October 1, 2016

Health Conditions Treatable by a Ketogenic Diet – Part 1

Here are 15 health conditions that may benefit from a ketogenic diet:
#1. Epilepsy. Epilepsy is a disease that causes seizures due to excessive brain activity. Anti-seizure medications are effective for some people with epilepsy. However, others don’t respond to the drugs or can’t tolerate their side effects.

Of all the conditions that may benefit from a ketogenic diet, epilepsy has by far the most evidence supporting it. In fact, there are several dozen studies on the topic.

#2. Metabolic Syndrome. Metabolic syndrome, sometimes referred to as prediabetes, is characterized by insulin resistance. You can be diagnosed with metabolic syndrome if you meet any 3 of these criteria:
Large waistline: 35 inches (89 cm) or higher in women and 40 inches (102 cm) or higher in men.
Elevated triglycerides: 150 mg/dl (1.7 mmol/L) or higher.
Low HDL cholesterol: Less than 40 mg/dl (1.04 mmol/L) in men and less than 50 mg/dl (1.3 mmol/L) in women.
High blood pressure: 130/85 mm Hg or higher.
Elevated fasting blood sugar: 100 mg/dl (5.6 mmol/L) or higher.

People with metabolic syndrome are at increased risk of diabetes, heart disease and other serious disorders related to insulin resistance.

#3. Glycogen Storage Disease. People with glycogen storage disease (GSD) lack one of the enzymes involved in storing glucose (blood sugar) as glycogen or breaking glycogen down into glucose. There are several types of GSD, each based on the enzyme that is missing.

Typically, this disease is diagnosed in childhood. Symptoms vary depending on the type of GSD, and may include poor growth, fatigue, low blood sugar, muscle cramps and an enlarged liver.

#4. Polycystic Ovary Syndrome (PCOS). Polycystic ovary syndrome (PCOS) is a disease marked by hormonal dysfunction that often results in irregular periods and infertility.

One of its hallmarks is insulin resistance, and many women with PCOS are obese and have a hard time losing weight. Women with PCOS are also at an increased risk for type 2 diabetes.

#5. Diabetes. People with diabetes often experience impressive reductions in blood sugar levels on a ketogenic diet. This is true of both type 1 and type 2 diabetes. Indeed, dozens of controlled studies show that a very low-carb diet helps control blood sugar and may also provide other health benefits.

In a 16-week study, 17 of 21 people on a ketogenic diet were able to discontinue or decrease diabetes medication dosage. Study participants also lost an average of 19 pounds (8.7 kg) and reduced their waist size, triglycerides and blood pressure.

In a 3-month study comparing a ketogenic diet to a moderate-carb diet, people in the ketogenic group averaged a 0.6% decrease in HbA1c. 12% of participants achieved an HbA1c below 5.7%, which is considered normal.

Bottom Line: Ketogenic diets have been shown to reduce blood sugar in people with diabetes. In some cases, values return to a normal range, and medications can be discontinued or reduced.

Part 1 of 3 parts.

September 30, 2016

Studies Don't Tell Us Everything about Type 2

Diabetes dogma pertaining to type 2 needs to be challenged and questioned.

Cait O'Sullivan traveled all the way across the continent a few weeks ago to ask a question that's been haunting her for years. It's her job to know how drugs work, and this was her chance to confront the regulators. Cait O'Sullivan is a full-time academic detailing pharmacist for the British Columbia BC PAD service.

It was a public meeting at the FDA's Washington, DC, headquarters, and Health Canada officials would be there. The main item on the agenda was to be drug approval for type 2 diabetes.

O'Sullivan wanted them to state, on the public record, what scientific evidence they were using to support their approval of drugs for Type 2 diabetes. Because O'Sullivan has read the literature and she can't find it. After the meeting she flew back home to Vancouver Island empty handed. O'Sullivan is not the first to challenge the basis for tight blood sugar control in the treatment of Type 2 diabetes.

A Cochrane review in 2013, a
BMJ paper in 2014, and most recently a literature review from the Mayo Clinic in Rochester, Minn., have all investigated the evidence and found it lacking.

The theory is that using medication to tightly control blood sugar in type 2 diabetes will prevent the deterioration of tiny blood vessels, which can lead to damage in kidneys, eyes and other parts of the body, a composite outcome called "microvascular complications."

Curiously, the studies failed to show a corresponding drop in the risk of blindness, nor a reduction in the rate of kidney failure.

In medical journalism, it's a major challenge trying to reflect the uncertainty that is inherent in biomedical research. There's a perception that science delivers straightforward, objective answers. But interpretations can be surprisingly subjective, even though everyone is using the same data.

Witness the raging debate over the use of statins that has pitted two of the world's most prestigious medical journals in an increasingly heated argument over the evidence for some of the most commonly prescribed drugs in the world.

No one is suggesting that the drugs be tossed out, or that attention to glucose control should be recklessly abandoned.

But today, most patients have no symptoms. They find out they have Type 2 diabetes after a routine blood test. Should they also be given drugs to hit the tight glucose levels? This is where the evidence gap lies.

Back in her home on Vancouver Island, Cait O'Sullivan continues her work for the B.C. Ministry of Health, educating family doctors about the evidence behind the drugs they're prescribing. When she tells them about the debate over type 2 diabetes drugs, they are often surprised.

It's a debate that can only be resolved with more study and better data. That's why O'Sullivan's group is calling on Health Canada to demand better evidence when they approve type 2 diabetes drugs.

Right now Health Canada only requires evidence that the drugs lower blood sugar, and don't increase the risk of cardiovascular disease.

Please read both links as I only picked some of the material.

September 29, 2016

B12 Deficiency Linked to Heart Disease in PWD Type 2

Adults with type 2 diabetes and lowlevels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. CAN occurs when nerve damage affects the heart, which can be caused by prolonged hyperglycemia over several years in people with diabetes.

The Steno Diabetes Centre in Denmark sought to investigate the association of vitamin B12 deficiency and CAN in type 2 diabetes patients, so they analyzed data from 469 patents, all of whom were screened for CAN between June 2013 and December 2014.

Study participants also provided blood samples for serum vitamin B12 measurements, with researchers analyzing associations between deficiency and measures of neuropathy.

Those participants who were treated with metformin and/or proton pump inhibitors (PPIs) were more likely to have significantly lower levels of vitamin B12 compared to participants who were not on treatment. Additionally, vitamin B12 levels were linked to a lower diagnosis rate of CAN in models adjusted for sex, age, alcohol consumption, and diabetes duration.

The scientists also noted that a 25 pmol/L higher level of vitamin B12 was associated with a 21 per cent increase in the cardiovascular autonomic reflex test for deep breathing and a decrease in five-minute resting heart rate.

These findings remained after excluding patients that had received B12 supplements and following adjustment for confounding factors such as HbA1c, total cholesterol, smoking status, and triglyceride levels.

"The present study presents evidence that patients with type 2 diabetes who are treated with metformin and proton pump inhibitors have lower serum levels of vitamin B12 than patients not treated with these drugs," said the researchers.

"These findings support a growing amount of evidence that these drug therapies are a cause of vitamin B12 deficiency."

Studies are currently underway to assess whether a lack of vitamin B12 has causal role in the development of patients with CAN.

The results were published in the Journal of Diabetes and its Complications.

September 28, 2016

Beta Cell Is Key to Fighting Type 2 Progression

At the European Association for the Study of Diabetes Annual Meeting, a great amount of discussion is going on about the role of the beta cell in the pathogenesis of type 2 diabetes and how we are going to work to prevent the progressive loss of beta-cell function and mass that characterizes the disease.

Everybody recognizes that the beta cell is the key feature of why we get hyperglycemia as well as why we see a progression of the disease. With the approaches we are currently using, this disease results in a progressive loss of the ability of the beta cell to secrete insulin, along with loss of the beta cells that are responsible for making this critical hormone.

Many different approaches have been used until now to try to prevent this loss of beta-cell function. We have a variety of classes of agents that have addressed the beta cell directly as well as indirectly, perhaps by reducing the load of the beta cell so that the demand for it to produce and secrete insulin is decreased.

What has been learned through many of these interventions is that although we can maintain glycemic control for a period of time, inevitably there will be progression and we will need to add agents. Every patient with type 2 diabetes has beta-cell dysfunction, and every patient with type 2 diabetes needs to be aggressively treated to slow progression.

The different agents that have been used seem to have variable degrees of ability to slow progression. For example, the sulfonylureas, while being capable of stimulating insulin secretion, seem to drive the beta cell towards that inevitable loss of function far more rapidly than other approaches such as metformin or the thiazolidinediones.
In fact, if an individual were to live long enough, every patient with type 2 diabetes will have ultimate beta-cell failure that requires insulin-replacement therapy. We are losing patients to cardiovascular disease even with the more aggressive control of blood pressure and lipids, many of them before they have progressed to beta-cell failure.

The challenge is to come up with new approaches that would allow us to slow this progression. The traditional thinking, where one provides agents that stimulate the cell to secrete insulin, may not be optimal. We may need to start thinking of new approaches that would allow the beta cell to rest some and, therefore, be able to live longer.

Studies looking at individuals with prediabetes have identified that the beta cell is already defective. With interventions that improve insulin sensitivity, we can typically slow the progression of diabetes. Similarly, if we intervene in individuals with diabetes to reduce the demand on the beta cells with approaches as simple as aggressive lifestyle changes, we can slow progression.

We need to clearly focus on these areas to try to prevent our patients from getting progressive hyperglycemia due to progressive beta-cell loss and, ultimately, the diabetic complications that we traditionally see with the disease.

We've been seeing recently that a number of the agents that are used to treat type 2 diabetes, including GLP-1 receptor agonists and SGLT2 inhibitors, may offer hope in reducing diabetic complications in individuals with very advanced disease. Although this is very useful information, we have yet to fully understand how this is happening. The challenge for all of us is to find approaches that can be used earlier in the disease, perhaps with these classes of agents or others that would not allow us to worry about late-stage disease.

In my mind, the beta cell is the key. We are going to have to aggressively target it. We don't necessarily have to target it by stimulating it as much as resting it.

Every patient with type 2 diabetes has beta-cell dysfunction, and every patient with type 2 diabetes needs to be aggressively treated to slow progression. Failure to treat our patients aggressively is going to allow accelerated progression and ultimately result in failure and insulin therapy.

September 27, 2016

Should We Use More Than Insulin?

If you use insulin for diabetes, you still might get swings in your blood glucose levels occasionally. But what if the levels won't go down, even with insulin? Don't worry. It's not the only way to get your condition under control. Healthy habits and diabetes medicine can also help.

Some of best ways to prevent high blood glucose levels are old-school:
#1. Exercise. When you do it regularly, it's like adding another medicine to your care. It makes the insulin you take work better, and it removes the sugar, or glucose, from your blood.

It also helps you lose weight, which can lower blood glucose. Try to build up to at least 30 minutes of moderate exercise most days, even if you start with just 5 minutes. Talk to your diabetes care team first about how to work out safely.

#2. Eat right. A healthy diet keeps your blood sugar within a safe range. It's the most important way to help you shed pounds if you're overweight. Work with a registered dietitian or a certified diabetes educator to learn about the best food to eat and how to build a meal plan that works for your lifestyle.

Weight loss medications are another option you can consider if you need to get thinner. Talk to your doctor about which ones might be a good choice for you.

#3. Relax. Stress blocks your body from releasing insulin, and that lets glucose pile up in your blood. If you're stressed for a long time, your glucose levels will keep building. Regular exercise and relaxation techniques -- like yoga, meditation, tai chi, and breathing exercises -- can help.

If the insulin you take isn't enough to lower high blood sugar, your doctor may change how much you take and how you take it. For instance, he may ask you to:
  • Increase your dose.
  • Take a fast-acting type before meals to help with swings in blood sugar after you eat.
  • Take a long-acting type once or twice a day to help give you smoother blood glucose control.
  • Use an insulin pump, which may make it easier to manage your blood glucose levels.

Other Medications:

You may take other drugs along with insulin to fight blood glucose highs. Some common ones are:

Exenatide and liraglutide (GLP-1 receptor agonists). If you have type 2 diabetes, these drugs lower glucose highs and make you feel full after a meal, which can help you eat less and lose weight. You take these medicines by injection. They can cause some side effects, such as nausea, vomiting, weakness, or dizziness.

DPP-4 Inhibitors. These include drugs like alogliptin (Nesina), linagliptin (Tradjenta), saxagliptin (Onglyza), and sitagliptin (Januvia). If you have type 2 diabetes, they can help you lower your blood glucose after meals. You take them as a pill. Side effects vary, depending on the type you take.

Other Reasons for High Blood Sugar:
There are other possible reasons your blood sugar may be high, such as insulin resistance, which may run in your family. That's when your body doesn't respond as well as it should to the insulin it makes. Or, you may be taking a drug for another health problem that keeps your body from using it well.

How you use insulin can also matter. If you give yourself shots in the same place repeatedly, for instance, that area may scar, which can affect how your body absorbs the hormone. It helps to rotate spots or use an insulin pump.

Some people also take less insulin than they should. It might be because they're afraid of low blood glucose, or they're nervous about needles. You might feel more comfortable by slowly increasing your insulin dose. Consider an insulin pump or pen if you don't like needles.

Whatever the cause of your blood glucose highs, work closely with your doctor to find a solution. And always talk with him before you make any changes in your insulin dose.

September 26, 2016

How Sleep Apnea Hurts Your Health

Snoring can make for a bad night’s sleep, for you and your bed mate. But if it happens because you have obstructive sleep apnea (OSA), it is a sign of a bigger problem.

The condition raises your risk for other health issues like high blood pressure and diabetes. It can even make you more dangerous on the road. But when you treat sleep apnea, you can ease or even cure some of these issues.

Here are seven health problems you might face if you have OSA:
#1. High blood pressure.
#2. Heart disease.
#3. Type 2 diabetes.
#4. Weight gain.
#5. Adult asthma.
#6. Acid reflux.
#7. Car accidents.

High blood pressure. If you already have it, sleep apnea can make it worse. When you wake up often during the night, your body is stressed. That makes your hormone systems go into overdrive, which boosts your blood pressure levels. Also, the level of oxygen in your blood drops when you can’t breathe well, which may add to the problem. Treatment can make a difference, though. Some people with high BP who get help for sleep apnea will see their blood pressure improve. Their doctors may be able to cut back on their BP medications. But you shouldn’t stop or change your dose without talking to your doctor first.

Heart disease. People with OSA are more likely to have heart attacks. The causes may be low oxygen or the stress of waking up often. Strokes and atrial fibrillation -- a fast, fluttering heartbeat -- are also linked with the condition. Sleep apnea disrupts how your body takes in oxygen, which makes it hard for your brain to control how blood flows in your arteries and the brain itself.

Type 2 diabetes. Sleep apnea is common among people with this condition -- 80% or more of them may have OSA. Obesity raises a person’s risk for both disorders. Although studies haven’t shown a cause-and-effect link between sleep apnea and type 2 diabetes, not getting enough shut-eye can keep your body from using insulin properly, which leads to diabetes.

Weight gain. Extra pounds raise your chances of getting sleep apnea, and the condition also makes it harder to slim down. When you’re overweight, you can have fatty deposits in your neck that block breathing at night. On the flip side, sleep apnea can make your body release more of the hormone ghrelin, which makes you crave carbs and sweets. And when you're tired all the time, you might not be able to turn the food you eat into energy as efficiently, which can lead to weight gain. The good news? Treatment for OSA can make you feel better, with more energy for exercise and other activities. This can help you lose weight, which can help your sleep apnea.

Adult asthma. Science hasn’t proven a link to OSA, but people who get sleep apnea treatment may find they have fewer asthma attacks.

Acid reflux. There’s no proof that sleep apnea causes this kind of heartburn, but many people say it’s a problem. Treating it seems to improve apnea symptoms for some people, sleep doctors say.

Car accidents. When you feel groggy, you raise your risk of falling asleep at the wheel. People with sleep apnea are up to five times more likely than normal sleepers to have traffic accidents.

All the health problems linked to the condition can sound scary, but there are lots of ways to treat it. Your doctor may recommend a machine called CPAP, short for continuous positive airway pressure. The machine, with a mask attached by a hose, can help you breathe better at night and get the rest you need. It can take some getting used to, but people who use it when they sleep feel better and are healthier.

I can vouch for the above as I have sleep apnea and have been using various
models of the CPAP machine since 2001. From the list near the top, I have never had problems with number 5 and 7.

September 25, 2016

How the Elderly Are Preyed Upon

No this not about diabetes, but is about the scams and schemes that many of the elderly fall victim to almost on a daily basis.

Some of the scams include:
  1. People calling saying they are from the IRS and that you owe money
  2. People calling from Microsoft telling you that something is wrong with your computer
  3. People calling you claiming they are a member of your family and they have gotten into trouble and please wire them money
  4. People calling you saying they represent a charity doing great things for people in (supply the city or area of the disaster) and could you contribute money to help them.
These are just some of the scams being used to separate the elderly from their money. I have had all of the above, except number 3 tried on me, but I did not fall of any of them. Number one above goes like this – This is (name) from the IRS and we would like to get paid for (dollar amount) that you owe in back taxes for year (one of last three years). If you could go to your bank and have them put ($300 to $1,500 and it is seldom in an even hundred amount) on a debit card and when you arrive back home, please call (gives you a telephone number) and then read off the number to me, then we can mark your account paid in full.

If you do this, your debit card will be wiped clean and you will be out this money and nothing will change except in a few months or the following year, you will receive another call for another amount with the same instructions.

Never fall for this scam as the IRS does not call and they only send out a bill if you owe money. They will include the explanation of how they arrived at the amount and even suggest that if you had your taxes prepared have them check the amount and then mail the money in the form of a check and a copy of the bill they sent you with the check. They can also file in court for you to appear to be charged with tax evasion, but you will never receive a call unless you have been received an audit notice and have been in contact by telephone with the auditor.

Number 2 above has been attempted by different callers many times to the point that I just automatically tell them they are a scam and hang up on them. They say they are from Microsoft and your computer has notified them of a problem. They want you to go to your computer and then they will tell you to find the Internet service number assigned to your computer so that they can access your computer to make a change or repair some code to correct the problem on your computer.

Never let them do this. Microsoft does not call you and will send out a representative if there is a real problem. In addition, they know the number to reach your computer and can send out a repair for you to download and install if you have a problem.

Number three above is not one I have had tried on me as I know my relatives and would never send money as I would tell them to contact their parent if they were a relative.

Number four is another common scam and the elderly often fall victims to these people. Every time there is a disaster, such as the flooding in Louisiana or in Texas, these people start calling and saying they represent a charity and they are counting on you to give an amount to bring them closer to their goal for the disaster area. Chances are the charity does not exist and the money goes into the caller's pocket.

Now there are legal charities and they will operate through a bank and you are free to call the bank to see if the charity exists and if the account number is correct for the bank. Also, there is the Red Cross and they can be called and if you wish to give to them, the amount of your give will be designated for the disaster area.

Be careful as scams and schemes get more clever each year. I make is a policy to never give money over the telephone and even more careful when people show up at the door. If they provide the proper identification and will wait while I call the police department, I might give a small amount. Even then, I have had people leave when they heard me call to police department and start asking questions.