A Doctor with diabetes relates his health recovery with low carb nutrition.

Here is a great short video in which a doctor in South Africa describes the many improvements in his health with adopting a low-carb, ketogenic diet.

At 8:40 minutes, this video is also a good choice for helping you communicate with friends, family and your health care team about low carbohydrate nutrition.friends, family and your health care team about low carbohydrate nutrition.

A comment I would make is that this does not at all have to be a high protein diet. In fact, some people do not get the full benefits of low carbohydrate nutrition if they embrace a high protein intake. A moderate protein consumption is usually best.

Also, note that he needed to pay close attention to his medications as he started the change in eating pattern. It would have been very dangerous if he had not reduced the diabetes medication and blood pressure medication as needed as his food intake changed.

Finally, I definitely do not recommend the Dukan diet, which he mentions.

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Access Dr. Bernstein – diabetes control with low carb

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Diabetes Solution

Diabetes Solution (Photo credit: Earthworm)

Every month the highly-respected Dr. Richard K Bernstein has a teleconference.

From the email I received:

“Ask Dr. Bernstein Webcast and Teleconference !!! – TONIGHT!  Wednesday, Oct 31, 2012 Special Topic Diabetes/cancer and CVID

Please Ask Dr. Bernstein Your Questions NOW! By emailing us at publisher@diabetesincontrol.com or by going to www.askdrbernstein.net
Join the Ask Dr. Bernstein Webcast and conference call on Monday Oct 31,2012 7PM CST, 8PM EST and 5PM West Coast Time. Dr. Bernstein will answer your questions

To attend, visit: http://cdset.c.topica.com/maapWXOacaxnobtVXqrbaeQyvr/
Or Primary dial in number: Phone number: (206) 402-0100 PIN Code: 900326#  ”

(Note: for Canadian readers, this is definitely not the Dr. Bernstein of the diet clinic chain.)

Dr. Bernstein has endeavored over many decades to get out his message of blood glucose control to normal levels, and the essential role of low cab intake in that process.

Free Abbott meter offer – glucose, ketone

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Sadly only available to those in the US. If you are in the US, you might want to look into this offer from Abbott.

“In an effort to help you manage your blood sugar levels, your health insurance company is offering to  upgrade your blood glucose monitoring system, at absolutely no cost to you.1″

They have 3 test meters on offer, one of which is their meter that can test blood ketones and blood glucose – The Precision Xtra Blood Glucose and Ketone Monitoring System.

This is announced as a free meter UPGRADE, so check out the details.  LINK

Information on blood ketone testing – page on my blog My Keto Haven

Thanks to Jimmy Moore of Livin’ La Vida Low Carb for tweeting the tip.

Glucose Control Wins – Test!

A kit used by a woman with gestational diabetes.

A kit used by a woman with gestational diabetes. (Photo credit: Wikipedia)

Another week, another information packed newsletter from Diabetes in Control. If you have any reason to be interested in blood sugar control (that is, if you are alive and plan to be for a while), I highly recommend you sign up for their newsletter. I can’t highlight on this blog all that they publish that is important, or I would be posting little else.

There are many items in this week’s newsletter worth your attention. LINK  – this week’s newsletter is #649, if you need to search for it.

One is a report of a study, this time done in Sweden, that looked at 5 year outcomes among patients with inadequately controlled diabetes whose HgA1c improved versus those for whom it didn’t improve or worsened. It is important to note that this is a correlation study – there would be some other factors in the mix as to why some people’s HgA1c improved and others didn’t. Trouble is, we can’t do a causation study, as you can’t with-hold treatment from people

“Patients who had suboptimal glycemic control and reduced their HbA1c value by slightly less than 1% were 50% less likely to die within 5 years than were patients whose HbA1c did not improve….”

“After adjusting for baseline risk factors and treatment changes during the study period, patients whose HbA1c decreased were half as likely to develop cardiovascular or coronary heart disease as were those whose levels increased. They were also 33% less likely to experience fatal cardiovascular disease and 41% less likely to die from any cause than were those in the poorly controlled group. All of these differences were statistically significant.”

“We must make an effort to identify patients who don’t respond to diabetes medications earlier.”

Test, test and target. Even small improvements can mean big benefits. Do you know where your post-meal glucose values go? Blood glucose test kits are not expensive. Don’t wait for your fasting blood sugar to go up before you take action.

English: Illustration of the changes in blood ...

English: Illustration of the changes in blood glucose over time following a high and low GI carbohydrate. Designed and made Public Domain by Scott Dickinson (user: Studio34), Sydney, Australia. (Photo credit: Wikipedia)

Compare these results to the results from studies targeting how closely diabetic subjects followed the researcher’s versions of good lifestyle habits. What works is “the facts, ma’am” – test you glucose, set post-meal targets and keep tweaking and trying. The winning strategy is to find out what really works for you by watching your personal responses.

Consider the dismal outcome recently reported for the Look AHEAD trial, which went for 11 years and cost $220 million, which focused on achieving weight loss and found NO benefit in terms of reduction of heart attacks or strokes in people with diabetes.

Washington Post article on the results – LINK

Analysis of the results that is more informative – from Tom Naughton LINK

Extensive resources can be found on the web sites listed in the sidebar under “Blood Sugar Health”.

See also my post Restoring normal blood glucose levels associated with less progression to type 2 diabetes

Sleep Link to Cravings

Just out is a study of sleep apnea in people with diabetes.  This is a small study, but worth noting.  LINK to report of study in Medical News Today.

They report:

“They found that in a small sample of clinic patients, the risk for sleep apnea was high among diabetics compared with non-diabetics, and that sleep apnea appeared to be associated with carbohydrate craving.”

The researcher comments:

“Previous studies have shown that sleep deprivation may lead to changes in hormones that regulate appetite and hunger,” Siddique said. “These hormonal changes can lead to significant craving for high-calorie carbohydrates such as cookies, candy, breads, rice and potatoes. The current study supports previous findings by validating this in a community sample of diabetics.”

Have a look at the article to get a better understanding of what was found and what it means.

Reference:

American Academy of Sleep Medicine. (2012, June 15). “Link Between Sleep Apnea And Increased Risk For Carbohydrate Craving Among Diabetics.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/246563.php.
Addendum June 16th, in response to the comment below regarding observational studies:
The many limitations of observational studies are well known and always important to keep in mind.  They do provide a useful role in suggesting directions to look when trying to figure out actual cause and effect.  For many of the questions we need answers for, studies that could validly test for cause and effect are hard to come by or even in practice not going to be done, due to issues of study size, study costs, or simply what would have to be done to the human subjects in the process of testing for cause and effect.
In the case of this study, you get some insight into the motivation to conduct the research when you look towards the end of the article:
“The management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases.”
It seems they are looking to build a case for more attention to the problem of sleep apnea in the era of managed care and protocol-driven medicine. Notice they do not claim any proof of causation and they are not trying to use the study results found in order to justify an intervention of any sort (medication, lifestyle or otherwise), just to justify more awareness of the need to explore for possible sleep apnea in people with diabetes.  Obviously, the well-known “big neck” rule is not succeeding in getting the job done, leaving people suffering from sleep apnea undiagnosed.
Here is a post which links to a discussion between 2 couples regarding their experiences with low-carb, real foods living. Part of the conversation is about sleep apnea.  LINK

Restoring normal blood glucose levels associated with less progression to type 2 diabetes

A study just published in Lancet found that, in people with pre-diabetes, getting their blood glucose levels back to normal was associated with a cut by half in the number who went on to develop type 2 diabetes during the study period.

Coverage by BBC  LINK

Abstract of the research paper, Lancet site  LINK

With 35% of the US population age 20 years and older estimated to have pre-diabetes, it is urgent to understand this issue.  (The US stats are easy to get and among the highest, but certainly this is a major issue developing all over the world.)

The next step is recognition that a major tool to achieve the goal of normal blood glucose is control over the form and amount of carbohydrates eaten, and that post-meal self-testing will reveal each person’s requirements, in balance with their personal choices and circumstances.  This will bring normalization of blood glucose levels into the reach of almost all of those with pre-diabetes and diabetes (provided they have access to the resources and care needed), while enabling the least use of medication and therefore the least risk of medication side-effects.

There are three factors to be teased out here (the usual, more research needed):

  • the degree to which having lower levels of glucose in the blood lessened progression of damage to the insulin secreting cells of the pancreas, or other damaging effect of glucose levels above normal
  • the degree to which some people were less able to achieve normal blood glucose levels because of strictly physical factors, such as how much damage they already had to the insulin-secreting cells of the pancreas. (That is, the degree to which the people who achieved normal blood glucose were a different group of people than the ones who did not achieve normal blood glucose.  In that case, the ability to return to normal blood glucose levels would be a “marker” that distinguishes one group at less risk from another group at more risk – rather that being a “cause” of protection or progression)
  • the degree to which the people who did not achieve normal blood glucose readings were less engaged in trying to improve their blood glucose levels, which might suggest that they are people who do not take as much care of their health in other ways.

Curiously (or not curiously at all, when you think about it), among those who did not return to normal blood glucose levels, the group assigned to “intensive lifestyle” changes fared worse that the placebo group.  Why could that be?  It is highly likely that part of what they were taught as “intensive lifestyle intervention” was the usual higher carb, low-fat diet.

“Among participants who did not return to normal glucose regulation in DPP, those assigned to the intensive lifestyle intervention had a higher diabetes risk (HR 1·31, 95% CI 1·03—1·68, p=0·0304) and lower chance of normal glucose regulation (OR 0·59, 95% CI 0·42—0·82, p=0·0014) than did the placebo group in DPPOS.”

I hope this study gets wide media attention and that it spurs much more investigation into the damaging effects of “non-diabetic” levels of high blood glucose.

Please visit my other blog: Carpe Your Blood Sugar  http://carpeyourbloodsugar.com

Sunday Stories of Low Carb – June

Sunday Stories and 23 Jazz Concerts!

(1) Interview (about 13 minutes) on NEquals1Health.com among 2 couples regarding their experiences with the benefits of low-carb nutrition. LINK

(2) Gary Noreen, of Low Carb Review (lcreview.org), has written the story of his 19 years of controlling Type 2 diabetes with a low carb diet:

http://lcreview.org/main/my-story/

“They made the mistake of giving me a glucometer (blood glucose meter). I quickly found that eating cereal and skim milk for breakfast along with a banana made my glucose take off like a rocket. “Artery-clogging” eggs and bacon had no effect. This was bewildering.

Fortunately for me, the only Type 2 diabetes book in my local library was Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization by Dr. Richard Bernstein, who recommended a very low carbohydrate diet (30 gm/day) and no restrictions on fat except no trans fats. Dr. Bernstein’s very low carb diet quickly brought my blood glucose under control and dramatically improved my lipid measurements. 19 years later, I have never needed to inject insulin, my most recent A1c measurement was 5.6%, I have no diabetes complications, and my lipids are excellent.”

His story is much longer than the quote above, and he includes his lab test results and details of his medications and how he manages his health.  Note that after 19 years since diagnosis, and with sky-high blood glucose at diagnosis, he reports “I have no diabetes complications”.

Sunday Music

The CBC (The Canadian Broadcasting Corporation) is Canada’s public broadcasting corporation and the radio is commercial-free. They maintain a very extensive website.

www.cbc.ca/radio

One of their features is CBC Music, with multiple genre streams and tons of “concert on demand” recordings.

This link is to a page featuring over 20 jazz concerts.  LINK

Lottttsss of Sunday Music!

Carpe Your Blood Sugar

What if the urgent public health issue of the day is less obesity itself and more about the elevated blood sugar (glucose) levels that occur in the majority of those with higher amounts of body fat?

What if the true cut-off level for concern is less than the target values now used for screening tests, diagnosis and for management targets in diabetes?

What if the urgency comes from the combination of two factors:

  • the fact that at last estimate about half (46%) of the adult population in the US (for example, but other countries are headed in the same direction) have pre-diabetes or diabetes, and
  • these elevated glucose levels are now optional for the majority of people, because a different approach to management can be used (at least, for those who have access to regular medical care and the personal resources to manage a care plan involving self-monitoring of blood glucose).

What if having similarly elevated blood glucose levels (including below the threshold for diagnosis of diabetes) means that people who are classed as ‘normal’ body weight face many of the most worrisome health issues that we have incorrectly been blaming on the total body fat itself?

What if swings in blood glucose are itself a major driver of weight gain and those swings can be eliminated?

Metabolic Syndrome is a term used for a cluster of related medical problems or health indicators that have at their core a reduced ability for the body to handle glucose.  The root causes for this have not yet been understood, so we can’t say that we have a way to treat or correct the source cause of the metabolic syndrome itself.  But we can succeed in keeping the blood glucose in the normal range, and thus largely interfere with the means by which the metabolic syndrome causes damage.

Among the experts in obesity, there is a sea change over the past few years moving towards the realization that the amount of extra fat itself is not the major driver of the degree of health impact of the obesity.  Yes, there are physical impacts of simply being a larger size, such as stress on the joints.  At very high levels of body fat, there can be other serious effects of the physical size, such as strain on the heart and fluid accumulation in the legs.  Certainly we must keep in mind and be very aware that there are emotional impacts, which are related to such factors as weight-based discrimination and (unfairly) feeling personally inadequate for not loosing weight when surrounded by the attitude that it should be so easy.  There are also economic impacts, including discrimination in the work place.

But there is an “illness” aspect that the obesity experts refer to.  Some people who are overweight or obese are actually quite healthy in their metabolism. It is thought that these are not the ones who are headed (at least, not any more than usual) for heart attack, stroke, cancer or the other “illness” consequences that we have come to consider to be caused by high body fat itself. Having a high amount of body fat is not a sole determiner for whether someone is more at risk of these outcomes than someone of “normal” body weight.

Metabolic syndrome is thought to be the major part of the difference, as well as some other factors, such as inflammatory molecules coming from body fat stores, most particularly those in the abdomen.  Control of blood glucose levels, it could be argued, is the most readily attainable change that can be implemented at this time.

Blood sugar levels respond very quickly, in a matter of days, weeks or, at most, months when a well-designed and individually adjusted program is instituted that focuses on reducing the intake of glucose-producing foods, adjusted to create an eating plan that the individual finds acceptable as a long-term aspect of their medical care.

My new web site and blog has been set up as a place to consider these ideas, the relevant research, the experiences of clinicians, the input of people affected by high blood glucose and the implications for individuals and for public health.

www.carpeyourbloodsugar.com

Still in infant form, please visit “Carpe your blood sugar”.

A blog reporting glucose impact of low-carb products

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This site helps fill a need. Low Carb Review is a new site dedicated to reporting the results of one person’s test trials of low carb foods and products.  He reports the part that matters, which is the rise in blood sugar after eating.  His test subject is himself, but, being an engineer, he takes a very careful approach.

Each person’s blood sugar responses can be unpredictably different, but still this is helpful and a valiant contribution.

I think the pumpkin and ricotta cheese breakfast dish is tempting (he refers to this as pumpkin “cereal”).  You can click through from his site to the recipe, which he found on About.com Low Carb Diets.

Low Carb Review  lcreview.org

Impact of high blood glucose on vascular events and death

This study is just published.  When looking at this study, there are four key factors to consider:

  • This is a study that looks at correlation, it does not specifically test cause. People who had evidence of sustained exposure to higher blood glucose levels had worse outcomes, for whatever mix of reasons.
  • This study did not look at micro-vascular disease (such as nerve damage, kidney damage or eye damage) or rate of deterioration of glucose control, so the study does not say that there might not be health benefit from achieving a HgA1c of less than 6.5%
  • I’ll have to wait to see the full text of the study (and consider input from others who will doubtless publish commentary) to consider what further might be said of this study. For example, the fact that the results of the study did not suggest a protective effect from having HgA1C below 6.5% could be related to low numbers of the study group reaching such a relatively good level of control – although this was probably accounted for. Only further examination of the full study report will tell.
  • Also, HgA1C is only one way of looking at blood glucose levels.  It does not give information about aspects of blood glucose that vary between people, such as the degree of elevation of fasting glucose versus glucose spikes after meals.
Diabetologia. 2012 May 26.

Relationship between HbA(1c) levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes.

Department of Cardiology, Gentofte University Hospital of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark, ca@heart.dk.

Abstract

AIMS/HYPOTHESIS:

The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease.

METHODS:

HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models.

RESULTS:

Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.

CONCLUSIONS/INTERPRETATION:

In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

PMID: 22638548

Do you know where your blood sugar climbs after eating?  BloodSugar101.com