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Letter from the Editor, #770

Feb 27, 2015

We all know the definition of insanity is "doing the same thing over and over again and expecting the same results." Nowhere has this been more true than in medicine.

Thirty-five years ago, the "experts" decided that if you ate cholesterol it would raise LDL and Total Cholesterol, and the "fat free" era was born. Even though there have been many studies to the contrary, many of my patients still won’t eat an egg yolk or a piece of cheese, and obesity, diabetes and heart disease rates have skyrocketed.

When it came to diabetes clinicians like Bernstein, Atkins, Willette, and Sears, all said cut the carbs to lower glucose and control diabetes, but it has only been in the last 5-6 years that the ADA has reluctantly embraced a lowered carb approach.

Hypertension prevention and treatment had its own nemesis and that was salt consumption. We tried salt substitutes and low salt products and yet the incidence of elevated blood pressure has increased dramatically over the past 20 years. Now newer research indicates that salt is not the real culprit, but sugar might be. This could be the reason that the SGLT-2 inhibitors work rather than by eliminating salt, and why we see consistent decreases in blood pressure in patients using these medications….

A study published in Open Heart by James J. DiNicolantanio, PharmD, from Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and Sean C. Lucan, MD, MPH, from Albert Einstein College of Medicine in Bronx, New York, indicated that the average salt consumption has stayed pretty consistent at 3.5/4 grams a day, and the average lowering of systolic BP by cutting that in half is only 2.5mm HG. At the same time the consumption of sugar has increased from about 6 teaspoonfuls a day to around 30 teaspoonfuls, and blood pressure has increased as well.

The biggest effect seems to be from added or processed sugars like fructose and the researchers found that added sugars in the diet promote obesity and insulin resistance. Insulin resistance is encountered in 25% of adults and up to 80% of persons with essential hypertension. Insulin resistance may be a greater factor than obesity in promoting hypertension. In addition, compared with patients who consume less than 10% of their calories from added sugars, those for whom added sugars constitute 10% to 24.9% of total caloric intake experience a 30% higher risk for incident cardiovascular disease.

Also, higher consumption of added sugars is associated with negative consequences on serum lipid levels, and fructose is implicated in promoting the metabolic syndrome.

So it looks like it is time to say, "Hold the sugar and fructose, and use the salt."  


Another way you can help your patients to lose weight is to get them to add more fiber to their food choices. Find out why in this week’s Item #4.



TCOYD Health Fair Conference, Santa Clara Convention Center, Santa Clara, California, Saturday, March 7, 2015

With a day packed full of education, motivational tools, one-on-one sessions, and workshops, the TCOYD health fair is a great way to get your patients to take better care of their health and themselves. Sunday, March 1, 7PM ET

From "dLife explores how diabetes can impact your love life, and what you can do about it. Plus, a mouthwatering souffl that anyone can make from the dLife kitchen." Sundays live online at at 7 PM ET, 6 PM CT, and 4 PM PT. Keep up on the latest dLife news at

We can make a difference!


Dave Joffe, Editor-in-chief