Tag Archive for: blood sugar

Gluconeogenesis: Making Sugar

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On Tuesday, I said that blood sugars remained stable in all subjects throughout the study. How can that be when they would most likely use all their stored sugar in 24 hours or so? Their bodies made glucose out of protein and scraps from the breakdown of other substances.

Many hormones and connective tissue are made out of protein and are typically repaired after damage. The liver can use some amino acids from the damaged proteins to make metabolites that can enter the citric-acid cycle. When those remnants become scarce, the Number One source is muscle. Skeletal muscle is our protein storage facility, and while it isn’t preferred to use protein in this way, the body is protective of your blood sugar level and will protect it no matter what; it will make sugar for energy using whatever is available.

Use of fat as a fuel also increases, primarily in the mitochondria. While it’s complicated biochemistry, mitochondria are then stimulated to become more active and produce more free radicals. The good news is that researchers also observed an increase in antioxidant activity. Glutathione levels remained constant but an analog of glutathione called ophthalmic acid increased, keeping the rise in free radicals in check.

There was one more significant set of metabolites that were released. I’ll cover that on Saturday. What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41598-018-36674-9

A Case for Fasting

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During the food poisoning episode last week, I didn’t eat for 30 hours. Of course, I had slept most of that time and eating was the last thing I wanted to do. Even though I could have started eating again, I decided to continue the fast to at least 60 hours. I continued to drink fluids—I’m not going to live without coffee—but no food or drinks with calories.

Why do this? I had just scanned a research paper written by a Japanese research group who had four volunteers fast for that long. They observed interesting changes in metabolism by measuring by-products of metabolism in blood. They took blood samples before the study and then at 10 hours, 34 hours, and 58 hours. In prior research, they had discovered 14 changes in metabolites, but this time there were 30 more changes that occurred during the 58-hour fast.

It’s difficult to establish a time-course of events as they didn’t collect blood every two or four hours, but we can compare baseline numbers with the results of the other times blood was collected and analyzed. Initially the body relies on stored sugar in the form of glycogen, but eventually sugar gets used up and the body has to rely on fat stores. Here’s observation Number One: blood sugar was consistently maintained varying only 10 mg/dl over the observed times. Surprised? I’ll tell you why that happened on Thursday.

What are you prepared to do today?

        Dr. Chet

Health Headline: Ketogenic Diet and Type 1 Diabetes

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Researchers wanted to examine the blood sugar control of type 1 diabetics who use a very low carbohydrate, high-protein, moderate fat ketogenic diet. The diet was developed by Dr. Richard Bernstein, himself a type 1 diabetic. They used a unique study design: they requested volunteers from a Facebook group of children and adults who adhere to the Bernstein Diet. Over 300 volunteers completed an online survey about their diagnosis and diet. The diagnosis of type 1 diabetes was confirmed from medical records from a follow-up survey of medical staff.

This was a rigid ketogenic diet with no more than 30 grams of carbohydrate allowed per day. The average intake was 36 grams carbohydrate per day. The better the control of carbohydrate intake, the better the HbA1c score, with a mean of 5.7%. Remember, these were type 1 diabetics; there are many type 2 diabetics who don’t control their HbA1c that well. I think this study illustrated the potential of nutrition in affecting a disease system. One interesting aside was the healthcare professionals treating the patients seemed indifferent to the dietary approach regardless of the results.

Headline worthy? Yes, in context. Close to half the subjects did not provide access to medical personnel so the researchers relied on the initial subject surveys for information. They also had no access to any dietary records to confirm the diet. Still this was a unique way to use social media to gather information. The study has to be confirmed using traditional research design to assess the variables. But this approach examined people who live this diet on their own or with their children. That can provide insights that might be missed if the study were conceived by a group of research professionals discussing the question around a table.

What are you prepared to do today?

Dr. Chet

 

Reference: Pediatrics. 2018. doi: 10.1542/peds.2017-3349.

 

A New Approach to HbA1c

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Type 2 diabetes is a significant problem in North America and it’s spreading throughout the entire world. The treatment standard has always focused on controlling blood sugar, especially HbA1c. Normal is less than 5.7%. For most individuals, reducing the HbA1c to under 6.5% has been the goal for pharmacologic treatment.

HbA1c is a protein found on red blood cells that indicates blood glucose levels over the past 90 days. It develops when hemoglobin, a protein within red blood cells that carries oxygen throughout your body, bonds with glucose in the blood. Think of it as the sugar you ate over the last three months getting stuck to your red blood cells; the higher your HbA1c, the worse your control of your blood sugar has been. For a prediabetic, that means your days of diabetes meds and finger pricks is getting closer. For a diabetic, that opens the door to many of the worst consequences of diabetes, such as heart and kidney disease, blindness, and nerve damage.

Recently, the American College of Physicians published new guidance statements for the use of medications for controlling HbA1c. A committee of physicians examined the data behind the current standards of treatment for four of the major physician organizations including the American Diabetes Association. In the simplest terms, they wanted to know what benefits or hazards occur when treating adults with type 2 diabetes with medications. Should the goal be to get the HbA1c as low as possible with drugs? Or should the individual be part of the treatment equation?

This is an important issue and the topic for this week. I’m going to review evidence-based medicine on Thursday. You can get the entire story by listening to the Straight Talk on Health on evidence-based medicine, normally available only to Members and Insiders; I cover the entire concept of how EBM began and what it was intended to be. For those of you who haven’t chosen a membership yet, get more info here.

What are you prepared to do today?

Dr. Chet

 

Reference: Ann Intern Med. doi:10.7326/M17-0939.

 

The Science Behind Holiday Spices: Cloves

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No one has to tell us that Christmas and the New Year are coming; it’s in the air. You can smell the holiday season this time of year. This week, I’m going to cover three spices used this time of year and talk about some of the potential health benefits of each. I’m not suggesting their use makes foods healthy if they’re also high in sugar and fat—just that there’s some interesting science behind these spices.

If you prepare . . .

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The Answer to the Sugar Conundrum

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Whether you have prediabetes, type 2 diabetes, or are just concerned about the calories in the sugary treats this holiday season, what should you do? Go without and feel deprived, or indulge and pay some sort of price? Let’s take a look by beginning with a few questions.

Why do you want to reduce your sugar intake? Do you want to reduce your caloric intake? Is it because you know you have prediabetes or type 2 diabetes? Are you concerned about gaining weight over the holiday season? Once you know why you want to avoid sugar, you can start . . .

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Sugar Alternatives

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Dealing with our sweet tooth this week, let’s look at sugar alternatives that may give us better choices if we don’t want to use artificial sweeteners.

Sugar alcohols are one alternative; xylitol, sorbitol, and other sugar alcohols are often used in candies and other treats. They can be a reasonable alternative to regular sugar, but there are a few things you need to know. First, they have a pronounced aftertaste; it feels like a cool sensation. Second, they’re not calorie free but . . .

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The Sugar Conundrum

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During the holiday season, there are plenty of sugary snacks available. Candy, cookies, pies, all kinds of treats. But can something as simple as jam on toast, let alone the holiday treats, be an issue for someone with prediabetes or type 2 diabetes? With close to half of all adults afflicted with one condition or the other, any kind of sugar stops them in their tracks. I see people reading labels carefully in the grocery store and often hear the words “No good. It has sugar!” In the prediabetes and diabetes groups I . . .

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Pedelec: The Bottom Line

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I want everyone to exercise. Period. It doesn’t matter how. You can work within your physical limitations, but everyone needs to exercise. That’s why the pedelec story and research study attracted my attention. Combining what you have to do anyway—get to work—with physical activity could be just the ticket. Let’s see if this is your ticket to ride.


The Benefits

Even in a study as short as four weeks, there were some health benefits, especially for blood sugar control. For someone at risk for type 2 diabetes, which is just about everyone, it . . .

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Prediabetes: What Now?

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The messages this week have talked about the risk factors for prediabetes and how many people don’t know what they are. It’s time to change that, at least in those of you who read the messages. Please feel free to pass them along to anyone you feel might also be unaware.

How do you know if you’re actually prediabetic? It requires a blood test for a specific protein called HbA1c. This protein indicates the amount of sugar that’s been in your blood stream for the past 90 days. The number for your blood sugar might be . . .

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