GLP-1 analogs and DPP-4 inhibitors are being investigated by the U.S. Food and Drug Administration as causes of pancreatitis and thyroid cancer. These drugs include exenatide and saxagliptin, for example. Details are at MedPageToday.
If you’re not sure if your drugs fall into one of those classes, talk to your doctor or pharmacist or review them here.
Many of my patients have found they can cut their use of drugs by eating the Low-Carb Mediterranean Diet.
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“You gotta consider that free fatty acids may be causing insulin resistance….blah, blah, blah…which if it occurs in the liver, they may both be right!”
It refers to somewhat mysterious higher-than-expected blood sugars in the early morning hours, as between 6 an 9 AM. Even if you don’t eat breakfast; that’s why it seems mysterious. Assuming you slept all night, why would your blood sugars be too high, even before breakfast?
Dr. Richard Bernstein talks about it at DiabetesHealth. Dr Bernstein is a great resource for folks with diabetes, and to physicians who treat diabetes.
Peter at Hyperlipid suggests that dawn phenomenon isn’t as simple and straightforward as Dr. Bernstein says. In fact, Peter seriously questions, Dr. Bernstein’s explanation that it’s caused by the liver removing too much insulin from circulation. For those who don’t click through, I’ll summarize by saying Peter found evidence that nighttime growth hormone elevations (this is normal) lead to lipolysis (breakdown of body fats into free fatty acids to be used by various tissues for energy) and the FFA’s cause a degree of insulin resistance, leading to higher blood sugar levels in the early morning.
As a practical side note, some people with diabetes (should I start using PWD’s?) seem to suppress Dawn Phenom by drinking alcohol at bedtime.
Filed under Diabetes Complications
Caprese salad, naturally low-carb
Ketogenic Diets
First, let’s define ketogenic diets. For most folks, that means eating under 50 grams of digestible carbohydrate daily.
Your body gets nearly all its energy either from fats, or from carbohydrates like glucose and glycogen. In people eating “normally,” 60% of their energy at rest comes from fats. In a ketogenic diet, the carbohydrate content of the diet is so low that the body has to break down even more of its fat to supply energy needed by most tissues. Fat breakdown generates ketone bodies in the bloodstream. Hence, “ketogenic diet.” Also called “very-low-carb diets,” ketogenic diets have been around for over a hundred years.
What Could Go Wrong?
Long-term effects of a very-low-carb or ketogenic diet in most people are unclear—they may have better or worse overall health—we just don’t know for sure yet. Perhaps some people gain a clear benefit, while others—with different metabolisms and genetic make-up—are worse off.
If the diet results in major weight loss that lasts, we may see longer lifespan, less type 2 diabetes, less cancer, less heart disease, less high blood pressure, and fewer of the other obesity-related medical conditions.
Ketogenic diets are generally higher in protein, total fat, saturated fat, and cholesterol than some other diets. Some authorities are concerned this may increase the risk of coronary heart disease and stroke; the latest evidence indicates otherwise.
Some authorities worry that ketogenic diets have the potential to cause kidney stones, osteoporosis (thin, brittle bones), gout, and may worsen existing kidney disease. Others disagree.
Soon after adoption of very-low-carb eating, dieters may have headaches, bad breath, easy bruising, nausea, fatigue, aching, muscle cramps, constipation, and dizziness, among other symptoms. “Induction flu” may occur around days two through five, consisting of achiness, easy fatigue, and low energy. It clears up after a few days.
Very-low-carb ketogenic diets may have the potential to cause low blood pressure, high uric acid in the blood, excessive loss of sodium and potassium in the urine, worsening of kidney disease, deficiency of calcium and vitamins A, B, C, and D, among other adverse effects.
Athletic individuals who perform vigorous exercise should expect a deterioration in performance levels during the first three to four weeks of any ketogenic very-low-carb diet. The body needs that time to adjust to burning mostly fat for fuel rather than carbohydrate.
Competitive weight-lifters or other anaerobic athletes (e.g., sprinters) will be hampered by the low muscle glycogen stores that accompany ketogenic diets. They need more carbohydrates.
What About Adherence to the Diet?
It’s clear that for many folks, compliance with very-low-carb diets is difficult to maintain for six to 12 months. Some can’t do it for more than a couple weeks. Potential long-term effects, therefore, haven’t come into play for most users. When used for weight loss, regain of lost weight is a problem—but regain is a major issue with all weight-loss programs. I anticipate that the majority of non-diabetics who try a ketogenic diet will stay on it for only one to six months. After that, more carbohydrates can be added to gain the potential long-term benefits of additional fruits and vegetables, legumes, and whole grains.
Or not.
People with type 2 diabetes or prediabetes may be so pleased with the metabolic effects of the ketogenic diet that they’ll stay on it long-term.
The most famous ketogenic diet is Dr. Atkins New Diet Revolution. I’ve put together one call the Ketogenic Mediterranean Diet.
Filed under Carbohydrate, ketogenic diet
…and it just takes three sessions a week. By the way, study participants had type 2 diabetes. Quality of life – both mental and physical – improved over the course of the nine-month project. A quote from the DiabetesHealth article:
In assessing physical, emotional, and social aspects, the researchers found that those who exercised over the nine-month period-especially those who mixed aerobic and resistance training-had the most improved quality of life compared to those who were couch potatoes.
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Email is totally out of control and needs to be made illegal effective immediately. It is the worst thing that’s ever happened to humanity. Unless you consider the alternative – phone calls – which I view as an act of violence. “Why is he calling me? What emergency necessitated his dialing my number and waiting for it to ring, what utter atrocity required the disruptively instantaneous back-and-forth of a voice conversation?” But I digress…
…So don’t make all these dumbass folders and files you’re never going to use, just start blowing emails off as they come in. A wise man once said that your inbox is like a To Do list that someone else makes for you. To which I say, no thanks. I make my own To Do list, the needs and wants and tasks of others come after the tasks that are important to my clients and my practice.
As for what should replace the email, I vote for the Twitter direct message…
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They do it early every year. In case you’re interested, click this link. You may have trouble digesting it unless you’re a healthcare provider.
Here’s an understandable summary at the Joslin Diabetes Center blog.
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For example, here’s a recent quote from their blog:
The Mediterranean Diet is one of the highest rated diet plans to both prevent and manage diabetes.
The blog post has some tips on moving your diet towards Mediterranean. You don’t have to jump in with both feet, but I would!
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“Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI? SAD?
Remember that recent report on the best diet for diabetes from American Journal of Clinical Nutrition? I didn’t think so. Here’s Dr. Axel Sugurdsson’s summary:
Ajala and coworkers conclude that their review provides evidence that modifying the amount of macronutrients can improve glycemic control, weight and lipids in type 2 diabetes. In their analysis, low carbohydrate diets appeared to provide superior weight loss, better control of blood glucose, and better lipid profile, compared with low fat diets. The authors also conclude that vegan and vegetarian diet may improve glucose control and promote weight loss in type 2 diabetes.
Here’s the verbatim conclusion of the researchers from the article abstract:
Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.
No mention of vegan and vegetarian diets per se.
And now Dr. Sigurdsson’s concluding opinion:
What is the best diet for diabetes? Although, there is probably not a simple answer, the question reflects one of the main challenges of modern medicine. It is likely that our dietary recommendations will have to be tailored to the needs of the individual. A one-size-fits-all approach is unrealistic. Although not providing any definitive answers, the study by Ajala and coworkers is an important contribution to our understanding of this highly important issue.
I’ve reviewed some of the literature supporting vegetarian diets for diabetes. I’ve seen some evidence that the paleo diet may be beneficial. Regular readers here know that I currently favor a carbohydrate-restricted Mediterranean-style diet for control of diabetes.
Filed under Carbohydrate, Mediterranean Diet, Vegetarian Diet
You may know that she has type 1 diabetes. Mr. Hirsch writes:
Sonia Sotomayor dove beneath a parked car and scrunched up like a turtle. A hospital employee finally caught her by the foot and dragged her back into the building, with Sonia fighting him every step of the way. Sonia’s diabetes was diagnosed that day. It was the first time she had ever seen her mother cry.
The year was 1962, and the vignette opens Sotomayor’s memoir, My Beloved World, the surprise blockbuster nonfiction book of the year. Named to the U.S. Supreme Court in 2009, Sotomayor has been rightfully praised as a pioneer: the High Court’s first Hispanic justice, its third female justice – and its first justice with type 1 diabetes. Though her medical condition is not always front and center in the book, it is a powerful narrative thread to her life story, a cause of anguish but also a source of motivation and ultimately triumph.
Mr. Hirsch wrote a book on diabetes, Cheating Destiny, that would be of interest to anyone with diabetes. I reviewed it a few years ago.
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…according to an article at USAToday.
h/t Dr. Emily Deans (Twitter @evolutionarypsy)
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Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.
Bible Verse of the Day
Diabetic Mediterranean Diet 