What Doesn’t Work When You Treat Diabetes
In This Chapter
Recognizing the signs that a treatment won’t work
Identifying drugs, diets, and other treatments that don’t help
Everyone wants a quick and easy solution to their problems. For every problem, five people offer a quick and easy answer. Just send in the money. These cheats have got what it takes to take what you’ve got.
Being fooled by these claims may be a lot more serious for you than for the person who walked up to the man dressed as a polar bear who was promoting soft drinks in a shopping center. The first man said: “Don’t you feel foolish, dressed like a bear?” The “bear” replied: “Me, foolish? You’re the one talking to a bear.”
This chapter tells you as much as I know about diabetes tests and treatments that don’t work. Don’t expect to find every “wonder cure” for diabetes that you’ve read or heard about. As soon as this book is published, new, more seductive claims will be made. I hope that you will remain skeptical, use the information in this chapter to test claims out, and check with your doctor before you try something that may do more harm than good.
Developing a Critical Eye
Many clues can alert you that a treatment may not work. Here are a few:
If a treatment is endorsed by a Hollywood star or a sports figure, be highly skeptical. Always consider the source and make sure that it’s reputable. In this case, the fame of the star is being used to convince you, not any special knowledge that he or she possesses.
If the treatment has been around for a long time but is not generally used, don’t trust it. If a treatment has been around for a while and really works, it will have been tried in an experimental study where some people take it and some don’t. Doctors and medical texts recommend drugs that pass that test.
If it sounds too good to be true, it usually is. An example would be the claims about chromium improving blood glucose levels. The study that “proved” it was done on chromium-deficient people, a situation that does not exist in the United States.
Anecdotes are not proof of the value of a treatment or test. The favorable experiences of one or a few people are not a substitute for a scientific study. Perhaps those people did respond to the drug (or supplement or miracle cure), but it may have been for entirely different reasons.
A lot of information about diabetes is available on the web. In Appendix A, I provide the best resources currently available for diabetes from this amazing source. The same rules apply when you consider the validity of claims made on the web, with a few extra rules thrown in:
Don’t rely on search engines for validity. Search engines do not check claims for validity.
Go to the site of the claim and see whether most of the information there makes sense. If you find a lot of silly information, that should be a red flag. If you still feel the treatment might work, ask the webmaster (the person who develops the site) for references. If none are forthcoming, forget about the idea.
Go to sites that you know are reliable to see whether you can find the same recommendations. The treatments discussed on sites like the American Diabetes Association (ADA) and the Diabetes Monitor (see Appendix A) can be relied on. When a treatment’s value is uncertain, these sites can usually tell you the truth.
Go to medical conferences put on by reputable experts. You will be given web addresses that are reliable.
Identifying Drugs and Supplements That Don’t Work
In the past decade, so many drugs have been touted as the cure for diabetes that you would think everyone would be cured by now. The fact is, as I say again and again, you do have the tools right now to control diabetes, but the solution is not as simple as taking a pill. If it were, this book would not be necessary. In this section, I tell you about some drugs that have received unwarranted hype because they “worked” in a few people.
How the ADA labels new drugs
The American Diabetes Association evaluates new therapies and places them in one of four categories:
Clearly effective
Somewhat/sometimes effective or effective for certain categories of patients
Unknown/unproven but possibly promising
Clearly ineffective
If you’re about to try a new therapy that has not been recommended by your doctor and is not discussed in this book, you may want to contact the ADA and find out its position on the treatment. Of course, if you’re involved in a clinical trial that is trying to determine the effectiveness of a therapy, no one will know whether it works or not.
The Federal Trade Commission is concerned with all the phony “cures” for diabetes. They have set up a phony website called “Glucobate” that promises to be a cure for diabetes. When you click on “Order Now” they tell you about the hoax and offer tips to avoid being scammed, most of which you will find in this chapter.
If you participate in a clinical research study of a new drug, a system is in place to protect you. Make sure that the study has been approved by a review board in an institution that has been approved to do the research. Such institutions are usually accredited by an established organization like the Association for the Accreditation of Human Research.
See the sidebar “How the ADA labels new drugs” for information on how the American Diabetes Association evaluates new treatments.
Chromium
You can find articles singing the praises of chromium for controlling the symptoms of diabetes in all kinds of magazines and newspapers and on the Internet. Should you take supplements of chromium?
The strongest case for chromium comes from a study of people with type 2 diabetes in China. They were given high doses of chromium and were found to improve their hemoglobin A1c, blood glucose, and cholesterol while reducing the amount of insulin they had to take. However, these people were chromium deficient in the first place. People in the United States and other countries where the diet is sufficient in chromium do not have this deficiency and do not show improvement in glucose tolerance when they take chromium. In addition, chromium is present in such small amounts normally that it is hard to measure even in people without chromium deficiency.
The exact amount of chromium you need in your diet is uncertain but is estimated to be 15 to 50 micrograms daily. People who take much more than that tend to accumulate it in their livers, where it can be toxic. Some studies suggest that chromium can cause cancer in high doses.
For now, the evidence does not support the use of chromium in diabetes except for people who are known to be chromium deficient.
Aspirin
People who take the sulfonylurea drugs (see Chapter 10) sometimes have a greater drop in blood glucose when they take aspirin. This drop is because aspirin competes with the other drug for binding sites on the proteins that carry sulfonylureas in the blood. When they’re bound to protein, the sulfonylureas are not active; when they’re free, they are. Aspirin knocks the sulfonylureas off so that they’re free. As a result, aspirin has been recommended as a drug to lower blood glucose.
By itself, aspirin has little effect on blood glucose. Its effect with sulfonylureas is so inconsistent that it can’t be reliably depended on to lower the blood glucose.
Cinnamon
A number of articles in the medical literature since 2001 have suggested that cinnamon lowers the blood glucose in type 2 diabetes and improves fat levels as well. To verify these claims, a study called a meta-analysis was done and published in Diabetes Care in January 2008. In a meta-analysis, an analysis is done of all studies that are randomized so that the subjects don’t know if they are getting the drug or a placebo. In this case, none of five studies showed that cinnamon had a positive effect either on the blood glucose or blood fats. You may have noticed the same thing if you were taking a daily dose of a teaspoon of cinnamon. You can cease and desist!
Pancreas formula
Pancreas formula is sold on the Internet as a mixture of herbs, vitamins, and minerals that help diabetes. No clinical or experimental evidence shows that pancreas formula does anything of value in the human body. The claims that are made for this “treatment” are not supported by factual evidence.
Fat Burner
You may hear and read a lot of advertising for the Fat Burner product in reputable newspapers and on reputable radio stations. Advertisements claim that you can “burn fat without diet or exercise,” and they will even throw in, ABSOLUTELY FREE, a bottle of Spirulina to enhance your Fat Burner weight-control program. If you believe this is possible, I have a bridge I would like to sell you, cheap. In order to burn fat, you must exercise and stop taking in large amounts of carbohydrates or other sources of calories.
Ki-Sweet
The literature for Ki-Sweet offers another lesson in being skeptical. The creators of this “miracle” sweetener claim that it has a “special designation from the American Diabetes Association.” The ADA denies the claim, but how many people will buy something when they see ADA approval and not bother to see whether it’s true? No evidence exists that Ki-Sweet, made by squeezing the juice of kiwi, has any advantages over other sweeteners (which I discuss in Chapter 8).
Gymnema silvestre
Gymnema silvestre is a plant found in India and Africa that is promoted as a glucose-lowering agent as part of an alternative medical treatment called Ayurvedic medicine. Gymnema silvestre has never been tested in a controlled study in humans. One statement in its advertising is, “For most people, blood sugar lowers to normal levels.” No evidence exists that this is the case.
Avoiding Illegal Drugs
Drugs like cocaine, heroin, speed, and marijuana are not just illegal; they are especially harmful for the person with diabetes for several reasons:
Some make you excessively hungry, and you take in too many calories.
All cause you to lose your awareness of hypoglycemia, so you don’t treat it.
All cause a loss of judgment that results in the failure to take medications, eat properly, and exercise.
Some cause a reduced insulin response to food, so you become hyperglycemic.
Some cause you to lose your appetite, so you become hypoglycemic and malnourished with vitamin deficiencies.
Not a lot of valid information is available about each illegal drug’s impact on diabetes, because we cannot do studies where these drugs are given to one group of diabetics while a control group takes a placebo. But we do know the following:
Marijuana (grass, weed, bud, cannabis) causes increased appetite, which results in taking in too many calories.
Amphetamine (speed, Dex, crank) and ecstasy (derived from amphetamine and also called MDMA, E, X, adam, bean, and roll) increase the body’s metabolic rate, resulting in hypoglycemia because the user often does not eat properly and is unaware of the onset of low blood glucose.
Cocaine (coke, snow, nose candy, dust, toot) and freebase cocaine (crack, rock) lead to food deprivation, increased metabolism and caloric needs, and vitamin deficiency.
Heroin (dope, junk, smack) is similar to cocaine but has additional risks associated with injections, such as infection.
Do you need any more reason to get high on exercise rather than drugs?
Knowing the Dangers of Some Legal Drugs for Other Purposes
Just because a drug is legal does not mean it has no undesirable side effects. Several classes of drugs need to be used with caution. They may cause weight gain, prevent normal metabolism, and have many other effects that negatively affect your diabetes. This list is not exhaustive. One of the first places to look if you are doing everything right but still have poor control of your blood glucose is among the medications you take for other reasons.
Antipsychotics
In an issue of Diabetes Care (February 2004), four major medical associations warned that second-generation antipsychotic drugs, used to treat a variety of severe mental illnesses, can cause rapid weight gain, most of which is fat, leading to prediabetes, diabetes, insulin resistance, and abnormal blood fats.
The drugs differ in their risks, but clozapine (Clozaril, made by Novartis) and olanzapine (Zyprexa, made by Eli Lilly) appear to be the worst offenders. Other drugs named include risperidone (Risperdol, made by Johnson & Johnson), quetiapine (Seroquel, made by AstraZeneca), ziprasidone (Geodon, made by Pfizer), and aripiprazole (Abilify, made by Bristol-Myers Squibb).
If you are taking one of these drugs, ask your doctor to screen and monitor you for evidence of weight gain and insulin resistance. The benefits of taking the drug may outweigh the risks. In the article, the panel suggests that baseline screening consisting of a medical history and physical examination along with fasting glucose and blood fats be done before using the drug.
If you are overweight or obese, you should receive nutritional and physical activity counseling if you take one of these drugs. If you are at risk of developing diabetes, your doctor should use the drug that is least associated with this problem.
AIDS medications
Certain drugs that control AIDS, called protease inhibitors, block the body’s ability to store glucose, so people who use them may develop diabetes. More than 80 percent of the people who use them develop excess stomach fat, and half develop glucose intolerance. More than 10 percent develop diabetes. Table 17-1 shows the specific drugs with their brand names and manufacturers.
Table 17-1 Protease Inhibitors That Affect Glucose Metabolism
|
Generic Name |
Brand Name |
Manufacturer |
|
Saquinavir (hard gel) |
Invirase |
Hoffman–La Roche |
|
Saquinavir (soft gel) |
Fortovase |
Hoffman–La Roche |
|
Ritonavir |
Norvir |
Abbott Laboratories |
|
Indinavir |
Crixivan |
Merck |
|
Nelfinavir |
Viracept |
Pfizer |
|
Amprenavir |
Agenerase |
GlaxoSmithKline |
|
Lopinavir and ritonavir |
Keletra |
Abbott Laboratories |
|
Atazanavir |
Reyataz |
Bristol-Myers Squibb |
|
Fosamprenavir |
Levixa |
GlaxoSmithKline |
You should be screened before starting these drugs, and your doctor should monitor you carefully for weight gain and glucose intolerance. If diabetes does develop, the protease inhibitors are continued and the diabetes is treated. So far, none of the protease inhibitors stands out as more likely to cause diabetes.
Recognizing Diets That Don’t Work
For the overweight person with type 2 diabetes, any diet that causes some weight loss helps for a time. But you have to ask yourself these questions:
Am I prepared to stay on this diet indefinitely?
Is this diet healthy for me in the long run?
Does it combine all the features I need — namely weight loss, reduction of blood glucose, and reduction of blood fat levels — with palatability and reasonable cost?
If you can say yes to all these questions, the diet will probably work for you.
So how do you know which diets are healthy and effective, and which aren’t? First, take a close look at Chapter 8, where I discuss diet in much more detail. Next, develop a discerning eye for defects in the latest diet fads.
When you walk into a reasonably large bookstore, you may be overwhelmed by the number of diet books. But the more books that are written about this subject, the less we seem to know for certain. Why would authors bother to write dozens of new books on dieting each year if the solution rested in some older book? You can bet that word of mouth would have made that book the all-time bestseller in any category.
The diet books in print these days are way too numerous to list here, but they can be grouped into a few categories:
Diets that promote a lot of protein with little carbohydrate: The trouble with these diets is that they’re not a healthy and balanced approach. Unless you use tofu as your source of protein, you will be getting a lot of fat in your diet, much of it saturated fat, which is not good for you. The diet is lacking in vitamins that a supplemental vitamin pill may or may not provide. Few people stay on such a diet for long. How many people can eat chicken for breakfast, lunch, and supper? The diet is also lacking in potassium, an essential mineral.
People who do follow this kind of diet for a long time also find that they have problems with hair loss, cracking nails, and dry skin. Their breath and their urine smell of acetone because of all the fat breakdown. They become very dry and need to drink large quantities of beverages.
I see a place for this diet as a starter. Some people with type 2 diabetes who have high blood glucose levels show rapid improvement when started on a diet like this. As the glucose comes under control, the diet can be changed to a more balanced one.
Diets that promote little or no fat: The people who can follow a diet that is less than 20 percent fat deserve a new designation — fatnatics. This kind of diet is extremely difficult to prepare and perhaps even more difficult to eat unless you’re a rabbit. In order to make up the calories, people on this diet eat large amounts of carbohydrates. Chapter 8 makes it clear why this is not a good idea for people with diabetes.
Like the protein diet, this diet may be lacking in essential vitamins and minerals, especially the fat-soluble vitamins. Rarely do people stay on such a diet after they leave the confines of a spa or other sanctuary where the diet is promoted. However, this approach may also be a good way to start a dietary program for a person with type 2 diabetes, as long as the total calories are not greater than the daily needs of that individual.
Very-low-calorie diets: These diets require taking in food and drinks that contain less than 800 kilocalories daily (and generally do not taste very good). They are lacking in many essential nutrients and must be supplemented by vitamins and minerals. This approach cannot form the basis of a permanent diet because the dieter would eventually become emaciated. Most dieters who start this kind of program do not last on it and regain every ounce they have lost and then some. (There are always exceptions, of course.)
I do not like this kind of diet even as a starter diet because it is so unlike usual eating habits that people rapidly find it to be intolerable. Eating is a basic part of human existence, and it’s a source of great pleasure for people and other animals. A diet that takes away this fundamental activity cannot be tolerated for very long.
The transition from a very-low-calorie diet to a balanced diet is very difficult and rarely succeeds.