I have osteoarthritis, and my huband has just been diagnosed with diabetes
(type II, I guess--no insulin).

I've been trying to read up on these two conditions, and what really
surprises me is how few experiments have been done and how little is known.
Losing weight appears to be imperative for diabetes and advisable for
arthritis (at least, for -women- with arthritis), but, of course, the very
conditions that make weight loss advisable are part of the reason for the
weight gain.

For myself, I'm almost afraid to lose weight, because no matter how gentle
and sensible a diet I use (the last one was 1800-2000 calories, in about
eight small meals), the weight won't go off gradually and stay off.
Instead, it drops off precipitously, and then comes back on with much
interest, like bread on the waters.

With this experience, it's hard to be encouraging to my husband.  All I can
suggest is to make it as gradual as possible.

Meanwhile, some experts recommend no sugar, others, no fat, others, just a
balanced diet.  It's almost impossible to tell from their writings -which-
parts of their recommendations are supposed to help the condition, and
which are merely ideas the expert thinks are nifty.

Is it my imagination, or are these very old conditions very poorly
understood?  Is it just that I'm used to pediatrician-talk ("It's strep;
give him this and he'll get well.") and so my expectations are too high?

Bonita Kale

Feeling better, I am

J. Bronstein

From:          "Jonathan Block" <DEAN-2/JBLOCK>
Date:          20 Apr 93 16:10:01 EST
Subject:       National Organ and Tissue Donor Awareness Week 4/18-4/24

To all users;

The week of April 18th through the 24th is National Organ and Tissue
Donor Awareness Week.  This is a very good time for you to consider
becoming a donor if you are not already one.  It is a very important
issue for many reasons.  Just a few are;

1) approx. 30,000 people are on the national waiting list to receive
organs, and there are only 300,000 registered donors (not all will
qualify)

2) signing the backs of drivers licenses is not always adequate
because the licenses can be separated from you in accidents when
people need to know you are donor.

3) YOU might need a transplant someday.

If you are interested in more information about donation, or if you
would like to register to become a donor, you may contact The Living
Bank directly at:

                        The Living Bank
                        P.O. Box 6725
                        Houston, Texas  77265-6725
                        1-800-528-2971 (24 hrs.)

The Living Bank is the only total body organ and tissue donor
registry in the nation, and it works closely with the United Network
for Organ Sharing (UNOS) in Washington, D.C. maintaining its list of
donors.  The Living Bank is non-profit and exists totally off of
donations from private contributors.  Many famous people and doctors
have supported their work.  As a member of the League of Local Living
Bankers, I act in the capacity to represent the Living Bank as
needed.

If you have any questions, want any information or register to be a
donor without contacting The Living Bank directly, you can reply via
email and I supply what will be needed.

Thank you very much for considering becoming a donor.

Sincerely,

Jonathan D. Block

League of Local Living Bankers
for The Living Bank

Losing weight is supposed to help osteoarthritis by lessening the physical
wear and tear on the joints. It's suprising that you can lose weight
easily. Not very common. Why are you having trouble keeping it off? It's
true that it's not such a good idea to run around and do lots of physical
exercise with osteoarthritis. But cutting out dietary fats and
non-stressful exercise might help (like warm water swimming).

About the type II diabetes. I looked up a bunch of articles about this when
a friend of mine was diagnosed (it runs in my family too). It seems that
the best tactic is to try to lose weight because then often the diabetes
subsides. Exercise seems to help directly too. A person needs to learn how
to measure their own {*filter*} sugar levels and become conscious of what it
feels like to have high and low {*filter*} sugar. It's also important to go onto
medication when and if it becomes necessary. One of our family friends
refuses to do so. He's running {*filter*} sugars of 300 and that is
catastrophic. Can't reason with him. He's having trouble with vision,
circulation, and who knows what else.  

Some tricks...eat slow digesting carbohydrates, like rice and pasta rather
than quick digesting bread, muffins, and cakes. Eat vegetables and fruits
whole insted of consuming juices.

Cut fats now while you can still tolerate carbohydrates. Cheese is a killer,
also butter, margarine, and fatty meats. It's easy to eat lots of fat when
you are consuming store-bought foods. People will eat potato chips,
cookies, chocolate when what their body really wants is only the
carbohydrates in the food. So while the body is trying to pick up a hundred
or so calories of carbohydrate it takes on perhaps 500 calories of fat it
didn't need. That's a quarter pound of adipose tissue.  

Get exercise now while the body can tolerate minor stress. My dad can get his
{*filter*} sugar down to normal simply with exercise. But he really has to work
at it on a daily basis. (He's not very good at dieting and is seriously
overweight.)  

Sometimes I think diabetes is the disease of people who were built for
harsh conditions. It's commmonest among peoples who ate widely varied
natural diets, not rich in fats or even particularly in carbohydrates.  
High fiber diets. And people who worked at living. Hunter gatherer and
other non-sendentary sorts. (Farming actually caused a lower quality diet
for most people than hunting/gathering.)  

There are excellent classes about diabetes given where you can
learn all the latest information. Also, much cheaper than learning it from
visits with your doctor. They are usually run under a hospital's or
clinic's auspices.

Sometimes, some doctors don't educate their patients as well as they might
because they feel that their patients just aren't willing to be bothered.

Diagbetes is very ageing. It can cause blindness, arteriosclerosis, loss of
limbs, loss of {*filter*} capacity, and nerve damage. And I think it affects
the mind. I can tell when my dad or friend has high {*filter*} sugar, they
aren't as rational as otherwise. And low {*filter*} sugar (from the rebound
effects or carelessness about food) makes people mighty irritable.

-Jackie (Who is not a doctor ;)

-

Glad you are better!

Steve Holland

Type II diabetes is caused by too many fat cells that have become filled
with triglyceride(insulin-resistent).  There are endocrine causes of
obesity but these are rare and from your comments, your husband has been
worked up medically and found to have Type II diabetes which is the major
complication of obesity.  While osteoarthritis is not caused by obseity, it
is certainly exasporated by obesity.

The body has two major insulin-sensitive tissues(adipose tissue and muscle
tissue).  Carboydrate from your meals should go primarily into liver and
muscle glycogen when you eat(not adipose tissue).  Liver will contain about
20% of the total body glycogen(350 Calories) and this is used to get you
from meal to meal.  Muscle will contain about 1400 Calories of glucose as
glycogen but this energy is not used if you do not execise the muscles in
your body.  Consuming high glycemic foods and leading a sedentary
lifestyle is the best way to build up adipose tissue and once enough fat
gets stored(the average person should only have about 160,000 Calories
stored as fat, but most obese patients have 2 to 4 times this amount stored
in their adipose tissue), the fat cells try to cut down on their fat
storage by downregulation of the insulin-receptor(insulin resistence with high
{*filter*} glucose levels).  If you can get your muscles to use their glucose
between meals, most of your dietary glucose will go into the muscle and not
the adipose tissue.  Exercising also helps your body burn some of the fat
it has stored.  Calorie restriction by itself(dieting) results in more
muscle protein loss than adipose tissue fat loss.  Using the muscles helps
protect them from protein loss during dieting.

I posted the Glycemic Index table in Sci. Med. Nutrition and if you want a
copy of the table I'll e-mail it to you.  Processed carbohyrates have a
high glycemic index and this makes glucose control in Type II diabetes
difficult and it also makes weight contol difficult(glucose peaks fast and
then drops fast).  You want to eat foods that provide a slow glucose
absorption from the gut.  American Indians have a real problem with Type II
diabetes.  We have an AHEC program at our College that is working with the
Creek and Cherokee Indians in Oklahoma to educate them on ways to decrease
their high incidence of Type II diabetes.  This involves regular exercise,
eliminating refined carbs from the diet and chromium supplementation.

I'm going to summarize the dietary factors that are factors in Type II
diabetes.

        1. Need a high fiber, high complex carbohydrate diet(low Glycemic
           Index).
        2. Need to keep fat intake to 30% or less of total Calories.
        3. Need to exercise muscles regularly to deplete their glycogen
           reserves.
        4. Need to take chromium supplements to improve glucose tolerance
           (10 grams of yeast per day).
        5. Need to increase your intake of vitamin C(1-3 grams per day)
        6. Need to increase your intake of B6(10-15mg per day).
        7. Need to make sure that you are not magnesium or zinc deficient
           since these two minerals are often found to be low in patients
           with Type II diabetes.  

The best test for magnesium is a magnesium challenge test (0.2meq of Mg/kg
body weight given IV over a 4 hour period with a 24 hour urine).
Med. J Clin. Nutr. 20:632-35(1967).

Another good test that is much easier to run is the Leukocyte magnesium
level. Surgery 5:510-16(1982).  Magnesium is stored in bone(50% of the
total body magnesium) so you can't measure the magnesium reserve directly.
But white {*filter*} cells have a high magnesium requirement and their magnesium
content will start to drop well before the serum level of magnesium drops.

The best test for zinc status is the zinc tolerance test.  This involves an
{*filter*}challenge of 220mg zinc sulfate(50 mg of elemental zinc) with before
and after plasma zinc determinations.  A two to three fold increase in
plasma zinc is diagnostic for a zinc deficiency. J. Lab. Clin. Med. 93(3):
485-92(1979).  Zinc absorption from the gut is regulated(by
metallothionein) just like iron absorption is regulated.  Good iron or
zinc status, little iron or zinc absorption from the gut.

The Leukocyte zinc assay is easier to run but not as accurate as the zinc
challenge test. Clin. Sci. 60:237-39(1981).

RBC zinc is very easy to do and some clinical labs will run it but it is
the least reliable of the three zinc tests(but it's still better than
plasma or serum zinc levels).  J. Am Coll Nutr. 4(6):591-8(1985).

Weinsier and Morgan in their new Clinical Nutrition textbook suggest using
zinc without testing for nutrient status to see if symptoms respond(low
{*filter*} count, a lack of taste acuity and white spots in the fingernails).  
The role of zinc in Type II diabetes is much more complex and a therapeutic
effect would not be that easy to see.  I don't like recommending supplements
unless a demonstrated need can be shown for their use.  Not all Type II
diabetes patients have a low magnesium or zinc reserve.  Just about every
Type II diabetic has a low chromium status and chromium supplementation is
the single best treatment(lower {*filter*} glucose) aside from using exogenous
insulin.  While magnesium and zinc can display some toxicity, chromium is
the least toxic of the minerals.

Martin Banschbach, Ph.D.

As I read it, the standard diabetic diet was changed from low
carbohydrate to low fat in the 1980's because of concerns about
cholesterol.  Since then a number of papers have appeared
showing a low carbo diet is better than real world low fat diets
for controlling insulin resistance.  And recently research has
been reported indicating that low fat diets aren't all that
great at reducing cholesterol.

I know I'll be flamed for this, but I suggest you get a copy of
Dr. Atkins' 1992 low carbo diet book, read it carefully, and
discuss it with your endocrinologist.

--
Chuck Forsberg WA7KGX          ...!tektronix!reed!omen!caf
Author of YMODEM, ZMODEM, Professional-YAM, ZCOMM, and DSZ
  Omen Technology Inc    "The High Reliability Software"
17505-V NW Sauvie IS RD   Portland OR 97231   503-621-3406

The most healthy diet for Type II diabetics and all other Americans is a
low fat, high carb diet.  But the key is that the carbs used have to have a
low glycemic index and you need plenty of fiber in your food.  We have
refined most of the fiber and nutrients out of our grains.  Thats the
problem.  Sure, going on a high fat diet will help you control your {*filter*}
glucose levels if you have Type II diabetes but so will a complex carb, high
fiber diet.  If you couple this with exercise, you can make real progress
in getting the fat off and improving the insulin response of fat cells.
If you work your muscles between meals, you stand a good chance of getting
a good portion of the dietary carbohydrate into muscle(especially if you
don't push the glucose level in {*filter*} up to high too fast).  Where do you
think the fat is headed Chuck?  Yes, muscle will burn some of it after your
meal but most of it goes into adipose tissue.  If a Type II diabetic knew
what they were doing, they could get most of their dietary glucose into
muscle and not adipose tissue.

The new product for endurance atheletes uses medium chain triglycerides(
with can not be stored in adipose tissue) to provide the muscle with fatty
acids when they normally would not be present in the {*filter*} and this spares
a lot of muscle glycogen for the finish of the endurance event.  If our
Mother {*filter*} feed us when we were infants, we started life on a diet that
was 51% fat calories, 42% carb calories and 7% protein calories.  Now if Dr
Atkins can give me this kind of high fat diet, I'll take it(but he can't
because the human {*filter*} tissue synthesizes only medium chain fatty acids
and human milk has only medium chain triglycerides).  There is no other
normal dietary source of medium chain triglycerides.  If there were, it
would be great for Type II diabetes(ever wonder why formula feed babies
tend to be fatter than {*filter*} feed babies?).

Marty B.

I'm quite interesting in MCT oil myself, especially since I've been using
it daily for 6 months now.  I read about it and decided to try it in my
daily diet.  It's been used by bodybuilders for about 5 years or more.
The best stuff is call CAP-TRI.  I usually pour two tablespoons of MCT
oil on my broccoli or just take it straight.  It shouldn't be used for
frying, but can be used in low temperature cooking.  MCT oil is available
in pharmacies or in bodybuilding shops.  Even some healthfood stores carry
it.

I must say I like using MCT oil, it has all the characteristics of regular
oil in terms of calories, taste, and "satiety" factor.  It lets me keep
my intake of regular fats way down.  I only really use flax oil, macadamia
nut oil, pumkin seed oil or walnut oil anyway.

I have no plans at this stage to make MCT oil a permanent addition to my
diet, for I do not know what long term consumption effects there might
be (one supplier claims there are none -- John Parrillo), but I do plan
on continuing to use it during my weight loss phase since I see nothing
but positive results.

Now, where can I find tagatose, and does it have the same effect on insulin
as other sugars?

An aside:  Marty, what do you think of Atkin's "fat fast"?  A short,
less than 5 day fast of 1000 calories/day spread out over 5 small
meals, of which 90% is from fat.  E.G. 5 1 ounce servings of macadamia
nuts (90% fat by calorie).  He claims it is more effective than a pure
fast (no food) at reducing body fat while minimizing the loss of muscle
tissue.

What are the supplements that one should concentrate on during a very low
carb diet?  The electrolytes - particularly potassium, magnesium (as citrate),
B complex, folic acid, minerals... but not excessive calcium or C?

Tom