FDA issued a public safety information today ( June 15, 2011) that pioglitazone ( sold under the brand name of Actos) may increase the risk of urinary bladder cancer if drug is taken more than one year and in high doses. These finding are based on the interim 5-year review of an ongoing 10-year epidemiological safety study on pioglitazone. Earlier this week, pioglitazone was taken off the market in France. And In Germany, physicians are advised not to start any new patients on pioglitazone.
In the US, the drug is on the market. Physicians are advised to be more careful about signs and symptoms of potential urinary bladder cancer such as blood in the urine, urgency of urination, low abdominal pain and pain in the low back. The continuation of the use of pioglitazone (Actos) is a decision between patients and their physicians.
I think, France and Germany have over-reacted. To put things in perspective, patients with type 2 diabetes are at increased risk of any type of cancer, including urinary bladder cancer, which is a rare cancer. Why? primarily because these patients have underlying insulin resistance with compensatory high insulin level, which causes growth of tissues, benign as well as malignant.
Insulin resistance is the consequence of a number of factors including genetics, aging, obesity, sedentary lifestyle, stress and vitamin D deficiency. Therefore, my treatment approch consists of diet, exercise, stress management, vitamins and medications. As far as medications are concerned, I use metformin and pioglitazone, as these are the only two drugs that treat insulin resistance: metformin treats insulin resistance at the level of liver and pioglitazone at the level of muscle and fat.
With this comprehensive approach, I have seen some amazing results in my patients: an excellent control of diabetes, with very few complications and almost no one requiring insulin therapy.
In the last 12 years, I have treated thousands of type 2 diabetics with my above mentioned approach. Fortunately, I have not encountered a single case of urinary bladder cancer.
However, we should be careful with any drug and I agree with FDA patient safety information about pioglitazone.
An excellent study from University of Texas M.D. Anderson Cancer Center in Houston showed that patients with Type 2 diabetes who used insulin were 5 times more likely to develop pancreatic cancer and those who used oral medicines that increase insulin secretion, such as sulfonylurea drugs (Glyburide, Glipizide, Glimepiride, etc ), were 2.5 times more likely to develop pancreatic cancer.
On the other hand, patients who were on Metformin had a 62% lower risk for developing pancreatic cancer.
No surprise! Type 2 diabetic patients are at increased risk for all kinds of cancer, including pancreatic cancer. Why? Because the root cause for Type 2 diabetes is insulin resistance which results in a high level of insulin in these patients.
Insulin causes an increase in the growth of cancer cells. Therefore, if you take insulin shots or oral pills that increase insulin production (drugs such as Glyburide, Glipizide or Glimepiride and other sulfonylurea drugs ), you are obviously adding fuel to the fire, increasing your risk for cancer.
On the other hand, if you treat insulin resistance, then your insulin level goes down and your risk for cancer also goes down.
Metformin treats insulin resistance. Therefore, it was no surprise that metformin caused a decrease in the risk for pancreatic cancer in this study.
Currently, there are only three anti-diabetic drugs that treat insulin resistance; These are Metformin (Glucophage), Pioglitazone (Actos), and Rosiglitazone (Avandia).
As I mentioned in my book, "Take Charge of Your Diabetes," I focus on treating insulin resistance. I rarely use pills that increase insulin production and almost never use insulin in my Type 2 diabetic patients.
A very interesting study (1) from Spain shows that Mediterranean style diet as compared to low fat diet, reduced the risk for diabetes by 52%.
Mediterranean style diet consists of:
Abundant use of olive oil
Increased consumption of fruit, vegetables, nuts, legumes, and fish.
White meat instead of red or processed meat.
Preparation of homemade sauce with tomato, garlic, onion, and spices with olive oil to dress vegetables, pasta, rice, and other dishes.
Avoidance of butter, cream, fast-food, sweets, pastries, and sugar-sweetened beverages.
In alcohol drinkers, moderate consumption of red wine.
Reference: 1- Salas-Salvadó. J, Bullo M, Babio N et al. Reduction in the incidence of type 2 diabetes with the Mediterranean Diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized trial. Diabetes Care 2010: DOI:10.2337/dc10-1288.
No Surprise: Olive oil, nuts, and fish are known to reduce insulin resistance, the root cause of development of Type 2 diabetes.
On the other hand, fast foods, sweets, sodas and all bakery products, including all cereals, put a heavy load in terms of glucose on the overworked pancreas from insulin resistance and ultimately leads to development of type 2 diabetes. Please read my book, "Take Charge of your Diabetes" to fully understand insulin resistance and its consequences.
This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, Endocrinology 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.
Copyright © All rights reserved.