December 31, 2007

Happy New Year - And Welcome to National Diet Month!

If you visit your local supermarket on Wednesday morning the first thing you'll notice is that the isle that last week was full of holiday candy is now filled with expensive branded "diet" foods.

It's diet season. For the next four weeks people will eat diet bars, diet shakes, diet drinks, diet pills, and they'll drive up the price of boneless chicken breast. They'll clog the gyms and make it miserable for those of you who go to the gym every month.

It all ends the last week of January when the supermarkets move the diet food off the feature shelves and replace it with chips, dips, and Cheez Whiz for the Super Bowl. At that point most people's diets will have completely failed and they'll give up for another year.

If you've decided it's time to burn off those holiday pounds, good for you! But if you'd like to succeed on this year's diet, here are a few tips gleaned from my years of dieting adventures which you can read about in more detail on my Low Carb Diet Facts web site:

1.Avoid packaged "diet" foods and drugs. Many of them are full of soy, which is far from healthy. You can find out the facts about soy from this excellent book: The Whole Soy Story by Kayla T. Daniel. They are also filled with tons of additives of the sort you'd never eat in anything home cooked: glycerine, maltitol, modified food starch, etc. Many of these will raise your blood sugar--especially maltitol and glycerine. Raised blood sugar and/or insulin levels cause hunger.

Not only that, but bars and shakes filled with chemicals do not replace the high quality protein you find in good meat and cheese nor do the chemicals in them replace the nutrients you'll find in fresh salad greens and vegetables. A month of living on diet bars and shakes will leave you depleted of many nutrients and that, too, can make you hungry.

If you want to lose weight eat small portions of real food. Meat, soup, salad, green vegetables, cheese, colorful berries. If you keep your blood sugar flat, you will avoid hunger, which is the main benefit of a low carb diet for those of us with diabetes. If you aren't hungry, it's a lot easier to cut down on what you eat.

2. Be realistic about how much you will lose each week.

At the start of any diet you may see a dramatic drop in your weight. This is due entirely to flushing water out of your body and reducing your stomach contents. After that initial drop, you will very slowly start to lose real weight.

How much? You can see some very revealing graphs showing how much weight dozens of devoted low carb dieters lost over a period of many months HERE.

As you can see after the first couple weeks when people lose a lot of water weight, the median weight loss for a woman who weighs between 150-250 lbs is 4-5 lbs a month. That's about one pound a week. So if you have 50 pounds to lose, and "only" lose 1 pound a week you're doing great.

If you're an older lady, like me, don't even dream of losing a pound a week. A pound a month may be more like it, thanks to the natural slowing of metabolism that occurs for everyone as we get older.

3. Exercise has benefits, but weight loss is NOT one of them.

The people who sell gym memberships will promise you that going to the gym alone will cause you to lose weight. This is not true. The "calorie burning" counts you see displayed on the machines in the gym are completely fictional. This was recently documented by Gina Kolata writing in the New York Times HERE.

Many of us find that exercise makes us hungry. This is particularly true for people with diabetes because exercise makes our blood sugar fluctuate. If you come home from the gym ravenous and eat a couple hundred calories under the impression you've burned off more, you'll gain weight, not lose it. Exercise to look hot, build strength, and maintain cardiovascular fitness.

To get slim, cut out food. If you aren't sure what you are eating, invest in a food scale, weigh portions and look up the calories in that exact portion. If you don't know how much to eat, calculate your metabolic need with this handy tool: Calories Per Day Calculator. Be sure to describe yourself as "sendentary" as you probably are unless you are training for a marathon, play Football, or hang wallpaper for a living. Most of us way overestimate our activity level, even if we go to the gym.

A study of successful dieters who kept large amounts of weight off for many years found many of them only started exercising after losing the weight. That was my own experience and a whole year of near daily gym attendance did not help me lose further weight. I maintained my weight loss without exercise for several years thanks to some orthopedic problems, too.

So don't fall for the hype about exercise. Weight is about how much food you eat.

4. Cutting Carbs Helps but Calories Rule

The people who earn millions selling diet books and doing infomercials always tell you that their diet is all you need for success. Most of them greatly oversimplify the issues involved in dieting. I've met people who have lost large amounts of weight on just about any diet you can think of. I've also met people who have stalled on every possible diet, too.

So I am not going to tell you that if you cut the carbs weight will drop off like magic and you can eat luxuriously while watching pounds fade away. I find it easier to lose weight when I cut carbs--but only if I also cut my calories down significantly. Avoiding carbs controls my hunger and makes it possible for me to cut down on what I eat without feeling deprived. But for me it is the calorie levels alone that make the difference in my weight. The main reason I cut carbs is to bring down my blood sugar to healthy levels.

5. Some Diabetes Meds Make Weight Loss Very Tough

Avandia and Actos will pack baby fat cells on you and make it impossible to lose weight. Insulin can cause weight gain, especially, it seems, Lantus, though Levemir is supposed to cause little or no weight gain. I gained no weight on R insulin but did gain, rather dramatically, on Lantus. One reason to cut carbs if you are on insulin is to cut down the amount of insulin you need, this may also help you with weight loss. Insulin is a fat building hormone.

Some diabetes drugs may help with weight loss--if you cut back on what you eat while taking them. Metformin and Byetta are the only drugs with proven weight loss effects, but those effects are very modest. Studies show most people who take these drugs over a year lose only a couple pounds. You can harness their power to lose more if you cut back on what you eat.

6. Diet Pills are Dangerous and Usually Ineffective

Alli will keep you from metabolizing fat which is NOT healthy for your body as it leaches out fat soluable viatmins. But even if you can tolerate it, at the end of a year the studies show you probably won't lose more than a couple pounds and you won't keep those pounds off if you stop the drug. Is this worth the risk of pooping in your pants? That's the best known side effect of drugs that block fat digestion.

The over the counter "fat burners" are either complete scams or contain ephedra and other stimulants that are not good for your long-term health and may be very dangerous if you, like most people with diabetes, have a tendency towards high blood pressure. In that case, they can cause strokes. So if you must experiment with one of these, check your blood pressure regularly. Mostly though, they are likely to lighten only your wallet.

No over the counter drug will "blocks carbs." There is prescription drug that does, Acarbose (Brand name Precose) but the side effects of this drug are horrendous gas so bad that its maker, Bayer, stopped marketing the drug shortly after introducing it because even though it is mildly effective, no one would take it for very long. I could take one Precose a day and block about 15 grams of carbs, but quite frequently the gas would be very overwhelming. Unless you are all done with social life involving other humans, you probably don't want to block carbs.

If a "carb blocker" does not give you gas, it isn't blocking carbs, because any carbs that reach your gut not digested will ferment there thanks to the helpful bacteria we all have.

7. The Dirty Little Secret the Diet Books Leave Out

If you lose a significant amount of weight you will have to eat at a calorie level only one or two hundred calories higher than the calorie level you ate at to lose weight. All the studies show this to be true. It is the major reason that people are unable to keep off the weight they lose on diets.

So if you are serious about losing weight, you have to accept that the diet you'll have to eat for the rest of your life to maintain that weight loss will be one very much like the one you were eating while you lost the weight. In short, you'll have to stay on a diet for the rest of your life or all the weight will come back.

The people who profit from writing diet books rarely tell you this. They sell a ton of books to people who lose a ton of weight and then pack it right back on and become the market for New and Improved diet books by authors who pretend to have found yet another "diet secret." Even with those few books that do tell you this, experience shows that the readers ignore it, certain that THEY will somehow not find weight loss maintenance the problem that 95% of all other dieters have found it to be.

It's ugly, but it's reality. And if you want to lose weight and keep it off, you better take it seriously.

That's why it is a lot better to lose weight slowly but steadily eating a diet of foods you enjoy eating rather than going on any extreme diet which deprives you of things you love to eat. Do that, and you'll spend your diet looking forward to eating those foods as soon as the diet is over and when you burn out on dieting you will end up eating all those foods and they will pack the weight right back on.

If you are serious about weight loss, the diet is never going to be over.

December 27, 2007

Scams that Prey on People with Diabetes

It's time to hand out the lumps of coal. Here in no particular order are a list of scams that readers of this blog have asked me about.

1. Stem Cell "Cure" for Diabetes.

The weasels who run this one understand that most people know a lot more about Britney Spears' marriage than they do about science. They also know that you've heard dumbed down reports on TV about how stem cells might someday be able to cure diabetes. The result: an expensive scam that is 100% phony.

There is no technology available right now that will turn any stem cell into a beta cell. Just infusing a solution of stem cells into your body will NOT cause them to turn into beta cells, any more than swallowing a fertilized embryo would let you have a baby. End of story.

2. Herbal Substitutes for Oral Drugs or Insulin.

I get a lot of letters from people convinced that there must be some "natural" herb out there that will control their blood sugars and keep them from having to use oral drugs or insulin. Unfortunately, there isn't.

The oral drugs leave a lot to be desired, but at least when you take one of them you know what is in the pill and you can read peer-reviewed studies exploring what these drugs do. Herbs, in contrast, are completely unregulated and what little "research" there may be into the effectiveness of one of these herbs is almost always a tiny study funded by someone with a financial interest in the product that has been published in a vanity "Journal" which exists only to lend bogus credibility to what is actually an untested advertising claim.

Because there is no regulation of herbs and supplements most of the expensive bottles of supplements you buy--no matter who manufactures them--are full of mystery ingredients from from China and/or India including, at times, the toxins that notoriously pollute these countries' rivers and water supplies.

When these supplements are taken to the lab and tested, they frequently contain ingredients other than what are on the labels. More significantly, several "effective" herbal mixtures for diabetes sold in vitamin and "health food" stores have been found to be effective because they contain cheap first generation sulfonylurea drugs, which will lower your blood sugar dramatically--but which have been also found to cause heart attacks.

If you want to take a sulf drug, take a much safer second generation sulfonylurea drug like Amaryl. It is available as a generic for $4 at Wal-Mart. Why pay $30 for a bottle of chopped leaves and mystery sulf from China?

3. Sugar Free "Diabetic Foods"

Most of my readers know what a farce these are, but there are always new victims coming into the diabetes community who don't, to say nothing of their family and friends. I saw so many of these for sale this past Christmas season that I've concluded we can't warn people enough what a waste of money these are.

It isn't just "sugar" that harms people with diabetes, it is all carbohydrates. But almost all "Sugar free" and "Diabetic" products are full of flour and other starches. Most also contain maltitol or glycerine, which are not technically "sugar" but which break down into carbohydrates on digestion and can raise raise blood to surprising heights. If a "sugar free" food contains Lacitol, another sugar alcohol, it may not raise blood sugar that high, but it may give you a case of the runs that will ensure that your first experiment with "sugar free" products is your last.

If you are considering eating a "sugar free" or diabetic food, examine the nutritional panel closely and ignore any claim that the carbohydrates you see listed on it have somehow been magically relieved of their ability to raise blood sugar. It isn't true.

The one sugar alcohol that doesn't raise blood sugar is erythritol. Sadly, it can no longer be found in sugar free or "low carb" candies, probably because it was much more expensive than cheap maltitol. And even more unfortunately, though you can buy Erythritol at great expense in health food stores or by mail order, I have yet to find any recipe where the stuff you can buy is able to substitute effectively for sugar. It appears to need industrial food science techniques to work properly in candies.

This is only a start. What scams perpetrated on people with diabetes have you observed lately?

December 24, 2007

No Food has Carbs on Christmas!

It's only a matter of time until the Journal of Irreproducible Results publishes definitive proof of something we have all known: food eaten at Christmas and on New Years Eve contains no carbohydrates. This will be accompanied by a major long term study that shows that dieting during the holidays causes heart disease.

In fact, it's been a pretty good year for cheering dietary news. Peer reviewed research has confirmed that, for those of us getting on in age, being overweight is far healthier than being slim. There's evidence accumulating that eating saturated fat prevents stroke, and Gary Taubes has proven beyond doubt that the bad rap of sat fat stems from researchers a) confusing it with trans fat and b)blaming fat for the effects of the high carb side dishes people ate with their fats, and c) fudging their results.

Chocolate has made it into the ranks of health food. Soy has been shown to be the nasty poison it tastes like and someday it will be relegated to the ranks of other disgusting and worthless "health foods" like the blackstrap molasses and brewers yeast so beloved by health nuts in my youth.

So enjoy your holiday!

Food does have carbs the week after the holidays, and if you find yourself having a tough time getting back on track after the holidays are over, here's a page that has some tips that will help you get back into control: When You Crash Off Your Diet

December 19, 2007

One in six doctors is addicted or a drunk. Is yours? You'll never find out!

Buried in all the seasonal holiday cheer is this disturbing news story:
AP News: Programs Let Addicted Docs Practice

It blows the whistle on the way that the medical community protects its image by allowing doctors who are seriously impaired to continue practicing. It discusses how even when local medical associations know that a doctor is impaired and offer that doctor treatment for serious addictions or alcoholism, these organizations keep this information secret and allow the doctors to continue treating patients while undergoing rehab--even though, like so many other people in rehab, many doctors in rehab do not cure their addictions.

The article focuses on the major horror stories: obstetricians who kill babies by accident because they show up at the delivery drunk. Plastic surgeons who maim and mutilate their patients. Doctors who have a string of malpractice suits behind them along with drunk driving convictions who continue to attract new patients who have no way of finding out how dangerous they are.

There are a lot of these people. I grew up in a hospital family and I remember hearing my parents discuss the brain surgeon who operated drunk. But they liked him and it would never have occurred to them that they should have been demanding that the hospital administration for which they worked should pull this guy's license to operate. They just warned their friends not to go to him if they needed surgery. The rest of his patients? Well they were out of luck.

I remember being horrified when I heard this, but in all fairness to my parents, if they had made an issue of this man's impairment, or God forbid gone public with it, they would have been likely to have lost their jobs. That was how it was 40 years ago and that is how it is now. I later had a friend who was an M.D. who did have the courage to blow the whistle on another doctor at her hospital who had severely physically abused his wife, who was her patient. She lost her job. He kept his.

Perhaps the scariest thing in today's AP story is the statistics given about how common substance abuse is among doctors. The story cites statistics I've seen elsewhere that estimate that between 10 and 15% of ALL doctors have substance abuse problems. These statistics come from medical associations. Of those who are drunk or addicted, the estimate is that only 1% enroll in treatment programs. Meanwhile all these impaired doctors continue to treat patients who have no way of knowing how dangerous they may be.

Apparently, doctors cover for these guys out of the belief that its better to have patients die than to tarnish the reputation of the medical profession. But horror stories like these hide a much more pervasive problem. Doctors also cover for peers they know to be incompetent for reasons other than drug or alcohol abuse.

They know that colleagues may be giving outdated treatments. They know that some of the older practitioners may be in the early stages of dementia. They know that there are local endocrinologists who haven't a clue about how to prescribe insulin or thyroid medication. And they know, too, when a lot of their patients are coming down with MRSA in local hospitals. (There is no requirement that any hospital report the incidence of MRSA or other hospital borne infections to anyone.)

In short, the medical community knows a lot about the really bad medical care available in their regions. But they do nothing about it because far stronger than the Hippocratic Oath is the Physician's Code that says, "Speak No Evil of a Colleague." If the choice is your health or their profession's reputation, you're out of luck.

So ask your self this: If as many as one in six doctors may be practicing impaired, what percentage of doctors is giving substandard care?

How many prescribe expensive new drugs whose side effects are poorly understood because drug companies reimburse them for every new prescription written as part of a phony "study?"

How many ignore it when patients report severe side effects after they have been put on a new drug because they don't pay any attention to even the Black Box warnings flagging potentially deadly side effects of these drugs?

How many have set up their offices so that LPN "nurses" with a high school education and a certificate from a Junior College screen all patient calls and let these LPNS decide whose messages get passed on to doctors--in whatever garbled form the poorly educated, poorly paid clerk sets them down.

How many doctors are putting all their efforts into building up money making side line businesses like "laser hair removal" and other unregulated plastic surgery procedures instead of worrying about their patients' health?

When you read about the prevalence of impaired or incompetent doctors, you probably think that it this is someone else's problem. Your doctor is such a nice guy. Well, so was that brain surgeon who operated drunk. The fact is, you aren't likely to learn who the incompetent or dangerous doctors in your area are until you become their victim. Even if every doctor in your community knows who these people are.

December 14, 2007

Squeaky Wheels Needed at the Hospital

Last week I managed to inhale a piece of peanut. After 24 hours of croupy coughing my doctor sent me to the ER. I ended up hospitalized overnight, mostly because the doctor assumed that since I had diabetes I must be having a heart attack--which I wasn't. But during the night and morning I spent at the hospital the diabetes treatment I received was so terrible that I took my own advice and wrote a long letter to the Hospital's President and M.D. Patient care director detailing the problems with their diabetes treatment.

The problems I listed were these:

1. While each room had two brand new flat screen TVs, the blood sugar meter the nurse was using was a 5 year old Medisense meter that took a huge drop of blood, took 45 seconds to get a reading and was off by almost 50% from the value I got on my own Ultra 2 which had matched the previous night's lab draw very closely.

The nurse told me that my blood sugar of 79 was "heading for a hypo" and offered me orange juice when my Ultra read 115 mg/dl.

2. The nurse gave me a shot of insulin in a needle that must have been a 25 gauge or worse. It hurt like heck and left a huge bruise. Since many people's first exposure to insulin in in the hospital, I can see why so many Type 2s who first encounter insulin in the hospital will go to any length to avoid insulin.

3. The food I was given was from what called itself a "Carb Controlled Diabetes" menu. The "Control" in this case appears to mean that they made it impossible for you to eat anything BUT carbs. Breakfast offerings were French toast, pancakes, commercial breakfast cereal with extra high carb skim milk, toast and something they called "eggs" which when ordered turned out to be about 2 tablespoons of a powdered abomination that smelled strongly of sulfur and were so sickening I couldn't eat them. The toast came with a choice of low fat cream cheese, margarine or jelly.

To add insult to injury, when I asked for Peanut butter, what I got was fully hydrogenated and contained molasses. I was also told I could not have coffee with caffeine and when I protested the menu the Hospitalist M.D. assigned to my care lectured me about the importance of eating a low fat diet for the rest of my life to control my diabetes.

Well, I know that the hospitals in my region are locked in competition with each other for patients, because they run a lot of ads in the local newspaper touting their services. So I figured the best thing I could do would be to explain to hospital management why I was going to have to tell my diabetic friends that as far as this hospital was concerned "good control stops at the hospital door."

Yesterday I received a phone call from the M.D. in charge of their ER services who had been given my complaint by the head of Patient Care. He started off the conversation by telling me that his wife was a Pediatric Endocrinologist and that he had shown her my letter before calling me.

He said that she had thought my criticisms to be completely on target. She told him the Ultra was the most accurate meter available and that it was likely the old meters they were using were inaccurate. She added that she told her patients to bring their own needles to the hospital because the ones used there were so horrible, and she asked why the menu provided did not give the carb counts of the various foods and allow patients to eat at the carb level they were supposed to be eating at!

The doctor/administrator and I had a long talk, during which he accessed my What They Don't Tell You About Diabetes web site and I reminded him of the research showing the relationship of A1c and post-prandial blood sugar to heart attack risk and mortality (since he was an ER guy) and reminded him, too, of the WHI data that has discredited the low fat/high carb diet as a way of preventing heart disease.

He promised me that something would be done about the problems in his hospital that I'd identified and said that he would get back to me about the progress. I'm not hoping for miracles. They'll probably have to hear from a lot more patients before things change, and the quality of care in my region is such that most people with diabetes are still following the ADA's outdated advice that 180 mg/dl post meals is a great blood sugar and they are eating the ADA's sponsor's beloved high starch/high sugar diet so I don't expect a lot of people to complain.

But I learned a couple things from this experience:

1. Don't wait until you are in the hospital to find out what your local hospital's policy is about diabetes treatment--especially if you use insulin. Write a letter NOW to the M.D. administrator in charge of patient care at your local hospitals and ask them the following.

a. If I am hospitalized but conscious, will I be allowed to retain my own blood sugar testing supplies, and insulin needles? Will I be allowed to administer my own insulin using the doses I set? Will I be allowed to keep wearing my insulin pump?

I have heard horror stories of nurses removing pumps and giving generic insulin doses to people with Type 1. None of the nurses in my local hospital's cardiac ward had ever heard of the "insulin/carb ratio" nor did they know anything about Basal/Bolus insulin regimens. I was allowed to use my own Novolog pen, which I'd brought along, and to set my own Lantus dose (though they provided the Lantus which came in their railroad spike needle) but not all hospitals will allow patients to do this.

b. If I am not conscious, what is the blood sugar target your staff will use when administering insulin to me? Will they consult with my endocrinologist or PCP about my insulin dosing?

c. What kind of meters does your nursing staff use. How old are they? How often are they calibrated with the lab results?

d. Is your nutrition staff aware of the data that has emerged in the past decade which finds that the very low carbohydrate diet is both safe and very effective for controlling diabetic blood sugars? Do your nutritionists realize that the low fat/high carb diet can provoke dangerously high blood sugars in people with diabetes? When hospitalized will I be allowed to choose my own food or will I be forced to eat the discredited low fat diet that may raise my blood sugar to dangerous levels?

If you are told there is a "carb controlled" menu (as I was) tell them how many grams of carbs the nutritionists prescribe per meal, and state how many grams per meal you eat to maintain your currently excellent level of blood sugar control.

If every hospital started getting letters like this on a steady basis, things would change. I'm old enough to remember when hospital maternity departments actively discouraged new mothers from nursing. We La Leche League ladies changed, that, with a lot of letters, articles in the press, informational meetings with pregnant ladies, and public information campaigns.

Now its time for us folks with diabetes to take on the medical community by making it clear that we will not tolerate substandard care.

The peanut appears to have dissolved on its own. I'm not coughing, though I'm sure the sight of the bill I'm going to get (with my high insurance deductibles) will set me sputtering again. I will just have to write that off as "research costs" as this was educational and, I hope, may help some other folks get better treatment.

But don't wait until your gall bladder acts up or some imbecile rear ends you! Write that letter to your local hospital administration today and make it clear to them what kind of diabetes care you're looking for in the hospital you choose to patronize!

December 12, 2007

Actos is Dangerous Too!

If you follow the diabetes news, you probably saw reports today about a new study published in the Journal of the American Medical Association, this one, a study of the medical records of people over 65, is being reported as it if found that Avandia raised the rate of heart attacks and death. That is how the New York Times and many other news organizations are headlining this story. But that isn't actually what the study found. Here's a better report.

Study: Type 2 diabetes drugs raise heart risks: Chicago Tribute based on study published in JAMA

The crucial piece of information here is that, in a study of patient records of people over 65 taking various diabetes drugs both TZD drugs, Avandia and Actos, appeared to cause significant increases in death and heart problems.

I can't help but wonder if the way this story is being reported--with many news outlets making it sound like only Avandia causes excess heart deaths--is because Takeda, the maker of Actos, is advertising heavily in the media now that Avandia has been so thoroughly discredited. Are the media downplaying the suggestion that Actos too may be dangerous to keep this big-money advertiser?

In reports like those of the New York Times the article claims that Avandia alone is identified as dangerous because most of the patients taking TZD drugs in this study were on Avandia so there wasn't enough data to draw firm conclusions about Actos.

But we know that Actos, like Avandia, causes heart failure. It carries a black box warning to this effect in its prescribing information, as required by the FDA.

Heart failure means that the muscle of the heart has weakened. Research has found both TZD drugs appear to cause heart failure in people who did not have it before starting the drug. This may be because Avandia and Actos can cause intense water retention and swelling, which can stress a marginal heart.

We also know that Actos, like Avandia, causes thinning of bones leading to osteoporosis and fractures in older women. I discussed that in this previous blog post.

Sadly, most doctors have responded to the media blizzard of bad news about Avandia by switching their patients to Actos. That is probably because they don't have the time or inclination to research the safety of Actos on their own and depend too heavily on media reports and drug company salespeople for guidance on what drug to prescribe.

ADA Won't Recommend Against TZDs
In related news, Diabetes in Control reports that the latest ADA practice recommendations still recommend TZD drugs, despite the evidence against them.

This should come as no surprise, given the huge contributions the drug companies make to the ADA and the long track record the ADA has amassed of working to ensure that people with diabetes eat high carb diets full of their sponsors' junk foods that raise their blood sugar so that these patients need to take their other sponsors' expensive (and dangerous) drugs.

The ADA really should be renamed, "The American Association of Those who Profit from Diabetes." That is who they serve, not the people who HAVE diabetes.

What Does This Mean For You?
If you are a person with Type 2 diabetes you need to understand that both Avandia and Actos work by affecting the PPAR-gamma receptor. They both cause water swelling and this swelling is probably what strains the heart. They both also cause dramatic weight gain, because the way that they appear to work is that they push the body to create new fat cells which lower blood sugar by storing excess glucose in the form of fat in those new fat cells. They weaken bones because the receptor they affect also controls the rate that the body destroys bone cells, and the way they affect it makes for more bone destruction.

The drug companies claimed for years that both these drugs rejuvenated beta cells. This has never been proven. They also claimed that these drugs lessened the amount of metabolically dangerous belly fat. This to turned out to be a result of (intentional) misrepresentation of data. The ratio of belly fat to butt fat decreases with these drugs--but only because these drugs pack so much more new weight on the butt!

Meanwhile, with none of their supposed benefits proven--the ones that motivated doctors to put so many people on these expensive drugs--the heart and bone problems of these drugs have become apparent.

If your doctor assures you Actos is safe, remind him or her that it causes the same increase in heart failure as Avandia and causes the same bone thinning. Remind him or her that the only reason we don't have as much data pointing to the dangers of Actos the way we do about Avandia is that it never has had the market penetration or scrutiny that Avandia had.

Will we ever know the truth?
It's very unlikely Takeda will be funding any large scale controlled studies investigating the safety of Actos. Why kill the goose laying the platinum eggs? No one else has the kind of money it takes to fund the kinds of studies that will discover the long-term health damage Actos causes. And even if they do, do you really want to take this drug for the 10-12 years it would take for the real cost of using it to be proven beyond doubt--years during which your bones erode, new fat cells accumulate, fluid build up and stresses you heart, and who knows what is happening to other parts of your body that use this same PPAR-gamma receptor?

Let's Get Back to Basics
The reason we lower our blood sugars is to maintain our health. Any drug that improves blood sugar by increasing mortality is a bad drug. Any drug that improves blood sugar by causing osteoporosis--a major killer of older women--is not a good drug.

And the really sad part is that neither Avandia OR Actos lower blood sugar all that much. The typical A1c drop people see when taking this drug is around 1%--but that is when their A1c starts out at 9% or 10%. And the price people pay for this very small decrease in A1c is to pack on weight--in the form of new fat cells--that does NOT go away even if they stop taking the drug.

It is all so unnecessary! I get mail all the time from people who have brought their A1cs down from as high as 16% to the 5% range simply by cutting down their carbs to where they no longer are spiking over 140 after a meal.

This strategy has no dangerous side effects, and the only people who will tell you that cutting carbs is dangerous are those who are ignorant of the findings of current medical research.

As long as you eat enough protein, your body can manufacture every one of the grams of glucose your brain needs. Any dietitian who does not know this is ignorant and dangerous. Lowering your carbohydrate intake to where your blood sugar is normal or near normal will also improve your lipids. And low carb diets will not damage your kidneys unless, perhaps, you have end stage renal disease. Again, anyone who tells you differently is merely repeating old wives tales and is not familiar with what science has found.

The key to safety with low carb dieting is that you have to cut your carbs low enough to keep your blood sugars in the normal zone--under 140 mg/dl. Do that, and you will see dramatic improvements in your A1c--improvements much better than what you can get with either Actos or Avandia.

And if you do need a drug to lower your insulin resistance, Metformin has a much longer history of safe use and it is more effective than the TZDs.

If you can do it, regular exercise may also improve your insulin resistance better than TZDs.

There is simply no reason to take a drug that will erode your bones, strain your heart, and make you fatter, when there is a much safer way to control your blood sugars.

December 5, 2007

Bad Science: Study Published as Suggesting Byetta Can Replace Insulin Shows Opposite

UPDATE (April 2, 2013): Before you take Byetta, Victoza, Onglyza, or Januvia please read about the new research that shows that they, and probably all incretin drugs, cause severely abnormal cell growth in the pancreas and precancerous tumors. You'll find that information HERE.

Original post:

Study after study shows that Byetta is not the wonder drug that its manufacturer would like you to believe it is, but that doesn't keep the drug company from spinning the results of their disappointing studies.

Here's the abstract of this new study which was preformed by researchers who were forced to disclose that they were funded by the makers of Byetta:

Exploring the Substitution of Exenatide for Insulin in Patients With Type 2 Diabetes Treated With Insulin in Combination With Oral Antidiabetes Agents

It concludes "it is feasible to sustain glycemic control when substituting exenatide for insulin". But a closer look at the study finds that this is NOT at all what it really found.

First of all, the researchers stacked the deck for Byetta by comparing Byetta with insulin used incorrectly. To quote an editorial published besides the study "the insulin regimen used in this study was often non-physiological and that no attempt was made to optimize insulin therapy before substituting exenatide."

Secondly, even when compared to those using poorly prescribed insulin regimens, the people taking Byetta saw their A1c deteriorate and suffered many more side effects.

This doesn't stop the people who profit from Byetta from touting the idea that their study "proves" that expensive Byetta can be substituted for insulin.

You can bet your bippy drug company reps will be telling your doctor that these exciting new results mean they should move patients on insulin to Byetta.

If your doctor tells you this, call him or her on it and ask why they haven't looked at the actual data. You might also cite the conclusions published in the accompanying editorial by Drs. Julio Rosenstock, of the Dallas Diabetes and Endocrine Center, and Vivian Fonseca, of Tulane University, New Orleans, who were not funded by the makers of Byetta.

They wrote, "The overall effect on glycemic control was rather disappointing. ...this was clearly a negative trial, with a flawed study design and a conclusion that perhaps should have been stronger against substituting exenatide for insulin."

December 3, 2007

Avandia Causes Osteoporosis and Broken Bones--But Actos Does TOO!

This week's medical news is full of reports about a study that explains why Avandia causes osteoporosis.

Here's a report that gives more than the usual amount of detail about this study:

Avandia Researchers Find Reason Behind Bone Fracture, Osteoporosis Side Effects

I have already blogged about Avandia's connection with a doubling of the incidence of fractures this last year HERE.

But what concerns me now is that the way this new story is being reported makes it sound as if the osteoporosis is only a side effect of Avandia, a drug that for all practical purposes is dead after the press discovered the long-known fact that research proved it increases heart attacks.

But as the article I link above makes clear, the reason Avandia causes the bones to thin is because of the way it affects the PPAR-gamma receptor. To quote the report cited above, "the new research found that Avandia also appears to affect a key cellular protein called the peroxisome proliferator-activated receptor (PPAR-gamma). In their study, the California team discovered that activating this receptor in mice also stimulates the production of osteoclasts, cells whose key function is to degrade bone."

Those of you who study diabetes drugs know that it is NOT news that both Avandia and Actos stimulate PPAR-gamma. In fact, this PPAR-gamma stimulation has been the mechanism used to explain how these drugs work ever since the drug companies started selling them over a decade ago. So this finding that Avandia's effect on PPAR-gamma destroys bone suggests strongly that Actos, too, may cause osteoporosis and fractures.

The way the media has spun the Avandia story until now has been that Avandia is bad but Actos, its competitor, is still a good choice. But this new finding should make us think twice about using Actos at all.

The prescribing information for Actos clearly cites that osteoporosis and a doubling of bone fractures has been found by research to be an Actos side effect.

Here is what the FDA-mandated Prescribing Information for ACTOS tells us:

Fractures: In a randomized trial (PROactive) in patients with type 2 diabetes (mean duration of diabetes 9.5 years), an increased incidence of bone fracture was noted in female patients taking pioglitazone. During a mean follow-up of 34.5 months, the incidence of bone fracture in females was 5.1% (44/870) for pioglitazone versus 2.5% (23/905) for placebo. This difference was noted after the first year of treatment and remained during the course of the study. The majority of fractures observed in female patients were nonvertebral fractures including lower limb and distal upper limb. No increase in fracture rates was observed in men treated with pioglitazone 1.7% (30/1735) versus placebo 2.1% (37/1728). The risk of fracture should be considered in the care of patients, especially female patients, treated with pioglitazone and attention should be given to assessing and maintaining bone health according to current standards of care.

Note that these studies only lasted a few years. Over time it is likely that a higher incidence of broken bones and osteoporosis would be found with this drug. Men have thicker bones than women and it would take longer for bone thinning in males to be diagnosed.

Bottom line: Broken hips are one of the biggest killers of older people whose bones naturally thin with age. Hastening the degeneration of your bones is suicide. Don't take either Avandia or Actos. These drugs do not provide anywhere near enough benefit to outweigh their dangerous side effects.

Special strains of acidophilus fight yeast and adjust pH

I'm really happy to note that last week the New York Times wrote a long article praising Good Germs, Bad Germs: Health and Survival in a Bacterial World by Jessica Snyder Sachs, which I reviewed here enthusiastically a few weeks ago.

In the discussion of how we can harness other microorganisms to fight the harmful ones in our bodies, Sachs's book contained what the medical newsletters call a "pearl for practice", one which I tested out myself with excellent results.

Sachs discussed a product, Fem-Dophilus, that contains strains of acidophilus which are those that naturally colonize healthy female reproductive and urinary tracts. After killing off our own friendly acidophilus by using antibiotics, many of us have attempted to introduce acidophilus using yogurt, but it turns out that the kind of acidophilus found in yogurt is a different strain that does not flourish in our bodies for any period of time.

The benefits of having the right strains colonizing your body are that they outcompete yeasts and the bacteria that cause bacterial vaginosis by giving you the correct pH and secreting high levels of hydrogen peroxide that kill other microorganisms.

As those of you who read my blog know, I'm not a big fan of supplements, but I read enough user praise for Fem-Dophilus online to think it was worth a try. I bought it mail order. Buying it that way costs half of what you'll pay in local health food stores even with postage. I have been using it for three weeks.

It really works! Many, if not most, of us older ladies whose hormone levels have dropped have problems maintaining normal vaginal pH. If we have high blood sugars, we may be very susceptible to yeasts or other hostile microorganisms. Even if we have normalized our blood sugars if we had frequent urinary tract infections before diagnosis, we may have fatally screwed up the natural flora in our guts and vaginas.

I've gone through a lot of antibiotics in the past, because my high blood sugars gave me unrelenting urinary tract infections which resulted in some scarring that makes new infections even more likely to occur. After three weeks of introducing these friendly bacteria into my system, I am experiencing improvements in both digestion and in pH-related issues that are quite encouraging.

So if you are a woman who has been battling urinary tract infections or vaginal dryness investing in a bottle or two of this stuff might be well worth a try.

To update my report on another helpful supplement: Vitamin D.

After a brief period I stopped seeing any blood sugar effects from Vitamin D, but I did noticed that I seemed to be more cheerful than usual and when I stopped taking it I found that the mood effects wore off. They came back when I started it again. I think that the initial burst of cheerfulness many of us experience when going out on a sunny day may be connected with our body's pumping out some Vitamin D in response to the sun exposure. (If you are like me and have very pale skin, that cheerfulness turns to dismay as you almost immediately afterwards redden up and everything starts to burn!)

Vitamin D seems like it might be a very good supplement for people with diabetes to take, as it might be related to the depression that has been observed to accompany diabetes--along with the lowered Vitamin D levels.

One caution though: I read that if you don't take calcium WITH your Vitamin D, it may actually promote the storage of other metals in your bones--the ones you are getting in polluted air, Chinese supplements, and foods. So don't take Vitamin D without calcium. Cheese and other food sources are best. I use the kind of supplements that are mostly ground up limestone.