It is amazing that people who think we cannot afford to pay for doctors, hospitals, and medication somehow think that we can afford to pay for doctors, hospitals, medication and a government bureaucracy to administer it.
—Thomas Sowell
Eggs Are Linked to Heart Attacks in Diabetics?
The general population doesn’t need to worry about eggs causing strokes or heart attacks according to a new meta-analysis reviewed at Forbes. We still have a question about high egg consumption and heart attacks in diabetics.
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Dietitian Melanie Thomassian on Cooking With Oils and Fats
If you want to heat a fat or oil, it is really important that it can withstand the temperature you will be heating it to, and therefore that it will remain stable while you cook.
I recommend keeping some oils exclusively for cooking, while others should only be used as finishing oils, and for cold dressings.
You will see that I have listed the smoke point and the fatty acid percentages below. This is to help you understand why some options are good for one style of cooking, but perhaps not so much for another.
Remember, a higher smoke point is important, if you are cooking to a high temperature. But you also need to consider the fatty acid composition. A higher saturated fat percentage equals a more stable fat or oil, as we’ve already learned above 🙂
Read the rest. Fortunately, she spared us the bits about omega-6/omega-3 fatty acid ratio.
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New Type 2 Diabetes Treatment Guidelines
…from the American Association of Clinical Endocrinologists. I haven’t digested them yet, but didn’t want you to have to wait for that. Keep in mind they’re written for healthcare providers, so they may be difficult to understand.
Overweight and obesity are addressed without mention of specific diet recommendations.
You’ll find a nice table summarizing diabetes drugs and their effects on weight and various organ systems. It even includes the brand new SGLT2 inhibitor.
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What Are Nightshades, and Should I Avoid Them?
Rosemary Chicken (garnished with pico de gallo) and Rosemary Potatoes
The nightshade family includes tomatoes, peppers, potatoes (not sweet potatoes or yams), eggplant, goji berries, and even tobacco. Anecdotal reports indicate that consumption of these either cause or aggravate certain chronic medical conditions, such as arthritis, chronic fatigue, or irritable bowel syndrome.
Georgia Ede, M.D., has an article on medical effects of nightshades at her website. The potentially offensive chemicals in nightshades are called glycoalkaloids. I looked into this issue when deciding whether to include potatoes in my version of the paleo diet. (They’re included).
Dr. Ede’s writes:
As with any food sensitivity, the only way to find out is to remove nightshades from your diet for a couple of weeks or so to see if you feel better. There are ZERO scientific articles about nightshade sensitivity, chronic pain, or arthritis in the literature, however, the internet is full of anecdotal reports of people who have found that nightshades aggravate arthritis, fibromyalgia, or other chronic pain syndromes.
I bet I could eat a couple potatoes and tomatoes every day without ill effect. And there’s Chris Voigt, head of the Washington State Potato Commission, famous for his 60-day potato diet. As they say, your mileage may vary.
Some of the nightshades, such as potatoes, supply a major carbohydrate load that can spike blood sugars too high in many diabetics. Be careful. And use your home glucose monitor.
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Kelly Schmidt, RD, Interviews Eric Pelletier (T1 Diabetes) On Diet and Exercise
Eric is a Crossfitter who owns a Crossfit gym (or box, as they say). Kelly asks him about low-carb eating (even ketogenic) and how to manage food and insulin in the setting of vigorous exercise. Well worth a read, especially if you have type 1 diabetes.
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How Can One Possibly Eat Very-Low-Carb For Life?
Jerrymat left an insightful and inspirational comment on my review of Dr. Bernstein’s Diabetes Solution. Here it is:
♦ ♦ ♦
I am a 74 year old diabetic (T2) and have been following Bernstein’s plan for 26 months. I have lost 51 lbs, lowered my intake of insulin and have had reversal of several diabetic complications. My blood chemistry is much better than before and my A1c has gone from 9.1 to 5.0. My blood pressure is lower and I am healthier in virtually every measured way.
I cannot bring myself to abandon all fruits but I found I can satisfy myself with a quarter of an apple, a half of an orange, a quarter of a grapefruit, etc. I eat them much more slowly and with concentrated mental feelings of enjoyment. I currently limit myself to 40 grams of carbs per day and I continue to lose weight at the rate of a pound and a quarter a month. There was a long plateau period of no weight loss in the middle of the two years (13 months) but I kept at it. It has paid off.
Several writers on dieting say one cannot continue indefinitely on a low carb diet. I think they have the wrong attitude. The word “diet” has two distinct meanings. It can refer to what people eat on an ongoing basis. “The Inuit live on seal fat and protein in the winter and the same supplemented by summer time vegetative materials found on land.” The Inuit do not give up their diet or they would starve.
The other meaning is a special temporary change in one’s eating habits. As long as one considers what they are doing to be temporary they are doomed to drop off the temporary diet and resume their normal faire.
I have found a useful mental image to conjure up to help me. I once lived in the Mariana Islands where I could eat breadfruit. It was a wonderful food and in season very abundant. Breadfruit could be eaten every way that potatoes can. One can make breadfruit chips, french fries, mashed breadfruit, etc. A typical tree could produce thousands of lbs. However, now living in the Seattle area, I have no chance to obtain breadfruit. It is just a memory from earlier years. I find it OK to remember breadfruit with fond affection, even though I will never taste it again.
Now being on Bernstein’s diabetic diet, I no longer eat a number of once-loved foods: pizza, bread, corn-on-the-cob, catsup, etc. I just have the same fond memories of my lifestyle then as when I had breadfruit. It is OK to think of how I used to like ice cream, candy and cake. I just no longer live so that I can have those items. Pizza and french fries are just fond memories. They are just like the breadfruit. It is true that I could go to the supermarket and buy them. I could also take a plane flight to Guam and enjoy breadfruit. I don’t do either.
It is important to learn new concepts about food and invent new recipes.
One example is that I put store mix cabbage slaw in a bowl and added small defrosted salad shrimp. I added bacon bits, chopped radishes and green onions, along with both chopped black olives and a special brand of green olives. The latter were very large olives double stuffed with both garlic and jalapeno peppers. For dressing I mixed a store bought creamy Ranch dressing with raw tomato salsa and added the juice of half a lemon and half a lime. It is an absolutely wonderful taste combination. For side crunch and texture I used an idea of Dr. Bernstein, a couple of squares of processed cheese heated briefly in the microwave to become substitutes for crackers or bread, on the side. This tastes simply wonderful and I can eat it always as part of my new survival-to-old age diet.
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Periodic Tests, Treatments, and Goals for PWDs (Persons With Diabetes)
If you don’t like your physician, find a new one
So, you’ve got diabetes. You’re trying to deal with it or you wouldn’t be here. You’ve got a heck of a lot of medical information to master.
Unless you have a good diabetes specialist physician on your team, you may not be getting optimal care. Below are some guidelines you may find helpful. The goal is to prevent diabetes complications. Many primary care physicians will not be up-to-date on the guidelines. Don’t hesitate to discuss them with your doctor. Nobody cares as much about your health as you do.
Annual Tests
The American Diabetes Association (ADA) recommends the following items be done yearly (except as noted) in non-pregnant adults with diabetes. (Incidentally, I don’t necessarily agree with all ADA guidelines.) The complete ADA guidelines are available on the Internet.
- Lipid profile (every two years if results are fine and stable)
- Comprehensive foot exam
- Screening test for distal symmetric polyneuropathy: pinprick, vibration, monofilament pressure sense
- Serum creatinine and estimate of glomerular filtration rate (MDRD equation)
- Test for albumin in the urine, such as measurement of albumin-to-creatinine ratio in a random spot urine specimen
- Comprehensive eye exam by an ophthalmologist or optometrist (if exam is normal, every two or three years is acceptable)
- Hemoglobin A1c at least twice a year, but every three months if therapy has changed or glucose control is not at goal
- Flu shots
Other Vaccinations, Weight Loss, Diabetic Diet, Prediabetes, Alcohol, Exercise, Etc.
Additionally, the 2013 ADA guidelines recommend:
- Pneumococcal vaccination. “A one time re-vaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago.” Also repeat the vaccination after five years for patients with nephrotic syndrome, chronic kidney disease, other immunocompromised states (poor ability to fight infection), or transplantation.
- Hepatitis B vaccination to unvaccinated adults who are 19 through 59 years of age.
- Weight loss for all overweight diabetics. “For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed. The optimal macronutrient composition of weight loss diets has not been established. (Macronutrients are carbohydrates, proteins, and fats.)
- “The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” “It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal.”
- “A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.”
- “Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.”
- Limit alcohol to one (women) or two (men) drinks a day.
- Limit saturated fat to less than seven percent of calories.
- During the initial diabetic exam, screen for peripheral arterial disease (poor circulation). Strongly consider calculation of the ankle-brachial index for those over 50 years of age; consider it for younger patients if they have risk factors for poor circulation.
- Those at risk for diabetes, including prediabetics, should aim for moderate weight loss (about seven percent of body weight) if overweight. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Also important is exercise: at least 150 minutes per week of moderate-intensity aerobic activity. “Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).” Limit intake of sugar-sweetened beverages.
- “Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than two consecutive days without exercise. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.”
- Screening for coronary artery disease before an exercise program is depends on the physician judgment on a case-by-case basis. Routine screening is not recommended.
Olive, olive oil, and vinegar: classic Mediterranean foods
Obviously, some of my dietary recommendations conflict with ADA guidelines. The experts assembled by the ADA to compose guidelines were well-intentioned, intelligent, and hard-working. The guidelines are supported by 528 scientific journal references. I greatly appreciate the expert panel’s work. We’ve simply reached some different conclusions. By the same token, I’m sure the expert panel didn’t have unanimous agreement on all the final recommendations. I invite you to review the dietary guidelines yourself, discuss with your personal physician, then decide where you stand.
General Blood Glucose Treatment Goals
The ADA in 2013 suggests these therapeutic goals for non-pregnant adults:
- Fasting blood glucoses: 70 to 130 mg/dl (3.9 to 7.2 mmol/l)
- Peak glucoses one to two hours after start of meals: under 180 mg/dl (10 mmol/l)
- Hemoglobin A1C: under 7%
- Blood pressure: under 140/80 mmHg
- LDL cholesterol: under 100 mg/dl (2.6 mmol/l). (In established cardiovascular disease: <70 mg/dl or 1.8 mmol/l may be a better goal.)
- HDL cholesterol: over 40 mg/dl (1.0 mmol/l) for men and over 50 mg/dl (1.3 mmol/l) for women
- Triglycerides: under 150 mg/dl (1.7 mmol/l)
The American Association of Clinical Endocrinologists (AACE) in 2011 proposed somewhat “tighter” blood sugar goals for non-pregnant adults:
- Fasting blood glucoses: under 110 mg/dl (6.11 mmol/l)
- Peak glucoses 2 hours after start of meals: under 140 mg/dl (7.78 mmol/l)
- Hemoglobin A1C: 6.5% or less
The ADA reminds clinicians, and I’m sure the AACE guys agree, that diabetes control goals should be individualized, based on age and life expectancy of the patient, duration of diabetes, other diseases that are present, individual patient preferences, and whether the patient is able to easily recognize and deal with hypoglycemia. I agree completely.
The Problem With Diabetes Research
…according to an article at Medical News Today:
An analysis of diabetes trials worldwide has found they are not addressing key issues relating to the condition with almost two thirds focusing on drug therapy while only one in ten addresses prevention or behavioural therapies [which would include diet modification]. The research is published in Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), and is by Dr Jennifer Green, Duke University Medical Center, Durham, NC, USA, and colleagues.
h/t Tom Naughton
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Can You Form an Exercise Habit In Just 30 Days? Let’s Find Out!
Dietitian Melanie Thomassian at Dietriffic has issued a social media-based challenge to see if you can form an exercise habit over the course of 30 days starting April 15.
Much of the psychology literature I’ve seen suggests that habit formation takes more like eight to 12 weeks.
You’ve got very little to lose, and much to gain if you’re currently a couch potato. Why not join us?
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Diabetic Mediterranean Diet 