I ran into two different studies today that concerned factors that lead to brain dysfunction, a.k.a. dementia.
What was nice about these dementia studies, compared to most, is that they involved humans not mice, and that those subjects who had happy outcomes were not necessarily those who had made fortunate choices of grandparents. Both studies suggest things you and I can do to keep our brains functional.
The first study was published in this month's Diabetes Care. It looked at data from the notorious ACCORD study and concluded two things: "Higher A1C levels are associated with lower cognitive function in individuals with diabetes" and "FPG was not associated with [mental functioning] test performance."
Relationship Between Baseline Glycemic Control and Cognitive Function in Individuals With Type 2 Diabetes and Other Cardiovascular Risk Factors.(ACCORD-MIND) trial. Tali Cukierman-Yaffe et al.
The study found that a 1% rise in A1c (i.e. from 6.0% to 7.0%) was associated with a significant decline in scores on three different tests of mental functioning.
Though this is depressing news if you have a high A1c, people with diabetes lower their A1cs dramatically all the time. For some examples (and these are just a very few examples drawn from public postings and emails I get) visit The 5% Club: They Normalized Their Blood Sugar and So Can You.
Note, that this finding would explain why another study that is getting some press linked getting diabetes before age 65 with a higher risk of Alzheimer's.
Be very clear about this: The risk factor is not a Diabetes diagnosis. It is high blood sugars--the high blood sugars too many doctors consider "good control" for people with diabetes--blood sugars that result in A1cs near 7.0%.
It is very likely that if you are diagnosed with diabetes at any age, but control your blood sugars to a normal level--A 5% A1c, for example--you can have the same health as anyone else would who had not gotten the diagnosis.
The other study was published in The Journal of the American Geriatrics Society.
Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. Journal of the American Geriatrics Society, Han et al. 2008; 56 (12): 2203
You can read a detailed summary of this password protected study in Science Daily:
Science Daily: Common Medication Associated with Cognitive Decline in the Elderly.
This study linked anticolinergic medications to a significant loss of memory and found, in the words of Science Daily, The degree of memory difficulty and impairment in daily living tasks also increased proportionally to the total amount of drug exposure, based on a rating scale the authors developed to assess anticholinergicity of the drugs."
Anticholinergic drugs are used for many conditions. The drugs used to treat overactive bladders are strong anticholinergics. So are some drugs used to treat cold symptoms, breathing difficulties, digestive difficulties and a host of other symptoms.
Here is a list of anticholinergic agents:
Anticholinergic Agents
I have had doctors recommend drugs on this list to me. You may be taking them too. Because they block a class of chemicals that naturally decline as we age, and which are associated with memory function, you might want to review the medications you are taking to make sure you aren't taking one of these drugs. The drugs that are currently used to treat dementia work by increasing acetylcholine, the substance that these anticholinergic drugs decrease.
While following some references about anticholinergic drugs online, I ran accross a list of drugs called the Beers List/ This turns out to be a list of drugs that mainstream medical professionals have identified based on peer-reviewed research as being potentially dangerous for people older than 65 years old.
While I have some quibbles with some of the drugs on the list--estrogen for example, where the evidence that it is harmful seems to confined to women who started taking it after 65, not those who have taken it since the beginning of menopause, this list is well worth a look.
You can read the latest update, published in Annals of Internal Medicine in 2003.
Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Results of a US Consensus Panel of Experts. Donna M. Fick et al.
Here is a link to the list of these potentially dangerous drugs from the above article, along with the brief explanations of why they may be dangerous.
...Potentially Inappropriate Medication...
Here is a table which lists the dangerous drugs linking them to specific medical conditions for which they are a poor choice:
Drugs and Conditions
Follow up studies citing this study all point out that these drugs continue to be overprescribed to people over 65. Given my own experience, where doctors repeatedly prescribe inappropriate drugs to me despite my being clear about my medical history, it is very likely that, if you are an older person and are taking prescription medications for a variety of conditions, you may also be taking some of these inappropriate drugs, too.
Given its mainstream origin, this list is highly conservative. There are other drugs whose side effects may also be dangerous to brain function in the elderly. Of most concern is some evidence that statin drugs contribute to memory problems in older people. Cholesterol is a vital component of the brain and lowering it inappropriately may harm the aging brain. Research backing this finding is documented here:
Other Dangerous Drugs for People with Diabetes
Clearly, all of us who are approaching a certain age, and especially those of us who may have family histories of dementia, need to pay attention to these findings. Keeping our blood sugar as normal as possible is a first step. Keeping blood pressure normal is also vital to preserving brain function, as high blood pressure leads to the "mini-strokes" which cumulatively become vascular dementia. Vascular dementia is probably an even more frequent cause of dementia than is Alzheimer's Disease.
Once you've lowered your blood sugar and blood pressure, you aren't done. Don't let yourself become the victim of prescription drug-induced brain damage--and don't trust that your overly busy family doctor has kept up with the research connecting brain damage in the elderly with the use of common prescription drugs.
Sometimes you might have no choice, if the dangerous drug is one, like a chemotherapy agent, that you need to take to keep alive. But before you assume this is the case, grill the doctor who tells you that you need a potentially harmful drug about whether there are other, safer, drugs available. Often, it turns out that there are.
Bottom line: The older we are, the more exposed we are to brain damage. Vigilance about what we put in our bodies--both food and drugs--may make a huge difference in the quality of our later decades.
January 28, 2009
January 26, 2009
Other People's Diabetes: Back Off!!!
I get a lot of mail from people who are concerned about a relative's blood sugar. Often the relatives are parents who are in their 80s or older. My correspondents ask how they can get mom or dad to eat a low carb diet or use a more aggressive drug regimen to normalize their sky high blood sugars.
These people love their relatives and want them to be healthy, and I respect that. But their concern tempts them to cross an important barrier in a way that I, as a person with diabetes myself, consider invasive.
I feel very strongly that no one, and I mean NO one, no matter who they are or how concerned they might be, has a right to tell an adult with diabetes what they should eat or what drugs they should take. Those decision should be made by the individual with diabetes and no one else, because the person with diabetes is the one who has to eat the food, live with the side effects, and suffer the consequences of whatever choice they make.
This is a fundamental human right.
We can mention that there might be some new ideas--backed up by solid research--that others might find helpful. We can describe our own success. If people ask us how we achieved that success, we can explain what we do and reassure them that there are techniques out there that will work for them too, no matter how bad their current health might be. But we should not go beyond that.
I eat what I decide to eat, and what that is is no one's business but my own. I make that decision at every meal, every day of my life--and what I decide to eat changes from day to do depending on a wide variety of factors. Everyone else should have that right too.
It is painful to have stand by, unable to intervene, when so many people with diabetes are being given very poor dietary advice and even worse medical treatment--advice and treatment that shortens their lives and fills their days with unnecessary suffering. But I believe that the only legitimate way to address this pain is to share information with others in a way that leaves it up to the person with diabetes to decide how they want to deal with that information.
This belief informs everything that I, personally, do as a diabetes patient advocate. I make information available to people who have decided they want to improve their health. I do not evangelize to those who have not made that decision.
People who look for help with their blood sugar who turn to Google will find me. Google loves my Blood Sugar 101 web site. People searching Amazon for books will find me too now that Amazon has been featuring my book near the top of its "Type 2 Diabetes" bestseller list
for several months.
Because those people have chosen to seek better information for diabetes, I give it to them--lots of it. But I leave alone those people with diabetes who are not looking for better information and don't believe they need it.
If I meet them in live social situation I may mention that I have diabetes if it comes up in a discussion. If it feels right, I might mention that I've been very successful in controlling my blood sugar over the years using a low carb approach and keeping my blood sugar much lower than the levels most doctors recommend, which has let me avoid complications.
What I don't do is tell people that the doctors who tell them their 7% A1cs are "great control" are idiots. All that does it convince the person I'm speaking with that I am an idiot. If they mention their 7% A1c with satisfaction as proof they are in great shape, as all too many do, I might murmur that I've seen some interesting research that suggests this level isn't low enough to prevent nerve damage and that some of my friends have found that lowering their post-meal blood sugars below 140 mg/dl has eliminated nasty foot pain. If the person has foot pain, they might find that interesting. Many people with Type 2 don't, and the conversation ends there.
You can talk yourself blue in the face about the wonders of eating a low carb diet or the importance of maintaining normal blood sugars, but if the person you are talking to is content with their their situation, brainwashed by the drug and food companies, and trusts their doctor, all your talk will do is trigger anxiety, denial, and hostility towards yourself.
If the person involved is a family member, it will also trigger a lot of other, even less pleasant responses. Your 82 year old mom still remembers very clearly those days back when you were being toilet trained and this colors her willingness to take medical advice from you. Your husband, no matter how much he loves you, is likely to have his own issues about being bossed around by women--he had a mom, before he had you--and if you start getting between him and his food supply, no matter how well intentioned you are--you may end up with what those of us in the computer field call, "Unpredictable results" a.k.a. total system failure.
Brothers and sisters have their own reasons for ignoring anything you might tell them. If you're older than they are, they don't like being bossed around. If younger, what could you possibly know? Ask yourself, how often do you take unsolicited advice from them?
The situation becomes more complex when we have actual responsibility for these family members. If they are children, we do get to decide what they eat, for a while, but if we are wise and want them to succeed long term, we are very careful to bring them into the process of taking ownership of what they eat as soon as possible. We give them the information they need to make good choices, give them positive feedback and support, and are very careful to keep a healthy diet from being something they are forced to eat because a parent has imposed it.
Why? Because iids grow up and part of that growth process involves throwing off, sometimes violently, your control. If eating properly and controlling blood sugar is perceived to be your issue, when they get out on their own, kids may prove "you aren't the boss of me" by eating everything you've told them not to, running high blood sugar, and royally screwing up their health.
If you have responsibility for an elder who can no longer take care of themselves different factors come into play. If they are in a nursing home you may not have any ability to intervene in how they are fed or medicated. Nursing homes universally follow the old ADA dietary guidelines: lots of carbs, no fat, and if meal time insulin is administered, it is administered with the outmoded "sliding scale" technique that prevents hypos by keeping post-meal blood sugars very high. Institutions know they can't be sued for following the traditional dietary advice so they will follow it. If you protest, they'll tell you to find somewhere else.
If mom or dad is living on their own or with you, you have more options, but there is an important point to keep in mind: The health benefits your 80 or 90 year old relative will reap from better blood sugar control may not be significant enough to justify taking away all their favorite foods and, in their view, forcing them to eat in a way they aren't comfortable with.
This is an important point. If you are 50 years old, the diabetic complications you might get at 60 or 70 if you ignore your blood sugar are significant and it is worth making sacrifices to avoid them. If you are approaching 90, the chances that you will live long enough to get--or significantly worsen--those complications is fairly small. And when someone is 80 or older it is also almost certain that they have well established complications already--most notably heart disease--which have gone past the point where any diet will reverse them.
If that is the case, why not let mom eat what she wants and enjoy her food? If she is like most older people, she isn't eating much, anyway, and the loss of muscle mass from the natural anorexia of old age is a much bigger threat to her health than elevated post-meal blood sugars.
If your 88 year old mom is in the kind of shape where she is still windsurfing--or knitting beautiful sweaters--and your family has a tendency to live to 105, it might be worth discussing with her the benefits of keeping blood sugars normal by cutting back on sugars and starches. But if she is in that kind of health it is also likely that she has normal blood sugars and doesn't need to eat the way that you must--which is why she has stayed in such great shape as she ages.
There is no "one size fits all" solution for diabetes. That is the key idea that underlies all my writings. I know what works for me. I have heard from a lot of other people about what works for them--some of which would not work for me at all. If you stop by this blog or my main web site, I will do what I can to give you the information you need to know to best figure out what will work for you.
But once you pick up that fork, you're on your own and that is how it should be.
These people love their relatives and want them to be healthy, and I respect that. But their concern tempts them to cross an important barrier in a way that I, as a person with diabetes myself, consider invasive.
I feel very strongly that no one, and I mean NO one, no matter who they are or how concerned they might be, has a right to tell an adult with diabetes what they should eat or what drugs they should take. Those decision should be made by the individual with diabetes and no one else, because the person with diabetes is the one who has to eat the food, live with the side effects, and suffer the consequences of whatever choice they make.
This is a fundamental human right.
We can mention that there might be some new ideas--backed up by solid research--that others might find helpful. We can describe our own success. If people ask us how we achieved that success, we can explain what we do and reassure them that there are techniques out there that will work for them too, no matter how bad their current health might be. But we should not go beyond that.
I eat what I decide to eat, and what that is is no one's business but my own. I make that decision at every meal, every day of my life--and what I decide to eat changes from day to do depending on a wide variety of factors. Everyone else should have that right too.
It is painful to have stand by, unable to intervene, when so many people with diabetes are being given very poor dietary advice and even worse medical treatment--advice and treatment that shortens their lives and fills their days with unnecessary suffering. But I believe that the only legitimate way to address this pain is to share information with others in a way that leaves it up to the person with diabetes to decide how they want to deal with that information.
This belief informs everything that I, personally, do as a diabetes patient advocate. I make information available to people who have decided they want to improve their health. I do not evangelize to those who have not made that decision.
People who look for help with their blood sugar who turn to Google will find me. Google loves my Blood Sugar 101 web site. People searching Amazon for books will find me too now that Amazon has been featuring my book near the top of its "Type 2 Diabetes" bestseller list
for several months. Because those people have chosen to seek better information for diabetes, I give it to them--lots of it. But I leave alone those people with diabetes who are not looking for better information and don't believe they need it.
If I meet them in live social situation I may mention that I have diabetes if it comes up in a discussion. If it feels right, I might mention that I've been very successful in controlling my blood sugar over the years using a low carb approach and keeping my blood sugar much lower than the levels most doctors recommend, which has let me avoid complications.
What I don't do is tell people that the doctors who tell them their 7% A1cs are "great control" are idiots. All that does it convince the person I'm speaking with that I am an idiot. If they mention their 7% A1c with satisfaction as proof they are in great shape, as all too many do, I might murmur that I've seen some interesting research that suggests this level isn't low enough to prevent nerve damage and that some of my friends have found that lowering their post-meal blood sugars below 140 mg/dl has eliminated nasty foot pain. If the person has foot pain, they might find that interesting. Many people with Type 2 don't, and the conversation ends there.
You can talk yourself blue in the face about the wonders of eating a low carb diet or the importance of maintaining normal blood sugars, but if the person you are talking to is content with their their situation, brainwashed by the drug and food companies, and trusts their doctor, all your talk will do is trigger anxiety, denial, and hostility towards yourself.
If the person involved is a family member, it will also trigger a lot of other, even less pleasant responses. Your 82 year old mom still remembers very clearly those days back when you were being toilet trained and this colors her willingness to take medical advice from you. Your husband, no matter how much he loves you, is likely to have his own issues about being bossed around by women--he had a mom, before he had you--and if you start getting between him and his food supply, no matter how well intentioned you are--you may end up with what those of us in the computer field call, "Unpredictable results" a.k.a. total system failure.
Brothers and sisters have their own reasons for ignoring anything you might tell them. If you're older than they are, they don't like being bossed around. If younger, what could you possibly know? Ask yourself, how often do you take unsolicited advice from them?
The situation becomes more complex when we have actual responsibility for these family members. If they are children, we do get to decide what they eat, for a while, but if we are wise and want them to succeed long term, we are very careful to bring them into the process of taking ownership of what they eat as soon as possible. We give them the information they need to make good choices, give them positive feedback and support, and are very careful to keep a healthy diet from being something they are forced to eat because a parent has imposed it.
Why? Because iids grow up and part of that growth process involves throwing off, sometimes violently, your control. If eating properly and controlling blood sugar is perceived to be your issue, when they get out on their own, kids may prove "you aren't the boss of me" by eating everything you've told them not to, running high blood sugar, and royally screwing up their health.
If you have responsibility for an elder who can no longer take care of themselves different factors come into play. If they are in a nursing home you may not have any ability to intervene in how they are fed or medicated. Nursing homes universally follow the old ADA dietary guidelines: lots of carbs, no fat, and if meal time insulin is administered, it is administered with the outmoded "sliding scale" technique that prevents hypos by keeping post-meal blood sugars very high. Institutions know they can't be sued for following the traditional dietary advice so they will follow it. If you protest, they'll tell you to find somewhere else.
If mom or dad is living on their own or with you, you have more options, but there is an important point to keep in mind: The health benefits your 80 or 90 year old relative will reap from better blood sugar control may not be significant enough to justify taking away all their favorite foods and, in their view, forcing them to eat in a way they aren't comfortable with.
This is an important point. If you are 50 years old, the diabetic complications you might get at 60 or 70 if you ignore your blood sugar are significant and it is worth making sacrifices to avoid them. If you are approaching 90, the chances that you will live long enough to get--or significantly worsen--those complications is fairly small. And when someone is 80 or older it is also almost certain that they have well established complications already--most notably heart disease--which have gone past the point where any diet will reverse them.
If that is the case, why not let mom eat what she wants and enjoy her food? If she is like most older people, she isn't eating much, anyway, and the loss of muscle mass from the natural anorexia of old age is a much bigger threat to her health than elevated post-meal blood sugars.
If your 88 year old mom is in the kind of shape where she is still windsurfing--or knitting beautiful sweaters--and your family has a tendency to live to 105, it might be worth discussing with her the benefits of keeping blood sugars normal by cutting back on sugars and starches. But if she is in that kind of health it is also likely that she has normal blood sugars and doesn't need to eat the way that you must--which is why she has stayed in such great shape as she ages.
There is no "one size fits all" solution for diabetes. That is the key idea that underlies all my writings. I know what works for me. I have heard from a lot of other people about what works for them--some of which would not work for me at all. If you stop by this blog or my main web site, I will do what I can to give you the information you need to know to best figure out what will work for you.
But once you pick up that fork, you're on your own and that is how it should be.
January 16, 2009
Fine Tuning the Metabolic Calculator
UPDATE: 1/19/09: Kg/Cm option added to calculator for our non-U.S. users.
I got some good feedback here and from some of the low carb dieters on the Low Carb Friends forum. Many of you find that the predicted calorie levels the calculator comes up with are lower than what they can lose weight eating on a ketogenic diet.
So to check this out further, I dug out the detailed records I kept during my year of weight loss on a ketogenic diet back in 2003. This was a year long ketogenic diet, without insulin or diabetes meds. My usual daily carb input was between 40-60 grams. I lost a total of 33 lbs, starting from a high of 170 lbs though I only started logging when I was already at 160 lbs. I then compared the values the calculator gave me against my actual calorie intake and weight loss.
I found that I was burning many more calories than were predicted using the basal metabolic rate calculated by the Mifflin-St Jeor formula and adding activity calories based on the 1.2 factor which is used to estimate calories burned at a sedentary activity level.
I then figured out, based on my actual weight loss for each month, what the actual activity factor would have been for each month that would have yielded my actual calories burnt.
The actual activity factor was always higher than the standard 1.2 rate, though it fluctuated each month between a high of 1.56 and a low of 1.28 during the period when I achieved most of the 23 lb loss tracked by this data. (I had dieted for a few months earlier without tracking, for a total loss of 33 lbs.)
I was sedentary the first three months logged here, then I started going to the gym five or six days a week and doing an hour of treadmill. This did not make any appreciable difference in how many calories I burned. When I added some weights several months later at a time when I was exercising at maximum intensity on the treadmill, the activity factor had dropped closer to the traditional value given for light exercise (1.37) which was lower than it had been during my sedentary weight loss period. Some months when exercising and eating similarly, I gained weight. This is typical of what happens six months into a diet.
I then analyzed how wmy eight loss related to changes in my monthly carb intake, protein and fat intake and the percentage of the diet made up of the different nutrients. I did not see any clear patterns that were sustained over the 10 months I had logged. Early in the diet raising fat and lowering other nutrients appeared to help with weight loss, but later in the diet nothing seemed predictive.
After thinking this through, I came up with a new activity factor that may produce a more realistic idea of calories burned during the early months of a ketogenic diet and I have added it to the metabolic calculator.
This new activity level is called "Sedentary with metabolic advantage." It multiplies calculated Basal Metabolic Rate by a factor of 1.43 rather than the usual sedentary factor of 1.2 to estimate what the maintenance calorie level would be.
I also retained the standard sedentary calculation and added a new one for light activity. You can chose between these factors and use the one that best matches your experience.
If you are stalled using the "metabolic advantage" number, drop back to the sedentary number. Avoid the temptation to overestimate how hard you are exercising.
Finally, I also added to the calculator's display your calculated basal metabolic rate and of the factor being used to add calories for activity.
Here's the link to the calculator again:
Calculate Your Nutrient Balance on a Ketogenic Diet
Enjoy!
I got some good feedback here and from some of the low carb dieters on the Low Carb Friends forum. Many of you find that the predicted calorie levels the calculator comes up with are lower than what they can lose weight eating on a ketogenic diet.
So to check this out further, I dug out the detailed records I kept during my year of weight loss on a ketogenic diet back in 2003. This was a year long ketogenic diet, without insulin or diabetes meds. My usual daily carb input was between 40-60 grams. I lost a total of 33 lbs, starting from a high of 170 lbs though I only started logging when I was already at 160 lbs. I then compared the values the calculator gave me against my actual calorie intake and weight loss.
I found that I was burning many more calories than were predicted using the basal metabolic rate calculated by the Mifflin-St Jeor formula and adding activity calories based on the 1.2 factor which is used to estimate calories burned at a sedentary activity level.
I then figured out, based on my actual weight loss for each month, what the actual activity factor would have been for each month that would have yielded my actual calories burnt.
The actual activity factor was always higher than the standard 1.2 rate, though it fluctuated each month between a high of 1.56 and a low of 1.28 during the period when I achieved most of the 23 lb loss tracked by this data. (I had dieted for a few months earlier without tracking, for a total loss of 33 lbs.)
I was sedentary the first three months logged here, then I started going to the gym five or six days a week and doing an hour of treadmill. This did not make any appreciable difference in how many calories I burned. When I added some weights several months later at a time when I was exercising at maximum intensity on the treadmill, the activity factor had dropped closer to the traditional value given for light exercise (1.37) which was lower than it had been during my sedentary weight loss period. Some months when exercising and eating similarly, I gained weight. This is typical of what happens six months into a diet.
I then analyzed how wmy eight loss related to changes in my monthly carb intake, protein and fat intake and the percentage of the diet made up of the different nutrients. I did not see any clear patterns that were sustained over the 10 months I had logged. Early in the diet raising fat and lowering other nutrients appeared to help with weight loss, but later in the diet nothing seemed predictive.
After thinking this through, I came up with a new activity factor that may produce a more realistic idea of calories burned during the early months of a ketogenic diet and I have added it to the metabolic calculator.
This new activity level is called "Sedentary with metabolic advantage." It multiplies calculated Basal Metabolic Rate by a factor of 1.43 rather than the usual sedentary factor of 1.2 to estimate what the maintenance calorie level would be.
I also retained the standard sedentary calculation and added a new one for light activity. You can chose between these factors and use the one that best matches your experience.
If you are stalled using the "metabolic advantage" number, drop back to the sedentary number. Avoid the temptation to overestimate how hard you are exercising.
Finally, I also added to the calculator's display your calculated basal metabolic rate and of the factor being used to add calories for activity.
Here's the link to the calculator again:
Calculate Your Nutrient Balance on a Ketogenic Diet
Enjoy!
January 13, 2009
New Calculator: Optimum Nutrient Balance on a Ketogenic Diet
I've been doing a very low carb ketogenic diet the past couple weeks and revisiting some of the nutritional theory that floats around the internet under the name of diet advice.
For many years I have used nutritional software and a food scale to track and log my food intake when I diet, so I have a very good idea of what I'm eating. But recently I've gotten curious about the impact of macronutrient balance: how much of a difference it makes when we change the proportions of protein, carbohydrate and fat that total up to a given caloric intake.
When we cut carbs, we know we have to raise our protein intake high enough to provide the raw material from which the liver can synthesize the glucose it needs to run the brain--the only organ that requires some glucose to keep running. At the outset of a ketogenic diet the brain requires about 100 grams of protein.
We also know--though many supposedly trained nutritionists do not--that after three weeks on a ketogenic diet, the brain's requirements for glucose drop significantly--to about 40 grams a day--as it ramps up to run on ketones instead.
(This last phenomenon is why children with certain kinds of epilepsy are able to eat extremely low carbohydrate diets for years at a time and heal their brains.)
Our bodies also need dietary protein to repair our muscles. There are formulas we can use to calculate how much extra protein we need for this function.
If we eat enough protein, our bodies will not cannibalize lean muscle as we diet. So getting adequate protein is essential to healthy dieting. But there are limits to how much protein we should eat: too much protein will not only stall weight loss but will produce the unpleasant "diet breath" that many dieters erroneously attribute to ketones. In addition, excess protein can turn into glucose and raise blood sugar. So our goal when dieting should be to eat only as much protein as we actually need.
Once we know how much protein and carbohydrate we are going to be eating, the next question we need to ask is how many calories we want to eat. The traditional diet advice is to calculate your resting metabolic rate (BMR) --the amount of energy you use just breathing, digesting, and pushing blood around your body, and add to this the amount of calories burned by activity.
Many formulas exist to estimate the BMR, though they work best for large populations, not individuals. I reviewed the research that tested these formulas against actual measured BMRs, and it looks like the formulas that do the best job at estimating BMR in real people are the Mifflin-St Jeor formulas.
It turns out that the Harris-Benedict equations that many web sites use in their calculators were developed in the early 1900s and err by 18% when tested in the lab. They often overestimate calories burned and dieters who use them to set caloric goals may end up overeating.
Once we know how many calories we are supposedly burning, we can, in theory, lose a pound a week by eating 500 calories less than we are burning. This allows us to set a calorie goal.
Once we know how many calories we want to eat, we can calculate how much fat we can add to our previously computed protein and carbohydrate intake to come up with a final macronutrient prescription.
I've put together a calculator that will compute your own macronutrient prescription using the principles just outline and I'm inviting you to test it out.
The calculator is only designed to prescribe macronutrients to people on a ketogenic low carbohydrate diet, defined arbitrarily as one that does not exceed 80 grams of carbohydrate a day. It is only for adult use and should not be used by people older than 75 whose BMR is not calculated properly by the Mifflin-St Jeor formula.
It prescribes a nutrient breakdown for both maintaining your weight and for losing weight. However, no matter what your metabolic needs. It will not prescribe a diet of under 1100 calories a day out of a belief that eating below that level may unduly slow our metabolisms.
I put this calculator forth understanding that many people eating very low carb diets find it possible to eat more calories than nutrition formulas predict and still lose weight or maintain weight. Turn to this calculator if you are stalled.
This is a beta version. I'd be very interested in hearing from those of you who track your nutrients how well the calculator's prescriptions match your own experience with successful weight loss.
For those of you who are stalling on your diets, I'd be very interested in hearing whether using its prescriptions can help you break your stall.
Here's the link to the calculator:
Calculate Your Nutrient Balance on A Ketogenic Low Carbohydrate Diet
Please post your feedback about the calculator in the comment section of this post.
Thanks!
For many years I have used nutritional software and a food scale to track and log my food intake when I diet, so I have a very good idea of what I'm eating. But recently I've gotten curious about the impact of macronutrient balance: how much of a difference it makes when we change the proportions of protein, carbohydrate and fat that total up to a given caloric intake.
When we cut carbs, we know we have to raise our protein intake high enough to provide the raw material from which the liver can synthesize the glucose it needs to run the brain--the only organ that requires some glucose to keep running. At the outset of a ketogenic diet the brain requires about 100 grams of protein.
We also know--though many supposedly trained nutritionists do not--that after three weeks on a ketogenic diet, the brain's requirements for glucose drop significantly--to about 40 grams a day--as it ramps up to run on ketones instead.
(This last phenomenon is why children with certain kinds of epilepsy are able to eat extremely low carbohydrate diets for years at a time and heal their brains.)
Our bodies also need dietary protein to repair our muscles. There are formulas we can use to calculate how much extra protein we need for this function.
If we eat enough protein, our bodies will not cannibalize lean muscle as we diet. So getting adequate protein is essential to healthy dieting. But there are limits to how much protein we should eat: too much protein will not only stall weight loss but will produce the unpleasant "diet breath" that many dieters erroneously attribute to ketones. In addition, excess protein can turn into glucose and raise blood sugar. So our goal when dieting should be to eat only as much protein as we actually need.
Once we know how much protein and carbohydrate we are going to be eating, the next question we need to ask is how many calories we want to eat. The traditional diet advice is to calculate your resting metabolic rate (BMR) --the amount of energy you use just breathing, digesting, and pushing blood around your body, and add to this the amount of calories burned by activity.
Many formulas exist to estimate the BMR, though they work best for large populations, not individuals. I reviewed the research that tested these formulas against actual measured BMRs, and it looks like the formulas that do the best job at estimating BMR in real people are the Mifflin-St Jeor formulas.
It turns out that the Harris-Benedict equations that many web sites use in their calculators were developed in the early 1900s and err by 18% when tested in the lab. They often overestimate calories burned and dieters who use them to set caloric goals may end up overeating.
Once we know how many calories we are supposedly burning, we can, in theory, lose a pound a week by eating 500 calories less than we are burning. This allows us to set a calorie goal.
Once we know how many calories we want to eat, we can calculate how much fat we can add to our previously computed protein and carbohydrate intake to come up with a final macronutrient prescription.
I've put together a calculator that will compute your own macronutrient prescription using the principles just outline and I'm inviting you to test it out.
The calculator is only designed to prescribe macronutrients to people on a ketogenic low carbohydrate diet, defined arbitrarily as one that does not exceed 80 grams of carbohydrate a day. It is only for adult use and should not be used by people older than 75 whose BMR is not calculated properly by the Mifflin-St Jeor formula.
It prescribes a nutrient breakdown for both maintaining your weight and for losing weight. However, no matter what your metabolic needs. It will not prescribe a diet of under 1100 calories a day out of a belief that eating below that level may unduly slow our metabolisms.
I put this calculator forth understanding that many people eating very low carb diets find it possible to eat more calories than nutrition formulas predict and still lose weight or maintain weight. Turn to this calculator if you are stalled.
This is a beta version. I'd be very interested in hearing from those of you who track your nutrients how well the calculator's prescriptions match your own experience with successful weight loss.
For those of you who are stalling on your diets, I'd be very interested in hearing whether using its prescriptions can help you break your stall.
Here's the link to the calculator:
Calculate Your Nutrient Balance on A Ketogenic Low Carbohydrate Diet
Please post your feedback about the calculator in the comment section of this post.
Thanks!
January 8, 2009
Gum Disease Worsens Diabetes: Another Crazy Bernstein Idea Validated
Back when I first was diagnosed, a lot of people warned me not to pay any attention to that crazy Dr. Bernstein and his wacko fringe-science ideas.
And what wacko ideas they were!
In the first, 1997 edition of his landmark book, Dr. Bernstein's Diabetes Solution
Dr. Bernstein told people with diabetes that the 7% A1c was too high to prevent complications. He insisted people with diabetes who maintained normal blood sugars would not get the complications most other doctors believed to be inevitable. He told us that the secret to living long and healthy lives with diabetes was to cut way, way down on carbohydrates and eat as much fat as we wanted, assuring us that fat did not cause heart disease even though every other health authority in the world insisted it did.
Wacky stuff indeed, though what is even wackier is that a decade later there is growingevidence that he was correct on all these points and thousands of people with diabetes have lived through the decade without complications thanks to following his advice.
But the point of this post is not to gloat, but to point to an even wackier Bernstein idea that has suddenly veered into the mainstream--one that few readers of Bernstein seem to have noticed and one rarely discussed on online discussion groups.
That point is this: Dr. Bernstein insists that gum infections are a major cause of elevated blood sugars and that treating these infections aggressively can dramatically lower blood sugars.
It has long been known that gum disease is more common among people with diabetes and that people with diabetes who have gum disease tend to have more severe cases of gum disease than people without diabetes diagnoses. But the conclusion most researchers drew from this finding was that gum disease was simply just another complication of diabetes.
New research is changing this, for several reasons. First of all, new research has shown that the physiological response to gum disease is a body-wide inflammatory response that raises TNF-alpha which in turn increases insulin resistance, a finding earlier seen in the diabetic Zucker rat.
Recent research into cardiovascular disease has also found that untreated gum disease raises CRP and that treating gum disease can lower carotid intima-media thickness which is the currently fashionable measure of whether heart disease is being reversed.
Other research has found a connection between gum disease and the development of gestational diabetes.
The presence of gum disease also seems connected to a person's likelihood of developing severe diabetic complications. A study of Pima Indians found that gum disease was a strong predictor of mortality in Pima with diabetes. However, until recently not much research has looked at whether treating gum disease can lower blood sugars and decrease the incidence of complications.
A study of 165 veterans found that over a period of four months those given periodontal care had slightly better blood sugars and were less likely to need higher insulin doses, though it is not clear how much periodontal treatment these veterans received or whether four months is enough time to draw conclusions about the treatment's efficacy.
Another study, reported today in Science News found that treating gum disease lowered the costs of treating diabetes. This was a larger study of 2,674 people with Blue Cross insurance who received at least a year's worth of periodontal treatment. The authors conclude,
What all this new research means for you, if you have diabetes or prediabetes, is that, just as Dr. Bernstein states, it is essential that you take an aggressive approach to dental health with the emphasis on "aggressive".
The usual care dentists recommend may not be enough. Over the years, I have seen quite a few acquaintances lose all their teeth despite regular visits to the dentist. My impression is that this happens because dentists wait until gum disease is well established before recommending treatment and that they rarely use systemic antibiotics to treat it, relying instead on mechanical treatments like scaling.
Dr. Bernstein suggests that it may take many months of treatment with antibiotics to heal dental infections, a controversial position given that antibiotic over-use brings its own load of problems. However, he claims he has seen this approach work very well to help people with diabetes regain excellent blood sugar control. So if you have diabetes and periodontal disease that is progressing despite standard treatments, it might be worth investigating this approach further.
If you have diabetes or prediabetes and do not yet have significant gum disease, the single most helpful thing you can do is to floss your teeth every day. Brushing does not prevent gum disease, and, in fact, brushing with hard or even medium toothbrushes may cause gums to recede which promotes the development of gum disease.
Get into the habit of flossing at least once a day. If at first your gums bleed a lot or are painful, keep at it, over time they should toughen up and get healthier and bleeding will stop.
If you are told you have any pockets in the gums around your teeth, don't take a "watchful waiting" approach. Even low levels of gum infection will be calling forth an inflammatory response in your arteries and causing them to clog up. That same inflammatory response may increase damage to your nerves and kidneys. And of course, any infection will raise your blood sugars. So if you have any sign of gum disease, it is essential that you see a periodontist and do whatever you can to heal up your gums. If possible, look for a periodontist who supports your search for complete healing of your gum disease.
Eating a low carb diet may be helpful in preventing gum disease from starting. I cannot find any research to back this up, but over the years every hygienist who has cleaned my teeth has remarked on how little scale they have accumulated, even when I have gone longer than usual periods between cleanings. This has been true even when I have eaten closer to 100 grams a day of carbohydrate rather than a Bernstein-style much lower carbohydrate intake.
However, if you already have established bacterial colonies living deep within your gums, diet along may not be enough to solve the problem and you should visit a good periodontist.
The other major risk factor for gum disease is smoking. Smokers are much more likely to lose their teeth as they age and it may take years after you quit smoking to recover from the damage that smoking has done to your blood vessels. So if you have smoked in the past decade, assume you have early gum disease and ask your dentist to help you reverse it.
NOTE: Gum disease appears to be yet another of the unpleasant chronic diseases that attract vultures who prey on victims by promising miracle cures available only on the internet to those willing to pay a lot of money better spent on real dental help. Do not fall for these schemes!
And what wacko ideas they were!
In the first, 1997 edition of his landmark book, Dr. Bernstein's Diabetes Solution
Dr. Bernstein told people with diabetes that the 7% A1c was too high to prevent complications. He insisted people with diabetes who maintained normal blood sugars would not get the complications most other doctors believed to be inevitable. He told us that the secret to living long and healthy lives with diabetes was to cut way, way down on carbohydrates and eat as much fat as we wanted, assuring us that fat did not cause heart disease even though every other health authority in the world insisted it did.Wacky stuff indeed, though what is even wackier is that a decade later there is growingevidence that he was correct on all these points and thousands of people with diabetes have lived through the decade without complications thanks to following his advice.
But the point of this post is not to gloat, but to point to an even wackier Bernstein idea that has suddenly veered into the mainstream--one that few readers of Bernstein seem to have noticed and one rarely discussed on online discussion groups.
That point is this: Dr. Bernstein insists that gum infections are a major cause of elevated blood sugars and that treating these infections aggressively can dramatically lower blood sugars.
It has long been known that gum disease is more common among people with diabetes and that people with diabetes who have gum disease tend to have more severe cases of gum disease than people without diabetes diagnoses. But the conclusion most researchers drew from this finding was that gum disease was simply just another complication of diabetes.
New research is changing this, for several reasons. First of all, new research has shown that the physiological response to gum disease is a body-wide inflammatory response that raises TNF-alpha which in turn increases insulin resistance, a finding earlier seen in the diabetic Zucker rat.
Recent research into cardiovascular disease has also found that untreated gum disease raises CRP and that treating gum disease can lower carotid intima-media thickness which is the currently fashionable measure of whether heart disease is being reversed.
Other research has found a connection between gum disease and the development of gestational diabetes.
The presence of gum disease also seems connected to a person's likelihood of developing severe diabetic complications. A study of Pima Indians found that gum disease was a strong predictor of mortality in Pima with diabetes. However, until recently not much research has looked at whether treating gum disease can lower blood sugars and decrease the incidence of complications.
A study of 165 veterans found that over a period of four months those given periodontal care had slightly better blood sugars and were less likely to need higher insulin doses, though it is not clear how much periodontal treatment these veterans received or whether four months is enough time to draw conclusions about the treatment's efficacy.
Another study, reported today in Science News found that treating gum disease lowered the costs of treating diabetes. This was a larger study of 2,674 people with Blue Cross insurance who received at least a year's worth of periodontal treatment. The authors conclude,
The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent.This suggests that treating gum disease may indeed improve the course of diabetes, though we will have to wait for this study to be published to see if there is actual data published about the impact of treating gum disease on the participants' blood sugars.
What all this new research means for you, if you have diabetes or prediabetes, is that, just as Dr. Bernstein states, it is essential that you take an aggressive approach to dental health with the emphasis on "aggressive".
The usual care dentists recommend may not be enough. Over the years, I have seen quite a few acquaintances lose all their teeth despite regular visits to the dentist. My impression is that this happens because dentists wait until gum disease is well established before recommending treatment and that they rarely use systemic antibiotics to treat it, relying instead on mechanical treatments like scaling.
Dr. Bernstein suggests that it may take many months of treatment with antibiotics to heal dental infections, a controversial position given that antibiotic over-use brings its own load of problems. However, he claims he has seen this approach work very well to help people with diabetes regain excellent blood sugar control. So if you have diabetes and periodontal disease that is progressing despite standard treatments, it might be worth investigating this approach further.
If you have diabetes or prediabetes and do not yet have significant gum disease, the single most helpful thing you can do is to floss your teeth every day. Brushing does not prevent gum disease, and, in fact, brushing with hard or even medium toothbrushes may cause gums to recede which promotes the development of gum disease.
Get into the habit of flossing at least once a day. If at first your gums bleed a lot or are painful, keep at it, over time they should toughen up and get healthier and bleeding will stop.
If you are told you have any pockets in the gums around your teeth, don't take a "watchful waiting" approach. Even low levels of gum infection will be calling forth an inflammatory response in your arteries and causing them to clog up. That same inflammatory response may increase damage to your nerves and kidneys. And of course, any infection will raise your blood sugars. So if you have any sign of gum disease, it is essential that you see a periodontist and do whatever you can to heal up your gums. If possible, look for a periodontist who supports your search for complete healing of your gum disease.
Eating a low carb diet may be helpful in preventing gum disease from starting. I cannot find any research to back this up, but over the years every hygienist who has cleaned my teeth has remarked on how little scale they have accumulated, even when I have gone longer than usual periods between cleanings. This has been true even when I have eaten closer to 100 grams a day of carbohydrate rather than a Bernstein-style much lower carbohydrate intake.
However, if you already have established bacterial colonies living deep within your gums, diet along may not be enough to solve the problem and you should visit a good periodontist.
The other major risk factor for gum disease is smoking. Smokers are much more likely to lose their teeth as they age and it may take years after you quit smoking to recover from the damage that smoking has done to your blood vessels. So if you have smoked in the past decade, assume you have early gum disease and ask your dentist to help you reverse it.
NOTE: Gum disease appears to be yet another of the unpleasant chronic diseases that attract vultures who prey on victims by promising miracle cures available only on the internet to those willing to pay a lot of money better spent on real dental help. Do not fall for these schemes!
January 6, 2009
More Post-Holiday Detox Diet Suggestions
I've finished up one week of my two week post-holiday detox diet and have taken off a surprising amount of water weight, which is good news. It looks like one reason I gained so much weight over the holidays appears to be that using much more insulin than usual increased the amount of fluid in my body.
I hope you are doing well on whatever New Years diet you decided to try. But if you are having trouble getting back on track here are some more ideas that might help.
1. Keep it Simple! One problem with taking on a complex new diet is that it forces you to think about food all day long. You spend hours hunting up recipes. You look at pictures of delectable foods that fit your new diet scheme. You count the hours until you can eat power snack number 4 with its glucommanan noodles, coconut oil and flax sauce. You make a special trip to Whole Foods to buy some "must have" supplement or magical weight loss promoting food and end up surrounded by an ocean of foods you must NOT have which makes it that much harder to stay on track.
This is a great way to sabotage a baby diet. When you are detoxing from eating too much food, what you really need to do is to STOP THINKING ABOUT FOOD. The best way to do that is to decide in advance what you will eat. Buy what you need at the store. Decide what you'll have for lunch in advance. Make those choices non-negotiable for the two weeks of your detox diet. And then eat only those foods.
No new recipes. No new ingredients. No fancy "miracle weight loss" supplements. Just eat the stuff you decided to eat at the start of your diet and the essential supplements you may need for health: B vitamins if you are dispensing with grains or potassium if you are doing a diuretic diet.
Simplifying your diet this way makes it much easier to stop thinking about food and when you do that, you are more likely to succeed.
Once you are through your detox diet and have broken the cycle of overeating, you can adjust your diet and work in some new recipes. You can buy novel ingredients and even throw away your money on miracle diet aids if you want to, though I'd suggest you use that money for high quality veggies, meats, or cheeses instead.
2. Solve Hunger First Then Start Cutting Back on Portion Size. All weight loss diets succeed --when they do succeed which is not all that often--because they get you to cut back on how much you eat. Physiological hunger is the biggest foe you face when you start a new diet and the one that derails a lot of us. But the worst way to start a new diet is to cut way back on portions when your body is still in raging hunger mode.
If your diet is one that cuts back on carbohydrates--and if you have diabetes, I certainly hope it is--there is a very useful trick that will save you a couple days of misery at the start of your diet. The trick is to allow yourself to eat as much and as often as you want as long as the foods you eat do not contain more carbohydrates than your target amount. You probably aren't going to lose weight doing this, except for the water weight that is common at the beginning of most low carb diets.
But you will lower your blood sugars in a way that after two or three days will give you the flatter blood sugar curves that eliminate physiological hunger except when your stomach is empty and you really need to eat.
Once you get to the point where your blood sugar is not rocketing up and down, you will stop feeling inappropriate hunger and it gets a lot easier to eat less. Once you get to that stage, you will have to cut back on portions. But it is a lot easier to eat less when you aren't hungry and aren't obsessing about food.
I hope you are doing well on whatever New Years diet you decided to try. But if you are having trouble getting back on track here are some more ideas that might help.
1. Keep it Simple! One problem with taking on a complex new diet is that it forces you to think about food all day long. You spend hours hunting up recipes. You look at pictures of delectable foods that fit your new diet scheme. You count the hours until you can eat power snack number 4 with its glucommanan noodles, coconut oil and flax sauce. You make a special trip to Whole Foods to buy some "must have" supplement or magical weight loss promoting food and end up surrounded by an ocean of foods you must NOT have which makes it that much harder to stay on track.
This is a great way to sabotage a baby diet. When you are detoxing from eating too much food, what you really need to do is to STOP THINKING ABOUT FOOD. The best way to do that is to decide in advance what you will eat. Buy what you need at the store. Decide what you'll have for lunch in advance. Make those choices non-negotiable for the two weeks of your detox diet. And then eat only those foods.
No new recipes. No new ingredients. No fancy "miracle weight loss" supplements. Just eat the stuff you decided to eat at the start of your diet and the essential supplements you may need for health: B vitamins if you are dispensing with grains or potassium if you are doing a diuretic diet.
Simplifying your diet this way makes it much easier to stop thinking about food and when you do that, you are more likely to succeed.
Once you are through your detox diet and have broken the cycle of overeating, you can adjust your diet and work in some new recipes. You can buy novel ingredients and even throw away your money on miracle diet aids if you want to, though I'd suggest you use that money for high quality veggies, meats, or cheeses instead.
2. Solve Hunger First Then Start Cutting Back on Portion Size. All weight loss diets succeed --when they do succeed which is not all that often--because they get you to cut back on how much you eat. Physiological hunger is the biggest foe you face when you start a new diet and the one that derails a lot of us. But the worst way to start a new diet is to cut way back on portions when your body is still in raging hunger mode.
If your diet is one that cuts back on carbohydrates--and if you have diabetes, I certainly hope it is--there is a very useful trick that will save you a couple days of misery at the start of your diet. The trick is to allow yourself to eat as much and as often as you want as long as the foods you eat do not contain more carbohydrates than your target amount. You probably aren't going to lose weight doing this, except for the water weight that is common at the beginning of most low carb diets.
But you will lower your blood sugars in a way that after two or three days will give you the flatter blood sugar curves that eliminate physiological hunger except when your stomach is empty and you really need to eat.
Once you get to the point where your blood sugar is not rocketing up and down, you will stop feeling inappropriate hunger and it gets a lot easier to eat less. Once you get to that stage, you will have to cut back on portions. But it is a lot easier to eat less when you aren't hungry and aren't obsessing about food.
January 4, 2009
Meter Madness: Free Ultra Mini Meter Offer
I've been comparing my Ultras to the Aviva for several days and am seeing some very troubling high readings on the Accu-chek when my Ultras read in my target range. This reminds me of why I switched from an ultra to an Aviva three years ago.
Sometimes the Ultras and the Aviva match, sometimes the Aviva can read as much as 35 mg/dl higher on the same blood stick while the two Ultras (one an Ultra 2 and one a plain old Ultra) match within plus or minus 5 mg/dl.
When the Ultras give me a fasting blood sugar reading of 85 mg/dl and 90 mg/dl respectively when the Aviva says 118 mg/dl, I have to wonder about the Aviva. Especially when the next morning the Aviva reads LOWER than the Ultras the first time I test and matches exactly the second time. My first Aviva three years ago read almost 40 mg/dl higher than a lab draw taken a minute before.
Because several of the CGMS companies now use Ultra meters to calibrate their CGMSes I suspect that the Ultra is more accurate.
But both my Ultras are a couple years old and meters can degrade as they get older, so I don't want to draw any final conclusions until I compare the Aviva to a new Ultra. I found an offer for a free Ultra Mini on the LifeScan site and applied for one. If they send it to me, I'll compare the new mini to the Aviva.
If you would like a free Ultra mini, here is the link:
LifeScan Diabetes Meter Offer
The Ultra comes with 10 strips. Unfortunately the strips for both meters are extremely expensive without insurance coverage, so beyond the free strips, these offers are not good options for someone without insurance. Wal-Mart Relion meters use much cheaper strips.
If you have taken up the Aviva offer to see if you have diabetes treat the result as being a ballpark figure. Anything in the 200 plus or minus 20 mg/dl range probably does point to diabetes but at the lower range--85-120 mg/dl the result may be plus or minus 30 mg/dl or worse. Test a couple times. The number of strips that come with the free Aviva make that possible.
Don't waste strips on the control solution test. When my meters were reading 40% different from each other, they both checked out fine with control solution tests.
UPDATE: The Ultra Mini appears to be a repackaging of the old Ultra, but it's faster, which is a huge plus, as you aren't as liable to test before the meter is ready and waste a strip. It matches well with my old Ultras.
It doesn't keep detailed records of your past readings and break them out by post meal and fasting, which the Ultra 2 or Ultrasmart will do.
I like mine, especially for purse carry. Small and fast.
Sometimes the Ultras and the Aviva match, sometimes the Aviva can read as much as 35 mg/dl higher on the same blood stick while the two Ultras (one an Ultra 2 and one a plain old Ultra) match within plus or minus 5 mg/dl.
When the Ultras give me a fasting blood sugar reading of 85 mg/dl and 90 mg/dl respectively when the Aviva says 118 mg/dl, I have to wonder about the Aviva. Especially when the next morning the Aviva reads LOWER than the Ultras the first time I test and matches exactly the second time. My first Aviva three years ago read almost 40 mg/dl higher than a lab draw taken a minute before.
Because several of the CGMS companies now use Ultra meters to calibrate their CGMSes I suspect that the Ultra is more accurate.
But both my Ultras are a couple years old and meters can degrade as they get older, so I don't want to draw any final conclusions until I compare the Aviva to a new Ultra. I found an offer for a free Ultra Mini on the LifeScan site and applied for one. If they send it to me, I'll compare the new mini to the Aviva.
If you would like a free Ultra mini, here is the link:
LifeScan Diabetes Meter Offer
The Ultra comes with 10 strips. Unfortunately the strips for both meters are extremely expensive without insurance coverage, so beyond the free strips, these offers are not good options for someone without insurance. Wal-Mart Relion meters use much cheaper strips.
If you have taken up the Aviva offer to see if you have diabetes treat the result as being a ballpark figure. Anything in the 200 plus or minus 20 mg/dl range probably does point to diabetes but at the lower range--85-120 mg/dl the result may be plus or minus 30 mg/dl or worse. Test a couple times. The number of strips that come with the free Aviva make that possible.
Don't waste strips on the control solution test. When my meters were reading 40% different from each other, they both checked out fine with control solution tests.
UPDATE: The Ultra Mini appears to be a repackaging of the old Ultra, but it's faster, which is a huge plus, as you aren't as liable to test before the meter is ready and waste a strip. It matches well with my old Ultras.
It doesn't keep detailed records of your past readings and break them out by post meal and fasting, which the Ultra 2 or Ultrasmart will do.
I like mine, especially for purse carry. Small and fast.
January 2, 2009
Diet Ideas for your Post Holiday Detox
Here are a few suggestions that can help you recover from the holidays.
1. Do a Two Week Diet.
There are a lot of things you can tolerate for two weeks that are too daunting to contemplate for longer. And if you can get through two weeks, you will have broken the bad habits and rollercoaster blood sugars you developed during the holidays. Once you have a modest success behind you, you can set a second goal.
Too many people fail with their New Years diets because they are too ambitious. Instead of deciding to lose 100 lbs., try for five. After you lose those five pounds, you can work on losing five more. Do that twenty times and you've lost 100 lbs. But even if you only lose five, or ten lbs before you burn out on your diet, you'll have lost a lot more than most people lose on their New Year's Resolution diets.
2. Blood Sugar Control is More Important than Dieting for Weight Loss.
First things first. We'd all like to be slender, but if your blood sugars are out of control, the only diet that will improve your health is one that gets those blood sugars back down to safe levels.
Though doctors often tell people that losing weight will improve their blood sugars or "reverse" their diabetes, this is rarely true. The good news is that you can improve your blood sugars and prevent diabetic complications without losing a single pound if you follow the strategy you'll find explained here:
How to Get Your Blood Sugar Under Control
Once you have lowered your blood sugar to a safe range using the above technique--one that does not require you to restrict your food or work yourself into a state of deprivation--you can decide if you want to take on the much more stringent diet needed to achieve weight loss.
Many people will find it easier to lose weight once they get their blood sugars back in control because they will have lowered their insulin resistance or insulin usage. Flattening blood sugars also eliminates much of the intense hunger that leads to compulsive eating. Others of us will still have to struggle to lose weight, even with good blood sugars. Especially those of us who are older, female, or who have thyroid issues.
The good news is that with or without weight loss, if you are achieving safe blood sugar levels you can stop worrying about neuropathy, retinopathy and kidney damage.
3. If It Isn't There, You Can't Eat it.
The biggest mistake a lot of us make is relying on willpower to keep us from eating whatever it is we've decided not to eat as part of our new diet. This rarely works. So the first step to take if you want your new diet to succeed--whatever its goal--is to get rid of the foods that might derail you.
Go through your fridge and cupboards and remove all the foods you don't want to be eating over the next two weeks. If they are perishable, give them to someone who can use them without compromising their health. If they aren't, put them in a box in the basement out of sight.
If your home, like ours, is currently full of food gifts you don't want to throw out, give them to a family member and ask them to put them away someplace secret until the two weeks of your diet is over. By then you will have broken the out-of-control eating cycle and can decide what you want to do with them.
Along the same lines for two weeks do not go to restaurants where you know you'll be tempted to eat things that you can't handle. Do not accept invitations to dine with vegan friends or low fat dieters. For two weeks keep your environment as diet friendly as possible.
4. Stay Away from All Diet Foods No Matter What Their Labels Might Claim.
Eat real food: meat, cheese, nuts, and vegetables and leave the frankenfoods on the shelf. The foods, shakes, and bars sold as "Low Carb" are full of high carb additives that raise blood sugar and stall weight loss. Most contain soy which is thyrotoxic and bad for many of us. All are full of preservatives and other questionable chemicals. For this two week diet, shop the edges of your supermarket, avoid packaged food, and try to eat the foods your great-grandmother would had in her larder.
When you are back in control and have attained your first diet goal you can gingerly experiment to see if you can tolerate any of these foods, but for now, use the money you would have spent on them to buy fresh greens and vegetables filled with the naturally occurring nutrients your body will thank you for.
5. Ask Your Friends and Family to Support Your Goals.
People who love you may do the most to undermine you because they don't understand what is at stake. They want you to be happy and may associate food with happiness. So you must explain to them why it is important that you achieve your current goal and make it clear that you can accept nothing but complete support from them.
Be clear that you are NOT asking them to diet. Many times family members will sabotage your diet because they don't want to diet themselves and your dieting is confrontational. Just as you can't stop another person from drinking, you can't tell someone else what to eat.
In a calm and nonconfrontational manner, explain why this diet is important for you and what you need your family members, friends, or workmates to do to help you out for the next two weeks.
Suggest that family members buy snack foods, desserts and treats that you don't like. Not the ones that will call to you from the fridge. If family members are not supportive, print out a photo of a "diabetic foot" which you will find searching Google Images and ask them if they really want you to end up with one of those.
Right now is a great time to do an effective diet detox because everyone is thinking of dieting--at least for the next two weeks--and it is a lot easier to get going now than at any other time of the year. Expect the first two days to be tough and if you need help getting through them, visit one of the diet support groups or one of the online diabetes support groups.
You aren't the only person who has gone off the rails this holiday season. With this modest but effective approach, you may end up being one of the few who gets back on.
1. Do a Two Week Diet.
There are a lot of things you can tolerate for two weeks that are too daunting to contemplate for longer. And if you can get through two weeks, you will have broken the bad habits and rollercoaster blood sugars you developed during the holidays. Once you have a modest success behind you, you can set a second goal.
Too many people fail with their New Years diets because they are too ambitious. Instead of deciding to lose 100 lbs., try for five. After you lose those five pounds, you can work on losing five more. Do that twenty times and you've lost 100 lbs. But even if you only lose five, or ten lbs before you burn out on your diet, you'll have lost a lot more than most people lose on their New Year's Resolution diets.
2. Blood Sugar Control is More Important than Dieting for Weight Loss.
First things first. We'd all like to be slender, but if your blood sugars are out of control, the only diet that will improve your health is one that gets those blood sugars back down to safe levels.
Though doctors often tell people that losing weight will improve their blood sugars or "reverse" their diabetes, this is rarely true. The good news is that you can improve your blood sugars and prevent diabetic complications without losing a single pound if you follow the strategy you'll find explained here:
How to Get Your Blood Sugar Under Control
Once you have lowered your blood sugar to a safe range using the above technique--one that does not require you to restrict your food or work yourself into a state of deprivation--you can decide if you want to take on the much more stringent diet needed to achieve weight loss.
Many people will find it easier to lose weight once they get their blood sugars back in control because they will have lowered their insulin resistance or insulin usage. Flattening blood sugars also eliminates much of the intense hunger that leads to compulsive eating. Others of us will still have to struggle to lose weight, even with good blood sugars. Especially those of us who are older, female, or who have thyroid issues.
The good news is that with or without weight loss, if you are achieving safe blood sugar levels you can stop worrying about neuropathy, retinopathy and kidney damage.
3. If It Isn't There, You Can't Eat it.
The biggest mistake a lot of us make is relying on willpower to keep us from eating whatever it is we've decided not to eat as part of our new diet. This rarely works. So the first step to take if you want your new diet to succeed--whatever its goal--is to get rid of the foods that might derail you.
Go through your fridge and cupboards and remove all the foods you don't want to be eating over the next two weeks. If they are perishable, give them to someone who can use them without compromising their health. If they aren't, put them in a box in the basement out of sight.
If your home, like ours, is currently full of food gifts you don't want to throw out, give them to a family member and ask them to put them away someplace secret until the two weeks of your diet is over. By then you will have broken the out-of-control eating cycle and can decide what you want to do with them.
Along the same lines for two weeks do not go to restaurants where you know you'll be tempted to eat things that you can't handle. Do not accept invitations to dine with vegan friends or low fat dieters. For two weeks keep your environment as diet friendly as possible.
4. Stay Away from All Diet Foods No Matter What Their Labels Might Claim.
Eat real food: meat, cheese, nuts, and vegetables and leave the frankenfoods on the shelf. The foods, shakes, and bars sold as "Low Carb" are full of high carb additives that raise blood sugar and stall weight loss. Most contain soy which is thyrotoxic and bad for many of us. All are full of preservatives and other questionable chemicals. For this two week diet, shop the edges of your supermarket, avoid packaged food, and try to eat the foods your great-grandmother would had in her larder.
When you are back in control and have attained your first diet goal you can gingerly experiment to see if you can tolerate any of these foods, but for now, use the money you would have spent on them to buy fresh greens and vegetables filled with the naturally occurring nutrients your body will thank you for.
5. Ask Your Friends and Family to Support Your Goals.
People who love you may do the most to undermine you because they don't understand what is at stake. They want you to be happy and may associate food with happiness. So you must explain to them why it is important that you achieve your current goal and make it clear that you can accept nothing but complete support from them.
Be clear that you are NOT asking them to diet. Many times family members will sabotage your diet because they don't want to diet themselves and your dieting is confrontational. Just as you can't stop another person from drinking, you can't tell someone else what to eat.
In a calm and nonconfrontational manner, explain why this diet is important for you and what you need your family members, friends, or workmates to do to help you out for the next two weeks.
Suggest that family members buy snack foods, desserts and treats that you don't like. Not the ones that will call to you from the fridge. If family members are not supportive, print out a photo of a "diabetic foot" which you will find searching Google Images and ask them if they really want you to end up with one of those.
Right now is a great time to do an effective diet detox because everyone is thinking of dieting--at least for the next two weeks--and it is a lot easier to get going now than at any other time of the year. Expect the first two days to be tough and if you need help getting through them, visit one of the diet support groups or one of the online diabetes support groups.
You aren't the only person who has gone off the rails this holiday season. With this modest but effective approach, you may end up being one of the few who gets back on.
January 1, 2009
Free Meter & 60 Strips Offer from Accu-Chek
Accu-chek is offering a free Aviva meter with 60 strips and the really nice Multi-click lancet device at this page:
https://www.accu-chek.com/promo/us/avivaSkinsPromo.htm
I don't know how long the offer will be around, so if you are interested, you probably should go for it now.
If you have been wondering about whether you are diabetic, this is a great way to find out. I had an Aviva when the meter was brand new and it was not a good experience, but that was several years ago, and I took up the offer myself to check out how good the meter is now.
So far it is testing very close to my two Ultra 2s, which was not the case with the first Aviva I owned.
The company is making a big deal about offering "skins" for the meter. Obviously no one asked people with diabetes what they'd like to see improved with the meters. Like, say, accuracy. Or not failing if you test too quickly after turning the meter on. Or the ever escalating cost of strips.
Oh, well. I now have cheerful flowers on the front my new meter to console me for the ever rising price I pay for the testing that keeps me on track, even with great insurance (which is also ever-rising in price).
The Multi-click lancet is my favorite. It is much less painful than any other I have ever used. I find I can use one lancet needle for several months without any need to change it, so the pack of lancet drums I bought for my earlier device three years ago is likely to last me for the rest of my life. Don't twist the bottom of the lancet device or it will advance to a new lancet and you will not be able to reuse the old one.
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