Controlling Blood Sugar - Or Not (February 10, 2015)
First I wish to apologize for a big mistake. The fasting blood sugar levels I identified last week as normal, pre-diabetic and diabetic were incorrect. Those definitions have changed since I went to school back in the Bronze Age. The upper limit for normal fasting blood glucose is now 100-110 mg/dL. And the diabetic range is now above 126 (previously 140).
This kind of change happens very often in medicine, and usually it is for good reasons. If you want to be able to predict which people might develop a particular problem down the road, it can help a lot if you can precisely identify some characteristic (like the level of a substance in the blood) that they have in common. And it’s even better if this characteristic is something that, if fiddled with appropriately, helps prevent that problem from developing. That's supposed to be the reason for labeling people with fasting blood glucose between 100 and 126 as pre-diabetic and then treating them with drugs intended for diabetics.
Possessing a trait that predisposes you to a particular condition does not automatically mean that changing it will keep you safe from it. Therein lies one of the big problems with modern American medical practice, particularly with its pharmaceutical branch. Example: High LDL cholesterol is something that you see in people who are very likely to develop cardiovascular disease. And if someone has already had a heart attack, lowering LDL with statin medications also lowers the chance of a second heart attack. But there is no real evidence that lowering LDL levels with statins BEFORE you have heart disease means you won’t develop it. And this remains true despite the wholehearted yearning and investment of many billions of dollars by pharmaceutical companies over many decades to try to prove otherwise. Of course, many doctors prescribe statins to all and sundry anyway. That is why it pays to be educated and ask questions of your doctor to see if s/he is really on their toes.
But getting back to blood sugar levels, “pre-diabetes” is a modern classification that didn’t even exist until the American Diabetes Association (ADA) created it on the advice of its drug-shill-laden expert committee in the late 1990s, in effect creating a whole new disease category for people who up until then were simply told to quit eating so many donuts. It This would be a good thing if there was something about this action that improved the health of anyone or anything except Bristol-Meyer Squibb’s bottom line.
When a few years later the ADA then lowered the highest fasting blood sugar level you could have and still be considered normal to 100 (WHO thinks that it is more like 110), it almost doubled the number of Americans with pre-diabetes. (They did a similar thing with the blood levels for Hb A1c, incidentally, with no more evidence to support that than the other.) This puts a THIRD of adult Americans into the category of “pre-diabetic” and they can now be terrified into taking medication that doesn’t really help anything for a condition that doesn’t really exist in hopes of preventing another condition that they may never get anyway.
You can metformin the heck out of people with highish-but-not-yet-diabetic blood sugar and although it and its partners in crime will dutifully lower blood sugar levels, they seem to do very little if any good in terms of staving off diabetes or any of its complications. Certainly they give nowhere near the benefits that could be gained from diet and exercise. (This is probably at least partly because the actual reasons for high blood sugar can vary considerably from person to person, and why diet and exercise are so much better than taking medication.) Plus now you’re being subjected to the possibility of some very nasty side effects, spending all kinds of money, neglecting to make lifestyle changes that indeed MIGHT prevent diabetes, and helping to poison the fish in Lake Michigan with pharmaceutical runoff.
If your fasting blood glucose is no higher than 100, you’re golden. If it’s under 110, the World Health Organization thinks you’re still fine. If you’re over that but not yet diabetic at 126, you’ve got a lot of company – like HALF the adults in China. How sick are you really? Should you worry? Probably a little – enough to start exercising regularly and get your weight down, anyway.
Is there anything else you can do to lower blood sugar, like take a supplement or eat a particular food? There are a bunch that seem to have some beneficial effects on blood sugar, including some chinese herbs, although none of them have been evaluated to the point that they can be conscientiously recommended for that purpose. In my opinion, at least.
But there ARE things you can swallow, or not swallow, that may be of some benefit in helping to stave off diabetes, and that you may want to look at more closely. Especially if you’re already of normal weight and exercising regularly but still have that highish fasting blood sugar that is ominously termed “pre-diabetic”.
Carbohydrates. It kills me to say this, but there is no real evidence that eating processed junk affects your blood sugar in the long term. There are lots of other reasons not to eat sugar and refined carbs, among them that they displace whole grains from your diet (which are fiber- and magnesium-rich, both of which seem to be important in long-term blood sugar issues), and also that avoiding the deluge of insulin needed to process those foods seems like a good idea. But as of this moment, it looks like eating a saltine instead of a Mary’s Gone Cracker isn’t going to kill you in either the long or short run.
However, there is a big exception to this carbs-are-ok-so-far general rule, and that is that...
Soda is Very Bad. People who drink at least one sugary drink daily have about a 50% increased likelihood of being diagnosed with diabetes. Even when you take into account increased weight and other factors that normally might confound that kind of statistic, most of the risk remains. There's something really wrong with that stuff. Artificially-sweetened soft drinks are better, but they have their own set of risks, interestingly. You might want to forget the whole soda thing and instead drink...
Coffee. A group of 100,000 people who upped their coffee intake by two cups a day (that’s two eight-ounce cups, not two Monster Grande Overkills) saw their risk of diabetes decrease by 11% compared to those who didn’t change their coffee consumption. Those who CUT their consumption by two cups a day saw a 17% INCREASED risk of diabetes. Coffee is consistently linked to a decreased risk of diabetes, even when it’s decaf. There are many other studies besides this one that show this effect, and the benefits may be even stronger than this one study shows.
Vitamin D. People with higher levels of vitamin D have a lower risk of developing diabetes. Plus, in one good study, people in the pre-diabetes category taking 2,000 units of vitamin D a day saw their risk of diabetes decrease. Those who were normal or diabetic didn’t really see this effect, but more studies are being done to tease out the mechanism and see if it can be more broadly applied.
So these are my suggestions for you if there is something dicey about your blood sugar or you are concerned about it but you are not diabetic (and maybe even if you are). Exercise regularly (the standard recommendation of 150 minutes per week plus two sessions with weights) and get your weight into normal range. Those are far and away the best things you can possibly do. Then if your blood sugar is still a little questionable, you can try my suggestions. Past that, it’s between you and your medical doctor. Just be sure you ask him or her a lot of questions.
--dr. diane holmes
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