Category Archives: Uncategorized

Are You PWT1D or PWT2D?

A decade ago, some folks began to object to being called diabetics. Instead, they proposed “person with diabetes” or “people with diabetes.” Or simply PWD.

Given the major differences between type 1 and type 2 diabetes, I now propose PWT1D (person or people with type 1 diabetes) and PWT2D.

And so no one’s left out: PWLADA. Person with Latent Autoimmune Diabetes in Adulthood.

Whadda u think?

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

 

5 Comments

Filed under Uncategorized

U.S. Youths at Risk for Type 2 Diabetes and Prediabetes

Great exercise, but with risk of concussions, broken bones, and torn menisci

Obesity is a risk factor for type 2 diabetes in adults and also plays a significant role in the development of the disease at younger ages. Obesity is highly prevalent among US adolescents and young adults. Many adolescents and young adults with obesity already have blood sugar metabolism abnormalities, which is of great public health concern in view of the sharp increase in type 2 diabetes in adolescence.

From JAMA Network:

In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016 | Adolescent Medicine | JAMA Pediatrics | JAMA Network

Steve Parker, M.D.

PS: Regular exercise and loss of excess fat weight are two great ways to prevent both prediabetes and type 2 diabetes. They also help with treatment.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

 

1 Comment

Filed under Uncategorized

Improve Your Diet Quality With Salads

A masterpiece by Sunny Parker

I’m not generally a fan of U.S. federal government committee recommendations on what we should eat. They’ve led us astray before. For what it’s worth, the USDA and National Cancer Institute have put together a Healthy Eating Index. Salad-eaters score higher on the Index. I do believe the best salads are better than the crap most Americans eat.

From the Journal of the Academy of Nutrition and Dietetics:

Abstract

Background

Consuming salad is one strategy with the potential to harmonize diets more closely with national dietary guidance. However, it is not known whether nutrient intake and diet quality differ between people who consume vegetable-based salad and those who do not.

Objective

The objective of this study was to compare nutrient intake and diet quality between salad reporters and nonreporters.

Design

This study is a cross-sectional analysis of 1 day of dietary intake data collected via 24-hour recall.

Participants/setting

Adults 20 years and older (n=9,678) in What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 were included. Respondents who ate salad on the intake day were considered salad reporters.

Main outcome measures

This study estimated nutrient intake from all foods and beverages (excluding supplements) and evaluated diet quality using the Healthy Eating Index (HEI) 2015.

Statistical analyses

Nutrient intake and HEI scores were compared between salad reporters and nonreporters using paired t tests with regression adjustment for confounding variables. Results were considered significant at P<0.001.

Results

On the intake day, 23% of adults consumed salad. Energy, protein, and carbohydrate intakes did not differ between salad reporters and nonreporters. Salad reporters had higher intakes than nonreporters of dietary fiber, total fat, unsaturated fatty acids, vitamins A, B-6, C, E, K, folate, choline, magnesium, potassium, and sodium (P<0.001). Total HEI 2015 scores were significantly higher for reporters (56 of a possible 100 points) than nonreporters (50 points) P<0.001. Reporters also had significantly higher scores for eight of 13 HEI components: total vegetables, greens and beans, whole fruits, total protein foods, seafood and plant proteins, fatty acids, refined grains, and added sugars (P<0.001).

Conclusions

Incorporating vegetable-based salad into one’s diet may be one effective way to increase nutrient intake and improve overall diet quality. Regardless of salad reporting status, HEI scores show that diets of US adults need improvement.

Source: Consuming Vegetable-Based Salad Is Associated with Higher Nutrient Intakes and Diet Quality among US Adults, What We Eat in America, National Health and Nutrition Examination Survey 2011-2014 – Journal of the Academy of Nutrition and Dietetics

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

1 Comment

Filed under Uncategorized

Intermittent fasting improved health in new study 

One way to break your fast

Eating within a 10-hour window shouldn’t be too hard. Breakfast at 7 AM, finish dinner by 5 PM. That’s  right, we don’t need to be eating every 3–4 hours. Do you think our ancestors have been eating three meals a day for the last 200,000 years? I don’t. The probably went 24–48 hrs without much food on a regular basis.

From LA Times:

In an early effort to explore the benefits of daily fasting in humans, researchers have found that people who are at high risk of developing diabetes improved their health in myriad ways when they ate all of their meals over a span of just over 10 hours, then fasted for the remainder of their 24-hour day.

Source: Variant of intermittent fasting improved health in new study – Los Angeles Times

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

1 Comment

Filed under Uncategorized

Not Into Salads? Try This!

Salad and cheese

Jan over at Low Carb Diabetic has a great post on building a salad from the ground up.

“Salads make a nutritious and satisfying meal, whether it’s for lunch or dinner. The best part is that no two salads are exactly the same. There are limitless ways to make salad unique and flavourful. Get some tips for what to add to your next salad….”

Source: The Low Carb Diabetic: Super Salads – Some Tips for Building A Better Salad

Click for my nutritional assessment of various salad greens. Variety is also important.

Steve Parker, M.D.

1 Comment

Filed under Uncategorized

Science Skepticism

 

“You can’t tell whether I’m lying, delusional, ignorant, or simply incompetent. Sometimes even I don’t know!”

I ran across a 2016 article by Callie Joubert that summarizes skeptical ideas I’ve read about for years, but most people and physicians don’t know about. Bottom line: scientific research and medical studies aren’t nearly as reliable as you think.

Read the whole thing, but here are some excerpts:

We tend to think of science as a dispassionate (impartial, neutral) search for truth and certainty. But is it possible that we are facing a situation in which there is a massive production of wrong information or distortion of information? Is it possible that certain scientific disciplines are facing a crisis of credibility? Mounting evidence suggests this is indeed the case, which raises two questions: How serious is the problem? And what could explain this?

***

The title of an editorial in the prestigious medical journal The Lancet, dated April 6, 2002, asks the question, “Just How Tainted Has Medicine Become?”4 The article states, “Heavily, and damagingly so, is the answer.” Among other things, in 2001, researchers completed experiments with biotechnology products in which they had a direct financial interest and doctors did not tell their patients that others had died using these products when safer alternatives were available. In the same journal, dated April 11, 2015, Dr. Richard Horton stated the gravity of the problem as follows: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue . . . science has taken a turn towards darkness.”

In 2004, under the heading of “Depressing Research,” the editor of The Lancet had this to say about antidepressants for children: “The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure. . . . In a global medical culture where evidence-based practice is seen as the gold standard for care, these failings [i.e., of the USA Food and Drug Administration to act on information provided to them about the harmful effects of these drugs on children] are a disaster.”6 After being editor of the New England Journal of Medicine for 20 years, Dr. Marcia Angell stated that “physicians can no longer rely on the medical literature for valid and reliable information.”7 She referred to a study of 74 clinical trials of antidepressants that indicates that 37 of 38 positive studies were published. In contrast, 33 of the 36 negative studies were either not published or published in a form that conveyed a positive outcome. She also mentions the fact that drug companies are financing “most clinical research on the prescription drugs, and there is mounting evidence that they often skew the research they sponsor to make their drugs look better and safer.”

In 2011, researchers at Bayer decided to test 67 recent drug discoveries on preclinical cancer biology research. In more than 75 percent of cases, the published data did not match their attempts to replicate them.8 In 2012, a study published in Nature announced that only 11 percent of the sampled preclinical cancer studies coming out of the academic pipeline were replicable.9

In the prestigious Science journal, in 2015, the Open Science Collaboration10 presented a study of 100 psychological research studies that 270 contributing authors tried to replicate. An astonishing 65 percent failed to show any statistical significance on replication, and many of the remainder showed greatly reduced effect sizes. In plain terms, evidence for original findings is weak.

***

A discovery in physics, the hardest of all hard sciences, is usually thought of as the most reliable in the world of science. However, two of the most vaunted physics results of the past few years—“cosmic inflation and gravitational waves at the BICEP2 experiment in Antarctica, and the supposed discovery of superluminal neutrinos at the Swiss-Italian border—have now been retracted, with far less fanfare than when they were first published.”

***

Parker here again….

The science skeptic best known to physicians is John P.A. Ioannidis:

Empirical evidence from diverse fields suggests that when efforts are made to repeat or reproduce published research, the repeatability and reproducibility is dismal.

Another quote form Ioannidis:

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

Ioannidis again:

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision‐making.

If you like videos, here’s Ioannidis on YouTube.

Staying skeptical,

Steve Parker, M.D.

h/t Vox Day

 

1 Comment

Filed under Uncategorized

ADA Nutrition Conference in 2019: Low-Carb Eating on the Rise

Spaghetti squash with parsley, olive oil, snow peas, garlic, salt, pepper

I’m astounded by how many people with diabetes I meet who pretty much eat whatever they want. Others, when I ask if they’re on a particular diet, say, “I watch what I eat.” Which usually just means avoiding obvious sugar bombs.

The American Diabetes Association in 2019 hosted a conference on nutrition therapy for diabetes. I assume the ADA endorses the panel’s recommendations. The big news is continued movement toward carb-restricted eating. Some excerpts:

Today, there is strong evidence to support both the efficacy and cost-effectiveness of nutrition therapy as a key component of integrated management of individuals with diabetes. This is increasingly relevant as it is evident that “one-size-fits-all” eating plan is not suitable for prevention or management of diabetes, also considering diverse cultural backgrounds, personal preferences, comorbidities, and socioeconomic settings. The American Diabetes Association (ADA) is now emphasizing that medical nutrition therapy (MNT) is fundamental for optimal diabetes management, and the new report also includes information on prediabetes.

***

One of the key recommendations is to refer adults living with type 1 or type 2 diabetes to individualized, diabetes-focused MNT [medical nutrition therapy] at diagnosis and as needed throughout the life span, particularly during times of changing health status to achieve treatment goals.

           ***

The new consensus recommendations consider that a variety of eating patterns are acceptable for the management of diabetes.

In the absence of additional strong evidence on the comparative benefits of different eating patterns in specific individuals, healthcare providers should focus on the key factors that are common among the patterns, including emphasizing non-starchy vegetables, minimizing added sugars and refined grains, and preferring whole foods over highly processed foods.

Reducing overall carbohydrate intake for individuals with diabetes is associated with the most evidence for improving glycemia and may be applied in a variety of eating patterns.

For selected adults with type 2 diabetes who are not meeting glycemic targets or where reducing anti-glycemic medications is a priority, reducing overall carbohydrate intake with low or very low carbohydrate eating plans is also a viable approach.

***

Regarding weight loss in overweight or obese folks with diabetes or prediabetes:

…a low carbohydrate diet is now recognized as a safe, viable, and important option for patients with diabetes, and the other is that greater emphasis is now placed on weight loss in patients who are overweight/obese for the prevention of diabetes and its treatment.

Indeed, in type 2 diabetes, 5% weight loss is recommended to achieve clinical benefits, with a goal of 15%, when feasible and safe, in order to achieve optimal outcomes.

In prediabetes, the goal is 7–10% for preventing progression to type 2 diabetes.

“Metabolic surgery,” better known as bariatric surgery, and medication-assisted weight loss (aka weight-loss drugs) should be considered in some cases.

***

Best approach for optimizing blood sugars:

For macronutrients, the available evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with or at risk for diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

[Self-monitoring of carbohydrate consumption is important.]

People with diabetes and those at risk for diabetes are encouraged to consume at least the amount of dietary fiber recommended for the general population; increasing fiber intake, preferably through food (vegetables, pulses (beans, peas, and lentils), fruits, and whole intact grains) or through dietary supplement, may help in modestly lowering HbA1C.

***

What about sugar-sweetened beverages?

Firstly, sugar-sweetened beverages should be replaced with water as often as possible.

Secondly, if sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources.

***

Is alcohol forbidden? No.

…educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended.

To reduce hypoglycemia risk, the importance of glucose monitoring after drinking alcohol beverages should be emphasized.

Steve Parker, M.D.

PS: I note that William Yancy, M.D., was on the expert panel.

PPS: Bold emphasis above is mine.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

5 Comments

Filed under Uncategorized