The Internet May Be What the Doctor Ordered

A doctor ordering you to use the Internet? Well, things are changing, some doctors are suggesting this and giving out sites for patients to explore. Several members of our diabetes support group are on the receiving end, and from what I am hearing, the websites are of value. Some of us had visited the sites before the two doctors included them on their list, and we feel much better that the members that did not accept the sites from us are now accepting them.

The sites are a good variety, from nutrition to medications and habits for developing better diabetes management. At least the doctors are not limiting nutrition to only one type, but are promoting several types, but mainly low carb and medium carb. Allen and Barry were surprised when during our last meeting, they heard from two members that had been very set against medium carb and were talking about how they were going lower on medium carb and asked Allen how they could go even lower.

Allen just asked them what they were presently eating and what they wanted to eat. He was surprised when he added up the carbs as they described what they ate and when they stopped, they were about 80 grams and both said they wanted to get to about 50 to 60 grams. Barry said Allen was rather close and he suggested they remove the corn from the menu for both meals and this could bring them to about 55 grams. Allen agreed that would get them to about 55 grams and the small amount of peas from the evening meal could easily have them at about 50 grams.

Allen asked them if they used a scale for the foods and both said they did and said this is the way they calculated to the grams of carbohydrates they were eating. Barry suggested that they should increase the amount of fat when they lowered the amount of carbohydrates. One of the fellows said he would be, but may not increase the amount as much as the other fellow. When Allen asked his why, he said that too much fat caused diarrhea for him and Allen said then he should keep the fat level manageable for his system. Barry also suggested if they went lower they needed to consider increasing their salt intake for about two weeks.

Barry also suggested that they should schedule a nutrition session with Allison to make sure that they had a balanced food plan and not be missing vitamins and minerals the body might become short of in the long term. One said he had done this when they had gone below 100 grams per day and he agreed this would be a good idea when they went below 60 grams per day. Allen thanked them for asking questions and hoped they were happy with the plans. The fellows asked Barry and Allen what the number of grams of carbohydrates they were consuming. Allen said he was eating between 50 and 60 grams per day and Barry said he was between 60 and 70 grams per day.

Then one fellow asked if anyone was eating what is Dr. Bernstein's level at thirty grams. Allen said he had been that low for about six months and found he could not maintain this low a food plan. Not only was he becoming deficient in some vitamins and minerals, but also he was not feeling well near the end of the trial and needs to increase his daily carb intake. Barry said that after Allen's experience, many of the members were very hesitant to go lower than 80 grams of carbohydrates.

The other fellow said this is the explanation he needed and why they ignored us when we were promoting medium and low carb before the doctors had provided them with reading material.

CDC Reports Half of Eligible U.S. Adults Don’t Take Statins

This may be the best thing for them – see my blog here. I will be ditching statins over the next 45 days and I will not let a doctor convince me otherwise. In researching for the blog above, there were many articles on statins causing hardening of the arteries. Yet, the endocrinologists and cardiologists will not give them space on their websites. In a recent conversation with a cardiologist, when I mentioned this, he wanted to know where I read this and asked for URLs that I could email to him.

I did hear back from him and he said that he would need to rethink his policy of prescribing statins. He was gracious enough to say that he had not heard of these studies and even though most were behind paywalls, he did access them and was very surprised at what was in several of the studies. In the email, I did ask if he were able to read a couple of them, would he email me a copy. He did and for that I thanked him.

We have continued our discussion over the last several days and he thanked me for my blog referenced above and for including the statements by several doctors. While he was aware of Dr. Malcolm Kendrick's book “The Great Cholesterol Con”, he had not read it and with the URLs I had sent him, he had ordered the book.

I also asked him about the newest statin, the PCSK9 class. With our discussion, he said he would be in correspondence with Dr. Kendrick after reading his blog on this and reading my three blogs on the new drugs. He is not sure about prescribing presently, but stated he does have one patient that has asked about them and the patient fits the criteria, but he told the patient to wait.

Then he asked me for the results of my last lipid panel, which I sent to him. I received an immediate reply asking me how I had achieved the low levels for LDL, triglycerides, and a good reading for HDL. I said my way of eating and not following the food plan many registered dietitians push of carbohydrates and whole grains. I said I follow a low carb, high fat food plan with moderate protein. I eat lots of eggs and cheese that is not highly processed. I like sausage and bacon and I choose other high cholesterol foods that are not highly processed. I read food labels, ingredients, and avoid many canned foods except green beans and use a lot of dried beans that we use the pressure cooker to put moisture back into the beans. He asked how many carbohydrates I consumed per day. My answer was 30 to 50 grams per day and it varies by what I decide to eat for the day.

He commented that he had two patients eating very similar food plans and he said this must be why their lipid panels are always so good. He said he needed to stop for now, but that he would be back with more questions.

I have strayed from the topic so I will have to think about whether I really want to blog about the CDC saying half of eligible U.S. Adults don't take statins.

Our Second October Meeting

On October 21, we had Brenda's daughter, Allison, present on low carb/high fat food plans. We only had one member absent and Allison started after Tim introduced her.

Allison stated that low carb/high fat could vary from person to person. The grams of carbohydrates can vary from a low of 30 grams to about 100 grams per day. She next said that the number of grams should vary depending on what your meter tells you works for you. She said that some people set 140 mg/dl as the upper limit for post prandial meter reading.

She continued that this is even what I recommend as the upper limit. She said that some of you have lower limits, which are good for you, and this is what each individual should do. Next, she asked for a show of hands, telling people if they had not set an upper limit not to raise their hands when she said a number. She started at 140 and six hands went up. When she said 130, another six hands were raised, and 120 had 11 hands raised. Then she said 110 and 12 hands were raised. When she said 100, no hands were raised. She then asked if there were other numbers, several said 115 and a few said 125. Allison said there is a good mix for a group this size.

She then said that food plans should not be a one-size-fits-all food plan and I am happy that while many are using the same food plan, there are variances that can be worked with. She continued that unlike dietitians, she and Suzanne worked with what the person wants and may make some suggestions that will be workable. Your blood glucose meter should be your friend and used regularly by testing in pairs. Once the newer members have their food plan settled, then you should have one or both of us back to help refine it and create a balanced food plan.

She said we don't demand you eat a certain number of carbohydrates, and we don't dictate what fruits and vegetables you consume. Most important we don't demand that you include whole grains in your food plan. She continued that she might consider them for a few individuals that show her that the quantity they consume does not exceed the blood glucose goal (she said that she only has two individuals that have this possible).

Next, she asked if some were taking vitamin and mineral supplements. She was a little surprised at the number of hands raised. Next she asked how many had the cooperation of their doctors and been tested for the supplements they used. Only about half of the hands went up. Now she had a concerned look on her face and asked why they were not being tested. The one comment she heard was that they were natural and didn't need to be tested.

She then stated that for some people, the supplements could conflict with medications and cause more severe side effects. She asked Tim to put the slide up and she asked me what the slide meant. I said it is grapefruit and tells us that it can cause some heart, statin, and blood pressure medications to become toxic to our systems and put us in the hospital and if not avoided might kill us.

Next, she asked Tim for the second slide and she said that even Bob knows why we should be tested and where to research for medications the vitamin or mineral may cause prescription medication conflicts. You even need to take some of them only under the supervision of a doctor. She stated that Bob and the older members are aware of why you need to be tested and that is why you need to read the blogs posted about supplements and know where to research information for yourself.

Then she asked Tim if the blogs with links they should use could be included in an email. Tim said that when she gave him the slides, he had started composing an email and would finish it and send it to all members. Allison asked if he would include her as well as she said that she needed to use these for other patients she helped. Tim agreed and she looked at me, and I said they are available for everyone to read.

At that point, she open the discussion for questions and she spent the next half an hour answering questions, as did the older members. She thanked Tim for putting up the slides and then she thanked me for listing the blogs I did for her.

She talked with Tim and thanked him for having her do a presentation. Tim said she covered some important points many of the members needed and we would be asking her again.

Tips to Manage Blood Glucose on Insulin

Do you use insulin to manage your diabetes? How do I occasionally manage swings in my blood glucose levels? What can I do if my high blood glucose levels won't go down while using insulin? These are common questions I receive in emails.

First, I have to ask some questions. I ask if they have had classes given by a CDE/RD. What did they tell you about the food plan you should follow? I also ask if they need to lose weight that they have recently gained. This generally elicits the following answers – yes, they have had classes and they were advised to consume whole grains and eat between 45 and 70 grams of carbohydrates per meal. Many tell me they were overweight to start, are gaining more weight on insulin, and have not been able to lose any weight.

These answers tell me there are changes that need to be recommended. I always emphasize that diabetes is not their fault and ask if they are open to changing their food plan. I suggest that they avoid the whole grains and lower the amount of carbohydrates they consume. I suggest that they consider eating no more than 80 grams of carbohydrates per day and preferably only 60 grams with 20 grams for each meal.

I do tell people that for about two to three weeks, they may feel hungry, but after three weeks, this will often not be the case. This will vary by individual, some people can be hungry for two weeks, and some will take four weeks.

I do tell people that Dr. Bernstein recommends a lower carbohydrate food plan of 6-12-12, meaning six grams for breakfast, 12 grams for lunch, and 12 grams for dinner. I suggest that if they want to do this that they start out by lowering the number of carbohydrates over a period of about four weeks.

I warn these people to reduce the amount of insulin used as they reduce their carbohydrates. I do suggest that they immediately talk with their doctor about how fast they should reduce the amount of insulin, both basal (long acting) and rapid acting. I tell them that they want to do this to avoid hypoglycemia (lows).

I also warn then to be prepared to further reduce their insulin as their weight decreases, as insulin resistance can ease as well. I warn them that the doctor may want to take them off insulin and they should decide what they want.

If they are using oral medications, I give them the same advice and tell them that the amount of medication may need to be reduced and especially if they are taking a sulfonylurea.

I emphasize these three items, exercise, following a lower carb meal plan, and easing stress. I also tell them that if they cannot find a nutritionist that they trust, I will suggest one. Yes, I inform them that the person is a relative, but that they should find one that they trust and is not pushing carbohydrates. Find one that wants to work with them and balance the nutrition for a day, a week, and give them something to work with for the daily living.

Finally, I suggest that if anyone is pushing carbohydrates, they need to be careful and stay away from them. I tell them that it is not healthy to increase carbohydrates and expect to cover them with increased medication (oral or insulin). This will cause weight gain that will be difficult to lose. I do advise these people to stay away from low carb/low fat plans as this often causes weight gain, as the carbs are often not low.

Thoughts for Value in Food Labels

This blog by Professor Jennie Brand-Miller talks about what we really need on food labels to help us make better choices. I will do my best to comment on her ideas as she does have some important information. Before getting to that, I would like to discuss the US food labeling system.

The current revised food labels used on foods still allows for a 20 percent error margin and the processing companies and food manufacturers do not have to test their products as often. I can almost bet that some merchandise is outside of the 20 percent error margin because of the time of harvest, the farm where grown, and how the food was raised. Food that is raised on poor soils will not be as nutritious as food from fertile farmland. Then we have the chemicals used to keep insects down and herbicides used (including GMOs). Food that includes GMOs are said to be safe, but research is not up to date and is being challenged at various levels.

For manufactured foods, scales go a long way in helping meet the 20 percent error margin. This still does not guarantee that the 20 percent error margin is met 100 percent of the time, but they are higher in accuracy than for most raised foods.

The following are just a few of the considerations that need to be made:

• The energy content (calories) of a food is not the best way to judge a food – lentils and liquorice have the same energy density.
• The fat content of food is not the best way to judge a food – nuts have more fat and are more energy dense than French fries.
• The sugar content is not the best way to judge a food – dried fruit is full of sugar.
• The sodium content is not the best way to judge a food – soft drinks are low in sodium.

These are just a few of the considerations we need to determine our individual food plan. This is one reason many of us encourage each person with diabetes to develop your own food plan.

Some people need to consider the following when developing their food plan. Yes, you need to read the labels on all foods to have some idea of the nutrients and the amount your are consuming. You also need to use your meter to help you develop your food plan. Some ideas that you need to consider include:

1. Do you need to reduce the number of carbohydrates you consume?
2. Do you need to increase the amount of fat in your food plan?
3. Do you need to increase the amount of protein in your food plan?

The next thing I have to question as a person with diabetes is most of the food plans seem to be for the healthy person and not for people with diabetes. Authors seldom suggest that people with diabetes use their blood glucose meters before and after eating to learn if what they consume is causing their blood glucose levels to spike at levels that are too high to manage.

Brand-Miller says many ignore micronutrients – vitamins, minerals and phytochemicals. She continues they ignore two important proven attributes of foods in the new nutrition – the protein content and the GI of the carbohydrates. While those of us with diabetes need to restrict our intake of carbohydrates, this is not mentioned. Brand-Miller sidesteps the fat consumption that is essential for our satiety and helps reduce our appetite. She says carbohydrates and protein are proven to help to curb appetite. Then she says appetite matters. Appetite is what drives our energy intake. I says this is what causes our weight gain.

Professor Jennie Brand-Miller concludes this way - “What would I like to see on food labels? I’d like to see a system that:

• Focuses on the positive.
• Rates foods according to their contribution to desirable macronutrient and micronutrient intakes.
• Uses Adam Drewnowski’s Nutrient Rich Foods Index, which rates individual foods based on their overall nutritional value, as an essential component.
• Encourages higher protein intake, particularly from legumes.
• Distinguishes between naturally-occurring and added sugars.

I would advocate that we make the most of something we already have available to use on our food packaging here in Australia and that is proven to work: two certified and recognizable symbols that are signposts to both healthy foods and healthy diets.”
I think in the United States, we need a slightly different system, but with the USDA dietary guidelines not being part of it.

Lessons for People New to Type 2 Diabetes, Part 8

If you have not read Part 4 of this series, please do so. This is also about food, but I will be discussing the type of medications and food plans with them. First please understand that I use insulin and this allows me to eat some foods that people on oral medications cannot eat with any regularity.

I am still maintaining less than 80 grams of carbohydrates per day, and I am slowly working my amount of fat up. I no longer have the problems I had early on of using the porcelain fixture in the bathroom more than I wanted. I continue to adjust my protein levels – some days more, but often downward. This depends how the protein is fixed and the number of eggs I consume.

I admit that my lipid panel test results are improving and I have hope in the near future that statins will come off the list of medications I take. This to me is exciting and one more goal I have hope of accomplishing.

The landscape and attitudes of doctors is changing, albeit slowly. My blog here discusses a few of the actions and a little of what is happening. This doctor did surprise me and garnered himself two patients and was more understanding than I have heard about many doctors. He is in a largely rural area and apparently understands diabetes better than many doctors.

I am hearing more about doctors advising a low carb, high fat, medium protein food plan for people with diabetes and this surprises me. Yes, I think this is right, but for doctors to suggest this is unusual when most are still following the low fat mantra.

I will again emphasize that there is not a one-size-fits-all food plan. The quicker you accept this, the easier it will be to build your own plan or adapt another food plan that fits your needs. Use your meter to help you adapt or build your food plan, as this will aid you in finding one that you can accept and use on a daily basis. Other people often build a week's worth of menus so that they can vary what they eat. Several members of our support group have done this and they exchange recipes and test to see how their body reacts to the recipe and then adapt it if they need to do this.

One of our new members has tried a few recipes that A. J and James have been eating and said he was having trouble feeling full. They explained that he needed to test and see what his blood glucose level was at about one hour and again at two hours. He reported that his blood glucose had only increased 15 mg/dl from before to after meal testing. A.J suggested that he eat 10 more grams of carbs with the meal and see what happened. He did and said his blood glucose had only risen 20 mg/dl from his premeal reading. He added that he felt better and less hungry. A.J told him that was what worked for him and he could try adding another 5 grams of carbohydrates and do the same. He reported that he felt full then and his blood glucose had only increased 3 mg/dl above what the 10 grams of carbohydrates had been.

He and A.J discussed this and he now understood what could be done with different recipes that were testing too high and if he did this regularly, he could adapt more for himself. A.J is presently off all medications and the new member is on metformin. James is on insulin and has been long enough that he has been able to reduce his insulin use and he is no longer hungry. He has lost the few pounds he needed to lose and then his weight loss stopped. 

A.J suggested that he eat more slowly and chew his food more thoroughly, as this could help him feel full sooner and this could help him cut his carbohydrates.  The new member said this worked well for him and he was now maintaining his carb level below 60 grams of carbohydrates with no problems.

Lessons for People New to Type 2 Diabetes, Part 4

If you are new to diabetes, have you demolished the panic panel yet? Many people new to type 2 diabetes have panicked and delayed their acceptance for a longer period. In this blog, I will focus on food plans and try to suggest something that will help you in finding a food plan that will work for you.

An important lesson you need to learn is – just because another person with type 2 diabetes can do something and have good results – does not mean that it will work for you. This does not mean that you give up. This tells you that your diabetes is further or less advanced than it is for the other person and your body reacts differently than their body does. Do not forget this! There is not a one-size-fits-all solution for you! Yes, many doctors, dietitians, and even some nutritionists operate in this mode. This happens because they don't know how to properly assess patients and adapt something for them on an individual basis.

Something that was published recently on Health Central by Gretchen Becker might help in getting started. Her book is an excellent read and I refer to it more than I thought. Information - The First Year - Type 2 Diabetes, New York, Marlow & Company, 312 pages, by Gretchen Becker. I discovered this book within a month of diagnosis. It gave me information that I was not receiving from my doctor. Gretchen has type 2 diabetes and she gives the best definitions and reasons for controlling diabetes in non-technical language. Look for the Second Edition.

The other information that should be absorbed is on this site. Then down the page to the horizontal bar that has the following – Home, Diabetes Basics, Food, etc. in the bar. Select Food, explore, and read all you can as David writes a lot about diabetes. The only item that I have reservations about is the Glycemic Index. It was developed using healthy individuals and not people with diabetes. I use it as a guide and then let my meter tell me if a food item is one that I can eat, if I need to limit it, or eliminate it from my food plan. I encourage you to read as much of David Mendosa's website as you can.

I do encourage you to consider a food plan that is low carbohydrate, medium to high fat, and medium protein. All the experts are still pushing low carbohydrate, low fat, and more protein. Many are still concerned about saturated fat, but it can be consumed and the prior study by Ancel Keys has been shown to be false and more doctors are starting to see this.

Another problem for dietary advice is our own U.S. Department of Agriculture (USDA). The congressional mandate that created the Dietary Guidelines Advisory has been over stepping the boundaries and created the climate of obesity and increase in other diseases, such as diabetes and heart disease. The chart below displays this rather well.

 

The Healthy Nation Coalition has some great points on nutrition and is attempting to obtain information on whom and how policy decisions are made.

Please be careful of many food plans that government agencies and many registered dietitians promote. In general they will tell you that you need the carbohydrates and whole grains for your brain and that you will miss too many nutrients if you don't follow their advice. I have found that most of the nutrients are available in other foods without the added carbohydrates. Learn what works for you and not the mandates of others. If you can adapt their high carbohydrate meals to a level that your meter says fits you and your goals, then you have accomplished your needs and goals.