August 31, 2007

Good Food To Eat When Cutting Carbs

A lot of people tell me they'd like to cut back on carbs but don't know what they'd eat, since they aren't big on hunks of meat. So I've pulled together a bunch of "things every low carber knows" for those of you who are trying to cut back.

One thing to keep in mind. The fewer carbs you eat, the safer it is to eat fat. If you are keeping your carb intake under 15 grams per meal you can eat as much as 70% fat and see your cholesterol and lipid fractions improve. If you are eating 30-40 grams of carbs per meal, go easier on the fat!

Here are a bunch of ideas that I've picked up over the years by hanging out on the old newsgroup. This should get you started.

  1. Pancakes Whey Protein powder can be cooked up to make pancakes. Add some low carb strawberries or raspberries (frozen works great) and some sugar free Maple Syrup and you've got a delicious breakfast. Recipe on my Indispensible Low Carb Treats page.

  2. Potatoes A great substitute for mashed potatoes can be made by steaming or boiling cauliflower and pureeing it in a food processor and then adding some cream or half and half, butter or salt.It doesn't taste like cauliflower.

  3. Rolls If you can eat gluten, you can make delicious rolls that are very similar to popovers using the Magic Rolls recipe. You can find it HERE in the Eades' Low Carb Comfort Food Cookbook. Search for "Magic Rolls." It's on page 22. Make extra and freeze in a plastic bag.

  4. Veggies Here's a list of some very healthy very low carb vegetables you should eat as much as possible. Romaine Lettuce, Boston Lettuce, Red Lettuce, Mesclun mix, green beans, artichokes, avocado, asparagus, broccoli, cauliflower, cucumbers, eggplant, olives, spaghetti squash, acorn or butternut squash (small amounts), zucchini.

  5. Pasta Instead of pasta with its 50 gm per tiny 2 ounce serving, put sauces over lightly steamed zucchini strips you make with a vegetable peeler. Or use spaghetti squash.

  6. Sugar Substitute When baking, instead of using Splenda powder which contains maltodextrin, a sugar in baking quantities that can become significant, use DaVinci sugar free syrup which can be bought at Marshall's or TJ Maxx in the specialty food section. There is no sugar at all in these. I cook with the Caramel or Vanilla and use the White Chocolate for things like Cocoa. Usually a direct substitution works--1 tsp syrup for 1 tsp sugar. Do not do this for recipes which depend on sugar to hold everything together. It does work for custards and puddings.

  7. Cookies You can make delicious very low carb macaroons with a recipe on the Indispensible Low Carb Treats page.You can also make cookies using almonds ground very fine, but if you are trying to lose weight, almond flour is very high calorie and not a good option.

  8. Snack Food Sunflower seeds in the shell make a good "finger food" snack that are low carb and take the place of chips while watching the game, etc.

  9. Candy Low carb cream cheese fudge makes a nice chocolate candy treat. recipe on the Indispensible Low Carb Treats page.

  10. Pizza When it's pizza time, get a meat/veggie combo and just eat the toppings. Some people make "meatza" using a thin lining of pepperoni as the bottom crust when they make pizza at home.

  11. Chinese At Chinese restaurants, Hot and Sour soup works. So do barbecued spareribs and teriyaki strips, though they have some sugar. Ask that no sauce be put on the ribs. Some places do a crispy duck that works. Chicken with string beans often does too. There are some carbs in all of these, so don't eat there every day!

  12. Other restaurants Besides the obvious "chunk o' meat" entries try the steak "bistro" salads or Caeser salads with grilled chicken or shrimp (not fried!). Avoid any salad where you can't add the dressing yourself, though, as some chains will serve you bits of lettuce drenched in sugar as "salad." Stick with blue cheese, Parmesan pepper corn, or classic Italian dressing. Many flavored vinaigrettes are full of sugar. Many Steak House chains sprinkle MSG on their steaks which may improve flavor but leaves you ravenously hungry an hour later. That's what MSG--and soy sauce which contains natural MSG--do. Avoid those restaurants if you're trying to lose weight!

  13. Nuts Almonds, walnuts, and pecans are low carb in reasonable quantity and full of very healthy oils that lower cholesterol. You can heat them on a cookie sheet for a few minutes with a coating of DaVinchi flavored syrups to make them fancy.

  14. Sinful Desserts For a fancy dessert try making a low carb cheese cake. Use the Classic Philly 3 Step Cheese cake recipe and substitute DaVinci sugar free syrup for the sugar and bake for a few minutes longer than usual. Instead of graham crackers, use a crushed nut crust made by chopping walnuts or almonds and pressing them into the pan.

  15. LOTS OF GREAT RECIPES HERE Google Groups Advanced Search for "REC" on If you are looking for something in particular, search the newsgroup for "REC" and the name of the food.

  16. BREAKFAST Most "low carb" cereals are full of soy, which may not be good for your thyroid. If you must eat cereal, stick to high bran cereals, but read the labels carefully. Instead of using milk, which is full of fast carbs, try using a little half and half or else stir in some plain yogurt. Most people are at their most insulin resistant at breakfast, so if you can, try eating the classic eggs and meat breakfasts. Use the lower carb Rye Vita Dark Rye or Sesame Rye crackers instead of toast.

  17. AVOID PRODUCTS LABELED "LOW CARB!" Most of them aren't. Using a variety of bogus tricks food manufacturers sell a lot of products, like Atkins Advantage bars that are full of sugar alchohols that WILL raise blood sugar. These included Maltitol and Lacitol. The only sugar alcohol that is reliably low carb is Erythritol. Unfortunately, it is very expensive and though it looks like sugar, it does NOT cook like sugar, so avoid the tempation to buy it as a sugar replacement. Sadly, the good candies that used to be available with erythritol have disappeared.

  18. AVOID ALL "SUGAR FREE" OR "DIABETIC" FOODS. Again, they may be free of sucrose, but they are full of sugar alcohols that will raise blood sugar and many of them are full of flour which turns into glucose as soon as it hits your digestive tract. The people who run the companies that sell "Diabetic" foods full of flour and starch deserve to have their feet amputated like the poor victims who eat their products.

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 29, 2007

If Bill Gates Got Diabetes . . .

We'd all be better off.

No, this isn't another "I hate Bill Gates" diatribe. It's just that until someone who has the kind of moola Mr. Gates has, combined with an engineering frame of mind, gets diabetes, we are never going to see the studies funded that we NEED to have funded to make official the findings those of us who have normal health with diabetes have learned anecdotally.

It all comes down to hard cash. Right now almost all the money researching diabetes is coming from drug companies, and the only thing the drug companies research is, surprise, surprise, how wonderful their drugs are.

The truth is there is no pharmaceutical drug besides insulin that reliably lowers A1c more than 1% in ALL people with diabetes. And the average American with Diabetes, according to NHANES III has an A1c near 10%.

But you would not know that if you reviewed the various publications exploring "evidence based medicine" like the latest AACE practice recommendations (just published this week) which make it sound as if the only treatment for diabetes is pharmaceutical drugs. And for Type 2 diabetes these "evidence based" recommendations recommend doctors ONLY use oral drugs and a high carb/low fat diet until people's A1cs are high enough to have taken out their kidneys, retinas, and nerves.

So clearly what we need is for someone to fund research that collects some serious "evidence" about something OTHER than oral drugs!

It's not going to be coming from government--which is who USED to fund this research until the Republicans added a clause to the Constitution that said that American business had the right to do whatever it could in defense of its profits, including cutting all taxes that sent funds to non-industry funded medical research.

So folks like Mr. Gates are our only hope. If Mr. Gates should end up diagnosed with Diabetes--like so many of use who diet, exercise and still end up with abnormally high blood sugars--and decides he would like to do something to help the millions of us who don't have his resources--here are a few projects he might like to fund:

1. A twenty year study examining the impact of maintaining truly normal blood sugars on the progress of diabetic complications in people with Type 2. Think of this as UKPDS on steroids.

Participants in one arm of this study--at least 10,000 of them--will maintain blood sugars of 5.5% or less, using carb restriction, exercise, metformin, and both basal and bolus insulin where needed. Whatever it takes! Participants will be advised to cut their carbohydrate intake down to the level which produces blood sugars after meals that do not go over 140 mg/dl--the level associated with the beginning incidence of microvascular complications.

The control group for this study will be the entire diabetic population of a randomly chosen county treated with the standard treatments.

Participants will test blood sugars fasting and 1.5 hours after every meal and upload readings from their blood sugar meters monthly. They will be given a CGMS and long-use sensor once a year and instructed how to use it, uploading the data and detailed information about the food they eat and the drugs they take to verify their blood sugar patterns.

2. A ten year study testing the safety and efficacy of very low carb dieting for people with Type 2 diabetes.

All participants at the beginning of the study will be freshly diagnosed and will have been screened so that there are NO people with any early diabetes complications in either group. Again, we want 10,000 or so participants in each arm.

The control group is people given the standard dietary advice given diabetics, which is still, sadly, a diet of at least 125 g of carbs a day but usually much higher and a fat intake of under 30% of total calories.

The test group will limit their carbohydrate intake to 100 grams a day or less. Triglycerides, HDL, LDL, blood pressure, microvascular complications, thickness of carotid arteries and other cardiac health tests etc will be monitored every three months to track development of early complications.

Various expensive prizes will be offered every three months to participants to keep motivating them to participate. It is amazing what people will do for the chance of winning an iPod! At the end of 20 years one lucky person who stuck with the study gets a Maserati or a world cruise--something along those lines. Bill can afford it.

This study is particularly important. Despite the fact that a whole series of short term dietary studies have established the superiority of low carb dieting for people with diabetes, every single review of their data concludes "caution is required as we still do not know the long term effects of this diet" and then goes on to suggest they are probably bad. This study would answer that.

Both these studies would cost a lot of money because they would require large populations to be followed for many years. But "a lot of money" when you are discussing medical studies is something like $30M over ten years, which is lunch money for Microsoft Bill.

For now, this is our only hope of seeing ANY research that doesn't "prove" that oral drug A makes a tiny but not clinically significant (as opposed to statistically significant) change in the diabetes patient's health as it makes its lemming-like way over the cliff!

Don't YOU hope Bill joins "the club no one wants to join?"

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 22, 2007

Why not Choose a Person with Diabetes to head the ADA?

The ADA just announced that they've brought in Laurence Hausner to head the organization. Housner is a businessman who is an expert in "branding" whose last two jobs involved leading the Multiple Sclerosis Society and The Leukemia & Lymphoma Society where it appears enhanced fundraising was a major achievement of his leadership.

The ADA press release announcing his appointment says of his work at the Leukemia & Lymphoma Society, "As Chief Operating Officer, Hausner had oversight and management of all of the Society's operations, including revenue generation, finance, information technology, patient services, public policy, marketing, human resources and field management."

What the ADA's new CEO isn't is a person with diabetes. Which means that there isn't a hope in hell that he will push the organization to change the toxic advice it keeps giving people with diabetes--such as the advice posted on their web site that it might be dangerous for any person with diabetes to strive for "tight control" defined as a blood sugar of 180 mg/dl 2 hours after a meal and that bananas, oatmeal, and bread are the ideal diet for a person with diabetes--even those controlling their blood sugar with "diet" alone.

Clearly this new CEO's mission will be to raise even more money and build the ADA brand. That means avoiding any policy shifts that might annoy the ADA's top donors who include Cadbury Schweppes (the candy maker) and the bunch of other snack food purveyors who fund the organization now, as well as the drug companies that make the oral drugs the ADA's educational material treat as the only legitimate treatment for the very high blood sugars caused by the "diabetic" diet of high carb foods they have spent a fortune promoting to dietitians and doctors.

Is it really possible there isn't a qualified executive out there who has diabetes? Someone who might not see diabetes as "a heartbreaking disease" to use Hausner's words, but as a challenge that they have personally surmounted? Someone who has actually tested his or her blood sugar after a high carb meal and has some clue as to what it takes to avoid high blood sugars?

It's hard to believe there isn't. But it has been clear for years that the ADA is not an organization that answers to people with diabetes. Instead, it appears to serve those who profit from those who have diabetes, be it the doctors who treat their endless series of complications, the drug companies who sell them thousands of dollars worth of drugs a year, and the food companies who sell them crap that raises their blood sugar despite the ADA logo on the label.

So that leads me to one last question: Why do we people with diabetes let an organization full of people who don't have diabetes represent our disorder and be its voice in the world at large? Why do we let them define the appropriate treatments for our condition when they make it clear that they are driven by concerns other than attaining normal health for people with diabetes?

Finally, when will people with diabetes band together and start an organization that has as its primary concern NOT the building of the Diabetes brand--not the slathering of that brand on products guaranteed to raise the blood sugar of people with diabetes--but to spreading the knowledge that we already have of what it takes to achieve normal health after a diagnosis of diabetes.

An American Association of People With Diabetes might dedicate itself to teaching the public that that people who achieve normal blood sugars, no matter what their diagnosis, can have normal health, that they shouldn't settle for the dangerously high blood sugars the ADA has taught their doctors to call "good control," that the ADA's recommended A1c of 7% has been proven to lead to severe complications for most people with Type 2 diabetes and many with Type 1. Such an organization that might actually get across to the rest of the public at risk of diabetes and to the media that if you cut back on sugar and starch you can bring down your blood sugar because it is carbs, not fat, that harm the health of people with diabetes!

What a dreamer, eh?

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

Estrogen Decreases IR!

This showed up in the medical news today, confirming what I'd learned anecdotally:
Estrogen Receptors in Hypothalamus Region Play Role in Regulating Weight Gain

The key finding in this study is that when estrogen levels drop women become more insulin resistant and start gaining weight like crazy. Not just women with diabetes but all women.

That certainly was my experience.

As readers of this blog might remember, I decided to stop my estrogen supplementation last January, as I was concerned that I'd been on it long enough that heightened cancer risk might be an issue.

At the time I quit, my weight had been rock solid steady for 4 years. I'd actually lost a couple pounds when I switched to insulin but they had come back thanks to holiday dining.

I've never taken much estrogen. About 4 mg a month compared to the 18.6 most doctors prescribe. I was taking .3 mg of Menest, the estrogen NOT made from horse urine, every other day, with five days off at the end of each month to simulate natural cycling. Most women take .6 every day.

For the first month or so off Estrogen, I felt fine. But almost immediately after quitting I started to gain weight. I utilized the appetite suppression that I experienced on Januvia to go on a 1,150 calorie a day diet, and I stuck to it religiously for a month, weighing portions and using software to calculate intake. At the end of the month it wasn't clear if I'd lost any real weight at all! Once off the diet, the weight continued to rise and I felt bloated all the time.

My blood sugar, which had been perfectly controlled for a year with 2 -3 units of R insulin per meal deteriorated too. I was up to using 5 units per meal at one point without getting as good numbers as I had last year. And even with good control of meals my fasting bg shot up from the 80s to about 105 mg/dl.

My blood pressure, which had been so good I no longer need blood pressure meds shot up too, as did my pulse.

And finally 6 months after I stopped estrogen I started hot flashing AND developing dryness places where dryness is most definitely NOT anything you want to experience.

Fortunately, yet another reassessment of the Women's Health Initiative hormone study was published recently, which suggested that women who have been taking estrogen since the start of menopause can take estrogen safely until 65, and that, in fact, it appears that when estrogen is taken by women at the very start of menopause it prevents the development of calcification in the arteries. It is when estrogen is started in women who are in their mid 60s and have been menopausal long enough to have already developed hardened arteries that estrogen appears to enhance heart risk.

Since there is no history of estrogen sensitive cancers in my family, and since my doctor has done ultrasounds that show no build up of tissue in my uterus thanks to the very low dose of estrogen I'm taking, I came to a conclusion:

A drug that lowers my blood sugar, lowers my blood pressure, keeps my arteries from calcifying, keeps my weight controllable, and keeps me from feeling like crap all the time is a GOOD drug.

So I started back on it three weeks ago.

Here are my results so far.

1. Blood sugar is back to where it was last year. Fasting high 80s-mid-90s. I'm using 2 or 3 units of insulin, not 4 or 5 and getting great numbers. And what makes this really interesting is that I stopped taking Metformin a couple months ago and am still off it! So it seems to be the estrogen that was lowering my IR mostly, not the metformin!

2. Blood pressure is down, too. Pulse is much slower.

3. No more hot flashes.

4. Sensitive tissues are no longer dried out.

5. Weight has stabilized about 5 lbs over where I started last January, but I'll be working on getting it down soon.

Oh, and I'm taking a bit LESS estrogen than before, alternating between taking one pill every other day and one every third day.

I ams starting to wonder if the main problem with estrogen therapy is that they were doing the "One size fits all" dosing thing and giving a lot of smaller women like me far too much estrogen. I started doing the regimen I do now because the standard dose made me feel like crap and I worked the dose down to where it still took care of symptoms without making me feel chemical.

BOTTOM LINE: If you are a woman with diabetes with no family or personal history of estrogen sensitive cancers, taking estrogen at the beginning of menopause at doses that are much lower than what doctors usually prescribe might prevent an increase in insulin resistance and prevent high blood pressure. Discuss this with your gynecologist as I've found that family doctors tend to have a knee-jerk "estrogen is poison!" response. A good gynecologist who keeps up with the research (as mine does) may be more helpful to you.

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 20, 2007

Today's NYTimes Diabetes Report Misses an Important Point!

Gina Kolata wrote a series of articles that appeared in today's New York Times. One of them, "Obesity only part of the puzzle" cites two findings that have been published on my web site for 3 years--that there's an 80% concordance among identical twins for Type 2 diabetes--strong evidence that it is genetic, and that only a very small fraction of the obese ever develop diabetes. Kolata says 10%. I written at least 5 letters to the Times over the years protesting their articles stating as a fact,"Obesity causes diabetes," so this was very good news.

Unfortunately, the good news ended there. Instead of featuring the "Diabetes NOT caused by obesity" news, the paper chose to give most of its attention to another article by Kolata that reads like an advertisement for statin drugs. The article states as if this were a proven fact that "But no matter how carefully patients try to control their blood sugar, they can never get it perfect — no drugs can substitute for the body’s normal sugar regulation."

The article then goes on to state that people with diabetes are guaranteed to develop heart disease unless they take statin drugs.

"Looking past blood sugar to survive with diabetes."

There's only one problem with this. It isn't true.

People with diabetes can and do get normal blood sugars. In my years online I've met many of them. They do it with all different approaches but in general the strategies that give them normal blood sugars do NOT rely on oral drugs. They use any or all of the following: carb restriction, exercise, and carefully dosed insulin calculated with carb/insulin ratios and a very good understanding of the difference between basal and bolus insulin.

And because there is a lot of evidence linking A1c to heart attack risk, these people with diabetes who have A1cs in the normal range have a normal risk of heart attack, just like anyone else with that A1c.

High blood sugars in the range most doctors tell patients is "good control" glycosylates the receptors on your LDL molecules--i.e. glues them all up with glucose--which makes it tough for the body to remove that LDL and leads to clogged arteries. If your blood isn't full of glucose, your LDL gets removed from the body the way it is supposed to be. That is why most people who low carb see dramatic drops in their LDL. And they ALSO see dramatic drops in their trigycerides, the other lipid fraction associated with heart attack which Statins do NOT lower.

The other thing high blood sugars do is create neuropathy in the vagus nerve that regulates heart beat and blood pressure, which probably also contributes to heart attack by leading to abnormal heart behavior.

So promoting the idea that people with diabetes should try to avoid heart attacks by taking statins is like saying people who smoke in bed drunk should be sure to have a fire extinguisher in the house. Yes, it's better than nothing, but why not get them to stop smoking instead! Statins, do NOT prevent heart attacks in people who haven't already had one, and even in that group lots of people who take statins go on to have heart attacks. In fact, one half of people who have heart attacks have normal LDL. People with diabetes who settle for A1cs or 7% or higher will only cut their risk of heart attack by some modest amount. Not eliminate it.

But lowering blood sugar to normal levels CAN prevent heart attack by getting the sticky glue-cose out of your arteries and restoring normal function to the vagus nerve!

I've cited the research backing up these statements here: "A1c Predicts Heart Attack"

And who knows, maybe one day Ms. Kolata will discover that research too, as she finally did the "obesity doesn't cause diabetes" research!

But if I ever pick up a mainstream media report that tells people they can regain normal health by cutting back on their carb intake rather than taking expensive drugs I'll probably have MY heart attack from the shock!

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 15, 2007

LifeScan "Giveaway" - What Cynical Weasels!

A PR person working for LifeScan alerted me to the fact that her wonderful client is giving away 10,000 free meters.

Her press release explains that having thoroughly researched the needs of the meter-using population, LifeScan had decided that what we've all been needing is a choice of color for our meters.

Well, wake up. What we need is more affordable test strips.

And the other thing we need is for someone, like, say me, to point out what a cynical piece of self-serving crap this giveaway is, since every recipient of a "free" LifeScan meter will have to spend $100 on LifeScan's strips to be able to use it. LifeScan no longer includes even the ten pathetic free strips they used to include with their new meters.

Strips cost a lot more now than they did when I was diagnosed 9 years ago. This in an age where every other technological item decreases in cost with every passing month. I paid $1,900 for a computer in 1998. I paid $66 for 100 strips. Far more powerful computers are available now for $400, but strips are up to $100.

Last I looked, there wasn't anything special going on inside of the strips or the meter, no platinum, diamonds or gold. The cost goes up because we folks who use them are a captive audience and all the major companies who make strips that insurance will reimburse seem to have agreed to charge the same price, giving us no real choice.

But now you can get ripped off in the color of your choice!

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 13, 2007

Some Disturbing News about Januvia

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.

NEW Dec 19, 2008: If you want to better understand the health issues associated with Januvia, read the Dec 8, 2008 blog post citing the research that makes it clear that a "side effect" of how Januvia lowers blood sugar is that it turns off a tumor suppressor gene making it "a trigger for prostate cancer". This same mechanism has been linked with promoting melanoma, ovarian cancer and lung cancer. None of the approval testing for Januvia investigated this problem and there is evidence it is real and affecting people taking this drug.

You can read about this important issue here:

More Research Shows Januvia and Glinides Inhibit Tumor Suppressor Gene DPP-4

Here is the original post "Some Disturbing News About Januvia":

Diabetes in Control reports last week that "According to a survey, prescriptions for the diabetes drug Januvia have grown nearly threefold between the first week of 2007 and the week ending July 20. ... It was reported that patients were switched from metformin 21%, Avandia 17% and Actos 13%."

Once again we are being treated to the spectacle of doctors who do not understand a new drug's mode of action prescribing that new drug in a way that is guaranteed to damage the health of many of those patients.

Januvia does NOT affect Insulin Resistance

Januvia stimulates insulin production after meals and may inhibit the production of glucagon after meals. That's what it does folks, and that is ALL it does.

The problem here is that for at least 21% of the Type 2s in this study, doctors were taking them off drugs that countered insulin resistance and replacing them with this drug that stimulates insulin production.

Why is this dangerous? Because for many Type 2s insulin resistance, not lack of insulin production is the primary metabolic flaw causing their high blood sugars. Their cells do not respond normally to insulin, even very high levels of insulin, resulting in very high blood sugars. Drugs that reduce insulin resistance make it possible for less insulin to do a better job.

The term "insulin resistance" is bandied around a lot, but few people really understand its practical implications. The best way to get your head around what insulin resistance means is to compare the insulin doses required to achieve normal blood sugars by people who are not insulin resistant and those who are.

A 125 lb non-insulin resistant person with Type 1 diabetes who produces no homemade insulin at all might use a basal dose of Lantus of 12 units. If they ate a meal with a moderate number of carbohydrates--let's say, 30 grams, they would inject 2 to 3 more units of a fast acting insulin to mop up those carbs.

In contrast, a Type 2 who also weighs 125 (and yes, there are quite a few Type 2s who are normal weight) if taking no other drugs might use 50 units of Lantus and need 17 units of insulin to cover that same 30 grams of carbohydrate. If that insulin resistant Type 2 were to add metformin to their daily regimen, a drug which reduces their insulin resistance, their Lantus dose might drop to 30 units and their post-meal dose to 10 units.

In either case the insulin resistant person is using three to five times more insulin to get the same effect as the non-insulin resistant person.

But the study above reports that doctors are taking people OFF the drugs that reduce insulin resistance--21% of their patients were taken off Metformin and almost the same percentages were taken off Avandia and Actos, which also affect insulin resistance.

Then doctors are putting these insulin resistant patients a drug, Januvia, that does two things: Mainly it stimulates whatever beta cells are left to produce more insulin. Though since the doctor has just taken away the metformin, the patient is going to need to produce more than they were when they were taking metformin.

Januvia may also decrease glucagon secretion--glucagon is a hormone that pushes up blood sugar and there is some likelihood that it is overproduced in people with Type 2 diabetes. Decreasing glucagon production will lower blood sugar--but it is important to note it only lowers the blood sugar dumped by the liver into the blood stream in response to glucagon production. It does NOT lower the blood sugar rise caused by the digestion of the carbohydrates in your meal.

So switching someone to Januvia from Metformin means that you've now increased their insulin resistance while at the same time giving them a drug that only stimulates a very mild increase in insulin production from whatever living beta cells they have left.

Januvia DOES work very well in some people. But the thing that doctors don't seem to understand is that the people it works well for are those people who, like me, though diagnosed as "insulin resistant type 2s" are, as I am, insulin sensitive people whose beta cells due to some flaw have stopped secreting insulin in response to rising blood sugar.

People who are insulin sensitive but have a defect that stops living beta cells from secreting will also response strongly to sulfonylurea drugs like Amaryl or Glipizide.

And they will respond very strongly to Januvia, but unfortunately, the makers of this drug have carefully NOT measured the insulin sensitivity of their subjects before putting them on the drug. If they had done this, it would probably show that Januvia works mostly in people who are insulin sensitive, but doing that would rule out giving it to most Type 2s and destroy the lucrative market for this new drug.

Anecdotal Januvia Side Effect Report Updated

I have heard recently from someone who experienced serious constipation with Januvia. The Januvia Blog also has some new reports from people who have experienced rashes after taking it.

Copyright Janet Ruhl 2007. If you are NOT reading this on the content has been STOLEN.

August 8, 2007

Hunger is a Symptom

Our fat-hating society has transferred all the loathing we used to feel for blatant displays of greed, lust, and pride to a single sin, gluttony. The rest of those erstwhile sins now have transformed into the characteristics of the celebrities we admire.

This has had the unfortunate side effect of making people who find themselves feeling extremely hungry believe that they are suffering a moral lapse--gluttony--rather than recognizing that they are experiencing a medical symptom.

But the raging muchies--the kind of hunger that leaves you at the open fridge shoveling in everything in sight--is a symptom. You can induce it in an otherwise normal person with a couple of tokes of pot. You also see it in millions of otherwise normal women a few days before they get their period.

And sadly, it is a symptom that often emerges along with insulin resistance in people who have the genetic make up that leads to Type 2 diabetes because insulin resistance is a prime factor that leads to raging hunger.

Exactly why isn't completely understood, but we do know that one of the main things that can cause hunger is swiftly moving blood sugar of the type that happen when blood sugar goes way up after a meal and then plummets back down as it does in hypoglyemica.

People with Type 1 diabetes who are prone to severe hypos can tell you all about the hunger that comes with dropping blood sugars. In fact, someone on recently described waking up with a very low blood sugar and attempting to eat their clock radio. This sounds funny, but it isn't, first of all because it really happened to a real person and secondly because it shows how powerful the brain's response to a hunger signal can be. Hunger is the single strongest drive in any living being, far stronger than sex, because without food we all die.

But there are other metabolic changes that also cause raging hunger. Swift changes in insulin levels in the presence of normal or high blood sugars can also do it. Fluctuations in female hormones are yet another known cause. Cortisone drugs and our own adrenal hormones when they are out of whack can produce raging hunger. Abnormal levels of various brain hormones like Leptin and proteins like GLP-1 can cause relentless hunger, too.

Unfortunately, when most people start feeling hungry, they respond by getting angry at themselves. They get drawn into power struggles with their body and declare, "You glutton, you're going to do what I tell you and go on a diet!" And they do. But if they are hungry on their diet, it is only a matter of time until the brain has had enough and responds, "You're going to eat that stale donut, all those potato chips, and the three containers of left over Chinese food that have been sitting at the back of the fridge for a week!" And most likely you will. Because billions of years of evolution have made sure that when the brain says, "Eat!" You do, because if you don't you die, and organisms that were good at ignoring hunger symptoms mostly didn't live to reproduce.

But the good news is that once you realize that your raging hunger just means you are experiencing a medical symptom that is no more a moral failure than is a sore wrist or a weak knee you can get to work on figuring out what is causing that hunger symptom and make it go away.

First Line Defense Against Hunger

1. Flatten out your blood sugars. If your blood sugars are going W-A-Y up and then plunging down, you need to flatten them out. The easiest way to do this is to cut down on the foods that raise blood sugar, which are those containing starches and sugars.

In an early edition of his book, Dr. Bernstein's Diabetes Solution,, Dr. Richard K. Bernstein pointed out that people don't get out of control with fat alone and no one finds themselves longing to chug down a nice frosty pitcher of oil. It is excess sugars and starches that cause hunger cravings because they are what raise blood sugar. For many people, cutting way back on the carbs is all it takes to cure out-of-control hunger. It's important to note that it usually takes about 2 to 3 days to flush high carbohydrate foods out of your system, during which you may be more hungry, but if you can hang through those first couple days and confine your snacking to carb-free foods like cheese and meat most people will experience a dramatic decrease in hunger.

2. Work on your insulin resistance. High levels of circulating insulin can make people hungry, so try adding some exercise which often can curb this insulin resistance. If exercise isn't possible or if it isn't enough, and if you have a history of high blood sugar, talk to your doctor about taking Metformin or Byetta. (As I've written elsewhere, only keep taking Byetta if you do experience dramatic relief from hunger symptoms as otherwise it is an expensive waste.)

3. Hormones can make you hungry. Female hormones can have a dramatic effect on hunger both when you take them, as in birth control pills or ERT or when you don't take them, in menopause. Corticosteroid hormones whether taken as medications or produced by out of whack adrenal glands also can lead to overwhelming hunger, partially because they raise blood sugar, and partially because they upset so many other hormones.

If you think your hormones are part of the problem, work with your doctor to change your regimen if at all possible.

Sometimes with hormonal hunger there isn't anything you can do except to tell yourself, "This isn't about food, nothing I eat is going to help." Once you realize that the hunger you feel is symptom of a hormonal imbalance, not a signal you really need to eat, it can be easier to deal with. If you do eat, observe the effect it has on your hunger. If eating doesn't help your hunger, you know that you are suffering a medical symptom and the cure is not going to be more food.

4. Change what you are eating. You may notice you are a lot hungrier after eating certain kinds of breakfast than others. Note what you eat and how your hunger patterns respond during the next 12 hours. You may be able to eliminate some foods that cause hunger.

Some foods people think of as "healthy" that may be prime culprits in causing hunger are things like noodles, oatmeal, fruit smoothies, bananas, fruit spritzers, fruit juices no matter how organic, and whole grains. Eating these foods for breakfast can set you up for a whole day of relentless rollercoaster blood sugars. Try eating eggs for breakfast for a few days instead and see if it makes a difference.

5. If you inject insulin, you may need to take a careful look at your dosing or what insulin you are using. I have noted that I consistently get hungry a couple hours after using Novolog no matter what I eat. I'm not sure if it is because Novolog is a bit too fast for me or what, but if I feel hungry a few hours after using it I test my blood sugars and when I see they are normal, which I usually do, I know the hunger is a side effect of the insulin not a sign I need to eat anything else. That is one reason I prefer R insulin even though it isn't as convenient because I don't get hungry when I use it.

Some people find that Levemir causes them less hunger than Lantus. So if you are on Lantus and having a hunger problem talk to your doctor about trying Levemir.

6. Stay away from any foods containing these ingredients that are known to provoke hunger: MSG, and substances that contain MSG but are labeled "Hydrolyzed plant protein," "Hydrolyzed soy protein," and soy sauce. Other substances that can cause hunger are high fructose corn syrup and the Maltitol and Lacitol found in "low carb" or "no sugar added" products.

August 6, 2007

Why the Glycemic Index Fails for Many People with Diabetes

As simple as it seems, most doctors and dietitians still don't tell people with diabetes that the carbohydrate content of the food they eat is what raises their blood sugar and that lowering their carbohydrate intake will lower their blood sugar.

Instead, they recommend the so called "good carbs" which are those which are low on the "Glycemic Index," chief of which are what they call "Healthy whole grains," like whole wheat bread, brown rice, pasta, and oatmeal.

If you look any of these foods up in your handy carb counter--you DO have a carb counter, I hope!--you will see they all contain a lot of carbohydrate. Two ounces of whole wheat bread--one thin slice--generally contain around 29 grams of carbohydrate and how many people only eat one slice?

A single ounce of dry oatmeal contains 18 grams, but what most people consider a full serving is at least twice that size. Two ounces of low glycemic pasta contain around 56 grams of carb, but again, two ounces is a very small amount--about 1/3 of what most people consider a normal portion of pasta.

If you measure your blood sugar for several hours after eating a normal serving of whole wheat bread or oatmeal you will see a spike, possibly a very high spike well over 200 mg/dl. You may have to measure your blood sugar 4 hours after eating pasta to see the spike it causes because of how slowly it digests, but eventually it does digest, and if you keep testing you will see it cause a spike, too.

So what's going on here?

The answer is that the glycemic index only works for people who have a normal second phase insulin response. If you don't produce very much insulin, or if your insulin resistant body isn't responding to the insulin you produce, it won't work for you.

All the Glycemic index does is measure the speed with which the carbohydrate in a given food is digested and hence the speed with which the carbohydrate it contains hits the blood sugar.

Foods that are low glycemic usually contain a lot of fiber or, like pasta, contain complex starch molecules that take a while to digest.

This is very helpful to normal people because they have a robust second phase insulin response. When they start to eat, their body immediately dumps a load of insulin into the bloodstream to take the edge off any spike. That's the first phase insulin response--which people with any kind of diabetes rarely have. Then, as the food digests, if their blood sugar rises over 120 mg/dl (6.7 mmol/L) their beta cells dump a second load of insulin into the blood stream. This is the "second phase insulin response" and for many people including some people with mild type 2 diabetes it is much stronger than their first phase response.

For a normal person, this second phase insulin response kicks in at half an hour after eating and is done shortly after one hour after eating. If your carbohydrate is slowed down just a bit, a normal second phase insulin response can mop it up completely avoiding any spike in blood sugar response. So for a normal person with normal insulin response, the Glycemic index does point to foods that are healthier.

But people with diabetes don't usually have a normal second phase insulin response!

Here's a simple graphic from a page called "Secretion of Insulin and Glucagon" which shows you the amount of insulin secreted by normal people, people with impaired glucose tolerance and people with the kind of Type 2 that is characterized by Insulin resistance but who still produce some insulin.

Many people with Type 2 diabetes have little or no second phase insulin response left. And those that do usually are very insulin resistant, so although they may still secrete normal levels of insulin, their body has stopped responding to it, making that second phase ineffective for controlling blood sugar. And of course, most people with Type 1 diabetes whose beta cells are dead have NO natural insulin response at all.

When a person who doesn't have a robust second phase insulin response eats a "low glycemic" "healthy whole grain" there's no second phase insulin response waiting to mop up the carbs released from these foods. So every single gram of those carbs will hit the blood stream over the next couple hours. And since insulin isn't there to greet it or isn't able to do the job thanks to Insulin Resistance those grams of carb are going to raise the blood sugar. And because those "healthy whole grains" have a lot of carb in them, they're going to raise it a lot.

If a person is injecting insulin, slowing the carbs down a bit might allow these slower carbs to meet the insulin. Or it might not, because it is very tough to predict exactly when the low glycemic food will digest completely. If you try to dose for 4 ounces of pasta, for example, the insulin you injected to cover those 112 grams of carbs may well hit your blood stream before the pasta does, resulting in a nasty low.

But many so-called "low glycemic foods" actually hit the blood stream very fast--oatmeal certainly does for me. So your "low glycemic" oatmeal may raise your blood sugar before your injected insulin can get there to process it.

Unfortunately, doctor and nutritionists often don't seem to understand that you need an intact second phase insulin response for the glycemic index to be helpful. Nor do they realize that the research used to establish the "glycemic index" ratings of various foods was all done in normal people with robust second phase insulin responses.

If you are a Type 2, you can easily determine if you have an intact second phase insulin response. Eat a serving of whole grain bread with nothing else and then test your blood sugar at 1 hour 2 hours and 3 hours after eating it. If you don't see a blood sugar value over your target blood sugar, you have still got a second phase insulin response and you can use the Glycemic Index to help you choose what to eat. If you see a large spike after eating, you don't. It's as simple as that.

And if you don't have a second phase insulin response, the only difference between a high glycemic and a low glycemic food is that one hits you sooner and the other hits you later. But every single gram of carbs in those foods will eventually raise your blood sugar. And If that's the case, for any food that raises your blood sugar over the target you've set, the carbs it contains are not "good carbs" or "healthy carbs" no matter how healthy they might be for people who do not have diabetes!

August 3, 2007

Did Your Plastic Water Bottle Give You Diabetes?

Today's news carried a story about how 12 scientists have published a warning that a compound called bisphenol A, an estrogen mimic which is found in many plastics, has been conclusively linked with reproductive tract damage in many animals.

A chilling line from the report states "The scientists - including four from federal health agencies - reviewed about 700 studies before concluding that people are exposed to levels of the chemical exceeding those that harm lab animals. Infants and fetuses are most vulnerable, they said."

In addition the report explains, "The compound, bisphenol A or BPA, is one of the highest-volume chemicals in the world and has found its way into the bodies of most human beings.

"Used to make hard plastic, BPA can seep from beverage containers and other materials. It is used in all polycarbonate plastic baby bottles, as well as other rigid plastic items, including large water cooler containers, sports bottles and microwave oven dishes, along with canned food liners and some dental sealants for children."

Here is a link to the version of this story that appeared in the San Francisco Chronicle:

Scientists say plastic compound causes reproductive problems

What the article failed to mention is that several studies have also found that bisphenol A increases insulin resistance. For example, a study published in January 2006 in the journal Environmental Health Perspectives has a title that says it all:
"The Estrogenic Effect of Bisphenol A Disrupts Pancreatic β-Cell Function In Vivo and Induces Insulin Resistance".

Another article published in 2004 in The British Journal of Pharmacology, Bisphenol A affects glucose transport in mouse 3T3-F442A adipocytes concluded "it was demonstrated that BPA, one of the chemicals that we intake incidentally, affects the glucose transport in adipocytes [fat cells], and also that the environmental chemicals may be identified as one of the environmental factors that affect diabetes and obesity."

There are more studies out there along the same lines. What they have in common is that they were published in journals that don't get a lot of attention from the press and that no drug company or agribusiness powerhouse benefits from promoting these results to the media so these findings did not get the PR push that would get them into the news.

But if you have a weight problem linked to insulin resistance, they should get you thinking.

I have long believed that the so-called "obesity epidemic," though very real, is unlikely to have been caused by its victims' sloth and gluttony, because there is so much good research that shows that normal animals and for that matter, humans, cannot be made to gain and retain large amounts of weight even with overfeeding. Something needs to disrupt the normal regulatory systems of the metabolism for that to happen. And clearly something HAS disrupted them in a growing number of people.

Especially troubling is the finding that huge numbers of young children are experiencing dramatic obesity and developing type 2 diabetes when they are so young that it is not metabolically possible that their diabetes was caused by their obesity! It takes far more than a decade for an overweight adult to develop diabetes related to their obesity, yet children too young for elementary school are developing insulin resistance-related diabetes.

The finding that Bisphenol A has its most powerful effect on infants and small children, and that babies are sucking down formula from bottles that shed this toxic molecule, lying in cribs made of it, playing with toys full of it and may even have it applied to their teeth makes it very possible that bisphenol A is causing the insulin resistance which turns into both childhood obesity and childhood Type 2 diabetes.

The response to the scientists' warning was predictable: those with a financial stake in these plastics rush to assure us they are safe.

But some of us are old enough to realize that the plastics that surround us are a relatively new substances that only invaded our environment in the late 1950s and this makes us wonder if the growth in obesity and Type 2 diabetes might not track to the growing pervasiveness of these plastics and their toxic chemical in our environment and bodies.

Back when I was little in the early 1950s kids' toys were made of tin and thin sheet metal where they now are universally made of the hard plastics filled with Bisphenol A. Food tins were not lined in the chemical as they are now. Other food items were wrapped in cellophane--a cellulose product--not plastic wrap. Our metal lunch box held sandwiches wrapped in waxed paper. Our refrigerated water was stored in glass container. Our soda bottles were glass, too. And needless to say, we didn't sit at plastic keyboards in front of plastic monitors and push plastic mice around all afternoon after school!

And though my friends and I routinely scarfed down candy bars and fudge sundaes on our way home from school and ate lard-crusted pies with whipped cream topping and heaps of mashed potatoes each day at lunch, we were not fat. In fact, fatness in anyone young was unusual and if we asked about it our parents would sagely murmur something about them having "bad glands."

Now parents are more likely to explain that fat kids are lazy and their parents are gluttons It's become a huge part of our culture to blame people for their weight problems. The media echo this attitude, too. And it keeps people from asking the hard questions about what has changed to make obesity so common and to question whether environmental pollutants like those coming off the plastics that surround us that may really be the cause of this tragic epidemic of industrial poisoning.

August 1, 2007

Who ya gonna trust?

If you have just found out you have diabetes, you will almost certainly be told that part of the treatment for diabetes is "diet." The problem arises when you ask which diet.

It will take about 5 minutes of web research to learn that there is no agreement on what is the right diet for a person with diabetes. People with impressive medical credentials argue, often convincingly, for every possible diet a human could eat and some that very few humans would ever want to eat.

It is not my intention to debate diets in this blog entry. Instead, I'd just like to share a couple thoughts with you that might help you sort through the torrent of conflicting advice you're about to receive.

Most Dietary Research So Poorly Conducted the Results are Not to be Trusted.

Almost all research conducted by dietitians relies on having participants fill in a standard questionnaire about what they ate in the recent past.

I participated in one such study during a period when I was carefully weighing and logging every single bite I ate using LifeForm software because I wanted to really understand the impact of my food input on my weight and blood sugar.

After submitting my survey, the people conducting the study kindly sent me a print out they said showed what I'd been eating during the time period covered by the questionnaire.

Since I also had LifeForm's report that broke out exactly what I'd been eating over the identical period, I was surprised to see that the dietitians report was about 500 calories higher per day than what I had actually eaten, and that the percentages of Carb/Fat/Protein the dietitian's survey claimed I'd eaten bore no relationship to what analysis of my actual food logs showed I'd actually eaten.

I emailed the dietitian about this and offered to send a copy of my own computerized log and records to the dietitian but was told there was no need for it. They had confidence in their survey which used a standard form that was universal in dietetic studies.

So much for the accuracy of dietetic studies!

Beyond that, most dietary studies fail to control for many other factors than the one they are studying. Reading the actual study you see cited in the news often shows that strong conclusions are being drawn from the thinnest bits of data.

Even worse, most dietary research is funded by someone who profits from the food the research investigates. I've already discussed the deceptive studies that have touted the healing properties of chocolate and soy yogurt in this blog. But there are thousands of other such studies, all highly promoted in the press because the companies who sell these foods have active PR departments.

Bottom line: Treat all dietary studies with caution. Over the 9 years I've been following diabetes-related research I've seen just about every dietary research conclusion published contradicted by another equally poorly designed study. It's jungle out there!

Dietitians Do Not Keep Up With Research

No matter how much research comes out in mainstream journals showing that low fat diets have none of the positive health effects they were expected to have, a large proportion of dietitians continue to chant the religious mantra "fat is bad."

Even worse, many give out highly erroneous information such as the idea that the brain can't function on less than 130 grams of carb a day--which is more carb than I've eaten daily for the past 9 years, a period during which, apparently, brain-free, I've published several successful nonfiction books and designed some very complex software!

Dietitians continue to suggest people eat soy--though it is known to be poisonous to iffy thyroids. They suggest "low glycemic" diets to people with Type 1 diabetes who have no second phase insulin response which is what makes slow carbs useful to people with normal second phase insulin response--i.e. normal people and people with very early Type 2.

Don't Take Advice about Diabetes Diets from anyone who is NOT a Person who has Your Kind of Diabetes with Great Control

It was interesting to read the blog postings a couple years ago describing the diabetes journey of Dr. Bill, founder of the diabetes blog, who was an endocrinologist for years before he himself developed Type 1 diabetes. It was only when he started testing his own blood sugar after meals that he discovered that following the dietary advice he'd been giving patients for years raised his own blood sugar unacceptably.

This does not surprise me. Anyone who has tried to make insulin work with a nutritionist-recommended 300 grams of carbs a day or even a diet that is 1/3 carbs--and hence 55-70 grams of carbs per meal knows that this level of carb intake combined with unpredictable insulins makes it very tough to avoid hypos unless you let your blood sugar run high enough to cause complications.

This is one reason that so many of us people with diabetes have so much respect for Dr. Richard Bernstein, who was the very first diabetes patient in the world to use a blood sugar meter, with dramatic results. You may not agree with everything he writes (I don't) but Bernstein has forgotten more about diabetes than most of us will ever know, and everything he writes is worth checking out, if only because he's lived it.

It's that simple: The people whose advice is worth checking out are those who have the kind of diabetes you have, who have been able to maintain excellent control over a period of at least five years and who have not developed serious complications after adopting the diet they are advising you to try.

You'll get different and even conflicting advice from these people, too, because our bodies are different. If you are diagnosed with Type 2, there may be a huge difference in how much your diabetes is caused by insulin resistance and how much by insulin deficiency. People who are mostly diabetic from insulin resistance will get very good results from diets that won't work if your problem is insulin deficiency.

But the advice of someone who has your kind of diabetes and has made their diet work for them, is a good place to start. And the emphasis here is on the word "start".

No advice is good advice if your meter shows you getting blood sugars consistently over the level known to cause complications.

The AACE (American College of Clinical Endocrinology) says this level is 140 mg/dl (7.7 mmol/L) at 2 hours after eating. The ADA says it is 180 mg/dl at the same interval (though there is no current research that supports this level and a lot that supports the lower level.) But whatever your target is, if your diet is raising your blood sugar over that target, it's a bad diet.

Try out the ideas people share with you, but check them against what your meter tells you.

The best diabetes diet for you is the one that keeps your blood sugars in the safe zone!