Wednesday, February 4, 2015

The Nutrition Debate #285: “When diet and exercise aren’t enough…”

The copywriter should get a raise, or at least a bonus. This statin drug’s advertising slogan is the very definition of a red herring: an “idiom…used to refer to something that misleads or distracts from the relevant or important issue. It may be either a logical fallacy or a literary device that leads readers or characters towards a false conclusion.” Wiki goes on to say, “The expression is mainly used to assert that an argument is not relevant to the issue being discussed.”
If you’re reading this blog, you probably have been told by your doctor to “diet and exercise” to lose weight. And if you’re reasonably well read and up to date, you know that exercise is not an effective way to lose weight (in spite of all the TV advertisements). I’m not knocking exercise; both regular aerobic and anaerobic exercise have myriad health benefits, but reducing the unwanted body fat is not one of them. Besides, it makes me hungry and sweaty.
So, the slogan suggests that “when [assuming failure] diet and exercise aren’t enough” (and for most people who diet by following the government’s advice to eat a restricted-calorie, balanced, low-fat diet…and exercise as prescribed…it  is not enough), what’s a person to do? We lose a few pounds, are hungry all the time, and gain it all back. We’re desperate and depressed. We lack the “will power” to “eat less and exercise more.”  We are susceptible to almost any suggestion.
Well, folks, you’ve been set up. The ad goes on to suggest you should take a statin. And your doctor will surely suggest it, after noting in your chart that you have failed to lose weight by the “diet and exercise” prescription. And since the diet most doctors pitch is the one the AHA/ACC/AMA/ADA/USDA/HHS/ADM/Cargill/Quaker Oats and Kellogg’s recommends, you probably are suffering from co-morbidities and exhibit the risk factors collectively called the Metabolic Syndrome. (So much concensus, yet so little weight is lost!)
As with most people eating the Standard American or Western Diet, besides being overweight or obese, you probably have or are developing signs of hypertension (elevated blood pressure), and your Total Cholesterol is probably being described as “somewhat elevated,” and your fasting blood sugar may be “slightly high” (“We’ll have to watch that.”) What often isn’t mentioned is that your HDL cholesterol (HDL-C) is borderline low (≤40mg/dL for men; ≤50mg/dL for women) and that your triglycerides are borderline high (≥150mg/dL). 
 It’s this combination of “risk factors” that justifies, to the medical community, the statin prescription. After all, even though you’re taking your blood pressure meds, you’ve failed to follow doctor’s orders to lose weight by eating less (on a balanced low-fat diet) and exercising more; now it’s his turn to treat you effectively by simply writing a script. All you have to do is fill the prescription and take it faithfully. Your Total Cholesterol (TC) and LDL-C will go down, and your TC/HDL ratio (even though HDL-C is unchanged) will improve (because TC went down). And your doctor will chart that too.
And that’s the best that “medical science” can do for you, folks. “When diet and exercise aren’t enough…,” take another pill, in addition to the blood pressure pill(s) you already take. And note in the chart: 1) patient non-compliant with [bad] diet and exercise advice, 2) patient taking BP and cholesterol medications; 3) patient showed improvement in TC & LDL-C and TC/HDL ratio (no mention of  borderline HDL or trigs); and 4) follow-up visit for (pre-diabetic) fasting blood sugar.
Of course, so long as you eat a low-fat, high carb diet, your slightly broken glucose metabolism will get progressively worse. You will slowly continue to gain weight (because you glucose metabolism is broken, not because you are eating too much and exercising too little). Your fasting blood sugars will rise because of carbohydrate intolerance (a manifestation of Insulin Resistance). Your glucose metabolism has progressed through impaired glucose tolerance (IGT), to the impaired fasting glucose (IFG), what your tests are starting to reveal now.
Eventually, there is a strong likelihood that you will develop full blown type 2 diabetes. By then you will already have been started on metformin. Eventually you may work up to a cocktail of three pills for this condition alone. I did. Or maybe you’ll start with a SGLT2 inhibitor and/or a GLP-1 agonist or insulin injections. The last may be better for you, seriously.

And don’t forget the complications: microvascular (peripheral neuropathy, nephropathy, retinopathy), or macrovascular (CVD, MI, stroke). Or, you could just change your diet… Take charge of your health. I think HFLC could work for you, but regardless, try something. A change in diet can give you valuable information. There’s so little your doc can do; so much you can do for yourself.  A low-carb, high- fat diet is how I did it. If you’d like to see how diet can affect your health, or at least how it affected mine, please read The Nutrition Debate #281, #282 and #283 recently published on this blog.


  1. Dan, I look forward to reading your blog. I do want to remind you that there are people like myself who despite their best efforts find their diabetes progressing. I started Dr. B in 2006 and have worked hard to be very diligent, but diabetes is really complicated and despite my best efforts it has progressed such that I just don't even produce enough insulin. So these days I am on a full insulin regime and continue to use drugs like metformin to manage my insulin resistance.

    I totally agree with you that the boneheaded low fat, high carb calorie restricted diet leads the vast majority of people down a path that guarantees rapid progression in their diabetes. But that isn't the whole story as I'm sure you know.

    your friend


    1. Hi Brian,
      I get it. T2D IS a complicated disease, and many people do not respond to HFLC as well as I did. In fact, I'm consider myself VERY lucky that for the 1st 16 years after my diagnosis, I was in complete denial and left my diabetes management to doctors.

      That's sort of the motivation that I have for writing this blog. There are so many others like me who could avoid full development of the disease, even to diagnosis, and of course to progression, by eating LC. I believe they are the vast majority. Others will not be so lucky. That's got to be very frustrating to you and to people like Valerie who has also commented on several columns.

      I don't know how else to address the majority and motivate them, except to recognize and acknowledge that this WOE will not work for everyone...but it will for the vast majority of people who give it a solid try.

      And I'm sure you will agree, that the best thing that everyone can do is to keep their blood sugar in control. That YOU are doing much better than I...of that, I am sure. That is another reason I write this blog: to keep myself motivated!

      Your friend as well,

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