Consider the Paleo Diet for Diabetes

Photo by Vanessa Ray on Pexels.com

Some of you may know that I’ve designed a paleo diet for folks with diabetes. If interested, check out the Paleo Diabetic blog. Feedspot in February placed it on their Top 80 Paleo Diet Blogs and Websites list.

Steve Parker, M.D.

Click to purchase at Amazon.com.

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Got COVID-19? You May Not Need That Pulse Oximeter After All

…per a letter to the editor at New England Journal of Medicine.

Study participants were enrolled from Nov 2020 to Feb 2021. So probably before the delta and omicron variants. Outpatients were assigned either to a “standard program” of home monitoring or the standard program + pulse oximetry. There was no difference between groups in terms of “number of days alive and out of the hospital.” For the 30-day trial, that number was 29.4-29.5. In other words, very few of the ~1000 enrolees got very sick.

Pulse oximeters are readily available in the U.S. for ~$40.

The standard program was “COVID Watch, a 2-week program involving twice-daily automated text messages inquiring about dyspnea and offering rapid callbacks from nurses when appropriate. This program has been associated with improved survival as compared with no remote monitoring.5

I spent about 10 mins trying to find the age of these patients. No luck. I don’t even now if they were adults. Thanks, NEJM. I’m not totally convinced that outpatient oximetry has no role in home treatment of COVID-19. But clearly not every patient needs it. Perhaps just those at high risk of hospitalization and death.

Steve Parker, M.D.

PS: Obesity is a risk factor for severe disease from COVID-19. Let me help you do something about it.

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Recipe: Japanese-Style Salmon and Avocado Salad

If image owner (who?) objects to me posting the image, let me know and I’ll delete it.

This looks and sounds intriguing but I haven’t tried it yet. I’ve never combined avocado and salmon in an entree. I never imagined I’d like avocado in chicken soup, but it’s become a Parker Compound favorite.

Click for recipe at Tesco Real Food.

Steve Parker, M.D.

h/t/ Jan at The Low Carb Diabetic

PS: I couldn’t find the nutrition breakdown at Tesco Real Food, but Jan came up with this:

Nutrition Per Serving (1/4 of the total): Carbohydrate 4.3g Protein 28.7g Fibre 1.4g Fat 41g

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MCT Oil Stabilized Cognition in Alzheimer Disease

Conquer Diabetes and Prediabetes
“Should I go the ketogenic diet or use MCT oil?”

The study at hand was very small, only 20 participants. So results may not be reproducible. The Canadian researchers’ main conclusion: “This is the longest duration MCT Alzheimer Disease study to date. Eighty percent had stabilization or improvement in cognition, and better response with 9‐month continual MCT oil.”

MCT stands for medium chain triglycerides, which apparently are derived from coconut and palm oil. The MCTs provide a source of energy for the brain – ketones – as a partial substitute for the brain’s usual energy source, glucose.

Study participants as expected were elderly and had mild to moderate Alzheimer Disease. Folks with diabetes were excluded from participation.

The article introduction has some interesting facts:

The brain is an obligate glucose metabolizer using 120 to 130 g/day of glucose. It uses 16% of the body’s total O2 consumption, despite representing only 2.0% to 2.3% of adult body weight. In conditions of low carbohydrate intake or fasting, the body uses ketones (acetoacetate and beta hydroxybutyrate [BHB]) as an alternative energy source to glucose. Ketones are normally generated in fasting states from beta‐oxidation of adipose stores to maintain cerebral function. In long‐term fasting, ketones can supply > 60% of the brain’s energy requirements, and are preferentially taken up by the brain over glucose. This occurs in cognitively normal younger and older adults, as well as in those with mild cognitive impairment (MCI) and AD.

Ketones can also be induced with a very low carbohydrate high fat (VLCHF) diet. Medium chain triglyceride (MCT) oil has the potential to produce a nutritional source of ketones for an alternative brain fuel to glucose, or by the consumption of MCT oil or esterases in freeze‐dried form. This is independent of the fasting state or carbohydrate intake. Long‐term compliance with fasting or VLCHF and LCHF diet regimes is challenging and requires strict medical supervision. Hence, the potential advantage of nutritional ketone sources (MCT) over these restrictive diets. Our recent study showed a clear dose‐dependent effect on ketone (BHB) generation with varying doses of MCT supplementation, and was found to be equivalent in young, elderly, and AD subjects.

In Alzheimer Disease (AD), the brain is unable to use glucose normally, causing hypofunction of 20% to 40% in key areas of the brain responsible for the symptoms in AD.


The MCT oil used was Bulletproof Brain Octane ® (NPN 80057199). Are other MCT oils just as good? Hell if I know. The goal dose was three tablespoons (15 ml) daily. My sense is that it was recommended as one tablespoon (15 ml) three times daily. The average consumption ended up as two tablespoons daily. Caregivers were in charge of dosing and they tended to forget or omit the lunchtime dose. Some study participants had limited dosing due to MCT side effects: abdominal pain, diarrhea, or vomiting.

Conclusion:

This study shows that participants taking MCT supplementation for 11 months continuously did better cognitively than their peers who had their 11 months of MCT interrupted by 4 months of placebo (olive) oil. Given that most patients should experience a drop in their cognitive scores over the 15 months, the fact that those on longer continuous MCT did not, could be a sample size error for the outcomes other than Montreal Cognitive Assessment, but it could also be that the difference in scores (showing stability) is valid.

In other words, MCT oil didn’t improve cognition, but stabilized it. I.e., it prevented the usual expected decline over time.

Steve Parker, M.D.

h/t The Low Carb Diabetic

PS: Another way to provide ketones to the brain is a ketogenic diet. My book has one.

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R.I.P.: Dr Sarah Hallberg, a Low-Carb Hero

I was saddened to hear of the untimely death of Dr Sarah Hallberg even though I didn’t know her personally. DietDoctor has a tribute article about her in case you’re not familiar. An excerpt:

Dr. Hallberg first burst onto the low carb scene with a 2015 TED Talk: “Reversing type 2 diabetes starts with ignoring the guidelines” The video advocated using a low carb diet – eating minimally unprocessed whole foods like eggs, meat, and vegetables with butter or cheese – to improve blood sugar and reverse diabetes symptoms.

The video went viral and has now had more than 8.6 million views. As news of her passing spread, hundreds of viewers posted on the site saying how her advice had saved their lives.

Steve Parker, M.D.

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Will Alcohol Sabotage a Ketogenic Diet?

“Is the room spinning, or is it just me?”

Judicious alcohol consumption is a reasonable component of many successful ketogenic diets. But the practice can also be a dangerous minefield. Anne Mullins over at DietDoctor has a great article that will steer you away from the mines. An excerpt:

Nyström notes that alcohol is actually the fourth macronutrient after protein, fats and carbohydrates, and that in many nutrition studies its intake is often overlooked. In Mediterranean countries like Greece and Italy, alcohol makes up about 10 % of caloric intake and may partially contribute to the touted benefits of the Mediterranean diet, Nyström says.

Drinking alcohol, however, may slow weight loss for some. Dr. Sarah Hallberg advises her patients who are trying to lose weight and/or reverse diabetes to have a maximum 1 glass of wine for women and 2 for men, and not every day. “If they experience any weight stall, I recommend they stop the alcohol completely,” says Hallberg.

Both Dr. Jason Fung and Dr. Ted Naiman discourage any alcohol use among patients in their care who are still trying to lose weight, reverse diabetes or heal a fatty liver (see point 5). “I find alcohol is not conducive to steady weight loss,” says Fung.

Read the whole thing to learn about the dopamine reward system, alcohol abuse and addiction, liver diseases, and worse hangovers. If you regularly drink to the point of hangovers, that’s too much alcohol!

Steve Parker, M.D.

PS: Conquer Diabetes and Prediabetes includes a doctor-designed ketogenic diet as one option for weight loss and diabetes management.

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Can a Low-Carb Diet Be Sustained for Five Years?

Registered Dietitian Joy Kiddie has a blog post summarizing the results of her five-year low-carb journey.

It start thusly:

Tomorrow is March 5th and it is five years since I began my personal health and weight recovery journey that I’ve dubbed “A Dietitian’s Journey“.  While it began in 2017, in a way it still continues today and that is the point behind this post. 

Five years ago, I was obese, had type 2 diabetes for the previous 8 years, and had developed dangerously high blood pressure. 

Recommended. You’ll find out if low-carb eating put her diabetes into remission.

Steve Parker, M.D.

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Which is Healthier: Low-Cal Mediterranean Diet Or High-Protein Non-Mediterranean

Judicious wine consumption is one component of the traditional healthy Mediterranean diet

Researchers compared three low-calorie diets and concluded that the Mediterranean option was the healthiest. The study at hand today is way too small to be considered anything but a pilot study. So results may not be replicable on a larger scale. I’d like to know how compliant study subjects were with the protocol, because 700 calories a day for six weeks is quite a challenge.

Link to article article

Comparison of short-term hypocaloric high-protein diets with a hypocaloric Mediterranean diet: Effect on body composition and health-related blood markers in overweight and sedentary young participants

Highlights

A hypocaloric Mediterranean diet provides all the necessary nutrients.

The hypocaloric Mediterranean diet reduces body mass and fat mass and maintains fat-free mass.

The hypocaloric Mediterranean diet is beneficial on metabolic and inflammation/muscle- damage indices.

Hypocaloric high-protein diets with and without whey supplementation reduce body mass and fat-free mass but not fat mass.

Hypocaloric high-protein diets with and without whey supplementation are adverse on metabolic and inflammation/muscle-damage indices

Abstract

Objectives

The aim of the present study was to compare the short-term effects of a hypocaloric Mediterranean diet and two high protein diets, with and without whey protein supplementation, on body composition, lipidemic profile, and inflammation and muscle-damage blood indices in overweight, sedentary, young participants.

Methods

Thirty-three young, overweight, male and female participants (mean ± SD age: 22.8 ± 4.8 y; body mass: 85.5 ± 10.2 kg; body fat percentage: 34.3% ± 8.1%) were randomly allocated to three different hypocaloric (−700 kcal/d) diets: a Mediterranean diet (MD; n = 10), a high-protein diet (HP; n = 10) diet, and a high-protein diet with whey supplementation (n = 10). The intervention lasted 6 wk. Body composition and biochemical indices were evaluated 1 wk before and after the nutritional interventions.

Results

Body and fat mass were decreased in the MD and HP groups (−3.5% ± 1.1% and −5.9% ± 4.2% for body and fat mass respectively in MD, and −1.7% ± 1.2% and −2.0% ± 1.8% for body and fat mass respectively in HP;P < 0.05), with no significant decline of fat-free mass observed in the MD group. The MD group’s diet beneficially altered the lipid profile (P < 0.05), but the HP and HPW groups’ diets did not induce significant changes. Subclinical inflammation and muscle-damage indices significantly increased in the HP and HPW groups (7.4% ± 3.5% and 66.6% ± 40.1% for neutrophils and CRP respectively in HP, and 14.3% ± 6.4% and 266.6% ± 55.1% for neutrophils and CRP respectively in HPW; P < 0.05) but decreased in the MD group (1.8% ± 1.2% and −33.3% ± 10.1% for neutrophils and CRP respectivelyc; P < 0.05). Energy intake of carbohydrates and proteins were significantly related to the changes in body composition and biochemical blood markers (r = −0.389 and −0.889; P < 0.05).

Conclusions

Among the three hypocaloric diets, only the Mediterranean diet induced positive changes in body composition and metabolic profile in overweight, sedentary individuals.


Steve Parker, M.D.

PS: I haven’t read the full report and don’t plan to any time soon.

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Cataract Surgery Linked to Lower Risk of Dementia

Photo of the retina at the back of the eyeball. Light hitting here must traverse the lens, where cataracts form.

From JAMA Network, December 2021:


Association Between Cataract Extraction and Development of Dementia

Question  Is cataract extraction associated with reduced risk of developing dementia?

Findings  In this cohort study assessing 3038 adults 65 years of age or older with cataract enrolled in the Adult Changes in Thought study, participants who underwent cataract extraction had lower risk of developing dementia than those who did not have cataract surgery after controlling for numerous additional risks. In comparison, risk of dementia did not differ between participants who did or did not undergo glaucoma surgery, which does not restore vision.

Meaning  This study suggests that cataract extraction is associated with lower risk [~30% less] of developing dementia among older adults.

Importance  Visual function is important for older adults. Interventions to preserve vision, such as cataract extraction, may modify dementia risk.


Details in the abstract:

Objective  To determine whether cataract extraction is associated with reduced risk of dementia among older adults.

Design, Setting, and Participants  This prospective, longitudinal cohort study analyzed data from the Adult Changes in Thought study, an ongoing, population-based cohort of randomly selected, cognitively normal members of Kaiser Permanente Washington. Study participants were 65 years of age or older and dementia free at enrollment and were followed up biennially until incident dementia (all-cause, Alzheimer disease, or Alzheimer disease and related dementia). Only participants who had a diagnosis of cataract or glaucoma before enrollment or during follow-up were included in the analyses (ie, a total of 3038 participants). Data used in the analyses were collected from 1994 through September 30, 2018, and all data were analyzed from April 6, 2019, to September 15, 2021.

Exposures  The primary exposure of interest was cataract extraction. Data on diagnosis of cataract or glaucoma and exposure to surgery were extracted from electronic medical records. Extensive lists of dementia-related risk factors and health-related variables were obtained from study visit data and electronic medical records.

Main Outcomes and Measures  The primary outcome was dementia as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Multivariate Cox proportional hazards regression analyses were conducted with the primary outcome. To address potential healthy patient bias, weighted marginal structural models incorporating the probability of surgery were used and the association of dementia with glaucoma surgery, which does not restore vision, was evaluated.

Results  In total, 3038 participants were included (mean [SD] age at first cataract diagnosis, 74.4 (6.2) years; 1800 women (59%) and 1238 men (41%); and 2752 (91%) self-reported White race). Based on 23 554 person-years of follow-up, cataract extraction was associated with significantly reduced risk (hazard ratio, 0.71; 95% CI, 0.62-0.83; P < .001) of dementia compared with participants without surgery after controlling for years of education, self-reported White race, and smoking history and stratifying by apolipoprotein E genotype, sex, and age group at cataract diagnosis. Similar results were obtained in marginal structural models after adjusting for an extensive list of potential confounders. Glaucoma surgery did not have a significant association with dementia risk (hazard ratio, 1.08; 95% CI, 0.75-1.56; P = .68). Similar results were found with the development of Alzheimer disease dementia.

Conclusions and Relevance  This cohort study found that cataract extraction was significantly associated with lower risk of dementia development. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.


What else reduces risk of dementia? The Mediterranean Diet!

Steve Parker, M.D.

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Semaglutide Beats Liraglutide for Weight Loss

How much does it cost?

Semaglutide and liraglutide are drugs that were developed to treat diabetes and are FDA-approved for that. They are given by subcutaneous injection. Semaglutide is also FDA-approved for weight loss in non-diabetics if certain conditions are met.

Once-weekly semaglutide outperformed daily liraglutide in overweight and obese non-diabetics.

From JAMA Network:

Question Among adults with overweight or obesity without diabetes, what is the effect of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg, on weight loss when each is added to counseling for diet and physical activity?

Findings In this randomized clinical trial that included 338 participants, mean body weight change from baseline to 68 weeks was –15.8% with semaglutide vs –6.4% with liraglutide, a statistically significant difference.

Meaning Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide, compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity resulted in significantly greater weight loss at 68 weeks.

For prevention or improvement of overweight- and obesity-related illnesses, aim for loss of at least 5 to 10% of body weight. Assuming you’re overweight or obese in the first place. 16% body weight change is significant. 16% of 300 pounds (136 kg) would be 48 pounds (22 kg).

Steve Parker, M.D.

PS: My book’s less expensive than those drugs. And no needles!

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