Sugar shock

Chicken or egg – which came first? Even though it’s an intriguing
question, whatever the answer may be, it doesn’t really matter. I
don’t expect that even chickens spend much time mulling it over.

But a similar sort of question – one that matters considerably – is
posed by type 2 diabetes: Is heart health compromised by the high
blood sugar levels of diabetes, or by other conditions such as
hypertension that can be triggered by diabetes? In short: Which
comes first and which matters most?

Two studies published this month in the Annals of Internal
Medicine indicate that hyperglycemia (high blood sugar) may be
more of a culprit in the development of heart disease than
previously expected. And more importantly, the findings send a
strong warning to those who are not considered diabetic.

Getting a little hyper

In the e-Alert “Waking Up is Hard to Do” (9/20/04), I told you
about the groundbreaking INTERHEART study that revealed a list
of health factors that put the heart at greatest risk. I’m sure that
most HSI members were not surprised to see diabetes high on that
list. For many years now, researchers have been examining the
ways diabetes is associated with heart disease.

One of the most recent of those studies comes from Johns Hopkins
University here in Baltimore. The Hopkins researchers reviewed
the results of 13 studies to analyze the association between heart
disease in diabetic subjects and the severity of hyperglycemia
(which is measured by the percentage of glycosylated hemoglobin
(HbA1c) in blood). Daily fluctuations of blood glucose do not
affect HbA1c, so this marker provides a more accurate overall
indicator of hyperglycemia. In a nutshell: An HbA1c level of five
percent is considered quite safe, and seven percent or less is
considered normal. A level higher than seven is a red flag,
signaling the possibility of type 2 diabetes.

After reviewing the 13 studies, the Hopkins team concluded that
hyperglycemia may be directly associated with an increased risk of
heart disease in people with diabetes. And more specifically, every
time HbA1c increases by one percentage point, the risk of heart
disease or stroke raises by nearly 20 percent. Likewise, when
HbA1c percentage drops, heart disease risk drops as well.

The danger zone

In the e-Alert “Sugar in the Morning, Sugar in the Evening”
(9/4/02), I told you about the A1c test, which gives an average
measurement of HbA1c percentage in the blood over the 60 to 90
days prior to the test date. And it was this test that was used by a
UK research team to monitor hyperglycemia in more than 10,200
subjects (both diabetic and non-diabetic) over a three-year period,
with an additional three-year follow-up period.

The UK researchers found that for every HbA1c percentage point
that rose above five percent, risk of problems associated with heart
disease rose more than 20 percent. And this elevated risk remained
consistent, even when other factors such as smoking, high blood
pressure and a previous history of heart problems were taken into

This study produced two striking results: 1) Moderate-to-high
blood sugar levels were apparently directly responsible for heart
disease risk, and 2) Subjects whose HbA1c percentages were well
below the conventional danger level were still at risk.

One of the authors of the study told the New York Times that the
commonly accepted “average” blood sugar readings may need to
be reassessed.

Way to go

The next time you have a blood test, talk to your doctor about these
two studies and ask him to make a point of including an A1c test to
determine your HbA1c level.

If your HbA1c reading is in the pre-diabetic or diabetic range, your
doctor may suggest taking a drug to manage blood sugar levels.
The most common drug for type 2 diabetes is Glucophage, the
brand name for metformin. But most people will probably find the
tried and true method of diet modification and daily exercise to be
more effective.

In the e-Alert “Common Sense Approach To Treating Type II
Diabetes” (2/13/02), I told you about a New England Journal of
Medicine study that enlisted more than 3,200 adults (the average
age was 51) who were diagnosed with pre-diabetic elevated
glucose levels. Subjects were divided into three groups: one group
received a daily dose of Glucophage; one group received a daily
placebo; and one group participated in an intensive program with a
goal of at least 7 percent weight loss through diet adjustment, two
and a half hours of moderate exercise each week, and educational
sessions to reinforce behavior modification.

After following these subjects for an average of almost 3 years, the
researchers found that Glucophage reduced the incidence of
diabetes by about 30 percent versus placebo, but lifestyle changes
slashed the incidence rate by more than HALF – a full 58 percent.
Plus, patients in the Glucophage group had six times more
gastrointestinal side effects than those in the exercise and diet

Changing key lifestyle factors such as diet and physical activity is
easier said than done. But in the case of controlling blood sugar, a
little effort goes a long way.


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and another thing

Sometimes I wonder how experts in any given field attain that
exalted level of “Expert”. I’ve come to believe that the number one
requirement is to simply sound like an expert. Never mind the
actual content of what’s being said, as long as you give it the ring
of expertise.

Here’s a good example

A couple of weeks ago, members of the Royal College of General
Practitioners gathered for a conference in London. One of the
items on their agenda: How to address the growing obesity
epidemic. The solution: Make exercise more accessible and

Of course, this bright idea overlooks the glaringly obvious fact that
exercise is already free and accessible to all. It’s called Get Off
Your Duff And Walk, Jog, Do Pushups, Situps, Whatever, Just Get

But the Royal College’s idea is to make workout and sports
equipment more accessible. And how do you do that? According to
an Associated Press report, one of the College’s experts has the
answer: Tax breaks for exercisers! Under this plan, if you purchase
sports or exercise equipment, you’ll be allowed a deduction at tax

Okay is this REALLY the motivation that obese people have
been waiting for? Imagine someone who’s overweight, sitting
down to watch a couple hours of television after finishing off a
large meal. I’m pretty sure they’re NOT thinking, “I’d be
exercising right now if I could just get a tax break.”

It’s logic only a bureaucrat could love: Motivate good health with
tax breaks.

The best part is a quote from one of the College’s experts. (I won’t
mention his name. No reason to rub it in.) This expert – a doctor –
told the AP, “After all, obese people are likely to use more
National Health Service resources than fit and healthy people.”

Uh how’s that again?

I wonder if this expert ever saw the inside of a health club?
Because if he had, he would have seen lots of fit and healthy
people working out. That’s how they GET fit and healthy: They
use the resources. If obese people were in the least bit inclined to
do any type of exercise (which doesn’t really require any NHS
resources), then they would be fit and healthy instead of obese.

Maybe it’s time to give experts a tax break every time they keep a
crackpot idea where it belongs: back on the drawing board.

To Your Good Health,

Jenny Thompson
Health Sciences Institute


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“Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular
Disease in Diabetes Mellitus” Annals of Internal Medicine, Vol.
141, No. 6, 9/21/04,
“Association of Hemoglobin A1c with Cardiovascular Disease and
Mortality in Adults: The European Prospective Investigation into
Cancer in Norfolk” Annals of Internal Medicine, Vol. 141, No. 6,
“High Blood Sugar Also Poses Risk to Heart” Denise Grady, The
New York Times, 9/21/04,
“Reduction in the Incidence of Type 2 Diabetes with Lifestyle
Intervention or Metformin” The New England Journal of
Medicine, Vol. 346, No. 6, 2/7/02,
“U.K. Docs Suggest Tax Breaks for Exercise” The Associated
Press, 9/16/04,