As I reported a while back, my mom, a Type 2 diabetic on insulin injections for years, has gotten off them as a result of a grain free, very low carbohydrate diet (duh, that's how they all do it, in contradiction to the advice of the American Diabetes Association, that seems intent on keeping people on these medications). I will add that, as you can see from her own story, linked above, this happened when she began following my dietary advice in blatant, explicit, in-your-face, doc, contradiction to the "medical" authorities. Is that a general qualification in my case? No, absolutely not. But most doctors know shit-all about diet, nutrition, and metabolism. They know drugs.
She has stayed off them and her blood glucose readings have stayed below 95. She's still on Metformin, an oral medication, but so far, so good.
However, she has been having problems with nausea and vomiting every morning when she gets up. She's going to see her doctor about that tomorrow morning. But here's an interesting datapoint: last weekend she went camping for four days, forget all medications, and felt great, with no nausea at all. Gets back, gets on the meds again, and guess what?
Anyway, she calls to set up her appointment this morning and has to go through the advice nurse, first. Nurse is not aware that mom has unilaterally gone off insulin and mom doesn't volunteer that info. Instead, says she has "reduced it" steadily (yea: to zero, now!).
Care to guess what "advice" mom gets, keeping in mind that she has kept her BG below 95 consistently? She's told to stop the Metformin between now and tomorrow's appointment. Good. Guess what else? "Eat 15-20 grams of carbohydrate every two hours. As long as your blood glucose says below 240 [!!!!!!!!!!!!!!!!!!!] keep eating the carbohydrates."
Am I crazy, or is Big Medical out to kill their patients?
Oh, also, and I hadn't know this, but they had mom on a Statin for total C of 220, in spite of the fact that no study has yet to show any benefit to women on statins, while some have demonstrated a weak association with increased mortality.
She was smart enough to stop the statin some time ago.
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Please spread the word
I just wanted to point out that the "normal" side effects of Metformin are Nausea, vomiting and many other GI Symptoms. Restarting Metformin after being off it could very well trigger these problems again.
If your Mom needs to get taking Metformin she should use the XR (if she is not already) version of it. It seems to have less of the side effects of the old standard.
Rob
Stupid…yes. Surprising…no. Looks what is recommended by the ADA. If I only knew what I know now when my grandparents were alive (with diabetes of course). I do try to help friends when they ask about their parents. Its just an uphill battle when its my advice over all the experts.
Thanks, Rob. I passed that along.
Just infuriating, Richard. I'm super happy for your mom, though. She is lucky to have you.
I got my grandfather to read Dr. Bernstein's Diabetes Solution. He has lost 25 lbs. and has halved his insulin usage. (He's not as low carb as I would like, but his health has drastically improved in short order. I think he sees the connection and will likely cut carbs a lot further.)
I got him to read this book, and for both he and my grandma to test their vitamin D levels, over quite a bit of objection from my mom. Apparently she thinks reading and self-education for a 75 year old retired person that is bored out of his mind most days — well, it's just way too much work. "Trust the doctors, they know best." The attitude of 90% of the public, I daresay. She was completely surprised when he actually read the book and then started showing dramatic progress based on an application of its knowledge. She also serves sweets every time he comes over to their house and thinks my grandmother is a spoilsport for not making those things. Apparently it's lost on her that sugar = dead. I'm glad my grandparents listen to me and not her.
As for the story above, it's absolutely criminal that our medical professionals are offering such advice. It's one thing to offer meds if people won't heed rational dietary advice. I don't have illusions about peoples' willpower and I assume much of our population unfortunately fits into this category. However, it's quite another thing for a health professional to never offer anyone low carb advice in the first place and basically assume that everyone on the planet is lazy or irrational. I know my grandfather has never received such advice. He was totally shocked by many of the things he learned in the book I sent.
In a rational world, such medical professionals would be sued for medical malpractice!! It's like we are still stuck in the Dark Ages.
Actually, you can't even say based on the experience above that this nurse assumes laziness or irrationality. It appears that she does not even a rudimentary understanding of biochemistry. Does she know about gluconeogenesis? (rhetorical)
I think one of the justifications for telling diabetics to eat carbs all the time, and to keep shooting themselves up with insulin, is the risk of diabetic shock. However, that only logically happens when you've overcompensated with insulin *because* you've eaten too many carbs. Duh!
Honestly, this view that diabetics everywhere are going to go into diabetic shock if they limit their carbs is just too dumb. But it's very prevalent. My grandfather basically thought this before he read Dr. Bernstein's book. I can only assume he learned this crap from his doctors/nurses.
Monica, how good is low carb? 100 g of carbs or less? and how about thoughts on fruit such as apples? is two a day too much?
I hope you and your mom have given Jenny Ruhl's blog Diabetes Update and website Blood Sugar 101 a thorough reading. If not, you should. Jenny maintains two of the best sites on the internet on diabetes, if not the best. They dovetail nicely with the info in Dr. Bernstein's books, well maintained, and updated regularly. It's the first place I send anyone interested in learning more about any facet of diabetes.
The benefit statin therapy in diabetic patients with another risk factor (proteinuria, smoking, or hypertension) was proved in the CARDS trial, it was even stopped prematurely because of the overwhelming benefit, EVEN with normal cholesterol.
Mom has none of those risk factors.
Moreover, she's an individual. DOCTORS, paid I will add, did FUCKall to EASILY get her off insulin. I FUCKIN' did it.
Every fucking doc failed her as a patient. I stepped in. They're fucking fired.
Richard Nikoley
I will second that advice. I'm on metformin-ER, fortunately now available in generic form (and also available for a low price at Sam's Club, Costco, and Wal-Mart).
I still get occasional gut cramping and diarrhea on the metformin-ER, but it is less than on the regular form of metformin.
One thing I read about on Dr. Richard K. Bernstein's forums a couple of years ago, and something which works for me, is to take 1 tablet of loperamide (generic Imodium) every time I take a metformin-ER tablet. It cuts down on the side effects of diarrhea and gut cramping, which were severe for me when I first started to take the stuff.
Good for your mom that she doesn't blindly follow the doctors' and nurses' advice.
Stuff like this is why I'm not eager to have much contact with doctors, despite what I do for a living.
Another thing about metformin, regardless of which form is taken… the dose usually has to be increased slowly. I had to start with 1/2 a tablet once a day, then build up gradually to 1 tablet twice per day.
So… if your mom goes off metformin for more than a day or two, she may have to decrease her dose again and build up slowly. It works, but the GI side effects can be nasty.
Dr. Bernstein has his patients on very low carbs. Can't remember off-hand, but it's maybe 20 or 30 grams maximum per day, maybe less. Bernstein himself (a type I diabetic with normal blood sugar) is very strict about his carb intake, and indeed about his portion sizes, from breakfast to breakfast, lunch to lunch, and dinner to dinner. Although not everyone would want to be so strict, it works for him. Instead of a sliding scale, he knows how much insulin he has to take to cover the carbs in any one meal.
He pioneered the strict control of blood sugar for diabetics, and the use of personal glucometers for the same, although not the invention per se of glucometers.
He was originally an engineer when he figured out how to normalize and control his blood sugars… but no one in the medical union would listen to him until he went and got himself an MD degree in middle age.
When he was a young kid, it was considered to be impossible to have normal blood sugars in diabetics. He has reversed many of the usual sequelae of diabetes in himself. His neuropathy and eyesight are much better. He was finally able to put on some muscle bulk.
I'm so glad he has books out there. He also has a website. He also has his program on CD or DVD. He also has conference calls from time to time, which I believe may be at no charge. What a guy!
He practices somewhere near New York City but not in it. His program is something like $5,000, plus travel and lodging costs.
I consider it a great gift that he has made all this information available to the public. But since you need a personal doctor to get prescription medications, a lot of people are stuck with doctors who are ignorant of what Bernstein has to say… and not interested in learning.
Hi Richard,
I just wanted to mention that metformin causes a deficiency in certain vitamins (I tink it's the B's or B12) so a person taking it should supplement to avoid possible nerve damage and other side effects. There is lots of info on this on the net, so please google it.
Best wishes,
Kate (former Metformin taker).
I'd love to hear what Dr. Michael Eades has to say about the CARDS trial and whether or not it actually proved anything, or whether it was one of those observational studies he loves to rip apart.
Heck, I thought that people had to take biochemistry to get into a nursing program, albeit not the same course that chemistry majors take.
Isn't that the study which was stopped prematurely when the mortality of the statin-takers started approaching the level of the control group? There was a statistically significant difference in mortality between the groups at the start of the trial but as it progressed, the difference got smaller and smaller and so they stopped it short of being statistically insignificant while they had the chance, hiding behind ethics.
Here's my two cents because everyone is entitled to my opinion
The nurse was just "following orders" as it were. She has no reason to think that large amounts of carbs are anything but healthful becuase that's what everyone one from the government on down thinks. In fact, they don't think anymore they KNOW and it takes a very special mind to research the obvious….
I believe what is happening is something similar to the doctor way back when, and please don't quote me on any of this because this is just something I remember reading. I have no names or dates, just my fuzzy memory – but he believed the answer to colds and flu was to bleed the patients. Open a vein and literally desanguinate them. When others researched his methods and it appeared that bleeding had no effect on the course of the illness, he cried "Rubbish!" and what was his suggestion? "You're just not bleeding them enough! Bleed them harder!"
What has been society's answer to diets that have been proved not to work? "Rubbish! Diet harder!" "Cardio doesn't help fat loss? RUBBISH! You're just not WORKING HARD enough! DO MORE! GO HARDER!" etc etc.
So, back to the story. When the doctor had not one leg to stand on because science had progressed further than his ego or his method could prove, bleeding was no longer considered modern, appropriate care and it was left by the wayside.
Perhaps once this generation of super-inflated egos, I mean DOCTORS, have passed and science has progressed they'll stop the "Just carb them harder!" approach and it too will also be left by the wayside.
The fact they're pushing your mother so hard is a good sign – it's a last-ditch, hail mary pass effort to make the dying approach work.
Here is a counter to the CARDS trial, which goes along with Richards belief on treating the OVERALL risk, which is probably low for his mother who does not have any other risk factors or known coronary disease.
Abhimanyu Garg, Statins for all patients with type 2 diabetes: not so soon, The Lancet, Volume 364, Issue 9435, 21 August 2004-27 August 2004, Pages 641-642
Therefore, while landmark trials like CARDS increase our confidence in lipid-lowering drug therapy for prevention of coronary heart disease in patients with type 2 diabetes, it is still prudent to assess an individual's risk–benefit ratio before recommending long-term statin therapy. Thus more models need to be developed, such as the UK Prospective Diabetes Study risk engine, to assess coronary heart disease risk in patients with type 2 diabetes.13 For patients with type 2 diabetes at moderate to low risk of coronary heart disease, maximal lowering of lipids with diet, exercise, weight loss, and rigorous glycaemic control must be attempted before considering lipid-lowering drugs.
If your doctor does not understand the glycemic index, get a new one, better yet, see an endocrinologist. My dad has been on metformin for the last 10 years and has needed nothing else. His doc gave him information on glycemic index 10 years ago( we still have a refrigerator magnet from then explaining it), so I am surprised so many of you did not get the same info even now.
I hope there arent any family practioners on this board but, I think the problem with basic healthcare, is the gatekeeper, the old school family doc who is behind on the times. Quit your HMO plan and get a plan that lets you make specialist appoinments without a referral.
I feel your pain, Richard. My mother is a T2D, on a statin, and her TC was something like 180! I've tried dropping hints such as, "try just having eggs for breakfast and see what happens to your blood sugar," but it's hopeless. We already have a strained relationship… and if medicine was Christianity, my parents would be devout Catholics. Actually, they'd be a nun and a monk.
Thanks for all your comments on this, Pam. Forwarded to mom.
BTW, she did read Bernstein's book and is very low carb and off grain products almost entirely.
Richard Nikoley
Nope. I haven't dug into it, but it was randomized, placebo intervention.
I think I read something about that point, but I'm not certain. It would be interesting to see the _timeline_ on the deaths for each cohort.
Heh, yea, I think that sort of process underlies a whole lot of what goes on in society and in individuals. It's kind of the "double down" mentality. But, usually, you die, go broke, or hit the table limit before it all pays off.
I've seen Jenny's blog. Have sent my mom all the links. Thanks for reminding me of that.
No, that was the PROSPER Trial in patients between age 70 and 82 which actually showed harm, Relative risk of 1.23.
Here's the information on the CARDS trial.
Atorvostatin 10 mg
double-blind 5.5 years.
Trial participants :
Male and female type 2 diabetics with no history of CVD and normal cholesterol levels.
Number of particpants drug/control group 1428/1410
CHD deaths drug/control group 21/25
total deaths drug/control group 61/82
Relative risk for CHD mortality drug/control -17%
Relative risk fr total mortality -26%
When the mortality figures from all the trials were tabulated seperately for sex , they show NO longevity benefit for women at all. Despite the fact that over 1/2 of the millions of statin prescriptions written each year are handed to FEMALE patients , THESE DRUGS SHOW NO OVERALL MORTALITY BENEFIT REGARDLESS, REGARDLESS OF WHETHER THEY ARE USED FOR PRIMARY OR SECONDARY PREVENTION.
In women free of CAD, statins FAIL to lower both CAD and total and mortality , while women WITH CAD, statins lower CAD mortality (by their 11 PLEOTROPIC effects, not cholesterol lowering ) BUT INCREASE THE RISK OF DEATH FROM OTHER CAUSES, LEAVING OVERALL MORTALITY UNCHANGED.
Walsh JE, Pignone M. Drug Treatment of Hyperlimidemia in Women. Journal of the American Medical Association , May 2004;291 : 2243-2252.
I hope this information helps your cause Richard.
No OVERALL mortality(like being hit by a bus)…but reduced cardiovascular events
The end point of the study, and thus, purpose WAStime to first occurrence of the following: acute coronary heart disease events, coronary revascularisation, or stroke.
What about the morbidity from a stroke or MI? You may not live longer but your quality of life maybe different.
not being antagonistic, just fostering an intellectual discussion with like-minded people. When analyzing a paper, you have to remember what the end points are and what they set out to measure and if they met those goals.
The Bottom Line On Statin Drugs:
In trials lasting up to 6 years, statins have demonstrated the ability to reduce cardiovascular mortality in individuals with pre-existing CAD, and may also impart similar benefits to high risk hypertensives and diabetics.
THEIR USE IS NOT WITHOUT CONSIDERABLE RISK- STATINS FREQUENTLY PRODUCE:
* MUSCLE WAKNESS
*LETHARGY
*LIVER DYSFUNCTION
*COGNITIVE DISRUPTIONS RANGING FROM CONFUSION TO TRANSIENT AMNESIA
*SEVERE RHABDOMYOLYSIS THAT CAN LEAD TO KIDNEY FAILURE
Even in high risk patients the use of statin drugs SHOULD BE INSITITUTED WITH THE UTMOST CAUTION AND CLOSE MONITORING SHOULD BE MAINTAINED AT ALL TIMES
STATINS SIDE EFFECTS ARE UNDERREPORTED POEPLE
Look up Dr. Duane Graveline,He was a NASA doctor who warns people about the dangers of statin drugs and his own personal side effects.
the http://www.spacedoc.net .
Read this article by Anthony Colpo "Bad Cholesterol or BAD SCIENCE"
For the rest of us , the ability of these drugs to reduce cardiovascular mortality is highly doubtful and they APPEAR TO BE NEXT TO USELESS FOR REDUCING OVERALL MORTALITY.
Listening to the numerous 'experts' (who all have FINANCIAL TIES to statin drug makers) who urge HEALTHY people to take these drugs APPEARS TO DO LITTLE MORE THAN RELIEVE US OF HARD EARNED MONEY AND EXPOSE US UNNECESSARILY TO THEIR POTENTIALLY LIFE THREATING SIDE EFFECTS.
I am literally frothing at the mouth to confront doctors on this. I have been the victim MANY TIMES of doctors crap advice and SHODDY results.
What this doctors office was trying to do was keep her blood sugar from going too low, and her ending up in the hospital. If they keep her glucose up, then she will probably stay out of the hospital until the doc can see her. Lets face it, you can tool around with a glucose of 300 even more, and stay out of the hospital, but if it goes to 30… then you have acute and immediate problems.
That's not to say I'm defending them, I'm not. the doc was keeping her in a holding pattern until he could see her (albeit an unhealthy one) and the nurse was doing what she was taught, albeit outdated, unhealthy and just plain wrong.
As a nurse it frustrates me to no end the ignorance that's out there. I'm not optimistic that there will be a wholesale change to treating (curing?) type 2 with a PROPER diet. The drug companies are too powerful. And lets face it, a newly diagnosed type 2 is a 20-30 profit center. There is no money in curing type 2 with eating right. If there was, that's what the medical establishment would be doing. Like they told me in nursing school "health care is all about who lives, who dies, and who pays".
Here is Anthony Colpo's brilliant article that everyone on here should print out and challenge their doctor with:
"Bad Cholesterol OR BAD SCIENCE"
http://www.jpands.org/vol10no3/colpo.pdf
I have no tolerance for statinators
i have a problem with statins used incorrectly. They have their place.. Post MI, Post Stroke, multiple risk factors, NOT PRIMARY PREVENTION.
True. Post heart attack, or stroke and high risk diabetics (although the diabetics could be short term statin use)
My great aunt, not having those conditions , refused statins against her doctor's pressuring due to "high cholesterol" . Her cardiologist died of a heart attack. He was only 57. True story.
She is 96 almost 97 and her current cardiologist says she'll make it to 100 and most likely more.
Even IF statins did what they are touted as doing… who the hell wants to go through life with his cognitive abilities seriously impaired?
Would life still be worth living if you lost your mind? For me, I think not so much.
Or severe muscle cramps?
Or any of the other side effects?
We need good fats for the brain, which I have read is largely made up of fats to begin with.
The anti-cholesterol hysteria bandwagon needs to be retired.
A lot of endocrinologists aren't up-to-date on treating diabetes, either. It's still hard to find one whose approach is even remotely close to Dr. Richard Bernstein's.
This means that, most of the time, you will have to see at least several of them (at how many dollars per office visit) in order to find one who is suitable.
I've transcribed plenty of reports dictated by endocrine specialists who seem to have no problem with their patients (1) following an ADA diet, (2) over-eating carbs (but then I repeat myself), (3) taking large doses of insulin, etc.
And many endocrinologists are still stuck on stupid regarding the anti-fat hysteria, and they're prescribing statins right and left.
The glycemic index might be a good start, but it'd probably help even more if they tried getting their patients off sugar and grains.
Pam,
Are you sure those needing high dose insulin are type 2? It is very rare for type 2's needing high dose insulin. The type 2 patients that I started on insulin were all 300lb plus and had didnt care what they ate(not my fault, there is only so much I can do).
If those patients followed any diet, even the ADA diet, they would be doing pretty well, losing weight, and reducing their insulin resistance, and wouldnt need the high dose insulin. The problem is, 90% of those patients dont follow it. You, just by posting on this board, are smarter than that and are willing to change.
By the way, here what is posted at the ADA:
http://www.diabetes.org/food-nutrition-lifestyle/nutrition/meal-planning/carbohydrate-counting.jsp
Carbohydrate counting, or "carb counting," is a meal planning technique for managing your blood glucose levels. Foods that contain carbohydrate raise blood glucose. By keeping track of how many carbohydrates you eat and setting a limit for your maximum amount to eat, you can help to keep your blood glucose levels in your target range. Finding the right amount of carbohydrate depends on many things including how active you are and what, if any, medicines you take.
How much carb?
A place to start is at about 45-60 grams of carbohydrate at a meal. You may need more or less carbohydrate at meals depending on how you manage your diabetes. You and your health care team can figure out the right amount for you. Once you know how much carb to eat at a meal, choose your food and the portion size to match.
I think that is a great start for any type 2 that doesnt have a better diet. I dont see anything wrong with an endocrinologist recommending that. If anyone else does, please enlighten me so I can understand. It fits Marks daily apple, primal maintenance range also.
However, if you find in any of those reports of an endocrinologist asking their patient to consume 55% of their calories from carbs, then I will concede. The above diet is like 25-35%.
Richard, what did you recommend your mom to get off insulin?
Here is another kicker, Medicare who sets payment reimbursement for doctors, wont pay if you cant get your patients hemoglobin A1C in goal within a time period. Soooo, what do you think will happen…more medicine to get to goal faster or wait a year for patient to lose 50 lbs? The payment system doesnt care that you got your patient from 14% to 10%, they just want it below a threshold. This is called a "pay-for-performance" system. No consideration is made for improvement, just needs to below the magic number.
How F-ing stupid is that. You know who makes these rules? Idiots that sit in suits all day and have no clue what patient care is.
Dave that's pretty much what I figured. They are too scared of the short term danger of diabetic shock to think about the long-term consequences of what they are suggesting.
No doubt that there's a lot of regulation behind the scenes that is contributing to this nonsense, PaleoNewbie. I'm sure you have many tales. Unfortunately private insurance is not far behind Medicare in its shittiness…
Boy if we think it's bad now wait til the govt. gets full control of healthcare under the Obummer administration.
Excellent. Thank you. (I'm way behind and see that the discussion is far progressed, but thanks for stepping in).
Being hit by a bus is random to all participants, so it's a wash if the numbers are sufficient.
I'm skeptical of the benefits of statins for MOST people. I get they're beneficial to some. So are heart bypass operations. A paleo diet should prevent need of both, for MOST.
You go. Unleashed. Let Cod sort it out.
From what I've heard, you can't go hypo on metformin/glocophage. Mom is off insulin injections and I understand that could be a risk. However, I recall that mom didn't tell her she was completely off the injections (which she is), so that might be a valid argument for the other side.
Good catch.
Cued up for a read. Thanks.
Right. When the potential side effects are worth the risk in tradeoff.
Sad. Bet you didn't know anything about this when you set out.
Pam,
25% of Type 2's are on insulin.
But there are some reasons,
Progressive loss of Beta cells (yes, type 2's also lose pancreatic function)
failure to achieve goal with diet and excercise,
pregnancy,
contraindications to oral meds (renal impairment which many diabetics have, liver impairment)
Glucose toxicity (fasting >250, weight loss, Nausea, vomiting, fatigue)
Look for that in your reports that you transcribe.
And…a lazy doc.