Fight Aging With Fish-Derived Omega-3 Fatty Acids

Cold-water fatty fish loaded with omega-3 fatty acids include salmon, trout, sardines, herring, and mackerel

Cold-water fatty fish loaded with omega-3 fatty acids include salmon, trout, sardines, herring, and mackerel

A daily fish oil supplement for six months improved muscle size and strength in a group of elderly folks.

Admittedly it was a small study but it was randomized and the only intervention applied was for the experimental group to take 1.86 grams of EPA and 1.5 grams of DHA daily for six months. The control group was given corn oil. Study participants were 60–85 years old. The specific form of the fish-derived fatty acids was a proprietary product called Lovaza.

Improved strength during aging should help with maintenance of independent daily activities and prevention of falls. In other words, these fatty acids are anti-aging. I’d like to see the study replicated with more study participants.

I don’t know if the study was paid for by Lovaza’s manufacturer, nor whether that would influence results.

This study supports my recommendation of cold-water fatty fish (great sources of omega-3 fatty acids) in all my diets:

Steve Parker, M.D.


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Diabetes Drugs: SGLT2 Inhibitor May Improve Kidney Health

I’m not sure I believe this, but here ya go:

“A new class of diabetes drugs can protect kidney health in addition to lowering blood sugar levels, study results suggest.

The findings, published August 18 in the Journal of the American Society of Nephrology, investigated the renal effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, specifically canagliflozin, which reduce blood sugar by augmenting the excretion of glucose into urine.

“Since glycemic control is only modestly different between canagliflozin and glimepiride, our results suggest that potential kidney protective effects of canagliflozin may be unrelated to glycemic control,” the lead study author, Hiddo Lambers Heerspink, PhD, of the University Medical Center Groningen in the Netherlands, said in a statement.”

Source: New Diabetes Drugs May Also Improve Kidney Health | Medpage Today

PS: Even if these results are reproducible, remember that they may not apply to all drugs in the SGLT2 inhibitor class.

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When Is the Hemoglobin A1c Test Misleading?

From 97 to 90 mg/dl

Not the only way to assess glucose control

Can you believe I’ve had patients show me a week’s worth of home glucose tests showing great numbers, tell me they’ve been that good for the last three months, and then I find a sky high hemoglobin A1c test? How can that be? Sometimes the patient, usually a young one, is trying to pull the wool over my eyes. But there are other potential explanations.

Hemglobin A1c (or HgbA1c) is a standard measure of glucose control, or lack thereof, over the three months preceding the blood test.

It’s also used for diagnosis of diabetes and prediabetes. Levels between 5.7 and 6.4% suggest prediabetes. Levels of 6.5% of higher indicate diabetes.

Hemoglobin is the oxygen-carrying protein in red blood cells. HgbA1c tells us if many sugar molecules are stuck to the hemoglobin, a process called glycosylation. HgbA1c is sometimes referred to as glycated hemoglobin. About half of the HgbA1c value is determined by blood sugar levels in the month before the blood draw.

But the HgbA1c test isn’t always an accurate reflection of blood sugar levels.

Many factors unrelated to serum glucose (sugar) levels can alter the HgbA1c value. Here they are:


Pregnant women tend to have lower than average HgbA1c.

Certain Types of Anemia

Iron-deficiency anemia may yield falsely low or high HgbA1c, depending on whether it’s being treated or not.

Acute bleeding and hemolytic anemia give falsely low HbA1c values.

The unifying feature here is that young red blood cells, called reticulocytes, take some time to get glycosylated.

Lack of a Spleen 

HgbA1c will be falsely high. Your spleen removes old red blood cells. Not having a spleen increases the life span of red blood cells, so they can accumulate more glucose molecules.

Various Hemoglobin Types or Congenital Abnormalities

Hemoglobin S and hemoglobin C may lead to deceptively low HgbA1c. Hemoglobin F tends to overestimate.

Blood Transfusions

Recent red blood cell transfusions will lower the HgbA1c if it was elevated to begin with, especially if lots of blood is transfused.

Renal Failure

It’s complicated; talk to your kidney specialist.

Chronic Disease

HgbA1c values can be unreliable in chronic alcoholism, chronic narcotic users, severely high triglyceride or bilirubin levels, kidney failure, vitamin and mineral deficiencies (particularly the vitamins and minerals needed to make red blood cells).


Hispanics, Asians, and Blacks tend to have higher HgbA1c’s than Whites who have the same blood sugar levels. The difference is about 0.3% (absolute, not relative.

Wild Glycemic Excursions

What’s this? You might call it labile diabetes: dramatic swings between sugars too low and way too high. For example, this patient may have daily glucose swings between 40 and 210 mg/dl (2.2  and 11.7 mmol/l). His HgbA1c may turn out near normal or acceptable, but many experts worry that the wild oscillations may contribute to diabetic microvascular complications like eye and kidney disease.

Are There Alternatives to HgbA1c?

Yes. If you think the HgbA1c test is inaccurate, consider other tests such as continuous glucose monitoring, fructosamine, glycated albumin, 1,5-anhydroglucitol, and more frequent home glucose monitoring.

Steve Parker, M.D.

Reference: Bazerbachi, F., et al. Is hemoglobin A1c an accurate measure of glycemic control in all diabetic patients? Cleveland Clinic Journal of Medicine, vol. 81, #3, March 2014: 146-149

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Dr. Aseem Malhotra on Diet and Chronic Diseases

Yet another good post at DietDoctor:

“Only last week I saw a woman in her late sixties who was diagnosed with type 2 diabetes a quarter of a century ago. She had been on insulin injections for the past 17 years. But recently, after reading reports that type 2 diabetes is a condition of carbohydrate intolerance, she changed her diet. “What did you stop eating?” I asked her. “Bread, rice, and sugar,” she answered with a beaming grin. “But now I can enjoy eating cheese and butter again.” She no longer requires her 80 units of insulin.”

Source: Good Health Doesn’t Come Out of a Medicine Bottle – Diet Doctor

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T2 Diabetic Flouts His Doctor’s Advice

Yes, this is another low-carb success story from DietDoctor:

“Mike was recently diagnosed with type 2 diabetes. He was put on drugs, including insulin, to control his blood sugars. This made him gain lots of weight and he developed all kinds of complications.

Mike decided his treatment was not working. He decided to quit eating carbs, and to quit his mealtime insulin. His doctor panicked and said “you can’t do that”. Mike did it anyway.

Here’s what happened.”

Source: “‘You Can’t Do That,’ He Said. I Did It Anyway” – Diet Doctor

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Another T2 Diabetes Success Story at DietDoctor

“Bradley got type 2 diabetes in his forties, then he got fatty liver. Then the really bad thing happened.

He went to the diabetic clinic for help and was recommended a low-fat diet. Despite following it “to the letter”, he rapidly gained 15 pounds (7 kg) and needed to double his insulin doses, while feeling like he was starving! It obviously did not work.

Even though the clinic threatening to kick him out, he decided to do the opposite: a low-carb diet. A year later, everything has changed.”

Source: “As of Today I Take No Diabetic Medication at All” – Diet Doctor

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Introducing Tresiba (insulin degludec): a New Long-Acting Basal Insulin

Tresiba joins other long-acting insulins like insulin glargine (Lantus), insulin detemir (Levemir), and good ol’ NPH insulin. It was approved by the U.S. Food and Drug Administration this year; it’s been used in other countries for longer. Insulin degludec will have different names depending on the country.

Who Is It For?

  • Adults with type 1 and 2 diabetes
  • Not for diabetic ketoacidosis
  • We have no good data on use in children (under 18), pregnant women, and nursing mothers

How Long Does It Work?

It will last for at least 30 hours in most users. After that, effectiveness starts to taper off but some effect may be seen as long as 42 hours after the injection.

What Is Its Role In Treating Diabetes?

Insulin degludec is a basal insulin, meaning that it runs in the background continuously. It’s not designed to reduce blood sugar that rises after a meal. If your pancreas still makes insulin, release of that insulin may reduce after-meal glucose levels adequately. Otherwise, after-meal glucose elevations are addressed with bolus insulin injections. Bolus-type insulins are the rapid-acting ones like Humalog and Novolog.

Most NPH insulin users, and some insulin glargine (Lantus) users, need the injection twice daily. Because of its long duration of action, Triseba users should never need more than one injection daily. I don’t have much experience with Levemir because the hospital where I work doesn’t stock it.

Triseba users should take it at about the same time daily. If you miss that time by up to five or six hours either way, it probably won’t matter.

What’s the Dose?

For type 2 diabetics who have never used insulin, the starting dose is typically 10 units/day.

For type 1’s switching from other insulins, the usual starting dose is one-third to one-half of the total daily insulin dose, plus rapid-acting bolus insulin around meal times for the remainder.

Change the dose no more often than every three or four days.

How Much Does It Cost?

I don’t know. Likely more than some of the other basal insulins.

Steve Parker, M.D.

PS: Click here for full prescribing information.

PPS: If words like glargine, degludec, and detemir turn your stomach, you’ll appreciate my book.

You'll not find "degludec" in here

You’ll not find “degludec” in here

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