I don't usually write about commercial products, but this one seems interesting . . . if it fulfils its promise. It's a way of determining whether you're burning primarily carbohydrate or fat.
This is done by calculating something called the respiratory quotient (RQ), which is the ratio of carbon dioxide production to oxygen consumption. An RQ of 1 means you're metabolizing mostly carbohydrate, and an RQ of 0.7 means you're burning mostly fat. Obviously, numbers between these extremes indicate you're burning both. Protein has a small effect on the RQ.
When I was in a clinical study at the Joslin Diabetes Center some years ago, they measured my RQ. I had a big hood over my head for what seemed like a long time, and it was horrid when my nose started to itch but I couldn't scratch it.
Now an Israeli company has produced a little gizmo into which you breathe, and they say it will give you an RQ. It's not cheap (about $300), and it won't be available until next August, although you can order it now for $249. Last summer, articles were saying it would ship in February 2019 and preorder price was $179. I've seen a lot of gizmos being announced that never come to market, so I'll believe this one when I see it. Nevertheless, it's interesting.
So why would you care what your RQ was? Well, we can all be a little different, and some people may be better at burning carbohydrates or burning fats. Let's say you want to lose fat. When your carbohydrate intake, and hence your insulin level, is low, your hormones can help you break down the fat in your fat cells and ship fatty acids out into the circulation to be taken up and burned by tissues that need energy.
But if you don't burn the fatty acids very efficiently they'll just stay around and eventually may get taken up by the fat cells for storage as (ugh) fat.
It would be interesting to measure the RQ of someone just starting a low-carb diet and then keep measuring as the person became adapted to the diet. Would the RQ show more fat oxidation as time went by and the body became accustomed to using fat for energy? Could the RQ be shown to be related to the fatigue some people feel when going on a low-carb diet?
Some people are more efficient at fat burning than others. Could they determine this by measuring the RQ with this gizmo
If despite limiting carbohydrate in your diet, the gizmo showed that you were still getting a lot of your energy from carbohydrate, you would know that you had to limit carbohydrate more than some other people.
Of course the gizmo could also be used by people who wanted to burn a lot of carbohydrate.
I look forward to the day when this is actually available to see how people are using it.
Thursday, January 17, 2019
Friday, January 11, 2019
Connected Systems
Everything is connected.
No, this won't be a New Age rant on oneness with the universe. I'm speaking of the various systems in the body, which used to be put into boxes as if they operated on their own. There was the circulatory system, the nervous system, the respiratory system, the digestive system, and so forth, and many doctors specialized in one system or another.
Different processes were thought to take place in different systems. For example, gluconeogenesis (the formation of glucose from other compounds) was said to take place in the liver, and although it was mentioned that the kidney also performed some gluconeogenesis, this was mostly ignored. This approach made sense in the past, when measurement techniques were relatively crude, but today techniques have improved and it's even possible in some cases to measure what's going on in single cells.
So now, more and more, we're learning that the various organs have roles other than the main roles that have been known for decades, and the various systems are interconnected, sometimes in surprising ways. For example, not long ago, fat was considered just a way to store extra energy. It's now well known to secrete hormones too.
One recent study showed that a gut hormone interacts with brown fat to tell the brain that it's time to stop eating. The hormone, secretin, has been known since 1902, but its role was said to be to stimulate the pancreas to release bicarbonate to neutralize the acids coming from the stomach. Now it seems it has at least one other role. Mice injected with secretin had less appetite and increased the amount of heat the brown fat produced. Unless you're cold, heat is "wasted" energy, so increasing the amount of heat produced would mean they would gain less weight from the food they ate.
And a study of mast cells also revealed unexpected effects. Mast cells produce histamine, which is important in causing allergic symptoms, so many allergy sufferers take antihistamines. This study showed that histamine that goes to the liver, not the lungs or nose, also helps regulate ketogenesis (the production of ketone bodies from fatty acids).
It does this via a molecule called OEA (oleoylethanolamide). Previously, researchers thought OEA's role was to block hunger pangs. It does, but it also stimulates ketogenesis.
These complex interactions are one reason different people can react differently to various medications and diets. One person might have a difference in the mast cells and another might have a difference in the sensitivity of the liver to histamine and another might have a difference in some related but as-yet-unknown reaction in the same system. (I'm using the term "difference" rather than "defect" because sometimes a metabolic difference that is detrimental in one environment turns out to be beneficial in another.)
Hence we should never assume that what works for one person will work for us. Today we have so many tools to measure the various aspects of our diabetes that we can try something and then if it doesn't work try something else. No one diet or one drug or one exercise regime is best for everyone.
And we should remember that everything is connected. We shouldn't focus on just one system in our body and ignore the rest. They all talk to each other, and maybe healing an ingrown toenail will help our diabetes.
No, this won't be a New Age rant on oneness with the universe. I'm speaking of the various systems in the body, which used to be put into boxes as if they operated on their own. There was the circulatory system, the nervous system, the respiratory system, the digestive system, and so forth, and many doctors specialized in one system or another.
Different processes were thought to take place in different systems. For example, gluconeogenesis (the formation of glucose from other compounds) was said to take place in the liver, and although it was mentioned that the kidney also performed some gluconeogenesis, this was mostly ignored. This approach made sense in the past, when measurement techniques were relatively crude, but today techniques have improved and it's even possible in some cases to measure what's going on in single cells.
So now, more and more, we're learning that the various organs have roles other than the main roles that have been known for decades, and the various systems are interconnected, sometimes in surprising ways. For example, not long ago, fat was considered just a way to store extra energy. It's now well known to secrete hormones too.
One recent study showed that a gut hormone interacts with brown fat to tell the brain that it's time to stop eating. The hormone, secretin, has been known since 1902, but its role was said to be to stimulate the pancreas to release bicarbonate to neutralize the acids coming from the stomach. Now it seems it has at least one other role. Mice injected with secretin had less appetite and increased the amount of heat the brown fat produced. Unless you're cold, heat is "wasted" energy, so increasing the amount of heat produced would mean they would gain less weight from the food they ate.
And a study of mast cells also revealed unexpected effects. Mast cells produce histamine, which is important in causing allergic symptoms, so many allergy sufferers take antihistamines. This study showed that histamine that goes to the liver, not the lungs or nose, also helps regulate ketogenesis (the production of ketone bodies from fatty acids).
It does this via a molecule called OEA (oleoylethanolamide). Previously, researchers thought OEA's role was to block hunger pangs. It does, but it also stimulates ketogenesis.
These complex interactions are one reason different people can react differently to various medications and diets. One person might have a difference in the mast cells and another might have a difference in the sensitivity of the liver to histamine and another might have a difference in some related but as-yet-unknown reaction in the same system. (I'm using the term "difference" rather than "defect" because sometimes a metabolic difference that is detrimental in one environment turns out to be beneficial in another.)
Hence we should never assume that what works for one person will work for us. Today we have so many tools to measure the various aspects of our diabetes that we can try something and then if it doesn't work try something else. No one diet or one drug or one exercise regime is best for everyone.
And we should remember that everything is connected. We shouldn't focus on just one system in our body and ignore the rest. They all talk to each other, and maybe healing an ingrown toenail will help our diabetes.
Tuesday, January 8, 2019
On Eggs
Recommendations on eggs seem to go from one extreme to the other, or "yo-yo egg advice."
In the 1950s and 1960s, eggs were considered healthy. Adele Davis, a popular health food guru in those days, had a chapter in her book Let's Cook it Right titled "Serve Eggs and Cheese Daily." She went on to note that in addition to their protein content, eggs contain a lot of vitamins and minerals, which she discussed.
Then came the low-fat fad, in which any kind of fat was considered poisonous. Egg yolks, which contain a lot of fat as well as a lot of cholesterol, were banned from many tables, and Egg Beaters were used to make egg white omelets and other low-fat egg dishes.
Then the tide turned, and we were told one or two eggs a week, or even one a day (gasp), were OK unless we were diabetic, in which case we should stick to those tasteless egg white omelets. But then the experts changed their minds again and said eggs were OK even for people with diabetes.
And Harvard's Walter Willet said, “There was never any data that showed that people who ate more eggs had higher risk of heart attacks.”
Now comes a study from Finland that says that egg metabolites in blood are related to a lower risk of type 2 diabetes. Note that risk factors in the blood are not the same as actual mortality rates in egg eaters. But they're consistent with the idea that eggs aren't poison, and a previous study had linked egg eating with a lower risk of type 2. This new study was designed to help figure out how the egg consumption affected diabetes risk.
Have we yo-yo'd back to the 1950s and 1960s in terms of egg advice? I suspect we have.
In the 1950s and 1960s, eggs were considered healthy. Adele Davis, a popular health food guru in those days, had a chapter in her book Let's Cook it Right titled "Serve Eggs and Cheese Daily." She went on to note that in addition to their protein content, eggs contain a lot of vitamins and minerals, which she discussed.
Then came the low-fat fad, in which any kind of fat was considered poisonous. Egg yolks, which contain a lot of fat as well as a lot of cholesterol, were banned from many tables, and Egg Beaters were used to make egg white omelets and other low-fat egg dishes.
Then the tide turned, and we were told one or two eggs a week, or even one a day (gasp), were OK unless we were diabetic, in which case we should stick to those tasteless egg white omelets. But then the experts changed their minds again and said eggs were OK even for people with diabetes.
And Harvard's Walter Willet said, “There was never any data that showed that people who ate more eggs had higher risk of heart attacks.”
Now comes a study from Finland that says that egg metabolites in blood are related to a lower risk of type 2 diabetes. Note that risk factors in the blood are not the same as actual mortality rates in egg eaters. But they're consistent with the idea that eggs aren't poison, and a previous study had linked egg eating with a lower risk of type 2. This new study was designed to help figure out how the egg consumption affected diabetes risk.
Have we yo-yo'd back to the 1950s and 1960s in terms of egg advice? I suspect we have.
Sunday, December 23, 2018
Easy Sweet
This is a hard time of year for those of us with diabetes, especially when we're on low-carb diets. We're surrounded by sweet treats we can't have, and it's sometimes difficult to refuse. A few minutes ago, a neighbor showed up at the front door with a plate of chocolate chip cookies. I thanked her and then said unfortunately I couldn't eat them because I'm diabetic. She said then I could give them to someone else, and I didn't want to hurt her feelings, so I took them.
I haven't had a chocolate chip cookie for 22 years, so I decided to try a small bite. The first bite wasn't bad, so I ate the whole cookie. As a result, my blood glucose level went up to 187. Not something I want to make a habit of.
Mostly, I don't miss sweets, although I do eat homemade kefir with berries mixed in. But occasionally I do crave something intensely sweet, and I've come up with a quick solution.
I coursely grind together walnuts and 100% chocolate. You can use baking chocolate, but I find Kakosi's chocolate wafers much easier to grind. I'm sure other brands would be the same, but my favorite grocery store carries these.
Then I add some heavy whipping cream and sprinkle with some fake sugar. I like the erythritol-based sugars for this because they have crunch. If you want, you can add a few berries.
That's all there is to it. You can make it as sweet as you want, and it does satisfy that craving for sweetness.
A few years ago I posted a recipe for almost-instant chocolate cake. That's another option, but it takes a few more seconds to make and I'm always in a hurry.
I haven't had a chocolate chip cookie for 22 years, so I decided to try a small bite. The first bite wasn't bad, so I ate the whole cookie. As a result, my blood glucose level went up to 187. Not something I want to make a habit of.
Mostly, I don't miss sweets, although I do eat homemade kefir with berries mixed in. But occasionally I do crave something intensely sweet, and I've come up with a quick solution.
I coursely grind together walnuts and 100% chocolate. You can use baking chocolate, but I find Kakosi's chocolate wafers much easier to grind. I'm sure other brands would be the same, but my favorite grocery store carries these.
Then I add some heavy whipping cream and sprinkle with some fake sugar. I like the erythritol-based sugars for this because they have crunch. If you want, you can add a few berries.
That's all there is to it. You can make it as sweet as you want, and it does satisfy that craving for sweetness.
A few years ago I posted a recipe for almost-instant chocolate cake. That's another option, but it takes a few more seconds to make and I'm always in a hurry.
Thursday, December 13, 2018
Evesdropping Viruses
This has absolutely nothing to do with type 2 diabetes. At least not yet. But it's fascinating.
https://www.npr.org/sections/goatsandsoda/2018/12/13/676389858/a-virus-can-eavesdrop-on-bacterial-communication
Apparently, viruses can intercept molecules bacteria use to communicate with themselves and use that information to time their attack on the bacteria.
Are bacteria and viruses intercepting molecules human organs use to communicate? Or are various organs hijacking molecules other organs use to communicate with their kind?
It opens up a whole world of new ways of thinking about physiology.
https://www.npr.org/sections/goatsandsoda/2018/12/13/676389858/a-virus-can-eavesdrop-on-bacterial-communication
Apparently, viruses can intercept molecules bacteria use to communicate with themselves and use that information to time their attack on the bacteria.
Are bacteria and viruses intercepting molecules human organs use to communicate? Or are various organs hijacking molecules other organs use to communicate with their kind?
It opens up a whole world of new ways of thinking about physiology.
TMAO
A recent press release reported on a link between high blood levels of a compound called TMAO (trimethylamine N-oxide) and heart disease. Then they said high TMAO levels are linked to a diet rich in red meat, and such people have TMAO levels three times as high as those who eat mostly white meat or no meat.
The authors defined "rich in red meat" as about 8 ounces of steak daily.
Horrors! Sounds as if we should all avoid red meat and try to lower TMAO levels.
But wait! Another recent press release says we should all eat more vegetables and fish because these foods increase our TMAO levels, and "low-dose treatment with TMAO reduced heart thickening (cardiac fibrosis) and markers of heart failure in an animal model of hypertension."
The authors of the second study write, "It was previously thought that TMAO blood plasma levels--and heart disease risk--rise after the consumption of red meat and eggs. However, "it seems that a fish-rich and vegetarian diet, which is beneficial or at least neutral for cardiovascular risk, is associated with a significantly higher plasma TMAO than red meat- and egg-rich diets, which are considered to increase the cardiovascular risk."
Is it any wonder that people are confused about which diet is best to follow in order to reduce the risk of heart disease?
The effects of diets are complex. For one thing, different people may react differently to the same thing, and rodents may also react in a different way. For another, it's not usually just one component of a diet that is important; it's the diet as a whole. A red-meat and chocolate cake diet is different from a red-meat, vegetable, and salad diet. A 16-ounce steak has a different effect from 4 ounces of steak.
And TMAO could have a U-shaped effect so that small increases were beneficial but large increases were not, or vice versa.
Rat experiments don't always translate into effects on humans, but they're suggestive. Also, the second study was done in an animal model of hypertension.
Today, certain memes are popular, including "eat more fruits and vegetables" and "avoid red meat." But most fruits raise blood glucose levels in people with diabetes, and also to some degree in those without the disease. Sometimes it seems as if research is designed to prove these memes rather than to learn something new. It's easier to get research grant money if you are supporting the current dogma. Not long ago, that was low-fat, and people who didn't support that concept had trouble getting research grants. The South African scientist Tim Noakes, was accused of "unprofessional conduct" for advising a mother to wean her infant onto a low-carbohydrate diet. He was eventually found not guilty of any wrongdoing.
So we don't yet know if TMAO is beneficial or detrimental. As most research papers say, "More research is needed."
The authors defined "rich in red meat" as about 8 ounces of steak daily.
Horrors! Sounds as if we should all avoid red meat and try to lower TMAO levels.
But wait! Another recent press release says we should all eat more vegetables and fish because these foods increase our TMAO levels, and "low-dose treatment with TMAO reduced heart thickening (cardiac fibrosis) and markers of heart failure in an animal model of hypertension."
The authors of the second study write, "It was previously thought that TMAO blood plasma levels--and heart disease risk--rise after the consumption of red meat and eggs. However, "it seems that a fish-rich and vegetarian diet, which is beneficial or at least neutral for cardiovascular risk, is associated with a significantly higher plasma TMAO than red meat- and egg-rich diets, which are considered to increase the cardiovascular risk."
Is it any wonder that people are confused about which diet is best to follow in order to reduce the risk of heart disease?
The effects of diets are complex. For one thing, different people may react differently to the same thing, and rodents may also react in a different way. For another, it's not usually just one component of a diet that is important; it's the diet as a whole. A red-meat and chocolate cake diet is different from a red-meat, vegetable, and salad diet. A 16-ounce steak has a different effect from 4 ounces of steak.
And TMAO could have a U-shaped effect so that small increases were beneficial but large increases were not, or vice versa.
Rat experiments don't always translate into effects on humans, but they're suggestive. Also, the second study was done in an animal model of hypertension.
Today, certain memes are popular, including "eat more fruits and vegetables" and "avoid red meat." But most fruits raise blood glucose levels in people with diabetes, and also to some degree in those without the disease. Sometimes it seems as if research is designed to prove these memes rather than to learn something new. It's easier to get research grant money if you are supporting the current dogma. Not long ago, that was low-fat, and people who didn't support that concept had trouble getting research grants. The South African scientist Tim Noakes, was accused of "unprofessional conduct" for advising a mother to wean her infant onto a low-carbohydrate diet. He was eventually found not guilty of any wrongdoing.
So we don't yet know if TMAO is beneficial or detrimental. As most research papers say, "More research is needed."
Wednesday, December 12, 2018
Offering Hope
Charles Mattocks is passionate about diabetes. Controlling diabetes, that is.
He understands that because it's difficult to live with diabetes, some people just give up and don't try to help themselves.
Mattocks understands how difficult it is to live with diabetes because this celebrity chef, author, and TV producer has type 2 diabetes himself. He was diagnosed in 2011 at the age of 38 and was determined not to let the diabetes ruin his life. At first he controlled with diet and exersise, but then when his dietary vigilance relaxed a bit too much, he went on medication. A year after getting back on the wagon, he was able to come off the medication.
"Diabetes could kill me, but being diagnosed has saved my life and put my health at the forefront," he said." But Mattocks is concerned with more than just his own health. He wants to help other people deal with their diabetes, and especially to help people not yet diagnosed with diabetes avoid ever getting that diagnosis.
He realizes that most people don't know much about diabetes and feels that if he'd known when he was a kid what he knows now about diabetes, he never would have gotten it. For that reason, he's written a children's book titled "Diabetes and Healthy Eating." He's also involved with an RVcalled "Diabetic You RV" that travels around the country and offers information and free blood glucose and foot checks for anyone interested. In addition to calling attention to diabetes with its colorful decorations, the RV is staffed with medical people who can offer help to those interested.
Currently being worked on, the RV should be back on the road in a few months.
But Mattocks' primary focus is a TV reality show that takes a small number of people with diabetes to a resort in Jamaica, where he was born, and has various diabetes experts work with them for a week. His goal is to give hope to people who are struggling, and to give the viewers of the reality show hope as well. He feels that showing real people, not actors, with type 2 struggling but eventually succeeding in taking control will inspire others to do the same.
Some episodes from the first season, produced in 2017, can be seen here. He is currently working on a second season.
Mattocks has done many things in his life so far. He's traveled around the world to see how diabetes is affecting people in other nations. India is especially hard hit. He's also been involved with cooking and had a TV show called "The Poor Chef." Before his diagnosis he published a cookbook called Eat Cheap, but Eat Well, and in 2014 the American Diabetes Association published his The Budget-Friendly Fresh and Local Diabetes Cookbook.
Like Mattocks, because I know how very inconvenient, not to mention expensive, it is to have type 2 diabetes, I would also like to do what I can to prevent others from following in my path. But it's difficult. Most people simply aren't interested. When I suggested to a sister that she test members of her family once a year so that if they had the genetic predisposition, the disease would be caught early, when it's easier to control.
Her answer: "Why worry about a disease you may never get?"
If someone in a family in which the disease has occurred several times isn't interested, what is the likelihood that the average person would be? Most people assume it will never happen to them, even when it runs in the family and even when they're overweight. So I got discouraged at trying to help people prevent the disease and have focused instead on reading about research and trying to communicate the most interesting research results through this blog.
Hence it's good that people like Mattocks, who has a lot of energy and the ability to communicate well through talks and TV shows, are still in there fighting for people who might not be able to fight on their own.
There's a vast difference in how people with type 2 diabetes are learning. At one end of the spectrum are people who get all kinds of expensive gadgets like continuous glucose monitors and fancy software, document everything they eat in a nutrition program, join online Facebook groups and exchange information with others with the same interests. At the other end are the people who get a diagnosis, get medications, and expect the medications to control their disease while they continue to eat the same unhealthy food they've always eaten and continue to avoid exercise whenever possible. Sometimes, because of the cost, they don't even take the medications. Then they get complications like having a leg amputated or losing most of their sight. Of course, most people are somewhere in the middle of these extremes, but sadly, I think most patients are closer to the latter group than to the former.
Perhaps a reality show on TV will reach some of these people. I do hope so.
Anyone wishing to learn more about Mattocks and his show can go here.
He understands that because it's difficult to live with diabetes, some people just give up and don't try to help themselves.
Mattocks understands how difficult it is to live with diabetes because this celebrity chef, author, and TV producer has type 2 diabetes himself. He was diagnosed in 2011 at the age of 38 and was determined not to let the diabetes ruin his life. At first he controlled with diet and exersise, but then when his dietary vigilance relaxed a bit too much, he went on medication. A year after getting back on the wagon, he was able to come off the medication.
"Diabetes could kill me, but being diagnosed has saved my life and put my health at the forefront," he said." But Mattocks is concerned with more than just his own health. He wants to help other people deal with their diabetes, and especially to help people not yet diagnosed with diabetes avoid ever getting that diagnosis.
He realizes that most people don't know much about diabetes and feels that if he'd known when he was a kid what he knows now about diabetes, he never would have gotten it. For that reason, he's written a children's book titled "Diabetes and Healthy Eating." He's also involved with an RVcalled "Diabetic You RV" that travels around the country and offers information and free blood glucose and foot checks for anyone interested. In addition to calling attention to diabetes with its colorful decorations, the RV is staffed with medical people who can offer help to those interested.
Currently being worked on, the RV should be back on the road in a few months.
But Mattocks' primary focus is a TV reality show that takes a small number of people with diabetes to a resort in Jamaica, where he was born, and has various diabetes experts work with them for a week. His goal is to give hope to people who are struggling, and to give the viewers of the reality show hope as well. He feels that showing real people, not actors, with type 2 struggling but eventually succeeding in taking control will inspire others to do the same.
Some episodes from the first season, produced in 2017, can be seen here. He is currently working on a second season.
Mattocks has done many things in his life so far. He's traveled around the world to see how diabetes is affecting people in other nations. India is especially hard hit. He's also been involved with cooking and had a TV show called "The Poor Chef." Before his diagnosis he published a cookbook called Eat Cheap, but Eat Well, and in 2014 the American Diabetes Association published his The Budget-Friendly Fresh and Local Diabetes Cookbook.
Like Mattocks, because I know how very inconvenient, not to mention expensive, it is to have type 2 diabetes, I would also like to do what I can to prevent others from following in my path. But it's difficult. Most people simply aren't interested. When I suggested to a sister that she test members of her family once a year so that if they had the genetic predisposition, the disease would be caught early, when it's easier to control.
Her answer: "Why worry about a disease you may never get?"
If someone in a family in which the disease has occurred several times isn't interested, what is the likelihood that the average person would be? Most people assume it will never happen to them, even when it runs in the family and even when they're overweight. So I got discouraged at trying to help people prevent the disease and have focused instead on reading about research and trying to communicate the most interesting research results through this blog.
Hence it's good that people like Mattocks, who has a lot of energy and the ability to communicate well through talks and TV shows, are still in there fighting for people who might not be able to fight on their own.
There's a vast difference in how people with type 2 diabetes are learning. At one end of the spectrum are people who get all kinds of expensive gadgets like continuous glucose monitors and fancy software, document everything they eat in a nutrition program, join online Facebook groups and exchange information with others with the same interests. At the other end are the people who get a diagnosis, get medications, and expect the medications to control their disease while they continue to eat the same unhealthy food they've always eaten and continue to avoid exercise whenever possible. Sometimes, because of the cost, they don't even take the medications. Then they get complications like having a leg amputated or losing most of their sight. Of course, most people are somewhere in the middle of these extremes, but sadly, I think most patients are closer to the latter group than to the former.
Perhaps a reality show on TV will reach some of these people. I do hope so.
Anyone wishing to learn more about Mattocks and his show can go here.
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