The Nutrition Debate #210: “Diet and Exercise May Help Prevent Diabetes” – Duh!

I couldn’t believe this headline in my Medscape Alert email, so I opened the link and read the lede: “NEW YORK (Reuters Health) – Lifestyle changes made by people at high risk of diabetes appear to reduce their chance of developing the disease over the next two decades, according to a study from China.” Well, I wasn’t mistaken. This revelation does appear to have been made by a group of doctors, albeit in China. But, that Reuters Health would pick it up and assign a reporter to write it up, and then to issue the story from New York, is utterly amazing to me.

Well, at least they didn’t waste newsprint on this groundbreaking news. The study was first reported online (payment or subscription required) in the April 3^rd (not April Fool’s Day) Lancet Diabetes and Endocrinology. And, there was an interesting aspect to the story: The original study began in 1986 and ended in 1992! In it, 568 people with “higher-than-normal blood sugar levels but not high enough to be diagnosed with diabetes,” were placed into one of three intervention groups (diet, exercise, or diet plus exercise), plus a control group. The current study, begun in 2009, compared medical records and death certificates of 430 participants and 138 controls.

The goal of the original researchers (in 1986) was meritorious: “Diabetes is strongly associated with the increased risk of cardiovascular event and mortality,” the lead investigator of the 2009 study told the Reuters reporter. “They wanted to see if lifestyle changes, which included diet modifications and exercise, would help lower death rates.”As it turns out, they did, and especially for women. But “because there are no data on people’s lifestyle habits during the (original) study period,” “it’s impossible to say…how the participants responded to the interventions,” the new study said. Oh, well. Who can say?

But wait, we do have some data on the diet intervention. It “was meant to help people lose weight and normal-weight people reduce the amount of simple carbohydrate [sugars] they ate and the amount of alcohol they drank.” The Chinese understood perfectly how to prevent diabetes and reduce the risk of cardiovascular disease in the 1980s. So, it is all the more bewildering to me that the lead investigator, a Chinese, would say today, “We have to do something active to delay the development of diabetes in high-risk populations.” How could that be any plainer? What is he unable to see?

The results of the 2009 study were impressive though. “By the end of 2009, they determined that 28% of the intervention group had died, compared to 38% of controls.” “Twelve percent of the intervention group had died of heart-related conditions, compared to 20% of controls.” And, “Almost all of the benefit was found in women – there was very little difference in death rates among men based on whether they went through one of the lifestyle programs.”

The Reuters piece also reported, “The researchers also compared diabetes diagnoses and found that 73% of the intervention group had developed diabetes through 2009,” a very high number indeed but still lower than the control group’s 90%. Reuters related that the Lancet piece reported, “Those finding were similar for men and women.”

Perhaps the biggest takeaway from this Reuters story, though, was this: “The group based lifestyle interventions over a six-year period have long-term effects on prevention of diabetes beyond the period of active intervention.” The lead researcher concluded, “It is worth taking active action to prevent diabetes to reduce the risk of cardiovascular disease and mortality.” Now, if only he could figure out what the action should be… Maybe there’s a clue in the paragraph above that begins, “But wait, we do have some data on the diet intervention.”

The first 3 comments on this online piece were “interesting.” The first, by a pharmacist, was “…and they discovered the warm water.” I’m not sure of the allusion, but I’m pretty sure the comment is intended as sarcasm. The second comment is from an advanced practice ob/gyn nurse. It is, “Oh wow, this is groundbreaking!” I’m almost certain (and hopeful) that this comment is pure mockery. The third comment was from a physician. It was, “Useful study.” If my impressions are correct, and I admit to a confirmation bias here, the pharmacist and the nurse are better informed about diabetes nutrition than the doctor. That, of course, is sad and all the more reason to lament the lack of nutrition education in medical school (see #208, “Teach Doctors Nutrition”), and the profusion of misinformation being disseminated by our government, the medical/big pharma cabal and the big food manufacturing industries in the world today.

Perhaps the value of reporting over and over again the self-evident truth about low-carb eating to lose weight and improve health outcomes has some value after all. Eventually, more and more doctors will open their minds to the science they should have learned when they were in school. I can hope, anyway…