June 3, 2012 · 12:54 PM

A Little Known Way to Reduce Your Stroke Risk Starting Today

Older adults with high olive oil consumption have a lower risk of stroke, according to French investigators.

Caprese salad: mozzarella cheese, basil, tomatoes, extra virgin olive oil

The Mediterranean diet, rich in olive oil, has long been linked to lower rates of stroke.  French researchers wondered if that might be related to higher olive oil consumption.  Triglyceride esters of oleic acid comprise the majority of olive oil, and oleic acid blood levels reflect olive oil consumption.

Have you heard of monounsaturated fatty acids?  Oleic acid is one.

Methodology

Over 7,000 older adults without history of stroke were surveyed with regards to olive oil consumption.  Oleic acid plasma levels were measured in over a thousand of the study participants.  Over the course of five years, 175 strokes occurred.

Compared with those who never used olive oil, those with the highest consumption had a 41% lower risk of stroke.  The researchers made adjustments for other dietary variables, age, physical activity, and body mass index.

In looking at the plasma oleic acid levels, those in the highest third of levels had 73% lower risk of stroke compared to those in the lowest third.

Comments

Results suggest that the olive oil in the Mediterranean diet  may help explain the diet’s protection against stroke.  The researchers didn’t suggest an amount of olive oil that would reduce stroke risk.  I suggest at least one or two tablespoons (15–30 ml) a day, on average.  Olive oil is a key component of the Low-Carb Mediterranean Diet and Advanced Mediterranean Diet.

Steve Parker, M.D.

Reference:  Samieri, C. et al.  Olive oil consumption, plasma oleic acid, and stroke incidence: the Three-City Study.  Neurology, Published online before print June 15, 2011, doi: 10.1212/WNL.0b013e318220abeb

3 Comments

Filed under Health Benefits, Mediterranean Diet, Stroke

Tagged as , , , , , , ,

May 31, 2012 · 4:09 PM

Pioglitazone and Bladder Cancer

MedPage Today reports that another study links pioglitazone with bladder cancer in the U.K.  I’m not sure how the U.S. Food and Drug Administration will react to this.

We have 11 classes of drugs for treatment of diabetes.  Thiazolidinediones, aka glitazones or TZDs, are one class.  Pioglitazone and rosiglitazone are the only two drugs in the class, at least in the U.S.  Rosiglitazone is already highly restricted due to concern about heart toxicity.

This latest news confirms my inclination to treat type 2 diabetes with weight management, exercise, and a low-carbohydrate diet, when able.

Steve Parker, M.D.

2 Comments

Filed under Drugs for Diabetes

Tagged as ,

May 31, 2012 · 9:17 AM

Diabetes Blogger Jenny Ruhl Questioning Her Use of Facebook

Details here.

-Steve

Comments Off on Diabetes Blogger Jenny Ruhl Questioning Her Use of Facebook

Filed under Uncategorized

Tagged as ,

May 30, 2012 · 6:20 PM

TV’s Biggest Loser Plan Improves Diabetes and Prediabetes

TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and pre diabetics, according to an article May 30, 2012, in MedPage Today.  Some quotes:

For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.

In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…

The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.

Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.

At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.

“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”

Of the 35 participants in this study, 12 had prediabetes and six had diabetes.  This is a small pilot study, then.  I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place.  Of course, that’s not very realistic.  A chance to win $250,000 (USD) is strong motivation for lifestyle change.

Steve Parker, M.D.

PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.

Comments Off on TV’s Biggest Loser Plan Improves Diabetes and Prediabetes

Filed under Exercise, Overweight and Obesity, Weight Loss

Tagged as , , , , ,

May 29, 2012 · 11:09 PM

Diabetes Plus Bulimia Equals Diabulimia

MedPage Today has a brief article on “diabulimia,” a disorder in type 1 diabetics who withhold insulin in order to lose weight.

After following the women for 11 years, the researchers found that those who restricted insulin had increased rates of diabetes complications, shortened lifespan, and increased mortality risk.

Factors that were associated with insulin restriction included greater eating disorder symptoms, diabetes-specific distress, overall psychological symptoms, and fear of hypoglycemia at baseline.

Diabulimics believe the theory that insulin is a major fat-storage hormone.  Furthermore, the high blood sugar levels resulting from inadequate insulin dosing lead to loss of calories (sugar) via urine.

Steve Parker, M.D.

1 Comment

Filed under Diabetes Complications, Weight Loss

Tagged as ,

May 29, 2012 · 6:45 AM

Hot Off the Press: New ADA Hyperglycemia Management Guidelines

I’ll get to the following article when time allows.  It’s in a June, 2012, issue of Diabetes Care.  (Didn’t they publish management principles just six months ago?  Jeez.)

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach:  Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

-Steve

2 Comments

Filed under Drugs for Diabetes

Tagged as , ,

May 28, 2012 · 2:00 AM

Do Calcium Supplements Cause Heart Attacks?

A new European study suggests that calcium supplements almost double the risk of having a heart attack, at least in Germans.  You can read the full report in the current issue of Heart.

The medical literature on this issue is a confusing mess.  In other words, lots of conflicting results.

Huge numbers of women in the U.S. are taking calcium supplements either to treat or prevent osteoporosis and the associated broken bones (e.g., hips, wrists, spine).

What I’d like to know, and what nobody knows, is what is the effect of calcium supplementation on average longevity and quality of life.  Maybe I’d accept a higher risk of heart attack if calcium supplementation prolonged lifespan by two years.

In the interest of brevity, I’ll just say that the best way to get your calcium is probably through food rather than supplements.

Shereen Jegtvig has an article at About.com listing foods rich in calcium.

Exercise can also help keep your bones strong and break-resistant.

Steve Parker, M.D.

PS: If your doctor has you on a calcium supplement, you’d best get his blessing before you stop it.

8 Comments

Filed under Heart Disease, Supplements

Tagged as , , , , ,

May 27, 2012 · 8:38 PM

Quote of the Day

A tip for guys who like to wear speedos. It helps to carry a potato in your speedo. But make sure you wear it in the front.

— Keaton (comment No.23)

1 Comment

Filed under Quote of the Day

May 26, 2012 · 2:00 AM

U.S. Diabetes Prevalence From 1935 to 2011

From 1935 to 1996, the prevalence of diagnosed type 2 diabetes [in the U.S.] climbed nearly 765%.

This statistic is from the Centers for Disease Control and Prevention as cited in Increased Consumption of Refined Carbohydrates and the Epidemic of Type 2 Diabetes in the United States: an Ecologic Assessment, American Journal of Clinical Nutrition, 2004, vol. 79, no.5, pp: 774-779.

I thought 765% might be a misprint, so I did some digging.  A similar figure is in DHHS Publication No. (PHS) 82-1232 published in 1981:

  • Diabetes prevalence rose from 0.4% of the population in 1935,  to 2.4% in 1979.

This is a six-fold increase.  The major part of the upward trend started in 1960.  Interestingly, that’s when corn syrup started working its way into our food supply.  Coincidence?  The authors of the Department of Human Services paper write:

Preliminary evaluation of these trends suggests that the change in the prevalence of known diabetes has resulted from improvements both in detection of diabetes among high-risk groups and in survivorship among persons with diabetes.

To me, it sounds like they weren’t considering an true increase in the number of new diabetes cases (incidence), but better detection of existing cases and improved longevity of existing patients (prevalence).  Incidence and prevalence are often confusing.  Wikipedia has a clarifying article.  These days, both incidence and prevalence are greatly increased over 1935 levels.

In January of 2011, the U.S. Centers for Disease Control and Prevention released the latest estimates for prevalence of diabetes and prediabetes. The situation is worse than it was in 2008, the last figures available.

  • 8.3% of the total U.S. population has either diagnosed or undiagnosed diabetes (earlier percentages in this post were for diagnosed cases only)
  • 6% of the U.S. adult population has diagnosed diabetes (My calculation: Population in 2011 was 311 million; with 18.8 million diagnosed cases of diabetes, 7 million undiagnosed)
  • Nearly 27% of American adults age 65 or older have diabetes (overwhelmingly type 2)
  • Half of Americans 65 and older have prediabetes
  • 11% of U.S. adults (nearly 26 million) have diabetes (overwhelmingly type 2)
  • 35% of adults (79 million) have prediabetes, and most of those affected don’t know it

Here’s a post about prevention of type 2 diabetes.

Steve Parker, M.D.

Comments Off on U.S. Diabetes Prevalence From 1935 to 2011

Filed under DM Prevalence

Tagged as ,

May 25, 2012 · 7:37 PM

Science in Support of the Paleo Diet

Stockholm Palace

Investigators at Karolinska Institutet in Sweden found diminished weight, body mass index, blood pressure, and waist circumference in 14 healthy medical students eating a paleo diet for three weeks.  

I reviewed this research report in my effort to determine if the paleo diet—aka Old Stone Age, caveman, ancestral, or Paleolithic diet—has anything to offer diabetics.

Published in 2008, this seems to be one of the seminal scientific studies of the paleo diet in modern Europeans.

Their version of the paleo diet:

  • Allowed ad lib: All fresh or frozen fruits, berries and vegetables except legumes, canned tomatoes w/o additives, fresh or frozen unsalted fish and seafood, fresh or frozen unsalted lean meats and minced meat, unsalted nuts (except peanuts – a legume), fresh squeezed lemon or lime juice (as dressing), flaxseed or rapeseed oil (as dressing), coffee and tea (w/o sugar, milk, honey, or cream), all salt-free spices.
  • Allowed but with major restrictions: dried fruit, salted seafood, fat meat, potatoes (two medium-sized per day), honey, cured meats
  • Prohibited: all milk and dairy products, all grain products (including corn and rice), all legumes, canned food except tomatoes, candy, ice cream, soft drinks, juices, syrups, alcohol, sugar, and salt

What Did They Find After Three Weeks?

  • Average weight dropped from 65.2 kg (144 lb) to 62.9 (139 lb)
  • Average body mass index fell from 22.2 to 21.4
  • Average waist circumference decreased from 74.3 cm (29.25″) to 72.6 cm (28.58″)
  • Average systolic blood pressure fell from 110 to 104 mmHg
  • plasminogen activator inhibitor-1 decreased from 5.0 kIE/l to 2.8 kIE/l
  • All of these changes were statistically significant

The researchers looked at a number of other blood tests and didn’t find any significant differences.

Five men and three women completed the study. Of the 20 who originally signed up, one could not fulfill the diet, three became ill (no details), two failed to show up.

So What?

That’s a remarkable weight loss over just three weeks for slender people eating ad lib.

The study authors concluded that these paleo diet-induced changes could reduce risk for cardiovascular disease. They called for a larger study with a control group. (If it’s been done, I haven’t found it yet.)

Sounds reasonable.

Steve Parker, M.D.

PS: You’d think they would have said more about the three participants who got sick, rather than leave us wondering if the diet made them ill.

Reference: Österdahl, M; Kocturk, T; Koochek, A;Wändell, PE. Effects of a short-term intervention with a paleolithic diet in healthy volunteers. European Journal of Clinical Nutrition, 62 (2008): 682-685.

2 Comments

Filed under Heart Disease, Paleo diet, Weight Loss

Tagged as , , , , ,