MedPage Today yesterday reported that chronic consumption of alcohol may impair vision in diabetics. Drinkers performed less well on vision chart tests than non-drinkers. It’s not a diabetic retinopathy issue. Beer and distilled spirits were riskier than wine.
Glasses, contacts, or Lasik?
The MedPage Today article didn’t comment on the potential health benefits of alcohol consumption.
You can bet I’ll keep an eye on this.
Filed under Alcohol, Diabetes Complications
More than a year after the U.S. Food and Drug Administration approved Cycloset (bromocriptine mesylate) for treatment of type 2 diabetes, it’s now available at pharmacies. I updated my brief bromocriptine drug review of May 14, 2009.
I assume it’s the same bromocriptine that’s been available for years to treat Parkinson’s disease and acromegaly. Parlodel for Parkinson’s is sold as 2.5 and 5 mg tablets; Cycloset is 0.8 mg. [Update December 3, 2010: Cycloset is not the same formulation of bromocriptine used to treat other diseases. See first comment below.]
Filed under Drugs for Diabetes
Judging from improvement in hemoglobin A1c, 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, according to the latest research in the Journal of the American Medical Association.
One type of resistance training
One of the things that impressed me about Dr. Richard Bernstein’s book, Diabetes Solution, was his strong advocacy of weight training, also known as resistance training and strength training. Weight lifting is a typical example.
Prior studies had shown exercise-induced improvements (reductions) in hemoglobin A1c, a great test for overall diabetes control, in the range of o.66% to 1.0% (absolute change, not relative). That’s comparable to what we see with many drugs. Much easier to pop a pill though, huh?
One earlier study showed hemoglobin A1c lowered by 0.4% with resistance training, 0.5% with aerobic training, and 1.0% with combined resistance/aerobic. But folks doing both aerobic and resistance were exercising 270 minutes a week—39 minutes a day—which was significantly more than the people just doing one type of exercise. [This was the DARE study: Diabetes Aerobic and Resistance Exercise.]
Investigators at the Pennington Biomedical Research Center in Louisiana wondered which type of exercise would be more effective, comparing the same minutes per week of activity.
Methodology
They randomized 262 sedentary type 2 diabetics to one of four groups: control, aerobic exercise, resistance training 3 days a week, or combined aerobic and resistance training (resistance twice weekly). All three groups exercised for about 140 minutes a week—just 20 minutes a day, on average—for nine months. Exercise intensity was 50 to 80% of maximum oxygen consumption (determined by a baseline treadmill stress test). Nearly all participants were on diabetic drugs; 18% were on insulin. I think the aerobic group exercised on treadmills.
Participant characteristics: Women were 64% of the total. Average age 56. Forty-seven percent were non-white (114 black, 10 Hispanic/other). Average body mass index was 35. Average hemoglobin A1c was 7.7%. Not too many people dropped out of the study before it was over.
Results
No serious adverse event occurred during exercise. The authors didn’t mention the occurence of hypoglycemia.
The combination training group dropped their hemoglobin A1c average by 0.34% (p = 0.03). The pure resistance and aerobic exercisers didn’t show any improvement over the control group.
The combination group lost 1.6 kg body weight on average compared to the control group. Pure resistance and aerobic exercisers’ weights didn’t differ from the control group. [Remember, this was not a weight-loss study.]
Comments
The authors write:
The failure of the aerobic group to lose a substantial amount of weight (or fat) has been reported in numerous aerobic exercise trials, which may be due to aerobic training resulting in [higher] energy intake, expenditure compensation, or both.
If you’re trying to lose excess fat weight, resistance training appears to win over aerobic exercise.
Doing either aerobic execise or resistance exercise for an average of 20 minutes a day will not improve hemoglobin A1c levels in most type 2 diabetics. We can assume blood sugars aren’t lower either. It takes a combination of both types of exercise to lower hemoglobin A1c.
A hundred and forty minutes of exercise weekly—just 20 minutes a day—is not too much to ask for, if improved health and weight management are the goals. More would be better.
Over nine months, the control group ended up needing more diabetic drugs. The combination training group decreased its drug use.
Dr. Bernstein may still by right to stress resistance training over aerobic. I bet he’d say these folks weren’t exercising enough. The study at hand suggests that it’s important to do both types of exercise, especially if you’re not going to put much time into it.
The details of the resistance training program are probably important. You can read the study yourself and decide if participants were on a good regimen. I’ve little expertise in that area.
Diabetics taking insulin, sulfonylureas, and meglitinides are at risk for hypoglycemia during exercise. The study authors made little mention of this, so it may be safe to assume it wasn’t a problem. Certified diabetes educators saw participants monthly, which may have nipped the problem in the bud.
Reference: Church, T., Blair, S., Cocreham, S., Johannsen, N., Johnson, W., Kramer, K., Mikus, C., Myers, V., Nauta, M., Rodarte, R., Sparks, L., Thompson, A., & Earnest, C. (2010). Effects of Aerobic and Resistance Training on Hemoglobin A1c Levels in Patients With Type 2 Diabetes: A Randomized Controlled Trial JAMA: The Journal of the American Medical Association, 304 (20), 2253-2262 DOI: 10.1001/jama.2010.1710
Filed under Exercise
The Happy Hospitalist has a timely post about the safety of the infamous airport x-ray scanners.
Filed under Uncategorized
St. Peter's Square, Vatican City
The outstanding event of modern times was the failure of religious belief to disappear. For many millions, especially in the advanced nations, religion ceased to play much or any part in their lives, and the ways in which the vacuum thus lost was filled, by fascism, Nazism and Communism, by attempts at humanist utopianism, by eugenics or health politics, by the ideologies of sexual liberation, race politics and environmental politics, form much of the substance of the history of our century. But for many more millions—for the overwhelmimg majority of the human race, in fact—religion continued to be a huge dimension in their lives.
—Paul Johnson, in his book Modern Times, about the history of the 20th Century
Filed under Quote of the Day
Women double their risk of developing coronary heart disease if they have high consumption of carbohydrates, according to research recently published in the Archives of Internal Medicine.
Men’s hearts, however, didn’t seem to be affected by carb consumption. I mention this crucial difference because I see a growing trend to believe that “replacing saturated fat with carbohydrates is a major cause of heart disease.” If true, it seems to apply only to women.
We’ve known for a while that high-glycemic-index eating was linked to heart disease in women but not men. Glycemic index is a measure of how much effect a carbohydrate-containing food has on blood glucose levels. High-glycemic-index foods raise blood sugar higher and for longer duration in the bloodstream.
High-glycemic-index foods include potatoes, white bread, and pasta, for example.
The study at hand includes over 47,000 Italians who were interrogated via questionnaire as to their food intake, then onset of coronary heart disease—the cause of heart attacks—was measured over the next eight years.
Among the 32,500 women, 158 new cases of coronary heart disease were found.
Researchers doing this sort of study typically compare the people eating the least carbs with those eating the most. The highest quartile of carb consumers and glycemic load had twice the rate of heart disease compared to the lowest quartile.
The Cleave-Yudkin theory of the mid-20th century proposed that excessive amounts of refined carbohydrates cause heart disease and certain other chronic systemic diseases. Gary Taubes has also written extensively about this. Theresearch results at hand support that theory in women, but not in men.
Practical Applications
Do these research results apply to non-Italian women and men? Probably to some, but not all. More research is needed.
Women with a family history coronary heart disease—or other CHD risk factors—might be well-advised to put a limit on total carbs, high-glycemic-index foods, and glycemic load. I’d stay out of that “highest quartile.” Don’t forget: heart disease is the No. 1 killer of women.
See NutritionData’s Glycemic Index page for information you can apply today.
Disclaimer: All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status. Always consult your personal physician before making any dietary or exercise changes.
References: Sieri, S., Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., Pellegrini, N., Palli, D., Masala, G., Sacerdote, C., Veglia, F., Tumino, R., Frasca, G., Grioni, S., Pala, V., Mattiello, A., Chiodini, P., & Panico, S. (2010). Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study Archives of Internal Medicine, 170 (7), 640-647 DOI: 10.1001/archinternmed.2010.15
Barclay, Alan, et al. Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies [of mostly women]. American Journal of Clinical Nutrition, 87 (2008): 627-637.
Filed under Carbohydrate, coronary heart disease, Glycemic Index and Load
I had written recently of my ignorance regarding the modern version of the Paleolithic diet and lifestyle, thinking that Loren Cordain devised it around year 2000. Then I found a medical journal article from 1988 outlining it, co-written by S. Boyd Eaton, M.D.
Mat Lalonde, Ph.D., in an interview with Jimmy Moore instead suggested that Cordain would credit S. Boyd Eaton, M.D., with the trend.
The Paleolithic Prescription: A Program of Diet and Exercise and a Design for Living was published in 1988 by Harper & Row (New York). The authors are S. Boyd Eaton, M. Shostak, and M. Konner.
Eaton and Konner are also the authors of “Paleolithic nutrition: A consideration of its nature and current implications.” in New England Journal of Medicine, 312 (1985): 283-289.
If you have evidence that the “modern paleo” diet goes back further than this, please leave a comment.
Filed under Uncategorized
It was Jean-Jacques Rousseau who had first announced that human beings could be transformed for the better by the political process, and that the agency of change, the creator of what he termed the “new man”, would be the state, and the self-appointed benefactors who controlled it for the good of all. In the twentieth century his theory was finally put to the test, on a colassal scale, and tested to destruction.
—Paul Johnson in Modern Times (1991 revised edition)
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1. Taste
2. Variety
3. Health benefits
For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.
The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption. He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too. Dietary saturated fat does tend to raise cholesterol levels.
Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around. See References below for the most recent studies.
Relatively strong evidence supports the Mediterranean diet’s association with:
■ increased lifespan
■ lower rates of cardiovascular disease such as heart attacks and strokes
■ lower rates of cancer (prostate, breast, uterus, colon)
■ lower rates of dementia
■ lower incidence of type 2 diabetes
Weaker supporting evidence links the Mediterranean diet with:
■ slowed progression of dementia
■ prevention of cutaneous melanoma
■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars
■ less risk of developing obesity
■ better blood pressure control in the elderly
■ improved weight loss and weight control in type 2 diabetics
■ improved control of asthma
■ reduced risk of developing diabetes after a heart attack
■ reduced risk of mild cognitive impairment
■ prolonged life of Alzheimer disease patients
■ lower rates and severity of chronic obstructive pulmonary disease
■ lower risk of gastric (stomach) cancer
■ less risk of macular degeneration
■ less Parkinsons disease
■ increased chance of pregnancy in women undergoing fertility treatment
■ reduced prevalence of metabolic syndrome (when supplemented with nuts)
■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant
Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes? Association, of course, is not causation.
The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individuals in an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death. Make sure they stay on the assigned test diet. Then you’d have an answer for that population and those two diets. Then you have to compare the winning diet to yet other diets. And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.
Now you begin to see why scientists tend to rely on observational rather than interventional diet studies.
I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases. At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all popular. And you couldn’t pick three programs with more differences! So I had my work cut out for me.
After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population. People with particular medical problems or ethnicities may do better on another diet. People with diabetes or prediabetes are probably better off with a carbohydrate-restricted diet, such as the Low-Carb Mediterranean Diet.
Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones. The Mediterranean diet qualifies as plant-based.
What do you consider the overall healthiest diet, and why?
References:
Sofi, Francesco, et al. Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. American Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010. doi: 10.3945/ajcn.2010.29673
Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209
Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.
Sofi, Francesco, et al. Adherence to Mediterranean diet and health status: Meta-analysis. British Medical Journal, 337; a1344. Published online September 11, 2008. doi:10.1136/bmj.a1344
Feart, Catherine, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Journal of the American Medical Association, 302 (2009): 638-648.
Scarmeas, Nikolaos, et al. Physical activity, diet, and risk of Alzheimer Disease. Journal of the American Medical Association, 302 (2009): 627-637.
Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.
Fung, Teresa, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119 (2009): 1,093-1,100.
Mente, Andrew, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine, 169 (2009): 659-669.
Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.
Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.
Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.
A new scientific truth is not usually presented in a way to convince its opponents. Rather, they die off, and a rising generation is familiarized with the truth from the start.
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Bible Verse of the Day
Diabetic Mediterranean Diet 