This AP news release
Diabetics Try New Round-The-Clock Sensor
touting the success of Continuous Glucose Monitoring Systems (GGMS) cited this statistic attributing it to Dr. Irl Hirsch of the University of Washington:
Diabetics who do the worst job fighting their disease aren't going to put in extra effort to improve just because of a sensor, says Dr. Irl Hirsch of the University of Washington.
"We learned that lesson the hard way," says Hirsch, who presented research at a recent diabetes meeting suggesting the sensors instead will most benefit patients who can't lower their blood sugar to optimal levels — a score below 7 on a test called the A1C — despite following best-care guidelines.
Hirsch finds the sensors help lower A1Cs between 7 and 8.5, but not those who start out higher.[emphasis mine]
There's a reason for this, and sadly, it is another case of iatrogenic [doctor-caused] failure.
Monitoring and testing are worthless if doctors don't give people effective strategies for responding to unfavorable test results.
In the case of an unacceptably high blood sugar, the one strategy that will solve the problem is cutting way back on carbohydrates. It is carbohydrates that raise blood sugar and it is by lowering carbohydrates that you can bring down a very high blood sugar.
But most patients and, sadly, most doctors, don't get this.
Every week I get emails from recently diagnosed people with diabetes that they are baffled because at their doctor's urging they have "improved their diets" by adding lots more fruit and healthy whole grains, but their blood sugar is not improving.
Well, given that most fruit and all grains--whole or not--are full of carbohydrate, this should surprise no one. But when even doctors and nutritionists are telling people with diabetes to start out the day with a big bowl of oatmeal and a banana, you can see why these poor victims/I mean, patients can test 20 times a day and it isn't going to make a bit of difference.
If you give a patient a meter or CMGS and tell them that they should cut out the starches and sugars in their diet--no matter how "low GI"--and replace them with protein and fat until the blood sugar comes down into the safe zone, you will see huge improvements in people with A1cs as high as 13%.
My web page documenting reports from people who joined "The 5% Club" shows this very clearly.
The reason that Dr. Hirsch's patients with high A1cs aren't benefiting from monitoring is most likely because the reason they got those high A1cs in the first place is that they were eating the usual high carb/low fat diet that a frightening number of nutritionists and doctors still prescribe their patients.
Give people with high A1cs a CGMS or a blood sugar meter along with the simple advice you'll find here:
http://alt-support-diabetes.org/newlydiagnosed.htm
and you'll see people attaining far better A1cs than the not-low-enough-to-prevent-blindness 7% A1c that Dr. Hirsch seems to think is impossible to attain.
Tuesday, September 18, 2007
Friday, September 14, 2007
Invasion of the Blog Stealers
Some readers have expressed concern about the copyright violation notice I went and stuck on the bottom of my last ten posts.
Here's the reason it's there. Some bottom feeding web site hosted in a Far Eastern country has set up something that sucks in other people's blog postings and republishes them as if they were the blogger's own content. The point of all this appears to be to make money off the many Google Ads that top the page. When I checked my blog in Technorati recently, I saw dozens of my blog posts being copied in full this way by one site with the only clue as to where they came from buried in very fine print. Since these weasels seem to strip content on a daily basis, I figured I'd include the copyright violation note so that it would appear on their scum sucking site.
I love being linked and or quoted for a paragraph or so by people who share a common interest in improving the health of people with diabetes. Just don't pick up my entire post and publish it as if you wrote it!
Copyright Janet Ruhl, 2007. If you are reading this entire blog post anywhere but http://diabetesupdate.blogspot.com the contents were stolen.
Here's the reason it's there. Some bottom feeding web site hosted in a Far Eastern country has set up something that sucks in other people's blog postings and republishes them as if they were the blogger's own content. The point of all this appears to be to make money off the many Google Ads that top the page. When I checked my blog in Technorati recently, I saw dozens of my blog posts being copied in full this way by one site with the only clue as to where they came from buried in very fine print. Since these weasels seem to strip content on a daily basis, I figured I'd include the copyright violation note so that it would appear on their scum sucking site.
I love being linked and or quoted for a paragraph or so by people who share a common interest in improving the health of people with diabetes. Just don't pick up my entire post and publish it as if you wrote it!
Copyright Janet Ruhl, 2007. If you are reading this entire blog post anywhere but http://diabetesupdate.blogspot.com the contents were stolen.
Thursday, September 13, 2007
ADA Whores for another Sponsor
One of the ADA's shills brought it to my attention the "new partnership between the American Diabetes Association and V8 100% Vegetable Juice to help Americans bridge the vegetable consumption gap."
Campbell Soup is one of the many food companies who sell primarily starchy, salty foods that are are listed as The American Diabetes Association's corporate "friends" on the ADA site here. Do take a look. If you ever wondered why the ADA promotes questionable oral drugs, high carb foods, and a visit to the gym as the only way to treat Type 2 diabetes, a look at its big donors will answer your question.
So now it seems that the ADA has decided to promote a big donor's V8 juice as a suitable "vegetable" for people with diabetes
And what a vegetable it is! One 11.5 ounce bottle--the size you usually see sold--contains 15 grams of carbohydrate. Not only that, but if you do the math you'll see that the "fiber" listed on their label has already been deducted from the carb count. Though the way they list the fiber using the deceptive, European label style, makes it look like you could deduct them. Don't. They're all in the container. (Verify this using the Hidden Carb Calculator)
What do you get for your 15 grams of carbs? Not much. Pureed vegetables that have been heated and processed so that they've lost many of the original nutrients they started out with. They are very likely to have had the original vitamins replaced with imported Chinese vitamin supplements. Extra salt. Preservatives. And, of course, more blood glucose than you'd get in an entire package of Spinach, a pound of green beans, three artichokes, two zucchinis, etc.
It's worth noting that this ADA partnership announcement comes just as Coca Cola has taken over the distribution of V8. If you'll remember, recent studies have shown that drinking as few as 2 cans of either regular or diet coke doubles the risk of kidney failure. But you didn't hear that from the ADA, despite the fact that people with diabetes are the most vulnerable to kidney failure. Instead the ADA teams up with the company distributing yet another questionable food substitute.
Finally, it's worth noting that Campbell's markets a whole line of V8 branded juices, many of which are fruit flavored drinks that have 26 grams of carbs in a 12 ounce bottle. With the ADA's "V8" is good for you campaign, it's likely many unsophisticated people with diabetes will conclude that these very high carb V8 branded juices are good for them, too.
Here's the question of the day
Why, with the hundreds of millions of dollars that have been raised by the ADA over the past decades supposedly to help people with diabetes, does the average person with diabetes still not know that it is the carbohydrates they eat at meal times that raise their blood sugar? Or that lowering the amount of carbs they eat at meals could lower their blood sugar?
How much would it have cost to get that message out? Or does Campbell's soup and Coke not want you to know that?
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Campbell Soup is one of the many food companies who sell primarily starchy, salty foods that are are listed as The American Diabetes Association's corporate "friends" on the ADA site here. Do take a look. If you ever wondered why the ADA promotes questionable oral drugs, high carb foods, and a visit to the gym as the only way to treat Type 2 diabetes, a look at its big donors will answer your question.
So now it seems that the ADA has decided to promote a big donor's V8 juice as a suitable "vegetable" for people with diabetes
And what a vegetable it is! One 11.5 ounce bottle--the size you usually see sold--contains 15 grams of carbohydrate. Not only that, but if you do the math you'll see that the "fiber" listed on their label has already been deducted from the carb count. Though the way they list the fiber using the deceptive, European label style, makes it look like you could deduct them. Don't. They're all in the container. (Verify this using the Hidden Carb Calculator)
What do you get for your 15 grams of carbs? Not much. Pureed vegetables that have been heated and processed so that they've lost many of the original nutrients they started out with. They are very likely to have had the original vitamins replaced with imported Chinese vitamin supplements. Extra salt. Preservatives. And, of course, more blood glucose than you'd get in an entire package of Spinach, a pound of green beans, three artichokes, two zucchinis, etc.
It's worth noting that this ADA partnership announcement comes just as Coca Cola has taken over the distribution of V8. If you'll remember, recent studies have shown that drinking as few as 2 cans of either regular or diet coke doubles the risk of kidney failure. But you didn't hear that from the ADA, despite the fact that people with diabetes are the most vulnerable to kidney failure. Instead the ADA teams up with the company distributing yet another questionable food substitute.
Finally, it's worth noting that Campbell's markets a whole line of V8 branded juices, many of which are fruit flavored drinks that have 26 grams of carbs in a 12 ounce bottle. With the ADA's "V8" is good for you campaign, it's likely many unsophisticated people with diabetes will conclude that these very high carb V8 branded juices are good for them, too.
Here's the question of the day
Why, with the hundreds of millions of dollars that have been raised by the ADA over the past decades supposedly to help people with diabetes, does the average person with diabetes still not know that it is the carbohydrates they eat at meal times that raise their blood sugar? Or that lowering the amount of carbs they eat at meals could lower their blood sugar?
How much would it have cost to get that message out? Or does Campbell's soup and Coke not want you to know that?
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Wednesday, September 12, 2007
Beware Cortisone!
Today's e-mailbag brought a letter from someone who reported that their blood sugar deteriorated significantly after a single shot of cortisone administered by an orthopedic doctor and that, even two months later, it has not returned to the level it was before the shot.
I wish this were an isolated, oddball occurrence, but sadly, it is not. Years ago when I posted a question on the old alt.support.diabetes newsgroup about the events leading up to a Type 2 diabetes diagnosis, I heard from several people who said that their blood sugars, which had been marginal before a cortisone treatment, became fully diabetic afterwards.
It was only then that I connected my own diabetes diagnosis with the ten day long course of prednisone I'd been given the previous year and and realized that it was only after that treatment that I'd developed the raging hunger and uncontrollable weight gain that seems to have signaled that my blood sugars had crossed over some disastrous boundary.
Every doctor I've mentioned this too has pooh-poohed it. Yes, they say, cortisone temporarily raises blood sugars, but they should go back to normal afterwards. But my doctor said the same thing, even when faced with the evidence that I'd suddenly developed much stronger symptoms of diabetes.
So it is possible that doctors believe that cortisone will not worsen diabetes and because of that belief attribute the worsening when it occurs to something else! Alternatively, because cortisone is often given by orthopedic doctors who don't monitor a patients' blood sugar, it is possible that they don't ever learn of the effect of their shots on the patients.
My belief, after dealing with several rheumatologists and orthopedic doctors, is that these doctors often administer a shot of cortisone so that the patient--who is being billed well over $200 for the appointment--will feel that the doctor did something, since without cortisone, mostly all the doctor can do is advise patience.
Whatever the explanation, while I don't question that there are people with diabetes whose blood sugars return to normal after a cortisone treatment, I think we all need to be aware that cortisone can worsen our blood sugar, permanently. And if we have managed to get our blood sugars under control--especially if we've done it with diet and exercise, we should know that a single cortisone shot or course of prednisone may make it impossible to retain that good control without adding insulin.
That said, cortisone is a powerful drug that can dramatically improve symptoms of some severe autoimmune disorders and even, in some cases, save lives. If you need it for a serious autoimmune disease or to counter brain swelling, well, you'll just have to deal with any associated blood sugar issues. And they can be dealt with--usually by going on insulin.
But the tragic thing about cortisone is that it is often used in situations where the research makes it clear that it is nothing more than a placebo. Even worse, the conditions in which it is least likely to help are precisely those that many Type 2s are likely to develop: tendon problems like Frozen Shoulder and Carpal Tunnel syndrome.
While a cortisone shot may occasionally give some pain relief for frozen shoulder, the research shows that it does not shorten the healing time! The same is true of other tendon-related problems.
Here is a study that found that while cortisone shots produce short term improvement in frozen shoulder, three months later, the people who did NOT get the shots were in better shape!
http://ard.bmj.com/cgi/content/abstract/63/11/1460
Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.
R Buchbinder, J L Hoving, S Green, S Hall, A Forbes and P Nash
Annals of the Rheumatic Diseases 2004;63:1460-1469
I was also assured by a doctor that electrophoresis would deliver cortisone to another injured tendon--in my foot this time--and not raise my blood sugar and was dumb enough to believe it. The blood sugars I saw over the next week were much higher than usual. And it may or may not be coincidental that my fasting blood sugar, which until then had been controlled on a low carb diet, started to deteriorate.
Questions to Ask Before Taking a Cortisone Treatment
Before you go to any doctor about a joint- or spine-related problem--the ones most likely to result in a cortisone treatment, read up about your condition on the web.
Then answer these questions:
Remember, at blood sugars over 200 mg/dl beta cells succumb to "glucose toxicity" i.e. sugar poisoning. If you're down to having 25% of your beta cell mass functional, losing that last 5% may be all it takes to make it impossible to control with diet alone.
If your doctor won't prescribe insulin demand to know why, and if the reason isn't a very good one, find a doctor more respectful of your health.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
I wish this were an isolated, oddball occurrence, but sadly, it is not. Years ago when I posted a question on the old alt.support.diabetes newsgroup about the events leading up to a Type 2 diabetes diagnosis, I heard from several people who said that their blood sugars, which had been marginal before a cortisone treatment, became fully diabetic afterwards.
It was only then that I connected my own diabetes diagnosis with the ten day long course of prednisone I'd been given the previous year and and realized that it was only after that treatment that I'd developed the raging hunger and uncontrollable weight gain that seems to have signaled that my blood sugars had crossed over some disastrous boundary.
Every doctor I've mentioned this too has pooh-poohed it. Yes, they say, cortisone temporarily raises blood sugars, but they should go back to normal afterwards. But my doctor said the same thing, even when faced with the evidence that I'd suddenly developed much stronger symptoms of diabetes.
So it is possible that doctors believe that cortisone will not worsen diabetes and because of that belief attribute the worsening when it occurs to something else! Alternatively, because cortisone is often given by orthopedic doctors who don't monitor a patients' blood sugar, it is possible that they don't ever learn of the effect of their shots on the patients.
My belief, after dealing with several rheumatologists and orthopedic doctors, is that these doctors often administer a shot of cortisone so that the patient--who is being billed well over $200 for the appointment--will feel that the doctor did something, since without cortisone, mostly all the doctor can do is advise patience.
Whatever the explanation, while I don't question that there are people with diabetes whose blood sugars return to normal after a cortisone treatment, I think we all need to be aware that cortisone can worsen our blood sugar, permanently. And if we have managed to get our blood sugars under control--especially if we've done it with diet and exercise, we should know that a single cortisone shot or course of prednisone may make it impossible to retain that good control without adding insulin.
That said, cortisone is a powerful drug that can dramatically improve symptoms of some severe autoimmune disorders and even, in some cases, save lives. If you need it for a serious autoimmune disease or to counter brain swelling, well, you'll just have to deal with any associated blood sugar issues. And they can be dealt with--usually by going on insulin.
But the tragic thing about cortisone is that it is often used in situations where the research makes it clear that it is nothing more than a placebo. Even worse, the conditions in which it is least likely to help are precisely those that many Type 2s are likely to develop: tendon problems like Frozen Shoulder and Carpal Tunnel syndrome.
While a cortisone shot may occasionally give some pain relief for frozen shoulder, the research shows that it does not shorten the healing time! The same is true of other tendon-related problems.
Here is a study that found that while cortisone shots produce short term improvement in frozen shoulder, three months later, the people who did NOT get the shots were in better shape!
http://ard.bmj.com/cgi/content/abstract/63/11/1460
Short course prednisolone for adhesive capsulitis (frozen shoulder or stiff painful shoulder): a randomised, double blind, placebo controlled trial.
R Buchbinder, J L Hoving, S Green, S Hall, A Forbes and P Nash
Annals of the Rheumatic Diseases 2004;63:1460-1469
I was also assured by a doctor that electrophoresis would deliver cortisone to another injured tendon--in my foot this time--and not raise my blood sugar and was dumb enough to believe it. The blood sugars I saw over the next week were much higher than usual. And it may or may not be coincidental that my fasting blood sugar, which until then had been controlled on a low carb diet, started to deteriorate.
Questions to Ask Before Taking a Cortisone Treatment
Before you go to any doctor about a joint- or spine-related problem--the ones most likely to result in a cortisone treatment, read up about your condition on the web.
Then answer these questions:
- Does cortisone have an impact on the healing time for this condition or is it only being used as a pain relief strategy? If the latter, ask your doctor for alternative pain treatments. When I did this my family doctor was able to find a safe drug for me to use that made the pain bearable until nature healed the tendon problem.
- Are there alternative treatments that have as good an impact on the underlying condition that won't raise blood sugar?
- If you have a condition, like an autoimmune disease, where cortisone drugs are effective and perhaps life or joint-saving, will your doctor prescribe insulin to control the dramatic blood sugar spikes cortisone will cause? Insulin is the only treatment that can prevent these very high blood sugars which will kill your remaining beta cells. Lowering your carbs, sadly, will not. But there's some reason to believe that using insulin to lower these blood sugars may help preserve the cells.
Remember, at blood sugars over 200 mg/dl beta cells succumb to "glucose toxicity" i.e. sugar poisoning. If you're down to having 25% of your beta cell mass functional, losing that last 5% may be all it takes to make it impossible to control with diet alone.
If your doctor won't prescribe insulin demand to know why, and if the reason isn't a very good one, find a doctor more respectful of your health.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Monday, September 10, 2007
Why A1c "Average" Doesn't Match Meter Tests at Normal Blood Sugars
If you've been working hard to bring your blood sugars down to normal, your next A1c might be a disappointment. That's because many of us find that even if our meters show us having much better blood sugars--those truly in the normal range--we still may get A1cs of 5.5-5.7%. According to the formula most doctors use, these A1cs correspond to an average blood sugar of 118 mg/dl to 126 mg/dl (6.6 mmol/L - 7 mmol/L).
Why you'd get an average of 118 mg/dl when you are spending only 3 hours a month over 140 and have fasting blood sugars under 100 mg/dl seems hard to understand. It has happened to me, and to several other people I know.
Doctors will tell you that your testing must be missing significant highs. But a friend of mine who believed that was the case for her blood sugars which tested in the normal range but resulted in a mid-6% A1c used a CGMS for a month and did not find that her blood sugar was spiking at times she hadn't thought to test. It was pretty much what her meter had told her it was. Something else was causing the high A1c.
The real problem is, as I discussed in an earlier blog posting, that the averages associated with A1cs were derived from DCCT, a study where almost all the participants had A1cs ranging from 7% to as high as they go. So those A1c to mean glucose averages derived from DCCT appear to only hold true at the damagingly high blood sugars that were found in that study. (7% corresponds to an average blood sugar of 170-180 depending on the formula you use. We know from a ton of studies that blood sugars over 140 mg/dl damage all kinds of cells. )
Here's a study that shows why at normal blood sugars, red blood cells live a lot longer, so that those formulas no longer apply.
In this study the scientists measured the lifetimes of hemoglobin cells in normal people and diabetics and found that the cells of the diabetics turned over much faster--as little as 81 days, while normal people's could live up to 146
days.
They suggest that getting better control will cause the cells to live
longer. But when they live for a couple extra months, they will also continue to glycate--i.e. collect the bits of sugar that are measured in the A1c test. Cells that are living longer may collect after 5 months of life the same amount of glucose a person with poor control might collect in 3 months. That doesn't mean they have the average blood sugars as the person who developed that degree of glycation in the much shorter period.
This data also suggests if you lower your blood sugars from good control to great control, control, you probably want to test only every 6 months, not every three because it will take that long for your good control to show up.
http://care.diabetesjournals.org/cgi/content/full/27/4/931
This may also explain why many truly normal people have A1cs in the lower 5% range. They may have much longer lived red blood cells than normal. I have one very physically fit friend whose fasting blood sugar is never over 95 mg/dl and who tests no higher than 115 mg/dl after eating a very high carb meal that would put me into a coma, yet his A1c is 5.4%.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Why you'd get an average of 118 mg/dl when you are spending only 3 hours a month over 140 and have fasting blood sugars under 100 mg/dl seems hard to understand. It has happened to me, and to several other people I know.
Doctors will tell you that your testing must be missing significant highs. But a friend of mine who believed that was the case for her blood sugars which tested in the normal range but resulted in a mid-6% A1c used a CGMS for a month and did not find that her blood sugar was spiking at times she hadn't thought to test. It was pretty much what her meter had told her it was. Something else was causing the high A1c.
The real problem is, as I discussed in an earlier blog posting, that the averages associated with A1cs were derived from DCCT, a study where almost all the participants had A1cs ranging from 7% to as high as they go. So those A1c to mean glucose averages derived from DCCT appear to only hold true at the damagingly high blood sugars that were found in that study. (7% corresponds to an average blood sugar of 170-180 depending on the formula you use. We know from a ton of studies that blood sugars over 140 mg/dl damage all kinds of cells. )
Here's a study that shows why at normal blood sugars, red blood cells live a lot longer, so that those formulas no longer apply.
In this study the scientists measured the lifetimes of hemoglobin cells in normal people and diabetics and found that the cells of the diabetics turned over much faster--as little as 81 days, while normal people's could live up to 146
days.
They suggest that getting better control will cause the cells to live
longer. But when they live for a couple extra months, they will also continue to glycate--i.e. collect the bits of sugar that are measured in the A1c test. Cells that are living longer may collect after 5 months of life the same amount of glucose a person with poor control might collect in 3 months. That doesn't mean they have the average blood sugars as the person who developed that degree of glycation in the much shorter period.
This data also suggests if you lower your blood sugars from good control to great control, control, you probably want to test only every 6 months, not every three because it will take that long for your good control to show up.
http://care.diabetesjournals.org/cgi/content/full/27/4/931
This may also explain why many truly normal people have A1cs in the lower 5% range. They may have much longer lived red blood cells than normal. I have one very physically fit friend whose fasting blood sugar is never over 95 mg/dl and who tests no higher than 115 mg/dl after eating a very high carb meal that would put me into a coma, yet his A1c is 5.4%.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Sunday, September 9, 2007
The Hubris of "Medical Professionals"
This morning's email brought an angry letter from an anonymous nurse who told me that my views were worthless because she was a "medical professional" and I wasn't. No further information backed up this claim.
That made me think of the story I'd recently read in the Washington Post that documented just how ignorant "medical professionals"--in this case Doctors--can be.
Doctors Flunk Quiz about Supplements their Patients Use
There are two disturbing things in this study. One was that one third of 335 doctors did not know that the FDA doesn't regulate supplements and that no proof of supplements' efficacy is required before they are sold to the public. Almost two thirds did not know that they are supposed to report side effects from supplements to the FDA.
That's bad enough. But what is worse is this: After being given a brief course about supplements 9% of the doctors who had taken the course still flunked a quiz about supplements.
The torrent of email I get from patients who have been misdiagnosed with the wrong kind of diabetes, undiagnosed with blood sugars repeatedly over 200 mg/dl, told by their doctors that a "diabetes diet" is a low fat diet full of carbs, and left untreated with blood sugars high enough to give them the a1c of 7-8%-which represents average blood sugar of 172-207 mg/dl, convinces me that many doctors would flunk any test they were given about the current understanding of diabetes and its effective treatments.
Unfortunately, once a doctor goes into private practice, there is no requirement that he or she pass any test demonstrating that they have kept up with diabetes treatment. This is true, no matter how many patients with diabetes they treat. Doctors do have to take "continuing medical education" to retain their licenses but it is up to them what courses they take. If they aren't interested in diabetes, they can ignore it for the rest of their professional careers and many do.
I run into medical professionals from time to time who support what I do here. They aren't all self-satisfied egoists. But for those who are, let me stress this again, the appeal to authority won't impress any of us who use a blood sugar meter and our access to up-to-date medical research to determine the quality of advice dished out by medical professionals.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
That made me think of the story I'd recently read in the Washington Post that documented just how ignorant "medical professionals"--in this case Doctors--can be.
Doctors Flunk Quiz about Supplements their Patients Use
There are two disturbing things in this study. One was that one third of 335 doctors did not know that the FDA doesn't regulate supplements and that no proof of supplements' efficacy is required before they are sold to the public. Almost two thirds did not know that they are supposed to report side effects from supplements to the FDA.
That's bad enough. But what is worse is this: After being given a brief course about supplements 9% of the doctors who had taken the course still flunked a quiz about supplements.
The torrent of email I get from patients who have been misdiagnosed with the wrong kind of diabetes, undiagnosed with blood sugars repeatedly over 200 mg/dl, told by their doctors that a "diabetes diet" is a low fat diet full of carbs, and left untreated with blood sugars high enough to give them the a1c of 7-8%-which represents average blood sugar of 172-207 mg/dl, convinces me that many doctors would flunk any test they were given about the current understanding of diabetes and its effective treatments.
Unfortunately, once a doctor goes into private practice, there is no requirement that he or she pass any test demonstrating that they have kept up with diabetes treatment. This is true, no matter how many patients with diabetes they treat. Doctors do have to take "continuing medical education" to retain their licenses but it is up to them what courses they take. If they aren't interested in diabetes, they can ignore it for the rest of their professional careers and many do.
I run into medical professionals from time to time who support what I do here. They aren't all self-satisfied egoists. But for those who are, let me stress this again, the appeal to authority won't impress any of us who use a blood sugar meter and our access to up-to-date medical research to determine the quality of advice dished out by medical professionals.
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
Thursday, September 6, 2007
The Worst Non-Facts from Nutritionists
Here are a randomly chosen list of horribly bad advice people with diabetes have reported getting from registered dietitians in the last couple months. They all have in common that they are completely wrong.
1. If your blood sugar goes below 100 mg/dl, it's a hypo and you have to eat some carbs right away to bring it back up. (Told to a Type 2 controlling with only diet and exercise!)
No. The normal blood sugar range goes down to 70 mg/dl. The ideal blood sugar for someone who is controlling with diet alone is mid-80s.
2. Your brain stops working if you eat less than 130 mg/dl of carbs a day.
No. Your brain works fine with 0 carbs as long as you eat enough protein that the liver can convert that protein to provide the roughly 60 grams of carbs you need to run your brain. About 58% of the protein in your diet can be converted to glucose.
3. If you are low on potassium, you should eat bananas.
Not unless you love having very high blood sugars. You can get potassium from avocados, broccoli, spinach, winter squash, mushrooms, lean meats, clams, and fish, including salmon. If you still don't think you are getting enough, one sprinkle of Morton's Salt Substitute will provide more than enough potassium for anyone.
4. You have to drink at least 8 glasses of water a day. A lot more is even better.
No. This is the "Water Myth" which was invented by the companies that sell bottled water. Too much water washes water soluble vitamins out of the body and can stress marginal kidneys.
5. Eat a lot of healthy whole grains. (To a Type 2 controlling with diet)
Not unless you want unhealthy high blood sugars. All the studies supposedly proving whole grains were "healthy" compared a diet of whole grains to an even higher carb diet full of white flour and potatoes.
No one has funded a study that compares a diet rich in whole grains with one free of almost all grain products, where the whole grain diet would come in very poorly. That's probably because no one will get rich NOT selling cheap grain to the public. Studies of low carbohydrate diets very low in grain of all types have shown that they make huge improvements in the blood sugar and lipids of people with diabetes.
6. Pasta is very good for your blood sugar.
Pasta LOOKS good if you test your blood sugar only at 1 or 2 hours after eating it because it takes 5-7 hours to digest. If you tested after it digested you'd be likely to see the 23 grams per ounce hitting the blood stream and the sight would not be pretty. A typical restaurant serving of pasta contains about 160 grams of carbohydrate. Without any sauce. Add the sugary tomato sauce and you just plain don't want to know!
That's a start. Send me your nutritionist horror stories!
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
1. If your blood sugar goes below 100 mg/dl, it's a hypo and you have to eat some carbs right away to bring it back up. (Told to a Type 2 controlling with only diet and exercise!)
No. The normal blood sugar range goes down to 70 mg/dl. The ideal blood sugar for someone who is controlling with diet alone is mid-80s.
2. Your brain stops working if you eat less than 130 mg/dl of carbs a day.
No. Your brain works fine with 0 carbs as long as you eat enough protein that the liver can convert that protein to provide the roughly 60 grams of carbs you need to run your brain. About 58% of the protein in your diet can be converted to glucose.
3. If you are low on potassium, you should eat bananas.
Not unless you love having very high blood sugars. You can get potassium from avocados, broccoli, spinach, winter squash, mushrooms, lean meats, clams, and fish, including salmon. If you still don't think you are getting enough, one sprinkle of Morton's Salt Substitute will provide more than enough potassium for anyone.
4. You have to drink at least 8 glasses of water a day. A lot more is even better.
No. This is the "Water Myth" which was invented by the companies that sell bottled water. Too much water washes water soluble vitamins out of the body and can stress marginal kidneys.
5. Eat a lot of healthy whole grains. (To a Type 2 controlling with diet)
Not unless you want unhealthy high blood sugars. All the studies supposedly proving whole grains were "healthy" compared a diet of whole grains to an even higher carb diet full of white flour and potatoes.
No one has funded a study that compares a diet rich in whole grains with one free of almost all grain products, where the whole grain diet would come in very poorly. That's probably because no one will get rich NOT selling cheap grain to the public. Studies of low carbohydrate diets very low in grain of all types have shown that they make huge improvements in the blood sugar and lipids of people with diabetes.
6. Pasta is very good for your blood sugar.
Pasta LOOKS good if you test your blood sugar only at 1 or 2 hours after eating it because it takes 5-7 hours to digest. If you tested after it digested you'd be likely to see the 23 grams per ounce hitting the blood stream and the sight would not be pretty. A typical restaurant serving of pasta contains about 160 grams of carbohydrate. Without any sauce. Add the sugary tomato sauce and you just plain don't want to know!
That's a start. Send me your nutritionist horror stories!
Copyright Janet Ruhl 2007. If you are NOT reading this on http://diabetesupdate.blogspot.com the content has been STOLEN.
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