Facing A Pre-Diabetes Threat - And Acting

Type II diabetes is currently wreaking havoc on this nation's health system as virtually everyone not living under a rock knows. It would be bad enough if  diabetic nerve pain or slow-healing wounds were the major concern but they aren't. If little or no counter action is taken, blindness - a result of diabetic retinopathy - often follows, as well as kidney failure. My late brother John probably died of heart failure two years ago- but diabetes was also a major burden for him, including diabetic -caused blindness.

My wake up call arrived soon after getting back from Europe and having a full  battery of blood tests at my doctor's behest. She sent me a letter with the lab results and they weren't good. I won't go through all, only to note the triglycerides at 247 and the hemoglobin a1C at 6.3%. For those who don't know the lab and  most physicians define diabetes at 6.5% Needless to say, Janice freaked and I realized I had to act and soon - especially to avoid the fate of other family members including my aunt Polly and maternal grandmother - both of whom fell to diabetes.

My weight was also too much - at 192 - a result of eating 3 weeks worth of rich eastern European foods (goulash, sausages, fish soup, enormous breakfasts with multiple choices, and the desserts like Czech Tiramisu, Viennese apple strudel - and ice cream). But even before that I'd been gorging on all the wrong foods, like Ritter dark chocolate bars (I argued that dark chocolate is 'good for the heart' -  but I was gulping down a large bar each week). Plus chocolate chip cookies (4-5 gourmet large ones from Whole Foods), and chips.

Faced with the alarmingly high a1c, however, the time had come for action.

I informed wifey of my plan of action and naturally she was dubious at first. It included:

- Cutting out all packaged white and brown 'quick cook' (in 90s)  rice I'd been eating with almost each main meal - at 88 g of carbs each. To now be replaced by black rice  (also known as 'forbidden rice' or purple rice) with an extremely low glycemic index.

- NO more white, baked potatoes at the main meal, replaced by sweet potato halves instead.

- Breakfast of avocado on toast and 1 egg - replacing ham and eggs and fr. fries

- No more ordinary French fries at main meals -  now replaced  by sweet potato fries (they're in the frozen food section of your grocery)

- More fish meals (salmon, Mahi - Mahi) as opposed to burgers, steaks etc.

- Added sugars cut out by more closely looking at products with sugar in - like replacing regular catsup (with 4 g of sugar per spoonful) with reduced sugar catsup at 1 g.

- Elimination of junk foods, e.g. chips, chocolate chip cookies and candies as well as desserts, ice cream etc.

A true test came with Halloween when not one kid showed up and we ended up with two pounds of chocolate bars (mainly Snickers). I told wifey we would take a few out to eat over time, and bag the rest for next year. Since Halloween I have eaten one small Snickers and no more. (Wifey has eaten three but then her numbers are better than mine anyway.)

The main change was in carbohydrates - the quantity consumed as well as the type.

But even changing eating habits isn't enough so I began a more intense exercise program to, now going to wife's 'Planet Fitness' gym and doing a cycling cardio workout of 30 minutes three times a week  Each time going at least 5.6 miles with 193- 195 calories burned off. (No more speed walking after my doc had my right big toe x-rayed and found it was broken  - since that fall in Budapest over two months ago. So now I have to stay off it - or try to - while using an orthopedic shoe.)

The result? My weight as taken this a.m. is now 182, ten pounds less than what it was around Sept. 20th after getting back from Europe.

I didn't believe it at first so decided to try to get into a pair of waist 36 jeans I was about to give away. Pleased to see they now fit, I plan to keep them!

Meanwhile, my doc wants the a1c redone in January with other tests such as the triglycerides and fasting glucose. We will see, but I am now confident those numbers will be lower.

Another Medical Reversal - This Time On Niacin

"No more niacin for you!"

Reversals on key medical issues are causing many of us to wonder if it makes any sense to use medical guidelines at all, given they seem to change with each passing week.  The latest turnaround is on Niacin, which had been advised to control HDL - the high density lipoprotein cholesterol that wreaks havoc in arteries. It also had been found to lower triglycerides.

I had been faithfully taking it the past five years for these reasons - and had found that my last lipid panel last year yielded the best results ever (though granted, a role may have been played by other factors such as eating more fish, avocados, good fats in general). But what caught my attention was a medical brief in the most recent AARP Bulletin (September, p. 4) entitled 'Nixing Niacin'.  It noted:

"For 50 years, doctors have recommended high doses of the B vitamin niacin to lower cholesterol and improve heart health. But two large new studies show that niacin not only doesn't reduce deaths from heart disease, it puts patients at risk for serious side effects including infections and diabetes. 'This is no longer a drug for routine use' says Northwestern University preventive cardiologist, Donald Lloyd Jones."

Since I'd only just purchased some $35 in niacin a few days before I was curious to learn more about how the whole issue changed.  It turns out  the National Institutes of Health sponsored an American study, and the drug company Merck funded a large international study. One tested extended-release niacin, and the other evaluated a combination of extended-release niacin and laropiprant, an agent designed to make the niacin more tolerable.  Both studies failed to show that niacin reduced the risks of heart disease, stroke and death.

More sobering, researchers stopped the American study prematurely because the possibility of finding any benefit became so remote that its continuation seemed futile. Additional follow-up analyses conducted in both studies did not show that niacin provided a convincing benefit to any group of patients. 

 

 

But the worst news was that niacin caused  multiple side effects, many of which are serious.

 

It was learning about this that got me to (reluctantly) toss the 250 count  re-supply bottles I'd just purchased. As wifey said: "You can't continue to take it knowing what you know now."  And, of course, I will have to inform our family physician when we see her tomorrow.  One disturbing aspect of these recent studies is that in addition to the discomfort (i.e. flushing, random itching) that many patients have, they show that niacin can cause more serious side effects. In the international study, niacin increased the risk of gastrointestinal events such as diarrhea and ulcers by 28 percent; as well as musculoskeletal problems such as muscle damage and gout by 26 percent; rashes, skin ulcerations and other serious skin-related problems by 67 percent. Worse, increased infections by 22 percent; and gastrointestinal bleeding or other bleeding by 38 percent.

 

In addition, patients on niacin were 32 percent more likely to receive a diagnosis of diabetes than those not on the drug, and in those with diabetes, niacin increased the risk of serious problems with disease management by 55 percent. Safety problems were also apparent in the American study, in which those taking niacin had a higher risk of gastrointestinal problems and infections than those taking a placebo. It was the concordance of these studies in showing harms that is so convincing and which doubtless led to the AARP Bulletin notice - which I suspect many will now take to heart.

 

SO, without niacin in the cardiovascular arsenal what can be done? As I noted above, eating more good fats - such as found in avocado and fish like salmon. Also, it is possible that my consistent consumption of those alone may have been responsible for bringing my HDL and triglyceride numbers more in line - much more than the 500 mg of niacin I'd been taking every day.

 

Stay tuned, more medical turnarounds are bound to come!