WARNING!
This is an older article that may not reflect Dr. Mercola’s current view on this topic. Use our search engine to find Dr. Mercola’s latest position on any health topic.
By Dr. Mercola
The number of individuals suffering from diabetes continues to rise. In 2012, 20 million Americans had diabetes or prediabetes.1 According to the Centers for Disease Control and Prevention (CDC),2 the number is now over 30 million. This includes 23.1 million diagnosed and 7.2 million who are unaware of their condition.
Statistics also indicate there are 84.1 million adults with prediabetes. Interestingly, the estimated percentage of those with Type 1 diabetes has remained stable at 5 percent.3 Total medical costs and lost work and wages are estimated at $245 billion, and the risk of death for adults with diabetes is 50 percent higher than for nondiabetic adults.4
The rapid rise in prevalence strongly suggests Type 2 diabetes is not due to genetics. Insulin and leptin resistance are the foundational causes of diabetes. High blood sugar is merely a symptom thereof.
It is essential to make a point of discussing this condition frequently, as it is one of the greatest health threats facing much of the world, while also being one of the easiest to treat with simple lifestyle strategies.
However, while many physicians recommend dietary modifications, most individuals begin using oral and injectable hypoglycemic drugs to control blood sugar without addressing the underlying cause. The U.S. Food and Drug Administration (FDA) recently warned that a class of oral medications increases a diabetic's risk of a rare but life-threatening bacterial infection.5
FDA Warns Diabetes Drug May Be Linked to Serious Genital Infection
The infection, called Fournier's gangrene, occurs in the genital area of men and women. The bacteria usually enter the body through a cut and quickly spread. A diagnosis of diabetes is a risk factor for developing Fournier's gangrene. The class of medication associated with an increased risk are sodium-glucose cotransporter-2 (SGLT-2) inhibitors.
The infection causes necrotizing fasciitis, or flesh-eating disease, of the vaginal area in women and the area between the scrotum and anus in men. The FDA warns patients to seek immediate medical attention if they experience any symptoms of tenderness, redness or swelling or have a fever above 100.4 degrees Fahrenheit (F). The symptoms worsen quickly, so it is vital to seek immediate treatment.
In the five years between March 2013 and May 2018, the FDA identified 12 cases of patients taking the medication who developed the infection. They acknowledge these numbers only include reports submitted to the FDA and found in the medical literature. The real number may be higher. According to the FDA:6
"[T]here may be additional cases about which we are unaware. In 2017, an estimated 1.7 million patients received a dispensed prescription for an SGLT-2 inhibitor from U.S. outpatient retail pharmacies. Although most cases of Fournier's gangrene have previously been reported in men, our 12 cases included seven men and five women.
Fournier's gangrene developed within several months of the patients starting an SGLT-2 inhibitor and the drug was stopped in most cases. All 12 patients were hospitalized and required surgery."
The FDA found one patient had died and others required multiple disfiguring surgeries to stem the infection.7 As diabetes increases the risk of Fournier's gangrene, the data were analyzed for patients who were taking glucose-lowering agents.8 The infection is more typically found in men ages 50 to 60.9
The SGLT-2 inhibitors are a class of hypoglycemic drugs designed to work against SGLT-2, a low affinity, high capacity transporter protein found in the kidneys.
This class of medication was approved as an adjunct to diet and exercise to improve glycemic control in Type 2 diabetes and not for use in Type 1 diabetes. These are the brand name and generic names of the drugs currently on the market:10,11
Canagliflozin (Invokana) |
Dapagliflozin (Farxiga) |
Empagliflozin (Jardiance) |
Empagliflozin/linagliptin (Glyxambi) |
Empagliflozin/metformin (Synjardy) |
Dapagliflozin/metformin (Xigduo XR) |
Ertugliflozin (Steglatro) |
Infection Is Not the Only Concern With SGLT2 Inhibitors
Besides several safety communications that included concerns about increased risks of leg and foot amputations,12 this was the second safety warning the FDA issued against SGLT-2 inhibitors. May 15, 2015,13 the FDA issued a warning the drugs may lead to ketoacidosis, a condition in which the body produces high levels of acids often requiring emergency care or hospitalization for treatment.
In a search of the FDA Adverse Event Reporting System (FAERS), they identified 20 cases of diabetic ketoacidosis associated with the medications. Each patient required an emergency room visit or hospitalization for treatment. The FDA recommended discontinuing the drug if acidosis was confirmed, and instituting supportive medical care.14
The FDA found triggering factors in some cases included acute illnesses, such as urinary tract infections, gastroenteritis or the flu.15 Other patients found a reduced caloric or fluid intake and reduced insulin dosing could trigger diabetic ketoacidosis while taking the medication.
One month after the FDA announcement, the European Medicines Agency (EMA) also announced an investigation into the risk of diabetic ketoacidosis with SGLT-2 inhibitors.16 Health Canada quickly followed.
The EMA decision was prompted by their adverse events reporting database indicating more than 100 people suffered from diabetic ketoacidosis while using SGLT-2 inhibitors, serious enough to require hospitalization.
By the end of the year the FDA safety review prompted the addition of printed warnings on all labeling regarding the risk. They also included risks regarding life-threatening blood infections (sepsis) and kidney infections that began as urinary tract infections in people taking SGLT2 inhibitors.17
Diabetes Drugs Affect More Than Blood Sugar
There are nine classes of oral diabetes drugs, all of which differ in their side effect profiles. Some of the other known side effects of SGLT-2 inhibitors include vaginal yeast infections and yeast infections of the penis, upper respiratory tract infections, urinary tract infections and changes in patterns of urination. Others have reported hypotension, kidney dysfunction, bladder cancer and hypersensitivity reactions.18
The surge in new drug classes to treat Type 2 diabetes has been fueled by the rising number of individuals suffering from the disease. Drug companies are quick to step in and fill a growing desire for quick treatments, often leaving consumers to experience the side effects of taking a pill rather than changing their diet and lifestyle.
Many of these drugs also interfere with other medications you may be taking, including several heart medications and antibiotics. Injectable insulin plays a unique role in the exacerbation of diabetes, which I discuss in a previous article, "How to Reverse Type 2 Diabetes, Why Insulin May Actually Accelerate Death, and Other Ignored Facts." Potential side effects from various oral medications include the following:19
Thiazolidinediones — Liver disease, fluid retention, weight gain and increased risk for fractures and bladder cancer |
DPP-4 inhibitors — Hypoglycemia, fluid retention, hives, urinary tract infection and facial swelling |
Biguanides — Stomach discomfort, diarrhea, decreased appetite, interference with B12 absorption and exercise-induced hypoglycemia |
Sulfonylureas — Skin rashes, reduced red blood cell count, liver disease and upset stomach |
A-glucosidase — Gas, bloating and diarrhea |
Bile acid sequestrants — Stomach discomfort or pain, constipation and heartburn |
Bromocriptine mesylate — Nausea, headache, weakness, dizziness, sinusitis and constipation |
Diabetes Triggers Long-Term Damage to Organ Systems
In the long term, high glucose levels, which are the result of insulin resistance, damage large and small blood vessels, ultimately leading to an increased risk for heart attack and stroke, as well as problems with the kidneys, eyes, feet and neurological systems.20
It is also possible to experience nerve damage to internal organs, such as the stomach, intestines, bladder and genitals. These may result in digestive issues, urinary tract conditions and sexual dysfunction.21 Damage to small blood vessels also increases the risk of frequent infections and problems with wounds that will not heal.
Nerve damage in the hands, feet or arms, called diabetic neuropathy, affects nearly half of those with diabetes and is more common in those who have had the disease for a number of years. Symptoms range from pain and numbness in the feet or hands to problems with function with internal organs, such as your heart and bladder.22
Autonomic neuropathy damages nerves controlling your internal organs, while focal neuropathy typically damages a single nerve, often in your hand, head or leg. Proximal neuropathy is rare and disabling, causing nerve damage to your hip or thigh and often affecting only one side of your body. The good news is the risk of these kinds of complications can be reduced by making lifestyle changes to improve your insulin and leptin sensitivity.
Medical Treatments Don't Treat the Condition
Conventional medicine has pegged Type 2 diabetes as a problem with blood sugar control, and the medical goal of treatment is to reduce blood glucose levels in order to prevent blood vessel damage. However, as diabetes is primarily triggered by a seriously flawed diet and lack of physical activity, prescriptions to address blood sugar levels fail to address the root cause.
In other words, the medical community's approach is to treat the symptom of elevated blood sugar and not the condition of malfunctioning insulin and leptin signaling, and to use medications that come with their own long list of side effects that impact a number of bodily systems.
Lifestyle Strategies That Address the Root Cause of Diabetes
You do not have to become a part of the diabetes epidemic taking place in the world today. You merely have to be mindful of your everyday habits. Your body is a complex combination of chemicals, enzymes and hormones and, while it may be tempting to believe one hormone controls an entire system, the reality is far more intricate.
There is no question that regularly consuming excessive amounts of net carbs dramatically increases your risk, and consuming too much processed fructose will inevitably wreak havoc on your body's ability to regulate proper insulin levels. Although refined fructose initially has a relatively "low glycemic" profile, it leads to chronic insulin resistance and elevated blood sugar long-term.
So, while you may not notice a steep rise in blood sugar immediately following fructose consumption, it is likely changing your endocrine system's ability to function properly behind the scenes. Here are several simple and effective choices to naturally help your body control insulin resistance and sensitivity.
Increase your fiber intake — Include both soluble and insoluble fiber in your daily diet. Grains, even organic ones, are not an ideal source of fiber. Instead, eat more organic whole, unsweetened husk psyllium, chia seeds, sprouts and vegetables such as broccoli, cauliflower and Brussels sprouts. Aim to include 50 grams of fiber for every 1,000 calories you eat daily. |
Reduce net carbs — A low-net carbohydrate diet reduces inflammation and the amount insulin required to use the energy from the food you eat. Aim for 50 grams of net carbs per day.
This number is calculated by taking the grams of carbs you've eaten and subtracting the number of grams of fiber. In this way a high-fiber diet also helps you to lower the amount of insulin you need to utilize your food for fuel. |
Increase high-quality fats — When you reduce carbohydrates, your best alternative to replace them is high-quality, healthy fats necessary for keeping your heart healthy, feeding your brain, modulating genetic regulation and prevent cancer. Healthy fat sources include:
- Avocados
- Coconut and olive oil
- Organic, grass fed meat and dairy products such as butter
- Organic raw nuts
|
Exercise — Exercise is a diabetic's best ally, and can produce rather rapid results. Research23 published in Medicine & Science in Sports & Exercise found, for example, that a single session of moderate exercise can improve the way your body regulates glucose and reduces the spikes in blood sugar that occur after a meal (elevations in these spikes, known as postprandial glucose, or PPG, are associated with Type 2 diabetes, heart disease and death).
When you exercise for diabetes prevention or treatment, intensity is key. A slow walk around the block, while better than watching TV on the couch, is not likely to cut it (although if you're morbidly obese and very out of shape this is a good way to start).
Instead, high-intensity interval training, which is a core component of my Peak Fitness program, should ideally be included in your fitness program to achieve optimal results. |
Hydration — As you become dehydrated, your liver secretes a hormone that increases your blood sugar.24 As you hydrate, blood sugar levels lower naturally. To stay well-hydrated drink enough to maintain your urine color straw yellow throughout the day. |
Reduce stress — Stress increases the secretion of cortisol and glucagon, both of which affect your blood sugar levels.25,26 Control your stress levels using exercise, meditation, yoga, prayer or Emotional Freedom Techniques (EFT). |
Sleep — Getting enough quality sleep is necessary to feel good and experience good health. Poor sleeping habits may reduce insulin sensitivity and promote weight gain.27,28 |