December 3, 2012 · 1:04 PM

Dietitians’ Views on Mediterranean Diet for Diabetes

An eating pattern similar to the traditional Mediterranean diet can be integrated with existing national guidelines for the management of diabetes, blood pressure, and cholesterol. Existing data suggest that the Mediterranean diet has health benefits, including improved glycemic control and reduced cardiovascular risk, and may offer benefits to diabetes patients and clinicians alike in terms of palatability, ease of explanation and use, and promotion of improved health.

Olive oil and vinegar

Olive oil and vinegar

This excerpt is from an article by three dietitians writing in Diabetes Spectrum in 2009.  Click through for details if interested.

—Steve

Reference:  doi: 10.2337/diaspect.24.1.36  Diabetes Spectrum January 1, 2011 vol. 24, no. 1, p.36-40

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December 1, 2012 · 2:00 AM

QOTD: Why Do We Work?

Independence Hall: The U.S. Declaration of Independence was approved here on July 4, 1776

Independence Hall: The U.S. Declaration of Independence was approved here on July 4, 1776 (not much to do with Scotsman Adam Smith)

“It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.”

—Adam Smith

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November 29, 2012 · 5:40 AM

Low-Carb Research Update

“What about that recent study in American Journal of Clinical Nutrition…?”

As much as possible, I base my nutrition and medical recommendations on science-based research published in the medical literature.  Medical textbooks can be very helpful, but they aren’t as up-to-date as the medical journals.

In the early 2000s, a flurry of research reports demonstrated that very-low-carb eating (as in Dr. Atkins New Diet Revolution) was safe and effective for short-term weight management and control of diabetes.  I was still concerned back then about the long-term safety of the high fat content of Atkins.  But 80 hours of literature review in 2009 allowed me to embrace low-carbohydrate eating as a logical and viable option for many of my patients.  The evidence convinced me that the high fat content (saturated or otherwise) of many low-carb diets was little to worry about over the long run.

By the way, have you noticed some of the celebrities jumping on the low-carb weight-management bandwagon lately?  Sharon Osbourne, Drew Carey, and Alec Baldwin, to name a few.

My primary nutrition interests are low-carb eating, the Mediterranean diet, and the paleo diet.  I’m careful to stay up-to-date with the pertinent scientific research.  I’d like to share with you some of the pertinent research findings of the last few years.

Low-Carb Diets

  • Low-carb diets reduce weight, reduce blood pressure, lower triglyceride levels (a healthy move), and raise HDL cholesterol (another good trend).  These improvements should help reduce your risk of heart disease.  (In the journal Obesity Reviews, 2012.)
  • Dietary fat, including saturated fat, is not a cause of vascular disease such as heart attacks and atherosclerosis (hardening of the arteries).  (Multiple research reports.)
  • If you’re overweight and replace two sugary drinks a day with diet soda or water, you’ll lose about four pounds over the next six months.  (American Journal of Clinical Nutrition, 2012.)
  • United States residents obtain 40% of total calories from grains and added sugars.  Most developed countries are similar.  Dr. Stephan Guyenet notes that U.S. sugar consumption increased steadily “…from 6.3 pounds [2.9 kg] per person per year in 1822 to 107.7 pounds [50 kg] per person in 1999.  Wrap your brain around this: in 1822 we ate the amount of added sugar in one 12-ounce can of soda every five days, while today we eat that much sugar every seven hours.”
  • A very-low-carb diet improves the memory of those with age-related mild cognitive impairment. Mild cognitive impairment is a precursor to dementia.  (University of Cincinnati, 2012.)
  • High-carbohydrate and sugar-rich diets greatly raise the risk of mild cognitive impairment in the elderly. (Mayo Clinic study published in the Journal of Alzheimers’ Disease, 2012.)
  • Compared to obese low-fat dieters, low-carb dieters lose twice as much fat weight.  (University of Cincinnati, 2011.)
  • Diets low in sugar and refined starches are linked to lower risk of age-related macular degeneration in women.  Macular degeneration is a major cause of blindness.  (University of Wisconsin, 2011.)
  • A ketogenic (very-low-carb) Mediterranean diet cures metabolic syndrome (Journal of Medicinal Food, 2011.)
  • For type 2 diabetics, replacing a daily muffin (high-carb) with two ounces (60 g) of nuts (low-carb) improves blood sugar control and reduces LDL cholesterol (the “bad” cholesterol). (Diabetes Care, 2011.)
  • For those afflicted with fatty liver, a low-carb diet beats a low-fat diet for management. (American Journal of Clinical Nutrition, 2011.)
  • For weight loss, the American Diabetes Association has endorsed low-carb (under 130 g/day) and Mediterranean diets, for use up to two years. (Diabetes Care, 2011.)
  • High-carbohydrate eating doubles the risk of heart disease (coronary artery disease) in women.  (Archives of Internal Medicine, 2010.)
  • One criticism of low-carb diets is that they may be high in protein, which in turn may cause bone thinning (osteoporosis).  A 2010 study shows this is not a problem, at least in women.  Men were not studied.  (American Journal of Clinical Nutrition.)
  • High-carbohydrate eating increases the risk of developing type 2 diabetes (American Journal of Clinical Nutrition, 2010.)
  • Obesity in U.S. children tripled from 1980 to 2000, rising to 17% of all children.  A low-carb, high-protein diet is safe and effective for obese adolescents.  (American Journal of Clinical Nutrition, 2010.)

Mediterranean Diet

The traditional Mediterranean diet is well established as a healthy way of eating despite being relatively high in carbohydrate: 50 to 60% of total calories.  It’s known to prolong life span while reducing rates of heart disease, cancer, strokes, diabetes, and dementia.  The Mediterranean diet is rich in fresh fruits, vegetables, nuts and seeds, olive oil, whole grain bread, fish, and judicious amounts of wine, while incorporating relatively little meat.  It deserves your serious consideration.  I keep abreast of the latest scientific literature on this diet.

  • Olive oil is linked to longer life span and reduced heart disease.  (American Journal of Clinical Nutrition, 2012.)
  • Olive oil is associated with reduced stroke risk.  (Neurology, 2012).
  • The Mediterranean diet reduces risk of sudden cardiac death in women.  (Journal of the American Medical Association, 2011.)
  • The Mediterranean diet is linked to fewer strokes visible by MRI scanning.  (Annals of Neurology, 2011.)
  • It reduces the symptoms of asthma in children.  (Journal of the American Dietetic Association, 2011.)
  • Compared to low-fat eating, it reduces the incidence of type 2 diabetes by 50% in middle-aged and older folks.  (Diabetes Care, 2010.)
  •  A review of all available well-designed studies on the Mediterranean diet confirms that it reduces risk of death, decreases heart disease, and reduces rates of cancer, dementia, Parkinson’s disease, stroke, and mild cognitive impairment.  (American Journal of Clinical Nutrition, 2010.)
  • It reduces the risk of breast cancer.  (American Journal of Clinical Nutrition, 2010.)
  • The Mediterranean diet reduces Alzheimer’s disease.   (New York residents, Archives of Neurology, 2010).
  • It slows the rate of age-related mental decline.  (Chicago residents, American Journal of Clinical Nutrition, 2010.)
  • In patients already diagnosed with heart disease, the Mediterranean diet prevents future heart-related events and preserves heart function.  (American Journal of Clinical Nutrition, 2010.)

Clearly, low-carb and Mediterranean-style eating have much to recommend them.  Low-carb eating is particularly useful for weight loss and management, and control of diabetes, prediabetes, and metabolic syndrome.  Long-term health effects of low-carb eating are less well established.  That’s where the Mediterranean diet shines.  That’s why I ask many of my patients to combine both approaches: low-carb and Mediterranean.  Note that several components of the Mediterranean diet are inherently low-carb: olive oil, nuts and seeds, fish, some wines, and many fruits and vegetables.  These items easily fit into a low-carb lifestyle and may yield the long-term health benefits of the Mediterranean diet.  If you’re interested, I’ve posted on the Internet a Low-Carb Mediterranean Diet that will get you started.

Steve Parker, M.D.

Disclaimer:  All matters regarding your health require supervision by a personal physician or other appropriate health professional familiar with your current health status.  Always consult your personal physician before making any dietary or exercise changes.

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November 25, 2012 · 2:00 AM

This Is the Best Time Ever to Have Diabetes

Here’s a quote from a recent Diabetes Care:

Improved therapeutics and health care delivery have brought remarkable declines in the incidence of … complications, with a 50% reduction in amputations from their peak in 1997 and ∼35% reduction in the incidence of end-stage renal disease. Similarly, 10-year coronary heart disease risk dropped from 21% in 2000 to 16% in 2008.

Nevertheless, diabetes remains the leading cause of blindness, renal failure, nontraumatic lower-limb amputation, in adults 18 to 65 years of age.  We gotta stay after it!

The essay by Dr. Robert Ratner also notes 79 million Americans with prediabetes.  They need my Conquer Diabetes and Prediabetes book.  It’s only $9.99 (USD), a drop in the ocean compared to the $174 billion spent on diabetes in 2007 in the U.S.

—Steve

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November 23, 2012 · 2:00 AM

Do You Really Need to Restrict Salt Consumption?

Unfairly demonized?

The American Council on  Science and Health has a brief review of the latest research on salt restriction, and it’s not supportive of population-wide sodium restriction.  On the other hand, salt-restriction proponents believe it would reduce strokes, heart attacks, heart failure, and premature death.  I’ve been a salt-restriction skeptic for a couple decades.

Remember, table salt molecules contain one sodium atom and one chloride atom.  Salt-restricted and low-sodium diets are usually designated by the amount of sodium, not salt.

That being said, I do believe some individuals have elevated blood pressure related to relatively high sodium intake.  This may apply to one of every five adults with high blood pressure.  To find out if you’re one of the five, you could go on a low-sodium diet—1.5 to 3 grams a day—for one or two months and see what it does to your blood pressure.  Get your personal physician’s blessing first.

Steve Parker, M.D.

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November 22, 2012 · 1:05 AM

Happy Thanksgiving!

Godspeed = May God prosper you

It’s a wonderful holiday for my U.S.A. readers, started by the Pilgrims in 1621.

Godspeed,

—Steve

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November 20, 2012 · 6:35 PM

Is Your Blood Sugar Meter Accurate?

David Mendosa reviewed some reviews on home blood glucose monitor accuracy and reproducibility.  He was motivated by a recent review in Consumer Reports.  You’ll want to click through his links for details.  The last time I looked into this, I learned that a device could receive FDA approval if it could measure accuracy to within 20% of the actual blood sugar value as determined by a laboratory machine.  For a blood sugar of 200 mg/dl (11.1 mmol/l), the home device could give you a value anywhere between 160 and 240 mg/dl (8.9 to 13.3 mmol/l).  That doesn’t exactly inspire confidence, does it?

—Steve

 

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November 19, 2012 · 7:45 AM

What Causes Type 2 Diabetes?

“Beats me. I teach math!”

I have no simple answer for you, unfortunately.

You can lower your risk of type 2 diabetes significantly by avoiding overweight and obesity, by exercising regularly, and by choosing the right parents.  These provide clues as to the causes of diabetes.  The Mediterranean diet also prevents diabetes.

UpToDate.com offers a deceptively simple answer:

Type 2 diabetes mellitus is caused by a combination of varying degrees of insulin resistance and relative insulin deficiency. [Insulin is the pancreas hormone that lowers blood sugar.] Its occurrence most likely represents a complex interaction among many genes and environmental factors, which are different among different populations and individuals.

So, what causes the insulin resistance and relative insulin deficiency?

Understanding the pathogenesis [cause] of type 2 diabetes is complicated by several factors. Patients present with a combination of varying degrees of insulin resistance and relative insulin deficiency, and it is likely that both contribute to type 2 diabetes. Furthermore, each of the clinical features can arise through genetic or environmental influences, making it difficult to determine the exact cause in an individual patient. Moreover, hyperglycemia itself can impair pancreatic beta cell function and exacerbate insulin resistance, leading to a vicious cycle of hyperglycemia causing a worsening metabolic state.

The UpToDate article then drones on for a several thousand words discussing mouse studies, various genes, free fatty acids, adiponectin, leptin, amylin, insulin secretion, insulin resistance, impaired insulin processing, insulin action, body fat distribution, inflammation, various inflammatory markers, low birth weight, high birth rate, prematurity, etc.  More excerpts:

Increased free fatty acid levels, inflammatory cytokines from fat, and oxidative factors, have all been implicated in the pathogenesis of metabolic syndrome, type 2 diabetes, and their cardiovascular complications.

Insulin resistance may, at least in part, be related to substances secreted by adipocytes [fat cells] (“adipokines” including leptin adiponectin, tumor necrosis factor alpha, and resistin).

Type 2 diabetes most likely represents a complex interaction among many genes and environmental factors.

That’s the simplest answer I can give now.

Steve Parker, M.D.

Reference: “The Pathogensis of Type 2 Diabetes Mellitus”  by David K McCulloch, MD, and R Paul Robertson, MD, at UpToDate.com, updated June 2012, and accessed November 19, 2012.

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November 17, 2012 · 2:29 AM

QOTD: Homeopathy

I love it when ads for medical remedies claim to be “homeopathic.” That way I know straight away they’re no better than placebo.

—Steve Parker, M.D.

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November 14, 2012 · 8:13 PM

Does Dietary Protein Affect Blood Sugars?

The protein in this can raise your blood sugar

I’m considering whether I should advise my patients with diabetes to pay careful attention to the protein content of their diet, assuming they’re not malnourished.  It’s an important issue to Dr. Richard K. Bernstein, who definitely says it has to be taken into account.

Protein can undoubtedly raise blood sugar levels.  But is the effect clinically significant?  Most  dietitians and physicians pay little attention to it as a source of hyperglycemia.  Here are some of Dr. Bernstein’s ideas pulled from the current edition of Diabetes Solution:

  • The liver (and the kidneys and intestines to a lesser extent) can convert protein to glucose, although it’s a slow and inefficient process.
  • Since the conversion process—called gluconeogenesis—is slow and inefficient, diabetics don’t see the high blood sugar spikes they would see from many ingested carbohydrates.
  • For example, 3 ounces (85 g) of hamburger patty could be converted to 6.5 g of glucose under the right circumstances.
  • Protein foods from animals (e.g., meat, fish, chicken, eggs) are about 20% protein by weight.
  • Dr. B recommends keeping protein portions in a particular meal consistent day-to-day (for example 6 ounces with each lunch).
  • He recommends at least 1–1.2 g of protein per kilogram of ideal body weight for non-athletic adults.  That’s more than the usual 0.8 g per kilogram.
  • The minimum protein he recommends for a 155-lb non-athletic adult is 11.7–14 ounces daily.
  • Growing children and athletes need more protein.
  • Each uncooked ounce of the foods on his “protein foods” list (page 181) provides about 6 g of protein.
  • On his eating plan, you choose the amount of protein in a meal that would satisfy you, which might be 3 ounces or 6–9 ounces.
  • If you have gastroparesis, however, you should limit your evening meal protein to 2 ounces of eggs, cheese, fish, or ground meat, while eating more protein at the two earlier meals in the day.

“In many respects—and going against the grain of a number of the medical establishment’s accepted notions about diabetics and protein—protein will become the most important part of our diet if you are going to control blood sugars just as it was for our hunter-getherer ancestors.”

Conclusions

I haven’t changed my thinking on this issue yet, but will let you know if and when I do.  I don’t talk much about protein in Conquer Diabetes and Prediabetes in part because I wanted to keep the program simpler than Dr. Bernstein’s.  Albert Einstein reportedly said, “Everything should be made as simple as possible, but not simpler.”

As with most aspects of diabetes, your mileage may vary.  The effect of dietary protein on blood sugars will depend on type 1 versus type 2 diabetes, and will vary from one person to another.  So it may be impossible to set rigid guidelines.

If interested, you can determine how much protein is in various foods at NutritionData.

Steve Parker, M.D.

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