Less than Half of New Diabetes Patients Achieve less than 7A1C Goals

The ADA Guidelines only expect an HbA1c goal equal to or less than 7, yet a recent study of 1139 newly-diagnosed diabetics revealed that only 40.7% achieved their goal of <7. All of the patients in the study began insulin therapy according to the authors of “Glycemic Response and Attainment of A1C Goals Following Newly Initiated Insulin Therapy for Type 2 Diabetes,” in the current issue of Diabetes Care.  Although the abstract could have revealed the how the outcomes of other variables such as exercise, oral meds, and diet correlated  with each other, the only conclusion they chose to reveal was, “Insulin initiation at lower levels of A1C improves goal attainment and independently increases glycemic response.” Well, naturally, the sooner you initiate actions to normalize blood glucose, the more likely your goals will be achieved. What diabetics really want to know is what combination of lifestyle changes helped the patients who achieved an A1c of 5, for example.  Since the results did show the patients all seemed to have problems with preinsulin levels, I wonder if any of the researchers monitored patients with a diet using restricted slow-acting carbohydrates and muscle-sparing protein levels. Maybe the full text reveals this, but unfortunately we diabetics will have to pay for the article which more than likely doesn’t even cover what patients really want to know.

Source: Diabetes Care March 2012 vol. 35 no. 3 495-497

Posted by type2 on March 14th, 2012 under Sorting the Science | Comment now »


Green Tea

Looking for an alternative to sugarfree sodas? I know water is free from the tap, but sometimes I just want something else. My childhood memory of sitting down for a few minutes in the morning and sipping a cup of fragrant green tea came upon me the other day. My family lived for a few years in Hokkaido, Japan, and drinking green tea was a favorite way to take a from the hectic life of a teenager. So, I went shopping in search of that smooth, slightly sweet, aromatic flavor of my youth.

The word is out about green tea, so when I sought it out in the grocery stores, I found it everywhere: in sodas like Gingerale with green tea, in teas with flavorings added, and in teas from many US companies and China. None came close to the flavor I enjoyed back then. Some were bitter and others quite expensive. So I did some research, looking for the green tea I once enjoyed in Japan that had me so enthralled.

Some of the appeal probably has more to do with the peaceful atmosphere that surrounded the whole ritual of brewing and taking the time out to contemplate as I sipped this comforting drink. Some appeal is my desire to continue a healthier lifestyle. Unlike black tea, green tea is not fermented, so it retains many beneficial disease-fighting components. More than 450 organic compounds have been found in green tea, including vitamins C,B, H,D,A,K, minerals, amino acids, protein, and catechins EGCG and EGC. The first steeping brews the most nutrition, but you can resteep a second and third time for maximum nutrition. It has a smaller amount of caffeine than coffee, but still enough to keep you awake at night if you drink it close to bedtime. Green tea has a great combination of metabolism boosting and fat burning catechin polyphenols as well as antioxidants. But if the flavor is masked by artificial chemicals, is bitter like most bagged tea I tried, or very costly like most brands, it just doesn’t appeal to me.

A good green tea is what I long for, such as sencha, which can be steeped several times; so although it costs more, I can use the same leaves to make many cups for the whole day. Today, I’m on a quest to find a green tea from Japan. If you have any suggestions, please let me know.

Posted by type2 on August 16th, 2010 under Sorting the Science | 3 Comments »


My Comments on the 2010 USDA Guidelines

Over the course of the past year, I have been following the work of the Advisory Committee working on the recommendations for the 2010 My Pyramid Guidelines. As part of the process, anyone who wished to, could submit comments. My comments are as follows:

Please consider my observations as a type 2 diabetic who has experience as a teacher and librarian. If my advice is too insignificant for your consideration, perhaps quotations from some of the world’s greatest scientists and most admired leaders may enhance my own observations as you consider your changes to the 2010 Guidelines.

“If the facts don’t fit the theory, change the facts.” ~Albert Einstein
People who write the abstracts of scientific articles (time-stressed professionals rarely read full-texts) have sometimes misdirected or hidden the results either intentionally or through ignorance. Sometimes, I also find the analysis is incomplete, which might have revealed information about the methods or results that researchers and even laypeople like me need when trying to lay out a dietary pattern that works. One study, for example, was included as evidence that a low carbohydrate is no different from a high carbohydrate diet in terms of weight loss, in spite of the fact that both were “within the current carbohydrate guidelines!” How can such a study be used to support your conclusion when neither diet was close to the typical low carbohydrate diet? What the reviewer and your staff also failed to notice and use in your analysis is that an important satiety incretin, GLP1, was metabolically intact in the supposedly “lower” 45% carbohydrate diet and impaired in the higher carbohydrate diet. This has enormous implications in which level of carbohydrate should be recommended for the general population. If you are encouraging a level of carbohydrate consumption that inactivates hormones that tell a person they are no longer hungry, a hormone that can no longer help regulate the pancreas amylin level and aid in other metabolic processes, it isn’t any wonder we are a land of overweight people who are always hungry, unless like me you keep carbohydrates well below the minimum. In the areas of carbohydrate and fats, especially, some of the authors and reviewers you have in your library have falsely mislabeled results and hidden important facts that are obvious when even a layperson like me examines the entire study. Subcommittees have only glanced over the reviews or they would have caught them also, and have ignored other studies that don’t fit the theory that low-fat, high-carbohydrate diets are the best guidelines to follow.

“All our science, measured against reality, is primitive and childlike–and yet it is the most precious thing we have.” ~Albert Einstein
Granted, some research is not ideal and are flawed in one way or another. To ignore current research because it isn’t ideal, and then to rely on less than ideal studies to support the status quo, is child-like behavior unseemly in a group of scientists. The reality is that the American public is getting sicker and heavier since these guidelines began and the science is telling us why, if we would only drop the meta-analysis that misses key facts in an effort to simplify the message and go beyond the abstracts/reviews of ghostwriters/obviously-rushed reviewers and look at the science. Even with it’s limitations, and in spite of the pressures of the special interests that fund much of the research, we are learning. Please re-examine the science, and be wary of interpretations of the facts. I was very impressed with the conclusions and implications in the areas of food environment, food safety, and the importance of exercise. In the areas of weight-loss, and factors related to the prevention of heart disease, cholesterol, obesity, and diabetes, you barely touched the science that is out there in an effort to shorten your workload by the deadline. You are doing a disservice to us not to look beyond the primitive early science. Remember it wasn’t long ago that we said all cholesterol is bad, fats cause diabetes and heart disease, and sugar is just as good as any other carbohydrate for a diabetic. If you want to prevent these diseases, you need to look at the science related to these diseases and not ignore them or skim the surface. I see not a single expert in the field of diseases of the metabolism in your testimony.

“Everything should be made as simple as possible, but not simpler.” ~Albert Einstein
The old pyramid is too simple and doesn’t reflect recognized scientific facts. Even though everyone agrees that people require essential fatty acids, you can hardly tell fats are visually part of the pyramid. Carbohydrates may or may not be essential depending on the theory your scientists prefer, but no matter what theory’s chosen, science shows that carbohydrates should be a much smaller amount of the diet. Essential amino acids found in combinations of incomplete proteins for vegetarians should be described fully under a color describing protein with carbohydrate and warning that some essential vitamins such as B12 are inadequate. Complete proteins such as fish, meats, eggs, and milk products, should not be explained as a % of calories, but scientifically proven adequate requirements based on activity and age, etc. By simplifying the visual pyramid, you only end up misinforming and confusing people.

An alternate pyramid could show 3 sections: one ray for people with cultural/religious reasons to follow a vegetarian diet and guidelines; one ray for people who are perfectly happy with your new guidelines; one ray for those who have hyperinsulinemia, epilepsy, and other health issues, have family histories of diabetes, or desire to lose weight using low-carbohydrate, moderate protein, and healthy fat guidelines based on the latest science.

“Science is a wonderful thing if one does not have to earn one’s living at it.” ~Albert Einstein
There is a paucity of research focused on understanding nutrition, the metabolic processes involved in building healthy bodies, as well as the disease process without involving a patron/benefactor that is looking for a possible drug to license or processed food to market. If subcommittee scientists say there isn’t enough evidence to consider alternative nutrition guidelines that are working for millions of French, Japanese, and successful US subgroups, I think our government should fund it. Fees from health insurance companies can pay for it, since the results could conceivably save them money, regardless of the outcome. Even a librarian layperson like me could see the industry connections of many of the study’s writers and the careful wording designed to avoid losing one’s funding of future projects. Even in studies that tend to support the way of eating that works for me is partially beholden to Atkins Nutritionals to allow for processed foods that have ingredients called sugar alcohols that will raise my glucose level.

“The secret to creativity is knowing how to hide your sources.” ~Albert Einstein
Food labels are notorious for hiding sources. Even trans-fatty acids are hidden when a processed food ingredient like soybean oil is labeled Trans fat free even though it is hydrogenated. For someone on insulin or needing to watch their carbohydrate intake, even a 0.4 gram amount of carbohydrate per serving is important when added to other foods with hidden carbs in a single meal. Manufacturers have too much leeway in hiding true nutrition levels, so I and many others avoid processed foods. In food safety, the evidence of carcinogenic additives should be explained and a list of known carcinogenic ingredients should accompany your guidelines. I am quite skeptical of the nutritional levels found in the USDA nutrition database considering the drastic change in big corporate farming practices. We also need a level of toxicity for USA and imported foods added to the database. It’s disingenuous to expect us to look up the latest fish toxicity levels and at the same time encourage eating more fish. Our government does have a legitimate role in telling fish farmers to control for toxins in the water and to match feed to the healthier wild. When we eat farm-raised salmon, we expect the health benefits of salmon to be there. We expect you to tell meat producers to quit injecting our meat at the slaughterhouse. When we buy meat with natural flavoring, we don’t expect MSG, salt, dye, and preservatives-we expect fresh, unadulterated meat. Let us be the ones to add ingredients that show our culinary creativity and won’t harm us.

“You do not really understand something unless you can explain it to your grandmother.” ~Albert Einstein
What we need is a diet like what my grandmother grew up with: Grass-fed meat, fish from a pollution-free lake, full-fat milk and cheese, plenty of vegetables from the garden and root cellar, nuts and berries on occasion. What we need is at least one guideline that reflects the dietary patterns of our grandparents as they grew up. It is a shame entire generations have lost the ability to cook a good meal from local ingredients, because money was shifted to corporate farms to underwrite the growing of energy dense, nutritionally deficient grains that require supplementation to justify its inclusion in the guidelines, unpronounceable preservatives to last on the shelf, and sugar/HFCS to be palatable.

“The world we’ve made, as a result of the level of thinking we have done thus far, creates problems we cannot solve at the same level of thinking.” ~Albert Einstein
Trying to fit the new science into a one-size-fits-all pyramid hasn’t worked. Relying on bad science that has since been disproven has to be set aside; it has only led to a health crisis in our country. It is time to begin re-examining the science already in the database and adding what is missing. It is time to look beyond faulty reviews and meta-analysis to the original research. In light of what we now know about types of cholesterol, the role of hormones, phytochemicals, fatty acids, and other nutrients, the past research needs a second look. And if you don’t have enough people to do data entry and reviews, open the job up to include librarians. We as a general group tend to believe in the value of open access, and analysis of information with a critical eye.

“Any fool can make things bigger, more complex, … It takes a touch of genius and a lot of courage to move in the opposite direction.” ~Albert Einstein
There are two ways to encourage the consumption of important nutrients: you can name the low calorie vegetables that are important to eat daily that naturally contain high levels of nutrients and stay closer to the lower-carb recommendations science has proven is healthiest, or you can heavily encourage, subsidize, and approve mass enrichment of calorie dense, low nutrient weight-for-weight grains and further push guidelines meant to make us bigger and sicker. Which way do you choose to move?

“A fanatic is one who can’t change his mind and won’t change the subject.” ~ Sir Winston Churchill
In spite of the emerging evidence that the Keys 7 Countries Study, carefully crafted to fit his using his CVD prevention diet theory, was incomplete and flawed, the members of the subcommittees continue to keep to the same theory and show intransigence in their word choices toward alternate and equally effective dietary patterns. Just an example of changes I would suggest that would clarify:

Question 5: What is the Relationship between Macronutrient Proportion and Body Weight in Adults?
Conclusion
There is strong and consistent evidence that as long as calorie intake is reduced, the fat, carbohydrate, and protein macronutrient proportion of the diet is not related to losing weight. A moderate body of evidence provides no data to suggest that any one macronutrient is more effective than any other for avoiding weight regain in weight reduced persons. A moderate body of evidence demonstrates that diets with less than 45% of calories as carbohydrates are just as successful for long-term weight loss (12 months). There is conflicting evidence that they may be less safe, depending on what macronutrient is replaced by the carbohydrate. In shorter-term studies, low calorie, high protein diets may result in greater weight loss, but these differences are not sustained over time, when taken off the diet. A moderate amount of evidence demonstrates that intake of dietary patterns with less than 45% calories from carbohydrate or more than 35% calories from protein are just as effective than other diets for weight loss or weight maintenance, are easier to maintain over the long term due to enhanced satiety, and is safer when the carbohydrate is replaced by beneficial fatty acids.
Implications
No optimal macronutrient proportion was identified for enhancing weight loss or weight maintenance. However, decreasing caloric intake led to increased weight loss and improved weight maintenance. Therefore, diets that are reduced in calories and have macronutrient proportions that are within the ranges recommended in the Dietary References Intakes (IOM, 2002/2005) (protein: 15%-35% depending on age, activity level, and nutrient needs; carbohydrate: 15%-45% to keep intact normal metabolic processes and nutrient needs; fat: 20%-45% to keep intact neurological and metabolic processes); are appropriate for individuals who desire to lose weight or maintain weight loss. Diets that are less than 45 percent carbohydrate or more than 35 percent protein are as difficult to adhere to without support, are just as effective as other calorie-controlled diets for weight loss and weight maintenance, and is safer when the carbohydrate is replaced by beneficial fatty acids, and are therefore equally recommended for weight loss or maintenance.

“Never hold discussions with the monkey when the organ grinder is in the room.” ~ Sir Winston Churchill
All organ-grinders in the room have had equal access under an unprecedented open public forum this time. The transcripts of meetings and reviews of NEL data prove that the only way to really have a thorough discussion of the science, you need to add to the committee scientists and experts in the field who are well-respected and independent of manufacturers, lobbyists, and special interests, including the experts in disorders of metabolism. It is now time to not wait for the next guidelines committee to start adding the science to the database that you have missed and dig deeper into the evidence when the reviewers enter the data. The analysis and review of facts submitted should be examined with careful recognition of who the “organ grinder” was in the room when the research, review, or meta-analysis was performed. I just wish I had more time to point out more of the areas where you actually have the science, but missed important points that would lead you to different conclusions.

“What if I, a physician, told you, a diabetic, to eat a diet that consisted of 60 percent sugar, 20 percent protein, and 20 percent fat? More than likely, you’d think I was insane.”Dr. Richard K. Bernstein
For two decades, I tried to follow our USDA dietary guidelines but unable to maintain periodic weight loss, until I became diabetic. I then followed the ADA dietary guidelines religiously for two years until my HBA1c was over 9 and gained almost another 60 lbs! I also had all the poor markers for diabetes for two years until I landed in the hospital with Atrial Fib and necrotic gallbladder. I was 290 lbs on a 5’1” frame. That did it! I dropped my carbohydrate level to about 45 grams, knowing that an additional 1/3 of my protein can be converted to glucose if needed. My HBA1c is now 5.9 and kidney function, inflammation, neurological symptoms, and blood pressure have all improved or are normal. I have been gradually reducing my weight over these 2 years and do not plan to Ever move from the Diabetes Diet recommended by Dr. Richard K. Bernstein. It is a shame I didn’t know of the health dangers of even so-called moderate carbohydrate intake in terms of the excess calories, low nutrient levels, and hyperinsulinemia I experienced, which in turn led to high inflammation, high blood pressure, fat storage, and a host of other problems. I know this is only anecdotal evidence, so I will continue to look at the guidelines and evidence and add my comments I just had no time to by your deadline. If at all interested, you will find specific comments entered daily until I have studied it all at http://www.3fatchicks.com/diet-blogs/cookingfor2when1istype2 because, more than anything, I’d like to know why this way of eating is working when decades of guidelines never did.

“Men stumble over the truth from time to time, but most pick themselves up and hurry off as if nothing happened.” ~ Sir Winston Churchill
Please don’t let this happen this time.

Posted by type2 on July 25th, 2010 under Sorting the Science | 6 Comments »


The Benefits of Reading Dr. Bernstein’s Books

Well, let’s begin with the most important benefit for me right now – the HbA1c! It has moved from a little over 7 to 5.9! Although it isn’t equivalent to a thin normal person’s mid 4’s Dr. Bernstein wants for us, but I’m not thin yet and it will be a while before my old red blood cells are replaced. I love the idea of “Law of Small numbers” that Dr. Bernstein explained. It wasn’t hard to make a few changes to abandon the South Beach Phase 1 I’ve been on successfully losing almost 50 pounds, but I knew it was important to bring my blood glucose closer to normal. I followed Dr. Bernstein’s advice about gradually phasing into the Diabetes Diet and adjusting medicines as I go so I have avoided hypoglycemic symptoms. My triglycerides and LDL Total have gone up, but my HDL was a big reason for it. Is it possible to have higher triglycerides because fats in my body have been mobilized? Tell me what you think…

Posted by type2 on July 2nd, 2010 under Feed Your Hunger | 3 Comments »


How to Adapt Recipes for DH

The essential truth is this-carbohydrates MUST be restricted to normalize blood sugars. So far, I have followed the South Beach diet Phase 1 recipes with a few adaptations for my lower glucose needs and my DH is beginning to want to change his diet, just with a few more carbs on the side than I do. He is a great cook, so I’m lucky to have him on board.  The secret to having satisfied meals for both of you is to make whole grain rice, whole wheat noodles, Japanese sweet potatoes, or other side dishes for them and store them in the frig no more than 3 days or freeze them.

To adapt meals for your significant other, bake on the rack some root vegetables each time you use the oven. Cube them and bag extra servings in individual baggies to freeze, then microwave as you prepare the protein dish and any vegetable for the both of you. Better yet, make extra servings of your leafy or brassica vegetables.

Cook brown rice to add to DH’s meal and bag extra servings in individual baggies to freeze, then microwave in a little water as you prepare the protein dish and any vegetable. If you plan on using it within a few days, leave rice uncovered until it’s cooled slightly. Refrigerate and cover when cold. Next day, transfer to a freezer bag, separating the grains by applying pressure to the bag, and squeezing out all the air. The rice will keep about as long as fresh milk and retain its just-cooked state; it’s easy to just squeeze servings out of the bag to reheat in microwave or pan or oven. This storage method also has the advantage of reducing handling of the cooked rice.

Store cooked, drained and cooled pasta in the same manner.

Posted by type2 on March 4th, 2010 under Recipes | 2 Comments »


Sorting Through the Science

In the ten years I have been a diabetic, the science and information about the disease has expanded exponentially. Sorting through it all took up quite a bit of free time as I looked for the answers to my self-absorbed questions like, “Why me?” and “What should I do?” One helpful website was Dr. Bernstein, who began the push to have patients test their glucose at home and the “Law of Small Numbers” to help diabetics achieve normalized blood sugars. Read part of his book here.

Posted by type2 on March 4th, 2010 under Sorting the Science | Comment now »


Feeding Your Hunger

When dieting, I would go by the rule to eat fewer calories than I metabolize. Before the change in diet a few years ago, I was hungry all the time. Since drastically reducing carbs and adding lean protein and good fats, my cravings have subsided and what I eat has changed. Here are some snacks that feed my hunger cravings when they do occur:

 

Posted by type2 on March 4th, 2010 under Feed Your Hunger | 1 Comment »


My Diabetes Diet

Since 2007, I have been following (more or less) the South Beach Diet. My HbA1c has gone from over 9 to the low 7’s. My weight dropped from 290 to 244 from Jan. 2007 to March 2009. It has been hovering around that number for almost a year now. Breaking a pelvis, herniating two discs, and then breaking an ankle  can stall just about any efforts, especially when I had to limit exercise and deal with steroid shots. I have been reading  about ways to lower my glucose numbers to as normal as possible, especially when exercise is limited. My endo’s nutritionist has said that lowering glucose numbers to normal will also lead to weight loss. I have been reading Dr. Bernstein’s Diabetes Solution and will try to incorporate what I’ve learned into my diet.

Posted by type2 on March 4th, 2010 under How to Lose | Comment now »


How to lose 2 pounds in one day.

People say I don’t look it, but I weigh 244 lbs. Well, maybe they are being kind, since I don’t tell anyone beyond family. Not even all of them. Till now…now you know, too. For a long time I avoided the scale, until I landed in the hospital in terrible pain in 2007. The nurse announced to my husband who was clueless “290 pounds!” If the scale wasn’t one of those stainless things the size of a bed, I would have thrown it at her. The good news is the gallbladder took 2 pounds with it when it was removed. It also scared me enough to rethink the whole ADA “diet and lifestyle” my doctor and diabetes educator had recommended. I had stopped salting my food and drinking soft drinks many years ago. I walked and was on my feet a great deal. I ate only whole grains, limited fats, and followed the ADA diet exchange diet, but I was Always Hungry – Always.

When I was first diagnosed with Type 2 Diabetes, it wasn’t hard to cook for the two of us, because we could eat just about everything we already enjoyed, including low-fat high-fiber sugar-loaded desserts. But over time, the serving sizes grew larger and my HbA1c grew larger as well. After the surgery, I decided to change the direction of my diet from ADA exchanges that allow sugar and whole grains to the South Beach diet that allows only certain carbs. I have lost almost 50 pounds since then, with a few plateaus along the way. When the plateau happens, I think of it as an opportunity to reweigh what I eat and adapt my recipes. Illness and stress can make weight loss stall, too. Losing weight is not easy. Now there are two meals to prepare.

Posted by type2 on May 18th, 2009 under How to Lose, Introduction | Comment now »


What Does the Title Mean?

Well, if you or your loved one has Type 2 Diabetes and you are an “empty nest” couple, you will find a sympathetic friend here. Not only do you have a life-altering disease to manage, but often two different meals to manage as well. You will find recipes, disease management, lifestyle and diet ideas, and Type 2 Diabetes news that has helped me along the way. I hope you will share your ideas as well. Doing a Blog is a totally new thing for me, so if you have suggestions what to include, please let me know.

Posted by type2 on May 1st, 2009 under Introduction | Comment now »



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