No Such Thing As Type 2 Diabetes? Why Old Notions Of 'Disease' Need Revamping

As medicine advances, thanks to expanding research and sophisticating technologies, it’s always got the task of shedding its past and redefining itself. Part of this is to rid itself of conventions that are determined to be useless, or worse, erroneous. In a smart new editorial inThe Lancet, researcher Edwin Gale of the University of Bristol argues that there’s a major problem with the way we think about disease today, in particular the ones that are not so clear cut, like type 2 diabetes, which itself affects millions across the globe, and now includes a growing new subset: children. But slapping the “type 2 diabetes” label on a wide constellation of symptoms (and, perhaps, causes) that has no simple treatment is a major “category error,” argues Gale. And this error can lead us – researchers and patients alike – down the wrong path when it comes to solutions.

Here’s Gale’s central argument. He says that medicine, unfortunately, still has the tendency to look for a unique cause and/or symptom to define a “disease.” As it happened in the case of diabetes, over a century ago, a researcher decided that blood sugar was the way to define the disease, and this convention has, very sadly, stuck. Even today, committees of experts sitting around a table deciding what defines normal and abnormal blood sugar is considered an acceptable method. But, argues Gale, it’s not acceptable at all, and we need a better way: “a problem that cannot be defined in scientific terms cannot have a scientific solution.”

What we’ve learned in the last 50 or 60 years is that diseases like type 2 diabetes are actually multifactorial, and they’re “defined by their attributes and consequences rather than by their causal mechanisms, which remain unknown.” In the case of type 2 diabetes, after all, we don’t really know what causes it: We know that the body doesn’t use insulin correctly, and that there’s a laundry list of associated risk factors – overweight and obesity, being sedentary, high levels of blood fats, etc. – but we don’t really know what’s happening in the body to lead to the condition (or group of conditions). And as numerous the causes, so can be symptoms, which often vary widely from person to person.
Therefore, Gale says, “assuming standard causal mechanisms and universal treatment pathways” is our fatal flaw, and it leads to major problems in the solutions for the “disease.” He adds that our outdated notion of type 2 diabetes has led to decades of wasted research that could have been better spent in other avenues.
As Gale told the Lancet TV, “If you give something a name, you imply an entity; you imply that this thing actually exists. In practice, when somebody like myself talks about Type 2 diabetes, I’m saying ‘a form of diabetes for which I can find no other cause’. In other words, it’s a diagnosis of exclusion…There are various conditions, spectrums, and severities of diseases, all wrapped into this one definition.”
So what’s the solution, should “type 2 diabetes” be scribbled out of the medical texts? The answer, in a manner of speaking, is yes. Gale suggests that we have to realize that our current thinking has gotten us nowhere and to seriously readjust how we approach disease. “When a century of scientific endeavour brings us round to the conclusion that we cannot define what we are talking about, it might be time to consider adjusting our minds.”
He proposes we scrap the term “type 2 diabetes” and replace it with “idiopathic hyperglycemia,” at least for the time being. He realizes that changing our thinking will be a long process, since there’s a lot of money and power tied up in the old ways – but new thought leaders will emerge and help shift things in a better direction. “Ruling paradigms become entrenched around the sources of money and influence, and new thinking must wait for the present generation of power brokers to move into the rose garden. The ghostly entity of type 2 diabetes is likely to haunt us for years to come, although we might for the interim avoid a terminological loop by referring to it as idiopathic hyperglycaemia.”
Different disciplines have to collaborate, he says, since the “disease” is multifactorial – so should the effort be toward understanding it. “Present thinking examines glucose or lipids; future thinking will abandon the sectarian boundaries of academic specialties to achieve a more integrated view of phenotypic development. Idiopathic hyperglycaemia will no longer be considered as a disease in its own right, but as an outcome of networked processes contributing to the affluent phenotype of adiposity, hypertension, hyperglycaemia, hyperlipidaemia, and cancer.”
Science is undergoing a lot of changes and unrest right now (not that it’s ever not). Definitions of mental health disorders are being called into serious question. Major organizations are at odds over recommendations for when women should begin having mammograms. And years later, we’re still living with the specter of the flawed autism-vaccine study that was formally retracted, but which many still take as gospel. Things will change, we hope, though it may be slow.
So how long does it take science to shrug off old notions and definitions? Decades, or perhaps years, if we’re lucky. While researchers debate the fate of “the disease formerly known as diabetes,” please weigh in below on how science can best evolve, and how we should conceptualize these conditions that don’t have a clear cause or cure.
Graham

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Big Pharma Knew The Dangers Of Statins Decades Ago !

Check around any diabetes or health related forum or blog and the downside of statin drugs is a regular feature. People report many side effects from memory loss to muscle pain. The heart of course is a muscle, and is also at risk from statin damage. This I find extremely worrying and ironic, as the medics ply patients with statins to allegedly lower cholesterol, to err reduce the chance of a heart attack. It is now known statins deplete coenzyme Q10 levels, and this problem should be addressed for statin users. Very few people on the aforementioned forums or blogs, mention their Doctors have addressed maintaining coenzyme Q10 levels. Doctor John Briffa started a new post on his blog yesterday, discussing this serious situation. Part of his post below. As always interesting and informative. I knew of the situation regarding statins and the coenzyme Q10 some time ago, but the real stunner for me was when a commenter called Stephen Rhodes posted, proving  Merck Pharmaceuticals knew of the problem in June 1990. As Stephen says the "real shocker" is "this special combination medication was never made available to the public. It was basically put on the shelf and forgotten"

Eddie


Part of Dr. Briffa’s post.

“All of us need could do with maintaining coenzyme Q10 levels, and this has particular relevance to individuals who take statins: these drugs impair the product of coenzyme Q10. There is plenty of evidence in animals and humans that statins can indeed deplete the body of coeynzme Q10 [1].

The heart is a muscle, the cells of which contain mitochondria which depend on coenzyme Q10. Back in January, I wrote a post which explored the possibility that statins may be contributing to increasing incidence of heart failure (weakened heart function that can lead to symptoms such as fatigue, breathlessness and swelling in the legs).”

Stephen Rhodes comment.

Reading the article reminded me that I had heard something about this before.
The following is from http://www.functionalmedicineuniversity.com
The Statin and Co-Enzyme Q10 Patent
It is clinically documented statin medications (Lipitor, Crestor, Zocor, etc) lower the essential nutrient, Co-Enzyme Q10.
Co-Enzyme Q10 is an important co-factor in the production of energy and particularly important in muscle function.
Clinical studies show decreasing levels of Co-Enzyme Q10 lead to increasing severity of cardiovascular symptoms.
Now here is the shocker!
The pharmaceutical company, Merck, was issued a patent (4,933,165) on a special medication combining a statin medication and Co-Enzyme Q10.
The researchers knew back in the late 80s and early 90s the significance of adding Co-Enzyme Q10 to statins. Furthermore they knew very well the negative impact of taking statins without supplementing with CoEnzyme Q10.
The sad news is this special combination medication was never made available to the public. It was basically put on the shelf and forgotten.
To read the entire patent, download the patent and see what has been hidden from the public for over 20 years.
DOWNLOAD CoQ10-Statin Patent
http://www.functionalmedicineuniversity.com/statin-CoQ10.pdf

Link to Dr. Briffa's blog and article here.




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CV Safety of Vildagliptin in HF Unclear

LISBON -- The diabetes medication vildagliptin may be beneficial in patients with type 2 diabetes and heart failure, but its cardiovascular safety is uncertain, a placebo-controlled trial showed.
Both the placebo and vildagliptin groups had increases in left ventricular ejection fraction of 3% to 4% through 1 year, and the between-group difference of 0.54% was not significant (95% CI -1.97%-3.06%) and met criteria for noninferiority, according to John McMurray, MD, of the University of Glasgow in Scotland.
However, a nonsignificantly greater number of patients in the vildagliptin group died from cardiovascular causes (5.5% versus 3.2%) and from any cause (8.6% versus 3.2%), "probably highlighting the importance of studying drugs that lower glucose a lot more carefully in patients who've got both diabetes and heart failure," McMurray reported at the Heart Failure Congress here.
Vildagliptin has not been approved by the FDA but is marketed as Galvus in Europe.
Wolfram Doehner, MD, PhD, of Charité-University Medical School in Berlin and not involved in the trial, said the number of deaths is too low to definitely assess the effects of vildagliptin in that respect.
"What it does show from these very low numbers [is that] it's going in the wrong direction, but only to a nonsignificant degree, so you should really be very cautious to draw any conclusion," he said in an interview, noting that such signals have been seen before in other small trials and have then disappeared in larger studies.
The current trial, VIVIDD, met its primary endpoint by demonstrating noninferiority in the vildagliptin group for the change in left ventricular function through 1 year as measured by echocardiography.
It also met its major secondary endpoint by showing a significant reduction in glycated hemoglobin (HbA1c) through 16 weeks with vildagliptin versus placebo (difference 0.62%, 95% CI 0.30%-0.93%).
In his comments following McMurray's presentation, however, Doehner questioned whether the appropriate endpoints were chosen for the trial.
He pointed out that a similarly designed trial of rosiglitazone (Avandia) also demonstrated noninferiority on the primary endpoint of the change in left ventricular ejection fraction.
It is now known, however, that the glitazones cannot be used in patients with heart failure because of the cardiovascular risks, he said.
So the message is that echocardiographic measurements are important surrogates, but not more important than the clinical signals, he said.
Doehner also questioned whether HbA1c is an appropriate endpoint in patients with heart failure, noting that previous studies have yielded conflicting results about the relationship between HbA1c and outcomes in that population.
Also, he said, previous trials have failed to show that lowering HbA1c improves outcomes in the setting of heart failure.
Targeting increased insulin secretion doesn't get to the root of the problem, which is insulin resistance, Doehner said. Insulin resistance is the primary link between diabetes and chronic heart failure, and there is a need for therapies that address that problem in patients with both diabetes and heart failure, he said.
McMurray and colleagues conducted the VIVIDD trial to assess the cardiovascular safety of vildagliptin, which is a dipeptidyl peptidase 4 (DPP-4) inhibitor.
The drug was approved in Europe in 2007 and the drug's maker, Novartis, had applied to the FDA for approval. However, the agency strengthened its safety requirements for diabetes drugs after the cardiovascular risks of rosiglitazone became apparent, and Novartis pulled its application after the FDA requested more data.
A drug like this is important because a third to a half of patients with heart failure with a reduced ejection fraction also have diabetes, McMurray said, but little is known about the cardiovascular effects of diabetes medications in that patient subset because patients with heart failure are typically excluded from clinical trials of antiglycemic agents.
It is known that the glitazones induce a worsening of heart failure and there is a contraindication to using metformin in patients with severe heart failure because of the risk of lactic acidosis, highlighting the importance of studying the cardiovascular effects of diabetes medications in patients with both type 2 diabetes and heart failure, he added.
In the VIVIDD trial, 253 patients who had type 2 diabetes for at least 3 months, a HbA1c between 6.5% and 10%, New York Heart Association class I to III disease, and a left ventricular ejection fraction of less than 40% were randomized to receive either vildagliptin or placebo on a background of standard diabetes and heart failure therapy.
The mean age of the patients was 63 and about three-quarters were male. The average left ventricular ejection fraction was roughly 30% and the average HbA1c was 7.8%. Follow-up spanned 52 weeks.
There was a significant increase in left ventricular end-diastolic volume and a nonsignificant increase in end-systolic volume in the vildagliptin group that were unexpected in light of the slight increase in ejection fraction.
"The best conclusion we can come up with is that perhaps [the findings are] explained by vildagliptin having an effect on left ventricular compliance," McMurray said.
Brain natriuretic peptide levels decreased in both groups.
The overall rates of cardiovascular events were similar in the two groups, although mortality tended -- nonsignificantly -- to be higher in the vildagliptin group.
Ultimately, it is important to continue researching ways to treat patients with both conditions, and the VIVIDD trial adds significant information that can be used in that search, Doehner said.
Primary source: Heart Failure Congress
Source reference:
McMurray J, et al "The Vildagliptin in Ventricular Dysfunction Diabetes (VIVIDD) trial" HFC 2013; Abstract 99.
Graham
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Grandsons first fishing trip

Fishing and Fairy Princesses what do they have in common? The easy answer ..... amazing grandchildren.Weather again wasn't too brilliant but the boys i.e. Eddie, his son and grandson dressed up warmly and went fishing, leaving me and the girls playing with Fairy Princess Jigsaws and shopping trolley board games. We just love seeing the kids and grand-kids and come away tired but always uplifted.

It was grandsons first fishing trip. Would he catch a shark like the ones he saw at legoland yesterday? Err no said Grandad but I do hope you'll catch a carp. If the carp pulls you in can you swim "Yes I can swim four lengths now" was the proud reply. Well as you can see he caught a rather nice fish for his first fishing foray, At the end of the afternoon another surprise, Eddie gave him the rod and reel he had used to catch his very first fish. When grandson was asked had he enjoyed his first fishing trip, the reply was, "Yes, but it would have been better if it had been sunny". Couldn't agree more - perhaps summer will start this weekend, Saturday is 1st June.


 



All the best Jan
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Aggressive Blood Pressure Control Increases Coronary Heart Disease Risk Among Diabetic Patients

Abstract

OBJECTIVE Blood pressure control can reduce the risk of coronary heart disease (CHD) among diabetic patients; however, it is not known whether the lowest risk of CHD is among diabetic patients with the lowest blood pressure level.
RESEARCH DESIGN AND METHODS We performed a prospective cohort study (2000–2009) on diabetic patients including 17,536 African American and 12,618 white. Cox proportional hazards regression models were used to estimate the association of blood pressure with CHD risk.
RESULTS During a mean follow-up of 6.0 years, 7,260 CHD incident cases were identified. The multivariable-adjusted hazard ratios of CHD associated with different levels of systolic/diastolic blood pressure at baseline (<110/65, 110–119/65–69, 120–129/70–80, and 130–139/80–90 mmHg [reference group]; 140–159/90–100; and ≥160/100 mmHg) were 1.73, 1.16, 1.04, 1.00, 1.06, and 1.11 (P trend <0.001), respectively, for African American diabetic patients, and 1.60, 1.27, 1.08, 1.00, 0.95, and 0.99 (P trend<0.001) for white diabetic patients, respectively. A U-shaped association of isolated systolic and diastolic blood pressure at baseline as well as blood pressure during follow-up with CHD risk was observed among both African American and white diabetic patients (allP trend <0.001). The U-shaped association was present in the younger age-group (30–49 years), and this U-shaped association changed to an inverse association in the older age-group (≥60 years).
CONCLUSIONS Our study suggests that there is a U-shaped or inverse association between blood pressure and the risk of CHD, and aggressive blood pressure control (blood pressure <120/70 mmHg) is associated with an increased risk of CHD among both African American and white patients with diabetes.
  • Received January 22, 2013.
  • Accepted March 2, 2013.

Graham
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Chris Brasher shoes and boots as recommended by Dillinger !

Today this comment came in from our mate Dillinger.

"Right - I'm going to put the boot in. As well as all the low-carb stuff here Eddie recommended a while ago Brasher walking boots and I bought some when I needed a new pair. They are really good and I would never have heard about them otherwise. So thank you for the blog and thank you for the boot advice!"

As you can see we practice what we preach, Jan's walking shoes and boots. The ladies Brasher leather shoes are no longer made, a great pity as they are marvelous.





Eddie
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Going up North !

Next week we are going up North. We have a client in Lancashire and we work for them around once  a year. We always meet up with my best friend Graham. A room booked into a nice hotel and a table booked at our favourite restaurant. Cue much merriment and an obscene amount of booze consumed. The next day Jan drives and I turn up with a sore head and a camera in hand (thank God for auto focus) When the work is finished we proceed to Lancaster, the home of one of our sons. We then go up to the Lake District, our favourite place on earth. Last year we got way off the beaten track, and took a chance of not wrecking our car, driving up a mountain path, and marvelling at the view’s, if you have never visited the Lake District I highly recommend.

Eddie



View from high up


Peace and calm

  

The wonder of still water


Lake Windermere


England at it's finest


 Jan in our little red car

 Eddie





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OK I know it's summer but !

In all my long and ancient years, I have never known a worse summer. The boffins tell us we are undergoing global warming, are these the sort of guys who tell me saturated fats are dangerous and carbs are good grub for a diabetic ? I have little respect for many boffins. I can get better information down my local pub, and these bar room lawyers and medics  have one hell of a sense of humour. How we have fell about laughing at the so called healthy diet. OK tonight’s grub, great winter fodder, but in this bone chilling weather it keeps us warm and happy.

Eddie


                                      Rustic Pork Casserole



This meal is an absolute lowcarb stunner, and one of our favourites. 
Ingredients: Serves two
2/3 pork chops cut into pieces around an inch square or 25mm
2 large leeks chopped
1 hand full of button mushrooms
1 large sliced carrot
1 table spoon of dried mixed herbs

Approx 1 pint of gravy stock
Salt and pepper to taste.

Method
Clean, cut and place all ingredients in a casserole dish or earthenware oven proof pot with lid. Pour over the stock and cook at 190c in an electric oven 90 mins. Gas mark 5.

What could be easier, very lowcarb, real food and tastes great. Perfect for a cold winters night, or a British summer. Snuggle up with a glass of red wine and a good book. This is called living where I come from.
Eddie 

Check out our lowcarb food blog here.

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Chip off the old block ?

One of our sons was in London yesterday with his wife and two great kids seeing the sites. He posted this up on his face book page and gave me a chuckle. Where he gets his attitude  regarding Politicians is beyond me. One of his pics.

Eddie


"Can't believe I found the one building in London with the most lying cheating and thieving bast***s all in one place, even Pentonville prison has less crooks in it !!" Jimmy
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Sugar: The family that gave it up !

When their daughter was diagnosed with Type 1 diabetes, the whole Burt family gave up sugar. Just how hard was it? "For about a month it was like having a hangover and being so very groggy, lethargic, I couldn't concentrate," said Jason Burt, "and then gradually it was like a cloud lifting."

Jason Burt's daughter Lucy, who is 16, found out she had diabetes Type 1, also known as diabetes mellitus, in September 2011. It means the pancreas does not produce insulin to regulate blood glucose levels. If the amount of glucose in the blood is too high, the body's organs may be damaged.
 
The family, which includes two other children Jack, 12 and Emma, 18, has always lived what Jason calls a holistic life, with homeopathy and home schooling also a part of their lifestyle - so when Lucy was diagnosed it was a shock.Their doctor said that Lucy should check her blood levels regularly, inject insulin, but continue to eat a normal, balanced diet. However Jason and his wife Clare felt that they and their three children should all give up sugar. "It was a solidarity thing... it just made obvious sense that by giving up sugar, we're supporting her in a diet that we think is the best diet for her and her diabetes," Jason Burt told Radio 4's Food Programme.

They went against the doctor's advice, and have been following a low carbohydrate, no sugar, high protein, high fat diet, with lots of vegetables. They said it was very hard and uncomfortable to begin with, but now they all feel healthier, have higher levels of concentration, eat less overall, and their food bill has gone down too. Lucy Burt's diabetes is under control. She still takes a bit of insulin, but is mostly stable.

As a family they worked out they have lost 8.5 stone, with Jason and Clare losing three each. 

"I suppose and you started to feel more awake, more aware and since then I haven't looked back because my energy levels have been constantly good," said Jason Burt.

Despite the family having given up sugar, Jason feels strongly that the government has got its policy the wrong way round on obesity by blaming fat not sugar. He also feels that big companies get away with misleading marketing when they advertise their products as low fat, when they might have very high sugar levels.

More on this story here.

Eddie 

PS. Comment from reader added for clarification.

Anonymous said...Great story, Eddie, and we know they'll just keep on coming. "she had diabetes Type 1, also known as diabetes mellitus" Of course, all diabetes of whichever type is known as diabetes mellitus.
Just trying not to scare the horses : )

Geoff J
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Thank You

I think when growing up we obviously look to our parents for a good start in life, good advice, good teaching, good manners etc. We then do our best to pass this on to our children, and so we hope the good circle keeps on going. 

There are many good helpful things I remember, but for the purpose of this short piece (thank heavens I hear Eddie cry!) one piece of good advice that I do steadfastly follow stands out. Never forget to say please and never forget to say thank you. These three words are so simple but sometimes are so simply forgotten. We on the team do not forget that without you our readers we would look pretty silly talking to ourselves. So to all our readers, to all who take time to comment we say THANK YOU and send you all this bouquet of flowers. Well in thought if not in deed.

All the best Jan

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More on nuts !

Coffee and walnut cake


Ingredients
100 grams of ground almonds
100 grams of walnuts
1 teaspoon baking powder
2 large eggs
1 tablespoon of melted butter
2 tablespoons of double cream

1 tablespoon of instant coffee
100 grams of clotted cream

Method
Mix all dry ingredients in a bowl.
Melt the butter I used a Pyrex jug, add the eggs, cream. Place 1 tablespoon of instant coffee in a cup and pour some boiling water over the coffee, keep water to a minimum, just enough to melt the coffee. Then add the dry ingredients and mix. Microwave in a 700watt for 5 minutes. Allow to cool and cut in half. Spread on clotted cream and add walnut halves. Serves six, around five carbs per portion.
Coffee and pecan nut cake
Pecan cake same as walnut cake above but with 100 grams of pecan nuts
 Luxury Low carb nut cake

Ingredients
 125 grams of desiccated coconut un sweetened.
100 grams of ground almonds
55 grams golden flax seeds ground
4 beaten eggs
2 table spoons of sugar or sweetener of choice: see note below.
1 table spoon of baking powder
1 table spoon of cinnamon
1 table spoon of ground nutmeg
1 very large slug of Grand Marnier
half a cup of water
third of a cup of melted butter

I also add broken walnuts and almond flakes

Method mix all the dry ingredients in one bowl and the wet in another bowl. Add the wet to the dry and mix thoroughly. Bake for about 50 minutes at gas mark 7 or 200 in an electric oven. A little tip is to check it at around 45 minutes, by taking it out of the non stick tin, I line my tins with a long strip of baking paper, which makes it very easy to remove the cake from the tin. Cut it in half to check it has cooked right through. If not, back in the oven for a bit longer. I reckon the cake is less than 5 carbs for a nice thick slice. Serves eight.

Please note! If you are using aspartame/acesuflame sweetener, remember to reduce the heat to no more than 170 degrees. Above this and you end up with a truly awful taste and no sweetness.
  
Eddie
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My Wife is driving me nuts !

As reported here recently, my Wife Jan has joined our team, I am beginning to regret her signing up to our barmy army. Why is that you may be asking ? Well, for a start I have to fight to get near our internet computer these days. Secondly, she is bombarding me with information I have been writing and talking about for years. Did I know carbs are not essential ! Do you know how bad trans fats are for our health ! Seriously she is driving me nuts ! Have any of you ever given a copy of the Guinness Book of Records to a kid for Christmas ? I have, and they follow you around for two days saying “did you know” you’ve got the picture. Talking of nuts, she has tried to corner the worlds supply of Macadamia nuts, and I can’t open a lunch box these days without a pack staring up at me. I only have to say I am feeling a bit peckish, and the bloody nuts make an appearance. It gets worse. Jeez she has even questioned having the Free The Animal blog in our side bar, bleating “think of my ladies” It’s not all bad news, yesterday while surfing around she found this guy, Kris Gunnars.



Check this guy out she said, he has one great blog. I had a swift look and when I read this statement, “recommending a high-carb diet to diabetics is a crime against humanity” I thought yes, I like the cut of this blokes jib. This statement really fired me up, nothing ambiguous there eh ! Kris goes for the jugular, my kind of fella. Almost five years ago I stated on our website. “The dietary information offered to many newly diagnosed diabetics is at best nonsense and at worst criminal” and I think that is a fact, now more than ever. So check our Kris’s blog, it’s a fantastic site.

There is a silver lining to this cloud re Jan’s take over, with the weather at last warming up, I can spend more time down at my fishing club. Sitting around chewing the fat with a few old boys, and stopping off on the way home at my favourite pub for a drink or two. Getting back home after some sunbathing fishing, and being tormented by the smell of a great lowcarb roast in the oven, and a bottle of Rioja, quietly breathing on the dining room table, life could be worse.

Eddie


Link to Kris’s blog here.







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Type 2 Diabetes Progresses Faster in Kids, Study Finds


High blood pressure, other complications seen in adolescence

THURSDAY, May 23 (HealthDay News) -- Type 2 diabetes is more aggressive in children than adults, with signs of serious complications seen just a few years after diagnosis, new research finds.
"Based on the latest results, it seems like type 2 is progressing more rapidly in children," said Dr. Jane Chiang, senior vice president of medical affairs and community information for the American Diabetes Association. "Complications are appearing faster, and it appears to be at a more significant rate than we see in adults."
The results are alarming, Chiang and other experts said. "If these children continue to progress this rapidly, we could see many of the consequences of type 2 diabetes at a much younger age, like kidney disease and heart disease," she said.
The findings are from an ongoing study of treatment options for type 2 diabetes in children and teens. Researchers are using data from the same study group to assess factors related to the disease in youth, such as complications.
People with type 2 diabetes have higher than normal blood sugar levels because their body doesn't make or properly use insulin, a hormone needed to convert food into energy. Being overweight is the most significant risk factor for type 2 diabetes, according to the American Diabetes Association. The number of U.S. children with type 2 disease -- usually seen in adults over 40 -- is sizable and growing, experts say.
The study included nearly 700 children with type 2 diabetes who were between 10 and 17 years old at the outset and had had the disease for eight months on average. Type 2 diabetes is rarely seen in children younger than 10, Chiang said. All the participants had a body-mass index (an estimate of body fat based on a ratio of weight to height) at or above the 85th percentile, which is considered overweight.
The children received diabetes education and were randomized to receive one of three treatments: the drug metformin, metformin plus intensive lifestyle changes or metformin plus rosiglitazone (brand name Avandia).
At the start of the study, about 12 percent of participants had high blood pressure (hypertension). Four years later, about 34 percent had high blood pressure, and the risk was highest for males and those who were heavier, according to the report, which was published online May 23 in a special issue of the journal Diabetes Care.
Initial signs of kidney disease, called microalbuminuria, almost tripled in four years -- from 6.3 percent of the children to almost 17 percent, the study found.
Other highlights:
  • Destruction of beta cells -- the cells that produce insulin -- in children and teens occurred at a rate almost four times higher than in adults.
  • Metformin and rosiglitazone improved insulin sensitivity for the first six months of treatment. There was no change in insulin sensitivity for the patients who took metformin and made lifestyle changes, and there was a decrease in insulin sensitivity for youth on metformin alone. In adults, metformin generally improves insulin sensitivity.
  • Children and teens with higher blood sugar levels had the poorest outcomes on oral medications, and needed to begin using insulin sooner.
  • Over three years, the percentage of youth who needed medication to lower their LDL cholesterol (the bad type of cholesterol) increased from 4.5 percent to 10.7 percent. Lifestyle interventions didn't appear to help lower LDL cholesterol, although they did help lower the levels of triglycerides, another type of blood fat.
  • Eye damage occurred at a rate similar to adults. About five years after diagnosis, 13.7 percent of the youths had nonproliferative retinopathy, a condition that blocks blood vessels in the eyes.
"The rapid progression of hypertension and kidney disease was surprising," said Dr. Jane Lynch, the lead author of the hypertension and kidney disease part of the study.
"We really felt like we were on top of these kids as far as treatments, and they still progressed," said Lynch, a professor of pediatrics in the division of endocrinology and diabetes at the University of Texas Health Science Center at San Antonio.
Graham
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Isabel Bayrakdarian and the Armenian Philharmonic Orchestra "Song to the Moon"

Simply mind blowing ! Beauty beyond words !


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Iyeoka - Simply Falling

What more do you need a sunny day a good night with old mates in the local followed with good music to chill out with! Graham
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Recommended by our friend Carole.

If this music does not move you, check your pulse, you have probably died.

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Passion: Peter Gabriel, Nusrat Fateh Ali Khan & Baaba Maal

No words required.


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Djivan Gasparyan - Dle Yaman

Other than people, music has been the love of my life. I have played, or tried to play many instruments, usually poorly. One of  the instruments I failed to get a tune out of was the ancient Armenian instrument the Duduk. There are different ways to spell this instrument, but one thing is for sure Djivan Gasparyan is a virtuoso and arguably the best player in the world. Eddie
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Saturday night is music night Loreena McKennitt

Believe it or not when I’m driving in the mornings I always check into Woman's Hour on BBC radio four. Many years ago via Woman’s Hour I first heard this Woman, Loreena McKennitt. We have all her music on CD’s I think you will be highly impressed. Eddie

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New Analysis: LCHF Best For Long-Term Weight and Health Markers !

I have lost count of the times, I have read about a lowcarb diet only to discover, the trial subjects were consuming anything but a lowcarb diet. Some of these so called lowcarb diets exceeded 150 carbs per day. For me a lowcarb diet is 50 carbs per day or less. The study below fit’s the bill, and states “a diet with no more than 50 g carbohydrates” I know a diet of 50 carbs per day gives me a huge range of foods to choose from. If you are considering going lowcarb to control your weight or diabetes have a Google around, and you will quickly see, lowcarb does not have to be either boring or repetitive.

Eddie

 

Very Low -carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials.

 

Abstract 2013 May

 

The role of very-low-carbohydrate ketogenic diets (VLCKD) in the long-term management of obesity is not well established. The present meta-analysis aimed to investigate whether individuals assigned to a VLCKD (i.e. a diet with no more than 50 g carbohydrates/d) achieve better long-term body weight and cardiovascular risk factor management when compared with individuals assigned to a conventional low-fat diet (LFD; i.e. a restricted-energy diet with less than 30 % of energy from fat). Through August 2012, MEDLINE, CENTRAL, ScienceDirect, Scopus, LILACS, SciELO, ClinicalTrials.gov and grey literature databases were searched, using no date or language restrictions, for randomised controlled trials that assigned adults to a VLCKD or a LFD, with 12 months or more of follow-up. The primary outcome was body weight. The secondary outcomes were TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), systolic and diastolic blood pressure, glucose, insulin, HbA1c and C-reactive protein levels. A total of thirteen studies met the inclusion/exclusion criteria. In the overall analysis, five outcomes revealed significant results. Individuals assigned to a VLCKD showed decreased body weight (weighted mean difference - 0·91 (95 % CI - 1·65, - 0·17) kg, 1415 patients), TAG (weighted mean difference - 0·18 (95 % CI - 0·27, - 0·08) mmol/l, 1258 patients) and diastolic blood pressure (weighted mean difference - 1·43 (95 % CI - 2·49, - 0·37) mmHg, 1298 patients) while increased HDL-C (weighted mean difference 0·09 (95 % CI 0·06, 0·12) mmol/l, 1257 patients) and LDL-C (weighted mean difference 0·12 (95 % CI 0·04, 0·2) mmol/l, 1255 patients). Individuals assigned to a VLCKD achieve a greater weight loss than those assigned to a LFD in the long term; hence, a VLCKD may be an alternative tool against obesity.

Link to study here.
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The only problem I have with low carbing !

For me the only problem I have with low carbing is, it’s so TASTY, and the choice of foods are great.

As you know I am not diabetic I choose to eat  low carb high fat, for Eddie and other members of the team who are diabetic this lifestyle keeps their blood sugars at a safe level.

But going back to tasty low carbing and yesterday evening.


A Friday night at the end of a busy week, the weather had been more like Winter than Spring, I didn’t have any problem with deciding Friday night’s meal. At our local supermarket some great looking and great tasting green and black olives to start with, making sure the Pinot Grigio was chilled and the Rioja open to breathe. I’m more of a white wine fan whilst Eddie prefers red. Some lovely low carb sausages, served with mashed Swede, oodles of butter of course, some white cabbage, with an onion gravy. Tasted divine. Followed by some strawberries and double cream, yes slightly more carbs than raspberries, but very nice. We then watched a very interesting programme about Anne Boleyn and The Tudors, might not be everyone's cup of tea, but we enjoyed it.

Today’s choice:


Breakfast. Scrambled eggs, bacon and mushrooms.
Lunch. The crunch of iceberg lettuce, and coleslaw served with some grated cheese.


Dinner. Will be. Breast of Chicken with an assortment of low carb vegetables, definitely Swede because I have some left from last night. And yes you’ve guessed it finishing off with strawberries and double cream, although I may get some other berries to mix in with them.

Pleased to say, as we have not got any rain at the moment, we are off out to a local park just to enjoy a quiet stroll and some fresh air, whilst looking forward to another enjoyable TASTY low carb meal tonight.






All the best Jan
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Doctor Richard K Bernstein has been testing blood glucose meters.

THE MOST ACCURATE BLOOD GLUCOSE MONITOR?  The answer is in!

UPDATE: Ask Dr. Bernstein Webcast and Teleconference Call Wednesday May 29th,
2013 at 7PM CST.
 
You Have Been Waiting for The Final Results, to discover the most accurate 
monitor. The results are in.

After more than 10 months of testing and evaluating multiple monitors, Dr.
Bernstein will announce the most Accurate Glucose Monitor. After evaluating the
information and doing hands on testing and comparing with a professional
monitor, and lab results, the final results are in.
Be on the webcast Wednesday May 29th. Just go to www.askdrbernstein.net and
register for the webcast for free.

When taking insulin it is crucial that you are using the most accurate blood
glucose monitor to accurately determine your dose of insulin. It is also
important to know if your diet and exercise is having an affect. There is just
one accurate blood glucose monitor, that Dr. Bernstein is recommending, learn
which one.

We will also announce how to get one of the new monitors free of charge and how
to save 50 dollars on strips every time you purchase them or if you have
insurance pay no more than 15 dollars for a 100 strips.

If you can’t make the webcast, email me to get the info at
publisher@diabetesincontrol.com and I will email you the info after the webcast.

Dr. Bernstein will also discuss the new updates on Erythritol

Just go to www.askdrbernstein.net and register for the webcast for free.

If you have a question you would like answered by Dr. Bernstein, send your
question to me NOW! Email me at publisher@diabetesincontrol.com

Then if you want the most current information from Dr.Bernstein, get the 5 hours
of education from Dr. Bernstein. Go to secrets.diabetes911.net and learn how
you can have normal blood sugars. Be on the webcast and learn! Wednesday May 29th at 7PM CST Go to
www.askdrbernstein.net and register for free.

For your own A1c monitor go to www.a1ctest.com to find out if you are taking
the right medicine, eating the right foods and if you are being physical active
enough to control your diabetes. Or to just check your family members to see
their risk for diabetes. An A1c of 6.5% is diabetes and an A1c of 5.7 to 6.4
is prediabetes!

Dr. Bernstein will answer questions also discuss a surprising update on
Erythritol!

Dr. Bernstein has NO financial interest with ANY monitor company. This
information comes from months of testing.

Just go to www.askdrbernstein.net and register for the webcast for free.
 
 
Eddie 
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Anti-cholesterol drugs could increase diabetes risk: study

TORONTO — Some cholesterol-lowering drugs called statins appear to put users at an elevated risk of developing diabetes, a new study reports.
The work, by Toronto scientists, suggests that higher potency statins increase the diabetes risk, although this is not the case for lower-dose brands. 
At the end of the day, the cholesterol-lowering benefits of the drugs may outweigh the diabetes risks in many cases, said senior author Dr. Muhammad Mamdani. But he suggested it makes sense to try to use a lower-dose statin when possible.
"If a patient has a really high LDL" — the dangerous form of cholesterol — "then maybe you do need the high powered stuff like Lipitor and rosuvastatin or Crestor and you can actually go a bit higher on the dose," said Mamdani, director of the applied health research centre at the St. Michael's Hospital's Li Ka Shing Knowledge Institute.
"But for most of the patients you could probably get away with using something like pravastatin or even lovastatin.... I'd say for the vast majority of patients, those would be just fine."
Pravastatin, which is sold as Pravachol or Selektine, has actually been shown to be protective against diabetes in some studies. Lovastatin is sold under the brand name Mevacor.
Mamdani estimated the risk as follows: "For every 1,000 patients who takes one of the higher potency statins, you're going to see six to 10 additional patients being diagnosed with diabetes ... Had you used pravastatin, you would have seen between six to 10 fewer patients with diabetes."
"So the risks aren't huge," he continued. "But there are a lot of people taking these high potency statins. In fact, atorvastatin is by far — by far — the most popular statin."
The possible link between taking some statins and diabetes has been seen in the past. In fact, Health Canada warned in January that statin users may have a small increased risk of developing the condition and changed the labelling on the drugs to reflect that fact.
But previous studies have found conflicting results, so Mamdani and some colleagues conducted another. They looked at the records of more than 470,000 people 66 and older in Ontario who did not have diabetes when they started taking a statin, and found three brands of the drugs seemed to increase their diabetes risk.
The three drugs were atorvastatin, rosuvastatin and simvastatin, which are sold as Lipitor, Crestor and Zocor respectively.
The researchers said no increased risk was seen with fluvastatin (which is sold under the brand names Lescol, Canef and Vastin) or lovastatin.
Mamdani said there isn't an across-the-board answer here. "I don't think it should be . . . 'Everybody ditch the statin that you're on and take pravastatin.' It really should be left to the physician and the patient to see where the patient is at."
"(But) if you're one of the I think majority of patients who probably could do well on pravastatin, that's a conversation the patient may want to have with their physician."
The study was published in BMJ, a journal of the British Medication Association. The work was done by researchers at Toronto General Hospital, the Institute of Clinical Evaluative Studies, Sunnybrook Research Institute and the Li Ka Shing Knowledge Institute.

http://www.mississauga.com/community/health/article/1621331--anti-cholesterol-drugs-could-increase-diabetes-risk-study
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Bayer, Pfizer Accused of Making False Claims About Their Top-Selling Multivitamins !

A recent study sponsored by the National Institutes of Health, BASF Corporation, Pfizer and DSM Nutritional Products found that daily supplementation with a multivitamin significantly reduced the risk of cancer among men.
 This particular study used Pfizer’s Centrum brand of multivitamins, which brings in around $1 billion a year in sales (a hefty share of the $40 billion US supplement market).

Undoubtedly, Pfizer will seek to use these study results to claim that taking Centrum multivitamins may help you prevent cancer… a lofty marketing move that has already landed them (and other drug companies) in hot water…
Although it is good to see the Center for Science in the Public Interest (CSPI) keeping these companies honest, one of the biggest crimes is actually perfectly legal. These companies are using synthetic vitamins rather than natural ones in virtually all of their products, despite the compelling evidence of the vast superiority of natural versions.
In response, Pfizer agreed to drop certain claims related to “breast health” and “colon health” from the labels of its Centrum multivitamins, as well as from their Web site. CSPI subsequently agreed to withdraw their notice of intention to file a lawsuit.

More on this story here.
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Glaxo Chief: Our Drugs Do Not Work on Most Patients !

A senior executive with Britain's biggest drugs company has admitted that most prescription medicines do not work on most people who take them. Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them. It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public. His comments come days after it emerged that the NHS drugs bill has soared by nearly 50 per cent in three years, rising by £2.3bn a year to an annual cost to the taxpayer of £7.2bn. GSK announced last week that it had 20 or more new drugs under development that could each earn the company up to $1bn (£600m) a year.

Dr Roses, an academic geneticist from Duke University in North Carolina, spoke at a recent scientific meeting in London where he cited figures on how well different classes of drugs work in real patients.

Drugs for Alzheimer's disease work in fewer than one in three patients, whereas those for cancer are only effective in a quarter of patients. Drugs for migraines, for osteoporosis, and arthritis work in about half the patients, Dr Roses said. Most drugs work in fewer than one in two patients mainly because the recipients carry genes that interfere in some way with the medicine, he said."The vast majority of drugs - more than 90 per cent - only work in 30 or 50 per cent of the people," Dr Roses said. "I wouldn't say that most drugs don't work. I would say that most drugs work in 30 to 50 per cent of people. Drugs out there on the market work, but they don't work in everybody."Some industry analysts said Dr Roses's comments were reminiscent of the 1991 gaffe by Gerald Ratner, the jewelry boss, who famously said that his high street shops are successful because they sold "total crap". But others believe Dr Roses deserves credit for being honest about a little-publicized fact known to the drugs industry for many years.

More on this ten year old story here. I don't suppose anything has changed.

Eddie



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Worldwide Dietary Therapies for Adults With Epilepsy and Other Disorders


Abstract

During the 3rd International Symposium on Dietary Therapies held in Chicago, Illinois, there was a first-ever, half-day session devoted to the management of adults with epilepsy and other disorders with dietary treatments. Speakers from 3 different continents shared their successes, challenges, and future directions in their management of these patients. Diets used to treat adults included the classic ketogenic diet, the modified Atkins diet, and a low glycemic index treatment. The utility of dietary therapies was demonstrated not only in patients with epilepsy but also patients with propriospinal myoclonus, astrocytoma, type 2 diabetes, obesity, hyperlipidemia, and metabolic disorder. The session provided evidence that dietary therapies are safe and effective in adults.


Sorry can't access the full article.
Graham
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Sulphonylureas 'linked with CV mortality increase' !

GPs should consider alternatives to sulphonylureas in patients with Type 2 diabetes as their use is linked to an increase in cardiovascular disease, claim researchers.
 
The study
The US meta-analysis of 33 randomised and observational studies included 1,325,446 patients with diabetes a mean age ranging from 52 to 76 years. Cardiovascular composite endpoints such as a major cardiovascular event, cardiovascular death or stroke were compared for patients with diabetes taking sulphonylureas, compared with other diabetes treatments, such as metformin and thiazolidinediones. Ratios were adjusted for potential confounders including baseline cardiovascular risk, concomitant medications and diabetes severity.
The results
A significant association between sulphonylurea use and cardiovascular mortality was seen, with a relative risk 1.27 compared with other diabetes treatments. Sulphonylurea use was also significantly associated with a 10% increased risk of the cardiovascular composite endpoint, compared with other diabetes treatments.  Sulphonylureas were associated with a 16% increased risk of the cardiovascular composite endpoint when compared with metformin. Statistical pooling found no statistically significant associations between sulphonylureas use and stroke, compared with other diabetes treatments.
What this means for GPs
The researchers concluded that their results ‘warrant consideration in clinical practice, when other treatment options may be available’

Link to Pulse article 22nd. of May here.
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