Are You Getting These Nutrients? - Part 1

Tim called me the other day and asked if I had read this by Laura Dolson. I said I had and was working on a blog about it. He asked me how far I had gotten in my writing. I said I had started and been sidetracked by statins and was still reading about statins. He asked if he could stop by and I invited him.

After he arrived, he asked me to open my file, as he wanted to cover some of the points. After I had it opened, he asked me to scroll down to see the foods under each nutrient. Then he asked me to scroll to the bottom and asked my why vitamin B12 received so little attention. I said this is because this is for healthy people and not for people with diabetes and other chronic diseases that require addition of other nutrients.

This caused him to stop and think for some time. He finally agreed and asked if I was concerned about this. I said very concerned and had planned to try covering this in my writing. I don't know if I can make the case strong enough, but I planned on trying. He asked if I could send him a copy before it was published. I said yes, if he would send me any information he located that he felt was important enough. He said he would and he asked how many blogs I would have on this topic. I said that it looked like seven or more at present and if he found a lot more, then it could be even more.

We talked some more and he asked if I would accept information from others. I said I always have and if it was important enough, I would blog about it separately or combine it with other material I had on the topic. He asked if he could see some of the other topics I was considering writing about and had on my list. When I showed him, he was surprised and said he agreed, as there had been many topics of interest recently. I agreed and said it would be easier if my cataracts were not getting worse. This surprised him and he asked when this might happen. I said as soon as the eye surgeon felt comfortable that my eyelid was healed and would not cause possible infection that could compromise the surgery.

Then I had the thought of pulling some information from this source and this source plus some from here. Tim said he would pull together some of the material he was looking for and would email me copies. I told him not to make everything important and I would need some limits. He assured me that he would prioritize what he sent me on each nutrient.

Back to the topic as this is important for those of us eating low carb high fat. When we change our way of eating, we should be concerned about the nutrients we might be missing. Our support group is fortunate that we have two nutritionists that work with the way of eating we like. They check our foods and are looking for shortages that we may have. Other people need to either know nutrition or learn on their own.

As Tim said, vitamin B12 is often not given the attention it deserves and this is especially important for people with diabetes (PWD) on metformin and among the elderly. The elderly and PWD are especially vulnerable because as they age, many lose the ability to convert vitamin B12 from animal foods. Vitamin B12 is only found in liver, sardines, salmon, kidney, eggs, beef, and pork. There are no vegetable sources.

In the next blogs, I will cover Thiamin (vitamin B1), Folate (vitamin B9), Vitamin C, Magnesium, Iron, Vitamin D, Vitamin E, Calcium, Choline, Niacin, Vitamin A, and Zinc.

The first five nutrients above are nutrients to watch when you reduce carbohydrates, and the next three are ones that many people are often short of in what they eat. The last four are nutrients that people with chronic diseases are often short or deficient in their bodies, and vitamin B12 needs special consideration.

It is worth noting for vegetarians and vegan low-carbers, they are limiting their diets more and must be very conscious of the nutrients that may be omitting. This is especially true for vitamin B12, choline, niacin, vitamin A, and zinc.

Have Your Doctor Read This about LCHF

Keith Runyan, MD, is a retired physician, with type 1 diabetes, who graduated from Emory University School of Medicine in 1986. A vast majority of physicians he has encountered during his career have the patient’s best interest in mind and want to improve their health.

So if you learn about the benefits of a low carbohydrate lifestyle from books, articles published in medical journals, or God forbid, the INTERNET, you might wonder why your doctor is either not supportive or even cautions you against it.

His description of what doctors do not know is funny. He says the answer is simpler than you might think. It is not that your doctor does not want you to experience the benefits. It is most likely that your doctor was not educated about the effect of diet on disease. To understand this, let me give you some background about medical education.

In order to get into medical school in the first place, you have to be an excellent student. In our current education system, being an excellent student means being able to learn and retain lots of information in a short period of time and accurately recall that information on a test or later in medical training with their patients. It does not require that they be creative thinkers or innovators, or question what they are being taught. Once a student enters medical school, the amount and pace of learning is accelerated further. There is literally no time to question the validity of the material.

Most medical students have heard from their wise professors the phrase, “half of what you just learned is wrong, but we don’t know which half. However, that is a difficult concept to accept given the time and effort spent learning all that material. In essence, the overwhelming feeling at the end of medical school is, I know I don’t know everything, but at least I know what matters the most.”

The next piece to this puzzle is to know that nutrition is barely discussed in most (not all) medical schools. At Emory, in 1982, we had about 2 weeks of education in “nutrition.” But, what was covered was how the body metabolizes protein, carbohydrate, and fat, nutritional deficiency diseases, and the nutritional requirements to prevent those diseases. The fact that many chronic diseases like cancer, heart disease, diabetes, and digestive diseases were rare prior the adoption of the Western diet was not covered. He states that, “I did not learn this until 2011 when I read Good Calories, Bad Calories by Gary Taubes.”

Some physicians will be familiar with the low carbohydrate diet already and others may be willing to learn about it and support you especially when they see your condition is improving as a result. However, other physicians may immediately recognize it is not part of their armamentarium, therefore it must be either not effective, or possibly dangerous, especially if the word “ketosis” or “ketones” is mentioned. Although doctors should know the difference between “nutritional ketosis” and “ketoacidosis,” the term “nutritional ketosis” is only mentioned in the context of a low carbohydrate ketogenic diet and therefore is not discussed in medical school. So the only context in which most doctors know about “ketosis” is one of the following: starvation ketosis, diabetic ketoacidosis, or alcoholic ketoacidosis, none of which are good.

Dr. Runyan says, “For reasons that are beyond the scope of this article, it is best to have your physician on board with your low carbohydrate lifestyle. It will affect the need for or lack thereof of many of your medications. There can be side effects that are easily corrected with knowledge of how the diet works.”

I would advise reading the complete blog as this only covers part of it. Dr. Runyan covers a lot in his blog.

Drug-Drug Interactions Put Elderly at Risk

Barry called me when he read thisarticle in MedPage Today. Why don't people understand the problems polypharmacy cause and especially when they don't talk to their doctors about all the dietary supplements and complementary and alternative medicines (CAM) they are taking? Barry said he talks about all medications he is taking and if the doctor ignores him, he asks the doctor why.

I commented that many people do not because in the past many doctors would tell their patients not to take non-prescription medications and were none too polite about telling them this. Other doctors would belittle them for taking CAM.

Barry agreed and said that these people are putting their lives in jeopardy. He said his friend that ignored the pharmacist and died a few days later was a huge wake-up call for him. I added that many people today are not concerned and feel that the doctors don't care or they would be asking the proper questions. Some people have been told by the homeopathic practitioners that the medications they order are natural and not to talk to medical doctors about them. This is because of medical doctors in the past talked against homeopathic medications and CAM.

I found this very much on point and a warning to our doctors!

Action Points

• One in six U.S. seniors might be potentially at risk for a major drug-drug interaction, and 25% of adults did not disclose herb or supplement use to primary care physicians.
• Note that one study found that one-third of the population used complementary and alternative medicine.

Based on the 20 most commonly used medications and the 20 most commonly used supplements, the researchers identified 93 potential drug-drug interactions. And among the 20 common medications, 15 interactions were classified as "potentially of major or life-threatening severity."

Much of the article was about the following and I find this interesting and conflicting at the same time as many doctors do ask for a complete list or bringing in all medications to their appointment. The most common reason for nondisclosure was lack of inquiry by physicians (57%), while 47% of patients said they didn't believe their physician needed to know about their use of CAM.

"Contrary to earlier findings, our results attribute most nondisclosure to physicians not asking about CAM use or to concerns about physician knowledge regarding CAM rather than to physician discouragement or negativity about the use of CAM," Jou and Johnson wrote.

Only 2% of patients said their physician had discouraged them from CAM use in the past, and 3% said they had received discouragement in the present.

"Physicians should consider more actively inquiring about patients' use of CAM, especially for modalities likely to be medically relevant," they wrote.

Public Health England Decries Low Carb Diet

Low carb diets were called out on Thursday, March 17 by Public Health England. The agency stated that carbohydrates are the backbone of a healthy diet and that meals low in carbohydrates do not provide vital nutrition because they lack the fiber crucial for digestion.

The agency doubled down on its healthy eating advice to urge Britons to consume more potatoes, pasta, bread, and other starchy carbohydrates to increased fiber intake by more than half, from 19g a day to 30g a day.

In addition to five portions of fruit and vegetables a day, people need the equivalent of two wholemeal breakfast cereal biscuits, two thick slices of wholemeal bread and a large jacket potato with its skin. The experts declared that it was important to choose wholegrain options to obtain the most nutrition from carbohydrates.

The Eatwell Guide increases the amount of starchy carbohydrates from 33 to 37 percent of recommended daily intake.

The officials also warned people not to rely on supposedly healthy “juicing” diets for their nutrition. Fruit juices and smoothies should be limited to a

single 150 ml glass per day because they are packed with sugar and rarely include fiber. An agency spokesperson said, “There seems to be a juicing trend, and low-carb diets are popular, but the scientific evidence is telling us otherwise."

Fiber helps the body digest food, as well as keeping people feeling fuller for longer. Fiber is also known to protect against certain cancers, heart disease, and diabetes. One in nine cases of bowel cancer is linked to eating too little fiber.

Sian Porter, of the British Dietetic Association, said: "You still need to watch your portion size, but starchy carbohydrates should form the basis of any diet."

The guide also urges Britons to eat less cake, biscuits, and sweets, red and processed meat, and dairy. However, Terry Jones, of the Provision Trade Federation, told Farmers Weekly this was a "kick in the teeth" for hard-pressed dairy farmers.

He added: "I find it staggering that, at a time when ministers are expressing support for the sector, an agency of government should not only encourage consumers to reduce consumption of dairy products, but also seemingly ignore the positive role they can play in public health."

Doubling down in their encouragement of eating carbohydrates is not the way to create healthy eating and will encourage more obesity and more diabetes in Great Britain.

Diabetes Forums in and out of Trouble

Yes, diabetes forums come and go. The good ones seem to be able to survive, but they do have ups and downs and many recently have created problems for themselves with the way they have changes their formats.

http://www.dlife.com/diabetes-forum/ This link will take you to dLife, but the forum no longer exists, at least I have not been able to find it. I don't know when the forum disappeared, but it did during 2015. There are many ads on the site and different pages and there are a few good bloggers still writing for the site. On a rating of 0 (lowest) to 10 (highest), I would rate this site as a 2.

http://www.tudiabetes.org/ This site is still very active and has many features appreciated in a diabetes forum website. There are ads, but not an unreasonable amount, but they still can be a distraction. Using the rating system above, I would rate this site a 7.

http://www.diabetesdaily.com/forum/ This site is still very active. It has a decent forum and an excellent blog site. Just beware of not using hyperlinks. Try not to create them accidentally as you will be warned and then on continued use, you will be banned. This is an area where this site has little or no tolerance. It does have a recipe area. David Mendosa does also post a monthly blog on this site. Because of the hyperlink problem, I can only rate this site a 4.

http://www.diabetesforums.com/forum/ Another decent forum, but be careful as they are not too tolerant of links and hyperlinks, but a little bit nicer about letting you know and explaining where you went wrong. I would rate this site a 6.

http://www.diabetesforum.com/forum.php I will be writing a separate blog on this site.

http://www.dailystrength.org/c/Diabetes-Type-2/forum I am not familiar with this site and most members are women. It is not as active as it was years ago, but does have daily activity.

http://forum.americandiabeteswholesale.com/ This is basically a dead forum with only posts of a newsletter that shows in November the most recent post since May 2015. Rating = 0

http://forums.joslin.org/ Another forum that I thought had been pulled, but it was just that my URL had been overwritten. The last post is in January 2016 with the previous post in October 2015. Rating = 0

http://www.diabetesnet.com/forum/forum.php This forum is active, but basically for people on pumps and it is good for that. Unrated.

http://www.diabeticconnect.com/ This site has discussions but no more forums and has mainly participation by people with type 1 diabetes. Type 1 people do need a place and this may fit their needs.

There are other forums, but they are closed to people from the United States and are in other countries. I am surprised by a couple of them as we have many of the people from their country as members in the forums here. Oh, well, such is life.

When Will Doctors Believe in Statin Damage?

Most doctors will continue to insist on prescribing statins, but more and more evidence is coming to light about the damage to our bodies being caused by statins. Increasing numbers of Americans are being prescribed statin drugs to lower their risk of heart attack or stroke. The risks of these drugs to muscles and kidneys may be greater than previously thought.

Statins are also associated with a higher risk of type 2 diabetes and with more rapid deterioration in patients with chronic kidney disease.

Duane Graveline, M.D., M.P.H., and Philip W. Blair, M.D. writing in the spring issue of the Journal of American Physicians and Surgeons say, “The risks of these drugs to muscles and kidneys may be greater than previously thought.” Graveline and Blair calculate that between 2005 and 2011 there may have been nearly 2,000 deaths from rhabdomyolysis due to statins, based on the FDA's MedWatch records.

Authors conclude that statin-associated muscle and kidney damage are both more common and more insidious than generally believed. The "collateral damage is probably higher than most clinicians would consider acceptable." They advocate restricting statin usage until more is known about these effects.

Damage may be occurring even if the patient's CPK levels are normal, authors state. CPK (creatine phosphokinase) is the blood test doctors monitor to check for muscle damage. Although rhabdomyolysis is generally considered to be an acute crisis, there is a chronic progressive form as in the case report in the article.

Some 24 percent of Americans have a gene called SNIPS, which causes blood levels of statins to be much higher than expected, authors warn.

Also read my blog about statins causing hardening of the arteries, which was not reported in this study.

With all the bad news being found in studies lately, it is hoped that doctors will slow their efforts to over prescribe statins, but the American Heart Association is not backing down in their efforts to prescribe statins to more people. They are even pushing for prescribing to people that have normal lipid panels and young people.

Those of us following the research know that people are abandoning statins in greater numbers and won't allow future prescriptions, even if they are labeled non-compliant.

Statins Receive Scrutiny They Deserve

I like what is happening in Great Britain. I can only hope that the United States can learn from them. The Queen's former doctor, Sir Richard Thompson has called for an inquiry into the safety and efficacy of statins. This was after a review into key trials concluded the pills were not effective in protecting against heart disease.

The former president of the Royal College of Physicians and personal doctor to the Queen for 21 years said: “The statin data needs to be urgently scrutinized. We are very worried about it and particularly side-effect data, which seems to have been swept under the carpet. We have to be very wary of the doubts about statins produced by this new research and if we are wrong about widespread prescribing of this drug we have to stand up and say sorry.”

This is very powerful and would be a first for doctors or their organizations to admit something and to say “sorry.” The cholesterol-busting drugs are given to up to 12 million patients in the UK, or around one in four adults.

Supporters, including the British Heart Foundation charity, say they save lives and UK health regulators insist they are safe. Yes, they still do not recognize the more severe side effects and like the American Heart Association will continue to promote statins even when they may be proven wrong. Please read my blog here about statins causing hardening of the arteries, a leading cause of heart problems.

Critics say the risks, such as severe muscle pain, depression, fatigue, impaired memory, and stroke, outweigh the benefits others claim exist. They also claim that much of the data could not be trusted as it relied on trials carried out before 2005/6 when new rules were brought in to make scientific studies more credible. It was later found by independent experts that the studies have no effect on death rates.

Another is the 4S study published 1994, which the new study claims should not be relied on as it was run and analyzed statistically by staff paid by a manufacturer of statins. This “would today be totally unacceptable” said the new report’s lead author Dr Michel De Logeril. His report concluded, “Statins are not effective for cardiovascular prevention”. Dr De Logeril, a cardiologist at the University of Grenoble in France, added: “We cannot trust these trials. I would warn people not to take statins.”

He was backed by eminent London-based cardiologist Dr Aseem Malhotra, who said: “These are truly disturbing findings and fit in with the concept that all industry-sponsored studies should be seen as marketing until proven otherwise.”

Dr Malcolm Kendrick, who has studied heart health extensively agreed. He said: “This review confirms my fears that research on statins is fatally biased.”

Experts have urged anyone with concerns about the use of statins to contact their GP

Moreover, Fiona Godlee, editor of the British Medical Journal, added: “This carefully done piece of work reinforces the need for a thorough review of the evidence base on statins.”

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.