Low blood sugars

[Jake Di Vita]

Posting this from my phone...more thoughts later.

http://www.staffanlindeberg.com/DiabetesStudy.html

[Paul Santiago]

I had to chime in being a Type II. I admit I did not read all of the links in that Jake. I did read the couple of FAQ's. I read the caption under the 100 year old man. My grandmother just died in July at 101 and I'm pretty sure she hadn't heard of those things either.

What did catch my eye was the last couple of lines on the front page. This is the counter to decades of medical research in diabetes?

=====

"If you want to prevent or treat diabetes type 2, it may be more efficient to avoid some of our modern foods than to count calories or carbohydrate >>.

This is the first controlled study of a Paleolithic diet in humans."

===

"It MAY be more efficient"...

ok...

Edited February 23, 2010 by pas44

[Jake Di Vita]

So what we have here is a control study comparing a mediterranean diet approach vs. a paleo approach. At the end of the study, the people on the highly vaunted Mediterranean diet had little to no change in their insulin sensitivity while the paleo control group were technically not diabetic anymore. They had normal fasting blood glucose levels as well as normal insulin response to glucose. It is very clear that the whole lectin issue with these neolithic foods (grains, legumes, dairy) has some substantial impact on insulin dis regulation. So we're seeing it isn't only carbohydrate intake, but the type of carbohydrates that has an effect on this.

Also in regards to the paleo control group - They were not particularly low carb, and ate to satiety. Mostly with yams, sweet potatoes, lean meats, so on and so forth. I also suspect they would have had even more potent results had they restricted carbohydrate intake to under 75g a day. Not only were they metabolically deranged from some autoimmune issue that is being caused the lectins in the neolithic foods they were consuming, but the best way to reset insulin sensitivity is by dropping basal insulin levels overall.

I stand by my earlier assertion that Type II Diabetes is an environmental disease, and when you eliminate whatever is causing the problem in the environment, you tend to see improvement.

[bdo]

So what we have here is a control study comparing a mediterranean diet approach vs. a paleo approach. At the end of the study, the people on the highly vaunted Mediterranean diet had little to no change in their insulin sensitivity while the paleo control group were technically not diabetic anymore. They had normal fasting blood glucose levels as well as normal insulin response to glucose. It is very clear that the whole lectin issue with these neolithic foods (grains, legumes, dairy) has some substantial impact on insulin dis regulation. So we're seeing it isn't only carbohydrate intake, but the type of carbohydrates that has an effect on this.

Also in regards to the paleo control group - They were not particularly low carb, and ate to satiety. Mostly with yams, sweet potatoes, lean meats, so on and so forth. I also suspect they would have had even more potent results had they restricted carbohydrate intake to under 75g a day. Not only were they metabolically deranged from some autoimmune issue that is being caused the lectins in the neolithic foods they were consuming, but the best way to reset insulin sensitivity is by dropping basal insulin levels overall.

I stand by my earlier assertion that Type II Diabetes is an environmental disease, and when you eliminate whatever is causing the problem in the environment, you tend to see improvement.

So, are you saying that Type II DM runs along family lines only because that family has poor exercise and diet habits?

Yes, the environment plays a role. Is there a genetic component in some cases? Yes. There are genetic factors which are major risk determinants in certain ethnic groups.

I present to you the following study funded partly by the French government and a French charity.

http://diabetes.diabetesjournals.org/content/55/10/2903.full

Recently, the transcription factor 7-like 2 (TCF7L2) gene has been associated with type 2 diabetes in subjects of European origin in the DeCode study.

TCF7L2 is expressed in most human tissues, including mature pancreatic β-cells, with the exception of the skeletal muscle. In the subcutaneous and omental fat from obese type 2 diabetic subjects, TCF7L2 expression significantly decreased compared with obese normoglycemic individuals.

We found that the TCF7L2 gene is significantly expressed in human tissues that are vital for glucose homeostasis, including visceral and subcutaneous fat.

In conclusion, our results not only replicate the Icelandic data but also provide strong evidence that TCF7L2 is a major determinant of diabetes risk in the European population.

Edited February 24, 2010 by bdo

[eric nielsen]

So much of what Jake has posted is accurate & shows a significant understanding of the factors involved in diabetes Type II, that it is a shame to point out that

1. the seemingly accessible parts - the analogies to things other than cells, receptors, blood and organs; and

2. his major summation - that DMT2 can be fully reversed by almost anyone without recourse to medicine or insulin

Those two things are recklessly irresponsible, NOT analogous, and factually incorrect.

Please consider the source of all information you gather in from the Internet.

I'd encourage anyone diagnosed DMT2 or pre-diabetic to work as hard as they possibly can [as in, your #1 priority in life] to manage as much of their condition as possible by way of dietary control and extensive, regular exercise. And manage their condition with the guidance of their doctor.

[Jake Di Vita]

I never said anything should be done without recourse to medicine or insulin, Eric. Of course, inform your physician and do this under their supervision and take all necessary precautions. While we obviously don't agree on what this is capable of doing, I think all of us can agree that a paleo approach would not exacerbate things.

And yes, I realize my analogies are not 100% accurate. They aren't meant to be. They are meant to give a very basic insight into one of insulin's many functions in a way that everyone can understand.

bdo

You're confusing correlation with causation. Sure there are definitely people whom are more predisposed to it than others...but this condition is only a problem when you create the environment for it to be a problem.

[bdo]

So much of what Jake has posted is accurate & shows a significant understanding of the factors involved in diabetes Type II, that it is a shame to point out that

1. the seemingly accessible parts - the analogies to things other than cells, receptors, blood and organs; and

2. his major summation - that DMT2 can be fully reversed by almost anyone without recourse to medicine or insulin

Those two things are recklessly irresponsible, NOT analogous, and factually incorrect.

Please consider the source of all information you gather in from the Internet.

I'd encourage anyone diagnosed DMT2 or pre-diabetic to work as hard as they possibly can [as in, your #1 priority in life] to manage as much of their condition as possible by way of dietary control and extensive, regular exercise. And manage their condition with the guidance of their doctor.

I think we can all agree on that.

It would also be wise to get a comprehensive eye examination yearly as well regardless of which type of DM you have, especially since diabetic retinopathy is the leading cause of vision loss in adults in the US.

[bdo]

I never said anything should be done without recourse to medicine or insulin, Eric. Of course, inform your physician and do this under their supervision and take all necessary precautions. While we obviously don't agree on what this is capable of doing, I think all of us can agree that a paleo approach would not exacerbate things.

And yes, I realize my analogies are not 100% accurate. They aren't meant to be. They are meant to give a very basic insight into one of insulin's many functions in a way that everyone can understand.

bdo

You're confusing correlation with causation. Sure there are definitely people whom are more predisposed to it than others...but this condition is only a problem when you create the environment for it to be a problem.

The environmental factors such as poor diet and sedentary lifestyle are risk factors that predispose you to the disease just like having a certain genetic trait.

Risk factors can be broken down into modifiable risk factors and non-modifiable risk factors.

Just because you have none of the modifiable risk factors does not mean you are immune to the disease. It just means you have a reduced chance.

[Nik Habicht]

So what we have here is a control study comparing a mediterranean diet approach vs. a paleo approach.

One tiny (29 subjects total) limited time (12 weeks) study.....

At the end of the study, the people on the highly vaunted Mediterranean diet had little to no change in their insulin sensitivity while the paleo control group were technically not diabetic anymore.

I'm not an endo, but looking hard at the lab results, and translating their HgA1C levels, it's tough to tell if they were diabetic to begin with --- their initial A1C levels were very good (something for most diabetics to envy) at the beginning of the study....

It is very clear that the whole lectin issue with these neolithic foods (grains, legumes, dairy) has some substantial impact on insulin dis regulation. So we're seeing it isn't only carbohydrate intake, but the type of carbohydrates that has an effect on this.

I don't know enough about lectin to establish or reject causality one way or the other, but totally agree with your interpretation that it's not just carbohydrate intake but also the type of carbohydrate intake that matters. I've seen diabetics who didn't spike after a cup of milk, and others who spiked after a generous splash added to a mug of coffee. That's where measuring or weighing foods, consulting nutritional references and using a glucometer in conjuction with a food diary to establish blood glucose values prior to and after eating (to track the changes caused by eating those foods) come in to help the diabetic patient identify those foods that trigger a blood glucose spike and those that are better metabolized by the particular patient....

Also in regards to the paleo control group - They were not particularly low carb, and ate to satiety. Mostly with yams, sweet potatoes, lean meats, so on and so forth. I also suspect they would have had even more potent results had they restricted carbohydrate intake to under 75g a day.

I suspect that you'd be correct for at least a portion of the paleo group....

I stand by my earlier assertion that Type II Diabetes is an environmental disease, and when you eliminate whatever is causing the problem in the environment, you tend to see improvement.

I'd feel a lot more comfortable with that assertion, if you were a practicing endocrinologist and could back that up with both anecdotal experience from your years of practice and with multiple (and ideally larger and more long-term) studies.....

[Nik Habicht]

I never said anything should be done without recourse to medicine or insulin, Eric. Of course, inform your physician and do this under their supervision and take all necessary precautions.

Um, remember this:

If it can be controlled without insulin and without medication, and you don't have any of the effects of it - how is that not (for all intents and purposes) cured?

Replace the words "insulin sensitivity" with "sunburn." If you get a sunburn, how do you get rid of it? Stay out of the damn sun! If you are insulin resistant, how do you get rid of it? Increase your insulin sensitivity by changes in your life style.

When one has to choose a life of diabetes vs. a life of exercise and nutrition - I would hope the majority of people would say the exercise and nutrition is worth it....

That suggests doing this without recourse to medicine or medical care and in fact frames it as something that is strictly under the patient's voluntary control.....

[Nik Habicht]

While we obviously don't agree on what this is capable of doing, I think all of us can agree that a paleo approach would not exacerbate things.

I'd go so far as to argue that a paleo (or near paleo) approach, especially coupled with exercise, would not only not exacerbate things, but might actually help significantly....

And that would be a very good thing.....

[GrumpyOne]

Well, I'll give some insight when i go back to get the 6 month check, which should be in a couple of weeks. My intial A1C was 11 (August '09)blood sugar average of 275, at last check it was 7.4 (November '09) blood sugar average of 124. Bear in mind, from when I was diagnosed in late August till the 2nd check in November was not 3 months, so....

I have modified a great deal of my diet, lost 50 lbs, more active, and pretty much on the paleo diet. I am taking 500mg of Metformin in the morning, 5mg of Glipizide at lunch, and another 500mg of Metformin at night.

Thanks for all the info guys, lots of stuff to look into.

And guys, don't argue about this stuff! It may (and probably does) affect each and everyone of us a bit differently. So, what may work for one, may not work for another.

Edited February 24, 2010 by GrumpyOne

[bdo]

Are the HgA1c levels only in the full version?

At the end of the study, the people on the highly vaunted Mediterranean diet had little to no change in their insulin sensitivity while the paleo control group were technically not diabetic anymore.

I'm not an endo, but looking hard at the lab results, and translating their HgA1C levels, it's tough to tell if they were diabetic to begin with --- their initial A1C levels were very good (something for most diabetics to envy) at the beginning of the study....

Edited February 24, 2010 by bdo

[GrumpyOne]

Are the HgA1c levels only in the full version?

I haven't a clue, I'm new to this disease. All I know is, I don't want it, but I got it!

[bdo]

Are the HgA1c levels only in the full version?

I haven't a clue, I'm new to this disease. All I know is, I don't want it, but I got it!

Whoops, I slacked on using the quote function. I was speaking to Nik.

[GrumpyOne]

no prob!

[Jake Di Vita]

The environmental factors such as poor diet and sedentary lifestyle are risk factors that predispose you to the disease just like having a certain genetic trait.

Risk factors can be broken down into modifiable risk factors and non-modifiable risk factors.

Just because you have none of the modifiable risk factors does not mean you are immune to the disease. It just means you have a reduced chance.

Remember that Type II Diabetes is the ultimate expression of insulin resistance. It's on the far end of the scale. In the vast majority of cases (I would say all, but I'm sure I'd be flogged for it) genetics alone won't be enough to get you there.

If it can be controlled without insulin and without medication, and you don't have any of the effects of it - how is that not (for all intents and purposes) cured?

Replace the words "insulin sensitivity" with "sunburn." If you get a sunburn, how do you get rid of it? Stay out of the damn sun! If you are insulin resistant, how do you get rid of it? Increase your insulin sensitivity by changes in your life style.

When one has to choose a life of diabetes vs. a life of exercise and nutrition - I would hope the majority of people would say the exercise and nutrition is worth it....

That suggests doing this without recourse to medicine or medical care and in fact frames it as something that is strictly under the patient's voluntary control.....

I think you may have read that incorrectly. Another way of putting it is that if you don't experience any of the symptoms related to Type II Diabetes, and it is predictably stabilized without outside aid, you are effectively cured - in that it doesn't really effect your day to day quality of life. I never suggested blindly stumbling into this without devoted research and preparation or notifying your physician. Sorry for not being more clear.

[Paul Santiago]

Well, I'll give some insight when i go back to get the 6 month check, which should be in a couple of weeks. My intial A1C was 11 (August '09)blood sugar average of 275, at last check it was 7.4 (November '09) blood sugar average of 124. Bear in mind, from when I was diagnosed in late August till the 2nd check in November was not 3 months, so....

I have modified a great deal of my diet, lost 50 lbs, more active, and pretty much on the paleo diet. I am taking 500mg of Metformin in the morning, 5mg of Glipizide at lunch, and another 500mg of Metformin at night.

Thanks for all the info guys, lots of stuff to look into.

And guys, don't argue about this stuff! It may (and probably does) affect each and everyone of us a bit differently. So, what may work for one, may not work for another.

Way to go on the numbers decrease!!!! Keep it up and your numbers will keep dropping!!

I dropped 60 lbs last year and my A1C went from 7 to 5.3.

I'm now off the blood pressure and cholesterol meds. My wakeup reading before is about 105-110.

I take metformin and Byetta morning and night.

[Neomet]

I don't have too much of a dog in the Paleo/Type II debate being a type 1 but I will say that going to a specific diet or taking medication of any type for the rest of your life is not a cure. It is a method to control or mitigate a disease process. It would be like saying a transplanted kidney has been accepted by the host body as long as anti-rejection drugs continue to be taken.

This is probably a small point to researchers, pundits of various treatment modalities, and the public at large, but it is frankly almost insulting to many people with the disease. It is often heard as "There is a cure out there if only you weren't too weak to take it." No offense meant, as I am sure this is not the intent of any posters here or hell, even most of the public at large but enthusiasm for treatment options can often be heard that way.

Edited February 24, 2010 by Neomet

[Jake Di Vita]

It's the disease of western civilization. Every organism on the planet has a genetic preponderance to a specific diet. When you go away from that diet, there are consequences for it. It sucks, but that's just how it is. Google hyperinsulinism and any other disease you can think of. Not to mention gluten intolerance, acid-base balance, and omega 3 to omega 6 ratios.

The problem is most people have too big of an emotional attachment to eating, when for our health it should be viewed with purpose instead of pleasure. Ultimately everyone is going to do what they want to do, but man, I want to be healthy and active with my grandchildren when I have them. FWIW I don't think it's because people are too weak, I think it's because they are largely misinformed and lodged with doubt.

Isn't taking pills for an entire lifetime also a "method to control or mitigate a disease process."? Why is it that changing your diet should be viewed any differently? If you had to take those anti-rejection meds to live, you surely would wouldn't you?

[Nik Habicht]

Are the HgA1c levels only in the full version?

At the end of the study, the people on the highly vaunted Mediterranean diet had little to no change in their insulin sensitivity while the paleo control group were technically not diabetic anymore.

I'm not an endo, but looking hard at the lab results, and translating their HgA1C levels, it's tough to tell if they were diabetic to begin with --- their initial A1C levels were very good (something for most diabetics to envy) at the beginning of the study....

They're in the .pdf -- and I actually read the whole thing.....

Links on the page that Jake linked to....

BTW, Jake: Thanks for that link! It points me toward a (unknown to me) journal that seems to deal specifically with Diabetes -- and is sure to become a resource for the foreseeable future....

[Neomet]

I think you are missing my point Jake. I am not discounting the efficacy of a Paleo diet. That is why I included it with medication as opposed to contrasting it. I frankly don't know enough about it which is why I have not commented on the issue. My point is that whatever the patient does it is something they have to do for the rest of their lives. Have to means that the patient still has the disease. Cure means you can eat like the general population without having an A1c of 12. Grain diets may be an issue with western/affluent societies for any number of reasons but it does not impact everyone equally. If diabetes were a disease of western civilization everyone in western civilization would have diabetes. Diabetes is a disease of individuals.

[Nik Habicht]

The environmental factors such as poor diet and sedentary lifestyle are risk factors that predispose you to the disease just like having a certain genetic trait.

Risk factors can be broken down into modifiable risk factors and non-modifiable risk factors.

Just because you have none of the modifiable risk factors does not mean you are immune to the disease. It just means you have a reduced chance.

Remember that Type II Diabetes is the ultimate expression of insulin resistance. It's on the far end of the scale. In the vast majority of cases (I would say all, but I'm sure I'd be flogged for it) genetics alone won't be enough to get you there.

If it can be controlled without insulin and without medication, and you don't have any of the effects of it - how is that not (for all intents and purposes) cured?

Replace the words "insulin sensitivity" with "sunburn." If you get a sunburn, how do you get rid of it? Stay out of the damn sun! If you are insulin resistant, how do you get rid of it? Increase your insulin sensitivity by changes in your life style.

When one has to choose a life of diabetes vs. a life of exercise and nutrition - I would hope the majority of people would say the exercise and nutrition is worth it....

That suggests doing this without recourse to medicine or medical care and in fact frames it as something that is strictly under the patient's voluntary control.....

I think you may have read that incorrectly. Another way of putting it is that if you don't experience any of the symptoms related to Type II Diabetes, and it is predictably stabilized without outside aid, you are effectively cured - in that it doesn't really effect your day to day quality of life. I never suggested blindly stumbling into this without devoted research and preparation or notifying your physician. Sorry for not being more clear.

The huge problem with that generalization is that once you're diagnosed, glycemic control is a delicate balancing act that is easily disrupted. The patient requires regular monitoring, to ensure that there's no significant or long-lasting loss of euglycemia --- as that is what damages organs. Diabetics will live for years with the disease, with excellent control decades without major complications....

[Jake Di Vita]

It's thrown in with other diseases of western civilization for the reason that people don't experience these diseases when they have never been introduced to neolithic foods. (I'm sure I can grab citations for this if anyone really wants me to).

If that is how you view a cure, then you're absolutely right - it will never be cured.

Unfortunately life is horridly unfair and some individuals have to face that choice for the rest of their lives. I don't think that the eat well option should be looked at like a punishment though. I guess it's primarily dependent on what your individual priorities are.

[Neomet]

Yep, that's actually my point. I get the unfairness/inequity of life, trust me. I would give you a list of the problems I have after 42 years of well controlled diabetes to prove this point but it would be long, fairly boring to anyone but me, and if not whining, damned close to it. I still run into physicians/somewhat educated folks who say that if only I keep my A1c at this level or that level I wouldn't have any problems at all so you see, these issues are all really mine. I just need better priorities. I hate that phrase.

Its a simple point. its a disease that has no cure. Period. Not looking for a boo-hoo-hoo moment or a group hug here, but just a simple acknowledgment from those that interact with us that it is a disease that we are fighting with either diet, meds, exercise, all of the above... whatever to the best of our abilities.