June 5, 2015

Low-Carb Myths

David Mendosa started me thinking when he started this on Health Central. "Some people say that to follow a low-carb diet is expensive. But they’re spreading one of the most pernicious myths about diabetes management. This myth assumes that a low-carb diet means cutting back on inexpensive fat and eating a lot of costly protein."

The following are some of the myths promoted that I have heard, read about, or have been promoted to me by registered dietitians in emails:
  1. Eating low-carb is expensive. David explains this away very well in his blog.
  2. Low-carb eating means you are missing essential nutrients for life and especially cognitive function. While carbohydrates are considered a macronutrient, it is one that is not essential to life or brain function. It is some of the micronutrients in carbohydrates that we need a few of and these can be obtained in other less carb-dense foods or almost carb-free foods.
  3. Low-carb needs to be low fat as well. This is only what the medical profession and the dietitians that are nutrition ignorant and behind the times believe. Fortunately, Keyes has been proven wrong and low fat has been disproven to cause heart and artery problems.
  4. Low-carb means eating high protein. False - increasing protein for those of us with diabetes can be very unhealthy and dangerous. That is why there should be little, if no increase in protein. It is the fat that needs to be increased.
  5. By replacing carbs with fat, our cholesterol levels will dramatically Improve. The lobbying efforts by Big Pharma are being corrected and only those in the medical profession that are receiving money from Big Pharma will be left promoting statins. It may take several years to weed these out of the profession, but it will happen. The only possible redemption for statins is some studies that show inflammation reduction when statins are used.

It is sad that many dietitians are the tools of Big Food. Not only are they a problem in the United States, but in Australia, and now in South Africa. This article helps explain what is happening in South Africa. Of course, they looked to the situation in the United States and copied what the dietitians are doing here. The big food companies were all too happy to expand their influence and they are supporting the dietitians is South Africa.

That is one reason I have little faith in the dietitians and their attempts to become the only source of nutrition. Few are accepting what many people with diabetes are telling them and they instead listen to Big Food and are slowly attempting to promote what Big Food wants.

June 4, 2015

Some Suggestions for Low-carb Food Plans

David Spero, who writes for Diabetes Self-Management has two interesting blogs from
May 13 and May 20 about low-carb food plans. David used a comment from two years ago, by a reader who wrote: “I think a good definition of low carb would be the amount of carbs per day that you can safely eat and maintain your blood sugar in the normal range at all times.” I think this is very applicable, although others use numbers of grams of carbohydrates. I would encourage you to read both as I am not including a lot from either of his blogs.

I agree with the comment David chose and numbers only confuse the issue and may not be what you body chemistry is able to tolerate. Some are able to tolerate a larger number of carbohydrates while many can only tolerate a lower number. You have to find the low-carb food plan that fits your chemistry and body needs. That said, the range generally used for low carb varies from 30 grams to 100 grams of carbohydrates.

One note that is important to know - when I use carb(s) or carbohydrates, all numbers are in grams and I do not use the carb value often used of one carb equals 15 grams.  Many people say they are consuming 6-12-12 or a total of 30 grams of carbohydrates. Other people use different combinations for breakfast, lunch, and dinner. Some add snacks to this, but I prefer not. I usually consume 20-5-(10 to 25).

One habit most of us eating low carb have in common is we do not eat processed foods, grains of any type, and starchy vegetables. You should decide for yourself how low you want to go, depending on your meter readings and how you feel.

When is comes to determining the carbohydrate count of unpackaged foods, I have found that this free website can help. The two links I use are this for entering the recipe and this for making a grocery list. I have used both with success. Others may wish to use the link David provides in his blog. I would also encourage you to read the link to the study he listed.

Another author about low carb is David Mendosa and I would encourage your to read at least two of the blogs he has. The first is about carbs and their relationship to inflammation. The second is about the challenges of eating low-carb. These two blogs should help in your decision of eating low-carb.

The importance of this for people with type 2 diabetes cannot be emphasized enough and if you wish to manage your diabetes, you would be well served to read all the links provided in the blogs by David Spero and David Mendosa.

June 3, 2015

Learn Prediabetes Is Not Diabetes

Since 2003, when the American Diabetes Association (ADA) convened a group of “experts” to declare the blood glucose levels between 100 and 125 mg/dl (3.9 to 6.9 mmol/L) as prediabetes, all people were aware of was that diabetes started at 126 mg/dl (7.0 mmol/L).  This classification applies only to type 2 diabetes.

Since then the ADA has done little to encourage doctors to screen for prediabetes.  A few doctors have been screening for prediabetes and doing an excellent job at this, but the bulk of people with prediabetes are still unaware they even have this.  The ADA, for all their “expert” knowledge, has done little in the way of education or helping the people that might have prediabetes become aware of what might happen if they do nothing to prevent the onset of full type 2 diabetes.  

Receiving a diagnosis of prediabetes is a serious wake-up event.  It does not necessarily mean that type 2 diabetes is a foregone conclusion.  There are changes that you can make to slow the progression to diabetes and for some people to prevent diabetes.  The following are some suggestions to consider:

Develop an exercise regimen you enjoy.  Doing this is one of the best things you can do to make diabetes less likely.  If it has been a while since you exercised or you are medically able, start by building more activity into your routine by taking the stairs or doing some stretching during TV commercials.  Physical activity is an essential part of the treatment plan for prediabetes, because it lowers blood glucose levels and decreases body fat.  Check with your doctor to see if you have limitations.

Lower your weight if this is needed.  If you're overweight, you might not have to lose as much as you think to make a difference.  In one study, people who had prediabetes and lost 5% to 7% of their body weight (just 10-14 pounds in someone who weights 200 pounds) cut their chances of getting diabetes by 58%.

See your doctor more often if possible.  It is recommended to see your doctor every three to six months.  If you're doing well, you may get positive reinforcement from your doctor.  If it's not going so well, your doctor can help you get back on track.  If you are like me, you will appreciate words of encouragement, and even words needed to put you back on the right path.

Develop a good food plan that your meter approves.  Load up on vegetables, especially the less-starchy kinds such as spinach, broccoli, carrots, and green beans.  Aim for at least three servings a day.  Add more high-fiber foods into your day.  Enjoy fruits in moderation - 1 to 3 servings per day. Eliminate whole-grain foods as much as possible and do eliminate processed grains.  In general, eliminate white rice from your food plan.

Also, swap out high-calorie drinks.  Drink whole milk rather than skim milk and diet soda rather than regular soda.  Choose cheese, yogurt, and low carb salad dressings. Choose fresh fruit when it is available and not fruit juice.

Make sleep a priority and sleep the suggested hours when possible.  Not getting enough sleep regularly makes losing weight more difficult.  A sleep shortfall also makes it harder for your body to use insulin effectively and may make prediabetes and diabetes more difficult to manage.  Set good sleep habits.  Go to bed and wake up at the same time every day. Relax before you turn out the lights.  Don't watch TV or use your computer or smartphone when you're trying to fall asleep.  Avoid caffeine after lunch if you have trouble sleeping.

Get support and ask for help when needed.  Losing weight, eating a healthy diet, and exercising regularly is easier if you have people helping you out, holding you accountable, and cheering you on.  Consider joining a group where you can pursue a healthier lifestyle in the company of others with similar goals.  The right diabetes educator and nutritionist may also help you learn about what you need to do to prevent your prediabetes from becoming diabetes.  Sometimes this will be a doctor, a nurse, or just a friend.

Choose and commit to the task of managing your diabetes.  Having the right mind-set and a positive attitude can help.  Learn to accept that you won’t do things perfectly every day, but pledge to do your best most of the time.  Make a conscious choice to be consistent as possible with everyday activities that are in the best interest of your health.  Learn to tell yourself, I’m going to give it my best.  I’m going to make small changes over time that will become good habits.  These changes will add up over time and help you manage your prediabetes or diabetes if it progresses that far.

June 2, 2015

Sleep Apnea May Cause Blood Pressure Increase

I am finding some consistency in articles about sleep apnea and how it affects other diseases or conditions the patient may have. A new meta-analysis conducted by an international team of sleep and respiratory researchers suggests that untreated sleep apnea may be a major factor in causing medications to be less effective in reducing hypertension (high blood pressure) in some people.

In reading the entire article, there are several things mentioned that makes this meta-analysis more valuable. These include:
  1. Using continuous positive airway pressure (CPAP) therapy may be a key to helping people with hard to treat hypertension.
  2. Most people with resistant hypertension also have obstructive sleep apnea (OSA).
  3. OSA and resistant hypertension is a deadly combination that exponentially increases the risk of death or disability from a stroke or heart attack.
  4. The study indicated that the patients with resistant hypertension and the very highest blood pressure experienced the greatest reduction in blood pressure after using CPAP therapy
  5. This response suggests that untreated sleep apnea may be why these people haven’t seen improvement in their blood pressure despite the concurrent use of three or four medications.

Ulysses Magalang, MD, the study’s principal investigator and director of the Sleep Disorders Center at The Ohio State University Wexner Medical Center and co-author Christopher Valentine, MD, a nephrologist at Ohio State’s Wexner Medical Center both say that these findings suggest that physicians may need to be more aggressive with screening for sleep apnea and ensuring CPAP therapy compliance in patients with resistant hypertension.

Dr. Valentine did say, “That there is evidence about the benefits of CPAP in people with hypertension and OSA, but ours is the first analysis to systematically review CPAP use in people with difficult to treat hypertension and apnea.” He continued, “The results are clinically relevant because the effects that we found are significantly higher than what’s been previously observed in a more general hypertensive population. CPAP use could offer this subset of patients a new chance to reach a healthier blood pressure goal, or even to reduce their medication burden.”

Drs. Magalang and Valentine say that their findings also support the idea that resistant hypertension and OSA represent an “extreme phenotype” of those who have OSA, but never develop hypertension. The researchers further suggest that resistant hypertension in those with sleep apnea may be caused by a less common gene variant that nonetheless has significant impact.

It’s a hypothesis that will likely be put to the test over the next decade. The researchers who collaborated on the paper all belong to the Sleep Apnea Genetics International Consortium (SAGIC), a partnership of scientists from five continents who are building the first-ever international biomedical database to uncover the genetic causes of sleep apnea. By collecting biological material from thousands of patients with sleep disorders, the group hopes to amass enough data to start identifying underlying genetic causes of different conditions.

We’re only just now beginning to appreciate the link between sleep apnea and disease,” said Magalang. “We hope that one day we will find common genes shared between people who have uncontrollable blood pressure and sleep apnea, and that will open up a whole new world of interventions and treatment strategies.”

June 1, 2015

HbA1c Test May Not Be Applicable in Some Cases

This article shows why the American Diabetes Organization may be in the minority and not in the forefront of diabetes diagnosis. It raises some valid concerns and reasons not to rely on the gold standard American doctors are relying on for diagnosing type 2 diabetes.

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) highlights how anemia--a common condition in the general population, especially in women--can lead to a false diagnosis of diabetes based on HbA1c, when a person's blood sugar control is actually normal. The research is by Dr Emma English, University of Nottingham, UK, and colleagues.

In recent years, the World Health Organization (WHO) and the American Diabetes Association (ADA) have both pushed and advocated the use of the HbA1c for diagnosing type 2 diabetes. Following the recommendations of the WHO to use HbA1c as the diagnostic method for type 2 diabetes, the United Kingdom (UK) has issued expert guidance that one of the major issues affecting this usage was anemia.

With approximately 29% of non-pregnant women worldwide having anemia (the latest estimate from 2011), this translates to a significant number of people where the use of HbA1c for diagnosis of diabetes is unsuitable. The latest WHO estimate for anemia prevalence in men was 13%, likely to be higher in elderly men, although data are scarce.

I have several other blogs about the ineffectiveness of the HbA1c for diagnosis. That being said, generally, the HbA1c is effective for white Anglo-Saxon adults with the following exceptions:
  1. The HbA1c should never be considered for anyone undergoing dialysis – read my blog here.
  2. The HbA1c cannot be used for people with iron-deficiency anemia.
  3. The HbA1c has been shown by this study that it is unreliable for diagnosis of diabetes in children – see my blog here.

There is also much doubt about many other ethnicities not relying on the HbA1c as some significant variances have been proven. Some in the medical profession are openly stating that the A1C test needs to be standardized for each ethnic group

The review of research between 1990 and 2014 included studies which had at least one measurement of HbA1c and glucose, and at least one index of anemia involving non-pregnant adults not diagnosed with diabetes. The authors identified 12 studies suitable for inclusion, the majority of which focused on iron deficiency anemia and, in general, demonstrated that the presence of iron deficiency with or without anemia led to an increase in HbA1c values compared with controls, with no corresponding rise in blood glucose, thus rendering any diagnosis of diabetes in such individuals unreliable without further tests.

Calling for more research in view of the relatively small number of studies they were able to include in their review, the authors conclude: "The key questions that are still to be answered are whether anemia and red blood cell abnormalities will have a significant impact on the diagnosis of diabetes using HbA1c in the general population--something that is now widely performed."”

Until the ADA realizes these deficiencies in the HbA1c, some people will be diagnosed with type 2 diabetes that do not have diabetes. Others will not be diagnosed when in fact they may have type 2 diabetes. The ADA belief that one-size-fits-all approach to diabetes may someday be a liability that the ADA can no longer afford.