Gus at 9 Weeks
Melissa’s Pembroke Welsh Corgi
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 www.mendosa.com/diabetes.htm.
From time to time Diabetes Update may also include links to other Web pages of special interest.
My most recent contribution is:
- The Food Police
The publisher of Diabetes Digest told me that his magazine accepted an article from my Web site about the “food police.” Diabetes Digest is distributed free at over 15,000 major pharmacies. With a total circulation of over 5 million copies, it is the largest circulation diabetes magazine.
Meanwhile, you can read my article, “Beware the Food Police,” on my Web site. The URL is http://www.mendosa.com/food_police.htm.
- FenuLife Fenugreek
Two years ago when I interviewed Dr. P.V. Rao by calling him in Hyderabad, India, he told me that fenugreek had been mentioned in Ayurvedic literature as a treatment for diabetes. Dr. Rao heads the Department of Endocrinology and Metabolism in the School of Diabetology of the Nizam’s Institute of Medical Sciences there and manages Diabetes-India.com. I interviewed Dr. Rao for one of my “About the Internet” columns on the Web site of the American Diabetes Association at http://www.diabetes.org/main/community/info_news/web/july0101.jsp.
Ever since then I have had my antenna up waiting for further signals about this tasty seed. A few days ago, a company in Minneapolis named Acatris Inc. obliged. They sent me a press release that shows that their fenugreek extract, called FenuLife, reduces blood glucose levels in people with and without diabetes.
FenuLife contains a concentration of galactomannan, a soluble fiber. That means the way it works may be similar to that of guar gum, another concentrated soluble fiber. “The proven blood glucose lowering effect of gum guar is due to its high fiber content and not due to any chemical principle stimulating insulin release in human body,” according to Dr. Rao’s site at http://www.diabetes-india.com/template.php?incfile=alternate.html&title=Alternate+Medicines.
The Acatris press release stated:
“Researchers at Glycaemic Index Testing Inc. in Toronto, Canada tested 4 different dosages of FenuLife and compared it with two other fibre sources: psyllium husk powder and oat bran concentrate. A group of 10 non-diabetic subjects consumed a 50g glucose solution enriched with either of the indicated fibres. Finger prick capillary blood was taken for glucose analysis at 15, 30, 45, 60, 90 and 120 minutes after the start of the meal. A reduction in blood sugar levels was reported at all dosages, however most significantly with the highest dose of FenuLife, this establishing a clear dose-response effect. Neither psyllium husk powder or oat bran concentrate showed any effect at the tested dosages.”
What grabbed my special attention in that paragraph was the reference to Glycaemic Index Testing Inc. I knew that the owner of this company is someone with whom I am in regular correspondence, Thomas M.S. Wolever MD, Ph.D. Dr. Wolever is a professor in the Department of Nutritional Sciences, University of Toronto, and one of the world’s leading glycemic index researchers.
When I first mentioned the press release to Dr. Wolever, he sounded shocked. “Work done at GI Testing is done on a confidential basis,” he replied. “The terms which all clients agree to in writing are that they may not use the name of GI Testing...in any press release without permission. Also, I am not at liberty to discuss the results of any work done, nor disclose clients’ names, without permission. I have neither reviewed nor approved any press release from Acatris.”
Yet after I faxed the press release to Dr. Wolever, he felt at liberty to share his views with me. When I asked his authorization to reproduce them here, he concurred, requesting only that I don’t give the impression that he is too negative.
This is the essence of what Dr. Wolever wrote me:
I will be reminding them that they should have obtained my approval before releasing this. However, the client has now made public the fact that we did work for them, so I am not now divulging any confidential information to you!
I would have 2 comments. First is that FenuLife is a purified gum (in the form of a powder). The study we did was necessary to show that the gum has the potential to lower blood glucose. This is a good first step, but we are still some way away from having actual food products which people can use conveniently. It is an ingredient which may be useful, but the actual foods it is put into will have to be tested before we can make positive recommendations. It has generally been quite hard for manufacturers to get purified gums (e.g. guar) into palatable food products while retaining their efficacy in lowering blood glucose, and there are very few such products available on the market to my knowledge. This is because you tend to need quite high concentrations of gum to get a reasonable effect on the blood glucose, but these high levels have a negative effect on the palatability. Perhaps there are new technologies out their which can do it—e.g. some of the psyllium breakfast cereals are surprisingly palatable (if you like that kind of thing) and very effective. Perhaps FenuLife will have unique properties making it easy to get into palatable and effective products—this all remains to be seen.
Second comment: the oat bran and pysllium fibers used to compare to FenuLife were not very effective because they were not pure gums, and I would have guessed that they would have little or no effect from looking at them. We do know that more purified forms of these fibers can be effective in lowering postprandial glucose. Nevertheless, the fibres used were commercially available products, and FenuLife was certainly superior to them. This is not to say that FenuLife would be superior to more purified beta glucan from oats, or more purified psyllium—such comparisons have not been done. The message is that the effect of fibres on blood glucose are highly dependent on the specific formulation used, and we currently do not have any known chemical ways of determining which will work and which won’t.
- Preventing Retinopathy
We now have real hope to prevent—but not cure—diabetic retinopathy. Five researchers at three German universities and two in the United States have found that something called benfotiamine blocks three of the four major pathways leading to damage from the most common form of diabetes-related eye disease.
Rats with diabetes that were treated with this synthetic form of Vitamin B1 for 36 weeks did not develop any of the retina damage found in a similar group of untreated rats. Although benfotiamine has been widely used to prevent diabetic retinopathy in Europe for more than a decade, there are no double-blind clinical trials in humans. The could, however, start within a year.
The study appears in the February 18 advance online edition of Nature Medicine. The abstract is free online at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12592403&dopt=Abstract.
Already the entrepreneurs are getting into the act. One Canadian company says on a diabetes-related newsgroup that it is rushing to “make pharmaceutical-grade benfotiamine available to North Americans.”
Since the press nowadays rushes to report the least significant study as a major breakthrough, I wanted to hear what the author of the best book on diabetic eye disease had to say. So I wrote Dr. Paul Chous whose book Diabetic Eye Disease is due out this month or next. I reviewed it in Number 54 of this newsletter, and the review is online at http://www.mendosa.com/diabetes_update_54.htm#Eye.
“For more than 30 years, scientists have known of four biochemical pathways responsible for the blood vessel damage that causes many diabetes complications,” Dr. Chous replied. “This study shows that benfotiamine completely blocked three of these four chemical pathways....Drugs designed to block just one of these four, harmful biochemical pathways currently are being developed (e.g., PKC inhibitors).”
I answered back questioning what could block the fourth pathway. “The fourth pathway may, in fact, be affected by benfotiamine. According to the study’s lead author, their team has not isolated and studied that pathway vis-à-vis benfotiamine.”
I also wondered if benfotiamine could cure as well as prevent retinopathy. “It might reverse the earliest stages, but once ‘capillary closure,’ infarction (death) of retinal tissue and neovascularization are underway, I would not expect this therapy to reverse these processes, as a multitude of other biochemical pathways will be involved (i.e., the horse is out of the barn). Only time (and research) will tell, though.”
As a way to prevent this awful complication of diabetes, benfotiamine sounds wonderful. You can, however, take too much of it, so taking it without a prescription is a bad idea. Dr. Chous points out that unlike thiamine, which is water soluble, benfotiamine is fat soluble. Excess amounts of vitamins that are water soluble are eliminated rather easily in the urine. But fat soluble compounds are not. While that undoubtedly increases the retention and effectiveness of benfotiamine, that means it is potentially harmful in excess.
- Defeating Diabetes
If you thought that it was hard to have diabetes (and it is), imagine how much harder it is to be a vegetarian with diabetes. So many of the hot diets of the day—especially those of Dr. Atkins and Dr. Bernstein and on to the Eades and the Hellers—call for substantial portions of protein in the diet. There isn’t even much on the Web that I have felt good about recommending now that Virginia Messina’s article “Diabetes and a Vegetarian Diet” is no longer online. Update April 16, 2009: A correspondent found this important article on an Italian website in English at http://www.scienzavegetariana.it/nutrizione/vrg/diabetes.htm
That’s all changed now with the publication in February of Defeating Diabetes. The authors, Brenda Davis, RN, and Tom Bernard, MD, have actually produced much more than another book about eating the vegetarian way. In fact, the emphasis is so subtle that I entirely missed the point the first time I sat down to skim through the book. While the emphasis is on what we eat, the book adequately covers the other essential elements of diabetes treatment. And instead of talking about vegetarianism, the authors generally refer to their recommended “Plant-Based Food Guide for People with Diabetes.”
The authors have a pleasant absence of the dogmatism often exhibited by folks who are holier than thou. They don’t even say to stop eating meat. For example, in the section exhorting us to “Take Out the Trash,” they cover saturated fat and trans fatty acids, cholesterol, refined carbohydrates, excessive sodium, excessive alcohol, and excessive animal protein.
Ms. Davis and Dr. Bernard recommend eating low glycemic foods and provide a basic list. In fact, the book’s foreword is by David J.A. Jenkins, MD, the father of glycemic index studies. It was his article in the March 1981 issue of The American Journal of Clinical Nutrition that started the whole thing.
Believe me, I tried. But I couldn’t find anything outdated or wrong in this brand new book. While not the last word on diet for people with diabetes, if you aren’t up to speed on nutrition, it could be a useful addition to your libraries.
- The previous issue of Diabetes Update newsletter reviewed at length an important article by Jerome Groopman, an MD professor of medicine at the Harvard Medical School. The article, “Annals of Medicine: The Edmonton Protocol: The search for a cure for diabetes takes a controversial turn,” in the February 10 issue of The New Yorker. The article is currently online at Insulin-Free World Web site.
- ADA Column and Newsletter Frequency
I have coordinated the frequency of this newsletter with publication twice a month of my column, “About the Internet” on the Web site of the American Diabetes Association. However, the ADA advised me today that the organization is discontinuing my section of the site. The organization will now cover diabetes links internally. My February 14 column on “Hypoglycemic Supplies” is therefore the last of 124 columns that I wrote for the ADA starting in April 1997. During March I plan on moving these columns—except those that are about sites that are now dead and gone—to my site.
Since I am no longer producing this column twice a month, effective immediately I have reduced the frequency of this newsletter to monthly. The next issue should be available April 1. And that’s no joke.
Over the years since I started my Web site in February 1995 I have been blessed with the help of many people. Recently, two people volunteered assistance that is quite visible. In the previous issue I tell how Steve Dryja is responsible for a wonderful navigation tool, a menu on the left margin of every diabetes-related page (including this one, but only when viewed as a Web page rather than e-mail). It’s so good that it’s the way I find my own articles.
Even more recently, Abhijeet Mhapsekar was impressed that my site is non-profit. “I am happy to hear that you run this site for other people with diabetes for no financial profit. I have seen only a few good guys like you that help people, while others are busy making profit. Since you are playing your part in the ‘gift economy,’ I want to contribute to it. Since I am a website developer, a database programmer, and a graphic designer, I can help you whenever you want to update your site by designing new graphics, logos, banners, animations, writing webpages, etc., for free.”
I snapped up the offer! I answered Abhi (as he calls himself) that I had long longed for a logo. He immediately replied with the one at the top of this page (and soon to be at the top of all of my Web pages). I didn’t have to make one suggestion for the logo. I think it is inspired.
Abhi was born in Bombay, India, 20 years ago. He is pursuing a bachelors degree in commerce while working as a freelance programmer and web designer for small local companies in India. He says that he doesn’t have diabetes but is a bit overweight because of his sedentary lifestyle. Studying the glycemic index of each and every food has helped him get a new perspective towards dieting. “Now I can easily know which type of food is good and which is bad for dieting and also for a healthy living,” Abhi writes. “Even my parents will benefit from your website because they have diabetes and think that only sugar and refined foods are bad for people suffering from diabetes. I am sure that they will be surprised when I tell them how potatoes and other foods that have been mentioned in your site are worse than table sugar...Also, the chana dal page is very informative. I’ve been eating chana dal all my life, but I never knew that it had the lowest glycemic index and that it’s very good for health. I think that everyone should read the page on chana dal and should try to make chana dal a part of their daily meals.”
- I send out
e-mail in HTML format, which all Web browsers and most modern e-mail programs can display. HTML has live links to all the sites named in the text so that with a simple click of a mouse you can connect to the site you have just been reading about.
- This newsletter is free and will never include advertising. Nor will I ever sell, rent, or trade your e-mail address to anyone.
I send out Diabetes Update about twice a month. Previous issues are online:
- Diabetes Update Number 1: Diabetes Genes of December 10, 2000
- Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
- Diabetes Update Number 3: Starlix of January 3, 2001
- Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
- Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
- Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
- Diabetes Update Number 7: Dates of March 1, 2001
- Diabetes Update Number 8: Quackwatch of March 15, 2001
- Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
- Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
- Diabetes Update Number 11: iControlDiabetes of April 16, 2001
- Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
- Diabetes Update Number 13: Glycemic Index of May 15, 2001
- Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
- Diabetes Update Number 15: Glycemic Load of June 21, 2001
- Diabetes Update Number 16: Homocysteine of July 2, 2001
- Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
- Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
- Diabetes Update Number 19: Fiber of August 15, 2001
- Diabetes Update Number 20: How Diabetes Works of August 30, 2001
- Diabetes Update Number 21: Insulin Resistance of September 14, 2001
- Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
- Diabetes Update Number 23: Pedometer Power of October 15, 2001
- Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
- Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
- Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
- Diabetes Update Number 27: Insulin Index of December 14, 2001
- Diabetes Update Number 28: Fructose of January 4, 2002
- Diabetes Update Number 29: Aspirin of January 14, 2002
- Diabetes Update Number 30: Stevia of January 31, 2002
- Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
- Diabetes Update Number 32: The UKPDS of March 4, 2002
- Diabetes Update Number 33: Financial Aid of March 18, 2002
- Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
- Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
- Diabetes Update Number 36: Gila Monsters of April 30, 2002
- Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
- Diabetes Update Number 38: Native American Diabetes of June 3, 2002
- Diabetes Update Number 39: FDA Diabetes of June 19, 2002
- Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
- Diabetes Update Number 41: New GI and GL Table of July 15, 2002
- Diabetes Update Number 42: Diabetes Sight of August 1, 2002
- Diabetes Update Number 43: DrugDigest of August 18, 2002
- Diabetes Update Number 44: Hanuman Garden of September 3, 2002
- Diabetes Update Number 45: Guidelines of September 16, 2002
- Diabetes Update Number 46: Trans Fat of October 4, 2002
- Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
- Diabetes Update Number 48: Our Hearts of October 31, 2002
- Diabetes Update Number 49: Our Kidneys of November 15, 2002
- Diabetes Update Number 50: A1C<7 of December 2, 2002
- Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
- Diabetes Update Number 52: e-Patients of January 2, 2003
- Diabetes Update Number 53: Email News of January 16, 2003
- Diabetes Update Number 54: Third Generation Meters of January 31, 2003
- Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
This is a one-way “broadcast” mailing list that is not set up to accept replies. If you have any questions or wish to unsubscribe, simply write me at [email protected]. If your friends want to receive Diabetes Update, all they have to do is write me here.
Thanks for joining!