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.
American Diabetes Association Updated Their Standards of Care for 2013
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Joslin Diabetes Center Praises the Mediterranean Diet
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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Dr. Sigurdsson’s Thoughts on the Best Diet for Diabetes
“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
James Hirsch Reviews Sonia Sotomayor’s New Book
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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Diabetes In U.S. Costs $245 Billion Yearly
…according to an article at USAToday.
h/t Dr. Emily Deans (Twitter @evolutionarypsy)
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Low-Carb Diet Testimonial: DAR
DAR is a type 2 diabetic who controls her diabetes with carbohydrate-restricted eating. She shares her story in a recent blog post. She started low-carbing as a way to control diabetes, but writes that…
A nice side benefit to starting a low carb lifestyle was losing the 60 lbs I had fought a losing battle to avoid packing on (despite paying a lot of money for low fat diet plans and food). Admittedly, the last 10 lbs or so are difficult to lose and keep off and it’s a battle I’m still fighting every day, but watching the first 40 lbs or so melt off easily was so gratifying!
DAR’s website is a great source of low-carb recipes and I listed it as a resource in my Conquer Diabetes and Prediabetes book.
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A Cure for Type 1 Diabetes In Five Years?
Researchers at the University of Miami’s Diabetes Research Institute are excited about a new therapy they’re developing, call the BioHub. Riva Greenberg wrote about it at The Huffington Post:
The BioHub is an engineered “mini organ” that will house insulin-producing (islet) cells that, like normally functioning islet cells, sense blood sugar and release the precise amount of insulin to maintain normal blood sugar levels. “It will mimic the insulin function of a normal pancreas,” Dr. Camillo Ricordi, DRI’s Scientific Director and Chief Academic Officer, told me in a phone interview. “It will restore natural insulin production for any patient, no matter how long they’ve had diabetes.”
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The Case For Carbohydrate Restriction in Diabetes
Dr. Rollo would recognize this
In 1797, Dr. John Rollo published a book called An Account of Two Cases of the Diabetes Mellitus. Dr. Rollo was a surgeon in the British Royal Artillery. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. In case you don’t know, 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. (Don’t ask me how they measured blood and urine sugar back then.)
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.
Carbohydrate Intolerance
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.
Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbs 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.
What To Do About It
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.
Stretching actually doesn’t do any good for the average person
If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry. Alternatively, you could eat lots of carbs and take drugs to prevent the dangerous elevations in blood sugar they cause. We have 11 classes of drugs to treat diabetes. Unfortunately, the long-term side effects of most of them are not well-established. And they can get very expensive.
The American Diabetes Association recommends weight loss for all overweight diabetics. That tends to improve carbohydrate metabolism. The ADA’s 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).”
If I were a diabetic eating over 200 grams of carb daily, I’d cut my carbs way below 130 grams initially, to 20–30 grams of digestible carb. Then gradually increase carbs as tolerated, based on blood sugar readings. Ask your doctor what he thinks.
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What’s Metabolic Syndrome?
He’s at high risk for metabolic syndrome
“Metabolic syndrome” may be a new term for you. 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)
What To Do About It
Metabolic syndrome and simple excess weight often involve impaired carbohydrate metabolism. Over time, excessive carbohydrate consumption can turn overweight and metabolic syndrome into prediabetes, then type 2 diabetes. Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally. When my patients have metabolic syndrome, some of my recommendations are:
- weight loss, often via a low-carb diet
- low-carb diet if blood sugars are elevated
- regular exercise, with a combination of strength and aerobic training
If these work, the patient can often avoid costly drugs and their potential adverse effects.
Ask your doctor what she thinks.
Filed under Causes of Diabetes, Prediabetes
Ph.D. Chemist Controlled Diabetes with Low-Carb Diet
Wendy Knapp Pogozelski is a Chemistry professor at State University of New York. After she was diagnosed with LADA (latent onset diabetes of adulthood), she researched the available diabetes diets and achieved good blood sugar control on a carbohydrate-restricted diet and just seven units of insulin a day.
Then she saw a dietitian who convinced her to follow conventional wisdom and increase carbs to at least 130 grams daily.
The result was that my HbA1c rose above 7 percent. My blood sugar levels were frequently in the 200 to 300 mg/dl range (far above the normal level of about 85 mg/dl), even when I supplemented with extra insulin. My former dose of seven units of insulin per day increased to 30 units per day.
I’m not sure what she did after that.
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Diabetic Mediterranean Diet 