Blood sugar lessons from a Type I diabetic

A friend of mine is a Type I, or childhood onset, diabetic. He's had it for nearly 50 years, since age 6. He's also in the health industry and is a good observer of detail.

He made the following interesting comments to me recently when talking about the effects of various foods on blood sugar:

"When I eat normally, like some vegetables or salad and meat, I dose up to 10 units of insulin to control my blood sugar.

"If I eat a turkey sandwich on two slices of whole wheat, I usually dose 15 units. The bread makes my blood sugar go to 300 if I don't.

"If I eat a Cousins's Sub [a local submarine sandwich chain], I dose 15 units. The bread really makes my blood sugar go up.

"I can only eat a Quarter Pound from McDonald's once a year, because it make my blood sugar go nuts. I dose 15-20 units before having it, and I feel like crap for two days afterwards.

"If I eat Mexican food, I have to dose 15-20 units. For some reason, it's gotten worse over the years, and I need to dose higher and higher.

"Chinese food is the absolute worst. I dose 20-25 units before eating Chinese. I'll often have to dose more afterwards, because my blood sugar goes so berserk."

Nothing beats the real-world observations on the impact of various foods on blood sugar than the observations of people with Type I diabetes. All the insulin they get is in a syringe. Dosing needs to match intake.

Personally, though I love the taste of Americanized Chinese food, I've always been suspicious of what exactly goes into these dishes. But I was unaware of the blood sugar implications.

The impact of Mexican I believe can be attributed to the cornstarch used in the tacos and tortillas, though I also wonder if there are other starches being snuck in, as well.

There's a fascinating and vigorous debate going on at the Heart.org website among Dr. Melissa Shirley-Walton, the recently publicized proponent of "a cath lab on every corner": Dr. William Blanchet, a physician in northern Colorado; and a Track Your Plaque Member who calls himself John Q. Public.

John Q. has been trying to educate the docs about the Track Your Plaque program. Unfortunately, Dr. Shirley-Walton essentially pooh-poohs his comments, preferring to lament her heavy work load. In her last post, when she discovered that John Q. was not a physician, she threatened to block his posts and delete all prior posts.

However, Dr. Blanchet has emerged as a champion of heart scanning, intensive lipid management, and lipoproteins, much similar to our program. In fact, many of Dr. Blanchet's comments were so similar to mine that John Q. asked me if it was really me! (It is definitely not.)

Here's a sampling of some of the discussion going on now:

Dr. Blanchett started out the discussion by saying:

Stent Insanity
I have no trouble agreeing with the argument that we have initiated the widespread use of DES without adequate study regarding outcomes. Shame on us.

That said, we are ingoring the DATA that shows that most heart attacks occur as a result of non-obstructing plaque and all the talk about which stent to use ignors the majority of individuals at risk. In addition, for a decade we have known that stenting does not improve net outcomes anyway.

What ever happened to effective primary prevention? We discarded EBT calcium imaging like moldy cabbage without even looking at the outcomes DATA. With direction provided by EBT calcium imaging and effective primary prevention, I have been able to reduce myocardial infarction by 90% in my very large Internal Medicine practice. Through effectively identifying patients at risk and measuring success or failure of treatment with serial EBT, I have made the argument as to which stent to use moot. No symptomatic angina and rare infracts equals little need for any stent.

Is anybody listening? Certainly not the cardiologists whose wealth and fortunes are based on nuclaer imaging, angiography and stenting.

Dr. Shirley-Walton, skeptical of Dr. Blanchet's claim of >90% reduction of heart attacks using a prevention program starting with a heart scan:

To rely soley upon a calcium score will deprive you of a lot of information that could be otherwise helpful in the management of your patients.

Without seeming sarcastic, I must refute : "of 6,000 patients I've seen 4 heart attacks in 3 years". Although I certainly hope your statistics are accurate, I will suggest the following:

You've not seen all of the heart attacks since up to 30% of all heart attacks are clinically silent. So unless you are echo'ing or nuclear testing all of these patients in close followup, you aren't certain of your stats.

Secondly, in order to attribute this success to your therapy, you would have to have nearly 100% compliance. In the general population, compliance is often less than 50% with any regimen in any given year of treatment. If you can tell us how you've achieved this level of compliance, we could all take a lesson.

Dr. Blanchett, commenting on his use of heart scanning as a primary care physician:

CAC [coronary artery calcium] is an inexpensive and low radiation exam to identify who is at increased risk for heart attacks.

A study of 222 non-diabetic patients admitted with their first MI found 75% of them did not qualify for cholesterol modifying therapy prior to their initial MI (JACC 2003:41 1475-9). In another study of 87,000 men with heart attacks, 62% had 0 or 1 major risk factors (Khot, et al. JAMA. 2003). Almost all individuals with 0 or 1 risk factor are Framingham "Low risk" and therefore will not qualify for cholesterol lowering therapies. (JAMA. 2001;285:2486-2497)

Risk factors alone are not sufficient. In my practice, of the last 4 patients who have died from heart attacks, none qualified for preventive therapies by NCEP guidelines.

Studies have shown that CAC by EBT provides an independent and incremental predictor of heart attack risk. (1. Kondos et al, Circulation 2003;107:2571-2176, 2. Am Heart J 141. 378-382, 2001, 3. St Francis Heart Study Journal of the American College of Cardiology July, 2005) The old saw that CAC simply reflects risk factors and age is just wrong.

Although CT angiography shows great promise to reduce unnecessary conventional angiography and is helpful in emergency room chest pain evaluation, I do not see CT angiography as a screening study in asymptomatic individuals. 10 times more radiation than EBT calcium imaging plus the risk of IV dye exposure makes CT angiography inconsistent with the principles of a screening test. Taken in the context of a primary care physician's evaluation of heart attack risk, EBT calcium imaging has great value.

Coronary calcium changes management by: 1. Identifying those at risk who do not show up with standard risk stratification (St Francis Heart Study: Journal of the American College of Cardiology July, 2005). 2. Motivating patients to be compliant with therapies (Atherosclerosis 2006; 185:394-399). 3. By measuring serial calcium, we can see who is and who is not responding to our initial treatment so that we can further refine our therapeutic goals (Atherosclerosis, 2004;24:1272).

When used in the primary care preventive setting, CAC imaging is indeed of great incremental value. In my practice, in improves my outcomes so greatly that it compels Melissa Walton-Shirley to question my veracity.

Dr. Melissa Walton-Shirley:

Ahhhhhh.......the aroma of profit making, I thought I smelled it. [Accusing Dr. Blanchett of referring patients for heart scans for personal profit.]

I will tell you that I was a little hurt when I was called "a typical cardiologist with a butcher block mentality" after my primary pci piece for med-gen Med was reviewed by the track your placque [sic] folks.

Though, it's clear that they misunderstood and thought I was cathing for dollars, instead my intention was to "push" for primary PCI for AMI, it left me seething until the blessing of a busy schedule and a forgetful post menopausal brain took its toll.
None the less, an honest open discussion is always welcome here but I would appreciate it if everyone would just divulge their affiliations up front so that the context of their opinions could be better understood.

I also insist that the compliance described by you William B. is rather astounding and a bit unbelieveable, however if it's accurate, you are to be congratulated.

Dr. Blanchett, in response to Dr. Shirley-Walton's statement that she relies on stress testing:

I think that the threshold of comfort you get from stress test stratification is different than what I consider acceptable. It is hard for me to tell a bereaved spouse that the departed did everything I suggested and still died from a MI. Coronary calcium imaging provides me the tool that I need.

Are you aware that there are a number of studies that show a dramatic increase in risk of MI in individuals with an annualized increase in calcified plaque burden of >14%? I consider this to be a valuable measure of inadequacy of medical management. A stress test does not become positive until we have catastrophically failed in medical management. Consequently, even in the patient with “high risk” stratification, one can justify a calcium score to establish a baseline to measure adequacy of primary prevention. Calcium scores by EBT cost about 1/5th the cost of a nuclear stress test and subject the patient to 1/10th the radiation of nuclear imaging and provides more precise information.

Regarding John Q, I do not think that non-medical prospective should be excluded from this blog. I think we as physicians benefit from hearing how the non-physician public views medicine. I have become much better at what I do by listening to my patients and learning from them.

Dr. Blanchett continues:

Yes, I have seen a dramatic reduction in coronary events. Of 6,000 active patients, 48% being Medicare age and over, I have seen 4 heart attacks over the last 3+ years. 2 in 85 year old diabetics undergoing cancer surgery, one in a 90 year old with known disease and one in a 69 year old with no risk factors, who was healthy, and had never benefited from a heart scan.

The problem with coronary disease is that we rely on risk factors. Khot et al in JAMA 2003 showed that of 87,000 men with heart attacks, 62% had 0 or 1 major risk factor prior to their MI. According to ATP-III, almost everyone with 0-1 risk facto is low risk and most are do not qualify for preventive treatment. EBT calcium imaging could have identify 98% of these individuals as being at risk before their heart attack and treatment could be initiated to prevent their MI.

Treating to NCEP cholesterol goals prevents 30-40% of heart attacks. Treating to a goal of coronary calcium stability prevents 90% of heart attacks. Where I went to school a 40% was an F. Why are we defending this result instead of striving to improve upon it? I am not making this up, look at Raggi's study in Ateriosclerosis, Thrombosis, and Vascular Biology 2004;24:1272, or Budoff Am J Card

Melissa, I strongly disagree with the assertion that the stress test is a great risk stratifier. Laukkanen et al JACC 2001 studied 1,769 asymptomatic men with stress tests. Although failing the stress test resulted in an increased risk of future heart attack, 83% of the total heart attacks over the next 10 years occurred in those men who passed the stress test.
Falk E, Shah PK, Fuster V Circulation 1995;92:657-671 demonstrated that 86% of heart attacks occur in vessels with less than 70% as the maximum obstruction. A vast majority of patients with less than 70% vessel obstruction will pass thier stress test.

William, regarding your question of owning or referring for EBT imaging, I would be amused if it were not insulting. The mistake that is often made is that EBT imaging is a wildly profitable technology. It is not nearly as profitable as nuclear stress imaging. Indeed there are few EBT centers in the country that are as profitable as any random cardiologists stress lab.

How can we justify not screening asymptomatic patients? Most heart attacks occur in patients with no prior symptoms and according to Steve Nissen, 150,000 Americans die each year from their first symptom of heart disease. My daughter is at this moment visiting with a friend who lost her father a few years ago to his first symptom of heart disease when she was 8 years old. That is not OK! We screen asymptomatic women for breast cancer risk. Women are 8 times more likely to die from heart disease than breast cancer. We do mass screening for colon cancer and we are over 10 times more likely to die from heart attacks than colon cancer. An EBT heart scan costs 1/8th the cost of a colonoscopy.

So what say we drop the sarcasm and look at this technology objectively. Read the literature, not just the editorial comments. This really does provide incredibly valuable information that saves lives.

Yes, a 90% reduction in heart attacks in my patients compared to the care I could provide 5 years ago when I was doing a lot of stress testing and referring for revascularization. Much better statistics than expected national or regional norms. I welcome your scrutiny.

John Q. Public jumps into the fray with:

Fascinating, isn't it, that there appear to be two doctors, William Blanchet in this forum and Dr. William Davis, FACC, of cureality.com that both claim to have dramatically reduced risk of heart attack among their patients and/or actual calcium plaque score regression and BOTH are ardent proponents of CT Calcium Scoring?

Despite Dr. Blanchet's persuasive arguments backed up with numerous scientific citations and John Q.'s support, I sense they had no effect whatsoever on Shirley-Walton's way of thinking.

Such are the deeply-entrenched habits of the cardiology community. It will be many years and impassioned pleas to see things in a different light before the wave of change seizes hold.

Jenny
7/23/2008 6:57:00 PM |

Dr. Davis,

I don't have Type 1, but I have to use insulin to cover anything more than a trivial amount of carbs.

The problem with Mexican food is the beans, rice and tortillas.

In fact, most supposedly "low glycemic" foods like beans raise my blood sugar a lot, just a bit later than does white bread. A person with an intact 2nd phase insulin release would not see a spike from these low glycemic foods, though they would need to secrete a LOT of insulin to cover them.

The people who create the GI lists only test at an hour or two after eating. So if a food spikes someone high at 3 or 4 hours, they miss it.

That's why if you are looking for a diet that really keeps native insulin secretion low you want to count absolute carbs, NOT look at the glycemic index.

Anne
7/23/2008 11:19:00 PM |

I have heard other diabetics mention that chinese food is the worst when it comes to their blood sugar. Rice/noodles/sweet sauces/corn starch thickener = too many carbs. I wonder what else is used?

There are some big surprises when checking ingredients. An example would be the McDonald's hamburger and grilled chicken. The hamburger is beef, salt and pepper. If you think the grilled chicken is only chicken, you are wrong. Take a look. There are about 20 ingredients. Some are polysorbate 80, corn gluten, wheat gluten, sodium benzoate...and the list goes on and on. http://www.mcdonalds.com/app_controller.nutrition.categories.ingredients.index.html

Living gluten free and needing to check all labels and ingredients has been a real eye opener for me.
Anne

john
7/24/2008 3:35:00 AM |

the key ingredient (my Shanghai cooking teacher taught me) in wok cooking cabbage was sugar and caramelise it with the cabbage.

Emily
7/24/2008 9:52:00 AM |

Diabetes occurs because the body can't use glucose properly, either owing to a lack of the hormone insulin, or because the insulin available doesn't work effectively.
only way That control your diet.

water
7/24/2008 2:50:00 PM |

I second Anne's comments about gluten. My spouse was recently Dx as gluten intolerant. We'd been eating low carb, and had successfully controlled his blood sugar, but now that we are asking for the gluten free menus I can see lots of carbs on the menu in places I would not have imagined!

shreela
7/24/2008 10:23:00 PM |

Did your friend say whether his dosage requirements were the same for a particular kind of food whether it was made at home from scratch, or prepared at a restaurant, or from a grocery store ready-to-make box/bag?

Anonymous
7/24/2008 11:15:00 PM |

"Personally, though I love the taste of Americanized Chinese food, I've always been suspicious of what exactly goes into these dishes. But I was unaware of the blood sugar implications."
Type 2 diabetic with relatively low insulin resistance:
I can go to a Chinese buffet and select what expect to be proteins (meats) and vegetables. After so many attempts with spikes I have about given up on Chinese foods.

Frank Roy

jpatti
7/29/2008 9:48:00 AM |

The problem with Chinese eaten out is it's mostly noodles and rice - just starch.  Even those dishes that look like it's just meat and veggies comes swimming in a sauce full of sugar and corn starch.

Chinese food is OK when I make it myself.  I stirfry meats and veggies in avocado oil and season with some fresh ginger, garlic and tamari.  Without rice to soak up the flavorings, you don't have to use piles of tamari, so don't have to thicken the sauce particularly and don't need corn starch.  It's very yummy, actually more flavorful than what you can get when eating out, and a minimal impact on bg.

And cabbage carmelizes just fine without sugar.  A stirfry of just hamburger, shredded cabbage, ginger, garlic and tamari is a favorite around here.  It's one of the favorite meals of my husband who does not low-carb.

This is the thing wrt to dosing insulin, you *can't* dose for a high carb diet (though what is high carb may vary from person to person).

If I eat "normally" (which is pretty low-carb), I dose my insulin according to rules I have figured out for myself.  With these rules, my blood glucose *never* goes too high.  Of course it rises some with the meal (usually into the 120-140 range), but then settles back down before the next meal (to 80-110 or so).

If I eat a "cheat" meal, there's no right amount of insulin to take.  If I use the same rules to dose, my blood glucose goes up over 200, sometimes WAY over.  But it still returns to normal, it just takes a bit longer.

The amount of insulin it would take to keep my bg low after a meal would be *huge* - enough to cause me to go hypoglyemic after the peak.  And hypoglycemia is a *lot* more dangerous than running a bit high.

So what's the answer for a diabetic?  You just don't cheat very often.  High bg causes damage, you can't afford to do it much.  You cheat just often enough to keep yourself eating normally the rest of the time without building up  cravings that lead to binges.

The other thing is... what happens to a diabetic injecting insulin *also* happens to non-diabetics!  You just don't see it cause you're not filling a syringe.  But your body is pumping out piles of insulin to handle the carbs you eat, so if you indulge in carby foods, your insulin levels rise.

This causes a host of problems... including increasing the risk of heart disease and other problems associated with inflammation.

Even if your body *does* handle glucose properly, keep raising your insulin levels and eventually your cells start to become resistant.  Increasing insulin resistance therefore increases the chances you'll become frankly diabetic.

In short, while most folks can eat way more carbs than I can, no one needs to eat gobs of carby foods.

There's LOTS of good food to eat that isn't full of sugar and starch, which are really pretty bland foods anyways.

Dr. B G
7/29/2008 4:26:00 PM |

The secret ingredient in restaurant cooking is transfats.  Our favorite restaurant Long Life Veggie House in Berkeley (next door to the campus) uses it.  My husband loves that place! Every dish is DELICIOUS. They don't use MSG but they deepfry in hydrogenated veggie oils. *Deep fried* broccoli sure tastes much better than non-deep fried    Even if non hydrogenated veggie oils are used, the high amount of oil combined with really high carbs can really cause some severe metabolic changes.

The other ingredient is cornstarch and sugar -- it's not a lot but anyone insulin resistant may experience glucose excursions quickly.  Cornstarch makes food more tender b/c it coats the meat as it's stir fried (or deep-fried) which seals in flavor and moisture.

Pre marinating in sugar is like brining -- it also enhances flavor and moisture.  Have you ever had a brined Thanksgiving turkey??  WOW, it's awesome.  And you can't mess it up (ie, overroast or over bake)!

MSG -- this makes the food even more tasty -- and hard to resist! My mom's old Chinese cookbooks list MSG 1 tsp in almost EVERY recipe!

Homemade Chinese food is a lot more healthier but the rice portions can get pretty outrageously excessive in terms of carb/glycemic load and glycemic index.

-G

Anna
7/29/2008 11:42:00 PM |

I just returned from a two week stay in Italy, doing a bit of my own "Mediterranean Diet" experiments.  When practical, we sought out food sources and places to eat that were typical for the local area, and tried as much as possible/practical to stay away from establishments that mostly catered to tourist tastes.  I was really curious to see how the mythical "Mediterranean Diet" we Americans are urged to follow compared to the foods really consumed in Italy.

The first week, we stayed in a rural Tuscan farmhouse apartment (agriturismo), so many, if not most of our meals were prepared by me with ingredients I bought at the local grocery store (Coop) or the outdoor market in Siena.  In addition, I purchased really  fantastic free range eggs from the farm where we were staying (between some language issues and seasonality, eggs and wine were what we could buy from them - though I was tantalized by the not-quite-ripe figs heavy on many trees).  Mostly, our meals consisted of simple and easily prepared fresh fruits and vegetables, rustic cured meats (salami, proscuitto, pancetta, etc.) hand-sliced at the deli down the road, fresh sausages, various Italian cheeses, plus plenty of espresso.    It was a bit disappointing to find underripe fruit & tomatoes as well as old green beans in the grocery stores, not to mention too many low fat and highly processed foods, but all over Europe the food supply is becoming more industrialized, more centralized, and homogenous, so I'm not too surprised that it happens even in Italy.  But even with the smaller grocery store size, the amount of in-season produce was abundant, yet one still was better off shipping from the perimeter of the store, venturing into the aisles only for spices, olive oil, vinegar, coffee, etc.  Without the knowledge of where to go and the language to really talk in depth about food with people, I wasn't able to find truly direct and local sources for as many foods as I would have liked, but still, we ate well enough!

The first week I maintained blood sugar levels very similar to those I get at home, because except for the Italian specialties, we ate much like we always do.  A few rare exceptions to my normal BG tests were after indulging in locally made gelato or a evening limoncello cordial, but even then, the BG rise was relatively modest and to me, acceptable under the circumstance.  Even with the gelato indulgences, it felt like I might have even lost a few pounds by the end of the first week and my FBG didn't rise much over 100.

The second week we stayed in two cities (Florence & Rome), and I didn't prepare any of my own food because I didn't have a kitchen/fridge.  I found it impossible to get eggs anywhere for breakfast, and the tickets our hotels provided for a "continental" breakfast at a nearby cafÃ©/bar was always for a coffee  or hot chocolate drink and some sort of bread or roll (croissant, brioche, danish, etc.).  At first I just paid extra for a plate of salami and cheese if that was available - or went to a small grocery store for some plain yogurt), but then I decided to go off LC and conduct a short term experiment, though I didn't consume nearly as many carbs as a typical Italian or tourist would.

So I breakfasted with a broiche roll or plain croissant for breakfast with my cappuccino, but unfortunately no additional butter was available.  I didn't feel "full" enough with such a breakfast and I was usually starving an hour or two later.  Additionally, when I ate the "continental" breakfast, I noticed immediate water retention - my ankles,  lower legs, and knees looked like someone else's at the end of a day walking and sightseeing, swollen heavy.  Exercising my feet and lower legs while waiting in lines or sitting didn't seem to help.

Food is much more expensive in Europe than in the US, and the declining US$ made everything especially expensive (not to mention the higher cost of dining out rather than cooking at home), so we tried to manage food costs by eating simple lunches at local take-away places, avoiding the corporate fast food chains.  I was getting tired of salami/proscuitto & cheese plates, but the typical "quick" option was usually a panini (sandwich).  At first I tried to find alternatives to paninis, but the available salads were designed for side dishes, not main meals and rarely had any protein, and the fillings of the expensive sandwiches were too skimpy to just eat without the bread.  So I started to eat panini, although I sometimes removed as much as half of the bread (though it was nearly always very excellent quality pan toasted flatbreads or crusty baguette rolls, not sliced America bread).  So of course, my post prandial BGs rose, as did my FBG.  I also found my hunger tended to come back much too soon and I think overall I ate more than usual in terms of volume.

Then we deviated from the "Italian" lunch foods and found a better midday meal option (quick, cheaper, and easier to customize for LC) - stopping at one of the numerous kebab shops and ordering a kebab plate with salad, hold the bread (not Italian, but still Mediterranean, I guess).  I felt much better fueled on kebab plates (more filling and enough protein) than paninis, though I must say I still appreciated the taste of caprese paninis (slices of fresh mozzerella and tomato, basil leaves, mustard dressing on crusty, pan-toasted flat bread).  If I followed my appetite, I could have eaten two caprese paninis.

We had some great evening dinners, at places also frequented by locals.  This often was a fixed price dinner of several courses ("we feed you what we want you to eat").  Multi-course meals included house wine, and invariably consisted of antipasta (usually LC, such as a cold meat and cheese plate), pasta course (much smaller servings than typical US pasta dishes), main course plus some side vegetables, and dessert/coffee.   These were often the best meals we experienced, full of local flavor and tradition (sometimes with a grandmotherly type doing the cooking), and definitely of very good quality, though we noticed the saltiness overall tended to be on the high side.  I ate from every course, including some of the excellent bread (dipped in plenty of olive oil) and usually about half of the pasta served (2 oz dry?), plus about half of the dessert.   After these meals I always ran BGs higher than usual, varying from moderately high (120-160 - at home I would consider this very high for me) to very high (over 180).  By late in the week, my FBG was into the 115 range every morning (usually I can keep it 90-100 on LC food).  Nearly everything that week was delicious, well-prepared food, but the high carb items definitely were not good for my BG control in the long run.

And most days I was doing plenty of walking, sprinting for the Metro subway trains, stair climbing (4th and 5/6th floor hotel rooms!), etc. but since I didn't have my usual housework to do, it probably wasn't too different from my usual exertion level.

So it was very interesting to experience the "Mediterranean Diet" first hand.  Meats and cheeses were plentiful, fruits and vegetables played a much more minor role (main courses didn't come with vegetables other than what was in the sauce, but had to be ordered as additional items), but the overall carbs were decidedly too many.  As I expected, it wasn't nearly as pasta-heavy as is portrayed in the US media/health press, but it is still full of too much grain and sugar, IMO.  Low fat has become the norm in many dairy products, sadly, and if the grocery stores are any indication, modern families are gravitating towards highly processed, industrial foods.  Sugar seems to be in everything (I quickly learned to order my caffe freddo con panno or latte sensa zuccero - iced coffee with cream or milk without sugar) after realizing that adding lots of sugar was the norm).

And, after several days of breakfasting at the cafÃ© near our Rome hotel (where carbs were the only option in the morning), I learned that our very buff, muscular, very flat-stomached, cafÃ© owner doesn't eat pasta (said as he proudly patted his 6 pack abs).   I probably could have stuck closer to the carb intake I know works better for my BG control, but I figured if I was going to go off my LC way of eating and experiment, this was the time and place.

And yes, there were far fewer really obese people than in the US and lots of very slender people, but I could still see there were *plenty* of overweight, probably pre-diabetic and diabetic Italians (very visible problems with lower extremities, ranging from what looked like diabetic skin issues, walking problems, acanthosis nigricans, etc.).  Older people do seem to be generally more fit than in the US (fit from everyday life, not exercise regimes), but there were plenty of "wheat bellies" on men old and young, even more young women with "muffin tops", and simply too many overweight children (very worrisome trend).  So it may well be more the relaxed Italian way of living life (or a combination of other factors such as less air conditioning, strong family bonds, lots of sun, etc?) that keeps Italian CVD rates lower than the American rates, more than the mythical "Mediterranean diet".

Dr. William Davis
7/30/2008 3:46:00 PM |

Hi, Anna--

Your story is so well told that I'd like to post it in a future blog post.

Dr. B G
7/30/2008 4:58:00 PM |

Anna,

You R-O-C-K Girl!!

I love reading all your insightful thoughts and stories ... and now I know how to order high octane caffeine in italian (in addition (!!) to how to feed my feline friend ground whole bones + meat (ie vit D + protein, respectively) to prevent deficiencies.

-BG

Anna
7/30/2008 9:43:00 PM |

BG,

I R-O-C-K? Wow - tell my son, but I doubt he'll believe you. He was so tired of hearing me say what/who/where Rick Steves' travel book recommends...

Are you ready to try some Coratella? I suggest you look it up before you order . I sought out a recommended restaurant near the old South Roma stockyards in Testaccio, known for their special "fifth quarter" dishes, you know, for the "trippa of a lifetime". The waiter wouldn't let me order the Animelle a sale e pepe. Maybe next time...

Anonymous
11/20/2007 1:32:00 AM |

I give thanks that the health of my heart does not rely upon the Melissa Shirley-Waltons of the world.

Anonymous
11/20/2007 3:37:00 AM |

Where exactly is this debate going on? I was unable to find a forum at that site, even though the site index. I did a search for the doctors' names, and came up blank.
Thanks,
S

Dr. Davis
11/20/2007 3:45:00 AM |

Just go to heart.org and the Forum is on the left navigation bar. You will have to sign in, presumably as a media representative.

Anonymous
11/20/2007 1:24:00 PM |

Looks like this "John Q Public" has emerged from the shadows over at the HeartCipher blog.

http://www.heartcipher.com/archives/42

Anonymous
11/20/2007 1:27:00 PM |

The link to the forum in question is:

http://www.theheart.org/viewForum.do

The thread title is:

"DES showdown: Serruys vs Virmani"

Paul Kelly - 95.1 WAYV
11/21/2007 5:23:00 PM |

Hi Dr. Davis (and everyone!) -

In talking with my family physician today about CT Heart Scans, she said she doesn't like them because of the level of radiation. She said she just read an article that said even one CT can increase your chances significantly for leukemia, cancer, etc. She's a believer that a comprehensive stress test can tell you what you need to know - i.e. if you have plaque, it's going to affect the results of your stress test and is therefore detectable that way. Is the level of radiation really something to be scared of?

Paul

Rich
11/21/2007 10:20:00 PM |

Dr. Davis recently wrote a blog piece titled "Are Cardiologists the Enemy?" that seems particularly relevant here.

-Rich

Anonymous
11/23/2007 3:48:00 PM |

Since it seemed like I had read John Q Public's writing style recently, I clicked on this blog's side links, and found JQP was most likely HeartCipher. I read through some of HeartCipher's recent posts and found the link to the forum, at theheart.org -- not heart.org as originally linked.

Dr. Davis, perhaps the link could be corrected in the blog post?

Many thanks to the anon commenter for the DIRECT link to the thread (too bad I didn't reread through the comments before sleuthing LOL)! Once I receive my confirmation letter from theheart.org I'll be able to read it.

S

Dr. Davis
11/23/2007 4:05:00 PM |

Yes, my mistake, now corrected. Thanks.

Blood sugar lessons from a Type I diabetic

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The Heart.org online debate

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