February 21, 2011

Differing Brands of Generic Metformin Behave Differently

Dr. Bernstein has been preaching about this on his web telecasts for years, but it bears repeating: If you are having problems with generic metformin or not seeing it make much impact on your blood sugar, change brands before you assume it isn't working or that you can't tolerate it.

I just had this message brought home to me when my pharmacy (Walgreens) filled my prescription for metformin ER with tablets from SunPharma instead of the ones from Teva they'd given me for years.

The pills were about half the size of the ones I'd been getting, which suggested they contained less of a matrix substance to slow the release of the metformin. And sure enough, when I took the same dose I had been taking with no problems with the Teva brand metformin, I felt exhausted and semi-poisoned. It felt just like when I had taken an overdose of metformin some years ago, when my family doctor prescribed an overdose after confusing the dosage instructions for regular metformin--which can be taken in larger doses--with those of metformin ER.

Not only that, but my fasting blood sugars went up. Clearly the SunPharma metformin ER was not behaving like a true extended release should and releasing slowly through a 24 hour period but was hitting my blood stream all at once and then was done.

A quick visit to Google revealed that Sun Pharmaceuticals is an Indian company and that in the past the FDA has forced them to recall batches for quality issues.

When it was time to refill my prescription, I called my pharmacy and spoke with the pharmacist who shrugged off my concerns and told me I'd have to speak to the pharmacy manager (not available that day.) So I got on the phone and called other local pharmacies and asked them what brand they were dispensing. Two of them still carry the Teva brand, so I took my empty pill bottle to the closest one and they transferred the prescription and filled it with the Teva. I was very happy to find that it worked just the way I remembered, with no unpleasant side effects.

This experience made me wonder how many of the people who tell me they can't take metformin because of the side effects were victims of cheap versions like the SunPharma one.

If you try metformin and find the side effects overwhelming after a month's trial--typical problems would be dramatic digestive problems or a feeling of exhaustion and low grade toxicity--talk to your pharmacist about trying another brand or move your prescription to another pharmacy that carries another brand.

Dr. Bernstein says that the brand name version, Glucophage, is the best. I've never tried it so I can't verify that. If you can get it, go for it. I've heard that some pharmacies will order a specific brand for you if you ask, but before you do this, check how much the prescription will cost you as some insurers may not pay for your prescription if you specify the brand or they may make you to pay much more.

If you're taking metformin ER, which brand you are taking? How well does it work for you? Have you switched brands and seen a difference? Please cite the manufacturer name if you can. It would be nice to build up some expertise here as to how the different versions work. If I get enough feedback I'll add it to the page where I describe metformin on the Blood Sugar 101 site.

NOTE: You should be able to find the name of the manufacturer somewhere on your label. I believe this is a legal requirement in the U.S..


February 9, 2011

The Link Between Diet Soda Consumption and Stroke

A study to be presented at the International Stroke Conference 2011 in Los Angeles is getting some play in the health news. You can read a good summary here:

U.S News and World Report: Can Diet Soda Boost Your Stroke Risk?

The researchers "evaluated the soda habits of 2,564 people enrolled in the large Northern Manhattan Study (NOMAS) to see if there was an association, if any, with stroke. The participants were 69 years of age, on average, and completed food questionnaires about the type of soda they drank and how often."

Over 9 years, 22% of the study subjects had a stroke. After controlling for age, gender, ethnicity, physical activity, calorie intake, smoking, alcohol drinking habits, the presence of metabolic syndrome, vascular disease in the limbs and heart disease history those who reported drinking diet soda as opposed to no soda were 48 percent more likely to have a stroke.

In another article covering this same story published by MSNBC
other doctors are quoted as suggesting the problem might be what they eat with the soda--fast food, or possibly something in caramel coloring used to give sodas a brown color, which has been linked to stroke in animal studies.

Alert readers of this blog will, however, remember another equally likely explanation--one that has been known for years, but has received no coverage in the press, because the media get too much advertising money from Coke and Pepsi.

The link between diet soda and stroke may well be the phosphoric acid that is used in the all brown-colored sodas. As documented in my earlier blog post Coke Adds Death, brown-colored sodas are known to damage the kidneys. In fact, drinking as few as two brown-colored sodas--either diet or regular--a day doubles the risk of developing chronic kidney disease. Researchers believe the phosphoric acid is the culprit. Phosphates are a known problem for people who already have kidney disease.

It turns out that kidney damage and cardiovascular disease are tightly linked, and the presence of kidney disease often points to the existence of other vascular problems. This makes it very possible that damage to the kidney from phosporic acid is contributing to vascular damage in the brain which leads to stroke.

If phosphoric acid is the problem--and it is likely, since people consuming non-brown colored sodas had a normal risk of chronic kidney disesae, you can avoid it by avoiding heavily-advertised brown sodas like Coke, Pepsi and Dr. Pepper, in favor of the light and colored sodas that don't. If in doubt read the label. If it says "phosporic acid" give it a miss. People with diabetes have enough issues to contend with kidney-wise without adding to them.


February 8, 2011

Study Finds Dreamfields Pasta Produces Identical Glucose Curves as Regular Dry Pasta

UPDATE: The study referred to in this post was retracted by its authors and is no longer available online. The reason for the retraction was NOT that the data was wrong or that the study was misleading, but "because some of the data were obtained prior to receiving IRB [Institutional Review Board] approval."

Since it is not likely that the institution the authors of this study work retracted the study because of the horrifying ethical violation implied in forcing innocent volunteers to eat pasta—IRBs are set up to protect the public from unethical research—it’s likely someone did not have the deep pockets needed to withstand a lawsuit launched by the manufacturer of this profitable product that costs more than twice as much as regular pasta.

I have long been suspicious of the claims for Dreamfield's pasta that all but three grams of the over-50 grams reported on the label somehow mysteriously dissappear due to some magical process they refuse to describe. Now a report in this month's journal, Diabetes Care confirms I was right to be suspicious.

Here's the study:

Glycemic Response to Ingested Dreamfields Pasta Compared With Traditional PastaFrank Q. Nuttall et al.Diabetes Care January 26, 2011 vol. 34 no. 2 e17-e18. doi: 10.2337/dc10-1957

Here are the relevant graphs:


This study was done with subjects who did not have diabetes, however the significant and prolonged average blood sugar spike seen in the first group, suggests it contained someone (or two) with less "normal" blood sugars than would have been indicated by their fasting glucose test. The results make it clear that in thse study subjects, Dreamfields was metabolizing into glucose at the identical rate as cheap dry pasta.

Now mind you, the 50-some grams of carbohydrate in regular dry pasta does hit the blood sugar a lot more slowly than does bread of potatoes, which is why those dreadful diabetes magazines you find at your doctor's offices are full of pasta recipes.

But while dry pasta is a better choice than Froot Loops, as the curves on these graphs make clear, the carbohydrates contained in pasta trickle into the blood stream for hours after you eat. In people with Type 2 who still have a significant amount of second phase insulin response left, the trickle might be slow enough that you won't see a pronounced spike, but all that glucose will have to be metabolized--and most of it will turn into triglycerides and eventually be stored as body fat.

The data in this study explain to me why there are such varying reports within the diabetes community about whether Dreamfields does what the company claims it does, with some saying it works for them, and others reporting that it causes prolonged high blood sugars. Obviously, the people for whom Dreamfields works are still secreting enough second phase insulin to cover the long slow tail it produces.

But if Dreamfields does work for you, this study stronlgy suggests you could get the same effect from eating $.99 store brand pasta as you could eating the much more expensive Dreamfields. Just cook the regular pasta for the 9 minutes that Dreamfields suggests. Cooking any pasta longer than that will makes it digest more quickly.

Two last things:

1. Only cooked dry pasta metabolizes slowly. Fresh pasta--the kind you buy in the freezer section or at some fancy italian restaurants--is made with regular flour, not the more semolina flour that contains resistant starch. Fresh pasta digests very quickly and you will see a much larger spike after eating it.

2. The label portion size for a serving of pasta is tiny. Measure out 2 dry ounces on a cooking scale and cook it and you'll see what I mean. The serving of pasta you get at a restaurant is anywhere from 3 to 6 label portions. Since that very small 2 ounce portion contains over 50 grams of carbohydrate, the restaurant servings are anywhere from 150 to 300 grams. And that's without the "low fat" high carbohydrate sauce dumped on top.