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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April 6, 2015 · 3:06 AM

Our Latest Kitchen Gadget: A Vitamix

Our first creation with the Vitamix

Our first creation with the Vitamix

 

I call it a mixer; my wife calls it a food processor. My wife had been thinking about getting a contraption like this for months. She got excited and bit the bullet when she saw a live demonstration at Costco last year.

Almost immediately out of the box, my wife threw in a couple handfuls of ice, couple handfuls of frozen strawberries, and one and a half bananas. I thought this would be a fruit smoothie, but with the very thick consistency, “Italian ice” might be a better term.

One of our goals is to sneak more fiber, vegetables, and fruit into our kids diets. (Shhhh….don’t tell!)

It's a little noisy, but easily bearable

It’s a bit noisy, but easily bearable

$500 (USD) at Costco, so not cheap. It seems well-made and has a good SEVEN-year warranty!

$500 (USD) at Costco, so not cheap. It seems well-made and has a good SEVEN-year warranty!

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March 29, 2015 · 4:59 AM

Preserve Your Brain Function Despite Aging

There are ways of slowing or reversing losses in cognitive function. The most effective discovered so far is physical exercise, which protects the brain by protecting the body’s cardiovascular health. Mental exercise, often called brain training, is widely promoted, but it boosts only the particular skill that is practised – its narrow impact mirroring that of educational interventions at other ages. Various drugs are being investigated for their value in staving off normal cognitive decline, but for now preventive maintenance is still the best bet – avoid smoking, drinking to excess, head injuries and the like.

MRI scan of brain

MRI scan of brain

The quote above is from an Instant Expert paper on intelligence. It’s full of interesting facts such as the typical difference in IQ between strangers is 17 points. It answers the question whether an enriched school or home environment can increase intelligence.

Also, for preserving brain function, I think the Mediterranean diet helps, but it’s difficult to prove.

On a different note, the article mentions overload of patients’ brains when medical care is too complicated:

Given the complexity of self-care regimes, it is hardly surprising that some people make dangerous errors or fail to comply. The effective management of diabetes, for example, requires a person to keep blood sugar levels within a healthy range, which means coordinating diet, exercise and medication throughout the day, which in turn requires planning for contingencies, recognising when blood sugar is veering too high or low, knowing how to regain control and conceptualising the imperceptible but cumulative damage caused by failing to maintain control. There is no set recipe for people with diabetes to follow – their bodies and circumstances differ. Moreover, they get little training, virtually no supervision and no days off. Effectively managing your diabetes is a cognitively complex job and poor performance has serious consequences, including emergency room visits, lost limbs or eyesight, and even death. The lower the diabetic person’s IQ, the greater the risks.

You’ll also learn about the Flynn effect and possible explanations for it:

Over the past century, each successive generation has answered more IQ test items correctly than the last, the rise being equivalent to around 3 IQ points per decade in developed nations. This is dubbed the “Flynn effect” after the political scientist James Flynn, who most thoroughly documented it. Are humans getting smarter, and if so, why? 

I’m more inclined to think Idiocracy describes our future.

Steve Parker, M.D.

h/t James Fulford

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