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,

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!

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.

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.

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.

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.