishment just turn me out to pasture, as they would in most of Europe? Have I lived, in the government’s judgment, a useful but long enough life? Would I be just left, without treatment, to slowly dissipate…then die of “natural causes?” I ask because category #3, “those with diabetes,” is the only category with age guidelines for statin treatment.
But my issue with category #3 is with the phrase “those with diabetes.” Even Ann Peters, MD, writing about “How do New Statin Guidelines Affect Diabetes Care?” for Medscape Medical News, had to “ponder these guidelines” that “lump people with type 1 and type 2 together.” “I don’t think that type 1 and type 2 diabetes share similar features, at least not similar features with respect to the metabolic syndrome in all patients.” She treads lightly here, but I get her point. The clinician in practice needs to consider their individual patients. Bravo, Dr. Peters!
Dr. Peters describes herself “as one of the authors of the new diabetes position statement on the treatment of hyperglycemia” and “a diabetes specialist.” So, she is a fixture of the medical establishment, with a distinction:
“So, I think I will still monitor lipid panels. Perhaps not for absolute numbers, but to see that a patient is responding to therapy -- maybe as a marker for the fact that my patients are taking their therapy, and also to reinforce patients with some of the benefit from the treatments and lifestyle changes they have made, which I think can still be had along with the use of statin therapy in these high-risk individuals.”
“High risk individuals”? That’s how ALL diabetics are categorized by both these new statin guidelines and Dr. Peters. That includes not only type 1s, but ALL Type 2s as well, regardless of “the benefits of the treatments and lifestyle changes they have made.” By “treatments” Dr. Peters means drugs. And by “lifestyle changes” Dr. Peters means “diet and exercise,” although certainly not the very-low-carb, high-fat (VLCHF) Way of Eating that I espouse.
The medical establishment’s justification for this all-inclusive position for all diabetics is that, as Dr. Peters explains, “…regardless, [all] patients with diabetes are considered to be at high risk.” Thus, “Depending on their 10-year risk for an event, whether or not it’s greater than 7.5% (see category #4 in #180), they are all put on statins if they are between the ages of 40 and 75.” After age 75, in time, with standard nursing home care, they will be injected with basal and mealtime insulin and allowed to die of some other cause, such as heart disease or dementia.
In contrast, by eating a Very Low Carb diet, patients who have well-controlled Type 2 diabetes will have very good A1c’s, with stable blood glucose all day long, low blood pressure, low systemic inflammation, and great lipids including high HDL and low triglycerides, all without “taking their therapy”…since medical treatment for hyperglycemia will be unnecessary and unwarranted. But this doesn’t occur to Dr. Peters because her clinical practice is for people who need a “diabetes specialist.” If you treat yourself by the dietary choices you make, you will not need a diabetes specialist.
If, however, you’re a Type 2 and you follow the Lifestyle Modifications that accompany the new AHA/ACC Cholesterol Guidelines, your diabetes will be progressive as you “…consume a dietary pattern that emphasizes intake of vegetables, fruit and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts, and limits intake of sweets, sugar-sweetened beverages and red meats, ” with  emphasis on lowering saturated fat and sodium intake. And you will need a diabetes specialist… and a cardiologist too!

Thursday, August 15, 2019

Retrospective #180: The AHA/ACC Cholesterol Guidelines

In late 2013, the American Heart Association and the American College of Cardiology (AHA/ACC) issued a new set of cholesterol guidelines that is proving to be as disruptive as the Affordable Care Act (Obamacare). In fact, it is so much so that Medscape Cardiology issued a Special Report titled, “CV Risk Calculator and Guidelines Controversy.” It has six separate links to “News” and six more to “Experts Weigh In.” That’s way too much information for here.
So, succinctly put, what are the new cholesterol guidelines? And what’s all the stir all about?
The main recommendations are that individuals who fall into any of the following categories should be on a statin:
1.      Those with existing heart disease.
2.      Those with LDL levels above 190mg/dL
3.      Those with diabetes aged 40 to 75 years with LDL between 70-189mg/dL and without existing heart disease.
4.      Those without heart disease or diabetes, with an LDL between 70-189mg/dL and as estimated 10-year heart attack risk of above 7.5%.
The above bullets and the following analysis were provided by Ronesh Sinha, MD, at South Asian Health Solution.
“When comparing the old guidelines to this one, the first 3 categories are essentially unchanged. Most doctors would put heart disease patients, diabetics and those with LDLs above 190 mg/dl on statins. There are some advantages to the newer guidelines:
·         The focus of therapy is on statins, which are the default drug of choice. This is a good thing for those who truly need statins and should hopefully avoid cumulative toxicity from multiple drugs.
·         The concept of treating to a specific LDL target number has been eliminated. This is good since it should reduce unnecessary high dose statin therapy to reach low targets which have not been proven to reduce heart attack risk.
·         These guidelines do a better job of highlighting statin adverse side effects which will hopefully make clinicians think twice before pulling the statin trigger.
·         Greater overall emphasis on heart attack risk rather than a focus on the LDL number which makes more sense.”
Dr. Sinha’s main criticism is of the guideline’s 4th category: individuals who have no risk factors other than a 10-year heart attack risk above 7.5%. This is significantly lower than the prior cutoff of 20% and will result in many more people taking statins. Many more! And that’s actually an understatement. I recently saw an interview of a healthy individual on TV in which the doctor said to the 38-year old male, “In 2 years [when the patient achieved the category #3 threshold age of 40], you’ll be on a statin.” So, I decided to apply the “risk calculator” to myself.
The “risk factors” that are the sole basis of the 10-year heart attack risk are: Sex, Age, Race, Total Cholesterol, HDL-Cholesterol, Systolic Blood Pressure, Treatment for High Blood Pressure, Diabetes, and Smoker. I plugged my data into the new risk calculator and came up with a 10-year risk of atherosclerotic CVD of 28.1% (vs. 7.5%). Wow!
Then, I decided to see what I could do to lower my risk.  Age, sex, race were not things I could change. Neither could I improve my systolic blood pressure (110) or my diabetes (yes), treatment for hypertension (yes) or smoking status (no). And my HDL (85) was already outstanding. So, for me, that left only lowering Total Cholesterol (TC) and, using the Friedewald formula, the calculated LDL value. Quelle surprise! That’s what a statin does. So, I decided to ‘prescribe’ a statin for myself to lower my LDL and thus TC cholesterol by 50mg/dL, easily achieved on a statin. That would lower my LDL to 72, aligned to the goal of 70. Result, my 10-year risk of ASCVD was reduced from 28.1% to 25.3%. Hmmm… That reduction, even while taking a statin, was disappointing, to say the least.
Turns out, the only thing I could do that would lower my 10-year risk factor to 8% (near the 7.5% goal), was to lower my age 15 years. Otherwise, if my doctor followed these new guidelines, I would be on a statin.  No way, Jose! Fortunately, my doctor doesn’t follow the 40-year old rule, but your doctor may. Do you see where I’m going?

Wednesday, August 14, 2019

Retrospective #179: Vitamin D Supplementation

Supplementing with Vitamin D has become all the rage in recent years, but “Low concentrations of 25-hydroxyvitamin D (23[OH]D) are most likely an effect of health disorders and not a cause of illness,” according to a piece in Medscape Medical News.  The article reported on a “comprehensive review of observational studies and randomized clinical trials of Vitamin-D status and health outcomes” and appeared in Lancet Diabetes & Endocrinology. The author provided a link to a large-cohort study that had shown “strong associations” of low Vitamin D Concentrations (<30nmol/L) with all-cause, cardiovascular, cancer and respiratory disease mortality.
Vitamin D is an odd bird sort of “Vitamin.” It is not, strictly speaking, an essential Vitamin because, according to Wikipedia, it can be “synthesized in the skin, from cholesterol, when sun exposure is adequate.” However, people who live further from the equator get less exposure to the sun’s rays in winter. And people who work indoors get even less exposure. Plus, out of concern for skin cancer, many people block sun exposure with lotions. Finally, the elderly (mainly women), and others with limited mobility, have less opportunity to get Vitamin-D by natural means.
So, according to Wikipedia, “like other compounds called Vitamins, in the developed world, Vitamin-D is added to staple foods, such as milk, to avoid disease due to deficiency.” So, the Medscape piece said, the enthusiasm for Vitamin-D supplementation has been fueled by its “relatively low toxicity, the glimmer of positivity from some trials, and the large body of evidence from prospective observational studies.” In addition, the Vitamin-D supplement industry, and the artificial UV tanning industry have all helped fuel the enthusiasm.
Medscape related, “The new analysis showed moderate to strong associations between lower concentrations of 25(OH)D and higher risk of conditions from cardiovascular disease to infectious disease, glucose metabolism disorders, and mood disorders.” “The discrepancy between observational and interventional studies suggests that low 25(OH)D is a marker of ill health.” Quoting the Medscape piece, “In the interventional studies, participants had a baseline mean 25(OH)D concentration of less than 50nmol/L. Supplementation with 50µg/day of Vitamin D resulted in no significant improvement in health status.” Unit conversion: 50µg/day = 2000 iu.
This Medscape excerpt also addresses the effect of Vitamin-D supplementation’s on diabetes and cancer.
“As part of their review, the authors…conducted a meta-analysis of 16 trials that focused on the effects of Vitamin-D supplementation on HbA1c, the standard measure of long-term blood glucose control in diabetes. Although the observational studies showed an association between Type 2 diabetes and low Vitamin-D levels, supplementation with the Vitamin had no effect on reducing HbA1c.
The data also showed that high 25(OH)D concentrations were associated with a protective effect on colorectal cancer, but not other cancers. However, 2 large intervention trials showed no reduced risk of any cancers, including colorectal, with Vitamin-D supplementation.
One exception was seen in the elderly population (mainly women), who showed a slight reduction in all-cause mortality if they received Vitamin-D supplementation of 20 µg/day (= 800 iu). However, the authors say that the improvement could be related to Vitamin-D deficits caused not directly by the illness itself but by lifestyle changes resulting from the illness, such as a lack of mobility, restrictions on exposure to sunlight, or dietary modifications related to treatment.
‘In elderly people, restoration of Vitamin-D deficits due to aging and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival,’ they suggest.”
Medscape reports, “The authors speculate that a key mechanism that causes lower 25(OH) D concentrations in people with illness is disease-related inflammation.” “Ongoing trials will provide more information, but in the meantime (we) advise against Vitamin-D supplementation. In addition, says an author, “If an individual’s Vitamin-D concentration falls below a ‘sufficiency’ threshold of 75nmol/L, supplementation (is) an ill-advised practice.” “The wealth of evidence from randomized trials shows that this medical behavior is not grounded, and taking Vitamin-D supplements will make no difference in health status.” “It would be wiser to seek reasons underlying the low Vitamin-D level, such as inflammatory processes, or undiagnosed cardiovascular diseases, and fix them.

Tuesday, August 13, 2019

Retrospective #178: “Diabetes Rocks!”

The late David Mendoza wrote a nice article for Health Central in 2014 titled “Grateful for Diabetes.” Another one that month was titled “Diabetes without Drugs.” Both were excellent and short, and I recommend you search for and read them. But my favorite line from both was the last words of the “Grateful” piece: “Diabetes rocks!”
Mendoza explains “grateful” this way: “Knowing that we have diabetes can be good for us. You may think I’m crazy,” he says, “but some of us are thankful that we have diabetes. I wish all of us could share this feeling.” Note: it is actually the feeling that he is grateful for, not the diabetes. It is his reaction to the knowledge that he is a diabetic. But, having that knowledge, what action was taken? Mendoza explains it with a story:
“Mary Ann wrote me a few months ago that when a doctor told her she had diabetes, she didn’t know anything about it. At first, she felt shock, fear, anger, and grief. Then, she realized that she ‘had to be the one to take control of it’ and went on a low-carb diet, which helped her both to lose weight and to reduce her blood sugar. ‘I’m actually grateful for the diabetes diagnosis,’ she told me [Mendoza]. It inspired me to take control of my health’’’ (emphasis mine).
Mendoza then goes on to describe how, “Mary Ann’s journey from a diabetes diagnosis to good health parallels his own journey” (and mine). At the time he was diagnosed, he says, “I had an A1c of 14.4, weighed more than 300 pounds, and lacked energy.” “Today,” he says, “I tested my A1c…and found it is 5.4. I weighed myself, as I do every morning, and found that I now weigh 155.6 pounds. I have more energy than I had 20, 30 or even 40 years ago.”
Isn’t that inspirational? Do you understand now why David Mendoza, and I, say, “Diabetes rocks!”?
In “Diabetes without Drugs,” Mendoza tells more of his personal story. The lede of this piece in Health Central, and on his own website, says flat out, “If you have Type 2 diabetes, you can manage it without any drugs.” Mendoza doesn’t pull his punches. This is an unqualified statement, and he is an exemplar, to be sure. I wish I did as well.
David Mendoza was diagnosed a Type 2 diabetic in 1993. He was treated by his doctor in the orthodox way for 14 years, with “experience taking a wide range of diabetes drugs, including two different sulfonylureas, Glucophage (Metformin), and Byeta” (a GLP-1 injectable incretin mimetic). Then in 2007, with encouragement from a friend who is a Certified Diabetes Educator, he joined “a group,” “and for the past six years I haven’t taken any diabetes drugs, and yet I keep my diabetes in control with an A1c level usually about 5.4. When you manage your diabetes well, it [your A1c] is well controlled. It is normal. We know that the normal A1c is 6.0 or below.”
“An A1c level of 6.0 or below means that your diabetes is in remission,” Mendoza says. “It does not mean that you have cured it. If you relax your vigilance, your A1c level will go above 6.0 again, and you will again put yourself at risk of the terrible complications of uncontrolled diabetes.”
Mendoza doesn’t explain in this piece what “the group” he refers to was, but I’ll venture a guess it was a group of people who were motivated to be educated and seek mutual support to, among other things, undertake a Very Low Carb Way of Eating. “Any lifestyle change this fundamental is difficult,” Mendoza admits. “I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways.
The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had 1) to lose weight, 2) eat fewer carbohydrates, and 3) exercise more.”
As my readers know, my story is similar to Mendoza’s. I was diagnosed in 1986 and treated in the orthodox way with oral meds (3 classes, maxed out on 2)) for 16 years until my doctor suggested I try Very Low Carb (20 net carb grams a day) to lose weight. I had to drop the meds immediately and lost (at one point) over 180 pounds. My latest A1c was 5.6, but it has been as low as 5.0%. But I don’t do regular exercise. It makes me sweaty and hungry. LOL

Monday, August 12, 2019

Retrospective #177: The ADA’s Helpful Advice?

Readers here are accustomed to me slamming the ADA for their Type 2 diabetes treatment protocol (except when I am singing their praises as in “Cowabunga, the ADA makes the turn”). So, if you’ve had enough of that, read their magazine. That’s what I was doing in the doctor’s waiting room the other day when I came across this dreadful advice in a feature called, “Mail Call: Ask the Experts.” It was in a 2011 issue of the ADA’s Diabetes Forecast.
The reader wrote that she had recently been having “morning” (fasting?) readings in the 150-180mg/dl range and “…I cannot get them down.” She wanted desperately to know what was happening and what she could do about it. She explained that she was already taking two types oral diabetes meds, metformin and glipizide, a sulfonylurea. The response came from ADA expert Belinda Childs, ARNP, MN, BC-ADM, CDE. (Whew?)
The ADA’s expert told the letter writer (and all readers of this, the ADA’s official outreach organ, intended to educate the Type 2 diabetic population): “Type 2 diabetes is a progressive disease,” and “over time the body is less able to produce insulin. As your body’s needs change, additional treatments may be needed.”
Then, almost the entire balance of her reply to the letter writer was seven paragraphs describing in detail, by brand name, each of the classes of oral and injected diabetes prescription medications which were still available for her physician to prescribe as her disease “progresses” to becoming, ultimately, an insulin-dependent Type 2. That was it. Not a word about food choices, or carbohydrates. Just leave your diabetes care to your doctor and Big Pharma.
Of the magazine’s 80 pages, 28 pages (35%) were devoted to advertising, most of that for prescription meds. My observation is purely associative, though; it does not prove causation. Perhaps a randomized controlled trial might test the hypothesis that the expert advice given, and the medical advertising accepted, has a direct relationship. How about publishing the magazine without any pharmaceutical advertising, with just content advocating medical treatment? As a control, publish an edition in which the content recommends that Type 2 diabetes be treated by food choices alone, one edition with and one without big pharma ads. Do you think this ADA rag would survive?
The primary mission of the ADA and Big Pharma is their mutual survival. They need to sell ads to Big Pharma. To prosper, they must keep the pharmaceutical companies and the doctors who write the prescriptions happy. And doctors need to keep the patient dependent on medications too. How else can your doctor keep you coming back, besides saying, “Eat less (of a low-fat, high-carb diet) and exercise more”? Especially since that dietary prescription doesn’t work! Come to think of it, the last thing my doctor asked me recently was, “Need any renewals?”
The ADA’s Diabetes Forecast magazine masthead tells me the story of the ADA itself. There’s an MD in charge of “Medicine and Science,” and an RN, MSN, in charge of “Health Care and Education.” Other than that, all the other ADA officers are MBAs, CPAs, or without specialized credentials. The ADA magazine’s Editor-in-Chief and Associate Editors all have medical or related credentials. They also have an editorial board, on which our “expert” serves.
The ADA’s “Our Mission” statement on their masthead page has 3 high-sounding but rather limp tenets, especially #3: “The American Diabetes Association recommends that consumers familiarize themselves with nutritional information about food products.” That sounds to me like I am not the first to rail and foment about their mission.
Perhaps this is simply the natural history of any non-profit organization. See, for example, the “Illustrated History of Heart Disease: 1825-2015” timeline on the Diet Heart Publishing website: “In 1948 the AHA reinvented itself as a fundraising organization.” The parallels with the ADA are similarly disturbing. I think the list of corporate donors to the ADA, at, will help you understand why I view any medical advice coming out of the ADA with the contempt I think it deserves.
The ADA’s RDs and CDEs, as I reported in “Cowabunga…” have made the turn. It remains now only for the ADA’s medical side to have a similar awakening. I am dubious that they will though, given where their “bread is buttered.”