September 26, 2013 · 3:49 PM

Carbohydrate Restriction Versus Drugs for T2 Diabetes

“The only person definitely known to have died as a consequence of an association with a low-carbohydrate diet is Dr. Herman Tarnower, author of the Scarsdale diet, although, as they say used to say on the old TV detective shows, the immediate cause of death was lead poisoning. His girlfriend shot him.”

That’s how Richard David Feinman starts a post on management of blood sugars in type 2 diabetics with risky drugs instead of carbohydrate restriction. Of course, you can use both strategies if you have to, and many do.

Read the rest.

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September 25, 2013 · 11:59 PM

Longevity of Type 1 Diabetics Much Improved, But Still Far From Ideal

When I started my medical career three decades ago, it was uncommon to see a type 1 diabetic exceed 60 years of age. Thank God that has been changing for the better. A recent Scottish study found life expectancy in type 1 diabetics, compared to the general population, was 11 years shorter for men and 14 years shorter for women. In 1975, the gap was 27 years. One of the investigators was quoted by the article at MedPageToday:

“There is absolutely no doubt that glucose control is important for long-term outcomes in people with type 1 diabetes.”

From the Framingham Heart Study: Compared to those without diabetes, women and men with diabetes at age 50 died 7 or 8 years earlier, on average. This study population was a mix of type 2 and type 2 diabetes, with type 2 predominating, I’m sure.

Steve Parker, M.D.

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September 25, 2013 · 4:38 PM

Napping Linked to Diabetes and Prediabetes

…in Chinese retirees according to a article at Diabetes Self-Managment. In the study population, 70% of retirees took naps. I’d be surprised if that many U.S. retirees take naps. It’s unclear whether napping causes type 2 diabetes and prediabetes znc whether results apply to non-Chinese ethnic groups.

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September 25, 2013 · 6:12 AM

Do You Worry About Eating Too Much Meat?

If so, read the interesting essay by Dr. Georgia Ede on the health of traditional heavy meat-eating cultures such as the Masai and Inuits.

Of the Canadian Eskimos of a century ago, Dr. Ede writes:

Their diets were therefore extremely low in fiber most of the time, and very high in animal protein and animal fat.  These traditional ways of eating would terrify the USDA, the American Heart Association, the American Cancer Society, not to mention the Harvard School of Public Health, which remains a staunchly anti-meat, anti-saturated fat, anti-cholesterol institution.  How in the world did these uninformed fringe types manage to get all their vitamins and minerals without the heaping helpings of colorful fruits, vegetables, and whole grains without which we are told we shall surely perish?

Weren’t they cancer-riddled, heart-clenching, constipated, fat slobs who died young from scary deficiency diseases like rickets and scurvy?

[Apparently not.]

…

This post was not designed to provide an airtight argument for meat and health, but I do hope that it has at least prompted those of you who remain skeptical about meat to rethink what you’ve been led to believe. If you’ve got a hankerin’ for more information about meat and health, take a look at my meat page.

Check it out.

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September 23, 2013 · 4:33 PM

More on Treatment of Gestational Diabetes

…from Amy Campbell at Diabetes Self-Managment. This is the concluding part (III) of her series on GDM. Here’s my favorite part: 

“One of the positive aspects about gestational diabetes (GDM) is that it pretty much disappears after the baby is born. And of course, nothing tops the reward and joy of a happy, healthy baby!”

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September 23, 2013 · 1:33 AM

Book Review: The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes

I just finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face on a daily basis. His science-based recommendations are familiar to me since I reviewed many of his references at my blog, Diabetic Mediterranean Diet.

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a gym, although some home gyms will have them also. His regimen is easily done in 15-20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics. It may be that it just hasn’t been studied in type 2 diabetics yet.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review.

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September 22, 2013 · 4:28 AM

Heart-Healthy Lifestyle Prevents Cancer, Too

…according to a report in MedPageToday. Type 2 diabetes is linked to higher incidence of several cancers: liver, pancreas, uterus, colo-rectal, breast, and bladder.  On a brighter note, diabetics have lower risk of prostate cancer. Diabetes is also associated with higher risk of heart disease.

I'm still not convinced that severe sodium restriction is necessary or even possible for most people

I’m still not convinced that severe sodium restriction is necessary or even possible for most people

The American Heart Association has published guidelines aiming to reduce premature death and illness caused by cardiovascular diseases such as heart attacks, high blood pressure, and strokes.

The guidelines focus on seven factors critical to cardiovascular health:

  • smoking
  • blood sugar
  • blood pressure
  • physical activity
  • total cholesterol
  • body mass index (BMI)
  • ideal diet

Using data from the Atherosclerosis Risk In Communities study (almost two decades’ follow-up), researchers found that those who maintained goals for six or seven of the American Heart Association critical factors had a 51% lower risk of cancer compared with those meeting no goals.

For detailed information about the specific goals, click here.

As you might expect, I was curious about what the American Heart Association considered a heart-healthy diet.  I quote the AHA summary:

The recommendation for the definition of the dietary goals and metric, therefore, is as follows: “In the context of a diet that is appropriate in energy balance, pursuing an overall dietary pattern that is consistent with a DASH [Dietary Approaches to Stop Hypertension]-type eating plan, including but not limited to:

  • Fruits and vegetables: ≥ 4.5 cups per day
  • Fish: ≥ two 3.5-oz servings per week (preferably oily fish)
  • Fiber-rich whole grains (≥ 1.1 g of fiber per 10 g of carbohydrate): ≥ three 1-oz-equivalent servings per day
  • Sodium: < 1500 mg per day
  • Sugar-sweetened beverages: ≤ 450 kcal (36 oz) per week

Intake goals are expressed for a 2000-kcal diet and should be scaled accordingly for other levels of caloric intake. For example, ≤ 450 calories per week represents only up to one quarter of discretionary calories (as recommended) coming from any types of sugar intake for a 2000-kcal diet.

Diet recommendations are more complicated than that; read the full report for details.  Only 5% of study participants ate the “ideal diet.”  The AHA-recommended diet may have too many carbohydrates for some diabetics. The Mediterranean diet easily meets four out of five of those diet goals; you’d have to be extremely careful to reach the sodium goal on most any diet.

Cardiovascular diseases and cancer are among the top causes of death in Western societies.  Adhering to the guidelines above may kill two birds with one stone.

Steve Parker, M.D.

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September 16, 2013 · 1:01 PM

Treatment of Gestational Diabetes Mellitus

…more from Amy Campbell at Diabetes Self-Management. This is part 2 her series on gestational diabetes mellitus. 

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September 16, 2013 · 3:55 AM

Meal Plans For “Conquer Diabetes and Prediabetes”

For both types 1 and type 2 diabetes, carbohydrate restriction is a great way to help control blood sugars and minimize the toxicity and expense of drug therapy. Here are some low-carb recipes from my book, Conquer Diabetes and Prediabetes.

Breakfast:  Brats and Tomatoes

6 oz (170 g) tomato, sliced

2 tbsp (30 ml) AMD vinaigrette (see below) or commercial Italian dressing (regular, not low-fat, with 3 g or fewer carbs per 2 tbsp or 30 ml)

salt and pepper

2 pre-cooked bratwursts (about 2.3 oz or 65 g each)

6 tsp (30 ml) mustard (optional)

Dress the tomato slices with the vinaigrette, plus salt and pepper to taste. Heat 2 pre-cooked bratwursts as instructed on package. Use mustard on the brats if desired. Digestible carb grams: 8.

AMD VINAIGRETTE

Try this on salads, fresh vegetables, or as a marinade for chicken, fish, or beef. If using as a marinade, keep the entree/marinade combo in the refrigerator for 4–24 hours. Seasoned vinaigrettes taste even better if you let them sit for several hours after preparation. This recipe was in my first book, The Advanced Mediterranean Diet; hence, “AMD vinaigrette.”

Ingredients

1 clove (3 g) garlic

juice from ½ lemon (23 g or ml)

a third of a cup (78 ml) oil olive

2 tbsp (8 g) fresh parsley

½ tsp (2.5 ml)) salt

½ tsp (2.5 ml) yellow mustard

½ tsp (1.2 ml) paprika

2 tbsp (30 ml) red wine vinegar

Preparation

In a bowl, combine all ingredients and whisk together. Alternatively, you can put all ingredients in a jar with a lid and shake vigorously. Let sit at room temperature for an hour, for flavors to meld. Then refrigerate. It should “keep” for at least 5 days in refrigerator. Shake before using. Servings per batch: 3.

Nutrient Analysis:

Recipe makes 3 servings (2 tbsp or 30 ml per serving). Each serving has 220 calories, 2 g digestible carb, almost no fiber, negligible protein, 24 g fat. 3% of calories are from carbohydrate, 97% from fat.

Lunch:  Easy Tuna Plus Pecans

5-oz can (140 g) of albacore tuna

2 tbsp (30 ml) Miracle Whip Salad Dressing (or real, high-fat mayonnaise)

1 tsp (5 ml) lemon or lime juice

1 oz (28 g) pecan halves

Drain the liquid off the can of tuna then place tuna in a bowl. Add Miracle Whip Salad Dressing and lemon or lime juice. Mix thoroughly and enjoy. Eat 1 oz of pecan halves around mealtime or later as a snack. If you want to simplify this, forget the Miracle Whip and lemon; just use 1 oz (28 g) of commercial tartar sauce that derives at least 80% of calories from fat and has less than 3 g of carb per 2 tbsp or 30 ml. Digestible carb grams: 5.

Dinner:  Ham Salad

2 oz (60 g) cooked ham, cut in to small cubes

1 oz (28 g) celery, sliced and diced

1 oz (28 g) seedless grapes (about 4 grapes), cut into small chunks

1 oz (28 g) walnuts, coarsely crumbled

4 oz (110 g) romaine lettuce

3 tbsp AMD vinaigrette or commercial Italian, French, or ranch dressing having 2 or fewer grams of carb per 2 tbsp or 30 ml)

Lay out a bed of lettuce then sprinkle these on top: ham, celery, grapes, walnuts. Finish construction with AMD vinaigrette or commercial dressing. You’re done. Alternatively, substitute cooked chicken or steak for ham. With chicken, apple may work better than grapes. If having a glass of wine (6 fl oz or 180 ml) with meal, delete the grapes or the carb count will be too high. Digestible carb grams: 10.

(When commercial dressing is used, the digestible carb count is closer to 13 than 10 g.)

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September 12, 2013 · 2:00 AM

What’s “Gestational Diabetes”? No, It’s Not Type 3

You can't tell if she has it just by looking

You can’t tell if she has it just by looking

In a recent article Amy Campbell over at Diabetes Self-Management defines it and goes over risk factors, diagnosis, and why it’s important. I expect a second post on management principles in the near future.

Here’s my review from 2010.

In terms of the best diet, a recent study found no significant outcome differences on a 40% carb diet compared to a standard 55% carb diet. I would have guessed the lower-carb diet would better (see below).

Update Sept. 16, 2013:

Here’s part 2 of Amy’s series, beginning discussion of treatment.

I logged onto UpToDate.com and reviewed treatment briefly. The high points are:

  • See a registered dietitian for counseling.
  • “There is scant level 1 [high quality] evidence to support most aspects of the nutritional prescription for gestational diabetes mellitus.”
  • The authors limit carbohydrates to less than 40% of total calories.
  • Goals of treatment are 1) prevent ketosis, 2) support adequate weight gain of the mother based on body mass index, 3) support the baby, and 4) when drug therapy is needed, use insulin instead of pills.
  • UTD agrees with Amy that frequent blood sugar tests (at least 4x/day) with a home glucose monitor are helpful.

 

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