The Gastric Bypass Hype... Is It Really a Cure?

The headline declares: "Curing diabetes via surgery, without weight loss". It's a bold statement. It's enough to make one stop, and read. I admit I did just that.

Every week, it seems, we are bombarded with a new article declaring the magical, curative qualities of gastric bypass surgery. These articles make it seem like gastric bypass is the simplest, most sensible way of managing diabetes -- and gosh darn it -- everyone ought to pursue it so we can put a stop to this overwhelming epidemic that's going to just take over America, and murder us all. (Please note I am being sarcastic here.)

I admit I don't have all the answers -- if I did, I'd have long ago found a cure for all of us, and retired to my white castle atop a hill, facing the ocean. But what I can tell you is that I have a lot of questions and skepticism. And so should you.

Whenever there are articles like this, I look for red flags:

• Is the article edited properly? It might seem like a simple thing, but honestly, if someone in a professional, journalistic setting, doesn't care enough to edit their articles for grammar, spelling, content, and accuracy, they certainly might not care about outright lying to you to get some readership.
• Is the article unusually chipper or eager to present this as an 'all around' solution to a problem? Does it present ALL sides of the debate? Does it present ALL alternatives?
• Does the article portray accurate medical conclusions, information, and accurate explanations, or does it confuse the public about its target audience? 
• Does the article present accurate, statistical data, as has been reported by other research outlets, and scientific journals? 
• Is the study funded by third parties with deep pockets, and deep interests in the outcome of said study?

Taking all these questions into account, let's look at this week's gastric bypass article (which I have linked to above.)

Red Flag #1

The article starts off by telling us about Cristina Iaboni (a woman who was selected as a test subject for gastric bypass in leaner patients), and offers this description of her situation:

"Cristina Iaboni had the dubious distinction of being not quite obese enough. For all the pounds on her 5'5" frame, she did not meet the criteria for bariatric surgery to help control her type-2 diabetes.  

Yet six years of medications and attempts at healthy living had failed to rein in her blood glucose, leaving Iaboni terrified that she was on course to have her kidneys fail "and my feet cut off" -- common consequences of uncontrolled diabetes." 

Right off the bat, I'm kind of concerned about the quality of medical care Mrs. Iaboni may have received. Did her medical team question everything that needed to be questioned? Was she on insulin? When I read "6 years of medications," it literally screams at me that they kept her on every oral medication combination out there, and did NOT put her on insulin, like they should have. What kind of 'healthy living' changes did she attempt to make? Was she she still consuming a high carbohydrate diet, and just substituted her carbs for wheat, and whole grains? Did she even know how to carb count? Did her doctor ever test her for antibodies, and is she a LADA, instead? While the article declares she's 'cured,' I have the strong feeling this woman might rebound down the road.

Red Flag #2


Follow this logic statement with me: "If smoking triggers lung cancer, than smoking cessation should cure cancer."

Oh, it doesn't work that way, you say? Once you have it, you're stuck with it? Oh. Then why do some media and some 'researchers' assume that if obesity triggers diabetes (in those who are genetically predisposed, mind you), that losing weight should cure the diabetes?

The simple answer is "I don't know." The complex answer is "Because they probably have something to sell you."

Certainly, one can assume smoking cessation helps better manage cancer -- I am sure. One will be healthier, and respond better to treatments, and will have a stronger immune system... But one cannot say one is suddenly cured of the cancer. (Even when one is in remission.) Diabetes and weight loss are much the same: weight loss merely makes one healthier, and be able to respond better to treatments (ie, be more insulin sensitive, use less insulin and medications, sometimes none, etc.) These are only ways of tightly controlling diabetes, though, and slowing down it's progression. The absence of medicine is NOT an absence of illness. In this case, it is the strict diabetic patient's regimen that is the patient's medicine. The pancreas has damage, and this damage is irreversible, thus far. It is not, suddenly, magically healed.

Interestingly, this article seems ready to admit (though hesitantly so) that gastric bypass -- since people seemed to be 'magically' better just days after surgery -- proves that a diabetic 'cure' is NOT about weight control, or weight loss. However, here is where the red flag comes in: they are NOT willing to admit that the extreme dietary restrictions a patient must submit to (caloric and, consequently, carbohydrate level restrictions), post op, will play a role and immediately make less glucose available to the patient, and therefore, less high blood glucose issues. Now, normally, a patient who chose to control diabetes with diet and exercise would take a bit longer to achieve euglycemia (or normal blood glucose levels) when consuming a diet lower in carbohydrates and eating 'normal' amounts of food -- but they don't get a head start. A pre-op gastric bypass patient has to be on a type of fast with limited food and liquid intake, so they're already starting out with less available glucose in their system for a couple of days. Yes, they are going to have great numbers in just a few days. Barring other variables, yes, it's that simple, sometimes. I don't think this is rocket science.

Quite frankly, a patient could just go on the restricted diet, and skip the surgery, and achieve similar results... And not that long ago, some of these 'researchers' were practically claiming this same argument: A 'very low calorie diet' could cure type 2 diabetes. 


This article though, quickly sidesteps the discussion and dismisses it without much more than an acknowledgement.


Red Flag #3


The idea that type 2 diabetes begins in the gut is not a new one. It has been, however, a seldom reported one.

More commonly, you see articles speculatively linking the bacteria most known for leading to peptic ulcers (h. pylori), to endocrine disorders (as well as diabetes), and these have been quietly making the rounds since at least 2009, maybe even earlier. There's even an interesting study dating back to 1999, and involving children with type 1 diabetes, insulin requirements, and the presence of h. pylori. The most recent finding came this month, and it involves h. pylori and it's impact on A1C.

The underlying message is clear: bacteria, and inflammation, alter the body's ability to process glucose -- whether in the stomach, or in the gut.

But are the researchers missing the obvious clues? They mention that 'in the past,' patients with peptic ulcers who had surgeries altering their stomachs, and gut connection, 'cured' their diabetes. Or did they just achieve better control of their diabetes because a.) they were now having to, forcefully, eat far less, and b.) the surgery removed chronic inflammation from bacterial infection (which would have dramatically raised blood glucose levels)?

Other articles, and research, have pointed to a bacterial imbalance in the gut as a trigger to an imbalance in processing glucose, and development of type 2 diabetes, but they do NOT suggest surgery for 'curing' the disease. In fact, they suggest a more preventative method -- receiving gut microbiota transplantation. This seems to me like the less invasive, less dangerous, less costly and time consuming, way to go when it comes to researching a cure. Why are we not investing in this? Why is there such a PUSH for getting this dangerous surgery?

The attempts to also connect this surgery to a potential 'cure' or reversal of type 1 diabetes seem a bit far fetched, and improbable to me, and make me question if this researcher has a proper understanding of the etiology of type 1(a) diabetes -- and that it isn't just an insulin insufficiency scenario. I'm pretty sure people need insulin to live, and for many various metabolic functions, and just 'bypassing' a gut mechanism isn't going to make a person insulin independent. I'd like to see more than just three sentences in a poorly edited FOX news article, on the matter.

Red Flag #4


Numbers.

These articles always seem to exaggerate diabetes incidence numbers. This one is no exception. It claims that 8.3% of the world's population has diabetes, and that 11.3% of Americans, have it. Honestly, I don't know where the 11.3% figure came from, with these folks -- but according to the most recent data (released January 26, 2011 -- and not the 2010 date these folks claim) released by the American Diabetes Association, only 8.3% of Americans have diabetes -- and this includes all types, and the undiagnosed. 


Similarly, these folks make these grandiose claims for the 'remission' rates of Roux-en-Y to be 80-85%, and to be incredibly superior to other forms of gastric surgery. But major studies DON'T show that.

"New research reports that no procedure for weight loss surgery is any better at treating diabetes than another. The study, presented May 7 at the International Congress of Endocrinology/European Congress of Endocrinology in Florence, Italy, uses a large ongoing study to show that improvements to diabetes in patients undergoing such surgery is likely to be due to the degree of weight loss itself rather than the type of procedure." (http://www.sciencedaily.com/releases/2012/05/120507102225.htm)

And here's a more startling fact...

"Weight loss surgery is not a cure for type 2 diabetes, but it can improve blood sugar control, according to a new study published in the British Journal of Surgery. Whereas some previous studies have claimed that up to 80 per cent of diabetes patients have been cured following gastric bypass surgery, researchers at Imperial College London found that only 41 per cent of patients achieve remission using more stringent criteria." [emphasis added by me] (http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_4-1-2012-13-32-26)

And that's the ticket here, isn't it? What kind of criteria are these folks using to claim someone is cured? What are their A1Cs, now, and what are their average blood glucose numbers like? I've had folks tell me "I have an A1C in the 6.5% range, so I no longer have diabetes." But wait a minute? That's the number used to diagnosed diabetes to begin with! 

Hey, but you no longer need medicine (for now, anyway), so you must be cured, right? It sounds so pretty... It sounds like such a good sell.

And because it sounds like such a good sell... I give you:

Red Flag #5

"The cost of the bypass surgery is covered by a grant from Covidien Plc, which makes laparoscopic instruments and surgical staplers." 

Oh, so let me see... the people who profit the most from this surgery are the ones funding a study to tell me how awesome this surgery is, how high a success rate it has (even though it is absolutely not supported by independent studies), and how I will just be so cured.

Hmmmmmmmm. Let me think about that. Fox guarding the hen house much? This reminds me of last year, when the ADA published a study done by the Australian Dairy Association, claiming that milk consumption lowered risk of diabetes.

Of course you're going to tell me it's awesome! You want me to buy more of it, and you want me to fall in love with it. You need to make money, too, like everyone else! It's MARKETING.

The problem comes when the money making interests muddle the big picture, and really go against the best interests of the INFORMED patient.

What am I trying to get at, with this blog post? 


Should you avoid gastric bypass? Is it a dangerous alternative?

These are questions you must weigh for yourself... but what I would like to see is for patients to be able to weigh the TRUTH against the hype. NO ONE should promise that surgery will be a success, that it will heal and cure diabetes, or that it will be complication free; but, instead, they must help guide the patient to a point where they can soberly weigh their current health risks against the surgery's very real risks and potential failures. It is easier to accept the roll of the dice when we know that risks are possibilities -- and when we aren't lead to believe that this is just a simple, routine procedure, that will fix our woes forever.

More importantly -- the type of lifestyle changes required by these surgeries are far more demanding than say, pursuing a low carbohydrate regimen (like Berstein's Diabetes Solution, or Atkins), or even raw dieting. If a patient fails at these, or simpler life style changes -- when their life is not at stake -- what makes them feel they could do okay with the dietary demands of such a surgery? Because they got 'two weeks' of psychological counseling pre-op? Disordered eating, and compulsion, take years of counseling to improve (much more to 'fix')!

Additionally, studies have shown that after some time, people's diabetic symptoms may return, and some folks even regain weight and end up pursuing additional gastric surgeries. I am not entirely sure that the costs of surgery, with it's attendant complications, are worth my getting a 'free pass' for a few more years; especially, when I can just give myself that free pass with a more calorie restricted, low carbohydrate diet.

And I don't know about you... but I just like eating food in portions larger than a peanut.

The Moldy Cupcake Awards

Copyright © 2010 Julie King 
/ Gleeful Things. All Rights Reserved.

Today, I'd like to add a fun, new, regular segment to our blog called "The Moldy Cupcake Awards."

Ya' know... It's just so inspiring to read or watch the news, every week, and see ALL manner of misinformation, quacks, outright lies and drivel, just regularly being fed to the public for the sake of ratings. So, because you've inspired us, ALL of you who are the most deserving for writing, or producing, the shittiest materials out there for the public, will get a wonderful mention here... along with a not so sweet, and oh, so moldy critique.

You've worked HARD (not!) for it, so you're gonna get it! Today's deserving green, stale, sad, and moldy cupcake goes to... The View!

That's right. Earlier this week, the View produced this GEM for it's regular audiences.

 
Let's take a moment to examine this, not so educational moment, play by play. 
Right off the bat, I am immediately annoyed because for all her education, Barbara Walters CANNOT pronounce diabetes correctly. I'm sorry Barbara, it would seem you've spent your free days watching too many Wilford Brimley commercials.
If that doesn't annoy you, then the big letters headlining "The Fat Show," in the background, should. Oh, sure, Barbara, you aren't fat. Let's see your saggy behind in a bikini. I double dare you.  
She goes on ahead, and introduces this man, David Nathan, as the Director of the Diabetes Center at the Massachusetts General Hospital. It should SCARE the beejesus out of you that someone with such a title (and employed at a hospital, mind you) would get on such a show, and FAIL to grasp the opportunity: 

"So I think everyone recognizes that diabetes is a condition where your blood sugar is elevated. We all KNOW that. What many people don't understand is that when your blood sugar remains elevated over many years, blah, blah, blah... feet falling off... blindness... blah, blah..." (Okay, that's not entirely, a literal quote.) 

Dr. Nathan, for someone who calls himself a doctor you are surely very disconnected from reality.

1. NO, people do NOT know what diabetes is about. You could've spent a minute or two, telling people that our condition is a condition in which the body FAILS to be able to process glucose adequately, and that ALL food gets converted into glucose. NO, people do NOT know the difference between sugar, and blood glucose. People think if we just stop having Paula Deen lady donut burgers, and ho-hos, that blood sugar goes down, and diabetes goes away.

This is the kind of situation that gets people bullied by idiotic people thinking they can take on the role of diabetic police.

2. Meanwhile, everyone DOES know the serious complications diabetes may bring, so since they associate them with eating too much sugar, they are ALWAYS making jokes about our feet falling off, and us going blind. You could've clarified a little better that well controlled diabetes is the main cause of NOTHING... But you really missed the boat on this one. Thanks for letting the bullying cycle persist.

Now, I don't really understand why The View would have Paula Deen as some kind of 'interviewer' for this segment, asking things she really doesn't understand because she's just too new, and uneducated -- but it matters not, because this Dr. Nathan fails to answer her questions directly. She asks him what the connection is between obesity and diabetes, and he doesn't really say... He just muddles the picture by starting to talk about other majorly recognized risk factors, and how now, younger folks are getting diagnosed because of weight. Okay? So tell us something we DON'T know. Why not tell people "gee, the more you are overweight, the more your body will struggle to produce insulin -- and if you are genetically predisposed to insulin resistance, and diabetes, the more it will likely trigger your developing the condition at an earlier age..." Is it that difficult to speak to people with truth and honesty, and clarity? Do we think The View's audience are a bunch of simpleton housewives, who only know about dish soap? I wonder...

Oh, and I love how you describe Type 1 as "the insulin dependent, juvenile form... the Mary Tyler Moore form..." That's metaphor, right there!! A definitive moldy cupcake award for dialogue. Here's a TALL idea, for you: how about calling it the "my autoimmune system sucks, so it attacked itself" form. People will have this FOREVER, and can get it at ANY age. They don't grow out of it, and gosh darn it, MANY adults, every year, get it... WAY past their 'juvenile' years. Oh, and to add to it, you make it sound like type 2s don't need insulin, when in fact, if a type 2 diabetic is diagnosed early enough in their lifetime, they will more than likely need insulin before they die. MOST type 2 diabetics will go on to need insulin. It's a fact. Hell, it's an American Diabetes Association researched fact -- even when they're trying to act like it's not. 

One thing is pretty juvenile, though -- your casual approach to discussing diabetes. You nailed that one right on the head.

Now, dear Paula Deen tries so hard to stay relevant in this discussion. Paula, honey, NO ONE is born with type 1 diabetes. And I think an awful lot of parents out there would kind of take offense to your portraying their children as like 'having leukemia.' I say this, because while type 1 diabetes can be deadly and challenging, we all know you weren't trying to suggest they were 'troopers, fighters, survivors, and well adjusted kids...' No, you were trying to suggest they were sickly, weak, and likely to die from sneezing. Paula, I support your journey with diabetes, but sometimes... you gotta shut your lady burger pie hole. Okay? We should not comment on things we know not about.

I am not completely angry at the intense stupidity of this segment (okay, I lied...); I'm actually happy for your patient, Misty. I'm happy she's doing better, and is healthier.

What I'm not happy about is that Misty doesn't seem to understand what a diabetic diet is all about. She keeps talking about sugary drinks, sodas, juices. She doesn't talk AT ALL about controlling her carbohydrate intake, carefully weighing out her meals and portion control, in any way. In fact, NO ONE ever mentions carbohydrates and their role in any way -- and continuously focus on sugar!

Dr. Nathan, this is the BIGGEST disservice you can do for people -- letting them go on believing that diabetes is about sugar. IT IS NOT. Diabetes is NOT about juice boxes, soda, cookies, etc. It takes a hell of a lot more effort to control diabetes than to just cut out soda and juice boxes. In fact, I am so scared of Misty's apparent lack of knowledge of what it all entails, that I truly wonder what her A1C is, and what you justified to yourself was "excellent control" to make it seem she needed to get off the Metformin. I guarantee it's not in the 5.0-6.0 percent rating. It can't be. Not with her thinking it's just sugar. She probably goes home and has a plate full of wheat pasta, and calls it good.

"That's the beauty of type 2 diabetes... is that it is reversible." 

Diabetes is not reversible. Whenever folks discuss diabetes as 'reversible,' what they are referring to are the symptoms of uncontrolled diabetes. Blurry vision, dizziness, slow healing cuts, some forms of early neuropathy, thirst, continuous urination, headaches, mood swings, etc.

I have news, for you Paula... You'll still have diabetes, even when all those things are gone. You live life so that you CONTROL those things -- but you can't stop your routines, or those things WILL return. And quickly. Your diet is your MEDICINE. It's just exactly like medicine.

In this sense, Paula... ALL diabetes is reversible. Yes, even type 1 diabetes. It's a BOLD statement, but I know some pretty TOUGH type 1 diabetics out there that could run circles around me, any day, and to the average world look like they have NOTHING wrong with them. They have worked hard to REVERSE the horrible grip of uncontrolled diabetes which they had at diagnosis. TIGHT control is what we ALL aim for -- but it takes CONSTANT work and effort, and it is SO not a cure.

Photo by RingoFuentes

You can't go on living like just testing once a day, and not knowing what carbs do to you is, somehow, having diabetes in control. It is a full time job, and it causes a lot of psychological trauma, and exhaustion. There's just NO beauty in this pile of dung. (But you'd be a little prettier if you spoke a little less. :) Thank you.) The beauty is in US -- and how we evolve to adapt to the harsh winds of diabetes.

Additionally, Dr. Nathan, it is embarrassing that you would suggest to people that all they need to do is lose a modest amount of weight to better manage their diabetes -- this is untrue. While weight loss helps lessen some of the challenges of insulin resistance, it is NOT the way to control diabetes -- the way to control diabetes is to control one's diet and carbohydrate intake, along with weight lifting and resistance training, and sometimes, medication. When you tell people that losing 5-7% of their weight would reduce diabetes by 58%, you are leaving them with a lot of confusion, and mixed feelings. I mean... what the HELL does that even mean?????

You can't reduce diabetes by 58% when YOU ALREADY HAVE IT.

You must be talking about the poorly done, not so large, diabetic studies... who used a lot of extrapolation, inference, and ignoring of many, many additional risk factors and components, along with populations that did NOT represent a cross-section of the country... to claim that 58% of diabetes could have been PREVENTED. Which is another poorly used word. One can only REDUCE one's odds of disease -- not eliminate them. There is NO SUCH guarantee that you won't get diabetes, even if you do 'everything right.'

So, Dr. Nathan, Paula Deen, Barbara Walters... for all these reasons -- and I'm sure -- many more... You have earned yourself a Dung Cupcake. But they don't make dung cupcakes, so here's a moldy one, instead. You've earned it.

One big, so not so heartfelt, THANK YOU... for all the work you DON'T DO. You make the world one heck of a crappy place for diabetics everywhere.

(Oh, and in case you didn't get it... That's called sarcasm. It's a young people thing.)

. . . 

If you would like to submit 'nominees' for the week's crappiest stories worthy of a Moldy Cupcake Award, feel free to 'Contact Me,' and they shall be thoughtfully considered. :D We shall leave no moldy cupcake left behind. 

The School Lunch Debate: When Mystery Meat Is Truly A Mystery...

With the rising tide of juvenile type 2 diabetes, the debate on school lunches is one which is slowly starting to take the stage. It is, however, one of those subjects in which everyone has an opinion -- but not many have an actual evidence based opinion. Throw in the wrench that every school district is different, and you'll find mudslinging from all sides of the opinion spectrum:

Why can't parents just make healthful lunches for students? 

Well, right now, some schools are actually BANNING parents from preparing school lunches for their kids, claiming it is the parents making unhealthful meal choices. Of course, this is often true... No one can deny that. But it also makes many of us with diabetic loved ones CRINGE at the thought of what a school cafeteria lady, or health department, might think is a healthful school lunch. These places often lack in options. I'm thinking a main course of carbohydrates slathered in cheese and hot dogs, with a side of carbohydrates slathered in butter or salt, with a dessert full of carbohydrates, and a glass full of carbohydrates (because it has vitamins, so it must be good for your health, unlike that can of soda.) Your main sources of protein come from that powdered, grade A government issued cheese, and that powdered, grade A government issued milk. YAY. To top it off, throw an apple at it, for good measure, because apples make ANYTHING look healthy.

Some will argue, why can't parents just trust the school lunch system? 

'I always got healthful meals from the school system, and I turned out JUST fine.' I love these people the most. To them, anecdotal evidence is ALL the evidence that anyone will ever need, and it somehow, trumps everything. It's like seeing nothing but yellow parakeets, and assuming there are ONLY yellow parakeets in existence because that's all your local store carries. (Never mind that many of these folks have NO IDEA what a healthy meal even looks like, and tend to think that all a kid needs to do to stay healthy is to avoid candy and soda, and eat lots of fruitsandvegetables.)

Well, here's something that will blow your mind.

Did you know that the original idea of a 

'food pyramid' started  as a way to help 

ease food costs by spending money on basic, 

cheaper foods, and still get nutrition? The rest 

of the foods were meant as complements 

to enhance whatever nutrients were missing. 

Ever since the USDA started making low fat, 

high carb recommendations in the 80s, and 

implemented it's OWN food pyramid in 1992, 

obesity rates have skyrocketed.

The USDA describes their National School Lunch Program as: "a federally assisted meal program operating in public and nonprofit private schools and residential child care institutions. It provides nutritionally balanced, low-cost or free lunches to children each school day. The program was established under the National School Lunch Act, signed by President Harry Truman in 1946."

Right away, when you brush away the chaff... what should jump at you is the 'low-cost' descriptor used in this paragraph. What does this, casually thrown in, adjective have to say about this program? What is hidden between the lines? Well, what they don't tell you is that the National School Lunch Program started as a way to help a poor, starving population, through government subsidies --  the same subsidies programs which are still, to this day, overpowering our agricultural industry, and making it possible to produce mass amounts of low quality, less nutritionally dense foods. (McDonald's anyone?) When you invest in low quality, less nutritionally dense foods, they become LOW-COST, and easy to mass market to a multitude of industries, and other countries. Smaller farms CANNOT compete with the HUGE agribusiness industry that has come to dominate the markets, including... you guessed it -- the school lunch program market. While the school 'lunch ladies,' might VEND food for you, it usually comes pre-packaged, pre-made, or 'ready to make' sources, and local state federal agencies will contract their local school lunch program to a food service management company, to save a few bucks. If your local school district does not contract to one of these, they are the EXCEPTION.

The three companies, right now, that dominate the industry are Aramark, Compass Group, and Sodexo. They mass market less nutritional foods, serve nutritionally imbalanced meals, cut corners to save dollars, and contract with fast food giants to market to kids -- yes, including, soda manufacturers. Not only that, but they have been under investigation in the past, for serving foods SO low in quality, they were rejected by fast food industry safety standards. (It's gotta take a lot of balls to serve a kid something WORSE than fake fast food meat.) They have such a strong arm in the system, many of them have been able to lobby, and block legislation that would improve standards, including legislation that would have banned soda vending machines in some schools, for example. 

So when you throw in less nutritionally dense foods (so, even if you have a small serving of them, they're still not so great for you,) in an array of unbalanced meals (all carbs, and hardly anything else), no allowances for or enforcing of portion control (and just eat what you want, and how much you want of it), and the attending results of kids who will a.) not feel the stop and go of their hunger signals anymore, and b.) constantly feel hungry because they got no real nutrition, you will get increased likelihood of illness, development of chronic diseases, and a national fat kid tsunami.

That's right... every time your kid eats at one of these national school lunch programs, it's eating food that's probably worse than McDonald's. (And even if it would appear "balanced," the fact is... it's still food that is nutritionally inferior. Remember that. It's like comparing a home made creme filled cake, to a Twinkie. They are technically, the same thing, but that's where it ends. One of them still has FIBER, and many, many vitamins and minerals. I'll let you guess which one that is.)

Are you freaked out yet? YOU SHOULD BE.

Still, some people have blind faith in their National School Lunch Programs... And disbelieve or disregard those who try to stand up against it, and call for change. (Including some politicians.) But folks are fighting BACK. 


Folks like Sarah Wu, who "compelled by her own frustration with school meals — both as a mother and a teacher ... known anonymously as "Mrs. Q." committed to eating school lunch every school day in 2010 just like her students. Mrs. Q documented her experience and described the meals by blogging, tweeting and sharing photos on her blog Fed Up With Lunch: The School Lunch Project." Her blog is one of the first blogs to help capture national attention on this very concerning issue. Mrs. Q risked her employment on this... and there were many days I worried she'd get caught. Still, I cheered for her. Her voice has been effecting some serious awareness and change... but we need more.

More, nationally, as well as globally... Like little 9 year old, Martha Payne, from Scotland... who writes about her poor lunch school program at NeverSeconds. While you're not going to see her giving you an in-depth analysis on the corruption, and backdraft, of agribusiness subsidies... she will hold up every meal to critique, and scrutiny, so you can see with your own eyes what she and her peers are being served.

. . . 

America is at a critical point, right now... we are at a point where it's starting to matter very little what type of food you eat, because it was all cheaply made, and nutritionally bankrupt. Movies like "King Corn," "Supersize Me," and "Food, Inc.," have created some discussion... but quickly get swept under the rug as 'passing the buck,' and not taking personal responsibility for what we eat. But we are clearly living in a very obesogenic environment where it is getting increasingly difficult to make right and wrong decisions, and increasingly easy to be deceived. Yes, a lot of foods that make false health claims have food labels, and we could be better trained and educated at reading them... but what if we thought we were eating meat, and instead were getting meat with an incredibly high risk of bacteria, and lots of corn filler? What if it was given to us by a school lunch program, with no labels (just trust), and not the 'you should know better,' fast food industry?

Yes, we have freedom of choice, in America... as to what we eat. But to what EXTENT should we let the government and the food industry tamper with our food supplies? Market to us? To children who haven't yet developed some of the necessary critical thinking skills, and disciplines, to make good life choices? (Especially, when they don't even have a parent around, to help...) Or to populations with less income, less education, and less access to nutritious alternatives?

The rights and freedoms of those who want to make me less healthy (and not just by consuming more 'fats' and 'sugars,' mind you), start mattering VERY LITTLE to me... when the lives of children, and the future of our nations are involved.

I don't know how ALL chronic illnesses, cancers, and autoimmune conditions come to pass... but sometimes, I have a very good idea what might be contributing to their explosion... And it's not just having an extra piece of pie.

Guest Blog Post: A Diabetes Service Dog for Sarah

Here at the Angry Type 2 Diabetic, we see 'ourselves' as a voice to ALL persons with diabetes... So, even though we generally use this space to share about our own type 2 diabetic experiences, we'd like to cheerfully lend the spotlight, this week, to our friend, Michelle. Michelle is a wonderful mom to a type 1 diabetic child, and she has a very important message to share with ALL of you. You may find Michelle's regular blogging space at The Tightrope Tango, and show her some follow love.  

My name is Michelle, and first I want to thank my good friend Lizmari for lending me space on her awesome blog. Lizmari is an awesome advocate for all people living with diabetes, regardless of type. She’s also the reason we enjoyed some pretty awesome Ice Cream Sundae’s last August.

Most people I talk to (and I talk quite a lot these days) have never heard of a diabetes alert dog. We all know about Guide Dogs for the Blind, and most of us have heard of dogs to assist people with other disabilities such as mobility, seizures, hearing, etc. Diabetes alert dogs are specially trained dogs that focus on the scent of their person, and let that person know when their blood sugar begins to drop to an unsafe level. These dogs are most commonly used by people with type 1 diabetes, but some with type 2 diabetes are also using diabetes alert dogs to keep them safe.

Why is this necessary? Well, a lot of diabetics either never have, or lose the ability over time to sense changes in blood sugar. My daughter, Sarah, is 12. She’s had type 1 diabetes for about two and a half years. Since the beginning she’s had trouble recognizing when her blood sugar is low, until it is dangerously low (sometimes in the 40’s and 50’s mg/dL). Normal blood sugar (for a non-diabetic) ranges from around 70mg/dL to 130mg/dL. If blood sugar drops too low, unconsciousness, seizures, and death can occur. Sarah has difficulty feeling drops in her blood sugar during the day, but she does not feel them at night, period. Since she’s been diagnosed, she has never… not once… woken because she felt a low blood sugar. That is scary. The JDRF (Juvenile Diabetes Research Foundation) reports that 1 in 20 people with type 1 diabetes will DIE of a low blood sugar. 1 in 20! That's not a typo. It's not 1 in 20,000, it's 1 in 20. (http://www.jdrftalk.org/2011/11/07/percentage-people-type1-diabetes-die-low-blood-sugar-hypoglycemia/). I can’t let my beautiful child become a statistic, so right now I set alarms for 10:30, 11:30, and 2am. Sometimes more, sometimes less, depending on her food and activity for the previous day.

But I’m not perfect, and I make mistakes.

Once, last December, she went extremely low (27mg/dL). She was unresponsive. It was only around midnight and I only caught the low because I checked on her and found that she was horribly pale and covered in sweat. I saved her life that night, because she was still dropping and the body can't sustain a blood sugar much lower than that for very long. If I hadn't checked on her, she very easily could have slipped into a coma and been gone by morning.

We tried a CGM (continuous glucose monitor) but Sarah has a metal allergy and gets a severe rash. This is where the diabetes alert dog comes in. Diabetes alert dogs are not for everyone. They require a lot of care. They eat a lot, they poop a lot. Honestly, in the beginning I thought that a diabetes alert dog was too much responsibility for a child. But my child proved me wrong by volunteering many hours every month with Guide Dogs for the Blind. She learned to handle, groom, and correct them. She grew to love her new friends, and has taken weekend responsibility for a Guide Dog puppy on a number of occasions. 

I believe that in a few years, maybe 5, maybe 20, that diabetes alert dogs will be much more common and understood. Discounting the fact that an alert dog is a living animal, an alert dog is a medical device, a tool. An alert dog is always on watch with their wonderful nose. An alert dog can think, and will go find help if their charge doesn’t respond to their warnings. Guide Dogs call it intelligent disobedience, a term that describes when a dog makes a decision to take an action outside its normal training that is in the best interest of their person. This could be a dog that leaves Sarah’s side during school to go take the alert to the teacher or other adult. This could be leaving Sarah’s room during the night to come into my room and let me know that Sarah needs help.

The last thing I’d like to say to everyone who reads this is to not discount the needs of someone with diabetes simply because they don’t have an obvious disability. Many kids, like my Sarah, are active, funny, enthusiastic, and because their health, food and activity is watched very closely, they often appear healthier than the average child their age. I’ve had a few eyerolls when I’ve told people that my bouncy child, who just exudes health and vitality, needs a service dog to keep her safe. For someone with type 1 diabetes, safe and healthy require a lot of work, lots of acting on instinct, guesswork, etc. It’s not as easy as it looks, and even with constant effort we have lows and highs that could not have been predicted. Diabetes is always. It never stops. It never goes away or gives us a break. Sarah takes large doses of insulin 4-6 times a day. Any one of those could send her to a fatal low if she or I misjudge the carbohydrates in her food or misjudge how her activity will affect her.

Can you be 100% right ALL the time?

At this time, diabetes alert dogs are not covered by insurance. Those of us who have made this choice for our child must generally pay for the cost of training the dog. My hope is that once the abilities of these dogs are more fully understood and accepted, more groups like Guide Dogs for the Blind can be formed to raise funds and provide these amazing dogs at low or no charge to the family. The first step in making this a reality is education. Tell someone you know about these dogs, and help spread the word. Even if you don’t know someone with diabetes, someone you know does.

Talk. Educate. Your words can help save someone’s life.

If you’d like to learn more about Sarah’s journey to a diabetes alert service dog, please visit either her facebook page at https://www.facebook.com/ADiabetesServiceDogForSarah or her website at www.pawsforsarah.com. Sarah’s dog is coming from Canine Hope for Diabetics in Riverside, CA, hopefully in early 2013. 

Metformin and PCOS: Taking the Plunge... with Googly Eyes

"It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all." -- J.K. Rowling

I've been on every diet, I think. Every way of eating, or not eating, or thinking... or approaching. I've had the most success with intuitive eating, and with mindful control of carbohydrates, or lowered carbohydrate eating... and I stick to that.

People will say do this, do that, do the other... you're not doing it right, you ought to do x, y, and z... (while they ought to shut their pie holes.)

I've been on the chicken and lettuce diet, the LA diet, the beat juice diet, the LA Juice Fast diet... The 700 calorie a day, 36 grams of carbohydrate starvation diet... Weight Watchers, Doctor's Weight Loss, etc, etc...

You name it.

But with intuitive eating, and lower carb eating, I've lost the most weight and kept the most weight off long term -- AND, been happy.

Time passes by, however... and not in vain. I'm no longer 15.

Polycystic Ovarian Syndrome is taking it's toll on me, and while I've fought hard... with exercise, lowered carbs, birth control, and supplements for 20 YEARS.... I am now ready to admit that I need some help with it, and start a regular course of Metformin on top of my birth control regimen, and my Inositol.

A lot of people might see this as some sort of failure, or disappointment, but it's not. It's just a next step in management -- and in GOOD health. And my blood glucose numbers are fine, actually... But the hair that keeps camping on my face (while leaving my head), the continuous acne, darkening Acanthosis Nigricans around my neck, and the weight I've been putting on are NOT. I have MORE than paid my dues... and I'm quite happy to accept some help so that I don't spend more hours than I need to plucking hair. >:S

I don't feel bad about this decision; I actually feel quite relieved... I feel like maybe my ovaries won't get crushed under this weight, and I might have a chance (not that I want to, right now) to have a brat or two, one day. Who knows.

Or... maybe I might find a man who loves me and gets to see me while I actually still look like a woman -- and not, you know... like Homer Simpson. (Though there might be men out there who like the Homer Simpson look... Again, who knows.)

In any case, I am officially on Met... and no, my goal is not to get off of it, somehow. I will likely never get off of it. Even if my blood sugars are perfect; even if I weigh a 100 lbs. PCOS is a vicious disease... And in these 20 years, I've been so many different weights, it's not even funny. 170, 128, 190, 142, 248, 170... I know it's not going to go away, magically, with the next Dr. Douchebag's Book of Eat Green Raw Crap From the Ground, and Cure All Your Ailments with Monkey Poop.

So... why not do the NEXT best thing? Yes, I know you know...
PUT GOOGLY EYES ON THAT BIG ASS BOTTLE OF METFORMIN.

One should always put googly eyes on things one is hesitant to trust 

Take that, bitch. Ain't no one gonna make me feel like I'm downing horse pills. lol I will laugh at you... every time I see you. xD Bwahahahahahahaha.

What's in your pill and supplement arsenal? I'll show you mine, if you show me yours...

Diabetic Humble Pie

It was Wednesday at 2 AM, and I couldn't sleep. I stared at the walls intently as if they held hidden messages for me; my own hieroglyphs to decipher. Suddenly, just like an omen in a bad movie, the soft light that usually bathes the bedroom's walls was gone; complete blackness engulfed everything. Five minutes later, there was light, alright... Lightning and thunder made their explosive way into the picture. The stuff usually soothes, and helps me sleep, but that wasn't going to be the case on this morning. This morning I had to rise early, and walk to work... and it was going to be a very interesting, and very wet, walk to work.

And I can't begin to tell you just how interesting. 

Let's just say I completely underestimated the situation, and thought it was just... well... an annoying moment of rain, and some fading thunder. At 4 am, though, let's just also say that some things are better left unseen. 

Most of the homes on my city's main avenue are small, and unimpressive. Not a blight, by any means, but just average homes that probably serve as 'first homes' to many newlyweds, or even some retired folks. They don't really have much in the way of yards, trees, or shrubbery, but I got to see a few fallen branches here and there, and that's common out here in Iowa during some of our Spring storms. No biggie. 

But then, you hit a slight bend up the road... and the homes become bigger, 'stately', and with sprawling large front lawns, gardens, and trees. You might even see a posh car or two, parked on a driveway; testament to how much someone, somewhere, makes. And this is where the horror began. 

Have you ever seen a a tree trunk that's, maybe, a few feet wide, in diameter? Yes? Now, have you ever seen it BENT IN HALF, like the bending of a simple tulip stem; like a Twizzler... Like it was made of rubber? Well, at this point in my walk, very MANY of the trees were in this state.

I got quite scared. The city sirens never rang that morning, and no warnings or advisories were in effect for my county. But I know quite well a few of you KNOW what this represents. Unless the Jolly Green Giant's bratty son was out and about, or Godzilla, for that matter... the only two things I know that can do this to such large trees are tornadoes, and hurricanes. And we don't have hurricanes up in the northern Midwest. 

I really didn't know if this was still happening in the vicinity... I sure didn't hear anything in the way of a "freight train" noise. But by then, I was closer to work than to home, so I tried to finish the journey as quickly as possible, and get out of harm's way. Stupid? Maybe. Later, in the papers, experts were looking into whether a tornado 'potentially' touched down in Ames. Well, you sure could've fooled me. :/ 

I was very scared, and when I get scared... I tend to get angry at the impotence of the situation. Scared of being alone, scared I have nothing to rely on to save my own behind, and very angry. I don't know why... like what could I do? Slap the sky? I guess I just want life to happen smoothly, sometimes, and not scare the crap out of me. Not force me into confrontations, or situations I don't want. I JUST WANTED TO DO WHAT I HAD PLANNED - GET TO WORK! 

But life seldom cares what we want, and we have to roll with it...

So we come to Friday, at the second job. I worked an 11-5 pm shift, and I'd been sick with a stomach virus for a few days. Really, foolish or not, I didn't have much in my stomach at that moment; I was just too scared I couldn't keep any of it down. 

Lunch rush starts at this Mexican restaurant, and I'm quickly into the groove of things, making order after order after order. It's okay...! I'm in my element! Things are going awesome... 

And then, without notice, the floor was made of lava, and I was in a movie, and people were watching me. And I was making those burritos... on a compartment, atop a roller coaster ride, and trying to hold on soooo hard to the railing. I think I thought the burritos were the railing, at one point. Everything was funny, and sooo not funny, at the same time. I got scared, and very angry.

I wanted to stop, but there was no one else there. I'm pretty knew, so people don't really know much about what I need, or don't need, and frankly... I only work a few hours, part time. I guess I foolishly thought I could get away with it. I *knew* that I was having a quite sudden, and quite low, LOW. But I couldn't stop.

"I can finish this lunch rush," I say to myself... I can. By the time rush was done, I'm sure some of my folding, and wrapping, looked as mangled as those trees on my main avenue. I was so sick feeling, and so scared... Like a person drowning, and their head rising in and out of the water. Where the hell are the jellybeans? I quickly announced I'm going on break -- whether people like it or not -- and NO ONE refused. They must've seen something in my eyes, and wisened up. 

Funny, the place is typically crawling in ho-hos, twinkies, and jelly beans... and not a damn piece of sugar was in sight. 

Luckily, I ate through 3 pieces of candy I had in my pocket (too scared to go down the greasy, steep steps to the basement, and find my purse, and get the meter and the glucose tabs), and a cup of regular soda... 30 minutes later things seemed to improve. My break was only 15. 

I will have to ask if I can keep things upstairs -- we can't really keep personal things, nor food, in the work areas. But it's going to have to be... an uncomfortable conversation. I just don't like to bring it up.

ALL I WANTED WAS TO DO MY JOB, AND FINISH, AND GO HOME. 

In the end, I took a detour through Alice's Wonderland of Diabetic Crap, and finished with a terrible headache... and NOT from the magic mushrooms. :/ 

I hate Diabetes. *&^%#! Diabetes.

Lesson: We can't exactly plan for every situation, in life. Who the heck knows when a tornado's going to come in, and rip through your lunch rush, at work... BUT we must be willing to reach out to others, and identify safe beacons along the way. Don't hurt yourself because you want to be tough, and stubborn, and stupid. Just don't. It's so not worth it... 

"One order of diabetic humble pie, please. For here." 

Blue Cinco de Mayo...

In Loving Memory...

Gone too soon, nine years ago, today.

Gone, but not forgotten... 

Just one loving memory away.

Hector Rafael Collazo Santos

(September 11, 1938 - May 5th, 2003)

He may have lost his chapter with Type 2 Diabetes,

but the WAR continues with me.

I will keep on fighting, dad.

I will NOT give up.

Rest in Peace

When Will I Die From Type 2 Diabetes?

"I do what I have to do, so that I can do what I want to do."

Life is not a simple exercise for me. While it just seems to come naturally to some, it's just not so, for me. Having a positive state of mind is a continuous choice I have to make, and it is a continuous decision to stop self destructive thoughts in their tracks, and choose to believe the positive mantras that might seem cheesy, or ludicrous to me.

I don't really know why I am like this... and I could psycho-analyze it to death, but I'm not sure how helpful that would be. I'm pretty sure that some of the hurdles I've faced (especially in my childhood) have helped me develop a somewhat dim view of the world. Things like childhood obesity, a grim personal appearance (thanks to undiagnosed PCOS), constant exhaustion and mood swings (thanks to undiagnosed Hypothyroidism), uninvested parents and a lack of personal development, etc.

I felt so alone most of my childhood, and so inadequate, that I spent it trying to pursue instant gratification. In my teen years, eating and TV became my sole companions and comforts, while my family was mostly off in their own world. It's still like this today, you know. I don't get social phone calls from family, nor so much as a card on a birthday, or a holiday... and quite frankly, I don't remember the last time I got anything at all in the mail, from them, or even a social phone call. You can see why a child would try to drown itself with 'love' in the form of whatever one came across -- be it food, or TV, or what have you. Pick your poison.

When one is swimming in loneliness, illness induced mood swings, life induced anxiety, and self loathing... it is extremely hard to have self control of any kind. Whether it be with your refrigerator, or with your checkbook, or whatever brings you immediate release. What's worse is that when you don't have deadlines or commitments of any kind, you can put off desperately needed changes, for as long as possible and tell yourself that 'tomorrow, you will start;' but when someone tells you that you have NO choice, that it's the hour zero and you need to buckle down, or else... your life turns into a shiny, red button. Do not press the shiny red button, they say... You must guard yourself to never press the shiny red button. Everyone's anticipating, and policing you. Everyone knows.

History Eraser Button

If the video doesn't show, follow the link above.

This is what life is like for many of my fellow type 2 diabetics, right now... A shiny red button. It's easy to understand how one gets to that kind of place, and ever soooo hard to help someone get out of that place, see the light, and understand that although life may be smacking us with its behind (like the announcer guy on this Ren and Stimpy video), that we have a choice. We indeed have a choice, and our lives don't automatically go down the drain... Our destinies are not planned for us. We MAKE our own futures; we write them today.

Someone I admire profoundly, once said to me: "Lizmari, you are no one's victim." 

But it's so comforting to believe that I am; that I am life's victim, that I have no choices, that I am like a small boat, with no sails, and no paddles... at the mercy of life's waves. That I am being held hostage at the mercy of a big, shiny red button, awaiting to erase history; MY HISTORY. Or at least, in my warped sense of self I like to think it is... "Woe is me..."

Why? Because it's PAINFUL to not be anyone's victim. It takes MUSCLE, and exercising your discipline muscle is just as painful as stretching your calves. Ouch. 

... But I am not anyone's victim. I AM NOT, and neither are you. 

Listen to me, friend. You who decided to google "When will I die from Type 2 Diabetes?" and suddenly chanced upon my blog: You are not a tiny raft, alone at sea. You are a MASSIVE ship, and you can take charge of your course. You can choose to stir your ship into the icebergs, you can choose to press the shiny red buttons of your life, every day... Or you can choose to tell diabetes to buzz off.

"Hey, diabetes... GET LOST. You may place hurdles in my life, but you will NOT take me. Not today. TODAY WILL NOT BE THE DAY. I am NOT your victim. You are NOT my master. I AM, and I am allowed to BE, and you do NOT get to tell me who I am, what I am, and when I get to leave." 

I have my own shiny, red buttons... and I understand. Believe me, I do... 

But you have choices... And while you may decide to throw in the towel, let me remind you (or perhaps inform you), that Type 2 Diabetes =/= death. YOU have the power to let it equal LIFE. A life reborn, a life re-defined, a life EMBRACED. 

Embrace life, WITH diabetes. It may take courage to not be a victim... but I promise you, if you do it, you will NOT be disappointed. You will be OKAY. You will not just survive, but you will THRIVE. You can do this thing... Life awaits you! 

I promise. 

Will you take the challenge?