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Diabetes Update: Our Kidneys

Number 49; November 15, 2002

By David Mendosa

Catching Lions Catching Lions Serengeti Plain, Tanzania, 1968

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

  • Our Kidneys
    Just call me Pollyanna. You are probably younger than I am, so you may be too young to know that Pollyanna is a children’s classic by Eleanor H. Porter published in 1913. Pollyanna was always looking for something to be glad about, and so am I. Currently, in my “About the Internet” column I am thankful that so many of us have diabetes.

    I am sorry that each of us personally has a disease with such serious complications. But because we are such a crowd, many companies and organizations are here to help us. The current column is about the Kidney and Urology Foundation and other organizations, including the American Diabetes Association, that are out there for one of the most severe complications of diabetes. Kidney disease affects from 10 to 21 percent of those of us with diabetes. We have several tools to control it so that it does not progress to end-stage renal disease (ESRD), where not even Pollyanna would find much to be glad about.

    The address of my column about Our Kidneys is

Updates include:

  • The News About Diabetes
    The column on the ADA Web site that I update the most often is about sources of news for people with diabetes. My September 1998 column is now seriously outdated. This March I covered "The Varieties of Diabetes News" again.

    But now even that revision is dated. My friend Gretchen Becker writes me to recommend the beta version of Google News. Gretchen is the author of one of the best books ever written for people with diabetes, The First Year—Type 2 Diabetes: an Essential Guide for the Newly Diagnosed, the subject of another of my ADA columns. Her second book, Stop Diabetes: 50 Simple Steps You Can Take at Any Age to Reduce Your Risk of Type 2 Diabetes, was recently published and is reviewed below.

    "Type in diabetes and you can get feature newspaper stories from around the globe," she says.

    I like it so much that one of my favorite links,, now takes me directly there.

    As Alison Kraus would say, it’s my "New Favorite", supplanting my former favorite, Yahoo! News.

    For example, last week’s big diabetes story was a report in The Lancet about how drinking a lot of coffee can prevent diabetes. Yahoo’s coverage was adequate: three quite similar Reuters dispatches and a HealthScoutNews article. Google News, on the other hand, linked 14 reports from around the world as I write.

    If you search today, you may well find more, because Google News includes articles that appeared in more than 4,000 news sources within the past 30 days. I don’t find how many news sources that Yahoo claims, but I do know that the number of articles about diabetes that it links has declined substantially this year.

Research Notes:

  • AGEs
    There seems to be less and less that we can safely eat. Now, the latest research says that the way we prepare food can also contribute to diabetic heart disease.

    Leading this research is Helen Vlassara, M.D. She is a professor at the Mount Sinai School of Medicine in New York. Dr. Vlassara is the lead author of a research report that seems to concern everyone who hears about it.

    The report is “Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy” published in PNAS, the Proceedings of the National Academy of Sciences Early Edition 2002;10,1073/pnas.242437999. It is on-line at and available for a $5 fee (which is a reasonable amount in comparison to what many other publications charge).

    I was glad to get the article (in my Pollyannaish way), but you can read fine summaries free on-line from AP, Reuters Health, and HealthScoutNews.

    Dr. Vlassara and her associates found that foods cooked at high temperatures dramatically increased the production of advanced glycation end products (AGEs). These compounds in the blood stimulate cells to produce inflammation-causing proteins. Some scientists suspect that they cause blood vessel damage.

    Dr. Vlassara says that a lifelong diet high in AGEs leaves the immune system in a constant state of low-grade inflammation, which damages the small and mid-sized arteries. This, in turn, can lead to heart disease and other complications of diabetes.

    She has been studying the role of AGEs at least since she presented a study at the 1996 annual meeting of the American Diabetes Association. Even back then she was saying that cooking without water causes sugars to combine with proteins to form AGEs. Browned foods, such as brown cookies, bread crust, basted meats, brown beans, and even coffee beans are suspect.

    Now they add even more to the list of usual suspects. Toast and processed foods are out. Likewise, barbeques and microwave ovens, because they cook too quickly. Cola and chocolate drinks also are loaded with AGEs, Dr. Vlassara says. She recommends boiling or steaming and sugar-free versions of clear sodas, instead of the diet versions of dark drinks, some of which add caramelized products which are heavy in AGEs.

    The good news is that Dr. Vlassara and her associates are writing a cookbook for meals that are low in AGEs. The other good news is that the study is not the last word. It is a preliminary report based on a study of 24 people. Other experts say that we need more research to understand the role of AGEs in heart disease and whether all AGEs are bad for us.

  • Vitamin E
    You could prove that water would not quench your thirst if the dose was one drop. You could prove that water would not put out a fire if you tested only one of water’s component. Neither hydrogen nor oxygen would work.

    Likewise, you can prove that Vitamin E is useless if the dose and the components don’t make sense. That is what Eva Lonn, M.D., of McMaster University in Hamilton, Ontario, Canada, and her associates have succeeded in doing.

    They proved that “400 IU/day of RRR-α-tocopheryl acetate administered for an average of 4.5 years to people with diabetes and at high risk for CV [cardiovascular] events had a neutral effect on CV outcomes, on microvascular complications, and on glycemic control.” The study, “Effects of Vitamin E on Cardiovascular and Microvascular Outcomes in High-Risk Patients With Diabetes,” appears in the current issue of Diabetes Care, pages 1919-1927. It is on-line at

    The dose, in lay terms, was 400 International Units of Vitamin E in the form of d-alpha-tocopherol. That amount is half the dose recommended in the Harvard Cocktail. The form ignores the fact that Vitamin E is a complex of eight different compounds, four tocopherols and four tocotrienols.

    This is one area where we clearly do need more research.

Book Review:

    Stop Diabetes by Gretchen Becker
  • Stop Diabetes
    Gretchen Becker calls her new book Stop Diabetes: 50 Simple Steps You Can Take at Any Age to Reduce Your Risk of Type 2 Diabetes. Just published by Marlowe & Company in New York, this 194-page paperback lists for $12.95 (although sells it for $10.36).

    At either price the book is a bargain. Not only for those at risk of diabetes. But just as much for those of us who already have the disease. That’s because Gretchen’s 50 tips that help to prevent diabetes also mitigate its effects.

    Gretchen has quickly become one of the country’s leading diabetes experts. Earlier this year her first book, The First Year—Type 2 Diabetes was the subject of my ADA column. She is, in fact, the only author with more than one book on my list of the best diabetes books.

    Gretchen has a superb talent for knowing and writing about the current science of diabetes in a voice that is clear and even fun to read. She is also a great synthesizer, a fact that is no better illustrated than the way she puts what she calls “the mother of all tips.” There is nothing better for those at risk of diabetes as well as those who already have it than to “eat less and move more.”

    Other steps (tips) that she recommends deal with some of my biggest interests, using the glycemic index and avoiding trans fats. I am also impressed by the timeliness of her recommendation that we “don’t overdo the browned foods.” Here she writes about AGEs.

    “I was worried that maybe it was too far out,” she wrote Wednesday on a diabetes mailing list. The new research reported above validates her concern and proves that Gretchen is leading edge, not over the top.


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