Rosiglitazone is pretty much dead. Here’s the eulogy at the FDA website. Rare is the doctor who will jump through all the paperwork hoops when we have 10 other classes of drugs to treat diabetes, plus another, safer drug in the thiazolidinedione class.
Rosiglitazone is linked to higher rates of heart disease and death.
Steve Parker, M.D.
.
Filed under Drugs for Diabetes
Exercise is not supposed to be fun. If it is fun, then you should suspect that something is wrong.
The quote above is from an essay entitled “Exercise vs Recreation” by Ken Hutchins, posted at the Efficient Exercise website. Skyler Tanner works at Efficient Exercise and his blog is one that I follow. We have a strange connection. Skyler grew up in Fountain Hills, AZ; I live about 20 miles from there. He lives in Austin, TX, now; I lived there for eight years.
Here’s another quote from that essay:
One pound of human fat can support the energy demands of running 35-45 miles, probably more. This would require the average man to run for 6-8 hours. He would burn the calories he could easily ingest in as many minutes.
Hutchins’ essay is thought-provoking. It may change the way you think about exercise.
Filed under Exercise
The Mediterranean diet preserves heart muscle performance and reduces future heart disease events, according to Greek researchers reporting in the American Journal of Clinical Nutrition, May 19, 2010.
Reuters and other news services have covered the story.
The Mediterranean diet is well-established as an eating pattern that reduces the risk of death or illness related to cardiovascular disease—mostly heart attacks and strokes. Most of the studies in support of the heart-healthy diet looked at development of disease in general populations. The study at hand examined whether the diet had any effect on patients with known heart disease, which has not been studied much.
How Was the Study Done?
The study population was 1,000 consecutive patients admitted with heart disease to a Greek hospital between 2006 and 2009. In this context, heart disease refers to a first or recurrent heart attack (70-80% of participants) or unstable angina pectoris. Acute heart attacks and unstable angina are “acute coronary syndromes.” Average age was 64. Sixty percent had a prior diagnosis of cardiovascular disease (coronary heart disease or stroke). Thirty percent had diabetes. At the time of hospitalization, half had diminished function of the main heart pumping chamber (the left ventricle), half had normal pump function. Men totalled 788; women 212.
On the third hospital day, participants were given a 75-item food frequency questionnaire asking about consumption over the prior year. If a potential enrollee died in the first two hospital days, he was not included in the study. A Mediterranean diet score was calculated to determine adherence to the Mediterranean diet. Mediterranean diet items were nonrefined cereals and products, fruits, nuts, vegetables, potatoes, dairy products, fish and seafood, poultry, red meats and meat products, olive oil, and alcohol.
Left ventricle function was determined by echocardiogram (ultrasound) at the time of study entry, at the time of hospital discharge, and three months after discharge. Systolic dysfunction was defined as an ejection fraction of under 40%. [Normal is 65%: when the left ventricle is full of blood, and then squeezes on that blood to pump it into the aorta, 65% of the blood squirts out.]
Participants were then divided into two groups: preserved (normal) systolic left ventricular function, or diminished left ventricular function.
They were followed over the next two years, with attention to cardiovascular disease events (not clearly defined in the article, but I assume including heart attacks, strokes, unstable angina, coronary revascularization, heart failure, arrhythmia, and death from heart disease or stroke.
Results
The Authors’ Conclusion
Greater adherence to the Mediterranean diet seems to preserve left ventricular systolic function and is associated with better long-term prognosis of patients who have had an acute coronary syndrome.
My Comments
I agree with the authors’ conclusion.
We’re assuming these patients didn’t change their way of eating after the initial hospitalization. We don’t know that. No information is given regarding dietary instruction of these patients while they were hospitalized. In the U.S., such instruction is usually given, and it varies quite a bit.
In this study, lower risk of cardiovascular death was linked to the Mediterranean diet only during the initial hospital stay. Most experts on the Mediterranean diet would have predicted lower cardiovascular death rates over the subsequent two years. Mysteriously, the authors don’t bother to discuss this finding.
For those who don’t enjoy red wine or other alcoholic beverages, this study suggests that the Mediterranean diet may be just as heart-healthy without alcohol. A 2009 study by Trichopoulou et al suggests otherwise.
Reference: Chrysohoou, C., et al. The Mediterranean diet contributes to the preservation of left ventricular systolic function and to the long-term favorable prognosis of patients who have had an acute coronary event. American Journal of Clinical Nutrition 2010. DOI: 10.3945/ajcn.2009.28982
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Filed under Alcohol, coronary heart disease, Health Benefits, Mediterranean Diet
The Mediterranean diet reduces the risk of strokes seen on brain MRI scans, according to a study earlier this year in Annals of Neurology.
Brain researchers at various U.S. institutions studied a multi-ethnic population in upper Manhattan (the WHICAP cohort). Average age of the 707 study participants was 80. Baseline diet was determined by a questionairre. A Mediterranean diet score was calculated to quantify adherence—or lack thereof—to the Mediterranean diet. Participants without dementia at baseline underwent MRI scanning initially, then again an average of six years later.
What Did They Find?
One third of participants had MRI evidence for a stroke. Higher adherence to the Mediterranean diet was linked to significantly lower odds of stroke. Compared to those eating least like the Mediterranean diet, those with the highest adherence had 37% lower odds of an stroke being found on MRI scan. Those with medium adherence had 20% lower odds.
So What?
This is the first study to show such an association between strokes on an MRI scan and the Mediterranean diet. Be aware that you can find stroke on an MRI scan in someone who thought they were perfectly healthy; in other words a clinically silent stroke. The authors note only one previous report finding lower risk of clinically obvious stroke with the Mediterranean diet, in women—I thought there were more.
The same group of researchers had previously demonstrated that higher compliance with the Mediterranean diet is linked to lower risk of Alzheimers disease and mild cognitive impairment.
If I wanted to protect my brain from stroke, I’d be sure follow a Mediterranean-style diet, keep my blood pressure under 140/90 mmHg, stay physically active, keep my weight under control, and not smoke.
Reference: Scarmeas, Nikolaos, et al. Mediterranean diet and magnetic resonance imaging-assessed cerebrovascular disease. Annals of Neurology, 69 (2011): 257-268. doi: 10.1002/ana.22317
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Filed under Uncategorized
I recently read The New Sonoma Diet: Trimmer Waist, More Energy in Just 10 Days, by Dr. Connie Guttersen RD, PhD, published in 2010. It’s not designed specifically for people with diabetes or prediabetes. Per Amazon.com’s rating system, I give it four stars (I like it).
The New Sonoma weight-loss method works because it counteracts the major cause of overweight—excessive consumption of sugars and refined starches—through portion control. This Mediterranean-style program is likely to reap the major health benefits of the traditional Mediterranean diet: longer life and less chronic disease (heart attacks, strokes, high blood pressure, diabetes, dementia, and cancer).
Most of the food recommendations herein are consistent with Monica Reinagel’s wonderful new book, Nutrition Diva’s Secrets for a Healthy Diet: What to Eat, What to Avoid, and What to Stop Worrying About. On Sonoma, you’ll eat natural, minimally processed, whole foods.
The primary improvements over the 2005 version of Sonoma are the time-saving and budget-saving strategies. The recipes are easier and quicker. I didn’t try any, but they sound yummy. Dr. Guttersen also exands the “Power Foods” from 10 to 12, adding beans and citrus fruit. I’m glad to see the author addressed many of my criticisms of her great 2005 book. I do miss the old refrigerator-ready pull-out depicting the subdivided plates.
Here’s a brief summary for those unfamiliar with Sonoma. There are three Waves. Wave 1 lasts 10 days and is supposed to break your addiction to sugar and refined flour. Wave 2 lasts until your weight-loss goal is reached, and provides more calories, wine if desired, and more variety. Wave 3 is the lifelong maintenance phase: more fruit and veggies, plus occasional sugary desserts, potatoes, and refined flour. Portion size is controlled either by following her exact recipes or through her plate method. Breakfast fits on a 7″ plate (or 2-cup bowl), while lunch and dinner are on 9″ plates, subdivided into various food groups such as proteins, grains, or veggies. Optional recipes are provided for Wave 1 and the first two weeks of Wave 2.
As in 2005, Dr. Guttersen doesn’t reveal how many calories you’ll be eating. My estimate for Wave 3 is 2000 a day. Less for the earlier Waves.
You’ll find indispensible information on shopping and food preparation. Keeping a food journal is rightfully promoted in certain circumstances. I like the discussion of psychological issues, mindful eating, dining out tips, and weight-loss stalls. The mindful eating portion reminded me of Evelyn Tribole’s Intuitive Eating: A Revolutionary Program That Works and Intuitive Eating: A Practical Guide to Make Peace with Food, Free Yourself from Chronic Dieting, Reach Your Natural Weight.
The author makes a few claims that are either wrong or poorly supported by the scientific literature. Examples include: 1) beans are linked to longer life and reduced heart disease risk, 2) grapes are almost as good as wine for heart protection, 3) the health benefits of spinach “border on the miraculous,” and spinach helps prevent inflammatory conditions such as arthritis and asthma, 4) whole grains prevent stroke, gastrointestinal cancer, and diabetes, 5) adding salt and butter for flavor is unhealthy, 6) medicinal qualities of herbs and spices are well documented, 7) saturated fats “are found exclusively in highly processed food products,” 8) you’ll break a lifetime craving for sugary sweets in Wave 1, 9) 64 ounces of water a day is ideal, 10) exercise significanlty helps most people with weight loss, 11) low-carb eating cannot be maintained because it’s unhealthy and unsatisfying, and 11) saturated fats raise the risk of heart disease.
Much of the book reads like an infomercial; at times I even wondered if it was ghost-written by a marketing professional. The author is unflaggingly optimistic. The testimonials would have more credibility if attributed to full names, not just “Betty” or “Bill.” She overstates the health benefits of the individual Power Foods, which are all plant-derived. I’d like to see cold-water fatty fish on the list.
Dr. Guttersen has great faith in observational studies linking specific foods to health outcomes; I have much less faith. Such studies are far from proof that specific foods CAUSE the outcome. They’re just associations, such as swimsuit sales being linked to warm weather. Warm weather doesn’t cause folks to buy swimsuits; the desire to swim does.
Speaking of associations, a multitude of observational studies link whole grain consumption with 20-25% lower risk of heart disease. We may never have proof of cause and effect because the appropriate study is so difficult. Sonoma recommends two whole grain servings a day, which is the heart-healthy “dose” supported by science.
The author’s discussion of exercise is improved over 2005’s, but is still minimal. Why not refer readers to respected Internet resources? We agree that exercise can help with weight-loss stalls and long-term maintenance of weight loss.
Overall, this is one of the healthiest weight-loss programs available. The average non-diabetic person won’t go wrong with Sonoma. In fact, Sonoma-style eating may be the healthiest of all for the normal-weight general public, with the exception of its avoiding saturated and total fat.
For folks with diabetes or prediabetes, I prefer Dr. Bernstein’s Diabetes Solution or, of course, Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.
Filed under Book Reviews
With a suspicion that the Dukan Diet may be the next diet fad in the U.S., I read The Dukan Diet: 2 Steps to Lose the Weight, 2 Steps to Keep It Off Forever by Pierre Dukan (2011, first American edition). On Amazon.com’s rating system, I give it two stars.
Think of Dukan as a Low-Fat Atkins Diet.
The Dukan Diet is apparently very popular in Europe. It’s comprised of four phases. The Attack Phase, also called “Pure Protein,” lasts usually two to seven days. Eat all you want from the protein-rich food list, mostly skinless chicken, low-fat meat, fish, and nonfat dairy. No carbs at all except for the dairy. The Cruise Phase is next: Alternate Pure Protein days with proteins and non-starchy vegetables until you’re at your goal weight. Eat all you want from the low-carb veggie list. Consolidation Phase lasts five days for every pound lost. Eat more variety but limited quantities: two slices of whole grain bread, one portion each of fruit and cheese daily, one or two servings of starchy carbs (e.g., legumes, flour, cereals), plus two “celebration meals” a week, carefully defined. Proteins and low-carb veggies are still unlimited. Finally, the Permanent Stabilization Phase is lifelong and similar to Consolidation Phase, but requires one Pure Protein day per week, such as Thursdays. Also, take no stairs or elevators. All phases include prescribed servings of oat bran.
During the active weight loss phases, this diet is low-fat, low-carb, and high-protein. You don’t have to count carb grams, fat grams, or calories. Presumably, Dr. Dukan has done all that for you, although he never shares the average calories consumed nor the macronutrient breakdown (i.e., what percentage of calories are derived from protein, fat, or carbs). The latter two phases are still very low-fat but allow a bit more carbs.
I liked this book more than I expected. It’s obvious the author has copious experience with dieters, especially women. The writing is clear. He’s a serious, earnest man, not a charlatan. Although some will criticize the book’s repetitiveness, it’s a proven educational technique. For weight management, Dr. Dukan and I agree that 1) weighing daily is good, 2) abstinence from sugar rarely eliminates the longing for sweets, 3) artificial no-calorie sweeteners are OK, 4) the 4-7 pound weight loss in Attack Phase is mostly water, not fat, 5) discipline and willpower are important, 6) after losing weight, you’ll regain it if you ever return to your old ways, and 7) a realistic weight goal is essential.
Dr. Dukan recommends at least 20-30 minutes a day of walking. He provides little information on resistance training, although increasing evidence supports it as a great weight control measure. I wish he’d mentioned high intensity interval training (HIIT).
The book contains numerous recipes, including a week of menus for the Attack Phase. Disappointingly, none of the recipes include nutritional analysis.
You’ll find an index. It doesn’t list glycogen. Insulin, a primary fat-storage hormone, is mentioned on only one page, one sentence.
This is one fat-phobic diet. In Dr. Dukan’s view, “fat in food is the overweight person’s most deadly enemy.” All fat consumption contributes to fatness, and animal fats “pose a potential threat to the heart.” It seems Dr. Dukan never got the memo that total and saturated fat content of foods have little, if anything, to do with heart or other cardiovascular disease. While criticizing Dr. Atkins’ diet for demonizing carbohydrates, Dr. Dukan demonizes fats. Yet Dr. Dukan does all he can to banish both carbohydrates and fats from his weight loss phases.
Dr. Dukan makes several erroneous statements, including 1) all food is made up of only three nutrients, 2) all alcoholic beverages are high in carbohydrates, 3) all shellfish are carbohydrate-free, 4) he implies that when dieting or fasting, we convert much of our fat into glucose, 5) there are no indispensable fats, 6) fat is bad for the cardiovascular system, 7) vinegar is the only food containing sour taste, 8) fruit is the only natural food containing rapid-assimilation sugars, 9) “Anyone who loses and regains weight several times becomes immune to dieting,” 10) weight loss releases into the bloodstream artery-toxic fat and cholesterol, 11) many overweight folks are unusually good at extracting calories from food, 12) some people can gain weight even while they sleep, 13) exercise is vitally important for losing weight, and 14) the Atkins diet raises triglycerides and cholesterol levels dangerously.
Will the diet work? I’m sure many have lost weight with it and kept it off. It does, after all, limit two of the major causes of excess weight: sugars and refined starches.
In considering rating this book two or three stars, I asked myself if I’d recommend it to one of my patients looking to lose weight. Initially I had concern that the diet may be deficient in essential fatty acids since it’s so fat-phobic. “Essential” means necessary for life and health. Then I figured that the body’s own fat stores would provide adequate essential fatty acids, at least in the first two phases. The later stages, I’m not so sure. Carefully choosing specific foods would eliminate the risk, but how many people know how to do that? Separate from that potential drawback, there are other diets that are better for the non-diabetic population, such as The New Atkins Diet for a New You, Protein Power, the Ketogenic Mediterranean Diet (free on the Internet), and The New Sonoma Diet. You’ll have no risk of fatty acid deficiency with those.
For people with diabetes or prediabetes, I like Atkins Diabetes Revolution, Dr. Bernstein’s Diabetes Solution, and, of course, Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.
If you limit carbs, there’s just no need for fat-phobia.
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Filed under Book Reviews
On May 2, 2011, the U.S. Food and Drug Administration approved the use of linagliptin for adults with type 2 diabetes. It’s in the class called DPP-4 inhibitors. You’ll see it sold in the U.S. as Tradjenta.
How do they come up with names like Tradjenta? The manufacturer wants it unique, so there are no claims of copyright infringement. You also want to avoid sounding like another drug on the market, to avoid mixing up the drugs. A committee is usually involved to consider all the angles, especially marketing.
How Does Linagliptin Work?
It’s complicated. It inhibits an enzyme, dipeptidyl peptidase-4, ultimately leading to insulin release from the pancreas into the bloodstream, and lowered glucagon levels.
Any Side Effects?
Linagliptin may slightly increase the risk of pancreatitis. It seems to be pretty well tolerated overall, with the most common adverse effects being a runny or stuffy nose, or sore throat. When given with an insulin secretagogue drug, like sulfonylureas, linagliptin can increase the odds of hypoglycemia. Due to an interaction, it’s best not to use linagliptin with rifampin.
What’s the Dose?
Only one: 5 mg by mouth daily. No need to adjust the dosage for underlying kidney or liver disease or age.
Usage
It’s for adults with type 2 diabetes. It may be used as the sole diabetic drug along with diet and exercise. It can also be used in combination with metformin, a sulfonylurea, or pioglitazone. It’s not been studied in people taking insulin, in pregnancy, or in nursing mothers, so it’s best to avoid those settings for now.
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Filed under Drugs for Diabetes
Oldways has put together an article reviewing Mediterranean diet promotional efforts in each of the 50 United States. I’m honored that they focused on me in Arizona. The Oldways website is jam-packed full of practical info on how to move towards the healthy Mediterranean diet pattern.
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Filed under Mediterranean Diet
Loss of excess weight is a mainstay of therapy for nonalcoholic fatty liver disease. A very-low-carb diet works better than a reduced-calorie diet, according to a recent study in the American Journal of Clinical Nutrition.
Nonalcoholic fatty liver disease (NAFLD) occurs in 20 to 40% of the general population, with most cases occuring between the ages of 40 and 60. It’s an accumulation of triglycerides in the liver.
Nonalcoholic steatohepatitis (NASH) is a subset of NAFLD, perhaps 30% of those with NAFLD. Steatohepatitis involves an inflammatory component, progressing to cirrhosis in 3 to 26% of cases.
Researchers at the University of Texas Southwestern Medical Center assigned 18 obese subjects (average BMI 35) to either a very-low-carb diet (under 20 grams a day) or a low-calorie diet (1200 to 1500 calories a day) for two weeks. Liver fat was measured by magnetic resonance technology. The low-carb groups’ liver fat decreased by 55% compared to 28% in the other group. Weight loss was about the same for both groups (4.6 vs 4 kg).
Bottom Line
This small study needs to be replicated, ideally with a larger group of subjects studied over a longer period. Nevertheless, it appears that a very-low-carb diet may be one of the best dietary approaches to nonalcoholic fatty liver disease. And I bet it’s more sustainable than severe calorie restriction. The Ketogenic Mediterranean Diet, by the way, provides 20-30 grams of carb daily.
Refernce: Browning JD, Baker JA, Rogers T, Davis J, Satapati S, & Burgess SC (2011). Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. The American journal of clinical nutrition, 93 (5), 1048-52 PMID: 21367948
Filed under ketogenic diet, Overweight and Obesity, Weight Loss
Dr. Stephan Guyenet at Whole Health Source provides details about the large increase in U.S. consumption of industrial seed oils over the last hundred years. I’ve not studied the issue in detail, so I have no opinion about the health ramifications. But it’s interesting for sure. Dr. G is well worth reading.
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Filed under Fat in Diet
Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Bible Verse of the Day
Diabetic Mediterranean Diet 