I do not control which ads are displayed by Google Ads nor do I endorse the products advertised. Ads claiming diabetes is curable or reversible should be ignored.

Sunday, November 11, 2012

The Fat Tax: Dare I say I Told Them So?

I am flat out preparing for departure on my Myanmar trip tomorrow but I could not let this news item pass unnoticed:

Denmark to scrap world's first fat tax
"The fat tax and the extension of the chocolate tax - the so-called sugar tax - has been criticised for increasing prices for consumers, increasing companies' administrative costs and putting Danish jobs at risk," the Danish tax ministry said in a statement.
"At the same time it is believed that the fat tax has, to a lesser extent, contributed to Danes travelling across the border to make purchases.
"Against this background, the government and the (far-left) Red Green Party have agreed to abolish the fat tax and cancel the planned sugar tax."
I wrote earlier on this subject: Taxes For Our Own Good, concluding that I believe that the suggestions to tax foods for public health reasons are misguided at best and may be counter-productive at worst. Not only do such taxes not work, especially when they choose the wrong foods to tax, they can become expensive liabilities for the businesses forced to become tax collectors on the government's behalf adding accounting and red tape costs. As Danish businesses were quick to report:

Businesses call fat tax a failure on all fronts
Levy costs millions of kroner and has not resulted in consumers making healthier choices, say food producers. Finance minister Bjarne Corydon (Socialdemokraterne) is not opposed to trimming the fat tax, but the lost revenue will have to be made up
Denmark's surcharge on the fat content of foods has cost businesses 200 million kroner since it was implemented last October, according to Dansk Erhverv, a business advocacy group. The tax has been expensive,” chamber spokesperson Lotte Engbæk Larsen told Jyllands-Posten newspaper. “Businesses have had to absorb the costs of administration, set up new IT systems and explain it all to customers and suppliers.”
Larsen said that the red tape was the only thing to come from the levy, since it did not encourage customers to pick less fatty food.
“There have been absolutely no health benefits gained from this tax,” said Ole Linnet Juul, of DI Fødevarer, a food industry advocacy group.

Yes, I will say I told them so. Food taxes are not the way to improve public health. Hopefully the social engineers promoting these taxes in other parts of the world, including my own country, will heed the lessons of this failed Danish experiment.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

Tuesday, August 14, 2012

Lisa's Story

One of the nice things about being on several forums is seeing the success stories. Ordinary people doing extraordinary things. Not Olympic athletes but people like you and I who decided that they were not going to become part of the abysmal diabetes statistics but that they would restart their lives for longer, healthier happier lives with less risk of diabetes complications. I have collected a limited selection and listed them on Other's Stories.

Today this story was posted on the ADA forum. Lisa graciously granted me permission to repeat it here.

Hi! My name is Lisa, I have type 2 diabetes and this is my story.

I am a working mother/wife with four grown children and one grandchild. I am not very athletic, and my most favorite activity is reading my Nook. (Just ask my darling hubby! Oh boy, is he ever sorry he gave me that thing!) Exercise is a challenge for me. I am not into marathons or trendy exercise programs, just old-fashioned walking and biking. I am active in my church and love to help out wherever I can. I love my five cats. Yes, five! I acquired them while working through my empty-nest phase.

My story begins like most of us: hearing that my fasting blood glucose (BG) reading put me over the “limit.” No prediabetes, do not pass go, go directly to full-on diabetes. No “get out of jail free” card for me.

This had been on my radar for quite some time. Oddly, it still took me by surprise. I am on medications for high triglycerides, cholesterol, blood pressure and allergies. My liver is slightly enlarged due to non-alcoholic fatty liver disease (NAFLD). I don’t take medicine for this or my diabetes, but I was advised to lose weight. Gee, that never occurred to me! Still, I sometimes joke that I am a walking pharmacy. The pharmacy knows me by sight. This can be a good thing, actually.

Six years ago, I managed to lose 40 pounds and kept it off two years by eating a very low-carb, high-protein diet and lots and lots of walking and biking. Then a series of unfortunate life events sort of took the stuffing out of me, and much of that weight crept back on. I might have forestalled my diagnosis a few years with all that. Little did I know that the low-carb/high-protein diet was perfect for a person with diabetes!

Since my diagnosis in December 2011, with an A1C of 6.4 and fasting blood glucose of 146, my doctor agreed I should try to manage with diet and exercise. I went home, cried, ranted and then threw out all my junk foods. I went back on my diet program and got to walking again at least for 30 minutes as many days of the week as I could manage. I lost 20 pounds in three months. I’m kind of stuck there now. But, the A1C went down from 6.4 to 5.9 three months later, and then 5.8 after the next three months. So that’s good progress.

The hardest thing to deal with is feeling ashamed for allowing this to happen. I can sometimes feel alienated from others and resentful of my situation when I have to say “no" to certain food—foods that I am, on the inside, drooling to devour! Also painful is that the media tends to focus on the questionable idea that diabetes is caused by being overweight . . . like it was my fault.

Within the American Diabetes Association’s online community, I have found hope and the knowledge that this was not my fault. I have realized that I can manage my diabetes and still live a full, happy life. I found necessary information on what BG levels I should be looking for in fasting, pre-meal and post-meal glucose monitoring. Test, adjust, retest (as my fellow members Alan_S and LizzyLou recommend). Most importantly, I found motivation due to the dreadful complications that can happen to me if I do not keep my glucose levels down.

The most morale-boosting, uplifting thing is chatting with people who understand what it is like to ride the roller coaster of high glucose, then go low, then feel cranky, sleepy, dizzy and just all-around crazy. Who knew food particles on our fingers could affect meter readings? Who else would understand our frustrations? Who else could we ask, “Why are my feet tingling? I only had one baby-size ice cream cone! You mean all that tingling and jack-hammer pains in my toes are from high glucose?” These people "get it" in ways I pray my dear family and friends never will.

So, I will endeavor to remain in the “5% club” without medications as long as I can. I have no problem taking them, if it becomes necessary, if it means keeping complications at bay. I will exercise, eat according to my meter and keep up with my new friends on this community. They offer so much inspiration, motivation and humor in our situation so I can laugh, learn and improve instead of cry, backslide and give up.

Never give up!

Take Care,


Thanks Lisa.

Cheers, Alan
Everything in Moderation - Except Laughter

Friday, August 10, 2012

Large New York Baked Low Carb Cheesecake

I owe thanks for this recipe to a great cook on the ADA forum who posts as Granny Red. She attributed her source as LowCarbLuxury.com. After baking it several times I have modified it slightly by experimenting. 



1 1/2 cups Almond Flour
6 Tbsp Splenda
5Tbsp butter, melted 


24 oz (750gm) cream cheese
¾ cup Splenda
One tablespoon of sugar
3 eggs
2 tsp vanilla extract
1 tsp lemon extract or a good squeeze of lemon
16 oz (600ml) sour cream

Note: the eggs, cheese and sour cream need to be at room temperature. If the cheese is too stiff to beat easily sit the containers in warm water for a little while until the cheese softens. 


Crust Base 

Use extra butter to grease an 8 or 9 inch (20-25cm) springform pan. I also put a circle of greased brown paper on the bottom to be certain the cake does not stick; this step may not be necessary if you use a non-stick pan. 
Mix the splenda and almond flour (sometimes I make my own coarse version from almonds in the blender; it works just as well) with melted butter, press evenly onto the bottom of the pan for a thin layer without holes and press any excess up the sides of the pan. If you don't have enough almond flour to go all the way up the sides don't worry, just go up as high as you reasonably can. It's not really critical as long as the base is covered. In that situation I use greased brown paper around the sides to minimise sticking. Set the pan aside while mixing the filling. 


Beat the cream cheese until light and fluffy, keeping the mixer on a low-medium setting throughout the beating and mixing process. Add the mixed splenda and sugar a little at a time and continue beating until creamy. The original recipe had more Splenda, but I found that a tablespoon of sugar with less Splenda improved the flavour for my non-diabetic wife without raising the carbs too much. You can adjust that to your own taste. 

Add one egg at a time and beat very briefly after each egg. When the eggs have been mixed into the cream cheese add vanilla and lemon extract or lemon juice and mix briefly until just combined. Add the sour cream last and beat briefly until incorporated.

Pour the mixture into the springform pan. Bake at 300 F or 150C for about 1 hour, then check to see if it is nicely brown on top. If not, let it cook for another 15 minutes. When it is cooked, prop open the oven door, turn off the heat and leave it in the oven for at least an hour. Then remove it from the oven and allow it to cool to room temperature before placing it in the fridge until the next day. 

Don't try to serve it on the day of cooking; it will not be set properly if you do. Do not be disappointed if it sinks slightly in the middle. That is normal, or, at least, it was for the ones I made. 

The result is 16 satisfying slices. I individually wrap some in clingwrap for the freezer; they freeze and defrost well.

Calories 340
Fat 32 gm
Protein 8 gm
Carbohydrates 6 gm

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

Monday, July 23, 2012

Taxes For Our Own Good

Recently there have been disquieting moves by social engineers in several countries proposing use of taxes to force the public to eat healthier. Examples are: Denmark introduces food fat tax and from the UK: Fat tax' on unhealthy food must raise prices by 20% to have effect, says study.   

I didn't worry much about it when those proposals were in far-off places; I was confident that Aussies were much too sensible to let that happen here. But now our media are starting to join the push: Chew the fat on a sugar tax to trim waistlines.

I should have seen it coming when the “Traffic Lights” concept was first proposed: The WA Health Traffic Light System and Green Light, Eat Right. 

It appears that those who wish to save us from ourselves - and from overloading the public health system - are resolved to make us eat healthier whether we like it or not.

There are a lot of things I dislike about that concept, not the least being the idea that the government or its agencies has any right to direct me on a matter as basic as the food I choose to put in my mouth, apart from ensuring that it is not actually poisonous and is safely and humanely produced. I'll leave that philosophical side of the discussion for now and concentrate on the practical aspects.

There are two separate parts to the question:
  1. Does prohibitively taxing items based on their impact on health have a significant effect on public use of those items?
  2. If taxes or public education programmes are used with the intention of improving public health are the right food groups being taxed, promoted or discouraged? 
Do Taxes Work To Change Bad Habits?

There are two clear examples in this country. In Australia the Federal government has been steadily increasing taxes and excise on tobacco and alcohol over the past century. Our taxes are quite heavy on those items when compared to many other countries. For example, a packet of 20 Marlboro is over $16 and a 700ml (24oz US) bottle of cheap whisky starts at $28. Our dollar and the US dollar are close to parity at the moment.

Historically each time taxes or excise were increased on either commodity there were short-term reductions in use, but time shows those were just temporary blips. Changes in alcohol taxes sometimes led to changes in preferences from beer to spirits or wine or vice versa, but had little effect on overall consumption or consequent health problems such as youth drunkenness or adult alcoholism.

We had a recent specific example with the alcopops tax. The government was concerned with drinking problems in teenagers. They decided that the root cause was alcopops, a form of popular alcoholic soft drinks. They decided that drastically increasing the taxes on those was the way to fix the problem.

Effect of the increase in “alcopops” tax on alcohol-relatedharms in young people: a controlled interrupted time series

Med J Aust 2011; 195 (11): 690-693. doi:10.5694/mja10.10865
Objective: To measure alcohol-related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government “alcopops” tax in 2008.
Design, setting and participants: Interrupted time series analysis over 5 years (28 April 2005 to 27 April 2010) of 15–29-year-olds presenting to EDs with alcohol-related harms compared with presentations of selected control groups.
Main outcome measures: Proportion of 15–29-year-olds presenting to EDs with alcohol-related harms compared with (i) 30–49-year-olds with alcohol-related harms, (ii)15–29-year-olds with asthma or appendicitis, and (iii) 15–29-year-olds with any non-alcohol and non-injury related ED presentation.
Results: Over a third of 15–29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15–29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s, and visitors to and residents of the Gold Coast.
Conclusions: The increase in the tax on alcopops was not associated with any reduction in alcohol-related harms in this population in a unique tourist and holiday region. A more comprehensive approach to reducing alcohol harms in young people is needed.

Similarly, taxes on cigarettes have had only a marginal effect.

1991-92 to 2007-08 (2007-08 dollars)

Note that smoking was relatively unchanged when taxes were increased in the early '90s but dropped significantly later despite steady taxes from the mid-90s on. The significant reductions in cigarette smoking in this country came from better public education and various new State laws such as restriction of advertising, labelling changes, restricting sales to minors and drastically reducing the public places where people could legally smoke; allied to a paradigm shift in public acceptance of smoking in social situations. For example: 


The current focus of the anti-tobacco lobby on the rights and health of non-smokers has led to a proliferation of smoking bans in enclosed public places. The NSW Parliament only recently passed the Smoking Environment Amendment Act 2004 which will gradually phase-in an extension of smoking bans to include licensed premises in NSW. The support for such smoking bans has been growing and the implementation of similar restrictions in Ireland and New York appears to have been successful.

Smoking bans are only one method of tobacco control. The use of tobacco is also controlled through restrictions on the way it is packaged and advertised. Particular strategies are applied to minors such as prohibiting the manufacture and sale of toys and confectionery that resemble tobacco or the act of smoking, as well as prohibiting the sale of tobacco to persons under the age of 18. Health warnings have been included on tobacco packages for thirty years but have continued to adapt to contemporary requirements with graphic warnings the most recent development. The price of tobacco may be influenced by taxation policies and smoking cessation can be encouraged through media campaigns, and the availability of nicotine replacement therapy and telephone counselling. Litigation may also affect the activities of tobacco companies.

Tobacco continues to be the cause of much death and disease not only in Australia but also worldwide. The damage attributed to tobacco has been recognised by the World Health Organization and by the numerous countries to have signed and/or ratified the Framework Convention on Tobacco Control. Accordingly, governments continue to seek strategies that will encourage the minimisation, prevention and cessation of tobacco use.

I write as a long-term heavy smoker, who became increasingly annoyed as those changes occurred over the past few decades but eventually gave up in 2001. Now I look back and wonder why I took so long to wake up to the harm it was doing to me.

Will They Tax The Right Foods?

In my opinion this question is actually more important. If we accept the dubious hypothesis that taxes will work to solve the problem, to have any chance of success those taxes should target the right foods. Similarly any public education initiatives should be providing valid and useful information.

Based on the present proposals the foods to be targeted are fats, sugar and salts. The West Australian "Traffic Light" system clearly indicates what we could expect:

Green Foods and Drinks

Foods and drinks classified as Green are the healthiest choices. They are excellent sources of important nutrients needed for health and wellbeing, and low in saturated fat, added sugar and salt, and are lower in energy density.
Can be eaten every day or at every meal.
Examples include: Plain or whole grain breads and cereals, vegetables and salads, fruit, low fat milks and dairy products, lean meats, fish and poultry, eggs, and nuts and legumes.

Amber Foods and Drinks

Foods and drinks classified as Amber are mainly processed foods. They have some nutritional value but contain moderate levels of saturated fat, added sugar and/or salt and can, in large serve sizes, contribute to excess energy intake.
Should be carefully selected and eaten in moderation.
Examples include: Full fat milk and dairy products, some breakfast and cereal bars, some un-iced, plain, lower fat cakes and muffins, some processed meats (e.g. ham, pastrami), poly- or mono-unsaturated spreads, breakfast cereals with no added sugar or fat.

Red Foods and Drinks

Foods and drinks classified as Red are energy dense and nutrient poor foods and drinks that are high in saturated fat, sugar and/or salt. They can contribute to excess energy intake if consumed in large amounts or on a frequent basis.
Red foods also include deep fried foods, confectionary and chocolate (energy size limit), crisps, corn chips and similar salty snacks (energy size limit), sugar sweetened soft drinks, energy and sports drinks (energy size limit).
Should only be eaten occasionally.
Examples include: Fried foods, savoury commercial products such as pies and sausage rolls, snack bars, sweet biscuits, cakes and sweet pastries, small size confectionary and packets of crisps, some sweetened drinks and processed meats such as salamis.

Logically, taxes would be highest on the "Red Foods" and education would be focused on promoting the "Green Foods". In other words, we would be taxed and educated to eat in a way that is extreme low-fat and high-carbohydrate.

I can't imagine many programmes likely to lead to worse results. That would entrench the terrible low-fat high-whole-grains doctrine of the 20th century that I am becoming convinced is a significant factor in the so-called obesity epidemic occurring in the 21st.

Fat consumption in moderation is a trivial part of the problem and sugar is only part of the problem. My definition of moderation in that context is very different to the dieticians who advise governments; it is more like my Grandma, who wasted very little of the sheep when Grandfather killed it. She lived to 102.

The real problem is excessive carbohydrate consumption; sugar is only part of the carb load. A tax on sugar, even if it worked to cut sugar consumption, would have only a minimal effect as the nation continued to start its day with a wonderful 'healthy' bowl of highly processed cereal, drenched in milk, accompanied by some low-sugar spread on multigrain toast and margarine, washed down with a glass of 'healthy' fruit juice. Then, after a 'healthy' breakfast the day continues with an overload of 'healthy' multigrain breads and loads of fruit, spuds, corn, rice and pasta. All, of course, fat-free and low-sugar; so wonderfully healthy. Yeah, right.

Taubes puts it together better than I can; I agreed with him long before I had heard of him: Why We Get Fat and Good Calories, Bad Calories.

I believe that the suggestions to tax foods for public health reasons are misguided at best and may be counter-productive at worst.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter

PS See also this follow-up post: The Fat Tax: Dare I say I Told Them So?

Friday, February 03, 2012

ADA Standards of Medical Care in Diabetes 2012

The ADA has just released their 2012 Position statements on several issues. A clickable set of pdf files can be found in the latest Diabetes Care Table of Contents page.

The most important document is probably the overall position paper: Standards of Medical Care in Diabetes 2012

I am posting the links immediately for those who wish to read the ADA documents for themselves in detail. I will post more detailed comments later after I have had time to analyse the full document.

A quick skim found that there are some significant changes, especially in acceptance of low-carbohydrate diets in the Medical Nutrition Therapy section. Unfortunately, they tend to still qualify that with statements like:
  • For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short term (up to 2 years). (A)
  • c For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)
With no direct acceptance that low-carb may be better for blood glucose levels, not just weight. There is some oblique acceptance:
115). A meta-analysis showed that at 6 months, low-carbohydrate diets were associated with greater improvements in triglyceride and HDL cholesterol concentrations than low-fat diets; however, LDL cholesterol was significantly higher on the low-carbohydrate diets (116).
 and earlier in the paper:
Macronutrients in diabetes management

  •  The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. (C)
  • Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control. (B)
  • Saturated fat intake should be <7% of total calories. (B)
Of course, that final comment can make low-carbing difficult for some. Not for me; I simply ignore that :)

There are also some other significant changes in non-dietary areas, such as very qualified acceptance of the value of post-prandial home testing.

One of the changes that may be of concern to those who believe that diet and exercise should be tried first and medication should only be added if d&e is inadequate is this:
2. Therapy for type 2 diabetes

  •  At the time of type 2 diabetes diagnosis, initiate metformin therapy along with lifestyle interventions, unless metformin is contraindicated. (A)
There is a lot more; take a little time to read the papers in depth.

Cheers, Alan, T2, Australia

Everything in Moderation - Except laughter