…according to an article at Diabetes Care.
Visit the Linus Pauling Institute for dietary sources of magnesium.
Higher Magnesium Consumption May Reduce Risk of Type 2 Diabetes
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Does Parker Practice What He Preaches?
I don’t post many pictures of myself here. It’s appropriate for you to wonder what a “diet doctor” looks like. I tell anyone interested about the benefits of weight management and exercise, and how to do it. At a shade under 6 feet tall (183 cm), I weigh 170 lb (77.3 kg). Last May, I hiked seven miles to Phantom Ranch at the bottom of the Grand Canyon; we hiked the 10 miles back up and out a few days later on a different trail. The canyon is about a mile deep.
Steve Parker and son Paul hiking on the Mogollon Rim of Arizona near Horton’s Creek and Spring
Filed under Exercise
Consider Reducing Insulin Before AND After Exercise If You Have Type 1 Diabetes
She most likely has type 1 rather than type 2 diabetes
…to avoid hypoglycemia, according to an article at DiabetesHealth. A snippet:
Previous research had suggested that reducing insulin intake before exercise was enough to prevent hypoglycemia.
“It’s been well known that people with type 1 diabetes need to heavily reduce their insulin before exercise, but now we’ve showed that it’s important to reduce it after exercise,” says lead author Daniel J. West, PhD, from North Umbria University in the United Kingdom, in an article that appeared on the Medscape Medical News website.
The article looks at the experience of only 11 exerciser, all men, so it may not be widely applicable.
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Experts Debate Composition of the Mediterranean Diet
…but they have some good ideas as to the healthy components, according to a report in MedPageToday. A sample:
Through a subtractive statistical technique, the EPIC investigators calculated that the biggest chunk of the health advantage—24%—came from moderate alcohol consumption (predominantly wine).
The other relative contributions were:
- 17% from low consumption of meat and meat products
- 16% from high vegetable consumption
- 11% from high fruit and nut consumption
- 11% from high monounsaturated-to-saturated lipid ratio (largely due to olive oil consumption)
- 10% from high legume consumption
Here’s my definition of the Mediterranean diet.
Reference:
Sofi F, et al “Ideal consumption for each food group composing Mediterranean diet score for preventing total and cardiovascular mortality” EuroPRevent 2013; Abstract P106.
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Filed under Alcohol, Fruits, legumes, Mediterranean Diet, nuts, olive oil, Vegetables
Recipe: Pico De Gallo
According to Wikipedia, pico de gallo is Spanish for rooster’s beak. I always thought it was peck of the rooster, because it’s got some bite to it. You decide how spicy you want it based on how much jalapeño you use. Also note that one batch of jalapeños is different in heat from the next.
Our rooster, Chuck: handsome but mean!
Pico de gallo is a condiment that compliments eggs, meat, and guacamole, to name a few. I throw it in a bowl of soup sometimes. Save any you don’t eat in the ‘frig, but eat it within three days.
Ingredients:
- tomatoes, fresh, 7 oz (200 g), chopped very finely
- onion, fresh, 2 oz (60 g), chopped very finely
- jalapeño pepper, fresh, 1 whole (14 g), chopped very finely after discarding stem
- cilantro, fresh, 10–15 sprigs chopped finely to yield 3–4 tbsp (2 g)
- salt, 2 pinches (2/16 tsp) or to taste
Instructions:
If you prefer less spicy heat, use less jalapeno and don’t use the seeds. Combine all ingredients and you’re done. Eat at room temperature, chilled, or heated at medium heat in a saucepan (about 5 minutes, until jalapenos lose their intense green color).
Servings: 3 servings of 1/2 cup (120 ml) each.
Nutritional Analysis Per Serving:
- 8% fat
- 81% carbohydrate
- 11% protein
- 21 calories
- 4.5 g carbohydrate
- 1.2 g fiber
- 3.3 g digestible carbohydrate
- 104 mg sodium (2 pinches of added salt)
- 216 mg potassium
Some prefer it coarsely chopped like this – it’s quicker
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Filed under Recipes
Omega-3 Fatty Acid Supplements Fail to Prevent Dementia
- I like fish, but raw whole dead fish leave me cold
Supplementation with omega-3 fatty acids does not help prevent age-related cognitive decline and dementia, according to an article at MedPage Today.
The respected Cochrane organization did a meta-analysis of three pertinent studies done in several countries (Holland, UK, and ?).
The investigators leave open the possibility that longer-term studies—over three years—may show some benefit.
I leave you with a quote from the MedPage Today article:
And while cognitive benefits were not demonstrated in this review, Sydenham and colleagues emphasized that consumption of two servings of fish each week, with one being an oily fish such as salmon or sardines, is widely recommended for overall health benefits.
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Filed under Dementia, Uncategorized
Do Clinical Studies Support Carbohydrate-Restricted Eating in Type 1 Diabetes?
Sweden has lots of blondes
Yes, there are a few. We’ll take a close look at one today. (See the references below for more.)
In the introduction to the study at hand, the authors note:
The estimation of the amount of carbohydrates in a meal has an error rate of 50%. The insulin absorption may vary by up to 30%. It is therefor virtually impossible to match carbohydrates and insulin which leads to unpredictable blood glucose levels after meals. By reducing the carbohydrates and insulin doses the size of the blood glucose fluctuations can be minimized. The risk of hypoglycemia is therefore minimized as well. Around-the-clock euglycemia [normal blood sugar] was seen with 40 g carbohydrates in a group of people with type 1 diabetes [reference #2 below].
The immediate resulting stable, near-normal blood glucose levels allow individuals to predict after-meal glucose levels with great accuracy.
For individuals with type 1 diabetes one year audit/evaluation of group education in this regimen has shown that the short-time lowering of mean hemoglobin A1c by 1 percentage unit and the reduction in mean rate of symptomatic hypoglycemia by 82% was maintained [reference #3].
***
There is no evidence for the use of the widely recommended high-carbohydrate, low-fat diet in type 1 diabetes.
Study Set-Up
Swedish investigators educated study participants on carbohydrate-restricted eating from 2004 to 2006 [reference #1]. They recently audited their medical records for results accumulated over four years. At the outset, participants were given 24 hours of instruction over four weeks. My sense is that they all attended the same diabetes clinic. The subjects’ mean age was 52 years and they had diabetes for an average of 24 years. Seven had gastroparesis. Fourteen used insulin pumps. Of the 48 study subjects, 31 were women, 17 were men. The diet regimen restricted carbohydrates to a maximum of 75 grams a day, mainly by reducing starchy food.
Results
As measured three months after starting the diet, HDL-cholesterol rose and triglycerides fell to a clinically significant degree (p<0.05). Average weight fell by 2.7 kg (a little over a pound); average baseline weight was 77.6 kg (171 lb). Hemoglobin A1c fell from 7.6 to 6.3% (Mono-S method).
As measured one year after start, meal-time insulin (rapid-acting, I assume) fell from 23 to 13 units per day. Long-acting insulin was little changed at around 19 units daily.
By two years into the study, half the participants had stopped adhering to the diet. The remainder were adherent (13 folks) or partly adherent (10). We don’t know what the non-adherents were eating.
Four years out, the adherent group had hemoglobin A1c of 6.0%, and the partly adherents were at 6.9% (p<0.001 for both). The non-adherent group had returned to their baseline HgbA1c (7.5%). Remember, at baseline the average HgbA1c for the group was 7.6%.
The authors don’t say how many participants were still adherent after four years. From Figure 2, adherence seems to have been assessed at 60 months: 8 of the 13 adherent folks were still adherent, and 5 of the 10 partly adherent were still in the game. So, of 48 initial subjects, only 13 were still low-carbing after five years later. By five years out, half of all subjects seem to have been lost to follow-up. So the drop-out rate for low-carbers isn’t as bad as it looks at first blush.
Conclusion
The authors write:
An educational program involving a low-carbohydrate diet and correspondingly reduced insulin doses for informed individuals with type 1 diabetes gives acceptable adherence after 4 years. One in two people attending the education achieves a long-term significant HbA1c reduction.
They estimate that this low-carb diet “may be an option for 10-20% of the patients with type 1 diabetes.” Only 17% of their current diabetes clinic population is interested in this low-carb diet. They didn’t discuss why patients abandon the diet or aren’t interested in the first place. Use your imagination.
Major carbohydrate restriction in type 1 diabetics significantly improves blood sugar control (decreases HgbA1c), lowers insulin requirements, and improves cardiovascular disease risk factors (increases HDL cholesterol and lowers triglycerides).
Low-carb eating wasn’t very appealing to Swedes in the mid-2000s. I wonder if it’s more popular now with the popularity of LCHF dieting (low-carb, high-fat) in the general population there.
References:
1. Nielson, J.V., Gando, C., Joensson, E., and Paulsson, C. Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit. Diabetology & Metabolic Syndrome, 2012, 4:23. http://www.dmsjournal.com/content/4/1/23
2. O’Neill, D.F., Westman, E.C., and Bernstein, R.K. The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus. Metabolic Syndrome and Related Disorders, 2003, 1(4): 291-298.
3. Nielsen, J.V., Jönsson, E. and Ivarsson, I. A low carbohydrate diet in type 1 diabetes: clinical experience – A brief report. Upsala Journal of Medical Sciences, 2005, 110(3): 267-273.
Filed under Carbohydrate
Large Breakfast Rich in Protein and Fat Beats a Small Breakfast Strategy in Type 2 Diabetes
…according to research reported at MedPageToday. This was a relatively small study with about 30 participants in each treatment arm. A snippet:
Patients in the big-breakfast group were instructed to consume 33% of their daily calories in their morning meal — that included up to 30% protein, up to 37% fat, and the rest in carbohydrates. Patients in the small-breakfast group were instructed to consume 12.5% of their daily calories at breakfast — with up to 70% in the form of carbohydrates.
Average fasting glucose decreased 14.51 mg/dL in the big breakfast group and decreased 4.91 mg/dL in the small breakfast group (P=0.011), she said at the annual meeting of the European Association for the Study of Diabetes.
The big breakfast group also saw a significant drop in systolic blood pressure (almost 10 mmHg), although probably not to the point it created a problem.
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Filed under Fat in Diet, Protein
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.
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Filed under Drugs for Diabetes
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.
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Filed under Diabetes Complications
Diabetic Mediterranean Diet 