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

Potato Poison

August 30th, 2010 · 2 Comments

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.

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Losing Weight the Easy Way

August 16th, 2010 · 67 Comments

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.

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The Chia Controversy

August 16th, 2010 · 20 Comments

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 →]

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Water Everywhere

August 9th, 2010 · 1 Comment

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.

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Brain Food

July 9th, 2010 · No Comments

Whether people with diabetes need bigger brains that other people is something that science hasn’t studied yet. But some scientists who have studied our early ancestors have just discovered that we got our big brains originally from a diet that came in large part from fish and other aquatic animals.

Until now, most of the scientists who study our early ancestors assumed that they lived on the plains of East Africa. This “savannah theory” seemed to point at a diet of roots, seeds and nuts, some green plants and the occasional small game — the hunter-gatherer hypothesis. This is pretty far from the oceans where fish live.

But fish also live in lakes and streams. And now we know that some of our earliest ancestors about 1.95 million years ago lived around such a wet environment. Archeologists working in northern Kenya found that our ancestors ate a lot of fish, turtles, and crocodiles. By analyzing the bones of the animals and the stone tools that our ancestors made the scientists showed that in fact we descend from a long line of fish-eaters.

Yesterday This Fisherman Caught a Smallmouth Bass — Our Ancestors Caught Prehistoric Bass

The connection between fish and brains is omega-3 oils, which make up about 60 percent of the fatty acids in our brains. And about 2 million years ago our ancestors first developed the big brains that humans have.

We didn’t get their big brains from plants, because our bodies are inefficient in converting plant-based omega-3 into the long-chain omega-3 that our brains need. Only fish, shellfish, algae, and those animals that feed largely on aquatic sources have a lot of omega-3 that our brains can use.

Our mothers told us that fish was brain food. And now we know that they were right in this as in so many other things.

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.

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Weight Control Registry

June 29th, 2010 · No Comments

The National Weight Control Registry is the best guide we have showing us how people actually lose weight and keep it off. These are the people who have succeeded in a major weight loss program and in keeping off the pounds.

Diabetes doctors typically tell us to loose 10 percent of our body weight. I know from my own experience that this helps to control our blood glucose level. And I know too that getting down to a normal body mass index, or BMI, is even better for maintaining a low A1C level.

The National Weight Control Registry started in 1994 and now tracks more than 5,000 people. And because I am one of them, the people at the registry sent me a copy of a publication that summarizes their findings as thanks for returning a one-year questionnaire. The article, “Long-term weight loss maintenance,” appeared in the American Journal of Clinical Nutrition.

To be included in the registry, people have to be at least 18 and have kept off at least 30 pounds for a year or more. I reached that milestone four years ago. And a couple of years ago my friend Gretchen Becker encouraged me to share my results with the registry.

I haven’t seen any statistics about how many of the people included in the registry have diabetes. But I know that my weight loss strategies have been different from most. Using Byetta got me started with my weight loss program, and a very low-carb diet intensified it.

Most people, however, say that they have lost weight by following a low-calorie, low-fat diet. Without question, weight loss means a low-calorie diet. Almost certainly, following a diet of any sort is also a key to success. In fact, participants who maintained a consistent diet during the week and year after year were much more likely to maintain their weight than those who varied their approach.

Other keys include:

Eating breakfast every day, followed by 78 percent of registry members.

High levels of physical activity. Fully 94 percent report that they get more exercise now than they did before they lost weight, and 90 percent report that on the average they exercise an hour a day. Walking is the most common activity, reported by 78 percent of the participants.

Regular weighing. More than 44 percent report that they weigh themselves at least once a day.

I know from my own experience that when my scales broke in February just before I went on a long trip that not weighing myself regularly was disastrous for my weight. In a three-month period I gained 12 pounds and am now fighting to take them off.

The really good news is that it gets easier. People who successfully maintained their weight loss for two to five years had a much greater chance of long-term success.

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.

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Posted in: Diabetes Diet, Exercise For Diabetes

Education Helps in A1C and Weight Control

May 28th, 2010 · No Comments

Your best help in reducing your A1C and your weight could be to work with a Certified Diabetes Educator and a nutritionist. That’s the implication of a study that Issac Sachmechi, M.D., presented at the annual meeting and clinical congress of the American Association of Clinical Endocrinologists in Boston today.

Health Central sent me to the meeting, where I interviewed Dr. Sachmechi this morning. He is clinical associate professor of medicine at Mount Sinai School of Medicine in New York City and Queens Hospital Center in Jamaica, New York.
Dr. Sachmechi presented his poster and abstract, “Impact of Diabetes Education on HbA1C and Weight Reduction at the meeting.” He told me that he designed the study and involved the chief resident and one of his colleagues. Certified Diabetes Educators and nutritionists provided the diabetes education.

Dr. Sachmechi Supports Diabetes Education

Don’t people with diabetes generally get diabetes education? “No,” Dr. Sachmechi replied. “In many areas of the country people with diabetes don’t get nutritional advice or see CDEs. The CDEs show them how to do home glucose monitoring, how to prevent hypoglycemia, the importance of exercise, and other things that are needed for the care of diabetes.”

But doesn’t it cost a lot of money? “I don’t think so,” Dr. Sachmechi replied. “Certainly, a session with a CDE costs less than a session with a physician!”

The study group of 150 people included people with type 2 diabetes who their primary care physician referred to two CDEs and a dietitian. A control group of 150 people with type 2 diabetes didn’t get to see either a CDE or a dietitian.

The researchers compared the A1C and weight of the study participants before and then six months after the study. A1c went down 1.02 percent in the study group but only 0.59 percent in the control group. The average weight went down 2 pounds in the study group but only 0.71 pounds in the control group.

“This is one of the few studies demonstrating a measurable improvement in diabetes control and weight loss solely due to diabetes education and diet counseling in a municipal hospital with limited resources,” Dr.Sachmechi concluded. Dr. Sachmechi’s study worked with people with diabetes who are largely uninsured and generally have poor health literacy. My conclusion is if diabetes education works there, it can work for you too.

Dr. Sachmechi tells me that he is now working on the impact of support groups on the impact of A1c and other measures of diabetes control. Do support groups help us? That’s what he hopes to find out, and I will let you know here the results of that study.

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.

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Posted in: Psychosocial

Losing Weight with a Hydrogel

May 28th, 2010 · 7 Comments

Today, after 15 years of work, a Boston-based company focused on obesity and diabetes came out of stealth mode. Gelesis Inc. unveiled something that promises to make losing weight a lot easier.

Nothing on the immediate horizon could be more important for most of us who have diabetes. More than 85 percent of us are overweight or obese, according to a survey by the U.S. Centers for Disease Control and Prevention.

While I lost a lot of weight by using the first GLP-1 mimetic, Byetta, and then more by following a very low-carb diet, it wasn’t easy. That personal experience is in part what makes me so excited about the product that Gelesis presented to the public for the first time today.

The company made its presentation at a media briefing that I was privileged to attend. Health Central sent me to Boston this week to attend the 19th annual meeting and clinical congress of the American Association of Clinical Endocrinologists. About 1,700 doctors from all over the world are here for the association’s largest meeting ever.

I arrived in Boston yesterday evening, and for me the meeting started with the media briefing this morning. It started with a bang as two doctors presented the results of their efforts to date. After the briefing, I cornered four other experts involved with the development of their product.

Dr. Hassan Heshmati, the chief medical officer for Gelesis, kicked off the presentation. He announced that they have developed the first superabsorbent hydrogel composed entirely of food components. They call it Attiva.

It swells up after people swallow it, making people feel full. This feeling of satiety lasts even after it goes through the stomach into the intestines. Then it safely degrades in the colon and releases the liquids that it absorbs, one of Attiva’s important safety features.

They designed Attiva to have the same physical properties as masticated food. The most common side effect was nausea. But only about 7 percent of the people in their clinical trial experienced it, Dr. Heshmati said.

After Dr. Heshmati’s introduction of Attiva, Eric Elenko, Ph.D., showed us what Attiva can do. Dr. Elenko is a partner in Puretech Ventures, which co-founded Gelesis.

Eric Elenko Shows How Absorbent Attiva Really Is

To measure Attiva’s effect on satiety, doctors at the Gemelli Hospital in Rome, Italy, gave it to 95 people. While some of them had a normal weight, others were overweight or obese, and they had an average body mass index of 31. [Read more →]

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Posted in: Diabetes Medication

Eating Too Fast

April 30th, 2010 · 4 Comments

Eating fast probably comes naturally to all of us. Hiking a long trail on my vacation in New Zealand a few days ago, I ate as quickly as I could when I stopped, because I wanted to get to the hut before dark.

I ate for the energy that I needed to finish the hike, not for pleasure. For once, I wasn’t concerned about the taste of the food or eating too much of it too fast.

This must have been the way my ancestors and yours ate back in the days when they went out on the hunt or to gather roots and berries. This comes naturally to human beings.

But nowadays we have much more food much more readily available. Normally we don’t have to be concerned about getting enough energy to get to our destination. We have the pick of the most tasty food from around the world. We eat for pleasure much more than for sheer energy.

With a different goal we need a different eating strategy. Specifically, we need to slow down so we won’t overeat. As a bonus, slowing the speed with which we consume our meals giaves us more time to savor them.

Eating slowly has been one of the hardest eating lessons that I have had to learn.  Not until I admitted to a friend that I always eat too fast have I been able to control my eating speed. My acknowledgement to another person was the key to controlling my behavior.

We have to fully accept the truth of our existing state before we can expect to progress or to heal.  Recognizing and admitting our own problem is the necessary first step towards change. This is perhaps because the light of awareness or acceptance or humility is in itself a healing.  If we are forever in denial about where we are stuck, we will continue to overlook the keys that are out there that can set us free.

Once I fully accepted that I ate too fast, I adopted some specific strategies. I had always told myself that I ate fast just because I didn’t want my hot food to get cold. So I started with food that we normally eat at room temperature, like a salad.

Then I consciously told myself to put down the fork or spoon between bites. Now I completely chew what was in my mouth before picking it up again.

While chewing, I don’t do anything else except concentrate on the wonderful food that I am eating. Now, I really taste my food.

Eating more slowly means for me that I don’t eat as much as I did before. This is because of the fact that was long well known to me that our bodies and brains need some time, like about a quarter of an hour, to register that we are full.

The great food that we get now can be so much better and so much easier to obtain then what our hunter-gatherer ancestors were able to eat. We owe it to ourselves to savor it.

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.

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Sources of Omega-3

April 20th, 2010 · 6 Comments

The best way for us to boost the amount of omega-3 fats in our diet might be to come to New Zealand. This country must have the largest offering of fish in the world.

This month I am vacationing on the country’s South Island and have been feasting on all sorts of fish. I know that many people don’t love fish as much as I do. But even those who aren’t particularly found of them will certainly find some varieties and different preparations to suit their taste buds.

Those of us who have diabetes really need the benefits to our heart health that regularly eating fish provide. Everyone’s hearts are healthier when we consume high levels of the long-chain omega-3 fats that cold-water fish in particuar have.

Of course, coming to New Zealand isn’t the only way to increase our omega-3 consumption. In fact, eating fish isn’t the only way either. For starters, we don’t actually have to limit ourself to cold-water fish, even though these fish have the most omega-3.

Take a quick look through the KIM-2 database, which I have written about earlier in this series of articles on achieving a good balance of omega-3 and omega-6 fats. These two types of polyunsaturated fats compete in our bodies. High levels of omega-3 fats are anti-inflammatory, while high levels of omega-6 fats are pro-inflammatory.

The KIM-2 database does show that the cold-water fish like salmon and sardines have extraordinarily good ratios of omega-3 to omega-6 fats. But it also doesn’t show ANY fish with more omega-6 than omega-3. That’s one reason why I am eating fish with Maori names that I have never heard of and which don’t appear in the KIM-2 database.

And it’s not just fish where we can get our long-chain omega-3s. The world also has a great variety of seafood that is high in omega-3.

Beyond fish and seafood we have fish oil or krill oil to supplement our omega-3 level. These supplements come in either liquid or capsule form. Some people who don’t like the taste of the liquid do very well with capsules.

But what about the dilemma that vegetarians and vegans face? Even this is not a problem. Think for a moment where fish and seafood find the ultimate source of their omega-3 fats. That source is the lowest on the food chain, a plant called algae.

We can skip the intermediate links in the chain and go ourselves directly to the source. Several companies now offer long-chain omega-3 fats in vegan algae.

Those capsules aren’t cheap. On the other hand coming to New Zealand to eat fish isn’t either.

P.S: I originally wrote this article for HealthCentral.com on March 11, 2010. I am now back in the U.S. after vacationing in New Zealand. You can read about the trip here: http://www.mendosa.com/fitnessblog/?cat=17

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.

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