Eat This or You're a Bad Person!
Monday, September 30, 2013
Fasting Glucose: 85 mg/dl.
Glucose 1 hour after dinner: 105 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 124/76 mmHg, 55 bpm.
Exercise: 5.4 mile run.
We are social creatures. We may like to think of ourselves as individualists, but we exist within a culture, and we have to fit into it. What we eat may seem to be a personal decision, in theory, but the reality is that we often feel we have no choice but to go along with the crowd -- mainly because the crowd is so seldom shy about pushing us to go along with it.
After running today (a long run, with super-steep hills), I ate the kind of lunch I figured I could get away with -- not low-carb, but not too high-carb either. And then, on the way out of the cafeteria, I found out about a little office celebration which I ought to be at, but had (by mistake) not been invited to. Now that I knew about it, and had been steered toward it, I had to go.
This was a little celebration for a big project at work which had recently been completed. In the movie business, it would be called a wrap party, I guess. We're in a less glamorous business (we make industrial test equipment, mainly for the smart-phone industry), and the project was not as large in scale as a movie production, so this celebration was small, and only about an hour long, and no alcohol was served. But about thirty of us were gathered there to celebrate the introduction of the new product we had just introduced. And the centerpiece of the celebration was a big decorated cake with hardly any spelling errors.
It was a thick multi-layered cake with loads of icing, and it tasted like a trifle -- super sweet and fruity. A big ceremonial fuss was made of cutting it into big pieces and handing them out to everybody. It sounds silly, I realize, but I felt as if it was socially impossible to refuse to have a piece of this cake at this celebration -- that I would be considered not just ungracious but a troublemaker if I refused. He's not a team player, I imagined them thinking. He wouldn't have any of the big expensive cake we brought in to celebrate the team's achievement. Who does this guy think he is?
I eventually did take a stand when I was pressured hard to have a second piece of cake. Somehow it became possible for me to say "That would be a really bad idea for me", leaving them to imagine why it would be a really bad idea. At this point I can't remember which of them I've told that I have diabetes and need to be careful, but it doesn't matter whom I've told, because nobody I've told takes it seriously anyway. I don't seem unhealthy to them, therefore there's no real issue here. The fact that they see me running every day at lunchtime doesn't make them think I'm dealing with a serious health issue; it makes them think I have no health issue to deal with.
I think the workplace, and the unfortunate ideas prevailing there about how one "celebrates", are not only a major problem for employees with diabetes, but are also a major problem for employees who would like to avoid having diabetes. The little celebration also included an array of other snacks, all of them high-carb, and I avoided sampling any of those, but the cake was the item that I felt was being insistently forced on me, and that I felt I could not refuse. There are just too many occasions for cake (or doughnuts, or croissants, or bagels, or chocolate) in the workplace. I don't know what can be done about it, but I'm noting it as an issue we all need to think about more than we're doing.
An hour later, with gloomy feelings about what I would find out, I tested my blood sugar: 154! Well above what I usually get, and somewhat above what my doctor suggested as a reasonable upper limit. That's what comes of adding a big icing-laden piece of cake to a lunch that was already as carb-intense as any lunch for me ought to be.
In the evening I had a low-carb dinner to prove to myself that I could still get a low post-prandial result despite the mandatory cake earlier in the day. I got a 105, which I was a lot happier with. But, if our society is going to get healthier, it is going to need to stop pressuring and embarrassing people into eating what they know they shouldn't. Cake should not be a weapon. Not even a social weapon.
Another thing people were giving me a bad time about at the celebration was that I had not obtained an employee badge in the new style. Apparently, once again, I had been left off an e-mail list; I was unaware that I was supposed to be getting a new badge. Nearly everyone else had done it already. Anyway, after the celebration, I climbed the hill to the security office to get this taken care of. I don't know that it's a great picture, but it does look more like me than previous versions have done.
Two Creepy Things for Thursday
Thursday, September 26, 2013
Fasting Glucose: 86 mg/dl.
Glucose 2 hours after lunch: 103 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 90/58 mmHg, 60 bpm.
Exercise: 4 mile run.
My Creepy Run
Running at night is creepy, at least in my immediate neighborhood, which is poorly lit and partly woodsy. When I say that it's creepy, I don't mean that as a 100% negative thing. The creepiness of it has a certain amount of appeal for me -- it's a slightly otherworldly experience. It adds a touch of drama. It's kind of scary, but not too scary. That doesn't mean I entirely like it, or even mostly like it. I only 15% like it.
The issue only came about at all because my schedule at work was weird today, and there was no opportunity for me to run in the daylight. And when I was free to run, I felt so reluctant to go out in the dark that I came within a hair of deciding not to do it. But then I thought, do I really want to explain in my blog why I didn't?
So I put on my brightest LED headlamp and took off running down the super-dark tree-lined driveway that takes me out to the main road (with its mostly non-functional street lights).
About half-way through the run, I was on a very dark sidewalk, with an undeveloped hillside dropping away from me on the other side of it, and I became aware of something ahead of me, far enough ahead of me that my headlamp wasn't lighting it adequately. What was it? A jogger? It was moving up and down a bit. But it didn't quite seem like human movement. A dog? I didn't seem to be catching up to it; it stayed the same distance ahead of me. One bright spot, but seemingly too high off the ground to be a dog, but not high enough to be an adult human. Should I perhaps not be following this thing, whatever it was?
What eventually cleared up the mystery was that another one of those things leaped up the hillside and onto the sidewalk ahead of me, this time close enough for my headlamp to show it clearly: a deer. The bright spot was its white tail.
I saw another one on the way back home, in the bushes -- a very young one, with its eyes brilliantly lit by my headlamp, looking like an alien creature. And I thought, this is a little too weird for me. A route that I feel perfectly comfortable running when the sun's up, transformed into a spooky and alarming environment by the darkness.
Tomorrow, dammit, I'm running in the daylight, no matter how I have to juggle my schedule to make it happen.
Is this the future of exercise?
This is Neuro-Muscular Electrical Stimulation (NMES); it's a method of using electrodes to stimulate involuntary muscular contractions. It's not half as horrible as it sounds, by the way; in the videos I've seen the contractions don't look like violent cramps. NMES was developed as a method of therapeutically working muscles in post-surgical patients who are not yet ready to get up and about. But might it have other uses?
A French study looked into the possibility that NMES might give Type 2 diabetes patients the same improvement in insulin sensitivity in muscle cells which exercise provides. And apparently it does. Lying back and letting the electrodes take care of the muscle-contractions for you seems to boost insulin sensitivity the same way real exercise does.
Okay. Good. But in what circumstances is this useful?
Certainly it would be useful for Type 2 patients who are disabled in one way or another, and cannot exercise. But is it really a substitute for exercise?
Increased insulin sensitivity is not the only health benefit that exercise provides; nobody is claiming that NMES provides the same cardiovascular benefits as real exercise. It doesn't burn a lot of calories either.
So, if you're a bed-ridden Type 2 patient, NMES might help you out with glycemic control, but I suspect that's about the extent of its significance.
What Color Is your Fat?
Wednesday, September 25, 2013
Fasting Glucose: 84 mg/dl.
Glucose 1 hour after lunch: 117 mg/dl.
Weight: 191 pounds.
Blood pressure, resting pulse: 115/72 mmHg, 60 bpm.
Exercise: 5.3 mile run.
Beige is the New Fat!
The language of color is a bit mysterious to me. I know that "purple" used to mean red, because old literature and poetry described blood as being purple. But you would think the name of a color that specifically refers to the color of blood could not gradually change its meaning until, a few generations later, it began to designate the color of horrible, artificially flavored "grape" soft drinks and candies. (And by the way, no grape was ever that color; how did that shade came to be accepted by the public as recognizably grapey?)
I am also greatly puzzled by Homer's constant references to "the wine-blue sea"; I'm willing to accept that the sea is blue, but not that wine is. However, the original Greek phrase is apparently obscure; some translate it as "the wine-dark sea", or even "the wine-faced sea" (it may refer to the turbulent surface of freshly-poured wine, not to color.) Since it's questionable whether Homer was any more a real person than Betty Crocker is, I doubt that scholars are ever going to get to the bottom of this one. And Homer, if he existed, was reputed to be blind, so if there's anybody whose color comparisons need to be regarded skeptically, it's him.
Anyway, the color of fat is starting to be seen as terribly important, so I wish there was a little more consistency about how fat color is described. That's all I'm saying.
We think of fat as being white, and most of it is. But there is a type of fat which isn't white. Exactly what color it is, I'm not sure. Scientists call it "brown fat", more often than not. But they also speak of "beige fat". At first I assumed these were two distinct types of fat, but apparently they are two names for the same thing. If you search for "beige fat" on Wikipedia, you are redirected to "brown fat" without explanation. So I guess the two terms have to be synonyms. It seems to me that beige is rather a long way from brown. Beige is the color of tea with a great deal of milk in it. Brown is the color of coffee with no milk at all in it. (Yes, I know that coffee that's that brown is usually called black -- there seems to be no end to our carelessness with color names.) But beige is the new brown (or the new black coffee if you prefer).
The reason brown/beige fat isn't white is that fat cells of this type have a much higher concentration of mitochondria. Mitochondria are the little chemical energy factories within a cell; they happen to contain iron compounds, and are therefore brown. Or beige. Anyway, this kind of fat cell exists to burn energy (unlike white fat cells, which store energy and hang onto it as long as they can so they can keep you from looking good at the beach). It used to be thought that only babies had brown/beige fat. It burns energy specifically to maintain body heat. (Maintaining body heat is harder for a small body, because of the unfavorable surface-to-volume ratio.) But now we know that adults have brown/beige fat, too, even though it makes up a smaller share of total body fat in an adult. Brown/beige fat in adults tends to be concentrated in the upper torso; there isn't a lot of it there, but it's good to have it. Brown/beige fat takes calories from white fat and burns them, and it is believed that having more brown fat helps prevent obesity, diabetes, and dyslipidemia.
That sounds nice, but how do you grow more brown/beige fat? Well, according to some researchers in Spain, one thing you can do is take melatonin regularly. It's available as a cheap supplement which most people use as a sleep aid (it adds to the natural melatonin which the body produces, or at least is supposed to produce, when it's time for you to sleep). Anyway, the Spanish researchers say that rats (obese and non-obese rats alike) grow more brown fat when they're dosed with melatonin. So there you go, proof positive that melatonin will help you control your weight and your diabetes! At least if you're a rat. But maybe it works for people too.
I just took a melatonin pill; I'll let you know if I look any browner tomorrow. But even if I stay as white as ever, it may help me sleep.
Not a Wonder Drug, Apparently
If you see a molecule like this when you're out playing, boys and girls, don't pop it in your mouth.
That would be the basic molecular design for a family of diabetes drugs known as sulfonylureas -- examples include glipizide, glimepiride, and various other glippy and glimy names. They work by stimulating your pancreas to make more insulin than it is otherwise inclined to do. It sounds like a worthy cause, but apparently it leads to trouble. A new study finds that, compared to various other drug therapies for Type 2 diabetes (such as metformin, or combinations of metformin with certain other drugs that aren't sulfonylureas), it has an unwanted side effect: it significantly increases your risk of dying from various causes.
I guess this isn't going to do a lot for the stock price of companies that make sulfonylureas. I'm sure they'll try to come up with a study to refute this one, but we'll see how it goes. I know I'm prejudiced against diabetes drugs in general, but it seems to me that "significantly increases the risk for death" is not a phrase anybody wants to see on a sales brochure.
Ask me how surprised I am that the study didn't compare the safety of sulfonylureas to lifestyle-based diabetes treatment. The safety of drugs is compared to other drugs, not to getting along without drugs.
Physicians are starting to say it's time to think about ditching the sulfonylureas. A Dr. Craig Currie is quoted as saying, "I am bewildered it's still being used. People should avoid using a drug where the balance of evidence, at the moment, demonstrates that it kills people." Well, if you put it that way!
The Monitored Life
Tuesday, September 24, 2013
Fasting Glucose: 78 mg/dl.
Glucose 1 hour after lunch: 150 mg/dl.
Glucose 2 hours after lunch: 112 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 116/74 mmHg, 60 bpm.
Exercise: 5.4 mile run.
I know what I should do about lunch on workdays. I should get up extra-early in the morning, and make a lunch for myself which I know will not present me with any kind of challenge to glycemic control. This is not what I generally do, however. I would do it if there wasn't a cafeteria at work. But there is a cafeteria at work, and I know that if I finish my lunchtime run in the nick of time, I can get out of the Building 4 locker room, and sprint upstairs to the cafeteria, and buy something.
On the other hand, what I find when I show up in the cafeteria a minute before it closes is whatever nobody else bought, and it might not be the right thing for me.
Today I ran an especially difficult route (5.4 miles, and hills as steep as any mortal runner should be asked to climb), and that plus my low fasting test this morning made me want to believe that I could get away with eating whatever kind of lunch I found when I climbed the stairs up to the cafeteria. What I found when I got there was a sandwich made with the big pieces of ciabatta as the bread. A little more starch than I usually take in, but I assumed I could handle it.
Apparently I couldn't handle it; 150 mg/dl is a higher post-prandial glucose test result than I am comfortable getting. I tested again after two hours to make sure I wasn't still way up there; the result then was a reassuring 112. But still! I don't like to see 150 a half-hour after lunch. This is what comes of not bringing your lunch to work.
And then I spent my afternoon fretting about the concert I was supposed to go to after work. I had a meeting that was scheduled to end at 6:45, which in theory was fine because I figured I could arrive at the concert on time so long as I left the office at 7:00. But the meeting is run by, and attended by, some of the most long-winded individuals I have ever known, so it seemed highly probable that the meeting would go overtime. (It did.) I knew I would have zero time to get hold of anything for dinner after the meeting, so in cafeteria I bought a bottled protein-shake (a comparatively low-carb one) and some mixed nuts, so I could consume these as my dinner on the way to the concert.
This kind of thing is probably a major cause of "diabetic burnout". If you're seriously trying to keep your blood glucose under control, then you are constantly aware, throughout the day, that nearly everything you are doing and thinking all day, all the little scheduling issues and glucose tests, are things that other people don't have to fret about. This encourages "why me?" thinking, which of course is the enemy of effective management of any kind of chronic disease. Once you start thinking "if other people don't have to do this, I shouldn't have to do it either", you're pretty much lost.
The main thing I can set against "why me?" thinking is that it's probably a mistake to say that other people don't have to do this stuff. It would be more accurate to say that other people don't do this stuff; whether they are truly getting away with not doing it is an open question.
The concert was nice, by the way. But it brought me home late without a lot of time for writing a thoughtful blog post. As you have perhaps guessed!
If it Ain't Broke...
Monday, September 23, 2013
Fasting Glucose: 78 mg/dl.
Glucose 1 hour after lunch: 124 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 114/73 mmHg, 61 bpm.
Exercise: 4.1 mile run at lunchtime; yoga class in the evening.
This was the first weekend where I felt autumn coming on -- it rained Friday night and Saturday morning, and even after the skies cleared, I could sense a different feeling in the air. And by the end of this week, sunset will be before 7 PM. It's strange that, even though I have always liked autumn better than summer, I nevertheless feel a touch of sadness whenever I first feel summer fading away.
But autumn is the best time to run, or do much of anything else outdoors, so once I'm finished mourning for summer I ought to be able to start enjoying the season.
Tinkering with Hormones
What does it really mean to say that you are "deficient" in a particular hormone and need to be dosed with supplemental quantities of it, to restore you to health?
The mere fact that you don't have as much of a given hormone at age 50 as you did at age 20 does not necessarily mean you are "deficient". Are you really supposed to have as much of that hormone at age 50 as you did at age 20? Might it not be unhealthy to have as much of that hormone at age 50 as you did at age 20?
It is easy to make an argument that, if production of a particular hormone declines with age, then aging is "caused" by diminishment of that hormone and can be "cured" by supplemental doses of it. It sounds plausible enough. Who cares if the evidence doesn't bear it out? It's a good story, and it's the kind of good story that can inspire people to sign checks.
"Aging clinics" are springing up these days, where doctors prescribe doses of hormones which supposedly defeat the aging process. The two most popular hormones for this sort of activity are human growth hormone (HGH) and testosterone. The doctors who work at such clinics tend not to be endocrinologists, and they tend to prescribe these hormones "off-label", meaning that they prescribe the hormones for purposes other than those approved by the FDA. Such hormones are supposed to be prescribed only for those who lack normal quantities of them for a person of their age and background. However, doctors are allowed to prescribe a drug for whatever condition they want to prescribe it for, "off-label" or not, so if they want to, they can set up a clinic which claims to offer a fountain of youth to anybody who is willing to pay for it.
The trouble with this approach is that giving patients over 50 as much HGH or testosterone as they would have had when they were under 30 probably does more harm than good; such hormone treatments are believed to accelerate aging, or at least increase the risk of diseases of aging.
Even a treatment as seemingly straightforward as insulin for diabetes patients is not without its risks. It's all very well to inject insulin to make up for whatever insulin-producing capacity the pancreas has lost. But some people with diabetes are not simply given enough insulin to make up for what the pancreas is no longer producing -- some people are given more insulin than a healthy pancreas would normally produce (in order to compensate for insulin resistance), and the result is a chronic insulin overdose which can have harmful effects on the cardiovascular system. The arteries don't seem to like being dosed generously with insulin, and this issue ought to be taken into account.
I'm not suggesting that all hormone therapies are bad, but it does seem to me that "aging clinics" which raise your hormone levels well above what they would normally be for someone of your age are really playing with fire, and shouldn't be allowed to continue doing so until they can demonstrate that such treatments do more good than harm. And I doubt that such a claim can be demonstrated.
The Walking Cure
Thursday, September 19, 2013
Fasting Glucose: 95 mg/dl.
Glucose 1 hour after dinner: 115 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 110/69 mmHg, 64 bpm.
Exercise: 6 mile hike.
A Walk in the Woods
A "new product introduction" I've been involved in at work for a long time finally got finished; we just won approval to release it. Before the next project after that one can heat up too much, I'm taking a few days off to relax. This afternoon I relaxed by taking a walk in the woods in Bear Valley, near Inverness, California.
As always when I take a walk in the woods, I brought a camera with me and tried to capture the experience -- even though I know how hard it is to get good photographs in the woods. Except on foggy days, the extreme dynamic range between the brightest and dimmest elements in the scene usually defeats the camera altogether.
But I did get a few good shots today.
And apparently I got some good exercise too, as my post-prandial glucose after dinner was good. So here's to walks in the woods!
Gastric Bypass: Cure or 'Cure'?
There was a headline in Medscape today which read, "Gastric Bypass 'Cures' Diabetes in Almost a Third of Patients". The scare-quotes around the word cures are there to appease those who write furious letters of complaint to anyone who suggests that diabetes is ever, in any sense, curable. But clearly the underlying message is that gastric bypass is a real cure, not just a 'cure'.
The first thing that occurred to me was to wonder what "almost a third of patients" means. Strictly speaking, a third would be 33.3%. The article cited above says, "27% had complete remission maintained for 5 years, and that is the operational definition of a 'cure' by [American Diabetes Association] ADA standards. Hopefully this will help people understand that the effects we see after these procedures are durable."
Call me petty, but isn't 27% a lot closer to "a fourth of diabetes patients" than it is to "a third of diabetes patients"? Would it not be fair to say that the 'cure' was not durable, for nearly three-quarters of gastric bypass patients? Does this whole thing not sound more like marketing literature than research news?
The article links to another article, which does put the 'cure' rate at 25% of patients, not 33.3%. And both articles lead me back to yet another article which puts the 'cure' rate at 24% rather than 25%. I don't know how much lower the figure would go if I keep digging further, but maybe 24% is, in fact, rock bottom. It's still better than the kind of results most people get from drug therapy, but it's also a comparatively low success rate for a very difficult surgery which has painful long-term consequences, can come undone, and is being sold to the public as a miracle diabetes cure.
My own diabetes case meets the ADA's operational definition of a 'cure', and that's after 12 years, not 5. And I didn't have a team of surgeons take apart and reassemble my digestive tract, leaving me with a stomach the size of tangerine.
And so, bypassers, I laugh at your so-called 'cure'! Now go away, or I shall taunt you a second time!
Beware the Bun!
Wednesday, September 18, 2013
Fasting Glucose: 91 mg/dl.
Glucose 1 hour after dinner: 122 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 123/74 mmHg, 63 bpm.
Exercise: 5.3 mile run.
Here it is National Cheeseburger Day, and what have I done about it? Nothing! I didn't even find out about it until the day was nearly over.
I didn't even buy an appropriate sweatshirt.
I can't help feeling that cheeseburger enthusiasts, having heard reports to the effect that the most unhealthy ingredient in a cheeseburger is probably the bun, have said to themselves "We'll see about that!", and have been trying to add so many extra layers of beef and cheese that the balance is restored.
The goal seems to be to push the calorie count to record levels. I guess the idea is that, even if saturated fat isn't as toxic as we were once led to believe, the sheer quantity of it will kill us anyway, if we work hard enough at it!
The Trouble with Being an Outlier
A reader who was recently diagnosed with Type 2 diabetes, and has been hoping to control it without medication, wrote to me today to thank me for providing an alternative to the usual literature that is published on this subject, all of it blandly assuming that everyone with Type 2 diabetes is either dependent on medications already, or soon will be. The impression created, for anyone who is new to diabetes and looking for options, is that there aren't any options that don't involve drug dependency. This message is a wee bit discouraging for those who had been hoping that maybe they could control this disease without pharmaceuticals.
No doubt the people who write diabetes literature already have their defense ready: most diabetes patients are on meds or soon will be, so one might as well write as if this were universally true. It's certainly easier to write that way; acknowledging the exceptions would be so tiresome!
I see a problem with this assumption: it's a self-fulfilling prophecy, and is probably intended to be. Life would be so much simpler if all patients managed their diabetes in the same way, and preferably in a very simple way. "Take 20 milligrams of this three times a day", for example, has a beautiful simplicity to it; if you can make people think there's no other way to do it, nobody will complicate the situation by checking out the alternatives. Trying to explain to people how to do what I'm doing would be irritatingly laborious, so it's best not to let people find out that anybody is doing what I'm doing.
Maybe the conspiracy of silence on this subject is not as sinister in its motivation as I'm making it appear, but I think it is nevertheless harmful to hand out expert advice in which crucial information is suppressed because (1) you think it only applies to a minority of people, and (2) you don't think people who are in the minority, in any way, are important.
Illness and Fairness
Tuesday, September 17, 2013
Fasting Glucose: 95 mg/dl.
Glucose 1 hour after dinner: 97 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 117/72 mmHg, 61 bpm.
Exercise: 5 mile run.
The Equal-Opportunity Disease!
Type 2 diabetes has sometimes been portrayed as a disease which discriminates against particular segments of the human population. More than twenty different genes have been found to increase one's risk of developing diabetes, and because the frequency of these genetic variants is not evenly distributed across the planet, some ethnic groups face a higher diabetes risk than others do. Also, following diagnosis with the disease, some ethnic groups also seem to do worse than others, on objective measures such as the hemoglobin A1c test.
However, a new study gives us the encouraging news that Type 2 diabetes deals with the human race more fairly than we might have supposed. The study looked specifically at post-menopausal women, but it would not be surprising to discover that its conclusions apply to post-menopausal men as well -- or rather, to men who are old enough that they would be post-menopausal if they had ever been meno-non-pausal in the first place. (And by the way, why "pausal"? Is the idea that somebody has hit the "pause" button, and if someone hits it again the menses will revert to "play" mode? If I were a woman I'd be worrying about that one all the time. Medical terminology is weird.)
Anyway, here's what the study found: "Using data from the Women's Health Initiative... we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes... Within each racial/ethnic subgroup, women with diabetes had an approximately 2-3 times higher risk of all-cause, cardiovascular, and cancer mortality than did those without diabetes. However, the hazard ratios for mortality outcomes were not significantly different between racial/ethnic subgroups."
Get that? Diabetes may discriminate against you, based on your ethnic background, in terms of your risk of developing the disease. But once you've got it, diabetes isn't any more likely to kill you than it is to kill other diabetes patients with a different background.
I suppose this should make me feel warm inside, but so far it really doesn't. Maybe that's because I'm a little more fixated on that estimate about the 2 - 3 times higher mortality, compared to people who don't have diabetes at all. That certainly looks like discrimination!
Having somewhere between double and triple the normal risk of death within a given time period (from heart disease, from cancer, and from other causes) is a bit daunting. I console myself with the thought that the people whose case histories drive the mortality statistics are different from me in a way which increases their risk.
Sooner or later we'll find out if I'm right about that.
Monday, September 16, 2013
Fasting Glucose: 86 mg/dl.
Glucose 1 hour after breakfast: 123 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 119/71 mmHg, 55 bpm.
Exercise: 4 mile run at lunchtime; yoga class in the evening.
Breakfast is, for most people, the trickiest meal of the day in terms of controlling carbs. There's a reason why breakfast foods (cereal, toast, etc.) tend to be high-carb: people tend to crave high-carb foods at that time of day, presumably because of the long overnight fast since dinner. For a lot of people it would be more important to do a post-prandial glucose test after breakfast than after lunch or dinner, not only because breakfast tends to be high-carb, but because a lot of people have a harder time with glycemic control in the morning than they do later in the day. That doesn't seem to be my pattern; I'm more carb-tolerant in the morning than later, so it doesn't seem as necessary to test then (and my morning schedule tends to make it difficult to fit in a test after breakfast). But today I had an opportunity to do a test after breakfast, and I took it. The result (123 mg/dl) is about par for the course, even for a non-diabetic person, so that's reassuring.
Later in the morning, not long before I was going to go for a run, I started feeling as if I might be a little low. I wasn't having serious symptoms of hypoglycemia, but I was feeling oddly hungry, and I was afraid it would get worse if I went running without eating anything. I took an extra glucose test, and the result was 80 mg/dl. Not hypoglycemic, but in the lower end of the normal range. Perhaps I had fallen rapidly to get there, and the rapid drop had made me feel a little iffy. I decided to eat a small piece of fruit; shortly after than I went for a run, and had no ill effects. The feeling that I was getting low did not come back.
I am alert to the possibility of hypoglycemia (mainly because I hate the way it makes me feel), but I try not to over-react to it. Emergency measures are usually not called for.
Yes, it's time once again to answer the questions asked (or at least implicitly asked) by those whose Google searches have sent them here recently.
"would an a1c test of 7 mean medication"
Probably; the risk of diabetes complications starts rising steeply once the hemoglobin A1c test result climbs above 6.9%, so doctors are expected to "do something about it" (that is, add or intensify medications) if a patient is at 7.0% or higher. My own doctor has told me that, if my A1c reached 7.0%, he would have to conclude that my non-medicated approach was no longer working. Fortunately, I haven't done any worse than 5.8% since diagnosis.
"can stress affect a1c test"
Not in the sense that it would cause you to get a false reading on the test. If stress somehow results in your blood glucose levels going up, then the increase in blood glucose levels will make the A1c result go up. Stress won't create a false indication that your glucose is elevated; if your A1c result goes up, it will be because glucose really did go up.
Elevated levels of "stress hormones" might possibly trigger inflammation, which might trigger insulin resistance, which might result in higher glucose levels. But stress doesn't have a more direct impact on A1c results.
"does alc level 7.3 mean you have diabetes"
Yes; 6.5 is the diagnosis point. Being above 7.0 wouldn't leave any room for argument.
I have been diagnosed with diabetes for twelve years now, and the worst A1c result I've seen to date was 5.8. So it seems a little surreal to me when I hear from people who think they're non-diabetic, or possibly non-diabetic, even though they are getting A1c results which would throw me into a panic if I got them myself.
"what can raise your a1c if you're not diabetic"
Becoming diabetic. An increased A1c result indicates a rising level of glycation (unwanted bonding for sugars to proteins), and a rising level of glycation indicates a rising level of glucose.
There are medical circumstances (such as hemodialysis) which can cause your A1c test result to suggest a lower glucose level than is in fact present, but I haven't heard of a circumstance which can cause your A1c result to suggest a higher glucose level than is in fact present.
"sometimes i always see ant in my urine what does that signifies"
Schizophrenia would be my guess.
A diabetes diagnosis is no longer a popularity contest, in which we offer taste-tests of our urine to swarms of ants and bees to see how well they like it. We've left the bronze age behind in that regard, and now we test our blood chemically when we want to know how much glucose is in it.
Forget the bugs, people! I'm getting tired of writing about them!
"what kind of sickness that cause killing ant by urine"
No sickness that I've got, I hope!
"my blood sugars 212 after eating cake"
Better knock it off, then; cake is not for you, if that's how your system reacts to it. But maybe smaller doses of it could work? Experiment to find out.
"what does having slightly elevated blood sugar levels feel like"
Exactly like not having slightly elevated blood sugar. Unfortunately, we are not able to sense our blood sugar level most of the time. A low produces recognizable changes in how we feel, but a high usually doesn't.
"what happens if a diabetic doesn't take their incline"
Their spelling gets really bad. My goodness, that has to set some kind of record for creative mis-spellings for "insulin"! But maybe Auto-Correct did it.
What happens if people who need insulin don't take it is that their blood glucose rises to harmful levels.
"can you just have high blood sugar and never have low sugar"
Yes, although people who take insulin or other glucose-lowering drugs sometimes have lows because their medication was a little too much for a given occasion.
Almost anybody, diabetic or not, medicated or not, can have lows from time to time, but people with very high blood sugar who aren't getting large doses of meds might never see a low.
"do diabetics always have glucose in urine"
No; if your blood glucose level is below the "renal threshold" (that is, the level it can reach before your kidneys are no longer to exclude it from your urine), then you won't have sugar in your urine. The renal threshold is between 160 and 200 mg/dl, depending on the individual.
"i am diabetic and on medicine but i still wake up every hour to pee."
That needs to be checked out with your doctor. Either your blood sugar is pretty far out of control, or you have some other medical problem which is causing excessive urination.
"is someone with sticky urine and high blood sugar evident of diabetes"
I'm not sure where sticky urine fits in here (if it fits in at all), but high blood sugar isn't evidence of diabetes -- it's the very definition of diabetes. If your blood is abnormally sugary, you're diabetic -- regardless of the viscosity rating of your urine.
I've seen these questions about "sticky urine" before. I have to wonder how people are assessing the stickiness of their urine -- and what's motivating them to check it out. Anyway, if peeing out molasses is a possibility, I'm pleased to report that it hasn't happened for me so far.
Friday the 13th Wrap-up
Friday, September 13, 2013
Fasting Glucose: 78 mg/dl.
Glucose 1 hour after lunch: 97 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 129/78 mmHg, 56 bpm.
Exercise: 4 mile run in the evening.
Strikingly low glucose tests today; I'm not sure exactly why. It's tempting to attribute it to the fact that I'm now running again, but today's strikingly low post-prandial test was before I went running. I was pretty careful about carbs today, but not to a dramatic extent. Some days your body just cooperates with you, and some days it doesn't, and it can be awfully hard to explain the variations.
Rocket-Frog is Not a Fake!
NASA has confirmed that this rocket-launch photo from last week is not doctored; the blast of the rocket engines threw some debris high into the air, including a frog which had been resting on the launch pad. There's no reason to think the frog actually reached orbit; presumably it soon fell back to the ground. No reports yet on how the astro-amphibian is doing.
Anyway, a launch pad is a not a safe place to take a nap. If you learn nothing else from me today, at least you'll have that.
Playlists for your Endothelium
Are your music-listening habits doing what's necessary to maintain healthy endothelial function?
The endothelium is the inner lining of a blood vessel, and you might assume it's nothing more than a material barrier placed there to hold the blood in, but you'd be wrong. The endothelium is an actively functioning tissue which responds to (and also generates) chemical commands. For example, it is very involved in the processes which cause blood vessels to dilate or constrict to adjust blood pressure. When endothelial function is impaired, various health problems can result -- especially cardiovascular disease. If you don't want to have a heart attack or a stroke, you want to have normal endothelial function. Unfortunately, a lot of people with diabetes have impaired endothelial function, which is at least part of the reason for the elevated cardiac risk associated with diabetes.
So, if you have diabetes, you want to be doing whatever you can to improve your endothelial function. A new Dutch study has identified two things that can do the trick: exercise training and listening to at least 30 minutes a day of your favorite music. Music alone wasn't as effective as exercise alone, but combining the two was substantially more effective than either treatment alone.
And which music should be used for this therapeutic purpose? The reasearches say that "There is no an 'ideal' music for everybody and patients should choose music which increases positive emotions and makes them happy or relaxed".
So there you have it. After you finish your workout, listen to whatever brings you musical joy, and let the insides of your arteries do some healing.
Snacks and Satiety
A study of children's snacking behavior compared how much children ate when offered a snack consisting of (1) potato chips, (2) cheese, (3) vegetables, or (4) cheese and vegetables combined. The children could eat as much as they wanted of whatever version they were offered, so the experiment was mainly a test of how many calories the children had to eat before their appetites were sated.
It turned out that the children who ate the cheese and vegetable combination reached satiety earlier, and ended up consuming 72% fewer calories, than those who ate potato chips.
I don't know if this information turns your world upside down, but I offer it for whatever it may be worth.
Spice or Medication?
Thursday, September 12, 2013
Fasting Glucose: 96 mg/dl.
Glucose 1 hour after lunch: 113 mg/dl.
Weight: 192 pounds.
Blood pressure, resting pulse: 113/74 mmHg, 61 bpm.
Exercise: 4.1 mile run.
Cinnamon: Here We Go Again!
A small study conducted in 2003 in Pakistan (and who could doubt information that comes from that great world capital of rationality?) found that daily doses of cinnamon improved both glucose control and serum cholesterol in patients with Type 2 diabetes. Ever since then, contradictory reports have been coming in, with one study saying cinnamon really does help, and the next saying it doesn't.
My reaction to the original Pakistan study was to experiment on myself, by filling gelatin capsules with cinnamon and taking them daily. As usually happens with experiments of this sort, I found a substantial improvement at first which later seemed to tail off to nothing. The likely explanation is that, when you are testing a claim of this sort, "confirmation bias" makes you want the claim to come true, so you unconsciously adjust your behavior (and in this case your diet) to bring your blood sugar down. Because you're making that adjustment, you see an improvement at first, but it fades over time as you forget to make the adjustment. I was probably carb-cutting more aggressively than usual while testing the effect of cinnamon, at least at first; then I reverted to standard behavior and the improvement faded to nothing. That's how I read my experience, anyway.
Scooping two gelatin half-capsules through a mound of cinnamon and struggling to jam them back together was a tiresome chore (cinnamon turns out to be an irritating substance to handle, and I had to use rubber gloves), which may be why I was almost relieved to see the effect fade away over time. (Good -- I don't have to keep doing this for the rest of my life!) Drugstores later began to sell ready-made cinnamon supplement capsules (at inflated prices, of course), but the added convenience didn't motivate me to stick with cinnamon as a "drug". As it happens, I like cinnamon, so I use it on any foods that seem suited to it, and I hope that it's helping me a little. But, for me, cinnamon is a spice, not a medication.
A 2008 meta-analysis of various existing studies concluded that cinnamon does not actually help diabetes patients, and that seemed to be that.
But studies continued. And now, a further meta-analysis finds that cinnamon does provide benefits -- (reduced fasting blood glucose and improved lipids). It isn't as effective as the best diabetes meds, but it's better than some.
However, according to this meta-analysis, cinnamon does not improve Hemoglobin A1c test results. This seems a little strange. Is cinnamon bringing down blood glucose on average, or just on fasting tests? Something doesn't make sense about the data presented. Maybe we still need more studies.
Actually, what we need are larger studies. Most cinnamon studies performed so far have looked at small numbers of participants. Maybe that's why the results have been all over the map.
I'm not naive about why cinnamon research hasn't received enough funding for large studies to be feasible. Nobody holds a patent on cinnamon; it's been around for a while, and nobody is going to get way with claiming it as their "intellectual property" now. If there aren't billions of dollars to be made, why spend millions of dollars investigating it?
My strong suspicion is that, if cinnamon made a big difference, the data on it would not be so ambiguous. But it probably makes some difference, so perhaps it's worth making an effort to add it to your diet.
I await further data.
Doubting the Latest Research News
Wednesday, September 11, 2013
Fasting Glucose: 81 mg/dl.
Glucose 1 hour after lunch: 131 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 127/76 mmHg, 62 bpm.
Exercise: 4.6 mile run.
The poison-oak recovery continues; I dared to go running at work, exposing my legs to view in the locker room as well as outdoors. Not that there were many people around to see me. Today was the United Way "Day of Caring", and a lot of my coworkers were away from the office doing volunteer work. I wasn't participating. My rule is never to sign up for a new volunteer work project before I have recovered from whatever physical damage the last one did to me.
Once again, it felt good to be running again.
"There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact."
So said Mark Twain. Was he right about that?
Probably so, at least in a lot of cases. I read a fair amount of science journalism, and the more widely publicized a piece of research is, the more often it turns out to be a questionable small-scale study which didn't come within a mile of proving what it is reported to have proved. Particularly questionable are small-scale studies which purport to show that some knee-jerk assumption people are likely to make is in fact true. It is never more important to be skeptical of research news than when the news seems to confirm something you were already prepared to believe.
The latest specimen of this genre is a study which supposedly proves that men who take an active role in looking after their small children (changing diapers, providing meals and baths) have small testicles, while men who avoid such duties have large testicles.
At first I heard about this from popular newspaper summaries, which made it sound as if the study found that men with small testicles not only did more in the way of child care but also showed more brain activity in regions associated with child care. But that's journalists making a summary. Is that what the actual study said?
I can't access the entire research paper, I can only access the abstract of it, so any conclusions have to be tentative. But it sounds to me as if the researchers did not actually monitor men's child-care behaviors: "We tested this hypothesis by measuring aspects of reproductive biology related to mating effort, as well as paternal nurturing behavior and the brain activity related to it. Both plasma testosterone levels and testes volume were independently inversely correlated with paternal caregiving. In response to viewing pictures of one's own child, activity in the ventral tegmental area—a key component of the mesolimbic dopamine reward and motivation system—predicted paternal caregiving and was negatively related to testes volume. Our results suggest that the biology of human males reflects a trade-off between mating effort and parenting effort, as indexed by testicular size and nurturing-related brain function, respectively."
Did a lawyer write that? I don't think it answers my most urgent question about the study. Did the researchers actually observe how men with varying testicle volume behaved with their children? Or did they simply conclude that a particular kind of brain activity is correlated with parental care-giving, and that this brain activity is more common in men with small testicles?
I'm not sure how they measured testicular volume. It would be easy enough if the things were fully detachable; you could drop them in a glass of water and see how much fluid volume they displaced. (And then, if you refused to give them back, you would have created the ideal father, who changes diapers like crazy because he's got nothing else on his mind.) But most real-world testicles have a man still attached to them, which makes measurement a little more difficult; the inevitable margin of error would seemingly leave the measurement open to conscious or unconscious bias. And variations in ambient temperature, which affect virtually every kind of measurement process, might play an especially significant role in a measurement of this sort.
Also, I don't know how they quantified the nurturing behavior of the men in the study, if indeed they observed it at all (instead of reading brain scans like tea leaves and drawing their own conclusions). But it seems to me that, in measuring such a thing, there would have to be a margin of error which would leave the measurement open to conscious or unconscious bias.
It is exceedingly difficult for me to believe that the researchers went to work on this issue with no preconceived ideas about whether men who change diapers have smaller or larger testicles than men who don't. With the opportunity for biased observation so large, and the scale of the study so small (only 70 men participated), I think there is every reason to be skeptical about the conclusion that men with small testicles take care of their children, but men with large testicles are too busy making more of them to be bothered.
By the way, the study was published in the Proceedings of the National Academy of Sciences, a periodical which calls itself "PNAS" for short. I'm not sure how they pronounce that, but if this is the kind of work they're publishing, I'm willing to take a guess.
Rested and Ready
Tuesday, September 10, 2013
Fasting Glucose: 91 mg/dl.
Glucose 1 hour after lunch: 105 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 101/65 mmHg, 65 bpm.
Exercise: 4 mile run in the evening.
Today I decided that my poison-oak-ravaged legs were healed up enough that I could risk exposing them to public view. After I got home from work, I went for a run around the hills of my neighborhood. After many days of not running, I was a little worried that I would find it hard to get back into it, but it actually felt great to be doing it again.
I think I'm even ready to have my legs be seen in the locker room at work, so I'm going to try to return to my usual routine of lunchtime running. What a relief!
Hypoglycemia: Not a Minor Issue
A friend sent me a photo of a jeep belonging to diabetes patient he knows who blacked out at the wheel during a hypoglycemic episode.
The guy survived with nothing worse than a broken leg, but clearly the accident was bad enough that it could easily have resulted in death or permanent disability for the driver -- and for anybody else who might have been sharing the road with him at the time.
I get the impression that a lot of people, including doctors prescribing glucose-reducing meds to patients who might be able to get by with less medication or even none, don't take hypoglycemia as seriously as they ought to. Hypoglycemia itself seldom kills anyone directly, but the accidents it causes can kill people quite easily, and repeated hypoglycemic episodes, even if they seemingly have no serious consequences at the time they occur, can take a pretty serious cumulative toll on health. How many neurons die during each episode, and how many can we afford to lose during our lifetimes? And how much cumulative impact from such episodes can the heart survive unharmed?
I tend not to fret about hypoglycemia myself, because I'm not on any meds that can trigger it, so the lows I experience are the same sort of infrequent and not-very-severe lows that even non-diabetic people experience occasionally. Admittedly, any kind of low is an uncomfortable experience which I greatly dislike, but I know how to recover from it, and anyway I don't have to go through it more than once or twice a year. I don't even remember when the last one was. (Having written that, I'll probably have one tomorrow, but the point is that they're uncommon for me.) I don't worry about hypoglycemia because I don't need to, but for a lot of people with diabetes it's a pretty big issue, and it needs to be considered a little more seriously as a potentially dangerous side-effect, when diabetes therapies are being compared.
If doctors gave serious consideration to diabetes therapies that don't cause hypoglycemic episodes, they'd have to take the approach I'm using more seriously than most of them currently do, because I don't think anything with comparable advantages is available from the pharmacy.
Never Say Higher or Lower
Monday, September 9, 2013
Fasting Glucose: 94 mg/dl.
Glucose 1 hour after lunch: 124 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 131/86 mmHg, 56 bpm.
Exercise: Walk at lunchtime; yoga class in the evening.
Darwin's Devoted Misunderstanders
The basis of health science is biology, and the basis of biology is evolution, so misunderstanding evolution can really get in the way of understanding health issues. Which is a shame, because evolution may be the most widely-misunderstood of the big scientific ideas.
There isn't any logical reason why evolution should be hard to understand, since most of it boils down to four statements, none of which is hard to grasp:
- Individual organisms vary genetically, even within a local population of the same species.
- Some genes are advantageous in practical terms; they give an organism an improved chance of surviving and reproducing, at least within a particular local environment.
- Over succeeding generations, those genes which confer an advantage tend to build up within the local population, resulting in adaptive change.
- Over many generations, local adaptive change causes life to diversify, because new species branch off from existing species, and different species become increasingly unlike one another.
The trouble arises not from what is contained in those statements, but from what most people imagine is contained in them. There is nothing there which suggests that evolution has a purpose (like rain, evolution just happens, for no better reason than that the conditions required for it are present). There is nothing there which suggests evolution is proceeding toward a goal, or even in any specific direction. Nevertheless, what most people assume is that evolution is a story of "progress" and "advancement" -- a linear sequence, in which "lower" organisms are replaced by "higher" ones, and "simple" organisms are replaced by "complex" ones. None of that is justified; Darwin wrote that words such as higher or lower should not even be used in comparing species.
Also, most people entirely miss the idea that evolution is about species branching out in every direction; instead of endless diversification, people imagine evolution is a steady march in one direction. The literal direction is left to right, because human evolution is invariably symbolized by a parade of primates which looks like this:
Or like this:
Or like a million and one variations on those images which we have all seen a million and one times. That representation of "evolutionary advancement" (with its false suggestion that chimps are direct human ancestors) has become so familiar to us that we recognize it immediately, and take it in without thinking about it. The concepts implied by it can therefore be taken for granted by cartoonists, to make a point about what they think true "advancement" looks like...
...or to suggest where "advancement" might lead to us being replaced someday...
...or to suggest, in any of several ways, that "advancement" has ceased and things are now heading the wrong way:
The notion that evolution equals progress towards a goal is probably so firmly embedded in the popular imagination that there is no getting rid of it now. The people who claim evolution isn't true are usually rejecting their imagined version of evolutionary theory (based on that stupid damned illustration) rather than the real thing. For example, owing to their failure to understand the branching concept, they demand to know why apes are still around, if we evolved from them? (Which is like demanding to know why, if you're alive, your cousins aren't dead.)
Clinging to this simple vision of evolution as progress makes it hard to make sense of the more complex realities of biology. For example, a given gene might be advantageous in one situation and disadvantageous in another, which is why people find it so hard to understand why we're stuck with common genes which put us at risk for diseases. Shouldn't evolution have eliminated those "bad" genes long ago? Not necessarily. In a few cases, the picture is fairly clear. The gene that puts you at risk for sickle-cell anemia also protects you from malaria, so it's a common gene in parts of the world where malaria is a major threat. Genes that put you at higher risk of diabetes are also believed to make you better able to survive a famine. Genes for dark skin protect you from skin cancer, while genes for pale skin protect you from vitamin D deficiency; regional skin color variations probably reflect local evolutionary compromises between those two potential problems.
Most of the time, though, trying to use evolution to explain peculiarities of health and behavior is a more complex business than people like to pretend. We don't necessarily know enough about all of the factors affecting genetic change over time to say for sure why things are the way they are. As a rough rule of thumb, I would say that if a proposed evolutionary explanation for a human health issue seems marvelously clear and simple and convincing and straightforward, it's very likely to be mistaken. I don't think it's good to base an approach to healthy living entirely on an appealing story about what evolution has been up to. On the other hand, I don't think it's good to reject an approach to healthy living simply because a proposed evolutionary rationale for it is unproved and unlikely.
I recently read about an evolutionary biologist who has been attacking the popular "paleo" diet concept on the grounds that the evolutionary rationale for it (we shouldn't eat foods that weren't available to our remote ancestors, because evolution hasn't had enough time to adapt us to those foods) amounts to nothing more than naive and unverifiable speculation. According to this view, we don't know enough about the range of foods that were eaten by our paleolithic ancestors, nor do we know enough about how quickly humans can adapt to new foods, to come up with an evolution-based prescription for proper diet.
A lot of fans of the diet have responded that (1) they are following the diet because it works for them, not because they entirely buy into the evolutionary rationale for it, and (2) if evolutionary theory doesn't necessarily prove the diet is good, neither does it prove the diet is bad, and (3) there are reasons besides evolution to think refined grains have not been a helpful addition to the human diet.
I'm inclined to call it a draw, here. Yeah, it's simple-minded and silly to claim that an unverifiable evolutionary story line is all we need to lead us to a healthy way of eating. But it's also simple-minded and silly to claim that a given way of eating is unhealthy just because its advocates might be guessing wrong about the pace of human adaptation to a varying diet.
Evolutionary considerations can certainly give us insights into human health issues, but they won't be very helpful insights if they distort a complex reality in order to mold it into a good story -- or a good illustration.
The Big HR
Thursday, September 5, 2013
Fasting Glucose: 87 mg/dl.
Glucose 1 hour after lunch: 131 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 125/80 mmHg, 55 bpm.
Exercise: Walk at lunchtime.
Of all the facts and figures that might be mentioned in a report on medical research, one of the most important is Hazard Ratio -- so it's a shame that many such reports not only don't define Hazard Ratio, but don't spell out the name of it: often it is represented by the mysterious initials "HR".
Hazard Ratio is the amount by which a given risk contributor multiplies the risk you would have without it. If people working in a given coal mine have twice as much risk of lung cancer as people who don't work there, then the HR for working in that coal mine is 2. If they have somewhat elevated risk but not doubled risk, the HR will be somewhere between 1 and 2. If they have exactly as much risk as everyone else, the HR is 1. If they have less risk than everyone else, the HR is less than 1.
My coal mine example makes HR sound a bit simpler than it is. You have to define a lot of things pretty carefully, to make your HR meaningful. For example, you can't just compare anyone who works in a coal mine to anyone who doesn't. The people you're examining, inside and outside the coal mine, need to be comparable in age and initial state of health. If you compare miners with non-miners who also happen to be younger and healthier to start with, the comparison isn't valid.
Today I read a report on the HR for cardiovascular disease, and for all-cause mortality, in elderly patients with varying blood pressure ranges. (Doctors are trying to work up a new set of recommendations for treatment of hypertension in the elderly.)
If you look at the table of HR values for patients aged 65 to 74, there is a consistent trend of rising risk of cardiovascular disease as blood pressure climbs. At >149 mm Hg systolic pressure the risk is more than doubled. That seems clear enough.
But notice that, in the right column, patients over 74 show less of a clear trend. For them, the hazard ratio is 1 (or less than 1!) until the pressure gets very high.
Hazard Ratios for Cardiovascular Disease
|Systolic Blood Pressure||HR, Age 65-74||HR, Age >74|
|<120 mm Hg||1.00||1.00|
|120–129 mm Hg||1.14||0.80|
|130-139 mm Hz||1.34||0.69|
|140–149 mm Hg||1.44||1.06|
|>149 mm Hg||2.33||2.18|
I hasten to add that patients over 74 are not necessarily doing better than younger ones, despite the lower HR. The HR is a relative measure. We're comparing over-74 people to other over-74 people, not to younger people. A hazard ratio of 1 merely means that they're doing as well as other over-74 people. Apparently, in most people over 74, blood pressure isn't a significant factor in risk of cardiovascular disease. This doesn't mean their risk of cardiovascular disease is low -- just that their presumably high risk isn't made measurably worse by blood pressure, until the pressure exceeds 149.
The HR values for all-cause mortality show a similar pattern: risk rises steadily with blood pressure for people under 75, but not for older people. For many people over 75, treating high blood pressure might turn out not to be worth it.
Hazard Ratios for All-Cause Mortality
|Systolic Blood Pressure||HR, Age 65-74||HR, Age >74|
|<120 mm Hg||1.00||1.00|
|120–129 mm Hg||1.06||0.86|
|130-139 mm Hz||1.16||0.78|
|140–149 mm Hg||1.35||1.18|
|>149 mm Hg||1.67||1.00|
Before we conclude anything at all from this, we need to find out more details about what the absolute risk values are. An HR of 2 doesn't mean much to me if I don't know how large the risk is that I'm doubling. If the base risk is one in a million, I might not mind increasing it to 2 in a million, but if the base risk is high, I might be nervous about increasing it by only 10%.
Anyway, be on the lookout for "HR" or "Hazard Ratio" in research news; it helps you figure out if the research findings are really a earth-shaking as the researchers involved want you to think.
Leisure, Affluence, Illness
Wednesday, September 4, 2013
Fasting Glucose: 91 mg/dl.
Glucose 1 hour after lunch: 122 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 128/74 mmHg, 62 bpm.
Exercise: Evening walk.
I think I'm finally over the hump with poison-oak situation. I certainly wouldn't want to show my legs to anybody right now, but they're less raw and less red than before, and also less itchy. From here it has to get better. Pretty soon -- I'm aiming for Friday -- I think I'll be able to handle doing a real run, and not keep using walks after meals as my workout equivalent.
So far, blood sugar control is still surprisingly good in the absence of what I consider real exercise. Weight control is a problem, though. Also, not doing real exercise makes me feel like an invalid -- as if I were a surgery patient recently home from the hospital, hobbling around trying to recover.
At least my neighborhood is extremely hilly, so an evening walk isn't the leisurely stroll it would be elsewhere.
Plus, it's a pretty area to be walking in. You don't notice that quite as much when you're running.
And, although summer is drawing to a close, I still have enough time after work to enjoy the slow descent of sunset down the hillsides.
China's Got Diabetes
Is every nation that becomes economically successful -- or at least successful enough that most people can eat more or less what they want -- inevitably going to suffer a diabetes epidemic?
China is the latest country to encounter that problem. In 1980, diabetes prevalence in China was less than 1%. It's now 12%. That's according to a new study of about 100,000 Chinese adults. Of the 12% who had diabetes, two-thirds of them were undiagnosed, more than a quarter of them were untreated, and fewer than 40% of them had "adequate glycemic control".
Not only that: more than half of the adults studied were "prediabetic"!
Chinese public health officials are now bracing themselves to be hit by a tidal wave of cardiovascular disease, stroke, and kidney disease driven by the diabetes epidemic.
I don't know what the solution is going to have to be, but I hope we can find a better solution to diabetes prevention than desperate poverty (which involves health risks of other kinds).
Is Insulin Optional?
Tuesday, September 3, 2013
Fasting Glucose: 86 mg/dl.
Glucose 1 hour after lunch: 111 mg/dl.
Weight: 193 pounds.
Blood pressure, resting pulse: 123/71 mmHg, 59 bpm.
Exercise: Walk at lunchtime.
I'm continuing to recover from my terrible poison-oak outbreak, but the recovery process is slow. My lower legs are still pretty raw, and way too ugly to expose to public view, so I'm still not back to running, and for the time being I'm continuing to use hilly walks rather than running as my workout method. In terms of glucose control, it's working out surprisingly well; in terms of weight control, not so much.
O Soleus Mio!
The University of Geneva (UNIGE to its friends) has issued a maddeningly un-detailed report indicating that glucose can be controlled even in the absence of insulin.
Perhaps you're wondering why this should be considered an exciting possibility. Most humans (and other mammals) use insulin to regulate blood glucose levels. People with diabetes don't produce it, or don't produce enough of it, or have diminished cellular sensitivity to it. Treatment of diabetes involves injecting it, or stimulating the pancreas to produce more of it, or boosting cellular sensitivity to it. Is there a need to seek another solution?
Well, in some cases, yes. People who inject a lot of insulin over long periods tend to suffer ill effects from it, as a consequence of repeated hypoglycemic episodes, and also because it tends to promote high cholesterol and heart disease. So, if an alternative path to glycemic control were available, it would be worth a look. And the Geneva researchers think they have identified such a path; they say that "life without insulin is possible".
So what replaces insulin? Another hormone called leptin -- which regulates appetite (which is why it is is usually studied in hopes of finding an obesity cure), and also regulates the way the body stores fat. "Researchers from UNIGE's Faculty of Medicine conducted experiments on rodents devoid of insulin, to which they administered leptin, a hormone that regulates the body's fat reserves and appetite. Thanks to the leptin, all the subjects survived their insulin deficiency. Using leptin offers two advantages: it does not provoke hypoglycemia and it has a lipolytic effect. 'Through this discovery, the path to offering an alternative to insulin treatment is emerging. Now we need to understand the mechanisms through which leptin affects glucose level, regardless of insulin level,' explains Professor Coppari."
Gratified as I am to hear that a set of lab rats "survived their insulin deficiency" (for how long?) on leptin, that still doesn't tell me how well their glucose was regulated. It also doesn't tell me how the leptin regulates glucose, but apparently the mechanism of glucose control by means of leptin isn't yet understood by the researchers themselves. They have established this much: unlike insulin, which does most of its glucose-regulating work in skeletal muscles, leptin disposes of glucose in the liver, in "brown fat", and in one specific muscle (the soleus, or calf muscle). How leptin does whatever it does there is not yet established. (It involves interaction with neurons in the hypothalamus, if that clears it up for you.)
What I take away from this is that (1) researchers have not found a diabetes treatment breakthrough, but they have found a clue that might lead them to one some day, and (2) glucose regulation in non-diabetic people is somehow assisted or modified by a leptin-based mechanism, and we need to find out more about how it works.
Leptin has a rather sad history of being cited as the key to future breakthroughs -- usually breakthroughs related to weight control -- in countless research reports which don't lead to anything later. All I have to do is see the word "leptin" in a press release to automatically think "this probably isn't as important as they're making it sound". Experience has made me cynical.
The research does explain one thing: why I have such a problem with cramps in my soleus muscles. All that leptin activity I've got going on in there, to make up for whatever insulin isn't doing for me, is probably stressing out my calves more than they can stand.
"NOT MEDICATED YET"
Reading the Stats
What this is about
I am going to use this space to report on my daily process of staying healthy -- what I'm doing, and what results I'm getting, and how I interpret the connection between the two.
I am not trying to taunt anybody, by reporting better results than they are getting themselves. I'm doing this to provide encouragement, not irritation.
Regardless of what your own health situation is now, you can probably pick up some useful ideas by tracking what I'm doing, and seeing what the results are. I don't mean that you should do whatever I do, or that imitating my behavior will get you the same results I get. We all have to figure out what works for us. Let's just say that I'm giving you an example of some things to try, and they might help. If they don't, try something else!
One word of warning: I sometimes participate in endurance sporting events (including "century" bike rides and the occasional marathon), but please don't assume that you would have to participate in extreme sports to get the kind of results I'm getting. Most of the year I'm not working out nearly that hard, and I still get very good results. For some people, vigorous walking may be enough. (But if it isn't in your case, don't cling to the idea that it ought to be enough -- do whatever it takes to get good results!)