April 16, 2016

Education Can Make a Difference

Kate Cornell really hit one out of the park in her “importance of education” blog.
Her statement, “education in relation to type 2 diabetes has been my passion, for lack of a better word. It is something which I feel is sorely lacking and desperately needed,” says a lot.

Why doctors don't do any diabetes education is a mystery to me. I can understand why most doctors avoid referring patients to certified diabetes educators (CDEs). With the numbers of people with type 2 diabetes, and the small numbers of CDEs, in this area and many other rural areas there are many reasons diabetes education is lacking. Medicare does not reimburse doctors for education and does a poor job of reimbursing CDEs.

Can these be solved? More than likely not, but time will tell. With Medicare's bidding process taking front page, maybe Congress will also take a look at the way Medicare is paying doctors and others.

While Paula Deen was a flop in her attempt to promote a diabetes product, was not knowledgeable about type 2 diabetes when she made her announcement, and could not carry on a coherent discussion without making mistakes.

The latest two celebrities have more experience with type 2 diabetes, but I can't say they aren't above making money; they at least made their decisions after doing some research.

Dr. Phil is promoting Bydureon® (exenatide extended-release) the once a week injectable. He doesn't claim to use the product, but does promote the following rules:
At the core of the ON IT Movement is Dr. Phil’s “6 Rules to Get ON IT.” At OnItMovement.com, Dr. Phil McGraw explains these six rules in a series of motivational videos:
  1. Move forward. Tackle your type 2 diabetes head on – no more guilt, no more being overwhelmed.
  2. Get educated. Understand more about type 2 diabetes so you’ll be armed with the know-how to fight back more effectively.
  3. Build a team. Pull together a team – your doctor, your spouse, your kids, a trainer at a gym or your buddies at work – and lead it.
  4. Replace bad habits. Think about which aspects of your lifestyle need to change, and one by one, replace the bad habits with good habits.
  5. Make a plan. Have goals and create a plan to get you to those goals.
  6. Stick to it. Join the ON IT Movement to learn more about tools that can help you stick to your plan – whether it’s finding healthy recipes, getting ideas for exercising or learning how to change your everyday habits.

James Earl Jones says he is using Invokana® (canagliflozin) and that it is helping him with his blood glucose levels. He has done interviews and this is one to read.

At least both celebrities agree that one-size-does-not-fit-all and that each person needs to find their own path and what works for them.

April 15, 2016

Statins Are Causing Some Memory Loss

If you thought that the bad news about statins was over, think again. We are seeing more and more research bringing more bad and sad news about the prescription epidemic for statins and how the American Heart Association is slowing losing credibility as a medical group. It would not be so bad if the AHA hadn't doubled down and encouraged prescribing statins to people that had normal lipid (cholesterol) results in children, adolescents, and young people.

Statins are a mainstay in diabetes therapy, but connections have been made between memory impairment and statin use. Previous case studies and case series have found a link between the use of statins and memory loss. However, there is a lot of conflicting information on the topic.

A recent retrospective cohort study was undertaken to determine whether there is an association between statin use and acute memory loss. 482,543 participants on statins were compared to 482,543 participants receiving no therapy and 26,484 receiving a lipid-lowering agent other than a statin. Participants were analyzed 30 days after first exposure to therapy. The comparison between groups utilized logistic regression to analyze the results, which allowed an estimate of an odds ratio (OR) with a 95% confidence interval (CI).

The results of the study found an association between the use of statin therapy and acute memory loss at 30 days. Statin use compared to non-users of a lipid-lowering agent yielded an odds ratio of 4.40 (CI: 3.01-6.41). When comparing the group of non-statin lipid-lowering agents to non-users, the odds ratio was 3.60 (CI: 1.34-9.70). However, when comparing the statin group to the non-statin lipid-lowering agent group, the odds ratio was 1.03 (CI: 0.63-1.66).

While the results support the hypothesis that there is an association between statin use and acute memory loss, it also makes an association between other lipid-lowering agents and acute memory loss. There was no statistical difference found between acute memory loss caused by statin use when compared to other lipid-lowering agents. This study makes the association between acute memory loss and any lipid-lowering agent, not limiting the effect to statins alone. It should be noted that there is also some evidence in various studies that long-term statin use may be beneficial to memory. This study does not address that conflicting viewpoint.

I do like what Tom Naughton writes about statins. I will list four of his blogs, which are telling it like it is about statins.

April 14, 2016

Doctors Are Not Treating Prediabetes

Barry called me earlier this week, said he had something to talk to me about, and asked if I could come to his place. I said yes and headed out the door. When I arrived, I had expected Ben, but Allen and Tim were there also, plus another person we all were introduced to by Barry. Barry said his name for the group was Jay.

Barry then continued that Jay had a doctor appointment this morning and after the labs were discussed, Jay asked for a copy and the doctor had his nurse run a copy. Next, he wanted to prescribe a statin, a blood pressure medication, and another medicine that they talked about but he decided not to prescribe. Barry then said his plasma glucose was at 136 and his A1c was 6.4%. All that was said by the doctor was your sugar level is moving up and to watch what he ate. He said this is the main reason I called everyone here.

I asked Barry what he had discussed with Jay. Barry said he had looked at the lab results and from the lab results and asking Jay what his blood pressure was, he could see that he needed the blood pressure medication. He said that he wanted the rest of us to look at the cholesterol numbers, as he didn't think a statin is warranted. Jay handed the report to Allen and Allen read it to the rest of us. HDL 58, LDL 84, Triglycerides 70 and a few ratios. All agreed that statins should not be needed.

I added that the reason for the statin prescription is obvious – his A1c is 6.4% and this tells most doctors to prescribe a statin. Tim said he agreed with me and that is the reason for not diagnosing prediabetes and prescribing metformin or insulin to help the pancreas heal and possibly delay or prevent diabetes.

Ben spoke then and said he agreed and said that we should get him to a doctor that will diagnose and is not afraid of prescribing. Allen said he was on the fence, but with the A1c, he could understand and would support us. Jay started asking questions then and said he did not want to go to another doctor. Barry then asked if he wanted to know about prediabetes. Jay said if it was serious, the doctor would have said something.

Tim and I looked at each other and Tim said to Jay, that it was his choice, but when he actually has diabetes, he cannot say he did not have a warning, unlike the rest of us that did not know until diagnosis. With his plasma glucose reading and the A1c, he should know that he is moving toward type 2 diabetes rather rapidly.

Jay asked Barry if this was true. Barry said yes, and if you continue to ignore it, you will soon have diabetes. Barry then added that it may be too late with an A1c of 6.4%. Ben added that the doctor sees this and knows he will soon have a patient with type 2 diabetes that he will be able to treat. Allen said the comment he made “your sugar level is moving up and to watch what he ate,” is what we understand now as code for prediabetes.

I said that is the reason most doctors will not diagnosis prediabetes is because they know that they will soon have a patient to treat and possibly more regularly if they don't manage it properly. Doctors in general, believe diabetes is progressive and people will develop some of the complications and they will be able to treat many of the complications.

Jay asked what complications? Barry started with blindness; kidney failure, meaning dialysis; heart disease; nerve damage, meaning pain for many people; and possible organ failure. I could see Jay looking very worried. I said this does not have to be this way, but it does require action by you to change your way of eating, exercise regularly, if able, and test regularly. I said some people go through stages – anger or shock, denial, and finally acceptance before they take action.

Tim said if you will let us get you to an endocrinologist that knows diabetes, he can give you medication(s) that will help manage your blood glucose problem and possibly prevent diabetes from developing. Your A1c does indicate a serious problem with blood glucose and does need to be treated now. Jay finally admitted he was concerned and asked Barry who he would recommend. Barry said he would take him if Allen would go with him once he had an appointment. Allen said he had the phone number, started the call, and then handed he phone to Jay and we could hear Jay giving the receptionist his information. Jay finished and told Barry his appointment was for April 29 at 2:20 PM.

Tim asked Jay if he had a computer and he said he did. Barry said he would give Jay some of my blogs, some by David Mendosa, and other areas to read. Tim thanked him and we excused ourselves and left.

I forgot to say anything about the public service advertising about predicates, as this is an on target promotion and deserves our attention. I have now seen four of their ads and the last two were not over the top and were on target to wake people up about prediabetes.

April 13, 2016

Some Diabetes Drugs Cause Weight Gain

This is something you need to be aware of and lower the amount of carbohydrates you consume when you receive your diagnosis of diabetes. Weight gain is a complaint about many diabetes medications, both oral and insulin. Sulfonylureas, thiazolidinediones, and insulin do cause weight gain because they help the body absorb nutrients and move glucose into the cells for use and storage, which causes the initial weight gain.

Metformin and incretin mimetics usually don't cause weight gain and may even cause a little weight loss and they are considered weight neutral. Many people say they don't want to start insulin therapy because it causes weight gain. Most people keep eating the same foods they have been eating and do not reduce the amount of carbohydrates they consume and this is the main cause of weight gain.

What many people do not realize, if your blood glucose levels are consistently high over a period of time, and your medication is not controlling your blood glucose levels, your body tries to get rid of the excess glucose through the kidneys. If this continues for long enough, you will have kidney damage or one of the diabetes complications. Dialysis can result and this is not favorable for your health. This is the reason for lowering the carbohydrates you consume.

Hypoglycemia can also cause weight gain. If you've ever had low blood sugar, you know that feeling of anxiety you get that makes you overeat to get your blood sugar back up. Some pre-mixed or intermediate acting insulins require that you eat on a schedule. If the dose is too high, you may need to eat extra snacks to avoid low blood glucose, which then leads to weight gain. If this happens, work with your doctor or diabetes educator for assistance.

If you overeat, you gain weight. Just because you can "take insulin to cover it" doesn't give you free reign to overindulge. This is what many people unfortunately continue to do and this is not good. This is when people blame the insulin and forget that it was what they did that caused the weight gain. If they would have reduced the amount of carbohydrates they consumed, the extra insulin would not have been necessary and the weight gain would have stopped before it became a problem.

What can you do to prevent or minimize weight gain? Here are a few tips:
  • Exercise and maintain a healthy food plan.
  • Use glucose products to treat low blood glucose instead of eating junk food.
  • Get help from your doctor or diabetes educator if you find you're eating to keep your blood sugar up. You may need a medication change or insulin dose adjustment.
  • If weight gain is a concern, ask your doctor for other medication options. However, realize that reducing the amount of carbohydrates will stop weight gain.

April 12, 2016

A Diabetes Forum May Be in Trouble

Diabetes forums come and go and it is a shame when a good one is being brought down by those that want to create problems for members. A few people, less than six really pushed hard to the owners to force out most of the moderators and open the forum up to their way of doing things. This has moved the forum away from low carb, high fat way of eating toward several types of diets, but including LCHF.

Instead of eating to your meter, they could care less about testing and more about the different foods they could still consume and take enough medications to cover the increased calories. Then the owners needed to put one of their own into the mix to make sure that the discussions were open and headed in the direction they want.

Many of us are watching and waiting to see if the forum folds like so many others or whether it can survive the new leadership. One of the leaders is very difficult and I personally don't think has the personality to manage a diabetes forum since she does not have diabetes, but is one of the upper management in the ownership company and this is why many are very concerned.

The other person does have type 2 diabetes, but is not very convincing in what she posts and this is just a personal observation, but sincerity does not seem part of her personality.

In addition to this, some of the complainers are now posting and making statements which seem very argumentative and many are trying to have them stop. In addition, these same people are trying to make some of the long time members agree with statements they just say were said and become very belligerent when people don't come to their support.

There are days when posts and topics are up over what they had been, but now are trending downward and then back up and then down lower. The complainers have pulled back and are only posting when they can create conflicts. Several other complainers have now had their memberships opened up from being banned and are also directing the forum away from the low carb high fat way of eating to other ways of eating. Some are calling them similar to LCHF, and there are others that want to eat their carbohydrates or comfort foods and are talking about these.

The people that had been posting regularly are decreasing and others are posting very short posts to increase their post count. To my way of thinking a five or six word post is not saying much and does allow for post counts to increase rather rapidly.

Granted this is just my opinion and I am not the owner of the site, and like one of the complainers told me, “Shut up and go away” in a personal message. I will just hide and watch, and see what happens.

April 11, 2016

April Meeting with Both Nutritionists

Normally I would have posted this for Sunday, but I wanted to complete the series since I had to hand out copies for Sunday to members. Our April meeting was very different and many were discussing the blogs on nutrients. Both Allison and Suzanne were there and Suzanne commented that our group was very different from most people or small groups she has had contact with and wanted to thank us for thinking of them. Allison said yes, even she could appreciate the blogs as Brenda had made her aware of them.

Tim told them to take over as he had the slides ready and would use them when needed. Allison said we had hit on two ideas that would definitely help them balance our food plans easier and wanted everyone to be aware of these.
  1. Always have any lab results available if any of the nutrients were tested and are part of the lab reports.
  2. Try to keep a food log available for them to look at and if necessary a recipe of some of the ingredients in the foods. Example, if cauliflower is substituted for potatoes, make a note of this.
  3. Always have a list of medications and supplements you are taking. Indicate which dietary supplements may have been ordered by the doctor. Example, vitamin B12 for long time metformin users as this may indicate that you have lost the ability to absorb vitamin B12 from the foods rich in them.
Suzanne said that several had two of the above, but no one has had all three. She said Allen and Bob have had the first and third and have been told by their doctors to take vitamin B12 and D. She says this means both have lost the ability to absorb vitamin B12 from the foods. Vitamin D is lack of sunshine more than likely.

There were several questions about vitamin B12, and Suzanne said she would answer the first. There were several about metformin and vitamin B12 and Suzanne said that now we have a link that metformin does cause a deficiency of vitamin B12. We are not sure of why this happens, but if you have taken metformin for several years, you should be tested for vitamin B12. This is the safest way to know and many doctors will not do the test and just tell you to eat animal foods, liver, sardines, and salmon rank highest, with liver having the largest amount of vitamin B12. Kidney, eggs, beef, and pork are also good sources.

Allison continued that often the elderly do not have enough acid to digest the animal foods and absorb the vitamin B12, thereby causing the vitamin B12 deficiency. For any of you that are vegetarians, or vegans, you must take a supplement to maintain vitamin B12 levels.

This drew a few more questions about vegetarians and one asked if they should eat some liver or salmon to prevent vitamin B12 deficiency. Suzanne said that this would not happen because people that were strict vegetarians would not have enough acid in their stomach to absorb vitamin B12. The question was then rephrased to say that she was considering moving to a vegetarian diet. Suzanne said that initially she could have enough acid, but that in a month or two she would not and a supplement would be necessary.

Allison said that if a vegetarian or vegan moved away from this way of eating, that it could take a year or longer to be able to absorb vitamin B12 and some individuals never regain this ability if they are older. People in their 20's still can remain deficient for a year or longer and children have been deficient into their teens. She continued that is one reason we generally stay away from these situations.

Suzanne agreed and said with a group like this, we will work with you to a point, but discourage you from adopting either of these on a full-time basis. The next question was what Suzanne was waiting for and it was about why was it necessary to take many of the nutrients with knowledge or under supervision of a knowledgeable doctor.

Suzanne said that like the B vitamins, they are all water-soluble and the excess is flushed by your system. Vitamin A and E are fat-soluble and can become toxic if you consume too high a dosage. Vitamin D is in truth a hormone and will not become toxic until near 400,000 IU or above. Some people use 10,000 IU and have no problem for several months.

Allison said that the minerals are important, but can become toxic if not taken carefully under the supervision of a doctor. Safety should always be first and care taken to void problems. The mineral iron is tested in women of child-bearing age because they need enough and not too much for carrying the baby. Men can often be ignored by doctors and other doctors just refuse to test for many of the nutrients covered by Bob.

Tim said the meeting was over and then the questions really began as many wanted answers and but did not want everyone to know who asked the question. A few of us started the cleanup and as we finished, Suzanne asked to speak to Tim and myself. She said she would not be able to attend meetings until the next year and was just happy for this meeting. We said thank you for letting us know and asked if she would be doing any consultations. She said no and she would be too busy for consultations. Tim asked for everyone's attention that was still there and made the announcement about Suzanne's planned absence.

Allison then stated she would also be gone for the month of May until the end of September. She said that she would schedule as many as she could before the end of April and the rest would need to wait until October. Tim thanked her and we both asked if there was anyone we could talk to if the need arises. Both said they would each supply two names and phone numbers to Tim after they had approval to do so. We thanked them and the meeting broke up.

April 10, 2016

Are You Getting These Nutrients? - Part 14

Zinc is an essential trace mineral, so you get it through the foods you eat. Next to iron, zinc is the most common mineral in the body and is found in every cell. It has been used since ancient times to help heal wounds and plays an important role in the immune system, reproduction, growth, taste, vision, and smell, blood clotting, and proper insulin and thyroid function.

Zinc also has antioxidant properties, meaning it helps protect cells in the body from damage caused by free radicals. Free radicals may contribute to the aging process, as well as the development of a number of health problems, including heart disease and cancer. Antioxidants can neutralize free radicals and may reduce or even help prevent some of the damage they cause.

Your body doesn't need a large amount of zinc. The recommended daily allowance for adults is 8 - 11 mg. It’s common to have slightly low levels of zinc, but taking a multivitamin, plus eating a healthy diet, should give you all the zinc you need.

It's rare for people in industrialized countries to be seriously deficient in zinc. Low zinc levels are sometimes seen in the elderly, alcoholics, people with anorexia, and people on very restricted diets. People who have malabsorption syndromes, such as Crohn's disease or celiac disease, may also be deficient in zinc.

Symptoms of zinc deficiency include loss of appetite; poor growth; weight loss; lack of taste or smell; poor wound healing; skin problems such as acne, atopic dermatitis and psoriasis; hair loss; lack of menstrual period; night blindness; white spots on the fingernails; and depression.

Zinc reduces the amount of copper your body absorbs, and high doses of zinc can cause a copper deficiency. For that reason, many doctors recommend that you take 2 mg of copper along with a zinc supplement.

Your body absorbs 20 - 40% of the zinc present in food. Zinc from animal foods like red meat, fish, and poultry is more readily absorbed by the body than zinc from plant foods. Zinc is best absorbed when taken with a meal that contains protein.

The best sources of zinc are oysters (richest source), red meats, poultry, cheese (ricotta, Swiss, gouda), shrimp, crab, and other shellfish. Other good, though less easily absorbed, sources of zinc include legumes (especially lima beans, black-eyed peas, pinto beans, soybeans, peanuts), whole grains, miso, tofu, brewer's yeast, cooked greens, mushrooms, green beans, tahini, and pumpkin, and sunflower seeds.

Zinc is available in several forms. Zinc sulfate is the least expensive form, but it is the least easily absorbed and may cause stomach upset.

More easily absorbed forms of zinc are zinc picolinate, zinc citrate, zinc acetate, zinc glycerate, and zinc monomethionine. If zinc sulfate causes stomach irritation, you can try another form, such as zinc citrate.

The amount of elemental zinc is listed on the product label (usually 30 - 50 mg). To determine the amount to take in supplement form, remember that you get about 10 - 15 mg from food.

Zinc lozenges, used for treating colds, are available in most drug stores. There are also nasal sprays developed to reduce nasal and sinus congestion, although they may have some safety issues.

You should take zinc with water or juice. If zinc causes stomach upset, it can be taken with meals. Don't take zinc at the same time as iron or calcium supplements.

A strong relationship exists between zinc and copper. Too much of one can cause a deficiency in the other. If you take zinc, including zinc in a multivitamin, you should also take copper.

Daily intake of dietary zinc (according to the National Academy of Sciences) are listed below:
  • Men 19 years and older: 11 mg (RDA)
  • Women 19 years and older: 8 mg (RDA)
  • Pregnant women 14 - 18 years: 12 mg (RDA)
  • Pregnant women 19 years and older: 11 mg (RDA)
  • Breastfeeding women 14 - 18 years: 13 mg (RDA)
  • Breastfeeding women 19 years and older: 12 mg (RDA)

You should not take high doses of zinc for more than a few days unless your doctor tells you to. Talk to your doctor before taking more than 40 mg of zinc per day and take breaks from zinc supplementation. During those breaks, get zinc from a well-balanced diet.

Because of the potential for side effects and interactions with medications, you should take dietary supplements only under the supervision of a knowledgeable doctor.

Research has shown that less than 40 mg a day is a safe amount to take over time, but researchers are not sure what happens if more is taken over a long period. Additional concerns have been raised about combining multivitamins and additional zinc supplements and an increased risk of dying from prostate cancer. Speak with a physician.

Taking 100 mg of zinc daily, or taking supplemental zinc for 10 years or longer, has been linked with a doubling of the risk developing prostate cancer in men.

Common side effects of zinc include stomach upset, nausea, vomiting, and a metallic taste in the mouth. High doses of zinc can cause dizziness, headache, drowsiness, increased sweating, loss of muscle coordination, alcohol intolerance, hallucinations, and anemia.

There are reports that a single dose of zinc as high as 10-30 grams can be lethal.

Very high doses of zinc may actually weaken immune function. High doses of zinc may also lower HDL ("good") cholesterol and raise LDL ("bad") cholesterol.

Some people who have used certain zinc nasal sprays to treat a cold have lost their sense of smell. Talk to your doctor before using a zinc nasal spray.