May 21, 2016

Sugar, Not Fat Is the Cause of Obesity – Part 2

Some history is in order. In 1980, the US Government issued its first Dietary Guidelines without any scientific evidence, only the say-so of “experts.” The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them; food companies develop products to comply with them. Their influence extends beyond the US. In 1983, the UK government issued advice that closely followed the American example.

The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. Instead of becoming healthier, we grew fatter and sicker.

Look at a graph of postwar obesity rates at this source (and about two thirds of the way down the page) and it becomes clear that something changed after 1980. In the US, the line rises very gradually until, in the early 1980s, it takes off like an airplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the UK, the line is flat for decades until the mid-1980s, at which point it also turns towards the sky. Only 6% of Britons were obese in 1980. In the next 20 years that figure more than trebled. Today, two thirds of Britons are either obese or overweight, making this the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.

At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decades-long health catastrophe. Naturally, then, a search for culprits has ensued. Scientists are conventionally apolitical figures, but these days, nutrition researchers write editorials and books that resemble liberal activist tracts, fizzing with righteous denunciations of “big sugar” and fast food. Nobody could have predicted, it is said, how the food manufacturers would respond to the injunction against fat – selling us low-fat yogurts bulked up with sugar, and cakes infused with liver-corroding transfats.

Nutrition scientists are angry with the press for distorting their findings, politicians for failing to heed them, and the rest of us for overeating and under-exercising. In short, everyone, business, media, politicians, consumers – is to blame. Everyone, that is, except scientists.

But, it was not impossible to foresee that the vilification of fat might be an error. Energy from food comes to us in three forms: fat, carbohydrate, and protein. Since the proportion of energy we get from protein tends to stay stable, whatever our diet, a low-fat diet effectively means a high-carbohydrate diet. The most versatile and palatable carbohydrate is sugar, which John Yudkin had already circled in red. In 1974, the UK medical journal, the Lancet, sounded a warning about the possible consequences of recommending reductions in dietary fat: “The cure should not be worse than the disease.”

I would suggest reading the rest of the long article as I can only make a mess of it and I think you would be better served reading it yourself.

May 20, 2016

Sugar, Not Fat Is the Cause of Obesity – Part 1

This article really tied together some of my thoughts about sugar and its effects on our bodies. Six names that are behind this are Robert Lustig, John Yudkin, Dr Paul Dudley White, Ancel Keys, Gary Taubes, and Nina Teicholz. There are several others mentioned, but I admit I am not familiar with them.

Robert Lustig is a pediatric endocrinologist at the University of California who specializes in the treatment of childhood obesity. A 90-minute talk he gave in 2009, titled Sugar: The Bitter Truth, has now been viewed more than six million times on YouTube. In it, Lustig argues forcefully that fructose, a form of sugar ubiquitous in modern diets, is a “poison” culpable for America’s obesity epidemic.

A year or so before the video was posted; Lustig gave a similar talk to a conference of biochemists in Adelaide, Australia. Afterwards, a scientist in the audience approached him. Surely, the man said, you’ve read Yudkin. Lustig shook his head. John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.

If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” wrote Yudkin, “that material would promptly be banned.” The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered. He died, in 1995, a disappointed, largely forgotten man.

Perhaps the Australian scientist intended a friendly warning. Lustig was certainly putting his academic reputation at risk when he embarked on a high-profile campaign against sugar. But, unlike Yudkin, Lustig is backed by a prevailing wind. We read almost every week of new research into the deleterious effects of sugar on our bodies. In the US, the latest edition of the government’s official dietary guidelines includes a cap on sugar consumption. In the UK, the chancellor George Osborne has announced a new tax on sugary drinks. Sugar has become dietary enemy number one.

This represents a dramatic shift in priority. For at least the last three decades, the dietary arch-villain has been saturated fat. When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet. Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes. But by the time he wrote his book, the commanding heights of the field had been seized by proponents of the fat hypothesis. Yudkin found himself fighting a rearguard action, and he was defeated.

Not just defeated, in fact, but buried. When Lustig returned to California, he searched for Pure, White and Deadly in bookstores and online, to no avail. Eventually, he tracked down a copy after submitting a request to his university library. On reading Yudkin’s introduction, he felt a shock of recognition.

Holy crap,” Lustig thought. “This guy got there 35 years before me.”

May 19, 2016

AND and Their High Carb Diet

I knew this day would come and I would be asked why I was so against the Academy of Nutrition and Dietetics (AND). This question came from a Certified Diabetes Educator (CDE) and I was surprised by her sincerity. She said she was considering additional schooling to add the title RD to her list. Because of this I attempted to be reasonable and not over the top about my dislike for members of AND and still encourage her to find another profession to study.

These are the points I raised:
Members of AND, in general, are shills for big food.
Members of AND promote high carb low fat meals and set meal carb consumption too high.
Members of AND are working to become the only source of nutrition and criminalize people with more nutrition education.
Many members of AND are also CDEs and when they are to teach as a CDE, they switch to teaching nutrition.
Members of AND are intolerant of diabetes coaches, nutritionists with a Masters degree or a PhD.
Members of AND feel that all people with type 2 diabetes need to do is increase the dosage of a medication or add more medications.

The CDE said she had heard many of these things and know they switch from teaching topics for CDEs to nutrition because this is what they are directed to do.

I explained that our support group has a great relationship with our insurance companies and report this every time to prevent them from being paid for non-CDE topics. Whenever we have to deal with dual titled CDEs and RDs, we are very careful about what is taught. When they switch, we walk out and report to our insurance company to prevent them being paid for switching.

I then asked her why she did not want to become a nurse. She said that she had thought about it, but was not sure she could. I said that many hospitals have full time CDEs working for them as RNs. I told her that I had a cousin being paid to take courses for becoming a CDE at a hospital as by the end of last year, both RN, CDEs were retiring. She seemed interested for a few minutes, but decided she did not want to become a RN. I reminded her that not all RNs are required to be on the floor, because my cousin was a surgical specialist and this was why the hospital wanted her to become a CDE.

I also suggested that some hospitals may reimburse costs to become a RN. I said then you would be obligated to that hospital for several years. She commented that was not something she wanted, as she liked the idea of being able to move when she felt like it.

Because I knew she would probably become a dual title RD/CDE, I ended my conversation, excused myself, and left.

May 18, 2016

Make Safety a Priority at Spas and Salons

I admit I will not go to a salon for trimming my nails since I am a person with diabetes. Yet, I know several others within our support group that do. One of them needed to go to the doctor because of an infection in one of her toes caused by the person in the salon. Fortunately, she went early enough that treatment saved her toe. I prefer my podiatrist, because he looks at my feet and checks for problems.

The author of this article in WebMD covers many of the safety tips for people that insist on using them and spas. If you have diabetes, you may get more peace of mind if you take precautions at the spa or salon.

Some of these precautions include:
  • Avoiding nicks or cuts on you skin.
  • Carrying your own tools that you have boiled to disinfect.
  • Do not let your tools be used on anyone else.
  • Have the bowl sterilized before you put your feet in.
  • If the salon doesn’t seem quite right or doesn’t look clean, don’t go in.
  • Always tell your nail technician or any spa-service provider that you have diabetes.
  • Make sure they practice good hygiene.

There are also other cautions, but never be afraid to leave is things don't look right. By using the above precautions, you will also lower your odds of getting an infection.

Because diabetes can cause poor blood flow to your limbs, it’s harder for white blood cells to reach small wounds so they can heal properly. If your nail technician nips your cuticle or rubs too roughly on your heel to remove dead skin, you can get a small wound that turns into a serious infection.

Ingrown toenails may also lead to foot infections, so it’s important to keep your nails trimmed and filed. If your blood sugar isn't well-controlled, or if you have damage to your nerves (diabetic neuropathy), be careful when trimming your nails. Also, tell your technician to be cautious before she gives you manicures or pedicures at a salon.

You can cut your nails way too short, and can cut the soft tissue around your nails. For someone with diabetes with complications like neuropathy, this can open the door to infection. Use caution with scissors or clippers, or using anything that can cut or lacerate your skin.

If you don’t feel comfortable trimming your own nails or going to a salon or spa, ask a podiatrist to do it instead. Podiatrists are doctors who specialize in foot care and treating foot diseases. A nurse practitioner or physician assistant at a podiatry clinic might also safely trim your nails.

Here are some safety tips for your next salon or spa visit, if you feel your must:
  • Tell the spa or salon owner, or your aesthetician, that you have diabetes before you begin any service. Talk to the staff about any concerns you have or precautions you need to take.
  • It’s safe to use tools like a pumice stone or sanding surface to remove dead skin from your heels. Be gentle, though. Avoid using metal scrapers to remove skin.
  • If you have corns or calluses on your feet, tell your technician to gently rub or smooth them rather than cutting them or using any liquid callus remover.
  • Make sure soaking water is not too hot to avoid burns you might not be able to feel. The water should be between 90-95 F. Ask the technician to test it before you put your feet in.
  • Tell your nail technician to trim your nails with a clipper and then file them smooth with an emery board.
  • Ask if soaking tubs and tools are washed and sterilized after each person’s use. If a salon or spa doesn't seem clean, don’t go there.
  • Tell your nail technician to never cut into the corners of your toenails. This might cause an ingrown toenail and an infection.

May 17, 2016

Mistakes Made in Blood Glucose Testing

I admit that I can make mistakes, but I don't understand some of the mistakes I see other people make. Yes, I occasionally forget to wash my hands after handling food, but when I see the reading, I know it is not correct. I stop, wash my hands, paying extra attention to the finger I will be using, then dry my hands carefully. Then when I retest, I see the reading near what I was expecting and know the correct amount of insulin to inject. It is probably because of the insulin that I am more careful not to make as many mistakes.

Allen has lost a friend because he did not care to do his testing correctly and sometimes not at all. So when Allen called me to meet him at the restaurant that we frequent as soon as possible, I went. When I arrived, he was seated at a table and carefully pointed out the fellow sitting at a window table. The fellow had dumped out a vial of test strips onto a less than clean table and was testing. He picked up his lancing device and pricked his finger. Then he dug his meter out of his pocket, inserted a test strip, and pushed it into the blood.

When the reading came up, he shook his head and removed the test strip. Allen said that he had followed the fellow into the parking lot and seen him remove the vial of test strips from the dash and the same with the meter and shove the meter into his pocket. Allen said he had his testing equipment with him and we should move to the table where this fellow was sitting. I said I would join them after getting an ice cream cone.

When I arrived at the table, Allen was telling the fellow that he should wash his hands with soap and water and when he returned he would test his blood glucose. When the fellow left, Allen started gathering up the test strips and left four on the table. They had been in water on the table, had absorbed water into the strip, and would no longer be useful.

When the fellow returned, Allen took one of his test strips out and inserted it into his meter. The fellow lanced the place he wanted tested and after blood was available, Allen inserted the test strip into the blood. In a few seconds, the reading was 111 mg/dl. The fellow said that looks correct. I said that he would never receive this reading from the test strips he was using and the four still on the table would give him an error message. We both could see the puzzled look the fellow was giving us.

He pulled his meter back out of his pocket, picked up one of the test strips, and inserted it. I don't remember the message number, but Allen said this was because when he dumped out the vial onto the table, they had absorbed water that was on the table. Some of the others may have slid through the water as well ruining them. Allen said that the number of strips you used figures about 15 dollars and the rest in that vial is probably another 40 dollars and they will not give you reliable results because you dumped them on the table and exposed them to sunlight and water that may contain food particles, which can cause them to give erroneous readings. In addition, he had them and your meter on the car dash in direct sunlight, which caused them to heat up. The meter you stuffed in you pocket and it probably picked up lint and will cause errors when used.

I picked up Allen's testing pouch and said he keeps everything in here and out of the sunlight. If he is out in the rain, he has a waterproof pouch to carry this in. When he tests like he did on you, he only removes one test strip and uses it within 30 seconds to obtain an accurate reading. We do not pretend that lint can't get in the meter, but we work to prevent this and carry our testing supplies in the case they come with to prevent loss from sunlight and heat.

I asked where he stored his test strips at home and he said in the bathroom. Allen said he would accompany him to his home if he would allow this and show him where to store the test strips and if the air conditioner failed like mine has, how to protect them in a cooler and use a cold pack. The fellow said you would do this. Allen answered we always help when we can.

The fellow said he would like to have something to eat before they went anyplace. Allen said okay, and I left to go home. Allen called later and thanked me as he felt we had helped the fellow. He would continue to work with him and see how he was doing.

May 16, 2016

Fat Is Not Our Enemy – Part 2

In this blog, I will discuss the rest of the oils. First, olive oil is a favorite of mine. This oil if a relatively stable mono-unsaturated fat that keeps well. For storage, it is best to store olive oil in a dark place to stop oxidation. Some people warn against using olive oil because of the 12 percent of saturated fat it contains. Others argue that this is beneficial.

Homemade mayonnaise is tasty and heart healthy. It is healthier that what you can buy in the store because you know exactly goes into it and there is no need for preservatives. You can keep it for up to a week if stored in the refrigerator. The recipe that can be found at this link is different from what I use, but is still a good idea.
Some tips:
  • Use cold pressed, organic versions when possible; quantities can be small so won't hit the wallet too hard and this ensures they are as fresh as possible, before being stored in a cool dark place.
  • Add assorted nut oils such as walnut and hazelnut for taste won't hit the wallet too hard and this ensures they are as fresh as possible, before being stored in a cool dark place.
  • Add assorted nut oils such as walnut and hazelnut for taste.
Always avoid oil. The relative degree of saturation of the fatty acids in a oil will give an indication as to whether an oil is resistant to oxidation, at high or low heat. Saturated and mono-unsaturated fats are those most resistant to heat, reducing the chance of oxidation. This provides another important reason to limit polyunsaturated fats such as seed oils to use in mayonnaise and salad dressings.

After a period when the world fell in love with margarine and told us that saturated fats like butter, lard and coconut oil were bad for our hearts, there is growing evidence that saturated fats and oils (liquid fat) are in fact good for us.
Dietary fat, which is also a constituent of many of the foods you eat, is crucial to the absorption of fat-soluble vitamins, particularly vitamins A, D, K and E. It’s the ability of these vitamins to dissolve in fat that allows for their absorption, moving across the cell walls of the small intestine and into the body's general circulation. The vitamins progress through the intestine, into the bloodstream and then to the liver, where they are stored until the body needs them. Without enough fat in your diet, your body cannot effectively absorb these essential fat-soluble vitamins.

Dr. Fred Kummerow analyzed the arteries and blood of patients who had undergone heart bypass operations and found elevated levels of oxidized cholesterols, called oxysterols.

“These cholesterol derivatives are the real culprit in the development of heart disease”, Kummerow said "and frying foods in overused oil or smoking cigarettes can oxidize cholesterol, creating these derivatives.”

May 15, 2016

Fat Is Not Our Enemy – Part 1

You may need a magnifier to read some of the products mentioned in the image below. However, you can read about each item here. I would urge you to read this as well on Facebook.

Which fat is for frying? Don’t use the typically large bottles of cheap vegetable and seed oil such as sunflower and corn oil. They contain a high proportion of Omega-6 fatty acids of which most of us already get too much in our diets and some of the commercial processing methods are questionable. The ‘least bad’ of these big bottle solutions is probably rapeseed oil, sometimes marketed as colza, though remember that it is highly processed, purified and bleached before it passes through a de-odoriser to take away the 'cabbagy' smell, although admittedly, it is richer in Omega-3. These seed oils also emit unhealthy elements into the air where you are cooking when heated so - be careful with them.

Martin Grootveld, professor of bio-analytical chemistry and chemical pathology at De Montfort University, was asked in 2015 to investigate the "healthiest" oils to cook with for the BBC series Trust Me I'm a Doctor. We know that when fats and oils are heated the molecular structure changes, producing chemicals called aldehydes that have been linked to heart disease and cancer even in small quantities. But what his team discovered surprised even him. They found that sunflower oil and corn oil produced aldehydes (which are toxic compounds) at levels 20 times higher than recommended by the World Health Organization. Many people are not aware of the aldehydes and their toxic nature.
  • Saturated fats are good for you so it’s quite OK (even beneficial to your health) to use beef dripping, butter, coconut oil and goose fat!
  • ... Especially coconut oil, sometimes labeled as coconut butter, is heart-healthy. It doesn’t go easily rancid and has a high smoke point, so it’s great for frying. Some people say it has too much taste but in it’s mostly the distinctive smell that reminds you of its origins.
  • The cheaper olive oils have a relatively high smoke point but they go rancid more quickly than the above-mentioned fats and oils so keep in a cool dark place. Extra virgin is better kept for salads.
  • Ghee - make your own clarified butter to allow for higher cooking temperatures and store it, for months if needed, in your fridge; Ghee is both delicious & nutritious.
Aldehydes = Any of a class of reactive organic chemical compounds obtained by oxidation of primary alcohols, characterized by the common group CHO, and used in the manufacture of resins, dyes, and organic acids.

When it comes to fats and oils, there are three degrees of saturation. Your cooking choices are: saturated fat, mono-unsaturated fat and poly-unsaturated fat; although you won't find that on the label. Importantly, the first two are much more resistant to heating.

The third group, poly-unsaturated fats deserve our attention because they can be so rich in Omega-3 and Omega-6 fatty acids, which the body needs because it cannot make them itself. As a general guideline, our diets have become too rich in Omega-6 so we need to seek out as many ways of ingesting Omega-3 as possible… preferably through fresh foods rather than pills. On this message, all nutritionists agree, but not necessarily when it comes to reducing Omega-6.