February 20, 2016

Whole Eggs Hold Possible Key for Vitamin D Deficiency

A simple change in diet could boost vitamin D levels for millions of Americans suffering from Type 2 diabetes, according to new research from Iowa State University published in the Journal of Agricultural and Food Chemistry. No wonder my vitamin D levels are higher than expected. When you eat more than a dozen eggs per week, I was not aware that this would help my vitamin D levels.

I just know that a couple of my doctors go ballistic when I talk about the number of eggs I eat. Then they insist on increasing the dosage of the statins I take. Fat chance as I never fill the prescriptions and I plan to stop all statins by the end of this month.

The fact that this is a rodent study is disappointing because many rodent studies do not translate to humans. Vitamin D is important for bone health and many diseases, but people with diabetes have trouble retaining it along with other nutrients because of poor kidney function.

Iowa State researchers are most interested in 25-hydroxyvitamin D-3 (25D) – the form of vitamin D in the blood that reflects vitamin D status. For that reason, it made sense to test eggs in the diet rather than other foods containing vitamin D or a supplement. Eggs are the richest source of 25-hydroxyvitamin D-3 in the diet, and there isn't any conversion required to make it into the blood. If you take it in a supplement or food fortified with vitamin D, it has to be converted to that form. In addition, eggs are a complete source of protein.

Concentrations of 25D were 148 percent higher for the egg-fed group and plasma triglyceride concentrations – a risk factor for cardiovascular disease – dropped 52 percent.

Rowling and colleagues Kevin Schalinske, professor of food science and human nutrition, and Samantha Jones, a graduate research assistant, are still working to understand why more vitamin D is retained from eggs than supplements. They say it may be related to other components found in eggs.

Please do not skip the egg yolk, which makes for the complete protein and provides all of the 25D is only in the yolk. This is what makes the eggs complete and all the nutrients are in the yolk. Eggs are relatively inexpensive and readily available. From a vitamin D standpoint, you want to consume the whole egg.

The next step is to determine the minimal amount of eggs needed in the diet to yield a benefit. The study was designed to replace protein in the diet, so the rats were fed the equivalent of 17 to 18 eggs daily. However, based on the results and the severity of the rats' diabetes, researchers expect a much lower dosage will be effective in humans. They also want to know if health benefits are enhanced when additional dietary constituents that promote the maintenance of vitamin D status and reduction of diabetic symptoms, such as fiber, are added to the diet.

You may need even less eggs if you combine it with something else that does not provide vitamin D per se, but rather protects the kidney and prevents loss of vitamin D. Understanding what's going on with egg consumption, promoting vitamin D balance, and making sure there's a linkage to outcomes whether it's bone health or kidney health is of utmost importance.

February 19, 2016

Liraglutide Does Exhaust Beta Cells

Victoza (liraglutide) has black box instructions and may soon add another label to an already severe black box label.

Long-term use of liraglutide, a substance that helps to lower blood glucose levels in patients with type 2 diabetes, can have a deteriorating effect on insulin-producing beta cells, leading to an increase in blood glucose levels. This is according to a study on mice implanted with human insulin-producing cells conducted by a team of scientists from Karolinska Institutet, Sweden, and the University of Miami, USA. The researchers flag the possible consequences of this popular form of therapy in the next issue of the journal 'Cell Metabolism'.

Blood glucose suppressors in the form of analogues of the incretin hormone GLP-1 are commonly used in the treatment of type 2 diabetes, since they stimulate the glucose response of the pancreatic beta cells to make them secrete more insulin. There is now compelling evidence that liraglutide therapy is efficacious at least in the short term, since it produces an initial reduction in blood sugar. However, many patients do not respond to the treatment and some even display adverse reactions such as nausea, vomiting and diarrhea.

While this is a study using rodents, it may have a message for clinicians to watch on humans prescribed Victoza. To study the long-term effects of incretin therapy, which has never previously been assayed, researchers at Karolinska Institutet and the University of Miami worked with humanized mice, generated by transplanting human insulin-producing cells into the anterior chamber of the eye. The mice were given daily doses of liraglutide for more than 250 days, during which time the researchers were able to monitor how the pancreatic beta cells were affected. The results showed an initial improvement in the insulin-producing cells, followed by a gradual exhaustion, with reduced secretion of insulin as a response to glucose. This, they say, was unexpected.

Since there is a lack of clinical studies on the long-term effect of these drugs in diabetes patients, this is a very important discovery. Clinicians need to consider these results before prescribing blood-glucose suppressing GLP-1 analogues when planning long-term treatment regimens for patients. This study also shows in general how to carry out in vivo studies of the long-term effects of drugs on human insulin-producing cells, which should be extremely important to the drug industry.

The study was financed by grants from several bodies, including the Diabetes Research Institute Foundation (DRIF), the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases, the Swedish Research Council, the Knut and Alice Wallenberg Foundation, the Family Erling-Persson Foundation, the Stichting af Jochnick Foundation, the European Research Council (ERC) and the Novo Nordisk Foundation. Corporate interests: Per-Olof Berggren is co-founder and CEO of Biocrine, an unlisted biotech company that uses the anterior chamber of the eye as a research tool. Midhat Abdulreda is a consultant for the same company.

February 18, 2016

Non-RD Recommends Highly Processed Foods

This is one blog that really fell flat. Written by a non-diabetic person and only an English major for a type 2 diabetes website, it should be a warning to all people what can happen when non-professionals are allowed to write for a diabetes website that do not understand the importance of avoiding highly processed foods. You may read her bio here or click on her name under the title of the article. It is down the page several bios.

When I started reading her blog, I knew something was not right. She loves microwaving food and not cooking any other way. She at least admits she does not cook. Personally, I do use a microwave for warming leftovers from previous meals that my wife or I have cooked and even then, we sometimes reheat the food on the stove.

This writer has not learned how to cook and thinks it is necessary to stand over the stove for hours to have a good home cooked meal. For her it is easier to microwave a frozen meal than spend a few minutes to enjoy healthy food. I definitely do not appreciate her claim of shoving the food in your piehole (meaning your mouth) in five minutes or less. This is a great example of what people with diabetes should not do and as a person with diabetes, I like enjoying my food and eating slowly to avoid creating blood glucose spikes.

What I found funny was her request to “stop judging me.” This is how she tries to justify that packaged foods are usually not healthy, but full of starches, sodium, and preservatives.

Then the following is stated by her, “It’s already hard enough when a person is trying to eat healthier and exercise – so I don’t think that we should have to change our ENTIRE lifestyle and try to fit cooking in as well. So! Here are some tips and tricks for eating healthy AND keeping it easy-peasy-microweezy…
  • Low sodium: To keep it simple, I just use the daily-value percentage thing on the package and try not to buy anything that’s too high a percentage per serving. I also drink a lot of water, just to be on the safe side.
  • Microwave versions of things you used to have to cook/bake, i.e., sweet potatoes, oatmeal, frozen veggies… the list is endless. If you Google your fave foods + “microwave recipes”, you’ll probably find even more.
  • Frozen veggies count! On days that I already ate a microwavable meal and like two hours later I’m hungry, I’ll heat up a BUNCH of frozen veggies and to make them interesting, either sprinkle some parmesan cheese or dressing on them, or make it into soup.
  • Leftovers! Don’t forget – if you take home half your meal from a restaurant (go you if you can do this – the struggle is real) that’s an awesome little microwavable meal for the next day!
  • Find your happy (microwaveable meal) place: Mine is Trader Joe’s. I love them because they sell a lot of really delicious, inexpensive, microwavable meals that encompass most if not all of these tips.
  • More “real” ingredients, less chemicals: if I’m not at Trader Joe’s, I look for meals that have more of the “real food” ingredients that I recognize, like vegetables and proteins, and less things that I can’t pronounce.

I really hope these are helpful. Please let me know YOUR tips in the comments below! And now, the next time someone attacks you for only cooking with a microwave, you can turn your nose up right back at them and give them a little micro-wave goodbye!”

No, I do not agree with her lifestyle and lazy way of eating. Writing this on a website for people with type 2 diabetes is not a way to appeal to people that read her writing. Bad habits are still bad habits and not what a person with type 2 diabetes should be reading.

February 17, 2016

Confusion about Gluten and Diet

Tim called and asked me to a meeting for a few of us. When I arrived, it was just four of us: Brenda, Sue, Tim, and myself. Tim said this is an exploratory discussion about gluten-free foods. I asked what had prompted this and Sue said that a couple of friends of hers and her husband's were strongly advising eating gluten-free foods for weight loss. Brenda said that she remembered I had blogged about the problems gluten-free foods can cause.

I agreed and asked Tim to do a search on my blogs using the words 'gluten-free' and when he had the short list I suggested this one to start and Brenda agreed that was the one. Sue read it and said it fits with what the friends were promoting.

I asked Tim to keep the search results and open an Internet search for “Gluten-Free is Not a Weight Loss Diet.” There were several in the list, but this article was the one I was looking for and had him open it. Tim skimmed it and then let Sue and Brenda read the article. Sue said this answered her concerns and let her know that she was right in ignoring them and asked Tim to send her the link.

I said I will have a blog about this and I am happy that the issue is back and we could use this for a meeting. Tim said he would like to have this presentation and if Brenda and Jason did not mind, he would do this on February 20.  Brenda told him to go ahead as she and Jason were working on additional material and having their presentation in March would work for them.

Brenda thanked me for having the information as she had looked and did not find my blogs and did not know of the latest article on gluten-free. She said that it definitely is one of the biggest diet fads and she doesn't believe a gluten-free diet will help people lose weight. Brenda said she has seen this in magazines at checkouts and sees some foods claiming to be gluten-free.

The article says that gluten-free is not a weight loss diet. It is an elimination diet specifically intended for the one percent of Americans who have the autoimmune disorder, celiac disease. Celiac disease is one of the most commonly misdiagnosed diseases by doctors. The diet will also help people with non-celiac gluten sensitivity.

Most people don’t even know what gluten is yet they believe it’s as detrimental to their waistline as Twinkies. Gluten is a protein found in many grains like wheat, rye, barley, oats, and triticale. Examples of foods with gluten include pastas, breads and cereals. Gluten has a glue-like effect that holds foods together and helps maintain their shape.

Gluten isn’t bad for you unless you have celiac disease or non-celiac gluten sensitivity, where gluten acts an irritant so a gluten-free diet would actually provide relief to the body. A doctor should monitor the diet in order to prevent complications.

Non-celiac gluten sensitivity, more commonly called gluten sensitivity or gluten intolerance, doesn’t cause an immune response towards gluten or damage the intestinal lining. However, people with gluten intolerance have similar symptoms to those with celiac disease, including bloating, abdominal pain and diarrhea. Symptoms can set in a few hours or even days after consuming gluten. Some additional symptoms of this intolerance include non-intestinal symptoms such as headaches, difficulty thinking clearly, joint pain, and numbness in the legs, arms or fingers. Headaches and fatigue are the most common symptoms.

More of my blogs on gluten are here and here.

February 16, 2016

Big Pharma's Pill Push to Patients

This day was coming. Back in November 2012, I wrote about smart pills and what some of this meant, but I suspected that it would take a few more years for the drug companies to really ramp up their intentions. We can now see that they don't care about those that live on limited incomes and can't afford their high priced drugs; they are going to force people to take them.

Around the world, drug companies are spending big money to push patients into taking their drugs. According to this article, the drug industry loses tens of billions in worldwide sales each year when patients don't bill, or refill, their prescriptions.

Therefore, the drug makers from all countries are spending money for programs aimed at nagging patients to take every pill their doctors prescribe. The drug companies are investing in smart pills that will send alerts when they haven’t been swallowed at the prescribed time. They’re subsidizing gift cards to thank patients who remember to refill. They're also paying patients to go on talk circuits to tout the virtues of taking medications properly.

In the USA, they're lobbying the federal government for permission to pay third parties, such as pharmacists, to encourage patients to take their pills. The drug companies say these investments are focused on improving patients’ health. “We’re not pushing pills here, we’re pushing adherence,” said Joel White, president of the Council for Affordable Health Coverage, an advocacy group that works with the industry.

But, Matt Lamkin, an assistant professor at the University of Tulsa College of Law who’s studied the issue, sees another motive. Pharma companies have the sense “that they are leaving billions on the table” when medicine isn’t taken and prescriptions aren’t filled, Lamkin said. The push to improve adherence, he said, “reframes the goal of boosting sales as a goal of public service.”

It is a complicated problem because patients may decide not to fill prescriptions because they don’t have the money or need food. Another big reason pills are skipped; they just don’t work very well. Significant percentages of patients don’t respond to the medications they’re prescribed or experience serious side effects.

I would also be concerned, as this will be expanded to know which doctors are prescribing which medications and pressure will be applied there to promote prescribing. I would urge you to read the full article.

I have written another blog titled, Not Taking a Medication – Who Is to Blame? This should be read as it explains some of the real problems facing patients about prescribed medications.

February 15, 2016

Manage Depression and Manage Diabetes

Among people with diabetes, depression is a fact of life. Some have severe depression, but for most, it is mild depression. It is also a fact that many people with diabetes do not seek the help they need because of the stigma that is attached to depression.

Depression has been linked to increased hyperglycemia, morbidity, and mortality. The treatments for the symptoms as well as for depression can lead to improvement in quality of life. Depression is feeling blue or sad, which can interfere with daily life and be a burden on the patient and those around them.

There are many symptoms of depression. This list is just a few:
  • feeling of depressed or sad mood
  • diminished interest in activities, which used to be pleasurable
  • weight gain or loss
  • psychomotor agitation or retardation
  • feeling of guilt
  • difficulty concentrating
  • recurrent suicidal thoughts

There are many causes of depression such as genetics, environmental factor, or psychological factors. This is also a reason that the stigma should not be put on people with depression as often it is not something that they can control. Progress is being made in finding other causes for depression and I have a blog about five of these.

It my understanding, about 67 percent of people with diabetes do suffer from some type of depression; however, most of the time you will see this listed as just depression with no definitive definition. Then about 19 percent of people with diabetes suffer from serious depression and again no accurate definition accompanies this statement.

Some depression tends to run in families and scientists are investigating certain genes that make an individual more prone to depression. However, while genetics do play a big part in depression, many would agree that it is the combination with environmental or other factors that would bring on depression. The loss of a loved one, trauma, difficult relationship, or any stressful situation may trigger a depressive episode in a patient. These are debilitating symptoms for a patient and can prevent them from taking proper care of themselves.

A retrospective cohort study looked at 1,399 patients diagnosed with both depression and type 2 diabetes, and compared their glycemic control using their A1c levels. The study found that 50.9% of depressed patients who are on antidepressants have good glycemic control as compared to only 34.6% of depressed patients without antidepressants. After adjusting for covariates, the study found that those on antidepressants are twice as likely to attain their glycemic goals as compared to those not receiving antidepressants.

February 14, 2016

No Hope for Carbohydrate Woman

Hope Warshaw is coming under fire in the USA and in Great Britain, in forums and blogs. I find this amusing in so many ways and at least people are holding her feet to the fire. When Hope Warshaw (current 2016 AADE president) makes a mistake, she really makes a big one.

She uses a consistent theme and this is one of them: This is a quote from her article: “Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet. New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines (1/31/11) for carbohydrate: about 45 to 65 percent of calories.”

Old Dogma: Losing weight will make blood glucose levels plummet no matter how long you have had type 2 diabetes. The message that people continually hear from their providers is “If you’d only lose weight, your blood glucose would go down.” And the common reply from people with type 2 is “I’ll try harder with my ‘diet’ over the next few months, but please don’t put me on a diabetes medication.””

New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis.”

She does make some sense here, but with a low carb, high fat way of eating, weight will continue to decrease and level off near ideal weight. This is where she is so wrong. High carbohydrate, low fat diets fail and weight is normally rising when people follow this diet.

I can agree with her when she says: “The reality is that if blood glucose is out of control, it’s time to progress to blood glucose-lowering medication(s), because it’s doubtful that weight loss alone will get and keep blood glucose under control. Today, most experts, including the American Diabetes Association and American Association of Clinical Endocrinologists, agree that people with type 2 should start on a blood glucose-lowering medication that decreases insulin resistance–the core problem in type 2–at diagnosis.”

She is off base because CDEs think more oral medication is always best when many need to consider insulin. Being a dual title RD/CDE, you know that she will do the bidding of Big Food and also Big Pharma. It is in her nature to promote carbohydrates and has been involved in several disputes in the past because of this.

This ode to carbohydrate woman is from June 17, 2013 and fits quite well.