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

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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Posted in: Diabetes Diet

Vitamin E for Your Fatty Liver

June 16th, 2010 · 3 Comments

With all the ways that we have now to treat fatty liver disease I don’t understand why any of us still have it. Yet most people with diabetes suffer from this potentially dangerous condition.

Now we have yet another tool in our arsenal against fatty liver disease. It’s a strange one. Not strange as in being unfamiliar, but rather strange as being surprising.

The new tool that may reverse fatty liver disease is vitamin E.

Years ago I had fatty liver disease myself. My late wife had it too. I was able to reverse it, but for her it eventually progressed to cirrhosis of the liver, which killed her three years ago.

Sadly, we didn’t know then how serious fatty liver disease could be and about all the ways to avoid it. I’ve written here how milk thistle and metformin can help. So too can eating a diet high in omega-3 fats. Exercise certainly works, as I know from my own experience. Even a little exercise helps.

The latest word on potential treatments for fatty liver disease saw the light of day a week ago in the advance online edition of The New England Journal of Medicine. Many people consider this the world’s leading medical journal. As of today only the abstract is free online, although I was able to download the full-text yesterday. The NEJM plans to publish the study in the printed journal tomorrow.

Researchers found that vitamin E improved the livers of people who had nonalcoholic steatohepatitis (NASH), which lay people like us know as fatty liver disease. In the study 247 adults with advanced fatty liver disease were randomly assigned to take vitamin E or a placebo (dummy pills) for nearly two years. They found that 43 percent of those treated with vitamin E showed significant improvement in their liver, while only 19 percent of those who received a placebo got better.

The dose was 800 IU of the natural form of vitamin E. The specific form was “RRR-α-tocopherol (formerly known as d-α-tocopherol) vitamin E,” according to the full-text of the research report. [Read more →]


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Posted in: Diabetes Complications

Who the Empowered Health Seekers Are

June 2nd, 2010 · No Comments

The odds are that you haven’t yet fully empowered your search for good health. I know this about you because a couple of months ago HealthCentral surveyed 2,888 of its registered members who have one of eight chronic conditions, including diabetes, and who completed the study. And in this respect at least people with diabetes are just like the people with the other seven chronic conditions.

HealthCentral CEO Christopher M. Schroeder and James E. Burroughs, associate professor of commerce at the University of Virginia, presented their findings at the DTC National Conference in Washington, D.C. earlier this month and shared them with me. After asking the people in the survey all sorts of standard psychological assessments, they found that about 30 percent of us take an active role in our health care plan. If you are in this group, one of your characteristics is that you are energized and engaged when you need to learn new tasks or master new subjects — you are what the survey calls a person with a need for cognition. If you are an empowered health seeker, the other characteristic you have is self-confidence — you have, in the formal terminology of the survey, high self-efficacy.

You can click to view the study, “Understanding What Motivates the Empowered Patient,” here. Mr. Schroeder and Professor Burroughs prepared it in association with Ted Smith, Ph.D., HealthCentral’s executive vice president for research.

My posts here at HealthCentral and your many comments are just one small corner of this huge health resource. HealthCentral is a collection of condition and wellness websites providing clinical information, tools, and mobile applications. Its sites provide a platform for more than 3,000 bloggers, 200 expert patients, and more than 12 million monthly visitors sharing real-life experiences about specific conditions. [Read more →]


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Posted in: Psychosocial

The Trouble with Naps

May 28th, 2010 · No Comments

My most recent post here reviewed a new study indicating that resting after meals is hard on the pancreas, could lead to diabetes, and could make existing diabetes worse. This is an interesting hypothesis and one that you can check out yourself.

But one of my correspondents suggests that the results might be related to the fact that overweight people who overeat at a meal are more likely to lie down. “Edgy thin people probably jog instead,” she says.

That’s a good suggestion, and I’m not sure that the authors of the new study controlled for weight. But now comes a closely related study that indirectly offers support for the hypothesis that lying down after we eat isn’t a good idea.

People in China in the 50s and over who regularly take naps after a meal increase their risk of diabetes by 28 to 36 percent, according to a study just published in Sleep, the official publication of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The authors of the study are associated with universities and hospitals in China and the U.K.

Correlation, of course, doesn’t prove causality. It is suggestive and may be a good suggestion to follow, because the only downside is probably being a bit tired, which in fact could lead to a better night’s sleep. Anyway, a little jog after a meal will do a lot more to reduce blood glucose than lying down ever will.

The authors of the study that I review last week are in Kazakhstan and Ukraine, while the new study is China-based. Some of the most interesting research on diabetes now seems to be coming from countries that hadn’t been at the forefront of diabetes research. This Internet age seems to be leveling the playing field.

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


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Posted in: Diabetes Diet

The Rest Trap

May 6th, 2010 · 3 Comments

Learning that you have diabetes can be overwhelming. All at once your life has changed.

In fact that is really good. Now you can be healthier than you ever were — if you get more active, lose weight, take your medicine, and cut your stress.

Those are the essentials. The rest are optional tweaks and theory.

Like this one today. The journal Medical Hypotheses deals only in theory, as its title implies.

This journal has an “article in press” that it will publish soon. It’s not online yet.

One of the authors, Alexander Dynyak, M.D., lives and works in Almaty, Kazakhstan. If you don’t know where that is, join the crowd. But Kazakhstan is in Eurasia and is the ninth largest country in the world in land area. It is also the world’s largest landlocked country.

Another author, Andrey Dynyak, is currently pursuing his M.D. degree in Ukraine. Andrey also publishes their research findings on and sent me a copy of the Medical Hypotheses study.

The study has the usual technical title: “Diabetes mellitus: Hypoxia of the islets of Langerhans resulting from the systematic rest prone on the back after a meal?” In plain English, that means that the islet cells in our pancreas might not get enough oxygen and cause diabetes if we lie down in the two hours after we eat.

Who would have thought of that! I certainly never did. But the islets are especially susceptible to oxygen deficiency. This study investigated whether the pressure on the pancreas of food in the stomach after a meal might be related to diabetes. To test their hypothesis, the authors surveyed people with diabetes compared with a control group. The people with diabetes numbered 91 and those in the control group numbered 20. Every one of the people with diabetes had been resting after eating at least three or four times each week. But only 2 of those in the control group, or 10 percent, did.

Then the researchers attempted to get the people with diabetes to change their resting behavior. The researchers recommended that the people with diabetes not lie down within two hours of a meal. That’s because this is the average time it takes for food to pass through our stomachs.

But only 20 percent of the people with diabetes were consistent in not resting during those two hours. Of those, however, the researchers found general improvements, an increased capacity for work, better blood glucose control, and less need for diabetes medication.

The article indicates that resting during the two hours after a meal might lead to diabetes. I wondered if this might, however, imply that people who already have diabetes should also avoid resting then.

“Yes, that is basically what it implies,” Andrey Dynyak replied. “In general, a passive rest within one to two hours after a meal in a recumbent position should be avoided. However, being more specific for diabetes, a passive rest after a meal prone on the back or reclined is what should be avoided.

“Unfortunately, it is becoming such a common and usual behavior that by many is regarded as normal. Fortunately, it is easy to test, and positive results can be seen shortly after changing this specific behavior.”

I think that these far-off researchers might be onto something. It’s definitely worth testing if you have been lying down during the two hours that it takes for your stomach to digest your food. It won’t make your life worse, and could well make it a lot better.

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


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Posted in: Diabetes Diet

Omega-3: Tested

March 22nd, 2010 · No Comments

No wonder that I’m so healthy and happy lately! I just got back the results of my omega-3 test, and they were quite satisfactory.

In December I wrote in “Testing Omega 3” about the HS-Omega-3 Index that uses a standardized methodology to measure the percentage of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) in our red blood cells. It also measures the ratio of omega 3 to omega 6. In that article I gave a brief review of some of the reasons why I think that omega-3 is crucial to our diet — and deficient in the diet of most people who have diabetes.

On January 27 I ordered my test from GeneSmart, and I got my results in today’s mail.

A “desirable” level on the HS-Omega-3 Index is over 8 percent. My level came back as 12.6 percent.

A desirable ratio of omega-6 to omega-3 is under 5 to 1. My ratio is 2.1 to 1.

The only advice that GeneSmart was able to offer me was to maintain my intake of the omega-3 fatty acids, EPA and DHA. I will.

But in the packet they did include a nice set of tables about fish and their omega-3 content. Here is a copy:

Click to enlarge

Click on the image above to enlarge

I get my omega-3 levels from eating fresh or frozen (not farmed) cold-water fish about five times a week. I prefer king salmon and Chilean sea bass — technically Patagonian toothfish — which tastes a whole lot better than it sounds. I usually add canned salmon, sardines, or albacore tuna — packed in water, not oil — to my salad at lunch. Sometimes I add a small can of anchovies, which I have been able to find only packed in oil, which I drain off. I also supplement my omega-3 from krill oil, which I wrote about here exactly two years ago at “Krill Oil.”

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Posted in: Diabetes Testing

Broken Link Between Saturated Fat and Heart Health

March 3rd, 2010 · No Comments

You won’t read it in the mainstream press. But the most significant study ever of the effect of saturated fat on our hearts appeared Wednesday.

In fact, I couldn’t find any mainstream articles about it today. Not one of the four sources that I rely on heavily for leads to new studies has carried a word about this one. In fact, another source, Google News, instead turned up articles headlined like “Reduce your intake of saturated fats or suffer a heart condition,” “Ban butter to save our hearts, says doctor,” and “Not all fats are equal – saturated fat is the real baddie.”


The new study should drive the last nail in the coffin of the supposed link between eating saturated fat and getting heart disease. Since heart disease is the most common as well as the most serious complication of diabetes, nothing could be more relevant to us.

Ever since 1953, when a physiologist named Ancel Keys, Ph.D., compared fat intake and deaths from heart disease in six countries, including the U.S., the American medical establishment has clung to an unproven belief that saturated fat was evil. But even by 1957 we should have known better, after Jacob Yerushalmy, Ph.D., established that Keys was guilty of the sin of cherry picking. While Dr. Keys used data from six country, he actually had statistics from 22 countries available. And when scientists analyzed those statistics, the apparent link between eating fat and heart disease disappeared. [Read more →]


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Posted in: Diabetes Diet

Fit and Not Fat

February 17th, 2010 · No Comments

We can’t be truly healthy if we are fat. That’s the bottom line of study reported online December 28 before it’s printed in Circulation, the journal of the American Heart Association.

Previous studies seemed to show that something called “healthy obesity” might exist. They indicated that obese people who didn’t have the metabolic syndrome — a pre-diabetic condition — weren’t at increased risk of heart disease.

But the new research indicates that those studies didn’t follow those people long enough. Only after about 15 years did their heart problems show up in an exceptionally long-term study of 1,758 Swedish men starting when they were 50. The study, “Impact of Body Mass Index and the Metabolic Syndrome on the Risk of Cardiovascular Disease and Death in Middle-Aged Men,” followed them for 30 years. [Read more →]


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Posted in: Diabetes Diet

Diabetes Rising Book Review

February 17th, 2010 · 3 Comments

Diabetes Rising is a strange name for the most readable book ever written about diabetes. But diabetes is a strange disease, as Dan Hurley shows in the book that Kaplan published yesterday.

The publisher sent me galley proofs of the new book several months ago. I’ve been waiting to review it until it became generally available.

Of the hundreds of books on diabetes that publishers and authors send me every year, I don’t usually review any of them. I’ll keep one or two of them in my bookshelf for reference, but I give away the vast majority of them, usually to my local library.

Diabetes Rising is the exception because its author has exceptional qualifications to write about it. Dan Hurley is a medical journalist who regularly contributes to the science section of The New York Times as well as to many other major publications. He earned his other relevant qualification 34 years ago at the age of 18. That’s when he got type 1 diabetes. [Read more →]


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Posted in: Book Reviews

Bad Science

December 11th, 2009 · 2 Comments

Whenever I become conscious of a word or concept new to me, I began to notice it everywhere. All of you probably have had this experience.

It is so common that we even have a nice big word for it thanks to the great Swiss psychiatrist Carl Jung: Synchronicity.

A couple of weeks ago a member of the diabetes support group that meets in my apartment loaned me a book called Bad Science. A practicing physician in the U.K.’s National Health Service and newspaper medical columnist named Ben Goldacre wrote it and Fourth Estate published it last year in the U.K.

The book is a detailed indictment of the British press for its woeful ignorance of some basic scientific concepts. Like one of my favorites, “regression to the mean.” This sounds complicated. But it is simply the fact that everything, including our health, has a natural cycle. Since we tend to see a doctor when we feel the worst, we think that his or her treatment helped us, while we would soon feel better no matter what the treatment was. [Read more →]


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Posted in: Diabetes Basics

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