February 10, 2012
Now the controversy is also coming back to fats and whether we should eat low fat as many in the medical community preach in their low-fat mantra. I find it interesting that one article about a study showing that natural fats are not putting people at increased risk of heart disease. This is about trans fats. Those that are man made are still proving to make people at increased risk for heart disease. The man made trans fats were created by our chemical companies for the purpose of increasing shelf life of many foods.
Natural trans fats are now being shown to not increase the risk for heart disease. They exist in beef, pork, lamb, butter, and milk. While moderation is emphasized, these trans fats do not seem as harmful as their man made counterparts. The study was published in the American Journal of Clinical Nutrition.
Of course, this study has its supporters and naysayers. The US Department of Agriculture agrees with the study. The USDA also supports the milk producers in the US. Then the director of university nutrition at Washington University in St. Louis says we need more studies before we make statements like this. Although not mentioned, the director has interests in the chemical industry.
February 9, 2012
Thanks to Joslin for bringing TAG (total-available-glucose) to my attention here. They may say it is out of vogue and not relevant for today's meal planning, but more are talking about it and blogging about it. Even TuDiabetes.org has a group called TAGers United.
Not listed as a TAG study, this 2006 study about protein, carbohydrate, and fat consumption for people with type 2 diabetes is very enlightening. The study is from 2006 and came from the University of Minnesota. While not praising or damning fat, this study was for determining the best diets for type 2 diabetes and using different ratios of protein, carbohydrates, and fat.
This study was funded by the American Diabetes Association (ADA), with some support from the Minnesota, Colorado, and Nebraska Beef Councils plus the Department of Veterans Affairs. Yet the ADA has moved very little from their low-fat mantra.
The same subjects were people with type 2 diabetes that was not treated. For 5 weeks, they were on a control diet with a protein carbohydrate fat ratio of 15:55:30. Then the same group spent 5-week periods on other ratios. The 30:40:30 ratio diet resulted in moderate decrease in 24-hour glucose area and % total glycohemoglobin (%tGHb). The 30:20:50 ratio diet resulted in a 38% decrease in 24-hour glucose area, a reduction in fasting glucose to near normal and a decrease in %tGHb from 9.8% to 7.6%. They obtained a similar result 30:30:40 ratio diet.
The long-term objective has been to develop a diet that does not require weight loss, oral medications, or insulin. The other requirement is that the diet controls blood glucose in people with type 2 diabetes. The spokesperson said, “Our studies indicate that a decrease in metabolically available dietary glucose, associated with an increase in protein and fat, over an extended period of time, can significantly lower the integrated blood glucose concentration. The decrease is comparable to that obtained using oral agents and occurs without weight loss.”
I found this information while doing research for another blog. TAG is referred to as total dietary glucose (TDG) in this study. They determined that the actual glucose from protein depends on the type of protein and it varies from 50 to 84 grams per 100 grams of protein eaten. Fat generally produces only 10 percent glucose.
Read the study for type 2 diabetes with increased fat as part of the diet.
February 8, 2012
When the American Diabetes Association endorses something, look out. By that, I mean the less than honorable surgeons will find a way to fatten their wallets. From the Federal Food and Drug Administration (FDA) to the California Department of Insurance (CDI), plus other agencies are continuing their investigations into the practices of gastric banding in Southern California.
“In December, the US Food and Drug Administration (FDA) warned the marketing firm called 1-800-Get-Thin and 8 affiliated surgery centers that the ads are misleading because they fail to spell out the risks of the surgery. The agency ordered the businesses to change the ads immediately.” The FDA has this right, and the risks are not to be taken lightly. See my blog here for links to many of the risks.
What is frightening are the deaths, which has resulted from the surgery since 2009. Supposedly, there have been at least five deaths to patients after having the gastric banding operation. The 1-800-Get-Thin marketing firm and the surgery centers have been the subject of two wrongful-death suits and a whistleblower suit from ex-employees and patients. The last suit alleges the cover-up of a patient death in addition to other problems.
In addition to the CDI investigation, the Los Angeles County Board of Supervisors is investigating the ad campaign. They are seeking legislation to regulate bariatric surgery centers. Then we know when something like this hits the news, you can be assured members of Congress will want to hold hearings.
The whistleblower suit goes on to show who the real owners are and that they have been disciplined by the California Medical Board in 2008. It goes on to expose the shell companies that were designed to conceal the brothers' ownership.
At least this surgery may be rid of a couple of bad apples that is doing damage to patients and giving gastric-banding a black eye. The important aspect of this is the adverse publicity may make patients think twice and be sure they understand all the risks of this type or surgery.
Read the three articles that cover much of the same areas – article 1, article 2 and article 3. Be sure you know the risks before you submit to this surgery and do your due diligence in investigating the surgeon and surgery center doing the procedure. Gastric-banding or lap-band surgery is not for everyone.
February 7, 2012
Is basic information too simplistic? Or in this case, the correct answer? This is one time I feel very strongly that a basic discussion leaves more unanswered questions than it answers. While the information given makes sense, it stops by not covering any of the real variables and leaves one statement hanging in the wind.
This statement should have been included – in all cases, be sure to talk with your doctor about your meal plan so it can be tailored to your needs and the size of your medication dose. Simple, but effective in direction for the medication the doctor may prescribe. Many people just do not eat breakfast and this can be a problem for some medications to prevent hypoglycemia (lows).
If you are on a dose of medication that can cause low blood glucose reactions, your doctor may be able to decrease the dose of medication to avoid hypoglycemia or change medications. I can agree that three meals per day is good for most people; however, there are many people with diabetes that do not eat three meals per day whether it is breakfast or another meal. If the doctor is not aware of this, problems may be created that can be avoided.
Then the blog really makes you think when they talk about insulin. Is this the only time you should talk with your doctor? I think you must communicate with your doctor whether you are on no medications, oral medications, or insulin. Even one of Joslin’s own blogs discusses the three choices for insulin injection for type 2. Why was this not linked to this blog?
Also missing was several other key points. Many people with type 2 diabetes have found that grazing (5 to 8 small meals per day) works very well with some oral medications. Others have found that low-carb is the way to go and others have settled on the medium range of carbs per day that works best for them. This is not a “one size fits all” world that medical people seem to dream exists.
Please read the blog that started this thought. I have one more thought before leaving this. Basic information may work, but do not leave gaping holes in the information.
February 6, 2012
When two people you respect write about the same topic with seemingly opposing viewpoints, it really can make you scratch your head. Gretchen Becker first covered this and I was in full agreement with her. Her blog is here. Then David Mendosa covered the same study on February 3 here.
Gretchen's statement, “Here we go again! It seems that every few years another group announces that blood glucose (BG) testing strips aren't useful in patients with type 2 diabetes who don't take insulin.” This is an explanation often faced by people with type 2 diabetes not on insulin.
David's statement, “A big new review shows that people who don’t use insulin are wasting their time and money when they test their blood glucose.” This is something that got me to thinking and rereading both blogs very carefully. Both statements seem to be heading in the same direction.
After reading and rereading both blogs about this study in done in Europe, it is important to understand that the same types of studies are done in North America. The governments in Europe, Canada, and the USA, plus the medical insurance companies in the USA are all looking for ways to lower costs.
What should offend every person with type 2 about these studies is they use the term SMBG (self-monitoring of blood glucose) as if it were the culprit. They then state that blood glucose testing is a waste of time and resources. What they omit is that the medical professions in all countries are lax in giving patients the education necessary to understand how to use the blood glucose readings. They provide very little in guidance to their patients for proper decision making when looking at blood glucose readings.
Some of us around the world have been fortunate to receive some education in what to do with our blood glucose test results. Others have been able to research online and self-educate themselves. It is knowing how to adjust diet and exercise to keep blood glucose levels as close to normal as possible that gives meaning to testing. The readings are truly of no value unless you know what to do to bring high readings down and how different foods affect your blood glucose levels. This also applies to preventing lows and all extreme highs and lows.
In essence, you need to become your own science experiment with yourself as your own lab rat or mouse. This is where the challenge is and where learning how diet and exercise affect your blood glucose proves knowledge can be very powerful. There are many factors like general health, other diseases, mental or medical conditions can make this even more of a challenge.
This discussion is for those people not using insulin. So read both blogs and you will see that they are in agreement. They have stated that education is the power in knowing how to use blood glucose readings to adjust diet and exercise and possible other lifestyle adjustments for better health.