Category Archives: Fat in Diet

Control Blood Sugar With Extra-Virgin Olive Oil

Steve Parker MD, Advanced Mediterranean DIet

Naturally low-glycemic index Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Italian researchers found that extra-virgin olive oil taken with meals helps to reduce blood sugar elevations after meals in type 1 diabetics. This may help explain the lower observed incidence of diabetes seen in those eating a traditional Mediterranean diet, which is rich in olive oil.

Before going further into the weeds, remember that glycemic index refers to how high and quickly a particular food elevates blood sugar. High-glycemic index foods raise blood sugar quicker and higher compared to low-glycemic index foods.

The study at hand is a small one: 18 patients. They were given both high- and low-glycemic meals with varying amounts and types of fat. Meals were either low-fat, high in saturated fat (from butter), or high in monounsaturated fat from olive oil. Meals that were high-glycemic index resulted in lower after-meal glucose levels if the meal had high olive oil content, compared to low-fat and butter-rich meals.

If meals were low in glycemic index, blood sugar levels were about the same whether the diet was low-fat, high in saturated fat, or rich in olive oil.

Action Plan

If you have type 1 diabetes and plan on eating high on the glycemic index scale, reduce your blood sugar excursions by incorporating extra-virgin olive oil into your meals.

Steve Parker, M.D.

Reference: Bozzetto, Luigarda, et al. Extra-virgin olive oil reduces glycemic response to a high-glycemic index meal in patients with type 1 diabetes: a randomized controlled trial. Diabetes Care, online before print, February 9, 2016. doi: 10.2337/dc15-2189

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Filed under Fat in Diet, Glycemic Index and Load

Ghee is making a comeback, at least in India

Also known as clarified butter, ghee is a traditional food in India. I’ve been reading about it for several years but I haven’t tried it yet.

From Times of India:

“Clarified butter remained India’s culinary star for centuries till it was sidelined in the 1980s by vegetable oils because of its high saturated fat. The new oils were aggressively marketed as superior and heart-healthy. Of late, research has shown that saturated fats have no link to obesity, heart disease or early death. In January 2015, the US dietary guidelines declared for the first time that total dietary fat and cholesterol intake are not a concern for healthy people. Now, on the back of some recent studies which maintain that it reduces fat and lower cholesterol, ghee too is making a big comeback in India. It is also making a splash abroad in alternative health circuits.”

Source: Ghee with glee – Times of India

You can make your own ghee. Alton Brown has a recipe, as does Michelle Tam.

If you still think saturated fat is bad, here’s the research proving otherwise.

Steve Parker, M.D.

PS: If you fear saturated fat, rest assured there’s none in my books.

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Should You Reduce Saturated Fat Consumption If You Have Heart Disease?

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Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years

For the bulk of my medical career, physicians thought that saturated fat caused heart disease, specifically coronary artery disease and heart attacks. Most doctors still think that. In 2009, I spent 80 hours reviewing the scientific literature supporting the saturated fat/heart disease connection. The evidence was very weak, if not nonexistent.

But what if you are already a heart disease patient? Would continuing saturated fat consumption have any effect on your longevity and risk of future heart attacks? If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.

Dr. Sigurdsson is a cardiologist in Iceland.

Some quotes from his blog:

For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.

The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.

*   *   *

Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.

Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.

It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.

Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.

These recent scientific data don’t imply that we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.

So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.

On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.

It appears the jury is still out…

RTWT.

Steve Parker, M.D.

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Filed under Fat in Diet, Heart Disease

Major U.S. Diet Changes over the Last 100 Years

Medical student Kris Gunnars has an article at Business Insider, of all places, that shows graphically many of the major U.S. dietary changes of the last hundred years. In this case, transmogrification may be a better term than mere “changes.” Much of the Western world has evolved in similar fashion.

You need to read the article and ponder the graphs if you question why we have so much obesity, type 2 diabetes, heart disease, hypertension, and perhaps cancer. You’ll see dramatic increases in consumption of added sugars, industrial seed oils (esp. soybean), soda pop and fruit juice (added sugar!), total calories, and fast food. You’ll see how much we’ve increased dining away from home. Butter consumption is down drastically, but doesn’t seem to have done us much good, if any.

Sugar cane

Sugar cane

 

There’s fairly good evidence that coronary artery disease (CAD) the cause of most heart attacks) was very prominent between 1960 to 2000 or so, but it’s been tapering off in recent years and didn’t seem to be very common 100 years ago. Understand that you can have it for 20 years or more before you ever have symptoms (angina) or a heart attack from it. In fact, the disease probably starts in childhood. I’ve always wondered about the cause of the CAD prevalence trends, and wondered specifically how much of the long-term trend was related to trans-fat consumption. But I’ve never been able to find good data on trans-fat consumption. Kris came up with a chart of margarine consumption, which may be a good proxy for trans-fats. Another of his charts includes shortening, a rich source of trans-fats and probably also a good proxy. I remember growing up in the 1960s that we always had a 1/2 gallon tin can of Crisco hydrogenated fat in the cupboard. Shortening consumption increased dramatically from 1955 until dropping like a rock around 2000.

The timeline curves for trans-fat consumption (by proxy) and prevalence of coronary heart disease seem to match up fairly well, considering a 20 year lag. In the early 1990s, we started cutting back on trans-fats, and here we are now with lower mortality and morbidity from coronary artery disease. (CAD is very complex; lower rates of smoking surely explain some of the recent trend.)

Read the whole enchilada. Very impressive. Highly recommended.

Steve Parker, M.D.

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Filed under Causes of Diabetes, coronary heart disease, Fat in Diet, Heart Disease

Supplemental Omega-3 Fats’ Effect on Heart Disease, Stroke, Cancer, and Death: No Relationship In a General Population

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

I’ve been sitting on this research report a few years, waiting until I had time to dig into it. That time never came. The full report is free online (thanks, British Medical Journal!). I scanned the full paper to learn that nearly all the studies in this meta-analysis used fish oil supplements, not the cold-water fatty fish the I recommend my patients eat twice a week.

Here’s the abstract:

Objective: To review systematically the evidence for an effect of long chain and shorter chain omega 3 fatty acids on total mortality, cardiovascular events, and cancer.

Data sources: Electronic databases searched to February 2002; authors contacted and bibliographies of randomised controlled trials (RCTs) checked to locate studies.

Review methods Review of RCTs of omega 3 intake for 3 6 months in adults (with or without risk factors for cardiovascular disease) with data on a relevant outcome. Cohort studies that estimated omega 3 intake and related this to clinical outcome during at least 6 months were also included. Application of inclusion criteria, data extraction, and quality assessments were performed independently in duplicate.

Results: Of 15 159 titles and abstracts assessed, 48 RCTs (36 913 participants) and 41 cohort studies were analysed. The trial results were inconsistent. The pooled estimate showed no strong evidence of reduced risk of total mortality (relative risk 0.87, 95% confidence interval 0.73 to 1.03) or combined cardiovascular events (0.95, 0.82 to 1.12) in participants taking additional omega 3 fats. The few studies at low risk of bias were more consistent, but they showed no effect of omega 3 on total mortality (0.98, 0.70 to 1.36) or cardiovascular events (1.09, 0.87 to 1.37). When data from the subgroup of studies of long chain omega 3 fats were analysed separately, total mortality (0.86, 0.70 to 1.04; 138 events) and cardiovascular events (0.93, 0.79 to 1.11) were not clearly reduced. Neither RCTs nor cohort studies suggested increased risk of cancer with a higher intake of omega 3 (trials: 1.07, 0.88 to 1.30; cohort studies: 1.02, 0.87 to 1.19), but clinically important harm could not be excluded.

Conclusion: Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.

Reference: Hooper, Lee et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ  2006;332:752-760 (1 April), doi:10.1136/bmj.38755.366331.2F (published 24 March 2006).

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Filed under coronary heart disease, Diabetes Complications, Fat in Diet, Fish, Heart Disease, Longevity, Stroke

Low-Carb Diet Improves Glucose Control in Japanese Type 2 Diabetics

Mt. Fuji in Japan

Mt. Fuji in Japan

I don’ know anything about Japanese T2 diabetes. I’ve never studied it. Their underlying physiology may or may not be the same as in North American white diabetics, with whom I am much more familiar.

For what it’s worth, a small study recently found improvement of blood sugar control and triglycerides in those on a carbohydrate restricted diet versus a standard calorie-restricted diet.

Only 24 patients were involved. Half were assigned to eat low-carb without calorie restriction; the other half ate the control diet. The carbohydrate-restricted group aimed for 70-130 grams of carb daily, while eating more fat and protein than the control group. The calorie-restricted guys were taught how to get 50-60% of calories from carbohydrate and keep fat under 25% of calories. At the end of the six-month study, the low-carbers were averaging 125 g of carb daily, compare to 200 g for the other group. By six months, both groups were eating about the same amount of calories.

Average age was 63. Body mass index was 24.5 in the low-carb group and 27 in the controls. (If you did the research, I bet you’d find Japanese T2 diabetics have lower BMIs than American diabetics.) All were taking one or more diabetes drugs.

The calorie-restricted group didn’t change their hemoglobin A1c (a standard measure of glucose control) from 7.7%. The low-carb group dropped their hemoglobin A1c from 7.6 to 7.0% (statistically significant). The low-carb group also cut their triglycerides by 40%. Average weights didn’t change in either group.

Bottom Line

This small study suggests that mild to moderate carbohydrate restriction helps control diabetes in Japanese with type 2 diabetes. The improvement in hemoglobin A1c is equivalent to that seen with initiation of many diabetes drugs. I think further improvements in multiple measures would have been seen if carbohydrates had been restricted even further.

Steve Parker, M.D.

Link to reference.

h/t Dr Michael Eades

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Filed under Carbohydrate, Fat in Diet

Can You Manage Your Type 2 Diabetes Without Drugs?

David Mendosa says you can. I’m not quite that optimistic, but probably a majority can, if they have the knowledge, discipline, and willpower. Here are some snippets from David’s blog:

You can use drugs to bring your A1C level down to normal. That’s a good thing. But this strategy does have its costs, and those costs aren’t just money out of your pocket or your checkbook. The worst of those costs are the potential side effects of the drugs.

***

But some of us think we have a safer strategy of managing our diabetes without drugs. Back in 2007 I joined this group with the encouragement of a good friend of mine who is a Certified Diabetes Educator. Before that, I had 14 years of experience taking a wide range of diabetes drugs, including two different sulfonylureas (Diaßeta and Amyrl), Glucophage (metformin), and Byetta. For the past six years I haven’t taking any diabetes drugs, and yet I keep my diabetes in control with an A1C level usually about 5.4.

I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways. The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had (1) to lose weight, (2) eat fewer carbohydrates, and (3) exercise more.

Read the whole enchilada. It’s brief.

Steve Parker, M.D.

 

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Filed under Exercise, Fat in Diet