Monday, September 21, 2015

Fat: The New Health Paradigm

I have just read the opening summary of a startling document published by the Credit Suisse Research Institute.

I predict that this publication is going to become one of the most hotly debated documents in the fat vs carbs diet wars this year. The conclusions the authors arrive at are summarised very succinctly on the opening pages.

Their conclusions will not surprise many in the on-line diabetes community as most of us have been saying this for years (for example Eggs, Carbs and Cholesterol, Cholesterol, Fats, Carbs, Statins and Exercise) but they will cause consternation in many of the world's respected dietetic and diabetes authorities. This is not a journalist's article or a book by an organisation with an agenda or a diet to sell; it is a very well researched and supported scientific paper.

Below are abbreviated selections from the summary; these statements are well supported in the body of the document which I am still in the process of studying. I decided to post early to alert readers to the document and allow others to read it in full.

Triangulating several topics such as anthropology, breast feeding, evolution of primates, height trends in the human population, or energy needs of our various vital organs, we have concluded that natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
Saturated fat has not been a driver of obesity: fat does not make you fat. At current levels of consumption the most likely culprit behind growing obesity level of the world population is carbohydrates.
A proper review of the so called “fat paradoxes” (France, Israel and Japan) suggests that saturated fats are actually healthy and omega-6 fats, at current levels of consumption in the developed world, are not necessarily so.
The big concern regarding eating cholesterol-rich foods (e.g. eggs) is completely without foundation. There is basically no link between the cholesterol we eat and the level of cholesterol in our blood.
Doctors and patients’ focus on “bad” and “good” cholesterol is superficial at best and most likely misleading. The most mentioned factors that doctors use to assess the risk of CVDs—total blood cholesterol (TC) and LDL cholesterol (the “bad” cholesterol)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles (pattern A or B) and the ratio of TG (triglycerides) to HDL (the “good” cholesterol).
Based on medical and our own research we can conclude that the intake of saturated fat (butter, palm and coconut oil and lard) poses no risk to our health and particularly to the heart. 
The main factor behind a high level of saturated fats in our blood is actually carbohydrates, not the amount of saturated fat we eat. Clinical trials show that a low carbohydrate diet is much more effective in lowering the level of saturated fat in our blood than a low-fat diet.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter

Friday, September 18, 2015

I Think I May Have Diabetes...

"I think I may have diabetes....and I don't want to die..."

The wording varies but I see this question with increasing frequency on all the forums I read. I have written replies to these posts so often I felt it was time to archive a standard response.

The web is a wonderful source of information but too often people who really should be asking questions like this of their doctor are asking strangers on the net. 

My usual answer is very brief and says exactly that: see your doctor. I highlighted that because it needs to be emphasised.

Unfortunately that isn't always immediately possible for everyone. There can be many reasons for that.  The most common excuses are lack of money, lack of availability of medical support or simply fear of hearing bad news. 

For those with an urgent need and obvious hypo or hyper symptoms or who have tested repeatedly high on a glucometer the suggestion changes from "see your doctor soon" to "get to an ER (emergency room) fast". 

For others unable to see their doctor soon I urge them to at least make the appointment. Do what is necessary to find the money or time or courage but not seeing the doctor can turn out to be much more expensive in the long term. 

Another variant has appeared recently. Some doctors appear hesitant to diagnose if A1c is OK but fasting or casual blood glucose are just over diagnostic thresholds even when the patient has some symptoms. Too many doctors appear to have forgotten that A1c was only recently approved as a diagnostic tool because the patient can be diabetic if other indicators are high despite a normal A1c. I see an increasing number of posts from people in those circumstances who were told they are “borderline” - whatever that means - or “you are not diabetic yet, just eat healthy and exercise and you'll be fine” without a meter or other advice being prescribed.

At this point I will remind readers: I am a diabetic, not a doctor, and only a doctor can diagnose diabetes.

What follows are suggestions for people whose situation is not urgent, who have a long wait to see their doctor or who have seen their doctor but are still unsure. 

Part 1. Discovery

Obtain a home blood glucose test meter and an adequate supply of test strips. How you do that will vary depending on your local health support system. In the US cheap meters and strips are available from several sources; Walmart's Relion Prime was one of the first cheap meters but you may find others if you search. Note that the cost of test strips will be more important than the cost of the meter in the long term. In Australia you will have to pay full price until you are officially diagnosed, but check with the chemist because there are often discount specials.

When you get your meter read this (click on it): Painless Pricks.
Test four times a day for two or three days: immediately on waking (fasting) and one hour after your last bite of breakfast, lunch and dinner. The results you are hoping for are as follows:
  • Fasting: 4 to 5.5 mmol/l (Australia, Canada, UK or other millimole countries) or 70 to 99 mg/dl (USA and other milligrams countries).
  • Post-meal: 4 to 8mmol/l or 70 to 140mg/dl.
If all your tests are inside those ranges, relax. Diabetes is most unlikely to be your problem. Don't throw your meter away because it may be wise to occasionally test in future years to see if anything has changed. In that case be aware that test strips have an expiry date.

If any of your results are outside those ranges immediately wash your hands and re-test. If, after re-testing, it is still out of range just record it the first time. If a second test at another time is out of range make an appointment with the doctor for qualified diagnostic testing. 

Part 2. Action.

If your tests were outside the ranges read this while you wait for your appointment with the doctor: Getting Started
For those unable to obtain a meter, this may help while waiting to see the doctor: What to Eat at First

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There is nothing I could eat I like more than my eyes

Saturday, August 01, 2015

Blood Glucose Targets 2015

Several years ago I investigated the different targets suggested by three major respected US diabetes authorities. As a result I wrote this: Blood Glucose Targets. My 2006 summary included this comparison table:

Over the years those have changed very little. The 2015 comparison noting significant changes in bold is:

Sources: ADA, Joslin, AACE.

The ADA and Joslin now agree on the looser 2hr post-prandial target of 180(10) and both have also lowered the threshold for fasting. The AACE guidelines are unchanged. If you read the details on the linked pages all add caveats concerning relaxation of targets in case of other medical conditions, age etc.

Thirteen years after diagnosis, thankfully still free of complications, I see no reason to significantly change my closing remarks originally written nearly ten years ago.

The AACE advise much tighter post-prandial targets. I doubt that anyone would consider the American Association of Clinical Endocrinologists, a professional community of several thousand physicians specializing in endocrinology, diabetes, and metabolism as a bunch of fanatical radicals. Nor would they be promulgating guidelines impossible to be attained by the majority.

Unfortunately, nobody but pro-active type 2 diabetics talks much about 1hr PP targets. My personal logic is that I treat their 2hr as my recommended max peak for any post-prandial, as I discussed in When To Test? Those AACE guidelines then agree very closely with Jennifer's Test, Test, Test advice. Make your own judgment on which of those guidelines you think will lead to fewer complications.

Sadly, it appears that only 1/3 of senior diabetics are achieving even the loose ADA targets, but that is a discussion for another topic.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter