Tuesday, March 20, 2007

'Almost' All You Need To Know About Diabetes

Dr. Richard Jackson and Amy Tenderich give diabetics a useful tool

Lose 30 pounds. Get your blood pressure down. Lower your LDL cholesterol and triglycerides and get that HDL cholesterol up. Keep an eye on your blood sugar and have it checked often.

Does any of this sound familiar? Sure it does and you may have even heard it from your own doctor regarding your flailing health because of you are overweight or obese. It's the dreaded lecture that comes from physicians when they see certain health indicators come back as irregular.

But what if what you are dealing with is something even more life-threatening than just a bout with obesity, hypertension, or a poor lipid profile? What if it’s one of the most dreaded of all diseases that makes you feel like your world has come to an official end? That’s exactly what happens to some people when they are told they have been diagnosed with diabetes.

What did I do to cause this? How can something like this happen to me? Will I ever live a "normal“ life again or am I destined for a life of painful insulin injections, expensive prescription medications, and endless doctor visits for the rest of my life?

These thoughts are not only very real to people who are told they have diabetes, but it can paralyze them even when they otherwise have their life under complete control. Diabetes has quite literally turned the life of millions of people upside down and leaves them with very little hope or help. Where can people turn when they are faced with such despair about this complex disease they have?

Whether you are Type 1 or Type 2 diabetic, then you have undoubtedly been given some all-too-familiar generic advice about handling your diabetes (like I illustrated at the beginning of this review) which is all meant to help you I am sure. Unfortunately, though, this kind of one-size-fits-all approach to diabetes is not only shortsighted, but incredibly ineffective.

That’s where the mostly informative new book from Harvard medical professor and Joslin Diabetes Center investigator Dr. Richard Jackson as well as saucy and always on point professional journalist, blogger, and diabetes sufferer Amy Tenderich comes into play. It’s called Know Your Numbers, Outlive Your Diabetes: 5 Essential Health Factors You Can Master To Enjoy A Long And Healthy Life (Marlowe Diabetes Library) and will quickly become your handy reference resource guide for almost everything you ever wanted to know about diabetes.

I say "almost“ for a reason which I will explain in a moment.

First, the good parts of this book. It is very well put together in an enjoyable format mixing a healthy dose of diabetes facts alongside some hands-on practical advice about how to best implement the proper lifestyle changes that need to take place for optimal diabetes management. While this can be a rather drab and boring topic to discuss, Dr. Jackson and Tenderich do a yeoman’s job of keeping it fun and engaging.

And I really like the fact that the authors strongly urge people living with diabetes to implement permanent lifestyle changes. At the same time, they push the positive message that diabetics don’t necessarily need to attempt to make multiple changes all at once, but instead slowly begin to work them into their individual routine incrementally. I agree with this bit-by-bit strategy because it is the best way to make the changes take hold and become a permanent habit whether it is with weight loss, diabetes, or anything else. Breaking out of those old habits takes time.

Know Your Numbers, Outlive Your Diabetes hits the ground running right away in the first six chapters explaining why you need to be concerned about your health when you have diabetes and points to the five tests that every single diabetic absolutely must have checked regularly if they are going to lick this disease by learning to manage it well.

What are these five tests? Very simply put, it’s the following:

1. Your A1C
2. Your blood pressure
3. Your lipid profile (cholesterol)
4. Your microalbumin (What?! Don’t worry, they explain!)
5. Your eye exam

While Dr. Jackson and Tenderich do not explicitly recommend people who are not diabetic to have these tests conducted, I think it is an extremely good idea considering there are tens of millions more pre-diabetics walking around and have no idea they are either already or becoming insulin resistant. Taking preventative action now would likely slow down the expected diabetes boom coming over the next few decades.

You can certainly appreciate the "been there, done that“ feel of this book which does a fabulous job of removing the mystery and awe out of diabetes for good. Whether you have just been diagnosed with diabetes or even if you are a decades-long veteran living with the disease, there is plenty of useful statistics and data to keep you occupied for hours as you learn all the ins and outs of diabetes.

But I have one pretty major concern about the book that makes me say it is "almost“ a comprehensive look at the subject of diabetes. While there is plenty of discussion about carbohydrates and how controlling your intake of them whether they are in the form of sugar, pasta, rice, potatoes, or otherwise in Know Your Numbers, Outlive Your Diabetes, the lack of a real sense of urgency about trying to keep them limited as a means for managing diabetes is not emphasized heavily enough and given the significance it deserves. All the latest research indicates that reducing carb intake can bring about permanent control of diabetes and you just don't hear this message stated explicitly in this book.

For a book like this about diabetes releasing in the year 2007, how can you totally ignore the many years of clinical studies (like this one) that have been conducted by valient researchers like Dr. Eric Westman from Duke University and Dr. Mary C. Vernon from the University of Kansas and the co-author of Atkins Diabetes Revolution? What about Dr. Steve Phinney or Dr. Jay Wortman? And let's not forget Dr. Mary Gannon and Dr. Frank Nuttall, too! I could easily continue on with many more names, but these are enough to get you started.

Not only have these amazing researchers shown the vital statistics for their diabetic patients become normalized, but many of them were able to come completely off of all their prescription medicines for good. GASP! How can this be? You'd never know this was possible if you only read this book because there was no mention of ending diabetes drug use in Know Your Numbers, Outlive Your Diabetes--NONE! Just the strong "now take your medicines regularly along with a low-fat diet" message that diabetics have had to suffer through long enough.

Where was the promotion of this major "cure“ for diabetes which was highlighted nationally by Adam Campbell in Men’s Health magazine in November 2006 found within the pages of this diabetes book, hmmm? The glaring absence of this cutting edge information about diabetes is like talking to someone about how to drive a car that doesn't have a steering wheel. Sure, you may get somewhere, but not necessarily where you want to go.

Furthermore, there was nary a single mention of the most famous diabetes expert who has implored a low-carb solution to his Type 1 diabetes for decades—the amazing Dr. Richard Bernstein! This man has done more to add quality of life and even saved the lives of millions of diabetics through his bestselling books and personal practice. However, if you read Know Your Numbers, Outlive Your Diabetes it’s as if Dr. Bernstein and his common sense strategies for tackling diabetes don't even exist. Shame on them for this grave omission!

To be honest, it was quite scary reading over and over again in this supposedly all-encompassing book on the topic of diabetes that people with this disease need to consume as much as 60 percent carbohydrates daily, including regular servings of sugar if they want it "in moderation!" Say what?! ARGH!

Are they trying to make these people get sicker and sicker?! What kind of irresponsible advice like this is being given to diabetics?! Yikeseroo! How about just giving them a little arsenic "in moderation" while you're at it, too? Sheeez!

Yet, at the same time, the authors emphasize the critical nature of carbohydrate reduction in the management of diabetes. So which is it? I understand we are all different with a variety of factors that will work for the individual person, but come on! I’m a big believer in people finding what works for them in weight loss and health management at my blog, but I see no downside for diabetics who want to control their disease naturally through diet by livin‘ la vida low-carb.

What will happen if diabetics decide to take the low-carb pathway to reversing the effects of their disease is they will get better than they’ve ever been before, seeing their A1C drop into "normal“ range and staying there, lower their blood pressure, significantly drop their triglycerides, raise their HDL cholesterol levels, and ward off many of the inevitable future health issues due to their diabetes. Not a bad deal if you ask me!

Of course, the lack of any information about the low-carb nutritional approach to combat diabetes in Know Your Numbers, Outlive Your Diabetes may have more to do with the American Diabetes Association and their ill-advised recommendations than anything else. It is quite clear that Dr. Jackson and Tenderich relied heavily on their skewed advice for diabetics.

You see the unmistakable fingerprints of their needless warnings about lowering LDL cholesterol (with even MORE medications such as statins—EEEK!), avoiding saturated fat, lowering salt intake, and controlling fat, calories, and portion sizes in page after page of this book. It really was more than a little nauseating to read all of this information while "low-carb" was nowhere to be found. I can't tell you how incredibly disappointing this was to me because diabetics who read this book will be left in the dark about what very well could be the solution to their disease.

While I certainly can appreciate what Dr. Richard Jackson and Amy Tenderich have done with their book Know Your Numbers, Outlive Your Diabetes to help educate people with this disease get the basic information they may be looking for, it is the blatant omission of critical information about low-carb as a viable treatment option for diabetes that has me gravely concerned.

And if you are diabetic, you deserve to be armed with all the facts so you really can "outlive your diabetes."

3-21-07 UPDATE: Amy Tenderich read my review and had this to say about it.

Hi Jimmy,

I wasn't aware that you had diabetes, or that you where one of the True Believers that low-carb diets can make your diabetes "go away" (which is misleading).

Please understand that an extreme low-carb diet is not the answer for MOST people; in fact, it only serves to frustrate them and lend to a continuous sense of failure. Good for you if you have managed to follow Dr. Bernstein's plan, but again, it really isn't the answer for most people.

In addition, my book was geared at helping people gain a framework for their long-term, all-around health with diabetes. We do state that limiting carbs helps glucose control, but we had no intention of giving people specific diet advice, since everyone is different.

Best of luck to you,

Amy Tenderich

Isn't it funny how she described low-carb as an "extreme" answer to diabetes? Ahhh, well I decided to write Amy back and share where I was coming from.

THANKS, Amy. I don't have diabetes personally, but I keep up with the latest research that comes out about it. While I entirely agree with you that a low-carb diet is NOT the answer for every diabetic, it's not even provided in your book as an option for people who have the disease.

If no specific diet advice is promoted, then why all the talk about limiting saturated and total fat and consuming as much as 60 percent of carbohydrates per day? The fact is a high-carb, low-fat diet raises blood glucose levels which is why you have to take medication and even insulin along with it to control blood sugars.

But why not give your body the opportunity to come off of diabetes meds and insulin by consuming a protein-rich, low-carb diet? That's exactly where all the latest research is pointing and the ADA is slowly moving towards this fact.

I'm sorry you are disappointed with my review, but none of what I wrote is surprising to anyone who has read my blog for any length of time. This is too important a subject to simply let things slide because that is doing a grave disservice to diabetics everywhere.

With that said, I like the basic information that you provide people with diabetes in the book as I stated in the first part of my review. For someone that knows nothing about this subject, your book is an excellent resource. I certainly hope that message comes through loud and clear as well because you and Dr. Jackson have done fantastic work in that realm.

THANK YOU again for allowing me the opportunity to review your book. Take care, Amy!

Jimmy Moore

She is attempting to set up an interview for me with Dr. Jackson to directly address the issues I brought up in my review and the absence of low-carb options in his book. Stay tuned for that coming up soon. Share your comments about how Amy Tenderich responded to my review below. I'd love to know what you think!

3-22-07 UPDATE: Amy did at least acknowledge in this column at her Diabetes Mine blog today that including at least a mention of the low-carb solution to diabetes should be included in future editions of her book.

"We do talk a lot about limiting carbohydrates, but steer clear of recommending the kind of severe eating restrictions that tend to pit a person against their own willpower--which for so many people ends ends in binging, or creates a roller coaster cycle of eating. That said, we probably could have done a better job of at least introducing Dr. Bernstein's approach. Second edition, anyone?"

Well, at least that's a good start, Amy, and I'm happy to see you acknowledge this. THANK YOU!

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Blogger Science4u1959 said...

"the American Diabetes Association and their ill-advised recommendations [...] It is quite clear that Dr. Jackson and Tenderich relied heavily on their skewed advice for diabetics."

The advice from the ADA is not ill-advised. It borders to downright criminal negligence and medical malpractice. This is the very organization that promotes to diabetics to consume, as much as they can, the very substances that are guaranteed to kill them in the end: carbohydrates.

That's Government-sponsored and Government endorsed crime, if you'd ask me. The entire ADA and similar organizations are nothing more than completely dysfunctional, money-hogging bureaucratic behemoths without any relevance or benefit to the populace - just like any other bureaucracy. Sorry, but I have only utter contempt for these "professionals". Maybe it's because they killed too many of my friends.

3/21/2007 5:23 AM  
Blogger renegadediabetic said...

Jimmy, Thanks for the review from a low-carb perspective. I haven't yet read the book, but will have to get it. Sounds like it has some good info, despite the low-fat bias.

I don't fault them for the low-fat bias. The low-fat message for diabetics is everywhere. The medical establishment is more interested in limiting fat (especially that root-of-all-evil, saturated fat) than in eliminating sugar & refined carbs. Their philosophy is eat your 50% - 60% carbs, because that's what you need to be healthy, and cover it with medication if necessary. My experience tells me they have it all bassackwards. I now eat more fat (even, gasp, saturated fat) and fewer carbs than I did before I became diabetic and I have seen significant improvements in glucose, cholesterol, and blood pressure, with minimal medication. Their approach is good for the drug companies, but is killing diabetics.

I was recently pondering the notion I hear that whole grains prevent diabetes. It dawned on me that they are comparing a diet with whole grains to the standard american diet, which is high in refined grains. Well duh, if you go from refined grains to whole grains, you will see less risk of diabetes. The question is, what risk reduction will you see from eating little to no grains? To the best of my knowledge, there are no studies testing that. I'll bet anything that you will see a greater risk reduction. I used to eat a lot of whole grains, but they didn't help me lose weight or prevent diabetes.

Suzique at Waisted in the Wasteland had a good post on the low-fat, diabetes thing. One of the commenters insisted that diabetics should eat complex carbs. It's hard to tell if this person was being facetious, but I had to add my point of view.

3/21/2007 11:01 AM  
Blogger Jimmy Moore said...

One of my readers wanted to share her feedback about my review, but had trouble posting it. Here's what she wanted to share:


Even though all of the new studies are proving everything us medical people have had drummed into our heads for years is wrong, it is difficult sometimes (even for Moi) to wrap our heads around this.

I have been a low carb proponent for several years now and constantly combat this with my Mother who is a Type II diabetic.

Her Dr tells her the exact opposite of what I talk to her about. Guess who wins???? LOL Certainly not a know it all nurse daughter you can be your boots on that.

She certainly thinks that the way I eat is crazy! Even when I try to define it as just I will eat some meat and some veggies Mom. That will be good enough. She becomes offended that I am not eating the cake she made me specially. She can also have some because Dr Ron said it was okay once or twice a week to have something sweet!!

I certainly fight this at work we have plenty of obese diabetic residents who are all on No Concentrated sweets diets. They get fruit sometimes but other times a smaller portion of cake or pie, maybe reduced sugar whatever.

However even with the reduced sugar most of these things are still high carb. This only goes for the dessert too, they still get all of the pasta and breading on their food everyone else does.

3/21/2007 12:50 PM  
Blogger renegadediabetic said...

I posted my last comment before Amy Tenderich's response. I don't consider low carb an "extreme" approach. I'm also not following Dr. Bernstein's diet to the letter. Low carb may not be the answer for everyone, but I beleive more diabetics would benefit from it if they tried it. Why not put it out there as an equal alternative to low fat and let individual diabetics decide which plan to follow -- based on what their glucose meters and A1C levels say.

I'm under no illusion that my diabetes will "go away." I may be able to get off my meds and keep my blood sugar at normal, non-diabetic levels through my new lifestyle. However, if I go back to my previous way of eating, my blood sugar will skyrocket. I have accepted that my body can't process carbs like it used to and I've made the necessary lifestyle changes.

I agree with you that "limit fat and eat up to 60% carbs" is "dietary advice." Funny, that's what I did before I became diabetic. By their logic, I should never have become diabetic. Also, what blood sugar "numbers" do they espouse? I'll bet it's the dangerously high targets from the ADA or American Association of Clinical Endrocrinologists. Don't they know that high blood sugar, even in the "normal" range, kills over 3 million people a year? See:
The medical establishment is more concerned with getting LDL cholesterol under 100 mg/dL than with getting blood sugar under 100 mg/dL. Of course, they have it all bassackwards.

It will be interesting to see what Dr. Jackson has to say. Please let them know that you can not only cite studies, but also personal experience. Only 15% of diabetics acheive an A1C < 6%.(What does that say about the state of diabetes care???) Mine is and I can forsee the day I get off diabetes meds. Many people would kill to have my lipid profile, yet I'm not on cholesterol medication and I break most of the "rules" for lowering cholesterol. My blood pressure is normal and I will eventually ask about getting off my blood pressure meds. Getting off refined cabs & fake fats, cutting way back on starches, and yes, even increasing fat consumption worked wonders for me.

3/21/2007 2:32 PM  
Blogger Science4u1959 said...

"It will be interesting to see what Dr. Jackson has to say". Indeed, that will be interesting. I hope and pray that it will be something rather different than "It needs more study" or "I can't access PubMed" or something lame and weak like that. Or even worse, something politically correct, like "essential carbs" and that load of crock. Why obviously intelligent and reasonable people like these researchers don't listen to REAL-WORLD experts like you - who realized fantastic health benefits and a wonderful lipid profile - will never cease to amaze me.

3/21/2007 10:01 PM  
Blogger Science4u1959 said...

"...but steer clear of recommending the kind of severe eating restrictions that tend to pit a person against their own willpower--which for so many people ends ends in binging, or creates a roller coaster cycle of eating."

Sigh. Amy, Amy... Where's the evidence for this statement? Can I see ONE study confirming this? Or perhaps some clinical evidence? There is NONE! These so-called "severe" low-carb "restrictions" actually prevent binge eating, and willpower is something that is not really necessary. At least less willpower than on high-carb, portion control starvation diets. The only thing that might be beneficial is perhaps a thick skin against this kind of "wisdom".

3/22/2007 11:16 AM  
Blogger ewe2lamb said...

Being a type 2 diabetic is a severe challange in this world. Thank all the gods that be that we are living in the 21st century with all the medical advances for treatment of this nasty disease. That being said, the ADA, MDA, the Endos assn. and all others are not facing the facts that diabetics are.

Extreme low carbing is the only way to get the A1c numbers down. When they come down, the cholestral problem goes away. the high blood pressure problem is partially solved.

I do not think anyone can ever get totally away from having to take some antidiabetic drugs forever. That is not how the thing works. Weight control works for a while, as does low carb lifestyle.

Replacing sugar and starch with fats works very well to keep the brain functioning.

Non diabetic medical personel do not have the incentive to stay with the extreme low carb lifestyle. Therefore they say it is too hard for people to stick with it.

I test my glucose numbers fasting, before and after all food intake, and before bed. My diabetes has progressed to taking MDI (multiple daily injections) and oral meds, inspite of eating extreme low carb, increasing my activity level and every other thing I was advised to do.

BTW: did you know doctors all flip out if one gets their A1c down in the vicinity of 5??? anything below 5.5 is considered too low for a diabetic person.

3/22/2007 3:14 PM  

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