Godspeed = May God prosper you
It’s a wonderful holiday for my U.S.A. readers, started by the Pilgrims in 1621.
Godspeed,
—Steve
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Is Your Blood Sugar Meter Accurate?
David Mendosa reviewed some reviews on home blood glucose monitor accuracy and reproducibility. He was motivated by a recent review in Consumer Reports. You’ll want to click through his links for details. The last time I looked into this, I learned that a device could receive FDA approval if it could measure accuracy to within 20% of the actual blood sugar value as determined by a laboratory machine. For a blood sugar of 200 mg/dl (11.1 mmol/l), the home device could give you a value anywhere between 160 and 240 mg/dl (8.9 to 13.3 mmol/l). That doesn’t exactly inspire confidence, does it?
—Steve
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Is Fructose Unfairly Demonized as a Cause of Obesity?
Mainly because of its low cost, HFCS [high fructose corn syrup] consumption replaced approximately one-third of the total sugar consumption in the USA between 1970 and 2000, paralleling to some extent the increasing prevalence of obesity during this period. Consequently, HFCS has been a particular focus of possible blame for the obesity epidemic. However, HFCS consumption has remained very low in other parts of the world where obesity has also increased, and the most commonly used form of HFCS contains about 55% fructose, 42% glucose, and 3% other sugars, and hence is associated with similar total fructose and glucose intakes as with sugar. Furthermore, sucrose is hydrolyzed in the gut and absorbed into the blood as free glucose and fructose, so one would expect HFCS and sucrose to have the same metabolic consequences. In short, there is currently no evidence to support the hypothesis that HFCS makes a significant contribution to metabolic disease independently of the rise in total fructose consumption.
Given the substantial consumption of fructose in our diet, mainly from sweetened beverages, sweet snacks, and cereal products with added sugar, and the fact that fructose is an entirely dispensable nutrient, it appears sound to limit consumption of sugar as part of any weight loss program and in individuals at high risk of developing metabolic diseases. There is no evidence, however, that fructose is the sole, or even the main factor in the development of these diseases…
— Luc Tappy in BMC Biology, May 21, 2012 (the article is a review of fructose metabolism and potential adverse effects of high consumption)
PS: Luc Tappy believes that excessive calorie consumption is an important cause of overweight and obesity.
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Kidney Stones on the Rise
“Ah hah! There it is, stuck in the ureter.”
MedPage Today in May, 2012, reported a substantial increase (70%) in the prevalence of kidney stones in the U.S. over the last two decades. Stone prevalence rose from 5.2% to 8.8% of the population. Prevalence was based on the periodic National Health and Nutrition Examination Survey, which asked participants, “Have you ever had kidney stones?”
Stone prevalence began rising even earlier. Again according to the third NHANES, prevalence increased from 3.8 percent in the period 1976 to 1980 to 5.2 percent in the years 1988 to 1994.
Older studies estimated that one in 10 men and one of every 20 women will have at least one painful stone by the age of 70.
What are kidney stones make of?
Three out of four patients with kidney stones form calcium stones, most of which are composed primarily of calcium oxalate or, less often, calcium phosphate. Pure uric acid stones are less than 10 percent of all stones.
Why the increased stone prevalence? Does diet count?
Unfortunately, the article doesn’t offer any speculation as to why kidney stones are more prevalent. Kidney stones have a genetic component, but our genes have changed very little over just two decades. I wonder if diet plays a role.
UpToDate.com reviewed diet as a risk factor for kidney stones. Some quotes:
There are several dietary factors that may play an important role in many patients: fluid, calcium, oxalate, potassium, sodium, animal protein, phytate, sucrose, fructose, and vitamin C intake. Lower intake of fluid, calcium, potassium, and phytate and higher intake of sodium, animal protein, sucrose, fructose, and vitamin C are associated with an increased risk for calcium stone formation. The type of beverage may also influence the risk. The effect of calcium intake is paradoxical, with a decreased risk with increased dietary calcium and an increased or no change in risk with calcium supplements.
The combination of dietary factors may also have a significant impact upon stone risk. As an example, the Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein. Based upon an analysis of three large cohorts, adherence to a DASH-style diet lowered the risk for kidney stones among men, older women, younger women, high body mass index (BMI) individuals, and low BMI individuals. Thus, the DASH diet is a reasonable option in the attempt to reduce the risk of stone recurrence.
Higher sucrose [table sugar] intake is associated with an increased risk of stone formation in younger and older women.
Standard advice to prevent initial and recurrent kidney stones is to avoid low urine output. Do that by drinking plenty of fluid.
Although I pay about $400 a year for access to UpToDate, they offer free public access to some of the website. Here’s the UpToDate poop sheet on kidney stones.
Extra credit: Medical conditions that predispose to kidney stones include primary hyperparathyroidism, obesity, gout, diabetes, and medullary sponge kidney.
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Could an Ancestral Diet Cure Pima Diabetes?
Saguaro cactus fruit is edible
I ran across a 1991 New York Times article by Jane Brody discussing the benefits to Pima Indians of returning to their ancestral diet. The Pima have major problems with obesity and diabetes. (I frequently treat Pima Indians in the hospital.) Some quotes:
Studies strongly indicate that people who evolved in these arid lands are metabolically best suited to the feast-and-famine cycles of their forebears who survived on the desert’s unpredictable bounty, both wild and cultivated.
By contrast, the modern North American diet is making them sick. With rich food perpetually available, weights in the high 200’s and 300’s are not uncommon among these once-lean people. As many as half the Pima and Tohono O’odham (formerly Papago) Indians now develop diabetes by the age of 35, an incidence 15 times higher than for Americans as a whole. Yet before World War II, diabetes was rare in this population.
Pima Indians traditionally ate a diet of tepary beans, mesquite seeds, corn, grains, greens, and other high-fiber/low-fat foods. The switch to a diet high in sugar, refined grains, and other highly processed convenience foods may well be responsible for the current high rates of obesity and diabetes. Australian aborigines have the same problem.
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U.S. Spends $83 Billion Yearly on Hospital Care of Diabetes
“Let’s hope this thiazolidinedione doesn’t give you bladder cancer.”
At least according to the Agency for Healthcare Research and Quality.
-Steve
PS: The article I link to above says diabetes is the fifth leading cause of death in the U.S. Not so, according to the Centers for Disease Control and Prevention, which lists diabetes in seventh place. I suspect it’s not even as high as that.
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Quote of the Day
And you will know the truth, and the truth will make you free.
—John 8:32
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Diabetes Blogger Jenny Ruhl Questioning Her Use of Facebook
-Steve
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How Has the U.S. Diet Changed Over the Last Century?
U.S. obesity rate over last 40 years
On a related note, Civil Eats posted a cool info graphic showing the sources of calories in the U.S. diet and how those sources have evolved over the last four decades.
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Elizabeth Woolley Reviews Diabetic Diets
…at her About.com column on type 2 diabetes. I don’t endorse everything there; just thought you might be interested.
I still see doctors at the hospital order “ADA diet” (American Diabetes Association) for their patients with diabetes.
There is no ADA diet.
-Steve
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Diabetic Mediterranean Diet 