Book Review: Blood Sugar 101

I just finished reading "Blood Sugar 101" by Jenny Ruhl. It's a quick read, and very informative. Ruhl is a diabetic who has taken treatment into her own hands, using the scientific literature and her blood glucose monitor to understand blood sugar control and its relationship to health. The book challenges some commonly held ideas about diabetes, such as the notion that diabetics always deteriorate.

She begins by explaining in detail how blood glucose is controlled by the body. The pancreas releases basal amounts of insulin to make glucose available to tissues between meals. It also releases insulin in response to carbohydrate intake (primarily) in two bursts, phase I and phase II. Phase I is a rapid response that causes tissues to absorb most of the glucose from a meal, and is released in proportion to the amount of carbohydrate in preceding meals. Phase II cleans up what's left.

In a person with a healthy pancreas, insulin secretion will keep blood glucose under about 130 mg/dL even under a heavy carbohydrate load. The implications of this are really interesting. Namely, that blood glucose levels will not be very different between a person who eats little carbohydrate, and one who eats a lot, as long as the latter has a burly pancreas and insulin-sensitive tissues.

Most Americans don't have such good control however, hence the usefulness of low-carbohydrate diets. This begs the question of why we lose blood sugar control. Insulin resistance seems like a good candidate, maybe preceded by leptin resistance. As you may have noticed, I'm starting to think the carbohydrate per se is not the primary insult. It's probably something else about the diet or lifestyle that causes carbohydrate insensitivity. Grain lectins are a good candidate in my opinion, as well as inactivity.

Diabetics can have blood glucose up to 500 mg/dL, that remains elevated long after it would have returned to baseline in a healthy person. Ruhl asserts that elevated blood sugar is toxic, and causes not only diabetic complications but perhaps also cancer and heart disease.

Heart attack incidence is strongly associated with A1C level, which is a rough measure of average blood sugar over the past couple of months. It makes sense, although most of the data she cites is correlative. They might have seen the same relationship if they had compared heart attack risk to fasting insulin level or insulin resistance. It's difficult to nail down blood sugar as the causative agent. More information from animal studies would have been helpful.

Probably the most important thing I took from the book is that the first thing to deteriorate is glucose tolerance, or the ability to pack post-meal glucose into the tissues. It's often a result of insulin resistance, although autoimmune processes seem to be a factor for some people. Doctors often use fasting glucose to diagnose diabetes and pre-diabetes, but typically you are far gone by the time your fasting glucose is elevated!

I like that she advocates a low-carbohydrate diet for diabetics, and lambasts the ADA for its continued support of high-carbohydrate diets.

Overall, a good book. I recommend it!

Scientist Discovers that Only Pills can Control Hypertension

I went to a presentation today by a prominent hypertension researcher. His talk began with a slide that had two pictures side-by-side: one of the late fitness advocate Jim Fixx, and the other of Winston Churchill. Fixx was a marathon runner, while Churchill was inactive, overweight and had a famous appetite. Fixx died of a sudden heart attack at 52, while Churchill lived to 90. The presenter went on to state that this is an example of how genes control CVD risk, implying that despite Fixx's exercise, his genes had condemned him to an early death.

I wanted to jump up and yell "I think you're leaving out the alternate hypothesis: running marathons and eating junk food isn't healthy!" But instead I suffered quietly through what ended up being an inane yet informative presentation.

His lab looks for gene variations that affect blood pressure (BP). There's a huge amount of money and research going into this. His lab and others have come up with two classes of mutations:

• Common allele variants that have an insignificant but measurable effect on blood pressure.
• Rare genetic mutations that have a significant effect on BP. The most common affects 1 in 2,000 people in the US.

Despite truckloads of funding and research, they have yet to uncover any gene or combination of genes that accounts for even a fraction of hypertension in Americans. So what's the next step? Keep looking for genes.

There is certainly a genetic component to hypertension, but it is only expressed in an unhealthy environment.  Hypertension is tightly linked to lifestyle. It's a quintessential aspect of the "disease of civilization". It's highly responsive to carbohydrate restriction, as a number of clinical trials have shown. Remember the Kuna? They don't get hypertension when they live a non-industrial lifestyle (despite eating more salt than the average American), but as soon as they move to the city their hearts explode. It's been demonstrated in a number of other similar cases as well. Genetics are clearly not responsible.

Don't get me wrong, I do think genetics can modify a person's response to a poor lifestyle. But when the lifestyle is healthy, the vast majority of these differences fade away. I have a more thorough discussion of this point here.

If you give just the right dose of poison to a group of animals, 50% will die and 50% will survive (called the EC50 dose). You might then conclude that genetics had determined who lived and died. You wouldn't be wrong, but you'd be missing the point that what killed them was the poison.

The thing that really bothers me about this thinking is it's disempowering. The presenter suggested that the reason for the difference between Fixx and Churchill was their genes. If genes have us in such a tight grip, why bother trying to live well? The only logical solution is to pop hypertension pills and eat cake all day.

My guess is that if they had lived a more natural lifestyle, Fixx would have made it to 90 and Churchill would have been fit and lean.

By Rik Ganderton
President and CEO

So much to say. Firstly, my thanks and thanks from our executive team and the Board of Directors to our nurses, security, physicians and all staff involved in handling a significant incident in our Emergency Department at the Centenary campus on April 16.

We placed the Centenary Emergency Department on redirect status following the incident in which a patient seriously injured himself late that morning. Staff and physicians responded immediately to the situation and in handling the redirection of ambulances and emergency patients like the professionals they are.

OUR RECOVERY CONTINUES
We have been busy in healthcare partner and public consultations concerning our improved new model of mental health care delivery.

Much has been reported in the media. For clarity, please reference the information posted on our web site since March 25.
From the consultations, we have been able to better define issues, such as transportation of patients and families, which we will address during the next five months before our improved model of mental health care is put into place.

It’s important that our patients, families and communities—in addition to all of you—know that this model represents better access to our services by:

• Increasing crisis services from 12 to 16 hours a day, seven days a week at both campuses;
• Maintaining our outpatient services, which serves the majority of mental health patients at both campuses;
• Ensuring access to all mental health services, including emergencies, continues at each campus;
• Pooling expertise for inpatient care.
Our Rouge Valley Ajax and Pickering mental health information page has much more detail on this.

More information is available online at www.rougevalley.ca and at www.centraleastlhin.on.ca.

FUNDING
We have received funding from the provincial government as announced on April 13. That funding is not new and will not change our need to become more effective as we move up to the standards of the best community hospitals in Ontario.
We also remain focused on implementing our Deficit Elimination Plan so that we can effectively reduce our $78 million long-term debt and working capital deficit.

You’ve heard me say it many times in our Town Halls, but it’s worth repeating: we know we can perform with the best hospitals in Ontario—a top quartile performer rather than average, or worse. Rouge Valley is striving to be among the best of Ontario community acute care hospitals in both quality and effectiveness.

Having met many of you during the last year, I know we have the dedicated, high quality staff, physicians and volunteers to achieve this.”

Real Food V: Sauerkraut

Sauerkraut is part of a tradition of fermented foods that reaches far into human prehistory. Fermentation is a means of preserving food while also increasing its nutritional value. It increases digestibility and provides us with beneficial bacteria, especially those that produce lactic acid. Raw sauerkraut is a potent digestive aid, probably the reason it's traditionally eaten with heavy food.

Sauerkraut is produced by a process called ‘anaerobic’ fermentation, meaning ‘without oxygen’. It’s very simple to achieve in practice. You simply submerge the cabbage in a brine of its own juices and allow the naturally present bacteria to break down the sugars it contains. The process of ‘lacto-fermentation’ converts the sugars to lactic acid, making it tart. The combination of salt, anaerobic conditions, and acidity makes it very difficult for anything to survive besides the beneficial bacteria, so contamination is rare. If it does become contaminated, your nose will tell you as soon as you taste it.

Store-bought sauerkraut is far inferior to homemade. It's soggy and sterile. Ask a German: unpasteurized kraut is light, crunchy and tart!

My method is inexpensive and requires no special equipment. I've tested it many times and have never been disappointed.

Materials

• Wide-mouth quart canning jars (cheap at your local grocery store)
• Beer bottles with the labels removed, or small jars that fit inside the canning jars
• Three tablespoons of sea salt (NOT iodized table salt-- it's fatal to our bacteria)
• Five pounds of green cabbage

Recipe

1. Chop cabbage thinly. Ideally the slices should be 2 mm or so wide, but it doesn’t matter very much. You can use a food processor, mandolin or knife.
2. Put all the cabbage together in a large bowl and add the salt. If the salt is not very dense (sometimes finely ground sea salt can be fluffy), you can add up to 5 tablespoons total. Mix it around with your hands. Taste some. It should be good and salty.
3. Let the salted cabbage sit in the bowl for 30 minutes or so. It should be starting to get juicy.
4. Pack the cabbage tightly into the canning jars. Leave 2-3 inches at the top of the jar. When you push on the cabbage in the jar, you should be able to get the brine to rise above the cabbage. Try to get rid of air bubbles.
5. Put water into the beer bottles and place them into the canning jars. The weight of the bottles will keep the cabbage under the brine. It’s okay that some of the brine is exposed to the air; the cabbage itself is protected.
6. Let it sit for 2 weeks at room temperature! As the fermentation proceeds, bubbles will form and this will raise the level of the brine. This is normal. You might get some scum on top of the liquid; just check for this and scrape it off every few days. It won’t affect the final product. If the brine drops to the level of the cabbage, add salt water (1 tsp/cup, non-chlorinated water) to bring it back up.
7. Taste it! It should be tart and slightly crunchy, with a fresh lactic acid flavor. If fully fermented, it will keep in the fridge for a long time.

Here are some photos from making sauerruben, which is like sauerkraut but made with turnips: