January 14, 2017

Health Is Everything – Update

A few months ago, I would not have given this a second thought, even with type 2 diabetes. Now it is part of my everyday thoughts and wondering how to improve my health.

I said an update would be coming and it is time. I am working on typing with both hands and am having more success. I do need to work at having my arm in the right position and keeping it there. I seldom have a lot of pain doing this, but pain is still there in a dull presence.

The physical therapy that I am getting at our local hospital is helping and I have no I idea how long I will need it. I cannot move my arm a lot in many directions beyond a certain limit, but the exercises are helping and seem to be working in reducing the muscle pain in my upper arm and shoulder. I feel fortunate for every little success.

The one time when pain is up is getting up in the morning. I apparently do something during the night that is irritating my shoulder and I have to work for some time to get the muscle back where it works with my arm and not against my arm. During the day, I can move my arm the wrong way and up goes the pain and then I need to work the arm a few minutes to move the muscle back to where it works properly.

My prostate is undergoing radiation and the PSA has dropped a few points, but still is above where is should be. I have not had some of the common problems that we are warned about, but it is still early and I have about six weeks of radiation to go.

I am not driving now to my appointments and not driving is a relief. The appointments are earlier and I am home earlier than when driving myself. I have been told that it is common for people undergoing radiation to become tired and should not drive.

I will try to post more at a later date when things may change that are worth telling. I have been surprised at my positive attitude through all of this. Yes, I can sound otherwise when explaining some of the problems with my shoulder and the muscles, but during therapy the staff ask specific questions and know the limits that my arm can move.

January 13, 2017

Hospital Patients Twice as Likely to Die With Hypoglycemia

This runs against what was said about six years ago. Then it was hyperglycemia that was the problem for people with diabetes when hospitalized.  You were often required to have blood glucose readings of 180 mg/dl or higher.

Now hospitalized patients who experience low blood glucose levels are at substantially increased risk of death, both over the short term and after discharge, compared with those who don't have hypoglycemia, regardless of their diabetes status, new results from a large-scale study indicate.

The findings show that, in hospitalized patients with spontaneous and insulin-related hypoglycemia, the mortality risk is more than doubled, rising to an approximately fourfold increased risk of death in patients with severe hypoglycemia (compared with those without hypoglycemia).

The research, which was published online recently in the Journal of Clinical Endocrinology & Metabolism, coincides with the publication of a series of recommendations to tackle the threat of hypoglycemia to diabetes patients.

Noting that hypoglycemia is common among hospitalized patients, regardless of diabetes status, lead researcher Amit Akirov, MD, Institute of Endocrinology, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel, said: "These data are a timely reminder that hypoglycemia of any cause carries the association with increased mortality."

And Dr Akirov told Medscape Medical News that the finding that death rates are higher with severe vs moderate hypoglycemia "indicates a possible dose-dependent effect — a decrease in blood glucose levels is associated with an increase in mortality rates."

However, although he and his coauthors put forward several potential explanations as to why hypoglycemia may be associated with increased mortality risk, there remain a number of unanswered questions.

He said: "There is some controversy regarding the importance of blood glucose levels, as some claim this is a real cause for increased mortality, while others believe this is a marker of the general status of the patient. Further research is needed to try to find the answer to this question."

As most hospitalized patients get routine blood tests, and these usually include glucose levels, "there is probably no need for a specific recommendation" to do this, he said, but stressed that it's important to have this information on admission.

Implications of Hypoglycemia Are Unclear. Although it is known that spontaneous and insulin-related hypoglycemia are common in hospitalized patients, both with and without diabetes, the definition of hypoglycemia in hospitalized patients is inconsistent, and so the true prevalence and prognostic implications remain unclear.

To examine the association between hypoglycemia and mortality in hospitalized patients, Dr Akirov and colleagues defined hypoglycemia as a blood glucose level less than 70 mg/dl (3.9 mmol/L), which was stratified into moderate hypoglycemia (40–70 mg/dl, 2.2–3.9 mmol/L) and severe hypoglycemia (less than 40 mg/dl, 2.2 mmol/L).

His team gathered data on all first admissions to an Israeli 1300-bed tertiary medical center with 10 medical wards between January 2011 and December 2013. Mortality data were obtained to June 2015, with the medical database used to collate self-reported data on alcohol use, smoking, and body mass index, as well as the presence of comorbidities.

Diabetes was defined as a previous diagnosis of diabetes in medical records or use of any oral hypoglycemic agent, glucagon-like peptide 1 (GLP-1) agonist, or insulin at admission.

Patients were therefore divided into: non–insulin-treated controls (NITC) and insulin-treated controls (ITC), non–insulin-related hypoglycemia (NIH) and non–insulin-related severe hypoglycemia (NISH), and insulin-related hypoglycemia (IH) and insulin-related severe hypoglycemia (ISH).

From an overall cohort of 33,675 patients, 2947 (9%) were identified to have at least one blood glucose value less than 70 mg/dl

January 12, 2017

People with Diabetes Seldom Told the Truth

This long blog actually talks about why diabetics are not told the truth. Our Registered Dietitians are good at this and I am surprised that one would actually write about this topic and is essence telling the truth.

I’m appalled constantly at the misinformation we nutrition experts are telling folks with diabetes. It’s all over the place. The “everything in moderation” mantra, and how we need to eat less meat, less fat, and more whole grains, is a pervasive theme drilled into young dietitians, and spread to the public through our dietary guidelines. This information is making people sick.”

In our quest to avoid the truth and focus on individual super foods that will save us, this post is telling diabetics that dates are so amazing because seven of them provide 4g of fiber. They forgot to mention that 7 dates equals 126g of carbs with no fat, so that’s pretty much like a syringe of sugar shot directly into your blood if eaten on an empty stomach. None of these top 10 lists had protein, and the only fat was flax seeds (for their omega-3’s) but what about fatty fish or fish oil, which is much more bioavailable? Why aren’t we instead telling them to avoid excess carbohydrates, because the last time I checked, you can actually reduce blood sugar by… not eating sugar!

How Many Carbs Do We Really Need? The short answer: ZERO.

“The lower limit of dietary carbohydrate compatible with life apparently is zero, provided that adequate amounts of protein and fat are consumed. However, the amount of dietary carbohydrate that provides for optimal health in humans is unknown. There are traditional populations that ingested a high fat, high protein diet containing only a minimal amount of carbohydrate for extended periods of time (Masai), and in some cases for a lifetime after infancy (Alaska and Greenland Natives, Inuits, and Pampas indigenous people) There was no apparent effect on health or longevity. Caucasians eating an essentially carbohydrate-free diet, resembling that of Greenland natives for a year tolerated the diet quite well. However, a detailed modern comparison with populations ingesting the majority of food energy as carbohydrate has never been done.”

They base the carbohydrate requirement of 87g-112 grams per day on the amount of glucose needed to avoid ketosis. They arrived at the number 100g/day to be “the amount sufficient to fuel the central nervous system without having to rely on a partial replacement of glucose by ketoacid,” and then they later say that “it should be recognized that the brain can still receive enough glucose from the metabolism of the glycerol component of fat and from the gluconeogenic amino acids in protein when a very low carbohydrate diet is consumed.” (Meaning, ketosis is NO BIG DEAL. In fact, it’s actually a good thing and is not the same as diabetic ketoacidosis that type 1 diabetics and insulin dependent type 2 diabetics can get.) The RDA of 130g/day was computed by using a CV of 15% based on the variation in brain glucose utilization and doubling it, therefore the RDA (recommended daily allowance) for carbohydrate is 130% of the EAR (estimated average requirement).

What are the Dangers of Overeating Carbohydrates? Answer: DIABETES (but they won’t actually say this)

So, How Many Carbs are We Telling Diabetics to Eat? Answer: TOO MUCH

Even though we have no actual need for carbs at all, and the RDA is 130g/day, the general guideline for adults with diabetes is 45 to 60 grams of carbohydrate per meal, and snacks having 15 to 30 grams of carbs. For the average adult eating three meals and two snacks a day (recommended) this equals a daily recommended intake of between 165g and 240g of carbs per day.

We’re Completely Failing Diabetics.
We nutrition experts are miserably failing at preventing and treating folks with diabetes. According to the CDC, 12.6% of Americans have diabetes, costing us $245 billion dollars in direct and indirect medical expenses. I’ve seen the incredible damage diabetes can do to people and it’s pretty ugly. It’s listed as the seventh leading cause of death, but because people don’t really die of “diabetes” but rather die of complications due to diabetes, like kidney failure and cardiovascular disease, the number is likely much higher. The rate is only increasing, especially in countries newly adopting our “heart-healthy” standard American diet. All over the world, people are giving up their healthy traditional diets and are drinking soda instead of water, using canola oil instead of traditional fats, and eating more refined junk foods – oh and it’s not only unhealthy but more expensive to eat this way too.

Why can’t we tell folks who have diabetes the truth: that eating an “everything in moderation,” high carb, low fat and low protein diet will increase your chances of a completely preventable disease (in the case of type 2) that can lead to a very uncomfortable death?

Please read the full article, which I have only skimmed, to learn the full truth about the lies those of us with diabetes are told.

January 11, 2017

Use Low-Carb, Not Low-Fat for Weight Loss

Are you trying to lose weight after the holidays or just wanting to lose weight? This article should be of value in either attempt. Look no further; Mayo Clinic physicians say that low-carb diets are slightly better than low-fat diets for weight loss in the short-term.

The plethora of diets on the weight loss market is often confusing. Low-carb diets, in particular, go under numerous names - such as Atkins, South Beach, Paleo, and Ketogenic. So, which of these is the best option for weight loss? Are the diets safe, and is there a huge difference in results between them?

The Mayo Clinic in Arizona aimed to review studies that examine low-carb diets, in order to find out if they are safe and effective for weight loss, and cardiovascular and metabolic health. They published the results of their study in The Journal of the American Osteopathic Association.

Depending on the diet, the physicians found that the definition of low-carb diet is highly variable. Previous studies have shown low-carb diets as comprising less than 45 percent of daily calories from carbohydrates. However, this figure is not dissimilar to the typical Western diet that has more than 50 percent.

While all of the reviewed diets were based on the idea of carbohydrate restriction, the allowed carbs accounted for anywhere between 4-46 percent of daily calories, which the researchers say, "convolutes the evidence."

Physicians advise eating 'real foods,' not highly processed meats. An analysis of 41 trials that evaluated the effects of low-carb diets on weight loss revealed that participants lost between 2.5-9 more pounds than individuals who followed a low-fat diet.

"The best conclusion to draw is that adhering to a short-term low-carb diet appears to be safe and may be associated with weight reduction," says Dr. Heather Fields, an internal medicine physician at Mayo Clinic and lead researcher on this study.

"However, that weight loss is small and of questionable clinical significance in comparison to low-fat diets. We encourage patients to eat real food and avoid highly processed foods, especially processed meats, such as bacon, sausage, deli meats, hot dogs, and ham when following any particular diet," she adds.

To analyze the potentially harmful effects and safety of low-carb diets, Fields and colleagues looked at research conducted between January 2005 and April 2016. People tend to eat more meat when carbohydrates are restricted, which could increase the risk of death from all causes, including cancer.

Most of the studies failed to provide the source or quality of proteins and fats consumed in the low-fat diets, making it difficult to draw conclusions linking excessive meat consumption to all-cause mortality and increased cancer risks.

However, the studies did show that compared with other diets, low-carb diets were effective for weight loss without adverse effects on blood pressure, glucose, and cholesterol.

"Physicians must keep in mind that the literature is surprisingly limited, considering the popularity of these diets and the claims of health benefits in the public press. Our review found no safety issues identified in the current literature, but patients considering low-carb diets should be advised there is very little data on long-term safety and efficacy," Field notes. Low-carb diets may provide short-term weight loss satisfaction.

Field notes that drawing broad conclusions proved difficult due to various limitations within the research. Some of the studies did not include information on the type of weight lost, such as whether it was fat, muscle, or water. Also, many of the studies relied on participants recalling foods and beverages they had consumed, which can be subject to error.

Dr. Tiffany Lowe-Payne, an osteopathic family physician, points out that several factors can affect a person's success with weight loss, including genetics, personal history, and their ability to stick to the diet.
"As an osteopathic physician, I tell patients there is no one-size-fits-all approach for health. When you think of what dieters want - and what they need to stay motivated - it is the satisfaction of results. They want to see significant weight loss and fast. For many, a low-carb lifestyle provides the answer they are looking for." Dr. Tiffany Lowe-Payne

Dr. Lowe-Payne recognizes that carbohydrates make up a considerable part of many people's diets. She also highlights that after 6 months, weight loss is virtually the same for individuals regardless of whether they are on a low-carb or low-fat diet.

For patients who are trying to lower their blood sugar levels or manage insulin resistance, low-carb diets have been shown to be beneficial, Lowe-Payne concludes.

January 10, 2017

Researchers May Have Way to Speed Up Insulin

In the Journal of Biological Chemistry, researchers describe how they predicted the effect with computer simulations and then confirmed it with laboratory experiments. Scientists suggest that a small chemical alteration to insulin makes the molecule act more rapidly while preserving its function in the organism.

The researchers - from Switzerland, the United States, and Australia - found that they could speed up the disassembly and release of insulin from its complex structure to its available form by replacing a single hydrogen atom with an iodine atom in its molecular structure.

Insulin is a small protein that regulates blood glucose by passing signals into cells. In the body, it exists in two forms: a complex one for storage and a simpler one for action.

In its storage form, insulin exists as a zinc-bound complex of six identical molecules called a hexamer. The simple, active form is an unbound single molecule, or monomer. When the body requires insulin to regulate blood sugar, the hexamer disassembles into monomers.

The insulin molecule then has to bind to a partner molecule - known as the insulin receptor - that sits on the surface of cells. This binding allows signals from the insulin to pass into the cell.

For some time, researchers have been experimenting with ways to control this disassembly process to improve the treatment of diabetes - a disease in which insulin production is impaired or when the body cannot use it properly.

Researchers use various approaches to explore and discover new ways to fight disease with molecules that do not exist in nature. This includes creating synthetic versions, or analogs, of naturally occurring compounds.

Protein engineering involves altering the structure and function of proteins - the chemical workhorses of the organism - using only a computer or through evolution in the laboratory.

One area of application that is showing promise is the development of designer drugs to protect against several strains of influenza virus.

In the new study, Markus Meuwly, a chemistry professor at the University of Basel in Switzerland, and colleagues experimented with various insulin analogs by strategically replacing individual atoms in the molecular structure of natural insulin.

This is a promising approach for optimizing medicinal compounds.

Computer simulations based on quantum chemistry and molecular dynamics, which model processes in the body involving insulin, allowed the team to observe the properties of the analogs.

They then carried out laboratory experiments to confirm the properties observed in the computer simulations. These experiments used methods such as crystallography and nuclear magnetic resonance.

The researchers discovered that exchanging one hydrogen atom for one iodine atom improved the availability of insulin but did not change its affinity for the insulin receptor.

It is quite conceivable, say the researchers, that their insulin analog - which differs from natural insulin by only a single atom - has clinical potential as a new drug.

The use of halogen atoms - a group that includes fluorine, chlorine, bromine, and iodine - is a promising approach for optimizing compounds in medicinal chemistry, say the researchers, who add: "Inspired by quantum chemistry and molecular dynamics, such 'halogen engineering' promises to extend principles of medicinal chemistry to proteins."

This is very interesting and practical for advancing medicine.

January 9, 2017

Doctors Ignore “Screen and Treat” to Prevent Diabetes

"Screen and treat" policies to preventing type 2 diabetes are unlikely to have substantial impact on this growing epidemic, concludes a study published by The BMJ.

The prevalence of type 2 diabetes is rising globally. In the UK, for example, about 3.2 million people have the condition and by 2025, it is predicted that this will increase to five million, at an estimated cost of £23.7bn ($30.2bn, €28.2bn) to the NHS.

There are two approaches to prevention: screen and treat, in which people are identified as "high risk" and offered individual intervention, and a population-wide approach, in which everyone is targeted via public health policies. The UK's National Diabetes Prevention Program follows Australia and the United States in placing the emphasis on a screen and treat approach.

But this approach will be effective only if a test exists that correctly identifies those at high risk (sensitivity) while also excluding those at low risk (specificity); and an intervention exists that is acceptable to patients and clinicians.

So a team of researchers, led by Professor Trish Greenhalgh at the University of Oxford, assessed the diagnostic accuracy of screening tests for pre-diabetes (high risk of developing type 2 diabetes in the future) and effectiveness of interventions in preventing onset of type 2 diabetes in people with pre-diabetes.

They analyzed the results of 49 studies of screening tests and 50 intervention trials. Screening tests included fasting plasma glucose (higher than normal blood sugar levels after a period of fasting) and raised glycated hemoglobin or HbA1c (proportion of red blood cells with glucose attached, indicating blood glucose levels over the previous 2-3 months). Interventions were lifestyle change or treatment with metformin (a drug that helps lower blood sugar levels).

They found that the diagnostic accuracy of tests used to detect pre-diabetes in screening programs was low - fasting glucose is specific but not sensitive and HbA1c is neither sensitive nor specific - suggesting that large numbers of people will be unnecessarily treated or falsely reassured depending on the test used.

Lifestyle interventions lasting three to six years showed a 37% reduction in relative risk of type 2 diabetes, equating to 151 out of 1000 people developing diabetes compared with 239 of 1000 in the control group. This fell to 20% in follow up studies.

Use of metformin showed a relative risk reduction of 26% while participants were taking this drug, translating to 218 out of 1000 developing diabetes while taking metformin compared with 295 of 1000 not receiving it. The authors warn that study quality was often low and results may have been affected by bias (problems in study design that can influence results).

They conclude that "screen and treat" policies will benefit some but not all people at high risk of developing diabetes, and they should be complemented by population-wide approaches for effective diabetes prevention.

In a linked editorial, Professor Norman Waugh from Warwick Medical School says adherence to lifestyle change across whole populations is the key to prevention of type 2 diabetes.

He points out that "pre-diabetes" is an unsatisfactory term because many people so labeled do not develop diabetes, and believes there is a balance to be struck between the medical model of screening and treating of individuals of individuals, and the public health model of changing behavior in the whole population at risk.

He says public health measures targeted at the whole population at risk could include interventions to help weight control, such as changes to taxation of foodstuffs and interventions to make physical activity easier or safer.

However, he acknowledges that adherence to lifestyle advice remains poor, and concludes that preventing or delaying type 2 diabetes "requires effective measures to motivate the general population to protect their own health."

The missing factor not discussed (probably wisely) is the attitude of doctors toward the whole population and doing the “screen and treat” protocol to attempt to stop the diabetes epidemic.

January 8, 2017

Diet Drinks No Better Than Full Sugar for Healthy Weight

Sugar-free and "diet" drinks are often seen as the healthier option - but researchers from Imperial College London have argued that they are no more helpful for maintaining a healthy weight than their full-sugar versions.

This seems like the right perspective, but I would disagree, because I have seen people using diet drinks eat more when drinking diet drinks.

Artificially-sweetened beverages (ASBs) are alternatives to full-sugared drinks. They contain no sugar and are sweetened with artificial sweeteners instead. ASBs are often known as "diet" versions of soft drinks, and may be perceived by consumers as the healthier option for those who want to lose weight or reduce their sugar intake. However, there is no solid evidence to support the claims that they are any better for health or prevent obesity and obesity related diseases such as type 2 diabetes.

Professor Christopher Millett, senior investigator from Imperial's School of Public Health, said "A common perception, which may be influenced by industry marketing, is that because 'diet' drinks have no sugar, they must be healthier and aid weight loss when used as a substitute for full sugar versions. However we found no solid evidence to support this."

Sugar-sweetened beverages (SSBs) such as soft drinks, fruit-flavoured drinks, and sports drinks, make up a third of UK teenagers' sugar intake, and nearly half of all sugar intake in the US. SSBs provide many calories but very few essential nutrients, and their consumption is a major cause of increasing rates of obesity and type 2 diabetes.

ASBs currently comprise a quarter of the global sweetened beverages market, but they are not taxed or regulated to the same extent as SSBs - perhaps due to their perceived harmlessness, say the researchers.

Despite having no or very little energy content, there is a concern that ASBs might trigger compensatory food intake by stimulating sweet taste receptors. This, together with the consumers' awareness of the low-calorie content of ASBs, may result in overconsumption of other foods, thus contributing to obesity, type 2 diabetes and other obesity-related health problems.

Professor Millett and colleagues outlined current evidence of the health effects of consuming ASBs. Although there was no direct evidence for a role of ASBs in weight gain, they found that there was no evidence that ASBs aid weight loss or prevent weight gain compared with the full sugar versions.

In addition, the production of ASBs has negative consequences for the environment, with up to 300 liters of water required to produce a 0.5 L plastic bottle of carbonated soft drink.

Dr Maria Carolina Borges, first author of the study from the Federal University of Pelotas in Brazil added: "The lack of solid evidence on the health effects of ASBs and the potential influence of bias from industry funded studies should be taken seriously when discussing whether ASBs are adequate alternatives to SSBs."

Professor Carlos Monteiro, co-author from the University of Sao Paulo, said: "Taxes and regulation on SBS and not ASBs will ultimately promote the consumption of diet drinks rather than plain water - the desirable source of hydration for everyone."

The authors added: "Far from helping to solve the global obesity crisis, ASBs may be contributing to the problem and should not be promoted as part of a healthy diet."