May 24, 2015 · 1:31 PM

David and Goliath: Dr. Briffa Versus National Health Service on Low-Carb Diets

The United Kingdom’s National Health Service last year published guidelines favoring low-fat weight-loss diets over low-carb ones. Dr. John Briffa objects:

See here for a comprehensive review of 23 studies which demonstrates superior results achieved by low-carb diets with regard to weight loss and disease markers. To my mind, dietician Sian Porter and the NHS Choices website have done a bad job of communicating the facts and summarising the evidence. I wish to formally complain about the inaccuracies in this article and its (to me) clear bias and lack of balance.

Read the whole enchilada (plus this update).

Steve Parker, M.D.

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May 15, 2015 · 4:26 AM

Does a Low-Carb High-Fat Diet Work for South Asian Indians With Diabetes?

Indian street seller selling tea - masala chai

Indian street seller selling tea – masala chai

Dr. Andreas Eenfeldt shares an email from Aniruddha Bhaduri, a 43-year-old diabetic living in New Delhi. He’s had type 2 diabetes for ten years.

Ani had poor control of his blood sugars despite following the dietitian-recommended high-carb diet and taking three diabetes drugs. In his frustration, Ani started doing research on his own and ran across Eenfeldt’s version of low-carb high-fat (LCHF) eating. After just one month of LCHF dieting, his blood sugars came down from 300+ mg/dl (16.7+ mmol/l) to an average of 97 mg/dl (5.4 mmol/l). His doctor reduced his drugs, too. Ani mentioned that eating LCHF in India is “a bit expensive.”

Although Ani’s high triglycerides dropped like a rock, I have a little concern about his total cholesterol and LDL cholesterol, both of which rose. That bears watching.

Click through to Dr. Eenfeldt’s blog and you’ll find a photo of Ani. Note that he’s not obese. Like East Asians, Indians develop T2 diabetes at lower degrees of body fat (BMI) than do Americans and Europeans. Could that be genetic? You bet.

This story is interesting to me because I had no definite evidence that LCHF eating was effective for Indian type 2 diabetes. Due to potential genetic differences between Indians and other ethnicities, it’s a mistake to simply assume they would respond to the diet like Europeans, for example. My Low-Carb Mediterranean Diet is a version of LCHF; no Indian has ever reported back to me whether it helped them or not. Now I have one anecdote to support LCHF eating in Indians.

Steve Parker, M.D.

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May 9, 2015 · 12:23 AM

Are Obesity and Type 2 Diabetes Caused By Pollution?

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

Salmon is one the the cold-water fatty fish loaded with healthful omega-3 fatty acids, but also persistent organic pollutants

It sounds like Jerome Ruzzin is convinced that’s the case. I put some thought into it last August and was skeptical—still am, but I’m keeping an open mind. Mr. Ruzzin has a review article published in 2012 at BMC Public Health (“Public health concern behind the exposure to persistent organic pollutants and the risk of metabolic diseases”). Here’s his summary:

The global prevalence of metabolic diseases like obesity and type 2 diabetes, and its colossal economic and social costs represent a major public health issue for our societies. There is now solid evidence demonstrating the contribution of POPs [persistent organic pollutants], at environmental levels, to metabolic disorders. Thus, human exposure to POPs might have, for decades, been sufficient and enough to participate to the epidemics of obesity and type 2 diabetes. Based on recent studies, the fundaments of current risk assessment of POPs, like “concept of additive effects” or “dioxins and dl-PCBs induced similar biological effects through AhR”, appear unlikely to predict the risk of metabolic diseases. Furthermore, POP regulation in food products should be harmonized and re-evaluated to better protect consumers. Neglecting the novel and emerging knowledge about the link between POPs and metabolic diseases will have significant health impacts for the general population and the next generations.

Read the whole enchilada.

The cold-water fatty fish I so often recommend to my patients could be hurting them. They are major reservoirs of food-based POPs.

Steve Parker, M.D.

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May 6, 2015 · 5:32 AM

Dr. Sarah Hallberg Makes the Case for Carbohydrate Restriction in Type 2 Diabetes

If you reduce carb consumption, what do you replace it with? Dr. Hallberg favors fat.

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April 27, 2015 · 2:00 AM

Introducing Myself To South Asian Indian Diabetes

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

“Asian Indian” as opposed to American Indian, aka Native Americans.

Since I have a number of blog visitors from India, I decided I need to know more about Indian diabetes. I started by reading “The current sate of diabetes mellitus in India.” I looked at a few other things, too, thanks to the Internet. Here are a few facts and issues:

  • India has at least 32 million diabetics (most of whom have type 2 diabetes); it’s the country with the most diabetics (data from 2000)
  • The population of India is 1.28 billion
  • By 2030, diabetics in India may number 79 million
  • The prevalence of diabetes in urban centers is perhaps 9% of the population; higher in southern locales, lower in the north
  • Indians tend to see type 2 diabetes at much lower BMIs compared to Western populations
  • India is rife with diversity: genetic, cultural, linguistic, socio-economic, among others
  • Poverty—or at least lack of affluence—is a major stumbling block to diagnosis, treatment, epidemiologic study, clinical research, and intervention
  • Vegetarianism is more common than in the West
  • I need to learn more about Indian cuisine and foods such as jowar, chappathis, and chana dal (aka Bengal gram dhal), to name just a few
Indian woman cooking chapati

Indian woman cooking chapati

It’s clear to me that I cannot assume that Indian type 2 diabetes is the same type 2 disease I treat here in Scottsdale, Arizona, an overwhelmingly non-Indian population.  If it’s not the same disease, the optimal treatment may be different. I hope to learn more about Indian diabetes over the next year.

Steve Parker, M.D.

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April 26, 2015 · 1:44 PM

Thank You, My Readers From India

I’m not sure why, but lately I’m getting lots of blog visitors from India. Even more than from Canada and Australia. If you guys are looking for something in particular that you’re not finding here, let me know.

Steve Parker, M.D.

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April 25, 2015 · 5:23 AM

QOTD: Exercise and Weight Loss

Let me be clear. Exercise is not important because it burns calories! Exercise without calorie restriction is a remarkably ineffective weight loss intervention, because it usually makes us hungry enough to replace the calories we burn. Exercise is important because it restores your ability to oxidize fat—both when fasting and after meals. And we can tie this in with mitochondrial dysfunction by noting that exercise is proven to increase mitochondrial volume.

—J. Stanton

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April 20, 2015 · 2:47 AM

Major U.S. Diet Changes over the Last 100 Years

Medical student Kris Gunnars has an article at Business Insider, of all places, that shows graphically many of the major U.S. dietary changes of the last hundred years. In this case, transmogrification may be a better term than mere “changes.” Much of the Western world has evolved in similar fashion.

You need to read the article and ponder the graphs if you question why we have so much obesity, type 2 diabetes, heart disease, hypertension, and perhaps cancer. You’ll see dramatic increases in consumption of added sugars, industrial seed oils (esp. soybean), soda pop and fruit juice (added sugar!), total calories, and fast food. You’ll see how much we’ve increased dining away from home. Butter consumption is down drastically, but doesn’t seem to have done us much good, if any.

Sugar cane

Sugar cane

 

There’s fairly good evidence that coronary artery disease (CAD) the cause of most heart attacks) was very prominent between 1960 to 2000 or so, but it’s been tapering off in recent years and didn’t seem to be very common 100 years ago. Understand that you can have it for 20 years or more before you ever have symptoms (angina) or a heart attack from it. In fact, the disease probably starts in childhood. I’ve always wondered about the cause of the CAD prevalence trends, and wondered specifically how much of the long-term trend was related to trans-fat consumption. But I’ve never been able to find good data on trans-fat consumption. Kris came up with a chart of margarine consumption, which may be a good proxy for trans-fats. Another of his charts includes shortening, a rich source of trans-fats and probably also a good proxy. I remember growing up in the 1960s that we always had a 1/2 gallon tin can of Crisco hydrogenated fat in the cupboard. Shortening consumption increased dramatically from 1955 until dropping like a rock around 2000.

The timeline curves for trans-fat consumption (by proxy) and prevalence of coronary heart disease seem to match up fairly well, considering a 20 year lag. In the early 1990s, we started cutting back on trans-fats, and here we are now with lower mortality and morbidity from coronary artery disease. (CAD is very complex; lower rates of smoking surely explain some of the recent trend.)

Read the whole enchilada. Very impressive. Highly recommended.

Steve Parker, M.D.

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April 17, 2015 · 12:25 AM

Live Longer and Reduce Risk of Cancer and Heart Disease With Vegetables and Fruits

MedPageToday has some of the details.  A quote:

The largest benefits were seen in people who ate seven or more servings of fruits and vegetables a day compared with those who ate less than one serving, with the higher level of consumption associated with significantly lower all-cause mortality (hazard ratio 0.67; 95% CI 0.58-0.78), lead researcher Oyinlola Oyebode of University College London, and colleagues, reported online in the Journal of Epidemiology and Community Health.

Spaghetti squash, an under-utilized vegetable

Spaghetti squash, an under-utilized vegetable

The population under study was English. In addition to lower risk of death, the heavy fruit and vegetable consumers had lower rates of cancer and cardiovascular disease. Click for the actual research report.

If seven servings a day seems like a lot, note that a typical serving is only half a cup. You’ll get those with the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

1 cup spaghetti squash with minced black olive, sweet pepper, garlic, salt, pepper, celery

1 cup spaghetti squash with minced black olive, sweet pepper, garlic, salt, pepper, celery

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April 9, 2015 · 6:13 AM

If You’re Having Bariatric Surgery to Treat Your Type 2 Diabetes, You May Want RYGB Instead of LAGB

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An article at Diabetes Care suggests that insulin-treated T2 diabetics getting bariatric surgery were almost twice as likely to get off insulin if they had roux-en-Y gastric bypass rather than laparoscopic adjustable gastric banding. The former procedure is also generally more effective for weight loss.

If you think bariatric surgery is a sure-fire cure for type 2 diabetes, it’s not.

Steve Parker, M.D.

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