Several of the online bookstores are listing my book, Blood Sugar 101, as being "out of stock." This is very temporary. Our distributor is adding UK distribution to their system, which required changing the listing in their database. This caused the book to be listed as "temporarily out of stock" while the update was applied
I'm assured that it will be back in stock within a few days, and when it is, UK buyers should be able to buy Blood Sugar 101 from online bookstores in the UK.
Thanks to everyone who has purchased the book until now. Sales are going really well. The Amazon ranking has been consistently high on the list of Type 2 books, which means people who aren't aware of this blog can find it on a search.
I'm so happy this is happening, as it means more people are getting the benefit of the information Blood Sugar 101 contains.
June 30, 2008
June 25, 2008
Details: The "Big Breakfast Diet" was Low Carb & Very Low Cal
There's been a lot of ignorant coverage of the supposed benefits of a high carb big breakfast for dieters.
Now Diabetes in Control has published the details of this study and they are quite different than what the media coverage would suggest.
Here are the pertinent facts:
1. The specific of the diets (emphasis mine):
The low-carb diet allowed 1,085 calories a day with 17 grams of carbohydrates, 51 grams of protein, and 78 grams of fat. Breakfast for members of this group was to be 290 calories with 7 grams of carbohydrates and 12 grams of protein.
The modified form of this diet allowed 1,240 calories a day with less total fat (46 grams) but more carbs (97 grams) and protein (93 grams). The main feature was a 610-calorie "big breakfast" accounting for about half of the daily carbohydrates (58 grams), protein (47 grams), and fat (22 grams).
2. So as you can see, both diets were both technically low carb. But the first version is TOO low carb. The carb intake on that diet is so low that it is not possible for dieters eating it to eat the healthy low carb greens and vegetables which are essential to eating a healthy low carb diet.
That "low carb" diet does not match the description of any of the low carb diets that long term low carbers eat. Even Dr. Bernstein--the most stringent of all the low carb diet gurus--allows his dieters 30 grams a day of carbohydrate with possibly another 6 gram snack and recommends eating those carbs in the form of low carb vegetables.
3. These diets were also very unhealthy because they were extremely low calorie. The dieters were eating at a level so low that they were likely to depress their metabolisms. This guarantees weight regain.
Moreover, the "low carb" diet had 14% less calories than the other diet, a significant difference quite capable of explaining the result independent of the meal composition.
The beauty of the low carb diet is that it makes it possible for obese people to lose weight while eating a lot more calories than is possible on other diets.
The weight regain suffered by the so-called low carb dieters may have been the usual rebound suffered by any dieter eating under 1200 calories a day. That the two diets had different calorie intake levels should make any result attributed to dietary composition suspect.
3. This study was done in normal people and the carb loading technique it explored is not suitable for people with diabetes. This is because people with diabetes are most resistant to insulin in he morning thanks to dawn effect. That means they would end up with very high blood sugars after such a high carb meal which would result in a blood sugar swing that would make them very hungry by lunch time, tempting them to eat more.
4. This was not a peer reviewed study. It was a "poster session" at a conference where the researchers briefly described their research. This means that the quality of the research still has to be assessed.
If there is any value to the finding here--which is questionable, it might be that eating more early in the day can help prevent the after dinner snacking that derails so many dieters. Unfortunately the poor design of this study makes it hard to know if it really proved that.
You can test the idea in your own diet by moving some calories to breakfast from lunch or dinner and seeing if it makes you less hungry. Make them fat or protein calories, though, as a high carb breakfast is guaranteed to make you hungry unless you have rock solid normal blood sugar!
Now Diabetes in Control has published the details of this study and they are quite different than what the media coverage would suggest.
Here are the pertinent facts:
1. The specific of the diets (emphasis mine):
The low-carb diet allowed 1,085 calories a day with 17 grams of carbohydrates, 51 grams of protein, and 78 grams of fat. Breakfast for members of this group was to be 290 calories with 7 grams of carbohydrates and 12 grams of protein.
The modified form of this diet allowed 1,240 calories a day with less total fat (46 grams) but more carbs (97 grams) and protein (93 grams). The main feature was a 610-calorie "big breakfast" accounting for about half of the daily carbohydrates (58 grams), protein (47 grams), and fat (22 grams).
2. So as you can see, both diets were both technically low carb. But the first version is TOO low carb. The carb intake on that diet is so low that it is not possible for dieters eating it to eat the healthy low carb greens and vegetables which are essential to eating a healthy low carb diet.
That "low carb" diet does not match the description of any of the low carb diets that long term low carbers eat. Even Dr. Bernstein--the most stringent of all the low carb diet gurus--allows his dieters 30 grams a day of carbohydrate with possibly another 6 gram snack and recommends eating those carbs in the form of low carb vegetables.
3. These diets were also very unhealthy because they were extremely low calorie. The dieters were eating at a level so low that they were likely to depress their metabolisms. This guarantees weight regain.
Moreover, the "low carb" diet had 14% less calories than the other diet, a significant difference quite capable of explaining the result independent of the meal composition.
The beauty of the low carb diet is that it makes it possible for obese people to lose weight while eating a lot more calories than is possible on other diets.
The weight regain suffered by the so-called low carb dieters may have been the usual rebound suffered by any dieter eating under 1200 calories a day. That the two diets had different calorie intake levels should make any result attributed to dietary composition suspect.
3. This study was done in normal people and the carb loading technique it explored is not suitable for people with diabetes. This is because people with diabetes are most resistant to insulin in he morning thanks to dawn effect. That means they would end up with very high blood sugars after such a high carb meal which would result in a blood sugar swing that would make them very hungry by lunch time, tempting them to eat more.
4. This was not a peer reviewed study. It was a "poster session" at a conference where the researchers briefly described their research. This means that the quality of the research still has to be assessed.
If there is any value to the finding here--which is questionable, it might be that eating more early in the day can help prevent the after dinner snacking that derails so many dieters. Unfortunately the poor design of this study makes it hard to know if it really proved that.
You can test the idea in your own diet by moving some calories to breakfast from lunch or dinner and seeing if it makes you less hungry. Make them fat or protein calories, though, as a high carb breakfast is guaranteed to make you hungry unless you have rock solid normal blood sugar!
June 24, 2008
A Giant Step Backwards: Misinterpreting ACCORD Harms People with Diabetes
The fallout from the ACCORD study continues, and it is going to cause a lot of unnecessary kidney failure and neuropathy.
If you'll remember, ACCORD was the study where they took people who had diabetes and preexisting heart disease , put them on every drug possible, including Avandia, Actos, Byetta and Insulin, encouraged them to eat a high carb/low fat diet and discovered that there were a very small number of so-called "excess deaths" in the group who achieved blood sugars nearer 6.5% compared to those who aimed for the old 7.0% ADA target.
The take home message from this for doctors was that lowering the A1c kills people with diabetes.
A second study, ADVANCE, which involved a lot more people with diabetes and lasted longer--a study which did NOT use Avandia, Actos, or Byetta found NO such excess deaths in the group that lowered their A1c. Not only that, but the group in the ADVANCE study that achieved the 6.5% A1cs had 21% less kidney disease--a major finding given how many type 2s end up on dialysis.
Clearly the problem illuminated in ACCORD was not that lowering A1c kills people with diabetes but that the combination of drugs given to people with diabetes to lower their blood sugar along with the high carbohydrate diet was not safe for people with preexisting heart disease.
The lack of excess deaths and the decrease in kidney disease found in the ADVANCE study should have in itself been reason to advise lowering the blood sugar targets for all people with diabetes using a protocol similar to that used in ADVANCE--which was one that did not use the newer, possibly more dangerous diabetes drugs. Ideally more scientific effort would now be put into analyzing the differences between the two studies to determine why ACCORD showed those excess cardiac deaths and the larger, longer ADVANCE study did not.
My guess is that the ACCORD population was sicker to start with--i.e. their diabetes was of much longer standing at the time the study began, that their diets were probably higher in carbs, trans fat, and junk food (ACCORD was an American study while ADVANCE was not), and that the addition of Avandia and Actos to their protocols--both known to be cardiotoxic--was probably more significant than the drug company funded researchers revealed.
Whatever the explanation, if your doctor tells you to RAISE your A1c to "be safe"--which I am hearing from my correspondents is becoming horrifyingly common-- remind him or her that:
1. There is NO study about the safety of lowering A1c using a low carb diet rather than using dangerous drugs like Actos and Avandia with the high carb/low fat diet that was used in ACCORD. All early indications from small studies are that lowering blood sugar by lowering carb intake improves all cardiovascular markers and does not worsen heart disease.
2. ADVANCE showed decisively that lowering A1c prevents kidney disease.
3. ADVANCE lasted longer and involved more people with diabetes than ACCORD and found NO increase in cardiac deaths.
There's a petition you can fill out addressing the NIH's dangerous issuing of a warning about the dangers of lowering A1c based on the ACCORD findings. You will find it here:
Petition: NIH must acknowledge existing science
Don't hold your breath expecting this to change anything.
If you'll remember, ACCORD was the study where they took people who had diabetes and preexisting heart disease , put them on every drug possible, including Avandia, Actos, Byetta and Insulin, encouraged them to eat a high carb/low fat diet and discovered that there were a very small number of so-called "excess deaths" in the group who achieved blood sugars nearer 6.5% compared to those who aimed for the old 7.0% ADA target.
The take home message from this for doctors was that lowering the A1c kills people with diabetes.
A second study, ADVANCE, which involved a lot more people with diabetes and lasted longer--a study which did NOT use Avandia, Actos, or Byetta found NO such excess deaths in the group that lowered their A1c. Not only that, but the group in the ADVANCE study that achieved the 6.5% A1cs had 21% less kidney disease--a major finding given how many type 2s end up on dialysis.
Clearly the problem illuminated in ACCORD was not that lowering A1c kills people with diabetes but that the combination of drugs given to people with diabetes to lower their blood sugar along with the high carbohydrate diet was not safe for people with preexisting heart disease.
The lack of excess deaths and the decrease in kidney disease found in the ADVANCE study should have in itself been reason to advise lowering the blood sugar targets for all people with diabetes using a protocol similar to that used in ADVANCE--which was one that did not use the newer, possibly more dangerous diabetes drugs. Ideally more scientific effort would now be put into analyzing the differences between the two studies to determine why ACCORD showed those excess cardiac deaths and the larger, longer ADVANCE study did not.
My guess is that the ACCORD population was sicker to start with--i.e. their diabetes was of much longer standing at the time the study began, that their diets were probably higher in carbs, trans fat, and junk food (ACCORD was an American study while ADVANCE was not), and that the addition of Avandia and Actos to their protocols--both known to be cardiotoxic--was probably more significant than the drug company funded researchers revealed.
Whatever the explanation, if your doctor tells you to RAISE your A1c to "be safe"--which I am hearing from my correspondents is becoming horrifyingly common-- remind him or her that:
1. There is NO study about the safety of lowering A1c using a low carb diet rather than using dangerous drugs like Actos and Avandia with the high carb/low fat diet that was used in ACCORD. All early indications from small studies are that lowering blood sugar by lowering carb intake improves all cardiovascular markers and does not worsen heart disease.
2. ADVANCE showed decisively that lowering A1c prevents kidney disease.
3. ADVANCE lasted longer and involved more people with diabetes than ACCORD and found NO increase in cardiac deaths.
There's a petition you can fill out addressing the NIH's dangerous issuing of a warning about the dangers of lowering A1c based on the ACCORD findings. You will find it here:
Petition: NIH must acknowledge existing science
Don't hold your breath expecting this to change anything.
June 18, 2008
Dr. Bernstein's Letter Recommending Blood Sugar 101
I posted earlier that Dr. Bernstein had written me a very nice letter praising my book, Blood Sugar 101. I wrote back and asked his permission to quote what he'd written and received that permission from him last week.
So here's what Dr. Bernstein had to say about my book:
"Thanks for sending me a copy of BLOOD SUGAR 101. I enjoyed it very much and actually learned a lot of important facts.
"I was impressed by your ability to scour the scientific literature and document your findings.
"I think this book should be read by all diabetics because of the valuable material that cannot be found elsewhere."
I am thrilled beyond words. Simply stated, there is no one in the world whose praise could mean more to me, because there is no one else whose own work has had such a huge impact on my life and health as Dr. Bernstein's has.
I had a terrible time getting a diagnosis because of the peculiar nature of my diabetes--very high blood sugars after meals, normal fasting blood sugar. Without Dr. Bernstein's book I might have gone for years more with the continual UTIs and yeast infections and have developed the heart disease that is endemic in the side of my family that carries this oddball diabetes gene.
But the tools he gave me in his books helped me get to near normal blood sugars, and also helped me understand enough about diabetes and its treatment to be able to evaluate the quality of the medical treatment I was getting.
He broke the way for a generation of people with diabetes--both Type 1 and Type 2--by championing the idea that lowering blood sugars will prevent complications years before that concept was proven by the DCCT, as this 1993 New York Times article makes that very clear: Vindication for a Diabetes Expert
For decades his was the sole voice calling for people with diabetes to cut the carbs, throughout the period when all people with diabetes were told that fat would kill them and the only safe diet for them was one that contained 300 g a day of "healthy carbs"--a diet that raised their blood sugar dramatically after every meal they ate.
Because many people with diabetes find the austerity of the diet that Dr. Bernstein recommends hard to accept, one of the things I set out to do when I did the research that led to Blood Sugar 101 was to learn what the academic research had found about the connection between blood sugar level and complications. This seemed to me the best way to determine if the blood sugar targets that Dr. Bernstein insists on are what is required for health.
My conclusion, based on the data, is that achieving Dr. Bernstein's blood sugar targets probably is ideal--especially if it can be done without using questionable drugs like the TZDs and sulfonylureas, but that true normal probably is a bit higher than what he prescribes. So it is likely that a slightly higher set of blood sugar targets probably confers the same health benefits as his do with the advantage of being easier to achieve for people who do not have personalities that incline them to iron discipline.
Dr. Bernstein addressed this difference between us, too, in his letter, which made his praise all the more valuable to me.
He wrote, "I wish that our guidelines for blood sugar targets and carbohydrate intake were closer together but this is a battle that I have been losing for many years."
But that said, I don't think he's losing that battle at all. I think his shadow lies over a whole generation of us who have learned how our blood sugar rises when we eat carbs, who use basal/bolus regimens (which he appears to have pioneered), and who are ten years or more past a diabetes diagnosis without having developed the horrible complications that even a decade ago most doctors assumed that we would get.
My book grows out of the revelations that his work provided and without his work, none of mine would have happened.
Thank you Dr. Bernstein.
So here's what Dr. Bernstein had to say about my book:
"Thanks for sending me a copy of BLOOD SUGAR 101. I enjoyed it very much and actually learned a lot of important facts.
"I was impressed by your ability to scour the scientific literature and document your findings.
"I think this book should be read by all diabetics because of the valuable material that cannot be found elsewhere."
I am thrilled beyond words. Simply stated, there is no one in the world whose praise could mean more to me, because there is no one else whose own work has had such a huge impact on my life and health as Dr. Bernstein's has.
I had a terrible time getting a diagnosis because of the peculiar nature of my diabetes--very high blood sugars after meals, normal fasting blood sugar. Without Dr. Bernstein's book I might have gone for years more with the continual UTIs and yeast infections and have developed the heart disease that is endemic in the side of my family that carries this oddball diabetes gene.
But the tools he gave me in his books helped me get to near normal blood sugars, and also helped me understand enough about diabetes and its treatment to be able to evaluate the quality of the medical treatment I was getting.
He broke the way for a generation of people with diabetes--both Type 1 and Type 2--by championing the idea that lowering blood sugars will prevent complications years before that concept was proven by the DCCT, as this 1993 New York Times article makes that very clear: Vindication for a Diabetes Expert
For decades his was the sole voice calling for people with diabetes to cut the carbs, throughout the period when all people with diabetes were told that fat would kill them and the only safe diet for them was one that contained 300 g a day of "healthy carbs"--a diet that raised their blood sugar dramatically after every meal they ate.
Because many people with diabetes find the austerity of the diet that Dr. Bernstein recommends hard to accept, one of the things I set out to do when I did the research that led to Blood Sugar 101 was to learn what the academic research had found about the connection between blood sugar level and complications. This seemed to me the best way to determine if the blood sugar targets that Dr. Bernstein insists on are what is required for health.
My conclusion, based on the data, is that achieving Dr. Bernstein's blood sugar targets probably is ideal--especially if it can be done without using questionable drugs like the TZDs and sulfonylureas, but that true normal probably is a bit higher than what he prescribes. So it is likely that a slightly higher set of blood sugar targets probably confers the same health benefits as his do with the advantage of being easier to achieve for people who do not have personalities that incline them to iron discipline.
Dr. Bernstein addressed this difference between us, too, in his letter, which made his praise all the more valuable to me.
He wrote, "I wish that our guidelines for blood sugar targets and carbohydrate intake were closer together but this is a battle that I have been losing for many years."
But that said, I don't think he's losing that battle at all. I think his shadow lies over a whole generation of us who have learned how our blood sugar rises when we eat carbs, who use basal/bolus regimens (which he appears to have pioneered), and who are ten years or more past a diabetes diagnosis without having developed the horrible complications that even a decade ago most doctors assumed that we would get.
My book grows out of the revelations that his work provided and without his work, none of mine would have happened.
Thank you Dr. Bernstein.
June 16, 2008
Post Surgery: I'm Doing Great!
I had my surgery last Tuesday and I'm doing very well, but I'm supposed to rest and not use my arms much, so I'll keep this brief.
I asked my surgeon what blood sugar they prefer in someone with diabetes and she said "Under 200" which is pretty appalling. I explained my outlook and she was very supportive of my low carb diet and blood sugar targets. I asked her if I needed to eat more carbs during the healing phase, and she said, "No. The low carb diet is an excellent diet for healing."
I'd been eating very low carb with lots of colorful veggies and greens for the three weeks before surgery and have continued with that diet for the past week.
At the hospital I tested at 88 mg/dl on their meter at 7 AM which the nurse thought was dangerously low. I explained it wasn't and that I had not used any basal insulin that morning. They promptly hooked me up to a lactate drip so they could raise my blood sugar.
I made a huge point to the anesthesiologist about my insulin sensitivity and made it clear that if they had to lower my blood sugar, using a typical Type 2 insulin dose could literally kill me. (Which it could.) I'm still alive, so she must have listened.
The surgery lasted three hours. They told me after the surgery that my blood sugar had gone up to 139. It dropped back into the 90s by the time I went home.
I'm currently using my usual basal insulin but almost no meal time insulin as I am eating only meat, cheese, greens, LC veggies and lots of berries, and that keeps my blood sugar between 95 and 115 most of the time. I'm trying to get about 100 g of protein a day, which is about right for my weight. I don't want to screw around with insulin shots at meals if I don't have to because the pain drug slows digestion and it is hard to know when the food will digest.
But I'm on the mend, everything is going really well, and I'm really enjoying taking time off from doing all the stuff I usually do.
I'll leave you with this fascinating piece of diabetes research published in this past months edition of the journal, Diabetes Research and Clinical Practice:
Dietary Breads: Myth or Reality
Someone finally decided to see if the so called glycemic index works for people with diabetes. Here's what they did:
"One hundred twenty one type 2 diabetic patients were randomized into three groups as whole wheat, wheat bran and rye bread groups. Each group ate 100 g of bread with water with in 10 min. Blood glucose measurements were made at every 30 min in 2 h. Insulin was measured at fasting and at the second hour in the patients who do not use insulin. The same processes were repeated on the following day, with white wheat bread for each group."
Here's what they found:
"No significant difference was found in either glycemic or insulinemic effects between four types of breads when compared to each other. (p = 0.093 for glycemic effect and p = 0.297 for insulinemic effect)."
In short, "healthy" whole grains raised blood sugar as much as white bread.
Show this article to your doctor!
I asked my surgeon what blood sugar they prefer in someone with diabetes and she said "Under 200" which is pretty appalling. I explained my outlook and she was very supportive of my low carb diet and blood sugar targets. I asked her if I needed to eat more carbs during the healing phase, and she said, "No. The low carb diet is an excellent diet for healing."
I'd been eating very low carb with lots of colorful veggies and greens for the three weeks before surgery and have continued with that diet for the past week.
At the hospital I tested at 88 mg/dl on their meter at 7 AM which the nurse thought was dangerously low. I explained it wasn't and that I had not used any basal insulin that morning. They promptly hooked me up to a lactate drip so they could raise my blood sugar.
I made a huge point to the anesthesiologist about my insulin sensitivity and made it clear that if they had to lower my blood sugar, using a typical Type 2 insulin dose could literally kill me. (Which it could.) I'm still alive, so she must have listened.
The surgery lasted three hours. They told me after the surgery that my blood sugar had gone up to 139. It dropped back into the 90s by the time I went home.
I'm currently using my usual basal insulin but almost no meal time insulin as I am eating only meat, cheese, greens, LC veggies and lots of berries, and that keeps my blood sugar between 95 and 115 most of the time. I'm trying to get about 100 g of protein a day, which is about right for my weight. I don't want to screw around with insulin shots at meals if I don't have to because the pain drug slows digestion and it is hard to know when the food will digest.
But I'm on the mend, everything is going really well, and I'm really enjoying taking time off from doing all the stuff I usually do.
I'll leave you with this fascinating piece of diabetes research published in this past months edition of the journal, Diabetes Research and Clinical Practice:
Dietary Breads: Myth or Reality
Someone finally decided to see if the so called glycemic index works for people with diabetes. Here's what they did:
"One hundred twenty one type 2 diabetic patients were randomized into three groups as whole wheat, wheat bran and rye bread groups. Each group ate 100 g of bread with water with in 10 min. Blood glucose measurements were made at every 30 min in 2 h. Insulin was measured at fasting and at the second hour in the patients who do not use insulin. The same processes were repeated on the following day, with white wheat bread for each group."
Here's what they found:
"No significant difference was found in either glycemic or insulinemic effects between four types of breads when compared to each other. (p = 0.093 for glycemic effect and p = 0.297 for insulinemic effect)."
In short, "healthy" whole grains raised blood sugar as much as white bread.
Show this article to your doctor!
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