The cholesterol issue is at the heart of every dietary recommendation for the past 30 years, says Dr. Jonny Bowden. “When you think about it — and I have thought about it — it has influenced everything we have been taught about what to eat and what not to eat.”

Together with Stephen Sinatra, M.D., a board certified cardiologist with more than 30 years of clinical practice, they wrote a new book, The Great Cholesterol Myth, which Fair Winds Press published on November 1. Alternatively, you can get a Kindle edition, which is what the publisher sent me for review.

Dr. Bowden has a Ph.D. in nutrition and is the author of 10 books with some of the soundest advice on what to eat that I have ever read. His book Living Low Carb is one of the very best books on the lifestyle that I follow and recommend. My only regret is that I failed to discover it when it came out, so I haven’t reviewed it. Dr. Bowden tells me, however, that a revised edition is in the works, and I will certainly review it as soon as I get my hands on it.

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If we’re lucky, we will get diabetic neuropathy in our lifetimes. Nearly 60 percent of people with diabetes in America have it after a quarter of a century.

Neuropathy may be the most common complication of diabetes and can make walking difficult as well as leading to even more serious problems like losing a limb. Diabetic neuropathy is damage caused to the nerves, and it can result in numbness, tingling, burning, and pain. Until now the painkillers that we could use don’t work well for everyone.

Now, however, a study from the University of Calgary shows evidence supporting a new drug therapy to treat diabetic neuropathy. The drug is called nabilone.

“My pain was so severe that I could barely walk a block,” says Leslie Bonenfant, who has type 2 diabetes and participated in the study. “After taking nabilone, I can manage my pain and I can function day to day,” she says.

Leslie Bonenfant (left) during a medical exam with Dr. Cory Toth

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Diabetes doesn’t hurt. That’s one of the biggest problems we have in taking this insidious disease seriously.

But when we don’t manage our diabetes, some of its complications can be painful. And about 40 percent of us have acute or chronic pain. That’s the bad news.

This bad news comes to us in a new study of more than 13,000 adults with type 2 diabetes in the Kaiser Permanente, Northern California system. About 42 percent of them reported that they had acute pain and about 40 percent said their pain was chronic. The most common complication they mentioned was fatigue, about 25 percent, followed by neuropathy, about 24 percent.

The findings, “Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study,” will appear in the Journal of General Internal Medicine and is now available online. The lead author is Rebecca L. Sudore, M.D., and her assistant sent me a copy of the full-text.

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When you keep your blood sugar level as low as the levels of people who don’t have diabetes, your have little risk of having a heart attack. But when you let your sugar level rise just a little, that risk goes up a lot.

Healthy people who don’t have diabetes have a fasting blood sugar level of less than 6 mmol/l, according to researchers at the University of Copenhagen. That’s the equivalent of an A1C level of 5.4. The Journal of the American College of Cardiology just published their study in the issue for June 19/26, 2012.

The researchers drew on three observational studies that included 80,522 Danes. Observational studies cannot prove a cause, but the researchers went further. They used “a Mendelian randomization approach … to circumvent confounding and reverse causation.”

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Endurance athletes and hot yoga enthusiasts are hardly the only people who have to stay hydrated. Anyone who has a sweaty job needs to make sure to replenish the minerals lost at work. People like me who have diabetes need to be especially careful to stay in balance.

Even if you aren’t much of an athlete or work in a hot and humid place you can perspire a lot when you go to the tropics. I know from my current experience.

Right now I am writing from Caye Caulker, a tiny island in the Caribbean Sea off the mainland of the Central American country of Belize. I am here primarily to photograph birds, and that requires lots of hiking. The weather has stayed mostly at 80° hot and 95-100 percent humid.

To  stay hydrated I don’t just consume a lot of salt. That can help in an emergency. When I was a kid in high school, I had a summer job washing bottles in a dairy at the western edge of the Colorado desert. When I collapsed after a few days, my parents took me to our family doctor, who prescribed salt tablets. While I was able to go right back to work, this wasn’t an ideal solution.

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Ever since I learned about a new treatment for neuropathy at the annual convention of the American Diabetes Association in June, I have been trying to think of a good reason why not to write about it. I failed.

As a journalist, I am naturally skeptical. As Louis Menard wrote in the current issue of The New Yorker, “A person whose financial requirements are modest and whose curiosity, skepticism, and indifference to reputation are outsized is a person at risk of becoming a journalist.” That’s me.

I am skeptical of any purported cure for diabetes. I am even skeptical of new treatments for any of its complications. I am especially skeptical of the so-called “medical foods” that our companies keep dreaming up.

But I am also curious about anything new out there that really might be able to help us. And we do need help with diabetic neuropathy.

At least 60 percent of us have some degree of neuropathy. Diabetes raise our blood glucose level, and a high level of glucose in our blood can damage the nerves in our bodies. Often the nerves at the body’s periphery are the first to suffer with burning, shooting, or stabbing pains. Uncontrolled, the pain becomes severe.

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Don’t go from the nourishment of nuts to chowing down on carbs. That’s the opposite of what I mean by the title of this article. I mean to suggest that substituting nuts in your diet for some of your carbs makes sense.

A study that will appear in the August issue of Diabetes Care, a professional journal of the American Diabetes Association, shows that eating nuts every day can help us manage our type 2 diabetes and prevent its complications. This research reports that eating just two ounces of nuts as a replacement for carbohydrates proved effective in managing our blood glucose and lipid levels.

Dr. Cyril W.C. Kendall of the University of Toronto, who is the corresponding author, sent me the full-text of the study, “Nuts as a Replacement for Carbohydrates in the Diabetic Diet.” The abstract of the study is online.

The lead author of the study is Dr. David J.A. Jenkins. That name is what brought the study to my attention because he created the most powerful tool to evaluate carbohydrates.

That tool is the glycemic index, which his 1981 article in the American Journal of Clinical Nutrition kicked off. Slow to gain traction here, the GI seems nowadays to be everywhere.

When I learned in 1994 that I had diabetes, I began following the glycemic index, and my first book lauded it. Since then, however, I have gone beyond that diet. And Dr. Jenkins also seems to have done so.

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Hypothyroidism now appears to be one of the most common complications of diabetes. Fortunately, it is one of easiest conditions to manage. All it requires is taking one little pill the first thing every morning to make up for the thyroid hormone that we lack.

Checking our TSH level is the usual way our doctors have to find out if we have hypothyroidism. Our pituitary glands make TSH, short for thyroid stimulating hormone.

How common hypothyroidism is depends on how we define a normal TSH level. Currently, most countries set the reference range at 0.40 to 4.5 mIU/l. But some organizations and many new studies suggest that a level of 4.5 is far too high to be considered normal.

The American Association of Clinical Endocrinologists considers 0.3–3.0 to be the normal range. But the National Academy of Clinical Biochemistry guidelines indicate that more than 95 percent of normal people have TSH levels below 2.5.

The HUNT study from Norway reported in a 2008 issue of The Archives of Internal Medicine that they used the TSH test to measure the thyroid function of 17,000 women and 8,000 men with no known thyroid or heart disease. All the people in the study had a “normal” TSH level of 0.5 to 3.5. The people in the lowest TSH group, those with a level of 0.5 to 1.4, had 70 percent less heart disease than those in the highest TSH group, who had a level of 2.5 to 3.5.

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We need both information and support to deal with the diabetes demon we carry around with us every day. In the past 15 years the explosive growth of the Internet — and especially the HealthCentral web site — now give us as much information as we can handle.

The Internet is also pretty good in giving us support. But we still get the best support face to face.

This morning Bill Polonsky gave some of us a taste of the support that he provides to people with diabetes. As the guest speaker closing the two-day 2011 Roche Social Media Summit at the Hard Rock Hotel in San Diego, Bill spoke to 37 writers and bloggers about diabetes.

Bill is the founder and president of the Behavioral Diabetes Institute in San Diego. This is the only institution in the world focusing on the emotional aspects of diabetes.

He has a Ph.D. degree and is also a Certified Diabetes Educator. Bill also is Associate Clinical Professor in Psychiatry at the University of California, San Diego.

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Regular readers may remember that I reported here on earlier studies about some benefits from intermittent fasting. But a study reported yesterday shows that fasting also lowers the risk of heart disease and diabetes and increases the good HDL cholesterol and reduces triglycerides, weight, and blood glucose levels. It also increases the bad LDL cholesterol.

Research cardiologists at the Intermountain Medical Center Heart Institute in Murray, Utah, reported these finds at the annual scientific sessions of the American College of Cardiology in New Orleans. Tomorrow’s issue of the Journal of the American College of Cardiology will print the results of this study led by Dr. Benjamin D. Horne, Intermountain’s director of cardiovascular and genetic epidemiology.

LDL went up by 14 percent and HDL by 6 percent. But the increase in cholesterol from fasting is probably not a bad thing, as Dr. Horne explains.

“Fasting causes hunger or stress,” he pointed out. “In response, the body releases more cholesterol, allowing it to utilize fat as a source of fuel, instead of glucose. This decreases the number of fat cells in the body. This is important because the fewer fat cells a body has, the less likely it will experience insulin resistance or diabetes.”

Dr. Horne’s team conducted two fasting studies. One included more than 200 people. Another included 30 people who only had water for 24 hours and then studied for another day. During this additional 24-hour period the researchers subjected the subjects to blood tests and other physical measurements.

Now I have the incentive to get back to intermittent fasting. Just as soon as I finish the fish in my fridge.

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.