October 23, 2011 · 7:30 AM

Nasal Insulin Slows Dementia?

 

Insulin administered via the nasal passages slowed or stabilized mental functioning and functional abilities in a pilot study of people with Alzheimer disease and mild cognitive impairment, according to Seattle-based investigators.

As you probably know, dementia is a huge problem for our aging population, and Alzheimers is the most common form of dementia.  The Mediterranean diet is associated with lower risk of mild cognitive impairment and has long been linked to lower risk of dementia as well as slower mental decline in existing Alzheimer dementia patients.  The Mediterranean diet also seems to prolong life in Alzheimer patients.  So I’m always interested in ways to prevent and treat Alzheimers.  Mild cognitive impairment is often a precursor to Alzhiemer disease.

Methodology

The study involved 104 non-diabetic participants with Alzheimer disease (40) or amnestic mild cognitive impairment (64).  They were randomly assigned to one of three groups: placebo (control group), nasal insulin 20 IU twice daily, or nasal insulin 40 IU twice daily. 

Insulin was delivered through a ViaNase device which releases the insulin in to a chamber covering the nose; the participant breathes regularly for two minutes to pick up the dose.  This insulin goes directly to the central nervous system without affecting blood insulin levels or blood sugar levels.

Mental and functional abilities (for example, activities of daily living) were measured at baseline, then again 2, 4, and six months later.  Some of the participants (23) underwent lumbar puncture (for dementia biomarker analysis) and PET brain scans (18).

Comments

This was a well-designed pilot study.

Nasal insulin was well-tolerated.  It’s not commercially available in the U.S.

ResearchBlogging.orgRegarding the placebo group, I was surprised that the researchers could document mental and functional deterioration over this relatively short-term study (4–6 months).  I’m impressed with the need to treat age-related cognitive decline early and aggressively, when we have something that works.

How would nasal insulin work?  We don’t know for sure, but it seems to relate to insulin’s effect on

  • the ability of neurons (brain cells) to communicate with each other through synapses
  • modulaton of blood sugar metabolism in the hippocampus and other brain areas
  • facilitation of memory
  • ß-amyloid peptide

In case you’re wondering, standard subcutaneous injections of insulin can’t be used in studies like this because of the risk of low blood sugar.

I agree wholeheartedly with study authors that “these promising results provide an impetus for longer-term trials of intranasal insulin therapy in adults with amnestic mild cognitive impairment or Alzheimers disease.”

Psychiatrist Emily Deans blogged about this study at Evolutionary Psychiatry September 21, 2001.  Please see her cogent remarks.

Steve Parker, M.D.

Reference:  Craft, S., Baker, L., Montine, T., Minoshima, S., Watson, G., Claxton, A., Arbuckle, M., Callaghan, M., Tsai, E., Plymate, S., Green, P., Leverenz, J., Cross, D., & Gerton, B. (2011). Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment: A Pilot Clinical Trial Archives of Neurology DOI: 10.1001/archneurol.2011.233

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October 18, 2011 · 1:42 AM

LADA Awareness Week

"Who can tell us about LADA?"

This is the first ever LADA Awareness Week, organized by Diabetes Hands Foundation and dLife.  LADA stands for Latent Autoimmune Diabetes in Adults.  I think of it as type 1 diabetes that starts in adulthood, although there are some differences from typical juvenile-onset type 1 diabetes.

Seven-and-a-half to 10% of apparent type 2 adult diabetics have LADA.  It’s caused by the body attacking its own pancreas beta cells and thereby impairing insulin production; in other words, it’s an autoimmune thing.

Here are some generalities (with exceptions, of course) about LADA, compared to typical type 2 diabetes:

  • lower body mass index, often under 25
  • age at onset under 50
  • poorer response to dietary management
  • poorer response to oral diabetic medications
  • acute symptoms at time of diagnosis (e.g., weight loss, thirst, frequent urination, ketoacidosis, malaise, etc.)
  • higher risk of developing diabetic ketoacidosis
  • much more likely to need insulin

How Is LADA Diagnosed?

First of all, the doctor has to consider the possibility, based on the clinical factors above.  The autoimmune nature of the disease is reflected in islet-cell antiobodies (ICA) and antibodies to glutamic acid decarboxylase (anti-GAD).  These are testable in the blood.  One of the two may be enough.  If the disease is far enough along, blood levels of C-peptide will be low.  C-peptide reflects the body’s production of insulin.

For more information on LADA, talk to your doctor or visit this page at dLife.

Steve Parker, M.D.

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October 16, 2011 · 11:50 PM

Dr. Andreas Eenfeldt Explains LCHF Diet

LCHF Cheese

Dr. Eenfeldt of DietDoctor.com gave a talk at the recent Ancestral Health Symposium in California, on the rationale of the current low-carb, high-fat diet (LCHF) so popular in his home country of Sweden.  It’s very understandable to the general public and is a good introduction to low-carb eating.  The entire YouTube video is 55 minutes; if you’re pressed for time, skip the 10-minute Q&A at the end.

He also discusses the benefits of LCHF eating for his patients with diabetes.

If you reduce carbohydrate, you’re going to replace it with either protein, fat, or both.  As Dr. Eenfeldt recommends, the Ketogenic Mediterranean and Low-Carb Mediterranean Diets replace carbs more with fats than protein.

Steve Parker, M.D.

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October 14, 2011 · 2:09 AM

Coronary Heart Disease on Decline in U.S.

The U.S. Centers for Disease Control and Prevention reports this month that the prevalence of self-reported coronary heart disease declined from 6.7% of the population in 2006, to 6% in 2010.  Figures were obtained by telephone survey.  Coronary heart disease, the main cause of heart attacks, remains the No.1 cause of death in the U.S.

Self-reports of heart disease may not be terribly reliable.  However, I remember an autopsy study from Olmstead County, Minnesota, from a few years ago that confirmed a lower prevalence of coronary heart disease.  I wrote about that at my old NutritionData.com Heart Health Blog, but those posts are lost to posterity.

The CDC report mentioned also that mortality rates from coronary heart disease have been steadily declining for the last 50 years. 

Improved heart disease morbidity and mortality figures probably reflect better control of risk factors (e.g., smoking, high blood pressure), as well as improved treatments.  I’ve never seen an estimate of the effect of reduced trans fat consumption. 

Obesity is always mentioned as a risk factor for heart disease, yet obesity rates have skyrocketed over the last 40 years.  You’d guess heart disease prevalance to have risen, but you’d have guessed wrong.  In view of high obesity rates, some pundits have even suggested that the current generation of Americans wil be the first to see a decrease in average life span. 

The American Diabetes Association offers a free heart disease risk calculator, if you’re curious about your own odds.  My recollection is that the calculator works whether or not you have diabetes.

Steve Parker, M.D.

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October 12, 2011 · 12:52 AM

Avoid Drug Toxicity By Avoiding Drugs

David Mendosa over at Diabetes Developments writes about avoiding diabetes drug toxicity with low-carb eating.

Steve Parker, M.D.

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October 10, 2011 · 2:00 AM

“New” Drug for Diabetes

The U.S. Food and Drug Administration a few days ago announced its approval of Juvisync for treatment of type 2 diabetes.  It’s just a combination of sitagliptin and simvastatin, drugs that have been on the market for years.  Simvastatin isn’t a diabetes control drug at all; it’s a cholesterol-lowering drug in the statin class.

Better living through chemistry

I often see patients with potential drug side effects.  If they’re taking six drugs, the culprit is usually only one of the drugs.  So I tell the patient to put that one drug on hold and see what happens.  Combination drugs interfere with that strategy, so I tend to avoid them. 

Steve Parker, M.D.

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October 9, 2011 · 2:18 AM

Does Diminished Work Activity Explain Our 50-Year Overweight Trend?

Daily work-related energy expenditure over the last half-century in the U.S. has decreased by over 100 calories.  This may well explain the increase in body weights we’ve seen, according to a 2011 article in PLoS ONE.

I sorta hate to open this can o’ worms, but it’s important.  As a population, are we fat because we eat too much or because we burn too few calories in physical activity?  Or is it a combination?  The correct answer may help us learn how to reverse the trend.

Methodology

Authors of the study at hand estimated the amount of energy (calories) necessary to perform various jobs, then noted changes in numbers of people employed in those jobs over time.  In the early 196os, for example, nearly half of U.S. jobs required at least moderate intensity physical activity, compared to less than 20% demanding that degree of energy now.  The authors note the dramatic shift from manufacturing to service-type jobs over the last 50 years.  Service jobs, like mine, often entail a lot of sitting and standing around. 

They chose to ignore how much energy we expend in exercise, figuring what we do in a 40-hour work week overwhelms the 1-2 hours of  exercise we may do.

Researchers’ Findings and Conclusions

They found that work-related daily energy expenditure has decreased by over 100 calories over the last half-century, which (in the authors’ view) would account for a significant portion of the increased body weight we’ve seen.  Since physically demanding jobs are unlikely to see a resurgence, the authors advocate physically active lifestyles away from workplace. 

Discussion

Surveys indicate that only one in four of us fulfill the federal physical activity guidelines: 150 minutes a week of moderate intensity activity or 75 minutes a week of vigorous intensity activity.  When activity is actually measured with an accelerometer, only one in 20 achieve that lofty goal.  We over-estimate how much we exercise, and under-estimate how much we eat.

(If you want to emulate a Paleolithic lifestyle, you should probably shoot for an hour of exercise daily, not 20 minutes as above.)

The researchers cite studies showing significantly increased average per capita calorie consumption in the U.S. over the last several decades.  Some experts estimate the caloric increase is in the range of 500 a day for adults; the authors here think that’s too high but don’t offer a specific alternative. Looking at one of their references (Hall et al), they must think the increase is closer to 200 calories a day, comparing 2005 to 1975.

Several studies suggest that average daily energy expenditure has not decreased in developed countries, at least from the 1980s to the present.   A strength of the current study at hand is that it spans about 50 years, up to 2008.

My sense is that both calorie consumption (too much) and physical activity (too little) contribute to our overweight problem that started 40 or 50 years ago.  Excessive consumption is the predominant factor.  To “exercise off”  the calories in a Snickers candy bar, you’d have to jog for an hour.  If you’re watching your weight, you’ll have more success if you just skip the Snickers.

In case you couldn’t tell,  I still believe in the “calories in/calories out” model of overweight and obesity, aka “the energy balance equation.”  At the same time, I believe certain foods  are more fattening than others: concentrated sugars and refined starches.

Steve Parker, M.D.

References:

Church, T.S., et al.  Trends over 5 decades in U.S. occupation-related physical activity and their associations with obesity.  PLoS ONE, 2011, 6(5): e19657.  doi: 10.1371/journal.pone.0019657  

Swinburn, B., et al.  Increased food energy supply is more than sufficient to explain the U.S. epidemic of obesity.  American Journal of Clinical Nutrition, 2009 (90): 1,453-1,456.  

Hall, K.D., et al.  The progressive increase of food waste in America and its environmental impact.  PLoS ONE, 2009, 4(11): e7940.  doi: 10.1371/journal.pone.0007940

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October 5, 2011 · 12:33 AM

Mediterranean Diet Linked to Brain Preservation

 The Mediterranean diet slowed age-related mental decline in elderly Chicago residents, according to researchers at Rush University Medical Center.  The investigators noted that a Manhattan population following the Mediterranean diet also showed slower mental decline and lower rates of Alzheimers dementia.

Over 3,000 study participants (2,280 blacks, 1,510 whites) were studied for an average of eight years.  Food consumption was determined by questionnaires, and mental function was tested every three years.  Adherence to the Mediterranean diet was judged according to a Mediterranean diet score developed by Panagiotakis, et al.

The greater the adherence to the Greek-style Mediterranean diet, the lower the rate of mental decline over the course of the study.

Mental decline to some extent is a normal part of aging.  If we can avoid it or lessen it’s impact, why not?  A couple ways to do that are regular exercise and the Mediterranean diet.

Would a low-carb Mediterranean diet work just as well or better?  Nobody knows yet.

Steve Parker, M.D.

Reference:  Tangney, Christine, et al. Adherence to a Mediterranean-type dietary pattern and cognitive decline in a community population.  American Journal of Clinical Nutrition, 2010.  doi 10.3945/ajcn.110.007369

 

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October 1, 2011 · 5:36 AM

Mediterranean Diet Linked to Less Sudden Cardiac Death in Women

"Trust me. You don't want sudden cardiac death until you're very old!"

A Mediterranean-style diet is one of four factors helping to greatly reduce the risk of sudden cardiac death in women, as reported by Reuters on June 5, 2011. The other factors reducing risk were maintainence of a healthy weight, regular exercise, and not smoking.

The study involved women only, so we don’t know if the research, reported in the Journal of the American Medical Association, applies to men.  I bet it does.

This study confirms many earlier ones linking the Mediterranean diet with longevity and reduced rates of heart disease.

Steve Parker, M.D.

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September 27, 2011 · 2:38 PM

Introducing Paleo Diabetic, a New Blog

A few of my patients have asked me if the paleo diet and lifestyle would be good for their diabetes.  I’m not sure.  A few pilot studies suggest it would be.  I expect much more published scientific research over the coming decade, in addition to self-experimentation reports by patients.  I’ll be looking into the matter at Paleo Diabetic.

The paleo diet in modern times began gathering steam in 2008.  It’s still not widely known or followed, but the trend is definitely upwards. 

The idea behind the paleo diet—also referred to as the Stone Age or caveman diet—is that optimal health depends on adherence to dietary and lifestyle factors to which we’re genetically adapted.  Our current mix of genes overwhelmingly reflects the Paleolithic era of human cultural development, starting anywhere from 750,000 to 2.5 million years ago, and ending around 10,000 years ago.  It’s also called the Stone Age.

The paleo diet pattern isn’t set in stone.  In general, it includes nuts, vegetables, fruits, fish, meat, and poultry.  It excludes or limits grains, dairy, legumes, sugars other than fruit or honey, industrial seed oils (e.g., from soybean and corn), and modern processed, highly refined foods.  Fresh, natural, and “organic” are preferred.

I’ve already got a few posts up and plan on new ones once or twice weekly.  If you’re interested, please join me at Paleo Diabetic.

Steve Parker, M.D.

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