The first drug to reduce mortality in type 2 diabetes revealed! And it’s low carb in a pill!

How the drug works

How the drug works

Finally there’s a drug that can help people with type 2 diabetes live longer and healthier lives.

As incredible as it sounds most drugs in type 2 diabetes – like insulin – only helps to control blood sugar. They don’t actually improve the disease or help patients live longer. Sometimes they even make things worse.

Yesterday at the huge diabetes conference in Stockholm that changed. Results from a large trial shows that the drug Jardiance can help people with diabetes get less heart disease AND live longer (besides lowering blood sugar, blood pressure and even helping people to lose weight).

This is massive news for anybody interested in type 2 diabetes. And it makes perfect sense.

While other drugs are trying to hide the problem in type 2 diabetes (too much sugar in the body), Jardiance and other similar SGLT2-inhibitor drugs try to get rid of the problem. They increase the loss of glucose via the urine, by making people pee out up to 70 grams per day of the carbohydrates they eat.

Of course you can likely get the same or even stronger effect – and avoid all of the side effects – by simply not eating the carbohydrates in the first place. But hey, nobody can make money selling that. Read free advice on how to do it.


I wrote about a similar drug (Farxiga) two years ago: Low-Carb Diet in a Pill – A Good Idea?


  1. robert
    350$ a month, oh my! A 12$ pill... Why not just buy low-carb food for that kind of money?

    I may have mentioned it before, maybe here or somewhere else: what are the consequences of chronically elevated glucose levels in the bladder and connecting 'pipework'? I would imagine it to be a perfect habitat for all sorts of potentially nasty microorganisms: watery solution, warm, food & drink for free. Kidney infections don't sound appealing to me, at all.

    If I had to choose for myself, I'd probably go for a bit of Metformin + strict low-carb / keto. After a while the Metformin might not be needed anymore.

  2. Anders A
    Well, the drug companies must also make living, don't they? ?

    But hopefully a step in the right direction for more people to understand the obviously very complicated fact that if you have a disease that gives you too high blood sugar levels, you just might need to cut back on sugar and carbohydrates...

  3. Simon Thompson
    Exactly my sentiments. What is more outrageous is that the expensive anti diabetes drugs (with the exception of metformin) are not being trumpeted as reducing mortality. Peeing out glucose will also contribute to UTI's and thrush. I completely agree, that running about with a p.g. of 3.5 in nutritional ketosis is a much safer and cheaper alternative.
  4. Soul
    Nice timing, and could be a nice improvements over current diabetes medications. It does make me wonder though if Jardiance helps address the health problems resolved that Dr. Davis writes about in his book series WheatBelly. I believe that to be less likely. Wonder too about the 38% improvement mention, if that is relative risk or absolute risk improvement.
    Reply: #6
  5. BobM
    Personally, I think we need more of the following. The American Diabetes Association asked “What was your most recent blood glucose reading?” Many answers are “They’re great because we’re eating a low carbohydrate diet and not the diet recommended by the ADA.” Many of these mention Dr. Bernstein (an advocate for low carb with Type 1 diabetes).


    We need to rise up and let them (ADA or whatever organization is in your country) know the diet they're recommending does not seem to work and in fact makes things worse. When they start seeing that there are many, many N=1 arguments against their diet and for a low carb diet, perhaps they'll begin to change. The optimist in me hopes so. The pessimist thinks they'll ignore this outpouring.

  6. BobM
    Soul, I can guarantee it's relative risk. The absolute risk is probably small.

    There are the results:


    A total of 7020 patients were treated (median observation time, 3.1 years). The primary outcome occurred in 490 of 4687 patients (10.5%) in the pooled empagliflozin group and in 282 of 2333 patients (12.1%) in the placebo group (hazard ratio in the empagliflozin group, 0.86; 95.02% confidence interval, 0.74 to 0.99; P=0.04 for superiority). There were no significant between-group differences in the rates of myocardial infarction or stroke, but in the empagliflozin group there were significantly lower rates of death from cardiovascular causes (3.7%, vs. 5.9% in the placebo group; 38% relative risk reduction), hospitalization for heart failure (2.7% and 4.1%, respectively; 35% relative risk reduction), and death from any cause (5.7% and 8.3%, respectively; 32% relative risk reduction). There was no significant between-group difference in the key secondary outcome (P=0.08 for superiority). Among patients receiving empagliflozin, there was an increased rate of genital infection but no increase in other adverse events.;

    For some reason, they put a lot more people in the group under test and not as many in the placebo group. Not sure why that is. I don't have time now to calculate actual risk, but will see if I can do so later.

  7. A Non
    My father takes Forxiga (a similar carb excretion drug) along with a whole raft of other medications to control his diabetes and lower his "risk factors", I have told him time and time again that his diabetes can be hugely improved with LCHF. He seems to be of the generation that tablets cure and help people longer... Am still trying to convince him otherwise (I am T1 and my HBA1C is much better than his now), small steps, big problems...
  8. Eric
    Is it the dose of the pill or the dose of the carb intake?
    What happens to a1c levels and ketones?
    Could a low dose increase the effectiveness of high fat diet.
    What about non diabetics?
  9. Linda
    Hi, I thought I'd leave a comment as I've been on canagliflozen, which has the same action of excreting blood sugar through the urine, for a few months now. I eat a pretty strict LCHF and do IF since March this year. I remain on metformin and it is only now that my BG is approaching acceptable levels. I sent a question to Dr Fung who surmised that I was still pretty insulin resistant despite nearly a year of LCHF. For some of us, it will take a long time for our bodies to reverse what has been a lifetime (maybe 57 - x years, not many I think) of insulin resistance.
    Meanwhile, while diabetes cannot be treated with drugs that mask the problem, using drugs to reduce blood sugars does have the benefit of reducing your risk of damage through high blood sugar. LCHF and IF are a great way to treat the insulin resistance and therefore the diabetes. By itself, this drug would be just another mask but I believe we in this community who are 'hard cases' can use it to good effect until our BG levels are normalised and then, yippee, we can be drug free.
    This LCHF has been the most hopeful WOL I've experienced in years. What a great community, and this blog and links are compulsive reading for me, Andreas.
    Reply: #15
  10. Linda
    I forgot to say that I'm in Australia where the drug started off on our PBS so was subsidised but now it's off for some reason and I paid $100 for this month's supply. Linda
  11. Dr Ben
    Surely metformin also reduces mortality by 40% in UKPDS study
  12. Dr Ben
    It is a good reminder to doctors that the primary purpose of treating type 2 diabetes is to prevent cardiovascular disease, renal disease, foot disease, eye disease and stroke.

    The common focus on reduction in glucose and HbA1c, while interesting is just sales talk. The real game is disease prevention.

  13. Sandi
    I was on Jardiance for about 2 months, didn't like it at all.

    My blood sugar is high due to Cushings and this drug didn't help much at all, and gave me a horrible cough that lingered for months after I stopped taking it.

  14. Z.M.
    So, randomized trials show that statins don't help diabetics with cardiovascular mortality and total mortality despite large reductions in LDL (ASPEN, 4D). IMPROVE-IT also showed no CV mortality or total mortality benefits with reductions in LDL (including the subgroup of diabetics). Yet, this drug increases LDL slightly but clearly reduces both CV mortality and total mortality. The lipid hypothesis is a bunch of BS! Would be nice to have this study replicated though.
  15. Bonnie
    Linda - thank you for your comments! I've been LCHF for 2 years now, and while my BG is much lower, it's not as low as it should be. I thought I was doing something wrong, but perhaps it's just going to take a while. I can't take Metformin (bad side effects) so I'll check into canagliflozen. Some years ago I was warned that Metformin was the only diabetes drug that wouldn't cause weight gain. Because canagliflozen actually gets rid of blood sugar, it shouldn't cause weight gain - I hope!
  16. Eddie Mitchell
    I took this from elsewhere but hits the nail on the head I reckon.

    (Before you jump in the band wagon, that even the Diet Doctor seem to has fallen. These type of drugs do very little to lower blood glucose because one of the side effects is increased gluconeogenesis, not good for a diabetic liver. Not to mention urinary track infections, vaginal infections and possible bladder cancer.)

    Cutting through the Jardiance Study Hype: Be Cautious with this Drug!

    Today's diabetes news is focusing on a study, published in the New England Journal of Medicine where the press release states:

    Results after a median follow-up of about three years illustrated that patients receiving Jardiance had a 14-percent lower rate of the primary composite outcome than did those in the placebo group. Specifically, the drug was associated with a significant 38-percent lower rate of death from CV causes, while no significant difference was noted in the risks of non-fatal heart attack or non-fatal stroke. Meanwhile, patients treated with Jardiance also had significantly reduced rates of heart failure hospitalisations and death from any cause, with relative risk reductions of 35 percent and 32 percent, respectively.

    If this is true, it would be logical for doctors to put all their patients with diabetes on this drug, but closer inspection of the actual published study made it very clear to me that it was far from true, and that the actual statistics had been heavily massaged to achieve the final numbers published.

    Here's what the actual study reports:

    1. The study was conducted only in people diagnosed with diabetes and established cardiovascular disease. That was defined as people who had already had a heart attack, stroke, stenting, unstable angina or a failed stress test. So these were people who were already quite ill with heart disease. Not your average person with well-controlled diabetes.

    2. The drug, Jardiance (Empaglifozin) did a poor job of lowering the blood sugar of these people, whose starting A1c ranged from 7% to 10%. "At week 94, the adjusted mean differences in the glycated hemoglobin level between patients receiving empagliflozin and those receiving placebo were -0.42 percentage points and -0.47 percentage points respectively; at week 206, the differences were -0.24 percentage points and -0.36 percentage points." The two numbers refer to the two doses. At the end of the study the average A1c was 7.81 in those taking the drug. This suggests (though the standard deviation isn't given) so it is hard to know where the blood sugars clustered. This still means that means that a lot of people had A1cs north of 8%.

    3. More people had fatal strokes while taking Jardiance than while taking the placebo. More people had nonfatal strokes while taking Jardiance than while taking placebo This data is on page 45 of the appendix to the study. More people taking Jardiance also had silent myocardial infarctions (heart attacks) on Jardiance than in the placebo group. More people were hospitalized for unstable angina on the lower dose of Jardiance than on placebo and the higher doses was pretty close to placebo.

    4. Sub Group analysis showed that Blacks, people with better kidney function, people with A1cs over 8.5%, those with peripheral artery disease, and those on insulin did better on the placebo. (I.e. not taking the drug.) People over 65 were borderline for doing better on placebo.

    5. A relatively small number of these people who were seriously impacted by cardiovascular disease actually died or had a serious adverse event in both groups. The actual difference in the number of deaths was an improvement of about 3% in the group as a whole--ie. out of every hundred 3 more people survived. This isn't trivial, but it is quite different from the inflated "risk" statistics being publicized that inflate the numbers. Basically if you have serious heart disease and take this drug, your chance of having a heart attack or heart failure goes down, while your chance of having a fatal or nonfatal stroke goes up.

    6. One quarter of those who participated in the trial dropped out. Many had adverse events, the most common of which was a genital infection (i.e. yeast.) These were much more common among women than men, and far higher in the group taking Jardiance than the placebo group. One in ten women on the drug had a significant genital infection. I have heard anecdotally that these infections are very painful and extremely hard to clear up, even after the drug is discontinued.

    This suggests to me that if you have had a heart attack this might be a drug worth considering, though if you are concerned about stroke or have a history suggesting it is a possibility, you might want to avoid it.

    But if you haven't been diagnosed with heart attack or stented, you might want to think twice and concentrate instead on lowering your A1c. There is a clear cut relationship between A1c and heart attack risk and an A1c of 8% correlates to a much higher risk than one in the 5% range. You can't get to the 5% range with this drug, which is likely to lower your A1c a quarter of a percent. You can by cutting out carbs and, if that doesn't work because your beta cells no longer are making any insulin, finding a doctor who will give you an effective insulin regimen (basal and bolus.)

    But as we all know, doctors are far too busy and overburdened to actually read this study and think through all the reported results. They will read newsletters that provide summaries instead. So all they will hear is that 38% risk improvement and the prescriptions will be written for everyone with Type 2 diabetes--and some for people with Type 1, as there is a movement afoot to promote this drug for Type 1, too.

    This may end up causing unnecessary, life-destroying strokes in people who needed never have them.

    Be careful!

    Reply: #17
  17. Dr. Andreas Eenfeldt, MD Team Diet Doctor
    To be honest I think that post totally misses the point. To me the interesting thing is the fantastic effect on reducing mortality without any super blood glucose lowering effect.

    We already know from the ACCORD, ADVANCE and VADT trials that great blood glucose lowering does NOT necessarily lead to better health, in fact sometimes it's dangerous (ACCORD).

    Recommending insulin treatment to hyperinsulinemic type 2 diabetics after the ACCORD trial in particular seem not just wrong but clearly dangerous.

    In type 2 diabetes the best treatments seem to be focused on getting the excess sugar out of the body, not just out of the blood (and into other already over-loaded tissues). This drug is a perfect example.

  18. Eddie Mitchell
    I have great respect for you Andreas and all you have done for the low carb community. On this occasion we have to agree to disagree. I thought you summed up the situation perfectly at the end of your article.

    "Of course you can get a much stronger effect – and avoid all of the side effects – by simply not eating the carbohydrates in the first place. But hey, nobody can make money selling that. "

    Now, that comment I agree with 100%.

    Kind regards Eddie

  19. Sascha Bentley
    for those of us who are severely insulin resistant, why take a drug.
    stop eating carbs. not low carb which is great but not perfect, but no carbs.
    at some point, the cells will release the sugars in the body.....

    many people have more than diabetes....they have other issues for which fasting is not recommended....

  20. Ahmad Zahar
    Earlier I was taking a herbal product call ? Inudin from India. In absorbs the sugar in our food intake but doesn't solves the high blood glucose but only controls BG. But since LCHF , my glucose index has normalise and even my BP too. I'm no more on statins . The best thing my pharmacist has advise me to stop the herbal medicine ? totally out of fear my glucose will go down. Thanks all for the wonders of LCHF.
  21. chris c
    You could probably offset the cost by selling your urine to make jam.

    Sorry but I'm not impressed by the increased UTIs and thrush (been there, don't want to go there again) and pissing your bones down the toilet along with the excess glucose. The only drug I'd seriously consider is metformin which actually addresses metabolism in several ways, from the mitochondria on up.

    By eating the exact opposite of what the dietician told me was a "healthy diet" not only did my BG fall into normal range but my IR fell through the floor (trigs/HDL went from nearly 7 to under 1 and has stayed there for over a decade now), and I lost the 15kg she made me gain. I used "test test test" to control my postprandial BG and the rest just fell into line. IF this starts to fail I will consider metformin, then possibly postprandial insulin (I lack Phase 1 insulin but so far my Phase 2 is holding up well).

    I accept I'm going to die prematurely due to doctors choosing not to take my symptoms seriously for the first 50 years of my life, I'd rather do so quickly of a heart attack or stroke than slowly from cancer with bits missing. Or spend years on dialysis, I suspect long term use of this stuff may lead to kidney damage.

    It MAY have a valid niche market but I suspect it will be widely touted and do more harm than good.

  22. Carrie
    I was on a similar drug for a few weeks and it was a constant juggling of getting enough fluids, carbs, and side effects. Yet my Doctor tried to convince me to stay on it.
    Sure it sounds like low carb in a pill but if you eat the carbs you still get the insulin response don't you?
  23. Kate Hewitt
    $350 a month??? Glad I'm in the UK where it's free
  24. Margaret
    3am and thrush is driving me crazy!!!!! I cant stop scratching to the point of bleeding. Have to get up at 6 am to go to work - feel like screaming!!
  25. Ricardo Herrera
    From Panama:
    Low carbohidrate intake is free, is healthy and safe money.

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