December 24, 2016

Canadians Physicians for Better Dietary Guidelines

Doctor Malcolm Kendrick blogged about this on the December 16 and thus alerted many people about what is happening in Canada. A petition signed by over two hundred Canadian doctors is asking the Health Minister to change the dietary guidelines for Canada. You can read more about it here

For the past 35 plus years, Canadians have been urged to follow the Canadian Dietary Guidelines. During this time, there has been a sharp increase in nutrition-related diseases, particularly obesity and diabetes.

I can only hope that the American doctors would do something like this, as there has been sharp increases in obesity and diabetes in the United States since 1980 as well. Every five years when the dietary guidelines are issued, people have complained about the lack of scientific evidence for many of the guidelines.

For more information on obesity in the United States, click on this link and then on Home and then go down the page about two thirds for the graph.

We are especially concerned with the dramatic increase in the rates of childhood obesity and diabetes. In 1980, 15% of Canadian school-aged children were overweight or obese. Remarkably, this number more than doubled to 31% in 2011; 12% of children met the criteria for obesity in the same reporting period. This has resulted in a population with a high burden of disease, causing both individual suffering, and resulting in health care systems, which are approaching their financial breaking points. The guidelines have not been based on the best and most current science, and significant change is needed.

We are a group of Canadian Physicians and Allied Health Care professionals who wish to see significant change to the dietary guidelines, and insist they be based on the best and current evidence.

They have put together a list of things that they believe should happen

Points for Change

The Canadian Dietary Guidelines should:
  1. Clearly communicate to the public and health-care professionals that the low-fat diet is no longer supported, and can worsen heart-disease risk factors
  2. Be created without influence from the food industry
  3. Eliminate caps on saturated fats
  4. Be nutritionally sufficient, and those nutrients should come from real foods, not from artificially fortified refined grains
  5. Promote low-carb diets as at least one safe and effective intervention for people struggling with obesity, diabetes, and heart disease
  6. Offer a true range of diets that respond to the diverse nutritional needs of our population
  7. De-emphasize the role of aerobic exercise in controlling weight
  8. Recognize the controversy on salt and cease the blanket “lower is better” recommendation
  9. Stop using any language suggesting that sustainable weight control can simply be managed by creating a caloric deficit
  10. Cease its advice to replace saturated fats with polyunsaturated vegetable oils to prevent cardiovascular disease
  11. Stop steering people away from nutritious whole foods, such as whole-fat dairy and regular red meat
  12. Include a cap on added sugar, in accordance with the updated WHO guidelines, ideally no greater than 5% of total calories
  13. Be based on a complete, comprehensive review of the most rigorous (randomized, controlled clinical trial) data available; on subjects for which this more rigorous data is not available, the Guidelines should remain silent.

Quoting Dr. Kendrick - My sense of what is now happening is that the momentum against the very stupid and damaging nutritional guidelines that have dominated the Western World for the last forty years is reaching breaking point. This group even managed to throw ‘restricting salt intake’ into the dustbin.

December 23, 2016

Hypoglycemia and Diabetes – Part 2

Part 2 of 2 parts

When you have low blood glucose, first, eat or drink 15 grams of a fast-acting carbohydrate, such as:
  • Three to four glucose tablets
  • One tube of glucose gel
  • Four to six pieces of hard candy (not sugar-free)
  • 1/2 cup fruit juice
  • 1 cup skim milk
  • 1/2 cup soft drink (not sugar-free)
  • 1 tablespoon honey (put it under your tongue so it gets absorbed into your bloodstream faster)
Fifteen minutes after you've eaten a food with sugar in it, check your blood glucose again. If your blood sugar is still less than 70 mg/dl, eat another serving of one of the foods listed above. Repeat these steps until your sugar becomes normal. These are important steps and should be followed.

Hypoglycemia may make you pass out. If so, you'll need someone to give you a glucagon injection. Glucagon is a prescription medicine that raises blood sugar, and you may need it if you develop severe hypoglycemia. It's important that your family members and friends know how to give the injection in case you have a low blood sugar reaction.

If you see someone having a severe hypoglycemic reaction, call 911, or take him or her to the nearest hospital for treatment. Do not try to give an unconscious person food or fluids as they may choke. Never give a person insulin if they are having an episode of hypoglycemia as this could kill them.

Do not drive when you have low blood glucose. It's very dangerous. If you're driving and you have hypoglycemia symptoms, pull off the road, check your blood sugar, and eat a sugary food. Wait at least 15 minutes, check your blood sugar, and repeat these steps if necessary. Eat a protein and carbohydrate source (such as peanut butter crackers or cheese and crackers) before you drive on. Be prepared – always keep a sugar source in your car at all times for emergencies.

If you have diabetes, ways you can prevent hypoglycemia include:
  • Follow your meal plan.
  • Eat at least three evenly spaced meals each day with between-meal snacks as prescribed if necessary.
  • Plan your meals no more than 4 to 5 hours apart.
  • Exercise 30 minutes to 1 hour after meals. Check your sugars before and after exercise, and discuss with your doctor what types of changes can be made.
  • Double-check your insulin and dose of diabetes medicine before taking it.
  • If you drink alcohol, be moderate and monitor your blood sugar levels.
  • Know when your medicine is at its peak level.
  • Test your blood sugar as often as directed by your doctor or what your experience has taught you.
  • Carry an identification bracelet or other identification that says you have diabetes and specify the type of diabetes you have.
Always carry a list of the medications you are currently taking in your wallet, purse, or in what you carry daily. Always list your primary care doctor and the phone number for him/her so contact can be made if you are unable to communicate at the time.

December 22, 2016

Hypoglycemia and Diabetes – Part 1

Part 1 of 2 parts.

Hypoglycemia can be caused by diet, some medications and conditions, and exercise. This is one reason for testing as often as many of us do. If we don't have enough sugar (glucose) available in our bodies, low blood glucose or hypoglycemia can happen for those of us with diabetes.

If you develop hypoglycemia, please record the date and time when it happened and what you did. Share your record with your doctor, so he or she can look for a pattern and adjust your medications, if necessary. Call your doctor if you have more than one episode of unexplained hypoglycemia in a week.

While it is true that most people feel the symptoms of hypoglycemia when their blood glucose level falls below 70 milligrams per deciliter (mg/dl), you will need to learn what your symptoms are and act on them.

Most of the early symptoms include:
  • Confusion
  • Dizziness
  • Feeling shaky
  • Hunger
  • Headaches
  • Irritability
  • Pounding heart; racing pulse
  • Pale skin
  • Sweating
  • Trembling
  • Weakness
  • Anxiety

Without treatment, you might develop more severe symptoms, including:
  • Poor coordination
  • Poor concentration
  • Numbness in mouth and tongue
  • Passing out
  • Nightmares or bad dreams
  • Coma

If you have any doubts about the diabetes medications you are taking, be sure to ask your doctor if any of your medicines can cause hypoglycemia.

Insulin treatment can cause low blood sugar, and so can a type of diabetes medications called "sulfonylureas." Commonly used sulfonylureas include:
  • Glimepiride (Amaryl)
  • Glipizide (Glucotrol)
  • Glibenclamide (Glyburide, Micronase)
  • Gliclazide

Older, less common sulfonylureas tend to cause low blood sugar more often than some of the newer ones. Examples of older drugs include:
  • chlorpropamide (Diabinese)
  • nateglinide (Starlix)
  • repaglinide (Prandin)
  • tolazamide (Tolinase)
  • tolbutamide (Orinase)

You can also get low blood glucose if you drink alcohol or take allopurinol (Zyloprim), aspirin, Benemid, probenecid (Probalan), or warfarin (Coumadin) with diabetes medications.

You shouldn't get hypoglycemia if you take alpha-glucosidase inhibitors, biguanides (such as metformin), and thiazolidinediones alone, but it can happen when you take them with sulfonylureas or insulin.

You can get low blood glucose if you take too much insulin for the amount of carbohydrates you eat or drink.

For instance, it can happen:
  • After you eat a meal that has a lot of simple sugars
  • If you miss a snack or don't eat a full meal
  • If you eat later than usual
  • If you drink alcohol without eating any food

Don't skip meals if you have diabetes, particularly if you're taking diabetes medications.

If you have diabetes and think you have hypoglycemia, check your blood sugar level. Do your levels often drop after meals that include a lot of sugars? Change your diet. Avoid sugary foods, and eat frequent small meals during the day.

If you get low blood sugar when you haven't eaten, have a snack before bedtime, such as a protein or a more complex carbohydrate.

Your doctor may find that you take too much insulin that peaks toward the evening-to-morning hours. In that case, she may lower your insulin dose or change the time when you get your last dose of it.

December 21, 2016

Yo-yo Dieting Causes Weight Gain

I think the timing of this article is on target. The holiday season is here and the food seems more carb or calorie laden than usual. Specialty breads, cakes, and other carb dense foods are everywhere you turn. As people with diabetes, you may want to think long and hard about the food you chose to eat. According to new research, if you diet for a period of time and then eat more for a few days, your brain interprets repeated dieting as short famines, prompting the body to store more fat for futures food shortages, resulting in weight gain.

The study, published in the journal Evolution, Medicine and Public Health, was led by Prof. Andrew Higginson, from the University of Exeter, and Prof. John McNamara, of the University of Bristol, both in the United Kingdom.

Keeping weight in check is a health benefit; compared with people of a healthy weight, people who are obese are at increased risk for many diseases. For instance, the risk of high blood pressure, type 2 diabetes, coronary heart disease, and stroke are all higher in the obese population. More than one-third of adults in the United States are obese, so keeping weight at a healthy level is a major priority from a public health perspective.

Although shedding holiday pounds may be a popular focus for many of us in January, the Centers for Disease Control and Prevention (CDC), say that people who lose weight gradually - about 1-2 pounds per week - are more successful at keeping the weight off.

Previous studies have investigated the negative health effects of yo-yo dieting. One study recently presented by the American Heart Association suggested that yo-yo dieting increases the risk of heart disease death.

For the latest study on yo-yo dieting, the researchers utilized a mathematical model of animals, such as birds, that know when food is in abundance or is scarce but do not know when the situation will change. The researchers note that animals respond to food shortages by storing energy and gaining weight.

Their model demonstrates that when food is in short supply, much like during a phase of dieting, an efficient animal will gain excess weight between periods of food shortage.

Prof. Higginson says, "Our model predicts that the average weight gain for dieters will actually be greater than those who never diet. This happens because non-dieters learn that the food supply is reliable so there is less need for the insurance of fat stores." Prof. McNamara adds that their model "shows that weight gain does not mean people's physiology is malfunctioning or that they are being overwhelmed by unnaturally sweet tastes." It could be that their brain is working normally, "but uncertainty about the food supply triggers the evolved response to gain weight," he adds.

The researchers say their model shows that the desire to eat increases as a diet continues and this desire will not go away as weight is gained. This is because the brain thinks that further famines are likely. The model may explain why many people get into a cycle of weight gain in the wake of increasingly restrictive diets; it only serves to communicate to the brain that it must store fat.

For those of us who over-indulge during the holiday season, however, what is the best way to lose weight? "The best thing for weight loss is to take it steady. Our work suggests that eating only slightly less than you should, all the time, and doing physical exercise is much more likely to help you reach a healthy weight than going on low-calorie diets," says Prof. Andrew Higginson, University of Exeter

The CDC offers some good advice for healthy weight loss. Because 1 pound equals 3,500 calories, they recommend reducing caloric intake by 500-1,000 calories per day to lose 1-2 pounds per week. Once a healthy weight is achieved, the CDC says to rely on healthful eating and physical activity most days of the week to keep the weight off over the long term.

Even a modest weight loss will confer health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars, the organization adds.

December 20, 2016

Preventing or Delaying Type 2

At least the American Diabetes Association is including information that has been published by others during the year relating to metformin and vitamin B12 deficiency.  

Now I will quote from the statements by the ADA:
  • Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI greater than or equal to 35 kg/m2, those aged less than 60 years, women with prior gestational diabetes mellitus, and/or those with rising A1C despite lifestyle intervention. A
  • Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

Pharmacologic agents including metformin, α-glucosidase inhibitors, orlistat, glucagon-like peptide 1 (GLP-1) receptor agonists, and thiazolidinediones have each been shown to decrease incident diabetes to various degrees in those with prediabetes. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention (37). For other drugs, cost, side effects, and durable efficacy require consideration.

Metformin was less effective than lifestyle modification in the DPP and DPPOS but may be cost-saving over a 10-year period (34). It was as effective as lifestyle modification in participants with BMI greater than or equal to 35 kg/m2 but not significantly better than placebo in those over 60 years of age (17). In the DPP, for women with history of GDM, metformin and intensive lifestyle modification led to an equivalent 50% reduction in diabetes risk (38), and both interventions remained highly effective during a 10-year follow-up period (39). Metformin should be recommended as an option for high-risk individuals (e.g., those with a history of GDM, those who are very obese, and/or those with relatively more hyperglycemia) and/or those with rising A1C despite lifestyle intervention. Consider monitoring B12 levels in those taking metformin chronically to check for possible deficiency (see Section 8 “Pharmacologic Approaches to Glycemic Treatment” for more details). Unquote”

This is a very good statement by the ADA and tells us, at least on this topic, that they are at least concerned about vitamin B12 deficiency.

Several of our support group members have contacted me when I sent them an email about this and a link to the 2017 ADA Guidelines. Allen said that Barry, Ben, and he were happy this is in the guidelines and they thanked me for bringing this to their attention. They said they were forwarding my email and link to all of the members. I thanked them for that and said I appreciated them doing this.

Later, Brenda called and thanked me for the information and was thinking of using the guidelines for the topic. I told her I would help where I could and give the person chosen, any links necessary. She thanked me and said she would make the person aware of this.

December 19, 2016

Food Companies Like to Put Bias into Research

If you think there is bias inscientific research by Big Pharma and Big Food, you would be correct. I know as a reader, I normally start at or near the end of any article to find out who the funded the study and who the authors of the study are to discover who may have conflicts. If it is only an abstract, then it is at the start that I look for potential bias in the study.

Other keys that I look for is the organization of the study, if this is even specified. It can be interesting when the study is done at a university and I can obtain an email address for corresponding and requesting a copy of the study. This allows for an easier analysis and chance to discover conflicts.

Consumer choice is often guided by recommendations about what we should eat, and these recommendations also play a role in the food that’s available for us. Recommendations take the form of dietary guidelines, food companies’ health claims, and clinical advice. But there’s a problem. Recommendations are often conflicting and the source of advice not always transparent.

Governments issue national dietary guidelines to inform people’s food choices and the nation’s food policies. To be credible and scientifically sound, they should obviously be built on rigorous evidence. But often they are driven by other needs. In the United States, agriculture is a large driver and many studies show the bias of Big Agriculture. High fructose corn syrup is strongly promoted by the corn industry and other products are also promoted.

Public health dietary guidelines and policies are influenced by political, economic, and social factors. Bias in research is the systematic error or deviation from true results or inferences of a study. Pharmaceutical, tobacco or chemical industry funding of research biases human studies towards outcomes favorable to the sponsor.

Even when studies use similar rigorous methods – such as keeping study information away from participants (blinding) or removing selection bias between groups of patients (randomization) – studies sponsored by a drug’s manufacturer are more likely to find the drug is more effective or less harmful than a placebo or other drugs.

This bias in pharmaceutical industry sponsored studies is just like the sugar industry sponsored studies that downplayed sugar’s link to heart disease while putting the blame on fat.

Financial conflicts of interest between researchers and industry have also been associated with research outcomes that favor companies researchers are affiliated with.

So how does this happen? How can industry-funded studies use methods similar to non-industry funded studies but have different results? Because bias can be introduced in several ways, such as in the research agenda itself, the way research questions are asked, how the studies are conducted behind the scenes, and the publication of the studies.

Industry influences on these other sources of bias in research often remain hidden for decades.

It took over 40 years to show how the tobacco industry undermined the research agenda on the health effects of secondhand smoke.

It did this by funding “distracting” research through The Center for Indoor Air Research, which three tobacco companies created and funded. Throughout the 1990s, this center funded dozens of research projects that suggested components of indoor air, such as carpet off-gases or dirty air filters, were more harmful than tobacco. The center did not fund research on secondhand smoke.

There is a high risk of bias when the methodology of the study (how the study is designed) leads to an error when assessing the magnitude or direction of results. Clinical trials with a high risk of methodological bias (such as those lacking randomization or blinding) are more likely to exaggerate the efficacy of drugs and underestimate their harms.

Publication bias occurs when entire research studies are not published, or only selected results from the studies are published. It is a common myth publication bias comes about because scientific journal editors reject studies that don’t support the hypothesis or question the studies were asking. These are called negative or statistically non-significant studies. But negative research is as likely to be published as positive research. So, it’s not that.

Analysis of internal pharmaceutical industry documents from 1994 to 1998 shows the pharmaceutical industry had a deliberate strategy to suppress publication of sponsored research unfavorable to its products. Industry-funded investigators were not allowed to publish negative research that did not support the efficacy or safety of the drugs being tested.

This has contributed to a clinical literature dominated by studies demonstrating the efficacy or safety of drugs. The tobacco industry also has a history of stopping the publication of research it funded if the findings didn’t lean in favor of tobacco products.

Please read the full article here to further understand the different bias that is so unfavorable to many studies.

December 18, 2016

A Good Organization Gone Bad

I feel very sad as I write this. I dislike what is happening to the diabetes newsletter by “experts” at the Mayo Clinic. Apparently, funds are becoming shorter and many articles are being repeated on a regular basis. The real problem is the refusal of the staff posting the article to answer questions. Some of the questions are from people crying for help, and these most often are not answered.

Since our health with diabetes and even prediabetes is important, the Mayo Clinic turning their backs on these people is inexcusable and showing lack of respect for people needing help.

I am wondering if there are problems among the Mayo Clinic employees that are causing many of the problems. I am also concerned that what was a great newsletter may become a relic and no longer of any value to people new to diabetes and a nuisance for people that have had diabetes for several years. I have had thoughts about unsubscribing to the newsletter, but with the latest antics, felt that someone needs to be aware of what is happening and inform others about the weaknesses of the Mayo Clinic and their treatment of people with diabetes.

If you doubt the last sentence, one of our support group members did receive and keep an appointment with the diabetes department. He felt that the doctors for diabetes had no interest is helping him and showed it by writing prescriptions for three oral medications and increasing his dosage for the statin and blood pressure medication. When he asked why they were taking him off insulin, the answer was that this was what the ADA recommended. He stated he had been on insulin for five years and saw no reason to return to oral medications when insulin worked so well for keeping his blood glucose under control. Again, he was given the answer that the ADA recommended this.

He said if he was new to diabetes, he could agree, but having diabetes for almost 9 years and A1c's over 10 percent on oral medications, he could not understand why they would be so careless with his health. At that point, he said that doctor handed him the prescriptions and left the exam room.

Another problem I have with the diabetes newsletter is some of the questions that are argumentative more that true questions. Yet given the chance, why is the author or someone at the Mayo Clinic not presenting facts to answer the questions. Maybe they don't know the answers or worst yet, don't want people to know the correct information.