The sugar hypothesis of heart disease triumphs yet again over the lipid hypothesis. A study presented recently in Rome and published in the New England Journal of Medicine demonstrates that efforts to lower blood sugar pay off better in lower rates of heart disease and longer life than do efforts to lower cholesterol.  In fact, to be ruthlessly honest about it, efforts to lower blood sugar do seem pay off whereas efforts to lower cholesterol don’t much at all.
Researchers presented data from a long-term study (almost 30 years long) showing that subjects who lowered their blood sugar levels with drugs for a period of 10 years reaped large rewards in terms of reduced incidence of heart attack and reduced incidence of all-cause mortality long after the end of the study.

Here is how the study was done:

From 1977 through 1991 patients were enrolled in a study to determine the benefits (or lack thereof) of intensive glucose lowering with medications (insulin or sulfonylurea) compared to conventional glucose control achieved through diet (more about which later).  Researchers randomized the subjects into the drug-treated, intensive-glucose-control arm or the diet arm of the study and waited and watched for ten years.  At the end of the ten years, the subjects on the intensive-glucose-control arm demonstrated a reduced risk of microvascular complications, a nonsignificant reduction in incidence of heart attack and no improvement in all-cause mortality.  (There was a subset of obese patients in this study who were treated with metformin who showed significant reductions in incidence of heart attack and all-cause mortality by the end of ten years.)

Other than the improvement shown in the obese diabetic patients on metformin and the decrease in microvascular complications, there was no real advantage to the strict glucose control within the ten year study period.  After the study was completed, the subjects were no longer followed regularly for their disease and were returned to the care (or lack thereof) of their own physicians.
Researchers then performed a 10-year post study monitoring just to see what had happen, and were surprised to learn that those patients who had undergone the strict glucose control experienced fewer heart attacks, fewer diabetic symptoms, and lower all-cause mortality.  The reductions in risk were, in my opinion, extraordinary.   There was a 15 percent reduction in heart attacks and a 13 percent reduction in the most important statistic of all: all-cause mortality.
Said one of the directors of the study in a comment that beggars belief and is worthy of the Reckless Award for a stupid statin statement as reported on HeartWire:

UKPDS [United Kingdom Prospective Diabetes Study] has definitively shown today that early glucose-lowering in the longer term really does impact on cardiovascular disease in people with type 2 diabetes. We’re talking about a 13% reduction in all-cause mortality and a 15% reduction in MI. Now, that may not be as big as what we see with a statin or something, but given the millions of people with diabetes, this is a very substantial change, and it is over and above the other treatments that patients are getting.

“Now, that may not be as big as what we see with a statin…”  Are you kidding me?  This guy must be another one who has drunk way too much of the statin-laced cool aid.  If the companies that make statins could get even half… half, hell, if they could get even a third or a fourth of these results, there would be dancing in the streets in statin land.
I’m putting the following in bold so that it will stand out.

As I’ve written countless times in this blog, randomized, placebo-controlled studies (the only kind that matter) have shown that statins provide no decrease in all-cause mortality (the only statistic that really counts) in women of any age whether they’ve ever had a heart attack or not.  These same studies have shown that statins provide no decrease in all cause-mortality in men over the age of 65 regardless of whether or not they have ever had a heart attack.  The only group of people for whom statins have shown any benefit in terms of a decrease in all-cause mortality is men under the age of 65 who have already had a heart attack.  And even in these men, the decrease in all-cause mortality is minuscule.  So minuscule in fact, that some authorities don’t even think the expense of statins is worth the tiny risk reduction.

A 13 percent reduction in all-cause mortality is pretty huge, and seems to be a ‘legacy effect’ of the strict blood sugar control these subjects experienced during the ten years they were on the study.  To be completely accurate, it could be said that the drugs these subjects took are what is bringing about their decreased risk of death, but given the side effects of these drugs, I kind of think that is doubtful.
Chronically elevated blood sugar, even when elevated just a little, is toxic to the blood vessels.  Knowing this, it makes sense that if blood sugar is kept tightly regulated for ten years, less damage should accrue to the vascular systems over this period.  And, since heart disease is the major killer of people worldwide, and since heart disease is a manifestation of vascular damage, it also makes sense that if you minimize vascular damage for ten years, you will have less risk of heart disease and earlier death.  At least that’s the way I see it.

From the hindsight of today, it’s really easy to see why those with tightly controlled blood sugars would have fared better than those on the conventional diet, when you realize what the conventional diet was at the time of this study.  From the original paper in The Lancet (1998) 352(9131) 837-853:

The patients were advised to follow diets that were low saturated fat, moderately high fibre and had about 50% of calories from carbohydrates…

That pretty much tells us all we need to know.  Ten years of a high-carb diet verses ten years of tightly-controlled blood sugar.  Which do you think caused the most vascular damage?
Almost three years ago I wrote another post on the subject of the sugar hypothesis, but that was at a time that this blog had about 12 readers.  Those of you who weren’t readers way back then might want to give this one a look now.  It shows that variations even within the normal range of blood sugars are correlated in a dose-response fashion with mortality.

The take home lesson of these studies is that blood sugar is much more closely correlated to health and longevity than are cholesterol levels.  Yet everyone is focused on cholesterol.  Why?  Because the drug companies want us to be focused on cholesterol.  The pharmaceutical industry has brainwashed the public and, even worse, has brainwashed most of the doctors out there (as evidence, see the quotation above by the director of the UKPDS, who is an academician and should know better).
The nice thing is that it’s pretty easy to tightly control your blood sugar levels without drugs.  How?  By taking blood sugar control out of the hands of your pancreas and turning it over to the liver.  You can do this by keeping your carbohydrate intake low enough to ensure that your liver has to produce glucose.

When the liver gets into the glucose production business, it turns it out in a slow, steady fashion, making just the amount necessary.  Blood sugars stay low, and glucose-induced damage to the vascular system is minimized.  If you follow a good-quality, whole-food, low-carbohydrate diet, your blood sugar will stabilize.  If you’ve already got type II diabetes, following such a diet might not completely solve your problem, but it will make it a lot better.  I have never seen any kind of therapy that works better than a low-carb diet to lower and stabilize blood sugar levels.  It truly is amazing.  If you do have type II diabetes, you must work with your physician to regulate your medications because you will need to reduce your dosages or eliminate the medications very quickly or your blood sugar will fall too low too fast.  As one of my colleagues says when telling other physicians about this therapy: nothing in your medical experience heretofore will have prepared you for how quickly this will work.  And, unlike some other therapies it works every time


  1. Any chance, Doc, you could comment on how this study differs from the one which had to be stopped because people were dying? I (think I) recall that in that study the patients were given blood-sugar control meds, but the diet kept the sugar coming, which led to disaster. It sounds like this study also just focused on the meds, but not the diet, and so should have led to similar tragedies. Instead, it seems to support the health claims of low-carbing.
    You’re referring to the ACCORD study that had to be stopped. The ACCORD study was of people with long-term type II DM, many of whom already had vascular problems and in many cases had already had a heart attack. These subjects had been living with enormously elevated Hgb A1c levels for a long time. And they had had these elevated levels (which indicate chronically elevated blood sugar) for a long time despite having been on drugs. The researchers cranked up their insulin levels and/or drugs to try to normalize their blood sugars. In doing so, they made an already bad situation worse. They reduced blood sugar levels, which had already done a lot of their damage, by increasing insulin, which magnified this damage.
    In the case of the UKPDS study, the subjects were newly diagnosed diabetics who had never been treated. Anyone who had a history of heart disease or vascular damage was excluded from the study. So, in contrast to the ACCORD subjects, these started with relatively healthy vascularity. By quickly normalizing their blood sugars, they minimized the damage to their blood vessels for ten years before being released from the study. And that ten years of decreased damage paid big dividends down the road.
    I would bet that had the subjects on the ACCORD study been treated with low-carb diets instead of intensive medical glucose lowering, they would have done much better because they would have reduced both their blood sugar levels AND their insulin levels.

  2. I am so thankful that I learned about low-carbing before I became diabetic, because I know that’s where I was headed based on my family history and the low-fat high-carb diet I tried to adhere to (it was easy to adhere to the high carb part, almost impossible to stick with the low fat) that put me over two hundred pounds. Thanks for all the motivation you provide to stay faithful to low carb eating–I am going to die someday of something, but I am hopeful it doesn’t have to be from diabetes/heart disease/stroke/pancreatic cancer like my parents and grandparents. Anytime I get a little wistful about some of the foods I choose not to eat any more, I just tick off the list of diseases I am likely to escape by keeping my blood glucose low. 40g of carbs in a day is a “heavy carb” day for me; I usually can keep it to 30g or less and it gets easier and easier to make the sacrifice in food choices to do that. Better that than diabetes, heart disease, stroke, cancer, Alzheimers, GERD, Barrett’s Esophagus, macular degeneration, auto-immune disorders. . . .
    Hey Ethyl–
    I’m glad you’re doing so well. Keep it up.

  3. The compelling evidence keeps on compiling!
    Dr. Eades, I have searched through your site, but haven’t come up with anything on what you eat on a daily basis. Have you ever made a post on such a topic, perhaps a sample menu for an average day for you and your wife? My wife and I have just recently been introduced to the lower carbohydrate way of looking at nutrition, and we were just interested in what you ate! 🙂
    Maybe this comment will inspire me to do a photo post on a day’s diet for the two of us. I have a number of meals that we’ve eaten presented in the blog, but can’t give you the titles of the posts. If I could, you could see what we eat. Look at this post and the ones right before and right after when we were in Italy. We eat at home about like we ate there.

  4. Was there any distinction made between patients treated with insulin and those treated with meds? Otherwise this study seems to vindicate insulin as inoffensive which would really (really!) surprise me.
    How do those meds work exactly? Wikipedia mentions the effect of Metformin on insulin sensitivity, which would lead us back to hyperinsulinemia as the problem. Any thoughts?
    Insulin is inoffensive in small doses. If you don’t have some insulin, you’re in big trouble. The problem comes with excess insulin. The subjects in this study were people who had just been diagnosed with type II diabetes and had no other health problems. It didn’t take a whole lot of insulin for them to regulate their sugars. And since they got the insulin early on and kept their blood sugars tightly controlled, they didn’t develop the vascular damage they otherwise might have.
    Insulin is a Goldilocks and the Three Bears kind of hormone. You don’t want too much; you don’t want to little; you want just the right amount. These folks got a little more than just the right amount in terms of how much insulin one would like to have circulating, but got just the right amount to keep their sugars regulated.
    When people first have their insulin/glucose go haywire, they typically have erratic blood sugars and, consequently, erratic insulin levels. If you could monitor them on a constant basis, you would see that overall they have both elevated sugar and elevated insulin. The elevated blood sugar is causing vascular damage; the elevated insulin is acting as a growth stimulator to an developing plaque. It’s the two together that cause the problem. If you give people small amounts of insulin to keep their blood sugars normal, you make them better. If you get them to keep both their blood sugars normal and their insulin normal, you make them well.
    Metformin works by increasing the sensitivity to insulin; the sufonylureas make the pancreas release more insulin.

  5. Dr Eades – every week you or someone else raises research like this which provides yet further evidence to erode the conventional thinking on heart disease and support the hypotheses people like you and Taubes put forward. Clearly the arrogance and pride of dyed-in-the-wool accademia is a hard thing to shift, but even jaded accademics change their mind eventually. I know that pharma big business is also a factor in preventing the truth being officially recognised. But really – how much longer do you think we will have to wait before there is universal recognition that the convention thinking is wrong?
    I think the day is getting ever closer. As all the low-fat zealots die off, their collective influence will be felt less and less. Right now most of the nonsense is being driven by the drug companies that make statins – but as more and more articles come out like the one in Business Week (a link is in this post), their influence will wane. I would predict that in ten years we will have made a pretty significant shift.

  6. Hi Mike,
    Just to prove some of your disciples are still with you and awake (I’m sure there were more than 12 of us!) the link for this paper is wrong (it takes you to a blood pressure study published in the same issue) You want this one –
    In terms of that early post on the sugar hypothesis which I have used a lot, it would be interesting to know the fate of those with compromised response to a GTT (then and now) who took note and kept their blood glucose low through diet (even though their response to a glucose challenge would still mininally put them in the higher risk bracket).
    Hey Malcolm–
    Thanks for the correct link. It’s all changed out now. There were two studies side by side, and I grabbed the wrong one.
    There have been a number of follow up studies using the Whitehall data. In the last one I read, there was a strong correlation between elevated glucose in a GTT and stroke.
    Enter ‘Whitehall Study’ in the search window of PubMed and take a look around.

  7. Dr. Eades,
    your posts about nutritional research are just suberb. Myself being a pharmacy student I consider this blog being one of the best sources of unbiased information about carbohydrate restriction, metabolism and blood glucose control. High fasting glucose level (and I’m a healthy, active, lean, 19-year old) was the reason I switched from a high-carb diet to a very-low-carb one (5-30g of carbs per day). A few weeks ago I had blood tests done after 7 months of living a low-carb lifestyle and the results were both expected and unexpected. I would be really grateful if you could state your opinion about them.
    The format is before/after.
    Glucose 107 / 78 mg/dl (27% decrease)
    Total-C 157 / 288 mg/dl (83% increase)
    LDL-C 92 / 210 mg/dl (128% increase)
    HDL-C 43 / 56 mg/dl (30% increase)
    TAG 87 / 112 mg/dl (29% increase)
    apoB 101 / 90 mg/dl (11% decrease)
    My father is a doctor and he almost got a shock when he saw the LDL-C and Total-C numbers. I tried to convince him that since apoB got lower and LDL-C has increased, the size of the C-carrying particles has gone way up and such particles are not very capable of causing damage to the vascular system. He just doesn’t believe me and keeps saying my blood tests were better before than they are now.
    Do you have any idea why such a dramatic rise in Total-C and LDL-C occurred and why TAG increasd? Usually a low-carb regimen doesn’t change Total-C or LDL-C much and reduces TAG (although I had low TAG level before in the first place so maybe the change isn’t that significant). A note you might find helpful – I’m also doing IF and I’m eating around 4000kcal/day (4hours/week of weight lifitng and 3-6 hours of aerobic exercise).
    Sorry for my English, it’s not my native language.
    It’s difficult to say what caused these changes. They could even be the result of a lab error. You are correct in pointing out to him that your LDL particle size is larger. The triglyceride level is basically what it was before. Blood sugar is great. I’ve seen these changes in my own patients, and they tend to change by the next lab.
    If you are healthy and lean and only 19, I wouldn’t worry about it. Just wait and see what things look like on your next lab. Or even repeat this one to make sure it isn’t an error.
    Your English is terrific. Unless you had told me, I would have thought you were a native speaker.

  8. Hi Dr. Eades,
    I’m one of those original 12 readers, I think, and I haven’t commented in a while, but this post gives me a chance to tell you about my recent hospital stay. My experience is, in a way, like a little mini-study related to the study you’ve posted about. I had “infectious colitis,” IOW a bacterial thing that caused fever, diarrhea and stomach cramps (not to be confused with chronic colitis, a whole different thing). After three days of those symptoms I went to see my doctor, who thought I was reacting with pain too much when she felt around on my abdomen and who said she wanted me to get a CT scan. There was enough pain in the right lower quadrant that she wanted to rule out appendicitis — though I did not have the classic presentation of that.
    Because of an irregularity near the cecum, I was admitted to the hospital for IV antibiotics and further evaluation. I answered the same list of questions many many times. Smoke? No. Diabetes? No. Heart disease? No. Colon cancer? No. Unusual bowel movements? No. Chronic intestinal problems? No. No, no, no, I did not have any of those diet-related problems. I did have a “blood pressure of a 20-year-old” and other indications of mostly excellent health.
    My hospitalist said my doctor told him I have high cholesterol but am not treating it. He said I should be on a low-cholesterol diet. I said I was on a low-carbohydrate diet. He said it should be low-cholesterol and low fat. I said something like, now why would I want to do that, it would make me fat. I was disoriented from not having eaten for three days and didn’t have the brainpower to expound on my low triglyceride and blood sugar levels or the fact that although my LDL is high, it’s all the big fluffy kind and not the small beebee kind and oh by the way there’s no actual science that proves lowering cholesterol in women has any benefit whatsoever.
    The long story short is that the antibiotics helped, my cecum was biopsied during a colonoscopy the next day (I was overdue for my first anyway and was glad not to have to do the whole prep), and I went home feeling relatively well. I probably ate something; it felt like food poisoning all along. My colon was perfect, not a single polyp.
    So there’s me, in Bed One, really quite basically healthy, and my roommate on the other side of the curtain, I’ll call her Londa, in Bed Two. She arrived shortly after I did. She was maybe 60, but looked and acted like she was in her 80s. (I heard a nurse say, “I’m 57, so you’re not that older than me!”) And she had every Western-diet-related disease known to man. She had smoked for 20 years, I’m sure that didn’t help, so he had emphysema. She also had diabetes, COPD, heart disease (with pacemaker), and I couldn’t list all the rest, there were too many to keep track of, oh, I forgot diverticular disease, but every one she mentioned I remembered seeing on a list in the Protein Power LifePlan book. She was on about 25 different meds.
    If she’s 60, then she’s only 7 years older than I am, but we looked like there were about 20 years between our ages.
    Vast, unending crews of doctors and other caretakers came and went. She’d just been in the hospital about a week ago and there was great concern about why she was back so soon. Finally a doc said to her, “I’ve put in orders that you can have a meal now. We’ll put you on the diabetic/cardiac menu plan. So you can go ahead and order something if you’d like.” At this hospital they give you a menu and you call up and order something. Dietary has your info so you’re restricted to whatever your orders are.
    So Londa called up and I was astounded when she ordered for her “diabetic/cardiac” meal the following: turkey with stuffing, mashed potatoes and gravy, dinner roll, some sort of veggie, chocolate pudding, vanilla wafers, and a Sprite. She ate it when it got there and within 20 minutes was calling for a nurse so she could go puke it up. Wish I’d had my noise-cancelling headphones then!
    I later learned her blood sugar was 400 either right before or right after she’d eaten. The doctors were mystified why all this had happened but of course the fact that she’d just had this huge load of carbs was never mentioned. Maybe that had nothing to do with it. But all night — I do mean all night — people were in and out of that room trying to figure out what was going on with her. My husband came back to see me the next morning and I pointed in the direction of my roommate and whispered, “That will never be me, never never never.”
    He and I wondered what was the initial trigger that caused her health to go downhill. What condition brought her to her doctor’s office and what med did he put her on or diet tell her to do that led to the rest of the 25 meds and the pacemaker and so forth? What could they have done initially that would have minimized or cured the original problems? Of course the fact that she smoked for 20 years didn’t help, but I smoked too at one time — quit 16 years ago.
    I just thought it was an interesting contrast, me v. Londa. Would it occur to anyone there that the differences in our basic health or need for healthcare have anything to do with what we choose to eat on a daily basis? Sadly, no, I’m afraid.
    I’m going to print the bolded paragraph about statins not having any effect on all-cause mortality in women of any age and tape it into my little health notebook that I take to appointments. Oh, and one exciting discovery over there was that, since it’s a teaching hospital, they have a 3,500-volume medical library that includes subscriptions to 250 medical journals that the public is allowed to go and use. I couldn’t check anything out but I could sit there and read. I thought that was a fantastic discovery.
    Thanks for listening and thanks for your continued excellent blog. Best to you & MD.
    Great story. Sad, too. But all too common.
    For the most part, people don’t seem to want to take responsibility for their own health – they want to pass that off to the medical profession. Then those in the medical profession become enablers in the patient’s deteriorating health status. It’s really shameful.

  9. Good morning Dr. Eades.
    Still enjoying your posts and books so much. I am following the lc diet and feeling great. However, I have tried this diet before with Atkins and still have a recurring issue I wonder if you can comment on…
    I always start out gangbusters and then everything seems to come to a halt. It seems to be once I have lost the initial water weight. I have kept my carb count to around 30 grams daily. Calories range from 1300 to 1600 a day. The first 2 weeks I lost 5 lbs a week, now it is 1 lb every 2 weeks. I have starting the weight training recommended in slow burn.
    I have never shown to produces ketones when tested. Does this matter when I am following the diet? I am also probably in early menopause. I have read this can be an issue but how much of an issue could it be? Does hrt help?
    In the past I have low carbed as an attempt to lose weight. But now after keeping up with all the info, thanks to you, I know it needs to be a lifestyle.
    HRT could help a lot. Were I you, I would get my hormone levels checked to see what’s going on. Then, if they are low, don’t let anyone put you on Premarin and Provera, the default choices for most physicians. Try to find someone who knows how to prescribe natural hormones.
    Another thought…sometimes when people first switch over to low-carb diets, they start getting more protein than before and they start building a little lean mass. This new lean mass weighs. So if you lose a few pounds of fat and gain a couple of pounds of lean mass, the net weight loss doesn’t look that good. Which is why I always measure people in the clinic. If there is a lean for fat tradeoff, it shows up in the measurements.
    You might want to also consider removing dairy from your diet. I’ve had a lot of anecdotal evidence from a lot of people – including Gary Taubes – that removing dairy brings about an increase in weight loss.
    I’ve never put a lot of emphasis on the level of ketones. I’ve seen people lose enormous amounts of weight on low-carb diets without ever going into measurable ketosis.

  10. The link from the word “published” in your text leads to a publication from the UKPDS study, but it is on the topic of the possible benefit of tight blood pressure control. You probably meant to link to another article.
    Thanks. I got it changed.

  11. The other interesting thing is that the people in the UKPDS had pretty awful targets for “tight” blood glucose control – they were aiming for A1cs under 7%. We can hope that, by aiming for truly normal bg levels by low carbing, that our prognosis is even better.
    Precisely. Good point.

  12. Akira Endo, a Japanese scientist whose discovery of the first cholesterol-lowering statin drug helped extend the lives of millions of people, is one of five winners of this year’s Lasker Awards for medical research, it was announced Saturday.
    And the beat goes on.
    At some point in the future, people will be shaking their heads and saying ‘How could those fools have been so stupid?”

  13. I am just reading Taubes’ Good Calories, Bad Calories, so this “sugar hypothesis” is a very timely read for me. Thanks for pointing it out. And thank you and MD for the service you provide the community with your blogs. It’s like an oasis of nutritional sanity in a world of processed pseudo foods and drugs.
    Thanks for the kind words. We appreciate them.

  14. One question: I’ve heard that dairy and meat raise insulin levels too; are either of these claims true?
    This isn’t a riddle BTW. Thanks.
    They do, but they also raise glucagon as well, which mitigates the rise in insulin.

  15. Mike, thanks for the comments on this study. Just as I’m reading it, I’m watching the latest TV add from the Corn Refiners Association. What an idiotic piece of misinformation!! In the add there is this young couple having a picnic and the girlfriend offers an ice cream (more ice than cream…). The boyfriend refuses because there is HFCS but can’t say why he wouldn’t eat it… until the girlfriend talks him into eating it explaining that it’s ‘made out of corn, and that contains the same calories as sugar (referring to the fructose), and that it’s just fine in moderation…”
    My blood just boils sometimes when I see this kind of stupidity… the calories argument is so lame. I’m sure the guys from the Corn Refiners Association don’t know a thing about the metabolic effects of fructose. Yet the add says at the end… ‘get the facts…’
    Maybe the Corn Refiners, besides learning a thing or two about fructose, could use the article you just discussed to ‘get their facts’ straight.
    I don’t think they have any interest in getting their facts straight. I think there interest is in selling HFCS.

  16. You might want to also consider removing dairy from your diet. I’ve had a lot of anecdotal evidence from a lot of people – including Gary Taubes – that removing dairy brings about an increase in weight loss.
    I was going to ask you about dairy…….any idea about the amount one can retain any links or papers pleasum ?
    Do you still adhere to the exorphin addiction ?
    No ideas about anything with this. It’s all anecdotal. You’ll have to go by trial and error.
    I do adhere to the addiction philosophy I described in the PPLP.

  17. Hi Michael,
    I’m just reading your Protein Power book again… the rest are on their way from Amazon… and I finished the section on eicosonoids. Would you say that the increase in heart disease associated with higher blood glucose levels has to do with the series two eicosonoids being more predominant (because of higher insulin), and therefore the cause? Just interested if your take on the ecosonoid balance is still the same as when you wrote the book.
    Many thanks Michael for another great blog entry,
    I’m not as concerned with it now as I was then. Especially the notion that we have to be careful of arachidonic acid intake. If we keep insulin levels low, it doesn’t much matter.

  18. Off Topic – but interesting.
    This report in Times of India could explain A LOT:
    MELBOURNE: Scientists have discovered that going veggie could be bad for your brain-with those on a meat-free diet six times more likely to suffer brain shrinkage.
    Vegans and vegetarians are the most likely to be deficient because the best sources of the vitamin are meat, particularly liver, milk and fish. Vitamin B12 deficiency can also cause anaemia and inflammation of the nervous system. Yeast extracts are one of the few vegetarian foods which provide good levels of the vitamin.
    The link was discovered by Oxford University scientists who used memory tests, physical checks and brain scans to examine 107 people between the ages of 61 and 87.
    When the volunteers were retested five years later the medics found those with the lowest levels of vitamin B12 were also the most likely to have brain shrinkage. It confirms earlier research showing a link between brain atrophy and low levels of B12.
    Based on some of the conversations I’ve had with Vegans, I can believe this hypothesis to be true (anecdotal for sure, but when in doubt apply Occam’s razor).
    I saw this report in another source and tracked down the paper. I haven’t read it yet, but when I do, I’ll post on it if it’s blogworthy. Might explain the behavior of some of our vegetarian friends, though.

  19. Dr. Mike,
    I’m sorry, this is off topic but it is slowly turning into a source of contention between my husband and me. We have a 3 month old who we are getting ready to introduce to solid foods. As a low-carb, Protein Power follower, I cringe at the idea of feeding him rice cereal and have recently read that “studies have shown” that we may not be introducing babies to meat early enough. I have found a study here that talks about breastfed babies (which ours is) and iron and zinc deficiencies and how babies tend to absorb more zinc from meat (toward the end of the page). It also states that it has been shown that infants introduced to meat earlier receive more sufficient levels of iron, B-6 and B-12. I would just assume skip the rice – or use it sparingly – and jump right into meat and select veggies.
    My husband, while not outright arguing with me, says I’m starting to sound like an “I-refuse-to-vaccinate-because-it’s-bad-despite-the-lack-of-evidence-saying-so” mom. Aside from the references in that study (which I am still digging through), have you heard of any other studies showing that we should start infants on the road to lower carb lifestyles? Do you think I am overreacting to the idea of cereals? I just seem to find a lot of evidence saying that the current guidelines for introducing “complementary foods” are arbitrary, and that we should re-examine the introduction of meat into the mix. Before I go head-to-head with my husband and pediatrician (and start my child on the wrong dietary-foot), I thought I would see if you have any thoughts on this.
    Please feel free to ignore this or not publish it. It is pretty off topic. Thank you!
    In my opinion, the guidelines are arbitrary. I believe that children don’t really need to be started on solid food until they’re one year old. Breast milk is fine until then. Primitive people breast feed their kids sometimes to two or three. No Paleolithic babies started off with rice, so I don’t see why modern babies should. The pediatrician told the mother of our first grandchild to start him on rice when he was about six months old. We happened to arrive for a visit right about then, and persuaded her to abandon her efforts and stick to the breast. The kid had maybe three servings of rice cereal before he switched. After this episode, all our grandchildren were started on solid foods as they approached a year old, but they were fed vegetables and meat. Our daughters-in-law used their food processors to make a puree of sauteed turkey or chicken, so they had a little meat as well. It worked fine.

  20. I’m puzzled why the Japanese have such low rates of diabetes when they eat such a high glycemic diet.
    It’s too complicated to get into in an answer to a comment. Read Taubes’ book and you should learn why.

  21. This is not off-subject, but a confirmation of how sugar-entrenched our society is.
    A nutritional ad here at the University shows a picture of a carton of chocolate milk and a banana with the caption that they both contain the same amount of sugar.
    Now when I looked at that I saw two items way too high in sugar and way too low in nutrients. What the advertisers were trying to say is that Chocolate Milk is as healthy as a banana. To me that reads “unhealthy” to others it’s supposed to mean “healthy.”
    Now this is the type of idiocy that really needs to be dealt with.
    So much idiocy, so little time.

  22. ME: “I think the day is getting ever closer. As all the low-fat zealots die off, their collective influence will be felt less and less.”
    I sure hope you are right. If anything the low fat carpet bombing campaign has escalated exponentially, at least in Canada even after Taubes’s latest salvo. We are getting hit from every form of media with the ‘saturated fat is a killer, low fat is healthy’ message. This past weekend’s edition of the Globe and Mail (Canada’s equivalent of the New York Times) ran a two and a half page feature story on the Wellspring Academy’s (a private school) solution to the problem of childhood obesity (‘Weight Training: Going Fat Free’ – Globe Focus September 13, 2008).
    At a cost of $6,350.00 US a month (minimum 4 month stay) parents can sequester their overweight offspring in the academy where they will be put on a diet of 1200 calories per day -15% from fat. By my estimates this puts them on about 200 grams of carbs/day.
    On the program, students can eat white bread, drink unlimited amounts of diet pop and 10 bananas for lunch if they so choose. Splenda is an integral part of the program (a Wellspring food group) which some students slather over everything. Students are taught to fry bananas with no fat spray and Splenda.
    The Wellspring program was designed by Daniel Kirschenbaum (The Healthy Obsession). The article states that according to Kirschenbaum genes account for 75% of the reason people become overweight. Genetics makes them slow metabolizers (how about carbohydrate sensitive?). So they can’t help but pack on the pounds.
    The Wellspring Academy was the vision of an entrepreneur who obviously saw a big fat profit in fat. Even though some parents are forced to take out home equity loans to finance their children’s stay at the camp the Wellspring program is expanding into other countries. While claiming an impressive success rate the article notes that some do regain what they lost. One girl featured in the story regained weight even before she arrived home from the academy.
    It doesn’t take much imagination to figure out what is going to happen to someone who has lost weight on a low fat, high carb, calorie restricted diet. They will try to continue to limit fat but not carbs. The article notes that one student of the academy who was featured on the TV show ‘Extreme Makeover’ arrived at the academy weighing 483 pounds, lost 197 pounds on the program and the ballooned up to 562 pounds later. Yet, the low fat diet continues to be promoted as the solution to the growing epidemic of obesity.
    A sorry state of affairs it is. I wonder why Kirschenbaum thinks that those same 75 percent of genes didn’t cause kids to be obese 40 years ago when the percentage of fat in the diet was a lot higher than it is today?

  23. Dr. Eades,
    Not sure were I should put this because I’m probably the only one who reads this blog that is/has been chronically underweight my whole life. Lived on sugar as a kid, gained a little during my drinking days in college, then have lost that and back to being way underweight. 33 Male 5’10” 114 at last check. Do you think a low carbohydrate diet would be beneficial to the underweight? My problem seems to stem from a lack of true appetite, I eat because I feel awful or irritable and must eat something, especially sugar. In fact I carry Smarties around with me because they work quickly, are pure dextrose, and are super cheap compared to the diabetic hypo candies. When I’ve tried to low carb I cut almost all the carbs out till I’m in ketosis but then I have no appetite, and feel super fatigued. Is there a threshold of days (months) I must reach, or do underweight people need high sugar diets. I’m just plain confused. Anyways I know you can’t address me personally due to legal issues but if you could make a statement or even a whole post on underweight people low carbing, and how one would put it into action that would be amazing.
    Hey Eric–
    Underweight is a problem for those who experience it. An old medical text by Wolfgang Lutz, an Austrian low-carb researcher and physician shows some remarkable photos of people who are underweight who gained with a good-quality, low-carb diet. It does take diligence. Start resistance training. Get some L-leucine supplements and eat plenty of meat and even a little starch, and you should start to see some results.
    Keep me posted.

  24. Thanks for the post Dr. Mike.
    I’ll print it, highlight it and send it to my mother. But she recently mentioned to my son that although I keep sending her articles her Dr. still says she needs to take the statins … so she does. And this from a woman who is suffering from almost whole body joint pains since taking the statins. She thinks it’s all arthritis.
    She’s not even trying to hear that lower cholesterol numbers don’t really mean anything in terms of heart health. “But the Dr. says . . .”
    BIG SIGH . . .
    Sorry that there is such widespread ignorance in the medical profession. I wish I could help. You should at least have your mom taking some CoQ10 if she persists in taking the statins.

  25. Hi Dr Eades! Great post as usual! I recently stumbled upon a website called fibermenace and saw a video on this website about deadly side effects of fiber. I will provide a link in case you have time to watch that video. its quite revolutionary, wonder what you think about it? Thanks
    I am familiar with it. And, in fact, have had a dialogue with Mr. Monastyrsky in the comment section of this blog.

  26. Thanks for the excellent article Doc.
    By the way, could you please share the BG level one should aim for before and after meals? Also after the meals within 2 hours, can you share the BG’s accpetable increase in blood and then coming back to normal BG levels?
    For example, in my case, the BG starts from ~87 and goes up to 110 (45 mins after meals) and then comes back to 89-95 in 2 hours. Is this ok? I am a Type II Diabetic and on LC diet for the past 4 months and not on any diabetic medications.
    Please reply
    You want as little excursion as possible. And a rapid return to normal. What’s important is the area under the blood glucose curve. Your numbers are quite acceptable.

  27. Dr Eades have you seen the post at Fanatic Cook – The More Fat you eat and the More Sat Fat the higher the risk for diabetes?
    • It was the finding of the San Luis Valley Diabetes Study:
    Dietary Fat Predicts Conversion From Impaired Glucose Tolerance To NIDDM. The San Luis Valley Diabetes Study
    … which found that an extra 40 grams of fat a day led to a 3.4 times increased risk for type 2 diabetes. That association was adjusted for obesity and energy intake… meaning someone could be lean and not eat a lot, but if what they did eat was high in fat, it raised their risk for diabetes.
    • It was the finding of the EPIC-Norfolk Study in the US:
    Fat Consumption And HbA1c Levels
    … which found that HbA1c (an indicator of average blood glucose over the previous three months) was positively associated with total fat intake … the more fat one ate, the higher their average blood glucose. It also found that the more saturated the fat, the higher the average blood glucose. These findings, as above, were adjusted for obesity and energy intake.
    • It was the finding of two cohorts in the Seven Countries Study:
    Dietary Factors Determining Diabetes And Impaired Glucose Tolerance. A 20-Year Follow-Up Of The Finnish And Dutch Cohorts Of The Seven Countries Study
    … which found that “a high intake of fat, especially that of saturated fatty acids, contributes to the risk of glucose intolerance and [diabetes].” These findings, as above, were adjusted for obesity and energy intake.
    Hmmm. Let’s see. About 30 years ago when I got into this business the average American diet contained about 48 percent of calories as fat, much of it saturated, and there was no diabetes epidemic. Now the average diet contains much less fat – around 33-35 percent – and there is a diabetic epidemic. Tell me again how accurate those studies are? Sounds like the Fanatic cook should stick to cooking fanatically and let others interpret the medical studies.

  28. Are you aware of situations where your non-diabetic patients or non pre-diabetic patients fasting blood glucose rises over time on a low carb diet? Hyperlid had a post related to this some time ago:
    When those with the fasting blood glucose in the 90’s and low 100’s on a low carb diet carb up (> 150 g carbs/day for a minimum of 3 days ala GTT preparation) their blood glucose returns to ‘normal’ levels of 70’s and 80s. Also, per the link cited, their A1C is in normal range despite their relatively high fasting blood glucose even when low carbing. Do you have an explanation for this phenomenon? It seems counter intuitive given that a diabetic’s blood glucose will usually fall on a low carb diet.
    The idea you are writing about has been published in a couple of articles titled The Carnivore Connection. You can get the pdf of one here. I’ve seen this phenomenon in my own patients occasionally, but more often than not I find that their blood sugars stay down. The patients who do have a slight increase in fasting blood sugars all have normal or slightly low HgbA1c levels, which indicates that the area under their blood sugar curves is okay over the long run.

  29. The alternate hypothesis that Gray Taubes wrote about in ‘What If It’s Been A Big Fat Lie’ could be called the Sugar Hypothesis. I would actually prefer to call it ‘The Blood Sugar Hypothesis of Heart Disease’ given that some people are lucky enough to be able to eat huge amounts of sugar and other carbohydrates and still maintain low blood sugars. My only concern is that it might be criticized as the BS Theory of Heart Disease. Thanks for the time and space to comment.

  30. Off topic, but I would like to add a entry for the Reckless (under the catagory of “Stupid Statements By a Docotor” … this years nominess are….)
    In the next ten years, one of the things you’re bound to hear is that animal protein… is one of the most toxic nutrients of all that can be considered. Dr. T. Colin Campbell
    I think he’s been named Professor Emeritus of Ornish U.

  31. A question for you, if I may. I have a physical exam coming up soon with my doctor, after about a year of eating low-carb. Most likely, my blood test results will show increased total cholesterol, increased HDL levels and decreased triglyceride levels. Past experience tells me he will be concerned about the total cholesterol, and I don’t think he will be impressed with my recitation of sources which indicate total cholesterol is not a valid measure of cardiovascular disease (e.g. a book written by a science writer, a “diet” book, a blog). Any suggestions as to how to discuss these likely results with my doctor without insulting him? Any resources I can refer him to that he might actually read and trust? Thanks.
    Having been on the other end of countless doctor-patient interactions, I’m always amazed that people are worried about how to discuss these issues with their doctors. The first thing that you have to understand is that your doctor works for you, not the other way around. You’re paying for your doctor’s advice. But that doesn’t mean you have to take it. Instead of worrying about how you can persuade your doctor that cholesterol isn’t a valid measure of cardiovascular disease, ask him/her to present you the evidence that it is. He/she can’t, and, as Samuel Johnson said, “There’s an end on’t.” I can tell you from being in the field for a long time, that doctors are more worried about losing patients than patients are about losing their doctor. Speak frankly. Don’t worry about whether he/she will be ‘impressed’ with your recitation of sources. That’s not important. Just think him for his advice and go do what you know is right.

  32. Melanie,
    Our youngest daughter, who is almost 2 yrs old, was intruduced to solid food at 8 months (her mother couldn’t breast feed). We started her with pureed meat and vegetables, yoghurt, and fruits. Even now she mostly eats low carb, eggs, meats, veggies and tons of fruits (plus dairy products). She loves all kinds of meats and cheese (even Brie!)I try to keep her away from the evil grain based foods, but when she gets her hands on bread or crackers, she goes crazy. Hopefully we are giving her a good foundation for life. She is a lean and tall kid. Our other kids are on the husky side —-like her parents. My wife ate a Zone type diet when she was pregnant with our little one and had lots of sunshine. Our daughter is hardly sick and when she gets the occasional cold she gets over it quickly. Good health really starts with good nutrition.

  33. Hi Dr Mike! I recently listened to Dr Gundry giving an interview for Jimmy Moore podcast. His book turn off the genes that kill you is an interesting concept. I am not sure if you are familiar with his work. Do you share some of his beliefs? I met with Mr Monastyrsky before on a Russian radio station in Brooklyn when he hosted a nutritional show. He is an interesting fellow but a bit too unacceptable to an open dialogue.
    I haven’t read Dr. Gundry’s book nor have I heard his interview yet, so I can’t say whether I’m in agreement with him or not.

  34. My grandmother, who raised eight children on a farm during the early part of the 20th century, said that she breast-fed all of her kids until they were old enough to walk to the dinner table and that’s when they started solid food. She found the whole concept of feeding babies special little jars of food to be nonsense.
    My mother, on the other hand, was a big fan of sticking rice cereal mixed with formula in an evening bottle as soon as possible because she swore it made us sleep through the night.

  35. Thanks Dr. Eades for the advice I’ll keep you posted. I guess I should mention my hardest difficult is an allergy to whey, so no cheeses, cream or protein powder and I have problems with wheat and eggs as well(which is probably due to a leaky gut) I use clarified butter though. So I’m going head first into steaks with lots of butter and maybe some small potatoes or small amounts of rice with lots of butter. I’ll take some L-leucine 5 grams enough? I’ll probably take it in a BCAA supplement unless you think that is problematic. I’ve also heard of pemmican, which I may try though it doesn’t sound to appealing. I’m going to go 100% and see how things turn out and let you know!
    Thanks again,
    If you eat plenty of meat an additional 5 gms of L-leucine should be enough. You should get at least 12 grams per day, but much of that will come from the meat. BCAA supplements are fine, just make sure the L-leucine content is okay.
    I’m eager to learn the outcome.
    Good luck.

  36. Re: my puzzlement about why Asians on the traditional diet (mostly rice) didn’t get much diabetes or heart disease and you said read Gary Taubes.
    I actually asked him that question and he said he didn’t know but he thought it was because in the past they didn’t refine the rice as much and they didn’t eat sugar.
    I also asked him why vegetarians are skinnier and he gave the same answer, he thought maybe it was because they tend to eat less refined foods.
    My take on the situation is that Asians on a traditional diet don’t eat refined carbs and they don’t eat many calories. Even a high-carb diet (as a percentage of calories) isn’t all that high if the calories are low. And, traditionally, Asians following a traditional diet (who usually live in rural areas) work pretty hard. Plus, they generally eat a fair amount of fish, which has fats that are protective. These are all points Taubes makes in his book (or maybe were left on the cutting room floor when the book was edited down from 700-800 pages to about half that. I read the first version and the last, but can’t remember if this was in both or just the first).
    As Asians become more Westernized they are beginning to develop all the diseases that we do.
    I think the same applies to some vegetarians, but not all. It’s not a general finding that vegetarians are all skinny. In fact, some are downright fat. If they consume small amounts of food that isn’t very energy dense, it stands to reason that they’ll be slim. Which also doesn’t necessarily equate to health.

  37. I’m wondering what other people think. I’ve been doing some research on healthy eating and low carb diets in particular and came up with this one site called where there are debates by experts on various subjects. There is one debate called: “Are Low Carb Diets Healthy?”.
    I like the idea that these people are experts in their fields, but this one guy says something that gives me pause. He says something to the effect that eating whole plant foods is associated with having good health but diets high in animal protein and fats are not. He also says that in a global sense, a sustained low carbohydrate diet which comes mainly from animal foods creates significant challenges for the planet and also other health issues for people such as antibiotic resistance.”
    What do you think he means when he says that a diet which comes primarily from animal proteins is bad for the planet? That’s the first time I ever heard that. If you have time, take a look and let me know what you think by posting your comment. Thanks!
    I think the idea that the eating meat “creates significant challenges for the planet” is absolutely absurd. As is the idea that eating meat causes antibiotic resistance. This idiocy has almost become a religion for some. I will have to post at length on this in due course.

  38. The antibiotic concern is due to the belief that cattle are given antibiotics and as a result we ingest them making us more resistent to them in general.
    The concern for the planet is related to the enormous amount of cattle raised and how their waste breaks down into chemicals that end in rivers and water tables that upset the eco balance in a negative way. I believe this was explained in a book called “diet for a small planet”, a book from the early 80’s i believe, promoting vegetarianism.
    Btw, I was a vegetarian for around 10 years and now trying to fight the obesity it caused by low carbing.
    I think the antibiotic concerns and the planet-related concerns are total hogwash. But that’s just me. Others may think differently. I’ll try to do a post on my perspective on all this in due course.

  39. Hi DrEades,
    Can you comment on the soon-to-be-released diabetic medicine Liraglutide(GLP 1- glucagon like peptide 1) that promises to regenerate(to some degree) beta cells?
    Also, what are your parameters for blood sugar and HbA1C?
    Thank you for your great blog.
    I don’t know enough about the new medicine to comment intelligently. I do know that a lot of good work has been done on GLP-1, but I don’t know exactly what this drug does. I’ll give it a look. Thanks for pushing me.
    I like to keep blood sugar levels in the 75-85 level and HgbA1C as low as possible, somewhere below 5 if possible.

  40. I’m glad to see your support for relying primarily on breastmilk for the first year of a baby’s life in a comment above. My son wasn’t big on solids until more like 15 months (ate a wide variety of tastes, textures, but small quantities). My daughter is approaching 2 and still enthusiastically nursing along with eating solids (she has always been more interested in them than DS, but prefers meats, cheese, sour cream, etc. to sweet tastes or carbs, funny enough). Neither child started on any solids until 6 months and we skipped rice cereal altogether.
    I did want to add that while I am thrilled to see you actively encouraging moms to rely on breastmilk for the first year of life, many *non* primitive moms nurse their babies into toddlerhood (2-3 years or later), LOL. The AAP recommends a minimum of one year of breastfeeding (with no “upper limit” established), and the WHO recommends a minimum of 2 years of breastfeeding, including in industrialized nations.
    Anyway, kudos for the overall support for BFing 🙂
    Any chance you could do some posting on PCOS in the near future? I’m a woman without weight issues but with PCOS…I lowcarb and take metformin. Past tests for IR haven’t shown IR, but metformin helped me get pregnant with DD which was a pleasant surprise 🙂
    It may not have come through in my response to the comments, but I am a proponent of breast feeding until at least age 1, but for however long beyond that mother and kid are happy with it. And you are right, many primitive cultures do breast feed until toddlerhood. I don’t see a problem with it – it’s probably the way our ancient ancestors did it, which means that’s the way we’re hard wired.
    I’ll see if I can come up with a post on PCOS in the future.
    Thanks for the suggestion.

  41. A sorry state of affairs it is. I wonder why Kirschenbaum thinks that those same 75 percent of genes didn’t cause kids to be obese 40 years ago when the percentage of fat in the diet was a lot higher than it is today?
    $6350/month will help you think *anything*
    Is this guy a financial genius or what? He has developed a reversible diet thus guaranteeing plenty of repeat business.
    Give a man a cure and you have an income for a day. Give a man an incurable but treatable condition and you have an income for life.

  42. I was in the eye dr.’s office today, and she had some sort of diabetes magazine published by Better Homes and Gardens. The cover photo was of some sort of apple cake, about 5 inches high. Inside it said (I swear) that to control your diabetes it is important that you eat a low-cholesterol, low calorie, low saturated fat diet. No mention of carbohydrates? How do they even have the gall to get away with that?? I have no concept of how the system could be THAT broken.
    In other news I have been eagerly awaiting the posting of minutes from the 2010 Dietary Guidelines meeting from 29 Jan, and they have not yet been posted. Hopefully they are having a tough time incorporating the low carb research that I sent them. Dare to dream eh?
    Dare, indeed.

  43. I am thinking seriously about the carnivore connection and was wondering …what caused the death of the hunters…how long did they live…how active were they?

  44. Dr. Eades,
    I am 61 yoa, had 6 gestational diabetic pregnancies, and upon looking back have never had an acceptable blood glucose level. My fasting insulin is less than 1 and my HA1C about 13, I have never taken insulin, my BG stays in the 200’s unless I eat simple carbs. Would the no carb/low complex carb regimen work for me. I want to heal my pancreas and would like to contact you by phone for a consultation. Thank you
    For medico-legal reasons I can’t do phone consults. Given your history as presented in your comment, I think a no-carb/low-carb regimen would work fine for you. As low as your insulin is, you may not be making a lot. You should find a physician who understands low-carb diets and work with him/her to get you going.

  45. Just saw a compelling lecture by Dr. Robert Lustig in which he said that glucose is actually not the problem, since it is the life energy giving force and all living organism uses glucose. What we need to watch out for is FRUCTOSE. According to him. fructose is metabolised in the body the exact same way as ethanol, except that the brain doesn’t recognise fructose and only the liver can handle fructose. In his exact words, fructose is poison. You can watch the video here and interview here.

  46. You wrote, “To be completely accurate, it could be said that the drugs these subjects took are what is bringing about their decreased risk of death, but given the side effects of these drugs, I kind of think that is doubtful.”
    While not really disagreeing in any way with the main points of this post, I think you might be too hasty in concluding conclusively that some significant part of this lower mortality could be a direct side effect of medications. There is significant evidence that metformin activates some of the biochemical pathways believed to be responsible for the benefits of caloric restriction, and therefore it could be partly responsible, apart from its effects on blood sugar.
    Thanks for the blog!

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