HeartWire on November 23, 2009, reported the discovery of atherosclerosis (hardening-of-the-arteries) in Egyptian mummies 3000 years old.
So it appears that atherosclerosis in not just a disease of modern civilization, as suggested by some.
Modern Heart Disease Found in Ancient Egyptian Mummies
Filed under coronary heart disease
Quote of the Day
The urge to simplify a complex scientific situation so that physicians can apply it to their patients and the public embrace it has taken precedence over the scientific obligation of presenting the evidence with relentless honesty.
—Gary Taubes, in Good Calories, Bad Calories (2007)
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Are Vegetarian Diets Any Good For Diabetes?
Plant-based diets may offer special benefits to people with diabetes, according to a recent review article by U.S. researchers who reviewed the pertinent English language literature published since 1966. They found 116 potentially relevant articles, 10 of which were directly related to diabetes management and glucose control.
The authors failed to define “vegetarian” early on. Some vegetarians eat eggs, some eat cheese, some drink milk. I assume vegans eat no animal products whatsoever. On the last page of the review the authors write that a vegetarian “does not eat meat, fish, or poultry” although it’s not clear if that applies throughout the review. There are many references to “low-fat vegetarian” diets, with little or no mention of moderate- or high-fat vegetarian diets.
The authors often refer to vegetarian diets as “plant-based.” No doubt, they are. But even the healthy Mediterranean diet is considered plant-based, while clearly not vegetarian.
It’s also unclear whether they focused on type 1 or type 2 diabetes. My sense is, probably type 2.
Here are the major points:
- Are vegetarians less likely to develop diabetes? Observational studies have found a lower prevalence of diabetes among vegetarians compared to non-vegetarians, especially among Seventh Day Adventists. In other studies, meat consumption is linked to higher risk of diabetes among women.
- Do vegetarian diets help control diabetes? Several small studies showed that low-fat near-vegetarian and vegan diets improved glucose control and insulin sensitivity and reduced diabetes medication use, compared with a traditional diabetes diet – which is typically low-fat and high-carb. I’m not sure, but I assume that the intervention diets were not heavy in refined, processed carbohydrates, but instead consisted of natural whole plant foods. “Weight loss accounts for much although not all, of the effect of plant-based diets on glycemic control,” they write.
- Heart disease is quite common in older diabetics. Do vegetarian diets offer any cardiac benefits? They cite Dr. Ornish’s Lifestyle Heart Trial of a low-fat vegetarian diet and intensive lifestyle intervention: smoking cessation, stress management (meditation?), mild exercise, and group meetings. Dr. Ornish’s program reduced LDL cholesterol by 37%, reversed heart artery blockages in 82% of participants, and found 60% lower risk of cardiac events compared to the control group. Dr. Ornish’s Multisite Lifestyle Cardiac Intervention Program also documented impressive cardiac results at 12 weeks, but had no control group. Dr. Caldwell Esselstyne is also mentioned in this context.
- Vegetarian diets are linked to lower blood pressure, which may help prolong life and prevent heart attacks and strokes.
- Antioxidant-rich foods like fruits and vegetables—common in the Mediterranean diet and vegetarian diets—may lower cardiovascular disease risk.
- People with diabetes are at risk for impaired kidney funtion. In women with impaired baseline kidney funtion, high animal protein intake is associated with continued kidney deterioration.
- A small study showed dramatic improvement in type 2 diabetics with painful neuropathy over 25 days on a low-fat vegan diet and a daily 30-minute walk. Many participants were able to reduce diabetes drug dosages.
- Do any diabetes advocacy associations endorse vegetarian diets for people with diabetes? The American Dietetic Association deems that vegetarian and vegan diets, if well-planned, are nutritionally adequate. I don’t know the position of the American Diabetes Association. Vegetarians need planning to get adequate vitamin D, B12, and calcium.
- “Low-fat vegetarian and vegan diets do not require individuals to limit energy or carbohydrate intake….” If true (and these guys should know), that might broaden the diet’s appeal.
- I saw no mention of decreased overall mortality in vegetarians.
My Comments
Have you heard of the Physicians Committee for Responsible Medicine? Their president is Neal Barnard, the lead author of the study at hand. He has a new book on reversal of diabetes with a low-fat vegetarian diet.
The authors cite a journal article (reference #16) in support of plant-based diets, but the article doesn’t mention a vegetarian or vegan diet—it’s high-carb, high-fiber diet. I didn’t review all 92 of their references to see if any others were misleading.
“Plant-based diets” must be a euphemism for vegetarian diets. Too many people shut down when you talk to them about vegetarian diets.
I won’t rule out the possibility that vegetarian/vegan diets may be helpful in management of diabetes. Such diets are, of course, 180 degrees different from the very low-carb diets I’ve reviewed favorably in these pages! Both models, ideally, move away from the over-processed, concentrated carbohydrates so prevalent in Western culture. Perhaps that’s the unifying healthy theme, if there is one.
Or different sub-types of diabetes respond better to particular diets.
I heartily agree with the authors that larger clinical trials of vegetarian diets in diabetics are needed. I’d love to see a long-term randomized controlled trial comparing a very low-carb diet diet with a low-fat vegetarian diet. That’s the best way to settle which is better for diabetics: vegetarian or low-carb.
It’ll never be done.
Has a vegetarian diet helped control your diabetes?
Reference: Barnard, Neal, et al. Vegetarian and vegan diets in type 2 diabetes management. Nutrition Reviews, 67(2009): 255-263. doi: 10.1111/j.1753-4887.2009.00198.x
Low-Carb Ketogenic Diet for Overweight Diabetic Men: A Pilot Study
A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients, according to U.S. researchers. The 2005 report recommends that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar dramatically.
Methodology
Twenty-eight overweight people with type 2 diabetes were placed on the study diet and followed for 16 weeks. Seven people dropped out, so the analysis involved 21, of which 20 were men—the study was done at a Veterans Administration clinic. Thirteen were caucasian, eight were black. Average age was 56; average body mass index was 42. The seven dropouts were unable to come to the scheduled meetings or couldn’t follow the diet. No dropout complained of adverse effects of the diet.
Results
Participants were instructed on the Atkins Induction Phase diet, which daily includes:
- under 20 g carbohydrate
- one cup of low-carb vegetables
- two cups of salad greens
- four ounces of hard cheese
- unlimited meat, poultry, fish, eggs, shellfish
- a multivitamin
At the outset, diabetes medication dosages were reduced in this general fashion: insulin was halved, sulfonyureas were halved or discontinued. If the participant were taking a diuretic (fluid pill), low doses were discontinued; high doses were halved.
Study subjects returned every two weeks for diet counseling and medication adjustment (based on twice daily glucose readings and episodes of hypoglycemia). Food cravings and/or good progress on weight goals triggered a 5-gram (per day) weekly increase in carbohydrate allowance. In other words, if a participant’s weight loss goal was 20 pounds and he’d already lost 10, he could increase his daily carbs during the next week from 20 to 25 g. Carbs could be increased weekly by five gram increments as long as weight loss progressed. [This is typical Atkins.] Food records were analyzed periodically.
Results
- hemoglobin A1c decreased from an average baseline of 7.5% down to 6.3% (a 1.2% absolute decrease and 16% relative drop)
- the absolute hemoglobin A1c decrease was at least 1.0% in half of the participants
- diabetic drugs were reduced in 10 patients, discontinued in seven, and unchanged in four
- average body weight decreased by 6.6%, from 131 kg (288 lb) to 122 kg (268 lb)
- triglycerides decreased 42%, while cholesterols (total, HDL, and LDL) didn’t change significantly
- no change in blood pressures
- average fasting glucose decreased by 17% (by week 16)
- uric acid decreased by 10%
- no serious adverse effects occurred
- one hypoglycemic event involved EMS but was treated without transport
- only 27 of 151 urine ketone measurements were greater than trace
My Comments
The degree of improvement in hemoglobin A1c—our primary gauge of diabetes control—is equivalent to that seen with many diabetic medications. I see many overweight diabetics on two or three drugs and a standard “diabetic diet,” and they’re still poorly controlled. This diet could replace the expense and potential adverse effects of an additional drug.
In August this year I blogged about a study comparing the Atkins diet with a traditional low-fat diet in overweight diabetic black women in the U.S. As measured at three months, the Atkins diet proved superior for weight loss and glucose control.
This study at hand is small, but certainly points to the effectiveness of an Atkins-style very low-carb ketogenic diet in overweight men with type 2 diabetes.
Yancy, William, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men]. Nutrition and Metabolism, 2:34 (2005). doi: 10.1186/1743-7075-2-34
Filed under Carbohydrate, ketogenic diet, Overweight and Obesity, Weight Loss
Fish With Omega-3 Fatty Acids Reduce Risk of Blindness
Age-related macular degeneration is the leading cause of blindness in Americans over 65. Impaired vision precedes blindness. A recent study linked consumption of omega-3 fatty acids with 30% lower risk of developing macular degeneration. Believe me, it’s a lot better to prevent it than try to treat it once present.
[I have a couple older relatives with macular degeneration, so I pay close attention to the scientific literature.]
What’s the best sources of omega-3 fatty acids? Our friend, the fish. Especially cold-water fatty fish such as tuna, trout, sardines, herring, mackerel, halibut, and sea bass. A few plants are also decent sources, but our bodies don’t utilize those omega-3 fatty acids as well as they do from fish.
Note that the Ketogenic Mediterranean Diet has a prominent role for fish.
Reference: SanGiovanni, J.P., et al. Long-chain polyunsaturated fatty acid intake and 12-y incidence of neovascular age-related macular degeneration and central geographic atrophy: AREDS report 30, a prospective cohort study from the Age-Related Eye Disease Study. American Journal of Clinical Nutrition, 90 (2009): 1,601-1,607. First published October 7, 2009. doi:10.3945/ajcn.2009.27594
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For Heart’s Sake, Should You Avoid Red Meat in a Low-Carb Diet?
Low carbohydrate diets tend to contain disproportionate amounts of fat from animal sources. Red meat has long been vilified as a major source of saturated fat that some experts believe cause hardening-of-the-arteries (atherosclerosis) via elevations in LDL cholesterol. Others disagree. Poultry, fish ,and shellfish generally have lower amounts of saturated fat than red meat. Would a low-carb diet with a predominance of poultry, fish, and shellfish lead to a more advantageous cholesterol profile?
A 2007 report from U.S. researchers found no lipid advantage to the poultry/fish/shellfish model. In fact, despite high cholesterol and fat intakes, neither diet caused a significant change in total, HDL, or LDL cholesterol levels. Triglycerides fell in both groups, but to a statistically significant degree only on the poultry/fish/shellfish group.
Fun Fact: Did you know that four of every 10 women in the U.S. are trying to lose weight? The figure for men is one in three.
Methodology
Researchers in Minnesota and Iowa enrolled 18 subjects (6 males, 12 females) between the ages of 30 and 50 who wanted to lose weight. Average body mass index was 31.7, which is mildly obese. The were encouraged to eat an Atkins-style ketogenic diet with a maximum of 20 g carbs/day, providing 1,487 total daily calories, with 7% of calories from carbohydrate, 43% from protein, and 50% from fat. This included two or three cups of salad greens and low-carb vegetables. Three ounces of cheese daily was allowed. Subjects were randomly assigned to eat either red meat or poultry/fish/shellfish. Dietary intervention lasted 28 days.
[This is very similar to Atkins Induction Phase, although Atkins does not limit total calories. The researchers did not say why they wanted to limit total calories.]
Data were not used from six subjects for good reasons (see article). So final data analysis included only 12 subjects.
Results
Both groups lost the same amount of weight: about 5.5 kg (12 pounds) over 28 days.
Average carbohydrate intake was about the same for both groups: 55 g/day.
Average total daily caloric intake was about the same for both groups: 1,380.
The poultry/fish/shellfish group ate 630 mg cholesterol daily, twice as much as the other group. [Eggs and shrimp were popular.]
The difference in intake of saturated fat approached, but did not reach, statistical significance (32 g/day in the red meat group vs 25 g).
Neither diet caused a significant change in total, HDL, or LDL cholesterol levels. Triglycerides fell in both groups, but to a statistically significant degree only on the poultry/fish/shellfish group.
Urine ketones at or above 5 mg/dl were detected on 75% of all dipstick tests.
My Comments
I’m skeptical about the accuracy of the calorie counts. Most people eating Atkins-style take in about 1,800 cals/day. The preponderance of females, however, may explain the unusually low average caloric intake. They didn’t follow their carb restriction very closely, did they? These were free-living subjects not locked in a metabolic ward.
The researchers note that the allowance of cheese in both groups may have sabotaged their efforts for a clear delineation of higher versus lower saturated fat groups.
HDL cholesterol usually rises significantly on low-carb diets. Lack of that here may just be a statistical aberration.
This is such a small study that it’s impossible to draw firm conclusions. Nevertheless, if someone is losing weight on a low-carb diet, it may not matter much from a lipid viewpoint whether they eat a predominance of meat or a predominance of poultry, fish, and shellfish. The study at hand cannot address the long-term consequences of such a choice.
Reference: Cassady, Bridget, et al. Effects of low carbohydrate diets high in red meats or poultry, fish and shellfish on plasma lipids and weight loss. Nutrition & Metabolism, 4:23 doi: 10.1186/1743-7075-4-23 Published October 31, 2007
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Filed under Carbohydrate, Fish, ketogenic diet, Overweight and Obesity
Book Review: 21 Life Lessons From Livin’ La Vida Low-Carb
Here’s my review of Jimmy Moore’s new book, 21 Life Lessons From Livin’ La Vida Low-Carb: How the Healthy Low-Carb Lifestyle Changed Everything I Thought I Knew. I rate it five stars, Amazon.com’s highest rating.
♦ ♦ ♦
Thinking about quitting your low-carb lifestyle? Read this book first.
Jimmy Moore is a leading advocate for low-carb eating. His purpose with this book is to educate, encourage, and inspire overweight people to begin or maintain their own low-carb journey. And he succeeds in spades.
Mr. Moore assumes the reader already knows how to do low-carb eating. If you don’t, I’m sure Mr. Moore would recommend Dr. Atkins New Diet Revolution as the single best source. As with all diets, low-carb eating has a high drop-out rate. Most people lose some weight then return to their old way of eating, gaining the weight back.
Even as the author of a balanced, calorie-restricted diet book, I’ll admit that many people have had phenomenal success with low-carb diets, without caloric restriction. Mr. Moore is one of those: 180 pounds (82 kg) weight loss in one year, and sustained over five years. Could he be lying? Sure. But my gut feeling is he’s not.
This book is not only a survey of the low-carb world covering the last decade, its an autobiography. He shares his traumatic upbringing and the frustrating premature death of his morbidly obese brother from heart disease. You’ll learn about Mr. Moore’s movie career alongside George Clooney. I was also surprised to learn that Mr. Moore lost 170 pounds (77 kg) in 1999, not on a low-carb diet, but a low-fat one! Then what happened? I won’t spoil it for you. Mr. Moore also owns up to his regrettable and embarrassing affiliation with the Kimkins diet in 2007.
The only weak chapter is the one on childhood obesity. Mr. Moore moves away from his previous science- and evidence-based arguments, using personal opinion and anecdote more often. This partly reflects the fact that childhood obesity hasn’t been studied nearly as much as the adult version.
I particularly like Mr. Moore’s review of the scientific evidence in favor of low-carb eating. The science was inspired and driven by the low-carb craze of 1998-2004. But the study results weren’t published until after the fad peaked. So most people aren’t familiar with the science. Mr. Moore presents it in very understandable terms, which is a gift.
As heavily invested as he is in low-carb eating, does Mr. Moore condemn other methods of weight management? By no means. He repeatedly writes: “The point is to find the proven nutritional plan that works for you, follow that plan as exactly as prescribed by the author, and then stick to it for the rest of your life.”
Additional information: Jimmy Moore’s Livin’ La Vida Low-Carb Blog
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Do Beans and Peas Affect Glucose Control in Diabetics?
Beans and peas improve control of blood sugar in diabetics and others, according to a recent report from Canadian researchers. The effect is modest.
Dietary pulses are dried leguminous seeds, including beans, chickpeas, lentils, and peas. Pulses fed to healthy volunteers have a very low glycemic index, meaning they don’t cause much of a rise in blood sugar compared to other carbohydrates. They are loaded with fiber and are more slowly digested than foods such as cereals.
Investigators examined 41 clinical trials (1,674 participants) on the effects of beans and peas on blood glucose control, whether used alone or as part of low-glycemic-index or high-fiber diets. Eleven trials looked at the effect of beans and peas alone, with the experimental “dose” averging 1oo g per day (about half a cup). The article doesn’t specify whether the weight of the pulse was the dry weight or the prepared weight. I will assume prepared.
Pulse given alone or as part of a high-fiber or low-glycemic index diet improved markers of glucose control, such as fasting blood sugar and hemoglobin A1c. The absolute improvement in HgbA1c was around 0.5%. Effects in healthy non-diabetics were less dramatic or non-existent.
My Comments
This study was very difficult for me to digest. The researchers lumped together studies on diabetics and non-diabetics, using various doses and types of pulses. No wonder they found “significant interstudy heterogeneity.”
Cardiovascular disease is common in diabetics. I’m aware of at least one study linking legume consumption with lower rates of cardiovascular disease. I was hoping this study would answer for me whether I should recommend legumes such as peas and beans for my type 2 diabetics. Beans and peas do represent a low glycemic load, which is good. But I think I’ll have to keep looking for better-designed studies.
Reference: Sievenpiper, J.L., et al. Effect of non-oil-seed pulses on glycaemic control: a systematic review and meta-analysis of randomised controlled experimental trials in people with and without diabetes. Diabetologia, 52 (2009): 1,479-1,495. doi: 10.1007/s00125-009-1395-7
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Filed under Carbohydrate, Fiber, Prevention of T2 Diabetes
Self-Experimentation: Does Vinegar Promote Weight Loss?
![MPj03878520000[1]](https://diabeticmediterraneandiet.com/wp-content/uploads/2009/11/mpj038785200001.jpg?w=107&h=150 "MPj03878520000[1]")
I reported recently that apple cider vinegar in a Japanese study population reduced body weight by 2.2 to 4.4 pounds (1—2 kg) over 12 weeks. The dose was 15—30 ml daily, or 1—2 tbsp. The researchers think the active ingredient is simply acetic acid.
On November 14, 2009, I started another self-experiment: I’m drinking 7.5 ml (1.5 tsp) Heinz apple cider vinegar twice daily, mixing it in 8—10 fl oz of water plus 1/2 packet (1.75 g) of Truvia sweetener, with or without 1 heaping tsp of sugar-free Metamucil. I’ll do this for 12 weeks. If I weighed over 200 lb, I would have chosen the 30 ml/day vinegar dose. But I’m only 155 lb.
Why Truvia? We had some in the house, I don’t think I absorb its erythritol and rebiana, and it makes the vinegar much more palatable.
Why Metamucil? You can figure that one out, Spanky.
A small-scale “experiment of one” like this isn’t worth much. Too many variables can affect the outcome. For instance, the holiday season is just around the corner. Most Americans gain five pounds between Thanksgiving and New Years. I’ve been no exception to that in the past.
I’m not totally committed to the experiment. But I’ve gotta do something with that huge bottle of vinegar my wife bought.
Filed under Weight Loss
Olive Oil in Mediterranean Diet Linked to Lower Body Weight
![MPj04332860000[1]](https://diabeticmediterraneandiet.com/wp-content/uploads/2009/11/mpj043328600001.jpg?w=100&h=150 "MPj04332860000[1]")
The source of virgin olive oil
This consisted of a high intake of fruit and vegetables and of non-refined cereals and fish, and the use of virgin olive oil as the main source of fatty food. Moreover, a high intake of legumes and nuts is recommended.
We’ll have more details when the research is published in a peer-reviewed scientific journal. Olive oil is a type of fat. This finding of lower body weight on an olive 0il-rich Mediterranean diet run counter to the generally accepted idea that dietary fat causes body fat. Lower body weight is linked to lower risk of diabetes.
Reference: A diet rich in virgin olive oil reduces body weight, according to research by the University of Navarra. Press release, August 3, 2009.
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Diabetic Mediterranean Diet 