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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August 13, 2019 · 7:37 PM

Is Weight Training Better Than Aerobics for Heart Health?

One…..more…..rep!

“Lifting weights is healthier for the heart than going for a run or a walk, new research has found. Scientists looking at the health records of more than 4,000 people have concluded that, while both forms of exercise reduce the risk of developing heart disease, static activities such as weight lifting or press-ups [push-ups] have a greater effect than an equivalent amount of dynamic exercise such as running, walking or cycling.

The research challenges commonly held assumption that so-called “cardiovascular” pursuits like running are of greatest benefit to the heart.”

Source: Weight lifting better for heart health than running, new study finds

I like these findings, but wonder if they can be replicated.

Steve Parker, M.D.

low-carb mediterranean diet

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August 6, 2019 · 3:35 PM

Mediterranean Diet Associated with 41% Risk Reduction for Age-Related Macular Degeneration, a Common Cause of Blindness

Photo of the retina at the back of the eyeball, where macular degeneration occurs

Not news to me…

“Protecting a patient’s eyes may be more heavily influenced by diet than previously thought. A new study, which analyzed data from a pair of previous study populations, found that people aged 55 and over who maintained a Mediterranean-style diet reduced their risk of developing late-stage age-related macular degeneration (AMD) by 41%.”

Source: Mediterranean Diet Associated with 41% Risk Reduction for AMD | MD Magazine

low-carb mediterranean diet

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July 30, 2019 · 8:45 PM

Lack of Fitness Is Worse for Your Health Than Smoking, Diabetes, and Heart Disease

exercise for weight loss and management, dumbbells

At least he’s trying…

I’ve long advocated that life and health insurance companies base their premiums on results of individual treadmill exercise tests or similar. Here’s why.

From CNN:

We’ve all heard exercise helps you live longer. But a new study goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results “extremely surprising.”

“Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker,” Jaber told CNN. “We’ve never seen something as pronounced as this and as objective as this.”

Source: Not exercising worse for your health than smoking, diabetes and heart disease – CNN

Most folks can improve their fitness by exercising regularly. But what about nonresponders?

Steve Parker, M.D.

PS: All of my weight-loss books recommend and teach you how to improve your level of fitness.

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July 30, 2019 · 1:15 AM

New Systematic Review Concludes Omega-3 Fatty Acids Have NO EFFECT On Cardiovascular Disease and Longevity

Conquer Diabetes and Prediabetes, Steve Parker MD

Salmon is a rich source of omega-3 fatty acids

That headline is the conclusion of a Cochrane systematic review of the evidence. As you read the summary below, be aware that the main omega-3 fatty acids are alpha-lenolenic acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA).

From Cochrane Library:

Increasing EPA and DHA has little or no effect on all‐cause deaths and cardiovascular events (high‐quality evidence) and probably makes little or no difference to cardiovascular death, coronary deaths or events, stroke, or heart irregularities (moderate‐quality evidence, coronary events are illnesses of the arteries which supply the heart). EPA and DHA slightly reduce serum triglycerides and raise HDL (high‐quality evidence).

Eating more ALA (for example, by increasing walnuts or enriched margarine) probably makes little or no difference to all‐cause or cardiovascular deaths or coronary events but probably slightly reduce cardiovascular events, coronary mortality and heart irregularities (moderate/low‐quality evidence). Effects of ALA on stroke are unclear as the evidence was of very low quality.

There is evidence that taking omega‐3 capsules does not reduce heart disease, stroke or death. There is little evidence of effects of eating fish. Although EPA and DHA reduce triglycerides, supplementary omega‐3 fats are probably not useful for preventing or treating heart and circulatory diseases. However, increasing plant‐based ALA may be slightly protective for some heart and circulatory diseases.

Source: Omega‐3 fatty acids for the primary and secondary prevention of cardiovascular disease – Abdelhamid, AS – 2018 | Cochrane Library

These findings are contrary to my views. I’m not sure who’s right. I still aim for cold-water fatty fish consumption twice a week.

Steve Parker M.D.

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July 23, 2019 · 2:52 PM

Lowering Blood Pressure to 120 Systolic May Reduce Age-Related Memory Loss, Even Dementia

Exercise also seems to protect against memory loss and dementia

Keep your eyes on this development, folks. Potential game-changer. And a boon to Big Pharma. From NBCnews.com…

Lowering blood pressure to recommended levels can prevent dementia and the memory and thinking problems that often show up first [mild cognitive impairment], researchers reported Wednesday.

People whose top blood pressure reading was taken down to 120 were 19 percent less likely to develop mild cognitive impairment, the loss of memory and brain processing power that usually precedes Alzheimer’s, the study found. And they were 15 percent less likely to eventually develop cognitive decline and dementia.

***

It may take a few more years before the study conclusively shows whether the risk of Alzheimer’s was actually reduced because of the lower blood pressure,the researchers said.

It’s the first intervention that has been clearly demonstrated to lower rates of mental decline.

***

The findings come from a large trial of blood pressure called the Systolic Blood Pressure Intervention Trial, or SPRINT.

It has already found that lowering systolic blood pressure — the top number in a blood pressure reading — to 120 or less can prevent stroke, heart attacks, kidney disease and other problems.

Source: Tight blood pressure control can cut memory loss, study finds

Steve Parker, M.D.

PS: The Mediterranean diet also protects against dementia.

low-carb mediterranean diet

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July 22, 2019 · 3:22 PM

High Diabetes Rate in South Asians in the U.S. Is Not Related to Body Composition (e.g., High BMI)

Indian woman cooking chapati

“We did not identify strong evidence that accounting for body composition explains differences in the risk for type 2 diabetes. Future prospective studies of the MESA and MASALA cohorts are needed to understand how adipose tissue impacts the risk for type 2 diabetes and how to best assess this risk.”

So the high incidence of diabetes and prediabetes in South Asians in the U.S. is related to genetics or diet or activity levels?

Source: Body Composition and Diabetes Risk in South Asians: Findings From the MASALA and MESA Studies | Diabetes Care

Steve Parker, M.D.

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