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. "
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