From MedPageToday
January 7, 2013 · 4:12 PM
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My 14-year-old son is a budding artist. His work is viewable and for sale at DeviantArt. You can order prints of various sizes and quality, along with his art on cups and refrigerator magnets. Thanks for taking a look. Paul will get a kick out of the bump in page views whether you buy or not!
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Filed under Uncategorized
Type 2 Diabetes Ages Brain Prematurely
Type 2 diabetes accelerates age-related cognitive decline in the Netherlands, according to new research published in Diabetes Care. T2 diabetes is also linked to decreased brain gray matter in women. Finally, T2 diabetes in the elderly is associated with altered brain structure (as seen on MRI scans) and impaired brain function.
The Mediterranean diet may help prevent this sort of decline.
—Steve
Filed under Dementia
Meal Plans From “Conquer Diabetes and Prediabetes”
A couple blog readers have asked to see meal plans for the Low-Carb Diabetic Diet. I’ve lined up three days worth so far, to be published today, Jan. 12, and Jan. 19, 2013. I’ll do more if requested. These recipes are from Conquer Diabetes and Prediabetes.
Day 1
Breakfast: Eggs and Bratwurst
3 large eggs
1.5 tbsp (22 ml) olive oil
salt and pepper
1 (66g) pre-cooked bratwurst
Sauté eggs in the olive oil, salt and pepper to taste. Microwave a pre-cooked bratwurst. Digestible carb grams: 2.
Lunch: Tossed Tuna Salad and Almonds
3.5 oz (100 g) lettuce
1.5 oz (42 g) chopped onion
5.5 oz (150 g) chunked tomatoes
5-oz can (140 g) of solid white albacore tuna packed in water (drain and discard the fluid)
1.5 tbsp (22 ml) extra virgin olive oil
½ tbsp (7.5 ml) balsamic vinegar
salt and pepper
1 oz (28 g) almonds
In a 3-qt (3 liter) bowl, put lettuce, onion, chunked tomatoes, and tuna (3.25 oz or 90 g at this point). Add the olive oil, balsamic vinegar, and salt and pepper to taste. Mix well with a fork. Enjoy almonds separately, before, during, or after salad. Digestible carb grams: 12.
Dinner: Steak and Mushrooms
1.5 tbsp (21 g or 22 ml) butter
2 tsp (10 ml) olive oil
6 oz (170 g) steak
5 oz (140 g) sliced white mushrooms
2 tsp (10 ml) Worcestershire sauce or A.1. Steak Sauce
5 oz (150 ml) red wine
salt and pepper
Grill or sauté (with olive oil or butter) the steak. Melt 1.5 tbsp (22 ml) of butter in pan, add mushrooms and cook over medium heat about 3 minutes, stirring frequently. Season steak and mushrooms with salt and pepper to taste. Enjoy steak with your favorite steak sauce or Worcestershire sauce, but no more than 2 g of carbs in the sauce (e.g., 2 tsp (10 ml) of A.1. Sauce or Lea & Perrins Worcestershire sauce has 2 g of carb). Digestible carb grams: 10.
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Filed under Recipes
My Paleo Diet Trial
For the last year, I’ve been pondering whether the paleo diet has anything to offer folks with diabetes or prediabetes. The paleo diet, by the way, is also called the Paleolithic, Stone Age, Old Stone Age, hunter-gatherer, or caveman diet. It definitely has some potential as a diabetes management approach. I’ve been eating paleo-style for the last three months.
Why am I trying it?
- Direct experience with implementation obstacles
- Potential health benefits
My first Parker Paleo Diet meal: sautéed mixed veggies and pan-fried chicken breast
My current version of paleo is not designed for someone with diabetes or prediabetes. That may come in the future. By “current version,” I mean I’ll quite likely tweak it over the coming months.
Here’s what I’ve been eating (or not) on the Parker Paleo Diet:
FORBIDDEN FOODS: Grains (e.g., corn, wheat, rice), Dairy, Legumes (peanuts, beans, peas, green beans), Industrial Vegetable Oils (soybean, corn, safflower, etc.), Alcohol, Refined Sugars.
PROTEINS: Meat, fish/seafood, eggs, poultry, and wild game. Bacon OK; minimize other processed meats.
NUTS & SEEDS: Especially walnuts, macadamia, cachews, almonds. Limit to 1-2 oz/day.
FRUITS: Limit 2 pieces/day?
VEGETABLES:
Lower-Carb: Greens (lettuce, spinach, chard, collard, mustard geen, kale), radicchio, endive, bok choy, herbs, celery, radishes, mushrooms, cabbage, jicama, avocado, asparagus, okra, cucumbers, cauliflower, broccoli, peppers, summer squash, zucchini, Brussels sprouts, green onions, tomatoes, eggplant, tomatillos, eggplant, artichokes, turnips, rutabagas, spaghetti squash, carrots, onions, leeks, water chestnuts (small serving). This list generally starts with the lower carb items and gradually increases to higher carb grams. All these have 5 or fewer carbs per serving; most are much less.
Starchy, Higher-Carb: Beets (6 g, GI 64), winter squashes (acorn, butternut), water chestnuts, parsnips (9 g, GI 97), potatoes (35 g, GI 87), sweet potatoes, (20 g, GI 61), cassava (37 g), taro (21 g), plantains. Some categorize carrots as starchy.
HERBS & SPICES: Cilantro, parsley, basil, rosemary, thyme, etc. Salt (minimal), pepper, vinegar.
OILS: Extra virgin olive, canola, flax, avocado.
CONDIMENTS: Olive oil vinaigrettes, mayonnaise from olive oil & egg yolk, and ?
LIQUIDS: H2O, coffee, tea
After two months of paleo eating, I summarized my experience at Paleo Diabetic.
By the way, I don’t have diabetes or prediabetes. The paleo diet has some potential benefit for those conditions, particularly as compared to the standard American diet. Ideally, I’d like to see more clinical studies before recommending it. Dr. Frassetto and colleagues at the University of California-San Francisco should be publishing their results soon.
Steve Parker, M.D.
Filed under Paleo diet
Mediterranean and Low-Carb Diets Beat Low-Fat for Weight Loss Over Six Years
Israeli flag
Remember Shai et al’s 2008 DIRECT study that compared weight loss over two years on either a low-carb, low-fat, or Mediterranean diet? I reviewed it at length in 2008.
The same Isreali researchers now report the results of an additional four years of follow-up. Do you know of any other weight loss study over that length of time? I don’t.
Of the 322 original study participants, 259 were available for follow-up for an additional four years. Of these, 67% told researchers they had continued their originally assigned diet.
Over six years, the weight loss was as follows:
- 0.6 kg (about a pound) in the low-fat group
- 1.7 kg (almost 4 pounds) in the low-carb cohort
- 3.1 kg (almost 7 pounds) in the Mediterranean group
The difference between the low-carb and Mediterranean groups was not statistically significant.
Almost all the original study participants (86%) were men, so it’s debatable whether these results apply to women. I bet they do. I assume most of the participants were Israeli, so you can also debate whether results apply to other nationalities or ethnicities.
Bottom Line
For long-term weight management, Mediterranean and low-carb diets appear to be more effective than traditional low-fat, calorie-restricted dieting.
Beth Mazur at her Weight Maven blog has some worthwhile comments about the study.
Incidentally, my Advanced Mediterranean Diet (2nd Edition) book features both a traditional Mediterranean diet and the world’s first low-carb Mediterranean diet.
Filed under Weight Loss, Weight Regain
Comprehensive List of Low-Carb Vegetables
A half cup of sliced bell pepper has about 2 grams of digestible carbohydrate
Laura Dolson over at About.com has a helpful list of low-carb veggies. Helpful if you:
- experience excessive blood sugar spikes from high-carb items
- are restricting carbs for weight management
- are eating a Paleo Diabetic diet
-Steve
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Filed under Paleo diet, Vegetables, Weight Loss
14 Little-Known Weight-Loss Tips
“Look…the soda’s not for me, OK?”
These have worked for lots of my patients. Take what works for you and discard the rest.
- Plan on grocery shopping, meal preparation, and taking meals to your workplace.
- Keeping a record of your food consumption is often the key to success.
- Accountability is another key. Do you have a friend or spouse who wants to lose weight? Start the same program at the same time and support each other. That’s one of many ways to have accountability.
- If you tend to over-eat or snack too much, floss and brush your teeth after you’re full. You’ll be less likely to go back for more anytime soon.
- Eat at least two or three meals daily. Eat breakfast every day. Ignore the diet gurus who say you must eat every two or three hours.
- Eat slowly and allow yourself time to enjoy your food; you’ll be a better judge of when your’re full.
- Don’t eat while watching TV.
- Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost. Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc. Choose the reward in advance, to give you something to work toward.
- Don’t start a diet during a time of stress.
- Maintain a consistent eating pattern throughout the week and year.
- If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while. Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.
- Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase. Weekly thereafter.
- Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then. That’s normal. Just get back on your original weight-loss plan for a month or two.
- Tell your housemates you’re on a diet and ask for their support. You may also need to tell your co-workers and others with whom you spend significant time. If they care about you, they’ll be careful not to tempt you off the diet.
Indispensable? OK, maybe that’s a little over the top. But each of these tips has proven indispensable to at least one of my patients.
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Filed under Weight Loss
In T2 Diabetes, Which Comes First: High Insulin Levels or Insulin Resistance?
I couldn’t find a decent picture of a liver or pancreas, so this will have to do….
Excessive insulin output by the pancreas (hyperinsulinemia) is the underlying cause of type 2 diabetes, according to a hypothesis from Walter Pories, M.D., and G. Lynis Dohm, Ph.D. The cause of the hyperinsulinemia is a yet-to-be-identified “diabetogenic signal” to the pancreas from the gastrointestinal tract.
This is pretty sciencey, so you’re excused if you stop reading now. You probably should.
They base their hypothesis on the well-known cure or remission of many cases of type 2 diabetes quite soon after roux-en-y gastric bypass surgery (RYGB) done for weight loss. (Recent data indicate that six years after surgery, the diabetes has recurred in about a third of cases.) Elevated fasting insulin levels return to normal within a week of RYGB and remain normal for at least three months. Also soon after surgery, the pancreas recovers the ability to respond to a meal with an appropriate insulin spike. Remission or cure of type 2 diabetes after RYGB is independent of changes in weight, insulin sensitivity, or free fatty acids.
Bariatric surgery provides us with a “natural” experiment into the mechanisms behind type 2 diabetes.
The primary anatomic change with RYGB is exclusion of food from a portion of the gastrointestinal tract, which must send a signal to the pancreas resulting in lower insulin levels, according to Pories and Dohm.
Why would fasting blood sugar levels fall so soon after RYGB? To understand, you have to know that fasting glucose levels primarily reflect glucose production by the liver (gluconeogenesis). It’s regulated by insulin and other hormones. Insulin generally suppresses gluconeogenesis. The lower insulin levels after surgery should raise fasting glucose levels then, don’t you think? But that’s not the case.
Pories and Dohm surmise that correction of hyperinsulinemia after surgery leads to fewer glucose building blocks (pyruvate, alanine, and especially lactate) delivered from muscles to the liver for glucose production. Their explanation involves an upregulated Cori cycle, etc. It’s pretty boring and difficult to follow unless you’re a biochemist.
The theory we’re talking about is contrary to the leading theory that insulin resistance causes hyperinsulinemia. Our guys are suggesting it’s the other way around: hyperinsulinemia causes insulin resistance. It’s a chicken or the egg sort of thing.
If they’re right, Pories and Dohm say we need to rethink the idea of treating type 2 diabetes with insulin except in the very late stages when there may be no alternative. (I would add my concern about using insulin secretagogues (e.g., sulfonylureas) in that case also.) If high insulin levels are the culprit, you don’t want to add to them.
We’d also need to figure out what is the source of the “diabetogenic signal” from the gastrointestinal tract to the pancreas that causes hyperinsulinemia. A number of stomach and intestinal hormones can affect insulin production by the pancreas; these were not mentioned specifically by Pories and Dohm. Examples are GIP and GLP-1 (glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1).
Keep these ideas in mind when you come across someone who’s cocksure that they know the cause of type 2 diabetes.
Reference: Pories, Walter and Dohm, G. Lynis. Diabetes: Have we got it all wrong? Hyperinsulinism as the culprit: surgery provides the evidence. Diabetes Care, 2012, vol. 35, p. 2438-2442.
Filed under Causes of Diabetes
What’s Dr. Bernstein Got Against Tomatoes?
Looks reasonable to me
Dr. Richard Bernstein cautions his diabetic patients and readers of Diabetes Solution to keep a tight lid on consumption of tomatoes. An excerpt from page 149:
If you have them uncooked in salad, limit yourself to one slice or a single cherry tomato per cup of salad.
His concern is that tomatoes will raise your blood sugar too high.
That doesn’t make sense to me. A 3-inch diameter tomato has 7 grams of carbohydrate, 2 of which are fiber. So the digestible carb count is only 5 grams. That’s not much. So do tomatoes have a high glycemic index? Unlikely, although it’s hard to be sure. Good luck finding a reliable GI for tomatoes on the Internet.
I think Dr. Bernstein’s wrong about this one, which is rare. I suppose it’s possible that tomatoes deliver some other substance to the bloodstream that interferes with carbohydrate metabolism, but Dr. Bernstein doesn’t mention that.
Do tomatoes play havoc with your blood sugars?
Filed under Carbohydrate, Vegetables
Diabetic Mediterranean Diet 