December 10, 2012

Research Posted on The BS101 FB Page Since September

It's time to collect and post all the substantive, research-related posts that have been posted on the Blood Sugar 101 Facebook Page.

As you can see there is the usual mix of disturbing findings about environmental pollutants, bad diet advice, dangerous prescription drugs, mistaken medical policy, and the benefits of lowering blood sugar by cutting back on carbohydrates.

I have put red arrows (==>) next to a few studies that have immediate, serious health implications for people with diabetes.

I continue to be less than thrilled with FB, but since so many people use it I've concluded it is a pretty good way to reach people who would otherwise never find this blog.

Study: After weight loss, Roux-en-Y causes dramatic post-meal blood sugar spikes. Banding makes no difference in blood sugar. Stats argue against either being a "cure" for diabetes, doesn't it.

See this chart:

From this article

Ketones may why calorie restriction leads to life extension. So don't starve yourself, cut back on carbs.

Apparently, free speech extends to drug reps lying about prescription drugs. We're all screwed.

"Countries that use high fructose corn syrup in their food supply have a 20% greater prevalence of type 2 diabetes compared with countries that do not" Study says.
Dangerous concentrations of PCBs are found in many women's blood. They are known to promote diabetes.

You'll find lots of low carb holiday treats including cookies and other desserts here that you can indulge in without spiking your blood sugar.

Flame retardants are hormone disrupters that promote obesity. You can't avoid them if you own upholstered furniture.

What a shocker: The Wash Post notices that drug companies have polluted high impact medical research studies.

A mouse study finds the specific cancer gene that is silenced when dietary carbs are restricted.

PCBs which concentrate in body fat (and therefore in the fat of the meat we eat) not only cause diabetes, they lead to infertility. This is a serious issue for people eating low carb diets, alas. Organic meat may be better, but the pervasiveness of these toxins in our environment makes them difficult to avoid with husbandry practices, as the animals still have to breath polluted air and drink polluted water.

A UK study concludes that screening for diabetes doesn't prevent bad outcomes. No one draws the obvious conclusion--UK treatment for diabetes sucks. Which it does.

BPA slows thyroid in pregnant animals and their offspring.

==> The EU has approved dapagliflozin which will be sold as Forxiga. This drug blocks absorption of glucose in the kidney, so you lower blood sugar by peeing away glucose. The FDA did NOT approve it because of possible liver damage and signals of breast and bladder cancer. Do NOT take this new drug until it has been on the market for at least 5 years and we know a bit more about what it really does.

Arsenic, DDE, dioxin and pesticides all are strongly associated with both diabetes and obesity. It's NOT personal choices damaging our children.

==> FDA committee approved very long lasting basal insulin. But it isn't better than Lantus/Levemir and the 70/30 mix makes it impossible to cover post-meal spikes safely.

More evidence that sulfonylureas are worse for the heart than metformin. There is a well-understood reason why this should be true. They are discussed HERE

Doctors really are biased against fat people. If you thought your doctor was dissing you, it wasn't paranoia.

==> Low vitamin D levels correlate to longevity in this new study. Perhaps because high levels often result in calcium in arteries.

==> If you have heart disease and diabetes don't let a cardiologist rush you into stenting, the way this NEJM editorial explains they will. A major long-term study found coronary artery bypass produces much better results in people with diabetes than stenting.

Another study proves that soy is useless against menopausal symptoms. Since it also promotes autoimmune attack by promoting leaky gut, wise women avoid soy.

The radical weight loss surgeries can lead to significant bone loss.

==> If you have any signs of early diabetic kidney disease Pradaxa could be very dangerous. The FDA is being defensive since it approved it. Doctors are rarely aware of the fine print about who should NOT get a new, heavily marketed drug.

Cochrane Review: Cranberry juice for Urinary Tract Infections is a myth promoted by people funded by the cranberry industry. It's extremely high in sugar and terrible for blood sugar. High blood sugar promotes UTIs.

Losing weight using a low fat/high carb diet that raises blood sugar won't reduce heart disease. Duh. It isn't the weight. Note the supposed experts never ask, "What diet?" But just assume "diet" doesn't work. The "experts" cited are drawing huge sums as they are  on the payroll of drug companies as "consultants" and other weaselly terms meant to hide the fact that they are drug pitchmen.

Ex- top insurance exec (at a company I used to write software for) reveals how insurers deceitfully manipulate data to make it look like people are uninsured by choice.

The Sweetarts sold at drug store and convenience store counters have shrunk. The new nutritional info shows they are no longer 2 grams each. Now they are 1.6 grams. Important to know if you use them to correct lows.

Doctors finally admit that lowering post-meal blood sugars is ALL you need to do to avoid heart attack. But they also want to link it to DPP-4 inhibitors, ignoring the cancer and immune system risks. If you can lower your post-meal blood sugar without these dangerous drugs, do it.{3d16eba1-1568-4b2d-8e92-b516391831f7}/dpp-iv-inhibitors-appear-to-reduce-cv-risk-in-type-2-diabetes-

It took 6.5 years to "decades" before the benefits of tight control became obvious in the landmark diabetes studies. Lowering A1c DOES help. If you wait another decade until ignorant doctors finally admit lowering your A1c 5% range using SAFE technique WILL significantly lower the rates of all complications, it may be too late for you as the higher blood sugars associated with 7% A1cs will have damaged and destroyed your organs.

BD is announcing a new Ultra-Fine needle that is supposedly even thinner than their previous ones. My experience with the short ultra-fines is that they are painless. The new ones should be even better.  Note, however, that contrary to what you may be told, many of us find we can get several days worth of injections from one pen needle before it starts to blunt.

Almost all rice contains the inorganic form of arsenic that’s known to cause bladder, lung and skin cancers. And to destroy pancreas' ability to secrete insulin, too.

November 26, 2012

Food Self-Defense for the Holidays

We people with diabetes have just entered the six week period during which managing what we eat can morph from a daily challenge to an ongoing nightmare, culminating, all too often, in diet disaster.

As anyone who has read my books or web site knows, I'm not a fan of rigid regimentation or obsessive self-denial. I believe very strongly that the key to crafting an effective diabetes diet that you can stick to for decades, not months, is to respect yourself and your emotional needs, build in safety valves, and provide enough variety to avoid burn-out.

But over the past decades the holidays have morphed into a celebration of gluttony, not just of food, but of every kind of consumer good. And those of us who don't believe that the best way to show our love for the people around us is to shower them with gifts and stuff them with sugary, fatty food are labeled "Scrooges" or  accused of promoting economic slowdown that will rob our neighbors of jobs.

Unless you are an independently wealthy, only child orphan who lives in a cave in the wilds of Montana, the chances are you will find yourselves continually assaulted by the messages:  Buy More! Spend More!  Eat more!

So the weeks ahead are a minefield. Because food isn't just food. Food is memories. Food is love. Food is what keeps us safe when things get scary. Food is what keeps us alive and when we are feeling threats to our survival, real or symbolic, food is the easiest way to fight them off. It's legal. It's cheap. It's everywhere.

If we didn't have a medical condition where eating certain foods raised our blood sugar in ways that will, over time, clog up our arteries, damage our kidneys, shut down our retinas, and destroy our nerves, the food we are faced with during holidays might leave us a few pounds heavier, but all in all the holiday eating would really be no big deal.

But for people with diabetes the case is very different. Because if we get out of control with our food for a month or longer, we kick off physiological changes that can make us ravenously hungry and lead to months and even years of eating the foods that will ruin our organs.

So while a day here and there of unrestrained eating won't kill us, people with diabetes cannot let those days turn into weeks. And to do this they must NOT rely on the dieter's worst friend, that questionable  facility known as,"Will power," but on the known and tested strategies that help us get through weeks of food temptations without having to rely on it.

So without further ado, I list below the techniques you can adopt to keep yourself from going off the rails at this most dangerous time of the year.

1. If It Isn't There, You Can't Eat It. We're talking about the food you bring home. If there is something you are really craving, eat a portion at a restaurant or a friend's house--watching portion size, but don't bring a big box or bag of it home.  If the food isn't in the house no matter how much it calls out to you, you can't eat it. It's as simple as that. Meanwhile, stock up on delicious foods that you can eat.

If you have to bring something dangerous home because you have to serve it to others, keep it out of sight. I have learned the hard way that anything left out on the counter will beg me to eat it every time I enter the kitchen. Put things you don't want to have tempt you in the closet or in the back of the fridge where you can't see them.

2. Ask Friends or Loved Ones For Help With Food. If you have a good relationship with people likely to give you food gifts or invite you to dinner and/or parties, explain--briefly--that foods filled with carbohydrates raise your blood sugar and suggest some alternatives that would be a treat for you at the holidays so that, for example, they can show their fondness for you by offering your a delicious platter of low carb imported cheeses, or sausages, or nuts, that will not raise your blood sugar instead of a brandied cake or sugar cookies that will put you into a hyperglycemic fog.

If someone screws up and with the best of intentions gives you something toxic to your diet, like a box of high carb, maltitol-laden "sugar free" cookies, thank them, eat one in their presence to signify that you appreciate their thoughtfulness and throw the rest  away when you get home. Later, at some less emotionally-fraught time you can explain to the giver that "sugar free" products are actually full of hidden sugar that raise people's blood sugar. But don't do it when you are presented with the gift unless you want to make the giver feel bad.

If you are given something that was a huge treat before your diagnosis and can't face throwing it out, ask a family member to hide it away and dole out appropriate portions on a schedule you give them in advance. I have been known to ask My Sweetie put certain much-loved candies in his safe (to which I don't have the combination) because I know what will happen if they are too accessible, but still want to eat a small serving now and then throughout the holiday season.

3. Bring Your Own Food to Events Where You Might Not Have Safe Choices. Fortunately many events nowadays are potlucks, so you can bring a rotisserie chicken to the family gathering or a hunk of cheese to the office party if you are eating a strict low carb diet. Salads with nuts, seeds, and mixed greens are another safe option. If you bake low carb cookies or bars, make a plate of them, labeled so people will know what they are--and avoid them if they don't like artificial sweeteners, leaving more for you.

Search online to find low carb options now, so that when you are faced with the need to prepare or bring low carb treats you will have some at your disposal.

If you have to go to a formal event where there are no safe options, it can be harder to bring your own food as doing so might make a poor impression on your hosts or other attendees. Eating at home before you go can be helpful here. There should be something you can eat just about anywhere, and worst case, if you have to eat a token portion of something for politeness sake having eaten earlier will keep you from going overboard.

4. Plan for Indulgences. This is where the safety valve strategy comes in. Decide what is an appropriate level of off-plan eating for the next few weeks and schedule what you will eat in advance, concentrating on things you will really enjoy.

If your diabetes diet is very new, and you haven't learned how to get back on plan after going off plan, you will want to be very conservative. One or two portions may be all you can tolerate this year, but you can limit yourself with the thought that in a year when your new diet has become habitual you can loosen up some.

If you have learned how to get back on track after going off your diet, you can be a bit more relaxed, but make sure that you do go back on your diet when you have planned to.

5. Test, Test, Test! When you go off plan, test your blood sugar 1 and 2 hours after eating, to reinforce your understanding of why you are on your diet in the first place. The point isn't to scare yourself--one day of high blood sugars a week isn't going to make you go blind. But daily exposure to blood sugars that spend many hours over 140 mg/dl will, over time, damage your organs in ways that may be irreversible. Testing after eating keeps a lot of us honest, and I highly recommend it this time of year.

6. Learn How to Get Back On Track. If we have had our blood sugar under control, eating a lot of carbs can catapult us back into a state of rabid hunger, which is the main reason many people believe (erroneously) that they are "addicted" to carbs and that a single bite of high carb food will send them into an unrecoverable tailspin.

I have written about this at length HERE. Read this page BEFORE you contend with holiday treats. Learning how to recover from a high carb, blood sugar spike-fest is the single most useful skill many people with diabetes will ever learn, and the one that will make it possible for them to maintain their blood sugar control for the decades of healthy life they deserve to live after a diabetes diagnosis.

If you've been doing a good job controlling your blood sugar, let us know what you do to to get through the holiday eating extravaganza by posting in the comment section below.

November 4, 2012

Over the Next Weeks I'll Be Updating the Main Blood Sugar 101 Web Site

I haven't been posting much on this blog as I've been very busy with other things over the past few months. Now that I have a bit more time, I am going to be looking over the various pages on the main Blood Sugar 101 web site and bringing them up to date.

I post all significant changes to the main web site on the Changes to Blood Sugar 101 blog, which makes it easy to keep up with them.

If you have any ideas about how to improve the main web site, or any topics you feel should get more coverage, please mention them in a comment on this post. However, keep in mind that there are already over 100,000 words posted on this site and its blog so the challenge with this web site is to keep it from becoming so overwhelming that the people who come to it for the first time don't miss the important information I'd like them to take away from it.

The focus needs to remain on explaining to people what blood sugar levels are normal, what levels cause diabetic complications, and what strategies safely lower blood sugar and prevent complications.

My web stats show me what pages on the site people actually visit, and for now, it is the pages that stick to that core mission that receive the heaviest traffic. The rest of the site, as fascinating as it might be, rarely gets visited. So the only changes I'm really interested in making are those that will make the pages that convey this vital information even more useful.

October 12, 2012

Final Update: My Experimental Diet

I continued eating a very low carb, very low calorie, gluten-free diet that matched the parameters set by my nutritional calculator though last Sunday, but I waited to report on the outcome until my glycogen had refilled. That would make clearer what the real impact of the diet had been.

I also went to the lab last Thursday as it was time for my semiannual visit to the endo, which gave me more insight into what changes the diet had made in my health.

Nutritional Breakdown

Here is what I ate during the second week of my diet. As you can see it was only slightly higher than the intake the previous week. Salt was well controlled and protein was slightly higher than recommended for someone on a long term low carb diet, but lower than that for someone not at all adapted to ketosis*:  

Impact on Weight

I had set my calories at the brutally low level that the nutritional calculator predicted should yield a weight loss of 1 lb a week. The level was low because I am old and short, and because I started out at a normal weight. Since it only takes about 1,560 calories to maintain my current weight, the nutritional theories I lay out in my Diet 101 book, which are embodied in the calculator, predict I would have to eat no more than 1,060 calories a day for a week to lose a pound of real fat.

Before starting the diet my weight had been hovering around 146.5 lbs, however, it was 148 lbs the day I started the diet thanks to the very salty Vietnamese lunch I'd had the day before with it's miso-based soup and soy-sauce based sauce. I always gain 2 or 3 lbs after eating a soy-sauce laden meal.

My weight on Monday morning after 2 weeks on my diet was 141.2.  This was a loss of scale weight of 6.8 pounds, but because I was eating less than 20 grams of carbs all week, I knew that a good 3 lbs or more of my weight loss was due to the loss of glycogen, which is the substance our body uses to store glucose in both our livers and our muscles. (Details about glycogen-related weight loss HERE.)

I had stopped taking my metformin in the middle of the first week as metformin does interesting things to glycogen and I wanted my diet trial to be cleaner. So after 10 days without metformin and 14 without carbs, I figured I'd probably flushed out as much glycogen as I was going to lose. In the past that was usually about 3 lbs.

Since glycogen comes back as soon as you raise your carbs I expected to see the 3 lbs come back within a few days after ending my diet and raising my carbs back to their usual level which is around 100 g a day.

I also expected that some of my weight loss was due to the fact that since I was eating so little to meet my caloric goal there was less weight of food in my stomach and gut. That too would come back.

Since this past Monday, I have started using metformin again and eating about 100 grams of carbs a day, while eating a maintenance diet. My glycogen is probably as refilled as it's going to get.  My weight this morning was 144.6. This is almost exactly 2 lbs less than my average weight during the weeks before I started the diet.

This confirms that my nutritional calculator does a good job of predicting weight loss and, most importantly, that there is no "metabolic advantage" for me in eating a very low carb diet. I did not lose any more weight than would be predicted by caloric deficit.

Had I been in a study, however, my specious loss of 6.8 lbs might have made it look like there was an advantage to eating a very low carb diet since low fat diets don't always flush out glycogen and the food may weigh more.

Unfortunately, it looks like, as usual, the weight came off my face and neck which look more wrinkly and stringy than usual. My tummy, which is the only place I carry significant amounts of subcutaneous fat, doesn't seem any smaller.  The Tanita readings are fluctuating so much that I'll have to wait another week or so to see if they show any substantive loss of body fat percentage.

Blood Pressure

My two week diet was designed to be low in salt, because it is too easy to eat a lot of salt while eating a classic LC diet and I have issues with my blood pressure. I bought low salt cold cuts without preservatives at Trader Joe's and stuck with cheeses that were lower in salt, too. No pork rinds or other salty low carb snacks!

My blood pressure was all over the place during my diet, high and normal an then high again.  When I started to cautiously supplement with potassium chloride (in the form of Morton's Not Salt) it dropped to completely normal and stayed that way for the last few days of the diet.

I was supplementing with the potassium because I get leg cramps and palpitations when I eat very low carb without potassium. This is because flushing out glycogen also triggers a loss of potassium. (This loss is measured in some studies as a rough gauge of how much glycogen has been lost.)

My lab results from last Wednesday when my blood pressure was 122/73 showed that my blood sodium level was at the very bottom of the normal range and potassium was in the middle of the normal range. This was reassuring, as I had a concern that the Captopril I take might cause my potassium levels to rise too high. I was not dehydrated, based on my normal BUN. In the past when eating LC I have almost always had a high BUN. Controlling protein might have helped there as did the potassium.

When I ended my diet and went back to eating normally, my blood pressure soared. As a further experiment I went back to supplementing with potassium, thanks to the suggestion one of you sent me, and today my blood pressure is back to being normal, at 114/74, as opposed to the 151/92 it was three days ago.

Since I had a lot of trouble with very high blood pressure while eating a very low carb diet in the past--the exact opposite of what the LC gurus claim happens--I'm starting to think that BP for me is all about those potassium levels. Low carb diets can be very high in sodium and potassium deficient, and that may be why I had so much trouble with blood pressure eating a long-term low carb diet.

Blood Sugar

My blood sugars had continued to be beautiful--in the 70s and low 80s at all times. So it was daunting to discover that the lab said my blood sugar was 92 mg/dl when my meter said it was 83 mg/dl. This means that the FreeStyle Lite meter that my insurer forces me to use reads low.  So it's probable that  my 70s were really 80s and 80s were 90s. It also means my occasional 140s were probably really 150s.

My A1c was 5.5%, which is .2% lower than usual. Some of the drop is due to the low carbing I'd done during the previous 2 weeks. Though doctors think that the A1c reflects the control of the last 3 months, this is not entirely true. The A1c  most strongly reflects the blood sugar control during the previous 2 weeks, with the rest of the past experience only making a smaller contribution.

My A1cs are always higher than predicted by my average meter readings, and this one is no different. I attribute this to the likelihood that my red blood cells are living longer than average which will raise how much glucose has become bonded to them. It is that, not actual blood sugar levels, that the A1c measures.

Mood and Energy

By the end of my diet I felt like absolute crap. I wasn't sleeping well and was having the vibrant dreams that happen early on in a ketogenic diet, but there was no sign of the energy burst I usually experience at that phase of an low carb diet.  This may be a result of how low my calories had to be for me to lose weight. 

Whatever the explanation, I felt exhausted and depressed, and just walking around was a challenge. As soon as my diet was complete and I raised my carbs back to their usual level I felt like my old self with much better energy.

I was very hungry throughout the last week, too, even though my fat intake was reasonably high and my blood sugars completely flat. 

Because my blood sugars are very well controlled right now I did not get into binging once I stopped my diet and started eating carbs again. In fact, I had a couple days when I was very busy with a new project over the past few days where I didn't end up eating all that much. This verified my belief that, for me, when I am eating carbs, hunger is entirely about how high my blood sugars surge. Right now they aren't surging very high even when I eat 20-30 g of carbs per meal, so I'm not experiencing blood sugar-caused hunger.

In the past eating a very low carb diet for a few weeks has given me decent energy and no hunger, but I wasn't limiting calories. However, throughout the past 5 years when I've done a very low carb diet not counting calories, I haven't lost an ounce of real weight.

Miscellaneous Observations

I ended up having a lot of heartburn on this diet. Peanut butter and Greek yogurt both caused it. Cheese did not (ruling out that I'm sensitive to dairy, per se.) When I went back to eating gluten at the end of the diet I did not experience heartburn. There doesn't seem to be any reason for me to go gluten free. 


Calories count. My nutritional calculator is pretty accurate.  It is extremely hard to find low carb foods that meet the caloric target I have to hit to lose weight without boosting protein too high.

This diet confirmed that for me to lose any weight at my age (64) and size (5' 3 and 144 lbs) I'd have to eat no more than 1250 calories a day to lose 2 lbs a month, even on a low carb diet, which for me would be an unsustainable starvation diet.

So my conclusion is that my weight loss diet days are over and that now that I'm heading into my misnamed "golden years" I better get used to carrying a bit more weight because the alternative is a starvation lifestyle.

Fortunately, there is a solid body of research suggesting that the healthiest weight for people my age and older skews towards the "overweight" category (BMI of 25 and a bit higher).

What this may mean for you is that the time to lose weight is when you are in your 30s, 40s, and 50s, when you burn more calories just breathing and walking around. Our metabolic rate drops with each decade we survive--even with exercise--so it gets tougher to lose weight as we get older.

Low carb diets are very effective for people with a lot of weight to lose whose caloric needs are much higher, but their main advantage in respect to weight loss is that when people cut out carbs they cut out all the high caloric junk that is what caused them to gain weight in the first place.  If you control protein it becomes much tougher to overeat on a low carb diet, too.

The true virtue of low carb diets is, of course, that they control blood sugar very well. If my current blood sugar-control regimen stops working, I know that cutting back on carbs will drop my blood sugar (as long as I have functional beta cells, which fortunately, seems to be the case.)


NOTE: In response to a point brought up in one of the comments it's worth noting that after Thanksgiving I did 10 days of a classic "Don't count anything but carbs" diet. In contrast to what happened with the calorie controlled low carb diet described above, I lost a grand total of 2 lbs during the "all you can eat" LC diet which came back when I raised carbs out of the ketogenic range. I was spilling urinary ketones from day 3 to day 10. Blood sugar and blood pressure were normal on that diet (after a rocky first few days for the blood pressure, again) but as has been the case for me for the past 5 years, a ketogenic  low carb diet without caloric restriction is worthless for weight loss.
* I used the body fat percentage my Tanita scale provides when using the calculator to estimate intake. If I omitted the body fat percentage, the calculator would tell me that I would have to eat a starvation diet to lose 1 lb a week, which it won't provide numbers for.

October 1, 2012

More Adventures in Very Low Carb Dieting

So this morning begins the second week of my very low carb diet experiment. Here's what LifeForm has to say about what I ate.

Sodium: 1568 mg
Vitamin A: 112%
Vitamin C: 95%
Calcium 83%
Iron 27%

Since I only ate one meal away from home, I was able to weigh all my portions and use label information.

The low iron is fine. Too much iron is a problem for many of us with diabetes and many older people. Since I dumped my cast iron cooking pan, when tested mine is always normal. If it dropped, the cast iron pan would quickly solve that problem.

My weight this morning was 142.4. lbs

My average fasting weight for the past week was 144.0

This average doesn't include my morning weight the day that I started the diet.

This represents a loss of 2.3 lbs since the morning after my first full day of dieting. (I did not use my starting weight as it was artificially high thanks to having eaten a very salty meal the previous day.)

Boring Food Does Make It Easier to Diet

As I mentioned in an earlier post, I have been home-testing Stephan Guyenet's palatability thesis. So far it looks like he may have a point. One huge benefit of eating almost the same food every day and doing no cooking fancier than frying up an egg or baking a chicken is that it cuts way down on thinking about food.

A few days ago I stopped in to visit one of the active low carb forums (one that banned me a few years ago, most likely for telling the truth about the bogus "low carb" crap the site owner sells.)  The main thing that struck me was how obsessed with food all the posts were. Everyone was posting recipes, many of them extremely high in calories, and often they were for cakes, desserts, and candy-like treats. Just reading the site made me start craving food.


The rest of the time when I knew exactly what I was going to be eating I did not think about food until it was time to eat my [tiny] meal. No way was I going to be slavering thinking about eggs with cheese for breakfast, salad with meat and cheese for lunch, yogurt with sunflower seeds for dinner.

Thinking about food may in fact get the brain secreting hormones that change our metabolism in ways that fight weight loss.

Take Away Lesson: Though variety is essential for maintaining a low carb lifestyle, and also likely to be very important for sustaining a successful diet phase, it might be a very good strategy to eat one set group of foods each week and only research (and shop) for the next week's foods during a short period of time. Look at the recipe sites and cookbooks before you start your weight loss diet--or while you are maintaining.

More Thoughts on Glycogen

When I started this experiment I was taking 1000 mg of metformin every day. I had to stop taking it mid-week because my blood sugars were so low that I didn't need even the small lowering that metformin produces. 

After the first day's loss--which was likely mostly salt from that Vietnamese lunch, I didn't lose anything for about 4 days, then I dropped another couple pounds. I have often observed that metformin blocks the early loss of glycogen that occurs when I eat a ketogenic diet. My guess is that stopping the metformin allowed me to lose more glycogen.

I'm starting to think that metformin somehow "locks" the liver glycogen which is why it can be so helpful in lowering fasting glucose. But it also means you can't lose glycogen when you are in a ketogenic state. Since that stored glycogen isn't accessible when you take metformin, this isn't an issue, but it can make for odd patterns of weight loss.

In any event, as gratifying as the number on the scale my be most of the weight loss is glycogen and will come back when I eat more than 70 grams of glucose (my own personal ketogenic threshhold. Many people's are higher because they are larger than me.)  I maintain around 100 g a day, so I won't really know how much fat I lost for a while.

NOTE: If you don't understand what glycogen is and the role it plays in weight loss this topic is covered extensively in my book Diet 101: The Truth About Low Carb Diets.  You'll find a brief summary online HERE.


I was turning ketone strips pink all the time, mostly "small", with one "moderate" and one "light" reading. Interestingly the "light" reading occurred when I was feeling really hungry and before a drop in scale weight. Perhaps that is a sign I was burning newly freed-up glycogen as the metformin wore off.


I had long periods when I wasn't hungry, but noticed that I did get hungry--often very hungry--in the evening 4 or 5 hours after my last meal. (No snacks on this diet!) I resorted to the "Two Gram Cure" and it worked. When I tested my blood sugar at these hungry time it was usually in the 70s. 

This confirms my belief that for me, at least, it is blood sugar level that causes hunger.


Since my blood sugar normalized on the Coenzyme Q10 I have been eating quite a lot of wheat. I went completely grain free this week, but so far I can't say that I noticed any of the magical changes claimed for going wheat or gluten free.

I don't have any of the kinds of antibodies associated with gluten allergy nor do I have any history or family history of autoimmune disease, so this is predictable. I still had some heart burn, mostly because yogurt causes me to have heart burn.

Blood Pressure

It's up, sadly. This often happens when I eat a very low carb diet, contrary to the "one-size-fits-all" claims of those who make millions selling diet hope. After one day when it dropped, it went right back up and was alarmingly high another morning, though responsive to medication (captopril). Some of this may have to do with it getting cold here on our windy hilltop and my refusing to turn on the heat (expensive oil) while the calendar read "September." Cold will raise blood pressure, but probably not as much as mine is rising.

Blood Sugar

Fasting this morning was 83 mg/dl, again suggesting that the metformin is wearing off. Post meals it is dropping into the 70s. For the last thee mornings my fastings were in the 70s. 

Energy Level

Not great, in fact, I've been really droopy much of the time. I have had some trouble sleeping and I have been having those very vibrant dreams that often come with ketosis. 

Plans for This Week

I'm going to stay in ketosis this week but raise my calories to 1250 as I don't think starvation diets are smart. The extra calories will be fat. Not having me eat with him is a stress for my Sweetie, who, as men are prone to do, has lost more weight simply because he is having to get his own meals and we aren't doing any social eating, than I am eating like an anorectic bird.

I'm remembering the social toll that is taken by not making meals a major part of socializing. I will be glad to get back to my usual regimen, hopefully having eliminated the carb creep that happened over this past summer. I'd like to stay maintaining at my usual 100-110 g a day level and 1600 calories a day (which is a tad higher than what the calculator says I should eat, but is what I can eat without feeling like I'm starving myself.)


September 28, 2012

Walking the Low Carb Walk

After participating in the low carb call-in show and hearing from so many dieters there and in the email the show provoked, I started thinking it might be interesting to do a stint of very low carb dieting myself, just to see if I noticed anything new, now that I've done so much research.

Though I ate a very strict low carb diet for many years, I have been eating under 110 grams a day since 2009, largely because the medication choices I'd made have made it possible to keep my blood sugars in better control at that level than at a lower one.

The last time I ate a ketogenic low carb diet was for about 5 months in 2008. Over that time  my fasting blood sugar rose and I didn't lose any weight that didn't come right back when I boosted my carbs.

That was fine: I was eating that way to prepare for some surgery and promote healing afterwards, and since I healed up very quickly, it seemed to help. But once I was healed up, I decided there was no real point in eating a ketogenic diet since my main focus is on blood sugar control 

Things are quite different now. My blood sugar is better than it has ever been, thanks to my very unusual response to a low dose of Coenzyme Q10. (I am currently exploring what might explain this and have called on an expert in oddball forms of diabetes to help me with this. I'll report on it if I learn anything that will be useful to others with odd forms of insulin-sensitive diabetes.)

But because I've been able to eat much more widely than I had been able to, even with insulin, I have been eating a lot these past few months, and though my scale weight was only up 2-3 lbs, my pants informed me that I had a choice: cut back a bit, or buy new pants. That's the kind of message I take seriously, so this past Monday I embarked on a new very low carb diet.

What Was Different This Time?

One thing that was different this time is that the work I did last year to upgrade my nutritional calculator using the most up-to-date formulas and taking into account body fat percentage yielded me more information about what it would take for me to lose weight. That meant that unless I wanted to diet for the next 6 months, losing the 3 real pounds I'd set as a weight goal meant cutting way back on calories to a level that ruled out any "luxuriant eating."

I decided to see what would happen if during the first week I ate following the guidelines that the calculator set for losing 1 lb a week. I used my bodyfat percentage as estimated by my Tanita scale, which gave me a slightly higher caloric intake than the calculator gives me when I omite body weight percentage. (That's because I truly do have a "large build" with very big leg muscles for a women--so big that even when I weighed 110 lbs I couldn't fit into those fashionable Frye Boots that everyone wore in the 1970s.)

The calculator told me that I could lose a pound a week eating roughly 1050 calories a day.

How Much Protein To Eat?

This posed one problem--was I to calculate how much protein I should eat based on the formula used for experienced low carbers, or should I use the formula for beginners that assumes that I would need a lot of extra protein to provide glucose to run my brain until it switched over to burning ketones?

At this low a calorie level, eating the extra protein would make it impossible to eat a safe low carb diet, because protein would use up all my calories leaving my fat intake dangerously low.

I decided to experiment and see if my body remembered how to burn ketones after my 7+ years of low carbing in the past and stick with a protein intake that while higher than my requirements while in a fully ketotic state was a lot lower than the amount needed for a newbie.

That seems to have been a good call. I'm on Day 5 and have been in Ketosis every time I have tested since Day 3 (based on testing with urine testing strips) except once after I ate some protein powder that seems to have had more carbs in it than the label claimed.

I haven't had any headache or other symptoms that come from adjusting to burning ketones. So apparently there is no need to eat any more than the amount of protein a long-term low carber would need.

How Much Glycogen-Associated and Water Weight Loss? 

I lost 3.5 lbs within 24 hours of starting my diet. This suggests that much of my most recent weight gain was water weight, possibly from eating too much salty food. That is too short a time for me to have burned through three pounds worth of stored glycogen.

Since I have been taking metformin for years, I probably don't have a lot of stored glycogen left to burn. My experience in the past while low carbing while taking metformin is that I don't lose glycogen-related water weight. However, if I stop taking metformin, I regain what looks a lot like glycogen-related weight for the next week.

How Much Real Weight Loss? 

After that first day's loss, I haven't lost any more weight. I weighed the same this morning as I did Tuesday morning. However, I don't really expect to see real weight loss occuring that quickly, since even if I am eating at a level that will result in a pound of real weight loss over a week after 4 days I would have only lost slightly more than .5 lbs, which is an amount easily hidden by salt-related fluctuations.

How's My Blood Sugar Reacting? 

My fasting blood sugar was 91 mg/dl the morning before I started my diet. It dropped to 85 the next day and was 84 any time I tested it until this morning when I woke up at 76. An hour after lunch today it was again 76. 

When I felt hungry, I used my 2 gram cure and it worked. I used it five times over the past 4 days, but never more than once within a 3 hour period.

What is the Impact on My Blood Pressure?

My blood pressure had risen the past two weeks, as it always does when the house chills down (I refuse to run the heat until October, but having adapted to 73 F  all summer the mornings we experience that are  64-65 F takes some getting used to.)

My blood pressure dropped remained high on Day 1 and 2, then dropped quite dramatically, to normal on Day 3 and morning on Day 4. Then in the afternoon of Day 4 it shot up very high (163/89) after I experienced a burst of stress hormones. It was normal again on the morning of Day 5 (123/76).

I think the stress hormones were the result of either blood sugar or blood pressure dropping too low, generating a counterregulatory burst.

In the past when I ate LC I had several dramatic stints of very high blood pressure, contrary to what you read in the bestselling books. I will keep a closer watch on both sugars and BP to avoid the stress release as it feels rotten and takes 3 hours to abate.

What Am I Eating?

Not much! 1050 calories is such a low calorie intake that it's tricky getting enough protein without going overboard on the fat. All the usual low carb diet tricks that make low carbing enjoyable and sustainable are out. Bacon and cream cheese have too much fat for the protein they contribute. So I am pretty much testing Stephen Guyenet's theory that eating boring food helps us lose weight. 

I'm using my food scale to weigh everything, and learning how fast those calories pile up. I'm also seeing how many of my "go to" low carb foods that I eat when I'm not trying to lose weight push my calorie intake way up--like the low carb cocoa I make with half and half or the bits of cheese I put in my salads.

That said, since with the exception of my experiment with the protein powder my blood sugars have been rock solid flat, I haven't been hungry except, sometimes, an hour or so after eating and about 9 P. After eating is when I've used the 2 gram cure.  I'm thinking I probably ought to eat my last meal a bit later (I tend to eat dinner between 5:30 and 6 PM.) That might keep me from getting hungry right before I'm ready for sleep.

The foods I've been mainly eating are:

1 soup bowl full of romaine and/or baby spinach every day

1 small campari tomato

1 slice of fresh red pepper
home made olive oil and vinegar dressing with herbs
havarti cheese with dill in salad (from Trader Joe's)

1 egg with 1 oz munester or havarti cheese for breakfast

Protein shakes made with 1 scoop of protein

Supermarket rotisserie chicken ("all natural")

Trader Joe's uncured low salt pastrami

I was out one afternoon and ate pulled pork and saag paneer from the Whole Foods buffet.

Fage Greek yogurt, both 0% and 2% fat (since that was what was in the fridge.) I'm not having any trouble getting my fat up to target, so it will be 0% tonight

1 tbs of unsalted roasted sunflower seeds with the yogurt

Davinci White Chocolate Sugar Free Syrup with Splenda for sweetening cocoa and yogurt

Homemade low carb cocoa (Hershey's cocoa, Davinci syrup, and half and half)

decaf tea

decaf coffee 2 cups a day. I'm not avoiding caffeine for diet reasons, but caffeinated coffee
pushes up my blood pressure so I am not currently drinking it.

NOTE: The Six Star brand Vanilla Cream Protein Powder I bought at Walmart tasted revolting and raised my blood sugar. It took 20 minutes for the aftertaste to go away.
Highly NOT recommended.

Nutritional Breakdown

LifeForm tells me that my average daily intake for 5 days (including tonight's dinner) has been 1045 calories.

Fat: 63 g, 58%
  Sat fat: 28 g, 26%

Carbs: 22 g
  Fiber: 3 g (I am also taking a spoonful of no-sugar psyillium ever day)
  Sugars: 14 g (this includes the sugar in the yogurt which I believe has been fermented

Protein: 81 g 34% (My requirement to supply my brain after adapting to ketosis is only 63 g but I wanted some slack to avoid consuming muscle if I was wrong about the
   retained ability to adapt.)

I'm not sure if this is interesting to anyone but me, so let me know if you want to hear more in the comments, where I'll also be happy to answer questions.

September 22, 2012

My Live Call-In Show with Jimmy Moore is Now a Podcast

You can now hear my latest interview with Jimmy Moore as a podcast. Find it HERE or download it on iTunes.

The topic was "Overcoming Low Carb Problems." Not surprisingly, most of the questions were about not losing weight.

As most of you know my take on the Low Carb diet is that it is an effective way to lower blood sugar. Flattening blood sugar makes us lose the raging hunger that makes so many people with diabetes and prediabetes overeat and gain. So when most people normalize their blood sugar and stop eating the high carb, high calorie junk foods that they used to rely on, they lose weight. Often a significant amount. For a while.

The data I've reviewed, and my years of participating in online diet discussion groups have convinced me that normal weight loss on a low carb diet goes through three phases. A quick weight loss phase where as much as 20 lbs can be lost within weeks--all glycogen, and not body fat, a slower phase lasting up to 6 months when weight comes off at a reasonable pace (a pound a week, for example) and the final phase where weight loss slows to the point where many people can't detect it, get discouraged and quit, though in fact if they stick to the diet they'll lose 1/2 a pound or a pound a month for quite a while longer.

Some people have better results, but since these are the average, for everyone who does better, someone does worse. This isn't because they're doing it wrong--though the doctors who profit mightily from selling magical diet dreams often use that as the explanation for why their magical diets fail real people. These conclusions are supported by lots of academic research and the testimony of decades' worth of online dieters, including that of the small group of people honest enough to admit that their diets haven't lived up to their hopes even when they've pursued them religiously.

Many people have a false idea of how their weight loss should proceed on a low carb diet because the online Low Carb and Paleo cultures are dominated by young, fit men, and doctors whose only experience of weight loss is knocking off 10 or 20 pounds in middle age. You rarely hear the voices of older women and those with serious metabolic problems. (Jimmy is a refreshing exception to this rule, but he's also an outlier. Very few people lose 200 lbs their first year on this or any other diet.)

So newbie dieters in the latter categories often assume that they will experience the same results as these vocal, young, healthy proponents of the diet who can lose steadily eating 2500 calories worth of delicious high fat food every day. But this ignores the fact that a 220 lb 35 year old man with a healthy metabolism may easily be able to lose weight while eating twice as much food as a 200 lb 55 year old woman. No matter how often that woman goes to the gym or how low her carb intake.

That's why many of the questions on this call in show were from older women and people with metabolic issues who thought there was something wrong with them when they couldn't lose on the kind of regimen that works for the outspoken, young, male proponents of these diets.

There isn't. For most older women with serious weight problems, losing weight means cutting way down on calories no matter what the macronutrient composition of their meals, and even then, weight loss will be slow--half a pound a month is not unusual after the first five or six months. Cutting carbs eliminates the appetite problem that make it so tough to cut back on food, but cutting carbs without cutting calories only works during the heady first few weeks and months of the diet. After that, it's time to get out the food scale, weigh portions, look up the nutritional value of what's on your plate, figure out how much your body burns daily, and eat significantly less than that amount every day for months and perhaps years to come.

This argument explains why my book Diet 101: The Truth About Low Carb Diets isn't a runaway bestseller.  But it also explains why it's getting rave reviews on Amazon from people who say things like, "No BS here, folks" and " It was almost shocking to read a book that was completely honest on this subject -- no pie in the sky promises, just realistic statements and expectations supported by fact."

Another issue I discuss in response to questions on this live show was something the diet and weight loss surgery do their best to keep you from learning: most people never get to their diet goals, even when they amputate their stomachs and make it impossible to eat anything but an ultra low carb/low food diet.

I dug in and looked at some stats from WLS studies and found that a surprising number of people did not lose more than 50% of their excess weight even on these extreme regimens that force people to eat low carb. At best, most people lose 80% of their excess weight. If that's the best people can do on a forced ultra low carb/low food diet, it makes sense that a free range low carb diet is not going to get most people to their weight loss goal--because most people's weight loss goals, when they start out very overweight, are simply not realistic.

My own experience with polling the Low Carb community is that while there are some lucky people who do get to their goals, they are few in number. Most people lose 20% of their starting and then weight loss slows way, way down. If they stick to it, some can lose more, but if they push too hard, some end up with weight losses that can only be maintained by staying on a very rigid, low calorie diet for the rest of their lives. It's much harder to maintain on that kind of stringent regimen than it is on one that lets you feel like you're eating a reasonable amount of food.

That's why I often advise people to lose what you can lose without starving yourself, then work on maintaining that loss. Appreciate your victories. If you've normalized your blood sugar you won't end up with diabetic complications, even if you still weigh more than you'd like. Focus on maintaining what you have lost, however much it is. Maintaining a modest weight loss for a decade or more is a huge achievement--far healthier, harder, and more impressive than losing a lot of weight and regaining it all five years after your weight loss effort began.

All this is discussed in this podcast, but if you want to go into any of these topics in depth, I'd suggest reading my book, Diet 101: The Truth About Low Carb Diets. If you only get the simplified, pre-chewed version of diet advice that fits onto a web page or an interview, you will never learn all you need to know to truly understand your metabolism. We live in a society that caters to those who are too lazy to dig in, read, study and think. But it is by doing just that that you'll put yourself in a situation where you won't have to ask any expert or rely on their advice no matter how wierd, because you'll have the tools needed to evaluate all claims and chose the health strategies most likely to work for you in your own, individual circumstances.

September 13, 2012

Research Cited on the Blood Sugar 101 FaceBook Page

It's been a while since I posted the list of the links to news stories I've cited on the Blood Sugar 101 FaceBook page, so here they are. I've organized them by general topic.

Causes of Diabetes and Obesity
Gut Bacteria: Fish study illuminates how gut bacteria associated with obesity might promote it. The bacteria, also found associated with obesity in humans increases the absorption of dietary fat. i
Storing higher amounts of fat in the pancreas may explain high rate of diabetes in Hispanics. Insulin deficiency--as is so often the case--is the problem in the Latinos studies here, not insulin resistance.

PFOAs: "Increasing PFOA levels were associated with CVD [heart disease] and PAD [peripheral artery disease], independent of various confounders (ie, age, sex, race, smoking status, BMI, diabetes, hypertension and serum cholesterol levels)." " PFOAs are found in furniture (fire retardants), surfactants, lubricants, polishes, paper and textile coatings, and food packaging.

This is the kind of problem that should be addressed by politicians because as individuals we can't protect ourselves from these dangerous chemicals. (I mentioned the research about PFOAs in Diet 101 since it is one of the known pollutants that contribute to insulin resistance.)
More evidence that environmental chemicals are causing obesity in very young children.  Chemical exposure in the womb from household items may contribute to obesity

Phthalates: Phthalates cause both obesity and diabetes. They are in just about everything we buy.  CBS News reports:

"For the investigation, scientists randomly purchased and tested 20 back-to-school items from New York City dollar stores and other retailers. They found Disney's Dora the Explorer Backpack contained phthalate levels over 69 times higher than the allowable federal limit for toys. The Amazing Spiderman Lunchbox contained 27 times the federal limit, while the Disney Princess Lunchbox exceeded the toy limit by 29 times. Children's rain coats, rain boots and 3-ring binders also were found to contain the toxins."

How much of this toxic chemical did you bring back from your last shopping trip?
BPA: Urine levels of this plastic in humans correlate with the presence of narrowed arteries.;jsessionid=BEB6D6767CE1D9A15175A02A7A796E6A

Explained here:
Inflammation: Neutrophils (a kind of white blood cell whose job is to attack bacteria) raise insulin resistance: this may provide insight into the connection between inflammation and IR.  Rather than just suppressing them, though, we need to ask what is provoking the inflammation.

Gum Disease: A huge epidemiological study (NHANES) links gum disease with insulin resistance. The link is likely causative--the inflammation from gum disease increases insulin resistance and raises blood sugar. Eliminating gum disease can often lower blood sugar. But lowering blood sugar can also make it easier to fight gum disease.

Though the people in this study are called "diabetes free" we know that current testing methods for diabetes miss many people who have diabetic blood sugars after they eat.

Complications of Diabetes
Retinopathy: Black Americans develop retinopathy at lower A1c levels than whites.  Retinopathy begin at A1c levels of 6% to 6.4% for white patients vs. 5.5% to 5.9% for black patients. That's probably because A1cs are not reliable for diagnosing diabetes when people have certain genetic red blood cell variants, like the sickle cell trait.

"Results suggesting that the prevalence of retinopathy appears to increase at a lower HbA1c level in black patients with diabetes vs. white patients have led researchers to recommend against raising the diagnostic threshold of HbA1c in black patients."

If you are a Black person, use your meter to measure your post-meal blood sugars. That isn't affected by the sickle cell trait and post-meal numbers, rather than the A1c will give you a very good measure of how effective your control is.  To avoid retinopathy, keep your blood sugar below 140 mg/dl at all times if possible. Blood sugars rising over 200 mg/dl at any time correlate with a much higher risk of diabetic retinopathy leading to blindness.

Diet and Weight Loss 
Eating on a schedule may provide better weight control by using circadian clock to burn fat: Yes, this is a mouse study but even so the finding is intriguing.  It shows that "... a carefully scheduled high-fat diet can lead to a reduction in body weight and a unique metabolism in which ingested fats are not stored, but rather used for energy at times when no food is available."

Note that the "high fat diet" give mice is actually a junk food diet--high in fat and carbs. Even so the mice in this study who ate strictly scheduled meals gained less weight than those eating any other diet they were given.

Organic Food: 
Bad Science: A much touted new meta study claims organic food "not healthier" than nonorganic food. This claim is made by pooling the results of many separate studies (the funding of which is not revealed but is likely to be from big food companies). The claim of equivalence rests on the idea that the amount of nutrients is the same. But it brushes away hese findings:

" ... researchers found that organic produce had a 30 percent lower risk of pesticide contamination than conventional fruits and vegetables ... Two studies of children consuming organic and conventional diets did find lower levels of pesticide residues in the urine of children on organic diets, though the significance of these findings on child health is unclear. Additionally, organic chicken and pork appeared to reduce exposure to antibiotic-resistant bacteria, but the clinical significance of this is also unclear

Pesticides in the bloodstream contributed heavily to obesity and diabetes.

In a long-running study, monkeys whose caloric intake was restricted by 30 percent didn’t live any longer than their normal-weight peers. This article analyzes why this study differs from an earlier one that showed a life-extension benefit.

You need to eat fat with your salad to properly digest the micro nutrients it contains.

Smoking and Insulin Secretion: If you want to stop smoking and not gain weight, cut your carbs then quit.  Increased bodyweight after stopping smoking may be due to changes in insulin secretion which may increase hunger.  This effect takes about 3 months to wear off.

"The most striking metabolic findings were an increased first phase insulin secretion in response to glucose challenge, as well as increased carbohydrate intake in the free choice buffet after three months of non-smoking. Participants showed significant fasting insulin resistance, where the normal response to a given amount of insulin is reduced, at three months, but not at six months, while dynamic insulin sensitivity (the sensitivity to insulin in the postprandial state) assessed during the OGTT remained unchanged throughout."

This means more insulin is produced but actual insulin sensitivity remains the same. (The way that fasting IR is calculated is misleading here.) This means blood sugar will drop more sharply after eating, which causes hunger.

Treatments for Diabetes
New Drug: A new (expensive) opiate has just approved for neuropathy. But it only treats the symptom, not the caase. You can reverse neuropahty (over several months) by lowering your blood sugar until it is below 140 mg/dl at all times after meals. This is better than taking an addictive drug that masks the symptoms of the nerve damage that leads to impotence, infections that won't heal and cause amputation, and damage to the autonomic nerves that lead to heart beat abnormalities and, potentially, death.

Instructions on how to lower your blood sugar below 140 mg/dl can be found HERE.

Actos: The FDA has approved the first generic version of Actos. If it ever makes it into your local pharmacy the media will finally learn about the serious side effects of this dangerous drug, which include serious osteoporosis, retinal edema, and heart failure in people who didn't have heart failure before they started the drug.

The sudden "discovery" of dangerous side effects is what happened when Lipitor went off patent. Suddenly the media "discovered" that it significantly raised the risk of developing diabetes.

Cheap Strips: Walmart is selling 50 strips for its Relion Prime meter for $9. The meter is $16.24. Tell your friends who could benefit from checking their blood sugars after meals. This is a real opportunity for those who have hitherto been unable to afford the blood sugar testing strips needed to get full control over blood sugar using the "Test, test, test" strategy you'll find explained HERE.

Experimental Retinal Prosthesis: Researchers have come up with a retinal prosthesis that appears to work in mice and may offer real hope to people who have gone blind from retinopaty. This is still highly experimental mouse research, but even so it's a huge breakthrough.
Artificial Retina Could Restore Sight To The Blind

Omega-3 supplementation: Using Fish Oil fails to live up to the many health claims made for it. Fish oil failed to demonstrate brain-protecting effect in random controlled trials and a study of 70,000 people finds it doesn't lower the risk of stroke or heart attack.

The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not avoid heart disease.

Getting your fish oil from eating fish rather than pills may be a poor strategy given the very high level of mercury and other pollutants in most fish today--which is way higher than what you see in the published tables most health authorities rely on, which still display data collected in the 1970s when toxin levels were much lower.

Harmful Drugs and Treatments
NSAIDs: An epidemiological study find that all NSAIDS are linked to higher risk of having second heart attack. Heart attack survivors who take the most commonly used pain relievers face a raised risk for dying or suffering another heart attack, new research shows.

While it is possible that the need for pain relievers is related to some other cause of heart attack, there is other evidence which suggests that the mechanism by which NSAIDs work may raise cardiac risk.

Drugs that lower sex drive: Antidepressants, Statins, Beta Blockers, and opiate pain killers. Thee of the four very commonly prescribed to people with diabetes.

Corporate Malfeasance

American Diabetes Association: 78% of funds donated to American Diabetes Association go to a telemarketing company that lies about the percentage it takes. I reported about this problem in 2008based on a report in the L.A. Times HERE. Since then the ADA has done nothing to correct the problem and, in fact, it has grown worse.

Don't contribute to the ADA and explain to your friends and family why, if they care about people with diabetes,  they should not give the ADA a penny.

For fraudulently representing and marketing Paxil, Welbutrin and Avandia, GSK's fine is a tiny fraction of its earnings.

Risperdal: A slap on the wrist for a drug company whose atypical antipsychotic drug, Risperdal, causes obesity and raises the risk of diabetes. The off label uses turned out to kill people. $181M sounds like a lot, but they earn billions each year from this drug.

Lying Drug-Company Funded Researchers: "Only one in seven authors reported by whistleblowers to be involved in off-label marketing activities fully disclosed their conflict of interest in published articles.

"Conflict-of-interest statements made by physicians and scientists in their medicajournal articles after they had been allegedly paid by pharmaceutical manufacturers as part of off-label marketing programs are often inadequate, highlighting the deficiencies in relying on author candidness and the weaknesses in some journal practices in ensuring proper disclosure, according to a study by international researchers published in this week's PLoS Medicine."

August 13, 2012

Why Thinner People with Diabetes May Have Worse Outcomes

A study published last week in the Journal of the American Medical Association (JAMA) came up with the conclusion that "Adults who were normal weight at the time of incident diabetes had higher mortality than adults who are overweight or obese."

The study can be found at:

If you have been doing a good job controlling your weight and read only the media reports about this study, you may have found it disturbing. If your doctor is one of those who only reads the "25 words or less" summary of medical findings, you may even hear that losing weight is dangerous for diabetics.

Hermes Florez, MD, PhD. Florez, the director of the division of epidemiology and population health sciences at the University of Miami's Miller School of Medicine, who wrote an editorial about this study  was quoted as saying, ""If you are normal weight, you may be at higher risk from diabetes, especially if your fitness status is not so good."

But even a cursory reading of the methodology used in this study should make it clear that the outcomes for people who were normal weight at their diabetes diagnoses has little to do with their weight or, for that matter, fitness.

The data used in this study came from pooling data from the "Atherosclerosis Risk in Communities study, 1990-2006; Cardiovascular Health Study, 1992-2008; Coronary Artery Risk Development in Young Adults, 1987-2011; Framingham Offspring Study, 1979-2007; and Multi-Ethnic Study of Atherosclerosis, 2002-2011."

As you will immediately notice, all but one of these studies go back 20 years or more, to the days before doctors understood that only by lowering blood sugar could people with diabetes avoid diabetic complications. So most of the people who participated in the studies whose data was used in this meta analysis were diagnosed in the bad old days, after which they were likely to have received extremely poor treatment.

How bad? Before the middle 1990s, patients diagnosed with Type 2 almost never were given home blood sugar meters. The only time their blood sugar was measured--fasting--was when they saw their doctor once every few months. Since the only drugs available to treat Type 2 Diabetes were the sulfonylureas which can cause dangerous hypos,  the only concern doctors had about these newly diagnosed people's blood sugar was that it not drop low enough to cause hypos. As a result, doctors encouraged patients to keep their blood sugars high and when they administered A1c tests doctors  saw no problem with patients maintaining A1cs in the 10% range or higher.

So what does this have to do with why their weight at diagnosis might have given normal weight people a higher likelihood of dying over the subsequent decades? Just this: Nowadays those of us who keep up with diabetes are aware that most normal weight adults diagnosed with Type 2 are very likely not to have classic  Type 2. Most have a slow-developing form of autoimmune diabetes called LADA that is very similar to Type 1.

This form of diabetes does not respond at all to the oral drugs that are somewhat effective for Type 2. But back in the days when patients had no way to test their blood sugar after eating and doctors considered A1cs as high as 13% "safe" these patients could go many years without being put on insulin. And even when they were put on insulin, because they didn't have meters, they injected only enough insulin to prevent the sky-high blood sugars that cause the fatal condition, diabetic ketoacidosis. Many patients on insulin still had blood sugars that rose into the 200s and even 300s.

So normal weight people with LADA would have ended up with blood sugars much higher than those of the overweight Type 2s who were more likely to respond to the sulfonylurea drugs and, later, metformin, most newly diagnosed people with diabetes received.

And because we now know that there is a straight line relationship (in large groups of people, at least) between A1c and the likelihood of heart disease, it doesn't take genius to suspect that the explanation for the extra cardiac deaths in the group of normal weight people with diabetes was the those much higher blood sugars they ran due both to misdiagnosis and to the way doctors ignored the damage caused by high blood sugars until the middle of the 1990s.

A second group of normal weight people diagnosed with diabetes as adults who are likely to end up with poor outcomes are people with milder versions of one of the many, unrelated, forms of genetic diabetes that are lumped together under the name MODY.

Many people diagnosed with MODY have family histories of relatives dying young of heart attacks while young and fit. This is probably because exposure to blood sugars that remain over 150 mg/dl for hours each day will over time cause the arteries to become diseased. People with these forms of MODY have had that kind of elevated blood sugar all their lives. But until very recently only those with the worst cases were diagnosed, and the rest, whose genes gave them "pre-diabetes" for much of their lives, lived with abnormal post-meal blood sugars for  many years, and only developed full fledged diabetes much later on in life, perhaps after becoming a bit more insulin resistant.

Because they were thin, doctors didn't consider a diabetes diagnosis when they had symptoms that should have pointed them that way.  (In my 20s, my doctors waved off my highly abnormal glucose tolerance test results as "nothing to worry about" precisely because I was normal weight.)

Some rare forms of genetic diabetes are caused by genes that damage not only blood sugar control but other organs, most notably the kidneys and the mitochondria. Mortality in families that inherit these unfortunate genes have nothing to do with diabetes but with the other organ damage that is due to these gene variants.

But for most people with either MODY or LADA it's pretty clear that if you keep your blood sugars in the normal range (under 140 mg/d--7.7 mmol/L) at all times you can, over time, reverse much of the damage that you have already suffered and avoid the premature heart attacks and kidney failure that carried off so many people diagnosed with diabetes in the past, when they were allowed to run very high blood sugars.


There is also one other reason why thin people diagnosed with diabetes may have a higher risk of dying--one that wasn't addressed by this study's methodology. The journal article states that the data were adjusted for "demographic characteristics and blood pressure, lipid levels, waist circumference, and smoking status." However, what was left out was co-morbidities--i.e. the presence of other diseases.

One of the most important comorbidities to be considered is pancreatic cancer, since there is growing evidence that a very early symptom of pancreatic cancer may be the onset of diabetes. This is discussed in the Mayo Clinic web page HERE. A small but important subset of normal weight people who die prematurely with diabetes are people whose pancreases failed because they were infiltrated with cancerous cells.

In addition, many drugs used to treat cancers and life-threatening diseases are capable of causing diabetes, for example the steroids administered during chemotherapy or to treat COPD. Powerful steroids were also prescribed in the past to people with neuromuscular diseases like MS. Data sets like those glommed together in this study can't tell us whether a person was diagnosed with diabetes after a course of chemo or whether they died of cancer, COPD, or MS. So the presence of people in this data pool who were diagnosed with diabetes who also had one of these other life-shortening conditions could also explain a significant amount of the excess mortality this study uncovered.

Whatever the explanation, if you are a normal weight person diagnosed with diabetes, there's no need to panic. If you track your blood sugar after meals with a meter and keep it as close to the normal range as possible, you should do fine. The worst treatment doled out to people with diabetes nowadays is far better than what the people involved in these studies back in the late 70s, 80s and early 90s were given after their diagnoses, and for those of us who pursue normal blood sugars the future should be a lot brighter, no matter what our weight.

P.S. If your doctor tells you there's no point in losing weight because thin diabetics have even more heart attacks than fat ones, find a new doctor. I wouldn't have warned about this in the past, but over this past year I have been sent so many stories about doctors giving idiotic advice based on their having misunderstood a media report about a research study that I no longer assume doctors will even bother to read the full report before changing their practice recommendations.

July 16, 2012

Interesting Research Links posted on FaceBook since 6/6/2012

Here are links to and brief comments about the most important research findings I've posted about on the Blood Sugar 101 FaceBook page over the past six week.  I've put the most important in red.

"for women...moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial."

(Thanks to Peter at the blog, Hyperlipid, for the citation.) This epidemiological study debunks the relationship of Total Cholesterol to cardiovascular death.


Dr. Hattersley (the MODY expert)'s team identifies another gene associated with "Type 2" diabetes in normal weight people.

Low dose aspirin raises risk of severe stomach or brain bleeds especially in people with diabetes--cutting heart attacks at the expense of causing strokes and hospitalizations for gastric bleeding (which can be very serious.) A huge epidemiological study should make us rethink the recommendation of daily aspirin.

Research examines major bleeding risk with low-dose aspirin use in patients with and without diabetes

A new C-peptide lab test is ACCURATE (unlike the one you had) and can detect very small amounts of insulin production even in people
with longstanding Type 1. Worth reading in full.

Study suggests physicians have no clue as to how to dose post-meal insulin for Type 2s. Shameful.

Patients requiring more than one dose of prandial insulin problematic for physicians


Duh. Basal insulin alone is is far more effective than expensive, dangerous oral drugs that may promote cancer. Why does the doctor who comments on this sound so surprised?

Fish oil (omega-3) fails to affect heart disease or deaths in 12K subject, 6+ year study.

N–3 Fatty Acids and Cardiovascular Outcomes in Patients with Dysglycemia — NEJM

Whoops, fish oil fails to demonstrate brain-protecting effect in random controlled trials. The way doctors continue to insist it must be good for you reminds me of the response to the low fat diet research that showed the diet did not help prevent heart disease.

Byetta produced A1cs in the 5% range for 1/3 of those who took it in this trial, duplicating what we've seen elsewhere, along with weight loss. Don't let your doctor put you on Victoza instead of Byetta. Byetta is a safer, better tested and more effective drug in the same price range.

Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with diabetes.

A lower carb, med-adjusted diabetes diet causes modest but maintainable weight loss and blood sugar improvement over 4 years.

You need to eat fat with your salad to properly digest the micro nutrients.

Study: No-fat, low-fat dressings don't get most nutrients out of salads


1 in 500 obese patients in the open [WLS] surgery group died during or shortly after the procedure, compared to one in 1,000 in the laparoscopic group. But doctors who recommend WLS tell patients to avoid tight blood sugar control as it is "dangerous." Please show me where 1 in 1,000 patients die from tight control!

A frightening look at what heartless people whose only interest is their own profits recommend. Raise the A1c for older people to 8% and you eliminate lots of Medicare recipients. And don't forget to enrich surgeons while killing 1 out of 200 people who have WLS. Criminal!

Wall Street Journal: New Strategies for Treating Diabetes


A good example of the isomer problem I discuss in Diet 101. The lab-created isomer kills people and is the one found in supplements, rather than the expensive natural one.


Dramatic illustration of difference between visceral (unhealthy) and subcutaneous (cosmetically unappealing) fat. CT scans.

How fat is fat? : The Lancet


Phthalates are plasticizers and in most soft bottles and much packaging. Research suggests they are a cause of diabetes.

Diabetes could be linked to phthalates, chemical in common household products, study suggests