December 9, 2013 · 4:24 PM
DietDoctor has some ideas based on a recent scientific study:
A new exciting Swedish study provides us with strong clues on how a person with diabetes should eat (and how to eat to maximize fat burning). It’s the first study to examine in detail how various blood markers change throughout the day depending on what a diabetic person eats.
The study examined the effects of three different diets in 19 subjects with diabetes type 2. They consumed breakfast and lunch under supervision in a diabetes ward. The caloric intake in the three diets examined was the same, but the diets differed in the following manner:
- A conventional low-fat diet (45-56% carbs)
- A Mediterranean diet with coffee only for breakfast (= similar to 16:8 intermittent fasting) and a big lunch (32-35% carbs)
- A moderate low-carbohydrate diet (16-24% carbs)
All participants tested all three diets, one diet each day in randomized order.
Click through for results. Hint: Carbohydrate restriction works.
November 2, 2013 · 5:04 PM
…according to the Heart and Stroke Foundation. Some quotes:
The study found an average reduction in waist circumference of eight centimeters, a reduction in systolic blood pressure of 6 mm Hg and an aerobic fitness improvement of 15 per cent over the first nine months of the study.
Improvements in waist circumference, blood pressure and fitness can lead to numerous other health benefits including a reduced risk of developing high blood pressure, as well as improving osteoarthritis symptoms, quality of life, physical functioning, and cognition.
The high-intensity interval training was done two or three times a week over 20-30 minutes each session. Click for an example of HIIT on a stationary bike. More basic info on HIIT.
The classic Mediterranean diet has too many carbohydrates for many diabetics, although it’s better for them than the Standard American Diet. That’s why I devised the Low-Carb Mediterranean Diet.
Steve Parker, M.D.
Olives, olive oil, and vinegar: classic Mediterranean foods
October 17, 2013 · 6:39 PM
…by Johns Hopkins researchers.
Six thousand Americans were followed over eight years, with attention to heart disease and death. Significantly lower death rates were seen in nonsmokers, and those maintaining a healthy weight, exercising regularly, and eating the Mediterranean diet. The more adherence to those healthy factors, the lower the risk of death
h/t Lyle J. Dennis, M.D.
Reminder: Conquer Diabetes and Prediabetes is now available on Kindle and other ebook formats. That’s where you’ll find the full Low-Carb Mediterranean Diet.
October 3, 2013 · 2:00 AM
…but they have some good ideas as to the healthy components, according to a report in MedPageToday. A sample:
Through a subtractive statistical technique, the EPIC investigators calculated that the biggest chunk of the health advantage—24%—came from moderate alcohol consumption (predominantly wine).
The other relative contributions were:
- 17% from low consumption of meat and meat products
- 16% from high vegetable consumption
- 11% from high fruit and nut consumption
- 11% from high monounsaturated-to-saturated lipid ratio (largely due to olive oil consumption)
- 10% from high legume consumption
Here’s my definition of the Mediterranean diet.
Steve Parker, M.D.
Sofi F, et al “Ideal consumption for each food group composing Mediterranean diet score for preventing total and cardiovascular mortality” EuroPRevent 2013; Abstract P106.
August 12, 2013 · 8:17 AM
Don’t wait to take action until it’s too late
Insulin resistance and high blood insulin levels promote age-related degeneration of the brain, leading to memory loss and dementia according to Robert Krikorian, Ph.D. He’s a professor in the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati Academic Health Center. He has an article in a recent issue of Current Psychiatry – Online.
Proper insulin signaling in the brain is important for healthy functioning of our brains’ memory centers. This signaling breaks down in the setting of insulin resistance and the associated high insulin levels. Dr. K makes much of the fact that high insulin levels and insulin resistance are closely tied to obesity. He writes that:
“Waist circumference of ≥100 cm (39 inches) is a sensitive, specific, and independent predictor of hyperinsulinemia for men and women and a stronger predictor than body mass index, waist-to-hip ratio, and other measures of body fat.”
Dr. Krikorian thinks that dietary approaches to the prevention of dementia are effective yet underutilized. He mentions reduction of insulin levels by restricting calories or a ketogenic diet: they’ve been linked with improved memory in middle-aged and older adults.
Dr. Krikorian suggests the following measures to prevent dementia and memory loss:
- eliminate high-glycemic foods like processed carbohydrates and sweets
- replace high-glycemic foods with fruits and vegetables (the higher polyphenol intake may help by itself)
- certain polyphenols, such as those found in berries, may be particularly helpful in improving brain metabolic function
- keep your waist size under 39 inches, or aim for that if you’re overweight
I must mention that many, perhaps most, dementia experts are not as confident as Dr. Krikorian that these dietary changes are effective. I think they probably are, to a degree.
The Mediterranean diet is high in fruits and vegetables and relatively low-glycemic. It’s usually mentioned by experts as the diet that may prevent dementia and slow its progression.
Read the full article.
I’ve written before about how blood sugars in the upper normal range are linked to brain degeneration. Dr. Krikorian’s recommendations would tend to keep blood sugar levels in the lower end of the normal range.
Steve Parker, M.D.
PS: Speaking of dementia and ketogenic, have you ever heard of the Ketogenic Mediterranean Diet? (Free condensed version here.)
April 13, 2013 · 2:00 AM
If you don’t like your physician, find a new one
So, you’ve got diabetes. You’re trying to deal with it or you wouldn’t be here. You’ve got a heck of a lot of medical information to master.
Unless you have a good diabetes specialist physician on your team, you may not be getting optimal care. Below are some guidelines you may find helpful. The goal is to prevent diabetes complications. Many primary care physicians will not be up-to-date on the guidelines. Don’t hesitate to discuss them with your doctor. Nobody cares as much about your health as you do.
The American Diabetes Association (ADA) recommends the following items be done yearly (except as noted) in non-pregnant adults with diabetes. (Incidentally, I don’t necessarily agree with all ADA guidelines.) The complete ADA guidelines are available on the Internet.
- Lipid profile (every two years if results are fine and stable)
- Comprehensive foot exam
- Screening test for distal symmetric polyneuropathy: pinprick, vibration, monofilament pressure sense
- Serum creatinine and estimate of glomerular filtration rate (MDRD equation)
- Test for albumin in the urine, such as measurement of albumin-to-creatinine ratio in a random spot urine specimen
- Comprehensive eye exam by an ophthalmologist or optometrist (if exam is normal, every two or three years is acceptable)
- Hemoglobin A1c at least twice a year, but every three months if therapy has changed or glucose control is not at goal
- Flu shots
Other Vaccinations, Weight Loss, Diabetic Diet, Prediabetes, Alcohol, Exercise, Etc.
Additionally, the 2013 ADA guidelines recommend:
- Pneumococcal vaccination. “A one time re-vaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago.” Also repeat the vaccination after five years for patients with nephrotic syndrome, chronic kidney disease, other immunocompromised states (poor ability to fight infection), or transplantation.
- Hepatitis B vaccination to unvaccinated adults who are 19 through 59 years of age.
- Weight loss for all overweight diabetics. “For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed. The optimal macronutrient composition of weight loss diets has not been established. (Macronutrients are carbohydrates, proteins, and fats.)
- “The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” “It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal.”
- “A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.”
- “Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.”
- Limit alcohol to one (women) or two (men) drinks a day.
- Limit saturated fat to less than seven percent of calories.
- During the initial diabetic exam, screen for peripheral arterial disease (poor circulation). Strongly consider calculation of the ankle-brachial index for those over 50 years of age; consider it for younger patients if they have risk factors for poor circulation.
- Those at risk for diabetes, including prediabetics, should aim for moderate weight loss (about seven percent of body weight) if overweight. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Also important is exercise: at least 150 minutes per week of moderate-intensity aerobic activity. “Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).” Limit intake of sugar-sweetened beverages.
- “Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than two consecutive days without exercise. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.”
- Screening for coronary artery disease before an exercise program is depends on the physician judgment on a case-by-case basis. Routine screening is not recommended.
Olive, olive oil, and vinegar: classic Mediterranean foods
Obviously, some of my dietary recommendations conflict with ADA guidelines. The experts assembled by the ADA to compose guidelines were well-intentioned, intelligent, and hard-working. The guidelines are supported by 528 scientific journal references. I greatly appreciate the expert panel’s work. We’ve simply reached some different conclusions. By the same token, I’m sure the expert panel didn’t have unanimous agreement on all the final recommendations. I invite you to review the dietary guidelines yourself, discuss with your personal physician, then decide where you stand.
General Blood Glucose Treatment Goals
The ADA in 2013 suggests these therapeutic goals for non-pregnant adults:
- Fasting blood glucoses: 70 to 130 mg/dl (3.9 to 7.2 mmol/l)
- Peak glucoses one to two hours after start of meals: under 180 mg/dl (10 mmol/l)
- Hemoglobin A1C: under 7%
- Blood pressure: under 140/80 mmHg
- LDL cholesterol: under 100 mg/dl (2.6 mmol/l). (In established cardiovascular disease: <70 mg/dl or 1.8 mmol/l may be a better goal.)
- HDL cholesterol: over 40 mg/dl (1.0 mmol/l) for men and over 50 mg/dl (1.3 mmol/l) for women
- Triglycerides: under 150 mg/dl (1.7 mmol/l)
The American Association of Clinical Endocrinologists (AACE) in 2011 proposed somewhat “tighter” blood sugar goals for non-pregnant adults:
- Fasting blood glucoses: under 110 mg/dl (6.11 mmol/l)
- Peak glucoses 2 hours after start of meals: under 140 mg/dl (7.78 mmol/l)
- Hemoglobin A1C: 6.5% or less
The ADA reminds clinicians, and I’m sure the AACE guys agree, that diabetes control goals should be individualized, based on age and life expectancy of the patient, duration of diabetes, other diseases that are present, individual patient preferences, and whether the patient is able to easily recognize and deal with hypoglycemia. I agree completely.
Steve Parker, M.D.
Filed under Diabetes Complications, Exercise, Fat in Diet, Fiber, Mediterranean Diet, Overweight and Obesity, Prediabetes, Prevention of T2 Diabetes
Tagged as ADA clinical guidelines, American Association of Clinical Endocrinologists, american diabetes association, blood glucose goals, blood sugar goals, diabetes goals, diabetes treatment, diabetic diet, low-carb diet, Mediterranean Diet, periodic tests, Weight Loss
March 9, 2013 · 2:00 AM
“Vegan? Vegetarian? Mediterranean? Low-Carb? ADA? Low GI? SAD?
Remember that recent report on the best diet for diabetes from American Journal of Clinical Nutrition? I didn’t think so. Here’s Dr. Axel Sugurdsson’s summary:
Ajala and coworkers conclude that their review provides evidence that modifying the amount of macronutrients can improve glycemic control, weight and lipids in type 2 diabetes. In their analysis, low carbohydrate diets appeared to provide superior weight loss, better control of blood glucose, and better lipid profile, compared with low fat diets. The authors also conclude that vegan and vegetarian diet may improve glucose control and promote weight loss in type 2 diabetes.
Here’s the verbatim conclusion of the researchers from the article abstract:
Low-carbohydrate, low-GI, Mediterranean, and high-protein diets are effective in improving various markers of cardiovascular risk in people with diabetes and should be considered in the overall strategy of diabetes management.
No mention of vegan and vegetarian diets per se.
And now Dr. Sigurdsson’s concluding opinion:
What is the best diet for diabetes? Although, there is probably not a simple answer, the question reflects one of the main challenges of modern medicine. It is likely that our dietary recommendations will have to be tailored to the needs of the individual. A one-size-fits-all approach is unrealistic. Although not providing any definitive answers, the study by Ajala and coworkers is an important contribution to our understanding of this highly important issue.
Read the rest.
I’ve reviewed some of the literature supporting vegetarian diets for diabetes. I’ve seen some evidence that the paleo diet may be beneficial. Regular readers here know that I currently favor a carbohydrate-restricted Mediterranean-style diet for control of diabetes.
Steve Parker, M.D.
December 23, 2012 · 6:10 AM
Remember Shai et al’s 2008 DIRECT study that compared weight loss over two years on either a low-carb, low-fat, or Mediterranean diet? I reviewed it at length in 2008.
The same Isreali researchers now report the results of an additional four years of follow-up. Do you know of any other weight loss study over that length of time? I don’t.
Of the 322 original study participants, 259 were available for follow-up for an additional four years. Of these, 67% told researchers they had continued their originally assigned diet.
Over six years, the weight loss was as follows:
- 0.6 kg (about a pound) in the low-fat group
- 1.7 kg (almost 4 pounds) in the low-carb cohort
- 3.1 kg (almost 7 pounds) in the Mediterranean group
The difference between the low-carb and Mediterranean groups was not statistically significant.
Almost all the original study participants (86%) were men, so it’s debatable whether these results apply to women. I bet they do. I assume most of the participants were Israeli, so you can also debate whether results apply to other nationalities or ethnicities.
For long-term weight management, Mediterranean and low-carb diets appear to be more effective than traditional low-fat, calorie-restricted dieting.
Beth Mazur at her Weight Maven blog has some worthwhile comments about the study.
Incidentally, my Advanced Mediterranean Diet (2nd Edition) book features both a traditional Mediterranean diet and the world’s first low-carb Mediterranean diet.
Steve Parker, M.D.
December 3, 2012 · 1:04 PM
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
This excerpt is from an article by three dietitians writing in Diabetes Spectrum in 2009. Click through for details if interested.
Reference: doi: 10.2337/diaspect.24.1.36 Diabetes Spectrum January 1, 2011 vol. 24, no. 1, p.36-40
November 29, 2012 · 5:40 AM
“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 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.)
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.
Filed under Carbohydrate, Fat in Diet, Health Benefits, Heart Disease, ketogenic diet, Mediterranean Diet, nuts, olive oil, Stroke, Vegetables, Weight Loss
Tagged as Atkins diet, dementia, diabetes, diet-heart hypothesis, dietary fat, healthy diet, heart attack, low-carb diet, low-carb diet research, macular degeneration, Mediterranean Diet, mild cognitive impairment, nutrition research, olive oil, paleo diet, saturated fat, Stroke