Tag Archives: carbohydrates

Olympian Teeth Suffering From High Carb Consumption

 BBC has the story:

The beaming smiles of gold-medal winners Usain Bolt, Jessica Ennis-Hill and Mo Farah are some of the defining memories of London 2012.

But a team at University College London says many competitors had dental problems.

“Our data and other studies suggest that, for a similar age profile, the oral health of athletes is poor. It’s quite striking,” said lead researcher Prof Ian Needleman.

He said eating large amounts of carbohydrates regularly, including sugary energy drinks, was damaging teeth.

Impaired immune system function associated with hard training may also play a role.

Many, if not most, high-level athletes think high carbohydrate consumption is necessary for optimal performance. They should know better than I. For their sake, I hope meticulous oral care—brushing, flossing, professional cleaning—helps preserve dental health.

Super athletes may not be as healthy as you think. They push their bodies so hard that they move beyond health into injury and chronic inflammation.

Steve Parker, M.D.

tooth structure, paleo diet, caries, enamel

Cross-section of a tooth

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The Case For Carbohydrate Restriction in Diabetes

Dr. Rollo would recognize this

Dr. Rollo would recognize this

In 1797, Dr. John Rollo  published a book called An Account of Two Cases of the Diabetes Mellitus. Dr. Rollo was a surgeon in the British Royal Artillery. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. In case you don’t know, this was an era devoid of effective drug therapies for diabetes.

The soldier apparently had type 2 diabetes rather than type 1.

Rollo’s diet led to loss of excess weight (original weight 232 pounds or 105 kg), elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.  (Don’t ask me how they measured blood and urine sugar back then.)

This makes Dr. Rollo the original low-carb diabetic diet doctor. Many of the leading proponents of low-carb eating over the last two centuries—whether for diabetes or weight loss—have been physicians.

Carbohydrate Intolerance

Diabetes and prediabetes always involve impaired carbohydrate metabolism: ingested carbs are not handled by the body in a healthy fashion, leading to high blood sugars and, eventually, poisonous complications.

Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbs in a normal, healthy fashion. In a way, carbs are toxic to them. Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death, among other things.

What To Do About It

Diabetics and prediabetics simply don’t tolerate carbs in the diet like other people. If you don’t tolerate something, you have to give it up, or at least cut way back on it. Lactose-intolerant individuals give up milk and other lactose sources. Celiac disease patients don’t tolerate gluten, so they give up wheat and other sources of gluten. One of every five high blood pressure patients can’t handle normal levels of salt in the diet; they have to cut back or their pressure’s too high. Patients with phenylketonuria don’t tolerate phenylalanine and have to restrict foods that contain it. If you’re allergic to penicillin, you have to give it up.

Stretching actually doesn't do any good for the average person

Stretching actually doesn’t do any good for the average person

If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry. Alternatively, you could eat lots of carbs and take drugs to prevent the dangerous elevations in blood sugar they cause. We have 11 classes of drugs to treat diabetes. Unfortunately, the long-term side effects of most of them are not well-established. And they can get very expensive.

The American Diabetes Association recommends weight loss for all overweight diabetics. That tends to improve carbohydrate metabolism. The ADA’s 2011 guidelines suggest three possible diets: “For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).”

If I were a diabetic eating over 200 grams of carb daily, I’d cut my carbs way below 130 grams initially, to 20–30 grams of digestible carb.  Then gradually increase carbs as tolerated, based on blood sugar readings. Ask your doctor what he thinks.

Steve Parker, M.D.

 

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Sugar and Carbohydrates Linked to Impaired Brain Function in Elderly

 

Note the sugar cubes

Note the sugar cubes

The Mayo Clinic recently reported that diets high in carbohydrates and sugar increase the odds of developing cognitive impairment in the elderly years.

Mild cognitive impairment is usually a precursor to dementia.  Many authorities think dementia develops more often in people with diabetes, although some studies refute the linkage.

Mayo investigators followed 940 patients with normal baseline cognitive functioning over the course of four years. Diet was assessed via questionnaire. Study participants were ages 70 to 89. As the years passed, 200 of them developed mild cognitive impairment.

Compared with those eating at the lowest level of carbohydrate consumption, those eating at the highest levels were almost twice as likely to go to develop mild cognitive impairment.

The scientists note that those eating lower on the carbohydrate continuum were eating more fats and proteins.  Whether the Low-Carb Mediterranean Diet prevents cognitive impairments remains to be seen.

Steve Parker, M.D.

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What’s Our Preferred Fuel?

Dr. Jay Wortman has been thinking about whether our bodies prefer to run on carbohydrates (as a source of glucose) or, instead, on fats.  The standard American diet provides derives about half of its energy from carbs, 35% from fats, and 15% from proteins.  So you might guess our bodies prefer carbohydrates as a fuel source.  Dr. Wortman writes:

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm.Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

Dr. Wortman, who has type 2 diabetes,  in the same long post also writes about oolichan grease (from fish), an ancestral food of Canandian west coast First Nations people. 

Steve Parker, M.D.

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High-Carbohydrate Eating Promotes Heart Disease in Women

Women double their risk of developing coronary heart disease if they have high consumption of carbohydrates, according to research recently published in the Archives of Internal Medicine

Men’s hearts, however, didn’t seem to be affected by carb consumption. I mention this crucial difference because I see a growing trend to believe that “replacing saturated fat with carbohydrates is a major cause of heart disease.”  If true, it seems to apply only to women.

We’ve known for a while that high-glycemic-index eating was linked to heart disease in women but not menGlycemic index is a measure of how much effect a carbohydrate-containing food has on blood glucose levels.  High-glycemic-index foods raise blood sugar higher and for longer duration in the bloodstream.

High-glycemic-index foods include potatoes, white bread, and pasta, for example.

The study at hand includes over 47,000 Italians who were interrogated via questionnaire as to their food intake, then onset of coronary heart disease—the cause of heart attacks—was measured over the next eight years. 

Among the 32,500 women, 158 new cases of coronary heart disease were found.

ResearchBlogging.orgResearchers doing this sort of study typically compare the people eating the least carbs with those eating the most.  The highest quartile of carb consumers and glycemic load had twice the rate of heart disease compared to the lowest quartile. 

The Cleave-Yudkin theory of the mid-20th century proposed that excessive amounts of refined carbohydrates cause heart disease and certain other chronic systemic diseases.  Gary Taubes has also written extensively about this.  Theresearch results at hand support that theory in women, but not in men. 

Practical Applications

Do these research results apply to non-Italian women and men?  Probably to some, but not all.  More research is needed.

Women with a family history coronary heart disease—or other CHD risk factors—might be well-advised to put a limit on total carbs, high-glycemic-index foods, and glycemic load.  I’d stay out of that “highest quartile.”  Don’t forget: heart disease is the No. 1 killer of women.

See NutritionData’s Glycemic Index page for information you can apply today.

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.

References: Sieri, S., Krogh, V., Berrino, F., Evangelista, A., Agnoli, C., Brighenti, F., Pellegrini, N., Palli, D., Masala, G., Sacerdote, C., Veglia, F., Tumino, R., Frasca, G., Grioni, S., Pala, V., Mattiello, A., Chiodini, P., & Panico, S. (2010). Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study Archives of Internal Medicine, 170 (7), 640-647 DOI: 10.1001/archinternmed.2010.15

Barclay, Alan, et al.  Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies [of mostly women].  American Journal of Clinical Nutrition, 87 (2008): 627-637.

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Has Low-Carb Eating Been Good for YOU?

Just add steamed broccoli and a spinach salad!

Just add steamed broccoli and a spinach salad!

Low-carb or carbohydrate-restricted eating has been very beneficial to many people with type 2 diabetes, judging by what I hear from my patients and read on the Internet.  By “beneficial,” I mean has this eating style helped you to control your glucose levels, lower your hemoglobin A1c, ameliorated complications, helped you lose weight,  energized you, or just plain made you feel better?

I would love to hear about your experiences with carb-restricted eating, both good and bad.  How much did you restrict your carb intake?  How did you go about it?  Did you go “full Atkins,” and restrict carbs to 20 or less grams a day?   Or were you more moderate, restricting carbs to 30% of total calories, as in The Zone Diet?  [The typical American diet derives 55-60% of all calories from carbohdrates.]  If you don’t care to share with the world, please send me an email to steveparkermd (at) gmail (dot) com.  I’ll keep all all personal responses to my email address private and confidential.

Thanks!

Steve Parker, M.D.

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Eat the Right Carbs to Alleviate Diabetes and Heart Disease

Harvard’s Dr. Frank Hu in 2007 called for a paradigm shift in dietary prevention of heart disease, de-emphasizing the original diet-heart hypothesis and noting instead that “. . . reducing dietary GL [glycemic load] should be made a top public health priority.”  Jim Mann at the University of Otago (Dunedin, New Zealand) authored a 2007 review of carbohydrates and effects on heart disease and diabetes.  Here are highlights from the article summary in the European Journal of Clinical Nutrition:

The nature of carbohydrate is of considerable importance when recommending diets intended to reduce the risk of type II diabetes and cardiovascular disease and in the treatment of patients who already have established diseases. Intact fruits, vegetables, legumes and whole grains are the most appropriate sources of carbohydrate. Most are rich in [fiber] and other potentially cardioprotective components.  Many of these foods, especially those that are high in dietary fibre, will reduce total and low-density lipoprotein cholesterol and help to improve glycaemic control in those with diabetes.

Frequent consumption of low glycaemic index foods has been reported to confer similar benefits, but it is not clear whether such benefits are independent of the dietary fibre content of these foods or the fact that low glycaemic index foods tend to have intact plant cell walls.

A wide range of carbohydrate intake is acceptable, provided the nature of carbohydrate is appropriate. Failure to emphasize the need for carbohydrate to be derived principally from whole grain cereals, fruits, vegetables and legumes may result in increased lipoprotein-mediated risk of cardiovascular disease, especially in overweight and obese individuals who are insulin resistant.

Why does this matter to me and readers of this blog?  Dietary carbohydrates are a major determinant of blood sugar levels, tending to elevate them.  Chronically high blood sugar levels are associated with increased complication rates from diabetes.  People with diabetes are prone to develop heart disease, namely coronary artery disease, which causes heart attacks, weakness of the heart muscle, and premature death. 

Steve Parker, M.D.

References: 

Mann, J.  Dietary carbohydrate: relationship to cardiovascular disease and disorders of carbohydrate metabolismEuropean Journal of Clinical Nutrition, 61 (2007): Supplement 1: S100-11.

Hu, Frank.  Diet and cardiovascular disease prevention: The need for a paradigm shift.  Journal of the American College of Cardiology, 50 (2007): 22-24.

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Dental Problems and Systemic Chronic Disease: A Carbohydrate Connection?

Perfect health on a carnivorous, low-carb diet

Perfect health on a carnivorous, low-carb diet

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations.  For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease.  The exact nature of that association is not clear.  In the 1990s it seemed that infections – chlamydia, for example – might be the unifying link, but this has not been supported by subsequent research.     

The article is written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle).  He is no bomb-throwing, crazed, radical. 

The “old theory” to which I referred is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of fermentable carbohydrates, in the absence of good dental care, leads both to certain dental diseases – caries (cavities), periodontal disease, certain oral cancers, and leukoplakia – and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia.  In other words, dietary carbohydrates cause both dental and systemic diseases – not all cases of those diseases, of course, but some.   

Dr. Hujoel does not define “fermentable” carbohydrates in the article.  My American Heritage Dictionary defines fermentation as:

  1. the anaerobic conversion of sugar to carbon dioxide and alcohol by yeast
  2. any of a group of chemical reactions induced by living or nonliving ferments that split complex organic compunds into relatively simple substances

As reported in David Mendosa’s blog at MyDiabetesCentral.com, Dr. Hujoel said, “Non-fermentable carbohydrates are fibers.”  Dr. Hujoel also shared some personal tidbits there. 

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs.  Dental effects of excessive carb intake can appear within weeks or months, whereas the sysemtic effects may take decades. 

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory.  In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases.  If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

Adherents of the paleo diet and low-carb diets will love this article; it supports their choices.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet.  Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups.  Problem is, I’m not sure it can be done.  It’s hard enough for most people to follow a low-carb diet for four months.  And I’m asking for 30 years?!   

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs.  He mentions the aphorism: “no carbohydrates, no caries.”  Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation. 

Don’t be surprised if your dentist isn’t very familiar with the concept.  Has he ever mentioned it to you?

Steve Parker, M.D.,

Author of The Advanced Mediterranean Diet

Reference:  Hujoel, P.  Dietary carbohydrates and dental-systemic diseasesJournal of Dental Research, 88 (2009): 490-502.

Mendosa, David.  Our dental alarm bell.  MyDiabetesCentral.com, July 12, 2009.

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High Glycemic Load and Low Grain Fiber Increase Risk of Type 2 Diabetes in Men

Minimally refined grain

Minimally refined grain

A study published in 1997 helped establish the association between glycemic load, dietary fiber, and type 2 diabetes in men.

Methodology

Over 42,000 mostly middle-aged men in the Health Professionals Follow-up Study, without diabetes at baseline, were followed over six years to see if  diet composition was related to onset of type 2 diabetes.  Food intake was determined by a questionnaire.  95% of participants were white.

Results

523 cases of type 2 diabetes developed.  Men with the highest glycemic index eating pattern were 37% more likely to develop diabetes compared to the lowest glycemic index.

Cereal (grain) fiber was inversely related to risk of diabetes.  That is, the higher the intake of grain fiber, the lower the risk of developing diabetes.

The combination of high glycemic load and low cereal fiber yielded the highest rate of diabetes.

Total dietary fiber was not associated with reduced risk of diabetes.

Fiber from fruits and vegetables was not associated with diabetes one way or the other.

As other studies found, total carbohydrate intake was not related to risk of diabetes.

Take-Home Points

These findings may or may not apply to women and non-white ethnic groups.

Grains in a minimally refined form reduced the incidence of diabetes in this population.

Diets with a high glycemic load increase the risk of diabetes, at least in men.

Elsewhere, I’ve reviewed studies indicating that, in women, both high glycemic load and high glycemic index eating increase the risk of type 2 diabetes.  Click here for details.

We must wonder if  established cases of diabetes would respond positively to diets with low glycemic load and grains in a minimally refined form.  Or is it too late?

Steve Parker, M.D.

Reference:  Salmeron, Jorge, et al.  Dietary fiber, glycemic load, and risk of NIDDM in Men.  Diabetes Care, 20 (1997): 545-550

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Can Diabetes Be Prevented in Older Adults?

42-15653241A study published yesterday supports the idea that even in older adults, over 65, type 2 diabetes can be prevented in most cases by healthy lifestyle choices.

Researchers examined the participants in the Cardiovascular Health Study – 4,883 men and women over 65 at baseline – over the course of 10 years.  Median age at enrollment was 73.  Participants were followed clinically for 10 years.  New cases of diabetes over 10 years: 337.  Researchers suspected, based on previous studies in younger folks, that a reduced incidence of diabetes onset would be related to:

  • physical activity levels above the median (half of people exercise less than the median, half exercise more)
  • never smoking, or minimal and years ago
  • “healthy diet,” defined as high fiber, low glycemic index foods, lower trans fats, higher polyunsaturated-to-saturated fat ratio
  • low body mass index (not overweight)
  • waist circumference under 92 cm (36.2 inches) for men and 88 cm (34.6 inches) for women
  • low to moderate alcohol use

We’ll call these “lifestyle factors.”  Participants were analyzed to see how well they fit this profile and whether or not they developed diabetes.

Results

The more each of these lifestyle factors characterized a person, the lower the risk of developing diabetes.

High physical activity and healthy diet by themselves reduced risk of diabetes by half.

Study authors estimate that healthy lifestyle choices could prevent eight or nine out of 10 cases of diabetes in older adults.

Take-Home Point

The researchers rightfully point out that their results are associations, not proof that these lifestyle factors prevent diabetes.  Given the totality of the evidence from this and other studies, I would adopt many of the low-risk lifestyle choices if I wanted to avoid diabetes.

Steve Parker, M.D.

Reference:  Mozaffarian, D., et al.  Lifestyle risk factors and new-onset diabetes mellitus in older adultsArchives of Internal Medicine, 169, (2009): 798-807.

Update April 30, 2009:

Research in younger populations has associated the following factors with prevention of type 2 diabetes:

  1. Avoid overweight, or lose weight if you are overweight (body mass index over 25)
  2. Regular physical activity
  3. Don’t start smoking, or quit if you do
  4. Pick the right parents

Some cases of diabetes are related to genetic factors beyond our control.  Having parents or close relatives with diabetes suggests that you may be genetically predisposed.  Genetics is not necessarily destiny, however.

-Steve

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