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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Hot Plates for Slow Eating

January 14th, 2011 · No Comments

When I eat too fast, I eat too much. I knew that, but until now I haven’t been able to help it.

Now Juan Ramirez has come to my help. In March I wrote here about “Eating Too Fast” and some of the strategies I use. After that article, Juan wrote me about his invention to help us slow down at the table.

When we eat slowly, we can avoid overeating and therefore can control our diabetes better. But some of us eat fast because we like our meals to be hot rather than lukewarm. I know that’s my excuse.

Now, however, the great food cool off is no longer inevitable. I know this because I bought one of the “HotSmart Gourmet Plates” that Juan Ramirez invented and wrote me about.

“I am pre-diabetic myself and I am convinced that eating slowly works to avoid overeating, preventing obesity and type 2 diabetes,” Juan emailed me. “My heat-retentive plates keep food warm, need only one minute preheating, and stay hot for more than 30 minutes. The rim stays always cool for safe easy handling with your bare hands.”

This message grabbed my attention. I had to have one, but when Juan wrote me, he had one little problem. He was sold out of them at that time.

Recently he wrote to tell me that he was caught up with demand, and now has them in stock. “All you have to do is type HotSmart in the main page for all departments.” Or you can go to Amazon’s direct link for HotSmart Gourmet Plates.

Two of Juan’s websites explain the HotSmart plate in more detail. They are HotSmart Gourmet Plates and Lose Weight By Eating Slowly.

As soon as I got Juan’s message that Amazon had his plates back in stock I ordered one. Amazon sells them for $18.85 each.

Since then I have made a point of using my HotSmart plate for every hot meal that I eat now. It really works for keeping my food hot and keeping me from gobbling it down.

My guess is that like me you may have the secret little vice of eating too fast. If you do, eating off a HotSmart plate can help. While it won’t force you to slow down, it will take away any excuse you made to yourself to bolt your food down the hatch.

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


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The Buzz About Kimchi

December 16th, 2010 · No Comments

“What’s all this buzz about kimchi?” a friend asked me the other day. “People are talking about the health benefits of this Korean dish.”

Yes, the recent buzz about kimchi is strange, because Koreans have been eating this fermented vegetable relish for at least three thousand years. It’s not that kimchi is a revolutionary new food straight out of a high-tech laboratory.

In fact, our rediscovered appetite for kimchi is a part of the conservative food movement that careful and thoughtful people have begun to follow. Kimchi is one of the most important fermented foods.

“Fermentation, like cooking with fire, is one of the initial conditions of civilization,” writes Burkhard Bilger in the current issue of The New Yorker. “The alcohol and acids it produces can preserve fruits and grains for months and even years, making sedentary society possible.”

We can date the beginning of the new buzz about kimchi to at least 2003 with the publication of Sandor Katz’s underground best-seller, Wild Fermentation: The Flavor, Nutrition, and Craft of Live-Culture Foods. Then, in 2005, Korean scientists claimed that 11 of 13 infected chickens started to recover from avian flu after being fed an extract of kimchi.

My personal rediscovery of kimchi was an automatic result of my visit to South Korea last month. With a single exception, the restaurants that I ate in served me kimchi with every meal.

One of the Kimchi dishes on this table is the really red one

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Intermittent Fasting

November 5th, 2010 · 10 Comments

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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Promises to Myself

November 4th, 2010 · 1 Comment

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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Eating Blueberries with a Smile

November 4th, 2010 · No Comments

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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Visualize Yourself

November 4th, 2010 · No Comments

My friend Jay has type 2 diabetes and is a member of the diabetes support group that meets every month in my apartment. But he is also a primary care physician, and almost half his patients have diabetes.

Jay is therefore uniquely qualified to help us. At the most recent meeting of our support group we were already  running overtime. But it was Jay’s turn to speak, and he wanted to share with us the “shock treatment” that he uses with his new patients who have diabetes. I’m glad that he did and that I can share this treatment with you.

Jay starts by explaining that diabetes, high blood pressure, and heart disease are the three main silent killers. Because they usually don’t offer us any advance warning of the hidden damage that they do to our bodies, these diseases are truly insidious.

Then, he suddenly turns off the lights in the windowless office. “Visualize yourself 15 years from now,” he says. “This is what you might be seeing then, if you don’t control your diabetes.”

This is Jay’s shock treatment. But any technique that will get us to open our eyes to the consequences of uncontrolled diabetes is better than none, he says.

Jay asked each of the members of our support group to look in the mirror each morning and visualize ourselves 15 years later. For me this gave me one more piece of encouragement to eat right, stay slim, and exercise so I will still be able to see my face in the mirror 15 years from now when I will be 90. If I’m still around then, I hope to continue seeing a computer monitor so I that I will still be able to write you.

As Jay left my apartment that day, I took him aside and told him that I already could visualize his shock treatment. My ophthalmologist had just told me after my semiannual checkup that I have two small micro-aneurysms in my left eye that he hadn’t seen before.

Jay’s shock treatment worked especially well because I was already shocked. Micro-aneurysms can lead to diabetic retinopathy, which can, of course, lead to blindness, the complication of diabetes that I have always dreaded the most.

Now I have even more incentive to keep my A1C level in the low 5 range, if not down to 4.5, which is my goal. I hope that you don’t need any more incentives to control your own diabetes.

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


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Fish, Inflammation, and Insulin Resistance

November 4th, 2010 · No Comments

Omega-3 fats reduce chronic inflammation and insulin resistance. Now we know why.

Tomorrow the journal Cell will publish a report telling how researchers at the University of California, San Diego identified the molecular mechanism that omega-3 uses. The full-text of the article by Jerrold Olefsky, M.D., and his associates is online.

They found a key receptor on macrophages, which are specialized white blood cells that engulf and digest cellular debris and pathogens. Omega-3 fats activate this macrophage receptor with broad anti-inflammatory effects and improved insulin sensitivity.

When we have insulin resistance, insulin doesn’t regulate our blood glucose levels as well, and it often leads to type 2 diabetes. “Chronic, low grade tissue inflammation is an important cause of obesity-related insulin resistance,” the study states. As I have reported here previously, Dr. Olefsky has been working to see how we can “block or disarm this macrophage inflammatory pathway in humans,” preventing insulin resistance and type 2 diabetes.

Dr. Olefsky’s group used cell cultures and mice. They didn’t use people. But by using mice they were able to “knock out” or turn off specific genes. “Mice are currently the most closely related laboratory animal species to humans for which the knockout technique can easily be applied.” Doing this to humans would not be practical, and if it were, it wouldn’t be ethical.

I applaud this research. But not Dr. Olefsky’s proposed solution.

“These results,” the study says, “strongly argue that anti-inflammatory effects can ameliorate insulin resistance in obesity.” But then the study’s authors go on to say that this knowledge “may prove useful in the future development of new therapeutic approaches for the treatment of insulin resistant diseases.”

As I wrote in review of Dr. Olefsky’s earlier research, “He’s thinking drugs to reverse a sad situation.” He still is, but we can think diet now.

We can simply increase the level of omega-3 fats in the tissues of our bodies. Cold-water fish like salmon and sardines are the most effective. Fish or krill oil works too. But, as I have written here, we need to cut back on omega-6 fats first.

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


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Water and Weight

November 4th, 2010 · No Comments

We are more interested in water than we are in Obesity. Yet they are connected.

A year ago the professional journal Obesity published the results of a randomized, controlled clinical trial that compares weight loss among dieters who drink water before meals with those who do not. When the people in the trial drank just two 8-ounces of that simple stuff right before each of their three daily meals, they lost about 5 pounds more than those in the trial who didn’t increase how much water they drank. The trial lasted just 12 weeks.

But almost nobody noticed that study. As much as I am personally and professionally interested in weight loss, I sure didn’t.

The senior author of the study, Brenda Davy, is associate professor of nutrition at Virginia Tech in Blacksburg, Virginia. She tried again to get the word out last week, and this time she succeeded.

This time she presented her research at the national meeting of the American Chemical Society in Boston. That’s how I and just about everyone else learned about it.

At first, I decided not to write about this study, figured that it was old news. But when I read about it in the current issue of The Economist yesterday, I knew that this was a hot topic.

Few of the more than 300 articles in the press that covered Professor Davy’s talk mentioned that this was old news. The American Chemical Society’s press release didn’t bother to tell us that.

But when I asked Dr. Davy when a professional journal would publish her research, she told me that Obesity already had published it. This is important, because publication in a peer-reviewed journal like Obesity gets a lot more credit from the scientific community than something that some professor says at a meeting.

My guess is that you too didn’t notice the report in Obesity or even one of the many articles in the press reporting on Dr. Davy’s talk. Even if you did, a gentle reminder here might be enough for some of us to take a little action.

Personally, I’m more than interested in drinking water before meals to lose weight. I took action. While I am no longer obese, my current body mass index crept up a little from all of my travels this year. At 20.1 it is higher than where I feel the best.

So I have been drinking a lot more water ever since reading about this study. And in a week my weight is down to 161 from 163. It works for me.

Professionally, I know that almost everyone else who has diabetes also struggles with his or her weight. That’s why I’m recommending that you add this simple and inexpensive appetite control to your current strategy.

All I’m asking is that you drink two 8-ounces of water before every meal and keep track of your weight. One more thing — please let this community know if it works for you too.

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


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Super Salads

September 28th, 2010 · 5 Comments

When we follow a low-carb diet to control our diabetes and to lose weight, the first carbohydrates to go are starchy foods. Then, we reduce two sugars, sucrose (table sugar) and fructose.

Starchy foods have a high glycemic index, particularly tubers like potatoes and grains like wheat and wheat products, including bread, bagels, and baguettes. The trouble with sucrose is that it’s half fructose (the other half is glucose). And the trouble with fructose, including high-fructose corn syrup and agave nectar, is its impact on the liver, which metabolizes it. That raises our triglyceride levels and leads us to secrete more insulin, which in turn leads to more insulin resistance. Fructose also leads to high blood pressure.

What’s left? Fiber, of course. In the U.S. we count fiber as a carbohydrate, although much of the rest of the world counts it separately. Having some fiber in our diet is probably a good thing, but we can’t live on it.

But beyond starch, sugar, and fiber are the green leafy vegetables. The mainstay of salad. That’s what’s left.

Even Dr. Richard K. Bernstein, the leading exponent of a very low-carb diet for controlling diabetes, thinks that it makes sense for us to eat some slow-acting carbohydrates. While “there is no such thing as an essential carbohydrate,” as Dr. Bernstein writes in Dr. Bernstein’s Diabetes Solution, he also writes that “it seemed reasonable to conclude that, since our prehistoric ancestors consumed some plants, plant foods might well contain essential nutrients that were not yet present in vitamin supplement and not even been discovered.”

All of a sudden Dr. Bernstein found that he was eating salads as well as cooked vegetables. He says that he now relishes salads.

I certainly do too. A big salad is my main meal, which I eat at lunchtime giving my body enough hours to digest it before going to bed.

A couple of years ago I wrote here about what I put in my salads. But I keep discovering new ingredients that I relish.

My best find, I think, is BroccoSprouts, which just like the name indicates is sprouted broccoli. I wrote about BroccoSprouts here a year ago and still add them to almost every salad.

More recently I found a preparation of one of my favorite vegetables. Whole Foods markets now usually have artichoke hearts. In the produce section you can find “ArtiHearts Fresh Natural Artichokes” from Monterey Farms.

Five years ago I wrote in my “Diabetes Update” newsletter reviewing a book, Prickly Pear Cactus Medicine. Many people in Mexico use it to prevent high blood glucose levels, and it has one of the lowest glycemic indexes of any food. When I reviewed that book, I was concerned that the prickly pear cactus sold here was the species that tastes better than the one studied more for its glucose-lowering effect. Of course, it’s probably the former, but I now eat and enjoy it anyway, because it is undoubtedly low carb and good tasting. Sold in bottles or cans as “Tender Cactus” and “Nopalitos,” the prickly pear cactus that Whole Foods and major supermarket chains sell isn’t prickly. Someone else has removed the thorns for us.

I happened to have planned to write this much about salads anyway. But this morning I ran across a new study in BMJ, originally called the British Medical Journal. It is among the world’s most influential and widely read peer-reviewed general scientific journals in the field of medicine. Just yesterday BMJ published “Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis.”

The study concluded that their meta-analysis supported recommendations to promote the consumption of green leafy vegetables in the diet for reducing the risk of type 2 diabetes. My conclusion is that something that can reduce the risk of our getting type 2 diabetes can’t be harmful for those of us who are already living with this condition.

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


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Sugar-Free Chocolate

September 14th, 2010 · 1 Comment

If you don’t like chocolate, you can leave now and read my other posts. But if you do like chocolate,  please stick around.

Everybody still here? I thought so. Chocolate is most people’s top comfort food.

But many of us who have diabetes do all we can to avoid sugar. Regular sugar, or sucrose, is half fructose. And fructose has lately earned a bad rap. If you wonder why, you might want to check out a couple of my reviews, one from 2007 and another from 2008.

Most of us have tasted enough sugar-free chocolate to doubt that it anybody can make it taste right. But somebody has. So now you can eat your chocolate without the sugar and enjoy the great taste. Kiss chocolate guilt goodbye!

In the interest of science I have been taste-testing chocolate bars that Mary Jo Kringas sent me at no charge. Somebody had to test them!

Mary Jo started the conversation by telling me that she developed a chocolate bar sweetened with inulin from chicory root and from erythritol. They are 60 percent cocoa solids.

Inulin is soluble fiber. It passes through much of our digestive system intact and therefore doesn’t raise our blood glucose level.

Erythritol is one of the sugar alcohols. But unlike the commonly used maltitol, it has a glycemic index of zero.

That sounded good enough for me to go to the trouble of asking Mary Jo to send me a case of her chocolate bars and to eat them. I knew that I had to do a taste test on your behalf.

Since my rather mature taste buds might be fallible, I convened a tasting panel of three younger testers. The panel consisted of a 20-year-old university student named Rachel, a 21-year-old manager of an ice cream store named Lauren, and a 58-year-old psychotherapist named Barry.

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