September 7, 2019 · 6:11 PM

From Diabetes Care: What About Sugar Substitutes?

I enjoy an aspartame-flavored Fresca now and then

“The U.S. Food and Drug Administration (FDA) has reviewed several types of sugar substitutes for safety and approved them for consumption by the general public, including people with diabetes (211). In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners. These include saccharin, neotame, acesulfame-K, aspartame, sucralose, advantame, stevia, and luo han guo (or monk fruit). Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control. However, an American Heart Association science advisory on the consumption of beverages containing sugar substitutes that was supported by the ADA concluded there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia (212). Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy. If sugar substitutes are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake (213), although further research is needed to confirm these concepts (214). Multiple mechanisms have been proposed for potential adverse effects of sugar substitutes, e.g., adversely altering feelings of hunger and fullness, substituting for healthier foods, or reducing awareness of calorie intake (215). As people aim to reduce their intake of SSBs, the use of other alternatives, with a focus on water, is encouraged (212).

Sugar alcohols represent a separate category of sweeteners. Like sugar substitutes, sugar alcohols have been approved by the FDA for consumption by the general public and people with diabetes. Whereas sugar alcohols have fewer calories per gram than sugars, they are not as sweet. Therefore, a higher amount is required to match the degree of sweetness of sugars, generally bringing the calorie content to a level similar to that of sugars (216). Use of sugar alcohols needs to be balanced with their potential to cause gastrointestinal effects in sensitive individuals. Currently, there is little research on the potential benefits of sugar alcohols for people with diabetes (217).”

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

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September 5, 2019 · 10:26 AM

ADA Is Starting to Embrace Low-Carb Eating

 

Beautiful, huh? Radishes are a non-starchy vegetable.

From Diabetes Care…

Consensus recommendations:

A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.

Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:

○ Emphasize nonstarchy vegetables.

○ Minimize added sugars and refined grains.

○ Choose whole foods over highly processed foods to the extent possible.

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.

For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic medications is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

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September 3, 2019 · 8:21 AM

Do Diabetics Need as Many Carbs as Other Folks?

From Diabetes Care:

Do carbohydrate needs differ for people with diabetes compared with the general population?

Carbohydrate is a readily used source of energy and the primary dietary influence on postprandial blood glucose. Foods containing carbohydrate—with various proportions of sugars, starches, and fiber—have a wide range of effects on the glycemic response. Some result in an extended rise and slow fall of blood glucose concentrations, while others result in a rapid rise followed by a rapid fall. The quality of carbohydrate foods selected—ideally rich in dietary fiber, vitamins, and minerals and low in added sugars, fats, and sodium— should be addressed as part of an individualized eating plan that includes all components necessary for optimal nutrition.The amount of carbohydrate intake required for optimal health in humans is unknown. Although the recommended dietary allowance for carbohydrate for adults without diabetes (19 years and older) is 130 g/day and is determined in part by the brain’s requirement for glucose, this energy requirement can be fulfilled by the body’s metabolic processes, which include glycogenolysis, gluconeogenesis (via metabolism of the glycerol component of fat or gluconeogenic amino acids in protein), and/or ketogenesis in the setting of very low dietary carbohydrate intake.

Source: Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report | Diabetes Care

low-carb mediterranean diet

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August 29, 2019 · 2:04 AM

Does the Keto Diet Prevent or Treat Alzheimer’s Dementia?

Sunny’s Super Salad

Maybe…we don’t know yet.

Have you noticed references to “keto diet” like there’s only one ketogenic diet? There are many ketogenic diets and some of them are dangerous. When choosing one, at least look for one designed by a registered dietitian or physician.

From a recent scientific article:

Highlights

•Impaired brain glucose metabolism and amyloid β plaques are associated with Alzheimer’s disease pathology.

•Ketones provide an alternative metabolic precursor to glucose in the brain.

•Ketogenic diets likely reduce amyloid plaques and may reverse their neurotoxicity.

•Modern diets high in carbohydrates may contribute to increasing Alzheimer’s incidence.

•The ketogenic diet (including carbohydrate restriction) might be useful in the management of Alzheimer’s disease.

Source: The ketogenic diet as a potential treatment and prevention strategy for Alzheimer’s disease – ScienceDirect

Steve Parker, M.D.

PS: If you have Conquer Diabetes and Prediabete,  you already have the Ketogenic Mediterranean Diet

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August 28, 2019 · 2:26 AM

How to Treat Hypertension Without Drugs

Lot’s of good ideas in this video. Additionally, I’ve see a couple studies supporting hibiscus tea as a natural remedy.

Dr Berry says only one in a million persons has blood pressure that is sensitive to dietary salt. That is, high salt intake increases blood pressure. On the other had, I’d say one in four of the hypertensive population is salt-sensitive.

Steve Parker, M.D.

low-carb mediterranean diet

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August 27, 2019 · 1:46 AM

Anti-Alzheimers Drugs Are a Waste of Money

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“Honey, let’s talk to doc about stopping those drugs.”

I commonly admit patients to the hospital who happen to be taking either Aricept or memantine (or both) in an effort to slow the cognitive decline of dementia. Aricept is a cholinesterase inhibitor, abbreviated ChEI below.

A meta-analysis published in November 2018 in JAMA Network suggests that folks taking those drugs have a more rapid cognitive decline compared to those who don’t. Moreover, the rate of decline for those taking memantine, with or without ChEIs, was faster than those receiving ChEIs only or receiving neither medication.

A typical dose of Aricept (donepezil) is 10 mg/day. The average wholesale price for that pill is $20.23 (USD). One brand of memantine is called Namenda, and the usual dose is 10 mg twice daily. Average wholesale dose for that is $17.80/day.  Take both those drugs daily for one month and it’s $1,140.90. Or $13,690.80 for a year. And that’s the wholesale price.

I can think of a few better uses of that money.

Admittedly, there must be individual patients that respond better than average to these drug, and some respond worse than average. You can’t tell in advance who those are.

Click the link below for the full study. From the Abstract:

Results

Across 10 studies, of 2714 participants, the mean (SD) age was 75.0 (8.2) years, 58% were female, and 9% were racial/ethnic minorities. There were 906 participants (33.4%) receiving ChEIs, 143 (5.3%) receiving memantine, 923 (34.0%) receiving both, and 742 (27.3%) receiving neither. Meta-analysis showed those receiving ChEIs or memantine were associated with significantly greater annual rate of decline on the ADAS-cog [a test of cognition] than those receiving neither medication (1.4 points/y; 95% CI, 0.1-2.7).

Conclusions and Relevance

Similar to observational studies, many participants in AD clinical trials receiving ChEIs or memantine experience greater cognitive decline. This difference is nearly as large as the hypothesized effect sizes of the treatments investigated in the trials. Concomitant use of ChEIs or memantine may be confounded with outcomes on the ADAS-cog and should be considered in design of clinical trials of potential therapeutic agents for AD. Post hoc analyses stratifying by ChEIs or memantine must be interpreted cautiously given the potential for confounding.

Source: Association of Concomitant Use of Cholinesterase Inhibitors or Memantine With Cognitive Decline in Alzheimer Clinical Trials: A Meta-analysis | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network

Steve Parker, M.D.

PS: The Mediterranean diet helps prevent or postpone dementia.

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August 26, 2019 · 2:43 AM

I Just Learned About Chaffles…

…at Diabetes Daily. I assume the word rhymes with waffles. From DD:

If you haven’t heard of the term “chaffle” yet, are you really living? The latest craze has taken the diabetes online community (DOC) by storm. One moment I was inquiring about what exactly a chaffle was, and the next, I found myself a golden ticket to an underground world with over 100,000 keto-crazed chaffle fanatics! What is a chaffle you ask? A chaffle is basically a cheese and egg alternative to bread, cooked in a mini (or regular, just adjust recipes accordingly) waffle maker that can be used for anything from breakfast foods straight through your after-dinner treat. It basically acts as a base to any creative concoction you can conjure up. Why are people with diabetes so excited about chaffles? Well for one, those of us who love to experiment with new low-carb options now have this new blank canvas to create from. But more importantly, this latest invention can also help keep your blood sugars in check straight from morning till night!

Click the link for recipes.

Source: 5 Chaffle Ideas to Get You from Breakfast to Dessert – Diabetes Daily

Steve Parker, M.D.

low-carb mediterranean diet

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August 18, 2019 · 4:50 PM

What’s the Best Blood Pressure Goal If You Have Hypertension?

Not bad

I’m not formally questioning the guidelines of established authoritative bodies, but just maybe they’re too high. The 2017 guideline from the American College of Cardiology recommended a treatment goal of under 130/80. Reduction of cognitive impairment is only one of many considerations in setting a treatment goal.

Aiming for systolic blood pressure of 120 or less (instead of 140) may reduce the risk of age-related brain impairment. A recent study suggests the mechanism is better brain blood flow.

Ischemia means poor or no blood flow.

Small vessel ischemic disease (SVID in the brain) is something I see so often in 70-year-olds that I usually ignore it. Mind you, I’m a hospitalist and usually looking for acute major strokes, brain tumors, and bleeding on CT scans. SVID is a chronic disease and it’s often difficult to say how long a specific lesion has been present and whether it’s causing symptoms. Ischemia in the brain is linked to impaired cognitive functioning and dementia. On the other hand, some brain ischemic lesions don’t seem to cause any detectable impairment.

From JAMA Network:

Question:  Is intensive blood pressure treatment associated with less progression of small vessel ischemic disease, as reflected by cerebral white matter lesion volume?

Findings:  In this substudy of a randomized clinical trial of 449 hypertensive patients with longitudinal brain magnetic resonance imaging, intensive blood pressure management to a target of less than 120 mm Hg, vs less than 140 mm Hg, was associated with a smaller increase in white matter lesion volume (0.92 cm3 vs 1.45 cm3).

Meaning:  More intensive blood pressure management was associated with less progression of cerebral small vessel ischemic disease, although the difference was small.

Source: Association of Intensive vs Standard Blood Pressure Control With Cerebral White Matter Lesions | Dementia and Cognitive Impairment | JAMA | JAMA Network

Steve Parker, M.D.

PS: The Mediterranean diet also reduces dementia and cognitive impairment.

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August 17, 2019 · 12:35 PM

Outrageous Drug Costs in the U.S.

I don’t have the resources to confirm the figures below, but I won’t be surprised if accurate. From Public Interest on Twitter:

https://platform.twitter.com/widgets.js

Lower carb eating is likely to reduce the need for diabetes drugs.

Steve Parker, M.D.

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August 14, 2019 · 8:53 AM

What’s the Optimal Diet for Type 1 Diabetes?

A mess of Bacon Bit Brussels Sprouts: 6 grams of fiber per serve

Dr. Muccioli over at Diabetes Daily posted a brief article on a recent research study. A snippet:

The authors found that a higher intake of fiber was associated with lower average blood glucose values. In contrast, a higher intake of carbohydrate, alcohol, and monounsaturated fat was negatively associated with glycemic control (these patients typically experienced more variability in their blood glucose levels). Finally, the analysis revealed that “substituting proteins for either carbohydrates, fats, or alcohol, or fats for carbohydrates, were all associated with lower variability in the measured blood glucose values.”

Source: Which Dietary Patterns Are Best for Type 1 Diabetes Control? – Diabetes Daily

Eaton and Konner figured the Paleolithic diet provided over 70 g/day of fiber. How much are we in the West eating now? Something like 15–20 grams.

Steve Parker, M.D.

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