James Hirsch Reviews Sonia Sotomayor’s New Book

You may know that she has type 1 diabetes.  Mr. Hirsch writes:

Sonia Sotomayor dove beneath a parked car and scrunched up like a turtle. A hospital employee finally caught her by the foot and dragged her back into the building, with Sonia fighting him every step of the way. Sonia’s diabetes was diagnosed that day. It was the first time she had ever seen her mother cry.

The year was 1962, and the vignette opens Sotomayor’s memoir, My Beloved World, the surprise blockbuster nonfiction book of the year. Named to the U.S. Supreme Court in 2009, Sotomayor has been rightfully praised as a pioneer: the High Court’s first Hispanic justice, its third female justice – and its first justice with type 1 diabetes. Though her medical condition is not always front and center in the book, it is a powerful narrative thread to her life story, a cause of anguish but also a source of motivation and ultimately triumph.

Read the rest.

Mr. Hirsch wrote a book on diabetes, Cheating Destiny, that would be of interest to anyone with diabetes.  I reviewed it a few years ago.

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Diabetes In U.S. Costs $245 Billion Yearly

…according to an article at USAToday.

h/t Dr. Emily Deans (Twitter @evolutionarypsy)

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Low-Carb Diet Testimonial: DAR

DAR is a type 2 diabetic who controls her diabetes with carbohydrate-restricted eating.  She shares her story in a recent blog post.  She started low-carbing as a way to control diabetes, but writes that…

A nice side benefit to starting a low carb lifestyle was losing the 60 lbs I had fought a losing battle to avoid packing on (despite paying a lot of money for low fat diet plans and food).  Admittedly, the last 10 lbs or so are difficult to lose and keep off and it’s a battle I’m still fighting every day, but watching the first 40 lbs or so melt off easily was so gratifying! 

DAR’s website is a great source of low-carb recipes and I listed it as a resource in my Conquer Diabetes and Prediabetes book.

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A Cure for Type 1 Diabetes In Five Years?

Researchers at the University of Miami’s Diabetes Research Institute are excited about a new therapy they’re developing, call the BioHub.  Riva Greenberg wrote about it at The Huffington Post:

The BioHub is an engineered “mini organ” that will house insulin-producing (islet) cells that, like normally functioning islet cells, sense blood sugar and release the precise amount of insulin to maintain normal blood sugar levels. “It will mimic the insulin function of a normal pancreas,” Dr. Camillo Ricordi, DRI’s Scientific Director and Chief Academic Officer, told me in a phone interview. “It will restore natural insulin production for any patient, no matter how long they’ve had diabetes.”

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The Case For Carbohydrate Restriction in Diabetes

Dr. Rollo would recognize this

Dr. Rollo would recognize this

In 1797, Dr. John Rollo  published a book called An Account of Two Cases of the Diabetes Mellitus. Dr. Rollo was a surgeon in the British Royal Artillery. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. In case you don’t know, this was an era devoid of effective drug therapies for diabetes.

The soldier apparently had type 2 diabetes rather than type 1.

Rollo’s diet led to loss of excess weight (original weight 232 pounds or 105 kg), elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.  (Don’t ask me how they measured blood and urine sugar back then.)

This makes Dr. Rollo the original low-carb diabetic diet doctor. Many of the leading proponents of low-carb eating over the last two centuries—whether for diabetes or weight loss—have been physicians.

Carbohydrate Intolerance

Diabetes and prediabetes always involve impaired carbohydrate metabolism: ingested carbs are not handled by the body in a healthy fashion, leading to high blood sugars and, eventually, poisonous complications.

Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbs in a normal, healthy fashion. In a way, carbs are toxic to them. Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death, among other things.

What To Do About It

Diabetics and prediabetics simply don’t tolerate carbs in the diet like other people. If you don’t tolerate something, you have to give it up, or at least cut way back on it. Lactose-intolerant individuals give up milk and other lactose sources. Celiac disease patients don’t tolerate gluten, so they give up wheat and other sources of gluten. One of every five high blood pressure patients can’t handle normal levels of salt in the diet; they have to cut back or their pressure’s too high. Patients with phenylketonuria don’t tolerate phenylalanine and have to restrict foods that contain it. If you’re allergic to penicillin, you have to give it up.

Stretching actually doesn't do any good for the average person

Stretching actually doesn’t do any good for the average person

If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry. Alternatively, you could eat lots of carbs and take drugs to prevent the dangerous elevations in blood sugar they cause. We have 11 classes of drugs to treat diabetes. Unfortunately, the long-term side effects of most of them are not well-established. And they can get very expensive.

The American Diabetes Association recommends weight loss for all overweight diabetics. That tends to improve carbohydrate metabolism. The ADA’s 2011 guidelines suggest three possible diets: “For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).”

If I were a diabetic eating over 200 grams of carb daily, I’d cut my carbs way below 130 grams initially, to 20–30 grams of digestible carb.  Then gradually increase carbs as tolerated, based on blood sugar readings. Ask your doctor what he thinks.

Steve Parker, M.D.

 

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What’s Metabolic Syndrome?

metabolic syndrome, low-carb diet, diabetes, prediabetes

He’s at high risk for metabolic syndrome

“Metabolic syndrome” may be a new term for you. It’s a constellation of clinical factors that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

  • high blood pressure (130/85 or higher, or using a high blood pressure medication)
  • low HDL cholesterol:  under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
  • triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
  • abdominal fat:  waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
  • fasting blood glucose over 100 mg/dl (5.55 mmol/l)

What To Do About It

Metabolic syndrome and simple excess weight often involve impaired carbohydrate metabolism. Over time, excessive carbohydrate consumption can turn overweight and metabolic syndrome into prediabetes, then type 2 diabetes.  Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally. When my patients have metabolic syndrome, some of my recommendations are:

  • weight loss, often via a low-carb diet
  • low-carb diet if blood sugars are elevated
  • regular exercise, with a combination of strength and aerobic training

If these work, the patient can often avoid costly drugs and their potential adverse effects.

Ask your doctor what she thinks.

Steve Parker, M.D.

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Ph.D. Chemist Controlled Diabetes with Low-Carb Diet

Wendy Knapp Pogozelski is a Chemistry professor at State University of New York.  After she was diagnosed with LADA (latent onset diabetes of adulthood), she researched the available diabetes diets and achieved good blood sugar control on a carbohydrate-restricted diet and just seven units of insulin a day.

Then she saw a dietitian who convinced her to follow conventional wisdom and increase carbs to at least 130 grams daily.

The result was that my HbA1c rose above 7 percent. My blood sugar levels were frequently in the 200 to 300 mg/dl range (far above the normal level of about 85 mg/dl), even when I supplemented with extra insulin. My former dose of seven units of insulin per day increased to 30 units per day.

I’m not sure what she did after that.

Read more here.

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One Potential Cause of Type 2 Diabetes: Sugar Consumption

Robert Lustig and associates looked at sugar consumption and diabetes rates in 175 countries and found a strong link between sugar and type 2 diabetes.  It’s not proof of causation, just suggestive.  From the abstract:

“Duration and degree of sugar exposure correlated significantly with diabetes prevalence in a dose-dependent manner, while declines in sugar exposure correlated with significant subsequent declines in diabetes rates independently of other socioeconomic, dietary and obesity prevalence changes. Differences in sugar availability statistically explain variations in diabetes prevalence rates at a population level that are not explained by physical activity, overweight or obesity.”

Read the rest.

Reference: Basu S, Yoffe P, Hills N, Lustig RH (2013) The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PLoS ONE 8(2): e57873. doi:10.1371/journal.pone.0057873

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Maybe Low-Carb Diets Are So Effective Because They Alter Gut Bacteria

Details are in The International Journal of Obesity.

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Both Aerobic and Strength Training Improve Quality of Life in Type 2 Diabetes

Details are at Diabetes Care.

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