Too Much Vitamin D and Calcium ==> Trouble

I've been struggling with a very tough to diagnose blood pressure problem for the past six months. A lot of expensive tests came up with nothing that would explain why my blood pressure was randomly surging well into the danger zone (168/110) and refusing to respond to the medications that had always worked for me in the past.

To make it more confusing every so often my blood pressure would randomly drop back to normal and stay there for a few days so it was clear that my high blood pressure was not due to obstructed arteries or kidneys.

As so often happens, my family doctor did one round of tests and then sent me to a nephrologist who was supposed to be an expert in blood pressure. The nephrologist did another round of tests and sent me to my endocrinologist. The endo did yet another round of tests that came up blank and then told me that such cases were extremely difficult to diagnose and that my insurer would not pay for the next step which involved going to an expert at a major hospital outside of our rural region.

Fortunately, a health news item came across my screen that gave me some insight into what was going on. It described a condition called "Milk Alkali Syndrome" which after many years of nonexistence had come roaring back. The syndrome causes high blood pressure and kidney problems.

You can read about Milk Alkali Syndrome in this summary posted on Diabetes in Control:

Calcium Supplements Can Increase Risk of Kidney Failure

Though the study makes it sound as if the problem is caused by calcium supplements, close reading reveals that it caused by the combination of high calcium and high Vitamin D and that the recent spike in cases has been caused by the recent fad of people supplementing with high levels of Vitamin D.

I have been supplementing with Vitamin D for three years at my doctor's suggestion because I am a melanoma survivor and there's some data suggesting Vitamin D fights melanoma. I had achieved a level of 39 ng/ml a year ago, taking 1000 IU a day so I had raised the dose to 2000 IU because I'd been influenced by some vocal online doctors to believe that higher was better.

When I dug out my many recent lab tests I found that my family doctor had tested my calcium level. It was NOT flagged as abnormal. The range for blood calcium went up to 10.3. But even so, My blood calcium was 10.3. So while my calcium level was normal, it was just barely normal.

Further research revealed that taking diuretics (which I was doing in an attempt to lower my very high blood pressure )lowers blood calcium. So that "normal" reading was almost certainly lower than the blood calcium level I'd had a few weeks before.

Hunting for previous values I found one from before I supplemented with Vitamin D which was in the 8s. Much more normal.

I do not supplement with calcium. I stopped after reading about the Aukland Study described further on in this post). But I do eat a lot of cheese. I had already noticed that there seemed to be some link between my blood pressure and my cheese intake, but I had thought this might have something to do with a factor found in aged cheese that has also been associated with elevated blood pressure. As a result, I'd cut back on aged cheese, but not all cheese.

When I looked at my latest Vitamin D test I found it showed my Vitamin D to be 55.8 ng/dl. The test a year and a half earlier when I'd been taking only 1000 IU a day had been 39 ng/dl. My doctor had thought 55.8 an excellent level, but recent research suggests that more is not necessarily better when it comes to Vitamin D levels.

All of a sudden, my mysterious symptoms started to come into focus. I had two "normal" lab results that were no more "normal" than a 2 hour glucose tolerance test result of 139 mg/dl (a result that often ignores a one hour value well over the 200 mg/dl level diagnostic for full fledged diabetes).

When I read on further, I learned that the safe ranges for Vitamin D were drawn from studies done on White males of European ancestry--and that some data suggests that people from Non-Northern European ethnic heritages have adapted to lower Vitamin D levels and that they do poorly when they attain the high blood levels suggested for White males.

More interestingly, a decently conducted three year study of older women given high dose injections of Vitamin D to avoid osteoporosis discovered that levels of blood Vitamin D corresponding to mine correlated with more not less bone fractures. You can read that study here:

Annual High-Dose Oral Vitamin D and Falls and Fractures in Older Women: A Randomized Controlled Trial. Kerrie M. Sanders. JAMA. 2010;303(18):1815-1822.

(Note that the units used in this study were nmol/L not the ng/dl labs use in the United States. Converting the units shows that these women started out deficient with average Vitamin D levels of 19.63 ng/dl, but after the Vitamin D shots their levels went up to an average 48.08 ng/dl.) We know that too much blood calcium is linked with bone brittleness, too.)

Another recent study, The Aukland Study, had found that women supplementing with calcium had more heart disease (presumably linked to calcification in their arteries) than women who didn't.

Vascular events in healthy older women receiving calcium supplementation: randomised controlled trial. Mark J Bolland. BMJ. 2008;336:262-266 (2 February), doi:10.1136/bmj.39440.525752.BE (published 15 January 2008)

And a disturbing comment in yet a brand new study commenting on the Aukland Study really got me thinking.

It said:

there is substantial epidemiological evidence that serum calcium levels in the upper part of the normal range are a risk factor for vascular disease

The combination of this information with the information that Milk Alkali syndrome (high blood calcium caused by high calcium and Vitamin D intake) caused high blood pressure suggested to me that I might have found the explanation for my blood pressure problems--and that I had been, once again, the victim of another doctor-caused medical disaster!

Once I had sorted this out, I stopped taking the 2000 IU a day of Vitamin D I had been taking for the past year. I cut out all cheese from my diet--which made me realize just how much cheese I'd been eating--much more than I thought!

I had read it takes about 2 weeks to eliminate HALF the excess vitamin D in the blood and that more Vitamin D is stored in fat and slowly released, so I figured it would take a while to restore truly normal calcium levels. Even so, after ten days it looks like I might be onto something. My blood pressure has already come down--it's in the 120s over 80s rather than the 140s over 90s when I wake up and has been staying in that range most of the day instead of spiking higher.

I will be avoiding cheese for another month and tracking how my blood pressure does. When I see my endo for my regular appointment in October I'll ask for repeat Calcium and Vitamin D tests. Since I did well at the 39 ng/ml Vitamin level I'll shoot for that--but only if I can sustain that level without elevated calcium. Meanwhile, I hope I haven't inadvertantly deposited damaging amounts of calcium in my arteries and kidneys.

WHAT DOES THIS MEAN FOR YOU?

For those of you reading this who have been supplementing with Vitamin D thanks reading all the doctor-inspired hype, my message here is NOT that you should not take Vitamin D.

Instead, what I'm saying is that if you are supplementing Vitamin D you need to get your blood levels of both Vitamin D and Calcium tested periodically so you can avoid dangerous Calcium levels. 1000 IU appears to be a safer level for supplementation than anything higher, and if you don't know what your levels are you should not supplement with more until you can check those levels out.

My other point is this: if you are eating a low carb diet and also taking white, chalky pills--prescription or other supplements), be aware that you may be getting much more dietary calcium than you realize.

Since it is looking like high normal calcium levels damage both your arteries and kidneys maintaining truly normal calcium levels is probably most important than obsessing about cholesterol.

UPDATE 8/5/10: Two months after stopping ALL Vitamin D supplementation and avoiding cheese my calcium levels are back to normal and my blood pressure is far more stable. I'm gong to stick with this regimen for a few more months and only supplement D in the fall after I stop gardening each day. I'll stick with the 1000 IU level which worked well for me in the past.

 

Vitamin D lowers Insulin Resistance?

UPDATE

Research published after this blog post was written finds that supplementing with Vitamin D, even in intravenous megadoses does NOT improve blood sugar or insulin resistance in any significant way. You can find citations to that research HERE.

Vitamin D may have some positive effects on heath, and I continue to take it, but it will not reverse any already existing autoimmune condition nor is it a diabetes cure. In fact, my own blood sugar stopped responding to Vitamin D within a week after I wrote this blog post.


If you found this page searching for help with lowering blood sugars, please check out this page: How To Get Your Blood Sugar Under Control. I hear every week from people who have used this technique to lower their blood sugars dramatically.


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Original Post

At my recent visit to the endocrinologist, the doctor suggested I add 1000 I.U. of Vitamin D to my daily regimen because of some recent data suggesting that it helps the body eliminate cells that have developed melanoma.

I followed her advice and started taking a pill every day around 10:30 when I take my metformin. A few days later I started to experience dramatic lows around 3 PM. Lows have rarely been a problem for me, as my body usually mounts an aggressive counterregulatory response at the first hint my blood sugar is dropping. All of a sudden I was seeing blood sugars in the 60s, and they were not resolving with the usual 2-4 grams of glucose. At one point as I battled a low I ended up eating 25 grams of Halloween candy and still only found myself in the 80s ninety minutes later.

It took me a few days to connect the lows with the addition of Vitamin D to my daily regimen. When I did, I started to read up on the relationship of Vitamin D to diabetes. It turns out that the relationship is a strong one, not only for people with Type 2,as a recent metastudy discovered--people with Type 2 appear to have low blood levels of Vitamin D and there is some suggestion that the combination of Vitamin D and Calcium may delay the diagnosis of Type 2, but also for people with Type 1. A Finnish study found that children who received Vitamin D supplementation appear to have a lower rate of Type 1 than those who did not.

There is also some data suggesting that Vitamin D may also be protective against Multiple Sclerosis, a disease that has long been known to be more prevalent in northern latitudes, as well as the data connecting it with cancer prevention.

The large dose of Vitamin D I am now taking appears to increase my sensitivity to insulin even though I am already insulin sensitive. It potentiates a dose as low as 1 unit of insulin, making it several times more powerful than usual. When I have skipped my insulin for a couple meals to see what the Vitamin D it might do when I don't use insulin (while eating very low carb meals) I did not experience the dramatic drop, but I did end up very slowly drifting down into the high 70s a few hours after dinner, rather than ending up in the 90s or low 100s as I would have expected to do.

I have read that it takes many months to completely restore Vitamin D levels to normal, so I'm going to keep supplementing and see what happens,though I'm thinking I might look for a lower dose pill and split the dose to see if I can avoid the dramatic drop all at once, as they are quite disturbing and leave me feeling jittery and off center for hours afterwards.

If you have had any interesting experiences with Vitamin D let me hear about them. I don't know if my sensitivity to Vitamin D is another of the things that grow out of my own, oddball form of Genetic diabetes or something that might be common among people with diabetes in general

Lab time again

I get labs every six months. This time my doctor checked my B-12 and Vitamin D levels, along with the usual stuff.

My A1c was 5.7%. That's pretty much what it always is. I had a cold last week and my blood sugars were higher than usual, so actually this A1c is better than I expected. It was 5.8% last October.

Using the most recent formula to equate A1c with blood sugar level, the one described HERE. this equates to an average blood sugar of 117 mg/dl.

My many meter readings are always lower than any A1c formula predicts, which suggests that I'm one of those people who is a high glycator. That topic was discussed HERE

My meter shows that my actual blood sugar average is closer to 100 mg/dl. But the biggest problem I have with blood sugar is my fasting blood sugar. I have a ferocious counter-regulatory response that fights all attempts to lower it. If I use even 1/4 of a unit too much Lantus, I'll wake up at 4AM with heart pounding and blood sugar at 107 mg/dl--a sure sign that I dipped into the 70s and caused that counter-regulatory response. If I don't use any insulin, even with a very low carb diet my fasting blood sugar will be in the 120s. So for now, I do what I can during the day to keep the blood sugar down. I'm still trying to tweak the Lantus dose to find one that will work, but for now my morning fasting blood sugar is 98-108 though I can get it to drop into the 80s during the day.

At my endo's suggestion, I've been supplementing with 1000 IU of Vitamin D every day for six months. My Vitamin D level was 39.8, with the normal range range being defined as 32-100 ng/ml. So it looks like I can boost my Vitamin D level without worrying about overdosing.

I'm using Vitamin D for its supposed usefulness in fighting melanoma not for any supposed effect on blood sugar. Though I initially saw a strong impact on my insulin sensitivity when I started the Vitamin D supplementation--I was hypoing on normal doses of insulin--it wore off very quickly. Now Vitamin D has no effect at all on my insulin sensitivity. Vitamin D does seem to improve my mood through the dark, short, sunless days of a New England winter. Plus, anything I can do to discourage rogue melanoma cells from taking root is all to the good.

My Vitamin B12 was on the high side, so that's good. Metformin can deplete Vitamin B12, so it is a good idea to check it every year if you are taking metformin.

My cholesterol was excellent. As usual the total was very high--I have that "longevity" variant of cholesterol that Dr. Nir Barzilai identified in the Albert Einstein Medical School Longevity Study. This gene makes for very large, "fluffy" LDL and HDL particles which tend not to clog arteries. My dad's cholesterol was measured at 340 when he was 70. I got into that study because he was a centenarian.

For the complete list of Longevity Study publications, click HERE.

So when I look at my cholesterol test result, what I look at is triglycerides and HDL. When I'm eating the right amount of carbohydrate and have my insulin set right, TGs are low and HDL is high. This time my HDL was 76, which is the highest it has ever been, and my TGs were 83 which is very healthy.

So I'm happy. But my doctors will probably look only at the total Cholesterol number which is 294 and have fits. That is what they always do. I have printed out data about the study and explained to them that I was informed that I do carry the longevity variant of CETP, and I have asked them to put it in my file, but it makes no difference, since none of them ever read my file but only look at the latest lab sheet.

My microalbumin test was great <3.0 with normal being defined as 0-20 mg/dl. The ratio of microalbumin to creatinine was <3.2, which is also great.

So basically, if I don't walk into the path of an oncoming car, or contract MRSA, or get bit by the wrong mosquito this summer, it looks like I should be around for many years to come.

Special strains of acidophilus fight yeast and adjust pH

I'm really happy to note that last week the New York Times wrote a long article praising Good Germs, Bad Germs: Health and Survival in a Bacterial World by Jessica Snyder Sachs, which I reviewed here enthusiastically a few weeks ago.

In the discussion of how we can harness other microorganisms to fight the harmful ones in our bodies, Sachs's book contained what the medical newsletters call a "pearl for practice", one which I tested out myself with excellent results.

Sachs discussed a product, Fem-Dophilus, that contains strains of acidophilus which are those that naturally colonize healthy female reproductive and urinary tracts. After killing off our own friendly acidophilus by using antibiotics, many of us have attempted to introduce acidophilus using yogurt, but it turns out that the kind of acidophilus found in yogurt is a different strain that does not flourish in our bodies for any period of time.

The benefits of having the right strains colonizing your body are that they outcompete yeasts and the bacteria that cause bacterial vaginosis by giving you the correct pH and secreting high levels of hydrogen peroxide that kill other microorganisms.

As those of you who read my blog know, I'm not a big fan of supplements, but I read enough user praise for Fem-Dophilus online to think it was worth a try. I bought it mail order. Buying it that way costs half of what you'll pay in local health food stores even with postage. I have been using it for three weeks.

It really works! Many, if not most, of us older ladies whose hormone levels have dropped have problems maintaining normal vaginal pH. If we have high blood sugars, we may be very susceptible to yeasts or other hostile microorganisms. Even if we have normalized our blood sugars if we had frequent urinary tract infections before diagnosis, we may have fatally screwed up the natural flora in our guts and vaginas.

I've gone through a lot of antibiotics in the past, because my high blood sugars gave me unrelenting urinary tract infections which resulted in some scarring that makes new infections even more likely to occur. After three weeks of introducing these friendly bacteria into my system, I am experiencing improvements in both digestion and in pH-related issues that are quite encouraging.

So if you are a woman who has been battling urinary tract infections or vaginal dryness investing in a bottle or two of this stuff might be well worth a try.

To update my report on another helpful supplement: Vitamin D.

After a brief period I stopped seeing any blood sugar effects from Vitamin D, but I did noticed that I seemed to be more cheerful than usual and when I stopped taking it I found that the mood effects wore off. They came back when I started it again. I think that the initial burst of cheerfulness many of us experience when going out on a sunny day may be connected with our body's pumping out some Vitamin D in response to the sun exposure. (If you are like me and have very pale skin, that cheerfulness turns to dismay as you almost immediately afterwards redden up and everything starts to burn!)

Vitamin D seems like it might be a very good supplement for people with diabetes to take, as it might be related to the depression that has been observed to accompany diabetes--along with the lowered Vitamin D levels.

One caution though: I read that if you don't take calcium WITH your Vitamin D, it may actually promote the storage of other metals in your bones--the ones you are getting in polluted air, Chinese supplements, and foods. So don't take Vitamin D without calcium. Cheese and other food sources are best. I use the kind of supplements that are mostly ground up limestone.

Why You Neet to Get Copies of Your Lab Test Results

Every time you go to the lab to get tested, insist on getting a copy of the results for your own files. You (or your insurance) paid for these tests and they are legally yours, so the lab or your doctor must give you a copy if you ask.

Most doctors will only tell you about abnormal lab test results and if nothing was what they consider abnormal they may only give you either a dumbed out summary or a verbal reassurance that "everything was fine."

Just how misleading this can be is shown by stories of people whose fasting blood sugar was 124 mg/dl who were told they were "fine", when one more mg/dl would have been enough to diagnose diabetes.

I experienced something similar. I was told my calcium values were fine when the normal range went up to 10.3 mg/dl and my reading was 10.3. Subsequent research turned up the fact that the high end of the "normal" range for blood calcium is associated with a significantly raised risk for heart disease.

As it was likely my raised blood calcium was due to overdoing my Vitamin D supplementation (which is a growing problem given the hype about this latest cure-all supplement) I stopped the supplementation since my blood Vitamin D level was far above the level defined anywhere as deficient and in another few months the blood calcium level had dropped to the middle of the range which is much less likely to cause serious health problems.

Keeping copies of truly normal lab results can also be important, because over time you may see a trend upward that points to a developing problem. If your "normal fasting blood sugar" each year was 75, 80, 85, 90, 95, 97, and 99 mg/dl these values would all be normal, but point to significant deterioration in your fasting blood sugar control. You'd end up a lot better off if you cut back on your carb intake while still normal than if you waited until it reached 101 mg/dl and you were officially told you were "pre-diabetic."

When you keep the actual copies of your lab tests you will also be able to tell if the doctor has actually done the right tests to determine what is wrong with you. For example, if you come from a family where many relatives have diabetes and have been relying on your doctor's assurance that you don't, it would be helpful to know whether he based this assurance on the fasting glucose test, the A1c, or a random glucose test.

If you are experiencing tingling in your extremities, your doctor should order a Vitamin B-12 test as Vitamin B-12 deficiency can look exactly like diabetic neuropathy and if not treated can cause permanent nerve damage. If you are taking metformin which can in some people cause problems with Vitamin B12 absorption and suddenly develop neuropathy while maintaining normal blood sugars, it is very important to ensure this test has been done.

If your doctor tells you that your cholesterol is too high, it is important to see whether this was based on a total cholesterol number alone, or took into consideration the readings for HDL and Trigycerides which are far more predictive of trouble.

Over the years, diagnostic standards change. This is another reason old lab tests may provide you with useful information years later. When I first ran into problems with my blood sugar, the definition of diabetes was a fasting blood sugar of 140 mg/dl. The cutoff subsequently dropped to 125 mg/dl.

A person who had been assured they weren't diabetic in 1996 based on the old standard might get more insight into why they already had diabetic complications like neuropathy or protein in urine the very day they were diagnosed with diabetes in 2000 if old copies of their fasting blood sugar tests showed they had been in the 130s consistently over the previous decade.

Another reason you want to hold on to your lab test sheets is that for many tests the range that defines normal varies from lab to lab and is not standardized. Labs also use different units for reporting test results. One of the big problems with Vitamin D recommendations is that labs use two different units for reporting blood levels of Vitamin D and people often assume they are deficient because they are looking at recommendations that are given using a unit that is not the one that their lab uses. Only your lab sheet will tell you what unit your lab used.

Insulin and C-peptide analysis are not standardized and and the lab reference ranges are different from lab to lab. Even the same hospital may send your blood draw out to different vendors for analysis so that the reference range will vary from year to year though you go to the same hospital lab. The reference range is essential for interpreting the result and when a test is not standardized, as is the case with insulin and C-peptide you can't compare your readings with those of others who use other labs.

There is another reason why you need to get copies of your test results right after you go to the lab. As I learned the hard way, after a few years it may be impossible to retrieve older lab results from the lab or your doctor.

Hospital labs do not keep results online for more than a few years. They are continually changing their computer systems and each time they make a change they get rid of old data. I found one set of labs impossible to retrieve from a local hospital only 3 years after they were done.

Doctors will have your old labs in their records, but you will lose access to those if you move to a new doctor. Even when you ask your old doctor to forward your medical records to the new doctor, what actually happens is that the doctor is sent a summary sheet not the actual records, which are put in storage somewhere and can be difficult or impossible to access if you need them.

If your doctor retires or moves to a new practice there may also be a brief period during which you can get your records, after which they may become impossible to retrieve.

When you get your lab tests you will often see values flagged as high that your doctor has not mentioned. The most common of these is the BUN which is often elevated in people who are eating a low carb diet because the low carb diet induces a degree of dehydration that affects the test result but does not cause any health problems. If you see a value on your lab sheet that concerns you, ask your doctor about it. There are also sites on the internet that explain the various test results and what they mean.

If you are paying for your lab tests as too many of us are, keeping copies of old tests can help you avoid unnecessary tests. If a doctor routinely schedules certain tests which you have long had normal values for, feel free to ask what the point of the testing might be.

All too often, the point of the test is to allow the doctor to qualify for some benefit to himself from imbecilic insurance-company sponsored programs that judge the quality of medical care by how many patients are given total cholesterol tests or quarterly A1c tests (irrespective of the value the tests show.)

If there is no health problem you need to diagnose or medication change you might make based on the result, there is no reason to pay for expensive testing.

When you go to a lab ask the person who does the test what the procedure is at that lab for getting your results. Some labs will give you the results as soon as they are ready if you show a driver's license. Others require you to fill out a form and will mail them to you.

It is helpful to get the results before your doctor's appointment so that you can discuss any issue you find in them. However, if you don't get a copy before the appointment, you can always ask the doctor to have a copy made at the front desk and can take that copy home with you.

 

Links to Studies Posted on the FaceBook Blood Sugar 101 Page

Because posts on FB scroll off I'm reposting the posts I've made on the Blood Sugar 101 FaceBook Page so that they will still be available here when they are gone from FB.

THE POSTS:


Scientists may not understand what causes painful neuropathy, but I hear all the time from people who have cured it by dropping bgs below 140 mg/dl at all times.

Scientists uncover potential treatment for painful side effect of diabetes

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FDA about to approve Lorcaserin which achieves 5% weight loss in less than 50% of obese people over a year. Magic it ain't.

http://www.nejm.org/doi/full/10.1056/NEJMoa0909809

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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

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Researchers "take advantage of a new mouse model of diabetes type 2, which, like humans, develops the disease in adults as result of a high-fat diet." Which means it doesn't have the same diabetes humans get which is genetically almost always from insufficient insulin production combined with factors that make for insulin resistance like mitochondria that burn glucose poorly.

Caffeine can prevent memory loss in diabetes

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Experimental basal #insulin that lasts 40 hours gives almost the same results as Lantus with slightly less nighttime hypos. But blood sugars still remain high because of the way it's dosed.

Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment

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Phthalates have also been linked with #diabetes in older people. Hard to eliminate our exposure. They're in everything.
Washington Post: If the food’s in plastic, what’s in the food?

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The news about #metformin just keeps getting better. It seems to protect against Parkinson's too!

Metformin can substantially reduce the risk of Parkinson's disease in diabetes, study suggests

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Serum levels of phthalate metabolites are linked with the development of type 2 diabetes in the elderly, Swedish researchers found.

Medical News:%20Common Chemical Tied to Diabetes in Seniors - in Endocrinology, Diabetes from MedPage

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This is about Type 1 #diabetes and mice, but it's still interesting and may have an application for Type 2, also.

Magnetic Nanoparticles Predict Diabetes Onset: Researchers from Harvard Medical School and Massachusetts General Hospital have developed a magnetic nanoparticle-based MRI technique for predicting whether—and when—subjects with a genetic predisposition for diabetes will develop the disease.

http://hms.harvard.edu/content/magnetic-nanoparticles-predict-diabetes-onset

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Blocking glucagon is way far from being a real treatment for #diabetes but it's an interesting concept.

Targeting glucagon pathway may offer a new approach to treating diabetes

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Slightly higher than normal blood sugars cause bad pregnancy outcomes, just as they cause #diabetes complications. Will doctors ever challenge the ADA's damagingly high diagnostic criteria?

New pregnancy risk for babies and moms: Overweight moms with moderately high blood sugar raise health risk

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Humans have evolved unique genes for fat metabolism, which supports our big brain. One reason why rodent research is so misleading.

Genetic adaptation of fat metabolism key to development of human brain

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Yet another study attributes to weight loss the effect of the mandatory carb-cutting enforced by WLS. The surgeons won't stop until everyone has this surgery. Note, that the incidence of diabetes in the most heaviest subjects in this group was under 10% and dropped by less than 6%. Most obese people will never develop diabetes, despite the hype. You need the genes to get it, and you need to cut carbs to lower your blood sugar. WLS isn't a "cure" it's a way of forcing people to cut carbs involuntarily.

Losing Weight When Obese Can Prevent or Cure Diabetes, Whatever the Initial BMI, Study Suggests

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Yet another antioxidant vitamin pill turns out to be harmful--Beta Carotene. Eat your veggies, folks and leave the pills on the shelf!

Potential 'dark side' to diets high in beta-carotene

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Confirmation of what we all know, bananas, oatmeal, and oral drugs won't do it. If only they taught these teens to cut carbs!

TODAY — A Stark Glimpse of Tomorrow — NEJM

also An Editorial on the Same Study.

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Read this list of unnecessary tests that you should NOT let a cardiologist perform on you. I've had some and refused another despite heavy pressure from an ER doctor. (I'd gone to the ER for something unrelated.) The last one can kill you.

http://choosingwisely.org/wp-content/uploads/2012/04/5things_12_factsheet_Amer_Coll_Cardio.pdf

From the same site's nephrology page: "Avoid nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes.The use of NSAIDS, including cyclo-oxygenase type 2 (COX-2) inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention and worsen kidney function in these individuals. Other agents such as acetaminophen, tramadol or short-term use of narcotic analgesics may be safer than and as effective as NSAIDs."

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Note that the recommendation is to get this nutrient from food, not pills. Chicken thighs will work. Bake them until crispy, paint with buffalo chicken hot sauce. Yum.Nutrient found in dark meat of poultry, some seafood, may have cardiovascular benefits

A nutrient found in the dark meat of poultry may provide protection against coronary heart disease in women with high cholesterol, according to a new study.

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Experimental drug stimulates a free fatty acid receptor in the pancreas which causes insulin secretion. And weight gain. What else it does it unknown as the testing on humans was brief and in few subjects.


Medical News:New Diabetes Drug Cuts Glycemic Risk - in Endocrinology, Diabetes from MedPage Today

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We recently learned Bisphenol A doubles insulin resistance, so a connection with heart disease is not that mysterious. I wish they'd correlated it with A1c. The EPIC-Norfolk study is the one that first found the tight correlation between A1c and heart disease even in the normal range.

Bisphenol A exposure linked to increased risk of future onset of heart disease

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Maternal PFOA blood levels => Fat daughters 20 years later. The obesity crisis's NOT just about lifestyle choices poeple.

The levels of the environmental pollutant perfluorooctanoic acid (PFOA) that mothers had in their blood during pregnancy increased the risk of obesity in their daughters at 20 years of age.

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Another reason to avoid those vegan "health food" diets. Arsenic is linked to rising rates of Type 2 diabetes. Next time you pick up an organic cereal bar or buy infant formula, you might want to read the label closely.

Arsenic found in organic baby food, cereal bars
todayhealth.today.msnbc.msn.co?m

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Yet another study in which supplementing with Vitamin D does NOT improve a condition associated with low Vitamin D levels but raises blood calcium--which is dangerous to your heart. Go easy on the Vitamin D folks!


Vitamin D is associated with decreased cardiovascular-related morbidity and mortality, possibly by modifying cardiac structure and function, yet firm evidence for either remains lacking.

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Huge study "Surprisingly, LDL cholesterol and total cholesterol, however, were not associated with stroke risk in this population" (Older women) Triglycerides were.
Lose the carbs, baby! Carbs are what raise triglycerides.

Triglyceride levels predict stroke risk in postmenopausal women

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Research, mostly rodent, showing raising insulin doesn't cause obesity unless you create hypoglycemia. Don't believe doctors who refuse insulin because "it will make you fat." Dose it right, and it won't. (I lost weight when I started insulin.)

Whole Health Source: Insulin and Obesity: Another Nail in the Coffin

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MRI scan 'better' for heart patients
A magnetic resonance imaging scan for coronary heart disease is better than the most commonly-used alternative, a major UK trial of heart disease patients has shown.

MRI is better at detecting heart disease, and safer than angiogram since it doesn't involve x-rays.

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An investigation by the Centers for Disease Control and Prevention, found that between 1996 and 2008, the amount of leg and foot amputations among U.S. individuals, aged 40+ with diagnosed diabetes dropped. This is good news, but there are still too many people getting amputations, mostly the very old and people in under-served poverty-striken communities who can't afford medical treatment that could lower their blood sugars.

Lower Limb Amputation Rates Associated With Diabetes Drop,

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Thousands of untested new supplements have flooded the market with only the manufacturer's say-so attesting to their safety. Read this article in full if you buy pills you are told are "natural." They may contain dangerous ingredients.

http://www.nejm.org/doi/full/10.1056/NEJMp1113325

Phosphate Additives Promote Hardening of the Arteries

Several weeks ago I posted about the disturbing link between blood phosphate levels and heart disease, pointing out that people eating low carb diets have a unique exposure to phosphates because they are added to so many of the meats you buy at the grocery store and order in restaurants. In this post I will explain more about what these phospate additives are and why they are so dangerous to our health.

Phosphates are compounds that contain phosphorous and oxygen. They are essential to the construction of every cell in our body as phosphates make up the backbone of DNA, They form essential components in cell membranes and are essential to the proper growth of plants. Adenoside Triphosphate (ATP) is the molecule every cell uses used to store energy. Without it, we're dead meat.

Therefore we get a dose of phosphates any time we eat any meat or vegetable. These are "organic phosphates" which are deeply bound into the structure of the foods we eat--so much so that only 40-60% of the phosphate we consume is actually bioavailable. The rest goes through us undigested.

But these organic are not the phosphates that pose a threat to health. The problem phosphates are the "inorganic phosphates"--chunks of phosphate containing rock--that are added to our foods. The are commonly used as preservatives, flavor additives, and to keep cream from separating in dairy products. Phosphoric acid, which converts to phosphate in our bodies, is added to soda to keep brown sodas from turning jet black, which would make them unappealing to most people. Phosphates are also frequently used to provide the chalky white pill material that holds the supplements you buy in pill form.

Unlike the organic phosphates these inorganic phosphates are 100% bioavailable. That means if you eat 500 mg of calcium phosphate, disodium phosphate, or any of the many other inorganic phosphates added to processed foods or supplements, the whole 500 mg will be absorbed. When it is, it will go into your bloodstream where where will raise your serum phosphate level.

It has long been known that consuming inorganic phosphates can be very dangerous for  people with severe kidney disease, as failing kidneys can't remove phosphates from teh blood, and these phosphates precipitate out in the kidney, destroying what little function is left.  But while doctors may be aware of this, few of them know that consuming inorganic phosphates also poses a major risk to normal people, because it can promote heart disease.

We know from several well-conducted studies that there is a direct link between serum phosphate level and heart disease. As a recently published review article explains, " Higher serum phosphate levels were independently associated with coronary artery calcification, vascular stiffness, left ventricular hypertrophy, and carotid artery disease, even among individuals with normal kidney function and serum phosphate levels within the normal range."

A study that matched CAC scans to serum phosphate levels verified that rising serum phosphate levels correlated directly to rising Agaston scores in a population who had completely normal kidney function.

The most comprehensive  study to investigate the impact of phosphates on heart disease was a study of the Framingham Offspring. It looked at serum phosphate levels in a group of over 3,000 normal people and then looked to see which of them had developed heart disease sixteen years later. It found that:

... a higher level of serum phosphorus was associated with an increased CVD [cardiovascular disease] risk in a continuous fashion. ... Individuals in the highest serum phosphorus quartile experienced a multivariable-adjusted 1.55-fold CVD risk ... compared with those in the lowest quartile... Serum calcium was not related to CVD risk.

Does Eating Inorganic Phosphates Raise Serum Phosphate Levels? 

After reading this, I could not help but wonder if those high serum phosphate levels that caused heart disease were caused by eating diets high in phosphate or whether people destined to get heart disease migh6 have high serum phosphate levels as a side effect of an undiagnosed preexisting health issue.

Could eating a diet high in phosphates be all it took to raise serum phosphate levels? This question was elegantly answered by a study published back in 1977.

In this study subjects who were allowed to eat only the foods supplied by the researchers were, for four weeks, fed a control diet free of any phosphate additives. Then, for the next four weeks, they were fed a diet that contained the identical amount of calories, protein, fat, and carbohydrate as the control diet but this diet was made up of foods containing inorganic phosphate additives, like American cheese, soda, and processed meats.

The report explains, "The average phosphorus content of the daily menu was 979 mg during the control period and 2124 mg during the test period." After a month of eating the foods with the added phosphates, the study participants blood was tested and it was found that they had experienced a dramatic rise in serum phosphates, accompanied by a decrease in serum calcium.  The addition of the phosphates to their diets also caused digestive distress to many of the participants--in some cases it persisted throughout the whole study.

When their serum phosphate levels were measured, they were found to have "increased from 3.76 ±0.38 mg/100 ml during the control period to 4.43 ±0.30 mg/ 100 ml [mg/dl] during the high-phosphorus period."  This was an 18% rise in serum phosphate level.  So yes, upping dietary consumption of inorganic phosphates will raise serum phosphate a lot, even in completely normal people.

And it is also worth noting that the amount of phosphate being consumed by the subjects in this study is likely to be far less than that consumed by the average person today since they were being fed a controlled diet containing only 2,200 calories.  Higher caloric intakes would result in higher intakes of inorganic phosphates, and higher serum phosphate levels, too. And people eating "healthy diets" who use supplements might be getting even higher amounts, since many chalky pill substrates are made mostly of dicalcium phosphate.

How Damaging Is This Added Phosphate?

The Framingham Offspring study found that in normal participants whose serum phosphate levels were in the top quarter of readings for the whole research group at the beginning of the 16 year study   there was a 55% higher risk of developing cardiovascular disease at the end of the study .  This is a big leap in risk, especially when it is attributed to a factor that is completely ignored by doctors, health authorities, and food companies.

Though we can't be confident in comparing the blood phosphate levels in the 1977 diet study and the Framingham Offspring study, as using different lab techniques will give different reference ranges, it's worth noting that the serum phosphate value representing beginning of the highest quartile in the Framingham Offspring Study--the level at which cardiovascular risk was 55% higher--was only 20% higher than the top of the lowest quartile.

So since we have seen that boosting the phosphate intake of a 2,200 calorie diet can easily achieve an 18% rise in serum phosphate levels,  it seems very likely that dietary consumption of phosphates, alone, is enough to boost serum levels into the range that correlates with a higher risk of heart disease.

Is it the Phosphates Causing Heart Disease or Are They A Lifestyle Marker?

Since inorganic phosphate intakes rise dramatically when people eat diets high in fast food and soda, it would be easy to dismiss the link between serum phosphates and heart disease as being due not to the phosphates themselves, but to the unhealthy diet that results in those high serum phosphate levels. In short, to point to serum phosphates as a marker of a diet rich in junk food.

But there is some other research that contradicts this argument.  The researchers who published the Framingham Offspring Study cite a study that found that  "... higher phosphorus levels increase the propensity of mineral deposition in vascular smooth muscle cells in vitro."  That study found that

HSMCs -[Aortic Smooth Muscle Cells] cultured in media containing normal physiological levels of inorganic phosphate (1.4 mmol/L) did not mineralize. In contrast, HSMCs cultured in media containing phosphate levels comparable to those seen in hyperphosphatemic individuals (>1.4 mmol/L) showed dose-dependent increases in mineral deposition.

Furthermore,  exposure to high levels of phosphates induces a phenotypic transformation of vascular smooth muscle cells into osteoblast-like cells that express biochemical markers characteristic of the cells that turn into bone.

What this means in plain English  is that in a petri dish, cells from heart arteries were fine when exposed to normal levels of phosphates, but when the levels rose to abnormally high levels the artery cells started to act like bone stem cells and fill up with tiny bits of rock. The higher the amount of phosphate they were exposed to, the more rock.

The Framingham researchers also cite a study showing that "higher serum phosphorus levels increase circulating PTH [parathyroid hormone] levels even in healthy individuals," pointing out that "Higher PTH levels may be proinflammatory" as they raise the level of a substance, IL-6, linked to heart disease.

These findings suggest that the problem is that when you eat too much phosphate-containing rock, that rock ends up floating around your bloodstream until it precipitates out in your heart muscle (and other) cells.

Phosphate, Vitamin D, and Niacin

An interesting side note to the issue of high serum phosphate is the finding that rising serum phosphates will lower Vitamin D production as Vitamin D is one of the regulators of blood phosphate levels.  (Discussed HERE).  If you have abnormally low Vitamin D levels when not supplementing Vitamin D, this could be pointing to the fact that your serum phosphate level is unhealthily high.

In patients with kidney failure, there is some evidence that supplemental niacin lowers the very high serum phosphate levels characteristic of kidney failure, though there is no research to answer the question of whether niacin lowers phosphate levels in people with normal kidneys. But it makes a lot more sense to lower serum phosphate levels by cutting out of your diet as much inorganic phosphate as possible rather than to drive with one foot on your physiological accelerator and one on the brake, which is what you do when you attempt to lower these levels by taking a supplement while consuming the phosphates.

What's Next?

I'll be writing more about the role of inorganic phosphates in our diets and what we can do to achieve normal serum phosphate levels. For now, your homework is to start reading labels for all the foods and supplements you consume, to see how many items you eat each day contain added inorganic phosphate.

Since I started doing this, back when I published my first post about the dangers of high phosphate levels, I've been at first surprised, and then horrified, to see just how much of what I have thought of as "healthy" foods and supplements are full of these dangerous, inorganic phosphate minerals.

Holiday Gifts for People with Diabetes

It's almost that time again!

People with diabetes are bracing themselves to smile graciously as they unwrap boxes of diarrhea-producing, blood sugar-raising "Sugar Free" cookies and tuck into dinners filled with diet-ruining high carb/low fat items prepared with love by friends and relatives who don't understand diabetes.

There's still time to head off these kinds of disasters. If you are shopping for someone with diabetes, I hope this list of suggestions helps you choose an appropriate gift. If you are a person with diabetes, don't be shy about letting those who love you know what kinds gifts would be most appreciated--and what kinds of foods you can eat.

SUGGESTED GIFTS

1. A Pedometer. The "10,000 Steps" program might be a great way to start a gentle but effective exercise program and the pedometer is a fun way to motivate and measure improvement. Count how many steps you take each day, then set goals that gradually raise your daily step count to 10,000. This has been shown to make dramatic impacts on fitness.

2. A Heart Rate Monitor. The heart rate monitor makes it possible to fine-tune an aerobic regimen so that it strengthens the heart. This is only an appropriate gift for someone who already is involved in some form of aerobic exercise. Pair the monitor with a book that explains how to use the monitor to improve cardiac fitness.

3. A gym or pool membership. If you are looking for an expensive gift consider a gym membership, but consult the recipient as to which club they prefer before you buy the membership as it will be nonrefundable.

4. Three Bottles of Vitamin D. If you live in a wintry climate and can't afford to give the gym membership, give the gift of Sunlight. 1,000 IU of vitamin D are safe for any adult and supplementing Vitamin D improves mood and appears to have impressive health benefits. Go for the oil-based Vitamin D3 (Cholecalciferol).

5. Blood Sugar Test Strips. This can be a wonderful gift for someone who is working on improving their blood sugar control as strips are very expensive and many insurance plans limit the number of strips a person can get each month. Make sure you find out which brand of meter the person uses as strips only work with specific meters. Amazon has some very good deals on strips, but check the comments to make sure that the expiration dates are current.

Do NOT give a meter as a gift! The biggest expense in blood sugar testing is not the meter but the strips. A "nice" meter might require the giftee to spend more on strips than they can afford. Also, many insurance plans limit the brands of strips they will pay for or charge a much higher deductible for strips of certain brands.

Check beforehand to find out what meter your recipient uses and whether they would appreciate more strips. This gift may be especially useful for people on Medicare which limits the number of strips given out severely.

6. Pharmacy Gift Cards. Many insurance plans have very high copays. A pharmacy gift card could be very helpful to a person who needs to fill prescriptions every month.

7. Stick Me Design Meter/supplies fashion bag. These are a delightful treat for women who carry blood sugar testing supplies or injection supplies. I have one myself and love it.

8. Pumpwear. This company makes a range of fashion accessories for people who use insulin pumps including quite a few for children.

9. Low Carb Cookbooks. Lowering carbohydrate intake is the key to improving blood sugars, but it can be tough to know what to eat. Low carb cook books can help people with diabetes learn more about what foods will work best to improve blood sugar control.

10. Low carb cooking ingredients. Many people with diabetes would appreciate a gift of DaVinci Sugar Free Syrups. They are extremely useful for making low carb desserts. They contain Splenda, so don't give them to people who don't use this artificial sweetener.

Other low carb cooking ingredients that might be appreciated are Not Starch which is a extremely low carb thickener that can be used to replace flour in gravy.

Other useful low carb supplies include Almond Flourand Vanilla Whey Protein Powder

I welcome your gift suggestions in our comment section, but will be deleting comments which are obvious spam so please do not put in links to commercial web sites of dubious interest to people with diabetes.

UPDATE Nov 13, 3:14 PM: Be sure to read the comments. Visitors have posted some really great gift ideas!

Dangerous Celebrity Doctors Who Prey on People with Diabetes

Not a week goes by than I don't get an email from someone directing me to the web site of yet another physician with poor or nonexistent credentials in endocrinology who's trying to duplicate the financial success of people like Neal "I'm a psychiatrist but that doesn't keep me from making millions giving bad advice about diabetes" Barnard or Joseph "even a stopped clock is right twice a day" Mercola.

What all these doctors have is common is this: little or no experience treating people with diabetes and grandiose claims that they have discovered secrets that will cure or reverse your diabetes. They publish bestselling books that propel them to TV stardom without anyone in the publishing or media community ever checking what happens to people with diabetes who follow their advice.

Barnard, in case you've been living under a rock, is a vegan activist who heads the PETA front group misnamed Physicians Committee for Responsible Medicine. His books claim that the cure for diabetes is a vegan, extremely low fat/high carbohydrate diet--a diet that leaves most people with diabetes fighting ravenous hunger, rollercoastering blood sugars, and advancing complications.

Barnard has no training in endocrinology. He's a psychiatrist who doesn't appear to have practiced much in his specialty. But he is a genius at self promotion and over the years he has promoted himself to where he is on peer review committees funding diabetes research and is a darling of the American Diabetes Association. This should be no surprise. The ADA is so invested in the low fat/high carbohydrate which it has promoted to people with diabetes for decades that they gravitate to anyone whose charisma might postpone the day when America discovers how poorly it has been served by the organization whose flawed advice, maintained in the face of decades of evidence against it, has been killing their loved ones with diabetes.

What you won't find on Barnard's TV show is any advice about testing after meals to see what foods raise your blood sugar, of course. But he's convincing (as so many psychopaths are). So Barnard will retire a multi-multi-millionaire and tens of thousands of people with diabetes who see him on legitimate looking TV shows will end up with unnecessary compliations as a result of eating the diet of grains, fruits, pasta, and soybeans he has convinced them are a healthy diet.

But there plenty of questionable self-promoting doctors who have jumped on the Low Carb bandwagon, too. Dr.(DO not MD) Joseph Mercola is the most notorious. Mercola won his first adherents in the alternative health community by turning against grains. Fine. There are problems with grains and I'd be the first to admit it. Since then he's jumped on whatever is the currently fashionable cure all, (right now it is Vitamin D).

But the problem with Dr. Mercola is that if you visit his site you'll see that he popularizes health ideas that are true (though discovered by others) so that he can sell you cures that are highly questionable verging on the fraudulent. His site funnels you into the "Products" and "Services" sections that sell branded worthless supplements like acai berry, and overpriced items like a $39 Vitamin D spray that will give you the same dose as a bottle of $6 capsules from Walgreens.

But Mercola doesn't stop there. Having lured you in with not entirely unreasonable content (available on hundreds of other sites) he does his best to sell you some some very bogus natural health cures. These include homeopathy, acupressure (though Mercola is NOT a trained acupuncturist, a discipline that takes several years of training), and chiropractic (though Mercola is also not a trained chiropractor). His articles on media outlets like the Huffington Post start out by citing some natural health idea beloved by the alternative health community--something along the lines of the ever popular "Aspartame is poison!" but then seguey into promoting his branded higly fringe cures.

In fact, a careful look at Mercola's credentials suggest he's a marginally trained D.O. with very little clinical experience treating metabolic disease. The hospital he cites on his web site as being the one he was once affiliated with, St. Alexius Medical Center, Hoffman Estates, IL, turns out to be a small Catholic mental health hospital. He is not board certified in any specialty that would suggest he has expertise in treating metabolic disease and his "professional affiliations" are not impressive. Most are fringe groups or things you can join if you have a medical degree and write a check. His publications appear to mostly be letters to various journals citing his personal theories not actual research.

This is not to say that all Mercola's health post are wrong. Only that he picks up ideas from elsewhere and uses them to lure people in so he can profit from selling his questionable products and services. And because he is plugging so much questionable content, his site is not helpful to people with diabetes.

These are just two of the celebrity doctors who want your money and who don't care that they are selling you crap that will not keep you from developing diabetic complications. There are plenty more. My site has become so visible I'm getting inundated with PR mailings from a host of celebrity doctor wannabes, all of whom have in common that they have something to sell and web presences that make it clear they have no clue what it takes to control diabetic blood sugars.

And that is the crux of why I'm posting this. It's one thing when money-hungry celebrity doctors market themselves to "the worried well," all those vaguely hypochondriac people who have nothing wrong with them except, perhaps, boredom or normal age related ailments. The worried well respond strongly to placebos and that is what most of these celebrity doctors' branded products really are.

But it's another issue entirely when they move from fleecing the worried well to pretending they have real solutions for people with diabetes. Diabetes does not respond to placebos.

Diabetes does not reverse in response to any supplement. Chiropractic can not lower your blood sugar. Acupuncture will not cure diabetic neuropathy. There is, in short, nothing any celebrity doctor is selling that will cure your diabetes and a lot that they promote that will make it worse because the false hope they give you keeps you from learning about the tried and true tools that could lower your blood sugar and keep you healthy.

What these effective tools have in common is that they don't require you to buy much beyond a blood sugar meter and possibly some safe prescription drugs any family doctor can prescribe--the most effective of which is $4/month generic metformin.

The only diet that will keep you healthy if you have diabetes is one that keeps your blood sugars below 140 mg/dl (7.7 mmol/L) at all times. What this diet will be varies from person to person. For many of us it will be a diet low in carbohydrate. For a very few who have a rare subset of diabetes where they are fat sensitive it may be one lower in fat. You won't know what diet will control your personal form of diabetes until you employ a blood sugar meter as described HERE. Follow the technique described on that web page and within 2 weeks you should have a very good idea what foods make up a safe diabetes diet for you.

But even that diet will not "reverse" your diabetes, because nothing has ever been shown to truly reverse established diabetes. Diet and medications can stop your diabetes from destroying your body and give you normal health, which is good enough for most of us. It isn't a miracle. It requires self-discipline and daily choices about what to eat and how to use our energy. But it works. Unlike the one-size-fits-all miracle cures of celebrity doctors.

There is no miracle cure for diabetes. It takes work, study, and an annoying amount of daily effort to preserve your health if you have abnormal blood sugar. Doctors who claim to have discovered health secrets usually have one real secret--they've gotten bored with treating patients and have decided to take the quick way to making a fortune and retiring from practice.

How To Evaluate The Credentials of Any Would-Be Celebrity Doctor

When someone with M.D. after his name sets himself up as a diabetes authority--or tells you that he has found "secrets" that will cure all that ails you--ask the following questions.

1. What is this doctor's board certification (if in fact he has one)? An endocrinologist or cardiologist should be board certified and actively practicing in that specialty for years before self-appointing himself an expert. A legitimate doctor should have completed a residency in the field he purports to be an expert in. Look at what medical school the doctor attended too. Brighter doctors get their degrees at schools associated with major teaching hospitals.

2. What hospital does he practice out of? Legitimate doctors have hospital privileges at good hospitals. A doctor who only practices out of his own clinic may be a doctor who was kicked out of his last hospital for harming too many patients or one whose credentials are very marginal.

3. How much time has this doctor spent treating people with diabetes and what evidence is there that his patients do better than the average besides his say so?

4. If his ideas are not mainstream, how much evidence does he give to support them and what is the quality of that research? Typically celebrity doctors will cite only three or four studies--sometimes without giving you any citations to the actual studies. The studies they cite may be small poorly conducted studies that were cherry picked to support the simplistic theory the doctor already came up with before doing any research.

5. What is this doctor selling? The more branded products and non-physician services you see for sale, the more dangerous the doctor is likely to be to your health. Doctors who no longer practice medicine except on TV shows are often the most dangerous to your health because it is years since they've actually treated a patient with a serious medical problem.

6. Does the doctor promise a miraculous cure available only with his products or services or only to those who follow his advice? If so remind yourself there is NO one cure for any form of diabetes. There is no one diet or drug that works reliably for every person with diabetes, either.

7. Check out what real people with diabetes have to say about any celebrity doctor's approach on online discussion groups. You'll see several linked on the right column of this blog. Be aware that there are shills promoting supplements on all online groups, so if you see someone enthusing about something expensive, click on their profile and see if they post about anything besides that supplement or treatment. But besides the shills most online discussion groups have a core of regulars who have been posting for years and whose comments may be useful. Read their opinions before you become just another victim of a doctors whose concern for his own fame and fortune is greater than his knowledge of what it really takes to survive diabetes.

 

Turning The Battleship Around: Low Carb Study at EASD

This week was the European Association for the Study of Diabetes (EASD) meeting. This is the European equivalent of the ADA Scientific Session and in my experience it usually features some worthwhile research.

Of interest to many of my readers was yet another study proving the efficacy of the low carb diet. This one was done by Richard Feinman, PhD, from the Downstate Medical Center in Brooklyn, New York. His study found to the surprise of no one who owns and uses a blood sugar meter, that a low carb diet is much better than a high carb diet in controlling blood sugar. The diet used in this study was one that was 20% carbohydrate, which would be one of 100 grams for a 2000 calorie intake, just north of the boundary where most people start spilling ketones.

This diet did not produce weight loss--it was designed not to, but still achieved dramatic improvements in blood sugar, overturning the touching, if false, belief of most doctors and nutritionists that it is weight loss that lowers blood sugar, rather than the lowering of carbohydrate intake that occurs with calorie restricted weight loss diets.

My point in mentioning this is not that the research is all that significant. We've had lots of research over the years that demonstrated this same effect. What's interesting is that, surrounded by Europeans, rather than the Drug Company and Food Industry goons who dominate the American Diabetes Association, Dr. Feinman mentioned the elephant in the room.

Here's what he said, as reported by Diabetes in Control: "...the science is not controversial but policy regarding dietary control in diabetes is."

He then added,

"The recommendations are for relatively high carbohydrates. When you press the ADA [American Diabetes Association] for their recommendations, they say they do not have a specific diet, but in fact they recommend a high-carbohydrate [diet] and give grudging support to a restricted-carbohydrate diet."

"I'd really like to see an impartial panel of scientists that doesn't necessarily have any commitment to nutrition, [such as] physicists or meteorologists. The goal would be a clearer analysis of the facts, laying out the options, especially for people with diabetes. Let the patient and the physician make the decision.

Predictably, he was met with a hail of fact-free objection from nutritionists who responded much like Jesuits confronted with Martin Luther.

You can read their science-free responses and the attempts of those who seek to smoothe the waters by claiming there is a middle way in the Diabetes in Control article which you will find here:

EASD: High-Protein/Low Carbohydrate Diet Effective for Weight Loss in Type 2 Diabetes NOTE: The title does not correctly reflect the finding which was that the Low carbohydrate diet is effective for blood sugar control in the absence of weight loss.

The fact is, there is no middle way. The low glycemic/high carbohydrate diet is very slightly better than a high glycemic/high carbohydrate diet, but it still produces blood sugars high enough to promote complications.

To avoid complications you need to get normal blood sugars, not slightly better diabetic blood sugars. To do that, you need to cut out a lot of carbs. Twenty percent works for many. I still need to use a bit of meal time insulin with a carb intake that high, but with insulin it works for me. Without fast acting meal time insulin, I need to drop to around 15% to get decent control.

The reason to highlight this presentation, though, is that for the very first time, a researcher has had the nerve to point to the fact that the ADA's promotion of the high carbohydrate diet is a political decision, not one based on science.

This, in the world of science, is a big deal. It isn't quite an accusation of corruption, but it is close.

In fact, I believe the American Diabetes Association is corrupt, and that its corruption is due to the fact that it is heavily funded by commercial interests who lose money when people with diabetes use an effective diet to control their blood sugar instead of drugs that cost almost $200 a month. Look at the cheap food conglomerates who sponsor the ADA and ask yourself how many of them sell high quality protein foods free of corn syrup, hydrogenated fats, and lots and lots of sugar and starch.

----

I'm off now to see my endo for my semi-annual checkup. My A1c will probably be higher than I'd like, because I had the flu three weeks ago. It's always higher than I expect, and because I was feverish for a few days and had high blood sugars much of the week I expect it to be even higher this time. In fact, save for when I was sick, I have kept my blood sugar under very good control throughout the last six months and even managed to knock off a few pounds, too.

Back later. . . .

My A1c turned out to be 5.8% which considering that I was seeing a bunch of 180s after meals the week after I had flu and the test was a week after that was extremely good news. Outside of the flu I thought I had been doing well. I'm also down 10 lbs since April, which is what I thought too. Partly that is due to going back on metformin, partly to getting food poisoning last summer which kept me from eating food for a week, and partly from the flu. I'll take it.

My blood pressure had shot up again--it's been fluctuating wildly of late since I got sick and can be anywhere from from 90/60 to 160/113 with no obvious explanation for why. It was fine yesterday--I measure at home--but it was awful at the office and on my home machine too. Back onto the Diovan!

I've been supplementing with 2000 IU of Vitamin D all year and she tested my Vitamin D level. It was 51, which is okay but I'm going to add another 1000 IU to the daily intake since it could be better. Finally all the kidney tests, microalbumin, creatinine etc. were completely normal.

The doc suggested that it would have been a good idea not to take the metformin while feverish with flu, given that during fever we produce higher levels of lactic acid and tend to get dehydrated. That's a bit of info to stash away for future use. I have been very exhausted since getting over this flu and she suggested going off the metformin for a week to see if that helped.

 

Debugging Unexpected Blood Sugar Highs

Every time I get things working, as far as balancing food and insulin, something changes and I get knocked back to square one. And, surprise, surprise, it has happened again.

Out of the blue, last week, I started seeing highs after meals using doses of insulin that up until then had matched specific food inputs perfectly. Over the week they've gotten worse until yesterday I spent most of the day well over 150 mg/dl and partly over 200, though I used more insulin yesterday than I've ever before used in one day.

I checked the Usual Suspects that I always consider when my blood sugar goes blooey on insulin, which I'll list here:

1. Meter problem: I tested highs on two different meters with strips from two batches and they matched within 4 mg/dl. No meter problem. (Of course, I washed my hands after seeing the first high, to make sure I didn't have sugary fingers.)

2. Insulin problem: Because I use very small doses of insulin, one vial or pen can last me a very long time. But over the past two years I've learned that any vial of insulin that gets used 3 times a day can deteriorate after six weeks, even if I've only used 100 units out of the 300 in the bottle. Sometimes I can see tiny crystals in the previously clear insulin. Sometimes I can't see anything, but replacing the vial or pen solves the problem of mysterious highs.

I replaced both my R and my Novolog pen with new ones. The problem did not go away.

3. Getting Sick? Sometimes we see rises in blood sugar days before we get sick.

I did end up developing a nasty viral outbreak in my mouth this past week, which is something I get from time to time. But I'm not sure that would be enough to cause the dramatic deterioration I'm seeing. I've had it before without seeing highs. And the outbreak is clearing up while the blood sugars are getting worse.

4. Carb Creep/Wrong Carb Insulin Ratio: Is that 30 grams of carbs really 60? Sometimes we get sloppy with our carb counting.

I thought that might be the problem, but yesterday I weighed portions and had a very good idea of what I was eating and saw crazy high numbers. More importantly, the timing of the highs was really strange--with the highest reading almost 3 hours after eating and injecting Novolog. When I did a Novolog correction at 3 hours, I ended up with a wicked low an hour later. This is NOT the usual pattern I see at all, but it does require further investigation.

5. A Change in Meds or Supplements: Any medication or supplement we take, whether for diabetes or not, can impact on our blood sugar.

In this case there were two obvious suspects. The high blood sugars started before I stopped taking Metformin again, and ideally I should have NOT stopped taking metformin when I developed highs, because my blood sugar will go up a bit without metformin, though not a lot. But I had no choice, as the Metformin was giving me continual burning stomach pain and I was also feeling very exhausted after taking it, which is something that had gone away when I stopped taking it before. So I decided that I had to stop taking it, because it was clearly not helping me out anymore.

But that said, I had stopped taking Metformin for several months only a few months ago without seeing dramatic highs. Usually I see a rise of about 10 mg/dl in fasting blood sugar and maybe of 20 mg/dl after eating when I am not taking Metformin. In the past, to correct for this I had only had to add another unit or so to my dose at meals, and 1.5 unit of NPH at night to knock down the fasting blood sugar. This was nothing like the 50-70 mg/dl rise I have been seeing this past week.

A I blogged earlier, I have also recently started taking 1000 IU of Vitamin E, which initially was causing lows which stopped after a week or so. Then after reading up about Vitamin E I added 2 Calcium/Magnesium supplement pills to my daily regimen, since it turns out that without available Cal/Mag Vitamin D may store metals in your bones. Hmmmmm. Needs further investigation!

6. Too Much Insulin Causing IR? It's one of the ironies of insulin use that if you use too much insulin the body may get into a counter-regulatory mode where surges fight and flight hormones push blood sugar up out of the low range and the body becomes more insulin resistant out of self-protection. I have always had a huge problem with unwanted counter-regulation in the past, which is characteristic of MODY-2, the kind of genetic diabetes I'm currently being tested for.

So this idea isn't so far fetched. When I figured out the right dose of Lantus to use to avoid hypos last year, I saw very high post-prandial numbers--and that was why I stopped the Lantus. I have been using increasing doses of NPH for the past month to try to get my always high fasting bg down and had added a unit or two every morning, too. Requires investigation.

7. Deteriorating Beta Cells: While this is not a likely explanation, we can't rule out that something may have caused my beta cells to shut down or otherwise misbehave. I don't think this is likely, because the last time I stopped using insulin (with a very low carb diet) my post-prandial control was a lot better than it had been 2 years ago when I started insulin, suggesting that beta cell rest had given me more function in my beta cells, not less.

Into Debugging Mode!

Since I come from a computer engineering background, I'm familiar with the techniques used to debug problems that develop in large, complex, poorly documented systems. So now it's time to sort out what might be causing these highs.

Key to doing this is the basic debugging concept: When there are multiple possible causes for a poorly understood problem, go back to something that works (if possible) and then change one thing at a time and see if you can reproduce the problem. Start with the most likely and work back to the least likely.

So here's what I'm gong to do:

1. Cut out everything that looks like it might be causing the problem: the Vitamin E/Cal/Mag supplementation, carbs, and NPH. I can do this because I am fortunate to still have some natural insulin production left. A Type 1 could not cut out a basal insulin, because cutting out the basal could make them very, very sick.

2. Cut carbs way, way down and stick to foods where I'm certain about the carb count. My most recent stint of low carbing wasn't that long ago. I was able to stay between 95-120 most of the time if I kept my carbs under 12 grams per meal and 6 at breakfast, a la Bernstein diabetes diet. I have some other problems that this diet makes worse, but for now I'm going to eat that way to get to an acceptable baseline. It mostly eliminates the problems caused by mismatching insulin to meals.

3. Add back one suspicious element at a time to see if I can determine what is causing the problem. Here's my thinking:

a. Add nighttime NPH. I started using NPH at night when I was off Metformin before because without Metformin my fasting blood sugar is always around 100 or more. It did not seem to cause a rise in my day time blood sugars. Because my fasting bg on a Bernstein diet will quickly go up to 110-120 mg/dl I want to address the high fasting value first before doing anything else.

If after doing this I don't see daytime highs:

b. Raise the number of carbs I eat in each meal gradually using my old reliable R insulin and my usual Non-Met carb/insulin ratio (1:10-1:12). Use measured portions of foods I'm familiar with. This should quickly tell me if using the wrong carb/insulin ratio was the problem.

If this solves the problem of daytime highs:

c. Add back the Vitamin D and Calcium/Magnesium.

If this doesn't cause daytime highs:

d. Add back the morning NPH dose.

Obviously, if one of these elements DOES cause the daytime highs, I'll have to stop using it.

I should wait a couple days before introducing each element.

Obviously, this is all a pain in the neck, but when I'm done, I should have a better idea of what is going on. I hope! If the problem was that I'm really about to come down with a cold, I might add everything back in and not reproduce the problem, but that works too.

Any other debugging suggestions from you folks who live with this crap day in and day out?

Research Round Up

Here are some more items I've collected over the past few months that don't justify a separate post but are still of interest. Click on the link to see the study.

1. Users of DPP-4 Inhibitors (i.e. Januvia and Onglyza) report far more infections than metformin users, especially respiratory infections which were twelve times more likely. This is not surprising, DPP-4 plays a significant role in the immune system and turning it off modifies how the immune system works.
2. Alpha cells secrete glutamate that damages beta cells. There have been several intriguing studies recently that suggest that an imbalance between the alpha cells that secrete glucagon, the hormone that raises blood sugar, and the insulin-secreting beta cells may play a part in causing diabetes. Keep an eye on this topic for further developments.
3. WHI finds NO relationship between blood Vitamin D levels and the later development of Type 2 diabetes in older women over a 7.3 year period. More cold water thrown on the latest fad cure-all. There may be reasons to normalize vitamin D levels, but I have been able to find zero evidence that preventing or improving diabetes is among them.
4. Whole fat dairy consumption lowers insulin resistance, raises HDL and correlates with "a substantially lower incidence of diabetes." The researchers who discovered this, by analyzing data from the 3736 adults studied in the Cardiovascular Health Study, appear to have been so disturbed by the implications of their study that they gave it a title that will keep anyone from noticing what they found, which is that eating butter and cream will improve your cardiovascular health.
5. Yet another study finds that A1c is a much better predictor of heart attack than a diabetes diagnosis or other "many other established risk factors" [i.e. cholesterol. "Every 1% increment [over 5.4%] independently predicts a 19% higher odds of MI [myocardial infarction, i.e. heart attack] after accounting for other MI risk factors including diabetes."

6. Higher saturated fat intake slows the progression of coronary artery disease in post-menopausal women. Carbohydrate intake speeds it up. In addition, "polyunsaturated fat intake was positively associated with progression when replacing other fats (P = 0.04) but not when replacing carbohydrate or protein. Monounsaturated and total fat intakes were not associated with progression."

7. Cortisone injections relieve pain of tendon problems in the short term but make them worse and more likely to recur long term. Tendon problems like frozen shoulder are a common diabetic complication. The evidence suggests that the best way to treat them is to leave them alone. They usually get better on their own in a few months. If they don't, my experience has been that acupuncture may help after the acute inflammation phase is over.
8. If you don't wash your hands before testing your blood sugar wiping away the first drop of blood and using the second drop will be more accurate--but don't squeeze Shockingly, the journal "Diabetes Care" actually published a study this month that is useful to people with diabetes.
9. Supplementation with Myo-Inositol may be very helpful in reducing insulin resistance and other characteristics of metabolic syndrome in post-menopausal women Don't go crazy with supplementation, based on this one study, since such studies are often paid for and skewed by companies selling the supplement, but keep alert to see if this finding is confirmed elsewhere.

March Diabetes News Snippet Post

Here are all the news items posted in March:

Jenny said...

People taking Byetta, Victoza, Januvia, and Onglyza had less heart failure than those not on these drugs. http://www.sciencedaily.com/releases/2013/03/130310164109.htm

However, it is likely this is because Avandia and Actos CAUSE heart failure, rather than that these other drugs prevent it. People are rarely put on both families of drugs at once.

It may also be because these GLP-1 related drugs are mostly prescribed to affluent, younger people with diabetes and good health insurance, while poorer people are put on the cheap sulfonylurea drugs which are now known to raise the risk of heart attacks.

10:19 AM, March 11, 2013

Jenny said...

Paleo fans will probably ignore the news that Mummy CT Scans Show Preindustrial Hunter Gatherers Had Clogged Arteries. From the report "The researchers performed CT scans of 137 mummies from across four continents and found artery plaque in every single population studied, from preagricultual hunter-gatherers in the Aleutian Islands to the ancient Puebloans of southwestern United States."

So plaque probably is some byproduct of an adaptation in the way humans process calcium--probably one that is a byproduct of the genetic changes that led to our species' distinctive bigger brains and smaller digestive tracts.

The Paleo diet is useful in helping cut back on junk food, but the idea that ancient humans were healthier than we are is almost certainly a fantasy. The life expectancies of junk food chomping modern day humans is far longer than that of any pre-agricultural peoples, if only because we have effective treatment for injuries and contagious diseases.

11:53 AM, March 11, 2013

Jenny said...

Exposure to DDT in womb results in high blood pressure decades later. http://www.sfgate.com/health/article/DDT-exposure-in-womb-tied-to-hypertension-4346800.php

I remember playing outside in the summer in 1954, and the spray truck passing by spraying huge clouds of DDT. We would take deep breaths of the stuff which had a curious smell. Later, before we went to sleep, my mom would spray my bedroom with it and then I'd crawl right into bed.

Maybe my high blood pressure isn't so mysterious!

9:44 AM, March 12, 2013

RLL said...

Having been, along with sibs, the victims of enraged ground wasp nests, my favorite revenge at 8-10 years old was DDT to the beasts.

1:07 PM, March 12, 2013

Jenny said...

A newly discovered, fatal virus works by activating DDP-4 receptors. However, the diabetes drugs (Januvia and Onglyza) that suppress these receptors do not inhibit the virus.

Reuters: Scientists find how deadly virus infects human cells

3:34 PM, March 13, 2013

Jenny said...

More problems with all incretin drugs--Byetta, Januvia, Onglyza, Victoza, etc. How many people will suffer life changing complications before the FDA acts? I bet your doctor is completely unaware of this ratcheting up of concern.

http://www.medpagetoday.com/PrimaryCare/Diabetes/37890

9:23 AM, March 15, 2013

Jenny said...

A bakery is found to have put sugar in its sugar-free baked goods. The really sad part is that no one seems to understand that the FLOUR in the baked goods is digested into glucose every bit as toxic to people with diabetes as the sucrose. (See last line for what I mean.)

http://www.latimes.com/business/money/la-fi-mo-butterfly-bakery-sugar-20130314,0,7328666.story

9:34 AM, March 15, 2013

Jenny said...

Industry strong-arms EPA onto allowing another very dangerous chemical to stay in your drinking water.

http://www.pbs.org/newshour/bb/environment/jan-june13/epa_03-15.html

5:52 PM, March 16, 2013

Jenny said...

This is to Skippy Pea, I deleted your comment because you had what looks like a ununintended Autocorrect" issue, but the answer to your question is that I don't recommend any protein meal replacements. I don't think they help with dieting and the ingredients are usually cheap omega 6 oils, chemical additives, and poor quality proteins. Why not try some Greek Yogurt with nuts and perhaps some berries instead?

3:08 PM, March 18, 2013

Jenny said...

Victoza (Liraglutide) does not provide significant weight loss in a new study. This reinforces my belief that it isn't as effective a drug as Byetta, while causing much more troubling side effects.

It produced only 4% more weight loss than a worthless placebo. That's 8 lbs lost more than on placebo for someone weighing 200 lbs--which you can easily accomplish without drugs by eating a very low carb diet for a month.

Note that this was on a high dose regimen, and that this drug has been connected with both thyroid cancer and pancreatitis at normal doses.

http://www.reuters.com/article/2013/03/18/us-novonordisk-idUSBRE92H0EY20130318

3:25 PM, March 18, 2013

Jenny said...

Some new research supports the "hygiene hypothesis" that Type 1 Diabetes is becoming epidemic because kids are growing up too clean and not encountering bacteria etc at critical stages of the development of the immune system.

Practical takeaway: let your kids play outside in real dirt when they are young and don't use antibiotic soaps.

http://www.sciencedaily.com/releases/2013/03/130318203334.htm

9:20 AM, March 19, 2013

Jenny said...

Potent statins linked to acute kidney injury. "Potent statins" are defined as:

Rosuvastatin (e.g. Crestor) at doses of 10mg or higher.
Atorvastatin (e.g. Lipitor) at doses of 20mg or higher.
Simvastatin (e.g., Zocor) at doses of 40mg or more.

http://www.cbc.ca/news/health/story/2013/03/19/statin-kidney.html

3:54 PM, March 20, 2013

Jenny said...

Interesting but very small study about the impact of supplementing with Vitamin D on various genes. Note that quite a few much larger studies have found ZERO impact of such supplementation on Type 1 diabetes, MS, or any other already existing autoimmune condition. If there is a benefit in supplementing with Vitamin D it occurs only before you have developed an autoimmunity.

Also note that they did measure blood levels after the supplementation which ended up on average in the low end of the normal range at 32 ng/ml. They did not observe what happens if you oversupplement and reach the much higher levels where nasty things can start happening to your calcium metabolism.

http://www.sciencedaily.com/releases/2013/03/130320212824.htm

10:28 AM, March 21, 2013

Jenny said...

The One Touch Verio meter has been recalled. Details here:

http://diabetes.webmd.com/news/20130325/glucose-meter-recall

2:46 PM, March 28, 2013

Jenny said...

Duh. Tech devices don't make significant changes in A1c--when not coupled with INFORMATION about how to really lower blood sugar.
http://www.medpagetoday.com/Endocrinology/Diabetes/38139

You can lower your blood sugar dramatically without using any technology but a blood sugar meter by using this technique:

How to Lower Your Blood Sugar

7:32 AM, March 29, 2013

Jenny said...

Scientists discover how Metformin stops cells from being cancerous--it blocks overproduction of inflammatory cytokines.

Science Daily: Scientists Discover How Drug Prevents Aging and Cancer Progression

9:27 AM, March 30, 2013

Jenny said...

High potency statins--high dose Lipitor and Crestor, for example, raise the incidence of hospitalizations for acute kidney injury. http://www.healio.com/endocrinology/cardiometabolic-disorders/news/online/%7B7A0F7760-A043-4AE8-9131-659AD4E6525C%7D/high-potency-statins-may-increase-risk-for-kidney-injury

3:30 PM, March 31, 2013