Lard Is Back!

Most of us have heard these offensive remarks, “lard ass, tub of lard, lardo.” I know I have and I still hear then occasionally. I am old enough to remember my parents butchering hogs and my mother always collected all the pork fat she could and rendering it for use in cooking. When she could, she also would obtain pork fat from a local locker when a person did not want it returned with the meat.

I know that even when margarine came into the stores, my mother was happy for all the extra lard she was able to obtain from the local locker. The locker, for those that are too young to know this, is a butcher shop that butchers beef and pork for people that did not know how and could not do it themselves. Until my father had a farm accident, we always did our own butchering and we always had a freezer full of meat, fruits, and vegetables.

Many people even today believe lard is bad for you. Recent studies have proved that saturated fats aren't that bad for you. I like lard because it doesn't change the flavor of foods like most cooking oils do. I do use some olive oils, but I prefer lard or butter depending on what I am cooking. Lard may be the newest, trendiest fat on the block.

Lard provides us with dietary cholesterol, which is, in fact, beneficial to the body and doesn’t contribute to blood cholesterol levels. Rather, it supports healthy hormone production and helps deal with inflammation.

While lists of heart-healthy foods don’t generally contain lard, it appears that they may want to consider adding it in the near future. The pervasive myth that animal fats increase the risk of heart disease is just that, a myth. Our great great grandparents consumed lard and butter and experienced extremely low rates of heart disease. Lard is part of a healthy diet and will not give you a heart attack.

Because of the way lard is chemically composed, it’s great to bake and to cook with. At around 40 percent saturated fat, 50 percent monounsaturated fat, and 10 percent polyunsaturated fat, its high saturated fat content prevents the other fat from oxidizing when introduced to heat.

After cod liver oil, lard ranks second on the list of foods highest in vitamin D.

It’s time to revitalize lard, a product that was in every American pantry and pan just mere decades ago. Rumors say that Upton Sinclair’s The Jungle may have played a big role in the killing of lard, but, regardless of who killed it, there’s no reason that lard can’t come back. Generations upon generations of cooks used this healthy fat.

Guidelines for Diabetic Foot Management

New evidence-based clinical-practiceguidelines on diabetic foot management cover five areas: ulcer prevention, off-loading, osteomyelitis diagnosis, wound care, and peripheral arterial disease. This is the first diabetic foot guideline developed by a multidisciplinary panel, which conducted separate systematic literature reviews for each of the five topics.

The document, sponsored jointly by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine, was published as a supplement to the February issue of the Journal of Vascular Surgery by Anil Hingorani, MD, of New York University Lutheran Medical Center, Brooklyn, and colleagues.

Asked to comment, endocrinologist and diabetic foot expert Jan S Ulbrecht, MD, of Pennsylvania State University, State College, told Medscape Medical News, "I think it's a hugely ambitious and comprehensive document, from a very distinguished group of authors." Dr. Ulbrecht added that although he takes issue with a few specific points, "There can be no doubt that if all care followed these guidelines, diabetic foot disease would be markedly diminished."

Five Recommendations: Examine Feet at Every Visit

The panel issued five recommendations for the care of the diabetic foot.

#1. For prevention of foot ulceration, the panel advises adequate glycemic control, periodic foot inspection, and patient and family education. For high-risk patients, including those with significant neuropathy, foot deformities, or previous amputation, custom therapeutic footwear is recommended.

#2. In patients with plantar diabetic foot ulcer, the panel recommends off-loading with a total contact cast or irremovable fixed-ankle walking boot. For those with nonplantar wounds or healed ulcers, specific types of pressure-relieving footwear are recommended.

#3. In patients with a new diabetic foot ulcer, the recommendation is a probe-to-bone test and plain films, followed by MRI if a soft-tissue abscess or osteomyelitis is still suspected following the probe-to-bone test.

#4. Debridement is recommended for all infected ulcers, with treatment of those infections based on the 2012 guidelines published by the Infectious Diseases Society of America. The current document provides detailed recommendations on comprehensive wound care and various debridement methods.

#5. The panel recommends measurement of ankle-brachial index (ABI) in all patients with diabetes starting at age 50. Those at high risk by virtue of foot ulcer history, prior abnormal vascular exam, or intervention for vascular disease or known cardiovascular disease should have an annual vascular examination of the lower extremities and feet.

The full text of the guidelines can be read here.

Metformin Does Cause B12 Deficiency

Allen called me shortly after he read this. I say shortly because he knows I sleep late and he does respect my sleep time. He was surprised that it has taken this long to publish something we have known for a long time. He knew that I would be busy for most of the afternoon and again the following day, but felt this was important enough to remind me of it and ask that I blog about it. Then he asked if I could meet with Ben, Barry, and him on Saturday. I agreed and was happy to do this.

When I arrived, they were waiting for me. Allen had printed a copy for me and asked if I had read it. I told him that I had and would be blogging about it after March 18. Barry said you already have posts that far out and I said yes. Plus, I have three other blogs ready to post and about 18 more topics I want to write in the weeks ahead. Ben said yes, there have been many topics of interest lately. I said I wish I had time to write about all the topics that interest me.

People taking metformin, one of the safest type 2 diabetes medications, for several years may be at heightened risk of vitamin B12 deficiency and anemia, according to a new analysis of long-term data. Allen knows this from first hand experience and others of us know this because our vitamin B12 levels were low and we cannot absorb what we need from the foods rich in B12.

Metformin helps to control the amount of sugar, or glucose, in the blood by reducing how much glucose is absorbed from food and produced by the liver, and by increasing the body’s response to the hormone insulin, according to the National Institutes of Health.

The study used blood samples and the researchers found that at year five, average B12 levels were lower in the metformin group than the placebo group, and B12 deficiency was more common, affecting 4 percent of those on metformin compared to 2 percent of those not taking the drug.

Borderline low B12 levels affected almost 20 percent of those on metformin and 10 percent of those taking placebo.

Average vitamin B12 levels were higher by year 13 than in year five, but B12 deficiency was also more common in both the metformin and placebo groups, as reported in the Journal of Clinical Endocrinology and Metabolism. The down side of being vitamin B12 deficient can mean nerve damage that is severe and may be irreversible. Severe and prolonged B12 deficiency has also been linked to impaired cognition and dementia. It can also cause anemia (low red blood cell count), but fortunately, this condition is reversible with treatment. Another finding of the study was more people in the metformin group were also anemic at year five than in the placebo group.

Humans do not make vitamin B12 and need to consume it from animal sources or supplements. Vegetarians may get enough from eating eggs and dairy products, but vegans need to rely on supplements or fortified grains.

Doctors who prescribe metformin to patients long-term for type 2 diabetes, gestational diabetes, polycystic ovarian syndrome or other indications should consider routine measurement of vitamin B12 levels, the authors conclude.

People who are taking metformin should ask their doctor about measuring their B12 level. Restoring healthy B12 levels is easy to accomplish with pills or monthly injections.

Finally, the study authors say, “The risk of B12 deficiency should not be considered a reason to avoid taking metformin.”

Blood Pressure Measurements in Question

Another controversy has erupted around blood pressure measurement and this has been created by doctors. Doctors have done this by creating a 'one-size-fits-all' program for hypertension treatment. Most are prescribing blood pressure medications to those that really don't need the medications and others are over prescribing the medications to lower blood pressure levels to those of the guidelines.

These doctors do not care that it may lower blood pressures too low for the elderly and cause them falls that may be very serious. All they care about is the levels and issuing the prescriptions. They do not take into consideration the person's age and other comorbid conditions, in other words the patient is not properly assessed.

Blood pressure readings vary, but most people with diabetes should have a reading of no more than 140/80. The first, or top, number is the "systolic pressure," or the pressure in the arteries when your heart beats and fills the arteries with blood. The second, or bottom, number is the "diastolic pressure," or the pressure in the arteries when your heart rests between beats, filling itself with blood for the next contraction.

There is some “expert” disagreement with the above numbers and some groups feel that BP readings should be 130/75-80. When it comes to preventing diabetes complications, normal blood pressure is as important as good control of your blood sugar levels.

A small reduction as the primary composite outcome may not justify the increased adverse events and costs associated with an intervention targeting systolic blood pressure (BP) less than 120 mm Hg, according to an Ideas and Opinions piece published online Feb. 23 in the Annals of Internal Medicine.

Eduardo Ortiz, M.D., M.P.H., from Washington D.C., and Paul A. James, M.D., from the University of Iowa in Iowa City, discuss the results of the Systolic Blood Pressure Intervention Trial (SPRINT), which were promoted before publication. The results showed a risk reduction in the primary composite outcome with a lower target systolic BP.

The researchers note that based on the results, for 1,000 persons treated over 3.2 years with a systolic BP target of less than 120 mm Hg versus 140 mm Hg, 16 persons would benefit, 22 would be seriously harmed, and 962 would experience no benefits or harms. In addition to a small decrease in event rates, the aggressively treated group more frequently had serious adverse drug events, which were possibly or definitely related to the intervention.

"We do not believe that the small absolute benefit seen in SPRINT provides convincing evidence that large segments of the population should be treated with additional drugs to a systolic BP goal less than 120 mm Hg, especially when the adverse events, costs, and burden of such treatment are considered," the authors write.

Many Type 2's Eat More on Oral Medications

Tim called 11 of us together the other evening. When I arrived, Ben, Barry, Allen, Jason, Sue, and Bob were already there. Shortly Brenda, A.J, Jerry, and Max arrived. Tim asked all of us one question – What were our eating habits shortly after diagnosis?

Tim continued that most of us may have changed immediately, and the rest changed slowly. All of us reduced our carbohydrates greatly or slowly as we saw improvements in our meter readings. Others of us did a lot of reading and started reducing our carbohydrates because of our reading. Some of us learned from others, like David Mendosa and a few other writers. By the time the six of us that were original to this group met, we were all eating low carb and medium to high fat. Some of us were eating higher protein until we learned that we needed to bring this back to normal levels and increase the amount of fat we were eating.

Allen asked what had caused this analysis. Tim said we have several possible new members for our April meeting and several of our current members that are continuing to eat more carbohydrates than when diagnosed. Sue said that is a problem and you want a different program for our April meeting. Brenda said this sounds like a plan and Jason added that will help Brenda and I work on our presentation even more.

Tim said, Yes, and I will let you continue your presentation if you are ready as we have postponed it too many times. Brenda said that this problem is more pressing and deserves our attention. Allen said we would go with what is decided tonight.

Tim thanked us and said he felt we needed to be concerned for a few of our members and help educate everyone about low carb high fat way of eating. Sue asked why that terminology? I answered because this is not a diet and is a way of eating that needs to be long-term. Most diets are at best short-term and then weight is often regained and the process starts over.

Brenda said this is a conversation that she and her daughter had recently and diet was a term her daughter did not like when it came to people with diabetes. She continued that 'way of eating' sounds very good and she would change to that. Sue agreed with her and added way of eating is something we needed to change when we were diagnosed.

The rest agreed and asked Tim where he had heard this. Tim said that I was the first place he had heard it and I added that I had found it on a diabetes forum. In addition, I would suggest we use 'eating to your meter' as a way of communicating with the potential new members.

Allen said this is what we have done in the past and now don't need to worry as much because most of the foods we eat now are familiar to us and we know what the effect will be from past testing. Barry said this may be of help for the new members and some of the recent members.

Allen said we will do our standard of having questions and talking about the VA and other topics that we want them to be aware and know. Tim thanked us for reminding him of this as he had forgot the topics we needed to cover for all new members. With that, we concluded our discussion and talked a little while before heading to our homes.

An Insulin Pump Cannot Help a Bad Diet

I have had many arguments with people with type 1 diabetes with insulin pumps when they say they could eat what they wanted and bolus insulin accordingly. Does this work? I don't believe so. It doesn’t work with injections and I don't believe it works with pumps either. Matching insulin to carbs is nowhere near an exact science. This is true whether taking injections or pumping. There is huge margin for error. The error can come from inaccurate food labeling. It can come from “estimating” our carb intake. It can come from how our body is absorbing the insulin itself (what degree of resistance we have).

Not to mention that a carb is not a carb. Pumps take into consideration carb quantity, not carb quality. For instance, 30 grams of carbs from broccoli will act completely differently in the body than 30 grams of carbs from cake. However, in your pump, these will both receive the same insulin coverage.

Next, eating whatever we want and taking insulin to cover it will cause weight gain and increased insulin resistance, whether we are on injections or a pump. Also, most insulin users are unaware that a portion of the protein we eat turns into glucose as well, particularly if you are an adult and sedentary and are eating more protein than you need.

Therefore, a low carb high fat approach is really necessary to avoid complications with pump use. Eating less carbs, thereby using less insulin, will reduce the margin for errors. See Dr. Bernstein’s law of small numbers here. Choosing better quality carbohydrates like non-starchy vegetables and eliminating processed and refined carbs like sugar and all grains as well as even “real food” that is high glycemic, like starches and most fruit, will stabilize blood glucose levels.

Just remember, an insulin pump is a delivery device. While pumps are wonderfully convenient and can even decrease insulin usage, as well as reduce the number of needle sticks, they can’t work miracles. They can only do their best with what you give them to work with. Eating a healthy, whole food, low carb high fat way of eating with frequent blood glucose monitoring and adjusting as needed will help you get the most from your insulin pump.

Some blood glucose fluctuations are not caused by factors that can be prevented, like elevations during “growth spurts” in children, hormonal changes or other physiologic processes that cannot necessarily be prevented. Add to these stress, lack of sleep, infections, and other causes.

Yet with all this, most of the type 1 people I have met recently are convinced they can eat what they want and cover with insulin. They have refused to consider any other way even though several are gaining weight and a couple are way overweight.

Our honorary type 1 member knows how important this is and has been forced to keep quiet because other type 1's don't believe her and even ridicule her for the way she eats. When she was in high school and active in sports, she did eat more, but still tried to eat low carb high fat with extra protein. Now that she is in college and not active in sports, she has been more careful in her way of eating.

Despite Hurdles, Telepsychiatry Use Rising

I admit that the terms used to help people with mental health are somewhat confusing and I don't know why the authors have to muddy the information and try to confuse people, especially those looking for services being offered in underserved areas of the United States.

The first term is telemental health and it is described as a rapidly growing field. It is used in a range of settings for patients with a variety of disorders. The second term is telepsychiatry. Then they use my favorite term, telemedicine and the last term is telehealth.

According to a 2014 report by the U.S.Department of Health and Human Services there is a major shortage of psychiatrists. The report states that there are 4,000 shortage areas in which there the psychiatrist-to-resident ratio is equal to or greater than 1:30,000.

Researchers continue to find support for its use in evaluating or treating an ever-expanding list of psychiatric disorders, including some of the latest studies involving attention-deficit/hyperactivity disorder, schizophrenia, post-traumatic stress disorder, and autism. Many of these studies investigated the efficacy of treatment delivered via video as compared to in person and have found that services delivered by video are at least as effective as in-person visits.

Most people have a high-speed connection even in rural areas although some of the 4,000 shortage areas do not have this. As potential applications of telemental health have expanded, many aspects of delivering care via video have eased considerably over years. The sound quality has improved while the occurrence of glitches like freezing has decreased.

However, some of the barriers that have hampered its use remain unchanged or are changing very slowly. Though some insurance companies now cover telehealth services, many do not. Clinicians should check with any insurance companies they work with to inquire about reimbursement for telehealth services.

In 2009, the American Telemedicine Association published Practice Guidelines for Video-Conferencing-Based Telemental Health that highlights necessary clinical and technological competencies, and the American Psychological Association released guidelines in 2013.

“The practice of telepsychology involves consideration of legal requirements, ethical standards, telecommunication technologies, intra- and interagency policies, and other external constraints, as well as the demands of the particular professional context,” the authors wrote.

Therapists providing services via telehealth should receive ongoing training, and they should check with the licensing laws and policies of the insurance companies with whom they are contracted to stay up to date on inevitable changes to come.

LCHF Being Discouraged by Dietitians

Are dietitians the modern day luddites? From what we are seeing, this is apparently very true. The dietetic groups in several countries are persecuting doctors and even their own members for speaking out against low fat high carbohydrate food plans and in favor with low carbohydrate high fat food plans.

Starting with Jennifer Elliott, an Australian dietitian, who has been de-registered by her professional body: the Dietitians Association of Australia (DAA) for putting her patients health above the interests of the corrupt DAA, to Professor Tim Noakes in South Africa who is facing a hearing that is anything but fair. Some are saying it is more like the Spanish Inquisition.

If dietitians and their associations were beacons of success, I could understand their concerns. However, many of the dietetic organizations and their members have received money from junk food companies. Most of the dietetic organizations and their members have not achieved anything in the obesity battle and the linked type 2 diabetes.

David Mendosa has a blog with an image of a headstone and the words on it are Low-Fat, born 1939, died 2015 – helped the world get fatter and sicker. Unfortunately, this may only be for the United States at present as the dietetic organizations and their members in many other countries are doubling down on the value of low fat and pushing carbohydrates with the help of junk food companies.

In the United States, the low fat high carbohydrate diet recommendations may soon be going the way of the Dodo, as will many dietitians that cling to failed pseudo science. If dietitians want to be respected as true professionals, they should they should start acting like professionals. This means that they would work with all professionals for the benefit of their patients. In addition, they must free themselves from junk food companies, who have infiltrated many of the dietetic organizations and bought the approval of countless dietitians worldwide.

Fortunately the world of dietetics is not a lost cause, indeed the opposite applies. The list of Scientists, Doctors and Dietitians grows longer by the day, who have raised themselves above the parapet, of greed and the corruption of junk food. They realize the last forty years of low fat and high carbohydrate recommendations have failed totally. These enlightened professionals are recommending a whole fresh food diet, it is ludicrous for anyone to argue against a real food lifestyle. The longer the established dietetic organizations try to turn back the tide, the more irrelevant they will become.

This diet can no longer be defended by appeal to the authority of prestigious medical organizations or by rejecting clinical experience and a growing medical literature suggesting that the much-maligned low-carbohydrate, high-protein diet may have a salutary effect on the epidemics in question.