Lifestyle Changes Proven to Not Protect the Heart in Diabetics

The federally funded Look AHEAD trial stopped because it did not demonstrate that lifestyle can help diabetics prevent heart attacks, strokes or death.

When I first glanced at this announcement I was, to say the least, shocked.  This is a summary of the Look AHEAD trial (Action for HEAlth Diabetes).  It looked at 5145 diabetics with a body mass index of >25 to see how well lifestyle changes could positively impact the risk of heart attack, stroke or death.  The study lasted for 11 years.

Sounds great!  Really–how could anyone object to this study?

The early results demonstrated that the patients were able to achieve an early, modest weight loss of 10%, although this weight loss dropped down to 5% after 11 years.

The less informed will look at the results from the Look AHEAD trial and mutter under their breath that they KNEW lifestyle changes didn’t work.  From a provider standpoint, this justifies the use of drugs to control the side effects of poor health and recommend bariatric surgery.  From the patient standpoint, it exonerates him or her from making lifestyle changes because they aren’t going to work anyway.

Of course, this is what one sees when they look at the surface of the Look AHEAD trial.  If you begin to dig a little deeper, you see some serious problems with the study.  Here’s how I see it:

  1. 175 minutes of exercise per week was recommended, despite the fact that many recent studies have supported short-burst aerobic activity for avoiding or managing diabetes and cardiovascular issues.
  2. The nutritional intervention was focused primarily on two things: calorie restriction and fat restriction.  This led to higher carb choices, with little emphasis on whole grain vs refined carbs.
  3. The worse offense, however, was the allowance of meal replacements.  This is the unforgivable fault in this study.

To get into more detail, four meal replacements were allowed:

  • Optifast of Nestle HealthCare Nutrition
  • Hoffmann-La Roche
  • Glucerna of Abbott Nutrition
  • Slim-Fast Brand of Unilever North America

Basically, these are sugar laden drinks in a dairy drink base with a smattering of vitamins flavored with artificial sweeteners (Glucerna contains acesulfame potassium) and artificial flavors.

Not sure this would classify as “nutrition.”

So overall, when the news media finally gets their collective teeth into this story, remember that the story behind the headline is a little less dramatic, and poor results were actually expected when you look at how the study was designed.

And, in case you have cancelled the dietary changes and exercise plans as a result of the cancelling of this study, maybe it’s not quite time to get back on the couch and drink your Ensure.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.