January 30, 2008

Statin Drug Manufacturers Deluge Media with Spin

Ever since the publication of the long-delayed results of the Zetia/Vytorin trial a few weeks ago, the study which raised serious questions about whether lowering LDL does anything to prevent heart attack death, the media have been full of M.D.s pontificating on the importance of lowering LDL and the wonderfulness of statin drugs.

I've heard them on NPR. I've seen them on my local TV news channel. Clearly the drug industry spinmeisters have been hard at work sending out press releases.

On the local news channel tonight, a doctor insisted that you could lower cholesterol by not eating fat and not eating cholesterol, but if that didn't work, you should take a statin drug because statins were "proven" to prevent heart disease in people with "risk factors."

Those of you who are educated about nutrition know that the first two statements are just plain wrong and that the third statement is only true if by "risk factors" you mean, "being a male, under 65 and having already had a heart attack." The sample patient in the TV news story was a young, thin, fit man, shown exercising at the gym, who said he had just been told he had high cholesterol. The point of the brief news story seemed to be that people like him needed to take statins.

On the NPR health show, the featured doctor went so far as to say he thought just about everyone should be on statins starting in their 20s.

As you may know, the American Heart Association (a wholly owned subsidiary of Big Pharma and the Cereal Industry) rushed into print immediately after the release of the Zetia/Vytorin results telling a New York Times reporter that people should continue taking these drugs even though this major study make it clear that they are at best ineffectual and at worse may make arteries clog faster.

A follow up article in the New York Times pointed out that the AHA failed to disclose to the reporter the many millions of dollars it gets from makers of these drugs. The article also pointed that the AHA's web site links to a page advertising Vytorin using what looks like an informational link purporting to be about the sources of cholesterol. Clearly the American Heart Association is highly influenced by the people who give them money.

New York Times: Heart Group Backs Drug Made by Ally.

I expect to see a lot more of this kind of story in the media in days to come. You will too. When you do, take the time to contact the media outlet and explain to them how disappointed you were that they presented a drug company press release as if it were a news story rather than providing a balanced story investigating the growing weight of evidence casting doubt on the efficacy of statins for anyone who is not a male under 65 with a previous heart attack.

And if you haven't already, check out Businessweek's Cover Story about Statins: Lipitor: Does it Make a Difference. A reporter there actually did some research!

UPDATE: Jan 31

Today's variant on the spin is a AHA "wear red" assault on women's health, which urges women to get their cholesterol measured--and points them to a web site recommending "healthy" low fat/high carb diets. The photo on the AHA sponsored web site is of a big slice of pizza made with low fat cheese.

Here you can see how many newspapers published the AHA's press release as if it were news:


Did ANYONE reporting on the health industry notice the huge and very well conducted Women's Health Initiative study (WHI) proved conclusively that low fat dieting DOES NOT HAVE ANY EFFECT ON WOMEN'S HEART DISEASE?

Obviously not. Junk food empires Campbells and Kelloggs are listed as sponsors of this AHA program but the top sponsor is Merck, makers of Vytorin and Zocor.

Alternative and Natural Treatments for Diabetes

One of the questions I'm asked most frequently by people who email me is "Aren't there any natural treatments I can use to normalize my diabetes?"

By "natural" people mean the herbs and supplements that are sold with the marketing message that the substances they contain are safer and more effective than pharmaceutical drugs.

The short answer is NO.

Very few supplements sold to help people with diabetes do anything at all but help you lose weight in your wallet. Many of them are just vitamin and mineral blends. You can read in more depth how flimsy is the data suggesting that any minerals really help with diabetes on my web page Bad and Questionable Supplements.

Many of the other supplements sold specifically for diabetes contain cinnamon, which has also been discredited as a blood sugar treatment now that we have some research that was not performed by a team of researchers headed by someone with a financial interest in cinnamon.

Occasionally you will hear on a forum or discussion group about a supplement that someone with diabetes reports has a dramatic effect on their blood sugar. Unfortunately, all too often the supplement works because it is chemically very similar to a pharmaceutical and that means--and this is extremely important--it has the same side effects as the pharmaceutical.

For example, some Chinese herbs used for controlling blood sugar turn out to be chemically very similar to sulfonylurea drugs. Bitter melon and ginseng fall into this category.

Application of modified in vitro screening procedure for identifying herbals possessing sulfonylurea-like activity. Y. Rotshteyn and S. W. Zito.

No one questions that sulfonylurea drugs work to lower blood sugar. The big problem with them, particularly the ones more like the herbs in function, is that the same chemical action that causes beta cells to pump out insulin also stimulates heart muscle in a way that increases heart attack. There is some concern that the continual stimulation of the beta cell by sulfonylureas may cause them to die over time. If your herb is stimulating insulin secretion by using the pathway sulfonylureas use, it is subject to these identical concerns.

Red rice yeast lowers cholesterol the same way as statins, because it contains natural statins, which mean when you take them you have the same risk of muscle damage and cognitive decline.

This is troubling enough, but then you run into the single biggest problem with herbs and supplements: Because they are completely unregulated, you have no idea what might be in the capsule you paid for.

When supplements are taken to the lab and analyzed they often turn out not to contain what they are supposed to contain. Even worse, they may contain other things that you didn't bargain for, be they pesticide residues or actual pharmaceutical drugs added to make them "effective."

You can read a description of what one company was selling instead of Hoodia in capsules labeled Hoodia: HERE. Sawdust was only one of the components filling the expensive capsule. Another article explains how lab analysis found that 11 out of 17 bottles of Hoodia contained NO Hoodia at all. Read it HERE.

In contrast, quite a few Chines herbs that appeared effective turned out when analyzed in the lab to contain added pharmaceutical drugs. You can read a chilling review of the various pharmaceuticals found on analysis of various Chinese herbs HERE.

Note that the drugs adulterating these herbal preparations included glibenclamide, a powerful sulfonylurea drug. Another was prednisone, which is a powerful corticosteroid that raises blood sugar and can permanently damage beta cells.

And HERE is an academic study of pesticides found in herbal supplements analyzed in the lab in 2004 which reports that "...pesticides were found in 44 out of 87 samples of botanical dietary supplements (the majority of these being ginseng products) suspected of containing pesticides. Over 30 different types of organochlorine, organophosphorus, and organonitrogen pesticide residues were present in these samples, with pentachloroaniline, pentachlorobenzene, and quintozene being the most abundant. A majority of these products contained more than one pesticide; one such sample was found to contain as many as 12 organochlorine compounds. Concentrations of pesticide residues ranged from 0.001 (pentachloroaniline and pentachlorophenyl methyl ester) to 5.57 mg/kg (quintozene)"

It's expensive to do these analyses so most of the herbs and supplements you see in the store do not get them. But based on the testing we do see, it's likely that you have a one in two chance when you buy a supplement that it either doesn't contain what you paid for, or that it contains pesticides and other dangerous contaminants.

So much for "natural" cures.

I have repeatedly heard from users of supplements who claim that the company whose products they use is different from the sleazy weasels I warn about. Further questioning always reveals that they draw this conclusion from claims made by the company itself, usually on its web site.

In fact, it is very difficult to know whether you can trust any supplement company, no matter how well-intentioned, given the complete lack of regulation and the fact that most of them buy their raw materials from China and the third world.

The problem is often beyond the control of even the most legitimate supplement vendors because of their dependence on merchants in third world countries where corruption runs rife. For example, right now, most of the vitamins sold by U.S. companies are manufactured in China and are subject to all the problems with all Chinese products: they are manufactured using polluted water heavy in pesticides and other industrial pollutants and they may very well be adulterated as the track record of Chinese companies for selling adulterated products is very poor.

Unless every batch of raw materials is subjected to extensive and very expensive testing for every possible contaminant, there is no way any company can guarantee the purity of its supplements. The capsule that contains a supplement this month, based on independent lab testing paid for by some journalist, may not contain it next month.

At least with pharmaceutical drugs, despite well-documented company shenanigans, you can trust that you are getting what you pay for in each capsule. And if you are willing to take some time and use Google Scholar you can find out what research studies have found about their effects.

My guess is that one reason for the huge success of "natural" herbs and supplements is that they stimulate the placebo effect, which is very real. People who believe something will make them better often get better--especially if what is wrong with them is something vague that isn't a real illness. But diabetes is a real illness and placebos do NOT lower diabetic blood sugars in any meaningful way.

The only way to lower blood sugar is to either a) cut way back on the carbohydrates in your food, those sugars and starches that metabolize into high blood sugars or b) use drugs that either supplement the insulin you lack, stimulate the production of more insulin by your body, or make the insulin circulating in your body more effective.

Cutting back on the carbohydrates requires no pills. Stop eating carbs and I guarantee you you will see your blood sugars drop. If they don't drop enough, it's time to research effective and safe diabetes drugs. I've done some of the work for you in various article published on the Drugs and Food section of my main diabetes site, recently renamed Blood Sugar 101.

A big part of figuring out which diet or drug might be best for you is figuring out the specific nature of your own diabetes. If you are insulin deficient, you'll need different drugs and dietary approaches from someone who is very insulin resistant but still produces a lot of insulin. That's something we'll discuss further.

But for now, resist the temptation to reach for the magic pills, no matter how beautifully packaged and how upscale the merchant selling them. If you have diabetes you don't need a placebo, you don't need mysterious and questionable substances, you need to cut back on the carbs that raise your blood sugar and if diet doesn't get the job done, you need to figure out what's wrong with you and which well-understood drug might be safe and helpful for you.

January 28, 2008

Plastics in our Blood Stream cause IR. PCBs & Pesticides Cause Diabetes, Hmmmm. . . .

Mouse on Left was exposed to Bisphenol A in the Womb

A CDC analysis of data from tThe most recent NHANES study finds that 92% of the 2,500 people studied had detectable amounts of bisphenol-a in their urine. That's the plastic that has been shown in research studies to diminish insulin sensitivity, among other effects.

Exposure of the U.S. Population to Bisphenol A and 4-tertiary-Octylphenol: 2003–2004. Antonia M. Calafat, Xiaoyun Ye, Lee-Yang Wong, John A. Reidy, and Larry L. Needham.

This article, Clearly Concerning:Do common plastics and resins carry risks? includes the revealing photo you see at the top of this article. The mouse on the left is one that was exposed to Bisphenol A in the womb, sustaining genetic damage. It also looks like a lot of folks I see strolling through the mall.

Can it be "coincidental" that the huge increase in obesity and diabetes we see now seems to have begun a few decades after plastics began to replace metal, wood, and cellulose-based products in our environment?

The plastics industry assures you that it is. Just like the cigarette industry they are putting out a stream of reassuring press releases telling you that the levels of this chemical which has been found in over 700 studies to damage genes are too low to cause damage. Here's a typical Plastics Industry "don't worry" article putting its own spin on the CDC study: New Data from CDC Confirms Human Exposure to Bisphenol A in the United States is Far Below Safe Limits

Notice that the argument that we have nothing to worry about relies on the finding that concentrations being found in people's urine suggest plastic concentrations in our bodies lower than the level set by regulators. They do NOT rely on citations of research showing these levels to be safe for humans.

Government regulators under the Bush administration are notorious for supporting polluters and ignoring science. So the fact that they have set "safe levels" means little. The truth is that what little information we have about the safety of these substances comes from rodent research involving high levels of exposure, but there is currently no reason to assume that the lower levels humans are exposed to are in fact safe. It's merely a guess. And it is very likely that the research that the regulators relied on to establish safe levels was supplied by the plastics industry.

Getting the plastics out of our environment would be a huge, possibly impossible task. Stop and look around you. Count how many plastic items are in your immediate environment. Without looking away from my computer I see 10 different plastic items, ranging from my phone, keyboard, speakers, battery charger, chair arms, calculator, pill container, and three decorative frog figurines (yes, I'm a sucker for anything frog).

Look at how much plastic surrounds your food: can liners, bags in cereal boxes, storage containers, foam meat packaging, microwave containers, plastic utensils, wraps, baggies, table cloths, place mats. It goes on and on.

But isn't it easier to blame people for being lazy pigs than to admit that industrial "progress" has turned almost all of us into a demonic science experiment whose results will not be clear until two or three more generations of babies are born with bodies laced with plastics?

In very closely related news, another study published this past October found that pesticides and PCB levels in the blood stream correlated with the incidence of diabetes in a carefully studied population.

The study, conducted among members of Upstate New York State's Mohawk tribe, found that the odds of being diagnosed with diabetes in this population was almost 4 times higher in members who had high concentrations of PCBs in their blood serum. It was even higher than that for those with high concentrations of pesticides in their blood.

Yet this study got NO coverage at all in the mainstream health press, though it shows a clear cut relationship between environmental pollutants and diabetes. The fourfold increase applies NOT to that feeble measurement, risk, which is used to amplify weak data, but to actual incidence. Why no press notice? Probably because this study wasn't conducted by a drug company with a large public relations department. Or because people skimming the title assumed it only applied to Native Americans, which is not true.

This is the same health press that routinely publishes wild statements unsupported by data claiming that "Type 2 diabetes is caused by obesity and can be prevented with diet and exercise."

Here's the article:

Diabetes in Relation to Serum Levels of Polychlorinated Biphenyls and Chlorinated Pesticides in Adult Native Americans. Neculai Codru, Maria J. Schymura,Serban Negoita,Robert Rej,and David O. Carpenter.Environ Health Perspect. 2007 October; 115(10): 1442–1447.Published online 2007 July 17. doi: 10.1289/ehp.10315.

Thanks to the Prairie Mary blog for brining attention to this!

It is very important to note that there is no reason to believe that the association of PCBs and pesticides and Type 2 diabetes is limited to people of Native American heritage. The entire population of the U.S. has been overexposed to powerful pesticides for a generation.

Are Environmental Pollutants the Smoking Gun for the Diabetes & Obesity Epidemic?

We have long known that obesity is often the most dramatic sign that an animal has suffered genetic damage. No one tells the cloned animal who develops unusual obesity early in life to eat less and exercise more. Instead, the scientists observing this effect will publish remarks explaining that the obesity suggests that subtle genetic damage has occurred that needs further study.

But somehow when it comes to the human population, people who are supposed to be scientists are more comfortable ascribing the relatively sudden and very dramatic increase in obesity and Type 2 diabetes, especially in our young, to moral failings, rather than genetic damage. This is true, even though, as we see in the studies cited above, we have plenty of reason to believe that our bodies are laced with chemicals known to cause the kinds of genetic damage that cause obesity and diabetes.

When toddlers develop Type 2 diabetes and dramatic obesity, it isn't because they are being over fed junk foods. Study after study of toddler eating habits which you can read about in every book about child raising showed that toddlers with healthy metabolisms self-regulate their food intake and do not become obese even if allowed to eat freely whenever they want.

No. Something else is going on. Something that if the public became aware of it would exact a catastrophic toll on the industries who have allowed it to occur. No wonder they're issuing cheery announcements to the tune of "Plastics in Your Body are Safe!"

But by the time society finally realizes its danger, we may have exposed two generations of our offspring, planet wide, to this genetic damage.

It's much easier to just tell yourself that mouse on the left should have avoided the donuts and gone to the gym more often.

January 21, 2008

Taking my Own Advice: The Power of Logging Food Intake

I've posted a lot in the past about how when I have been trying to lose weight how helpful I have found it to weigh food portions and log my daily food intake using software.

So when my recent attempt to drop the five pounds I packed on over the holidays seemed to be going nowhere, I decided it was time to take my advice and haul out the food scale and LifeForm food tracking software.

I've been logging my food intake for almost a week now, and, as usual, learning exactly what I've been eating is an eye-opener. Because I needed to clear the insulin out of my system (why is a long story I won't go into here) and because I can't handle more than a tiny amount of carbs without insulin, I've been eating the classic 1990s Atkins diet: meat, eggs, cheese, low carb vegetables and a daily large romaine salad filled with avocado, artichoke hearts, olives, green peppers and a small amount of tomato. I've been taking one 3 oz glass of wine at night which has helped greatly to lower my fasting blood sugar.

As expected I have found that my daily carb intake has hovered below 23 grams, which is reflected in the very good blood sugars I've been getting. However, I've been surprised by how many more calories it turns out I've been eating. Far more than what I thought I'd been eating.

Though by now I should know my portion sizes, I've been eating a lot more calories than I thought. Since I'm only 5' 3" and sedentary thanks to a really bad back, my body needs only about 1,600 calories a day to maintain. To lose weight, I have to eat less than that, and logging showed me that while I was eating less, it was only around 100 to 200 calories less--which means it would take from 18 days to more than a month to lose one pound. No wonder I wasn't seeing any dramatic weight loss.

So for me, the difference between weight loss and no weight loss often boils down to a few bites of cheese scattered through the day. Those few bites probably explain why so many stalled Atkins dieters find that cutting out cheese jump starts their diet.

It has nothing to do with any inherent properties of dairy, as many people erroneously believe. It's just that having what feels like "a few bites" of cheese lets you add an extra 300 calories to your daily input without feeling like you've eaten anything. And if you are within 20 pounds of your diet goal--the range where calories really start to count--those three hundred calories may be all it takes to stall you.

Logging my food showed me another problem area, too. Just as I caution others on my diet page about protein intake, which you can find HERE eating too much protein can also cause problems, and it turns out I have been eating a lot more protein than I need to eat.

I'd forgotten the important point that neither Atkins or Bernstein mention: that after a few weeks on a ketogenic diet your body makes certain adaptations which allow your brain to run partially on ketones. Once this takes place, you need a lot less protein than you do during the first two or three weeks on a low carb diet. This adaptation may also explain why so many low carb dieters stall out after week three. They are still eating those high protein intakes that the books recommend which aren't needed once the body is fully adapted to the diet.

This excess protein does a couple things. One is that it really irritates my urinary tract thanks to the production of ammonia as a breakdown product of protein digestion. But even more importantly, the liver turns that excess protein into glucose which raises my blood sugar. So as soon as I eat too much protein, I get hungry.

People often claim that ketogenic dieting ends hunger, but this is only true if the diet keeps blood sugars flat. For a person like me whose pancreas doesn't work properly, too much protein leads to significant rises in blood glucose as my liver transforms 58% of that protein into glucose. And that rise makes me hungry.

The answer for me may be to eat more fat and less protein. I have calculated how much protein I need to eat and it is about 30 g or five ounces less than I've been eating each day. If I can get the protein down to where it is supposed to be, hopefully I'll end the hunger that has me nibbling all that cheese and get my calories down to where I can lose the 1 to 2 pounds a month. That is a healthy rate for me. Even better, past experience has shown that I can maintain a weight loss achieved by dieting at that rate--though I may have to get back on the metformin to do so.

Meanwhile after 3 weeks on this diet I am down roughly 1 lbs not counting the 3 lbs of water weight that dropped off me as soon as I cut out all the carbs. Naturally weight fluctuates up and down on a daily basis, but averaging my daily weight gives me a pretty good idea of what is going on, and I probably will make it to 2 lbs lost for the month if I go easier on the protein.

How are you folks who started the January diet doing? Will you make it to the Super Bowl, still on your diet, unlike 99.5% of those who started on January 1? I hope so!

If you are having trouble, I'd urge you to find an online support group where you can find people who may have helpful tips for solving the problems you are running into. All the low carb diet books grossly oversimplify what is required to lose weight on this diet and they also make you feel like everyone else who does the diet finds it easy, which isn't true. Experienced dieters can really help you as you encounter the known speed bumps along the road.

You'll find a list of online low carb support forums HERE.

January 18, 2008

ADA Practice Recommendations - Take Action Now!

Don't take the health media's word on what this year's ADA Practice Recommendations say, read them yourself. They're online and full text is free:

ADA 2008 Practice Recommendations

The ADA, as touted earlier, now says it is okay to do a low carb diet for up to one year but only for weight loss. Unfortunately, they repeat the warnings that suggest this diet is a "high protein diet" that is harmful to the kidneys. This, of course, is not true as a well constructed low carb diet is a high FAT diet with about the same absolute amount of protein as a healthy standard diet.

The ADA is still obsessed with the idea that people with diabetes should eat a low fat diet with only 7% saturated fat.

Even worse, they still recommend 180 mg/dl as the post-prandial blood sugar target. That's a great target if you want neuropathy, since all the research shows it develops with exposure to blood sugars over 140 mg/dl.

And their recommendation for the ongoing diet for a person with diabetes is, you guessed it, "whole grains" and low fat. Which is a great way to keep their drug company sponsors selling drugs.

The main thrust of the ADA's diabetes treatment plan for Type 2s relies on the patient taking a ton of oral drugs. For Type 1s, they still recommend high carb diets, high insulin inputs, and lax A1c goals (which are all that is possible with that approach).

And though they now, in this position paper, finally admit that getting the A1c under 6% might be helpful, for reasons based on NO research I've ever seen they stress that the improvement in health made by dropping the A1c from 7% to below 6% is only, according to research, "small."

The only reason is appears "small" is that they never funded any research into the effects of lowering A1c below 7%. This is probably because doing so requires limiting carbohydrates to at a minimum no more than 120 g a day and for smaller people a lot less. With almost no studies you get almost no evidence. Duh.

The evidence of UKPDS is that the 7% A1c translates into a lot of blindness and neuropathy for people with Type 2 diabetes--far more blindness than is the case for people with Type 1 who have the same A1c. Despite this the ADA continues to tell Type 2s that the 7% A1c is all they need to achieve. Probably because with the drug regimens and high carb diets they promote they are all that is possible--though few Type 2s CAN achieve even a 7% A1c with high carb/oral drug regimens.

Here is the web page of the Chair of the committee that puts out these recommendations, Irl B. Hirsch. Faculty Profile
Dr. Hirsch has Type 1 diabetes, but like his brother who recently published a book, he appears to be fanatically anti-low carb and dedicated to the belief that people with diabetes should eat like "normal" people no matter what it does to their long term health or how many hypos they have driving.

If you have strong feelings about the new ADA recommendations, write to Dr. Hirsch expressing your concerns. Be sure to let him know what kind of diabetes you have, what kind of control you have, how long you've had that control, and what you've done
to get it. I'm going to.

Here's his email: ihirsch@u.washington.edu

January 16, 2008

You have a touch of cancer. . .

How would you feel if your doctor said:

1. "You have a touch of breast cancer. We'll keep an eye on it. Come see me in six months."

2. "You're only smoking one pack a day? That's fine."

3. "My scale says you weigh 200 lbs, but there's a 20% margin of error in the scale so you might weigh 180 or 220 lbs. It's not a big deal.

These sound bizarre and no doctor would say such a thing. Unless they were talking about Type 2 diabetes.

How many of you have heard:

1. "Your blood sugar's a bit high. We'll keep an eye on it. Come see me in six months."

Though diabetes is every bit as fatal and maiming as cancer, doctors have no understanding that as, with cancer, early diagnosis and aggressive treatment can prevent death and disfiguration.

A recent article in a family practice journal reported that most family doctors don't begin any drug treatment at all for patients diagnosed with diabetes until they have had an A1c over 8% for at least a year. That year is one in which nerve and beta cells die, retinal cells proliferate, glomeruli clog with protein, and the incidence--not risk, but incidence--of heart attacks is three to five times higher than normal.

2. "Your A1c is 7.3%. That's good control. Keep doing what you're doing."

Studies of "tight control" where tight control was defined as an A1c of 7% or less found that people with diabetes had fewer complications than those with A1cs even higher, but the incidence of complications at this A1c level was still extremely high. There was less blindness, but still a lot of blindness. And the heart attack risk at that level as mentioned above is many times that of normal.

Why do doctors continue to tell people to shoot for blood sugar levels we know cause significant death and disability? They don't tell people to keep smoking, but just smoke less. Doctors need to tell their patients the truth that only a normal A1c is safe and that with effort they can attain those normal A1c levels.

3. "The margin of error that we allow on your blood sugar meter may be up to 20%." That's customer service speaking. And if that means that you can't tell whether your blood sugar is 80 mg/dl, 60 or 100, well who cares.

On my recent trip to the hospital the nurse's hospital-issued blood sugar meter read 79 when mine read near 110. Mine turned out to be accurate, when compared to the lab's blood draw. The nurse admitted the meter was more than 5 years old but did not think this was a problem.

And did I mention we are paying $1 a pop for the test strips for meters that guarantee that kind of "accuracy?"

Isn't it time to do something about the Epidemic of Poor Medical Care?

January 14, 2008

Diet Reflections of an Almost Old Lady

The comments posted in response to my previous post on calculating protein got me rereading Lyle MacDonald's book and rethinking the whole question of what we "know" about nutrition.

Partly this is because, after two weeks of eating a low calorie, very low carbohydrate diet containing the nutrients that all the nutritional calculators tell me should have resulted in a weight loss of 2 lbs, I haven't come close to losing 2 lbs. The same thing happened last year when I dieted for an entire month, logging and weighing anything and eating on an average of a measly 1150 calories a day--for an entire month--only to see a whopping 1 lb weight loss that vanished when I started eating more food.

The explanation of why my body pays no attention to what nutritional research says should happen is most likely my age and gender: I'm a lady in late middle age, but over the past 50 years all nutritional research involving weight and diet has been conducted exclusively in healthy young men or, in those rarer cases when the studies included females, young females.

No one has done a well-conducted study in which the nutritional needs and physiology of ladies past the age of menopause has been thoroughly investigated. When I was young, I could lose five pounds in a couple weeks just by not eating bread, potatoes, and dessert. Now I can to eat a lot less than what guys in those famous starvation experiments ate--guys who didn't weigh a whole lot more than I do--and not even lose a pound.

I know age has a lot to do with this. Cutting out estrogen packed weight on me faster than you can say, "Now I know why all middle aged ladies gain weight!"

So it's worth thinking more deeply about what the nutritional research has "proven." The protein calculator I put together was based on information taken from studies of starvation and nutrition conducted on young men which came up with the "fact" that people need 100 grams of carbohydrate to run their brains. They also came up with the idea that any diet providing under 100 grams a day of carbohydrate is ketogenic. This last bit of information is repeated everywhere that the topic of ketogenic dieting is discussed.

But in my many years of ketogenic dieting, I found that I would pack on glycogen--a sure sign I was no longer in a ketogenic state and was taking in excess dietary carbohydrate--as soon as I ate over 75 grams of carbohydrate. NOT 100. The dramatic water weight gain of 2 or 3 lbs I experienced as soon as I exceeded that carbohydrate intake level was predictable and reproducible. So it's pretty clear that for me somewhere under 75 grams is my ketogenic threshold.

If that is the case, then, what does it say about how much glucose my brain needs? Who knows? No one has studied the glucose needs of the brains of old us ladies. It is possible that as we get older, we may make adaptations very much like those of long term ketogenic dieters and be able to run our brains on less carbohydrate and more of something else even when not in a long-term ketogenic state.

Why do the physiologies of old ladies work so hard to pack on weight and manage to do it on such low caloric inputs? Beats me. My guess is that it has something to do with the fact that evolutionary pressures select for the kinds of genes that produce old ladies who can survive on lower amounts of food because their presence enhances their grandchildren's chance of surviving to reproductive age.

If granny eats too much, when times get tough she's not likely to survive--what food there is goes to the males and more aggressive young women who grab it for their kids. But if granny can pack on some fat by living on scraps in the good times, she'll survive the tough times and put her life-accumulated wisdom to the task of keeping the grandkids alive so they can reproduce those genes.

Should Old Ladies Diet?

I've already cited the NHANES data that concludes that a bit of overweight appears to enhance long-term survival and that being thin or a normal weight after a "certain age" predicts an enhanced likelihood of death. So it might make sense to just live with the weight.

I saw this among my mom's friends. The ones who watched their weight and went to the gym are long gone. My mom, whose only exercise program involved walking to the restaurant for lunch and strolling around the plus size department, out lived them all.

That suggests to me that, by denying me weight loss despite my best efforts, Nature is trying to tell me something. On the other hand, the particular weight I'm trying to dislodge packed on extremely quickly--over five founds within two months. At that rate of gaining I was not going to end up in the comfortable "overweight" range, but be heading for "obese" in another year--a status that does not correlate with health and could really mess up my blood sugar control.

So a-dieting I go.

No matter what the weight outcome of this particular diet, the good thing about doing a month or so annually of a stringent diet is that it makes me aware of the bad eating habits that have crept in over the year. I notice all those "daily" pieces of chocolate that turned into five daily pieces of chocolate, to say nothing of the once rare visits to the bakery with the great homemade soup and homebaked bread that got out of control.

A couple weeks of carefully watching everything I eat and eating just about no carbohydrates at all should put me back to where eating that one chocolate a day seems like a treat again and the soup visit happens twice a month, not two or three times a week.

I'm going to stick with this extremely low carb diet for a while longer because eating that way is the only way I can go without insulin, and the change to analog insulins--though it resulted in beautiful blood sugars--seems to be what caused the sudden and unexpected weight gain. As I said before, I can't eat 2-5-5 forever. It's far too restrictive. But I'm heading into week 3 now, and will go through it before deciding on my next step.

Eventually I have to figure out a way to add more carbs and find an insulin regimen that won't pack on the weight. Finding out that 3 oz. of white wine at night is almost as good as very low does basal insulin for controlling fasting BG is a good first step, though I don't know if it will hold up when I start eating more than 5 grams of carbs per meal again. I can do this because the kind of diabetes I have involves a failure to secrete in response to rising blood sugars, but I do still produce a small but steady amount of basal insulin--just not enough to cover any significant amount of carbs at meals any more.

But for now, my diet is doing a good job of resetting my expectations and providing my annual overhaul of my eating habits. If I could lose a couple pounds, that would be nice, too. At least I'm not going to be gaining 5 lbs this month.

January 11, 2008

How Much Protein Do You Need on A Lower Carb Diet?

I've replaced my admittedly confusing web page about how to calculate your protein needs on a low carb diet which is found on my Low Carb Facts and Figures site with a new automatic on-line calculator. So now you can easily figure out how much protein you need to eat on your own low carb diet based on your own daily carb intake, your weight, and how long you have been eating a low carb diet.

The assumptions on which it is based are documented on the calculator pages. They are drawn from the research Lyle MacDonald published years ago in his book, The Ketogenic Diet.

You can try out the calculator HERE

The most important thing I learned from Lyle's book is something few nutritionists seem to understand. While it is true that the brain needs some glucose to run properly, since unlike all the other organs in the body it cannot run entirely on ketones or free fatty acids, 58% of the protein grams you eat can be converted into glucose in the liver. So there is no need to eat any carbohydrate at all.

But even more importantly, as Lyle documents in his book, after three weeks in a ketogenic state, the brain adapts and needs much less glucose than before. So while it is true that you need about 100 grams of glucose when you start eating a ketogenic low carb diet--one that provides less than 100 grams of carbohydrate a day--after three weeks on a ketogenic diet your brain needs only 40 grams of glucose.

Dr. Bernstein advises in his book that if you are eating his 6-12-12 grams of carb per meal regimen and are not losing weight, you should cut your protein intake. This should only be done after you have been on the diet long enough to have dropped your protein need, and you are trying this approach do double check that the amount of protein you are eating is enough to keep your muscles repaired.

If you are not eating a ketogenic diet, you will need about 100 grams of glucose to run your brain. You can use the calculator to calculate your protein need in that case, just select that length of diet option for "less than 3 weeks" on a low carb diet.

January 10, 2008

Diet Diary

I've written a bit about dieting on this blog of late because after maintaining a 15% weight loss for over four years with little effort, I found myself packing on weight this winter and realized I better do something about it.

There were a couple reasons for the weight gain:
  1. Last winter I went off my usual very low dose estrogen supplementation regimen for a few months. Blood sugar control got harder and weight started packing on. When I went back on the very low dose regimen (1/6 of what most women take) the weight I'd put on remained.

  2. Last summer I developed a burning pain in my upper stomach region which seemed to be linked to metformin, so I stopped taking metformin. That cleared up the stomach problem. It came back when I went back on met, so I stopped it a second time this November. The weight gain I experienced the first time I stopped metformin was modest, but when I stopped metformin the second time and also had to switch to using Lantus and Novolog instead of the R insulin I'd been taking for years thanks to what look like antibody problems with R, my weight gain increased dramatically. I gained about five pounds in two months.

  3. One last factor that may have played into weight gain is this: In the summer of 2006, for some reason that my doctor never adequately diagnosed despite a lot of tests, I started having a problem with mild nausea that kept me from being able to eat. I dropped five pounds without dieting. This was, I have to tell you, terrifying, given that I'm a cancer survivor and that I had never before in my entire life lost a pound that wasn't the product of a lot of hard dieting work. But tests showed no obvious cancer return and after a couple months, the problem, whatever it was, went away and I went back to eating normally. However, once I could eat again, I gained back those five pounds I'd lost very quickly and it seems like after that regain I've been much more prone to gain weight. So I wonder whether getting down to the the lowest weight I had ever been in fifteen years may have further lowered my metabolic rate and made it easier to gain weight in the future. There is a lot of research suggesting that the more you lose the more your metabolism slows.

Whatever the explanation, when I found myself up ten pounds at the end of the year compared to the previous January, I knew I needed to take steps.

I decided to do a very low carb diet because the analog insulins seemed to be causing me to gain weight and because my last attempt at weight loss, after the estrogen fiasco, a carefully weighted and measured low calorie diet with with more carbs, where my blood sugar was very well controlled by meds had not worked.

Because I wanted to eliminate all insulin if possible I decided to eat the classic Atkins induction diet: meat, cheese, eggs, whey protein powder, a large salad daily, and low carb veggies like spinach and green beans. Nothing else.

At first this diet was giving me too-high fasting blood sugars and hence too high post-meal blood sugars. Since the fasting blood sugar I wake up with each morning tends to stay my fasting blood sugar all day, that was a problem. But I accidentally discovered that drinking 1/2 a glass of white wine in the evening knocked my fasting blood sugar down significantly. With that tweak, I was able to stay in the 90s all day instead of the 110-115 range. Though to do this I could not even eat at the 6-12-12 carb level Dr. Bernstein recommends. I've been eating about 3-5-5.

This is no surprise. The reason I started using insulin in the first place is that I was going up to 140 mg/dl eating 12 grams of carbs.

The good news is that I've lost three pounds of water weight and one pound of real fat after twelve days. The bad is that this isn't a way that I can keep eating for a long time as it is too extreme. I'm going to stick with it for another week or two and then take stock.

Meanwhile here are a couple other things I remembered about dieting that might be of interest if you're dieting:
  1. Weight fluctuates up and down all the time, but if I average up my daily values each week and pay the most attention at the weekly average weight, I'll see a much clearer picture of my progress.

  2. Successful weight loss is slow. I went back and had a look at the records from the year I spent losing the 30 lbs and found that after the first month I never lost more than three pounds a month. Some months I lost only two. That means I better accept that weight is not going to drop off at anywhere near the rate I'd like (which is, of course, instantly!)

  3. No snacks. If you are young and have a real metabolism, you may be able to ignore this, but at my age snacks stall weight loss.

    The older we are, the less food our bodies need and that means no nuts, no slices of cheese here and there, and modest portions at meal time. I believe that even on a low carb diet calories matter. Especially for people who in the past were long term low carbers like me whose bodies are no longer shocked and surprised by the switch to a ketogenic diet.

    Cutting the carbs eliminates hunger and makes it easy to cut calories way down, but it's very easy to rack up a couple hundred calories by adding even the lowest carb treats. My food scale tells me that I can add three hundred calories of nuts and cheese and not even feel like I have eaten anything. So I don't even try.

  4. Water weight loss is motivating, but not real.

    I also found that if I'm not taking metformin I lose a lot more water weight when I cut back on carbs than I do if I am taking it. In fact, the last couple times when I went to a ketogenic diet while taking metformin I didn't lose any water weight at all. This time without met in the mix I lost three pounds the first couple days.

    This gives an interesting insight into what metformin might be doing for me--suppressing liver glycogen synthesis? Or it might just mean that Lantus was packing water on me since I also stopped the Lantus when I started the diet.

    It's hard to say. Whatever it is, I have to remember that as soon as I go over the ketogenic boundary, I'm likely to put those three pounds of water weight back on, so I shouldn't consider those three pounds as lost weight. Still I feel sleek and thin right now and my clothes fit again, and that does make it easier to not eat.

January 7, 2008

Health Care and Candidates

Whatever your political beliefs, if you have diabetes, health care should be at the top of your concerns when evaluating the campaign promises of any candidate.

I've had a couple random discussions with people of every political stripe lately, and what I've found is that people who have jobs or have spouses who have jobs that provide family health insurance have no clue what the rest of us are up against when it comes to getting insurance. Even worse, many don't realize how the loss of the job might bring with it the permanent loss of the ability to get health coverage thanks to their having a chronic health condition.

One person I know who identifies themselves as a rock ribbed Republican told me they are firmly opposed to any government intervention in health care and that, indeed, they wish they could opt out of Social Security when they turn 65. This person has total health care coverage care of a generous plan their spouse gets from a Fortune 100 employer. What they don't understand is that thanks to both having been diagnosed with preexisting conditions, were their spouse to lose their job, the power of the insurance lobby in their home state ensures that neither of them would able to buy private insurance at all.

If you have diabetes or for that matter, just about any diagnosis at all in your medical records, you have a "preexisting condition". In many states in the U.S. insurers are able to deny coverage to anyone who applies for insurance who has a preexisting condition. To get individual health insurance coverage you will have to give access to all your health records and you may even have to submit to a blood test. Even worse, if you do file a claim for an expensive hospital stay after getting insured, your carrier may refuse to pay it by saying that the claim points to your having had an undisclosed preexisting condition. This isn't hearsay. It has happened to people I know personally.

What exactly constitutes a preexisting condition? For one friend who was 22 years old, it was a single visit to an ER with a mysterious symptom which was diagnosed at the ER as being from a migraine headache. That was enough to keep them from being able to buy into a private health insurance plan. For someone else, it was having a doctor write in their record that they needed to have a hysterectomy. As it turned out, they didn't. But even years after refusing the surgery--with no further medical problems--the existence of that doctor's recommendation kept them from being able to buy into an individual health plan. A diagnosis of mitral valve prolapse--which is extremely common, was grounds for yet another person's health insurance rejection. Pre-diabetes? Forget it. Cancer of any type, you are uninsurable. Taking an antidepressant? That implies a preexistant condition too.

If you have a really serious condition, this lack of access to health insurance may lead to an early death. A recent study found that people with cancer are much more likely to die if they don't have health insurance mostly because they can't afford doctors visits and get late diagnosis, though the costs of chemotherapy may put it out of reach too.

I have a friend who has MS. This friend and their spouse are both self-employed and the family earns a good income. Unfortunately, at the time they bought their current health insurance plan, since they were both healthy they did not include drug coverage in their plan. Now after the MS diagnosis, they are trapped in their current plan with no possibility of buying another. Drugs for MS cost many thousands of dollars a month so the "private sector" insurers stay profitable by excluding new customers with MS from their plans. Unable to get the expensive drugs that show promise of halting the progression of this terrible disease, my friend may end up in a wheelchair years earlier than someone with a corporate job, just because someone checked off the wrong box on their insurance application a few years ago.

Another thing people who have insurance through their jobs don't understand is that just when you reach the decade of your 50s, when employers are most likely to fire you no matter how good your job performance, even if you can buy yourself self-paid health insurance it becomes extremely expensive.

All states I know of allow private sector insurers to use "age banding." That means that someone 30 years old may pay $300 less each month for the identical coverage offered to someone 50 years old no matter what the actual health history of these two people may be.

Massachusetts recently passed a law that makes it possible, and in fact, mandatory for everyone in the state to buy insurance. This is good in that it means that people with preexisting conditions and no employer can buy insurance. But since Massachusetts doesn't outlaw age banding, the monthly premium charged someone 50 or older in the cheaper plans runs about $500 a month per person with quite a lot of deductibles and the cost is predicted to rise steeply next year.

Where a person who has lost their job and has to buy their own insurance is supposed to come up with hat kind of money is a mystery that seems to have eluded the politicians who tout this as an "affordable" plan. For someone earning $100K a year $6,000 might be affordable, but the median family income in towns in the western part of Massachusetts where I live ranges from $35,000 to $51,000. The $12,000 a year it would cost a median income couple in their 50s to buy insurance is a huge bite of that income. For a family faced with a need to buy insurance thanks to sudden unexpected job loss it is out of reach.

When candidates talk about "private sector" solutions for providing health insurance they are talking like plans like that of Massachusetts that allow for-profit insurers to supply age-banded insurance to the public at any cost they decide to charge and passing laws that force everyone to buy this insurance no matter what it costs. Only highly paid politicians who don't have to pay for their own insurance could consider this a good, affordable, solution.

To me it seems ridiculous to think that private insurers who are paying the multimillion dollar salaries of the insurer's executives and the profits of their shareholders before a single dollar gets spent on health claims can solve the problem of offering affordable health insurance.

A health care "solution" that is really welfare for the insurance companies and HMOs is NOT what this country needs. We need to put the brightest NON-lobbyist minds to work on the problem and come up with a way of offering health care that is fair to doctors, hospitals, and people with health care needs.

I'm not holding my breath. The health insurance lobby is funding all the campaigns, so don't expect to see anyone propose a solution that regulates or limits the huge profits of the health insurers anytime soon.

January 3, 2008

Safe Low Carb Dieting for Weight Loss

I've gotten some mail from a few people who are very concerned about a scammy, dangerous diet that is being promoted in the media right now as being "low carb." Without further publicizing the lying weasel profiting from that particular diet, I thought I'd share a few thoughts about how to construct a healthy low carb diet that you can eat, healthily, for years. I learned this stuff through participating for six years in online low carb discussion boards.

1. A low carb diet should not be a high protein diet.
Your liver has the ability to transform protein into carbohydrate. Key to losing weight on a low carb diet is that you want to lower the amount of insulin circulating in your body. Eating too much protein may not raise your blood sugar--unless you are a Type 1 or a Type 2 whose beta cells are mostly gone--but it may raise the amount of circulating insulin in your body. Insulin is the hormone that tells your body to store fat, so to lose weight you don't want to eat a high protein diet. You want to eat a diet that contains the right amount of protein.

How much protein do you need? Well, you will need protein to repair damage to your muscles. In addition, if you are eating under 100 grams of carb a day you will probably need some protein to furnish the glucose needed to run your brain. Your liver can turn about 60% of the protein you eat into glucose, so you will eat a bit more protein to provide the glucose for your brain.

Beyond the small amount of protein needed for these two functions, any excess protein you eat can stall your weight loss, and even worse, too much protein in the diet causes the infamous "diet breath" that many people incorrectly label "ketobreath". It isn't ketones you are smelling when people are doing very low carb diets incorrectly. It's byproducts of protein digestion.

How much protein will be right for you depends on how many grams of carbohydrate you are eating and your size. I have put together a web page that tells you How To Calculate Your True Protein Need.

2. A Low Carb Diet Should Be a High Fat Diet.
Most of the calories in your low carb diet should be coming from fat. Fat, unlike protein, does NOT raise blood sugar or provoke any insulin response. And now that Gary Taubes has thoroughly debunked the badly conducted, politically motivated research that was used to argue that fat caused heart disease, we can all relax and enjoy the fat we eat.

The exception to the goodness of fats is trans fat. And despite all the labels that claim "no trans fat", any food that lists "hydrogenated" fats of any type on the label does contain trans fat. There are lots of them and you should avoid eating them.

When I was in the active weight loss phase of my year long low carb diet--the one whose 30 lb weight loss I maintained for four years--fat made up about 70% of all the calories I consumed. I'm not a big meat lover, so much of my fat and protein intake came in the form of nuts, eggs, and high quality cheeses.

3. Supplement B Vitamins if You Cut Out Grains
Most of us get our B vitamins, including Folic acid, from grains. So if you stop eating all grains you will have to use a supplement to replace the missing B vitamins. A simple drug store multi-vitamin is all you need. B vitamins are the only vitamins you won't be getting from meat, dairy, and lots of low carb greens, nuts, and berries.

4. Use Morton's Salt Substitute to Replace Potassium
A low carb diet especially in its early phases flushes a lot of fluid out of your body. You can read why this is HERE. The diuretic effect can cause you to lose potassium and if that happens you may get leg cramps.

Sprinkling a bit of Morton's Salt Substitute on your food is all you need to do to correct any potassium imbalance--UNLESS you are taking a potassium sparing blood pressure medicine. In that case, do NOT supplement with potassium. If you aren't sure if your blood pressure medicine is potassium sparing or not, ask a pharmacist. If you are taking a potassium sparing drug you don't have to worry about losing potassium.

If you are low in potassium, the usual symptom is leg cramping which resolves as soon as you consume a sprinkle of the salt substitute which is pure potassium. You can buy it in most supermarkets in the section where the salt is sold.

5. Eat LOTS of Greens and Berries.
If you only eat meat and cheese on your "low carb" diet you are going to end up missing valuable nutrients. If you eat meat and greens and packaged "low carb" foods full of chemicals and hidden carbs, you are also going to miss out on those nutrients--and you are going to end up gaining weight, as many packaged foods include ingredients that are forms of MSG (like hydrolyzed vegetable protein) that make you hungry.

In the old days, people in the low carb community used to tell each other "When you visit the supermarket, Shop the edges" . That's because, typically, fruit, veggies, meat, nuts, eggs and dairy are arranged around the outside edge of the market and all the prepared foods are in the aisles. The more you eat from the edges, the healthier you will be. Frozen veggies are fine, too.

6. Use Whey Protein Powder
Many low carb recipes tell you to use soy flour. Don't. It tastes nasty to many of us, and soy can have negative effects on your thyroid and can disturb your sex hormone balance. Whey protein powder tastes better than soy and has no hormonal effects. I use it in quite a few of my recipes. Vanilla or plain are best for cooking.

If you find yourself feeling depressive after a few weeks of your low carb diet, cut out any of the soy foods you may have added, including tortillas, "low carb" breads, or cereals. You may be amazed at how much cheerier you feel. I sure was.

7. It is Normal to Feel Edgy The First Week or Two
As your body switches over to running on ketones you may feel edgy and have trouble sleeping. This is completely normal and it goes away pretty quickly.

7. Take Advantage of Low Carb Beginner's Luck
The first time you eat a very low carb diet, your body has no clue what is going on and may drop surprising amounts of real weight in the month or two before it figures out what the heck is happening.

This is a one time thing. Once your body gets used to living on a low carb ketogenic diet, you will never again experience this burst of dramatic weight loss. You CAN lose weight the second time you go on a low carb diet--I've done it--but it takes a lot longer and requires a lot more discipline.

Because of this "beginner's luck" phenomenon, if you are low carbing for weight loss for the very first time, stick to your diet very carefully for the first three months. Avoid all commercially prepared "low carb" products. Most of them are full of hidden carbs that will sabotage your attempts to lose weight.

Stick with salad, low carb veg, meat, cheese, and small amounts of nuts. Do the diet straight without taking days off as long as you can because by doing that you will get the best weight loss. After a few months when your body gets used to the diet and weight loss drops to a modest amounts you can be a bit more flexible and experiment with different "low carb" products and the occasional higher carb day. But, at first, give yourself a while to let the diet do its magic!

8. Cholesterol Rises Early in Most Effective Diets
If you have a cholesterol test in the first three months of your diet when you are losing weight at a rapid pace expect to see your cholesterol be higher than it was before. This is normal. The fat in your blood stream is on its way OUT of your body. Many doctors don't know this--fortunately, mine did and explained it to me.

By the sixth month of your low carb diet you should start seeing dramatic improvements in your cholesterol, especially your HDL and triglycerides which are the fractions of cholesterol most closely associated with health.

That should be enough to get you started. . .