Number 78; January 1, 2005

Fireweed at Trappers Lake, Colorado

This newsletter keeps you up-to-date with new articles, Web pages, and books that I have written about diabetes.

• I list and link most of these on my at Diabetes Directory and in the site’s menu.

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

My recent contributions are:

• The Mangosteen Myth
  Have you ever heard of the marvels of mangosteen? If not, you can join the club. I never heard about it until last month. Among a multitude of other benefits, it is supposed to reduce blood glucose. So I investigated mangosteen. This article originally appeared December 25, 2004, on Mendosa.com as The Mangosteen Myth.

• The Medicare Mystery
  While the benefits of mangosteen may be purely a myth, how to take advantage of Medicare is for most of us a mystery. I do my best to unravel this riddle in my article that originally appeared in the December 2004 issue of Diabetes Health, which is now also online as The Medicare Mystery.

Update:

• Drug Interactions
  Last month’s issue of Diabetes Update linked four websites that provide drug interactions. I asked readers for their opinions on these sites. Lynne Whaley carefully checked out and compared them and authorized me to reproduce her email here:
  I went to the four drug interaction check websites you suggested to do a down and dirty quick check of my meds, and thought I would give you my gut reaction to what I discovered.

  Drugdigest.com was the least impressive of the four sites. I know a number of people who quickly scan a screen for what they are interested in, and may miss things, like instructions. This site would present a problem for the impatient scanner (like my husband!). Once instructions are read, the process of creating the list is quite straightforward and quick. The results were dismal — I take 5 prescription meds, and a number of over the counter supplements, and they only came up with one possible interaction (Lipitor/grapefruit) which is always noted on the prescription bottle.

  Next in line would be the Discovery site. I found their search instructions to be most succinct, but their method of creating the list the most tedious. They returned 2 drug/food results, and 4 drug/drug results for what appears to be 6 total results. There was one “Moderate drug/food interaction” for Lipitor, but no further information, not even the food to watch out for. (I “ass-u-me” it is grapefruit.) There was one “Moderate drug/drug interaction” for ramipril/celecoxib, but again, no further information (found it elsewhere). In essence, I got back only 1 drug/food and 3 drug/drug results. Their results did not always include the physical effects of adverse interactions, or suggestions about contacting one’s physician. The information was not written in layman’s terms, which some might find off-putting. (Their information was fleshed out by Drugstore.com and Drugs.com.)

  Drugstore.com comes next. Like Drugs.com they returned 5 drug interactions; 3 were drug/food and 2 were drug/drug. (All 5 of Drug.com’s results were drug/drug.) Two of the drug/food interactions are unlikely to occur since my prescription bottles always contain warnings about grapefruit (Lipitor) and alcohol (Glucophage). Unlike all three other sites, they listed the definition of “major,” “moderate,” and “minor” interactions at the end of the list, which I found helpful. While it is perhaps the most “readable” of the sites, 2 out of 5 possible drug/drug interactions just doesn’t get my vote.

  Drugs.com gets my vote for best overall for the simple reason they returned the most (5 drug/drug) results. None of the drug/drug interactions are noted on my prescription bottles. My MD and pharmacist have never mentioned any of the possible problems of the combinations that I am taking, nor the cumulative effects that might be experienced, all of which were nicely laid out at Drugs.com.

  I would suggest that anyone searching for information go to all four sites and compare notes; be a proactive consumer! What one site omits, another includes. The terminology of the sites is also different. Information which can be confusing at one site might be more clearly stated at another. The “major,” “moderate,” and “minor” ratings also varied from site to site. I tend to “get my shorts in a knot” if things look bad — seeing “major” on one site and “moderate” on another helps to lessen that “frenzy” down to “be aware and concerned.”

  Another correspondent — an endocrinologist — reports that he uses what is apparently a great commercial site, the Thomson Micromedex DRUG-REAX System. Apparently his company provides this service for him, and he doesn’t know how much it costs. I don’t either, because the company would not tell me or even let me sign up for the generally-offered trial subscription. In fact, the local sales representative was so unwilling to let me write anything about the cost of this site that she said their attorneys would call. They haven’t yet. I guess they have enough business without us.

Book Reviews:

This is the best time of the year for publishers to bring out books on diet and diabetes. During the holidays many of us eat too much. And some of us make New Year’s resolutions to take better care of our bodies.

Maybe that’s why I have more books to review in this issue than ever before. Here are four of them:

The Diet?


• The Diabetes Diet
  

  Right at the point where “Experts Say Low - Carb Craze May Be Over,” the leading advocate of low-carb diets for people with diabetes is coming out with his Diabetes Diet book.

  That may be chutzpah, but the book’s author, Dr. Richard K. Bernstein, has earned it. He personally has followed and prescribed a low-carb diet many years before it became a fad.

  And now that the fad appears to be dying, Dr. Bernstein remains its staunched — and most radical — supporter. Even the very title of his new book, The Diabetes Diet, reflects his audacity.

  His diet must be the most austere of any low-carb regime. Most foods advertising as low-carb fail by his standards.

  He even rejects the glycemic index. It “is at best flawed and misleading,” he maintains. “[T]he glycemic index…is a subjective rather than objective evaluation of the speed of the action of carbohydrate on blood sugar,” is, I believe, the most outrageous statement in this book. If there is any objective and scientific approach to what to eat, it has to be the glycemic index and glycemic load.

  While Dr. Bernstein has staked out his claim by publishing his diet recommendations in a separate book for the first time, the world is marching on. Here’s the key statistic: This September just 4.6 percent of Americans were following what they said was a low-carb diet, according to Melanie Warner’s article, “Is the Low-Carb Boom Over?” in the December 5 issue of The New York Times. The newspaper says this is down from 9 percent in January, according to the NPD Group, a research firm. (Sorry that I had to use a secondary source, but the NPD Group says that they won’t sell me this report for less than $15,000.)

  This doesn’t prove that Dr. Bernstein’s diet doesn’t work. But few of us are so desperate that we will follow it.

  Little, Brown in New York and Boston will publish The Diabetes Diet on January 3. This 291-page hardcover book lists for $24.95. ISBN 0316737844.

  

  The American Edition
  

• The Low GI Diet Revolution
  Published four months ago in Australia and reviewed here at that time, this book by the world’s foremost authorities on the glycemic index, is in my opinion the diabetes diet. It is also a weight-loss diet, the emphasis of this book.

  A low-GI diet is a science-based healthy medium between a low-fat and a low-carb diet. It reduces insulin levels without the harmful potential of these other diets.

  Currently the #1 bestselling diet in Australia, The Low GI Diet Revolution shows you how to make smart carbohydrate choices. Built around a 12-week action plan, this book also includes recipes and a table of foods tested for their glycemic indexes.

  Marlowe & Company in New York will publish The Low GI Diet Revolution January 24. ISBN: 1569244138. This 301-page trade paperback lists for $15.95.

  

  For Your Family
  

• Prediabetes
  It’s too late for you and me and the author of this book. But you can do members of your family a big favor if you give them a copy of Prediabetes: What You Need to Know to Keep Diabetes Away. This is the revised and expanded edition of Stop Diabetes published two years ago and reviewed here at http://www.mendosa.com/diabetes_update_49.htm.

  Just before the publication of Stop Diabetes the U.S. Department of Health and Human Services and the American Diabetes Association began to use the new term “pre-diabetes” to describe the condition in which blood glucose levels are higher than normal but not yet diabetic — also known as impaired glucose tolerance or impaired fasting glucose. Studies show that most people with this condition go on to develop type 2 diabetes within 10 years.

  Prediabetes is a lot better name than impaired glucose tolerance or impaired fasting glucose. It’s also a lot better name than Stop Diabetes (even though the usual style is to hyphenate it as pre-diabetes). As far as I know, this is the only popular book out there at the moment that is specific to pre-diabetes.

  Gretchen’s mantra is “eat less and move more.” It’s a great way to focus all of us with diabetes or pre-diabetes alike on the essentials of control.

  But Gretchen now believes that for people with pre-diabetes just “eating less and moving more may not be enough.” She writes me that “people with prediabetes should be willing to do more than people who might not actually be at risk.”

  Therefore, she added three new tips (numbers 1 through 3 of the 50 great tips in this important book). That’s the same number of tips she had in Stop Diabetes, since she deleted three of the least important.

  Disclosure: Gretchen Becker and I have worked together for years and I consider her a friend. I also consider her one of the very best writers about diabetes (and pre-diabetes). Her The First Year — Type 2 Diabetes is one of the two best books ever written about diabetes.

  Marlowe & Company in New York will publish Prediabetes January 15. ISBN 1569244642. This 200-page trade paperback lists for $14.95.

  

  International Textbook of Diabetes Mellitus
  

• International Textbook of Diabetes Mellitus
  You have to feel sorry for students nowadays. Many of them use wheeled carts rather than daypacks to carry their books because they are so heavy.

  I would guess that few of these books are heavier than the International Textbook of Diabetes Mellitus. The publisher, Wiley, a few days ago kindly sent me a review copy. This book is so big — 1980 large pages — that they had to divide it into two volumes. Together they weigh 15 pounds.

  This book is in fact so big that it took 4 editors-in-charge, 11 section editors, and 222 contributors to write its 116 chapters (or articles). All of the contributors are well-respected academics and doctors. That’s probably why they didn’t ask me to contribute.

  Still, the book mentions mendosa.com at least six times. The article on “Computer-assisted Diabetes Education and Information Technology in Diabetes Care” by Dr. Eldon Lehmann of St. Bartholomew’s Hospital and Imperial College in London, U.K., refers to my Software page. Dr. Lehmann developed an outstanding and free software program, called AIDA, to simulate the effects of changes in insulin and diet on your blood glucose profile. I mirror his interactive educational diabetes/insulin tutorial on my site.

  This is the third edition of this truly International Textbook. Encyclopedic in scope, it is the most complete and wide-ranging work on diabetes, covering all aspects of diabetes in a multidisciplinary approach. Sections covered include epidemiology, diagnosis, pathogenesis, management and complications of diabetes, and public health issues worldwide. It incorporates a vast amount of new data regarding the scientific understanding and clinical management of this disease.

  Besides Dr. Lehmann’s software article, I found the articles on new drugs, insulins, meters, exercise, and screening to be the most interesting, reflecting, of course, my personal interests.

  Aside from the needs of students, this is a reference work, best reviewed in a library. One reason you may not wish to buy it yourself is the price: $510. And that is not a typo. ISBN 0471486558.

  For more information see http://www.wiley.com/legacy/wileychi/itdm/.

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© Copyright 2005 David Mendosa. All Rights Reserved.

David Mendosa
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