Diabetic Mediterranean Diet

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.

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Filed under Diabetes Complications, Weight Loss

Tagged as diabulimia, type 1 diabetes

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

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Tagged as ADA, american diabetes association, hyperglycemia management guidelines

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.

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Filed under Heart Disease, Supplements

Tagged as calcium supplements, calcium-rich foods, exercise, foods with calcium, heart attacks, osteoporosis

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)

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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.

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Tagged as diabetes prevalence, prevalence of type 2 diabetes in U.S. over time

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.

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Filed under Heart Disease, Paleo diet, Weight Loss

Tagged as cardiovascular risk, Karolinska Institutet, Osterdahl, PAI-1, paleo diet, paleolithic diet

May 23, 2012 · 4:24 AM

Heart Disease Death Rates For Diabetics Falling Fast

MedPage Today on May 22, 2012, reported a dramatic drop in cardiovascular death rates for folks with diabetes:

The death rate from cardiovascular disease in U.S. adults with diabetes fell 40% from 1997 to 2004, CDC and NIH researchers said.

And that’s not all:

Additionally, all-cause mortality in diabetic participants dropped by 23% (95% CI 10% to 35%), Gregg and colleagues reported, from 20.3 to 15.1 per 1,000 person-years after adjusting for age.

The researchers identified several factors that likely account for the improved life expectancy for diabetic Americans.

Among them was the “steady improvements in quality and organization of care, self-management behaviors, and medical treatments, including pharmacological treatment of hyperlipidemia and hypertension,” Gregg and colleagues suggested.

The MedPage Today article didn’t define cardiovascular disease. It typically includes heart attacks, heart failure, strokes, aortic aneurysms, among a few others.

Hope that cheers you up!

Steve Parker, M.D.

PS: Here’s the original research article in the current issue of Diabetes Care.

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Filed under coronary heart disease, Diabetes Complications, Heart Disease, Stroke

Tagged as cardiovascular death rates in diabetes, cardiovascular disease deaths, diabetes, diabetic death rates, heart attack, Stroke

May 21, 2012 · 10:21 PM

Prediabetes and Diabetes on the Rise in U.S. Adolescents, Doubling in a Decade

The June, 2012, issue of Pediatrics has an article stating that the incidence of diabetes and prediabetes in U.S. adolescents increased from 9% in 1999 to 23% in 2008. The finding is based on the NHANES survey of 12 to 19-year-olds, which included a single fasting blood sugar determination.

The investigators offered no solution to the problem. I’m no pediatrician, but my guess is that the following measures would help prevent adolescent type 2 diabetes and prediabetes:

more exercise
eat less sugar and refined starches
keep body weight in the healthy range

I’m sure many of the adolescent type 2 diabetics and prediabetics are overweight or obese. A 2010 study out of Colorado found a low-carbohydrate, high-protein diet safe and effective for adolescents. Fortunately, the decades-long ascent of the adolescent obesity rate in the U.S. seems to have peaked for now.

Steve Parker, M.D.

PS: I scanned the article quickly and don’t remember if the researchers broke down the diabetes cases by type 1 and type 2. I’d be shocked if type 1 diabetes rose this much over the last decade.

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Tagged as adolescent diabetes, adolescent prediabetes, childhood diabetes, childhood diabetes rate, childhood prediabetes, childhood prediabetes rate

May 18, 2012 · 8:51 PM

Bladder Cancer Linked With Diabetes Drugs in Thiazolidinedione Class

MedPage Today reports that thiazolidinediones (aka glitazones) are linked to development of bladder cancer. Pioglitazone is the most commonly used TZD in the U.S. From the article:

The increased risk of bladder cancer associated with glitazones — which reached a relative increase of 72% in patients who started on the agents more than 5 years earlier — “appears to be a class effect,” the research team, led by Ronac Mamtani, MD, of the University of Pennsylvania in Philadelphia, concluded.

According to the National Cancer Institute, the U.S. has 74,000 new cases of bladder cancer yearly, and 15,000 annual deaths from bladder cancer.

If you take a thiazolidinedione, talk to your doctor about bladder cancer at your next visit.

Steve Parker, M.D.