August 16, 2012 · 7:23 AM

Cinnamon for Diabetes? It May Work, But Just Barely

In a meta-analysis…

Cinnamon lowered A1C by 0.09%, versus the usual 1% with medication. [Given that] A1c reflects overall glucose trends, cinnamon doesn’t look that impressive. Even at the extreme of the confidence interval, cinnamon has, at best, 10% of the efficacy of drug treatments. At worst, it’s completely ineffective.

One tasty component of a Cinnabon cinnamon roll

See all the wonky details in a post by pharmacist Scott Gavura at Science-Based Medicine.  I would only add that average changes in blood sugar and hemoglobin A1c in clinical studies don’t necessarily apply to an individual; some folks may respond much  better than others.

Steve Parker, M.D.

 

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August 13, 2012 · 1:05 AM

Video of HIIT on Bicycle

A “stationary” bicycle

Gretchen Reynolds is the Phys Ed blogger at the New York Times.  She posted a five-minute demonstration of high intensity interval training on a stationary bicycle.  It’s narrated by Martin Gibala of McMaster University.

No mention of Tabata’s pioneering work.

-Steve

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August 3, 2012 · 2:00 AM

AHA and ADA Position Paper On Non-Nutritive Sweeteners

The American Heart Association and American Diabetes Association just published a review paper on nonnutritive sweeteners, also known as low-calorie sweeteners, artificial sweeteners, noncaloric sweeteners, and intense sweeteners.  I quote from the conclusion section:

At this time, there are insufficient data to determine conclusively whether the use of NNS to displace caloric sweeteners in beverages and foods reduces added sugars or carbohydrate intakes, or benefits appetite, energy balance, body weight, or cardiometabolic risk factors.

With regard to nonnutritive sweeteners and glycemic response [in diabetics], 4 randomized trials that varied from 1 to 16 weeks in duration found no significant difference between the effects of nonnutritive sweeteners and various comparisons (sucrose, starch, or placebo) on standard measures of glycemic response (i.e., plasma glucose and insulin, HbA1c, C-peptide) and, in general, did not detect clinically relevant effects.

You’re welcome to read the entire document.

-Steve

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August 1, 2012 · 2:00 AM

Women With Diabetes Can’t Get No Satisfaction

“I’ll be OK if my sugar doesn’t drop too low”

Well, that’s not entirely accurate.

MedPageToday reported on a study of sexual satisfaction in women.

“While many diabetic women are interested and engaged in sexual activity, diabetes is associated with a markedly decreased sexual quality of life in women,” they wrote.

Complications of diabetes — including heart disease, stroke, renal dysfunction, and peripheral neuropathy — were associated with diminished sexual function among diabetic women, suggesting that “prevention of diabetic complications may be helpful in preventing sexual dysfunction,” in these patients, the researchers wrote.

Steve Parker, M.D.

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July 30, 2012 · 2:00 AM

New Weight Loss Pill – Qsymia – Now Available in U.S.

“These are flying off the shelves!”

On July 17, 2012, the U.S. Food and Drug Administration approved the combination of topiramate and phentermine for weight loss and management.  They’ll be marketed in the U.S. as Qsymia.

The drugs individually had been approved by the FDA years ago for other purposes, so we already know a lot about them.  If memory serves me, phentermine alone is FDA-approved for weight loss, but only for “several weeks,” which many physicians interpret as up to 12.

The press releases from the FDA and Vivus, Inc., don’t say how long the combo drug can be used.  I’m guessing up to one year since that’s how long the clinical trials lasted.  Any longer than that, you’re on your own.

Who Can Take Qsymia?

Obese adults with a body mass index 30 or higher, or overweight adults with BMI 27 or higher if they have one or more weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol.

You Should NOT Take Qsymia If You Have or Are:

  • Pregnant
  • Glaucoma
  • Overactive thyroid
  • Recent stroke
  • Recent unstable heart disease

If I Take the Pill, Do I Still Have to Exercise and Watch My Calories?

Yes.

What’s the Dose?

Phentermine 7.5 mg and topiramate 46 mg daily.  A double strength pill (15 + 92 mg) is available for select patients.

Final Thoughts

Lorcaserin (Belviq) is a weight loss drug approved by the FDA within the last month.  These are the first new weight loss drugs on the U.S. market since 1999.

Abbott voluntarily withdrew Meridia (sibutramine) from the U.S. market in 2010 due to concern about it causing heart attacks and strokes.

In 2008, the European Medicines Agency withdrew prescription-writing for the weight-loss drug rimonabant, citing concern about psychiatric side effects.

Between 1997 and 2007, five weight-loss drugs were removed from various markets around the world due to safety or effectiveness considerations: phenylpropanolamine HCl, dexfenfluramine HCl (e.g., Redux), fenfluramine HCl (Pondimin), diethylpropion HCl (Tenuate), and phentermine HCl (e.g., Ionamin).

It’s unknown whether weight-loss drug therapy reduces the morbidity and mortality of obesity over the long run.

I’ll wait at least two or three years before giving these new drugs to my patients—I’ve seen too many drugs withdrawn from the market because of adverse effects showing up years after drug approval.

Without permanent changes in lifestyle, lost weight is likely to return after you stop taking any weight-loss pill.

Clearly, drugs are no panacea.

Steve Parker, M.D.

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July 26, 2012 · 2:00 AM

What Are the Best Exercises?

Thanks to Meredith @HIITMama for bringing this Whole9 project to my attention:

We brought together 12 fitness experts from a broad range of backgrounds–with bodies of experience ranging from weightlifting to track and field to mixed martial arts, and over two centuries of collective coaching experience–to ask them all the same question:

If you could only perform five exercise movements for the rest of your life, which five would you do? (Assuming your goals are general health, fitness and longevity, and not a specialized sport)*.

The answers may surprise you.

If you want an effective and time-efficient fitness program, I’d review this series carefully.  You may have to research some terms like Turkish get-ups, farmer carries, and dips.  Find examples at YouTube.

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July 24, 2012 · 8:26 PM

Jimmy Moore Interviews Keith Runyan, M.D.

Jimmy posted a recent interview with type 1 diabetic Dr. Keith R. Runyan, who is a nephrologist and internist.

Dr. Runyan is training for his first Great Floridian Triathlon in October, 2012, so he naturally has a great interest in high level athleticism as it intersects with diabetes.

Dr. Runyan’s current carb consumption level didn’t come up specifically in the interview, but his website indicates he’s on a ketogenic diet heavily influenced by Dr. Richard Bernstein.  So I figure he’s eating under 50 grams of digestible carbohydrate daily.  He also tried Loren Cordain’s paleo diet; my sense is that it didn’t help much with his diabetes, but perhaps some.

Overall, the interview strongly supports carbohydrate-restricted eating for folks with diabetes.  Definitely worth a listen for anyone with diabetes who’s not sold on a very-low-carb diet.  If you’re sitting on the fence, at least check out his “About Me” page.

Steve Parker, M.D.

Triathlon: run, swim, bike

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July 24, 2012 · 2:00 AM

Sources of Calories in U.S. Diet Over Last Four Decades

Italian seaside totally unrelated to this post

Do you ever wonder how many of your total calories come from added sugars? Grains? Dairy products? Added fats?

Deriving your personal numbers would require detailed nutrient analysis, but if you’d like U.S. averages, see this cool infographic at Civil Eats.

It also shows how many calories are or were available for consumption per capita over time (without accounting for wastage in restaurants). It’s based on U.S. Department of Agriculture data.

A superficial glance suggests that U.S. per capita daily calorie consumption has increased by about 600 from the 1970s until now. But remember, these numbers don’t discount for restaurant wastage. Nor do I see an adjustment for children versus adults. I’ve seen other calculations of and extra daily 150 calories (women) to 300 calories (men). Even the lower numbers could explain our explosion of overweight and obesity.

Steve Parker, M.D.

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July 22, 2012 · 10:03 PM

Quote of the Day

Please use the comments to demonstrate your own ignorance, unfamiliarity with empirical data, ability to repeat discredited memes, and lack of respect for scientific knowledge. Also, be sure to create straw men and argue against things I have neither said nor even implied. Any irrelevancies you can mention will also be appreciated. Lastly, kindly forgo all civility in your discourse . . . you are, after all, anonymous.

—Guidelines preceding the comments section at Barry Ritholtz blog

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July 20, 2012 · 2:00 AM

Random Thoughts on Fitness

A couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low-back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lung, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, leg stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises.  I did Core Performance religiously for 15 weeks—it’s a good program, requiring 5-6 hours a week.

Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

I recently complete a stint with the Hillfit program.  Here’s my current regimen.

Newbies to vigorous exercise should seriously consider using a personal trainer.

Steve Parker, M.D.

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