How Can You Achieve Great Hemoglobin A1c Results?

How old is this device?

The good folks over at Diabetes Daily conducted a survey of people with diabetes to find out what they were doing to get good HgbA1c levels. HgbA1c is a measure of average blood sugar levels over the prior three months. Lower HgbA1c levels, generally speaking, are linked to fewer diabetes complications. Prevention is always better than treatment. If you run across someone succeeding at anything, wouldn’t you want to know how they do it, assuming it’s a goal you share?  I recommend the entire report to you. An excerpt:

Type 2 Diabetes

Those in the lower A1c bracket (<6.5%) are significantly more likely than those with a higher A1c (>8%) to:

  • Eat a very low-carbohydrate diet (<40 g per day): 32% vs. 13%
  • Eat a ketogenic diet (<20 g per day): 13% vs. 0%
  • Not vary their daily carbohydrate intake: 16% vs. 29%
  • Eat a low-carbohydrate lunch (<20 g) on a regular basis: 50% vs. 28%
  • Use an insulin pump: 10% vs. 3%
  • Vary the timing of their meal-time insulin: 53% vs. 40%
  • Exercise: Daily: 14% vs 8%. Exercise 4-6 times per week: 20% vs 8%.Exercise less than once per week: 51% vs 73%
  • Feel very confident about their diabetes management skills: 69% vs. 26%
  • Feel very optimistic about their long-term health: 58% vs. 30%
  • Feel that diabetes doesn’t greatly interfere with their daily life: 56% vs. 19%
  • Report a high degree of socioemotional support related to diabetes: 59% vs. 46%

Type 1 Diabetes

Those in the lower A1c bracket (<6.5%) are significantly more likely than those with a higher A1c (>8%) to:

  • Eat a very low-carbohydrate diet (<40 g per day): 22% vs. 7%
  • Not vary their daily carbohydrate intake: 9% vs. 28%
  • Use an insulin pump: 71% vs. 53%
  • Wear a continuous glucose monitor (CGM): 76% vs. 60%
  • Have lower “high glucose alert” setting on their CGM
  • Have lower “low glucose alert” settings on their CGM
  • Not vary the timing of their meal-time insulin: 43% vs. 59%
  • Incorporate the protein content of their meal in determining their bolus insulin dose: 44% vs. 23
  • Eat similar food every day, at similar times, AND limit eating out at restaurants: 20% vs. 7%
  • Exercise: Daily: 21% vs 11%. Exercise 4-6 times per week: 24% vs 8%. Exercise less than once per week: 40% vs 66%
  • Feel very confident about their diabetes management skills: 82% vs. 39
  • Feel very optimistic about their long-term health: 59% vs. 42el that diabetes doesn’t greatly interfere with their daily life: 35% vs. 21%
  • Report a high degree of socioemotional support related to diabetes: 68% vs. 56%

Source: Habits of a Great A1c Survey Data Report – Diabetes Daily

Lead researcher was Maria Muccioli, PhD.

Steve Parker, M.D.

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Which Diet Improves Insulin Resistance Better: Alternate-Day Fasting or Daily Calorie Restriction?

Horses, like Java, also get Metabolic Syndrome but it’s not quite the same as in humans. Java had to lose weight and change his diet.

Body tissue resistance to the effect of insulin is considered harmful by many experts. For instance, it may contribute to obesity, high blood pressure, type 2 diabetes, and cancer. BTW, if you have Metabolic Syndrome, you probably have insulin resistance. Regular exercise and loss of excess body fat are two ways  to reduce insulin resistance. Fasting also has an effect, but is it better than daily calorie restriction?

From a small study in the journal Obesity:

ABSTRACT

Objective

This study compared the effects of alternate‐day fasting (ADF) with those of daily calorie restriction (CR) on body weight and glucoregulatory factors in adults with overweight or obesity and insulin resistance.

Methods

This secondary analysis examined the data of insulin‐resistant individuals (n = 43) who participated in a 12‐month study that compared ADF (25% energy needs on “fast days”; 125% energy needs on alternating “feast days”) with CR (75% energy needs every day) and a control group regimen.

Results

In insulin‐resistant participants, weight loss was not different between ADF (−8% ± 2%) and CR (−6% ± 1%) by month 12, relative to controls (P < 0.0001). Fat mass and BMI decreased (P < 0.05) similarly from ADF and CR. ADF produced greater decreases (P < 0.05) in fasting insulin (−52% ± 9%) and insulin resistance (−53% ± 9%) compared with CR (−14% ± 9%; −17% ± 11%) and the control regimen by month 12. Lean mass, visceral fat mass, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, triglycerides, blood pressure, C‐reactive protein, tumor necrosis factor α, and interleukin 6 values remained unchanged.

Conclusions

These findings suggest that Alternate-Day Fasting may produce greater reductions in fasting insulin and insulin resistance compared with Calorie Restriction in insulin‐resistant participants despite similar decreases in body weight.

Source: Differential Effects of Alternate‐Day Fasting Versus Daily Calorie Restriction on Insulin Resistance – Gabel – – Obesity – Wiley Online Library

It would be interesting to compare the compliance and drop-out rates between the two groups studied. Is a daily 25% calorie deficit easier to stomach than a 75% reduction every other day?

Click for info on Equine Metabolic Syndrome.

Caution: Folks with diabetes who take drug that can cause hypoglycemia may well suffer actual severe hypoglycemia if they reduce their usual daily calories by 75%, or even 25%.

Steve Parker, M.D.

low-carb mediterranean diet

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Is the “Oldest Living Person” Really That Old?

Exercise is a fountain of youth available to every one

In The Blue Zones book, Dan Buettner discusses geographic regions where people live significantly longer than average. Sardinia, for example.

From Vox:

We’ve long been obsessed with the super-elderly. How do some people make it to 100 or even 110 years old? Why do some regions — say, Sardinia, Italy, or Okinawa, Japan — produce dozens of these “supercentenarians” while other regions produce none? Is it genetics? Diet? Environmental factors? Long walks at dawn?

A new working paper released on bioRxiv, the open access site for prepublication biology papers, appears to have cleared up the mystery once and for all: It’s none of the above.

Instead, it looks like the majority of the supercentenarians (people who’ve reached the age of 110) in the United States are engaged in — intentional or unintentional — exaggeration.

Source: Study: many of the “oldest” people in the world may not be as old as we think – Vox

Steve Parker, M.D.

PS: I still think the Mediterranean diet improves longevity.

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What’s a Reasonable Rate of Weight Loss?

paleobetic diet, low-carb, diabetic diet, paleo diet

Java had to lose weight when he developed metabolic syndrome

P.D. Mangan posted a good article on the risks of rapid weight loss. I agree with him that a max of 1–2 pounds a week is a reasonable weight-loss goal, and that a bit more than that is OK in the first week but highly inadvisable for the long run. Most folks do well if they settle into one pound a week.

From P.D.:

Slower Metabolism

A slower metabolism is another side effect of losing weight too quickly; since your body’s metabolism is essentially determining how much fuel you are needing to burn every day based on your activities and food intake, dropping calories out of your diet can considerably lower your metabolism. While this might not seem like a big deal, it is! A lower metabolism essentially causes your body to burn fewer calories each day than it typically would, and some research even shows up to a 23% decrease in calories that are burned each day. This doesn’t always go away when you stop losing weight quickly, either, your metabolism might take a while to get back on track and burning appropriately, which could affect your health and weight for a long time.

Muscle Loss

Lastly, your body could end up losing muscle as part of your quick weight loss routine. Granted, eliminating calories from your diet will have you lose weight, yes, but aside from a lot of that weight being water, some of it can also be muscle. A recent study done with people on a 500 calorie diet versus a 1250 calorie diet showed significant results; by the end of the trial, the participants on the 500 calorie diet lost six times more muscle than those on the 1250 calorie diet – an astounding loss in muscle in just a five-week span of time.

Source: Risks of Losing Weight Too Quickly – Rogue Health and Fitness

Steve Parker, M.D.

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Mediterranean Diet Reduces Need For Diabetes Medications

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Pharmacist counting pills

From Diabetes Care:

OBJECTIVE

To examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications.

RESEARCH DESIGN AND METHODS

From the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation.

RESULTS

After a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62–0.98) for Med-EatPlan + EVOO and 0.89 (0.71–1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68–1.11) for Med-EatPlan + EVOO and 0.89 (0.69–1.14) for Med-EatPlan + nuts compared with the control eating plan.

CONCLUSIONS

Among participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin.

Source: Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial | Diabetes Care

Steve Parker, M.D.

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Mediterranean Diet and Good Blood Sugar Levels Improve Brain Function in Type 2 Diabetes

MRI scan of brain

From Diabetes Care:

CONCLUSIONS

Both adhering to a Mediterranean diet and effectively managing type 2 diabetes may support optimal cognitive function. Healthy diets, in general, can help improve memory function among adults without type 2 diabetes.

Source: The Mediterranean Diet and 2-Year Change in Cognitive Function by Status of Type 2 Diabetes and Glycemic Control | Diabetes Care

Steve Parker, M.D.

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Mediterranean Diet May Prevent Gestational Diabetes

You can’t tell if she has gestational diabetes just by looking

From Newsweek:

Eating a Mediterranean diet while pregnant could prevent women at risk of gestational diabetes from developing the condition, a study has found.The women who took part in the study followed a Mediterranean-style diet, by eating more nuts, extra virgin olive oil, fish, white meat and pulses; while cutting their levels of red meat, butter, margarine, and cream. Researchers also asked the women to avoid sugary drinks, fast food, and those high in animal fats.

Source: Eating Mediterranean Diet During Pregnancy Could Cut Gestational Diabetes Risk: Study

Steve Parker, M.D.

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