After participating in the low carb call-in show and hearing from so many dieters there and in the email the show provoked, I started thinking it might be interesting to do a stint of very low carb dieting myself, just to see if I noticed anything new, now that I've done so much research.
Though I ate a very strict low carb diet for many years, I have been eating under 110 grams a day since 2009, largely because the medication choices I'd made have made it possible to keep my blood sugars in better control at that level than at a lower one.
The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.
That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help. But once I was healed up, I decided there was no real point in eating a ketogenic diet since my main focus is on blood sugar control
Things are quite different now. My blood sugar is better than it has ever been, thanks to my very unusual response to a low dose of Coenzyme Q10. (I am currently exploring what might explain this and have called on an expert in oddball forms of diabetes to help me with this. I'll report on it if I learn anything that will be useful to others with odd forms of insulin-sensitive diabetes.)
But because I've been able to eat much more widely than I had been able to, even with insulin, I have been eating a lot these past few months, and though my scale weight was only up 2-3 lbs, my pants informed me that I had a choice: cut back a bit, or buy new pants. That's the kind of message I take seriously, so this past Monday I embarked on a new very low carb diet.
What Was Different This Time?
One thing that was different this time is that the work I did last year to upgrade my nutritional calculator using the most up-to-date formulas and taking into account body fat percentage yielded me more information about what it would take for me to lose weight. That meant that unless I wanted to diet for the next 6 months, losing the 3 real pounds I'd set as a weight goal meant cutting way back on calories to a level that ruled out any "luxuriant eating."
I decided to see what would happen if during the first week I ate following the guidelines that the calculator set for losing 1 lb a week. I used my bodyfat percentage as estimated by my Tanita scale, which gave me a slightly higher caloric intake than the calculator gives me when I omite body weight percentage. (That's because I truly do have a "large build" with very big leg muscles for a women--so big that even when I weighed 110 lbs I couldn't fit into those fashionable Frye Boots that everyone wore in the 1970s.)
The calculator told me that I could lose a pound a week eating roughly 1050 calories a day.
How Much Protein To Eat?
This posed one problem--was I to calculate how much protein I should eat based on the formula used for experienced low carbers, or should I use the formula for beginners that assumes that I would need a lot of extra protein to provide glucose to run my brain until it switched over to burning ketones?
At this low a calorie level, eating the extra protein would make it impossible to eat a safe low carb diet, because protein would use up all my calories leaving my fat intake dangerously low.
I decided to experiment and see if my body remembered how to burn ketones after my 7+ years of low carbing in the past and stick with a protein intake that while higher than my requirements while in a fully ketotic state was a lot lower than the amount needed for a newbie.
That seems to have been a good call. I'm on Day 5 and have been in Ketosis every time I have tested since Day 3 (based on testing with urine testing strips) except once after I ate some protein powder that seems to have had more carbs in it than the label claimed.
I haven't had any headache or other symptoms that come from adjusting to burning ketones. So apparently there is no need to eat any more than the amount of protein a long-term low carber would need.
How Much Glycogen-Associated and Water Weight Loss?
I lost 3.5 lbs within 24 hours of starting my diet. This suggests that much of my most recent weight gain was water weight, possibly from eating too much salty food. That is too short a time for me to have burned through three pounds worth of stored glycogen.
Since I have been taking metformin for years, I probably don't have a lot of stored glycogen left to burn. My experience in the past while low carbing while taking metformin is that I don't lose glycogen-related water weight. However, if I stop taking metformin, I regain what looks a lot like glycogen-related weight for the next week.
How Much Real Weight Loss?
After that first day's loss, I haven't lost any more weight. I weighed the same this morning as I did Tuesday morning. However, I don't really expect to see real weight loss occuring that quickly, since even if I am eating at a level that will result in a pound of real weight loss over a week after 4 days I would have only lost slightly more than .5 lbs, which is an amount easily hidden by salt-related fluctuations.
How's My Blood Sugar Reacting?
My fasting blood sugar was 91 mg/dl the morning before I started my diet. It dropped to 85 the next day and was 84 any time I tested it until this morning when I woke up at 76. An hour after lunch today it was again 76.
When I felt hungry, I used my 2 gram cure and it worked. I used it five times over the past 4 days, but never more than once within a 3 hour period.
What is the Impact on My Blood Pressure?
My blood pressure had risen the past two weeks, as it always does when the house chills down (I refuse to run the heat until October, but having adapted to 73 F all summer the mornings we experience that are 64-65 F takes some getting used to.)
My blood pressure dropped remained high on Day 1 and 2, then dropped quite dramatically, to normal on Day 3 and morning on Day 4. Then in the afternoon of Day 4 it shot up very high (163/89) after I experienced a burst of stress hormones. It was normal again on the morning of Day 5 (123/76).
I think the stress hormones were the result of either blood sugar or blood pressure dropping too low, generating a counterregulatory burst.
In the past when I ate LC I had several dramatic stints of very high blood pressure, contrary to what you read in the bestselling books. I will keep a closer watch on both sugars and BP to avoid the stress release as it feels rotten and takes 3 hours to abate.
What Am I Eating?
Not much! 1050 calories is such a low calorie intake that it's tricky getting enough protein without going overboard on the fat. All the usual low carb diet tricks that make low carbing enjoyable and sustainable are out. Bacon and cream cheese have too much fat for the protein they contribute. So I am pretty much testing Stephen Guyenet's theory that eating boring food helps us lose weight.
I'm using my food scale to weigh everything, and learning how fast those calories pile up. I'm also seeing how many of my "go to" low carb foods that I eat when I'm not trying to lose weight push my calorie intake way up--like the low carb cocoa I make with half and half or the bits of cheese I put in my salads.
That said, since with the exception of my experiment with the protein powder my blood sugars have been rock solid flat, I haven't been hungry except, sometimes, an hour or so after eating and about 9 P. After eating is when I've used the 2 gram cure. I'm thinking I probably ought to eat my last meal a bit later (I tend to eat dinner between 5:30 and 6 PM.) That might keep me from getting hungry right before I'm ready for sleep.
The foods I've been mainly eating are:
1 soup bowl full of romaine and/or baby spinach every day
1 small campari tomato
1 slice of fresh red pepper
home made olive oil and vinegar dressing with herbs
havarti cheese with dill in salad (from Trader Joe's)
1 egg with 1 oz munester or havarti cheese for breakfast
Protein shakes made with 1 scoop of protein
Supermarket rotisserie chicken ("all natural")
Trader Joe's uncured low salt pastrami
I was out one afternoon and ate pulled pork and saag paneer from the Whole Foods buffet.
Fage Greek yogurt, both 0% and 2% fat (since that was what was in the fridge.) I'm not having any trouble getting my fat up to target, so it will be 0% tonight
1 tbs of unsalted roasted sunflower seeds with the yogurt
Davinci White Chocolate Sugar Free Syrup with Splenda for sweetening cocoa and yogurt
Homemade low carb cocoa (Hershey's cocoa, Davinci syrup, and half and half)
decaf tea
decaf coffee 2 cups a day. I'm not avoiding caffeine for diet reasons, but caffeinated coffee
pushes up my blood pressure so I am not currently drinking it.
NOTE: The Six Star brand Vanilla Cream Protein Powder I bought at Walmart tasted revolting and raised my blood sugar. It took 20 minutes for the aftertaste to go away.
Highly NOT recommended.
Nutritional Breakdown
LifeForm tells me that my average daily intake for 5 days (including tonight's dinner) has been 1045 calories.
Fat: 63 g, 58%
Sat fat: 28 g, 26%
Carbs: 22 g
Fiber: 3 g (I am also taking a spoonful of no-sugar psyillium ever day)
Sugars: 14 g (this includes the sugar in the yogurt which I believe has been fermented
away)
Protein: 81 g 34% (My requirement to supply my brain after adapting to ketosis is only 63 g but I wanted some slack to avoid consuming muscle if I was wrong about the
retained ability to adapt.)
I'm not sure if this is interesting to anyone but me, so let me know if you want to hear more in the comments, where I'll also be happy to answer questions.
September 28, 2012
September 22, 2012
My Live Call-In Show with Jimmy Moore is Now a Podcast
You can now hear my latest interview with Jimmy Moore as a podcast. Find it HERE or download it on iTunes.
The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.
As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.
The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.
Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.
Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)
So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.
That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.
There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.
This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller. But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."
Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.
I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.
My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.
That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.
All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.
The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.
As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.
The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.
Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.
Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)
So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.
That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.
There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.
This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller. But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."
Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.
I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.
My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.
That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.
All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.
September 13, 2012
Research Cited on the Blood Sugar 101 FaceBook Page
It's been a while since I posted the list of the links to news stories I've cited on the Blood Sugar 101 FaceBook page, so here they are. I've organized them by general topic.
Causes of Diabetes and Obesity
Gut Bacteria: Fish study illuminates how gut bacteria associated with obesity might promote it. The bacteria, also found associated with obesity in humans increases the absorption of dietary fat. i http://www.sciencedaily.com/releases/2012/09/120912125114.htm
*****
Storing higher amounts of fat in the pancreas may explain high rate of diabetes in Hispanics. Insulin deficiency--as is so often the case--is the problem in the Latinos studies here, not insulin resistance.
http://www.sciencedaily.com/releases/2012/09/120911102948.htm
*****
PFOAs: "Increasing PFOA levels were associated with CVD [heart disease] and PAD [peripheral artery disease], independent of various confounders (ie, age, sex, race, smoking status, BMI, diabetes, hypertension and serum cholesterol levels)." " PFOAs are found in furniture (fire retardants), surfactants, lubricants, polishes, paper and textile coatings, and food packaging.
This is the kind of problem that should be addressed by politicians because as individuals we can't protect ourselves from these dangerous chemicals. (I mentioned the research about PFOAs in Diet 101 since it is one of the known pollutants that contribute to insulin resistance.)
http://www.healio.com/endocrinology/cardiometabolic-disorders/news/online/%7B20BEA478-40E6-44F7-B8ED-4D6D37BC69B9%7D/Common-chemicals-found-in-paper-lubricant-products-increased-risk-for-CVD-PAD
*****
More evidence that environmental chemicals are causing obesity in very young children. Chemical exposure in the womb from household items may contribute to obesity
http://www.sciencedaily.com/releases/2012/08/120830135327.htm
*****
Phthalates: Phthalates cause both obesity and diabetes. They are in just about everything we buy. CBS News reports:
"For the investigation, scientists randomly purchased and tested 20 back-to-school items from New York City dollar stores and other retailers. They found Disney's Dora the Explorer Backpack contained phthalate levels over 69 times higher than the allowable federal limit for toys. The Amazing Spiderman Lunchbox contained 27 times the federal limit, while the Disney Princess Lunchbox exceeded the toy limit by 29 times. Children's rain coats, rain boots and 3-ring binders also were found to contain the toxins."
How much of this toxic chemical did you bring back from your last shopping trip?
http://www.cbsnews.com/8301-504763_162-57500969-10391704/back-to-school-study-finds-high-levels-of-phthalate-chemicals-in-kids-backpacks-supplies/
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BPA: Urine levels of this plastic in humans correlate with the presence of narrowed arteries.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043378;jsessionid=BEB6D6767CE1D9A15175A02A7A796E6A
Explained here:
http://www.huffingtonpost.com/2012/08/15/bpa-narrowed-arteries-coronary-artery-stenosis_n_1783354.html
*****
Inflammation: Neutrophils (a kind of white blood cell whose job is to attack bacteria) raise insulin resistance: this may provide insight into the connection between inflammation and IR. Rather than just suppressing them, though, we need to ask what is provoking the inflammation.
http://www.sciencedaily.com/releases/2012/08/120805144841.htm
*****
Gum Disease: A huge epidemiological study (NHANES) links gum disease with insulin resistance. The link is likely causative--the inflammation from gum disease increases insulin resistance and raises blood sugar. Eliminating gum disease can often lower blood sugar. But lowering blood sugar can also make it easier to fight gum disease.
Though the people in this study are called "diabetes free" we know that current testing methods for diabetes miss many people who have diabetic blood sugars after they eat.
http://www.healio.com/endocrinology/diabetes/news/online/%7B666BBF74-092D-4EEF-AA1A-C3D31C40A81E%7D/NHANES-Periodontal-infections-linked-to-insulin-resistance-in-diabetes-free-adults
Complications of Diabetes
Retinopathy: Black Americans develop retinopathy at lower A1c levels than whites. Retinopathy begin at A1c levels of 6% to 6.4% for white patients vs. 5.5% to 5.9% for black patients. That's probably because A1cs are not reliable for diagnosing diabetes when people have certain genetic red blood cell variants, like the sickle cell trait.
"Results suggesting that the prevalence of retinopathy appears to increase at a lower HbA1c level in black patients with diabetes vs. white patients have led researchers to recommend against raising the diagnostic threshold of HbA1c in black patients."
If you are a Black person, use your meter to measure your post-meal blood sugars. That isn't affected by the sickle cell trait and post-meal numbers, rather than the A1c will give you a very good measure of how effective your control is. To avoid retinopathy, keep your blood sugar below 140 mg/dl at all times if possible. Blood sugars rising over 200 mg/dl at any time correlate with a much higher risk of diabetic retinopathy leading to blindness.
http://www.healio.com/endocrinology/diabetes/news/online/%7B6A9DF0EB-86B4-47AD-AC4C-0C352A70398F%7D/Data-fail-to-support-change-in-diagnostic-threshold-of-HbA1c-in-black-Americans
Diet and Weight Loss
Eating on a schedule may provide better weight control by using circadian clock to burn fat: Yes, this is a mouse study but even so the finding is intriguing. It shows that "... a carefully scheduled high-fat diet can lead to a reduction in body weight and a unique metabolism in which ingested fats are not stored, but rather used for energy at times when no food is available."
Note that the "high fat diet" give mice is actually a junk food diet--high in fat and carbs. Even so the mice in this study who ate strictly scheduled meals gained less weight than those eating any other diet they were given.
http://www.sciencedaily.com/releases/2012/09/120912084430.htm
*****
Organic Food:
Bad Science: A much touted new meta study claims organic food "not healthier" than nonorganic food. This claim is made by pooling the results of many separate studies (the funding of which is not revealed but is likely to be from big food companies). The claim of equivalence rests on the idea that the amount of nutrients is the same. But it brushes away hese findings:
" ... researchers found that organic produce had a 30 percent lower risk of pesticide contamination than conventional fruits and vegetables ... Two studies of children consuming organic and conventional diets did find lower levels of pesticide residues in the urine of children on organic diets, though the significance of these findings on child health is unclear. Additionally, organic chicken and pork appeared to reduce exposure to antibiotic-resistant bacteria, but the clinical significance of this is also unclear
Pesticides in the bloodstream contributed heavily to obesity and diabetes.
http://www.sciencedaily.com/releases/2012/09/120903221122.htm
*****
In a long-running study, monkeys whose caloric intake was restricted by 30 percent didn’t live any longer than their normal-weight peers. This article analyzes why this study differs from an earlier one that showed a life-extension benefit.
http://www.nytimes.com/2012/08/30/science/low-calorie-diet-doesnt-prolong-life-study-of-monkeys-finds.html
*****
You need to eat fat with your salad to properly digest the micro nutrients it contains.
http://www.sciencedaily.com/releases/2012/06/120619230234.htm
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Smoking and Insulin Secretion: If you want to stop smoking and not gain weight, cut your carbs then quit. Increased bodyweight after stopping smoking may be due to changes in insulin secretion which may increase hunger. This effect takes about 3 months to wear off.
"The most striking metabolic findings were an increased first phase insulin secretion in response to glucose challenge, as well as increased carbohydrate intake in the free choice buffet after three months of non-smoking. Participants showed significant fasting insulin resistance, where the normal response to a given amount of insulin is reduced, at three months, but not at six months, while dynamic insulin sensitivity (the sensitivity to insulin in the postprandial state) assessed during the OGTT remained unchanged throughout."
This means more insulin is produced but actual insulin sensitivity remains the same. (The way that fasting IR is calculated is misleading here.) This means blood sugar will drop more sharply after eating, which causes hunger.
http://www.sciencedaily.com/releases/2012/05/120507210042.htm
Treatments for Diabetes
New Drug: A new (expensive) opiate has just approved for neuropathy. But it only treats the symptom, not the caase. You can reverse neuropahty (over several months) by lowering your blood sugar until it is below 140 mg/dl at all times after meals. This is better than taking an addictive drug that masks the symptoms of the nerve damage that leads to impotence, infections that won't heal and cause amputation, and damage to the autonomic nerves that lead to heart beat abnormalities and, potentially, death.
Instructions on how to lower your blood sugar below 140 mg/dl can be found HERE.
http://www.healio.com/endocrinology/diabetes/news/online/%7BC4F49DA4-87BC-4377-9185-A681B0FA955C%7D/FDA-approves-tapentadol-ER-for-diabetic-peripheral-neuropathy
*****
Actos: The FDA has approved the first generic version of Actos. If it ever makes it into your local pharmacy the media will finally learn about the serious side effects of this dangerous drug, which include serious osteoporosis, retinal edema, and heart failure in people who didn't have heart failure before they started the drug.
The sudden "discovery" of dangerous side effects is what happened when Lipitor went off patent. Suddenly the media "discovered" that it significantly raised the risk of developing diabetes.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315951.htm
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Cheap Strips: Walmart is selling 50 strips for its Relion Prime meter for $9. The meter is $16.24. Tell your friends who could benefit from checking their blood sugars after meals. This is a real opportunity for those who have hitherto been unable to afford the blood sugar testing strips needed to get full control over blood sugar using the "Test, test, test" strategy you'll find explained HERE.
http://health.walmart.com/health-advice/manage-diabetes-expense-walmart-relion/1006/?povid=cat976760-env189989-moduleA081612-lLinkBShelf1LearnMore
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Experimental Retinal Prosthesis: Researchers have come up with a retinal prosthesis that appears to work in mice and may offer real hope to people who have gone blind from retinopaty. This is still highly experimental mouse research, but even so it's a huge breakthrough.
http://www.medicalnewstoday.com/articles/249010.php
Artificial Retina Could Restore Sight To The Blind
*****
Omega-3 supplementation: Using Fish Oil fails to live up to the many health claims made for it. Fish oil failed to demonstrate brain-protecting effect in random controlled trials and a study of 70,000 people finds it doesn't lower the risk of stroke or heart attack.
The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not avoid heart disease.
Getting your fish oil from eating fish rather than pills may be a poor strategy given the very high level of mercury and other pollutants in most fish today--which is way higher than what you see in the published tables most health authorities rely on, which still display data collected in the 1970s when toxin levels were much lower.
http://www.bbc.co.uk/news/health-18410324
http://www.sciencedaily.com/releases/2012/09/120911161449.htm
Harmful Drugs and Treatments
NSAIDs: An epidemiological study find that all NSAIDS are linked to higher risk of having second heart attack. Heart attack survivors who take the most commonly used pain relievers face a raised risk for dying or suffering another heart attack, new research shows.
While it is possible that the need for pain relievers is related to some other cause of heart attack, there is other evidence which suggests that the mechanism by which NSAIDs work may raise cardiac risk.
http://www.webmd.com/heart/news/20120910/common-painkillers-risky-after-heart-attack
*****
Drugs that lower sex drive: Antidepressants, Statins, Beta Blockers, and opiate pain killers. Thee of the four very commonly prescribed to people with diabetes.
http://www.huffingtonpost.com/2012/08/20/low-libido-medication_n_1784142.html#slide=1400199
Corporate Malfeasance
American Diabetes Association: 78% of funds donated to American Diabetes Association go to a telemarketing company that lies about the percentage it takes. I reported about this problem in 2008based on a report in the L.A. Times HERE. Since then the ADA has done nothing to correct the problem and, in fact, it has grown worse.
Don't contribute to the ADA and explain to your friends and family why, if they care about people with diabetes, they should not give the ADA a penny.
http://www.huffingtonpost.com/2012/09/12/infocision-charity-scam_n_1871328.html
*****
For fraudulently representing and marketing Paxil, Welbutrin and Avandia, GSK's fine is a tiny fraction of its earnings.
http://www.nejm.org/doi/full/10.1056/NEJMp1209249
*****
Risperdal: A slap on the wrist for a drug company whose atypical antipsychotic drug, Risperdal, causes obesity and raises the risk of diabetes. The off label uses turned out to kill people. $181M sounds like a lot, but they earn billions each year from this drug.
http://www.washingtonpost.com/?business/?ny-ag-181m-settlement-with-jans?sen-over-marketing-anti-psycho?tic-drugs-for-nonapproved-uses?/2012/08/30/?36ee8182-f2c9-11e1-b74c-84ed55e?0300b_story.html
*****
Lying Drug-Company Funded Researchers: "Only one in seven authors reported by whistleblowers to be involved in off-label marketing activities fully disclosed their conflict of interest in published articles.
"Conflict-of-interest statements made by physicians and scientists in their medicajournal articles after they had been allegedly paid by pharmaceutical manufacturers as part of off-label marketing programs are often inadequate, highlighting the deficiencies in relying on author candidness and the weaknesses in some journal practices in ensuring proper disclosure, according to a study by international researchers published in this week's PLoS Medicine."
http://www.sciencedaily.com/releases/2012/08/120807194255.htm
Causes of Diabetes and Obesity
Gut Bacteria: Fish study illuminates how gut bacteria associated with obesity might promote it. The bacteria, also found associated with obesity in humans increases the absorption of dietary fat. i http://www.sciencedaily.com/releases/2012/09/120912125114.htm
*****
Storing higher amounts of fat in the pancreas may explain high rate of diabetes in Hispanics. Insulin deficiency--as is so often the case--is the problem in the Latinos studies here, not insulin resistance.
http://www.sciencedaily.com/releases/2012/09/120911102948.htm
*****
PFOAs: "Increasing PFOA levels were associated with CVD [heart disease] and PAD [peripheral artery disease], independent of various confounders (ie, age, sex, race, smoking status, BMI, diabetes, hypertension and serum cholesterol levels)." " PFOAs are found in furniture (fire retardants), surfactants, lubricants, polishes, paper and textile coatings, and food packaging.
This is the kind of problem that should be addressed by politicians because as individuals we can't protect ourselves from these dangerous chemicals. (I mentioned the research about PFOAs in Diet 101 since it is one of the known pollutants that contribute to insulin resistance.)
http://www.healio.com/endocrinology/cardiometabolic-disorders/news/online/%7B20BEA478-40E6-44F7-B8ED-4D6D37BC69B9%7D/Common-chemicals-found-in-paper-lubricant-products-increased-risk-for-CVD-PAD
*****
More evidence that environmental chemicals are causing obesity in very young children. Chemical exposure in the womb from household items may contribute to obesity
http://www.sciencedaily.com/releases/2012/08/120830135327.htm
*****
Phthalates: Phthalates cause both obesity and diabetes. They are in just about everything we buy. CBS News reports:
"For the investigation, scientists randomly purchased and tested 20 back-to-school items from New York City dollar stores and other retailers. They found Disney's Dora the Explorer Backpack contained phthalate levels over 69 times higher than the allowable federal limit for toys. The Amazing Spiderman Lunchbox contained 27 times the federal limit, while the Disney Princess Lunchbox exceeded the toy limit by 29 times. Children's rain coats, rain boots and 3-ring binders also were found to contain the toxins."
How much of this toxic chemical did you bring back from your last shopping trip?
http://www.cbsnews.com/8301-504763_162-57500969-10391704/back-to-school-study-finds-high-levels-of-phthalate-chemicals-in-kids-backpacks-supplies/
*****
BPA: Urine levels of this plastic in humans correlate with the presence of narrowed arteries.
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0043378;jsessionid=BEB6D6767CE1D9A15175A02A7A796E6A
Explained here:
http://www.huffingtonpost.com/2012/08/15/bpa-narrowed-arteries-coronary-artery-stenosis_n_1783354.html
*****
Inflammation: Neutrophils (a kind of white blood cell whose job is to attack bacteria) raise insulin resistance: this may provide insight into the connection between inflammation and IR. Rather than just suppressing them, though, we need to ask what is provoking the inflammation.
http://www.sciencedaily.com/releases/2012/08/120805144841.htm
*****
Gum Disease: A huge epidemiological study (NHANES) links gum disease with insulin resistance. The link is likely causative--the inflammation from gum disease increases insulin resistance and raises blood sugar. Eliminating gum disease can often lower blood sugar. But lowering blood sugar can also make it easier to fight gum disease.
Though the people in this study are called "diabetes free" we know that current testing methods for diabetes miss many people who have diabetic blood sugars after they eat.
http://www.healio.com/endocrinology/diabetes/news/online/%7B666BBF74-092D-4EEF-AA1A-C3D31C40A81E%7D/NHANES-Periodontal-infections-linked-to-insulin-resistance-in-diabetes-free-adults
Complications of Diabetes
Retinopathy: Black Americans develop retinopathy at lower A1c levels than whites. Retinopathy begin at A1c levels of 6% to 6.4% for white patients vs. 5.5% to 5.9% for black patients. That's probably because A1cs are not reliable for diagnosing diabetes when people have certain genetic red blood cell variants, like the sickle cell trait.
"Results suggesting that the prevalence of retinopathy appears to increase at a lower HbA1c level in black patients with diabetes vs. white patients have led researchers to recommend against raising the diagnostic threshold of HbA1c in black patients."
If you are a Black person, use your meter to measure your post-meal blood sugars. That isn't affected by the sickle cell trait and post-meal numbers, rather than the A1c will give you a very good measure of how effective your control is. To avoid retinopathy, keep your blood sugar below 140 mg/dl at all times if possible. Blood sugars rising over 200 mg/dl at any time correlate with a much higher risk of diabetic retinopathy leading to blindness.
http://www.healio.com/endocrinology/diabetes/news/online/%7B6A9DF0EB-86B4-47AD-AC4C-0C352A70398F%7D/Data-fail-to-support-change-in-diagnostic-threshold-of-HbA1c-in-black-Americans
Diet and Weight Loss
Eating on a schedule may provide better weight control by using circadian clock to burn fat: Yes, this is a mouse study but even so the finding is intriguing. It shows that "... a carefully scheduled high-fat diet can lead to a reduction in body weight and a unique metabolism in which ingested fats are not stored, but rather used for energy at times when no food is available."
Note that the "high fat diet" give mice is actually a junk food diet--high in fat and carbs. Even so the mice in this study who ate strictly scheduled meals gained less weight than those eating any other diet they were given.
http://www.sciencedaily.com/releases/2012/09/120912084430.htm
*****
Organic Food:
Bad Science: A much touted new meta study claims organic food "not healthier" than nonorganic food. This claim is made by pooling the results of many separate studies (the funding of which is not revealed but is likely to be from big food companies). The claim of equivalence rests on the idea that the amount of nutrients is the same. But it brushes away hese findings:
" ... researchers found that organic produce had a 30 percent lower risk of pesticide contamination than conventional fruits and vegetables ... Two studies of children consuming organic and conventional diets did find lower levels of pesticide residues in the urine of children on organic diets, though the significance of these findings on child health is unclear. Additionally, organic chicken and pork appeared to reduce exposure to antibiotic-resistant bacteria, but the clinical significance of this is also unclear
Pesticides in the bloodstream contributed heavily to obesity and diabetes.
http://www.sciencedaily.com/releases/2012/09/120903221122.htm
*****
In a long-running study, monkeys whose caloric intake was restricted by 30 percent didn’t live any longer than their normal-weight peers. This article analyzes why this study differs from an earlier one that showed a life-extension benefit.
http://www.nytimes.com/2012/08/30/science/low-calorie-diet-doesnt-prolong-life-study-of-monkeys-finds.html
*****
You need to eat fat with your salad to properly digest the micro nutrients it contains.
http://www.sciencedaily.com/releases/2012/06/120619230234.htm
*****
Smoking and Insulin Secretion: If you want to stop smoking and not gain weight, cut your carbs then quit. Increased bodyweight after stopping smoking may be due to changes in insulin secretion which may increase hunger. This effect takes about 3 months to wear off.
"The most striking metabolic findings were an increased first phase insulin secretion in response to glucose challenge, as well as increased carbohydrate intake in the free choice buffet after three months of non-smoking. Participants showed significant fasting insulin resistance, where the normal response to a given amount of insulin is reduced, at three months, but not at six months, while dynamic insulin sensitivity (the sensitivity to insulin in the postprandial state) assessed during the OGTT remained unchanged throughout."
This means more insulin is produced but actual insulin sensitivity remains the same. (The way that fasting IR is calculated is misleading here.) This means blood sugar will drop more sharply after eating, which causes hunger.
http://www.sciencedaily.com/releases/2012/05/120507210042.htm
Treatments for Diabetes
New Drug: A new (expensive) opiate has just approved for neuropathy. But it only treats the symptom, not the caase. You can reverse neuropahty (over several months) by lowering your blood sugar until it is below 140 mg/dl at all times after meals. This is better than taking an addictive drug that masks the symptoms of the nerve damage that leads to impotence, infections that won't heal and cause amputation, and damage to the autonomic nerves that lead to heart beat abnormalities and, potentially, death.
Instructions on how to lower your blood sugar below 140 mg/dl can be found HERE.
http://www.healio.com/endocrinology/diabetes/news/online/%7BC4F49DA4-87BC-4377-9185-A681B0FA955C%7D/FDA-approves-tapentadol-ER-for-diabetic-peripheral-neuropathy
*****
Actos: The FDA has approved the first generic version of Actos. If it ever makes it into your local pharmacy the media will finally learn about the serious side effects of this dangerous drug, which include serious osteoporosis, retinal edema, and heart failure in people who didn't have heart failure before they started the drug.
The sudden "discovery" of dangerous side effects is what happened when Lipitor went off patent. Suddenly the media "discovered" that it significantly raised the risk of developing diabetes.
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm315951.htm
*****
Cheap Strips: Walmart is selling 50 strips for its Relion Prime meter for $9. The meter is $16.24. Tell your friends who could benefit from checking their blood sugars after meals. This is a real opportunity for those who have hitherto been unable to afford the blood sugar testing strips needed to get full control over blood sugar using the "Test, test, test" strategy you'll find explained HERE.
http://health.walmart.com/health-advice/manage-diabetes-expense-walmart-relion/1006/?povid=cat976760-env189989-moduleA081612-lLinkBShelf1LearnMore
*****
Experimental Retinal Prosthesis: Researchers have come up with a retinal prosthesis that appears to work in mice and may offer real hope to people who have gone blind from retinopaty. This is still highly experimental mouse research, but even so it's a huge breakthrough.
http://www.medicalnewstoday.com/articles/249010.php
Artificial Retina Could Restore Sight To The Blind
*****
Omega-3 supplementation: Using Fish Oil fails to live up to the many health claims made for it. Fish oil failed to demonstrate brain-protecting effect in random controlled trials and a study of 70,000 people finds it doesn't lower the risk of stroke or heart attack.
The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not avoid heart disease.
Getting your fish oil from eating fish rather than pills may be a poor strategy given the very high level of mercury and other pollutants in most fish today--which is way higher than what you see in the published tables most health authorities rely on, which still display data collected in the 1970s when toxin levels were much lower.
http://www.bbc.co.uk/news/health-18410324
http://www.sciencedaily.com/releases/2012/09/120911161449.htm
Harmful Drugs and Treatments
NSAIDs: An epidemiological study find that all NSAIDS are linked to higher risk of having second heart attack. Heart attack survivors who take the most commonly used pain relievers face a raised risk for dying or suffering another heart attack, new research shows.
While it is possible that the need for pain relievers is related to some other cause of heart attack, there is other evidence which suggests that the mechanism by which NSAIDs work may raise cardiac risk.
http://www.webmd.com/heart/news/20120910/common-painkillers-risky-after-heart-attack
*****
Drugs that lower sex drive: Antidepressants, Statins, Beta Blockers, and opiate pain killers. Thee of the four very commonly prescribed to people with diabetes.
http://www.huffingtonpost.com/2012/08/20/low-libido-medication_n_1784142.html#slide=1400199
Corporate Malfeasance
American Diabetes Association: 78% of funds donated to American Diabetes Association go to a telemarketing company that lies about the percentage it takes. I reported about this problem in 2008based on a report in the L.A. Times HERE. Since then the ADA has done nothing to correct the problem and, in fact, it has grown worse.
Don't contribute to the ADA and explain to your friends and family why, if they care about people with diabetes, they should not give the ADA a penny.
http://www.huffingtonpost.com/2012/09/12/infocision-charity-scam_n_1871328.html
*****
For fraudulently representing and marketing Paxil, Welbutrin and Avandia, GSK's fine is a tiny fraction of its earnings.
http://www.nejm.org/doi/full/10.1056/NEJMp1209249
*****
Risperdal: A slap on the wrist for a drug company whose atypical antipsychotic drug, Risperdal, causes obesity and raises the risk of diabetes. The off label uses turned out to kill people. $181M sounds like a lot, but they earn billions each year from this drug.
http://www.washingtonpost.com/?business/?ny-ag-181m-settlement-with-jans?sen-over-marketing-anti-psycho?tic-drugs-for-nonapproved-uses?/2012/08/30/?36ee8182-f2c9-11e1-b74c-84ed55e?0300b_story.html
*****
Lying Drug-Company Funded Researchers: "Only one in seven authors reported by whistleblowers to be involved in off-label marketing activities fully disclosed their conflict of interest in published articles.
"Conflict-of-interest statements made by physicians and scientists in their medicajournal articles after they had been allegedly paid by pharmaceutical manufacturers as part of off-label marketing programs are often inadequate, highlighting the deficiencies in relying on author candidness and the weaknesses in some journal practices in ensuring proper disclosure, according to a study by international researchers published in this week's PLoS Medicine."
http://www.sciencedaily.com/releases/2012/08/120807194255.htm
August 13, 2012
Why Thinner People with Diabetes May Have Worse Outcomes
A study published last week in the Journal of the American Medical Association (JAMA) came up with the conclusion that "Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese."
The study can be found at:
http://jama.jamanetwork.com/article.aspx?articleid=1309174
If you have been doing a good job controlling your weight and read only the media reports about this study, you may have found it disturbing. If your doctor is one of those who only reads the "25 words or less" summary of medical findings, you may even hear that losing weight is dangerous for diabetics.
Hermes Florez, MD, PhD. Florez, the director of the division of epidemiology and population health sciences at the University of Miami's Miller School of Medicine, who wrote an editorial about this study was quoted as saying, ""If you are normal weight, you may be at higher risk from diabetes, especially if your fitness status is not so good."
But even a cursory reading of the methodology used in this study should make it clear that the outcomes for people who were normal weight at their diabetes diagnoses has little to do with their weight or, for that matter, fitness.
The data used in this study came from pooling data from the "Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011."
As you will immediately notice, all but one of these studies go back 20 years or more, to the days before doctors understood that only by lowering blood sugar could people with diabetes avoid diabetic complications. So most of the people who participated in the studies whose data was used in this meta analysis were diagnosed in the bad old days, after which they were likely to have received extremely poor treatment.
How bad? Before the middle 1990s, patients diagnosed with Type 2 almost never were given home blood sugar meters. The only time their blood sugar was measured--fasting--was when they saw their doctor once every few months. Since the only drugs available to treat Type 2 Diabetes were the sulfonylureas which can cause dangerous hypos, the only concern doctors had about these newly diagnosed people's blood sugar was that it not drop low enough to cause hypos. As a result, doctors encouraged patients to keep their blood sugars high and when they administered A1c tests doctors saw no problem with patients maintaining A1cs in the 10% range or higher.
So what does this have to do with why their weight at diagnosis might have given normal weight people a higher likelihood of dying over the subsequent decades? Just this: Nowadays those of us who keep up with diabetes are aware that most normal weight adults diagnosed with Type 2 are very likely not to have classic Type 2. Most have a slow-developing form of autoimmune diabetes called LADA that is very similar to Type 1.
This form of diabetes does not respond at all to the oral drugs that are somewhat effective for Type 2. But back in the days when patients had no way to test their blood sugar after eating and doctors considered A1cs as high as 13% "safe" these patients could go many years without being put on insulin. And even when they were put on insulin, because they didn't have meters, they injected only enough insulin to prevent the sky-high blood sugars that cause the fatal condition, diabetic ketoacidosis. Many patients on insulin still had blood sugars that rose into the 200s and even 300s.
So normal weight people with LADA would have ended up with blood sugars much higher than those of the overweight Type 2s who were more likely to respond to the sulfonylurea drugs and, later, metformin, most newly diagnosed people with diabetes received.
And because we now know that there is a straight line relationship (in large groups of people, at least) between A1c and the likelihood of heart disease, it doesn't take genius to suspect that the explanation for the extra cardiac deaths in the group of normal weight people with diabetes was the those much higher blood sugars they ran due both to misdiagnosis and to the way doctors ignored the damage caused by high blood sugars until the middle of the 1990s.
A second group of normal weight people diagnosed with diabetes as adults who are likely to end up with poor outcomes are people with milder versions of one of the many, unrelated, forms of genetic diabetes that are lumped together under the name MODY.
Many people diagnosed with MODY have family histories of relatives dying young of heart attacks while young and fit. This is probably because exposure to blood sugars that remain over 150 mg/dl for hours each day will over time cause the arteries to become diseased. People with these forms of MODY have had that kind of elevated blood sugar all their lives. But until very recently only those with the worst cases were diagnosed, and the rest, whose genes gave them "pre-diabetes" for much of their lives, lived with abnormal post-meal blood sugars for many years, and only developed full fledged diabetes much later on in life, perhaps after becoming a bit more insulin resistant.
Because they were thin, doctors didn't consider a diabetes diagnosis when they had symptoms that should have pointed them that way. (In my 20s, my doctors waved off my highly abnormal glucose tolerance test results as "nothing to worry about" precisely because I was normal weight.)
Some rare forms of genetic diabetes are caused by genes that damage not only blood sugar control but other organs, most notably the kidneys and the mitochondria. Mortality in families that inherit these unfortunate genes have nothing to do with diabetes but with the other organ damage that is due to these gene variants.
But for most people with either MODY or LADA it's pretty clear that if you keep your blood sugars in the normal range (under 140 mg/d--7.7 mmol/L) at all times you can, over time, reverse much of the damage that you have already suffered and avoid the premature heart attacks and kidney failure that carried off so many people diagnosed with diabetes in the past, when they were allowed to run very high blood sugars.
Comorbidities
There is also one other reason why thin people diagnosed with diabetes may have a higher risk of dying--one that wasn't addressed by this study's methodology. The journal article states that the data were adjusted for "demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status." However, what was left out was co-morbidities--i.e. the presence of other diseases.
One of the most important comorbidities to be considered is pancreatic cancer, since there is growing evidence that a very early symptom of pancreatic cancer may be the onset of diabetes. This is discussed in the Mayo Clinic web page HERE. A small but important subset of normal weight people who die prematurely with diabetes are people whose pancreases failed because they were infiltrated with cancerous cells.
In addition, many drugs used to treat cancers and life-threatening diseases are capable of causing diabetes, for example the steroids administered during chemotherapy or to treat COPD. Powerful steroids were also prescribed in the past to people with neuromuscular diseases like MS. Data sets like those glommed together in this study can't tell us whether a person was diagnosed with diabetes after a course of chemo or whether they died of cancer, COPD, or MS. So the presence of people in this data pool who were diagnosed with diabetes who also had one of these other life-shortening conditions could also explain a significant amount of the excess mortality this study uncovered.
Whatever the explanation, if you are a normal weight person diagnosed with diabetes, there's no need to panic. If you track your blood sugar after meals with a meter and keep it as close to the normal range as possible, you should do fine. The worst treatment doled out to people with diabetes nowadays is far better than what the people involved in these studies back in the late 70s, 80s and early 90s were given after their diagnoses, and for those of us who pursue normal blood sugars the future should be a lot brighter, no matter what our weight.
P.S. If your doctor tells you there's no point in losing weight because thin diabetics have even more heart attacks than fat ones, find a new doctor. I wouldn't have warned about this in the past, but over this past year I have been sent so many stories about doctors giving idiotic advice based on their having misunderstood a media report about a research study that I no longer assume doctors will even bother to read the full report before changing their practice recommendations.
The study can be found at:
http://jama.jamanetwork.com/article.aspx?articleid=1309174
If you have been doing a good job controlling your weight and read only the media reports about this study, you may have found it disturbing. If your doctor is one of those who only reads the "25 words or less" summary of medical findings, you may even hear that losing weight is dangerous for diabetics.
Hermes Florez, MD, PhD. Florez, the director of the division of epidemiology and population health sciences at the University of Miami's Miller School of Medicine, who wrote an editorial about this study was quoted as saying, ""If you are normal weight, you may be at higher risk from diabetes, especially if your fitness status is not so good."
But even a cursory reading of the methodology used in this study should make it clear that the outcomes for people who were normal weight at their diabetes diagnoses has little to do with their weight or, for that matter, fitness.
The data used in this study came from pooling data from the "Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011."
As you will immediately notice, all but one of these studies go back 20 years or more, to the days before doctors understood that only by lowering blood sugar could people with diabetes avoid diabetic complications. So most of the people who participated in the studies whose data was used in this meta analysis were diagnosed in the bad old days, after which they were likely to have received extremely poor treatment.
How bad? Before the middle 1990s, patients diagnosed with Type 2 almost never were given home blood sugar meters. The only time their blood sugar was measured--fasting--was when they saw their doctor once every few months. Since the only drugs available to treat Type 2 Diabetes were the sulfonylureas which can cause dangerous hypos, the only concern doctors had about these newly diagnosed people's blood sugar was that it not drop low enough to cause hypos. As a result, doctors encouraged patients to keep their blood sugars high and when they administered A1c tests doctors saw no problem with patients maintaining A1cs in the 10% range or higher.
So what does this have to do with why their weight at diagnosis might have given normal weight people a higher likelihood of dying over the subsequent decades? Just this: Nowadays those of us who keep up with diabetes are aware that most normal weight adults diagnosed with Type 2 are very likely not to have classic Type 2. Most have a slow-developing form of autoimmune diabetes called LADA that is very similar to Type 1.
This form of diabetes does not respond at all to the oral drugs that are somewhat effective for Type 2. But back in the days when patients had no way to test their blood sugar after eating and doctors considered A1cs as high as 13% "safe" these patients could go many years without being put on insulin. And even when they were put on insulin, because they didn't have meters, they injected only enough insulin to prevent the sky-high blood sugars that cause the fatal condition, diabetic ketoacidosis. Many patients on insulin still had blood sugars that rose into the 200s and even 300s.
So normal weight people with LADA would have ended up with blood sugars much higher than those of the overweight Type 2s who were more likely to respond to the sulfonylurea drugs and, later, metformin, most newly diagnosed people with diabetes received.
And because we now know that there is a straight line relationship (in large groups of people, at least) between A1c and the likelihood of heart disease, it doesn't take genius to suspect that the explanation for the extra cardiac deaths in the group of normal weight people with diabetes was the those much higher blood sugars they ran due both to misdiagnosis and to the way doctors ignored the damage caused by high blood sugars until the middle of the 1990s.
A second group of normal weight people diagnosed with diabetes as adults who are likely to end up with poor outcomes are people with milder versions of one of the many, unrelated, forms of genetic diabetes that are lumped together under the name MODY.
Many people diagnosed with MODY have family histories of relatives dying young of heart attacks while young and fit. This is probably because exposure to blood sugars that remain over 150 mg/dl for hours each day will over time cause the arteries to become diseased. People with these forms of MODY have had that kind of elevated blood sugar all their lives. But until very recently only those with the worst cases were diagnosed, and the rest, whose genes gave them "pre-diabetes" for much of their lives, lived with abnormal post-meal blood sugars for many years, and only developed full fledged diabetes much later on in life, perhaps after becoming a bit more insulin resistant.
Because they were thin, doctors didn't consider a diabetes diagnosis when they had symptoms that should have pointed them that way. (In my 20s, my doctors waved off my highly abnormal glucose tolerance test results as "nothing to worry about" precisely because I was normal weight.)
Some rare forms of genetic diabetes are caused by genes that damage not only blood sugar control but other organs, most notably the kidneys and the mitochondria. Mortality in families that inherit these unfortunate genes have nothing to do with diabetes but with the other organ damage that is due to these gene variants.
But for most people with either MODY or LADA it's pretty clear that if you keep your blood sugars in the normal range (under 140 mg/d--7.7 mmol/L) at all times you can, over time, reverse much of the damage that you have already suffered and avoid the premature heart attacks and kidney failure that carried off so many people diagnosed with diabetes in the past, when they were allowed to run very high blood sugars.
Comorbidities
There is also one other reason why thin people diagnosed with diabetes may have a higher risk of dying--one that wasn't addressed by this study's methodology. The journal article states that the data were adjusted for "demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status." However, what was left out was co-morbidities--i.e. the presence of other diseases.
One of the most important comorbidities to be considered is pancreatic cancer, since there is growing evidence that a very early symptom of pancreatic cancer may be the onset of diabetes. This is discussed in the Mayo Clinic web page HERE. A small but important subset of normal weight people who die prematurely with diabetes are people whose pancreases failed because they were infiltrated with cancerous cells.
In addition, many drugs used to treat cancers and life-threatening diseases are capable of causing diabetes, for example the steroids administered during chemotherapy or to treat COPD. Powerful steroids were also prescribed in the past to people with neuromuscular diseases like MS. Data sets like those glommed together in this study can't tell us whether a person was diagnosed with diabetes after a course of chemo or whether they died of cancer, COPD, or MS. So the presence of people in this data pool who were diagnosed with diabetes who also had one of these other life-shortening conditions could also explain a significant amount of the excess mortality this study uncovered.
Whatever the explanation, if you are a normal weight person diagnosed with diabetes, there's no need to panic. If you track your blood sugar after meals with a meter and keep it as close to the normal range as possible, you should do fine. The worst treatment doled out to people with diabetes nowadays is far better than what the people involved in these studies back in the late 70s, 80s and early 90s were given after their diagnoses, and for those of us who pursue normal blood sugars the future should be a lot brighter, no matter what our weight.
P.S. If your doctor tells you there's no point in losing weight because thin diabetics have even more heart attacks than fat ones, find a new doctor. I wouldn't have warned about this in the past, but over this past year I have been sent so many stories about doctors giving idiotic advice based on their having misunderstood a media report about a research study that I no longer assume doctors will even bother to read the full report before changing their practice recommendations.
July 16, 2012
Interesting Research Links posted on FaceBook since 6/6/2012
Here are links to and brief comments about the most important research findings I've posted about on the Blood Sugar 101 FaceBook page over the past six week. I've put the most important in red.
"for women...moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/
(Thanks to Peter at the blog, Hyperlipid, for the citation.) This epidemiological study debunks the relationship of Total Cholesterol to cardiovascular death.
*****
Dr. Hattersley (the MODY expert)'s team identifies another gene associated with "Type 2" diabetes in normal weight people.
http://www.sciencedaily.com/releases/2012/06/120601103808.htm
*****
Low dose aspirin raises risk of severe stomach or brain bleeds especially in people with diabetes--cutting heart attacks at the expense of causing strokes and hospitalizations for gastric bleeding (which can be very serious.) A huge epidemiological study should make us rethink the recommendation of daily aspirin.
Research examines major bleeding risk with low-dose aspirin use in patients with and without diabetes
http://www.sciencedaily.com/releases/2012/06/120605172017.htm
*****
A new C-peptide lab test is ACCURATE (unlike the one you had) and can detect very small amounts of insulin production even in people
with longstanding Type 1. Worth reading in full.
http://blog.sstrumello.com/2012/06/new-c-peptide-assay-could-expand.html
*****
Study suggests physicians have no clue as to how to dose post-meal insulin for Type 2s. Shameful.
Patients requiring more than one dose of prandial insulin problematic for physicians
http://www.healio.com/endocrinology/news/online/%7B561B9C43-F901-4497-A57A-684BC9F530E6%7D/Patients-requiring-more-than-one-dose-of-prandial-insulin-problematic-for-physicians
****
Duh. Basal insulin alone is is far more effective than expensive, dangerous oral drugs that may promote cancer. Why does the doctor who comments on this sound so surprised?
http://www.healio.com/endocrinology/news/online/%7B98FB0916-9882-4F51-A2E8-7D9CD2B01C72%7D/Insulin-glargine-bested-sitagliptin-for-HbA1c-reduction-in-insulin-nave-type-2-diabetes
*****
Fish oil (omega-3) fails to affect heart disease or deaths in 12K subject, 6+ year study.
N–3 Fatty Acids and Cardiovascular Outcomes in Patients with Dysglycemia — NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1203859
*****
Whoops, fish oil fails to demonstrate brain-protecting effect in random controlled trials. The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not help prevent heart disease.
http://www.bbc.co.uk/news/health-18410324
*****
Byetta produced A1cs in the 5% range for 1/3 of those who took it in this trial, duplicating what we've seen elsewhere, along with weight loss. Don't let your doctor put you on Victoza instead of Byetta. Byetta is a safer, better tested and more effective drug in the same price range.
Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with diabetes.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60479-6/abstract
*****
A lower carb, med-adjusted diabetes diet causes modest but maintainable weight loss and blood sugar improvement over 4 years.
http://www.sciencedaily.com/releases/2012/06/120612192756.htm
*****
You need to eat fat with your salad to properly digest the micro nutrients.
Study: No-fat, low-fat dressings don't get most nutrients out of salads
http://www.sciencedaily.com/releases/2012/06/120619230234.htm
*****
1 in 500 obese patients in the open [WLS] surgery group died during or shortly after the procedure, compared to one in 1,000 in the laparoscopic group. But doctors who recommend WLS tell patients to avoid tight blood sugar control as it is "dangerous." Please show me where 1 in 1,000 patients die from tight control!
http://www.reuters.com/article/2012/06/20/us-lessinvasive-weightloss-surgery-idUSBRE85J19920120620
*****
A frightening look at what heartless people whose only interest is their own profits recommend. Raise the A1c for older people to 8% and you eliminate lots of Medicare recipients. And don't forget to enrich surgeons while killing 1 out of 200 people who have WLS. Criminal!
Wall Street Journal: New Strategies for Treating Diabetes
http://online.wsj.com/article_email/SB10001424052702303292204577517041076204350-lMyQjAxMTAyMDAwOTEwNDkyWj.html?mod=wsj_valetleft_email
*****
A good example of the isomer problem I discuss in Diet 101. The lab-created isomer kills people and is the one found in supplements, rather than the expensive natural one.
http://www.sciencedaily.com/releases/2012/07/120712131721.htm
****
Dramatic illustration of difference between visceral (unhealthy) and subcutaneous (cosmetically unappealing) fat. CT scans.
How fat is fat? : The Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61925-9/fulltext
*****
Phthalates are plasticizers and in most soft bottles and much packaging. Research suggests they are a cause of diabetes.
Diabetes could be linked to phthalates, chemical in common household products, study suggests
http://www.boston.com/dailydose/2012/07/13/diabetes-could-linked-phthalates-chemical-common-household-products-study-suggests/2maQ1UQWxz1pZoKqAOmBFO/story.html
"for women...moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303886/
(Thanks to Peter at the blog, Hyperlipid, for the citation.) This epidemiological study debunks the relationship of Total Cholesterol to cardiovascular death.
*****
Dr. Hattersley (the MODY expert)'s team identifies another gene associated with "Type 2" diabetes in normal weight people.
http://www.sciencedaily.com/releases/2012/06/120601103808.htm
*****
Low dose aspirin raises risk of severe stomach or brain bleeds especially in people with diabetes--cutting heart attacks at the expense of causing strokes and hospitalizations for gastric bleeding (which can be very serious.) A huge epidemiological study should make us rethink the recommendation of daily aspirin.
Research examines major bleeding risk with low-dose aspirin use in patients with and without diabetes
http://www.sciencedaily.com/releases/2012/06/120605172017.htm
*****
A new C-peptide lab test is ACCURATE (unlike the one you had) and can detect very small amounts of insulin production even in people
with longstanding Type 1. Worth reading in full.
http://blog.sstrumello.com/2012/06/new-c-peptide-assay-could-expand.html
*****
Study suggests physicians have no clue as to how to dose post-meal insulin for Type 2s. Shameful.
Patients requiring more than one dose of prandial insulin problematic for physicians
http://www.healio.com/endocrinology/news/online/%7B561B9C43-F901-4497-A57A-684BC9F530E6%7D/Patients-requiring-more-than-one-dose-of-prandial-insulin-problematic-for-physicians
****
Duh. Basal insulin alone is is far more effective than expensive, dangerous oral drugs that may promote cancer. Why does the doctor who comments on this sound so surprised?
http://www.healio.com/endocrinology/news/online/%7B98FB0916-9882-4F51-A2E8-7D9CD2B01C72%7D/Insulin-glargine-bested-sitagliptin-for-HbA1c-reduction-in-insulin-nave-type-2-diabetes
*****
Fish oil (omega-3) fails to affect heart disease or deaths in 12K subject, 6+ year study.
N–3 Fatty Acids and Cardiovascular Outcomes in Patients with Dysglycemia — NEJM
http://www.nejm.org/doi/full/10.1056/NEJMoa1203859
*****
Whoops, fish oil fails to demonstrate brain-protecting effect in random controlled trials. The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not help prevent heart disease.
http://www.bbc.co.uk/news/health-18410324
*****
Byetta produced A1cs in the 5% range for 1/3 of those who took it in this trial, duplicating what we've seen elsewhere, along with weight loss. Don't let your doctor put you on Victoza instead of Byetta. Byetta is a safer, better tested and more effective drug in the same price range.
Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with diabetes.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60479-6/abstract
*****
A lower carb, med-adjusted diabetes diet causes modest but maintainable weight loss and blood sugar improvement over 4 years.
http://www.sciencedaily.com/releases/2012/06/120612192756.htm
*****
You need to eat fat with your salad to properly digest the micro nutrients.
Study: No-fat, low-fat dressings don't get most nutrients out of salads
http://www.sciencedaily.com/releases/2012/06/120619230234.htm
*****
1 in 500 obese patients in the open [WLS] surgery group died during or shortly after the procedure, compared to one in 1,000 in the laparoscopic group. But doctors who recommend WLS tell patients to avoid tight blood sugar control as it is "dangerous." Please show me where 1 in 1,000 patients die from tight control!
http://www.reuters.com/article/2012/06/20/us-lessinvasive-weightloss-surgery-idUSBRE85J19920120620
*****
A frightening look at what heartless people whose only interest is their own profits recommend. Raise the A1c for older people to 8% and you eliminate lots of Medicare recipients. And don't forget to enrich surgeons while killing 1 out of 200 people who have WLS. Criminal!
Wall Street Journal: New Strategies for Treating Diabetes
http://online.wsj.com/article_email/SB10001424052702303292204577517041076204350-lMyQjAxMTAyMDAwOTEwNDkyWj.html?mod=wsj_valetleft_email
*****
A good example of the isomer problem I discuss in Diet 101. The lab-created isomer kills people and is the one found in supplements, rather than the expensive natural one.
http://www.sciencedaily.com/releases/2012/07/120712131721.htm
****
Dramatic illustration of difference between visceral (unhealthy) and subcutaneous (cosmetically unappealing) fat. CT scans.
How fat is fat? : The Lancet
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61925-9/fulltext
*****
Phthalates are plasticizers and in most soft bottles and much packaging. Research suggests they are a cause of diabetes.
Diabetes could be linked to phthalates, chemical in common household products, study suggests
http://www.boston.com/dailydose/2012/07/13/diabetes-could-linked-phthalates-chemical-common-household-products-study-suggests/2maQ1UQWxz1pZoKqAOmBFO/story.html
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