March 25, 2012 · 12:34 AM

What About the Omega-6/Omega-3 Fatty Acid Ratio?

It’s estimated that the Old Stone Age diet provided much more omega-3 fatty acids and much less omega-6s, compared to modern Western diets.  This may have important implications for development of certain chronic diseases like cancer and heart disease.

This’ll improve your omega-6/omega-3 ratio!

I haven’t studied this issue in great detail but hope to do so at some point.  Evelyn Tribole has strong opinions on it; I may get one of her books.

I saw an online video of William E.M.Lands, Ph.D., discussing the omega-6/omega-3 ratio.  He mentioned free software available from the National Insitutes of Health that would help you monitor and adjust your ratio.

You can see the video here.  Dr. Lands’ talk starts around minute 12 and lasts about 45 minutes.  He says it’s just as important (if not more so) to reduce your omega-6 consumption as to increase your omega-3.  And don’t overeat.

Steve Parker, M.D.

10 Comments

Filed under Fat in Diet

Tagged as , , , , ,

March 20, 2012 · 8:37 AM

Meat and Mortality

Red meat and processed meat consumption are associated with “modest” increases in overall mortality and deaths from cancer and cardiovascular disease, according to National Institutes of Health researchers.  This goes for both sexes.

Data are from the huge NIH-AARP Diet and Heart Study, a prospective cohort trial involving  over 550,000 U.S. men and women aged 50-71 at the time of enrollment.  Food consumption was determined by questionnaire.  Over the course of 10 years’ follow-up, over 65,000 people died.  Investigators looked to see if causes of death were related to meat consumption.

What do they mean by red meat, processed meat, and white meat?

Red meat:  all types of beef and pork (wasn’t there a U.S. ad campaign calling pork “the other white meat”?}

White meat:  chicken, turkey, fish

Processed meat:  bacon, red meat sausage, poultry sausage, luncheon meats (red and white), cold cuts (red and white), ham, regular hotdogs, low-fat poultry hotdogs, etc.

What did they find?

See the first paragraph above.

Studies like this typically look at the folks who ate the very most of a given type of food, those who ate the very least, then compare differences in deaths between the two groups.  That’s what they did here, too.  For instance, the people who ate the very most red meat ate 63 grams per 1000 caories of food daily.  Those who ate the least ate 10 grams per 1000 cal of food daily.  That’s about a six-fold difference.  Many folks eat 2000 calories a day.  The high red meat eaters on 2000 cals a day would eat 123 grams, or 4.4 ounces of red meat.  The low red meat eaters on 2000 cals/day ate 20 grams, or 0.7 ounces.

The heavy consumers of processed meats ate 23 grams per 1000 cal of food daily.  The lowest consumers ate 1.6 grams per 1000 cal.

Comparing these two quintiles of high and low consumption of red and processed meats, overall mortality was 31-36% higher for the heavy red meat eaters, and 16-25% higher for the heavy processed meat eaters.  (The higher numbers in the ranges are for women.)  Similar numbers were found when looking at cancer deaths and cardiovascular deaths (heart attacks, strokes, ruptured aneurysms, etc).

It’s not proof that heavy consumption of red and processed meats is detrimental to longevity, but it’s suggestive.  The “Discussion” section of the article reviews potential physiological mechanisms for premature death.

The researchers called these differences “modest.”  I guess they use “modest” since most people eat somewhere between these extreme quintiles.  The numbers incline me  to stay out of that “highest red and processed meat consumer” category, and lean more towards white meat and fish.

The study at hand is from 2009.  Another research report in Archives of Internal Medicine this month supported similar conclusions. (Click for Zoë Harcombe’s critique of the study.)

The traditional Mediterranean diet and Advanced Mediterranean Diet are naturally low in red and processed meats, but not designed specifically for folks with diabetes.

Steve Parker, M.D. 

Reference:  Sinha, Rashmi, et al.  Meat intake and mortality: a prospective study of over half a million people.  Archives of Internal Medicine, 169 (2009): 562-571.

4 Comments

Filed under cancer, coronary heart disease, Stroke

Tagged as , , ,

March 15, 2012 · 6:47 PM

White Rice Linked to Type 2 Diabetes

Did you see this?

http://ca.news.yahoo.com/white-rice-seen-type-2-diabetes-says-study-233837784.html

-Steve

Update March 15, 2012: I read the primary research article and blogged about it at Advanced Mediterranean Life.

2 Comments

Filed under Carbohydrate, Causes of Diabetes

Tagged as , , ,

March 12, 2012 · 2:00 AM

Is Raw Milk Safe?

Caveat emptor

Interest in consuming nonpasteurized milk and cheese seems to be increasing in the U.S. over the last couple years. I don’t know why. Is it safe?

In case you’ve forgotten, the process of pasteurization is designed to kill pathogenic organisms that raw milk may harbor. Campylobacter and Salmonella are two of the common pathogens.

The U.S. Centers for Disease Control and Prevention this month published an article on disease outbreaks associated with nonpasteurized dairy products. Bottom line: Nonpasteurized products are 150 times more likely to be associated with foodborne illness compared to pasteurized product. The CDC wants states to consider more stringent regulation.

It’s hard to be sure, but my sense is that foodborne illness related to nonpasteurized dairy products in the U.S. is pretty uncommon, if not rare.

Mark Crislip at Science-Based Medicine says pasteurization is a good thing.

As for me, I’m not going out of my way looking for nonpasteurized milk and cheese.

Steve Parker, M.D.

Comments Off on Is Raw Milk Safe?

Filed under Dairy Products

Tagged as , , , , , ,

March 10, 2012 · 2:00 AM

Alec Baldwin Cut Out Sugar, Lost 30 Pounds

Mother Nature Network last January reported Alec Baldwin’s successful weight loss effort.  An excerpt:

“I gave up sugar,” he told Access Hollywood. “I lost 30 pounds in four months. It’s amazing.”
“(I do) Pilates, spin, not as much yoga as I’d like,” he added. “When we’re shooting (’30 Rock’) it’s tough…When we’re shooting and I can’t work out, I just have to eat less. So, I’m very conscious of that. But sugar was the real killer for me — that was the problem.”
 
 
 

2 Comments

Filed under Sugar, Weight Loss

Tagged as , ,

March 9, 2012 · 2:13 AM

What’s Our Preferred Fuel?

Dr. Jay Wortman has been thinking about whether our bodies prefer to run on carbohydrates (as a source of glucose) or, instead, on fats.  The standard American diet provides derives about half of its energy from carbs, 35% from fats, and 15% from proteins.  So you might guess our bodies prefer carbohydrates as a fuel source.  Dr. Wortman writes:

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm.Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

Dr. Wortman, who has type 2 diabetes,  in the same long post also writes about oolichan grease (from fish), an ancestral food of Canandian west coast First Nations people. 

Steve Parker, M.D.

4 Comments

Filed under Carbohydrate, Fat in Diet, Fish

Tagged as , , , , ,

March 2, 2012 · 12:59 AM

Book Review: The Blood Sugar Solution

I just finished reading the No.2 book at Amazon.com, The Blood Sugar Solution: The UltraHealthy Progam for Losing Weight, Preventing Disease, and Feeling Great Now!  Published in 2012, the author is Dr. Mark Hyman. I give it three stars per Amazon’s rating system (“It’s OK”).  Actually, I came close to giving it two stars, but was afraid the review would have been censored (i.e., deleted) at the Amazon site.  Click this link to see all the reviews at Amazon.com: http://www.amazon.com/Blood-Sugar-Solution-UltraHealthy-Preventing/dp/031612737X/

♦   ♦   ♦

The book’s promotional blurbs by the likes of Dr. Oz, Dr. Dean Ornish, and Deepak Chopra predisposed me to dislike this book.  But it’s not as bad as I thought it’d be.

The good parts first.  Dr. Hyman favors the Mediterranean diet, strength training, and high-intensity interval training.  His recommended way of eating is superior to the standard American diet, improving prospects for health and longevity.  His dietary approach to insulin-resistant overweight/obesity and type 2 diabetes includes 1) avoidance of sugar, flour, processed foods, 2) preparation of your own meals from natural, whole food, and 3) keeping glycemic loads low.  All well and good for weight loss and blood sugar control.  It’s not a vegetarian diet.

The author proposes a new trade-marked medical condition: diabesity. It refers to insulin resistance in association with (usually) overweight, obesity, and/or type 2 diabetes mellitus or prediabetes.  Dr. Hyman says half of Americans have this brand-new disorder, and he has the cure.  If you don’t have overt diabetes or prediabetes, you’ll have to get your insulin levels measured to see if you have diabesity.

He reiterates many current politically correct fads, such as grass-fed/pastured beef, organic food, detoxification, and strict avoidance of all man-made chemicals, notwithstanding the relative lack of scientific evidence supporting many of these positions.

Dr. Hyman bills himself as a scientist, but his biography in the book doesn’t support that label.  Shoot, I’ve got a B.S. degree in zoology, but I’m a practicing physician, not a scientist.

The author thinks there are only six causes of all disease: single-gene genetic disorders, poor diet, chonic stress, microbes, toxins, and allergens.  Hmmm… None of those explain hypothyroidism, rheumatoid arthritis, systemic lupus erythematosis, tinnitus, migraines, irritable bowel syndrome, Parkinsons disease, chronic fatigue syndrome, or multiple sclerosis, to name a few that don’t fit his paradigm.  Of course, it’s possible that the cause of those conditions in due time will be found to be one of the Six Pillars of Disease.

Dr. Hyman makes a number of claims that are just plain wrong.  Here are some:
  – Over 80% of Americans are deficient in vitamin D
  – Lack of fiber contributes to cancer
  – High C-reactive protein (in blood) is linked to a 1,700% increased probability of developing diabetes
  – Processed, factory-made foods have no nutrients
  – We must take nutritional supplements

Furthermore, he recommends a minimum of 11 and perhaps as many as 16 different supplements even though the supportive science is weak or nonexistent.  Is he selling supplements?

After easily finding these bloopers, I started questioning many other of the author’s statements.   

I was very troubled by the apparent lack of warning about hypoglycemia (low blood sugar).  Many folks with diabetes will be reading this book.  They could experience hypoglycemia on this diet if they’re taking certain diabetes drugs: insulin, sulfonylureas, meglitinides, pramlintide plus insulin, exenatide plus sulfonylurea, and possibly thiazolidinediones, to name a few instances.

If you don’t have diabetes but do need to lose weight, this book may help.  If you have diabetesor prediabetes, strongly consider an alternative such as Dr. Bernstein’s Diabetes Solution or my Conquer Diabetes and Prediabetes.

In the interest of brevity, I’ll not comment on Dr. Hyman’s substitution of time-tested science-based medicine with his own “Functional Medicine.”

Steve Parker, M.D.

PS: Science-Based Medicine, a blog, has an unflattering article from 2010 on Dr. Hyman and his views on dementia: http://www.sciencebasedmedicine.org/index.php/personalized-medicine-bait-and-switch/

5 Comments

Filed under Uncategorized

February 29, 2012 · 11:20 AM

Review of Chris Highcock’s Hillfit

Chris Highcock over at Conditioning Research has just released a new ebook on strength training for hikers: Hillfit: Strength.  Hiking is one of my favorite hobbies.  I particularly like walking up hills and mountains.  If you’re ready to reap the benefits of resistance training, this jargon-free plan is an excellent starting point, and may be all you’ll ever need.  Even if you never go hiking.

Chris is a fitness columnist for “TGO (The Great Outdoors).”  He lives and hikes in Scotland.  Chris’s goal with the program is to increase your enjoyment of hiking by increasing your level of fitness. 

He clearly presents four basic home exercises requiring no special equipment; they’re bodyweight exercises.  You get it done in 15 minutes twice a week!  The key is to do one set of each exercise, slowly, to exhaustion.  What’s slow?  Ten seconds for both lift and lowering.  For instance, when you do the push-up, you push up over  the course of 10 seconds, then let your body down slowly over 10 seconds.  The exercises are for both upper and lower body.

I’m reading about similar exercise ideas from Skyler Tanner, Doug McGuff, Nassim Taleb, Jonathan Bailor, and Doug Robb.  Bailor, in his recent book, also recommends only four exercises.  Highcock’s look a little safer for rank beginners. 

The idea is to recruit three different types of muscle fiber during the muscle’s movement.  If you move explosively and finish too soon (get your mind out of the gutter!), you’re only using  one type of muscle fiber (fast twitch, I think).  You want to stimulate a strength and growth response in all three types of muscle fiber.  And explosive or rapid movements are more likely to cause injury, without any benefit. 

Once you get the basic program down, Chris takes you through some easy variations (called progressions) to make the exercises gradually harder, so you continue to improve your strength and fitness. 

Chris understands that many folks can’t do a single push-up.  He takes you through pre-push-up movements to get you prepared  to do actual push-ups.  This goes for all four exercises.  I bet even my little old lady patients could use this program.  (This is not blanket clearance for everybody to use this program; I don’t need the lawsuits.  Get clearance from your own doctor first.)

The exercises incorporate our five basic movements: push, pull, squat, bend/hinge, walk/gait.  The four exercises are: wall sit (squat), push-up, modified row, and hip extension.

My only criticism of the book is that Chris should have used young, attractive, bikini-clad models to illustrate the exercises.  The existing photos are clear and helpful, however.

But seriously, the only suggestion I have for the next version of Hillfit would be to mention that it will take a couple or three weeks to see much, if any, improvement in strength once you start the program.  Same for when you increase the workload with the exercise progressions.  Perhaps this is in there, but I missed it.  You don’t want people quitting in frustration that they’re not seeing progress soon enough.

The author provides scientific references in support of his program, so he didn’t just make this stuff up.  Only one of the references involved mice!

Several “take home” points for me personally are: 1) stretching before or after exercise does nothing to prevent injury or soreness, and may hurt short-term athletic performance, 2) don’t hold your breath, 3) train to “momentary muscular failure.”  I’m not entirely sure what momentary muscular failure means.  It may not be Chris’s term, but it’s prominent in one of his best scientific references.  I use free weights and don’t think I can safely go 100% to momentary muscular failure.  Hitting momentary muscular failure, by the way, is more important than the amount of weight you’re moving.

Highly recommended.

Steve Parker, M.D.

PS: I’d like to see Hillfit available on Amazon’s Kindle and Barnes and Noble’s Nook.

PPS: When you go to the Hillfit website to order, you’ll find the price is £9.95 (that’s GBP, British pounds sterling).  I’ve never ordered anything priced in GBP.  In today’s U.S. dollars, that’s a little under $16.00.  You can pay via PayPal or a major credit card.  I assume the conversion from one currency to another is automatic and seamless.  I don’t know if there’s a extra fee by the payment processor for doing the conversion.

Disclosure:  Chris kindly sent me a free digital copy of his ebook.  I don’t know Chris.  I will receive no remuneration for this review, nor for book sales.

6 Comments

Filed under Exercise

Tagged as , , ,

February 24, 2012 · 2:00 AM

Aerobic Versus Strength Training for People With Diabetes

“Resistance training, similarly to aerobic training, improves metabolic features and insulin sensitivity and reduces abdominal fat in type 2 diabetic patients,” according to a report in the current issue of Diabetes Care.

Italian researchers randomized 40 type 2 diabetics to follow either an aerobic or strength training program for four months.  The increase in peak oxygen consumption (VO2 peak) was greater in the aerobic group, whereas the strength training group gained more strength.  Hemoglobin A1c was similarly reduced in both groups, about 0.37%.  Body fat content was reduced in both groups, and insulin sensitivity and lean limb mass were similarly increased.  Pancreas beta-cell function didn’t change.

Per this one study, neither type of training seems superior overall.  If you’re just going to do one type of exercise program, choose your goal.  Do you want more strength, or more sustainable “windpower”? 

The Pennington Biomedical Research Center found somewhat different results in their larger and more complex study published in 2010.  However, they were primarily testing for diabetes control (as judged by hemoglobin A1c improvement), rather the improvements in strength or aerobic power.  The found the combination of aerobic and strength training is needed to improve diabetic blood sugar levels.  Both types of exercise—when considered alone—did not improve diabetes control. 

As for me, I do both strength and aerobic training.

By the way, I only read the abstract of the current research, not the full report. High-intensity intervals on a treadmill help me git’r done quicker.

Steve Parker, M.D.

PS: PWD = people or person with diabetes.  Do you like that term or would you prefer “diabetic”?

Reference:  Bacchi. Elizabeth, et al.  Metabolic Effects of Aerobic Training and Resistance Training in Type 2 Diabetic Subjects
A randomized controlled trial (the RAED2 study).  Diabetes Care.  Published online before print February 16, 2012, doi: 10.2337/dc11-1655

6 Comments

Filed under Exercise

Tagged as , , , ,

February 22, 2012 · 2:00 AM

Oral Drugs for Type 2 Diabetes: Which Are The Best?

A guideline committee established by the American College of Physicians recently reviewed oral medications for treatment of type 2 diabetes.  Assuming blood sugars were still too high after diet and lifestyle modification, the firmest drug recommendations were:

  • Use metformin first.
  • If blood sugars are still too high, add a second agent to metformin.

This was not nearly as helpful as I’d hoped it would be!

The Problem: Too Many Options

We now have 11 classes of drugs for treatment of 26 million diabetics in the United States.  Clinicians are often at a loss as to which drug(s) to recommend for a particular patient.  For most of these drugs, we know very little about the long-term implications, such as effects on overall death rates, diabetes complications, heart attacks, cancer, and strokes. 

I can think of three diabetes drugs once approved by the U.S. Food and Drug Administration, but are now off the market or severely restricted due to serious adverse side effects: phenformin, troglitazone (Rezulin), and rosiglitazone (Avandia).  I fully expect one or more of our current drugs will have a similar fate; only time will tell which ones.

France took pioglitazone off the shelves in 2011 because of a link with bladder cancer.  It’s still available and popular in the U.S.

When you get into multi-drug therapy with two or three different oral drugs, the situation becomes even cloudier.

Some Needles in the Haystack

I reviewed the report from the guideline committee and found just a few clinical pearls to share with you. 

  • They didn’t mention at all the FDA’s recent restrictions on rosiglitazone, so I assume they don’t believe it’s more toxic to the heart than is pioglitazone.
  • Most oral drugs reduce hemoglobin A1c by an average of 1% (absolute decrease).
  • All double-drug regimens were more effective at controlling blood sugars than monotherapy (using only one drug): adding a second drug drops hemoglobin A1c another 1%.
  • “It was difficult to draw conclusions about the comparative effectiveness of type 2 diabetes medications on all-cause mortality, cardiovascular morbidity and mortality, and microvascular outcomes because of low quality or insufficient evidence.”  It was so difficult that they didn’t draw any firm conclusions.  In other words, in terms of overall deaths , heart attacks, heart failure, and strokes, it’s hard to favor some of these drugs over others.  However…
  • Compared to sulfonylureas, metformin was linked to a  lower overall death rate and cardiovascular illness (e.g., heart attacks, heart failure, angina).
  • Sulfonylureas and meglitinides tend to cause more hypoglycemia.
  • Thiazolidinediones are linked to a higher risk of heart failure; they shouldn’t be used in patients who already have serious heart failure.
  • Thiazolidinediones may increase the risk of bone fractures.
  • Metformin helps with loss of excess weight, reduces LDL (bad) cholesterol, and lowers triglycerides.
  • Metformin is cheaper than most other diabetes drugs.
  • For double-drug therapy: “No good evidence supports one combination therapy over another, even though some evidence shows that the combination of metformin with another agent generally tends to have better efficacy [better blood sugar control] than any other monotherapy or combination therapy.”

In contrast to these guidelines, the American Association of Clinical Endocrinology guidelines of  2009  recommend that  the following should be used earlier and more frequently:  GLP-1 agonists (exenatide) and DPP-4 inhibitors (sitagliptin, saxagliptin, linagliptin).  Furthermore, sulfonylureas should have a lower priority than in the past. From my limited perspective here in the Sonoran desert, I have no way of knowing how much influence, if any, Big Pharma had over the AACE guidlelines.

My concern about long-term safety of some these drugs compels me to favor carbohydrate restriction, which reduces the overall need for drugs.  Sure, that’s not true for everybody and it may not last forever.  The more carbs you eat, the more drugs you’re likely to need to keep blood sugars in control in an effort to avoid diabetes complications.

Don’t get me wrong; I’m not anti-drug.  As an internist, I prescribe plenty of drugs every day.  They are a major weapon in my armamentarium.  Regardless of the condition I’m treating, I always try to avoid drugs with unknown and potentially serious long-term consequences.

Steve Parker, M.D.

Reference: Qaseem, Amir, et al.  Oral pharmacologic treatment of type 2 diabetes mellitus: A clinical practice guideline from the American College of Physicians.  Annals of Internal Medicine, 156 (2012): 218-231.

Comments Off on Oral Drugs for Type 2 Diabetes: Which Are The Best?

Filed under Drugs for Diabetes

Tagged as , , , ,