Some Companies Say They Can Reverse Diabetes: They Can’t!
Take Metformin Even if Your Sugar is In the Normal Range if You Ever Had Type 2 Diabetes
Don’t you believe it. Over the last few days, I have been posting threads concerning diet, food, and their impact on type 2 diabetes and prediabetes. This much is true. Diabetes is a food disease. Weight, sugar, and carbohydrate content in your diet matter. Diabetes is diagnosed based on sugar levels. The most used criteria is a fasting glucose of 126 or higher.
When people say they can reverse diabetes, they mean they can reduce your fasting sugar to less than 126 fasting off medication. Weight loss reduces insulin resistance and if you lose enough weight, you can reduce your sugar below that level. If you think of type 2 diabetes as purely a sugar disease, that makes sense, but we know that understanding does not reflect the most recent research on of how diabetes works. Patients with type 2 diabetes, don’t die of the high sugar. They die of heart attacks, strokes, and an increased risk of cancer. Reducing the sugar to normal is beneficial but it does not dramatically reduce the risk. Other factors are involved.
Clinical trials designed to reduce heart attacks, strokes, and premature death from type 2 diabetes by reducing the sugar to near normal have uniformly failed. In fact, two out of three large trials designed to reduce the number of heart attacks, strokes, and deaths by reducing the sugar resulted in more deaths than less aggressive glucose treatment. That is because the same biology that causes high sugar also causes heart attack, stroke, chronic kidney disease, cancer, and death. Lowering the sugar is just part of the puzzle. Solutions that address the underlying biology can have a big impact.
Metformin directly interferes with the biology that causes diabetes, vascular disease, and cancer. Metformin reduces the risk of a heart attack by 40% compared with reaching the same glucose level by other treatments. Metformin directly inhibits the same master metabolic switch as the medication in the heart artery stent that slowly leaks out to keep it open. Jardiance, another diabetes drug lowers the sugar and helps patients lose weight. It reduces heart failure and chronic kidney disease progression whether patients are diabetic or not. It impacts the same underlying biology as metformin. Lisinopril, losartan, spironolactone, and eplerenone for blood pressure impact this same biology. Statins and aspirin do the same thing. Diet, exercise, and these medications don’t just lower the sugar, they protect your cells and organs.
When you combine these factors with diet and exercise to provide optimal medical treatment heart attack, stroke, mortality and progression to heart failure and dialysis are dramatically reduced. Life is prolonged and cardiovascular events are delayed by 8 years. Those who claim to reverse diabetes cannot produce evidence of those benefits and that is all that matters.
The reason optimal medical treatment is so much better is the new science. Now we know eating too much and adding abdominal fat persistently switches on genes that should be switched off. Those changes in genes begin in children who eat too much and gain weight. This fact is especially important because those gene changes are passed on to the next two generations. Those switched-on genes make it more likely that the child and his children and grandchildren will develop diabetes or have a heart attack.
Patients with diabetes have high glucose levels. Short periods of high glucose switch on genes that should be switched off. High glucose itself accounts for only about 25% of diabetic complications. Fairly brief periods of high sugar switch on genes that lead to heart attack, stroke, and chronic kidney disease. Those genes stay switched on even when the sugar returns to normal. These are genes that cause inflammation, scar tissue formation, and kill the functional cells in vital organs. We have known about a phenomenon called “metabolic memory” for a long time.
Early aggressive optimal medical treatment of diabetes early in the disease continues to provide benefit years later even when optimal treatment is later also provided to the comparison (or control) group. That is probably because early aggressive optimal treatment slows down the accumulation of damaging genes that are switched on. It’s a gift that keeps on giving.
If you look at the diagram that comes with this post, the molecules in the red boxes are switched on by poor diet and abdominal fat. The genes that produce these products remain switched on when the sugar returns to normal. The medicines in the green boxes block the effects of those genes. They keep you healthier longer. The dangerous complications of diabetes are mostly related to these genes. That is why you should not stop these medications when your sugar becomes normal. These medications block the effect of activated genes that damage the heart, liver, kidney, and brain.
If your blood pressure becomes normal, you should stay on some dose of lisinopril or losartan. If you are a diabetic and your cholesterol becomes normal, you should stay on some dose of a statin. If your sugar becomes normal you should stay on some dose of metformin. I have prediabetes, high blood pressure, and a 20% blockage in a heart artery. I take losartan, atorvastatin, and metformin faithfully. My pressure is 115/70. My bad cholesterol is 55, and my latest fasting sugar is 85. I would not think of stopping any of it.
“Reversing diabetes” does not remove the risk of diabetes and we should do away that that phrase altogether because it is wrong—too often dead wrong.
Bill, what do you think of the effects of Berberine? Any good?