Traditional Diet and Exercise Failed to Reduce Heart Attacks, Strokes and Mortality in Type 2 Diabetics: Unexpected Results of a Landmark Trial, Known as Look AHEAD

The Action for Health Diabetes (Look AHEAD) study, a trial comparing an intensive lifestyle-intervention program versus the standard diabetes support and education had to be stopped, as it failed to show any improvement in cardiovascular events or death rate. It is interesting to note that previously, the investigators were all excited that the trial would show a reduction in cardiovascular events, as it had shown improvement in cardiovascular risk factors.  

The study began in 2001 and was funded by the NIH (National Institute of Health). It enrolled 5145 Type 2 diabetic patients, who were roughly, equally divided into two groups: The intensive lifestyle-intervention arm, which  included individual sessions with a nutritionist and/or personal trainer, as well as group sessions and refresher courses versus the control group that received standard diabetes support and education. 

Intensive lifestyle-intervention did show an improvement in cardiovascular risk factors, but it did not translate into reduction in cardiovascular morbidity or mortality. In other words, intensive diet and exercise conducted with the help of dietitians and exercise trainers did not make any difference, as far as cardiovascular events are concerned. 

It is an excellent study that brings out several points: Current diet and exercise recommendations can improve cardiovascular risk factors, but do not prevent heart attacks, strokes and deaths. Isn't it time, we reevaluate our so called cardiovascular risk factors? Perhaps we are missing something. One such major factor is stress, which is well known to cause heart attacks and stroke. We don't even mention stress management when we talk of lifestyle intervention. Interesting, isn't it? Perhaps our recommendations about diet and exercise are also flawed. 

I came to these conclusions about fifteen years ago and developed my own treatment strategy for my Type 2 diabetic patients. It consists of five steps: My own recommendations about diet, exercise, stress management, vitamins/herbs and medications, in that order. The results have been astounding. Heart attack or stroke is a rare event in my Type 2 diabetic patients. When some of my Type 2 diabetic patients get hospitalized for elective surgery, usually some orthopedic surgery, they are shocked to see the kind of food on their tray (like cake, cereal, juice and pancakes) at the hospital. They refuse to eat half of those food items. Sadly, they also see the high charges of the dietitian's consultation fee on their discharge bill.  

I Have discussed my revolutionary, comprehensive and scientific treatment strategy in my book, "Take Charge of Your Diabetes."


This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.


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