You don’t have to exercise to help your heart. Sure, exercise will probably make your heart last longer, but it’s not the only thing you can do to avoid the biggest complication of diabetes.

Just standing up — otherwise known as giving your butt a rest — now seems to work independently of physical activity to reduce your chance of dying from heart disease. A new study that the American Journal of Epidemiology published online in advance of print on July 22 indicates that the less leisure time we spend sitting the better it is for our hearts.

You can read the abstract of the study, “Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults,” online. The lead author, Alpa Patel, Ph.D., of the American Cancer Society’s epidemiology research program, sent my the full-text of the study when I requested it.

Dr. Patel and seven of her associates explored the connection between sitting and mortality by analyzing the survey responses of 123,216 people who had no history of cancer, heart attack, stroke, or emphysema or other lung diseases. These were people who enrolled in the American Cancer Society’s 1992 Cancer Prevention II study.

The researchers examined how much time those people sat down after work as well as how much exercise they got between 1993 and 2006. The results were clear.
How much time they spent sitting was associated with an increased risk of death from heart disease for both men and women. Women — but not men — who sat less had a smaller risk of dying from cancer.

Women who reported that they sat for more than six hours a day during their leisure time versus those who sat for fewer than three hours a day had a 37 percent higher death rate from all causes. For men it was about 18 percent higher.  After adjusting for the amount of physical activity these people got, the researchers found that the association remained virtually unchanged.

But when people sat more and exercised less, the difference was even greater. Women had a 94 percent highr death rate from all causes. For men it was 48 percent higher.

“Several factors could explain the positive association between time spent sitting and higher all-cause death rates,” Dr. Patel says. “Prolonged time spent sitting, independent of physical activity, has been shown to have important metabolic consequences, and may influence things like triglycerides, high density lipoprotein, cholesterol, fasting plasma glucose, resting blood pressure, and leptin, which are biomarkers of obesity and cardiovascular and other chronic diseases.” [Read more →]

Many people with diabetes have already stopped eating potatoes for several reasons. Now we have one more.

Some varieties of potatoes raise our blood glucose level faster and higher than just about anything. The glycemic index of a baked russet potato is 111 on the scale where glucose equals 100.

A cup of hashed brown potatoes has 46 grams of carbohydrate. That’s more than a whole day’s ration of carbohydrates for people following the best known very low-carb diet for people with diabetes.

About 80 percent of a potato’s carbohydrate comes from starch, a white, tasteless, and odorless powder. But starch is cheap, and adding salt and fat can make it palatable.

Since hashed brown potatoes and french fries count as a vegetable, the potato is America’s most important vegetable crop. More than 30 percent of the vegetables that we eat are potatoes, and we eat 142 pounds of them each year.

Maybe people with diabetes eat fewer potatoes than other Americans. I hope so. But everyone who eats lots of potatoes not only indulges in a very high glycemic and very high carb food but also is at risk of potato poisoning.

Potatoes are a member of the deadly nightshade family. This family includes Jimson weed, mandrake, belladonna, tobacco, as well as potatoes and tomatoes. While potatoes, tomatoes, and other members of the nightshade family are important food sources, they are often rich in alkaloids, which are toxic to humans and animals and can range from being mildly irritating or fatal, depending in part on how much we eat. By affecting the nervous system, this poison causes weakness and confusion. Some people are especially sensitive to foods in the nightshade family and experience allergy-like symptoms from the alkaloids. These alkaloids protect the plant from attacks by microbes and insects by dissolving their cell membranes.

But this poison hasn’t discouraged us from eating lots and lots of potatoes. Cooking them long enough and avoiding the green parts and sprouts reduces their toxicity. But when people eat foods in the
nightshade family, the alkaloids can create pores in the lining of the gut. This increases intestinal permeability, and if enough of the alkaloids gets into our bloodstream, this destroys the cell membranes of our red blood cells.

The large amount of potatoes that we eat is what makes them a concern to Loren Cordain, who has been has been a professor in the Department of Health and Exercise Science at Colorado State University since 1982. His new paper, “Consumption of Nightshade Plants, Human Health and Autoimmune Disease Implications,” interested me so much that I bought a copy for $21.29. It was worth the money.

We eat somewhat less tomato products, and relatively few bell peppers, chili peppers, and eggplants, some of the other food crops in the nightshade family.

“When the gut becomes ‘leaky,’ it is not a good thing,” Dr. Cordain writes, “as the intestinal contents may then have access to the immune system, which in turn becomes activated, thereby causing a chronic low level system inflammation.” The increased intestinal permeability, particularly in people with diseases of chronic inflammation — like type 1 diabetes — and diseases of insulin resistance — like type 2 diabetes — particularly troubles Dr. Cordain.

His conclusion is “to eliminate or drastically reduce potato consumption, and for autoimmune and allergy patients to be cautious with the consumption of tomatoes, chili peppers, and eggplants.”

Until recently, I had a weakness for hashed brown potatoes, as I have written here. Even though I knew that potatoes are both high glycemic and high carb, that wasn’t enough to stop me. But knowing that they are poisonous did.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

With all the attention this week being given to the FDA’s review concerning heart problems connected with Avandia, one of the major diabetes drugs, you may have missed the bad news for what could have been the first new prescription drug for obesity in more than a decade. Another FDA advisory panel voted against Qnexa, which Vivus Inc. developed.

In year-long clinical trials people who took the highest dose of Qnexa averaged a 10.6 percent weight loss. Those taking a placebo lost 1.7 percent of their body weight.

Unfortunately for Vivus and for people who want to lose weight, the side effects of Qnexa outweighed its benefits in the minds of most of the FDA’s panel members. These weren’t niggling concerns. They include the possibility that people taking Qnexa would be depressed and think suicidal thoughts, have their memory and concentration impaired, be at greater risk of kidneys stones, and could suffer from heart problems.

If the FDA still approves Qnexa in spite of the panel’s recommendation against it, this could be the easy way for the great majority of people with diabetes to lose the 10 percent of our weight that our doctors have told us that we need to do. Almost everyone who has type 2 diabetes is overweight. Our government’s statistics show that 85 percent of all American adults with diabetes are overweight.

If an effective weight loss drug is no longer an option for us, we could be left with our own resources. Still, I know that drugs we already have to control our blood glucose can also help some of us with type 2 diabetes to lose weight. I lost a lot of weight by taking Byetta, and friends of mine are achieving weight loss success with Victoza.

But since all drugs carry with them the risk of side effects, which is the FDA’s biggest concern, many of us would like to be taking as few drugs as possible. We can’t do it with with willpower alone, as Gina Kolata emphasizes in her book Rethinking Thin.

In 2007 I decided to do without drugs entirely and yet I lost even more weight. The strategy that I adopted was the only proven way, a very low-carb diet, very much like the one that Dr. Richard K. Bernstein has himself followed for years and has taught successfully to thousands of his patients with diabetes. By following the recommendations in his
book, Dr. Bernstein’s Diabetes Solution, I was able to bring my weight down from 170, when I started low-carbing in December 2007 to 151 last October.

But this year has been murder for my weight. In all my traveling since February I lost control. While I had no problem staying on a very low-carb diet, I ate too much fat and protein when eating out and wasn’t able to reliably check my weight on a daily basis so that I could immediate take corrective action. Consequently, my weight crept up as
high as 169 a few months ago.

Only by carefully watching what I eat and weighing myself every morning have I been able to start bringing it back down to where I am more healthy, feel better, and my clothes fit. Today my weight is down to 162, but I still have a way to go to reach my ultimate weight goal of 155.

I know that I’ll do it. I also know that we still don’t have any easy way to lose weight and to keep it off.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

When one of my favorite researchers wrote on April 20 that “the potential adverse effects of long term, chronic chia seed consumption may outweigh the potential benefits,” I took notice. Loren Cordain, Ph.D., is a professor in Colorado State University’s department of health and exercise science. Dr. Cordain wrote one of the most intriguing books on nutrition, The Paleo Diet, which recommends that we avoid grains and dairy since our paleolithic ancestors weren’t able to eat those foods.

Dr. Cordain’s report in his April 10 newsletter is more detailed in his criticism of chia seeds. An excerpt is available online, but the guts of the chia seed report sells for $6.95 plus shipping and taxes.

My 2007 post here on chia seeds got lots of attention, including more comments — 112 to date — than any other. So I was concerned enough to contact the world’s leading researcher on chia seeds.

Wayne Coates, Ph.D., is professor emeritus in the office of arid lands studies at the University of Arizona, Tucson. Dr. Coates has researched chia seeds for three decades and wrote the definitive book on the subject, Chia: Rediscovering a Forgotten Crop of the Aztecs (The University of Arizona Press, 2005).

Dr. Coates purchased a copy of the chia seed report. He shared it and his comments with me.

“I do not want to get into a long discussion about this,” Dr. Coates writes, “but would like to make a few comments. In his article, Table 1 gives the nutrient profile for chia seeds. Interestingly he does not give the source of the data, and furthermore, he says it gives the ‘entire’ nutrient profile of chia seeds. In no way it is complete, and since the source is not identified, one can easily question its value as a reputable source.

“He talks about anti-nutrients in chia, yet he promotes flaxseed. The anti-nutrients in flaxseed are well-documented for both humans and animals. He criticizes the gel (which is soluble fiber) as possibly impairing fat absorption and the high fiber content as protein to be poorly absorbed. In some cases, there may be some negative effects, but the positive effects of consuming fiber in the diet in terms of bowel function and prevention of coronary heart disease are well-documented.

“He also does not like the fact that chia contains phytic acid. Phytic acid has been shown to have antioxidant, anticancer, hypocholesterolemic and other beneficial effects. So again, it is unclear why he states this is a negative aspect of chia.

[Read more →]

Getting together with 35 other people who have diabetes and write about it online is one of the best things about my work. I just returned home from a full day at the second annual Social Media Summit sponsored by Roche Diabetes Care. I still find myself invigorated by having spent hours in the company of so many passionate people.

Four of the 36 bloggers at the summit came from one organization — HealthCentral. Gretchen Becker posts here, Ginger Vieira posts here, Kerri Sparling posts here, and I post here.

Gretchen, Ginger, Kerri, and David

The combined passion for better diabetes care surfaced most intensely when our eight hosts from Roche brought in representatives from the American Diabetes Association and the American Association of Diabetes Educators to tell us what they were doing. If they had any idea of the number, range, and intensity of the comments that were going hit them, I wouldn’t have been surprised if they had declined to com.

On the other hand, we responded positively to our hosts, led by Lisa N. Huse, the director of strategic initiatives for Roche Diabetes Care. This company offers blood glucose meters, including the Accu-Chek Aviva, which I reviewed for Diabetes Health magazine, as well as insulin pumps. After welcoming us and giving each of us the chance to introduce ourselves Twitter-style in 140 words or fewer, Lisa briefly reviewed her company’s progress in the year since its first annual Social Media Summit, which I also took part in and reviewed here.

Last year Roche began in earnest to reach out to the diabetes community with that first meeting with those of us who write about diabetes. That effort was a good start, although of the 29 of us, only two of us represented the overwhelming number of people with diabetes who have type 2. I couldn’t count how many type 2s took part in this year’s event, although the number increased to include at least five or us. I was also pleased to note a much more representative number of people of color.

In the intervening year Roche started at least two major initiatives, which Lisa mentioned in her introductory remarks. The first is the Diabetes Care Project, which is a coalition of like-minded organizations focusing on improving the care of people with diabetes. Founded by the National Minority Quality Forum and Roche in partnership with the American Association of Diabetes Educators and Healthways Inc., the group’s website is the Diabetes Care Project.

The second big outreach to people with diabetes that Roche made between the two summits is the Genentech/Roche Diabetes Patient Member Research Community. This is a group of 300 people with type 2 diabetes is a private, by-invitation-only group representing Roche’s customer base. They provide the company with feedback about their concerns and what they want. By working with these people, Roche is able to learn about their customers’ lifestyles, mindsets, attitudes, fears, and passions.

In several ways the best part of this year’s event was Roche’s emphasis on the accuracy of blood glucose meters. The low standards of accuracy we have has long been my biggest concern with testing our blood glucose levels, one that I have written about many times. Recently, the U.S. Food and Drug Administration has also become concerned, as I wrote here a year ago.

The “Accuracy Activity” led by leading blogger Amy Tenderich, who writes at Diabetes Mine, and Todd Siesky, the new public relations chief for Roche Diabetes Care, was both fun and informative. We broke up into small groups where we debated what standards of accuracy we wanted at the two given levels — below and above 75 mg/dl. The activity forcefully brought home to me that we had to work with trade-offs and that we couldn’t hope for perfect accuracy.

Last year we met at Roche’s American headquarters in Indianapolis, Indiana. This year we travelled to Orlando, where we met at the Orlando World Center Marriott in a tropical resort setting. Of course, summer weather in Central Florida is hot and humid, but we never had to leave the hotel except to take the limos that Roche laid on for us to and from the Orlando Airport, which must be one of the most beautiful in the world.

We met just after the American Diabetes Association’s annual meeting, also in Orlando, which I had decided to skip this year, mostly because I didn’t want to subject myself to Florida’s summer weather. But I couldn’t resist Roche’s invitation to its second annual Social Media Summit at the same place. Roche brought off the event without a hitch. Of course, I hope they choose a cooler location next year.

The Whole Group of Us Had Fun

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Yesterday Medco Health Solutions presented a study at the Scientific Sessions of the American Diabetes Association. The study found that, contrary to warnings from the Food and Drug Administration, neither Byetta or Januvia increase the risk of acute pancreatitis.

Byetta and Januvia are two of the most important medications for type 2 diabetes, since they reduce blood glucose without increasing weight, which all the other diabetes drugs (except metformin, Victoza, and Symlin) do. In fact, Byetta is proven to reduce weight, and that’s why I wrote a book about it, Losing Weight with Your Diabetes Medication.

Due to reported cases of acute pancreatitis, several years ago the FDA added warnings to the labels for Byetta and Januvia.

However, Medco’s study indicates that patients taking either of these medications were no more likely to develop acute pancreatitis than patients taking other drugs to control diabetes. The study indicates there is an increased risk of acute pancreatitis for people with diabetes. But that it is not associated with the particular diabetic medication the patients are using.

“While cases of acute pancreatitis have been reported in patients using Byetta and Januvia, diabetic patients who are not taking these drugs also have been reported to have an increased risk for pancreatitis,” says Merri Pendergrass, MD, PhD, national practice leader of the Medco Therapeutic Resource Center for Diabetes, who conducted the study. “The major question has been are these medications causing the pancreatitis or are they innocent bystanders? Our findings are reassuring in that they did not reveal any increased risk of acute pancreatitis with Byetta and Januvia.”

Medco released even more good news for people taking Byetta. Another one of its studies presented at the ADA’s Scientific Sessions found that, despite FDA warnings, Byetta is not associated with an increased risk of acute renal failure in people with type 2 diabetes. This Medco analysis indicated that while there is an increased risk of acute renal failure in people with diabetes, the diabetes drug they are taking does not appear to impact that risk.

Medco Health Solutions Inc. conducted the study in association with the Medco Research Institute and the University of Texas Southwestern Medical School. Medco Health Solutions is a major pharmacy, ranking 35th on the Fortune 500. The study analyzed Medco’s pharmacy and medical claims data for more than 786,000 adult patients between January 2007 and June 2009.

They divided the people with diabetes into three groups based on whether they were taking Byetta, Januvia, or other diabetes drugs. A group of people without diabetes served as the control.

While the risk for acute pancreatitis was essentially the same among the three groups of people with diabetes, the average risk for all the diabetes groups was higher than that for the control group. Medco used comparable methodology and study parameters in the two studies.

The lack of increased risk of renal failure was news to me. But I’ve known for years that Byetta doesn’t pose an additional risk of pancreatitis, and I wrote about it here in October 2007. Now it’s time for the FDA to catch up.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

Sometimes it’s superior to be short. Especially if it’s a needle.

Now, the company that makes some of the highest quality needles and lancets has gone even further. Becton, Dickson and Company, which many of us know simply as BD, announced a few days ago that it has produced a pen needle that is even smaller and thinner than anything available before.

BD says that it BD Ultra-Fine Nano is the “world’s smallest pen needle” and is proven to be as effective as longer needles for anyone — big or small, thin or fat. These new needles promise to be less painful for any one of the 5 million Americans who inject insulin or GLP-1 to manage their diabetes.

Please catch the reference to GLP-1. This means that not only insulin users but also those of us who use Byetta or Victoza. These are the newest class of diabetes drugs that people with type 2 diabetes can use to reduce their A1C and their weight at the same time.

This shorter needle is just 4 mm long and has a thin 32 gauge. It provided equivalent glycemic control compared to 31 gauge needles that are 5 mm or 8 mm long and had “reduced pain, no difference in insulin leakage and was preferred by patients,” according to a study reported in Current Medical Research and Opinion. While five of the seven authors of this study work for BD, which raises a red flag, two of them are independent researchers. And one of them, Timothy Bailey, M.D., the director of the AMCR Institute in San Diego, I greatly respect and know personally.

Even though this needle is only 4 mm long, it reaches the subcutaneous tissue — the layer of fat that all of us have below our skin — that is the recommended site for injections of insulin and GLP-1s. And it’s not too long to mean a risk of injecting into muscle, where we can absorb insulin too fast, increasing the risk of hypos. So this new needle promises better glycemic control.

With this needle we don’t have to pinch-up the skin. And it fits all of the insulin pens and dosers sold here.

As I writer, I don’t like to admit that pictures can sometimes be superior to words. Even photos that I have taken myself, like this one. They seldom are, but this is an exception.

Here is one of those new needles mounted on a saline pen. You can see for yourself how short it really is.

A BD Ultra-Fine Nano Pen Needle on a Saline Pen

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

It is especially important for those of us who have diabetes to drink a lot of water, as unexciting as it is compared with all the other beverages that we have available. So I do my best to make it a bit more exciting.

For starters, I filter all my tap water, even though Boulder, Colorado, where I live, has perhaps the highest rated water supply in the country. We are, after all, the only American city that owns its own glacier, and because it is melting so fast we have a lot of runoff!

Then, I keep a couple of canteens in the fridge all the time. Cold water tastes better to me, perhaps because it reminds me of drinking out of cool mountain streams, something that I could do when I was a kid.

Now, I often drink carbonated water. For years I bought plastic (and sometimes glass) bottles of the stuff at supermarkets. I tried all the brands of sparkling water and finally found one that I really like, Germany’s Gerolsteiner, and available only in high end markets, like Whole Foods. I dislike the most common brand available in restaurants, San Pellegrino.

But I got tired of the expense and trouble of carting cases of the stuff home every week and of the landfill waste. So, with the encouragement of one of my correspondents I invested in a device that carbonates my own water. A company called SodaStream makes it and delivers a new cartridge every couple of months when I need one. The water that it carbonates tastes every bit as good as the bottled stuff without all the disadvantages that that stuff has.

I drink it straight — as I am at the moment. Or I make sparkling lemonade with TrueLemon and stevia for a total of zero calories.

We can also flavor carbonated water with lots of different flavors. The SodaStream device comes with samples of many flavors, and the calorie-free ones include orange, berry, lemon-lime, diet root beer, diet pink grapefruit, and diet cranberry-raspberry. Another possibility are the many DaVinci flavors.

I just make sure to cut off my water supply by dinner time. I already make enough trips to the bathroom at night.

Drinking a lot water is the single diet recommendation that all the health experts agree on. They do differ on the amount that they recommend.

Loren Cordain, professor of exercise physiology at Colorado State University in Ft. Collins, Colorado, and the author of the important book, The Paleo Diet, points out that our paleolithic ancestors drank nothing but water. While paleolithic sounds like it was a long time ago, it was only about 10,000 years before now — the time just before the agricultural revolution — and that’s a blink of an eye in terms of human evolution.

Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill, and the author of The World is Fat, emphatically recommends that we drink nothing but water. And lots of it.

But it isn’t true that the U.S. government recommends drinking at least eight glasses of water a day. That is an old urban myth, as I wrote in my first book What Makes My Blood Glucose Levels Go Up…and Down? Dr. Jennie Brand-Miller, Kaye Foster-Powell, and I co-authored this book together to explain the glycemic index, and the water section was one that I wrote.

When we are thirsty, water remains our best choice. Even when we are hungry, having a drink of water is a great idea. It can help us feel fuller and therefore make us less likely to overeat. This goes a long way toward keeping our blood glucose levels where we want them to be.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

A few days ago I received a rather unusual compliment, sent in an unusual way. True Immortals has got to be science fiction, but presents itself as being real. At least I think that it has to be science fiction.

The apparent narrator, supposedly named Glenn, admitted on a post earlier this month that he has diabetes. “That means it’s hard to keep my blood sugar under control, even with nine kinds of medication,” Glenn says. “I’ve had it since I was little, and it’s taken its toll. At the bottom of my mind there’s a hope that if we make contact with immortals we’ll discover some way not to die.”

Meanwhile, Glenn is doing everything he can to manage his diabetes. “I work with an endocrinologist, a cardiologist and a renal specialist, and I also see a holistic doctor and use supplements.” And he exercises.

But it was Glenn’s next sentence that really grabbed my attention. “I read mendosa.com like it was the Bible.”

“Because I do all this, I’ve held up longer than my specialists expected.” Now Glenn is worried that he won’t life long enough until “we learn how to overcome disease and death and stay healthy forever.”

A big part of me wonders if Glenn and the other people who believe that we can live forever are overly optimist. The other part of me believes that we can never be too optimistic. Better to think positive thoughts like those people who believe in immortality on earth than to wallow in negativity.

Maybe those who believe in true immortality are irrational. But my guess is that they will live longer than the naysayers among us, all the while taking better care of their bodies and having a happier life, no matter how short or long it is.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.