I have long contended that it is impossible for toddlers to develop Type 2 diabetes through overeating and lack of exercise. It takes more than a decade for adults to develop diabetes due to obesity. And quite a few studies have shown that toddlers with normal metabolisms regulate their food intake with surprising precision and will not become overweight even if given unrestricted access to food.
So it comes as a welcome bit of news that a recent study has found that Bisphenol A is leaching out of plastic baby bottles at an alarming rate, especially when these bottles are warmed. Here, at last, we find a very likely contributor to the epidemic of childhood obesity and Type 2 diabetes: Bisphenol A is a chemical known to disrupt endocrine function which has been tied to the development of diabetes and obesity in lab animals.
You can read the actual study by downloading the PDF you'll find linked on this page from the Center for Health, Environment & Justice:
Baby's Toxic Bottle
To quote the web page just cited, "BPA, a synthetic sex hormone that mimics estrogen, is used to make hard polycarbonate plastic. Ninety-five percent of all baby bottles on the market are made with bisphenol A. The results of the U.S. study show that, when new bottles are heated, those manufactured by Avent, Evenflo, Dr. Brown’s and Disney/First Years leached between 4.7 – 8.3 parts per billion of bisphenol A. Recent research on animals shows that bisphenol A can be harmful by disrupting development at doses below these levels."
The only scientists who question the harm done by this plastic that is used throughout our food supply are those on the payroll of the plastics industry.
While the presence of Bisphenol A in babies' and toddlers' blood streams may explain the early onset of the kinds of obesity that are not normally seen in children who have normal metabolisms, the exposure to this chemical and many other plastics suspected of disturbing endocrine functions doesn't end with the end of bottle feeding. Sippy cups are plastic. Water bottles are plastic. Ketchup and salad dressing bottles are plastic. Dishware and unbreakable glasses are plastic. Microwave trays are plastic. Your organic vegetables from the so-called "health food" store sit on plastic trays wrapped in plastic. It goes on and on.
Another related recent story found dangerous levels of phthalates in the bloodstream--another organic chemical which damages the body. Who knows what other plastics are leaching into us and what they are doing?
Plastics, you must remember, are made out of organic molecules and organic molecules have this way of fitting into the receptors in our bodies designed for something else and disturbing their function.
So yes, people may be obese because they overeat--but they may be overeating because vital receptors have been clogged by these organic compounds that are similar enough to substances like estrogen and other hormones to fit into receptors meant for them. The presence of these foreign organic molecules we call "plastic" are very likely to be disrupting the complex systems that regulate appetite, weight, and blood sugar metabolism.
The energy spent blaming victims of this unfolding disaster for their obesity and diabetes has taken attention away from the questions that should have been asked--like why are children too young to be able to eat themselves into any metabolic disease suffering the kinds of metabolic disruption we only see in animals with abnormal genes or those who have been intentionally poisoned in the lab?
We're getting some answers now, but it may be years until action is taken. Meanwhile our entire population has bodies laced with these chemicals, which may have become permanent parts of them. And while we are waiting for more evidence, you can count on industry representatives to continue to claim that their products are harmless, just like the cigarette industry did--very successfully--for a full 30 years after scientists linked cigarette smoking to a wide variety of cancers.
It will take a long time to get answers to the question of how much damage these plastics that infuse our environment have caused. Most medical research is funded by drug companies for whom the obesity and diabetes epidemics represent a golden opportunity to make money from each and every victim. A person with diabetes will have to take three or four expensive pills every day for the rest of their lives. Curing the diabetes epidemic would send their stock prices tumbling.
Other sources of funding have dried up, most notably government research dollars. Bush & Co. have done all they can to gut the government organizations like the EPA whose mandate use to be to protect the public. The EPA now spends its limited budget campaigning against laws that would limit pollution. So there is little money available to scientists who want to research questions like what the true impact is of these toxic plastics that are circulating in our blood streams. And for every dollar academic scientists scare up to look at these questions, ten are spent by the chemical industry to obscure the issue.
Don't let yourself be fooled! Demand that your elected representatives increase public funding for science that protects the public. And in this upcoming election, be sure that whatever your party affiliation you elect representatives whose records show that they respect science and that their support for "life" doesn't end the day a baby is born.
Friday, February 8, 2008
Wednesday, February 6, 2008
My Take on ACCORD
I've heard from quite a few people today asking me what I think of the news that the ACCORD study seems to have found a connection between lowering the A1c below 7% and having cardiac patients die more frequently.
Deaths Partially Halt Diabetes Study
I'd like to see a more detailed report on the actual findings than what is currently appearing in the press,There is very little information here about what were the actual protocols used in this study. Follow up releases include claims supplied by the maker of Avandia that the study did not connect the excess deaths with the use of Avandia or "any drug."
But the little I could find about how this study was designed suggests that it may be impossible to tease out what really caused the excess deaths, because the study participants were given not only a wide variety of blood sugar lowering drugs, but also an aggressive blood pressure lowering drug regimen, and they were put on the aggressive combination of fibrates with statins to lower their LDL.
Here's the NIH description of the study:NIH Study Will Test Best Ways to Lower Risk of Heart Disease and Stroke in Adults with Type 2 Diabetes.
Clearly the participants in this study were ALL taking a large number drugs which were interacting like crazy with each other in a large number of possible combinations, any one of which might be causing the excess deaths.
For example, we recently learned that lowering LDL by combining a statin with another LDL lowering agent may thicken plaque, as that is what happened when Zetia was added to a statin. We also know that for people with compromised liver function the Beta Blockers used to lower blood sugar can actually be toxic (that information is in the prescribing information) and that both statins and TZDs can each affect liver function. What happens to the liver when both kinds of drugs are prescribed at once along with fibrates may never have been studied before.
The glaring omission in this study is this: There was no control group which lowered their A1c without the use of drugs. All the participants were taking drugs, lots of them. So we have no true way of knowing if it was the lowered blood sugar or the drugs causing the excess mortality. This really is a shame as many of you reading this are people diagnosed with diabetes who have lowered your blood sugars below 7% using carb restriction and exercise alone. So there is no reason that such a control group could not have been included.
But this study only involved people taking drugs, so we can be pretty sure that the people with lower blood sugars in this study took MORE drugs than those with higher blood sugars and that it is likely that it is some effect of the interactions of these drugs to blame if, as is claimed in the GlaxoSmithKline press release the data could not point to a clear connection between ONE drug and the excess deaths.
If we ever get access to more data I'll be sure to let you know what it tells us. We all have learned by now that what the headlines tell us a study shows is often NOT what the study actually shows, and that will probably be the case here.
My own experience after almost ten years of keeping my A1c in the 5% range is that despite doctors spending an unholy amount of their time and my money trying to prove that I must have heart disease since I have diabetes and eat a low carb/high fat diet, I've come up clean on the scans, treadmill tests, monitoring, and everything else they could throw at me.
Deaths Partially Halt Diabetes Study
I'd like to see a more detailed report on the actual findings than what is currently appearing in the press,There is very little information here about what were the actual protocols used in this study. Follow up releases include claims supplied by the maker of Avandia that the study did not connect the excess deaths with the use of Avandia or "any drug."
But the little I could find about how this study was designed suggests that it may be impossible to tease out what really caused the excess deaths, because the study participants were given not only a wide variety of blood sugar lowering drugs, but also an aggressive blood pressure lowering drug regimen, and they were put on the aggressive combination of fibrates with statins to lower their LDL.
Here's the NIH description of the study:NIH Study Will Test Best Ways to Lower Risk of Heart Disease and Stroke in Adults with Type 2 Diabetes.
Clearly the participants in this study were ALL taking a large number drugs which were interacting like crazy with each other in a large number of possible combinations, any one of which might be causing the excess deaths.
For example, we recently learned that lowering LDL by combining a statin with another LDL lowering agent may thicken plaque, as that is what happened when Zetia was added to a statin. We also know that for people with compromised liver function the Beta Blockers used to lower blood sugar can actually be toxic (that information is in the prescribing information) and that both statins and TZDs can each affect liver function. What happens to the liver when both kinds of drugs are prescribed at once along with fibrates may never have been studied before.
The glaring omission in this study is this: There was no control group which lowered their A1c without the use of drugs. All the participants were taking drugs, lots of them. So we have no true way of knowing if it was the lowered blood sugar or the drugs causing the excess mortality. This really is a shame as many of you reading this are people diagnosed with diabetes who have lowered your blood sugars below 7% using carb restriction and exercise alone. So there is no reason that such a control group could not have been included.
But this study only involved people taking drugs, so we can be pretty sure that the people with lower blood sugars in this study took MORE drugs than those with higher blood sugars and that it is likely that it is some effect of the interactions of these drugs to blame if, as is claimed in the GlaxoSmithKline press release the data could not point to a clear connection between ONE drug and the excess deaths.
If we ever get access to more data I'll be sure to let you know what it tells us. We all have learned by now that what the headlines tell us a study shows is often NOT what the study actually shows, and that will probably be the case here.
My own experience after almost ten years of keeping my A1c in the 5% range is that despite doctors spending an unholy amount of their time and my money trying to prove that I must have heart disease since I have diabetes and eat a low carb/high fat diet, I've come up clean on the scans, treadmill tests, monitoring, and everything else they could throw at me.
Tuesday, February 5, 2008
Inconsiderate Thin People Cost Society a Bundle
After being deluged for years by media health pundits claiming that the costs of treating fat people are draining society dry it came as a refreshing surprise to read that when scientists actually did a study to determine the exact costs of all that obesity, they learned that it is not the obese costing society the most money. It turns out it's those damn thin people racking up the big bills.
Here's the story: Fat People Cheaper to Treat, Study Says
Here's the most interesting paragraph from the news report about the Dutch study that examined health histories of 1,000 people:
"Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
"The cost of care for obese people was $371,000, and for smokers, about $326,000."
An American researcher unconnected with this study commented that the previous claims that the obese were going to bankrupt society were based on "guesswork, political agendas, and changing science."
Clearly, it's time to stop bashing the obese and to start demanding that those selfish thin people do something to shorten their lives so we don't end up paying almost $100,000 extra per person to support them in those old age homes where they live out the slow deterioration made possible by their inconsiderate pursuit of fitness.
It's also worth noting that this study also found that while the obese had more diabetes, the thin had more strokes. Given a choice, I'd take diabetes over stroke any day. You can do something about diabetes. Stroke pretty much makes you its victim.
But joking aside, what this study really points out is how often the statements we read in the press about health issues are nothing more than guesses deriving from prejudices and reinforced by repetition, rather than information derived from well-constructed studies.
In another, related example, in March of 2004, Dr. Julie Gerberding, the head of the CDC, made the statement to the press that obesity caused 400,000 deaths a year. This was trumpeted throughout the media. But a study published by her own organization, the CDC, on April 20, 2005 in The Journal of the American Medical Association made it very clear that she'd pulled this impressive figure out of her imagination. The CDC research study published in JAMA found that the number of deaths attributable to obesity was actually 25,814. Not 400,000.
Did this second, research-supported, number get bruited around the media? No. Because it flew in the face of what people want to believe and diminished our ability to loathe and demonize the obese.
So don't expect the results of this new study to change public opinion either. No one is going to introduce legislation demanding that restaurants in Mississippi start supersizing the orders of thin people. But using the logic that has been applies to the obese, they ought to.
I mean, really. Those selfish, costly thin people! . . Why just look at that beanpole there, it's disgusting. He's a stroke just waiting to happen. . . . .
Here's the story: Fat People Cheaper to Treat, Study Says
Here's the most interesting paragraph from the news report about the Dutch study that examined health histories of 1,000 people:
"Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
"The cost of care for obese people was $371,000, and for smokers, about $326,000."
An American researcher unconnected with this study commented that the previous claims that the obese were going to bankrupt society were based on "guesswork, political agendas, and changing science."
Clearly, it's time to stop bashing the obese and to start demanding that those selfish thin people do something to shorten their lives so we don't end up paying almost $100,000 extra per person to support them in those old age homes where they live out the slow deterioration made possible by their inconsiderate pursuit of fitness.
It's also worth noting that this study also found that while the obese had more diabetes, the thin had more strokes. Given a choice, I'd take diabetes over stroke any day. You can do something about diabetes. Stroke pretty much makes you its victim.
But joking aside, what this study really points out is how often the statements we read in the press about health issues are nothing more than guesses deriving from prejudices and reinforced by repetition, rather than information derived from well-constructed studies.
In another, related example, in March of 2004, Dr. Julie Gerberding, the head of the CDC, made the statement to the press that obesity caused 400,000 deaths a year. This was trumpeted throughout the media. But a study published by her own organization, the CDC, on April 20, 2005 in The Journal of the American Medical Association made it very clear that she'd pulled this impressive figure out of her imagination. The CDC research study published in JAMA found that the number of deaths attributable to obesity was actually 25,814. Not 400,000.
Did this second, research-supported, number get bruited around the media? No. Because it flew in the face of what people want to believe and diminished our ability to loathe and demonize the obese.
So don't expect the results of this new study to change public opinion either. No one is going to introduce legislation demanding that restaurants in Mississippi start supersizing the orders of thin people. But using the logic that has been applies to the obese, they ought to.
I mean, really. Those selfish, costly thin people! . . Why just look at that beanpole there, it's disgusting. He's a stroke just waiting to happen. . . . .
Wednesday, January 30, 2008
Statin Drug Manufacturers Deluge Media with Spin
Ever since the publication of the long-delayed results of the Zetia/Vytorin trial a few weeks ago, the study which raised serious questions about whether lowering LDL does anything to prevent heart attack death, the media have been full of M.D.s pontificating on the importance of lowering LDL and the wonderfulness of statin drugs.
I've heard them on NPR. I've seen them on my local TV news channel. Clearly the drug industry spinmeisters have been hard at work sending out press releases.
On the local news channel tonight, a doctor insisted that you could lower cholesterol by not eating fat and not eating cholesterol, but if that didn't work, you should take a statin drug because statins were "proven" to prevent heart disease in people with "risk factors."
Those of you who are educated about nutrition know that the first two statements are just plain wrong and that the third statement is only true if by "risk factors" you mean, "being a male, under 65 and having already had a heart attack." The sample patient in the TV news story was a young, thin, fit man, shown exercising at the gym, who said he had just been told he had high cholesterol. The point of the brief news story seemed to be that people like him needed to take statins.
On the NPR health show, the featured doctor went so far as to say he thought just about everyone should be on statins starting in their 20s.
As you may know, the American Heart Association (a wholly owned subsidiary of Big Pharma and the Cereal Industry) rushed into print immediately after the release of the Zetia/Vytorin results telling a New York Times reporter that people should continue taking these drugs even though this major study make it clear that they are at best ineffectual and at worse may make arteries clog faster.
A follow up article in the New York Times pointed out that the AHA failed to disclose to the reporter the many millions of dollars it gets from makers of these drugs. The article also pointed that the AHA's web site links to a page advertising Vytorin using what looks like an informational link purporting to be about the sources of cholesterol. Clearly the American Heart Association is highly influenced by the people who give them money.
New York Times: Heart Group Backs Drug Made by Ally.
I expect to see a lot more of this kind of story in the media in days to come. You will too. When you do, take the time to contact the media outlet and explain to them how disappointed you were that they presented a drug company press release as if it were a news story rather than providing a balanced story investigating the growing weight of evidence casting doubt on the efficacy of statins for anyone who is not a male under 65 with a previous heart attack.
And if you haven't already, check out Businessweek's Cover Story about Statins: Lipitor: Does it Make a Difference. A reporter there actually did some research!
UPDATE: Jan 31
Today's variant on the spin is a AHA "wear red" assault on women's health, which urges women to get their cholesterol measured--and points them to a web site recommending "healthy" low fat/high carb diets. The photo on the AHA sponsored web site is of a big slice of pizza made with low fat cheese.
Here you can see how many newspapers published the AHA's press release as if it were news:
http://news.google.com/?ncl=1126994144&hl=en&topic=m
Did ANYONE reporting on the health industry notice the huge and very well conducted Women's Health Initiative study (WHI) proved conclusively that low fat dieting DOES NOT HAVE ANY EFFECT ON WOMEN'S HEART DISEASE?
Obviously not. Junk food empires Campbells and Kelloggs are listed as sponsors of this AHA program but the top sponsor is Merck, makers of Vytorin and Zocor.
I've heard them on NPR. I've seen them on my local TV news channel. Clearly the drug industry spinmeisters have been hard at work sending out press releases.
On the local news channel tonight, a doctor insisted that you could lower cholesterol by not eating fat and not eating cholesterol, but if that didn't work, you should take a statin drug because statins were "proven" to prevent heart disease in people with "risk factors."
Those of you who are educated about nutrition know that the first two statements are just plain wrong and that the third statement is only true if by "risk factors" you mean, "being a male, under 65 and having already had a heart attack." The sample patient in the TV news story was a young, thin, fit man, shown exercising at the gym, who said he had just been told he had high cholesterol. The point of the brief news story seemed to be that people like him needed to take statins.
On the NPR health show, the featured doctor went so far as to say he thought just about everyone should be on statins starting in their 20s.
As you may know, the American Heart Association (a wholly owned subsidiary of Big Pharma and the Cereal Industry) rushed into print immediately after the release of the Zetia/Vytorin results telling a New York Times reporter that people should continue taking these drugs even though this major study make it clear that they are at best ineffectual and at worse may make arteries clog faster.
A follow up article in the New York Times pointed out that the AHA failed to disclose to the reporter the many millions of dollars it gets from makers of these drugs. The article also pointed that the AHA's web site links to a page advertising Vytorin using what looks like an informational link purporting to be about the sources of cholesterol. Clearly the American Heart Association is highly influenced by the people who give them money.
New York Times: Heart Group Backs Drug Made by Ally.
I expect to see a lot more of this kind of story in the media in days to come. You will too. When you do, take the time to contact the media outlet and explain to them how disappointed you were that they presented a drug company press release as if it were a news story rather than providing a balanced story investigating the growing weight of evidence casting doubt on the efficacy of statins for anyone who is not a male under 65 with a previous heart attack.
And if you haven't already, check out Businessweek's Cover Story about Statins: Lipitor: Does it Make a Difference. A reporter there actually did some research!
UPDATE: Jan 31
Today's variant on the spin is a AHA "wear red" assault on women's health, which urges women to get their cholesterol measured--and points them to a web site recommending "healthy" low fat/high carb diets. The photo on the AHA sponsored web site is of a big slice of pizza made with low fat cheese.
Here you can see how many newspapers published the AHA's press release as if it were news:
http://news.google.com/?ncl=1126994144&hl=en&topic=m
Did ANYONE reporting on the health industry notice the huge and very well conducted Women's Health Initiative study (WHI) proved conclusively that low fat dieting DOES NOT HAVE ANY EFFECT ON WOMEN'S HEART DISEASE?
Obviously not. Junk food empires Campbells and Kelloggs are listed as sponsors of this AHA program but the top sponsor is Merck, makers of Vytorin and Zocor.
Alternative and Natural Treatments for Diabetes
One of the questions I'm asked most frequently by people who email me is "Aren't there any natural treatments I can use to normalize my diabetes?"
By "natural" people mean the herbs and supplements that are sold with the marketing message that the substances they contain are safer and more effective than pharmaceutical drugs.
The short answer is NO.
Very few supplements sold to help people with diabetes do anything at all but help you lose weight in your wallet. Many of them are just vitamin and mineral blends. You can read in more depth how flimsy is the data suggesting that any minerals really help with diabetes on my web page Bad and Questionable Supplements.
Many of the other supplements sold specifically for diabetes contain cinnamon, which has also been discredited as a blood sugar treatment now that we have some research that was not performed by a team of researchers headed by someone with a financial interest in cinnamon.
Occasionally you will hear on a forum or discussion group about a supplement that someone with diabetes reports has a dramatic effect on their blood sugar. Unfortunately, all too often the supplement works because it is chemically very similar to a pharmaceutical and that means--and this is extremely important--it has the same side effects as the pharmaceutical.
For example, some Chinese herbs used for controlling blood sugar turn out to be chemically very similar to sulfonylurea drugs. Bitter melon and ginseng fall into this category.
Application of modified in vitro screening procedure for identifying herbals possessing sulfonylurea-like activity. Y. Rotshteyn and S. W. Zito.
No one questions that sulfonylurea drugs work to lower blood sugar. The big problem with them, particularly the ones more like the herbs in function, is that the same chemical action that causes beta cells to pump out insulin also stimulates heart muscle in a way that increases heart attack. There is some concern that the continual stimulation of the beta cell by sulfonylureas may cause them to die over time. If your herb is stimulating insulin secretion by using the pathway sulfonylureas use, it is subject to these identical concerns.
Red rice yeast lowers cholesterol the same way as statins, because it contains natural statins, which mean when you take them you have the same risk of muscle damage and cognitive decline.
This is troubling enough, but then you run into the single biggest problem with herbs and supplements: Because they are completely unregulated, you have no idea what might be in the capsule you paid for.
When supplements are taken to the lab and analyzed they often turn out not to contain what they are supposed to contain. Even worse, they may contain other things that you didn't bargain for, be they pesticide residues or actual pharmaceutical drugs added to make them "effective."
You can read a description of what one company was selling instead of Hoodia in capsules labeled Hoodia: HERE. Sawdust was only one of the components filling the expensive capsule. Another article explains how lab analysis found that 11 out of 17 bottles of Hoodia contained NO Hoodia at all. Read it HERE.
In contrast, quite a few Chines herbs that appeared effective turned out when analyzed in the lab to contain added pharmaceutical drugs. You can read a chilling review of the various pharmaceuticals found on analysis of various Chinese herbs HERE.
Note that the drugs adulterating these herbal preparations included glibenclamide, a powerful sulfonylurea drug. Another was prednisone, which is a powerful corticosteroid that raises blood sugar and can permanently damage beta cells.
And HERE is an academic study of pesticides found in herbal supplements analyzed in the lab in 2004 which reports that "...pesticides were found in 44 out of 87 samples of botanical dietary supplements (the majority of these being ginseng products) suspected of containing pesticides. Over 30 different types of organochlorine, organophosphorus, and organonitrogen pesticide residues were present in these samples, with pentachloroaniline, pentachlorobenzene, and quintozene being the most abundant. A majority of these products contained more than one pesticide; one such sample was found to contain as many as 12 organochlorine compounds. Concentrations of pesticide residues ranged from 0.001 (pentachloroaniline and pentachlorophenyl methyl ester) to 5.57 mg/kg (quintozene)"
It's expensive to do these analyses so most of the herbs and supplements you see in the store do not get them. But based on the testing we do see, it's likely that you have a one in two chance when you buy a supplement that it either doesn't contain what you paid for, or that it contains pesticides and other dangerous contaminants.
So much for "natural" cures.
I have repeatedly heard from users of supplements who claim that the company whose products they use is different from the sleazy weasels I warn about. Further questioning always reveals that they draw this conclusion from claims made by the company itself, usually on its web site.
In fact, it is very difficult to know whether you can trust any supplement company, no matter how well-intentioned, given the complete lack of regulation and the fact that most of them buy their raw materials from China and the third world.
The problem is often beyond the control of even the most legitimate supplement vendors because of their dependence on merchants in third world countries where corruption runs rife. For example, right now, most of the vitamins sold by U.S. companies are manufactured in China and are subject to all the problems with all Chinese products: they are manufactured using polluted water heavy in pesticides and other industrial pollutants and they may very well be adulterated as the track record of Chinese companies for selling adulterated products is very poor.
Unless every batch of raw materials is subjected to extensive and very expensive testing for every possible contaminant, there is no way any company can guarantee the purity of its supplements. The capsule that contains a supplement this month, based on independent lab testing paid for by some journalist, may not contain it next month.
At least with pharmaceutical drugs, despite well-documented company shenanigans, you can trust that you are getting what you pay for in each capsule. And if you are willing to take some time and use Google Scholar you can find out what research studies have found about their effects.
My guess is that one reason for the huge success of "natural" herbs and supplements is that they stimulate the placebo effect, which is very real. People who believe something will make them better often get better--especially if what is wrong with them is something vague that isn't a real illness. But diabetes is a real illness and placebos do NOT lower diabetic blood sugars in any meaningful way.
The only way to lower blood sugar is to either a) cut way back on the carbohydrates in your food, those sugars and starches that metabolize into high blood sugars or b) use drugs that either supplement the insulin you lack, stimulate the production of more insulin by your body, or make the insulin circulating in your body more effective.
Cutting back on the carbohydrates requires no pills. Stop eating carbs and I guarantee you you will see your blood sugars drop. If they don't drop enough, it's time to research effective and safe diabetes drugs. I've done some of the work for you in various article published on the Drugs and Food section of my main diabetes site, recently renamed Blood Sugar 101.
A big part of figuring out which diet or drug might be best for you is figuring out the specific nature of your own diabetes. If you are insulin deficient, you'll need different drugs and dietary approaches from someone who is very insulin resistant but still produces a lot of insulin. That's something we'll discuss further.
But for now, resist the temptation to reach for the magic pills, no matter how beautifully packaged and how upscale the merchant selling them. If you have diabetes you don't need a placebo, you don't need mysterious and questionable substances, you need to cut back on the carbs that raise your blood sugar and if diet doesn't get the job done, you need to figure out what's wrong with you and which well-understood drug might be safe and helpful for you.
By "natural" people mean the herbs and supplements that are sold with the marketing message that the substances they contain are safer and more effective than pharmaceutical drugs.
The short answer is NO.
Very few supplements sold to help people with diabetes do anything at all but help you lose weight in your wallet. Many of them are just vitamin and mineral blends. You can read in more depth how flimsy is the data suggesting that any minerals really help with diabetes on my web page Bad and Questionable Supplements.
Many of the other supplements sold specifically for diabetes contain cinnamon, which has also been discredited as a blood sugar treatment now that we have some research that was not performed by a team of researchers headed by someone with a financial interest in cinnamon.
Occasionally you will hear on a forum or discussion group about a supplement that someone with diabetes reports has a dramatic effect on their blood sugar. Unfortunately, all too often the supplement works because it is chemically very similar to a pharmaceutical and that means--and this is extremely important--it has the same side effects as the pharmaceutical.
For example, some Chinese herbs used for controlling blood sugar turn out to be chemically very similar to sulfonylurea drugs. Bitter melon and ginseng fall into this category.
Application of modified in vitro screening procedure for identifying herbals possessing sulfonylurea-like activity. Y. Rotshteyn and S. W. Zito.
No one questions that sulfonylurea drugs work to lower blood sugar. The big problem with them, particularly the ones more like the herbs in function, is that the same chemical action that causes beta cells to pump out insulin also stimulates heart muscle in a way that increases heart attack. There is some concern that the continual stimulation of the beta cell by sulfonylureas may cause them to die over time. If your herb is stimulating insulin secretion by using the pathway sulfonylureas use, it is subject to these identical concerns.
Red rice yeast lowers cholesterol the same way as statins, because it contains natural statins, which mean when you take them you have the same risk of muscle damage and cognitive decline.
This is troubling enough, but then you run into the single biggest problem with herbs and supplements: Because they are completely unregulated, you have no idea what might be in the capsule you paid for.
When supplements are taken to the lab and analyzed they often turn out not to contain what they are supposed to contain. Even worse, they may contain other things that you didn't bargain for, be they pesticide residues or actual pharmaceutical drugs added to make them "effective."
You can read a description of what one company was selling instead of Hoodia in capsules labeled Hoodia: HERE. Sawdust was only one of the components filling the expensive capsule. Another article explains how lab analysis found that 11 out of 17 bottles of Hoodia contained NO Hoodia at all. Read it HERE.
In contrast, quite a few Chines herbs that appeared effective turned out when analyzed in the lab to contain added pharmaceutical drugs. You can read a chilling review of the various pharmaceuticals found on analysis of various Chinese herbs HERE.
Note that the drugs adulterating these herbal preparations included glibenclamide, a powerful sulfonylurea drug. Another was prednisone, which is a powerful corticosteroid that raises blood sugar and can permanently damage beta cells.
And HERE is an academic study of pesticides found in herbal supplements analyzed in the lab in 2004 which reports that "...pesticides were found in 44 out of 87 samples of botanical dietary supplements (the majority of these being ginseng products) suspected of containing pesticides. Over 30 different types of organochlorine, organophosphorus, and organonitrogen pesticide residues were present in these samples, with pentachloroaniline, pentachlorobenzene, and quintozene being the most abundant. A majority of these products contained more than one pesticide; one such sample was found to contain as many as 12 organochlorine compounds. Concentrations of pesticide residues ranged from 0.001 (pentachloroaniline and pentachlorophenyl methyl ester) to 5.57 mg/kg (quintozene)"
It's expensive to do these analyses so most of the herbs and supplements you see in the store do not get them. But based on the testing we do see, it's likely that you have a one in two chance when you buy a supplement that it either doesn't contain what you paid for, or that it contains pesticides and other dangerous contaminants.
So much for "natural" cures.
I have repeatedly heard from users of supplements who claim that the company whose products they use is different from the sleazy weasels I warn about. Further questioning always reveals that they draw this conclusion from claims made by the company itself, usually on its web site.
In fact, it is very difficult to know whether you can trust any supplement company, no matter how well-intentioned, given the complete lack of regulation and the fact that most of them buy their raw materials from China and the third world.
The problem is often beyond the control of even the most legitimate supplement vendors because of their dependence on merchants in third world countries where corruption runs rife. For example, right now, most of the vitamins sold by U.S. companies are manufactured in China and are subject to all the problems with all Chinese products: they are manufactured using polluted water heavy in pesticides and other industrial pollutants and they may very well be adulterated as the track record of Chinese companies for selling adulterated products is very poor.
Unless every batch of raw materials is subjected to extensive and very expensive testing for every possible contaminant, there is no way any company can guarantee the purity of its supplements. The capsule that contains a supplement this month, based on independent lab testing paid for by some journalist, may not contain it next month.
At least with pharmaceutical drugs, despite well-documented company shenanigans, you can trust that you are getting what you pay for in each capsule. And if you are willing to take some time and use Google Scholar you can find out what research studies have found about their effects.
My guess is that one reason for the huge success of "natural" herbs and supplements is that they stimulate the placebo effect, which is very real. People who believe something will make them better often get better--especially if what is wrong with them is something vague that isn't a real illness. But diabetes is a real illness and placebos do NOT lower diabetic blood sugars in any meaningful way.
The only way to lower blood sugar is to either a) cut way back on the carbohydrates in your food, those sugars and starches that metabolize into high blood sugars or b) use drugs that either supplement the insulin you lack, stimulate the production of more insulin by your body, or make the insulin circulating in your body more effective.
Cutting back on the carbohydrates requires no pills. Stop eating carbs and I guarantee you you will see your blood sugars drop. If they don't drop enough, it's time to research effective and safe diabetes drugs. I've done some of the work for you in various article published on the Drugs and Food section of my main diabetes site, recently renamed Blood Sugar 101.
A big part of figuring out which diet or drug might be best for you is figuring out the specific nature of your own diabetes. If you are insulin deficient, you'll need different drugs and dietary approaches from someone who is very insulin resistant but still produces a lot of insulin. That's something we'll discuss further.
But for now, resist the temptation to reach for the magic pills, no matter how beautifully packaged and how upscale the merchant selling them. If you have diabetes you don't need a placebo, you don't need mysterious and questionable substances, you need to cut back on the carbs that raise your blood sugar and if diet doesn't get the job done, you need to figure out what's wrong with you and which well-understood drug might be safe and helpful for you.
Monday, January 28, 2008
Plastics in our Blood Stream cause IR. PCBs & Pesticides Cause Diabetes, Hmmmm. . . .
Mouse on Left was exposed to Bisphenol A in the WombA CDC analysis of data from tThe most recent NHANES study finds that 92% of the 2,500 people studied had detectable amounts of bisphenol-a in their urine. That's the plastic that has been shown in research studies to diminish insulin sensitivity, among other effects.
http://www.ehponline.org/members/2007/10753/10753.pdf
Exposure of the U.S. Population to Bisphenol A and 4-tertiary-Octylphenol: 2003–2004. Antonia M. Calafat, Xiaoyun Ye, Lee-Yang Wong, John A. Reidy, and Larry L. Needham.
This article, Clearly Concerning:Do common plastics and resins carry risks? includes the revealing photo you see at the top of this article. The mouse on the left is one that was exposed to Bisphenol A in the womb, sustaining genetic damage. It also looks like a lot of folks I see strolling through the mall.
Can it be "coincidental" that the huge increase in obesity and diabetes we see now seems to have begun a few decades after plastics began to replace metal, wood, and cellulose-based products in our environment?
The plastics industry assures you that it is. Just like the cigarette industry they are putting out a stream of reassuring press releases telling you that the levels of this chemical which has been found in over 700 studies to damage genes are too low to cause damage. Here's a typical Plastics Industry "don't worry" article putting its own spin on the CDC study: New Data from CDC Confirms Human Exposure to Bisphenol A in the United States is Far Below Safe Limits
Notice that the argument that we have nothing to worry about relies on the finding that concentrations being found in people's urine suggest plastic concentrations in our bodies lower than the level set by regulators. They do NOT rely on citations of research showing these levels to be safe for humans.
Government regulators under the Bush administration are notorious for supporting polluters and ignoring science. So the fact that they have set "safe levels" means little. The truth is that what little information we have about the safety of these substances comes from rodent research involving high levels of exposure, but there is currently no reason to assume that the lower levels humans are exposed to are in fact safe. It's merely a guess. And it is very likely that the research that the regulators relied on to establish safe levels was supplied by the plastics industry.
Getting the plastics out of our environment would be a huge, possibly impossible task. Stop and look around you. Count how many plastic items are in your immediate environment. Without looking away from my computer I see 10 different plastic items, ranging from my phone, keyboard, speakers, battery charger, chair arms, calculator, pill container, and three decorative frog figurines (yes, I'm a sucker for anything frog).
Look at how much plastic surrounds your food: can liners, bags in cereal boxes, storage containers, foam meat packaging, microwave containers, plastic utensils, wraps, baggies, table cloths, place mats. It goes on and on.
But isn't it easier to blame people for being lazy pigs than to admit that industrial "progress" has turned almost all of us into a demonic science experiment whose results will not be clear until two or three more generations of babies are born with bodies laced with plastics?
In very closely related news, another study published this past October found that pesticides and PCB levels in the blood stream correlated with the incidence of diabetes in a carefully studied population.
The study, conducted among members of Upstate New York State's Mohawk tribe, found that the odds of being diagnosed with diabetes in this population was almost 4 times higher in members who had high concentrations of PCBs in their blood serum. It was even higher than that for those with high concentrations of pesticides in their blood.
Yet this study got NO coverage at all in the mainstream health press, though it shows a clear cut relationship between environmental pollutants and diabetes. The fourfold increase applies NOT to that feeble measurement, risk, which is used to amplify weak data, but to actual incidence. Why no press notice? Probably because this study wasn't conducted by a drug company with a large public relations department. Or because people skimming the title assumed it only applied to Native Americans, which is not true.
This is the same health press that routinely publishes wild statements unsupported by data claiming that "Type 2 diabetes is caused by obesity and can be prevented with diet and exercise."
Here's the article:
Diabetes in Relation to Serum Levels of Polychlorinated Biphenyls and Chlorinated Pesticides in Adult Native Americans. Neculai Codru, Maria J. Schymura,Serban Negoita,Robert Rej,and David O. Carpenter.Environ Health Perspect. 2007 October; 115(10): 1442–1447.Published online 2007 July 17. doi: 10.1289/ehp.10315.
Thanks to the Prairie Mary blog for brining attention to this!
It is very important to note that there is no reason to believe that the association of PCBs and pesticides and Type 2 diabetes is limited to people of Native American heritage. The entire population of the U.S. has been overexposed to powerful pesticides for a generation.
Are Environmental Pollutants the Smoking Gun for the Diabetes & Obesity Epidemic?
We have long known that obesity is often the most dramatic sign that an animal has suffered genetic damage. No one tells the cloned animal who develops unusual obesity early in life to eat less and exercise more. Instead, the scientists observing this effect will publish remarks explaining that the obesity suggests that subtle genetic damage has occurred that needs further study.
But somehow when it comes to the human population, people who are supposed to be scientists are more comfortable ascribing the relatively sudden and very dramatic increase in obesity and Type 2 diabetes, especially in our young, to moral failings, rather than genetic damage. This is true, even though, as we see in the studies cited above, we have plenty of reason to believe that our bodies are laced with chemicals known to cause the kinds of genetic damage that cause obesity and diabetes.
When toddlers develop Type 2 diabetes and dramatic obesity, it isn't because they are being over fed junk foods. Study after study of toddler eating habits which you can read about in every book about child raising showed that toddlers with healthy metabolisms self-regulate their food intake and do not become obese even if allowed to eat freely whenever they want.
No. Something else is going on. Something that if the public became aware of it would exact a catastrophic toll on the industries who have allowed it to occur. No wonder they're issuing cheery announcements to the tune of "Plastics in Your Body are Safe!"
But by the time society finally realizes its danger, we may have exposed two generations of our offspring, planet wide, to this genetic damage.
It's much easier to just tell yourself that mouse on the left should have avoided the donuts and gone to the gym more often.
Monday, January 21, 2008
Taking my Own Advice: The Power of Logging Food Intake
I've posted a lot in the past about how when I have been trying to lose weight how helpful I have found it to weigh food portions and log my daily food intake using software.
So when my recent attempt to drop the five pounds I packed on over the holidays seemed to be going nowhere, I decided it was time to take my advice and haul out the food scale and LifeForm food tracking software.
I've been logging my food intake for almost a week now, and, as usual, learning exactly what I've been eating is an eye-opener. Because I needed to clear the insulin out of my system (why is a long story I won't go into here) and because I can't handle more than a tiny amount of carbs without insulin, I've been eating the classic 1990s Atkins diet: meat, eggs, cheese, low carb vegetables and a daily large romaine salad filled with avocado, artichoke hearts, olives, green peppers and a small amount of tomato. I've been taking one 3 oz glass of wine at night which has helped greatly to lower my fasting blood sugar.
As expected I have found that my daily carb intake has hovered below 23 grams, which is reflected in the very good blood sugars I've been getting. However, I've been surprised by how many more calories it turns out I've been eating. Far more than what I thought I'd been eating.
Though by now I should know my portion sizes, I've been eating a lot more calories than I thought. Since I'm only 5' 3" and sedentary thanks to a really bad back, my body needs only about 1,600 calories a day to maintain. To lose weight, I have to eat less than that, and logging showed me that while I was eating less, it was only around 100 to 200 calories less--which means it would take from 18 days to more than a month to lose one pound. No wonder I wasn't seeing any dramatic weight loss.
So for me, the difference between weight loss and no weight loss often boils down to a few bites of cheese scattered through the day. Those few bites probably explain why so many stalled Atkins dieters find that cutting out cheese jump starts their diet.
It has nothing to do with any inherent properties of dairy, as many people erroneously believe. It's just that having what feels like "a few bites" of cheese lets you add an extra 300 calories to your daily input without feeling like you've eaten anything. And if you are within 20 pounds of your diet goal--the range where calories really start to count--those three hundred calories may be all it takes to stall you.
Logging my food showed me another problem area, too. Just as I caution others on my diet page about protein intake, which you can find HERE eating too much protein can also cause problems, and it turns out I have been eating a lot more protein than I need to eat.
I'd forgotten the important point that neither Atkins or Bernstein mention: that after a few weeks on a ketogenic diet your body makes certain adaptations which allow your brain to run partially on ketones. Once this takes place, you need a lot less protein than you do during the first two or three weeks on a low carb diet. This adaptation may also explain why so many low carb dieters stall out after week three. They are still eating those high protein intakes that the books recommend which aren't needed once the body is fully adapted to the diet.
This excess protein does a couple things. One is that it really irritates my urinary tract thanks to the production of ammonia as a breakdown product of protein digestion. But even more importantly, the liver turns that excess protein into glucose which raises my blood sugar. So as soon as I eat too much protein, I get hungry.
People often claim that ketogenic dieting ends hunger, but this is only true if the diet keeps blood sugars flat. For a person like me whose pancreas doesn't work properly, too much protein leads to significant rises in blood glucose as my liver transforms 58% of that protein into glucose. And that rise makes me hungry.
The answer for me may be to eat more fat and less protein. I have calculated how much protein I need to eat and it is about 30 g or five ounces less than I've been eating each day. If I can get the protein down to where it is supposed to be, hopefully I'll end the hunger that has me nibbling all that cheese and get my calories down to where I can lose the 1 to 2 pounds a month. That is a healthy rate for me. Even better, past experience has shown that I can maintain a weight loss achieved by dieting at that rate--though I may have to get back on the metformin to do so.
Meanwhile after 3 weeks on this diet I am down roughly 1 lbs not counting the 3 lbs of water weight that dropped off me as soon as I cut out all the carbs. Naturally weight fluctuates up and down on a daily basis, but averaging my daily weight gives me a pretty good idea of what is going on, and I probably will make it to 2 lbs lost for the month if I go easier on the protein.
How are you folks who started the January diet doing? Will you make it to the Super Bowl, still on your diet, unlike 99.5% of those who started on January 1? I hope so!
If you are having trouble, I'd urge you to find an online support group where you can find people who may have helpful tips for solving the problems you are running into. All the low carb diet books grossly oversimplify what is required to lose weight on this diet and they also make you feel like everyone else who does the diet finds it easy, which isn't true. Experienced dieters can really help you as you encounter the known speed bumps along the road.
You'll find a list of online low carb support forums HERE.
So when my recent attempt to drop the five pounds I packed on over the holidays seemed to be going nowhere, I decided it was time to take my advice and haul out the food scale and LifeForm food tracking software.
I've been logging my food intake for almost a week now, and, as usual, learning exactly what I've been eating is an eye-opener. Because I needed to clear the insulin out of my system (why is a long story I won't go into here) and because I can't handle more than a tiny amount of carbs without insulin, I've been eating the classic 1990s Atkins diet: meat, eggs, cheese, low carb vegetables and a daily large romaine salad filled with avocado, artichoke hearts, olives, green peppers and a small amount of tomato. I've been taking one 3 oz glass of wine at night which has helped greatly to lower my fasting blood sugar.
As expected I have found that my daily carb intake has hovered below 23 grams, which is reflected in the very good blood sugars I've been getting. However, I've been surprised by how many more calories it turns out I've been eating. Far more than what I thought I'd been eating.
Though by now I should know my portion sizes, I've been eating a lot more calories than I thought. Since I'm only 5' 3" and sedentary thanks to a really bad back, my body needs only about 1,600 calories a day to maintain. To lose weight, I have to eat less than that, and logging showed me that while I was eating less, it was only around 100 to 200 calories less--which means it would take from 18 days to more than a month to lose one pound. No wonder I wasn't seeing any dramatic weight loss.
So for me, the difference between weight loss and no weight loss often boils down to a few bites of cheese scattered through the day. Those few bites probably explain why so many stalled Atkins dieters find that cutting out cheese jump starts their diet.
It has nothing to do with any inherent properties of dairy, as many people erroneously believe. It's just that having what feels like "a few bites" of cheese lets you add an extra 300 calories to your daily input without feeling like you've eaten anything. And if you are within 20 pounds of your diet goal--the range where calories really start to count--those three hundred calories may be all it takes to stall you.
Logging my food showed me another problem area, too. Just as I caution others on my diet page about protein intake, which you can find HERE eating too much protein can also cause problems, and it turns out I have been eating a lot more protein than I need to eat.
I'd forgotten the important point that neither Atkins or Bernstein mention: that after a few weeks on a ketogenic diet your body makes certain adaptations which allow your brain to run partially on ketones. Once this takes place, you need a lot less protein than you do during the first two or three weeks on a low carb diet. This adaptation may also explain why so many low carb dieters stall out after week three. They are still eating those high protein intakes that the books recommend which aren't needed once the body is fully adapted to the diet.
This excess protein does a couple things. One is that it really irritates my urinary tract thanks to the production of ammonia as a breakdown product of protein digestion. But even more importantly, the liver turns that excess protein into glucose which raises my blood sugar. So as soon as I eat too much protein, I get hungry.
People often claim that ketogenic dieting ends hunger, but this is only true if the diet keeps blood sugars flat. For a person like me whose pancreas doesn't work properly, too much protein leads to significant rises in blood glucose as my liver transforms 58% of that protein into glucose. And that rise makes me hungry.
The answer for me may be to eat more fat and less protein. I have calculated how much protein I need to eat and it is about 30 g or five ounces less than I've been eating each day. If I can get the protein down to where it is supposed to be, hopefully I'll end the hunger that has me nibbling all that cheese and get my calories down to where I can lose the 1 to 2 pounds a month. That is a healthy rate for me. Even better, past experience has shown that I can maintain a weight loss achieved by dieting at that rate--though I may have to get back on the metformin to do so.
Meanwhile after 3 weeks on this diet I am down roughly 1 lbs not counting the 3 lbs of water weight that dropped off me as soon as I cut out all the carbs. Naturally weight fluctuates up and down on a daily basis, but averaging my daily weight gives me a pretty good idea of what is going on, and I probably will make it to 2 lbs lost for the month if I go easier on the protein.
How are you folks who started the January diet doing? Will you make it to the Super Bowl, still on your diet, unlike 99.5% of those who started on January 1? I hope so!
If you are having trouble, I'd urge you to find an online support group where you can find people who may have helpful tips for solving the problems you are running into. All the low carb diet books grossly oversimplify what is required to lose weight on this diet and they also make you feel like everyone else who does the diet finds it easy, which isn't true. Experienced dieters can really help you as you encounter the known speed bumps along the road.
You'll find a list of online low carb support forums HERE.
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