Dr David Ludwig Calls for More Research on Ketogenic Diets

Sous vide chicken and sautéed sugar snap peas. This meal is part of a ketogenic diet.

From The Journal of Nutrition:

Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: Click the pic below or here for a ketogenic diet.

low-carb mediterranean diet

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After Gestational Diabetes, How Do You Prevent Type 2 Diabetes?

Baby is still a few months away

From the Journal of the Academy of Nutrition and Dietetics:

Based on the current evidence, a specific dietary intervention for diabetes prevention in women with prior GDM [gestational diabetes mellitus] can therefore not be recommended. Previous systematic reviews have also consistently concluded that evidence for an effect of combined diet and physical activity interventions is inconclusive, with the exception of strong evidence from the Diabetes Prevention Program. Findings from that intensive intervention that focused on diet and physical activity to achieve and maintain weight loss of at least 7% of initial body weight showed >50% reduction in the risk of developing T2DM in women at high risk of T2DM including women with previous GDM; however, this personalised lifestyle intervention is unlikely to be feasible for implementation in routine care. As a limited number of studies have examined diet-alone and physical activity-alone interventions, it remains unclear which diabetes prevention approach would be most effective for women with a GDM history.

Source: The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies – Journal of the Academy of Nutrition and Dietetics

If it were me? I’d lose the excess weight with a reasonable diet and exercise regularly.

Steve Parker, M.D.

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Dietary Fat Should Influence Insulin Dosing In Type 1 Diabetes

Is this pane di casa?

Everyone with diabetes—whether type 1 or type 2—should know that the amount of carbohydrate in meals has in impact on insulin dosing. In general, the more carbs, the more insulin you need. Less well known is that dietary protein and fat also have an effect on insulin requirements. It’s complicated, and there’s quite a bit of variation from one individual to another. The study at hand involved folks with type 1 diabetes using an insulin pump. The test meal was a piece of bread (pane di casa, 45 g carb) plus avocado and other fats in varying amounts.

From Diabetes Care:

The current study has two important outcomes. First, the type of fat has no statistically or clinically significant impact on postprandial glycemia, but the amount of fat has a significant, dose-dependent effect. Second, the insulin delivery pattern, and in some cases total dose, needs to be adjusted based on the amount of fat in order to minimize the risk of early postprandial hypoglycemia and late postprandial hyperglycemia.

Source: Amount and Type of Dietary Fat, Postprandial Glycemia, and Insulin Requirements in Type 1 Diabetes: A Randomized Within-Subject Trial | Diabetes Care

Steve Parker, M.D.

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Are You PWT1D or PWT2D?

A decade ago, some folks began to object to being called diabetics. Instead, they proposed “person with diabetes” or “people with diabetes.” Or simply PWD.

Given the major differences between type 1 and type 2 diabetes, I now propose PWT1D (person or people with type 1 diabetes) and PWT2D.

And so no one’s left out: PWLADA. Person with Latent Autoimmune Diabetes in Adulthood.

Whadda u think?

Steve Parker, M.D.

low-carb mediterranean diet

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Alcohol Promotes Some Cancers, Inhibits Others

Alcohol is linked to higher risk of breast cancer

Do you drink alcohol in part because you think it’s good for heart and brain health? If so, you may be increasing your risk of cancer.

From JAMA Network:

Ample evidence has been available for some time indicating that alcohol use is a preventable risk factor for cancer, and the World Health Organization deemed alcohol a carcinogen more than 30 years ago. In the United States, it is estimated that 5.6% of incident cancer cases (approximately 87 000 each year) are associated with alcohol, including cancers of the oral cavity, pharynx, larynx, liver, esophagus (squamous cell carcinoma), female breast, and colorectum.1 Type of alcohol does not appear to matter; all alcoholic beverages include ethanol, which increases levels of acetaldehyde and in turn promotes DNA damage. Moreover, even moderate levels of consumption (often defined as approximately 14-28 g/d, the equivalent of about 1-2 drinks) appear to be associated with higher risk of some cancers, including cancers of the female breast.2 A protective association has emerged for some cancers, with the most evidence for kidney, Hodgkin lymphoma, and non-Hodgkin lymphoma.2 Nonetheless, the overall cancer burden associated with alcohol use is substantial and comparable with that of other preventable risk factors such as UV exposure and excess body weight.

Source: Alcohol and Cancer Risk: Clinical and Research Implications | Oncology | JAMA | JAMA Network

Steve Parker, M.D.

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U.S. Youths at Risk for Type 2 Diabetes and Prediabetes

Great exercise, but with risk of concussions, broken bones, and torn menisci

Obesity is a risk factor for type 2 diabetes in adults and also plays a significant role in the development of the disease at younger ages. Obesity is highly prevalent among US adolescents and young adults. Many adolescents and young adults with obesity already have blood sugar metabolism abnormalities, which is of great public health concern in view of the sharp increase in type 2 diabetes in adolescence.

From JAMA Network:

In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016 | Adolescent Medicine | JAMA Pediatrics | JAMA Network

Steve Parker, M.D.

PS: Regular exercise and loss of excess fat weight are two great ways to prevent both prediabetes and type 2 diabetes. They also help with treatment.

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Ultra-Processed Foods May Cause Diabetes

 

One example of UPF

A recent observational study done in France found an association between incidence of type 2 diabetes and consumption of ultra-processed foods.

What are ultra-processed foods? From the study at hand, “Ultraprocessed foods (UPF) (ie, foods undergoing multiple physical, biological, and/or chemical processes, among which mostly of exclusive industrial use, and generally containing food additives) are widespread worldwide and especially in Western diets, representing between 25% and 60% of total daily energy [calories].”

These results suggest an association between UPF consumption and type 2 diabetes risk. They need to be confirmed in large prospective cohorts in other settings, and underlying mechanisms need to be explored in ad hoc epidemiological and experimental studies. Beyond nutritional factors, nonnutritional dimensions of the diet may play a role in these associations, such as some additives, neoformed contaminants, and contact materials. Even if a causal link between UPF and chronic diseases cannot be established so far, the accumulation of consistent data leads public health authorities in several countries such as France or Brazil to recommend privileging the consumption of unprocessed/minimally processed foods, and limiting the consumption of UPF in the name of the precautionary principle.

Source: Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort | Lifestyle Behaviors | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

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