ScienceDaily has the report. This is exciting. But don’t hold your breath; human trials are years away.
Man’s Best Friend was also instrumental in the discovery of insulin.
h/t David Fisher RD
Gene Therapy Cure of Type 1 Diabetes: Dogs First, Then Humans?
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Extra Virginity: On Olive Oil and the Olive Oil Industry
Olives, olive oil, and vinegar: classic Mediterranean foods
EcoSalon has an interview with Tom Mueller, author of a new book on olive oil, Extra Virginity. Regarding olive oil…
Consumption is rising swiftly, quality olive oil shops are springing up nationwide. BUT, there’s zero government control of olive oil quality (the FDA has openly abdicated its legal role), and ignorance of what quality olive oil means is still rampant. Lots of bad oil, sometimes adulterated, is being sold as ” extra virgin olive oil” throughout America.
Here are Tom’s top three tips for choosing an olive oil:
1) Harvest date: must be fresh (within the current harvest year).
2) Who made this, and where? Specific producer and specific location of trees as well as oil-bottling.
3) Mention of specific cultivars (though by no means a guarantee of quality, I’ve found mention of specific olive varieties on the label tends to indicate a more professional/serious oil-maker.
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Does Diet Affect Irritable Bowel Syndrome?
“Dr. Parker, what can I do about these belly cramps?”
Four weeks of fermentable carbohydrate restriction reduces symptoms of irritable bowel syndrome, according to UK and Australian researchers.
Here’s the theory of how it works. Our intestines—colon, mostly—are loaded with bacteria. The food you feed your bacteria—fermentable carbohydrates, for example—may have an effect on the bacteria. Changes in bacterial populations in response to feeding, in turn, may lead to changes in irritable bowel syndrome and other aspects of health. This “gut microbiome” is a hot area of research and speculation.
I don’t have irritable bowel syndrome (IBS), but did notice a major decrease in gastrointestinal gas production when I reduced my digestible carbohydrate consumption to less than 50 g/day. That alone has at least potential to reduce IBS symptoms.
IBS is extremely common, affecting 10–15% of individuals in the developed world. Only 15% of those bother to seek medical attention. Of all referrals to gastroenterologists (stomach specialists), at least 25% are for IBS. There are few reliable treatments and cures. In some cases it mysteriously resolves on its own.
So I got excited when I ran across the study I reference above. I’m not going to spend a lot of time on it because I’ve already spent too much trudging through the article, and I don’t have much to show for it.
The way the investigators wrote their report gave me some heartburn:
- They never bothered to define “fermentable.” In this context it probably refers to digestion or breakdown of food by gut bacteria rather than by human hosts.
- They never bother to spell out exactly what foods the experimental subjects were eating as they restricted fermentable carbohydrate consumption.
- The intervention group (n=19) was instructed to restrict foods “high in fructans (e.g., wheat products, onions), galacto-oligosaccharide (e.g., legumes), polyols (e.g., pear, sugar-free gums), lactose (e.g., mammalian milk), and excess fructose (e.g., honey).” Does “restrict” mean “cut back a little” or “avoid entirely upon penalty of death”? Your guess is as good as mine. (It’s a joke—I know they wouldn’t kill’em.)
Have you heard of FODMAPs? That seems to be the intervention diet that restricted fermentable carbohydrates. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
You need a break. Enjoy.
Let me summarize their results simply by saying they found changes in gut bacteria and a reduction in irritable bowel syndrome symptoms, as compared with control subjects. The particularly responsive symptoms were bloating, borborygmi, and the urge to defecate. Abdominal pain strongly tended to improve but didn’t quite reach statistical significance. Diarrhea wasn’t affected. Also note that the IBS patients allowed into the study were not the type with constipation as a major issue.
So What?
If you want to try a FODMAP diet for your IBS, you won’t be able to figure out what to eat based on this report. Consult your own physician about it. I wonder whether many of them have even heard of FODMAP. Barbara Bolen, Ph.D., at About.com says the diet should be undertaken only with the supervision of a qualified nutritionist.
Reference: Staudacher, Heidi, et al. Fermentable Carbohydrate Restriction Reduces Luminal Bifidobacteria and Gastrointestinal Symptoms in Patients with Irritable Bowel Syndrome. Journal of Nutrition, 142: 1520-1518 (2012)
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Upper Normal Blood Sugars Linked To Brain Shrinkage
MRI scan of brain
Healthy bodies keep blood sugar levels in a fairly narrow range. You might think you’re fine if you’re anywhere within the defined normal range. Think again. Australian researchers found that folks with fasting blood sugars toward the upper end of the normal range had more degeneration (atrophy) in parts of the brain called the hippocampus and amygdala, compared to those in the low normal range. Degeneration in those areas is often manifested as dementia.
The hippocampus is critical for learning and memory formation and retention. The amygdala is also involved in memory as well as emotion. The two areas are intimately connected, literally.
How Was the Study Done?
Over 250 study participants aged 60 to 64 years had normal brains at baseline and were free of prediabetes and diabetes. They were mostly caucasian. MRI brain scans were done at baseline and again four years later. Significant atrophy (shrinkage) was seen in the hippocampus and amygdala over time, with greater atrophy seen in those with higher baseline fasting glucose levels.
Fasting blood sugar was measured only once, at the start, and ranged from 58 to 108 mg/dl (3.2 to 6.0 mmol/l). (Fasting glucose of 108 would be prediabetes according to the American Diabetes Association, but not by the World Health Organization.) Participants weren’t tested for deterioration of cognition (actual thinking).
So What?
The results of the study at hand are consistent with others that link higher rates of dementia with diabetes. Diabetics, even when under treatment, usually have higher average blood sugars than non-diabetics. The study authors speculate that damage from higher blood sugars may be mediated by inflammation and abnormal blood clotting (prothrombotic factors and platelet activation).
It’s interesting to contemplate whether non-diabetics and diabetics would have less risk of developing dementia if blood sugars could be kept in the lower end of the normal range. How could you do that? Possibilities include:
- avoid sugars and other refined carbohydrates
- limit all carbohydrates
- favor low-glycemic-index foods over high
- regular exercise, which helps maintain insulin sensitivity (insulin is a major blood sugar regulator)
- avoid overweight and obesity, which helps maintain insulin sensitivity
- for diabetics: all of the above plus drugs that control blood sugar
Reference: Cherbuin, Nicolas, et al. Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study. Neurology, September 4, 2012, vol. 79, No. 10, pp: 1,010-1,026. doi:10.1212/WNL.0b013e31826846de
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Filed under Dementia, Diabetes Complications
Ketogenic Diet Works for Children
Is there a trampoline out of view?
A ketogenic diet was safe and effective for weight loss in children and adolescents, according to a small study in the Journal of Pediatric Endocrinology and Metabolism. Fifty-six children were placed on either a ketogenic diet or a calorie-restricted diet. The investigators judged the low-carb ketogenic diet more effective.
I don’t treat children, so I don’t normally monitor the pediatric scientific literature. Thanks to Diet Doctor Andreas Eenfeldt for bringlng this to my attention. I’ve not read the full research report.
In 2010 I reported on research showing a low-carb, high-protein diet was safe and effective for severely obese adolescents.
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Low Glycemic Index Diets Reduce LDL and Total Cholesterol
…according to a recent report in Nutrition, Metabolism & Cardiovascular Disease. LDL cholesterol is the type we think contributes to coronary artery disease and other forms of atherosclerosis.
Learn about glycemic index at NutritionData.
My Low-Carb Mediterranean and Ketogenic Mediterranean Diets are undoubtedly “low glycemic index.” The Advanced Mediterranean Diet would also be significantly lower GI than the standard American diet.
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Carbohydrate Counting Not All It’s Cracked Up to Be
…according to an article at MedPageToday. In brief, carb counting involves estimating the digestible carbohydrate grams in a meal, then dosing rapid-acting insulin based on those grams and the individual’s prior responses to insulin. Turns out there’s not a lot of hard clinical evidence to back up the practice.
Carbohydrate counting is the best known method for matching insulin dosing to meals, and is the recommended dietary strategy for achieving glycemic control in type 1 diabetes, though that recommendation has been largely based on expert consensus, Bell said.
One commentator said it doesn’t work very well because most folks aren’t very good at it, they’re not vigilant enough.
A review panel “compared carbohydrate counting with usual care, which consisted of either general nutrition advice or low dietary glycemic index (GI) advice.” They found no significant differences in hemoglobin a1c between the approaches.
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Good News: Death Rates in Diabetics Are Falling
Although the incidence of diabetes has doubled in the U.K. and Canada, death rates in diabetics have fallen significantly over the last decade. This story is mostly about type 2 diabetes. An article at MedPageToday suggests explanations for the trend:
“Although caution should be exercised in identifying a trend-shift in the prognosis of patients with diabetes, more aggressive treatment during recent decades may be applicable to the present results,” Lind and colleagues observed.
Factors that may have contributed include the greater emphasis placed on glycemic control, lowering blood pressure, and use of statins.
However, the decrease in excess mortality also may relate to shorter duration of disease, the researchers pointed out.
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Hemoglobin A1c Test May Miss Many Cases of Diabetes
…according to a report at MedPageToday. If there’s any doubt about a new case of diabetes, consider a fasting blood sugar test or glucose tolerance test.
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Should People With Diabetes Restrict Carbohydrates?
Dr. John Rollo (a surgeon in the British Royal Artillery) in 1797 published a book, An Account of Two Cases of the Diabetes Mellitus. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. Mind you, this was an era devoid of effective drug therapies for diabetes.
The soldier apparently had type 2 diabetes rather than type 1.
Rollo’s diet led to loss of excess weight (original weight 232 pounds or 105 kg), elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.
This makes Dr. Rollo the original low-carb diabetic diet doctor. Many of the leading proponents of low-carb eating over the last two centuries—whether for diabetes or weight loss—have been physicians.
But is carbohydrate restriction a reasonable approach to diabetes, whether type 1 or type 2?
What’s the Basic Problem in Diabetes?
Diabetes and prediabetes always involve impaired carbohydrate metabolism: ingested carbs are not handled by the body in a healthy fashion, leading to high blood sugars and, eventually, poisonous complications. In type 1 diabetes, the cause is a lack of insulin from the pancreas. In type 2, the problem is usually a combination of insulin resistance and ineffective insulin production.
Elevated blood pressure is one component of metabolic syndrome
A cousin of type 2 diabetes is “metabolic syndrome.” It’s a constellation of clinical factors that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:
■ high blood pressure (130/85 or higher, or using a high blood pressure medication)
■ low HDL cholesterol: under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)
■ triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)
■ abdominal fat: waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman
■ fasting blood glucose over 100 mg/dl (5.55 mmol/l)
Metabolic syndrome and simple obesity often involve impaired carbohydrate metabolism. Over time, excessive carbohydrate consumption can turn obesity and metabolic syndrome into prediabetes, then type 2 diabetes.
Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally.
Carbohydrate Intolerance
Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbohydrates in a normal, healthy fashion. In a way, carbs are toxic to them. Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death, among other things.
Diabetics and prediabetics simply don’t tolerate carbs in the diet like other people. If you don’t tolerate something, you have to give it up, or at least cut way back on it. Lactose-intolerant individuals give up milk and other lactose sources. Celiac disease patients don’t tolerate gluten, so they give up wheat and other sources of gluten. One of every five high blood pressure patients can’t handle normal levels of salt in the diet; they have to cut back or their pressure’s too high. Patients with phenylketonuria don’t tolerate phenylalanine and have to restrict foods that contain it. If you’re allergic to penicillin, you have to give it up. If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry.
Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally.
But Doc, …?
1. Why not just take more drugs to keep my blood sugars under control while eating all the carbs I want?
We have 12 classes of drugs to treat diabetes. For most of these classes, we have little or no idea of the long-term consequences. It’s a crap shoot. The exceptions are insulin and metformin. Several big-selling drugs have been taken off the market due to unforeseen side effects. Others are sure to follow, but I can’t tell you which ones. Adjusting insulin dose based on meal-time carb counting is popular. Unfortunately, carb counts are not nearly as accurate as you might think; and the larger the carb amount, the larger the carb-counting and drug-dosing errors.
2. If I reduce my carb consumption, won’t I be missing out on healthful nutrients from fruits and vegetables?
No. Choosing low-carb fruits and vegetables will get you all the plant-based nutrients you need. You may well end up eating more veggies and fruits than before you switched to low-carb eating. Low-carb and paleo-style diets are unjustifiably criticized across-the-board as being meat-centric and deficient in plants. Some are, but that’s not necessarily the case.
3. Aren’t vegetarian and vegan diets just as good?
Maybe. There’s some evidence that they’re better than standard diabetic diets. My personal patients are rarely interested in vegetarian or vegan diets, so I’ve not studied them in much detail. They tend to be rich in carbohydrates, so you may run into the drug and carb-counting issues in Question No. 1.
PS: The American Diabetes Association recommends weight loss for all overweight diabetics. Its 2011 guidelines suggest three possible diets: “For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” The average American adult eats 250–300 grams of carbohydrate daily.
Filed under Carbohydrate, Causes of Diabetes, Prediabetes
Diabetic Mediterranean Diet 