July 11, 2016 · 6:03 AM

Higher risk of cancer before and after diabetes diagnosis 

The lifetime probability of an individual developing invasive cancer in the U.S. is about 4 in 10 (40%). A little higher in men (45%), a little lower in women (38%).

The good news is that cancer death rates in the U.S. have dropped over the last 20 years. The reduction is 18% for men and 10% for women.

The bad news is that the American Cancer Society projects around 600,000 yearly deaths from cancer in the U.S.

If we look at deaths of people under 85, cancer kills more people than heart disease.

In men, 25% of all invasive cancers will be prostate cancer. In women, breast cancer is the leader, comprising 26% of all cancers. (Common skin cancers are rarely invasive or fatal and are not included in these statistics. Melanoma, on the other hand, is invasive and dangerous.)

New research indicates that people with diabetes may be more prone to several cancers. Older research says men with diabetes are less likely than average to get prostate cancer. Don’t ask me why.

Medical News Today provides a few details:

People who have diabetes may have a higher chance of developing cancer either before or immediately after receiving a diagnosis of diabetes, according to a study published online in the American Cancer Society’s journal, Cancer.

Additional healthcare when people receive a diagnosis of diabetes may lead to more cancer diagnoses around the same time.The results indicate that there is a need for better understanding of the association between cancer and diabetes.

Previous studies have suggested that people with type 2 diabetes have a higher risk of developing several different types of cancer.

Source: Higher risk of cancer before and after diabetes diagnosis – Medical News Today

Steve Parker, M.D.

PS: The traditional Mediterranean diet protects against cancer. We don’t know if my versions of it are even better at preventing cancer.

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July 8, 2016 · 4:42 PM

Professor Tim Noakes Explains Why He Favors a Low-Carb Diet for Diabetes

Click the link below for details.

Overall, Prof. Noakes makes a lot of sense. I like the concept of diabetes as a disease of carbohydrate intolerance. He may not have everything right. For instance, experts debate whether insulin resistance is a cause or result of type 2 diabetes.

The professor writes:

“My interest in the dietary management of diabetes stems from watching my father’s rapid downward physical decent in the years after he was diagnosed with Type 2 diabetes mellitus (T2DM); the diagnosis of T2DM in myself; and my reading of the “alternative” literature which convinces me that T2DM does not have to be an inevitably progressive disease:My conclusion is that unlike my father, it is not my pre-ordained fate to die from the final common pathway in fatal T2DM – disseminated obstructive arterial disease. But to achieve that I will have to ignore what I was taught and which, in turn, I have conveyed to two generations of students:So to prevent the development of the disseminated obstructive arterial disease of T2DM, I will have to follow dietary practices that are the polar opposite of those my father was advised to adopt and which hastened his death; advice that I personally practised for 33 years and which ultimately caused me also to develop T2DM.”

Source: The Low Carb Diabetic: NOAKES: DOCTORS, DIETITIANS MAKE DIABETES A THREAT TO LIFE?

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July 5, 2016 · 9:27 AM

Recipe: Gazpacho – A taste of Andalusia

These are Hass or California avocados (the other common one in the U.S is the Florida avocado)

These are Hass or California avocados (the other common one in the U.S is the Florida avocado)

Here’s a recipe from The Low Carb Diabetic blog, one of my favorites. No carb count is provided but I bet it’s relatively low. If you know the carb count per serving, share in the comments. Calculate the carbs yourself at FitDay. Click the link below for the recipe. It’s paleo-diet compliant, if you don’t mind vinegar. A snippet:

“Gazpacho is a soup made of raw vegetables and served cold, usually with a tomato base, originating in the southern Spanish region of Andalucia, which some spell with a c, while others use an s! This soup can be great for a hot day when making a lunch that takes just a few minutes is exactly what you want. In our version of this Andalusian peasant dish we leave out the soaked bread and instead use a creamy avocado to give it substance.”

Source: The Low Carb Diabetic: Gazpacho – A taste of Andalucia

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July 5, 2016 · 8:53 AM

Endocrinologists Hesitant to Believe Empagliflozin Reduces Cardiac Events and Deaths

Larry Husten covers the issue at his blog. Click the link below for details. I’m in the endocrinology camp on this one. A quote from Mr. Husten’s post:

“An observer came away from the meeting with the strong impression that the endocrinologists did not want to accept any evidence that empagliflozin could reduce the risk of cardiovascular death; were not prepared to acknowledge that drugs might work in diabetes by effects that were independent of blood glucose; and wanted to be left in peace to be allowed to micromanage hemoglobin A1c without being reminded that doing so does not change the cardiovascular risk of patients with diabetes.”

Source: Prominent Cardiologists Decry Tepid Support For Empagliflozin By Endocrinologists

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July 2, 2016 · 5:05 AM

The Low Carb Diabetic: Roasted Jubilee tomatoes with a fresh herb crust

Try growing your own...

Try growing your own…

Tomatoes are a time-honored component of the Mediterranean diet. Their lycopenes and other phytonutrients may help preserve prostate health. Heres a recipe, with carb counts provided, from The Low Carb Diabetic:

“These tomatoes, when topped with a herby breadcrumb mixture, make a very nice starter or side dish. If you do not wish to use breadcrumbs, a substitute such as toasted pine nuts could be used instead…”

Source: The Low Carb Diabetic: Roasted Jubilee tomatoes with a fresh herb crust

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July 1, 2016 · 6:20 AM

Are Computers Sapping Your Brain?

Thinking about it...

Exercise your brain

I saw a patient at the hospital a couple years ago who had been brought in by ambulance after suffering some trauma (not to his brain). He couldn’t call any friends or relatives to let them know what was going on because he didn’t have his cellphone. His phone had all his contact numbers so he had no reason to memorize any. Would you be in the same boat?

DailyMail has an interesting article on whether our use of technology is making us dumber. If we turn over mental tasks like navigation and math to computers, do our brains waste away? Is this how the robots take over? Will we be seeing more and earlier cases of age-related dementia? E-mentia?

This is worth keeping an eye on.

Steve Parker, M.D.

PS: The five other members of my household all have cellphones. The only number I’ve memorized is my wife’s.

low-carb mediterranean diet

Front cover of book

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June 25, 2016 · 2:00 AM

Long-Term Severe Carbohydrate Restriction Is Possible!

I got an email a few days ago from a blog reader, J.H. (I won’t give his name because I didn’t ask permission to publish his letter):

Dr. Parker — I’m a 65 year old male who has battled insulin resistance and pre-diabetes for many years. About 15 months ago I started pursuing a very low carb (20 grams per day) ketogenic diet, and my health has improved significantly. I’ve lost about 35 lbs (down from 265), and I have not found it difficult at all to stay on this regimen. You mentioned in an article (https://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/) that you don’t believe people can stay with it for more than 6 months and that most people can only last about two weeks. With all due respect, hogwash! I was fortunate enough to become a patient of Eric Westman at Duke, and he does an excellent job of teaching the ketogenic diet to his patients. Any overweight person should give it great consideration, and it’s just not that hard to follow.

Best regards, J.H.

My response was: “Congrats on a job well done! I wish all my patients had your discipline and commitment.”

I have great respect for Dr. Westman. He’s the c0-author of The New Atkins for a New You. I reviewed it in 2010. No clinical studies have compared the effectiveness of Dr. Westman’s diet to my Ketogenic Mediterranean Diet, which attempts to lasso the health benefits of the time-honored traditional Mediterranean diet while helping folks lose weight. The Ketogenic Mediterranean Diet is a key component of Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

PS: You don’t have to know what ketogenic means to benefit from ketosis.

PPS: I have a non-diabetic version of the Ketogenic Mediterranean Diet for otherwise healthy folks who just need to lose a boatload of weight.

low-carb mediterranean diet

Front cover of book

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June 23, 2016 · 2:00 AM

Are These Two Diabetes Drugs Better Than the Others?

Better living through chemistry

Empagliflozin is a pill. Liraglutide is a once-daily subQ injection.

The two drugs in question are empagliflozin (aka Jardiance) and liraglutide (aka Victoza). Both are used to treat type 2 diabetes, not type 1.

A major problem we have with most diabetes drugs is that while they do lower blood sugars, we don’t have much evidence on whether they actually prolong life and prevent bad outcomes like heart attacks, strokes, cancer, blindness, kidney failure, amputations, and serious infections. It gets even more complicated. For instance, a given drug may eventually be proven to prolong life by a year via prevention of death from heart disease, while at the same time increasing the risk of spending that last year bedridden from a stroke.

It’s extremely difficult and costly to suss out these issues. It requires large clinical trials wherein half of the PWDs (people with diabetes) are treated with a particular drug, and the other half are treated with “standard therapy.” Five or 10 years later you compare clinical endpoints between the two groups. A couple studies have done this recently.

A blogger I follow, Larry Husten, wrote the following:

But it was the secondary goal of these trials that led to the transformation of the field. Baked into the trial design was the provision that if they were able to establish noninferiority then the trial investigators were permitted to test for superiority. The second phase began when Empa-Reg became the first trial to convincingly show a clear benefit, including a reduction in cardiovascular death and a reduction in hospitalization for heart failure. with empagliflozin (Jardiance, Merck). Then, more recently, the LEADER trial showed a significant reduction in cardiovascular events with liraglutide (Victoza, Novo Nordisk). In both trials nearly all the patients had significant established cardiovascular disease—precisely the population that cardiologists are likely to see.

Click the embedded links above for more details. Even better, read the original research reports if you have the time and knowledge. I support my family with a full-time job taking care of patients, so it will be a while (if ever) before I can dig into this further. (When my book sales make me independently wealthy, I’ll have more time for this!)

diabetic diet, low-carb Mediterranean Diet, low-carb, Conquer Diabetes and Prediabetes

Analyzing clinical reports requires a good grasp of logic, statistics, and basic science

Are the LEADER and Empa-Reg trials valid? Yeah, maybe. In an ideal world, other investigators would try to replicate the results with additional clinical trials. Are the published results free of fraud and bias? I don’t know.

Because we don’t know the long-term effects of many of our diabetes drugs, I favor doing as much as possible to control blood sugars with diet, exercise, and weight management.

Stay tuned for future developments.

Steve Parker, M.D.

PS: Just because one drug in a class of drugs reduces bad clinical outcomes, it doesn’t mean all drugs in the class do.

PPS: If it’s hard for you to pronounce empagliflozin and liraglutide, some of my books don’t even have them.

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June 22, 2016 · 2:59 AM

Have You Tried a Sardicado Sandwich?

California or Hass avocado

California or Hass avocado

Several years ago, Alton Brown lost a significant amount of weight, and one of the items on his diet was sardine-avocado sandwiches. I like sardines. I like avocados. But I never ever would have considered eating them mixed together.

A while back, I read Franziska Spritzler’s The Low Carb Dietitian’s Guide to Health and Beauty (great book; my review). One of her recipes involves the sardine-avocado combo, so I’m resolved to give it a try. Her recipe was simply 4 oz (120 g) canned sardines mixed with 1/2 medium avocado and sea salt, stuffed in a large red bell pepper. I bet the sardine-avocado mix would be good on a bed of lettuce if I don’t have a bell pepper. A little black pepper and a squeeze of lemon, too?

If memory serves, I paid $1.29 for this tin of sardines. "Best used by" date is five years from now.

If memory serves, I paid $1.29 (USD) for this tin of sardines. “Best used by” date is five years from now.

I may even try Franziska’s Chocolate Avocado Pudding, another combo I never would have imagined.

Click for Alton Brown’s sardicado sandwich.

Steve Parker, M.D.

PS: If you don’t like the smell of sardines, my books won’t offend your olfactory sense.

low-carb mediterranean diet

Front cover of book

 

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June 11, 2016 · 9:30 PM

Should You Reduce Saturated Fat Consumption If You Have Heart Disease?

kkk

Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years

For the bulk of my medical career, physicians thought that saturated fat caused heart disease, specifically coronary artery disease and heart attacks. Most doctors still think that. In 2009, I spent 80 hours reviewing the scientific literature supporting the saturated fat/heart disease connection. The evidence was very weak, if not nonexistent.

But what if you are already a heart disease patient? Would continuing saturated fat consumption have any effect on your longevity and risk of future heart attacks? If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.

Dr. Sigurdsson is a cardiologist in Iceland.

Some quotes from his blog:

For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.

The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.

*   *   *

Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.

Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.

It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.

Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.

These recent scientific data don’t imply that we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.

So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.

On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.

It appears the jury is still out…

RTWT.

Steve Parker, M.D.

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