Number 24; October 31, 2001

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contributions are:

on October 19, 2001
• Dominating Diabetes
  The DiabetesWatch.com Web site has started to publish a series of my interviews with people who succeed in keeping their HbA1c level at 6.0 or below.

  This test measures the percentage of your red blood cells that have glucose bound to them. Since these cells live for just two to three months, this test is an excellent measure of diabetes control over the past 90 days. When tested at standardized labs, as most are nowadays, 4-6% is the normal range.

  The American Diabetes Association has a goal for patients' levels to be below 7%, but doesn't encourage doctors to take action until the level goes above 8%. The recent ACE Consensus Conference on Guidelines for Glycemic Control reported here recently lowered the target to 6.5%.

  A recent prospective study by Kay-Tee Khaw et. al in the January 6, 2001 issue of the British Medical Journal of 4,662 men in England showed the lowest death rates among those with an HbA1c level below 5%. An increase of 1% was associated with a 28% increase in risk of death—independent of age, blood pressure, serum cholesterol, body mass index, and cigarette smoking habit. That's how important it is to control your A1c level.

  Robert Hocking is one person with diabetes who is successful in keeping his level very low. If you already had subscribed to DiabetesWatch.com, you can read my article about him by going to the message area and reading the one with the subject "Dominating Diabetes: People Who Are Finding the Way—Robert Hocking." Otherwise, you can read it on my site at http://www.mendosa.com/hocking.htm.

Updates include:

• Not Counting Carbs (Glycerin)
  Is glycerin a carbohydrate? No, according to the manufacturers of several nutrition bars. Yes, according to the Food and Drug Administration.

  Who would you believe?

  Glycerin, sometimes spelled glycerine, is a commercial product whose principal component is glycerol. Glycerin is a trihydric alcohol that is derived from animal fats and plants emollients. The terms glycerin, glycerine, and glycerol are often used interchangeably.

  "Glycerol and glycerin refer to the same substance," according to James E. Hoadley of FDA's Office of Food Labeling, quoted in the Winter/Spring 1999 Newsletter of the Institute of Food Technologists. "Carbohydrates are polyhydroxy aldehydes or ketones conforming to the general formula (CH20)n and their derivatives... ...three carbon sugars include glyceraldehyde (an aldehyde) and dihydroxyacetone (a ketone). The hydrogenated derivative of both these is glycerin [CH20)3H]. The chemical definition of carbohydrate is clearly inclusive of all three compounds...There is no rational basis to consider glycerin as anything but a carbohydrate," he says.

  But several companies that make nutrition bars haven't been counting their glycerin. One half of the 30 nutrition bars that ConsumerLab.com just tested exceeded their claimed levels of carbohydrates, often by large amounts. This organization, based in White Plains, New York, provides independent test results and information to help consumers and healthcare professionals evaluate health, wellness, and nutrition products.

  "One product, which described itself as a low carbohydrate diet bar, claimed only 2 grams of carbohydrates, but was found to actually contain 22 grams," the ConsumerLab site says. "A clue as to why this discrepancy existed was a statement written in small type on the product's label indicating that it contained glycerin but that the manufacturer was not counting glycerin as a carbohydrate."

  This is apparently CarbSolutions, a protein bar made by Richardson Labs, which says it is "for Low Carb Diets" and has "only 2 carbs," according to a review of the ConsumerLab site in the October 30, 2001, issue of The New York Times. Richardson Labs is a division of Rexall Sundown, which in turn is a unit of Koninklijke (Royal) Numico N.V. of the Netherlands. On April 26, 2001, the FDA sent a warning letter to the president of Richardson Labs saying the bar was misbranded, adulterated, and in violation of the federal Food, Drug, and Cosmetic Act.

  "This product is misbranded because the label bears nutrient content claims that are not authorized by regulation or the Act," the FDA's warning letter says. "The claims include 'For Low Carb Diets Only 2 Carbs!' (Section 403(r)( 1)(A)). The product is further misbranded because the label bears the statement 'Glycerine, polydextrose, xylitol, maltitol . . .have been omitted from the “Total Carbohydrate” count...' Glycerine, polydextrose, xylitol and maltitol are carbohydrates and must be included in the value declared for 'Total Carbohydrates' in nutrition labeling (Sections 403(a), 403(q) and 21 CFR 101.9(c)(6))."

  The FDA has also sent warning letters to several other manufacturers. On January 25, 2001, it told the president of Premier Nutrition that its Premier Eight Ultra Low Car Sports Bar must include the glycerol that it contains in its total carbohydrates. On November 30, 2000, it sent essentially the same letter to the president and CEO of Optimum Nutrition about its Protein Diet Bar. Nevertheless, the Optimum Nutrition Web site still advertises a Protein Diet Bar that includes the statement, "The product contains Glycerol. Glycerol is not a carbohydrate but has a colric [sic] value of 4.32 calories per gram."

  But what is the glycemic index of glycerin? I'm not sure, so I haven't added it to my Glycemic Index Lists. But apparently the reason that glycerin is not listed as a carbohydrate by these manufacturers is that glycerin does not effect blood glucose or insulin levels, they say.

  The dispute over glycerin is bad enough. But if the FDA bans the term "low carb," it's going to be more difficult for us to find these foods in the supermarket.

  Special Notice:

• Cough CPR?
  I post this item reluctantly and only to help stop the spread of dangerous health information. Unfortunately, one of the endocrinologists I admire most, Dr. Joe Prendergast, passed this story along as being true in his E-News mailing list of October 17. Since many of you subscribe to that list I hope to do what I can to counteract his report. I asked him to issue a retraction, and while he admitted his mistake to me, he inexplicably failed to issue a general correction.

  He called it "cough CPR...how to survive a heart attack when you are alone," citing Health Cares, Rochester General Hospital via Chapter 240s newsletter AND THE BEAT GOES ON ... (reprint from The Mended Hearts, Inc. publication, Heart Response)." If you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw and begin to feel faint, you have only about 10 seconds left before losing consciousness, he writes. "These victims can help themselves by coughing repeatedly and very vigorously. A deep breath should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest. A breath and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again."

  That is false and dangerous!

  I thought it would be such an important tip for readers of this newsletter—because people with diabetes are much more likely to suffer heart attacks than most people—that I searched the Internet for the source of Dr. Joe's report. I wanted to find the original report on the Rochester General Hospital site.

  In fact, what I found was the hospital's "Important Notice Regarding the article 'How to Survive a Heart Attack When Alone'" at http://www.viahealth.org/rgh/heartattack.htm. It says in part, "We can find no record that an article even resembling this was produced by Rochester General Hospital within the last 20 years. Furthermore, the medical information listed in the article can not be verified by current medical literature and is in no way condoned by this hospital's medical staff. Also, both The Mended Hearts, Inc., a support organization for heart patients, and the American Heart Association have said that this information should not be forwarded or used by anyone."

  The Mended Hearts site has issued an apology of sorts on-line at http://www.mendedhearts.org/heartattack_article.html. It says in part, "'How to Survive a Heart Attack When Alone' was initially published in a local chapter newsletter, without first verifying a medical source. The American Heart Association does not endorse the coughing procedure, and does not teach this as part of the core curriculum in any course...it is not a recommended procedure for the general public."

  The Urban Legends site says that this one has been circulating on the Internet since June 1999. The conclusion: "cough CPR could kill." See http://www.snopes2.com/toxins/coughcpr.htm.

  Announcements:

  1. Looking for Beta Testers
     Here is an opportunity to test a new blood glucose tracking program on the Web and perhaps get a new data cable at no cost. Joanna Wiebe, the CEO of healthCache, asked me to pass on this message to you. She writes:

     I am writing to ask for your help in locating beta testers for Version 1.0 of Diatrax (TM), a web-based self-management system that enables diabetics to download readings from their glucose monitors and send them over the Internet to a secure web server, giving them and their personal caregivers 24x7 access to annotated data and trend charts. The system has been developed by my firm, healthCache.com.

     This round of testing will only take a few minutes every day or so, over a period of a few weeks, to download results, view trends, and report bugs in the system.

     Testers can live anywhere, and should already be using a blood glucose meter to check results regularly. To be involved in the program, testers will need to have:

     • One of the following brands of meters:
       1. LifeScan OneTouch FastTake
       2. LifeScan OneTouch Basic
       3. LifeScan OneTouch Ultra
       4. Bayer Glucometer Elite XL
       5. Bayer Glucometer DEX

     • The cable that connects the meter to your PC (we can help obtain if needed)

     • A PC with a Windows 95 or better operating system (sorry, no Macs supported on this round)

     Participating in the beta test may help individuals better manage their blood glucose levels.

     The design of our program draws on our expertise from consulting on applications development with healthcare management information systems firms such as IDX Systems Corporation, Allscripts, PatientKeeper, 3M Health Care, and with provider organizations, through my other firm, OneMind.

     We have developed the Diatrax program to integrate with clinical information systems being put in place at healthcare facilities now, to serve as part of diabetes education centre programs. This way, people who use the program will be able to share annotated blood glucose and ketone results with their personal caregivers. Caregivers will be able to customize blood glucose target ranges, and receive automated alerts when individuals are outside their range or demonstrate other problems. We are in the planning stages of clinical trials at the moment, with the local university medical center. We also are interviewing for a US site for trials.

     For a 2-minute demo of the program, you can visit http://www.healthcache.com/demo/diatrax/
     username: diatrax
     password: diabetes
     

     For more detailed information, get in touch with me, at joanna@healthcache.com, or 519.652.5107; or the director of our testing program, Dan Fraser, at dan@healthcache.com or 519.858.5125.

  2. Insulin Resistance Webcast
     HealthTalk Interactive asked me to let you know about an upcoming webcast with actress Jane Seymour and three top diabetes specialists discussing an important type 2 diabetes factor: insulin resistance. The webcast, "Type 2 Diabetes and Insulin Resistance: What You Need to Know," will broadcast live Thursday, Nov. 1, at 8:30 p.m. Eastern (5:30 p.m. Pacific). Topics include:
     • What is insulin resistance in type 2 diabetes?
       
     • How do you prevent it?
       
     • What medications can help?

     For more information or to submit your questions, go to http://www.healthtalk.com/den/110101/index.html. Also, read more about insulin resistance and Syndrome X now from journalist David Mendosa at http://www.healthtalk.com/den/110101/index.html.

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  This newsletter is free and will never include advertising. Nor will I ever sell, rent, or trade your e-mail address to anyone without your permission.

  Archives:

  I send out Diabetes Update about once every two weeks. Previous issues are online:

  • Diabetes Update Number 1 of December 10, 2000

  • Diabetes Update Number 2 of December 18, 2000

  • Diabetes Update Number 3 of January 3, 2001

  • Diabetes Update Number 4 of January 17, 2001

  • Diabetes Update Number 5 of January 31, 2001

  • Diabetes Update Number 6 of February 15, 2001

  • Diabetes Update Number 7 of March 1, 2001

  • Diabetes Update Number 8 of March 15, 2001

  • Diabetes Update Number 9 of March 30, 2001

  • Diabetes Update Number 10 of April 2, 2001

  • Diabetes Update Number 11 of April 16, 2001

  • Diabetes Update Number 12 of May 2, 2001

  • Diabetes Update Number 13 of May 15, 2001

  • Diabetes Update Number 14 of May 31, 2001

  • Diabetes Update Number 15 of June 21, 2001

  • Diabetes Update Number 16 of July 2, 2001

  • Diabetes Update Number 17 of July 15, 2001

  • Diabetes Update Number 18 of August 2, 2001

  • Diabetes Update Number 19 of August 15, 2001

  • Diabetes Update Number 20 of August 30, 2001

  • Diabetes Update Number 21 of September 14, 2001

  • Diabetes Update Number 22 of October 1, 2001

  • Diabetes Update Number 23 of October 15, 2001

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  David Mendosa:
  A Writer on the Web: www.mendosa.com
  E-mail: mendosa@mendosa.com
  
  Office: 993 E. Moorhead Circle Suite 2F, Boulder, CO 80305