Another Large Study Links TZDs and Broken Bones

Page changed: Actos and Avandia: Dangerous Diabetes Drugs

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Thiazolidinedione Use and the Longitudinal Risk of Fractures in Patients with Type 2 Diabetes Mellitus Zeina A. Habib et al. JClinEndo&Metab Vol. 95, No. 2 592-600 doi:10.1210/jc.2009-1385

In this study, as summarized in the newsletter, Endocrine Today, which gives more information than the abstract, researchers,

... studied 19,070 patients at Henry Ford Hospital in Detroit between January 2000 and May 2007. The study group included 9,620 women and 9,450 men. During the study period, 4,511 patients had at least one prescription filled for a TZD. The investigators used electronically maintained medical claims data to identify nontraumatic bone fractures.

TZD use was associated with an increased risk for fracture in the overall cohort (adjusted HR=1.35; 95% CI, 1.05-1.71) and in women (HR=1.57; 95% CI, 1.16-2.14). Men, regardless of age, were not at an increased risk for fractures (HR=1.05; 95% CI, 0.70-1.58). Women aged 65 years and older appeared to be at the greatest risk for fracture (HR=1.72; 95% CI, 1.17-2.52). They found that the increased risk for fracture in women appeared after approximately one year of TZD use.

More Proof Metformin Is Protective Against Cancer

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Added this text with link to full text of a new study that found evidence that metformin protects people with diabetes against cancer.

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More evidence that metformin is protective against cancer emerged in a second study of 1,353 people with diabetes that lasted almost ten years. It was conducted in the Netherlands as part of the ZODIAC study and published in Februrary 2010. This study found that the cancer risk of people with diabetes taking metformin was identical to that of the population at large which was not the case with those who were not taking metformin. This is significant because people with diabetes have long been known to have a higher risk of cancer.

Metformin Associated With Lower Cancer Mortality in Type 2 Diabetes: ZODIAC-16 Gijs W.D. Landman et al.Diabetes Care Diabetes Care February 2010 vol. 33 no. 2 322-326. doi: 10.2337/dc09-1380

Afro-American Genes Linked to Poor Carbohydrate Metabolism

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Genes Linked to African Heritage Linked to Poor Carbohydrate Metabolism

It has long been known that African-Americans have a much higher rate of diabetes and metabolic syndrome than the American population as a whole. This has been blamed on lifestyle, but a 2009 genetic study finds strong evidence that the problem is genetic.

The study reports,

Using genetic samples obtained from a cohort of subjects undergoing cardiac-related evaluation, a strict algorithm that filtered for genomic features at multiple levels identified 151 differentially-expressed genes between Americans of African ancestry and those of European ancestry. Many of the genes identified were associated with glucose and simple sugar metabolism, suggestive of a model whereby selective adaptation to the nutritional environment differs between populations of humans separated geographically over time.

In the full text discussion the authors state,

These results suggest that differences in glucose metabolism between Americans of African and European may reside at the transcriptional level. The down-regulation of these genes in the AA cohorts argues against these changes being a compensatory response to hyperglycemia and suggests instead a genetic adaptation to changes in the availability of dietary sugars that may no longer be appropriate to a Western Diet.

In conclusion the authors note that the vegetarian diet of the Seventh Day Adventists, often touted as proof of the usefulness of the "Diet Pyramid" doesn't provide the touted health benefits to people of African American Heritage. Obviously, when hundreds of carbohydrate metabolizing genes aren't working properly the diet needed is a low carbohydrate diet.

The study is available in full text here:

Stable Patterns of Gene Expression Regulating Carbohydrate Metabolism Determined by Geographic AncestryJonathan C. Schisler et. al. PLoS One 4(12): e8183. doi:10.1371/journal.pone.0008183

ONE Hour GTT Result over 155 Correlates with Markers for Cardiovascular Disease

Pages Changed: A1c and Post Meal Blood Sugar Predict Heart Attack and Research Connectiong Organ Damage with Blood Sugar Level

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One Hour OGTT Result over 155 mg/dl(8.6 mmol/L) Correlates with Markers for Cardiovascular Disease

A study published in November of 2009 linked blood sugar readings one hour after ingesting glucose with high fibrinogen and leukocytes count (WBC), which point to subclinical inflammation, and with abnormal lipid ratios, and insulin sensitivity in a population of 1062 participants with normal glucose tolerance or prediabetes. "Normal" glucose tolerance as defined by doctors and researchers means a 2 hour blood sugar reading of under 140 mg/dl on an oral glucose tolerance test.

This study found

Elevated 1hPG [one hour plasma glucose] in NGT [people with normal glucose tolerance] and pre-DM subjects is associated to subclinical inflammation, high lipid ratios and insulin resistance. Therefore, 1hPG >155 mg/dl could be considered a new 'marker' for cardiovascular risk.

This strongly supports the message I have been emphasizing on this web site since 2004 that it is essential to keep one hour blood sugar reading after meals under 140 mg/dl.

The reliance of doctors on two hour glucose tolerance test results allows people to live for years with blood sugars high enough to promote complications long before they are diagnosed even pre-diabetes.

Inflammation markers and metabolic characteristics of subjects with one-hour plasma glucose levels. Gianluca Bardini et al. Diabetes Care Published online before print November 16, 2009, doi: 10.2337/dc09-134

New Page on Non-Fat Related Weight Gain and Loss Added to Low Carb Site

Page added: Don't Be Taken in By Fake Weight Loss or Fake Gain

Added a page to the Low Carb sister site of Blood Sugar 101 explaining the impact of factors including glycogen levels, dehydration, and salt on weight.

Many fad diets exploit people's misunderstanding of what causes very fast weight loss. Many people who eat low carb diets don't understand why it is so easy to "regain" a lot of weight after only eating a high carb diet for a day or two.

This page explains these phenomena.

FDA Adds Warning: Don't Take Byetta If Kidneys Seriously Impaired

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In late 2009 the FDA analyzed postmarketing data for Byetta and found 78 cases of kidney failure reported between April 28, 2005 and October 29, 2008, a period in which more than 6.6 million prescriptions for Byetta had been dispensed.

Given the prevalence of kidney failure among people with established diabetes this finding may or may not be related to the drug. The FDA now states that Byetta should not be prescribed to people with "severe renal impairment (creatinine clearance <30 ml/min) or end-stage renal disease." Caution should be used when prescribing it to people with "moderate renal impairment (creatinine clearance 30 to 50 ml/min)."

Because doctors are ignorant of or ignore FDA drug warnings check your creatinine clearance test results before you start Byetta. If your doctor has not given you this test once a year, find a new doctor. All people with diabetes should have their kidney function tested periodically.

Warning signals of kidney problems are: Increased serum creatinine, Changes in urination (color, frequency, amount), Unexplained swelling in the extremities, Increases in blood pressure, Lethargy, Dull ache in the mid to lower back. NOTE: Changes in appetite and digestion are also listed as symptoms of kidney dysfunction but are also normal responses to Byetta.

FDA Safety Information for Byetta

Common Herbicide and Fibrates Block Receptor That Stimulates GLP-1

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In 2007 scientists at New York's Mount Sinai Hospital discovered that the intestine has receptors for sugar identical to those found on the tongue and that these receptors regulate secretion of glucagon-like peptide-1 (GLP-1). GLP-1 is the peptide that is mimicked by the diabetes drug Byetta and which is kept elevated by Januvia and Onglyza. You can read about that finding in this Science Daily report:

Science Daily: Your Gut Has Taste Receptors

In November 2009, these same scientists reported that a very common herbicide 2,4 D blocked this taste receptor, effectively turning off its ability to stimulate the production GLP-1. The fibrate drugs used to lower cholesterol were also found to block the receptor.

Science Daily: Common Herbicides and Fibrates Block Nutrient-Sensing Receptor Found in Gut and Pancreas

What was even more of concern was the discovery that the ability of these compounds to block this gut receptor "did not generalize across species to the rodent form of the receptor." The lead researcher was quoted as saying,

...most safety tests were done using animals, which have T1R3 receptors that are insensitive to these compounds,

This takes on additional meaning when you realize that most compounds released into the environment are tested only on animals, not humans. It may help explain why so many supposedly "safe" chemicals are damaging human glucose metabolisms.