Cites

cc'd by email Uh, Alan, I think we have a language
difference here In the US, a "DA" is the local criminal
prosecutor.

Either it means something else to you, or your question
TOTALLY misses me.

Alan said:

I am preparing to fight some long battles with my local
DA. I have a fair library by now of appropriate cites, and
will continue my own searches.

But I would appreciate any that you may think useful for
supporting the following topics or views. I realise I
should look at both sides of the argument, but I don't
really need cites to support their entrenched views.

Topics

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo
protein) on lipids and kidney indicators
(creatinine, etc).

The dangers or otherwise of ingested cholesterol; are eggs
and shellfish safe?

Dawn effect, and should we add carbs to a high FBG reading
at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.

Alan <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

I am preparing to fight some long battles with my local
DA. I have a fair library by now of appropriate cites, and
will continue my own searches.

But I would appreciate any that you may think useful for
supporting the following topics or views. I realise I
should look at both sides of the argument, but I don't
really need cites to support their entrenched views.

Topics

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo
protein) on lipids and kidney indicators
(creatinine, etc).

The dangers or otherwise of ingested cholesterol; are eggs
and shellfish safe?

Dawn effect, and should we add carbs to a high FBG reading
at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.

The problem is that the answer to each of these questions
depends on the details of your particular clinical
situation. There are very few questions for which the answer
is the same across the spectrum of diseases and treatments
that make up the wacky world of diabetes. One simple
example: A type 1 diabetic on a single shot NPH regimen is
likely to see his highest BG readings of the day at a couple
hours post prandial. For the same patient on a pump with
Humalog, 2 hour post prandials are often the lowest BG
reading of the day.

When you add to the variability due to just treatment
options the fact that diabetes is not one, or even two,
monolithic diseases but two families of diseases, you start
to get an idea of difficultly of generalized answers.

--
-------
Charly Coughran [email hidden]

"Alan" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

I am preparing to fight some long battles with my local
DA. I have a fair library by now of appropriate cites, and
will continue my own searches.

But I would appreciate any that you may think useful for
supporting the following topics or views. I realise I
should look at both sides of the argument, but I don't
really need cites to support their entrenched views.

Topics

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo
protein) on lipids and kidney indicators
(creatinine, etc).

The dangers or otherwise of ingested cholesterol; are eggs
and shellfish safe?

Dawn effect, and should we add carbs to a high FBG reading
at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.

Alan,

Do you have a fax number? My dietician sent me a load of
photocopied stuff today, one article has a list of
references 3 pages long!! It will probably help for all of
the above, although it is not very pro low-carbing.

Anyway, I can fax it accross to you if you like, I'll use
the machine at work. You have been a great help to me (and
many others here too, I'm sure) and so I am keen to return
the favour!

Steve

steve AT bobbair . plus . com

Quoted message said:

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo protein)
on lipids and kidney indicators (creatinine, etc).

The dangers or otherwise of ingested cholesterol; are eggs
and shellfish safe?

Dawn effect, and should we add carbs to a high FBG reading
at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.

Mr Coughran's answer is very good as usual.

I regard diabetes as a family of diseases where the common
element is loss of some or all components of the glucose
control system.

I go to one doc and he has firm answers, The problem is that
he has a poor batting average with
me.

I have done poorly with my problems but it has not been from
lack of trying. The exact information we desire does not
exist. We use what we do know to handle the problems which
vary with individuals. That is the reason I stick here. I
learn something every week. Mostly from someone that has a
similar situation.

As far as diets there is no answer. If you do not like what
you see, wait a month for it to change.

As far as scientific publications, I worked to close to the
people generating and publishing data to have the intrinsic
respect for them that I see. Some very poor people out there
with doctorates.

All we can do is to read a broad spectrum of data and try
to fit it to our own case. I see that is what you are
doing. Guy

Ted Rosenberg said:

cc'd by email Uh, Alan, I think we have a language
difference here In the US, a "DA" is the local criminal
prosecutor.

Either it means something else to you, or your question
TOTALLY misses me.

No, I'm not being prosecuted for anything at the
moment AFAIK.

DA =>Diabetes Australia, similar to your ADA and dispensing
the same advice on carbs. Also see my "DA Conquest magazine"
thread on a.s.d.

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.

Charly Coughran said:

Alan <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

I am preparing to fight some long battles with my local
DA. I have a fair library by now of appropriate cites,
and will continue my own searches.

But I would appreciate any that you may think useful for
supporting the following topics or views. I realise I
should look at both sides of the argument, but I don't
really need cites to support their entrenched views.

Topics

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo
protein) on lipids and kidney indicators
(creatinine, etc).

The dangers or otherwise of ingested cholesterol; are
eggs and shellfish safe?

Dawn effect, and should we add carbs to a high FBG
reading at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.

The problem is that the answer to each of these questions
depends on the details of your particular clinical
situation. There are very few questions for which the
answer is the same across the spectrum of diseases and
treatments that make up the wacky world of diabetes. One
simple example: A type 1 diabetic on a single shot NPH
regimen is likely to see his highest BG readings of the day
at a couple hours post prandial. For the same patient on a
pump with Humalog, 2 hour post prandials are often the
lowest BG reading of the day.

When you add to the variability due to just treatment
options the fact that diabetes is not one, or even two,
monolithic diseases but two families of diseases, you start
to get an idea of difficultly of generalized answers.

Thanks for answering Charly.

Part of the problem is that you are quite correct, but our
authorities tend to promote exactly that - generalized
answers, usually involving high carbs and minimal testing.

I obviously expressed myself badly. The purpose of the cites
will be to support a letter to various authorities in
Australia, including Diabetes Australia and the ADEA
(Australian Diabetic Educators Association). The main thrust
of the letter will be to question the validity of the
present overwhelming emphasis in their teaching and
promotion of high carb diets for all diabetics. As I am T2,
the arguments will be based on the viewpoint of T2
treatment. By high-carb, I mean that their dieticians
generally promote 45 to 60 gms of carb at every meal for all
diabetics.

As a secondary issue, I will be also questioning other
matters such as their recommendations on testing frequency
and timing.

To show my own bias, I support the testing advice I first
learnt from Jennifer - "test, test, test". I am not on any
"name" diets; nor do I necessarily support low-carb; I
support minimal post-prandial BG spikes whether they occur
at 45, 60, 90 or 120 minutes (or even later). Therefore I
support frequent testing in the early stages of SMBG (Self
Monitoring of Blood Glucose) until the individual determines
what is causing those spikes, when they occur, and what
action may be taken to minimise them.

So, the testing cites I am looking for would be ones that
have found value in post-prandial testing (whatever the
timing), or that have shown SMBG to have improved other
health indicators such as HbA1c and lipids etc.

The dietary cites would be those that debunk the standard
"low carb means high protein and kidney disease or high fat
and heart disease" line, or which show specific improvement
in indicators such as lipids and creatinine on lower carb
diets than those promoted by the authorities here. I am not
looking for cites supporting extremes in any direction.

Alternatively, cites specifically showing the dangers of by
high carb low fat diets are also being sought.

I have a fair library of cites already to sift through, but
I was interested to see what else may be out there before
putting it all together. I am looking for studies done by
respected medical research organisations available on the
net, not newspaper articles or diet authors.

Thanks again for taking the time to answer.

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.

Steve Robertson said:

Alan,

Do you have a fax number? My dietician sent me a load of
photocopied stuff today, one article has a list of
references 3 pages long!! It will probably help for all of
the above, although it is not very pro low-carbing.

Anyway, I can fax it accross to you if you like, I'll use
the machine at work. You have been a great help to me (and
many others here too, I'm sure) and so I am keen to return
the favour!

Steve

steve AT bobbair . plus . com

Thanks Steve.

If you read my reply to Charly, I clarified what I'm
after there. I'm sorry, I don't have a fax, just email.
Remove starch for that. And because I'm a non-medical
layperson I'm limited to cites available on the net or at
my local library.

I'm not so much pro lo-carb as I am anti high spikes; I
suppose that's more like I am anti high carb at
inappropriate times of day.

Thanks for the compliment, nice to know I may have helped
somebody. On a more cynical note; according to Diabetes
Australia you would be heading for major kidney and heart
problems by following anything I suggest.

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.

On Fri, 02 Apr 2004 12:48:43 -0600, Guy <[email hidden]>
wrote: <snip>

Quoted message said:

All we can do is to read a broad spectrum of data and try
to fit it to our own case. I see that is what you are
doing. Guy

Yes Guy, I agree. My real problem with our various national
authorities (and the DA here follows yours in almost every
recommendation) is the rigidity of their high carb approach
and an inability to even consider the alternatives, such as
diet modified by testing.

I tried to clarify my needs a little more in my reply
to Charly.

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.

Alan <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

Charly Coughran said:

Alan <[email hidden]> wrote in
:"]news:[email hidden]:

Quoted message said:

I am preparing to fight some long battles with my local
DA. I have a fair library by now of appropriate cites,
and will continue my own searches.

But I would appreciate any that you may think useful for
supporting the following topics or views. I realise I
should look at both sides of the argument, but I don't
really need cites to support their entrenched views.

Topics

Benefits and timing of post prandial testing.

Comparison of differing diets (lo carb, lo fat, lo
protein) on lipids and kidney indicators
(creatinine, etc).

The dangers or otherwise of ingested cholesterol; are
eggs and shellfish safe?

Dawn effect, and should we add carbs to a high FBG
reading at breakfast?

Long term effects of low carb, or low protein, or low
fat diets.

You get the drift.

TIA

Cheers, Alan, T2 d&e, Australia.

The problem is that the answer to each of these questions
depends on the details of your particular clinical
situation. There are very few questions for which the
answer is the same across the spectrum of diseases and
treatments that make up the wacky world of diabetes. One
simple example: A type 1 diabetic on a single shot NPH
regimen is likely to see his highest BG readings of the
day at a couple hours post prandial. For the same patient
on a pump with Humalog, 2 hour post prandials are often
the lowest BG reading of the day.

When you add to the variability due to just treatment
options the fact that diabetes is not one, or even two,
monolithic diseases but two families of diseases, you
start to get an idea of difficultly of generalized
answers.

Thanks for answering Charly.

Part of the problem is that you are quite correct, but our
authorities tend to promote exactly that - generalized
answers, usually involving high carbs and minimal testing.

I obviously expressed myself badly. The purpose of the
cites will be to support a letter to various authorities
in Australia, including Diabetes Australia and the ADEA
(Australian Diabetic Educators Association). The main
thrust of the letter will be to question the validity of
the present overwhelming emphasis in their teaching and
promotion of high carb diets for all diabetics. As I am
T2, the arguments will be based on the viewpoint of T2
treatment. By high-carb, I mean that their dieticians
generally promote 45 to 60 gms of carb at every meal for
all diabetics.

As a secondary issue, I will be also questioning other
matters such as their recommendations on testing frequency
and timing.

To show my own bias, I support the testing advice I first
learnt from Jennifer - "test, test, test". I am not on any
"name" diets; nor do I necessarily support low-carb; I
support minimal post-prandial BG spikes whether they occur
at 45, 60, 90 or 120 minutes (or even later). Therefore I
support frequent testing in the early stages of SMBG (Self
Monitoring of Blood Glucose) until the individual
determines what is causing those spikes, when they occur,
and what action may be taken to minimise them.

So, the testing cites I am looking for would be ones that
have found value in post-prandial testing (whatever the
timing), or that have shown SMBG to have improved other
health indicators such as HbA1c and lipids etc.

The dietary cites would be those that debunk the standard
"low carb means high protein and kidney disease or high
fat and heart disease" line, or which show specific
improvement in indicators such as lipids and creatinine on
lower carb diets than those promoted by the authorities
here. I am not looking for cites supporting extremes in
any direction.

Alternatively, cites specifically showing the dangers of
by high carb low fat diets are also being sought.

I have a fair library of cites already to sift through,
but I was interested to see what else may be out there
before putting it all together. I am looking for studies
done by respected medical research organisations available
on the net, not newspaper articles or diet authors.

Thanks again for taking the time to answer.

Cheers, Alan, T2 d&e, Australia.

I tend to be on the wrong side of the diet wars no matter
which side I talk to. I believe you should start by
identifying the healthiest diet for the general population.
Then make adjustments to it directed at dealing with
whatever diabetic specific problems you are trying to
address. You can then look at the trade offs. What are you
losing by going away from the healthy diet and what are you
gaining in diabetes benefit. The problem, of course, is the
widely divergent answers to the healthy diet question.

The best review I know of is in the Jan. 2003 issue of
Scientific American, which is available at
sciam.comsciam.comOpen ↗. It discusses a redoing of the
FDA food pyramid in light of the last 20 years of
nutrition research, much of which they ignored the last
time they revised
it. Basically the answer is the low fat guys got it wrong,
there are good fats and bad fats. The low carb guys
got it wrong, there are good carbs and bad carbs.
Exercise and weight loss, if appropriate, are
absolutely basic. I don't think most diabetics have to
do much to their conclusions except, perhaps, tweak a
little here and there.

One piece of advice. Be very critical, in the academic
sense, of any material that supports your position. It is
extremely difficult to not let bad support get into your
list. If you run into someone who actually knows something,
they can focus on the one bad supporting citation and make
your entire argument look bogus. It is always best to start
with an open mind and let the data take you where it wants
to. It is best, but always the most difficult.

--
-------
Charly Coughran [email hidden]

Charly Coughran said:

I tend to be on the wrong side of the diet wars no matter
which side I talk to. I believe you should start by
identifying the healthiest diet for the general population.
Then make adjustments to it directed at dealing with
whatever diabetic specific problems you are trying to
address. You can then look at the trade offs. What are you
losing by going away from the healthy diet and what are you
gaining in diabetes benefit. The problem, of course, is the
widely divergent answers to the healthy diet question.

The best review I know of is in the Jan. 2003 issue of
Scientific American, which is available at
sciam.comsciam.comOpen ↗. It discusses a redoing of the
FDA food pyramid in light of the last 20 years of
nutrition research, much of which they ignored the last
time they revised
it. Basically the answer is the low fat guys got it wrong,
there are good fats and bad fats. The low carb guys
got it wrong, there are good carbs and bad carbs.
Exercise and weight loss, if appropriate, are
absolutely basic. I don't think most diabetics have to
do much to their conclusions except, perhaps, tweak a
little here and there.

One piece of advice. Be very critical, in the academic
sense, of any material that supports your position. It is
extremely difficult to not let bad support get into your
list. If you run into someone who actually knows something,
they can focus on the one bad supporting citation and make
your entire argument look bogus. It is always best to start
with an open mind and let the data take you where it wants
to. It is best, but always the most difficult.

--
-------
Charly Coughran [email hidden]

Thanks Charly

I didn't spend the five dollars, but as the author is
Willett, I suspect that is the same one as the Harvard Food
Pyramid at
hsph.harvard.edupyramids.htmlOpen ↗
which I do agree with - as a start base.

I also appreciate the advice on scientific method and
sources.

The remainder here got a little long. Skip it if you wish,
it just explains where I am coming from.

On soapbox.

I try not to get into the "diet wars" too. I did what you
recommend. I started with my own diet based on everything I
had ever heard from any source to lose weight and be
healthy, immediately after diagnosis in May 2002. I had
never heard of Atkins, Bernstein or Becker et al.

That was before I "discovered" Jennifer's advice here. And I
also discovered you and a lot of other people to whom I am
eternally grateful.

The initial diet worked very well for weight loss (basically
low-sat-fat) and I had lost about 10 Kg (22lbs) when I
started testing as Jennifer recommends and changed not just
the quantity of carbs, but the time of day I could eat them.
I was by then also learning from this group.

Then I did a course with the Diabetes Australia dietician
and learnt a lot more, but that was also the first time I
came across the official promotion of 45 - 60 gms of carb at
every meal for males, using meds to get your BGs down and
testing for type 2s using FBG and pre-dinner only. I was
also informed that Type 2 never got hypos; so why was I
shaking at
3.9 (70) mmol when I dropped from 12? Anger? I tried his
recommendations for about three weeks, considtently
spiking in the 9s (160) or above after breakfast or
lunch. I eventually decided not to keep hurting
myself. I am not on meds.

I continued to test, test, test and eat everything in
moderation, including as many beneficial foods as I could,
based on things learnt here and on a.s.d from Quentin and
others. I lost another 17 Kg (37 lbs), A1c stabilised at
5.9, lipids got better although LDL is still a little high,
no kidney disease indicators etc. And my other disease went
into remission.

I have friends and relatives who were diagnosed shortly
before me; they follow the same advice your ADA, the UK NHS,
and our DA advise. None of them have got below A1c of 7. In
the worst case, in the space of three years, an uncle in the
UK in his '70s has gone from fit and well to retinopathy,
neuropathy (no longer able to walk), and dialysis.

I suppose that's why I get a little passionate; not diet
wars, but the frustration with the total inability for the
ADA/DA dieticians to accept that new research is starting to
show alternatives to their advice. Advice which I believe is
hurting some of the people who follow it.

Off soapbox.

Amazing - you read this far! Thanks Charly.

Cheers, Alan, T2 d&e, Australia.
--
Everything in Moderation - Except Laughter.