It's common knowledge that diabetes and heart disease are linked. If you have diabetes, you are much more prone to heart disease than are your non-diabetic counterparts. I've sometimes wondered: why should that be? And here comes the answer, courtesy of a recent Netscape health article.

Scientists at Washington University School of Medicine in St. Louis have been examining the issue. Their conclusion? It all comes down to how the body metabolizes fat. The heart cells of diabetics lose a lipid (cardiolipin) designed to provide the heart with energy to function properly. Says Dr. Richard Gross, "Diabetic hearts run mostly on fats for fuel because glucose isn't readily available to them." Problem is, the absence of cardiolipin screws up the heart's cell membranes, both in terms of structure and function.

It's all downhill after the cardiolipin disappears. For one thing, the heart muscle cells begin to be starved of energy. Second, harmful substances form in the cells. Both these factors contribute to heart problems down the road. Observes Dr. Gross, "The pieces of the puzzle of diabetic heart disease are now rapidly falling into place. We hope that these kinds of studies will enable physicians to diagnose diabetic cardiovascular disease sooner and treat it earlier."

The votes of yesterday's advisory panel on Glaxo's Avandia demonstrate how dysfunctional this government can be. I was just reading up on the details. There were two key votes. On the question: does Avandia increase risk for heart attack, the vote was 20 to 3 in agreement. Yet, incredibly, the same panel also voted overwhelming - 22 to 1 - to keep Avandia on the market.

Coverage on the subject in today's New York Times described the meeting as "extraordinary" in that US Food and Drug Administration officials were openly in disagreement with each other as to what steps to take. As I mentioned yesterday, one of those officials, Dr. David Graham, said the drug should be withdrawn. However, Dr. Robert Meyer, another FDA high-up-official, disagreed.

Let's recap: Glaxo knew Avandia might cause heart trouble and informed the FDA of this. The FDA did nothing. An article in the New England Journal of Medicine (May 2007) stated the drug increased the risk of heart attack. The FDA twiddled its thumbs. Now this? The drug may stay on the market at the behest of the same FDA officials who voted in agreement that it poses a heart risk. Has the world gone mad? The sooner we get some reform at the FDA, the better off we will all be.

Also worth noting: the Times reports that Dr. Steven Nissen, whose NEJM article sparked the controversy, says he would have voted to remove Avandia from the shelves. Also quoted was Dr. Sidney Wolfe of Public Citizen, a drug safety advocacy group. Observed Dr. Wolfe: "If Avandia were up for approval today based on what we know now, it would be rejected."

Earlier today I blogged about the Avandia advisory panel which met today. As of earlier today, the word was an FDA official, David Graham, had issued a written preview of the comments he intended to make. In it, Graham stated his view that GlaxoSmithKline's diabetes drug Avandia is dangerous and should therefore be removed from sale.

Now comes breaking news from the Associated Press that the panel will recommend, against the wishes of many - Dr. Graham included, that Avandia stick around. According to the AP, government health advisers have argued that, hey, sure Avandia may cause increased risk of heart attack, but let's just keep it out there. What?! As of writing, the AP was still waiting for a tally of how the panel voted on the issue, but word is a majority voted against recommending a ban.

The FDA's patient representative for the panel was quoted as saying studies indicating Avandia causes heart trouble "have very significant weaknesses and are inadequate for us to make that kind of decision." In short, the FDA seems to be saying Avandia causes heart damage, but the study-based proof is not strong enough for a ban. Talk about your contradictory messages! Baffled? Disgusted? Join the club.

I was intrigued by a recent Swedish study reporting that people on a so-called "Stone Age" diet had more stable blood sugar levels than those on a Mediterranean diet. An intriguing claim, because it's so often said that Mediterranean-style eating is super-healthful. Let's also admit it is a delicious way to eat: yes, pasta and bread is there, but it's balanced out by tons of fresh fruits, vegetables, fish and olive oil. The Stone Age way is a bit more spare: we're talkin' meat, fish, and lots of whole grains, berries and nuts. Nary a sliver of Parmesan in sight.

However, the results of yet another study, this time from Australia, indicates Mediterranean-style eating is a good choice, especially for diabetics. Researchers from the University of Melbourne say Mediterranean-born immigrants in Australia are less likely to die from heart disease than other Australians. The researchers have concluded it's all down to dietary patterns. More than forty thousand people participated in the study over a period of ten years. The numbers revealed those who ate the most Mediterranean-style foods had a thirty percent lower risk of dying from heart disease. For diabetics, the researchers speculate, the benefits could be even higher, reducing the risk of death due to ischemic heart disease.

Results have been published in The American Journal of Clinical Nutrition. Visit Reuters for a discussion of the study.