October 7, 2015

The Supplement - Biotin

Biotin is a water-soluble vitamin that is generally classified as a B-complex vitamin. After the initial discovery of biotin, nearly 40 years of research were required to establish it as a vitamin. Biotin is required by all organisms but can be synthesized only by bacteria, yeasts, molds, algae, and some plant species.

Biotin is likely effective for treating and preventing biotin deficiency. Symptoms of deficiency include thinning of the hair (often with loss of hair color), and red scaly rash around the eyes, nose, and mouth. Other symptoms include depression, listlessness, hallucinations, and tingling in the arms and legs. There is some evidence that cigarette smoking may cause mild biotin deficiency.

There is insufficient evidence for:
  1. Hair loss. There is some preliminary evidence that hair loss can be reduced when biotin is taken by mouth in combination with zinc while a cream containing the chemical compound clobetasol propionate (Olux, Temovate) is applied to the skin.
  1. Diabetes. Biotin alone doesn’t seem to affect blood sugar levels in people with type 2 diabetes. However, there is some evidence that a combination of biotin and chromium (Diachrome, Nutrition 21) might lower blood sugar in people with diabetes, whose diabetes is poorly controlled by prescription medicines. Other early evidence shows that the same combination reduces ratios of total cholesterol levels to “good” high-density lipoprotein (HDL) cholesterol, “bad” low-density lipoprotein (LDL) cholesterol to HDL cholesterol, and non-HDL to HDL cholesterol in people with type 2 diabetes.
  2. Diabetic nerve pain. There is some evidence that biotin can reduce nerve pain in people with diabetes.

  1. Brittle fingernails and toenails. Biotin might increase the thickness of fingernails and toenails in people with brittle nails.

  1. Other conditions.

More evidence is needed to rate biotin for these uses.

Although overt biotin deficiency is very rare, the human requirement for dietary biotin has been demonstrated in two different situations: prolonged intravenous feeding (parenteral) without biotin supplementation and consumption of raw egg white for a prolonged period (many weeks to years). Avidin is an antimicrobial protein found in egg white that binds biotin and prevents its absorption. Cooking egg white denatures avidin, rendering it susceptible to digestion and therefore unable to prevent the absorption of dietary biotin.

Table 1. Adequate Intake (AI) for Biotin
Life Stage
Males (mcg/day)
Females (mcg/day)
0-6 months
7-12 months
1-3 years
4-8 years
9-13 years
14-18 years
19 years and older
all ages
all ages
Table 2. Some Food Sources of Biotin
Biotin (mcg) (32, 33)
1 packet (7 grams)
Bread, whole-wheat
1 slice
Egg, cooked
1 large
Cheese, cheddar
1 ounce
Liver, cooked
3 ounces*
Pork, cooked
3 ounces*
Salmon, cooked
3 ounces*
1 whole
1 cup
Cauliflower, raw
1 cup
*A 3-ounce serving of meat is about the size of a deck of cards.

Please take time to read these sources for more information on biotin:

October 6, 2015

More on AADE Activities

This not an easy topic, but I feel very confident that the article written by ANH-USA is on target. Where the problem in the proposed bill starts and needs change is - (a) IN GENERAL. —Section 1861(qq) of the Social Security Act (42 U.S.C. 1395x(qq)) is amended — (1) in paragraph (1), by striking ‘‘by a certified provider (as described in paragraph (2)(A)) in an outpatient setting’’ and inserting ‘‘in an outpatient setting by a certified diabetes educator (as defined in paragraph (3)) or by a certified provider (as described in paragraph (2)(A)).’’

There is more in the bill than the AADE website shows, but at this point I am not allowed to use it. One of my Senators has told me this and he is stating that at this time, the bill is not scheduled for committee and several attempts to bypass committee approval have met with defeat. Both my Senator and the attorney have stated that it is doubtful there will be action this year on H.R. 1726 and S. 1345.

On September 25, I met with an attorney who specializes in Social Security law. He feels that the landscape has changed. I had a printout of the two bills and he read and reread both and asked if I had any other versions available. After his arrival in Washington DC, and a meeting with several Senators and Representatives he called me on Saturday and stated that I could blog about what I knew, but that he could not say more at this time other than what is in the paragraph above.

The attorney did state that the bills currently on file confirm the article published by ANH-USA. If the wording is not changed, what the AADE told Diabetes Mine indicates they are deflecting the truth.

On Monday Oct 5, the attorney called again and stated he does agree that some wording needs to be added to fairly reimburse CDEs for their time on education. He thanked me for sending a copy of my blogs for Oct 3 and 5 and he is upset by the law in Kentucky and the charge of a misdemeanor for violating the law.

I will continue to correspond with both my senators and my representative to urge them to not approve the version currently on file. It is also no surprise that the members of #DiabetesMiseducation Coalition oppose these bills.

Founding members of #DiabetesMiseducation Coalition include:
  • International Association for Health Coaches
  • National Association of Nutrition Professionals
  • Nutrition Therapy Association
  • National Health Freedom Coalition
  • University of Natural Health
  • Maryland University of Integrative Health
  • Alliance for Natural Health USA
  • American School of Natural Health
  • Institute for Transformational Nutrition

These are all organizations that would be excluded under the changes, plus a few more.

This is speculation on my part, but I think that with all the AADE members and officers that have both the CDE and RD (registered dietitian)(dual) titles may be behind this and the Academy of Nutrition and Dietetics is making its presence felt in the actions of the AADE.

I will make my feelings known about the dual titles and that something needs action to specify that if they are acting as CDEs then they need to clearly state this at the beginning of any education and not stray into nutrition as many are doing. I have spoken about this with one of my Senators and she agrees that it should be one and not both and they should only bill Medicare for one topic and not two as some have been accused of doing.

October 5, 2015

Information on Monopolistic Health Organizations

When dealing with registered dietitians (RDs) and certified diabetes educators (CDEs) you will often be given bad advice. Not only is this true in the United States, but is full blown in Australia. At least others are blogging about this and letting everyone know about dietitians and how bad they are.

The dietitians in Australia, DAA (Dietitians Association of Australia) are really punishing one that advised a patient to eat low carb. Read this blog and then this blog. Apparently, it is against the law as stated by dietitians in Australia to promote low carb. Her dietitian organization, the Southern New South Wales Local Health District (SNSW Health), has removed her license and banned her from all dietetic activities.

As if this was not bad enough, we have Dr Darren Curnoe writing in The Conversation that there is plenty of evidence that humans have evolved to eat carbohydrates especially starches. Take the amylase genes which evolved to aid the digestion of starch either in our saliva or pancreas through secretion into the small intestine.” Associate Prof Darren Curnoe is based at the University of New South Wales. See the relationship? It is small wonder that the SNSW dietitian group heavily promotes carbohydrates.

I think those of us in the USA have an advantage as several court cases have stopped medical groups and others from running monopolistic and restrictive organizations. Read this - On February 25, the US Supreme Court ruled that North Carolina’s dental board violated antitrust laws by shutting down hair salons and day spas that offered teeth whitening services. According to the Wall Street Journal, “The decision preserves the power of antitrust enforcers to scrutinize professional licensing organizations, even if they are designated as state-government entities.”

Then with the Academy of Nutrition and Dietetics, Steve Cooksey was able to take the state of North Carolina and the Board of Dietetics and Nutrition to court on freedom of speech grounds, and with the assistance of the Institute of Justice have the court rule in his favor. With the Supreme Court case and this court decision anything put forth by the American Association of Diabetes Educators at the state level should be lost by the state CDE boards.

Therefore, I think if those of us that blog about diabetes and try to educate people about diabetes are put under the strain of criminalization by any CDE state board of diabetes education, we will have the law on our side. This means that the different meal plans (low carb or paleo food plans) are challenged by the AADE or AND, they will be dismissed.

This is good news and hopefully I will have more later.

October 4, 2015

Know When You Are Receiving Bad Advice

When dealing with registered dietitians (RDs) and certified diabetes educators (CDEs) you will often be given bad advice. You need to learn what some of the bad advice is and how to turn this back on them.

Yes, I can say mandates, mantras, and other platitudes because they are often what you will receive. They often don't properly assess you and try to bully you into accepting what they are telling you.

Recently, two of our members met with a RD/CDE (dual titles) for classes. Sue had not intended to go, but her doctor did ask her to go and report back to him. The other member was Jennifer and she was hoping to hear something more than she had been hearing from us.

When the class started, the emphasis was on whole grains and eating enough carbohydrates to prevent brain damage. Jennifer asked how many that meant and the answer was 45 grams to 70 grams per day. This told Sue that she had to think fast, but the instructor was on to planning meals that would see to it that they consumed enough carbohydrates.

When she finished with this and asked if they understood what they had been told, Jennifer asked if testing showed that they were too high for the blood glucose reading, should they reduce the grams for the next meal? The instructor did not miss a beat, but went right to telling them that if the reading was too high, they should talk to the doctor about increasing their medications or adding another medication.

Sue held her peace for that round as she was planning on dropping the bomb later. Jennifer asked what would be too high a reading and the instructor stated 180 mg/dl. Jennifer said that is in the range that could cause complications and the instructor said not if she was able to add another medication.

Jennifer said then she would need to reduce her carbohydrates as anytime she consumed whole grains; she would spike over 220 mg/dl. The instructor then advised her to have a talk with her doctor as she needed the nutrients found in whole grains.

At that point, Sue felt things had gone far enough, so she explained to the instructor that she was off all medications and eating low carb/high fat as was her husband. That really upset the instructor to the point she said that then she was not diabetic and why was she taking the class. Sue said that she had support from her husband and their support group and her doctor to work at getting off all medications and with the exercise and food plan has been able to stay off all medications.

Sue continued that whole grains are not the end-all and the nutrients could be found in other foods that were nutrient dense and did not have the carbohydrate content. Sue said even the ADA has partially accepted the low carb/high fat food plan which meant that the instructor was following the USDA guidelines instead. Sue concluded that by not encouraging testing and advising more medications that she was a fraud and did not have the best interests of patients in mind, only the interests of the corporate sponsors of the AADE and AND.

With that Sue and Jennifer left. Jennifer was very surprised at what the instructor had said and the way she was pushing whole grains, carbohydrates, and medications. Sue said she was glad Jennifer had asked about testing as most of the time they will not talk about testing and the readings to avoid. Sue said that her pushing medications is not good as this is what causes people to gain weight and often need more medication. The meal plan needs to be such that less medication is needed and if necessary help lose weight.

Jennifer asked how often to test. Sue told her to always test in pairs to be able to see how the meal affected her blood glucose levels. They had arrived at their cars and Sue said she was welcome to contact most of the older members and to ask her questions. They went their separate ways and Sue told her doctor what had happened. He thanked her and said this confirmed an earlier report by one of his patients.

October 3, 2015

Gretchen Becker Back on Wildly Fluctuating

The above link is to Gretchen's blog - please stop by and read.

Gretchen is back on her own blog from Health Central.   While I will miss her on Health Central, I welcome her back on Wildly Fluctuating.   Her first blog and second blog are on October 3, 2015.

AADE Is Not a Clean Organization

The Kentucky law is similar to what the Academy for Nutrition and Dietetics has passed in several states. It provides exclusive rules for whom may teach education and provides misdemeanor penalties for others providing diabetes education. I am not sure that even doctors are exempt. They are able to practice their profession, but the interpretation will be whether they can do any diabetes education.

Yes, there is a place for interpretation, but it seems that the law is clearly written to make the American Association of Diabetes Educators (AADE) the sole organization for doing diabetes education. It will be interesting to see if the Academy for Certified Diabetes Educators is included or excluded. A lot of authority is centered with the Board of Educators that is appointed by the Governor of Kentucky.

What I find surprising is the fees being charged to maintain an active license.
Pay licensing amounts as promulgated by the board through administrative regulation, with the following restrictions:
1. Initial licensing shall not exceed one hundred dollars ($100);
2. Annual renewal shall not exceed one hundred dollars ($100);
3. Biennial renewal shall not exceed two hundred dollars ($200);
4. Late renewal shall not exceed one hundred fifty dollars ($150); and
5. The reinstatement fee shall not exceed two hundred twenty-five dollars

(a) Licenses or permits shall be renewed annually or biennially if the board
requires biennial license renewal by administrative regulation.
(b) Licenses or permits not renewed within thirty (30) days after the renewal date shall pay a late penalty as promulgated by the board in administrative regulation.

These are not cheap fees for a CDE only working part-time. Unless this is a way of forcing CDEs to work full time or get out of the AADE.

Admittedly this is my opinion, but in my reading of the information, the AADE is taking actions similar to AND to become the only source of diabetes education. This is something I will oppose in my state as I feel that it is my right to obtain diabetes education where and when I choose and not from CDEs that want exclusive rights to diabetes education.

I see too many emails from people that CDEs are promoting nutrition and not diabetes education. On further investigation, many have had two titles after their names (i.e., CDE and RD). They are promoting high carb/low fat food plans and often the carbohydrate count in 45 grams or higher numbers per meal. This says that they are not allowing low carb/high fat (LCHF) food plans. All have been promoting whole grains, which those of us that do our testing know are the wrong foods for people with diabetes. The ADA is now allowing LCHF food plans, but the USDA is of course promoting whole grains and high carb/low fat (HCLF) food advice.

Most, but not all, CDEs do not promote testing of blood glucose levels other than one time per day and generally only at fasting in the morning if taking oral medications. Those of us on insulin that test more often know that it is necessary to test in pairs to discover how different food plans affect our blood glucose levels. Many of us sacrifice to purchase sufficient test strips to test at each meal, before and after exercise and before bed or about nine times per day, and sometimes we test more often if we feel that hypoglycemia may be happening.

October 2, 2015

Diabetes Is One of the Worst Chronic Diseases

Back in March 2012, I wrote this blog about the many ways that diabetes is worse than cancer. I have not changed my mind since and I feel that diabetes is one of the worst chronic diseases.

Some factors that keep rearing their ugly heads: (for type 2 diabetes)
  • Is doctors that haven't changed their attitude and blame patients for the disease.
  • Is doctors that threaten patients with insulin to get them to follow the oral drug route.
  • Is doctors that tell patients that they have failed if the want insulin.
  • Is doctors that leave insulin as the medication of last resort.
  • Is doctors that only believe that diabetes is progressive and don't support patients that want to manage diabetes.
  • Is doctors that will not screen at risk patients for diabetes.
  • Is patients that want to keep diabetes a secret.
  • Is patients that refuse to change lifestyle habits to help manage their diabetes.
  • Is patients that listen to the doctors above and believe them.
  • Is patients that feel this the twenty-first century and there has to be a cure.
  • Is patients that feel that a natural remedy is possible for managing diabetes.
Yes, both patients and doctors contribute to the problems we have today with diabetes. Many patients do end up with progressive diabetes because they refuse to properly manage their diabetes and for others, they become so discouraged by the guilt trip laid on them by doctors that they also do not manage their diabetes.

It is this unmanaged diabetes that leads to complications and often leads to an early death. This is why many of us that blog about diabetes try to convince people with diabetes that it is not their fault – not their fault.

We also tell people that they should live for today and manage their diabetes rather than living in the past and denial. Type 2 diabetes is manageable and often can be managed for many years without serious complications. Many people die of old age and natural causes before diabetes gets a strong foothold in their lives.

Most of us know that diabetes is manageable and we work to do this. The support group that I belong to works hard to show that diabetes is manageable. Yet, we are constantly meeting people that are like the patients in the list above and refuse to listen to us. This is when we become frustrated and have to wonder why people can be so set against doing what is best for their bodies, their lives, and their families.

October 1, 2015

Avandia Ups Bone Fracture Risk

Avandia is back in the news, and not in a good way. Inside our bones there is fat. Diabetes increases the amount of this marrow fat. A study from the UNC School of Medicine shows how some diabetes drugs substantially increase bone fat and thus the risk of bone fractures.

The study, published in the journal Endocrinology, also shows that exercise can decrease the volume of bone fat caused by high doses of the diabetes drug rosiglitazone, which is sold under the brand name Avandia.

These drugs aren’t first or second-line choices of treatment for type-2 diabetes, but some patients do take them,” said study first author Maya Styner, MD, assistant professor of medicine. “And we know there are drugs in development that target the same cellular pathways as rosiglitazone does. We think doctors and patients need to better understand the relationship between diabetes, certain drugs, and the often dramatic effect on bone health.”

According to Styner’s study, Avandia affects bone fat by enhancing a critical transcription factor called PPAR – peroxisome proliferator-activated receptor – which regulates the expression of specific genes in the nuclei of cells. Essentially, rosiglitazone takes glucose out of blood to lower blood sugar and treat diabetes. But that glucose is then packaged into lipid droplets – fat. Other researchers showed that some of that fat is stored in tissue, such as belly fat. Styner’s latest research showed that the drug also causes fat to be stored inside bone.”

The author did state the researchers were surprised at the large amount of bone fat caused by Avandia. They also were somewhat surprised that exercise could reduce this fat. But, that should be expected in a rodent study.

Many patients have been surprised that some diabetes drugs adversely affect bone health. However, diabetes by itself can harm bones.

Yet, other drugs under development that could be close to FDA-approval lower blood sugar by enhancing the PPAR pathway. These drugs are referred to as fibroblast growth factor-21 agonists. “Early reports show that the same bone concerns are popping up with these new drugs,” Styner said. “Doctors and patients need to be aware of this.” Bone fat, in general, isn’t nearly as well understood as other fat depots.”

Our field is just beginning to investigate bone fat and its implications for patients,” Styner said. But she said that more bone fat means less actual bone, which increases the risk of bone fractures.

Styner said her findings are not yet directly relatable to human activity. For humans, running isn’t nearly as natural. But she said she would still advise patients at risk of declining bone health to find an exercise that suits them; the default would be taking very long walks.

Then in an article in Endocrinology Advisor, the FDA is adding a warning to canagliflozin, the SGLT2-inhibitor that this drug increases the risk of bone fracture. Apparently, bone fractures are another source of concern for some of the oral diabetes drugs.

This is why I will stay with insulin and avoid oral medications.