March 2, 2012

Is Fructose Off the Hook for Overweight and Obesity?

According to the online site WebMD, more controversy is coming. In my reading lately, fructose and gluten-free are the latest to enter the controversy. We have seen sodium and fat at the head of the line, but the latest two entries are interesting. I feel that research agendas are driving all the controversies and not pure scientific research.

As a person with diabetes, high-fructose corn syrup is on the list of “do not eat items.” Therefore, it is with more than a passing interest that I read these articlse. I do have to wonder why there is no listing of the people who are quoted in the WebMD article and who they work for. Yes, in the WebMD article they are all associated with Canadian or US universities, but are they truly independent from the grain industry?

I have in the past, not been too kind to the corn industry and have had several nonproductive conversations with people in the industry. They always spouted the mantra of “sugar is sugar” and quoted industry experts that proclaimed there was no difference. They have well rehearsed answers.  This is most unsatisfying and leaves the discussion without any conclusion.

Most studies are too small and thus not very reliable. Quite possibly, they were done to obtain the results of the agenda of the researchers. This is disturbing at best. Plus, most studies or done using healthy people and not people with diabetes.

By reading a blog by Tom Ross here, and following his link, you may read about a study on fructose reported in the Annals of Internal Medicine (page down to find the abstract). Their review states that most trials had methodological limitations and were of poor quality. They do conclude that fructose does seem to cause weight gain when substituted on the same caloric level as the carbohydrate replaced.

Therefore, with the caloric intake being equal, fructose does not automatically mean weight gain. Now I have to question whether most people can reduce the caloric intake when they are unaware of the number of calories that have been added to their soft drinks and other processed foods. This is where better labeling requirements need to be placed on foods with added fructose, regardless of the type of fructose. The control group did have weight increase when the fructose calories were in addition to the carbohydrate calories already present.

These studies do make some sense of the fructose issue, but there are still many unanswered questions about the effect of fructose on the body, especially the lipid levels produced by fructose.

Now we have another study saying the opposite of these studies. “These studies may provide important insights into the cause of the prediabetic condition known as "metabolic syndrome," which currently affects more than one-quarter of adults in the United States.” Whether this is true, or is just another agenda driven study remains to be seen. Obviously there will be more studies.

March 1, 2012

Mayo Clinic Study – Prediabetes Does Not Mean Neuropathy

Every once in a while we all need to rethink what we have learned or come to expect. So it is with prediabetes and neuropathy. A recent study conducted by Mayo Clinic researchers states that people with prediabetes are no more likely to have nerve damage termed small fiber polyneuropathy than people in good health. The point being made is that this goes against two decades of medical reports. This is interesting!

According to the lead author, "It is highly unlikely that impaired glucose or associated metabolic derangements cause polyneuropathy, at least not to the high frequency previously reported."

February 29, 2012

FDA Issues New Warning On Statin Drugs

Now we will all be wondering about our statin pills. The Food and Drug Administration has issued new warnings for all statin drugs. In addition to muscle damage, memory loss, confusion, and diabetes are listed as possible statin side effects. This much has been reported by WebMD.

Medscape also has reported the warnings are for the entire drug class. “Brand name and generic versions of statin drugs must carry these warnings on their labels, the FDA today announced.” This is good news for some people that have been resisting their doctors, but do not stop until your doctor knows about this.

This was not intended for tonight, but I felt this should be publicized.

February 28, 2012

Gluten-Free Foods – Watch Nutritional Value

This was not what I had expected from WebMD. I do feel the writer may have it right. “Move over fat, salt, and sugar. There’s a new dietary villain in town and its name is gluten.” This is not to belittle those with celiac disease, as they do need to avoid any gluten. What the food industry is doing to gluten-free foods is not a good thing and is harming people more than helping them or serving peoples' best interests.

Best estimates say that approximately 18 million Americans have some degree of gluten sensitivity. About 3 million people are estimated to have celiac disease. Gluten-free foods are the latest food industry crime. They have little concern for the health and welfare of these consumers. Yes, the foods are gluten free, but it is all the junk that is added to these foods that creates additional problems for people trying to loose weight or even maintain a balanced nutritional diet.

According to Dr. William Davis, “Eliminating all things wheat from the diet is one of the most powerful health strategies I have ever witnessed. But replacing lost wheat with manufactured gluten-free foods is little better than replacing your poppy seed muffin with a bowl of jelly beans.” Dr. Davis is a strong advocate for a wheat free life.

Reading the Nutrient Facts panels and Ingredients panels on packaged foods is a good idea to help prevent nutritional vacuum in your daily food intake on a gluten-free diet. Consider purchasing gluten free products that have added vitamins and minerals.

Refined carbohydrates dominate most commercial gluten-free foods and it takes more gluten-free ingredients to produce a tasty product. Therefore, produced baked gluten-free foods are much higher in calories and total carbohydrates than the regular foods containing gluten.

Are there dangers from a gluten-free diet? Yes, even doctors that specialize in Celiac Disease are concerned about the nutritional dangers involved in eating gluten-free diets. They urge people to get nutritional counseling and follow the advice of a dietitian specializing in Celiac Disease. These doctors are also concerned about the levels (too high) of fat and too little of fiber. They state that people that need to be gluten-free and are closely monitored can receive tremendous benefits. Until you know that you have actual gluten sensitivity, be very careful about doing this on your own. There are many pitfalls that can damage your health unless you are under doctors orders and have assistance from people specializing in gluten-free diets.

Gluten-free should not be a fad because of the dangers. This is the concern of the medical community and rightly so as this is a dangerous fad. More can be read about gluten-free here. A gluten-free diet is not a plan for weight loss and can make weight management problematic for many.   Read this on WebMd as well and this article about gluten-free.

February 27, 2012

Tackling Diabetes Care Challenges

Another “Expert Group” for diabetes is not something that gives me a lot of hope. Again, they do not include any people from the patient side. Granted there are not a lot of experts these professionals would classify as patient experts.

The name of the program is called “Improving Quality in Type 2 Diabetes: A national Initiative to Assess Guideline Adherence and Physician/Pharmacist Coordination.” This is part of a U.S. multiphase initiative that is setting out to assess the effects of current in-practice behavior across multidisciplinary professions in caring for patients with type 2 diabetes. Sounds impressive, but will this really assist patients?

I always get a sickening feeling when I read things like this as I wonder what other limits are going to be imposed on those of us with type 2 diabetes. Is this another program to declare that type 2 patients on oral medications do not need to spend time testing? Or, will someone finally realize that the physicians are not doing their duty of educating patients on the value and meaning of self-monitoring of blood glucose (SMBG).

This is always a possibility and should be high on the priorities for any expert group, but will it? “The aims of the program are:
  • To reveal practice-specific obstacles of appropriate glycemic control in primary care and endocrinology in multiple locations and practice environments across the U.S.
  • To assess current pharmacist practices in terms of medication education and patient monitoring of those with type 2 diabetes, and
  • To determine the critical factors of successful interdisciplinary diabetes care by considering the behaviors and attitudes of physicians, staff, pharmacists and patients.”

Notice that the only mention of patients is in the last point above. Everything else is dedicated to practice level discussion. How will they determine the behaviors and attitudes of patients? Will this be just another adhering or non-adhering discussion about the patients? Or, will they actually consider the feelings and problems patients encounter in lack of diabetes education, continuing support and updated education, and the benefits of continuing education to assist the patients?

As a patient, I can only suspect that it will be more of the same lack of concern for the welfare of the patient and no thought about the lack of education provided. This will leave patients out in the cold and the “medical professionals” patting themselves of the back for again claiming to have improved life for the patient.

Until the professionals change their thought process and include patients with type 2 diabetes in any discussion, nothing will change from a patient perspective. No education will be provided to the patient, SMBG will continue to be downgraded, and patients will continue to wonder where to get reliable information and help in their management of diabetes.