Differing Brands of Generic Metformin Behave Differently

Dr. Bernstein has been preaching about this on his web telecasts for years, but it bears repeating: If you are having problems with generic metformin or not seeing it make much impact on your blood sugar, change brands before you assume it isn't working or that you can't tolerate it.

I just had this message brought home to me when my pharmacy (Walgreens) filled my prescription for metformin ER with tablets from SunPharma instead of the ones from Teva they'd given me for years.

The pills were about half the size of the ones I'd been getting, which suggested they contained less of a matrix substance to slow the release of the metformin. And sure enough, when I took the same dose I had been taking with no problems with the Teva brand metformin, I felt exhausted and semi-poisoned. It felt just like when I had taken an overdose of metformin some years ago, when my family doctor prescribed an overdose after confusing the dosage instructions for regular metformin--which can be taken in larger doses--with those of metformin ER.

Not only that, but my fasting blood sugars went up. Clearly the SunPharma metformin ER was not behaving like a true extended release should and releasing slowly through a 24 hour period but was hitting my blood stream all at once and then was done.

A quick visit to Google revealed that Sun Pharmaceuticals is an Indian company and that in the past the FDA has forced them to recall batches for quality issues.

When it was time to refill my prescription, I called my pharmacy and spoke with the pharmacist who shrugged off my concerns and told me I'd have to speak to the pharmacy manager (not available that day.) So I got on the phone and called other local pharmacies and asked them what brand they were dispensing. Two of them still carry the Teva brand, so I took my empty pill bottle to the closest one and they transferred the prescription and filled it with the Teva. I was very happy to find that it worked just the way I remembered, with no unpleasant side effects.

This experience made me wonder how many of the people who tell me they can't take metformin because of the side effects were victims of cheap versions like the SunPharma one.

If you try metformin and find the side effects overwhelming after a month's trial--typical problems would be dramatic digestive problems or a feeling of exhaustion and low grade toxicity--talk to your pharmacist about trying another brand or move your prescription to another pharmacy that carries another brand.

Dr. Bernstein says that the brand name version, Glucophage, is the best. I've never tried it so I can't verify that. If you can get it, go for it. I've heard that some pharmacies will order a specific brand for you if you ask, but before you do this, check how much the prescription will cost you as some insurers may not pay for your prescription if you specify the brand or they may make you to pay much more.

If you're taking metformin ER, which brand you are taking? How well does it work for you? Have you switched brands and seen a difference? Please cite the manufacturer name if you can. It would be nice to build up some expertise here as to how the different versions work. If I get enough feedback I'll add it to the page where I describe metformin on the Blood Sugar 101 site.

NOTE: You should be able to find the name of the manufacturer somewhere on your label. I believe this is a legal requirement in the U.S..

 

Cats, Hyperthyroidism and Bromine Toxicity

The U.S. EPA reported (Reuters, 8.15.07) a study that showed common chemicals (polybrominated diphenyl ethers-- PBDE's) found in nearly all our homes are contributing to a rash of thyroid problems in pets. This class of chemicals is used as a fire retardant. PBDE’s are also found in a variety of household items including computers, televisions, carpeting, furniture and mattresses. PBDE's are made from bromine.

Bromine, is from the family of halides. This chemical family contains iodine, fluoride and chlorine as well. The reason we are seeing such a high prevalence of iodine deficiency and thyroid disorders in humans is due, in large part, to the excess exposure of bromine from our modern conveniences. Bromine exposure causes our bodies to excrete iodine. If we don't supplement with extra iodine, bromine will bind to receptors in the body that are supposed to be binding iodine. In effect, bromine will replace iodine throughout the body.

What are the consequences of excess bromine levels? The consequences are severe; increased rate of cancer of the breast, thyroid, ovaries, uterus and prostate are due, in part, to bromine toxicity. Also, we are seeing dramatically increased rates of autoimmune illnesses including autoimmune thyroid disorders. My experience has clearly shown, as compared to those without a serious illness, those with a serious illness have markedly elevated bromine levels.

In the study of pets, household cats were found to have high bromine levels. What is the consequence to cats? Unfortunately, cats are now suffering from an epidemic of hyperthyroidism. Hyperthyroidism in cats used to be a rare condition. The researchers found PBDE's in 100% of the cats studied (23 cats). In the cats with hyperthyroidism, their PBDE levels were much higher.

So, what can you do? The main treatment for excess bromine is to avoid bromine exposure. Eat food that does not contain bromine such as organic fruits and vegetables. Avoid bread, pasta and cereal that contain brominated flour. Next, supplement with enough iodine to allow your body to detox from bromine. Finally, supplement with items that help your detoxification system function optimally. Vitamins C and E as well as unrefined salt and selenium can help.

Bromine toxicity is occurring in a large number of patients. Educate yourself about bromine. Then take the proper steps to help your body detoxify from it. Much more information about this process can be found in my book, Iodine: Why You Need It, Why You Can’t Live Without It, 4th Edition.

The Link Between Diet Soda Consumption and Stroke

A study to be presented at the International Stroke Conference 2011 in Los Angeles is getting some play in the health news. You can read a good summary here:

U.S News and World Report: Can Diet Soda Boost Your Stroke Risk?

The researchers "evaluated the soda habits of 2,564 people enrolled in the large Northern Manhattan Study (NOMAS) to see if there was an association, if any, with stroke. The participants were 69 years of age, on average, and completed food questionnaires about the type of soda they drank and how often."

Over 9 years, 22% of the study subjects had a stroke. After controlling for age, gender, ethnicity, physical activity, calorie intake, smoking, alcohol drinking habits, the presence of metabolic syndrome, vascular disease in the limbs and heart disease history those who reported drinking diet soda as opposed to no soda were 48 percent more likely to have a stroke.

In another article covering this same story published by MSNBC
other doctors are quoted as suggesting the problem might be what they eat with the soda--fast food, or possibly something in caramel coloring used to give sodas a brown color, which has been linked to stroke in animal studies.

Alert readers of this blog will, however, remember another equally likely explanation--one that has been known for years, but has received no coverage in the press, because the media get too much advertising money from Coke and Pepsi.

The link between diet soda and stroke may well be the phosphoric acid that is used in the all brown-colored sodas. As documented in my earlier blog post Coke Adds Death, brown-colored sodas are known to damage the kidneys. In fact, drinking as few as two brown-colored sodas--either diet or regular--a day doubles the risk of developing chronic kidney disease. Researchers believe the phosphoric acid is the culprit. Phosphates are a known problem for people who already have kidney disease.

It turns out that kidney damage and cardiovascular disease are tightly linked, and the presence of kidney disease often points to the existence of other vascular problems. This makes it very possible that damage to the kidney from phosporic acid is contributing to vascular damage in the brain which leads to stroke.

If phosphoric acid is the problem--and it is likely, since people consuming non-brown colored sodas had a normal risk of chronic kidney disesae, you can avoid it by avoiding heavily-advertised brown sodas like Coke, Pepsi and Dr. Pepper, in favor of the light and colored sodas that don't. If in doubt read the label. If it says "phosporic acid" give it a miss. People with diabetes have enough issues to contend with kidney-wise without adding to them.

 

Study Finds Dreamfields Pasta Produces Identical Glucose Curves as Regular Dry Pasta

UPDATE: The study referred to in this post was retracted by its authors and is no longer available online. The reason for the retraction was NOT that the data was wrong or that the study was misleading, but "because some of the data were obtained prior to receiving IRB [Institutional Review Board] approval."

Since it is not likely that the institution the authors of this study work retracted the study because of the horrifying ethical violation implied in forcing innocent volunteers to eat pasta—IRBs are set up to protect the public from unethical research—it’s likely someone did not have the deep pockets needed to withstand a lawsuit launched by the manufacturer of this profitable product that costs more than twice as much as regular pasta.
=====
ORIGINAL POST

I have long been suspicious of the claims for Dreamfield's pasta that all but three grams of the over-50 grams reported on the label somehow mysteriously dissappear due to some magical process they refuse to describe. Now a report in this month's journal, Diabetes Care confirms I was right to be suspicious.

Here's the study:

Glycemic Response to Ingested Dreamfields Pasta Compared With Traditional PastaFrank Q. Nuttall et al.Diabetes Care January 26, 2011 vol. 34 no. 2 e17-e18. doi: 10.2337/dc10-1957

Here are the relevant graphs:

http://care.diabetesjournals.org/content/34/2/e17/F1.expansion.html

This study was done with subjects who did not have diabetes, however the significant and prolonged average blood sugar spike seen in the first group, suggests it contained someone (or two) with less "normal" blood sugars than would have been indicated by their fasting glucose test. The results make it clear that in thse study subjects, Dreamfields was metabolizing into glucose at the identical rate as cheap dry pasta.

Now mind you, the 50-some grams of carbohydrate in regular dry pasta does hit the blood sugar a lot more slowly than does bread of potatoes, which is why those dreadful diabetes magazines you find at your doctor's offices are full of pasta recipes.

But while dry pasta is a better choice than Froot Loops, as the curves on these graphs make clear, the carbohydrates contained in pasta trickle into the blood stream for hours after you eat. In people with Type 2 who still have a significant amount of second phase insulin response left, the trickle might be slow enough that you won't see a pronounced spike, but all that glucose will have to be metabolized--and most of it will turn into triglycerides and eventually be stored as body fat.

The data in this study explain to me why there are such varying reports within the diabetes community about whether Dreamfields does what the company claims it does, with some saying it works for them, and others reporting that it causes prolonged high blood sugars. Obviously, the people for whom Dreamfields works are still secreting enough second phase insulin to cover the long slow tail it produces.

But if Dreamfields does work for you, this study stronlgy suggests you could get the same effect from eating $.99 store brand pasta as you could eating the much more expensive Dreamfields. Just cook the regular pasta for the 9 minutes that Dreamfields suggests. Cooking any pasta longer than that will makes it digest more quickly.

Two last things:

1. Only cooked dry pasta metabolizes slowly. Fresh pasta--the kind you buy in the freezer section or at some fancy italian restaurants--is made with regular flour, not the more semolina flour that contains resistant starch. Fresh pasta digests very quickly and you will see a much larger spike after eating it.

2. The label portion size for a serving of pasta is tiny. Measure out 2 dry ounces on a cooking scale and cook it and you'll see what I mean. The serving of pasta you get at a restaurant is anywhere from 3 to 6 label portions. Since that very small 2 ounce portion contains over 50 grams of carbohydrate, the restaurant servings are anywhere from 150 to 300 grams. And that's without the "low fat" high carbohydrate sauce dumped on top.

Perchlorate in Our Drinking Water

A recent article (2.3.11) in the New York Times was titled, “E.P.A. Standards for Drinking Water Single Out a New Group of Toxic Compounds.” The article stated that the Obama administration would impose limits on permissible levels of a new set of toxic chemicals in drinking water, including the first standards for perchlorate. Perchlorate is a dangerous compound, found in rocket fuel and fireworks, which has contaminated water supplies in 26 states.

Perchlorate is a chlorinated compound that can cause problems with iodine uptake into the thyroid gland. In fact, perchlorate can bind to and inactivate the transport mechanism that moves iodine into the thyroid gland. In effect, perchlorate can cause/worsen iodine deficiency. Estimates are that from 5 to 17 million Americans are drinking water contaminated with perchlorate.

The Obama decision reverses a Bush administration decision that there was no need to regulate perchlorate levels in the water supply. Overall, this is good news. We need clean drinking water. However, the E.P.A. has not yet set the standards for perchlorate. They estimate that standards will not be set for approximately two years.

Two years to set a standard for a known toxin in our water supply? Hello, Mcfly! Anyone home? (I really like the movie Back To The Future).

Perchlorate has been found to contaminate nearly all of the winter lettuce supplies in the U.S.—both organic as well as conventional sources. Folks, perchlorate toxicity is a big problem.

I have written and lectured extensively on the iodine deficiency epidemic that is plaguing our country. I believe that iodine deficiency, driven in part from perchlorate contamination of our water supply, is responsible for the epidemic of breast, thyroid, ovarian, uterine and prostate cancer. Furthermore, perchlorate exposure may be driving the large numbers of patients suffering from thyroid and other hormonal problems.

Overall, the E.P.A. announcement is good news. Finally the government is looking out for its citizens and setting standards to reduce our exposure to known toxins. However, we cannot wait for the government to do the right thing (two years???). We need to be educated about these toxins and how you can avoid them. In the case of perchlorate, the best advice I can give you is to ensure that you and your family are ingesting adequate amounts of iodine. My experience has shown that adequate amounts for most adults range from 6-50mg/day of a combination of iodine and iodide. More information about iodine and perchlorate can be found in my book, Iodine: Why You Need It, Why You Can’t Live Without It, 4th Edition.