15 Responses to “Diabetes, Cholesterol, BP: Normal is no longer normal”

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  1. avatar Paul says:

    If there is a correlation between height and CHD, then perhaps there is an argument for compulsory amputations below the knee in order to bring ‘at risk’ groups back into the ‘normal’ range.

  2. avatar Ash Simmonds says:

    *checks pharmaceutical patents*

    Nope, no patented drugs exist for lowering body temp yet (whilst subject remains alive), guess it’s still ok to be 37 deg C.

  3. avatar Hugh Mannity says:

    So if the normal range for fasting blood glucose is higher that currently espoused by the disease management industry, does that also mean that the “hard” number of 140 (US) or 7.8(UK) at which organ damage begins, is also inaccurate?

    Because it would seem to me that if normal biochemistry can vary that much, then the body’s organs should be similarly flexible. Rather than there being a hard line at which organ damage occurs, perhaps it’s n% higher than fasting.

    Similarly, just having the occasional peak where post-prandial blood glucose exceeds this “magic” number is unlikely to cause lasting damage. Lasting organ damage comes after substantial and prolonged abuse. But just how substantial or prolonged, is going to vary from individual to individual.

    Modern medicine doesn’t like squishy numbers. Especially the bean-counter driven American healthcare system. They’re all about hard numbers and “pay for performance”. It’s a very mechanistic model, which is fine if you’re talking cars or vacuum cleaners, but doesn’t work nearly so well with people.

    • avatar Zoë Harcombe says:

      Good point Hugh!

      • avatar Andrés says:

        Both of you should read Jenny Ruhl’s links.

        It is well known that turning from traditional food to industrial one wrecks havoc with our glucose tolerance and health. Just read late Barry Groves’ Trick and Treat or even Lindeberg, Cordain and Eaton’s Biological and Clinical Potential of a Palaeolithic Diet. Our western normal is clearly not healthy.

        Personal information through postprandial measurement is the way to go if we are interested in knowing if this occasional peak exceeds this “magic” number either just barely and not often or instead sharply and often. Why? Because it is quite clear that the deleterious effect is dose-dependent: read Petro’s take on the matter.

        It is highly irresponsible to suggest people their fasting blood glucose of 140 (7.8) or even 120mg/dl (6.7mmol/l) is OK.

  4. avatar Kenny says:

    Zoe, there seems to be at least some good news recently on the blood pressure issue.

    With Blood Pressure, Lower Is Not Always Better, New York Times


  5. avatar Andrés says:

    I will add the most relevant links to Jenny Ruhl’s work.

    In Misdiagnosis By Design – The Story Behind the ADA Diagnostic Criteria explains what Pam pointed out: “Therefore the “norms” were set at a high level.”

    In How Blood Sugar Control Works–And How It Stops Working explains what Judi pointed out: “According to Jenny Ruhl at Bloodsugar 101 by the time your fasting blood sugar is this high you are already most likely getting damaging post-prandial numbers of over 140.”

    In Research Connecting Organ Damage with Blood Sugar Level explains what those troubles are that Janknitz pointed out: “So they may be under 100 FBG and therefore “normal” on that curve, but they are already in trouble.”

    Under an unhealthy diet normal can be unhealthy. Everyone should check his/her postprandial blood glucose after most usual meals and act accordingly.

  6. avatar Pam Forrester says:

    I agree with Lauren and Janknitz. Lowering norms for FBG is a good thing. From what I have read Doctors were loathe to diagnose diabetes too early b/c of the ramifications on getting health insurance costs/death sentence perception ages ago. Therefore the “norms” were set at a high level. But as others have said damage to blood vessels, capillaries, organs, pancreas etc occurs earlier than most people think according to Blood Sugar 101. And just as Lauren said, Fasting Blood Glucose is the last thing to go after years of sugar organ damage.

    This is what I have read. Jenny Rhul has diabetes and great difficulty regulating it with diet and medication. Zoe, I agree with you, we do not want to medicate more and more people. We need to change our diets. The Diabetes Diet needs to be changed to decrease the need for medication.

    But I don’t think we need to raise the FBG norms. But I could be wrong. Jenny Rhul could be wrong. Could you do more of your wonderful research on this issue and let us know what you find?

  7. avatar Lauren says:

    I get what you are saying, but I am wondering what the “normal” population has been doing. I mean, has the normal curve been going upward, or has it been staying in the same place? I would guess that, at least for blood sugar, it has been straying upward, since so many people eat so many carbohydrates. So, perhaps, docs have been moving it BACK down to where it should be, or to where it used to be?

  8. avatar Judi O says:

    I agree with Janknitz, a fasting glucose number over 100 is a call to action. According to Jenny Ruhl at Bloodsugar 101 by the time your fasting blood sugar is this high you are already most likely getting damaging post-prandial numbers of over 140. By the time I took matters into my own hands and changed my diet I was already suffering from neuropathy in my feet. I was not considered a diabetic – my doctor had told me my fasting was “high normal” at 102 and we would just keep our eye on it. Right.

    When I began testing after meals I discovered my sugar was going as high as 182. My doctor didn’t seem concerned by this, but I began a primal style diet and have never looked back. Metformin can be helpful, but it’s mostly about how much carbohydrate you’re eating and doing some sensible exercise.

  9. avatar Janknitz says:

    I GET what you are saying, and I totally resent that my doctor is now telling me that my BP of 130/90 is now considered “pre-hypertension” when it used to be considered “normal”. They want to treat what was once considered normal. Ridiculous considering this is how high it goes with “white coat syndrome”. At home my BP typically runs in the 115/70 range–I’d be passing out all over the place if they tried to lower my “pre-hypertension” BP! Likewise for the changes in what is considered “normal” cholesterol, especially that no allowances are made for age, especially in women.

    OTOH, I do believe that there is a “diabetes spectrum” and that people who are considered “pre-diabetic” under the current standards are definitely on that spectrum (personally, I think HbA1C’s in the 5.7 range indicate they are already diabetic, but that is a personal opinion). Additionally, the so-called “normal” curve includes a lot of people who already have serious insulin resistance issues and do tend to be hyperglycemic, but maybe not when fasting–yet. So they may be under 100 FBG and therefore “normal” on that curve, but they are already in trouble. I have read that if you tested strictly a population of people who do NOT have insulin resistance, that the “normal” part of the FBG curve would range from about 70 to 85, not up to 100.

    I don’t think people need to be on diabetes drugs just because they are “on the spectrum”. But they certainly need to be paying attention to their diet and exercise AND be given the RIGHT diet advice, which doesn’t include eating low fat and lots of whole grains.

  10. avatar Lynne says:

    Zoe, thank you for this, as usual an informed and sensible response.

    • avatar Lisa Chase says:

      What a coincidence: I’m currently reading a book called “The Patient Paradox” by Margaret McCartney. I’ve only just started it, but she writes about something similar- that the medical industry nowadays seems to be treating “numbers” rather than actual symptoms or sickness. (For instance, so-called “high cholesterol” is not an actual illness, and yet millions of people are being treated as if it were). Not only that, but one blood reading can vary drastically from day to day, or even hour to hour; it’s just a “blip” in the greater scheme of things. In addition, there does not seem to be any evidence that medically lowering blood cholesterol or blood pressure does anything at all, aside from causing possible side effects- (pre-diabetes could be a different case IF they were to advise people with high blood sugar to reduce carbohydrates, but of course they don’t).

      On a side note, I am now considered “underweight” because my BMI is below “normal”. But I feel perfectly healthy, and when I look at film footage of women from the 1950’s or 60’s, my body type looks average for that time period. So what is “abnormal” anyway?

      • avatar Zoë Harcombe says:

        Hi Lisa – sounds like a great book – I do like M McC – one for the holiday downloads – thank you!

        In terms of health, overweight (25-30) is ‘better’ (Lenz M, Richter T,Mühlhauser I, ‘The Morbidity and Mortality Associated With Overweight and Obesity in Adulthood A Systematic Review.’ Dtsch Arztebl Int. 2009 October; 106(40): 641–648. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770228/) than underweight or normal. But anyone who is eating well and is finding a stable weight easy to maintain is probably at their natural weight. In some people this is low; in some it’s high. That’s why we have averages!

        Best wishes – Zoe

        • avatar Lisa Chase says:

          Hi Zoe,

          I had also read that being overweight is probably healthier than being underweight, particularly in muddle aged people. However, the only way I am able to “up” my weight is by eating sugar and refined carbohydrates, which I don’t want to do for obvious reasons! In fact, as soon as I stopped eating sugar and replaced it with healthy fats, I dropped down to this weight. (However, I feel much better eating this way!) One of the points I was trying to make though is that “averages” and what’s considered “healthy” might change over time, so there’s probably little point in stressing about it; for instance, my body type and weight looks like it was “average” for women of my age in the 1950’s and 60’s, if not now. To be honest, I was always a bit skeptical of BMI as a measuring tool (both for labeling “overweight” as well as “underweight”)- just as I am skeptical of other “numbers”.

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