Wednesday, October 10, 2007

DIABETES: Cascading, Grumbling & Floating

Sometimes a book is mightier than the AMA or even the pharm predators. Gary Taubes’ latest book seems to be one of them. He takes on several “known” food issues and by carefully tracing the history of the idea and rereading the original evidence, he finds evidence of “cascading” everywhere. Cascading is when a consensus develops about what works and why, but it comes out of the maybe/sorta/kinda results of research that is never quite confirmed but soon becomes the common wisdom. (If it doesn't work, it's the patient's fault.) A good example might be the release yesterday of news about a drug that helps “some” (a fifth or less) alcoholics give up or decrease their drinking. The release is accompanied by glowing praise from newly “saved” patients. The research was financed by the pharm company that produces the stuff and which declares, “Now you don’t have to go to expensive rehab or attend night-after-night of AA. Now you can just go to your family doctor for a prescription.” (Drug pushers sound alike.)

A doctor in Montana who writes a column for the GF Tribune noted this week a movement, very quiet, towards allowing “behind the counter drugs.” (http://tinyurl.com/32qtv6) This would mean “avoiding the expense of paying for a visit to a physician when you and the pharmacist know what you need.” The doctor tried to put a good spin on it, but I think it’s just another pharm scam.

Part of what’s pushing us in that direction is the attitudes of the doctors themselves, who have been convinced by the pharm villains that listening is not what patients need: patients need miracle drugs. The pharm people are also shutting down the supply of “samples” for doctors to give to patients. Now the doctors give the patients “vouchers” to present to the pharmacist, assuming there’s still a drug store with a pharmacist in your neck of the woods. The rules favor the Big Box pharm operations, which are much more agreeable and much less transparent. And you'll be more grateful to your pill-pusher than to your physician advisor.

What I predict -- and HOPE for -- is a rising class of “medical listeners” who can help people find their way through the absolute labyrinth of drugs that an aging person faces these days at the same time that they have diminished capacity to round up general info, say, on a computer, and time and focus to devote to sifting it. Anyway, a lot of things we thought we “knew” are turning out, on deeper investigation, to be pretty dubious.

The one that Taubes took on first was the idea that the calories of what goes in (food) equals what comes out (“food ash” -- poop) less energy. This is not so. The amount of calories extracted from the food depends on a whole symphony of hormones and other molecules which are entirely individual in detail, though tied into systems. Not only the amount but the kind and the disposition of those calories is governed by this “symphony”: some calories go to the liver, some to the cells for “burning,” some to muscle tissues, and some have atoms and molecules extracted to make more hormones etc. Cholesterol into one’s mouth does not equal cholesterol into one's veins and arteries. It might kinda/sorta/somewhat affect what makes it into your tissues, but it’s perfectly possible to scarf down bacon and have no cholesterol in the blood.

But that’s a natural fat people have been eating for a long time. Transfats and other human-constructed molecules go into the body and have no natural pathways. They must invent new ones and some of them might not do you any good at all. Molecular klinkers can accumulate, clogging up liver and other body factories. Clearly the body is a food “transformer” that does not just pass it all through after extracting calories.

Here’s another example of “cascading.” Diabetes 1 has been known for a long time and clearly is caused by a failure of the pancreas’ specialty cells, the Isles of Langerhans, to make insulin. People who aren’t making their own insulin either get insulin from other animals or take manmade insulin (hoping it is close enough to the human stuff to not create klinkers). Many people have been kept alive and have even thrived on this regime.

When Diabetes 2 came along, blood sugar was tested and was too high. This suggested a need for insulin BUT the other side of the equation was that it turned out cells could simply REFUSE insulin, even when it was present. This is an entirely different problem and gave rise to metformin and other similar drugs, including some that are now under suspicion of causing heart problems. What has not been much discussed, since these patients are also prescribed insulin-hypers and then insulin, is that a body can have TOO MUCH insulin in the blood, with bad consequences for other organs and feedback loops. (Few if any docs test for too much insulin.) It’s like cortisol, which is homemade (in the body) cortisone, which is helpful in small amounts but over time had an erosive effect, In fact, cortisol levels are somehow related to insulin. And so are the “sex” hormones and whole other molecule loop pathways. My friend can’t sleep if she takes metformin. It gives me a brief little “hot flash,” not so much the kind at menopause (which I didn’t have) but the kind you get when you work too hard too late.

All this stuff badly needs to be talked out frankly and with confidence with someone who really listens. That used to be doctors and pharmacists, but my friends and I are finding that they are no longer sympathetic or even willing to listen. It takes too much time. There’s a line behind you, a waiting room of sick people. My friend is inclined to edit what she tells both in order to keep the doctor from fixating on some pet peeve of his or because she doesn’t want to compromise her case for what SHE wants to do, what she thinks it’s possible to do. (She cannot tolerate a low-carb diet and insists that all fruit is healthy.) She’s more and more inclined to invest in what I consider to be quacks and I see that as a trend all over town. People tell me shocking things they pay money for. (The “clean colon” craze is here.) The healthiest thing I’ve heard of is probably foot massage. It’s still hard to find diabetes-friendly food in these stores except the stuff the pharm-food people tweak to be “fat-free, sugar-free, guilt-free.”

And me? I’m floating in space. My readings are good. My nurse practitioner left town. I can’t get the A1c that’s due until I accept another doctor, but who? What if I’m totally fooling myself? The friend I criticize still gets good A1c stats, so what’s the problem?

The only plan I have is staying alive until they figure this stuff out.

6 comments:

Bernard said...

Mary

I stumbled onto your blog courtesy of Google. If you're struggling with A1C control you may get some help and support from TuDiabetes. This is an active social networking site for folks with diabetes (and I'm one of them). There's also a VERY active Diabetes blogging community that's a source of information and help.

I've built a diabetes search engine that helps in searching for diabetes information. It indexes all known diabetes blogs (I add a few a week at this stage) and you may find it helpful.

Best of luck with your A1C. Trust me, I know just how difficult that is.

prairie mary said...

Thanks, Bernard. My A1C was at 11 when I was diagnosed and is now at about 6.3. My friend's is about the same. But our blood sugar readings don't square with this. I'm going to begin testing my little testing machine, which I haven't done until now. She compared her reading on her own tester with her reading on her husband's and got a twenty point difference.

I'm questioning the whole paradigm of what diabetes 2 is about -- I'm very much in the "metabolic syndrome camp." Will your search engine pick that up?

Prairie Mary

Kevin L. McMahon said...

Hi Mary,

One possible reason for the meter not agreeing with the A1c is that you have atypical blood composition (hematology) which nobody screens for and so thousands of people are getting the wrong answer from their physician's A1c. These are hemoglobinopathies and includes over 600 different causes like anemia, residual fetal hemoglobin that usually goes away after birth but not in everyone, etc...

You can get a hematology screening including an A1c without seeing a doctor. In fact, we ended up with the most accurate A1c possible (always within 0.1) and it's now available direct to patients.

This A1c method was previously only available to participants in clinical trials but we have spent the last couple of years preparing a kit that patients can order online. We expect it to be in stores early next year, too. It's called HomeCheck and it's located at http://diabetech.net/a1c.html We also offer comprehensive programs at http://healthcordia.com

prairie mary said...

Montana is a state that allows a person to walk into a clinic and get a blood test without a doctor's prescription. However, they don't provide interpretation. The other problem is that Medicare and Medicade depend upon doctors' prescriptions to authenticate payment. Other private insurance may not pay for un-prescribed blood tests either.

I was unable to find the cost of a blood test on Kevin's website, which implies it will be (like Bose sound systems)rather high. Clinics around here often have "health screenings," one-off events where people go to a school or church for mass blood draws. The suggested prices sort of imply that an a!c test might be around $50, but Kevin is promising more results than the standard.

Prairie Mary

Kevin L. McMahon said...

Sorry about the missing link to pricing through our healthcordia program affiliate...

http://www.healthcordia.com/howItWorks.html

For those who want to eliminate the possibility of abnormal hematology skewing A1c's or who want to be able to trust their A1c result, this is it.

Most people pay out of pocket first and can submit to their insurance with various results depending on their plan. Some physicians use this test in their office as part of clinical research. Others offer it as an alternative to a venipuncture with an additional co-pay with part of the cost being reimbursed by the insurance company and part by the patient.

We've also created a comprehensive annual program with this included along w education and access to CDEs via phone/email. We currently use PayPal for individuals and our online marketplace should be up shortly.

We work w Baylor, Texas Children's Hospital, Driscoll Children's Hospital, Fortune 100 employers, JDRF, etc... and we've been around developing this stuff since 2002.

Thanks for the chance to clarify.

prairie mary said...

Thanks, Kevin.

Prairie Mary