September 30, 2008

What Can You Eat? "Nutrition for Blokes" has Some Clues

The ongoing revelations about e coli in supermarket salad vegetables, Bisphenol-A in can linings and melamine in powdered milk point out to us the problems with relying on huge, anonymous multinational corporations for our food supply.

Intentional adulteration is a much bigger problem in packaged foods than any of us have realized--the melamine story is getting buried in the media thanks to the market meltdown, but every day it seems that a new brand name product is being found to contain melamine.

But even without adulteration, it turns out that many GRAS (generally regarded as safe) chemicals commonly added to packaged food, like sorbic acid, acetic acid, food colors and many others, turn out to be petroleum byproducts, many of them produced in bulk in Chinese refineries, and this, too, should be raising red flags in all of our minds as it is not likely any of these ingredients are being tested for adulteration.*

So what's a concerned omnivore to do?

One thing we can all do is eliminate from our diet the industrially prepared foods most likely to contain dangerous and adulterated additives and replace them with home cooked foods.

The other thing we can do is rely more on locally grown foods rather than those imported from parts of the world where slave labor tends crops in conditions that are not tolerated in more developed parts of the world.

If you have been thinking of eliminating questionable packaged foods and eating more locally grown produce but are not sure exactly how to go about it or don't have the energy to begin, a wonderful new book, Nutrition for Blokes may give you the encouragement you need.

Author Quentin Grady is well known to readers of for his incisive reporting on the little known health benefits of common vegetables and on the issues surrounding the different kinds of oils found in our food.

Now he has written a book that contains a quirky, personal and highly entertaining series of essays that intermix stories about his forays into his local farmer's market in New Zealand with observations about the little known health benefits of the foods he finds there which illuminate the many fascinating physiological functions of the micronutrients found in fresh vegetables, fruits, meats and fish.

Quentin's title tells us that there is something else going on in this book: his target reader is, by definition a "bloke." Bloke is a term used exclusively in those territories that were once part of the British Empire. It refers to what we in the U.S. would call a "regular guy" or perhaps, a "manly man." Blokes care about sports. They don't like to fiddle around in the kitchen. And they sure as hell are not going to sit still while someone lectures them about healthy eating.

Which is why Quentin's book is such a delight. Because somehow Quentin has figured out how to get blokes to care about the food they are putting into their bodies without lecturing or asking them to change their fundamental nature.

I gave a copy of this book to my own personal bloke, whose daily diet tends to be rich in impulse items and who, though he works hard at keeping his eyeballs from rolling upward when I launch into a tirade on some dietary outrage, could hardly be described as a health nut.

He read it, laughed at quite a few of the stories Quentin tells in its pages, and then astonished me by heading to Stop & Shop and coming home with a bag full of colorful peppers, avocados, fancy oil extracts, walnuts and fish.

For the next couple weeks we ate better than ever before, as I was served colorful salads prepared by my "bloke" at almost every meal. Obviously, Quentin was onto something!

Many of us regulars bought our copies of this book last year when someone was kind enough to arrange for the shipment of a few boxes from New Zealand. Now Quentin is selling his book directly to the public from a web site set up on my web marketing site. This allows him to take payment via PayPal which is extremely helpful as it handles the international currency conversion and enables purchasers to buy with a credit card or check.

Though I provided the sales web site that Quentin is using, I want to make it clear I have no financial interest of any kind in the sales of Quentin's book. I am letting you know about it solely because I love this book and would like more people to know about it.

Quentin is one of us--a person with diabetes--and he is also a fan of the "test test test" strategy that has popularized. So while his book is not written specifically for people with diabetes, it does take into account the issues important to people with diabetes.

You can find out more about Quentin's book on his web site here:

And re the origin of your food, if you are in the U.S. you should be happy to know that new regulations will go effect tomorrow, October 1, 2008, that will give you more information about the country of origin of some of the food you eat.

AP: More foods getting labeled as U.S. or foreign-grown

Note that the country of origin labeling breaks down as soon as you get into packaged foods. This is yet another reason to "shop the edges" in your supermarket where you can buy products like fruit, vegetables, cheeses, dairy, nuts, meat and fish that have been minimally processed rather than the more questionable foods that have been canned, bottled, or frozen.

* You can learn about the way petrochemicals become food additives in the book, Twinkie Deconstructed by Steve Ettlinger, though sadly, he does not bring to his subject the kind of critical thinking that such a topic demands.

September 29, 2008

Here's a Version of the "Control Your Blood Sugar" Flyer available in mmol/L

Several people have asked me for a version of the flyer explaining how to control blood sugar that would use the mmol/L blood sugar measurement that is used throughout most of the world.

You can now download a copy of the flyer with the mmol/L measurements here:

Sorry for my having given into an attack of U.S.-centric thinking!

September 27, 2008

Whey Protein Powder Contaminated?

The FDA announced it had started testing some imports of Chinese dairy products coming into U.S. ports after the news hit about the way that milk products in China had been contaminated with melamine.

But we all know that the FDA has been gutted by the Bush administration and does not begin to have the resources needed to test the avalanche of foods coming in from China. Not only that, but even when the FDA samples foods coming into our ports, the paperwork is so sloppy that if a food is tested and rejected, the shipper need only take it to a second port. There is often no paper trail showing it has failed inspection elsewhere.

And that doesn't even get into the issue of how the FDA only tests a tiny sample of shipments.

Why should this scare you? Because we don't know the extent to which Chinese dairy products filled with melamine, a toxic plastic, have permeated out own food supply.

All we know is this: large food manufacturers who are buying millions of pounds of powdered milk, casein and whey to put into everything from bread, to cookies, to candy, to sauces on frozen vegetables are very likely to have been buying these products from the Chinese factories because the Chinese are able to offer much lower prices than competitors.

Now that we are learning WHY they are able to lower their prices--by replacing milk protein with plastic, for example--shopping the Dollar Store for our food supply is not looking like such a good idea. But until two weeks ago, what large manufacturer was thinking like that?

This latest scandal has special relevance to people with diabetes. Many of us are already walking around with kidneys that have been damaged by years of exposure to high blood sugars. We have been assured that the tiny amounts of melamine that may have found their way into our packaged food products are only toxic to babies, not adults, but the truth is that melamine may very well be toxic for anyone with microalbumuria whose kidneys are already damaged.

The other issue relevant to people with diabetes who eat low carb diets is that a lot of us use whey protein powders as a base for baked goods since we try to avoid baking with grains. Given that whey powder is one of the products that the FDA has said it has been inspecting, and given that we have no idea where the makers of these whey protein powders have gotten that whey powder, it is not outside of the range of probability that some of this whey protein powder might be contaminated.

With that in mind, it might be a good idea to eliminate whey protein powder from our diets for a while, until the melamine that may very well have slipped into this country before the scandal erupted has finished making its way through the system.

Yes, this might seem overcautious, but with every day's news reports adding additional products and countries to the list of those found to contain Chinese milk products contaminated with melamine, it might just be prudent.

If you are a fan of so called "nutrition" bars, you might want to give them a miss if they list whey or casein on their labels for the same reason.

Manufacturers are clamoring to reassure the public that their products don't contain these suspect substances, but that is to be expected. They may not contain them now. What they may have contained three months ago when the product on your shelf was manufactured may be another story.

And sadly, there is no requirment to list the country of origin for the ingredients of any food sold in the U.S., only where they were packaged. Since the Chinese sell raw materials to other companies that package them in the U.S. and slap their own labels on them, you cannot trust any label information to keep you safe.

September 24, 2008

How You Can Help!

A lot of people have asked me what they can do to help people with diabetes. Well, one thing we can all do is get the same information that has been so helpful to all of us online to people with diabetes who aren't online.

To further this goal, I've put together a flyer which adapts the information found on the Alt.Support.Diabetes "Newly Diagnosed" web page so that it will fit onto one page.

It's a PDF file. If you like it, print out some copies and leave them by the pile of magazines at your doctor's office. Post some on community bulletin boards. Give it to friends with diabetes. Put it anywhere you see other posters.

The technique described on the flyer is very simple but extremely effective. It's time more people knew about it.

You can download the flyer by clicking on this link:


For the version that uses mmol/L measurements download


Be sure to click on "save a copy" to store a copy of the flyer on your own computer.

If you have comments or ideas for improving the flyer, please post them in the comments or email me at Let's make this flyer great and get it to the people in our communities who need this information!

September 23, 2008

Congress passes new Americans with Disabilities Act that Protects People with Diabetes from Discrimination

Lost in the cacaphony of the market meltdown is one piece of good news for people with diabetes: a new law which was just passed almost unanimously by congress, and which Bush says he will sign, says that employers can no longer discriminate against workers because they have diabetes.

This means that your employer will not be able to fire you because you require reasonable accommodations to take care of your blood sugar. If you need to take an occasional break to make a correction to your insulin dose or get some glucose, your employer cannot fire you. This doesn't sound like much, but I have read quite a few postings on over the last year from young people with Type 1 diabetes who have been forced off jobs because their employers insisted that they gamble with their lives by not making accommodations for their need to keep on top of blood sugars.

The law does not mean that an employer has to hire you if you are not qualified.

Existing law already provides that an employer cannot grill you about your health at an interview unless it is directly related to your ability to do the job, for example, if you are going to be driving a public bus or flying an airplane and are taking insulin.

Most people with diabetes need no accommodation at all from employers, but we may discriminated against--along with most people over 45--by employers who fear that having us on the payroll will push up their already enormous health insurance costs.

And as older people know, just having a law on the books doesn't stop discrimination for any quality that is obvious from a quick glance. Employers continue to discriminate in hiring based on age, color, body size, national origin, and gender. Often they do it by hiring contractors rather than full time employees. They do this so that the contracting agency company they hire can screen out the kinds of people the main company doesn't want to be bothered with.

People with Type 2 who tend to be heavy may therefore still find themselves facing discrimination at hiring time. But at least if you get hired you can't be fired because you have come down with diabetes.

Here's a write up about the new law and why it is being passed:,0,2819372.story

September 22, 2008

What does that C-peptide test result mean?

PLEASE READ THIS ARTICLE CAREFULLY BEFORE COMMENTING OR EMAILING ME QUESTIONS ABOUT YOUR C-PEPTIDE TEST! The point of this article is that the C-peptide test tells you only if you are making some amount of insulin, but not how much. It cannot be used to diagnose ANYTHING unless it is very close to 0. People keep emailing me asking me questions that could be answered by reading this post in full.

Now back to the post:
One of the common questions I get from readers of my web site is what the result of a C-peptide test might mean and whether it can identify the kind of diabetes they have.

Unfortunately, in many cases, the answer is, that it cannot.

C-peptide is a chain of proteins that is spun off in the process by which the beta cell makes insulin. During this process, a precursor molecule, proinsulin is split into insulin and C-peptide. So for every molecule of insulin your beta cells produce, they also produce a molecule of C-peptide.

C-peptide is removed from the bloodstream by your kidneys while insulin is removed by the liver. This makes a difference in how long these peptides stay in the bloodstream. It takes half an hour until C-peptide is removed, while insulin is gone in five minutes. This means that there should be five times as much C-peptide in your blood at any given time as there is insulin and the longer activity period should smooth out the effects of testing at any one particular moment.

However, if there is something wrong with your kidneys they may not remove C-peptide in a normal manner and the result of a C-peptide test may be misleading.

If a person is injecting insulin, measuring C-peptide is the only way doctors can determine whether they are also making insulin on their own since lab tests do not distinguish between injected insulin and homemade.

Some doctors prefer to measure C-peptide even in people not injecting insulin because of its longer life in the bloodstream which means you won't see as much fluctuation from moment to moment in C-peptide levels as you may find with insulin levels.

The main thing a C-peptide test tells you is whether or not your body is making C-peptide. This sounds like a "duh" kind of statement. But in fact, that really is all that the test tells us. This can be useful in itself--if there is no C-peptide in a blood sample, your beta cells are not making any insulin. A very low C-peptide result is the definitive way to diagnose severe Type 1 diabetes--though many people with Type 1 will continue to have a low level of C-peptide in their blood for years after diagnosis as good control started soon after at Type 1 diagnosis appears to keep a small number of their beta cells alive.

To derive more meaning for the results of a C-peptide test the lab must know whether it was taken fasting or not fasting and what the blood glucose level was at the moment it was taken. In theory, a high fasting blood sugar with a high C-peptide value should point to Type 2 diabetes primarily caused by insulin resistance. That is because the high C-peptide value would suggest a lot of insulin was being produced but insulin resistance was keeping it from lowering blood sugar. In contrast, a C-peptide value that was normal or below normal taken at the same time as a high fasting glucose would suggest a form of Type 2 where failing beta cells rather than insulin resistance was the primary thing raising blood sugar.

In theory, testing C-peptide very few years should also give you some idea of whether or not your beta cells are slowly failing.

Unfortunately, it is here that things start breaking down. The problem is that there is no standardization in the way that labs measure C-peptide or in the reference ranges they provide. A recent study that sent 40 different samples out to 15 laboratories found nine different techniques being used. The study found that "Within- and between-run CVs [coefficient of variation (CV) equals the standard deviation divided by the mean (expressed as a percent).It is used to measure consistency across a range of results] ranged from <2% to >10% and from <2% to >18%,respectively."

In short, if you sent the same sample to a different lab, you could get a very different result. This study concluded this inconsistency was greatest, "...especially at higher C-peptide concentrations. Within-laboratory imprecision also varied, with some methods giving much more consistent results than others."

It is usually suggested that because of the different test protocols and reference ranges in use, you use the same lab to compare C-peptide values, when trying to determine if your C-peptide levels are dropping. But the results of the study above suggest that "within laboratory imprecision" is significant enough to make this a questionable strategy, too.

Labs may also not provide on a reference range for fasting C-peptide test results since most doctors order only fasting C-peptide tests. This can be a problem for those of us who have forms of diabetes where our beta cells are able to secrete basal insulin (the slow steady drip of insulin that keeps our blood sugar normal in the fasting state) but are unable to secrete insulin in response to the rising blood glucose that happens at meal time.

This pattern is characteristic of some forms of MODY diabetes, and explains why a person with MODY-1 or MODY-3 may have completely normal fasting C-peptide while experiencing extremely high blood sugars after meals. You can see an example of this in this MODY case history where the young patient whose genetic testing diagnoses MODY-1 has a normal C-peptide along with a 9.2% A1c.

With this in mind, here's what your C-peptide can tell you:

1. Very Low C-peptide test results.If your CC-peptide is significantly below the normal fasting range given by your lab no matter when your blood sugar was tested your beta cells are likely to be dead or dying. If you are young or very recently diagnosed with diabetes of any type, a very low C-peptide value is a good way of diagnosing Type 1 (autoimmune) rather than Type 2 diabetes.

But if you have had Type 2 for decades, and have not kept your blood sugars at normal levels, you may also have a very low C-peptide test value because over the years the very high blood sugars you have been exposed to may have killed off your insulin-producing beta cells.

Some insurers require a C-peptide test result below .5 nanograms/ml before they will cover the costs of an insulin pump.

2. High Fasting C-peptide Test Results. A high fasting C-peptide test value taken at the same time as a high fasting blood glucose test value suggests that you are insulin resistant though still making lots of insulin. (Unless you have kidney disease, in which case this test result may not reflect your actual insulin levels.)

If your fasting C-peptide level is high, it is very likely that you will be able to control your blood sugar by cutting way down on the amount of carbohydrate you eat.

It also means that you should first try strategies that lower insulin resistance before trying drugs that stimulate more insulin release, such as Amaryl, Glipizide, Januvia or Byetta.

If you have high fasting C-peptide levels, the drug Metformin, which increases insulin sensitivity, should be helpful in lowering your blood sugar. Exercise may also be very helpful as many people (though not all) find it temporarily reduces insulin resistance.

Weight loss may or may not help, depending on what is causing your insulin resistance. There are normal weight people who are very insulin resistant, but some people who are obese are able to reduce insulin resistance by losing weight--though of course, there is some circular logic here, since high levels of insulin resistance make weight loss very difficult!

3. Nonfasting C-peptide test results. If your non-fasting C-peptide test is not abnormally low (pointing to completely dead beta cells) there is no accurate way to interpret a non-fasting C-peptide test result. There are research studies where nonfasting C-peptide measurements are taken and studied, but given the nonstandarization of this test across labs and the fact that most labs do not give any lab reference range for nonfasting values, the meaning of a nonfasting C-peptide test that is normal or high (compared to a fasting reference range) is impossible to interpret.

If you have a normal C-peptide, very high post-meal blood sugars, normal or near normal weight, and a family history of thin people diagnosed with Type 2 diabetes or Type 1 diabetes that stayed relatively easy to control, you may have MODY but a C-peptide test will not be able to diagnose it.

Normal or High C-Peptide Test Results May Be Good News.

There is some recent research that suggests that C-peptide rather than being an inert byproduct of insulin synthesis is, in fact, important for preventing diabetic complications. This research is in its infancy. You can read about it in this earlier blog post.

If in fact it turns out that C-peptide is able to prevent complications, those of us who have secretory defects that respond to beta cell stimulation may have to reconsider whether or not to stimulate our beta cells with drugs like Byetta or sulfonylureas or whether to supplement with injected insulin that does not contain C-peptide.

I have been informed by correspondents diagnosed with MODY that they have been told by Dr. Hattersley who is one of the world's authorities on MODY, that he prefers to stimulate insulin secretion with gliclazide (Diamicron), a sulfonylurea drug that is unfortunately not available in the U.S., rather than use injected insulin because he believes it gives better long term results. If, in fact, C-peptide turns out to be beneficial, that might explain this finding. Unfortunately I have not been able to find any published research supporting the advantages of beta cell stimulation over insulin supplementation for people with MODY. The sulfonylurea drugs available in the U.S. often cause dramatic hunger and blood sugar swings that make them unpleasant to use and which lead to weight gain.

For people who do not have genetic secretory defects, the disadvantages of stimulating insulin secretion with drugs may be made clear by the most recent follow up to the UKPDS study, where people who used metformin to lower blood sugar had a far better long term outcome in terms of heart attack as those who used sufonylurea drugs. (Though all groups in this study had many more complications than necessary since they started out with A1cs of 7% or higher and allowed them to deteriorate over subsequent decades.) I'll be discussing this study in detail in a future blog post.

September 17, 2008

Sixy-Five Percent of Funds Raised by ADA Go to Fundraisers NOT ADA

The next time you are tempted to contribute to the American Diabetes Association, consider this: The LA Times reported this July that only 35.1% of the money donated to the American Diabetes Association in California actually went to the ADA. The rest went to the for-profit fundraisers it hired.

American Diabetes Association rated in the LA Times Charity Database HERE

Here's who got the money that was raised in the name of the ADA:

List of Fund Raisers that ADA Money Went to - LA Times Charity Database

I've run into those ADA fundraisers. Last year they phoned me every night for a month. Since they are keeping 65% of every dollar they raise, their enthusiasm is understandable.

What is NOT understandable is why the American Diabetes Association is willing to lend its name to such predatory fundraising practices. Well conducted health charities in California keep 80% or more of every dollar raised in their name. Here is a list of other health charities in California and how much of the funds raised in their names actually get to them:

Other Health Charities Listed in the LA Times Charity Fund Raising Database

Nationally the news about the ADA's efficiency is not much better. The Charity Navigator web site which rates charities nationwide gives the ADA two stars and presents

this page of information about how the ADA uses its money.

Note that the ADA gets the lowest possible rating, one star, for "Organizational Efficiency" or how it spends its money.

The ADA gets $213 million dollars a year of which $7,678,945 is spent on "administrative expenses." That translated into English means "Salaries for top ADA executives.".

The Charity Navigator site calculates the "fundraising efficiency" of an organization which is how much money it spends to raise a dollar. They report that the ADA spends $.26 to raise a buck. In contrast JDRF spends $.09.

And this doesn't even get into the issue of what it is that the ADA does with the money it spends on programs. As readers of this blog know very well, much of the ADA's spending goes to promote the agendas of the drug companies that feed it millions.

The ADA has campaigned for a generation against telling people with diabetes that lowering carbohydrate intake can lower blood sugar. They have fought against lowering the recommended blood sugar targets for people with diabetes long after the American Association of Clinical Endocrinlogists lowered theirs.

The ADA continues to tell people with diabetes that it is a "myth" that people with diabetes should cut back on starch and sugar. They continue to promote high carbohydrate/low fat diets that make blood sugar control impossible and force people with Type 2 diabetes to rely on expensive, largely ineffective, dangerous oral drugs.

The ADA continues to tell people with Type 1 diabetes that it is dangerous to shoot for blood sugar targets lower than 180 mg/dl (10 mmol/L) two hours after eating.

And the ADA continues to be the authority that doctors turn to for guidance in how to treat their patients with diabetes--which is one reason why so many of them diagnose patients late, promote diets that raise blood sugar, and accept dangerously high A1cs as "good control."

The ADA is run by very well paid professional charity executives who do not have diabetes. These are people who have never tested their blood sugar after eating a high carb meal, people who have never suffered from neuropathy caused by poor medical advice, people who are not going to go blind from the advice they dish out. They have close ties to the drug companies who dominate their agendas. They have no interest in hearing from or catering to the needs to those of us who have diabetes even though they raise those hundreds of millions of dollars in our name every year.

It's time for this to stop. Let your friends and family know these facts about the ADA's shockingly bad rating as a charity so they aren't tempted to enrich for-profit fundraising companies in the mistaken belief that their money would be going to help cure your diabetes.

Every time I see an obituary in the newspaper where the bereaved family asks contributions in memory of their loved one be sent to the ADA I marvel at the con job the ADA has done on the American public.

Let's bring it to an end!

September 16, 2008

Thinking about Folks with Diabetes in TX/LA

The short attention span of the media has moved on from Hurricane Ike, but there are still millions of people without power in the Gulf Coast area, and predictions are that they will remain without power for weeks more.

I went through Hurricane Gloria in Connecticut (the week I was due to give birth to my second child) and waited a week to get our power back. But that was in the Northeast where September is the one month when you can get by quite happily without heat or air conditioning.

Texas is different. I've lived in Texas, and still remember the week in November when our air conditioning broke down and it quickly got up to 94 degrees in our apartment. I cannot begin to imagine what it must be like to be in Texas in September without air conditioning or power for weeks. But I know it must be horrible.

And that's without having to deal with diabetes.

Insulin goes bad very quickly when kept at temperatures in the 90s. So, of course, does food. People with Type 1 diabetes who find themselves trapped in a disaster area like the Gulf Coast is now could very quickly find themselves in a life-threatening situation. People with severe Type 2 who rely on insulin aren't in much better shape. And poor people with diabetes who left the area and holed up in motels thinking they could go home in a few days and who have run out of money are in even direr shape.

I wish there were some way to reach out and help. Unfortunately, the ADA does not appear to provide any programs for people with diabetes trapped in disaster areas. I just checked their home page and the only thing new on it is their "Recipe of the day" which is for "Couscous"--a pasta that contains 46 grams of carbohydrate for an unrealistically small serving of 1/2 cup.

If someone does know of a way for us to reach out and help people with diabetes who are having a tough time on the Gulf Coast, please let me know!

Meanwhile, each of us should probably stop and take a moment to think about steps we could take now to help us get through disasters that might strike our region: Hurricanes, tornadoes, floods, earth quakes, terrorist attacks, or just plain old infrastructure failure (a.k.a. "power blackouts.")

What would happen to you if you were without power for a month? What kinds of foods could you eat if you did not have a working refrigerator? If you could not get any money from an ATM or electronic Point of Sale system?

How would you keep your insulin cold? How would you get insulin if local pharmacies were also without power or you couldn't get out of your home because it was under water and the road impassable?

What other meds or treatments do you have to have to stay alive?

One of the saddest things about the mess in Galveston is the number of elderly people who apparently did not evacuate because they were attached to dialysis machines. We saw them being airlifted to "safety" but have to wonder why they weren't on some kind of priority list at the time when the evacuation order was given.

Maybe you will never have to deal with any of this. I hope so. But maybe you will, and if there is anything that these recent mega-disasters has shown us, it is that we take a lot of things for granted that if they aren't there make it really really tough for us to stay alive.

I'm not quite ready to move to a bunker in Montana filled with canned goods, but a generator is starting to look like maybe it isn't a luxury (our water comes from a well and without power we have no water or toilets). And it might be a good idea to have some high protein canned goods on hand since just about all of what I can eat without insulin is perishable.

What kind of things are you going to do to prepare yourself to take care of your diabetes if you run into a disaster?

September 12, 2008

Yet Another Problem with 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.

Update (January, 2009) : A much more important problem with Januvia--that it promotes cancer by inhibiting a tumor suppressor gene researchers have called "the trigger for prostate cancer"--is discussed in this more recent blog post:

More Research Shows Januvia and Glinides Inhibit Tumor Suppressor Gene DPP-4. Posted Dec 8, 2008.

Original Post:

If you have had or might get melanoma, ovarian cancer, lung cancer or prostate cancer, please read the above post before making your decision about whether Januvia is for you.

Here is the original post that was posted 9/12/08:

I have been hearing from people about a new, and, to me, very troubling problem with Januvia. The problem is this: now that doctors have decided that all people recently diagnosed with Type 2 Diabetes should be put on Januvia, prescriptions for the combination drug Janumet, which is made up of both Januvia and Metformin, are becoming much more frequent as a first prescription for diabetes.

Metformin is a very safe drug that has been used safely for decades. The most recent follow up to the UKPDS study, the 20 year follow-up, which was just presented at the annual EASD conference found that at 20 years after the start of the study, "Patients treated with metformin had a 21% reduction in risk of any diabetes endpoint (P=0.01), a 30% reduction in risk of diabetes-related death (P=0.01), a 33% reduction in risk of MI (P=0.005), and a 27% reduction in risk of all cause mortality (P=0.002)."

Metformin is a very good drug for people with Type 2 diabetes because it decreases insulin resistance both at the muscles and at the liver. If the liver becomes insensitive to insulin it becomes deaf to the message that rising insulin levels in the bloodstream should give it, which is: "Glucose coming in from food I just ate." Thus the insulin resistant liver continues to dump glucose into the blood stream when there already is glucose there from a meal. This causes even higher blood sugars after a meal than would be due to the meal alone.

Metformin is also the only oral drug which has been shown consistently in studies to lower body weight rather than cause weight gain.

And its only side effects are mild--digestive system effects that, while they may be unpleasant, are not in anyway life-threatening or even permanent.

But here's the problem: Metformin does irritate stomach and intestinal linings, particularly when a person has just started taking it. That is why the Extended Release (ER) form is a much better prescription than the regular form, as it minimizes unpleasant digestive reactions.

Januvia, however, has a side effect that makes Metformin even harder to tolerate: by boosting GLP-1 it causes the lower stomach valve to remain shut. Without metformin in your body, this merely leads to a feeling of fullness and upper abdominal bloat. But if you have metformin in your system, it leads to much worse stomach distress.

When I was taking metformin ER and added Januvia, I found that the only way I could tolerate the two together was to take the Metformin several hours before I took the Januvia. Otherwise, my stomach was a mess for hours.

But the Janumet combination pill combines fast-acting metformin--the version that already causes a lot more nausea and diarrhea than the ER form--with Januvia, so it greatly exacerbates the metformin gastric side effects.

So what I am hearing from people recently diagnosed with diabetes is that after being put on Janumet they develop horrible stomach symptoms and their doctors switch them NOT to plain metformin ER, but to plain Januvia!

Thus they lose any drug action against insulin resistance, and are left with a drug, Januvia, that, if it is effective at all--which it often is not --raises their insulin levels without lowering their insulin resistance.

They also come away believing they could never tolerate Metformin, when, in fact, most could were they given the gentler ER form without the stomach-valve-closing drug Januvia.

Given the extremely positive effect that was seen in patients taking Metformin in the UKPDS f0llowup study--patients who had almost half the risk of heart attack at 20 years as patients who had taken sulfonylurea drugs which, like Januvia, stimulate insulin secretion, this trend is disturbing.

Most prescriptions for diabetes drugs are written by overworked primary care doctors (family practitioners or doctors trained in "internal medicine") who have very little training in diabetes care beyond what they are told by drug company salespeople. Sadly, the Merck salesforce has done such a snowjob on these family doctors that they are now moving their newly diagnosed patients to Januvia, an expensive, dangerous drug that has no impact on insulin resistance, and away from metformin.

If you are on Janumet and are having serious stomach or intestinal side effects explain to your doctor that these side effects are being worsened by Januvia and that you want to take Metformin ER ALONE, without any Januvia.

Also, if you do stop Januvia or Janumet, remember that it takes about two weeks for the Januvia to completely leave your system, and even after that, it may take another few weeks for your stomach value to begin operating properly again.

It took me more than a month after I stopped Januvia to recover normal stomach emptying.

And if your doctor tells you that you should keep taking Januvia rather than Metformin because Januvia will "rejuvenate" your beta cells, point out to him that this is drug company hyperbole that is not substantiated by any study that has looked at the beta cells of human beings. Instead, it depends on misinterpretation of HOMA calculations, which merely reflect the amount of insulin secreted and which in addition, recent research has shown to be highly inaccurate.

Januvia does not regrow beta cells. It merely stimulates them to produce more insulin at meal times. And if you are insulin resistant, eating a high carb diet, and not taking metformin, that additional insulin will do one thing for you: pack on additional weight.

You've been warned!

September 9, 2008

More Evidence Connects Januvia to Cancer

Note since this post was made on 9/9/08 more research has been published which makes a stronger case that inhibiting DPP-4 is a trigger for prostate cancer and enhances the metastatic activity of ovarian, lung and melanoma cancers. To learn more about these findings and follow the citations to the published research, visit this page:


and scroll to the section titled "Research Connecting DPP-4 and Cancer."

Below is the original post:


An investment analyst recently sent me a report prepared by his firm which explored the question of whether more news about Januvia's link to cancer might have an impact on the value of the stock of a competing drug firm. The report cited Dr. Goldstein's letter to Annals of Internal Medicine, which analyzed the cancer statistics from the Phase III testing used to gain FDA approval for Januvia, and then added some new data taken from post-approval studies.

Here, taken from the investment company's report, is a chart of data presented by Januvia-maker Merck which summarizes two years of data from clinical trials as reported at the ADA 2007 conference.

[Click on the images to enlarge them]

The category that includes cancers here does not distinguish benign growths from cancers, but the text of the report points out that in fact are not broken out by type here, but in the Phase III data only one tumor out of 19 was benign. And in that study as Dr. Goldstein has explained there were 10 more cancers per thousand in the Januvia group than in the placebo group. That makes one suspect that the reason that the benign and cancerous growths were lumped together in one category is to obscure the fact that there were more cancerous growths found in this study.

Another chart provided by Merck at the same time is suggestive of this:

Here you see that there were 4 additional cases of Colon cancer in the Januvia group, and none in the placebo group. Colon cancer is one of the cancers that Dr. Goldstein pointed out have been linked to DPP-4 inhibition in previous research.

European data from an 18 month study of Galvus, another DPP-4 inhibitor that has not been approved in the U.S. but is approved for use in Europe found similar hints of a slight increase in the specific cancers that the research Dr. Goldstein flags says are those most likely to be promoted by inhibiting DDP-4.

These are not huge numbers of cancers, though for the people who got them, they were extremely significant. But when looking at this cancer data you must keep in mind that two years is a very short time in which to follow cancer incidence. A tiny but significant difference in cancer incidence at two years might well turn into a dramatic difference at ten years--if someone was to track the incidence of cancers in people taking these DPP-4 inhibiting drugs.

But given the way that aftermarketing studies have been shown to destroy the profitability of top drug, as they did for Avandia, we aren't likely to see such studies.

And because doctors are completely unaware of the linkage between Januvia and cancers it is very unlikely that they will report melanomas, prostate cancers, and colon cancers to the FDA as side effects of Januvia.

It is far more likely that these unnecessary deaths will go unnoticed. After all, doctors have already been told that people with Type 2 diabetes are more likely to develop cancer.

New data from Merck about Januvia was released at this week's EASD conference.

You can read summaries of five studies about Januvia presented at EASD from this Merck Press Release.

Note that the only side effects cited are those that occurred at a rate of 3% or higher--in at least 3 out of 100 people taking the drug.

But the rate of additional cancers that we saw in earlier reports were below that threshold. Still, assuming that the incidence difference attributable to Januvia remains at the same rate as seen in earlier studies, For every 1000 people taking Januvia, an additional 9 would contract a potentially fatal cancer.

But this statistic only becomes meaningful when you factor in how many people are actually taking Januvia. A Sept 4, 2008 press release from Decision Resources reports that "44 percent and 48 percent of surveyed endocrinologists and primary care physicians, respectively, expect to increase their first-line prescriptions for Januvia and 35 percent and 33 percent of surveyed endocrinologists and primary care physicians, respectively, expect to increase their second-line use of Januvia between 2008 and 2010."

And the Merck Press Release about the EASD presentations bragged that "More than six million total prescriptions for JANUVIA have been dispensed worldwide since launch. JANUVIA has received approval in 80 countries and is available in every region around the world."

So if 6 million people are taking Januvia, what does that 9 extra cases of cancer per thousand translate into? 54,000 people! 54,000 people who developed colon cancer, prostate cancer, ovarian cancer or melanoma because the DPP-4 which their body would have used to fight these cancers was turned off.

That's a LOT of people. Especially when you realize that it only took evidence that it had caused 155 unnecessary deaths to get Rezulin taken off the market.

And if you are one of those 54,000 people whose life is cut tragically short, it won't matter much to you that the incidence of this side effect does not rise to the 2% or 3% needed to get it included in the reports that doctors see.

The data presented at EASD showed that Januvia does lower blood sugar. But another study also showed that Byetta lowers it better. The recent bad press for Byetta linked it to 6 cases of pancreatitis, however it did not show that the rate of pancreatitis in the huge group of people taking Byetta was higher than that of the diabetic population at large. The Januvia data does compare cancer incidence in people not taking Januvia with those who were taking it, and that gives it far more credibility to my mind.

So I continue to believe that if you want to see what raising GLP-1 levels will do for your blood sugar, Byetta is a much safer alternative. Januvia raises GLP-1 by turning off DPP-4, the enzyme responsible for eliminating naturally produced GLP-1. Byetta is synthetic GLP-1 designed so that it sticks around longer than the natural stuff. With Byetta you are not messing with an enzyme (DPP-4) used throughout the body for many other, non-blood sugar related uses--like killing cells that have recently become cancerous.

And if you or a loved one do develop a cancer while taking Januvia make sure to tell your doctor about the research linking DPP-4 inhibition to cancer that Dr. Goldstein cited in his letter to Annals of Internal Medicine. And then report your case to the FDA yourself, because that is the only way that the FDA is going to learn about cancers linked to Januvia.

You can report serious side effects of FDA approved drugs here:

I hope you will never get cancer, but sadly, given the solid research connecting DPP-4 inhibition with the promotion of cancer and the very early data emerging from these very short clinical trials of Januvia, it looks like a lot of people with diabetes who are having this drug heavily promoted to them will.

September 5, 2008

Study: Mechanism Found that Explains Why Bisphenol-A Causes Metabolic Syndrome

There has been a lot of news this week about the impact of artificially created organic chemicals on our bodies. Now a major new finding comfirms what I have been suspecting all along: Bisphenol-A suppresses adiponectin--the hormone in fat that is part of the system that regulates how much additional fat our bodies put away.

Bisphenol-A is found in hard plastics like water bottles and baby bottles. It is also used in the lining of food cans, which means if you ever eat commercially prepared foods you are exposed to it, since much restaurant food starts out in cans.

Here's a good write up about this research:
Toxic Plastic Linked to Metabolic Syndrome

From that report we get this description of the study, published in the Aug. 14, 2008, online edition of the journal Environmental Health Perspectives:

"In a laboratory study, using fresh human fat tissues, the UC team found that BPA suppresses a key hormone, adiponectin, which is responsible for regulating insulin sensitivity in the body and puts people at a substantially higher risk for metabolic syndrome."

If you've been following the news, you will have noted that the plastics industry and its lobbyists have been fighting hard to keep this plastic in our environment and the FDA--that has never found a lobbyist whose interests it won't serve--continues to claim it is safe.

Other research has shown that many of us have detectible levels of Bisphenol-A in our bodies. And yet more research has shown that heating a plastic baby bottle releases a lot of Bisphenol-A into the milk in that bottle.

Plastic baby bottles made of Bisphenol-A have been around for a generation. But the plastics industry would have you believe that it is totally coincidental that the generation that grew up drinking from those baby bottles has the highest rate of obesity ever seen in our society.

Completely coincidental. Oh yeah.

Don't those lobbyists have kids and grandkids too?

September 4, 2008

Flame Retardants in Children's Blood: Another Cause of the "Obesity Epidemic"

I have long argued that the so-called "obesity epidemic" is caused not by moral failings--gluttony and sloth--but by genetic damage which destroys the normal in-built systems the body relies on to control hunger and weight.

A main cause for this huge upsurge in genetic damage is the way that humans have, over the past two generations, injected thousands of novel human-created organic chemicals into our environment. These chemicals are found in our air, water, shampoo and toothpaste, packaging, non-stick cooking pans, plastic dishes, baby bottles, cans, and now, it appears, home furnishings.

A disturbing report was just issued by a group called the Environmental Working Group. It found a fire retardant chemical used in electronics, toys and furniture has been detected in children's blood at triple the levels found in their mothers.

As the Reuters news article reporting this finding explains, "In a small pilot study of 20 families, the non-profit environmental group tested blood samples from mothers and their young children -- ages 18 months to four years -- for the presence of PBDEs, a hormone-disrupting chemical.

"In 19 of the 20 families, concentrations of PBDEs were typically three times as high in children as in their mothers, said Sonya Lunder, the study's author. One child had six times the level of the chemical that was detected in her mother.

You can read more about this study here:
Fire Retardant Found in Children.

The report continues: "PBDEs, or polybrominated diphenyl ethers, are hormone-disrupting pollutants that build up in the blood and tissues. Two forms of PBDEs are no longer made in the United States but are still present in items in U.S. homes, the study said.

"The largest volume of PBDEs are in electronics in a form called Deca, which is banned in European electronics and in some U.S. states, according to the study...

"The study cited peer-reviewed tests that showed a single dose of PBDEs given to mice on a single day when their brains were growing rapidly can cause permanent behavior changes, including hyperactivity."

But hyperactivity isn't the only effect of these chemicals on the body. Another study presented at Life Sciences 2007, a UK scientific gathering, goes into more depth about exactly what these bromine flame retardants do in the body:

Link Found between Flame Retardant in Sofas and Cancer

From this report we learn, "Brominated Flame Retardants (or BFRs) are known endocrine disrupters - ie. they interfere with the body’s endocrine system (our glands), adversely affecting hormones such as oestrogen and testosterone in the human body.

"The research found that TBBPA binds to cell membranes within the human body, altering their biophysical properties, and more specifically their calcium permeability, by affecting calcium transport proteins. This disrupts the way in which the cell communicates within the body - a communication process which is called cell-signalling. Errors in cell-signalling are implicated in a wide range of diseases such as cancer, diabetes and auto-immune syndromes."

Taken in isolation, this finding that flame retardant chemicals are in all our blood and even more concentrated in our babies is disturbing. But when we add it to the reports that find significant amounts of Teflon in maternal breast tissue, and which find Bisphenol A in human and especially baby blood, a picture starts to emerge and it is one that should be making all of us question whether obesity is really a matter of "poor lifestyle choices" as the chemical industry would have us believe, or a symptom of something far more disturbing.

The fact is, sedentary people who have normal metabolisms do not eat 4,000 calories a day, no matter how tempting. When I was raising my kids all the child health books pointed to studies that had proven conclusively that normal healthy toddlers would not over-eat no matter how much food they were presented with.

Back in those days it was also well understood that if children that young did display abnormal feeding patterns, it needed to be investigated, because an inability to stop eating of the type that led to obesity in children that young pointed to severe endocrine disruption, often linked to genetic conditions known to dysregulate feeding behavior.

And indeed, in my childhood in the 1950s obesity was extremely rare. If you referred to a schoolmate a, "The fat kid," everyone knew who you meant because the whole grade only had one. Yet our school cafeterias served cake for dessert every day. There were potatoes with every meal. We downed our share of candy bars, Twinkies and Hostess Snowballs (made with lard, not transfat). We ate plenty of french fries, pizza, and potato chips too. But we did not get fat.

Could this have had something to do with the fact that as babies we played with wood and metal toys, ate from metal pans, and crawled on wood, wool-carpeted, or linoleum floors?

It is hard to say. But what is disturbing to me is the way that the medical community completely ignores the evidence that our blood has become a chemical brew filled with complex organic molecules that are biologically active. Instead it continues to blame obesity and the rise in diabetes on "lifestyle choices."

Yes, people who get fat may eat too much. But the question is not "Why don't they have more will power?" It is this: What has happened to the in-built systems that in normal healthy people regulate appetite? What has disrupted the signaling that used to tell us we had eaten enough? What is causing the kind of ravenous hunger that would allow a person to eat 1500 calories at lunch?

The chemical industry puts a lot of money and lobbying power into assuring us every time a study like this comes out that these levels of alien chemicals in our bodies are safe. They don't base these claims on solid research findings because there are no studies on the long term effects of these chemicals on human bodies.

But the "research" is going on all around us as several hundred million people go about their lives with their bloodstreams filled with these artificially introduced bioactive organic molecules.

And that research right now appears to be turning to learning happens when babies are born to mothers who were themselves exposed to these chemicals in the womb. It will be another generation until we see those results. But the preliminary findings from this research on the human population are becoming clear: We have an epidemic of obesity, a much higher prevalence of infertility, a surge of Type 2 diabetes in people far younger than that the population that used to develop it, and most troublingly, we are seeing Type 2 diabetes develop in toddlers who are far too young to have developed diabetes from "lifestyle choices" since it takes about a decade for Type 2 to develop in response to diet-related obesity.

Are you feeling scared yet?


Later the same day:

Yet another study linking Bisphenol-A blood levels with changes in behavior and mood.

Chemical in Plastic is Connected to Health Problems in Monkeys

"In a study published in the Proceedings of the National Academy of Sciences, the Yale team exposed monkeys to levels of bisphenol A deemed safe for humans by the Environmental Protection Agency and found that the chemical interfered with brain cell connections vital to memory, learning and mood.

"'Our findings suggest that exposure to low-dose BPA may have widespread effects on brain structure and function,' the authors wrote. In contrast to earlier research on rodents, the Yale researchers studied monkeys to better approximate the way BPA might affect humans."

Change how the brain works, and you also change how much people eat.

September 2, 2008

Beta Blockers Worsen Blood Sugar--May Cause Diabetes

Many people know that it is a bad idea for anyone who takes insulin or a sulfonylurea drug to take a beta blocker. This is because it has long been known that these drugs block the counter-regulatory response that prevents a dangerous hypo or--if it cannot prevent the hypo--at least gives the victim some warning that one is coming by causing shakes and pounding pulse.

Now evidence from a huge study of almost 20,000 people has learned that beta blockers are dangerous to anyone with any blood sugar abnormality. The study is Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA,). It was published in Diabetes Care in May.

Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial--Blood Pressure Lowering Arm and the relative influence of antihypertensive medication.

It concluded: "Baseline FPG >5 mmol/l, BMI, and use of an atenolol +/- diuretic regimen were among the major determinants of NOD [Non-insulin dependent diabetes i.e. Type 2] in hypertensive patients."

An analysis of the study (which is still only available as an abstract to non-subscribers) published in Irish Medical News explains "Hypertensive patients allocated to amlodipine and perindopril were found 34% less likely to develop NOD [Type 2] compared with those allocated to the β-blocker/diuretic combination."

Diabetes in Control adds the following: "Says Dr Anoop Misra, director and head (diabetes and metabolic diseases) Fortis Hospitals: "In patients with hypertension, beta blocker drugs are no longer frontline therapy. These drugs may not only increase blood sugar levels in those who don't have diabetes, but may worsen sugar control in those with diabetes and also blunt warning symptoms when low sugar occurs."

My mail suggests that American doctors are not aware of the negative impact of beta blockers on the blood sugar of their patients as many people with Type 2 who contact me are taking these drugs. My own doctors have also prescribed beta blockers for me in the past.

Here is a list of commonly prescribed beta blockers:

Generic name/Brand Name
cebutolol- Sectral
Atenolol (G)- Tenormin
Betaxolol- Kerlone
Bisoprolol fumarate- Zebeta
Carteolol hydrochloride- Cartrol
Metoprolol tartrate (G)- Lopressor
Metoprolol succinate- Toprol-XL
Nadolol (G)- Corgard
Penbutolol sulfate- Levatol
Pindolol (G)- Visken
Propranolol hydrochloride (G)- Inderal, Inderal LA
Timolol maleate (G)- Blocadren

CAUTION! Do NOT Stop These Drugs Without Help from Your Doctor

One of the nastier problems with Beta Blockers is that if you are taking one and stop it suddenly you raise the risk of having a heart attack. So if you are taking a beta blocker, you MUST contact your doctor and ask for guidance as to the safe way of getting off of it and onto a drug that is safer for people with diabetes.

There are alternatives to Beta Blockers. ACE inhibitors like Lisinopril do not raise blood sugar and also appear to have some kidney-protective qualities. Those who cannot tolerate ACE inhibitors usually do well on ARB drugs which include Diovan (Valsartan) and Avapro (Irbesartan). ARB drugs besides lowering blood pressure, also lower insulin resistance slightly. Though this effect is not usually detectable in people who are severely insulin resistant, I see an immediate impact on my own blood sugar when I take a dose of Diovan after not having used it in a while.

HCTZ (Hydrocholorothiazide, often abbreviated HCT) is a diuretic which is prescribed alone or combined in pills containing other blood pressure drugs. It has been shown to raise blood sugar. This may be because as a diuretic it eliminates water from the blood stream and this concentrates the glucose that is left. Whatever the explanation, if you can control your blood pressure with medications that do not contain HCT do so. Your blood sugar will thank you. Many doctors immediately prescribe the combination pills that contain this diuretic as a first line treatment, rather than prescribing the other drug alone. But if you cannot get adequate control with just the one pill, HCT may help. Just make sure you drink a lot of water with it.

Blood pressure control is as important as blood sugar control in preventing heart disease and stroke and it is thought that the overall improvement in stroke and heart attack statistics over the past decade are due to patients having better blood pressure control. So don't let this news make you avoid doing something about high blood pressure. Just make sure that the drugs you take to control your blood pressure are ones that are safe for people with pre- and full fledged diabetes.

Other ways to lower blood pressure are:

1. Cut way down on carbohydrates. Many people, though not all, will see dramatic drops in their blood pressure when they cut down on their carbohydrate intake.

2. Exercise.

3. Lose weight.

4. Eliminate salt from your diet. Whether this works depends on your genetic make up. For people whose genes make them salt sensitive, cutting salt causes a dramatic improvement in blood pressure. For others it has no effect.