Sunday, August 26, 2012

Caffeine, Coffee and Breast Health

Caffeine, Coffee and Breast Health

Lots of people are confused about coffee, caffeine and breast health.

Some wonder whether caffeine causes breast pain?

Others ask if coffee or caffeine increases the risk of breast cancer?

Breast pain, called mastalgia, is a common symptom.
Some gynecologists will advise women who have breast pain to cut out caffeine.
But is there really evidence to support eliminating caffeine if you have breast pain? 
And how about that concern about coffee or caffeine and breast cancer?

Although there might be women for whom eliminating caffeine reduces breast discomfort, the evidence does not support any connection between breast pain and caffeine.

A variety of treatments have been studied and shown to be of benefit for women with breast pain. Of non-prescription approaches, some data suggest that high dose vitamin E may help for cyclic pain but not for chronic continuous symptoms.

How about the cancer concern?
multitude of studies have shown no convincing connection between coffee or caffeine use and breast cancer. That's certainly reassuring.

So please enjoy your coffee or tea each morning while reading that next piece of scary health misinformation in the morning paper.

Your Diabetes Endocrine Nutrition Group

Sunday, August 19, 2012

Curcumin and Life Extension

Curcumin and Life Extension

If you’re not suffering from severe pain or emotional distress, you probably would like to live longer.

And with that desire to live longer there naturally follows that humans will come up with many ways to make money off your desire for life extension.

In fact, there is an organization called Life Extension Foundation (LEF) that has a slick magazine and website. They sell dozens and dozens of pills that make a variety of claims.

Many of the pills they sell have the ingredient curcumin.
Curcumin is a chemical found naturally in the spice turmeric which is commonly used in Indian cooking.
Turmeric comes from the plant Curcuma longa.
Curcumin is thought to have anti-oxidant and anti-inflammatory properties.

Curcuma longa plant (from Wikipedia)

Curcumin chemical structure (Wikipedia)

Life Extension claims that: curcumin has been “found to increase detoxifying enzymes and promote healthy DNA function.  

They state that curcumin is “critical for optimal health” and you need to buy their special curcumin  that is better absorbed than the standard curcumin  supplement.

Wow! Those are amazing claims!
But do studies in humans show benefit from curcumin?
What do the randomized controlled trials in humans show?
Can curcumin extend life in any animal?

As of this date, there are over 5000 papers published on curcumin.

But there are very few trials in animals or humans that show benefit.
Two animal studies, one in the roundworm, one in the fruit fly, have shown life extension with curcumin. But neither of these two studies has been confirmed by other labs.

How about human studies? 

Curcumin is not helpful for cholesterol lowering. 

Two small studies done at the same center in Iran suggest benefit in kidney disease caused by lupus and diabetes.

One short-term small study with curcumin suggested benefit in patients with monoclonal gammopathy of uncertain significance (MGUS). MGUS can lead to multiple myeloma in some patients.

One study with curcumin seemed to show a reduced likelihood of relapse in persons with ulcerative colitis.

One study with curcumin along with quercetin showed benefit in early graft function after cadaveric kidney transplantation.

One study done in Thailand of the Curcuma plant extract seemed to show benefit for knee pain from osteoarthritis.

Although it has been thought that curcumin is poorly absorbed, curcumin is rapidly metabolized by the liver after absorption from the intestinal tract.

So curcumin shows promise. But a lot more work needs to be done on the value of curcumin if it is recommended as a supplement.

At this time, I’m not taking curcumin as a supplement. But I sure do enjoy my Indian cuisine.

And for the time being,  I will try to keep my weight down and my exercise up.
Sure that's a lot harder than taking a couple of pills. 
But weight control and exercise are two proven methods for life extension.

Saturday, August 11, 2012

Artificial Sweetener Risks

Artificial Sweetener Risks

How bad are artificial sweeteners?

Artificial sweeteners are more accurately called nonnutritive sweeteners.
Another name is non-caloric sweeteners.

A detailed scientific statement was published this month on nonnutritive sweeteners. The authors represented the American Heart Association and the American Diabetes Association.

So, are artificial sweeteners really bad for you?

Nonnutritive sweeteners are safe and may help reduce overall calorie intake.
Nonnutritive sweeteners do not increase blood glucose unlike sugars.
Nonnutritive sweeteners provide no or far fewer calories as compared to sucrose, corn syrup, agave or fruit juice concentrates.

There are 6 nonnutritive sweeteners that are approved by the U.S. FDA:

·      Acesulfame-K  with the brand name of Sweet One
·      Aspartame with brand names Equal or NutraSweet
·      Neotame with the brand name Neotame
·      Saccharin with the brand name Sweet’N Low
·      Sucralose with the brand name Splenda
·      Stevia (stevia glucosides) with brand names Truvia, PureVia and SweetLeaf

Some people fear nonnutritive sweeteners.

Here’s a reminder for those who have not taken a course in chemistry:
            all of these nonnutritive sweeteners are chemicals!

And your body is all chemicals too.
Without chemicals, life would not be possible.
Glucose and water are chemicals.
Cholesterol is a chemical. Hormones are chemicals.
Sodium chloride is a chemical. That’s table salt.

Ethanol is a chemical that’s in all alcoholic beverages. And because of U.S. government mandate, in the fuel for our autos.
Ethanol is known to mess up brain function causing a condition called “drunk”.
And ethanol causes liver and pancreas damage.
Too much ethanol can kill you quickly or, over time, too much ethanol can destroy your liver.

And too much water in the bloodstream can cause a life threatening condition called hyponatremia.

For those with diabetes, over time too much glucose in the blood causes damage to eyes, kidneys and nerves.

Okay enough about chemicals and about striking the right balance.

But nonnutritive sweeteners are artificial not natural. Right?
Come on, is natural the same as harmless or safe?
See my post on that simpleminded notion. 
And what does "natural" mean anyway? 
Strychnine and snake venom and poisonous mushrooms are not artificial.

As we all think about what is best for our body, we need to keep an open mind.

Everything has some risk associated with it.
There’s a good book called How Risky Is It, Really? 
This book deals with how and why we judge and often misjudge risk. 
See the author's website and take his risk quiz.

Our goal should be to learn enough to rationally balance all risks as we try to stay healthy.

Which nonnutritive sweetener do you use?

Sunday, August 5, 2012

Low blood sugar: treat it!

Low blood sugar: treat it!

Low blood sugar should be treated with or without symptoms.
Many people just don’t know this simple fact.

We routinely have those patients on insulin test their sugar when they come in for an office visit. It’s amazing how many have a low blood sugar with almost no symptoms.  A sugar below 70 milligram per deciliter (mg/dl) is considered low and a level that low is called hypoglycemia. Now to be clear, I am referring only to persons with diabetes in this post.

Too often patients decline treatment and say “but I feel fine!”
And some come in with their logbook showing repeated glucoses in the 60’s.
And they did nothing about that for weeks!
They wait to let me know until that office visit!

The brain needs glucose to function. The lower the glucose goes, the more likely there will be problems with brain function. With hypoglycemia, some people get angry, irritable or short tempered.
With hypoglycemia, others think more slowly or have changes in vision.

Sweating is a very common symptom of hypoglycemia. With a very low blood glucose, a person can pass out (lose consciousness) or have a seizure.
The level of glucose at which loss of consciousness or a seizure occurs varies but probably needs to be below about 35 mg/dl.

The more frequently someone gets hypoglycemia the fewer the typical symptoms of hypoglycemia they will feel. The typical symptoms are shakiness, heart beating fast, weakness and hunger.

When the glucose is repeatedly low, a person may not feel much at all. This is called hypoglycemia unawareness.

Because of hypoglycemia unawarenenss, we routinely test for hypoglycemia in our office in those people taking insulin.
The main concern with insulin therapy is the increased risk of hypoglycemia.
Those with hypoglycemia unawareness, usually have slower brain function when their glucose is low. But very often, they just don’t know that their brain is working slower.

Our brain adapts to low or high glucoses so we seem to function fairly well if our glucoses have often been low. And on the other hand, those who often have high glucose, hyperglycemia, may  not feel quite right when their sugar is normal.

By avoiding hypoglycemia, the person with hypoglycemia unawareness can regain awareness of hypoglycemia and start to feel symptoms again. That’s good.

It’s bad to not feel when your glucose is low.
We want our brains to work as well as possible. I do, and I assume you do too.

Of course, preventing hypoglycemia is the best approach. And smart insulin treatment as described in a previous post is the key to prevention of hypoglycemia. Here are some specifics on treatment.

And patients and doctors need to understand how to interpret results from blood glucose testing. Continuous glucose monitor systems such as the Dexcom system are a major advance in our goals to minimize hypoglycemia.

Two key points to keep in mind about blood glucose testing.
Expired blood glucose test strips can give goofy, unreliable readings.  So expired strips should not be used.

Also a blood glucose meter that is really cold or hot may give false readings.
I’ve seen that before with someone who left their meter in a cold car and had a glucose reading of 25 with no symptoms. And his Mom said he looked and acted just fine.
You would not be fine if your glucose is really 25. When the meter came to room temperature, his glucose tested 132.

Most meters usually are not accurate below a temperature of 40 F or above about 110 F.

But in the usual setting, a glucose below 70 mg/dl should be treated and not ignored. 
As we strive to get our diabetes under good control, we need to minimize hypoglycemia. And when we detect hypoglycemia, we should promptly treat it.