Hi All
Shortly after writing my comment on the USA Today "Diabetes revolution" article, I had cause to re-visit a report by the US National Committee for Quality Assurance.
It's worth browsing through. Although it is specifically about the USA, I doubt that other Western nations, such as mine, are significantly different:
THE STATE OF HEALTH CARE QUALITY 2007
Scroll down to page 35 for some details on diabetes.
For example:
ABOUT DIABETES
• Almost 2 in 3 Americans living with diabetes will die from heart disease or stroke.
• For every 1 percent reduction in blood sugar level (HbA1c), the risk of developing eye disease, nerve disease and kidney disease is reduced by 40 percent.
• Every 10 millimeters of mercury reduction in systolic blood pressure in diabetics results in a 12 percent reduction in diabetic complications.
• In the U.S., diabetes accounts for almost 45 percent of new cases of kidney failure.
• About 65 percent of people with diabetes have mild to severe forms of nervous system damage. Long-term effects include impaired sensation in the feet and hands, carpal tunnel syndrome and other nerve problems.
• Diabetics are more likely to die from acute illness such as pneumonia or influenza than those who do not have diabetes.
• Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness annually.
That doesn't sound much like a revolution in diabetes to me. More reports are available here: NCQA Newsroom
Cheers Alan
Sunday, December 09, 2007
The Diabetes Revolution?
This article has just appeared in USA Today: Diabetes 'revolution' is cutting both ways
I won't quote it because I don't want to infringe copyright. So I'll wait while you slip away and read it.
Back already? :-)
I wouldn't get too excited just yet. Have another look at those graphs that are at the top and on the left sidebar again. I hope I'll be forgiven for copying those. They may have changed the curve but the changes are rather un-dramatic.
I won't quote it because I don't want to infringe copyright. So I'll wait while you slip away and read it.
Back already? :-)
I wouldn't get too excited just yet. Have another look at those graphs that are at the top and on the left sidebar again. I hope I'll be forgiven for copying those. They may have changed the curve but the changes are rather un-dramatic.
The graph at the top shows diagnosis numbers tripling over a 25 year span. Despite changes in diagnostic criteria and populations that is still a giant increase at a time when we were being told by all dietary authorities that fat is evil and starch was good for us.
The other charts show: 
o Lower extremity amputations are exactly where they were,after a terrible peak in the '90s.
o Eye damage has dropped from 26% to 21%; still terribly high and hardly encouraging considering much of that drop could be related to improvements in eye treatment such as laser surgery over that time.
o The chronic kidney disease rate increased by 40% over that 25 years despite coming down from a peak in the '90s.
Despite all the feel-good words in the report, I have difficulty accepting the up-beat tone. The only thing I get out of it is the thought that they should be studying what changed in the mid-90s in diet and lifestyle in the American population.
I can think of a few things that may, or may not, be significant. Think about these for a while, and maybe you can add some of your own.
1. There has been almost no change in the dietary advice pushed by the major professional medical advisory bodies.
2. The diagnostic criteria change has led to earlier treatmentfor many.
3. Low-carb diets, whether you like them or hate them, led to a new awareness of the dangers of excess carbs in diet and may have had an effect on the consumption of carbs as a proportion of the Standard American (or Australian) Diet (SAD), particularly of those diagnosed with type 2 diabetes.
4. Home testing meters became much more available and easier to use.
5. The internet has empowered patients of all afflictions to gain knowledge to add to their doctor's advice.
Just thoughts. But I'm not rushing out to celebrate the 'revolution' in diabetes just yet.
Cheers, Alan
Friday, October 19, 2007
Psyllium, Fibre, Muesli and Nuts
Back when I started following Jennifer’s testing advice I gradually cut the starchy and high GI carbs in my daily menu significantly. I replaced them with other veges but on analysis I found I needed to add some fibre back into my menu. I found that the most readily available supplement to do that was psyllium husk; a food that is 80-85% dietary fibre.
If you do a little searching on psyllium you will find a lot of scientific papers on it’s various benefits. However, it’s not easy to eat the stuff directly. That’s why commercially available forms such as Metamucil have other flavours and ingredients added to make them palatable.
Separate to that, I also found that I could eat more carbs in the evening and that a small bowl of muesli at bedtime helped with my dawn effect numbers in the morning. Additionally, I try to eat some nuts regularly as part of my menu.
As a result of all those different factors I gradually developed this simple recipe for my bedtime snack.
Ingredients:
750gm or 1 Kg (1 1/2 to 2 lbs) pack of Muesli from the supermarket.
For those who haven’t eaten Muesli, it is usually a mix of rolled oats, other grains, dried fruits
etc. High in whole grains and fruits, so high carb but also high fibre. Usually about 65% carb and 10-14% fibre.
400-500 gms of mixed nuts, roasted but not salted.
My usual mix is brazils, walnuts, almonds, cashews; I vary it occasionally with pecans or other real nuts. No peanuts.
200-250gm psyllium husks from the local health food store.
The result is roughly a 4:2:1 ratio of Muesli:nuts:psyllium.
Method.
I chop the nuts coarsely in a food processor, but not to the point where they are a powder. I like the crunch when I eat them. Then I just mix all the ingredients together and store them in a large air-tight container.
Use.
At bedtime I put two or three tablespoons of the mix in a bowl and cover it with enough whole milk to wet it; I experiment to find the quantity needed to overcome the psyllium's tendency to set the mix solid:-)
Occasionally I use water instead of milk, or a combination of both.
For my most recent mix I worked out the actual numbers (US style, subtract fibre) for a 40gm serve with 100ml whole milk. Obviously these numbers will vary according to your muesli ingredients and choice of nuts:
Calories ................ 220__cal
Carbohydrate..........27__gm
Fiber........................8.5__gm
Protein .....................8__gm
Total Fat..................12__gm
Sat. Fat.....................3__gm
Mono. Fat.................5__gm
Poly. Fat....................3__gm
Cholesterol ..............13__mg
I eat that at bedtime 3-4 nights per week.
One other beneficial side effect was to improve my morning regularity.
Cheers, Alan
Everything in Moderation - Except Laughter.
A post-script, 16th May 2008.
This was brought to my attention today, published in the American Journal of Clinical Nutrition in 1999:
Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia
"Results of this study suggest that the addition of psyllium to a standard diet for diabetes is safe, is well tolerated, and offers an additional dietary tool to improve metabolic control in individuals with type 2 diabetes and hypercholesterolemia. "
If you do a little searching on psyllium you will find a lot of scientific papers on it’s various benefits. However, it’s not easy to eat the stuff directly. That’s why commercially available forms such as Metamucil have other flavours and ingredients added to make them palatable.
Separate to that, I also found that I could eat more carbs in the evening and that a small bowl of muesli at bedtime helped with my dawn effect numbers in the morning. Additionally, I try to eat some nuts regularly as part of my menu.
As a result of all those different factors I gradually developed this simple recipe for my bedtime snack.
Ingredients:
750gm or 1 Kg (1 1/2 to 2 lbs) pack of Muesli from the supermarket.
For those who haven’t eaten Muesli, it is usually a mix of rolled oats, other grains, dried fruits
etc. High in whole grains and fruits, so high carb but also high fibre. Usually about 65% carb and 10-14% fibre.
400-500 gms of mixed nuts, roasted but not salted.
My usual mix is brazils, walnuts, almonds, cashews; I vary it occasionally with pecans or other real nuts. No peanuts.
200-250gm psyllium husks from the local health food store.
The result is roughly a 4:2:1 ratio of Muesli:nuts:psyllium.
Method.
I chop the nuts coarsely in a food processor, but not to the point where they are a powder. I like the crunch when I eat them. Then I just mix all the ingredients together and store them in a large air-tight container.
Use.
At bedtime I put two or three tablespoons of the mix in a bowl and cover it with enough whole milk to wet it; I experiment to find the quantity needed to overcome the psyllium's tendency to set the mix solid:-)
Occasionally I use water instead of milk, or a combination of both.
For my most recent mix I worked out the actual numbers (US style, subtract fibre) for a 40gm serve with 100ml whole milk. Obviously these numbers will vary according to your muesli ingredients and choice of nuts:
Calories ................ 220__cal
Carbohydrate..........27__gm
Fiber........................8.5__gm
Protein .....................8__gm
Total Fat..................12__gm
Sat. Fat.....................3__gm
Mono. Fat.................5__gm
Poly. Fat....................3__gm
Cholesterol ..............13__mg
I eat that at bedtime 3-4 nights per week.
One other beneficial side effect was to improve my morning regularity.
Cheers, Alan
Everything in Moderation - Except Laughter.
A post-script, 16th May 2008.
This was brought to my attention today, published in the American Journal of Clinical Nutrition in 1999:
Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia
"Results of this study suggest that the addition of psyllium to a standard diet for diabetes is safe, is well tolerated, and offers an additional dietary tool to improve metabolic control in individuals with type 2 diabetes and hypercholesterolemia. "
Saturday, October 06, 2007
Cinnamon, Spices, Herbs and Similar
On the various diabetes groups I read there is a perennial question as to the benefits of cinnamon for reducing blood glucose peaks. Many of the stories about cinnamon can be traced back to a limited study in Pakistan a few years ago and some US follow-ups. I won't argue about their validity but I've seen no credible in-depth studies on the subject. However it keeps recurring almost weekly on places like the ADA forum and was discussed last month on the ADA web-site and last April on David Mendosa's excellent web-site. [see the post-script at the foot, added 18 February 2009
The minimal, if any, effect that cinnamon had on me was trivial. Reducing my carb input by just a few grams had a much greater effect. I still use cinnamon as a spice frequently and infuse it in my morning coffee - but for taste, not BGs. It did affect my post-breakfast BG peak indirectly, because I no longer add milk to my morning coffee as a consequence.
I use many other herbs and spices in my menu. Some for taste, some for medicinal purposes, some for both. Some have proven benefits, such as turmeric for some cancers, some are anecdotal. My attitude is that if it is not harmful I have nothing to lose and a possible gain by adding such things to my menu. However, I do NOT buy capsules or pills of cinnamon, or turmeric, or garlic or anything. I eat them by including the herbs, spices and specific foods regularly in my normal way of eating. Sometimes by spicing up an existing recipe, such as a sprinkle of turmeric and black pepper (the two are complementary) in a morning omelette; sometimes by adding new spicy dishes to my menu, such as Asian stir-fries etc.
So I have tiny amounts of many things almost every day.As I wrote this I started reviewing the herbs and spices in my menu over the last few days. Just normal days, nothing unusual. Turmeric, cinnamon, nutmeg, grated black pepper, cumin, paprika, thyme, mint, basil, rosemary, hot chili, fresh garlic, grated ginger and the broad combination spices of garam masala and commercial curry powder. That's in addition to ensuring my menu also included items like avocado, nuts, psyllium husks, leafy greens, onions, capsicum (peppers) etc. And, of course, a modicum of red wine. Most of my herbs are grown fresh at home. When the crop is over-abundant I dry it, chop it and store it for future use out of season.
As to which of those, if any, is helping my diabetes or CLL, who knows. But I'll follow my docs' advice and keep doing what I'm doing.
Because, even if they don't improve my health, they definitely help a slightly restricted menu taste good.
Post-script, 18th February 2009. I just became aware of this paper published in Diabetes Care in January 2008:
Effect of Cinnamon on Glucose Control and Lipid Parameters.
"CONCLUSIONS— In this meta-analysis of five randomized placebo controlled trials, patients with type 1 or type 2 diabetes receiving cinnamon did not demonstrate statistically or clinically significant changes in A1C, FBG, or lipid parameters in comparison with subjects receiving placebo."
"CONCLUSIONS— In this meta-analysis of five randomized placebo controlled trials, patients with type 1 or type 2 diabetes receiving cinnamon did not demonstrate statistically or clinically significant changes in A1C, FBG, or lipid parameters in comparison with subjects receiving placebo."
PPS Added 26th January 2014. This extract from an editorial is from the Annals of Internal Medicine published 17th December 2013
Other reviews and guidelines that have
appraised the role of vitamin and mineral supplements in primary or secondary
prevention of chronic disease have consistently found null results or possible
harms (5–6). Evidence
involving tens of thousands of people randomly assigned in many clinical trials
shows that β-carotene, vitamin E, and possibly high doses of vitamin A
supplements increase mortality (6–7) and that
other antioxidants (6), folic
acid and B vitamins (8), and
multivitamin supplements (1, 5) have no
clear benefit.
Despite sobering
evidence of no benefit or possible harm, use of multivitamin supplements
increased among U.S. adults from 30% between 1988 to 1994 to 39% between 2003
to 2006, while overall use of dietary supplements increased from 42% to 53% (9). Longitudinal
and secular trends show a steady increase in multivitamin supplement use and a
decline in use of some individual supplements, such as β-carotene and vitamin
E. The decline in use of β-carotene and vitamin E supplements followed reports
of adverse outcomes in lung cancer and all-cause mortality, respectively. In
contrast, sales of multivitamins and other supplements have not been affected
by major studies with null results, and the U.S. supplement industry continues
to grow, reaching $28 billion in annual sales in 2010. Similar trends have been
observed in the United Kingdom and in other European countries.
The large body of
accumulated evidence has important public health and clinical implications.
Evidence is sufficient to advise against routine supplementation, and we should
translate null and negative findings into action. The message is simple: Most
supplements do not prevent chronic disease or death, their use is not
justified, and they should be avoided. This message is especially true for the
general population with no clear evidence of micronutrient deficiencies, who
represent most supplement users in the United States and in other countries (9).
Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter
Monday, September 24, 2007
Good Advice, Bad Advice - Nicky's Experience
I have a friend in the UK named Nicky. We met in cyberspace on alt.support.diabetes and then I was privileged to meet her in person in London on my travels. Nicky is one of those who is not just trying her best to manage her diabetes but who has become active in trying to improve the situation in her own system.
Recently on a.s.d she was asked about her experiences with doctors and other patients over there. This was her reply. To see it in context it was here on alt.support.diabetes.
My doctor is adamant that I shouldn't test, and that I should base my diet on whole grains.
OTOH, I have an A1c of 5.5% (down from, I think, about 10.3% at dx), have come off all meds
(except thyroxine), and have reversed the neuropathy the doc missed at dx. The doc is quite surprised now that I don't see him very often - most of his other patients have progressed to needing insulin by this stage; the last time I needed a doc for me was last year's flu jab.
When I go to Diabetes UK meetings, I am the only one eating a low carb diet. I'm frequently the only one with a bg meter handy. Last weekend was a regional meeting where I hadn't seen some folks for a year. They looked a heck of a lot more than a year older, and two of them had got that neuropathy walk - leaning forward to see where their feet were, over their stomachs, stiff-legged from the pain. They had biscuits with their tea at breaks, and rice and a crumble pudding with their meal.
I'm 46, and if I follow my Dad's family pattern, I might make it to 100. Damned if I want to be blind or in a wheelchair for any part of that. Jennifer's advice, and the low-spike diet resulting from that, has given me a new lease of life, and improved my health enormously. I have no doubt that had I followed the doc's guidance, or that of the dietician who recommended oatmeal and bananas, I would be one of the folks who had seriously deteriorated. No, thanks.
I spend a fair bit of my time campaigning against Diabetes UK's dietary advice. However, they are handy people to know if you're fighting a battle for test strips.
Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25
Read that sig again. It's amazing what can be achieved with the RIGHT diet and exercise. Incidentally, when we meet up again I will be agreeing with everything she says; one of her preferred exercises is Karate:-)
Cheers, Alan
Everything in Moderation - Except Laughter
Recently on a.s.d she was asked about her experiences with doctors and other patients over there. This was her reply. To see it in context it was here on alt.support.diabetes.
My doctor is adamant that I shouldn't test, and that I should base my diet on whole grains.
OTOH, I have an A1c of 5.5% (down from, I think, about 10.3% at dx), have come off all meds
(except thyroxine), and have reversed the neuropathy the doc missed at dx. The doc is quite surprised now that I don't see him very often - most of his other patients have progressed to needing insulin by this stage; the last time I needed a doc for me was last year's flu jab.
When I go to Diabetes UK meetings, I am the only one eating a low carb diet. I'm frequently the only one with a bg meter handy. Last weekend was a regional meeting where I hadn't seen some folks for a year. They looked a heck of a lot more than a year older, and two of them had got that neuropathy walk - leaning forward to see where their feet were, over their stomachs, stiff-legged from the pain. They had biscuits with their tea at breaks, and rice and a crumble pudding with their meal.
I'm 46, and if I follow my Dad's family pattern, I might make it to 100. Damned if I want to be blind or in a wheelchair for any part of that. Jennifer's advice, and the low-spike diet resulting from that, has given me a new lease of life, and improved my health enormously. I have no doubt that had I followed the doc's guidance, or that of the dietician who recommended oatmeal and bananas, I would be one of the folks who had seriously deteriorated. No, thanks.
I spend a fair bit of my time campaigning against Diabetes UK's dietary advice. However, they are handy people to know if you're fighting a battle for test strips.
Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6% BMI 25
Read that sig again. It's amazing what can be achieved with the RIGHT diet and exercise. Incidentally, when we meet up again I will be agreeing with everything she says; one of her preferred exercises is Karate:-)
Cheers, Alan
Everything in Moderation - Except Laughter
Sunday, July 01, 2007
Self-Testing and Type 2 Management
A paper denigrating the value of patient self monitoring of blood glucose (SMBG) was published in the British Medical Journal a few days ago. Once again I am mystified that highly qualified medical researchers can spend tens of thousands of dollars (or, in this case, Pounds) to come up with a worthless result.
BMJ, doi:10.1136/bmj.39247.447431.BE (published 25 June 2007)
research-article
Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial
Read the full paper here: http://www.bmj.com/cgi/content/full/bmj.39247.447431.BEv1
Their conclusions:
Conclusions
Evidence is not convincing of an effect of self monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving glycaemic control compared with usual care in reasonably well controlled non-insulin treated patients with type 2 diabetes.
How did they arrive at that conclusion? In my opinion they failed to understand how to use SMBG systematically and had no concept at all of the process of using test results as feedback to change input for better results.
Rather than say it all twice, I'll repeat below my post to the BMJ "rapid response" section after the article. Hopefully, they will publish it; if not, at least it will appear here:
***
Response to BMJ
I am not a doctor. I am a type 2 diabetic patient who has a keen interest in patient self-management of diabetes, and who has spent far too much time over the past four years discussing this with other diabetics around the world on the net and personally. My only relevant publication is a patient's view online at http://loraldiabetes.blogspot.com/
This is not the first poorly performed study of blood glucose testing techniques published in the past twelve months, including one in my own country. All have suffered from the same basic flaw. SMBG is pointless – as is any testing of any sort – if the results are not used to either confirm that things are as expected or to assess what changes need to be made to improve the results next time.
However, if SMBG is used systematically to assess the success of past treatments and to then make changes in those treatments, in a continuously iterative method, it can be spectacularly successful. I accept that BMJ readers will consider anything I say as anecdotal; however I have seen it happen hundreds of times over the past five years.
This study was a waste of time and effort because the patients in the "most intensive" group were given no training in evaluating their test results with a view to improvement. In fact the basic premises of their training doomed them to failure: "They were also given training and support in timing, interpreting, and using the results of their blood glucose test to enhance motivation and to maintain adherence to diet, physical activity, and drug regimens." That was the worst thing they could have done - to maintain adherence to their present regimens, particularly diet. In fact they maintained it so well that they hardly changed their poor HbA1c levels at all.
As an aside, for the authors to consider A1c's in the mid 7's as "reasonably well controlled" is appalling to me. I would refer the authors to the EPIC Norfolk study which found that "HbA1c was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA1c concentrations below 5%. An increase of 1% in HbA1c was associated with a 28% (P<0.002) increase in risk of death " BMJ 2001;322:15 [Full] ( 6 January )
Now, back to SMBG. The single most important thing that the patient can do at home is modify diet. They should not change medications without doctor’s advice, there are realistic limits to the exercise they can add to their routine – but they can make dramatic changes in blood glucose levels with a diet modified by feed-back from post-prandial peak blood glucose levels.
I, and many of my friends around the world, have been following a systematic testing regimen that works for some years now. It is intensive in the initial stages, then becomes much more relaxed once individuals have created their own personal databases of foods and activities, so we know what foods and activities will cause blood glucose spikes (at the peak, not necessarily at two hours), and which won’t. It’s as simple as that.
I challenge the authors of this paper – or any other researchers for that matter, to repeat the study but train the "most intensive" group as follows:
Eat, then test after eating at your peak spike time and if blood glucose levels are too high then review what you ate and change the menu next time. Then do that again, and again, and again until what you eat doesn’t spike you. You will get some surprises, particularly at breakfast time. The so-called "heart-healthy" breakfast is NOT for most type 2's. Similarly, you will find variations through the day - the same thing will have different effects at breakfast, lunch, dinner and supper
As you gradually improve your blood glucose levels, review the resulting way of eating to ensure adequate nutrition, fibre etc are included and adjust accordingly. Test, review, adjust until you have a flexible and interesting menu that is nutritious but does not "spike" your post-prandial blood glucose; a menu you can follow for the rest of your life.
Studies such as the one in question are meaningless if the SMBG is not performed systematically and with a defined purpose.
***
Cheers, Alan
BMJ, doi:10.1136/bmj.39247.447431.BE (published 25 June 2007)
research-article
Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes: open parallel group randomised trial
Read the full paper here: http://www.bmj.com/cgi/content/full/bmj.39247.447431.BEv1
Their conclusions:
Conclusions
Evidence is not convincing of an effect of self monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving glycaemic control compared with usual care in reasonably well controlled non-insulin treated patients with type 2 diabetes.
How did they arrive at that conclusion? In my opinion they failed to understand how to use SMBG systematically and had no concept at all of the process of using test results as feedback to change input for better results.
Rather than say it all twice, I'll repeat below my post to the BMJ "rapid response" section after the article. Hopefully, they will publish it; if not, at least it will appear here:
***
Response to BMJ
I am not a doctor. I am a type 2 diabetic patient who has a keen interest in patient self-management of diabetes, and who has spent far too much time over the past four years discussing this with other diabetics around the world on the net and personally. My only relevant publication is a patient's view online at http://loraldiabetes.blogspot.com/
This is not the first poorly performed study of blood glucose testing techniques published in the past twelve months, including one in my own country. All have suffered from the same basic flaw. SMBG is pointless – as is any testing of any sort – if the results are not used to either confirm that things are as expected or to assess what changes need to be made to improve the results next time.
However, if SMBG is used systematically to assess the success of past treatments and to then make changes in those treatments, in a continuously iterative method, it can be spectacularly successful. I accept that BMJ readers will consider anything I say as anecdotal; however I have seen it happen hundreds of times over the past five years.
This study was a waste of time and effort because the patients in the "most intensive" group were given no training in evaluating their test results with a view to improvement. In fact the basic premises of their training doomed them to failure: "They were also given training and support in timing, interpreting, and using the results of their blood glucose test to enhance motivation and to maintain adherence to diet, physical activity, and drug regimens." That was the worst thing they could have done - to maintain adherence to their present regimens, particularly diet. In fact they maintained it so well that they hardly changed their poor HbA1c levels at all.
As an aside, for the authors to consider A1c's in the mid 7's as "reasonably well controlled" is appalling to me. I would refer the authors to the EPIC Norfolk study which found that "HbA1c was continuously related to subsequent all cause, cardiovascular, and ischaemic heart disease mortality through the whole population distribution, with lowest rates in those with HbA1c concentrations below 5%. An increase of 1% in HbA1c was associated with a 28% (P<0.002) increase in risk of death " BMJ 2001;322:15 [Full] ( 6 January )
Now, back to SMBG. The single most important thing that the patient can do at home is modify diet. They should not change medications without doctor’s advice, there are realistic limits to the exercise they can add to their routine – but they can make dramatic changes in blood glucose levels with a diet modified by feed-back from post-prandial peak blood glucose levels.
I, and many of my friends around the world, have been following a systematic testing regimen that works for some years now. It is intensive in the initial stages, then becomes much more relaxed once individuals have created their own personal databases of foods and activities, so we know what foods and activities will cause blood glucose spikes (at the peak, not necessarily at two hours), and which won’t. It’s as simple as that.
I challenge the authors of this paper – or any other researchers for that matter, to repeat the study but train the "most intensive" group as follows:
Eat, then test after eating at your peak spike time and if blood glucose levels are too high then review what you ate and change the menu next time. Then do that again, and again, and again until what you eat doesn’t spike you. You will get some surprises, particularly at breakfast time. The so-called "heart-healthy" breakfast is NOT for most type 2's. Similarly, you will find variations through the day - the same thing will have different effects at breakfast, lunch, dinner and supper
As you gradually improve your blood glucose levels, review the resulting way of eating to ensure adequate nutrition, fibre etc are included and adjust accordingly. Test, review, adjust until you have a flexible and interesting menu that is nutritious but does not "spike" your post-prandial blood glucose; a menu you can follow for the rest of your life.
Studies such as the one in question are meaningless if the SMBG is not performed systematically and with a defined purpose.
***
Cheers, Alan
Thursday, June 28, 2007
Ki Si Ming
This is one from my better half. Despite using a commercial Chicken Noodle Soup as part of the base it is surprisingly low in carbs and calories.
As usual, all quantities are very approximate and should be adjusted to your own taste.
Ingredients
Chicken Noodle Soup: One 50gm packet
Water: 5ooml (1pint) (use half the soup pack recommendation)
Mince steak (ground beef): 500gm (1lb)
Cabbage, shredded: 2 cups
Carrot, shredded: one medium
Onion, chopped: one medium
Curry powder: flat tablespoon
Olive oil or melted butter: 2 tablespoons
Salt and pepper to taste
Method
Fry the chopped onions in the oil or butter in a small saucepan until translucent and stir in the curry powder. Mix the packet of soup thoroughly with the water, then add it to the onions and bring to a gentle boil. Simmer for 15 minutes.
While the liquid is simmering fry the meat in a larger saucepan until browned, breaking up any lumps. Add the shredded carrot and cabbage, mix thoroughly and then pour the soup and onion mix in when it is ready.
Bring to a simmer and cook for 20-30 minutes, stirring occasionally. The result should be moist, with a light curry gravy, not soupy. Adjust by adding extra water if too dry, or cooking longer to reduce it if it's too liquid.
Serve with brown rice or noodles if your carb limit can handle that, or for your non-diabetic partner. Personally, I eat it as is without sides.
Serves 4 on it's own, 6 with rice or noodles.
Nutrition Count, will vary slightly depending on your packet soup.
Based on 4 serves.
Calories 210
Protein 8.2 gm
Total Fat 11.2 gm
Carbohydrate 13.5 gm
Fibre 2 gm
Sodium 800 mgm
As usual, all quantities are very approximate and should be adjusted to your own taste.
Ingredients
Chicken Noodle Soup: One 50gm packet
Water: 5ooml (1pint) (use half the soup pack recommendation)
Mince steak (ground beef): 500gm (1lb)
Cabbage, shredded: 2 cups
Carrot, shredded: one medium
Onion, chopped: one medium
Curry powder: flat tablespoon
Olive oil or melted butter: 2 tablespoons
Salt and pepper to taste
Method
Fry the chopped onions in the oil or butter in a small saucepan until translucent and stir in the curry powder. Mix the packet of soup thoroughly with the water, then add it to the onions and bring to a gentle boil. Simmer for 15 minutes.
While the liquid is simmering fry the meat in a larger saucepan until browned, breaking up any lumps. Add the shredded carrot and cabbage, mix thoroughly and then pour the soup and onion mix in when it is ready.
Bring to a simmer and cook for 20-30 minutes, stirring occasionally. The result should be moist, with a light curry gravy, not soupy. Adjust by adding extra water if too dry, or cooking longer to reduce it if it's too liquid.
Serve with brown rice or noodles if your carb limit can handle that, or for your non-diabetic partner. Personally, I eat it as is without sides.
Serves 4 on it's own, 6 with rice or noodles.
Nutrition Count, will vary slightly depending on your packet soup.
Based on 4 serves.
Calories 210
Protein 8.2 gm
Total Fat 11.2 gm
Carbohydrate 13.5 gm
Fibre 2 gm
Sodium 800 mgm
Saturday, June 09, 2007
Jennifer's Story
Five years ago when I started searching the net for advice on type 2, after I realised that the standard Diabetes Australia advice wasn't working for me, I discovered misc.health.diabetes on usenet. A guy from the UK calling himself Flying Rat sent me to his web-page to read "Jennifer's Advice". Since then I've found that advice in several other places.
It was the single most important thing I read after diagnosis. Jennifer's advice changed my life and I will always be grateful. I now repeat it to every newby I meet who stands still long enough:-)
Today, on a different forum, Jennifer posted the story of her first eight years after diagnosis. Here it is.
From Jennifer.
Eight years ago today I was diagnosed with T2 diabetes. I was very afraid...but fortunately for me I turned to this list and others for a shoulder and advice. And I found all of that and more. I utterly appreciate the patience and help I got in those first months/years, and can't fathom where I would have been without the internet, this list and you people. Truly.
So on my 8th diabetic anniversary I thought I'd look back. Here's my story... long but hopefully interesting. (Some of you may already know most of this, I ask your indulgence).
First a disclaimer. These are just my experiences. I believe with all my heart that each of us will respond to different things. Some folks do just perfectly on an ADA food plan... others find that low carb is the only thing that keeps their BG stable. The only way to know what works for you is to test, try, test, try. The idea of one size fits all NEVER works... in pantyhose or in health. ;-)
Now you should know, I am a decorated veteran of the diet wars... until age 36 when I decided never to diet again. I worked very hard at accepting my body and my life and I was finally able to let go of all that wasted mental energy I spent worrying and obsessing about diets and fat. It was wonderful.
So at 40, when I was dx'd with DM. I was petrified... I just knew I would walk into the doctors office and they'd take one look and say, "Well, just lose weight". And I would try and I would fail. As I had on every diet known to man since the beginning of time. But this time failure would mean blindness, amputation and other horrible complications, not just a bigger dress.
I immediately dove into the internet searching for any shred of hope. Everything I read said that carbohydrates raised your glucose levels. Atkins was not yet the total fad (that would happen a year or two later)... but there were a few books out and I read them all.
I started out with a very low carb approach. I didn't use any one plan, but read a number of books and took something from each of them. Including Protein Power, Dr. Bernstein and Atkins. At first I just (just! as though it was a snap... it wasn't!) cut out all "classic" carbs... bread, rice, pasta, cereal, sugar, beans, corn, potato, fruit etc. My BG dropped dramatically and quickly.
My A1c at dx 6/99 was 15.3
By 7/99 it was 8.5
By 9/99 it was 6.6
By 12/99 it was 4.9
I hovered in the 4's for awhile, but then chose to add back in some high fiber - non-white carbs and I've been in the 5's ever since. (with a small detour upward due to some urological problems)
Interestingly, I found something else occurred as well. I found an amazing correlation for me with regards to low carb and cravings and binges. I've spent my whole life fighting cravings and bingeing. I could eat a pound of pasta (with the "regulation" fat free sauce) and an hour later be standing in the kitchen in front of the fridge, starving. Needing to eat something, anything. Unable to stop thinking about food.
I grew up believing it was me. Something was wrong with me. I must have low self esteem or I was eating to fill up an "emotional hole". However, none of the rest of my life supported those theories. I was happy... except with my eating and my size. The low carb approach worked very well controlling my diabetes, But more amazing to me was that those almost daily crave attacks disappeared completely. Entirely. And so far they have never returned.
I must believe that for me, has to be some sort of metabolic disorder. Some kind of carbohydrate malfunction within me. It was the first time in my 40 years that I had not had these cravings. It's been wonderful. If they discovered a "cure" tomorrow for diabetes I would still eat this way.
After six months or so of very low carb, I used my meter to help add in other carbs at specific meals. I found, through testing, that I could eat a piece of whole wheat toast at breakfast with no appreciable rise in BG... I could eat some corn with a meal... On the downside: Pasta doesn't work for me at anytime... (until I found Dreamfields) Neither does rice.
I don't count carbs... I don't count calories... I don't count fat or protein grams. I eat whenever I'm hungry, I just restrict my carbs. I think the reason I've been able to maintain good BG numbers is because I didn't go on any one eating plan. I read many many books and took information from each. I was not going to sit down and write out a food plan for the week. That was too diet-like. I was not going to count anything, not portions, not calories, not anything. That was too diet-like. I wasn't going to weigh anything, not me or my food. That was too diet-like. I knew if I headed down those paths I would never survive. I had to find a way that fit my current life and yet would keep my BG in line. My personal history with dieting necessitated this for me.
I used my meter like a mad fool. Testing testing testing. I learned how my body used food. I learned which foods I could eat in great abandon, and which I had to limit. My meter is still a constant companion. When I stop testing I find my control slips. Using my meter keeps me aware and connected to my diabetes. The number I see isn't there to judge me, but to give me valuable information. Information is power.
Now I can walk into any restaurant, party, or other food situation and know what foods will raise my BG and what won't. It's enabled me to travel to Italy for a friends wedding which included three big dinners and many many other "eating" events and survive. It's enabled me to continue eating out many many times a week. And because it's not a DIET, I don't feel like I'm on something, therefore when I do eat a food that may spike my BG, I haven't gone "off"
something, so no guilt.
Giving myself permission to eat when I feel hungry, is a big difference from every diet I've ever been on. Where I netted out is that if I had to add them up I'd say I eat between 80g - 150g of carbs a day. Spaced out over 3 meals and 2 - 3 snacks. I have found that I can handle about 30g of carbs at any one "eating moment".
You may have noticed that I haven't mentioned exercise. I am a firm believer that exercise is vital to all bodies. Thin, fat, diabetic, not... I am a believer, but I have a hard time putting into practice what I believe ; ) It is my achilles heel. I feel so much better when I get regular movement, but can always find a "reason" to put it off. Since this is a journey that will last a lifetime (a long lifetime I hope)...exercise is something I will continue to work on.
All of this works for me! The answers all lie in an individuals blood glucose testing. Use any method that works. Keep hunting until you find one that does. Between food, exercise, oral meds and insulin, you can strike a balance to acheive numbers you can live with.
And I'm off to start my next 8 years.
Jennifer
Thanks Jennifer, for being there. Alan
It was the single most important thing I read after diagnosis. Jennifer's advice changed my life and I will always be grateful. I now repeat it to every newby I meet who stands still long enough:-)
Today, on a different forum, Jennifer posted the story of her first eight years after diagnosis. Here it is.
From Jennifer.
Eight years ago today I was diagnosed with T2 diabetes. I was very afraid...but fortunately for me I turned to this list and others for a shoulder and advice. And I found all of that and more. I utterly appreciate the patience and help I got in those first months/years, and can't fathom where I would have been without the internet, this list and you people. Truly.
So on my 8th diabetic anniversary I thought I'd look back. Here's my story... long but hopefully interesting. (Some of you may already know most of this, I ask your indulgence).
First a disclaimer. These are just my experiences. I believe with all my heart that each of us will respond to different things. Some folks do just perfectly on an ADA food plan... others find that low carb is the only thing that keeps their BG stable. The only way to know what works for you is to test, try, test, try. The idea of one size fits all NEVER works... in pantyhose or in health. ;-)
Now you should know, I am a decorated veteran of the diet wars... until age 36 when I decided never to diet again. I worked very hard at accepting my body and my life and I was finally able to let go of all that wasted mental energy I spent worrying and obsessing about diets and fat. It was wonderful.
So at 40, when I was dx'd with DM. I was petrified... I just knew I would walk into the doctors office and they'd take one look and say, "Well, just lose weight". And I would try and I would fail. As I had on every diet known to man since the beginning of time. But this time failure would mean blindness, amputation and other horrible complications, not just a bigger dress.
I immediately dove into the internet searching for any shred of hope. Everything I read said that carbohydrates raised your glucose levels. Atkins was not yet the total fad (that would happen a year or two later)... but there were a few books out and I read them all.
I started out with a very low carb approach. I didn't use any one plan, but read a number of books and took something from each of them. Including Protein Power, Dr. Bernstein and Atkins. At first I just (just! as though it was a snap... it wasn't!) cut out all "classic" carbs... bread, rice, pasta, cereal, sugar, beans, corn, potato, fruit etc. My BG dropped dramatically and quickly.
My A1c at dx 6/99 was 15.3
By 7/99 it was 8.5
By 9/99 it was 6.6
By 12/99 it was 4.9
I hovered in the 4's for awhile, but then chose to add back in some high fiber - non-white carbs and I've been in the 5's ever since. (with a small detour upward due to some urological problems)
Interestingly, I found something else occurred as well. I found an amazing correlation for me with regards to low carb and cravings and binges. I've spent my whole life fighting cravings and bingeing. I could eat a pound of pasta (with the "regulation" fat free sauce) and an hour later be standing in the kitchen in front of the fridge, starving. Needing to eat something, anything. Unable to stop thinking about food.
I grew up believing it was me. Something was wrong with me. I must have low self esteem or I was eating to fill up an "emotional hole". However, none of the rest of my life supported those theories. I was happy... except with my eating and my size. The low carb approach worked very well controlling my diabetes, But more amazing to me was that those almost daily crave attacks disappeared completely. Entirely. And so far they have never returned.
I must believe that for me, has to be some sort of metabolic disorder. Some kind of carbohydrate malfunction within me. It was the first time in my 40 years that I had not had these cravings. It's been wonderful. If they discovered a "cure" tomorrow for diabetes I would still eat this way.
After six months or so of very low carb, I used my meter to help add in other carbs at specific meals. I found, through testing, that I could eat a piece of whole wheat toast at breakfast with no appreciable rise in BG... I could eat some corn with a meal... On the downside: Pasta doesn't work for me at anytime... (until I found Dreamfields) Neither does rice.
I don't count carbs... I don't count calories... I don't count fat or protein grams. I eat whenever I'm hungry, I just restrict my carbs. I think the reason I've been able to maintain good BG numbers is because I didn't go on any one eating plan. I read many many books and took information from each. I was not going to sit down and write out a food plan for the week. That was too diet-like. I was not going to count anything, not portions, not calories, not anything. That was too diet-like. I wasn't going to weigh anything, not me or my food. That was too diet-like. I knew if I headed down those paths I would never survive. I had to find a way that fit my current life and yet would keep my BG in line. My personal history with dieting necessitated this for me.
I used my meter like a mad fool. Testing testing testing. I learned how my body used food. I learned which foods I could eat in great abandon, and which I had to limit. My meter is still a constant companion. When I stop testing I find my control slips. Using my meter keeps me aware and connected to my diabetes. The number I see isn't there to judge me, but to give me valuable information. Information is power.
Now I can walk into any restaurant, party, or other food situation and know what foods will raise my BG and what won't. It's enabled me to travel to Italy for a friends wedding which included three big dinners and many many other "eating" events and survive. It's enabled me to continue eating out many many times a week. And because it's not a DIET, I don't feel like I'm on something, therefore when I do eat a food that may spike my BG, I haven't gone "off"
something, so no guilt.
Giving myself permission to eat when I feel hungry, is a big difference from every diet I've ever been on. Where I netted out is that if I had to add them up I'd say I eat between 80g - 150g of carbs a day. Spaced out over 3 meals and 2 - 3 snacks. I have found that I can handle about 30g of carbs at any one "eating moment".
You may have noticed that I haven't mentioned exercise. I am a firm believer that exercise is vital to all bodies. Thin, fat, diabetic, not... I am a believer, but I have a hard time putting into practice what I believe ; ) It is my achilles heel. I feel so much better when I get regular movement, but can always find a "reason" to put it off. Since this is a journey that will last a lifetime (a long lifetime I hope)...exercise is something I will continue to work on.
All of this works for me! The answers all lie in an individuals blood glucose testing. Use any method that works. Keep hunting until you find one that does. Between food, exercise, oral meds and insulin, you can strike a balance to acheive numbers you can live with.
And I'm off to start my next 8 years.
Jennifer
Thanks Jennifer, for being there. Alan
Thursday, May 17, 2007
Useful Info
An index page for posts on a variety of miscellaneous topics.
Test, Test, Test
Teeth, Gums, Diabetes and Death
Cooking as a Survival Skill
Red, Red Wine
Millimoles and Milligrams
The Other Side of the Revolution
Eating Out
The Price of Eating Healthy
Analysis of a Day's Meals
Travelling With Type 2
I Ate Nothing! Why Are My BGs high?
Swine Flu, Diabetes and Good Sense
Test, Test, Test
Teeth, Gums, Diabetes and Death
Cooking as a Survival Skill
Red, Red Wine
Millimoles and Milligrams
The Other Side of the Revolution
Eating Out
The Price of Eating Healthy
Analysis of a Day's Meals
Travelling With Type 2
I Ate Nothing! Why Are My BGs high?
Swine Flu, Diabetes and Good Sense
Breakfast Stew, Low Carb
I make this up every few weeks and use the results for breakfast once or twice a week.
All measurements are approximate; it's one of those "make it up as you go along" type of dishes. The main thing is to not add too many high-carb veges to it - no spuds for example. Carrots are OK for me, but they do spike some people, so adjust to suit yourself. Replace with something like cabbage or capsicum - or any vege you like in season. It's a sort of combined vege stew and beef burgundy.
Ingredients
1.5-2kg (3.5-4lbs) approx of stewing beef - or any red meat.
2 cups celery, chopped
2 large carrots, sliced
one medium/large onion, chopped
4 cloves garlic, minced or crushed
1 rasher back bacon, chopped (about 4 American strips)
Chopped herbs to your taste; I use basil, mint and thyme.
Method
Fry the onions, garlic and chopped bacon in a little olive oil until the onion is starting to lightly brown; add the celery, carrots and herbs and stirfry over high heat until the veges have started to "sweat" but aren't fully cooked. Transfer to a bowl temporarily.
Trim the beef carefully of fat and gristle and cut into smallish cubes of 1-2cm, or 1/2"-3/4".
Fry the meat on high heat in a little olive oil in the same pan in small batches until they are sealed and brown but not cooked. Transfer to an appropriate sized casserole container for your oven. Don't do too much at once or they will release too much liquid and not brown correctly.
When all the meat has been fried and is in the casserole container, deglaze the pan with a cup or two of dry red wine. Sprinkle a teaspoon of guar gum over the reserved veges and mix together to spread it, then add to the casserole dish and mix with the meat. Add sufficient stock (or water and stock cubes) to the wine so that the result will be just enough to cover the mixture of meat and veg, bring to the boil, then pour into the mix and stir. Press down the mixture with a large spoon so that the liquid just covers the meat and veg.
Cook in a 140-160C (285-320F) oven for about 90 minutes (longer if it's a really cheap cut of meat) and leave it in the oven another 20 minutes after you turn off the heat. About half-way through, season with salt and pepper to your taste.
I also add a few sliced mushrooms to the mix sometimes.
Let it cool in the fridge overnight. Put 7-10 small individual serves in plastic containers in the freezer. When you want a quick no-fuss breakfast decant it into a bowl, zap it in the microwave while making your coffee or having your shower - and presto - breakfast.
Based on those ingredients and 8 serves, this is an approximate nutrition breakdown:
Calories________400__cal
Protein________38__gm
Total Fat_______20__gm
__Sat. Fat______9__gm
__Mono. Fat____10__gm
__Poly. Fat______1__gm
Carbohydrate____6__gm
__Fiber________2__gm
Sodium_______250__mg
Cholesterol_____125__mg
Cheers, Alan
All measurements are approximate; it's one of those "make it up as you go along" type of dishes. The main thing is to not add too many high-carb veges to it - no spuds for example. Carrots are OK for me, but they do spike some people, so adjust to suit yourself. Replace with something like cabbage or capsicum - or any vege you like in season. It's a sort of combined vege stew and beef burgundy.
Ingredients
1.5-2kg (3.5-4lbs) approx of stewing beef - or any red meat.
2 cups celery, chopped
2 large carrots, sliced
one medium/large onion, chopped
4 cloves garlic, minced or crushed
1 rasher back bacon, chopped (about 4 American strips)
Chopped herbs to your taste; I use basil, mint and thyme.
Method
Fry the onions, garlic and chopped bacon in a little olive oil until the onion is starting to lightly brown; add the celery, carrots and herbs and stirfry over high heat until the veges have started to "sweat" but aren't fully cooked. Transfer to a bowl temporarily.
Trim the beef carefully of fat and gristle and cut into smallish cubes of 1-2cm, or 1/2"-3/4".
Fry the meat on high heat in a little olive oil in the same pan in small batches until they are sealed and brown but not cooked. Transfer to an appropriate sized casserole container for your oven. Don't do too much at once or they will release too much liquid and not brown correctly.
When all the meat has been fried and is in the casserole container, deglaze the pan with a cup or two of dry red wine. Sprinkle a teaspoon of guar gum over the reserved veges and mix together to spread it, then add to the casserole dish and mix with the meat. Add sufficient stock (or water and stock cubes) to the wine so that the result will be just enough to cover the mixture of meat and veg, bring to the boil, then pour into the mix and stir. Press down the mixture with a large spoon so that the liquid just covers the meat and veg.
Cook in a 140-160C (285-320F) oven for about 90 minutes (longer if it's a really cheap cut of meat) and leave it in the oven another 20 minutes after you turn off the heat. About half-way through, season with salt and pepper to your taste.
I also add a few sliced mushrooms to the mix sometimes.
Let it cool in the fridge overnight. Put 7-10 small individual serves in plastic containers in the freezer. When you want a quick no-fuss breakfast decant it into a bowl, zap it in the microwave while making your coffee or having your shower - and presto - breakfast.
Based on those ingredients and 8 serves, this is an approximate nutrition breakdown:
Calories________400__cal
Protein________38__gm
Total Fat_______20__gm
__Sat. Fat______9__gm
__Mono. Fat____10__gm
__Poly. Fat______1__gm
Carbohydrate____6__gm
__Fiber________2__gm
Sodium_______250__mg
Cholesterol_____125__mg
Cheers, Alan
Saturday, April 28, 2007
Millimoles and Milligrams
I live in a country that uses mmol/L (mmol per litre) as the units for measurement of blood glucose and cholesterol levels, the most common lab numbers used for diabetes management. Most of the world uses that system – but the USA does not. The USA and several other countries use mg/dl (milligrams per decilitre). I havent the faintest idea why, but it can be very useful to be able to convert from one to the other.
My source for the conversion numbers is GlobalRPh.com.
Cholesterol
To convert from mmol/L to mg/dl for Cholesterol (total, LDL, HDL, VLDL) divide by 0.0259 or multiply by 38.6.
For Triglycerides divide by 0.0113 or multiply by 88.5.
Lipids ratios are mentioned in several papers discussing their relevance to cardiac risk and insulin resistance; remember to use conversions before applying US numbers. For example, based on those papers the triglycerides/HDL ratio should be under 1.3 for mmol/L and under 3.0 for mg/dl.
Blood Glucose
The conversion rate can be done either by multiplying by 18 (so 5.5 mmol becomes 99, but I usually round to the nearest 5, so 5.5 => 100) or divide by .0555 if you want to get totally accurate. The exact multiplier is 18.018. When accuracy is not critical, using a multiplier of 20 can be quick and useful.
Finally, a quick ready reckoner to convert blood glucose meter readings:
mg/dl mmol/L
100.........5.6
105.........5.8
110.........6.1
115.........6.4
120.........6.7
125.........6.9
130.........7.2
135.........7.5
140.........7.8
145.........8.0
150.........8.3
155.........8.6
160.........8.9
165.........9.2
170.........9.4
175.........9.7
180.......10.0
185.......10.3
190.......10.5
195.......10.8
200.......11.1
250.......13.9
300.......16.7
400.......22.2
500.......27.8
Cheers, Alan
My source for the conversion numbers is GlobalRPh.com.
Cholesterol
To convert from mmol/L to mg/dl for Cholesterol (total, LDL, HDL, VLDL) divide by 0.0259 or multiply by 38.6.
For Triglycerides divide by 0.0113 or multiply by 88.5.
Lipids ratios are mentioned in several papers discussing their relevance to cardiac risk and insulin resistance; remember to use conversions before applying US numbers. For example, based on those papers the triglycerides/HDL ratio should be under 1.3 for mmol/L and under 3.0 for mg/dl.
Blood Glucose
The conversion rate can be done either by multiplying by 18 (so 5.5 mmol becomes 99, but I usually round to the nearest 5, so 5.5 => 100) or divide by .0555 if you want to get totally accurate. The exact multiplier is 18.018. When accuracy is not critical, using a multiplier of 20 can be quick and useful.
Finally, a quick ready reckoner to convert blood glucose meter readings:
mg/dl mmol/L
100.........5.6
105.........5.8
110.........6.1
115.........6.4
120.........6.7
125.........6.9
130.........7.2
135.........7.5
140.........7.8
145.........8.0
150.........8.3
155.........8.6
160.........8.9
165.........9.2
170.........9.4
175.........9.7
180.......10.0
185.......10.3
190.......10.5
195.......10.8
200.......11.1
250.......13.9
300.......16.7
400.......22.2
500.......27.8
Cheers, Alan
Tuesday, April 24, 2007
Wine and Serendipity
I added a PS to my entry on Red, Red Wine today. Sometimes things have totally unforeseen side benefits:-)
I also have CLL, a type of leukemia. Nothing to do with diabetes. But, after I made the changes I mention in this blog, something odd happened. Purely serendipity according to my haemotologists, and maybe it will change tomorrow and Damocles Sword will drop. My CLL numbers improved as my diet and fitness changed and as my diabetes numbers improved.
I became aware of this report today: http://www.physorg.com/news96550822.html
“Antioxidant found in many foods and red wine is potent and selective killer of leukemia cells
A naturally occurring compound found in many fruits and vegetables as well as red wine, selectively kills leukemia cells in culture while showing no discernible toxicity against healthy cells, according to a study by researchers at the University of Pittsburgh School of Medicine.”
I believe that this is the original study:
http://www.jbc.org/cgi/reprint/M610616200v2
CYANIDIN-3-RUTINOSIDE, A NATURAL POLYPHENOL ANTIOXIDANT, SELECTIVELY KILLS LEUKEMIC CELLS BY INDUCTION OF OXIDATIVE STRESS
“These results indicate that cyanidin-3-rutinoside have the promising potential to be used in leukemia therapy with the advantages of being wildly available and being selective against tumors.”
Not just wine, also vegetables. Just serendipity - but the haemotologists tell me to keep doing what I'm doing.
Cheers, Alan
I also have CLL, a type of leukemia. Nothing to do with diabetes. But, after I made the changes I mention in this blog, something odd happened. Purely serendipity according to my haemotologists, and maybe it will change tomorrow and Damocles Sword will drop. My CLL numbers improved as my diet and fitness changed and as my diabetes numbers improved.
I became aware of this report today: http://www.physorg.com/news96550822.html
“Antioxidant found in many foods and red wine is potent and selective killer of leukemia cells
A naturally occurring compound found in many fruits and vegetables as well as red wine, selectively kills leukemia cells in culture while showing no discernible toxicity against healthy cells, according to a study by researchers at the University of Pittsburgh School of Medicine.”
I believe that this is the original study:
http://www.jbc.org/cgi/reprint/M610616200v2
CYANIDIN-3-RUTINOSIDE, A NATURAL POLYPHENOL ANTIOXIDANT, SELECTIVELY KILLS LEUKEMIC CELLS BY INDUCTION OF OXIDATIVE STRESS
“These results indicate that cyanidin-3-rutinoside have the promising potential to be used in leukemia therapy with the advantages of being wildly available and being selective against tumors.”
Not just wine, also vegetables. Just serendipity - but the haemotologists tell me to keep doing what I'm doing.
Cheers, Alan
Friday, April 20, 2007
Testing on a Budget
I'm very lucky to be in a country where diabetics in the past have successfully lobbied for specific support within the government health system to assist good diabetes control. I'm eternally grateful for the pioneers who created Australian medicare and the NDSS.
However, I'm daily reminded that others overseas are not so fortunate. Consequently, some have difficulty following the full Test, Test, Test regimen as Jennifer suggests because of strip cost.
For them, I suggest a "one strip a day" method. This works more slowly than following Jennifer's advice completely - but it can still work. When I say "one strip a day" I'm not counting the FBG or other tests the doctor wants - discuss with the doc if you can cut back there. In hard economic circumstances I can't see that doing FBG every second or even third day is going to be a problem for the doc - but check to be sure. Let's face it, the "average" type 2 out there is testing FBG maybe once per week, doing absolutely nothing with the result, and wondering why their A1c goes up every 3-6 months.
This other daily test strip is purely to let YOU know what's happening when you eat.
First, it will take a few extra BG tests for two or three days to discover when your peak timing is. Once you know that for each meal, you can focus on that timing. Some reckon you also need to test before meals to see what the rise was; in these circumstances I would see the pre-meal test as a waste of a strip. Just concentrate on the absolute peak level. Target one meal per week. Most of us have problems with breakfast, so I'd recommend starting there.
Test at the peak spike time, just for breakfast, until you have modified your breakfast to the point where the spikes are acceptable to you. I use Jennifer's guidelines, which are similar to the AACE, but check with your doctor if in doubt. Concentrate on that meal for one week, by that time you should have something workable. I've given some alternative breakfast ideas here, but think outside the square and find what works for you. There is no law that decrees cereal, juice, milk or toast before noon. I just finished a kransky sausage with one dry-fried egg before typing this (it's 7:40am here:-) That will be followed with black, cinnamon-infused coffee.
Then concentrate on Lunch for week two, Dinner for week three and so on. Then repeat over the next three weeks. Over time you will find a range of foods that are OK - and a range of foods that aren't - and slowly build a safe menu base.
Cheers, Alan
However, I'm daily reminded that others overseas are not so fortunate. Consequently, some have difficulty following the full Test, Test, Test regimen as Jennifer suggests because of strip cost.
For them, I suggest a "one strip a day" method. This works more slowly than following Jennifer's advice completely - but it can still work. When I say "one strip a day" I'm not counting the FBG or other tests the doctor wants - discuss with the doc if you can cut back there. In hard economic circumstances I can't see that doing FBG every second or even third day is going to be a problem for the doc - but check to be sure. Let's face it, the "average" type 2 out there is testing FBG maybe once per week, doing absolutely nothing with the result, and wondering why their A1c goes up every 3-6 months.
This other daily test strip is purely to let YOU know what's happening when you eat.
First, it will take a few extra BG tests for two or three days to discover when your peak timing is. Once you know that for each meal, you can focus on that timing. Some reckon you also need to test before meals to see what the rise was; in these circumstances I would see the pre-meal test as a waste of a strip. Just concentrate on the absolute peak level. Target one meal per week. Most of us have problems with breakfast, so I'd recommend starting there.
Test at the peak spike time, just for breakfast, until you have modified your breakfast to the point where the spikes are acceptable to you. I use Jennifer's guidelines, which are similar to the AACE, but check with your doctor if in doubt. Concentrate on that meal for one week, by that time you should have something workable. I've given some alternative breakfast ideas here, but think outside the square and find what works for you. There is no law that decrees cereal, juice, milk or toast before noon. I just finished a kransky sausage with one dry-fried egg before typing this (it's 7:40am here:-) That will be followed with black, cinnamon-infused coffee.
Then concentrate on Lunch for week two, Dinner for week three and so on. Then repeat over the next three weeks. Over time you will find a range of foods that are OK - and a range of foods that aren't - and slowly build a safe menu base.
Cheers, Alan
Saturday, April 14, 2007
Dieting for Life - What's in a Name?
Hi All
Well, the news is out, here is the headline: Dieting Does Not Work! The scientists are sure of it. It mystifies me that research dollars needed to be spent to discover that. All they needed to do was ask me.
Part of the problem is the definition of that word: "dieting". It's fascinating how a word can change in meaning. A diet used to be just the description of what you eat. You can see the gradual change in the progression of Webster's definitions:
Diet
a : food and drink regularly provided or consumed
b : habitual nourishment
c : the kind and amount of food prescribed for a person or animal for a special reason
d : a regimen of eating and drinking sparingly so as to reduce one's weight
Dieting as described in "a" or "b", to regularly or habitually consume food and drink, obviously does work or we'd all starve to death. So in that sense the sensational headline is wrong. But slowly we've come to think of dieting as definition "d" and eating "sparingly" doesn't work because it is unnatural for the human animal to do that as a way of life forever.
I think "way of eating" is a better term for how I intend to eat for the rest of my life, not just to achieve a short-term goal. I think I first saw it used by Bernstein in his book on diabetes. I slowly changed my way of eating continuously since diagnosis; first to lose weight, then to minimise BG spikes, then to ensure that I was getting the best nutrition possible without gaining back the weight or jeopardising blood glucose control.
But to be sustainable, the way of eating has to not only satisfy nutritional needs but our other social and psychological needs: to be able to eat in company comfortably; to be able to munch absently on something while we think; to have "comfort food" occasionally without guilt. The only way to achieve that is to train oneself over time to the point where we like what is appropriate for our needs and no longer crave what is inappropriate. That does not happen overnight and may never happen for some - but, in my opinion, it is the only way to change a way of eating permanently.
I'm only part of the way there myself. But it's amazing what I learnt to like, and dislike, once I accepted that my life does depend on it. Just as an example, I now look on something like mud-cake in the same way that someone with a sea-food allergy would look on lobster. Not that I think it's bad food - just bad for me. So I no longer want it and I don't feel deprived at all. As Jennifer puts it - it's not that I can't have it, it's that I don't want it.
Mind games? Maybe; but possibly life-saving mind-games if you can learn to play them over time.
Cheers, Alan
Well, the news is out, here is the headline: Dieting Does Not Work! The scientists are sure of it. It mystifies me that research dollars needed to be spent to discover that. All they needed to do was ask me.
Part of the problem is the definition of that word: "dieting". It's fascinating how a word can change in meaning. A diet used to be just the description of what you eat. You can see the gradual change in the progression of Webster's definitions:
Diet
a : food and drink regularly provided or consumed
b : habitual nourishment
c : the kind and amount of food prescribed for a person or animal for a special reason
d : a regimen of eating and drinking sparingly so as to reduce one's weight
Dieting as described in "a" or "b", to regularly or habitually consume food and drink, obviously does work or we'd all starve to death. So in that sense the sensational headline is wrong. But slowly we've come to think of dieting as definition "d" and eating "sparingly" doesn't work because it is unnatural for the human animal to do that as a way of life forever.
I think "way of eating" is a better term for how I intend to eat for the rest of my life, not just to achieve a short-term goal. I think I first saw it used by Bernstein in his book on diabetes. I slowly changed my way of eating continuously since diagnosis; first to lose weight, then to minimise BG spikes, then to ensure that I was getting the best nutrition possible without gaining back the weight or jeopardising blood glucose control.
But to be sustainable, the way of eating has to not only satisfy nutritional needs but our other social and psychological needs: to be able to eat in company comfortably; to be able to munch absently on something while we think; to have "comfort food" occasionally without guilt. The only way to achieve that is to train oneself over time to the point where we like what is appropriate for our needs and no longer crave what is inappropriate. That does not happen overnight and may never happen for some - but, in my opinion, it is the only way to change a way of eating permanently.
I'm only part of the way there myself. But it's amazing what I learnt to like, and dislike, once I accepted that my life does depend on it. Just as an example, I now look on something like mud-cake in the same way that someone with a sea-food allergy would look on lobster. Not that I think it's bad food - just bad for me. So I no longer want it and I don't feel deprived at all. As Jennifer puts it - it's not that I can't have it, it's that I don't want it.
Mind games? Maybe; but possibly life-saving mind-games if you can learn to play them over time.
Cheers, Alan
Saturday, March 24, 2007
Chili Crab
I developed this after I ate a wonderful Chili Crab in an apartment block cafeteria in Singapore on the way home in 2003 from our first trip. I kept experimenting until I came up with something with a similar flavour - but without the sugar.
Sauce:
½ cup water
½ cup ketchup (I use Napoli Sauce ) or 1/4 cup tomato paste
2 tbsp soy sauce
1 tsp chili flakes or 1 small chopped chili (adjust to taste)
1 tbsp vinegar
1 tbsp splenda
Cooking:
About 1 kg of live crab (2-3 lbs) or half that weight dressed.
1 tbsp of peanut or olive oil
2 or 3 cloves of garlic, minced
grated ginger to taste
1 chopped hot chili to taste
1 sliced medium onion
1 tsp cornflour (cornstarch) or a little guar gum as a carb-free alternative.
¼ cup water
Pre-cook the crab in boiling water. Divide the crab into appropriate portions, cracking legs and claws with the back of a heavy knife and set aside.
Mix sauce ingredients, set aside.
Heat the oil in a wok or heavy pan and stir-fry the onion and chili. Add ginger and garlic, fry briefly. I often add some chopped celery or carrots or greens at this stage as a variation.
Add the crab and stir-fry for two minutes then add the sauce and stir while heating for another five minutes or until crab is heated through.
Mix cornflour and water and add to the pan. If you are using guar gum you will need a little practice to get the quantity right for consistency; if in doubt start with too little. Cook and stir until the sauce is set and ready to serve.
Serve as is or with basmati rice if carbs are OK. Supply damp towels for diners - they will need them. This is not a dish to serve to a food snob who won't use their fingers.
You can separate the crab-meat out before cooking; but in that case make sure you still put some of the shell into the wok when stir-frying for the flavour that infuses into the sauce. Then you can remove the shell before serving for the more "genteel" diners.
Bon Appetit.
Cheers, Alan
Sauce:
½ cup water
½ cup ketchup (I use Napoli Sauce ) or 1/4 cup tomato paste
2 tbsp soy sauce
1 tsp chili flakes or 1 small chopped chili (adjust to taste)
1 tbsp vinegar
1 tbsp splenda
Cooking:
About 1 kg of live crab (2-3 lbs) or half that weight dressed.
1 tbsp of peanut or olive oil
2 or 3 cloves of garlic, minced
grated ginger to taste
1 chopped hot chili to taste
1 sliced medium onion
1 tsp cornflour (cornstarch) or a little guar gum as a carb-free alternative.
¼ cup water
Pre-cook the crab in boiling water. Divide the crab into appropriate portions, cracking legs and claws with the back of a heavy knife and set aside.
Mix sauce ingredients, set aside.
Heat the oil in a wok or heavy pan and stir-fry the onion and chili. Add ginger and garlic, fry briefly. I often add some chopped celery or carrots or greens at this stage as a variation.
Add the crab and stir-fry for two minutes then add the sauce and stir while heating for another five minutes or until crab is heated through.
Mix cornflour and water and add to the pan. If you are using guar gum you will need a little practice to get the quantity right for consistency; if in doubt start with too little. Cook and stir until the sauce is set and ready to serve.
Serve as is or with basmati rice if carbs are OK. Supply damp towels for diners - they will need them. This is not a dish to serve to a food snob who won't use their fingers.
You can separate the crab-meat out before cooking; but in that case make sure you still put some of the shell into the wok when stir-frying for the flavour that infuses into the sauce. Then you can remove the shell before serving for the more "genteel" diners.
Bon Appetit.
Cheers, Alan
Tuesday, March 20, 2007
Lasagna
Don't let the name scare you off. The blood glucose effect depends on serve size. Eat a little less, add some salad.
Originally on the back of a "Zafarelli" pack, modified somewhat. You'll need a lightly oiled lasagna baking dish, approximately 325x225x50 mm or 13" x 9" x 2".
INGREDIENTS
Basic
250 gm ( ½ lb) of lasagna sheets. Most no longer need pre-cooking, but check the label just in case.
250 to 300 gms ( ½ to ¾ lb) grated mozzarella cheese.
Grated parmesan cheese.
Meat Sauce:
2 to 3 tablespoons Olive oil
2 chopped medium onions
125 gm ( ¼ lb) roughly chopped bacon or ham
250 to 300 gms ( ½ to ¾ lb) of minced (ground) beef
1 cup water
3 cloves garlic, minced
2 x 400 gm (14 oz) undrained cans of chopped peeled tomatoes, or equivalent in ripe fresh tomatoes
¼ cup tomato paste
salt, pepper to taste
1 teaspoon chopped dried basil, 1 teaspoon oregano or chopped fresh equivalent to taste.
Bechamel Sauce:
2 tablespoons olive oil
2 tablespoons plain flour
600 mls (1 pint) milk
½ teaspoon of grated nutmeg
salt, pepper to taste
METHOD
Meat Sauce
In a large saucepan gently fry the chopped onion and bacon in a little olive oil until the onion is translucent and the bacon is cooked. Add the minced beef and stir over moderate heat until it has browned and separated. Add chopped garlic and gently cook until it is browned and incorporated. Add the water and chopped tomatoes with their juice and bring to a slow simmer. Then add herbs and seasoning to taste. Simmer for 30 - 40 minutes, stirring occasionally. Add just a little water if it starts to get too thick. Add the tomato paste and simmer while preparing the bechamel sauce, stirring occasionally.
Bechamel Sauce
Stir the flour and oil together over low heat. Increase the heat slightly being careful not to let it burn and continue stirring while gradually adding milk. Add the nutmeg and seasoning, continuing to stir until the sauce is smooth and thick but spreadable, adjusting slightly with more milk or flour as appropriate.
Assembly
Spread a thin layer of the meat sauce over the base of the lasagna dish and cover with one layer of lasagna. Then spread about 1/3 of the remaining meat sauce, followed by 1/3 of the bechamel sauce, and 1/3 of the mozzarella. Repeat the lasagna/meat/bechamel/cheese process until you have three layers or run out of sheets or sauces. And remember it doesn't have to be perfect. Liberally sprinkle the final cheese layer with grated parmesan.
Cooking
Bake in a moderate (180 C, 360 F) oven for about 40 minutes or until cooked when tested with a skewer. If the top browns too quickly, loosely cover with aluminium foil. Let stand for 10 - 15 minutes before serving. I cut it into 12 serves; non dieters/diabetics usually make it 6 or 8.
Serve it with a side green salad. I freeze individual serves in plastic containers for later use. When re-heating, add a little water or chopped tomatoes and sprinkle some fresh cheese on the top.
Calories per serve: 350
Protein..............15gms
Total fat............21gms
Carbs................25gms (more than I thought when I worked it out - it's the milk and tomatos) Fibre.................1gm
Bon Appetit
Cheers, Alan
Originally on the back of a "Zafarelli" pack, modified somewhat. You'll need a lightly oiled lasagna baking dish, approximately 325x225x50 mm or 13" x 9" x 2".
INGREDIENTS
Basic
250 gm ( ½ lb) of lasagna sheets. Most no longer need pre-cooking, but check the label just in case.
250 to 300 gms ( ½ to ¾ lb) grated mozzarella cheese.
Grated parmesan cheese.
Meat Sauce:
2 to 3 tablespoons Olive oil
2 chopped medium onions
125 gm ( ¼ lb) roughly chopped bacon or ham
250 to 300 gms ( ½ to ¾ lb) of minced (ground) beef
1 cup water
3 cloves garlic, minced
2 x 400 gm (14 oz) undrained cans of chopped peeled tomatoes, or equivalent in ripe fresh tomatoes
¼ cup tomato paste
salt, pepper to taste
1 teaspoon chopped dried basil, 1 teaspoon oregano or chopped fresh equivalent to taste.
Bechamel Sauce:
2 tablespoons olive oil
2 tablespoons plain flour
600 mls (1 pint) milk
½ teaspoon of grated nutmeg
salt, pepper to taste
METHOD
Meat Sauce
In a large saucepan gently fry the chopped onion and bacon in a little olive oil until the onion is translucent and the bacon is cooked. Add the minced beef and stir over moderate heat until it has browned and separated. Add chopped garlic and gently cook until it is browned and incorporated. Add the water and chopped tomatoes with their juice and bring to a slow simmer. Then add herbs and seasoning to taste. Simmer for 30 - 40 minutes, stirring occasionally. Add just a little water if it starts to get too thick. Add the tomato paste and simmer while preparing the bechamel sauce, stirring occasionally.
Bechamel Sauce
Stir the flour and oil together over low heat. Increase the heat slightly being careful not to let it burn and continue stirring while gradually adding milk. Add the nutmeg and seasoning, continuing to stir until the sauce is smooth and thick but spreadable, adjusting slightly with more milk or flour as appropriate.
Assembly
Spread a thin layer of the meat sauce over the base of the lasagna dish and cover with one layer of lasagna. Then spread about 1/3 of the remaining meat sauce, followed by 1/3 of the bechamel sauce, and 1/3 of the mozzarella. Repeat the lasagna/meat/bechamel/cheese process until you have three layers or run out of sheets or sauces. And remember it doesn't have to be perfect. Liberally sprinkle the final cheese layer with grated parmesan.
Cooking
Bake in a moderate (180 C, 360 F) oven for about 40 minutes or until cooked when tested with a skewer. If the top browns too quickly, loosely cover with aluminium foil. Let stand for 10 - 15 minutes before serving. I cut it into 12 serves; non dieters/diabetics usually make it 6 or 8.
Serve it with a side green salad. I freeze individual serves in plastic containers for later use. When re-heating, add a little water or chopped tomatoes and sprinkle some fresh cheese on the top.
Calories per serve: 350
Protein..............15gms
Total fat............21gms
Carbs................25gms (more than I thought when I worked it out - it's the milk and tomatos) Fibre.................1gm
Bon Appetit
Cheers, Alan
Thursday, March 15, 2007
Red, Red Wine
I am a believer in the value of a modest intake of alcohol in the form of red wine.
Some people cannot drink alcohol because they have addiction or other medical/ideological reasons for abstinence. For the rest of us the evidence is becoming fairly clear that a moderate regular intake of alcohol is beneficial, particularly for type 2 diabetics. The benefits appear to be enhanced if the alcohol of choice is dry red wine.
At the foot of this post I have given a brief sample of a search on HighWire using the following terms: "red wine" diabetes "type 2". Even I was surprised at the result, particularly with the findings of more recent research. So I've included the links for those who are interested, as well as some excerpts from some selected papers. (2019 note. The highwire search no longer works. Try a Scholar search on all words: "red wine" "type 2" diabetes)
I usually drink dry red wine. I have found that many people don’t understand the term "dry". It simply means "not sweet". Fortified wines such as port, or dessert wines such as sherry or tokay, or sweet fruity wines such as lambrusco or most white wines, aren’t suitable for me because the sugars in them raise my blood glucose. The only white wines I can drink are the very dry Sauvignons Blanc or Chablis styles.
In essence I drink dry red wine for the following reasons:
1. I like it. That’s important. If you don't like wine, don't start. I shudder at the thought of having to "take it as a medicine".
2. It appears to assist in blood glucose control when taken with meals.
3. It appears to improve my cardiovascular health, based on my own lab reports since I added it to my menu after diagnosis.
4. Red wines include some specific benefits over other alcoholic drinks and white wines because of their unique resveratrols and flavinoids.
The studies I’ve included in the links below tend to support the possibility that I’m not unique in seeing those benefits.
Any proposed changes in your alcohol consumption should be discussed with your doctor first. There may be other reasons for abstinence, apart from addiction, that your doctor is aware of. However, don’t automatically accept warnings against alcohol on medication packets - metformin is just one example – discuss those with your doctor to see if it applies in your individual situation.
The various studies aren't in agreement on "moderation". The definition appears to lie between one and three "standard" glasses daily for a male and half that for a female; personally I imbibe about a half-bottle of dry red daily which equates to 300-400ml. If in doubt your doctor will advise on that.
Cheers Alan, T2, Australia.
A PS, added 24th April '07.
I also have CLL, a type of leukemia. I became aware of this report today:
http://www.physorg.com/news96550822.html
“Antioxidant found in many foods and red wine is potent and selective killer of leukemia cells
A naturally occurring compound found in many fruits and vegetables as well as red wine, selectively kills leukemia cells in culture while showing no discernible toxicity against healthy cells, according to a study by researchers at the University of Pittsburgh School of Medicine.”
I believe that this is the original study:
http://www.jbc.org/cgi/reprint/M610616200v2
CYANIDIN-3-RUTINOSIDE, A NATURAL POLYPHENOL ANTIOXIDANT, SELECTIVELY KILLS LEUKEMIC CELLS BY INDUCTION OF OXIDATIVE STRESS
“These results indicate that cyanidin-3-rutinoside have the promising potential to be used in leukemia therapy with the advantages of being wildly available and being selective against tumors.”
PPS, added 20th March 2013: The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes Mellitus
Further reading:
Links to papers and articles for those who want to read further:
Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
http://tinyurl.com/zpt5m
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that
moderate alcohol intake has a beneficial effect on cardiovascular disease. The purpose of this review is to examine the epidemiological and biological evidence supporting the intake of red wine as a means of reducing atherosclerosis. On the basis of epidemiological studies,
moderate intake of alcoholic beverages, including red wine, reduces the risk of cardiovascular, cerebrovascular, and peripheral vascular disease in populations. In addition to the favorable biological effects of alcohol on the lipid profile, on hemostatic factors, and in reducing insulin
resistance, the phenolic compounds in red wine appear to interfere with the molecular processes underlying the initiation, progression, and rupture of atherosclerotic plaques. Whether red wine is more beneficial than other types of alcohol remains unclear. Definitive data from a
large-scale, randomized clinical end-point trial of red wine intake would be required before physicians can advise patients to use wine as part of preventative or medical
therapies."
*********
Diabetes Care 28:2933-2938, 2005
Alcohol Consumption and Risk of Type 2 Diabetes Among Older Women
http://tinyurl.com/nmo4q
"CONCLUSIONS-Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women."
********
Diabetes Care 27:1369-1374, 2004
Acute Alcohol Consumption Improves Insulin Action Without Affecting Insulin Secretion in Type 2 Diabetic Subjects
http://tinyurl.com/g6wyc
"CONCLUSIONS-Acute alcohol consumption improves insulin action without affecting ß-cell secretion. This effect may be partly due to the inhibitory effect of alcohol on lipolysis. Alcohol intake increases insulin sensitivity and may partly explain both the J-shaped relationship between the prevalence of diabetes and the amount of alcohol consumption and the decreased mortality for myocardial infarction."
*******
The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 2 661-672 doi:10.1210/jc.2004-1511
Beneficial Postprandial Effect of a Small Amount of Alcohol on Diabetes and Cardiovascular Risk Factors: Modification by Insulin Resistance
http://tinyurl.com/jylqx
"Alcohol enhanced the postprandial increase in energy
expenditure 30-60 min after the LC meal (increase, 373 ± 49 vs. 236 ± 32 kcal/d; P = 0.02) and HC meal (increase, 362 ± 36 vs. 205 ± 34 kcal/d; P = 0.0009), but suppressed fat and
carbohydrate oxidation. Some of our findings may be mechanisms for lower diabetes and cardiovascular risks in moderate drinkers."
**********
Diabetes 50:2390-2395, 2001
A Prospective Study of Drinking Patterns in Relation to Risk of Type 2 Diabetes Among Men
http://tinyurl.com/gjs22
"Using data from a 12-year prospective study, we determined the importance of the pattern of alcohol consumption as a risk factor for type 2 diabetes in a cohort of 46,892 U.S. male health professionals who completed biennial postal questionnaires. Overall, 1,571 new cases of type 2 diabetes were documented. Compared with zero alcohol consumption, consumption of 15-29 g/day of alcohol was associated with a 36% lower risk of diabetes (RR = 0.64; 95% CI 0.53-0.77).
This inverse association between moderate consumption and diabetes remained if light drinkers rather than abstainers were used as the reference group (RR = 0.60, CI 0.50-0.73). There were few heavy drinkers, but the inverse association persisted to those drinking >=50 g/day of alcohol (RR = 0.60, CI 0.43-0.84). Frequency of consumption was inversely associated with diabetes. Consumption of alcohol on at least 5 days/week provided the greatest protection, even when less than one drink per drinking day was consumed (RR = 0.48, CI 0.27-0.86). Compared with infrequent drinkers, for each additional day per week that alcohol was consumed, risk was
reduced by 7% (95% CI 3-10%) after controlling for average daily consumption. There were similar and independent inverse associations for beer, liquor, and white wine. Our findings suggested that frequent alcohol consumption conveys the greatest protection against type 2 diabetes, even if the level of consumption per drinking day is low. Beverage choice did not alter risk."
*******
(Circulation. 2000;102:494.)
Moderate Alcohol Consumption and Risk of Coronary Heart Disease Among Women With Type 2 Diabetes Mellitus
http://tinyurl.com/gwkal
"Conclusions-Although potential risks of alcohol consumption must be considered, these data suggest that moderate alcohol consumption is associated with reduced CHD risk in women with diabetes and should not be routinely discouraged."
********
Diabetes Care, Vol 15, Issue 4 546-548, Copyright (c) 1992 by American Diabetes Association
Short-term effect of red wine (consumed during meals) on insulin requirement and glucose tolerance in diabetic patients
http://tinyurl.com/f6bfk
"CONCLUSIONS--Moderate prandial wine consumption has no adverse effect on the glycemic control of diabetic patients. Thus, it appears unnecessary to proscribe the consumption of
red wine in moderation with meals to diabetic patients. Wine contains tannins and phytates that can explain its action."
********
DIABETES CARE, VOLUME 22, NUMBER 12, DECEMBER 1999 p2084
Meal-Generated Oxidative Stress in Diabetes
The protective effect of red wine
http://care.diabetesjournals.org/cgi/reprint/22/12/2084
"Our data show that red wine is able to preserve plasma from meal-induced oxidative stress in diabetes, suggesting that moderate consumption of red wine during meals may have a beneficial effect in decreasing the risk of cardiovascular disease in diabetic patients."
********
JAMA Vol. 282 No. 3, July 21, 1999
Alcohol Intake and the Risk of Coronary Heart Disease Mortality in Persons With Older-Onset Diabetes Mellitus
http://tinyurl.com/g4x87
"Conclusion. Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes."
*********
"Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
http://tinyurl.com/zpt5m
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that moderate alcohol intake has a beneficial effect on cardiovascular disease."
********
Finally, an interesting one specifically on resveratrol, a red wine component, and the insulin system.
Am J Physiol Endocrinol Metab 290: E1339-E1346, 2006. First
published January 24, 2006; doi:10.1152/ajpendo.00487.2005
Resveratrol, a red wine antioxidant, possesses an insulin-like effect in streptozotocin-induced diabetic rats
http://tinyurl.com/evxtp
"Aberrant energy metabolism is one characteristic of diabetes mellitus (DM). Two types of DM have been identified, type 1 and type 2. Most of type 2 DM patients eventually become insulin dependent because insulin secretion by the islets of Langerhans becomes exhausted. In the present study, we show that resveratrol (3,5,4'-trihydroxylstilbene) possesses hypoglycemic and hypolipidemic effects in streptozotocin-induced DM (STZ-DM) rats."
Note that I prefer to wait for the human trials confirmation - but it is the first time I've seen this effect of resveratrol noted anywhere.
Some people cannot drink alcohol because they have addiction or other medical/ideological reasons for abstinence. For the rest of us the evidence is becoming fairly clear that a moderate regular intake of alcohol is beneficial, particularly for type 2 diabetics. The benefits appear to be enhanced if the alcohol of choice is dry red wine.
At the foot of this post I have given a brief sample of a search on HighWire using the following terms: "red wine" diabetes "type 2". Even I was surprised at the result, particularly with the findings of more recent research. So I've included the links for those who are interested, as well as some excerpts from some selected papers. (2019 note. The highwire search no longer works. Try a Scholar search on all words: "red wine" "type 2" diabetes)
I usually drink dry red wine. I have found that many people don’t understand the term "dry". It simply means "not sweet". Fortified wines such as port, or dessert wines such as sherry or tokay, or sweet fruity wines such as lambrusco or most white wines, aren’t suitable for me because the sugars in them raise my blood glucose. The only white wines I can drink are the very dry Sauvignons Blanc or Chablis styles.
1. I like it. That’s important. If you don't like wine, don't start. I shudder at the thought of having to "take it as a medicine".
2. It appears to assist in blood glucose control when taken with meals.
3. It appears to improve my cardiovascular health, based on my own lab reports since I added it to my menu after diagnosis.
4. Red wines include some specific benefits over other alcoholic drinks and white wines because of their unique resveratrols and flavinoids.
The studies I’ve included in the links below tend to support the possibility that I’m not unique in seeing those benefits.
Any proposed changes in your alcohol consumption should be discussed with your doctor first. There may be other reasons for abstinence, apart from addiction, that your doctor is aware of. However, don’t automatically accept warnings against alcohol on medication packets - metformin is just one example – discuss those with your doctor to see if it applies in your individual situation.
The various studies aren't in agreement on "moderation". The definition appears to lie between one and three "standard" glasses daily for a male and half that for a female; personally I imbibe about a half-bottle of dry red daily which equates to 300-400ml. If in doubt your doctor will advise on that.
Cheers Alan, T2, Australia.
A PS, added 24th April '07.
I also have CLL, a type of leukemia. I became aware of this report today:
http://www.physorg.com/news96550822.html
“Antioxidant found in many foods and red wine is potent and selective killer of leukemia cells
A naturally occurring compound found in many fruits and vegetables as well as red wine, selectively kills leukemia cells in culture while showing no discernible toxicity against healthy cells, according to a study by researchers at the University of Pittsburgh School of Medicine.”
I believe that this is the original study:
http://www.jbc.org/cgi/reprint/M610616200v2
CYANIDIN-3-RUTINOSIDE, A NATURAL POLYPHENOL ANTIOXIDANT, SELECTIVELY KILLS LEUKEMIC CELLS BY INDUCTION OF OXIDATIVE STRESS
“These results indicate that cyanidin-3-rutinoside have the promising potential to be used in leukemia therapy with the advantages of being wildly available and being selective against tumors.”
PPS, added 20th March 2013: The Relationship Between Alcohol Consumption and Vascular Complications and Mortality in Individuals With Type 2 Diabetes Mellitus
"RESULTS During a
median of 5 years of follow-up, 1,031 (9%) patients died, 1,147 (10%)
experienced a cardiovascular event, and 1,136
(10%) experienced a microvascular complication.
Compared with patients who reported no alcohol consumption, those who
reported
moderate consumption had fewer cardiovascular
events (adjusted hazard ratio [aHR] 0.83; 95% CI 0.72–0.95; P = 0.008), less microvascular complications (aHR 0.85; 95% CI 0.73–0.99; P = 0.03), and lower all-cause mortality (aHR 0.87; 96% CI 0.75–1.00; P = 0.05). The benefits were particularly evident in participants who drank predominantly wine (cardiovascular events aHR 0.78,
95% CI 0.63–0.95, P = 0.01; all-cause mortality aHR 0.77, 95% CI 0.62–0.95, P = 0.02). Compared with patients who reported no alcohol consumption, those who reported heavy consumption had dose-dependent
higher risks of cardiovascular events and all-cause mortality.
CONCLUSION In patients with type 2 diabetes, moderate alcohol use, particularly wine consumption, is associated with reduced risks of
cardiovascular events and all-cause mortality"
Once again moderation is the key.
Once again moderation is the key.
Further reading:
Links to papers and articles for those who want to read further:
Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
http://tinyurl.com/zpt5m
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that
moderate alcohol intake has a beneficial effect on cardiovascular disease. The purpose of this review is to examine the epidemiological and biological evidence supporting the intake of red wine as a means of reducing atherosclerosis. On the basis of epidemiological studies,
moderate intake of alcoholic beverages, including red wine, reduces the risk of cardiovascular, cerebrovascular, and peripheral vascular disease in populations. In addition to the favorable biological effects of alcohol on the lipid profile, on hemostatic factors, and in reducing insulin
resistance, the phenolic compounds in red wine appear to interfere with the molecular processes underlying the initiation, progression, and rupture of atherosclerotic plaques. Whether red wine is more beneficial than other types of alcohol remains unclear. Definitive data from a
large-scale, randomized clinical end-point trial of red wine intake would be required before physicians can advise patients to use wine as part of preventative or medical
therapies."
*********
Diabetes Care 28:2933-2938, 2005
Alcohol Consumption and Risk of Type 2 Diabetes Among Older Women
http://tinyurl.com/nmo4q
"CONCLUSIONS-Our findings support the evidence of a decreased risk of type 2 diabetes with moderate alcohol consumption and expand this to a population of older women."
********
Diabetes Care 27:1369-1374, 2004
Acute Alcohol Consumption Improves Insulin Action Without Affecting Insulin Secretion in Type 2 Diabetic Subjects
http://tinyurl.com/g6wyc
"CONCLUSIONS-Acute alcohol consumption improves insulin action without affecting ß-cell secretion. This effect may be partly due to the inhibitory effect of alcohol on lipolysis. Alcohol intake increases insulin sensitivity and may partly explain both the J-shaped relationship between the prevalence of diabetes and the amount of alcohol consumption and the decreased mortality for myocardial infarction."
*******
The Journal of Clinical Endocrinology & Metabolism Vol. 90, No. 2 661-672 doi:10.1210/jc.2004-1511
Beneficial Postprandial Effect of a Small Amount of Alcohol on Diabetes and Cardiovascular Risk Factors: Modification by Insulin Resistance
http://tinyurl.com/jylqx
"Alcohol enhanced the postprandial increase in energy
expenditure 30-60 min after the LC meal (increase, 373 ± 49 vs. 236 ± 32 kcal/d; P = 0.02) and HC meal (increase, 362 ± 36 vs. 205 ± 34 kcal/d; P = 0.0009), but suppressed fat and
carbohydrate oxidation. Some of our findings may be mechanisms for lower diabetes and cardiovascular risks in moderate drinkers."
**********
Diabetes 50:2390-2395, 2001
A Prospective Study of Drinking Patterns in Relation to Risk of Type 2 Diabetes Among Men
http://tinyurl.com/gjs22
"Using data from a 12-year prospective study, we determined the importance of the pattern of alcohol consumption as a risk factor for type 2 diabetes in a cohort of 46,892 U.S. male health professionals who completed biennial postal questionnaires. Overall, 1,571 new cases of type 2 diabetes were documented. Compared with zero alcohol consumption, consumption of 15-29 g/day of alcohol was associated with a 36% lower risk of diabetes (RR = 0.64; 95% CI 0.53-0.77).
This inverse association between moderate consumption and diabetes remained if light drinkers rather than abstainers were used as the reference group (RR = 0.60, CI 0.50-0.73). There were few heavy drinkers, but the inverse association persisted to those drinking >=50 g/day of alcohol (RR = 0.60, CI 0.43-0.84). Frequency of consumption was inversely associated with diabetes. Consumption of alcohol on at least 5 days/week provided the greatest protection, even when less than one drink per drinking day was consumed (RR = 0.48, CI 0.27-0.86). Compared with infrequent drinkers, for each additional day per week that alcohol was consumed, risk was
reduced by 7% (95% CI 3-10%) after controlling for average daily consumption. There were similar and independent inverse associations for beer, liquor, and white wine. Our findings suggested that frequent alcohol consumption conveys the greatest protection against type 2 diabetes, even if the level of consumption per drinking day is low. Beverage choice did not alter risk."
*******
(Circulation. 2000;102:494.)
Moderate Alcohol Consumption and Risk of Coronary Heart Disease Among Women With Type 2 Diabetes Mellitus
http://tinyurl.com/gwkal
"Conclusions-Although potential risks of alcohol consumption must be considered, these data suggest that moderate alcohol consumption is associated with reduced CHD risk in women with diabetes and should not be routinely discouraged."
********
Diabetes Care, Vol 15, Issue 4 546-548, Copyright (c) 1992 by American Diabetes Association
Short-term effect of red wine (consumed during meals) on insulin requirement and glucose tolerance in diabetic patients
http://tinyurl.com/f6bfk
"CONCLUSIONS--Moderate prandial wine consumption has no adverse effect on the glycemic control of diabetic patients. Thus, it appears unnecessary to proscribe the consumption of
red wine in moderation with meals to diabetic patients. Wine contains tannins and phytates that can explain its action."
********
DIABETES CARE, VOLUME 22, NUMBER 12, DECEMBER 1999 p2084
Meal-Generated Oxidative Stress in Diabetes
The protective effect of red wine
http://care.diabetesjournals.org/cgi/reprint/22/12/2084
"Our data show that red wine is able to preserve plasma from meal-induced oxidative stress in diabetes, suggesting that moderate consumption of red wine during meals may have a beneficial effect in decreasing the risk of cardiovascular disease in diabetic patients."
********
JAMA Vol. 282 No. 3, July 21, 1999
Alcohol Intake and the Risk of Coronary Heart Disease Mortality in Persons With Older-Onset Diabetes Mellitus
http://tinyurl.com/g4x87
"Conclusion. Our results suggest an overall beneficial effect of alcohol consumption in decreasing the risk of death due to CHD in people with older-onset diabetes."
*********
"Am J Physiol Heart Circ Physiol 288: H2023-H2030, 2005.
First published January 14, 2005; doi:10.1152/ajpheart.00868.2004
Antiatherogenic potential of red wine: clinician update
http://tinyurl.com/zpt5m
"Complications of atherosclerosis remain the leading cause of morbidity and mortality in industrialized countries. Epidemiological studies have repeatedly demonstrated that moderate alcohol intake has a beneficial effect on cardiovascular disease."
********
Finally, an interesting one specifically on resveratrol, a red wine component, and the insulin system.
Am J Physiol Endocrinol Metab 290: E1339-E1346, 2006. First
published January 24, 2006; doi:10.1152/ajpendo.00487.2005
Resveratrol, a red wine antioxidant, possesses an insulin-like effect in streptozotocin-induced diabetic rats
http://tinyurl.com/evxtp
"Aberrant energy metabolism is one characteristic of diabetes mellitus (DM). Two types of DM have been identified, type 1 and type 2. Most of type 2 DM patients eventually become insulin dependent because insulin secretion by the islets of Langerhans becomes exhausted. In the present study, we show that resveratrol (3,5,4'-trihydroxylstilbene) possesses hypoglycemic and hypolipidemic effects in streptozotocin-induced DM (STZ-DM) rats."
Note that I prefer to wait for the human trials confirmation - but it is the first time I've seen this effect of resveratrol noted anywhere.
Monday, February 05, 2007
Sweet Curry
This curry has a surprisingly low carb count for the sweetness of the sauce.
Like most of my recipes, it's pretty basic. Make up your own curry powder if you wish to, or just use a bought powder and add your favourite ingredients - but it's always wise to make it the first time as shown, then modify next time.
Protein.......................24__gm
Total Fat....................17__gm
Sat. Fat.....................4.7__gm
Mono. Fat.................9.3__gm
Poly. Fat.......................1__gm
Carbohydrate...........18.4__gm
Fiber..........................2.7__gm
Cholesterol................76__mg
Bon Appetit
Cheers, Alan
Everything in Moderation - Except Laughter.
Like most of my recipes, it's pretty basic. Make up your own curry powder if you wish to, or just use a bought powder and add your favourite ingredients - but it's always wise to make it the first time as shown, then modify next time.
Sweet Curry
Serves 4.
All measures and weights are very approximate.
Tablespoons are level.
2 tbsp Olive Oil
500gm (1¼ lb) chuck steak
1 Onion
1 clove garlic
1 cooking apple
Juice ½ lemon
30gm (1oz) sultanas or raisins
2 tbsp curry powder
1 tbsp flour
1 tbsp chutney
300 ml (1/2 pint) stock or water and stock cube.
INSTRUCTIONS :
Trim any fat or gristle from the meat and cut into rough cubes of 2cm or 3/4".
Sear the meat in one tablespoon of olive oil in a medium saucepan and transfer to the casserole pot when browned.
The sauce:
Saute the onion in the pan juices, add a little more oil if necessary.
When the onions are translucent, add the chopped garlic and the peeled and roughly diced apple.
Stir in first the curry powder, then the flour and then add the stock.
Bring to the boil, add the chutney, lemon juice and raisins and simmer for five minutes.
Add the sauce to the browned meat in the casserole pot.
Cover and cook in a slow oven (150C, 300F) for two hours.
Stir occasionally, adjust liquid by adding a smidgin of water if necessary.
Turn off 30 minutes before serving and leave in the cooling oven.
Serve with a side salad if you are watching the carbs, with steamed rice if you're not. I can handle a heaped tablespoon of rice with it in the evening - let your meter decide.
Sometimes I add some chopped carrots or celery in the sauce, but keep an eye on the carbs if you add carrot.
NUTRIENT TOTALS per SERVING (w/o rice) :
Protein.......................24__gm
Total Fat....................17__gm
Sat. Fat.....................4.7__gm
Mono. Fat.................9.3__gm
Poly. Fat.......................1__gm
Carbohydrate...........18.4__gm
Fiber..........................2.7__gm
Cholesterol................76__mg
Bon Appetit
Cheers, Alan
Everything in Moderation - Except Laughter.