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Exercise For Diabetes, People With Diabetes

The Korean Paradox

South Korea is different from the United States.

In some important respects this Asian country is more like America than most of us would think. This country is a democracy with a booming economy.

But the differences are great and go beyond Korea’s use of a different language and even a different alphabet than Westerners use. The differences go far beyond history and tradition. The biggest differences that I have seen during my visit this month are in the people themselves.

I saw with my own eyes how thin almost all Koreans are. Coming from the United States — even though I live in the thinnest state — I have been amazed to see almost no obesity here.

So, of course, I expected that almost no one in Korea would have diabetes. After all, didn’t the American weight problem lead to the rapid rise of diabetes in our country?

We know that some sort of link between being overweight and having diabetes exists. We do know that being overweight doesn’t cause diabetes, because two-thirds of American are overweight and about one-tenth of us have diabetes. But as our weight has gone up so too has the proportion of people with diabetes. Those two conditions have to have some association. Continue Reading

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Diabetes Complications, Exercise For Diabetes

A Stand-Up Guy and His Desk

When I tell you that I am a stand-up guy, I wouldn’t blame you for assuming that I was boasting. After all, part of the standard Mafia definition of this term is one who “can be trusted.”

While I do hope that you can trust me, I call myself a stand-up guy because one of my own posts here inspired me to stand up a lot more. So, when I say that I am a stand-up guy, this is a fact, not a boast.

In a post here, “Standing Up for Your Heart,” I reviewed a study by Alpa Patel, Ph.D., and her associates that explored the connection between sitting and mortality. They found that the amount of time people spend sitting is associated with an increased risk of death from heart disease, which happens to be the biggest complication of diabetes.

When I digested the impact of that study, it reinforced my long-standing plan of converting my computer time from sitting to standing. Dr. James Levine, a Mayo Clinic endocrinologist, was my original my model. Four years ago I wrote here about how he mounted his computer over a treadmill, and while he works, he walks at the rate of 0.7 miles per hour.

Even before reading the new study led by Dr. Patel, I had told Abhijit Mhapsekar, who programs my mendosa.com website, about walking on a treadmill while he worked. I knew that it would help heal his bad back. And Abhijit actually did get a treadmill with his computer mounted over a desk.

But I dawdled. My apartment doesn’t have enough room for a treadmill and treadmill desk in addition to the wonderful teak desk that I’ve had since 1969.

Instead, I priced stand-up desks on the Internet and a local store for me to use without a treadmill. Those desks run from $1,300 to $,2300. And they weren’t awfully stable.

Instead, I had a handyman make me a stand-up desk. It is as simple as possible: just two tracks screwed into the wall with three brackets that are adjustable (and I have already adjusted them), with a board 24 inches deep by 43 inches wide, large enough for one of my computers and accessories. The new desk ran me about $300 and is very stable. Anyone with more skill than I have could make one for much less.

When I commissioned my new stand-up desk, I expected to use it a small part of the time. In fact, I now use it much more than my old desk.

I also think more clearly when I am standing up. Judge for yourself. I wrote this standing.

As a writer, I have always known that I learn more from my articles than even the most diligent readers do. This is just like teachers learn more than their students because of all the preparation that goes into their lessons.

And as a caring person my goal in life is to help other people who like me have to live with diabetes. The Talmud says that “to save one person is to save the world,” and even if I haven’t moved you yet to stand up more, my review of Dr. Patel’s work already inspired both Abdijit and me to get off our butts more.

That’s not all. After I got my new stand-up desk I told Dr. Patel about it. “Congratulations! I hope to move from sitting on my exercise ball to a stand-up desk soon myself.”

Can I inspire you too?

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Diet

Intermittent Fasting

People often fast for cosmetic, religious, or medical reasons. About 14 percent of American adults have reported that they have fasted to help control their weight. But I have begun to fast intermittently because it’s the natural way to eat — or not eat.

That fasting may appear at first glance to be unnatural just shows how far we have departed from our heritage. Eating three squares a day is certainly not what our paleolithic ancestors did. And if our paleolithic ancestors seem light years away from modern humans, just remember that the paleolithic period extended until the agricultural revolution, which was only about 300 generations ago. Genetically, we have hardly changed at all since them.

Articles by Dr. Michael Eades on his “Protein Power” blog first attracted my attention to intermittent fasting. The more I explored intermittent fasting, particularly in the work of Dr. Loren Cordain, like his book, The Paleo Diet, the more I knew that I had to check out that experience for myself.

In the past couple of weeks I made two intermittent fasts. The first was for 12 hours from sunrise to sunset and the second was 24 hours from dinner one night to dinner the next.

I drank only water, lemonade, and tea (both black and herbal). None with any calories. And plenty of it.

My 12-hour fast was similar to that of Muslims during the month of Ramadan. But hardly the same and not as challenging.

Since Muslims are the experts on fasting, I consulted with an imam, Ibrahim Kazerooni, before setting forth on my latest dietary experiment. He is both a friend and a member of my diabetes support group.

Ibrahim explained that Muslims can’t even drink water while fasting during the month of Ramadan. Their fasts last from 1 and 1/2 hours before sunrise until dusk. (As a Shiite Islamic priest, or imam, he was an Iraqi dissident who Saddam Hussein repeatedly imprisoned until Ibrahim was able to escape from Iraq in 1974; I understand that followers of Sunni Islam fast from dawn to sunset.)

“Take it easy at first,” Ibrahim explained. “Just do one day to start.”

He told me that the fast was beneficial for his blood glucose level, even it it was sometimes a bit too low. “It was no problem when I took my diabetes medication at night.”

People who have type 2 diabetes, as Ibrahim does, need to be careful of what they eat late at night when they break their fasts. They can lose weight, “if they don’t overload on sugar and starch.” He said that he lost seven pounds this time.

Now, after two fasts I am even more positive than I was from reading Drs. Eades and Cordain and from talking with Imam Kazerooni.

I did have brief headaches near the beginning of each fast. And a bit of a sore throat for a short while as I hiked during my first fast. At one point on the trail I felt hunger pains in my stomach for a few minutes. But I was amazed that otherwise I never got hungry.

My mood remained at a high level throughout. Physically, I may have even gained energy. For example, on my walk to the post office during the second fast I even did some intermittent jogging, something that I hadn’t done for several months.

I don’t take any diabetes drugs or other prescription medication. My blood glucose level once went down to 68 mg/dl, about as far as anyone with diabetes would want. The first thing on the morning after my second fast it was at 80 mg/dl, just below the 83 mark that Dr. Richard K. Bernstein, the leading exponent of a very low-carb diet, says that is the appropriate average for anyone. I lost 0.8 pounds, and now my weight is the lowest in eight months.

Later I thought to investigate the peer-reviewed articles on Medline and found this:

“Persons with Type 1 diabetes can participate safely in prolonged fasts [more than 25 hours] provided they reduce their usual insulin dose significantly and adhere to guidelines regarding glucose monitoring and indications for terminating fasting.”

People with type 1, unlike me, absolutely have to take insulin. And of course my intermittent fasts have not been “prolonged.”

I also found other studies indicating other benefits of intermittent fasting, including one that concludes:

“Reducing energy intake by controlled caloric restriction or intermittent fasting increases lifespan and protects various tissues against disease…”

Another study reported:

“It has previously been shown that fasting for the biblical period of 40 days and 40 nights is well within the overall physiological capabilities of a healthy adult.”

The experience freed me from the self-imposed tyranny of assuming that I just had to eat breakfast, lunch, and dinner. Skipping those meals even saved me lots of time in food preparation and eating.

In conclusion, the experience was so rewarding that I will continue intermittent fasts of various lengths. But not more than the biblical 40 days and 40 nights.

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Medication

Avandia Going Away

If you are one of the 600,000 Americans who take Avandia, you need to see your doctor right away. That’s only a small fraction of the 24 million of us here who have diabetes, but anyone who now takes it has an important — and perhaps a life-saving — decision to make.

The U.S. Food and Drug Administration just pulled the major diabetes drug Avandia (rosiglitazone) from the U.S. market — with two exceptions. This government agency responsible for drug safety and efficacy says that people with diabetes who are already on Avandia can keep on using it. But the FDA will let us take it only if we and our doctors swear that they have tried every other diabetes drug and that they and their doctors know how risky Avandia is for their heart.

The FDA’s decision also affects two drugs that combine Avandia with another drug. These are Avandamet, which is Avandia and metformin, and Avandaryl and glimepiride, one of the sulfonylurea drugs.

One study indicates that between when the FDA approved Avandia in 1999 and last year more than 47,000 Americans needlessly suffered heart attacks, strokes, or heart failure — or died. Still, the FDA’s decision yesterday will let people keep on taking Avandia. And the agency admitted that implementing its decision can take months.

The FDA had previously withdrawn our access to drugs years after the agency approved the them. Think thalidomide, which the FDA approved in the late 1950s and pulled in 1961 after mothers who took it gave birth to many children with tragic birth defects. Think too about the diabetes drug Rezulin, which the FDA approved in 1997 and withdrew 11 years later after about 400 people with diabetes died from liver failure. Rezulin and Avandia are two of the three drugs in the same class, the thiazolidinediones. The third member of this drug class, Actos, still appears to be safe.

So the FDA’s decision yesterday leaving a loophole was a strange one. Even more unusual was its coordinated announcement with European drug regulators. Well, they coordinated the timing of the announcement, which was highly unusual and perhaps unprecedented. But the European Medicines Agency took Avandia totally off the market there.

The world has a controversial Cleveland Clinic cardiologist to thank. A meta-analysis led by Dr. Steven Nissen that the New England Journal of Medicine published three years ago exposed Avandia’s dangers to people with diabetes.

With the FDA’s action yesterday the second shoe dropped. To mix a metaphor, if you take Avandia the ball is in your court now.


This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Diet

Promises to Myself

I’m getting desperate. I’m stuck. To completely control my diabetes I know that I have to control my weight.

Like Robert Frost, “I have promises to keep and miles to go before I sleep.”

Today I make these promises to myself:

I promise to take or accept no snacks at supermarkets or my barbershop — not even meat or cheese.

I promise not to buy any food that doesn’t fit my eating plan.

I promise not to buy any food, no matter how good for me, that I can’t resist eating too much of, like macadamia nuts.

I promise to eat no more than I usually eat at home when I eat a meal out.

I promise to drink one liter of water before every meal.

I promise to eat dinner at least three hours before bedtime.

I promise not to eat anything after dinner.

I promise not to eat any dairy (except for the one container of Greek yogurt now in my refrigerator).

I promise not to eat any grain or potatoes.

I promise not to eat any sucrose or fructose — not even spicy chai sweetened with honey (except the fructose that occurs naturally in up to one serving of fruit per day).

I promise not to use any oil with an unfavorable omega 3:6 ratio (except extra virgin olive oil).

Each of these public promises is binding on myself, David Mendosa, at least until I have lost the six more pounds that I want to lose so that I can get back down to a BMI of 19.5.

I promise to report back here when I have reached my ideal weight and that I kept these promises to do so.

Do you want to make any promises — either public or private — to help promote your weight loss and better health?

This article is based on an earlier version of my article published by HealthCentral.

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Diabetes Diet

Eating Blueberries with a Smile

Those of us who have diabetes have something to smile about when we learn that a tasty food we love to eat but we thought was bad for us is actually good. As I ate my blueberries this week I experienced those smiles.

Nobody likes blueberries more than I do. But the few times I have eaten them lately have been guilty pleasures. That’s because blueberries are high in carbohydrates, which can wreck havoc with our blood glucose control.

Blueberries seemed to decrease inflammation when researchers tested them in animals. In spite of their carb content animals appeared to have lower BG levels when they ate their berries.

But until now we didn’t know much about what blueberries would do for people. So Drs. William Cefalu and associates set out to study what blueberries might do for us. They work at the Pennington Biomedical Research Center, a part of the Louisiana State University System.

They didn’t study people with diabetes. Instead, for six weeks they studied 32 obese people who have prediabetes, or insulin resistance.

So, is this work relevant to those of us who have gone all the way into diabetes? I think so, because the difference between prediabetes and diabetes comes down to whether we have burned out lots of the beta cells in our pancreas or not. Like us, people with prediabetes already have a lot of insulin resistance that can eventually burn out the beta cells.
This study meets the highest standards of clinical trials — it is a double-blind, randomized, and placebo-controled clinical study design. The Journal of Nutrition will publish their findings in its October 2010 issue. Meanwhile, however, the journal has already published the study, “Bioactives in Blueberries Improve Insulin Sensitivity in Obese, Insulin-Resistant Men and Women,” online. While only the abstract is free online, I got the full-text through my subscription.

The people in the study who ate the blueberries had significantly improved insulin sensitivity compared to those in the control group who weren’t so lucky. Changes in body fat, calorie intake, or inflammation were not at work here.

Researchers guess that the health benefits of blueberries might come from their phenolic bioactive compounds like anthocyanins, which are also anti-oxidant. They are red, purple, or like blueberries in particular, blue. Dark blue.

The people in the study got their blueberries from frozen powder in a smoothie. The control group got their smoothies without the blueberries but with the same taste and calories.

Not increasing our calories — and the amount of carbs we eat — is also our challenge when we add blueberries to our diet. After all, one cup of them has 12 grams of carbs, the maximum amount those of us who eat low-carb will want to have in any meal.

When we add blueberries to what we eat, we can remove something else. This way we can keep smiles on our faces as we consume a delicious and healthy food.

This article is based on an earlier version of my article published by HealthCentral.

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