Very Low-Carb Diet Helps T1D Patients Achieve Glycemic Control 

Naturally Low-carb Caprese Salad

MedPage Today has a brief report that may interest you. A new study indicates that a very low-carb diet (VLCD) is beneficial to both adults and children with type 1 diabetes. No surprise to me, although I admit this was not an ideal study.

Among people with type 1 diabetes, following a very low-carbohydrate diet (VLCD) can aid in achieving glycemic control, researchers suggested.

Responses from an online survey of people with type 1 diabetes found that those who followed a VLCD reported very good glycemic control – a mean HbA1c of 5.67% ± 0.66%, according to the study by Belinda Lennerz, MD, PhD, of Boston Children’s Hospital, and colleagues. Overall, 97% of these participants achieved the recommended glycemic targets of the American Diabetes Association.

The average blood glucose levels among the subset of patients who reported these values were 104 ± 16 mg/dL, the researchers reported in Pediatrics.

Followers of this diet also noted very few adverse events, with only 2% of the total respondents reporting a diabetes-related hospitalization within the past year – 1% for ketoacidosis and 1% for hypoglycemia.

The survey included 316 responses from both adults with type 1 diabetes and the parents of children with type 1 diabetes. These individuals belonged to a Facebook group of people living with type 1 diabetes who adhere to a VLCD. While a VLCD is usually defined as ≤20 to 50 g per day of carbohydrates or ≤5% to 10% of daily caloric intake, the mean carbohydrate intake of these respondents was 36 ± 15 grams per day.

Source: Carb-Light Diet Helps T1D Patients Achieve Glycemic Control | Medpage Today

Click for the scientific citation.

More details from Maria Muccioli, Ph.D.

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The New Accuracy Standard for Home Glucose Monitoring Devices: +/- 15%

Finger-pricking four times a day gets old real quick!

The U.S. Food and Drug Administration has issued new guidelines for manufacturers of home glucose monitoring devices. The old standard was that the glucose reading of the device had to be within 20% of the actual or true value compared to a medical lab-grade machine.

For example, if the device read 165 mg/dl, the true value could be anywhere from 132 to 198 mg/dl.

Under the new +/- 15% rule, the true number should be between 140 and 190 mg/dl.

I bet you thought your device was more accurate than that.

From the FDA to device manufacturers:

“Blood glucose test results are used by people with diabetes to make critical decisions about their treatment; therefore, it is important that the results are accurate so that nutritional and drug dosing errors are better avoided. Your studies should demonstrate that your SMBG [self-monitoring of blood glucose] is sufficient for this purpose by showing that 95% of all SMBG results in this study are within +/- 15% of the comparator results across the entire claimed measuring range of the device and that 99% of all SMBG results are within +/- 20% of the comparator results across the entire claimed measuring range of the device.”

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Costs of Diabetes in the U.S. in 2017 

Healthcare dollars

Most of the numbers below won’t mean much to you because they are mind-boggling. Also note that most of the cost is caused by type 2 diabetes in people over 65. From Diabetes Care:

“The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).”

Source: Economic Costs of Diabetes in the U.S. in 2017 | Diabetes Care

Drastically reduce your diabetes healthcare expenditures by incorporating the ideas in my books. The ball’s in your court.

Steve Parker, M.D.

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Book Review: “The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally”

From Shutterstock.com

Dr Jason Fung is best known for his advocacy of fasting and low-carb eating. I recently read his latest book, The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally, published this year.

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I waffled between a four or five-star Amazon.com review, but settled on four-star because 1) I haven’t read all of the pertinent scientific literature, and 2) I’m not sure how feasible the Fung protocol is for the average type 2 diabetic (or PWD if you prefer).

When I mention diabetes or diabetic hereafter, it’s always type 2 diabetes, not type 1.

This book builds on the success of very low-carb eating as a therapeutic approach to type 2 diabetes. But it goes beyond that by advocating frequent prolonged fasts as a potential cure for diabetes. I’m talking about fasting for 30–36 hours at a stretch, for up to three times a week. On non-fasting days, his patients typically eat a low-carb diet, which makes sense to me. Two week-long sample meal plans are provided. Thus far, none of my patients have asked me about fasting. If the underlying science checks out, I’d seriously consider the Fung approach myself if I had T2 diabetes.

The longest fast I’ve done has been 24 hours. That’s pretty easy for me, probably because I eat low-carb, so my fat-burning cellular machinery is ready for action. In bro-science terms, I’m keto-adapted. I have no idea if fasting 36 hours would be any harder than 24. Maybe it’s easier if you’re obese.

Dr Fung shares many clinical vignettes from his Intensive Dietary Management Program in Canada. He doesn’t mention how many of his patients start the program and then drop out because it’s too difficult.

Why the intermittent fasting? Because it seems to be an efficient way to reverse the fat build-up in the liver and pancreas that cause the high blood sugars of diabetes. That fat build-up, in turn, is caused by high insulin levels, according to Dr Fung’s working theory of diabetes causation.

The author says the following is what causes diabetes and prediabetes. First, remember that dietary carbohydrates cause a release of insulin from the pancreas, in order to dispose of the carbohydrate as an immediate source of energy or for storage in the liver and skeletal muscles as glycogen. If the carb is not needed for immediate energy and if the glycogen tanks in liver and muscle are full, the glucose is converted to fat. That fat is ideally stored in specialized fat cells (adipocytes), but can also be stored in the liver and pancreas (called visceral fat). Excessive fat in the liver and pancreas eventually impairs function of those organs. To prevent this overload, cells have to become resistant to insulin’s effects. Diets rich in highly-processed, refined carbohydrates (especially fructose, sucrose, and starches) over-stimulate insulin release from the pancreas. Over time, this causes not only body fat, but also fat build-up in the liver and pancreas, impairing their function.

Intermittent fasting and very low-carb eating directly and immediately ameliorate the high insulin levels that cause diabetes. The fasting allows for extended periods of low insulin, which helps tissues regain or maintain sensitivity to insulin, he says.

Dr Fung rightfully points out that his program should be done under physician supervision, especially if you take drugs that can cause hypoglycemia. I can see patients taking this book to office visits and asking “Doc, can I try this?” Unfortunately, many doctors won’t take the time to read the book.

I wonder if this manifesto was actually written to convince physicians that what we’ve been doing for years is misguided, and that Fung’s approach is the way to go.

My favorite sentence: “…the very low-carbohydrate diet does remarkably well, giving you 71% of the benefits of the fasting without actual fasting.”

My least favorite sentence was regarding side effects (e.g., hunger pangs, muscle cramps, headaches) when starting fasting: “These side effects are often signs that the body is dumping its toxic sugar load.” No, that’s just good ol’ “induction flu,” more recently called keto flu.

I don’t know if Dr Fung’s causation theory of diabetes is correct or not. Maybe Dr Roger Unger’s glucagon-centric hypothesis is the reality. Ultimately what matters is whether his protocol actually reverses diabetes in significant numbers of folks, and does it safely. If the Fung protocol proves widely effective, and I hope it does, a Nobel Prize in Medicine may be in Dr Fung’s future.

Steve Parker, M.D.

 

Disclosures: I was given an Advance Reader’s Copy of the book by the publisher’s representative, otherwise I received no financial or other compensation. I don’t know Dr Fung.

Potential conflict of interest: I am a diet book author and blogger who advocates Mediterranean-style eating and low-carb eating for the general public and diabetics.

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Brown Fat: What’s That?

The Joslin diabetes blog has an interesting article on brown fat and its effect on metabolic rate and insulin sensitivity. Brown fat is just a type of body type different from the more plentiful white fat (which is actually more pale yellow). If there are other colors of body fat, I don’t know.

If you can “activate” your brown fat, it helps you burn more calories, which could be helpful if you’re trying to lose weight. It also improves insulin sensitivity: beneficial if you have type 2 diabetes or are prone to it.

From Joslin:

“When brown fat is fully activated, it can burn between 200 and 300 extra calories per day. It is most successfully activated through cold exposure. A recent study of people with type 2 diabetes had volunteers sit in a 50 degree room for a couple of hours a day for 10 days in shorts and short-sleeved shirts.

“When I say cold, it’s not icy cold, it’s not like the winter in Boston,” she says. “It’s more or less like the temperature we have here in autumn. After this mild cold exposure, all ten volunteers with type 2 diabetes, as shown in that study, displayed increased brown fat activity and improved insulin sensitivity. This is very exciting.”

Dr. Tseng is working on understanding exactly what is happening on a cellular level to activate brown fat in the cold to see if she can create a drug that will mimic the effects. “Although cold works, it’s just not pleasant,” she says. “If you had to sit in a cold room for a few hours every day, perhaps not everybody could accept that.”

Source: How Your Body Temperature Can Affect Your Metabolism | Speaking of Diabetes | The Joslin Blog

Another way to activate brown fat is exercise (at least if you’re a man or a mouse).

Steve Parker, M.D.

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Verners Views: Comparison between the approaches to Type 2 Diabetes by Dr David Unwin and Diabetes UK 

Low-carb vs standard “diabetic diet”:

The most significant fact to emerge is that those who follow the advice of Dr [David] Unwin are so often successful.

In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice:

(1) Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg, waist circumference fell by 15 cm, blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but in common with prior observations for low-carbohydrate diets a significant improvement would have been anticipated.From the perspective of the practice, there has been a huge saving in the expenditure on drugs used for the treatment of diabetes. The actual figure is about £38,000 per year against the regional average, which represents the lowest spend per 1000 patients in any of the 19 surgeries in the surrounding Southport (UK) and Formby area for which information was available. This saving should be seen against the extra costs of the Norwood Surgery diabetes intervention at just under £9,000 per year.

(2) There has also been an improvement in the obesity prevalence as determined by BMI. This has dropped from 9.4% before the initiative commenced to 8.4%. The National Health Survey for England shows that for adults there has been a steady increase in the prevalence of obesity in England between 2010 and 2015 (Table 1).

Source: 305. A Comparison between the approaches to Type 2 Diabetes (T2D) by Dr David Unwin and Diabetes UK | Verners Views

RTWT for diet details.

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Level of Fitness May Be More Important Than Number of Hours You Exercise

She can increase intensity by increasing the weight of those dumbbells

She can increase intensity by increasing the weight of those dumbbells

You’ve heard that “sitting is the new smoking,” right?

Regular physical activity prevents disease and prolongs life. But if you nevertheless still spend to much time sitting around either at work or home, the sitting tends to counteract the benefits of your exercise.

A new study says that your fitness level is more important for long-term health than the number of hours you exercise. Fitness level in this context was cardiorespiratory fitness, probably measured by a maximal-effort treadmill or bicycle test.

Some of your fitness level is inherited, but you can also improve your fitness with the proper intensity or duration of exercise. Rather than exercise longer, I prefer more intensity. Just strolling around the mall at 2 mph for two hours isn’t going to improve fitness in most folks.

From MNT:

The team conducted a cross-sectional study of 495 women and 379 men from Norway aged between 70-77 years. Sedentary time and physical activity were assessed by accelerometers, while cardiorespiratory fitness was determined by peak oxygen uptake (VO2 peak) – the measurement of the volume of oxygen that the body can utilize during physical exertion.

Researchers compared different levels of activity with fitness levels and cardiovascular risk factor clusters. A cardiovascular risk factor cluster was defined as the presence of three to five risk factors for heart disease.

These risk factors included: elevated waist circumference, elevated blood triglycerides or reduced “good” cholesterol levels, high blood pressure or treatment for hypertension, and elevated fasting blood sugar levels – combined symptoms commonly referred to as metabolic syndrome.

High cardiorespiratory fitness reduced risk of heart diseaseFindings – published in Mayo Clinic Proceedings – showed that when compared with women and men who were the least sedentary, women and men from the most sedentary group were 83 percent and 63 percent more likely to have cardiovascular risk factors from extended time sitting, respectively.

However, when the team took participants’ level of fitness into consideration – measured by having high age-specific cardiorespiratory fitness – they found that the fittest 40 percent had a decreased likelihood of cardiovascular risk factors from prolonged sitting.This finding held true even though the fittest participants spent between 12-13 hours per day sedentary and did not meet current moderate to vigorous physical activity guidelines.

Source: Fitness, not physical activity, mitigates negative effects of prolonged sitting – Medical News Today

PS: If you’re new to exercise, I teach you how to get started in my books.

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