I’ve seen this phrase first in the book “Blood Sugar 101“, by Jennifer (Jenny) Ruhl, and then encountered it on Jenny Ruhl’s web site. It refers to a group of diabetics dedicated to the idea that maintaining a certain set of low values of blood glucose (near normal values) prolongs health.  The phrase “The 5% Club” refers to the value of their hemoglobin A1c measurement: this is the percentage of glucose bound to hemoglobin, as determined by a blood test. Having a Hb A1c in the range of 5.0-5.9% (i.e a range that normal humans can have) reduces heart attack risk, reduces complications and prolongs quality of life. Since all these values are 5 point something, they become the 5% club.

One of the more interesting notions in Jenny’s book (I’m also still reading Garry Taubes’s book as well) is the idea that insulin resistance is the cause of obesity, rather than obesity being the onset that creates insulin resistance. That’s a view I’ve never heard before. As I’ve mentioned, my family gains a lot of weight roughly around 30 years of age. Is that the genetic-environmental onset of insulin resistance? When insulin can’t dump glucose into muscles, it encourages the production of fat and glycogen.

Alan Shanley, a well known online diabetic (he’s mentioned in Jenny Ruhl’s book) has been marveling that a well placed endocrinologist has now wholeheartedly embraced SMBG. SMBG is an acronym that stands for the mouthful phrase Meal Based Self Monitoring of Blood Glucose.  To note, in Dr Bernstein’s book (yes, I’m reading many books, all at the same time. I might finish one of them), he talks about obtaining one of the first blood glucose meters ever, and the push back he got from trying to use it as a self diagnostic tool. That just confuses me a little, because these days, 30 years since the introduction of the first meter for patients, I think it would be impossible to get a group of diabetics together, ones who actively manage their condition, who would want to go back to the days of one measurement a month and a whole lot of praying. Any diabetic with any self interest is testing, eating, testing again, and modifying their diet to keep what works and discard what does not.

One of the problems with this wholesale revolution in thought is that it was promoted by relatively recent (late 1990s and onward) online community action. Newsgroups and bloggers were big factors in getting the word out and therefore, the scientific literature simply hasn’t caught up to current patient practice. Too many tests still treat patients with average blood glucose levels ca 170 milligrams/deciliter as “normal”. That would scare almost any 5% club member out of their pants. So although the anecdotal evidence is impressive, the science hasn’t caught up (please understand that good diabetes testing may take 10 years to complete). The problem with taking anecdotal evidence too seriously is selection bias.

I have no absolute cure for this. For most diabetics, this tends to mean keeping an open ear to formal medical suggestions, but ultimately, taking your own advice on this disease. The people who seem to know what they are doing are those people who both are medically trained and suffer from the disease themselves. Because they live with it, their advice tends to be more friendly and understanding of those afflicted with the disease.

Notes: A brief biography of Dr Bernstein, the high priest of low carb diabetes management, can be found in a 1988 New York Times article. Another link, describing the 5% Club, can be found on the Alt Support Diabetes web site.