February 16, 2015 · 2:00 AM

Is Excessive Fructose Consumption the Cause of Type 2 Diabetes?

Lumps of Diabetes

Cubes of Diabetes?

A Pharm.D (Dr of Pharmacology) and a pair of MD’s surveyed much of the available scientific literature—both animal and human studies—and concluded that fructose is a major culprit in the rise of type 2 diabetes and prediabetes. Fructose does its damage by increasing insulin resistance. ScienceDaily has the details.

Be aware that their conclusion is certainly not universally accepted. I just read “Pathogenesis of type 2 diabetes mellitus” at UpToDate.com and saw no mention of fructose. Under dietary factors, they mainly talked about obesity and how that increases insulin resistance, leading to elevated blood sugars, while the reverse happens with weight loss. I haven’t looked at all the research so I have no definite opinion yet on the fructose-diabetes theory; I’m skeptical.

Fructose is a type of simple sugar. Common dietary sources of fructose are fruits, table sugar (aka sucrose, a 50:50 combination of glucose and fructose molecules), and high-fructose corn syrup (which is usually 42 or 55% fructose).

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

A few quotes from ScienceDaily:

“At current levels, added-sugar consumption, and added-fructose consumption in particular, are fueling a worsening epidemic of type 2 diabetes,” said lead author James J. DiNicolantonio, PharmD, a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute, Kansas City, MO. “Approximately 40% of U.S. adults already have some degree of insulin resistance with projections that nearly the same percentage will eventually develop frank diabetes.”

*   *   *

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health. Indeed, consuming fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunction, explained DiNicolantonio and colleagues. The authors propose that dietary guidelines should be modified to encourage individuals to replace processed foods, laden with added sugars and fructose, with whole foods like fruits and vegetables. “Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences,” they wrote.

If you’re eating a typical Western or American diet, you’ll reduce your fructose consumption by moving to the Mediterranean diet, the Advanced Mediterranean Diet, Low-Carb Mediterranean Diet, or the Paleobetic Diet.

RTWT.

Steve Parker, M.D.

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February 14, 2015 · 1:13 AM

Recipe: Apple, Pecan, Blueberry Lunch Bowl

paleobetic diet, diabetic diet, low-carb diet

So simple even a redneck like me can make it

My wife and I initially put this together for the Paleobetic Diet, but since I provide the nutritional analysis you can easily incorporate it into the Low-Carb Mediterranean Diet.

Ingredients:

2.5 oz (70 g) apple, diced (“red delicious” variety works well) (this is half a medium-sized apple)

2.5 oz (70 g) pecans, crumbled into small pieces

2.5 oz (70 g) raw blueberries

Instructions:

Mix all together in a bowl, then enjoy.

Servings: 1

Nutritional Analysis:

76% fat

20% carb

4% protein

570 calories

30 g carbohydrate

10 g fiber

20 g digestible carb

1.4 mg sodium

421 mg potassium

Prominent features: Quick and easy. Rich in copper, manganese, and thiamine. Inadequate protein to get you through the day, but you’ll make up for it at breakfast or dinner.

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January 30, 2015 · 2:41 AM

Guess How Many Hours a Year Obese Women Exercise Vigorously

Only one.

And obese men in the U.S. don’t do much better at 3.6 hours/year.

ketogenic diet, children

We exercised like this when we were kids

myfoxny.com has the story based on an article in Mayo Clinic Proceedings. A quote:

What kind of lives are the most inactive people living? “I think they’re living the typical life. They drive their children to school, they sit at a desk all day long, they may play some video games and they go to sleep,” Archer said.

He forgot about TV. What’s the American daily average now? Three hours?

Without a doubt, it’s incredibly difficult to exercise if you’re markedly obese. Here’s how.

Read more: http://www.myfoxny.com/story/24774893/average-obese-woman-gets-just-1-hour-of-exercise-a-year-study#ixzz2u2MMctiW

Steve Parker, M.D.

PS: FYI, I exercise vigorously about 50 hours/year.

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January 21, 2015 · 8:38 AM

Elevated Fasting Blood Sugar Linked to Pancreatic Cancer

A recent meta-analysis found that elevated fasting blood glucose levels, even in the prediabetic range, are associated with higher risk of developing pancreatic cancer. This is important because you can take action today to lower your fasting blood sugar level, which may lower your risk of pancreatic cancer over the long-term. The researchers conclude that…

“Every 0.56 mmol/L [10 mg/dl] increase in fasting blood glucose is associated with a 14% increase in the rate of pancreatic cancer.”

In the developed world, your risk of getting an invasive cancer is roughly one in four. Pancreatic cancer is the most lethal. Surgery is the way to cure it, but at the time of diagnosis only two in 10 patients are candidates for surgery because the cancer has already spread. Pancreatic cancer is the fourth leading cause of cancer death in the USA and the fifth in the UK. Nevertheless, pancreas cancer is not terribly common; the US has 50,000 new cases annually. As a hospitalist, I run across one or two new cases of pancreas cancer every year.

We’ve known for years that type 2 diabetes is linked to pancreatic cancer, with diabetics having twice the risk of nondiabetics.

What if you have elevated fasting blood sugars? There’s no proof that reducing them to the normal range will reduce your risk of pancreatic cancer. But if it were me, that’s what I’d shoot for.

Other that type 2 diabetes and prediabetes, some other risk factors for pancreas cancer are:

  • heredity
  • smoking
  • sedentary lifestyle
  • body mass index over 30 (obesity in other words)

You can alter most of those risk factors. Why not get started now?

Steve Parker, M.D.

PS: If you’re not sure if your fasting blood sugar’s elevated, click here.

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January 20, 2015 · 8:15 AM

John Yudkin Wrote a Book About Sugar Called “Pure, White, and Deadly”

Sugar is poisonous according to John Yudkin and Robert Lustig, among others. Australia’s “The Age” had the details but my prior link is no good. A quote:

[Robert] Lustig is one of a growing number of scientists who don’t just believe sugar makes you fat and rots teeth. They’re convinced it’s the cause of several chronic and very common illnesses, including heart disease, cancer, Alzheimer’s and diabetes. It’s also addictive, since it interferes with our appetites and creates an irresistible urge to eat.

This year [2014], Lustig’s message has gone mainstream; many of the New Year diet books focused not on fat or carbohydrates, but on cutting out sugar and the everyday foods (soups, fruit juices, bread) that contain high levels of sucrose. The anti-sugar camp is not celebrating yet, however. They know what happened to Yudkin and what a ruthless and unscrupulous adversary the sugar industry proved to be.

In 1822, we in the U.S. ate 6.2 pounds of sugar per person per year. By 1999, we were up to 108 pounds.

An occasional teaspoon of sugar probably won't hurt you

An occasional teaspoon of sugar won’t hurt you

The U.S. Department of Agriculture estimates that added sugars provide 17% of the total calories in the average American diet.  A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.  The average U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.

On the other hand, Fanatic Cook Bix found a study linking higher sugar consumption with lower body weight, which you might think would protect against type 2 diabetes, heart disease, and some cancers.

Steve Parker, M.D.

h/t Jamie Scott

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January 11, 2015 · 11:25 PM

Updated “Standards of Medical Care in Diabetes” Now Available Free Online

The American Diabetes Association every January updates their Standards of Medical Care in Diabetes. The document is lengthy, highly technical, and written for healthcare providers. Some of you may appreciate it. If I were a non-physician with diabetes, I’d learn as much about it as possible. Remember, no one cares about your health as much as you do. The 2015 version of the standards is called, appropriately enough, Standards of Medical Care in Diabetes—2015.

Updates to the guidlelines include:

  • recommendation not to sit inactively for over 90 minutes
  • pre-meal blood sugar target is now 80 to 130 mg/dl (4.4 to 7.2 mmol/l) instead of the old 70 to 130 mg/dl
  • added SGLT2 inhibitors to the drug treatment algorithm
  • recommended a diastolic blood pressure goal of 90 mmHg or less instead of the old 80 mmHg or less
  • increased the potential pool of statin drug users
  • added a section on management of diabetes during pregnancy

Steve Parker, M.D.

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January 10, 2015 · 7:23 AM

Dr. Roger Unger and his Glucagon-Centric Diabetes Model

Perhaps we’ve been wrong about diabetes all along: the problem isn’t so much with insulin as with glucagon.

At least one diabetes researcher would say that’s the case. Roger Unger, M.D., is a professor at the University of Texas Southwestern Medical Center. That’s one of the best medical schools in the U.S., by the way.

Glucagon is a hormone secreted by the alpha cells of the pancreas; it raises blood sugar. (There are also glucagon-secreting alpha cells in the lining of the stomach, and I believe also in the duodenum.) In the pancreas, the insulin-producing beta cells are adjacent to the glucagon-secreting alpha cells. Released insulin directly suppresses glucagon. So if your blood sugar’s too high, as in diabetes, may be you’ve got too much glucagon action rather than too little insulin action.

From Shutterstock.com

Don’t ask me what delta cells do

Dr. Unger says that insulin regulates glucagon. If your sugar’s too high, your insulin isn’t adequately keeping a lid on glucagon. Without glucagon, your blood sugar wouldn’t be high. All known forms of diabetes mellitus have been found to have high glucagon levels (if not in peripheral blood, then in veins draining glucagon-secreting organs).

This is pretty well proven in mice. And maybe hamsters. I don’t know if we have all the pertinent evidence in humans, because it’s harder to do the testing.

Here’s Dr. Unger’s glucagon-centric theory of the pathway to insulin-resistant type 2 diabetes: First we over-eat too many calories, leading to insulin over-secretion, leading to increased fat production (lipogenesis) and storage in pancreatic islet cells as triglycerides, in turn leading to increased ceramide (toxic) in those islet cells, leading to pancreas beta cell death (apoptosis) and insulin resistance in the alpha cell (so glucagon is over-produced), all culminating in type 2 diabetes.

For a diagram of this, click forward minute 40 and 10 seconds in the video below.

If this is all true, so what? It could lead to some new and more effective treatments for diabetes. Dr. Unger says that in type 2 diabetes, we need to suppress glucagon. Potential ways to do that include a chemical called somatostatin, glucagon receptor antibodies, and leptin (the latter mentioned in a 2012 article, I think). The glucagon-centric theory of diabetes also explains why type 1 diabetics rarely have totally normal blood sugars no matter how hard they try: we’re ignoring the glucagon side of the equation. I don’t yet understand his argument, but he also says that giving higher doses of insulin to T2 diabetics may well be harmful. I’m guessing the insulin leads to increased accumulation of lipids (and the associated toxic ceramide) in cells.

Not making sense? Try this YouTube video:

Steve Parker, M.D.

PS: Dr. Unger Says: “Without insulin, you can’t get fat.”

Apoptosis: the second p is apparently silent.

h/t George Henderson

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January 4, 2015 · 2:00 AM

Recipe: Chicken Avocado Soup

FullSizeRender

Avocados in soup? Yeah, I was skeptical, too. But it works amazingly well. Since I provide the nutritional analysis below, you can easily work this into the Low-Carb Mediterranean Diet, Ketogenic Mediterranean Diet, or Paleobetic Diet.

Ingredients

1.5 lb (680 g) boneless skinless chicken breast

1 tbsp (15 ml) olive oil

1 cup (240 ml) chopped green onions

1/2 jalapeno pepper (or 1 or 2 peppers if you wish), seeded and minced (use the seeds, too, if you want it very spicy hot)

2 roma tomatoes (5 oz or 140 g), seeded and diced

2 garlic cloves, minced

60 oz (1,700 g) low-sodium chicken broth

salt and pepper to taste (nutritional analysis below assumes no salt added)

1/2 tsp (2.5 ml) ground cumin

1/3 cup (80 ml) chopped cilantro

3 tbsp (45 ml) fresh lime juice (2 limes should be enough)

3 medium California avocados, peeled, seeded, and cubed

Instructions

Heat up the olive oil in a large pot over medium heat, then add the green onions and jalapeño; sauté until tender (1–2 minutes) then add the garlic and cook another 30 seconds or so. Next into the pot goes the chicken broth, cumin, tomatoes, chicken breasts, and optional salt and pepper. If adding salt, I’d wait until just before serving: taste it and then decide if it needs salt. Bring to a boil with high heat, then reduce heat but keep it  boiling, covered with a lid while the chicken cooks through-out. Cooking time depends on thickness of the breasts and may be 15 to 45 minutes. When done, it should be easy to shred with a fork. Reduce heat to low or warm then remove the chicken breasts and allow them to cool for 5–10 minutes. When cool enough, shred the chicken with your fingers and return it to the pot. Add the cilantro. Ladle 1.5 cups (355 ml) into a bowl, add one fifth or sixth of the avocado cubes (half of an avocado) and the juice of 1/4 to 1/2 lime. Enjoy!

IMG_2233

Serving size: 1.5 cup of soup plus 1/2 of an avocado

Servings per Batch: 5

Advanced Mediterranean Diet boxes: 1 veggie, 1 fat, 1 protein

Nutritional Analysis per Serving:

43 % fat

13 % carbohydrate

44 % protein

350 calories

12 g carbohydrate

8 g fiber

4 g digestible carb

638 mg sodium

1,180 mg potassium

Prominent features: Rich in protein, vitamin B6, vitamin C, niacin, pantothenic acid, phosphorus, selenium; plus a fair amount of fiber

PS: You can fancy this up just before serving by adding a couple large triangular corn tortilla chips (broken into a few bits) or half of a 6-inch (15 cm) corn tortilla (first, microwave for 20 seconds, then break into a bits). Both items each add 5 g of digestible carbohydrate; the tortilla chip option adds 60 calories and the corn tortilla adds 25 calories. Shredded cheese might be a nice topper, too.

 

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January 2, 2015 · 8:30 AM

Diabetes Drug Now Sold As Weight-Loss Aid

It’s liraglutide, which has been available to treat diabetes in the U.S. since 2009. It’s sold as Victoza. Click for my brief review of the drug class for diabetics. The weight-loss preparation will be sold in the U.S. as Saxenda and it’s a higher dose than is used for just diabetes.

Click for the CBS News report on Saxenda. A snippet:

One clinical trial that involved patients without diabetes found that patients taking Saxenda had an average weight loss of 4.5 percent after one year. Of the people treated with the drug, 62 percent lost at least 5 percent of their body weight. Meanwhile, only 34 percent of those given an inactive placebo had the same result.

Another clinical trial that included patients with type 2 diabetes found that patients had an average weight loss of almost 4 percent after one year. Of those given Saxenda, 49 percent lost at least 5 percent of their body weight, compared to 16 percent of those who were given a placebo treatment.

Click for the FDA’s press release.

Oh, by the way. You have to inject it daily under the skin (subcutaneous). And if you were hoping for a shortcut to weight loss, this ain’t it. You’re still supposed to follow a reduced-calorie diet and exercise regularly.

I’d try the  Low-Carb Mediterranean Diet first if I had diabetes.

Steve Parker, M.D.

PS: Full prescribing information.

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December 29, 2014 · 8:29 PM

Dulaglutide Joins War Against Diabetes

In September, 2014, the U.S. Food and Drug Administration approved the fourth drug in the GLP-1 analogue class: dulaglutide. The granddaddy in the class is exenatide (Byetta). The new GLP-1 receptor agonist will be sold in the U.S. under the name of Trulicity. It’s a once-weekly injection.

This is only a summary and is liable to change. Get full information from your prescribing healthcare provider and pharmacist.

Even walking helps with blood sugar control

Even walking helps with blood sugar control

Uses

For adults with type 2 diabetes, in conjunction with diet and exercise. It’s not a first-line drug. It can be used by itself or in combination with metformin, pioglitazone, glimiperide (and presumably other sulfonylureas), and insulin lispro (e.g., Humalog, a rapid-acting insulin). The drug has not been tried with basal (long-acting) insulins.

Dose

Start with 0.75 mg subcutaneously every week. Can go up to 1.5 mg weekly if needed.

Adverse Effects

Hypoglycemia is rare, but possible, when GLP-1 analogues are used as the sole diabetes drug. When it happens, it’s rarely severe. But the risk increases substantially when dulaglutide is used along with insulin or insulin secretagogues such as sulfonylureas or meglitinides.

Common side effects are nausea, vomiting, diarrhea, abdominal pain, decreased appetite, dyspepsia, and fatigue.

It might cause thyroid tumors and pancreatitis.

Do Not Use If…

…you have a family or personal history of medullary thyroid cancer, or if you have Multiple Endocrine Neoplasia syndrome type 2 or pre-existing severe gastrointestinal disease. Those who are pregnant or nursing babies should probably not take it since we have no data on safety. Don’t use for diabetic ketoacidosis.

Use only with caution if you have a history of pancreatitis or known liver impairment.

Steve Parker, M.D.

Click for full prescribing information.

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