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DPP4 inhibitors such as Galvus met increases risk of heart failure!

Galvus met, till date claimed as a safe drug has become very popular due to its effectiveness. It is also known as a Gliptin or DPP4 inhibitors. From latest clinical trials , it is seen to have increased risk of heart failure as published in a very recent article in AHA journals of Feb 2018 issue.

ahajournals.org/doi/abs/10....

Galvus met contains Vildagliptin which has not been approved by FDA, though its twin sister Sitagliptin has FDA approval.

Talk to your doctor if you need to reduce your dose of Galvus met or substitute by any other drugs.

In any case, try to control blood sugar by diet and exercise and minimise medication since most of the medicines seems to have some side effects or other.

Insulin seems to be safer than the oral medications.

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No.Insulin is as bad as secretagogue medicines.Galvus treatment is illogical, unscientific and harmful. Both insulin and galvus increase IR.And to prevent hypoglycemia when these drugs - insulin and galvus - are used one has to eat high carb diet.Not good.

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That is bad. Diabetes Mellitus is as old as mankind. Unfortunately, not a single medication has been discovered today by modern science which does not have any serious side effects.

Yes, people are trying to control blood sugar through diet and exercise which gives limited success !

Any latest up date on LWMDR (Long Wheat Mash Diet Regimen)??

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Diabetes is not a disease in itself so it can't be cured.So no medicinal cure for diabetes. Since t2d can't metabolize carbs they should eat carbs to the extent they can clear the sugar from the blood. More carbs than that will harm their vital organs.It's that simple.

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Agree that it is not a disease by itself. But unfortunately, even if you minimise carbohydrate, still the blood sugar remains elevated without medicines. And whatever medicines discovered so far, there is not a single effectve medicine without having serious side effects.

And the uncontrolled blood sugar has consequences / complications which are scary : kidney failure/Heart failure, liver failure, Retinopathy, nuropathy, leg amputation and so on.

The only way is yes : minimise carbo, maximise fiber, maximise protein. With Regards to Fat , zero oil and fat. In stead, moderately Source your fat from nuts and seeds rich in MUFA such as Almonds, omega 3 rich PUFA like flax seed and chia, wal nuts.

Avoid SFA.

Minimise medications

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Lchf diet.Low carb high / healthy fats diet.Not zero fat.Ketogenic ratio should be 3-4:1that's 75-80% calories should come from fats - the healthy ones. Zero fats means one has to eat either carbs or prots. How much protein can one eat daily? 1-1.5 g / kg body weight. More than that is not recommended because puts strain on liver and kidneys.

Yes.You are right.Sometimes inability to metabolise carbs is so severe that even endogenously produced sugar is not cleared efficiently. But that's rare.One can take drugs like metformin which enhances clearance of glucose by activating certain enzymes in the liver.Any drugs which whips pancreas to secrete more insulin is not recommended because that's what our pancreas is already doing.

Minimizing carbs alone can't be effective. One has to lose fats, esp belly fat, to overcome IR.Until that's done bs is not controlled. Minimising carbs brings down the elevated insulin levels which in turn helps dissolving fats from our body.Losing fat is a slow process. One has to be in a starvation mode which is practically impossible having lots of foods around us.That's why IF is also recommended.

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Dear Suramo

Agree with your approach on LCHF.

My thoughts:

(1) when I say Zero fat, I meant zero consumption of refined edible oil- RBD.

(2) Source your Fat so called healthy fats should be predominantly MUFA and omega 3 based PUFA. Omega 6 based PUFA should be avoided since omega 6 fatty acid promotes inflammation.

Thus Healthy fats are Almonds, macadamia nuts, Avocado fruit, Flax seeds, Chia seeds, wal nuts. SFA should be minimised since it increases LDL except coconut meat in moderation.

(3) yes very high protein more than 1.5 gm/kg body weight should be avpided.

(4) the ideal situation is controlling Blood sugar with(a) LCHF and if required (b) taking metformin only

(nothing else)

(c) Exercise/GYm/brisk walk 45 mnts twice daily and remain active for the day. Avoid long sitting.

(5) underweight/ Low BMI people need to be careful with LCHF as LCHF leads to undesirable weightloss for the underweight. In such a situation , carbo proportion perhaps needs to be moderated.

Your views please ?

I welcome all to comment on my thoughts!

We are all learning !

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I have different views for sfa.Co contains @46% mct. Vco @54%.Ghee is full of sct and mct upto 71%. The beauty of sct n mct is they get absorbed directly to the liver unlike lct which require bile salts / chylomicron for their absorption. The difference between sct mct and lct is that while lct in chylomicron bypasses liver and go into the systemic circulation where lct are stored in fatty tissues mct sct are carried to the liver where they are burnt to give instant energy i. e. bpc. Further sct mct can't be stored in the human body.All that fat we have is lct. So in my view sfa is wrongly incriminated. Ldl is not a harmful entity. Ldl is very important in fighting microbes.Its level below 80 mg /100 ml may be harmful. Actually cholesterol and other fats should be reviewed if they are harmful or useful. By the way now the doctors are recommending " nonhdl cholesterol assay.

google.co.in/search?q=non+h...

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Dear Suramo

We are on same page!

The entire issue of cholesterol needs to be reassessed. My cardiologist put me on a statin as a preventive measure. He told me to keep LDL under 70. Everytime I had muscle pain, he changed my statin but my muscle pain remained. I discontinued statin and learned to keep my lipid profile under control with diet and exercise. No muscle pain now.

Though I agree with the basic science behind SCT+MCT , but with coconut, I had a different experience. I took a large portion of raw coconut meat ( white portion of matured coconut) daily. 1 full coconut I ate within 2-3 days. After 3 months while my hdl went up from 45 to 55, my LDL also went up from 80 to 135. I was on a LCHF diet. I was taking almonds 15-20 nos per day.

And I lost 5kg weight in the process. My weight reduced from 58 to 53 and became underweight. Now I want to go back to my previous weight by including some more healthy carbo with high fiber in my diet. Not able to gain back my weight.

Perhaps, coconut is not for underweight people. Moreover, coconut has most of its MCT as C12, which is at a higher end of MCT which is just like a LCT. The actual MCT as C8/ C10 is just 15% in coconut which goes easily to liver without getting routed through peripheral tissues. MCT as C8/C10 gets easily converted in the ketone in the liver without chylomicron.

Not sure about Ghee though. You have mentioned Ghee has up to 70% SCT/ MCT, but to my understanding it would be much less. please confirm !

Still I love coconut. I have reduced the portion. I eat a small portion daily to finish one complete matured coconut by 5-6 days

No doubt coconut has anti microbial, anti inflammatory, anti viral. Property. And it can do wonders for the arteries.

All are welcome to comment how to increase weight. I am T2 and My Blood sugar is under control. Was taking Galvus met earlier. I have left Galvus met now. I take 850 mg metformin twice daily. I am aware metformin would allow me to increase my weight.

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What I meant is metformin has weight reducing property. I feel with heavy doses of metformin and LCHF it is difficult to increase weight. While it is easy to reduce weight with LCHF diet, it is difficult for a underweight T2 to increase weight with LCHF diet.

Please comment if some one have experience !

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I wouldn't be much obsessed about my weight as far as bs remains under control. Let the nature decide.Please review your decision about Adding carbs. Ldl too i wouldn't worry much.

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😄😄.Not new.

1) diagnostic tests are not totally useless. Yes.The whole body check up like things are means to earn money and disrepute the real need for diagnostic tests.

2) true.Diabetes can't be "cured " by drugs because it's not a disease but a metabolic derangement.

3) his dietary advice is disastrous. 700 g of fruits like banana, pineapple, grapes,sapota will cause nafld.Fruits for diabetics are not innocent or as we indians believe, healthy. He is preaching vegan.There are many people in the world who follow vegan diet.There are number of articles on vegan food and its usefulness / harm. Personally i don't subscribe vegan diet.As t2d we should avoid carbs as much as possible. So remaining macro nutrients are fats and prots.For a number of reason we can't eat proteins beyond a certain limit.So remains fats.Now vegetarian sources of fats are high in omega 6 and the studies show their harmful effects. Yes.Coconut oil,palm kernel oil,avocado oil, evoo,voo are useful but ghee is far more better and so much praised by our saints, the ancient scientists. Even science has proven ghee to be a better food. Dr swaroop has his own hypothesis unsupported. If he has done studies he should come out with them or scientifically, logically prove it.I wouldn't recommend or follow his dietary advice.

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My understanding is that Desi Ghee contains 25% SCT plus MCT i.e SFA containing C less than C12. The rest are above C12 which are of LCT type.

You said, Desi Ghee contains 70% SCT plus MCT. I am bit confused. I did a literature search which also confirms my understanding.

Also , there are some literature which says coconut oil weight reducing ( which I have also seen practically), where as Ghee may have weight increasing effect which in fact I would desire.

What is your understanding on this?

Finally, Request if you have some literature on

(1) Randomised trial on Ghee or (2) if you know some one practising predominantly Ghee in LCHF diet, what has been his results on Lipid profile, BS , weight !

Thanks

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I'm taking ghee plus co predominantly. I have reduced my weight by 10 kg and ag by 2". I'm also trying to find what i said - 71% sct n mct.Ghee and for that matter healthy fats in lchf diet reduce weight and body fats.Very much Scientific. high healthy fats in lchf diet elicit almost zero insulin response. This leads to lipolysis.

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With the above fats , what lipid numbers are you getting ?

Best regards

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I'll post my results when i'll get them done.

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Dear Suramo

Read this article by Harvard Prof declaring Co oil as a poison. Not sure of the authenticity of the article

You may like to go through and comment.

firstcoastnews.com/mobile/a...

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I don't believe in such articles. I have been using co ghee and evoo for about 2 years. I have fairly controlled my bs. I'll be posting my lipid profile soon.I have understood the science behind sfa scientifically. Let all such people play their tune.

There is gross misconception regarding sfa.Any unsaturated fat is less fit for cooking. Pufa is worse than mufa which in turn is worse than sfa.The reason is that on heating usfa get oxidized, become rancid. Lose their efficacy and become harmful. The world has been misinformed betrayed and misled for last 6-7 decades. Just to sell statins. Well. @70% of my caloric requirements come from fats.Co and ghee used liberally for cooking and evoo as dressing. Mustard oil for pickles.

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As far as science is concerned it is clear with respect to thermal stability at high temp during cooking of SFA Vs MUFA Vs PUFA.

But then should it not be stable inside your body if you eat at raw walnut, flax seed, sunflower seeds which are predominantly PUFA and Almonds , cashew nuts, Macadamia nuts, EVOO which are MUFA based.

RAW coconut/ oil or ghee is supposed to be stable inside our body whether you eat raw or cooked. The only issue I have seen in my case while both of these fats increased my HDL, it increased my LDL also. My LDL went up from 80 to 135 within a couple of months, though my HDLwent up from 42 to 53. My BS remained stable. I was scared of LDL as I did not find any literature which says excessive LDL is good!

Your body may react differently to co and ghee. Hope you are also taking some flax seeds too which to some extent could help reducing LDL and thus balancing Lipids

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Inside our body oils get absorbed in different ways.Stability is not needed there.

Well. Cholesterol theory is totally wrong and the nature is great. If ldl also increases with hdl there should be reasons we are yet to know. it's wrong teaching and preaching - according to my belief - that ldl is only bad.

No.I eat flax seeds and walnut infrequently. But take lots of evoo. According to my view cholesterol levels are directly proportionate to the degree of wear n tear. As such also now a days it's nonhdl cholesterol that's advised and taken into consideration.

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Ghee recommended by saints is not the ghee from a mixed fare obtained from buffalos , or hybrid cows . Even coconut meat or oil is found out to be not so good as per latest research . If everything is expected to be branded and recommended by the modern scientists then dooms day is not far off .

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I try to understand the science behind recommendations. True ghee recommended by saints is not from buffalo or present hybrid cows but still ghee produced traditionally by fermentation is far better.

Researches now a days are sponsored. Also there is lots of adultration to earn more. So unless a scientific explanation is put forward i'd not believe in any research outcome. I always read sfa not good because it raises cholesterol and can cause cva etc etc but i have not seen a scientific explanation. Usa has fooled the whole world for pretty 6-7 decades to sell statins. And for that they have concocted many theories and researches.Such articles i don't believe. Let there be concrete scientific explanation.

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But where do we get pure ghee? not even ISI branded .Any ghee we get is adulterated with animal fat which can't be used even for homas . so far as scientific researches you have hit the nail .How can we get scientific explanation in the absence of scientific research . Now literally the whole system is corrupt .so we have to go by our own experience and very carefully decide which food suits to our body requirements .In case of type1 D much choice is not there .

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That's a different issue. I make ghee at home. I also have local dairy/ies selling reasonably good quality ghee.Commercially available ghee usually is not made by standard fermentation process. So better avoided. And scientific researches have confirmed the benefits of ghee.

Well type 1 have no choice on insulin but afa foods are concerned the same principles as t2d are applied.

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We also make ghee at

home.we take one liter buffalo milk daily in the morning and heat it on simmer to form good and thick Skin on cooling it. I take morning sugarless tea with milk.Then milk is kept in refrigerator. Then again evening at about 5 pm same tea is repeated.Next day morning we remove the thick skin to a pot and keep this it again in refrigerator .Add a teaspoon of curd in it to commence fermentation process. Like wise we store about 2-3 weeks and after that keep this pot out side refrigerator for a day to complete fermentation process.Then in the portion of 3-4 tablespoons we put this in mixer to get white lumps of white butter. The buttermilk is taken away.The white butter is heated in simmer to get pure ghee.This is very tasty.

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Perfect. That's how ghee is made in my home too.But one can use probiotic or yogurt cultures for fermentation in stead or with curd.Both the cultures are considered better than curd.

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Dear Suramo

I posted a message at 4 PM today.. Don't know how it disappeared and did not get posted after submission.

Anyway, let me rewrite again.

Reference to the video in Glucose spike, I find even lean and thin built body is a risk factor for diabetes. The logic explained that if the muscle mass is low, then sugar does not get abosrbed simply because there is no takers for the blood glucose inside body due to lack of muscles. Then it should be imp that one remains within normal BMI range.

While I find a lot of posts in this forum on Weight reduction for obese T2 as a result of practising LCHF but I Did not find anyone with thin body structure T2 with Low BMI of 17-18 practising LCHF.

As explained you earlier, when I practised LCHF diet, my weight reduced from 59 to 52 within 3 months and I had to give up severe carbo restriction.

Can any one throw some light on Low BMI T2 practising LCHF without losing weight and muscle mass, though Suramo reassured me that one should not get obsessed with one's weight reduction as long as you achieve BS.

While I am aware that LDL increases with SFA, but I can manage my LDL without statin. Recently when I had consulted one of the top cardiologists after my comprehensive health check up, has advised me to keep my LDL goal below 60 and non-HDL below 100 and he advised to avoid SFA. When I took a second opinion in another city and another cardiologist , he also opined the same thing.

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All the cardiologists have been taught the same things. But i'm adverse on sfa advice. I don't agree to that advice.

HDL and LDL particles seem to play very different roles in the pathogenesis of atherosclerosis. Therefore, measuring the amount of cholesterol within these particles tells two different stories.

While high levels of LDL-C are associated with increased risk of heart disease, elevated levels of HDL-C are associated with lower risk. HDL particles appear to be involved in clearing and removing cholesterol from arteries and atherosclerotic plaques while LDL-particles seem to participate directly in the atherosclerotic process itself.

This is the reason the cholesterol carried by HDL particles (HDL-C) is often called “good cholesterol” and the cholesterol carried by LDL particles (LDL-C) is called “bad cholesterol.” Of course, it is the same cholesterol; the difference lies within the lipoproteins that carry it.

Measuring total cholesterol provides limited information about risk because the number includes both HDL-C and LDL-C.

If we, however, subtract HDL-C from the total cholesterol we will have a measure of the amount of cholesterol carried by all lipoproteins except HDL. Doing this simple math will give us the amount of cholesterol carried within all lipoproteins that are atherogenic. In other words; a measure of cholesterol carried within all the “bad” lipoproteins but not the “good” ones (which is only HDL). This measure is termed non-HDL cholesterol (non-HDL-C).

Relying on LDL-C alone may be misleading. For example, individuals with abdominal obesity, metabolic syndrome or diabetic lipid disorders often have elevated triglycerides, low HDL-C, and relatively normal calculated LDL-C. Despite their normal LDL-C, these patients produce highly atherogenic lipoproteins such as VLDL and IDL (intermediate density lipoprotein) as well as small dense LDL particles.

A patient with low LDL-C and high non-HDL-C is an example of a patient with increased risk who may slip through the cracks because we only look at LDL-C. These patients are also likely to have high LDL particle number (LDL-P) as well as high ApoB levels.

Recent evidence suggests that non-HDL-C shows a better correlation with small dense LDL particles than do other lipid parameters including LDL-C. Clinical studies strongly suggest that a predominance of small dense LDL-C is associated with increased risk of coronary heart disease.

Non-HDL-C has been shown to be a better marker of risk in both primary and secondary prevention studies. An analysis of data combined from 68 studies, non-HDL-C was the best risk predictor of all cholesterol measures, both for CAD events and for strokes.

The treatment goal for non-HDL-C is usually 30 mg/dL above the LDL-C treatment target. For example, if the LDL-C treatment goal is <70 mg/dL, the non-HDL-C treatment target would be <100 mg/dL.

How to Calculate Non-HDL Cholesterol

An advantage of using non-HDL-C is that you don’t need a fasting blood sample.

Non-HDL cholesterol is your total cholesterol minus your HDL cholesterol

This is the formula:

Non-HDL Cholesterol = Total Cholesterol – HDL cholesterol

So if your Total Cholesterol is 220 mg/dL (5.7 mmol/L) and your HDL cholesterol is 50 mg/dL (1.3 mmol/L);

Non-HDL Cholesterol is 170 mg/dL (4.4 mmol/L).

Here you can see how non-HDL-C levels are looked at in terms of risk:

above 220 mg/dL (5.7 mmol/L) is considered very high

190 – 219 mg/dL (4.9 – 5.6 mmol/L) is considered high

160– 189 mg/dL (4.1 – 4.8 mmol/L) is considered borderline high

130 – 159 mg/dL (3.4 – 4.0 mmol/L) is considered near ideal

below 130 mg/dL (below 3.4 mmol/L) is considered ideal for people at risk of heart disease

below 100 mg/dL (below 2.6 mmol/L) is considered ideal for people at very high risk of heart disease.

Fats are not villains and required for cell wall synthesis, many hormones and important secretions.

One has to eat protein and build muscles by exercise - strenuous if possible. But i think that was a simplified explanation. There are many thin people having diabetes but majority of them are not. Talking about t2d.Obese people tend to have t2d more than thin people. Also bad eating habits are the cause of young age heart attacks.

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@suramo.. very studious reply..🙏🏻

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Thanks Suramo!

Hats off! You guys are really pioneer in Health & Nutrition and i am sure all diabetes disorder will run away fromyou.!

Thanks for clarifying a lot of things. I am sure you have a lot of patience and energy to help the new comers in this forum. I will keep bothering you.

In other words, Non HDL-C can also be understood by the following formulae. Please correct me if I am wrong!

Non HDL- C = LDL+ VLDL= LDL+1/5 TG

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Dear Suramo

Another question how much Kcal food need to be taken in LCHF diet? Is it 2000kcal , is it1800? Perhaps it should be body weight based?

Now what happens if by chance you exceed the permissible KCal limit per day!

As we know 1 gm fat has 9 Kcal where as 1gm carbo and 1 gm protein has only 4Kcal and whether one needs to be careful in Calorie count in case of LCHF

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I have been on Galvus 50..1-0-0 for last 4 years.. my experience is good...

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Diabetic need not be very Calarie conscious...but yes, must be carb conscious....calories intake depends on nature of work,amount of work,once body stature etc....I take about 1500

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