What on Earth Can I Eat? Now out as an eBook!

When I reached my '50s I mistakenly thought that my learning years were long behind me. 

How mistaken I was. My double diagnosis in 2002 led to a whole new world where I was a naïve ignorant student learning about a host of mysterious things neglected from my education in my various earlier stages of life. Things like carbohydrates, insulin, blood glucose, lymphocytes and all that.

Some of those subjects were vital to my continued health. In many of those fields I will be a student for the rest of my life.

Other things I had to learn were less directly important but still necessary to assist my search for knowledge; thus I became net-savvy and learned how to use the web and usenet to get the information I needed. Later, further learning was needed to allow me to find ways to pass on to others the knowledge I had gained. As a consequence I spent a lot of time in 2010 researching self-publishing;. That led to me eventually publishing What on Earth Can I Eat? late last year.

Originally that was going to be the only form of the book, but after publication I received many requests from people to produce an ebook. That involved another learning curve, as I tried to re-work the manuscript for the various e-reading options. I floundered around until I was directed to Smashwords. That made it so much easier.

So now, responding to popular demand, the ebook is out there on the web!

I have to admit I'm still an old fogey and tend to prefer printed books, but for those modern people who prefer to download and read on their Kindle (or any other ebook reader) please click here: What on Earth Can I Eat? Food, Type 2 Diabetes and You. As a service to my blog readers, a $1.00 discount is available if you  include coupon number JP52U when you get to the checkout.

The Discovery of Insulin

A couple of years after I was diagnosed I spent a fascinating few hours reading a Canadian web-site titled “The Discovery of Insulin”. Recently I went looking for it again and was sorry to see it was no longer directly available on the web.

However, all is not lost! The marvellous way-back machine was able to find it again for me. I don't know how long such archives are kept, so I suggest you don't delay if you are interested in reading this wonderful story.

Begin here: The Discovery of Insulin

Use the site as you would any other, clicking on icons as appropriate. The way-back bar at the top is not too intrusive. I suggest you start by clicking “Enter” then click on “Introduction” before reading the rest. Click on the “Home” button at the top or your “back” button if “Home” is missing to return to the index page after you finish each section.

The dLife web-site also has a three-part video series on the discovery of insulin. I was unable to find the code to show them directly here so you will need to click on the links. The "non-intrusive" ads for Novo-Nordisk are worth wading through for the story.

The Story Of Insulin, Part 1

The Story Of Insulin, Part 2

The Story Of Insulin, Part 3

For those in the Tampa area tomorrow or in the Tyler, Tx, region next month, this exhibition may also be worth attending: Breakthrough: The Dramatic Story of the Discovery of Insulin

After reading and watching all of that information I was reminded again how remarkable this achievement was and how close it came to not occurring. There are millions of diabetics alive today as a direct consequence of the discovery; the story of Dr Lois Jovanovic's grandmother gives the perspective of those living under a death sentence back in the 1920s. As a lateral thought, one has to wonder whether it would have ever been discovered if there had been the same strict rules for using animals like dogs in lab experiments then as there are now.

At the moment I do not need insulin, but I am very grateful that it is available for that possible day in the future when I may need to.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter

Kitchen Essentials: Steamer Saucepan

For those who are discovering cooking as a survival skill for the first time this is the first in a short series of tips for new cooks.

I first started using a steamer saucepan set when I was wandering around in a caravan in 1997-98. I discovered a set in an op-shop while we were wandering and found it to be a wonderful tool for cooking a full balanced meal with several vegetables on a tiny two-burner caravan stove.

After I was diagnosed I found it became an essential tool in my kitchen as I increased the range of vegetables on my menu. I use it daily; often cooking five or more different vegetables at a time. I believe in the KISS rule (keep it simple) in most things; for cooking there are few things simpler than steaming. You really have to try hard to over-cook steamed veges, so you can concentrate on other foods where timing is more critical.

Apart from the obvious advantages of steaming vegetables to retain most of the vitamins and minerals, a steamer takes a lot of the work out of cooking regular meals.

I thought about polishing mine up for the pictures, but decided to show it as it is, because this battered old saucepan set has been in constant use for many years now:

Over the years we have added bits to it; not all match:

We use those extra sections for big family dinners. Usually we only need the base and one steamer section when cooking for three or four. For example, for dinner last night I put potato and Aussie pumpkin (Winter Squash) to be boiled in the bottom in just enough water to cover them; in the steamer section was 1/3 cob corn, peas, sliced carrot, broccoli and cabbage with chopped bacon. Each vegetable was placed separate from the others so that they could be easily served later without mixing together excessively. Here is how it looks with the boiled veges moved to the top section to keep warm while my fish cooks beside it and my wife's chops cook under the griller:

Some tips when using one.

1. Put root vegetables that need to be boiled, such as potatoes, in the bottom section and leafy/watery veges in the top for steaming.

2. If the veges in the bottom section cook before the rest of the meal is ready, transfer them to the top section to remain warm without over-cooking.

3. If the veges are cooked before your other foods are ready, remove the steamer set from the heat and transfer any veges in the bottom section to the steamer section. The residual heat in the hot water will act as a bain-marie and keep the veges warm without over-cooking them.

4. Don't overfill the base with water; use just enough to do the job with a little extra for safety so that you never boil dry. When the water comes to the boil, reduce the heat until it is just simmering. Retain that water after cooking for an excellent stock if you like to cook vegetable soups or stews.

5. As you gain experience, don't restrict the concept to just vegetables. Experiment with other foods, especially fish and seafoods.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter

Free Radicals and James Bond

I enjoyed this brief moment immensely yesterday while watching an old movie.

With all due respect to Ian Fleming and Sean Connery, "Never Say Never Again" was not the greatest Bond movie ever made. But it had one sterling moment:

For those unable to load youtube:

M: Too many free radicals. That's your problem.

James Bond: "Free radicals," sir?

M: Yes. They're toxins that destroy the body and the brain, caused by eating too much red meat and white bread and too many dry martinis!

James Bond: Then I shall cut out the white bread, sir.

A very wise decision, James.

I drank a toast to that with a glass of Shiraz after my steak without white bread last night.

Cheers, Alan
Everything in Moderation - Except laughter

The 600 Calorie Diet for Type 2 Diabetes

A British research group reported the following a few weeks ago. I had hoped the results would be a brief news report which would shortly go the way of many similar reports and disappear again. I was wrong. Suddenly new people are appearing on every forum I am on. They are either enthusiastically trying this new "miracle" diet or seriously considering it.

First, please take a moment to read the article:

Diabetologia
DOI 10.1007/s00125-011-2204-7

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol

E. L. Lim & K. G. Hollingsworth & B. S. Aribisala & M. J. Chen & J. C. Mathers & R. Taylor

It becomes obvious on reading the article that it does not seem to have occurred to the worthy researchers that their extreme low-calorie diet was also a moderate low-carb diet.

"After the baseline measurements, individuals with type 2 diabetes started the diet, which consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day."

Allowing for the variations in choices of non-starchy fresh veges that works out to be a little over 70gms carb, 50 gms protein and 15 gms fat daily. To me that is extremely low-fat and moderately low in carbs and protein - but also about half the level of 130 gms carb that too many food scientists continue to suggest will cause our brains to starve of energy. They don't appear to have mentioned cognition in the paper.

One has to wonder if their results would have been similar and the individuals healthier if they had simply reduced the carbs and left the fat and protein levels of the participants alone.

Instead, by concentrating on calories rather than a specific macronutrient such as fat, carbs or protein their research is interesting but hardly news. Gannon and Nuttall showed years ago that an iso-caloric diet can have very significant results for improved diabetes control when carbs are reduced and fat and protein increased; see their LoBAG series. This is the LoBAG30 paper. There is also a later paper on LoBAG20.

In short, the low-cal paper shows some promise but has too many confounders. Finally, can any type two reading this seriously consider eating 600 calories daily for the rest of their lives? You will find an excellent critique (as usual) of this nonsense on Jenny Ruhl's blog.

Even if it is only applied for a short period there are other dangers no-one has mentioned. An acquaintance of mine on alt.support.diabetes went on a similar starvation diet a few years ago and reported on progress on that newsgroup. A dramatic A1c drop ensued. So did a major eye damage problem. That is a known but thankfully rare danger. It can happen when there may be existing retinopathy (which the patient may be unaware of) and very sudden changes in blood glucose levels occur.

In brief, I have always counselled against extreme regimens in type 2 diabetes management, regardless of whether that extreme method involves diet, exercise, medications or anything else. I consider a 600kcal regimen very dangerous for any significant period of time and advise strongly against trying it. If you must try it, then only do so under strict, close medical supervision.

In my opinion a balanced regimen over a lifetime, refined by post-prandial testing and adjusted when required, is a better course to follow.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter.

Tight Control. When Will They Ever Learn?

Yet another meta-study implying that tight blood glucose control is dangerous for us was published this month. Here is the Press Release: Benefit of blood glucose lowering to near-normal levels remains unclear

The study is published by a German group called IQWiG, the Foundation for Quality and Efficiency in Health Care, a private law foundation with legal capacity. IQWiG's function according to its charter includes:

"(1) The Institute will work on issues of fundamental importance for the quality and efficiency of the services performed within the framework of the statutory health insurance (SHI) system as an independent scientific institution of the Foundation, in particular in the following areas:

1. Search for, assessment and presentation of current scientific evidence on diagnostic and therapeutic procedures for specific diseases;

2. Preparation of scientific reports and expert opinions on quality and efficiency issues of SHI services, taking age, gender, and personal circumstances into account;

3. Appraisal of evidence-based clinical practice guidelines on the epidemiologically most important diseases;

4. Issue of recommendations on disease management programmes;

5. Assessment of the benefits and costs of drugs;

6. Provision of easily understandable information for all citizens on the quality and efficiency of health care services, as well as on the diagnostics and treatment of diseases of high epidemiological relevance.

Its task is to support the Federal Joint Committee in fulfilling its statutory duties in these areas by the submission of recommendations (§139b [4] SGB V)"

Bearing in mind that the German health-care system is mainly funded by the government, they don't look just at the medical aspects but also at efficiency and costs. That is something to keep in mind when considering these reservations about the efficacy of tight control. Costs are very important when you run a government health-care system, but costs should have no bearing on the medical aspects of whether or not tight control of diabetes is good for patients.

The IQWiG news release includes this:

"Indications that patients with type 2 diabetes benefit from intensive blood glucose control were found only for the outcome "non-fatal heart attacks”. However, at the same time the data provide indications that severe hypoglycaemic episodes as well as other serious events in part occurred considerably more often in the intensive-therapy group than in the group with less intensive lowering of blood glucose levels.

Overall, the results of the current IQWiG report are consistent with those of reviews and meta-analyses recently conducted and presented by other researchers.

Question as to which treatment strategy is better still remains unanswered

The IQWiG Director Jürgen Windeler comments on the current report: "It is quite astonishing: individual interventions, particularly drugs, have in part been well investigated in studies; however, we know relatively little about the advantages and disadvantages of treatment strategies. If doctors are faced with the question as to what they can specifically offer to their diabetes patients, whether they should lower blood glucose levels as much as possible, and in which patients this a promising (or less promising) approach, they still do not receive satisfactory answers.” Even though this is a key question in the care of people with type 2 diabetes, the few studies available do not allow reliable conclusions."

The full IDWiG pdf report is here: Benefit assessment of long-term blood glucose lowering to near normal levels in patients with type 2 diabetes mellitus

They've missed the target again. There are many benefits of lowering blood glucose levels in diabetics to near-normal levels. But there are also many dangers in the intensive use of medications and insulin to achieve that goal.

The problem is not the goals but the methods.

Sadly, all they have done is confirm something that has been discussed by type 2 diabetics on diabetes forums ever since ACCORD and ADVANCE (both are included in this meta-study) were published. Those papers did not show that tight control is harmful, instead they showed that intensive use of oral medications and/or insulin to push A1c or FBG down can be hazardous to the health of a diabetic.

The factor missing from all of these studies is use of lifestyle changes, particularly diet and exercise, to achieve near-normal A1c and blood glucose levels. Repeatedly in all these studies the subjects were advised to follow the traditional (since Keyes) extremely low-fat high-carbohydrate diet and to then use medications and insulin to combat the results of that way of eating. I wrote some brief comments on the ACCORD and ADVANCE trials back in 2008 when they came out; nothing has changed since then.

Easily overlooked in the detail of this IQWIG paper is an even sadder acceptance of very poor targets:

"The goal in the test intervention group had to be long-term BG adjustment to near-normal levels (long-term lowering of HbA1c to levels at least lower than 7.5%, or long-term lowering of fasting BG to levels at least lower than 126 mg/dl or 7 mmol/l). Comparator interventions were those with no goal or a less intensive goal of long-term BG adjustment to near-normal levels."

We have already seen ACCORD used by the UK NHS and some other national diabetes authorities to discourage patients from trying for less than 7%; now they will probably use this to raise it to 7.5%.

One of the more enjoyable parts of being an active participant on several diabetes forums is that I get the opportunity to frequently offer congratulations to excited people reporting dramatic improvements in their diabetes indicators such as HbA1c, or significant improvements in the severity of complications. Often those congratulations are for joining the 5% club for achieving an A1c of less than 6%. Invariably those happy people report that their great results are from their efforts in making changes to their menu, usually as a consequence of post-meal testing, or their increases in exercise or both. Very rarely do they mention it was due to increasing meds but even then the diet and exercise usually changed first.

Those people do not seem to be encountering any of the problems warned about in meta-studies like this or ACCORD and ADVANCE.

To repeat myself, they've missed the target again. But I'll keep aiming for 6% or less.

Cheers, Alan, T2, Australia

Celebrating An Anniversary

I have a terrible memory for birthdays and anniversaries. I usually have to use memory aids such as calendars and computers to remind me of them. But there is one I never forget. Today is the last Saturday in April. That is a day I need no reminders for.

On the last Saturday in April 2002, exactly nine years ago as I write this, I was having a lazy weekend morning in bed and the bedside phone rang.

A couple of months before that I had been tentatively diagnosed with CLL from a routine blood test showing a high white count. That led to lots of confirming blood tests and a bone marrow aspiration. Apparently they can be painless, but no-one seems to have told the haematologist that performed mine. He remained my haematologist until a couple of years later when he wanted to do another one to “check on progress”. That guy was never going to laboriously drill holes in in my “strong” bones ever again; I found another haematologist that was happy to state that I did not need one. Time has proved him right.

I spent that two months searching for something I could do about my CLL and finding I could do nothing at all but “Watch and Wait”. Wonderful. I was well into the depths of diagnosis depression.

So, when the phone rang my mood was hardly bright and cheerful. It was about to get worse.

Caller: "Hi Alan, this is Dr ............ 's reception here. The Doctor wants me to make an appointment for you for Tuesday."

Me: "That's fine. I presume it's to discuss the latest test results for the leukaemia?"

Caller: "No, it's about your diabetes."

Me: "......stunned silence......."

Caller: "Hullo - are you there?"

Me: "About what?"

Caller: "Your diabetes."

Me: “I don't have diabetes, are you sure you have the right person?”

Eventually she convinced me that she did.

I have learned to like and respect my doctor. He is the best doctor I have ever encountered. If not for his knowledge and expertise my CLL and diabetes might not have been diagnosed for another five or more years. Less competent doctors had missed some very obvious signs, such as fasting blood glucose levels of 7.9 mmol/L (140 mg/dL) for at least five years before that. He certainly gained my attention; if he had not made it clear that if I did not gain control of the diabetes I may not live long enough to worry about the cancer, I might not have maintained the discipline to achieve control. But at that time we did not really know each other and I was also unaware of the stress on that very overworked small village practice.

So I hope he won't mind me mentioning this. When I received that call he had left for the day. I'm pretty resourceful when I'm scared. I'm sure he didn't appreciate the call at his home a few hours later after I tracked down his number, but I'm also sure that phone advice by the receptionist of diagnosis of a major chronic condition has not happened often since.

Waiting for that Tuesday appointment was one of the worst weekends of my life. In hindsight, my ignorance of anything to do with type 2 diabetes and everything associated with it such as complications, diet, exercise and the myriad other things we need to know to take control of this condition was abysmal. Much of my fear and worry over that terrible weekend was caused by that ignorance.

I have made up for that ignorance since; see my story here: Turning Points

If a diabetes diagnosis seems an odd thing to celebrate, look at it from my different perspective. It has been a bit of a bumpy ride at times, but I reckon the simple fact of being here, moderately fit and well for a 64 year old, to write this nine years later without any diabetes complications at all is well worth celebrating.

I think I'll open one of the better bottles of Shiraz from the "cellar" in my back bedroom cupboard tonight.

Salud!

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