Tag Archives: prediabetes

Dietary Advice for a 41-Year-Old South Asian With Prediabetes

The CulinaryRx blogger at MedPageToday asked two physicians what diet modifications they’d recommend for a 41-year-old man with prediabetes. (To read the article you may need to do a free sign-up.)

The moderator asked his experts twice whether carbohydrate restriction is important, and never got a straight answer. These experts must not think it’s important since they push legumes, lentils, fruits, and whole grains. Dr. Nadeau said he believes there is no specific diet for folks with diabetes. I almost fell off my chair when I read one comment recommending cookies and sweets, because they’re traditional. They also recommend low glycemic load, nuts, higher protein consumption, vegetables, and “good oils” like olive oil (ghee not mentioned).

Read this blog post for prior comments that include advice from possible clinicians.

I’m confident that Dr. Ronesh Sinha in Silicon Valley, California, would disagree with the advice of MedPageToday’s experts. Dr. Sinha would likely recommend limiting digestible carbohydrates to 50–150 grams/day as the most important dietary step. (I plan on a review of Dr. Sinha’s book here within a few months.)

I’m still looking for clinical studies of various diets for South Asians (aka Indian Asians) with prediabetes and diabetes.

Steve Parker, M.D.

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Filed under India, Prediabetes

Is Excessive Fructose Consumption the Cause of Type 2 Diabetes?

Lumps of Diabetes

Cubes of Diabetes?

A Pharm.D (Dr of Pharmacology) and a pair of MD’s surveyed much of the available scientific literature—both animal and human studies—and concluded that fructose is a major culprit in the rise of type 2 diabetes and prediabetes. Fructose does its damage by increasing insulin resistance. ScienceDaily has the details.

Be aware that their conclusion is certainly not universally accepted. I just read “Pathogenesis of type 2 diabetes mellitus” at UpToDate.com and saw no mention of fructose. Under dietary factors, they mainly talked about obesity and how that increases insulin resistance, leading to elevated blood sugars, while the reverse happens with weight loss. I haven’t looked at all the research so I have no definite opinion yet on the fructose-diabetes theory; I’m skeptical.

Fructose is a type of simple sugar. Common dietary sources of fructose are fruits, table sugar (aka sucrose, a 50:50 combination of glucose and fructose molecules), and high-fructose corn syrup (which is usually 42 or 55% fructose).

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

Damaging effects, if any, of fructose in these fruits may be mitigated by the fiber

A few quotes from ScienceDaily:

“At current levels, added-sugar consumption, and added-fructose consumption in particular, are fueling a worsening epidemic of type 2 diabetes,” said lead author James J. DiNicolantonio, PharmD, a cardiovascular research scientist at Saint Luke’s Mid America Heart Institute, Kansas City, MO. “Approximately 40% of U.S. adults already have some degree of insulin resistance with projections that nearly the same percentage will eventually develop frank diabetes.”

*   *   *

While fructose is found naturally in some whole foods like fruits and vegetables, consuming these foods poses no problem for human health. Indeed, consuming fruits and vegetables is likely protective against diabetes and broader cardiometabolic dysfunction, explained DiNicolantonio and colleagues. The authors propose that dietary guidelines should be modified to encourage individuals to replace processed foods, laden with added sugars and fructose, with whole foods like fruits and vegetables. “Most existing guidelines fall short of this mark at the potential cost of worsening rates of diabetes and related cardiovascular and other consequences,” they wrote.

If you’re eating a typical Western or American diet, you’ll reduce your fructose consumption by moving to the Mediterranean diet, the Advanced Mediterranean Diet, Low-Carb Mediterranean Diet, or the Paleobetic Diet.

RTWT.

Steve Parker, M.D.

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Filed under Causes of Diabetes, Sugar

Elevated Fasting Blood Sugar Linked to Pancreatic Cancer

A recent meta-analysis found that elevated fasting blood glucose levels, even in the prediabetic range, are associated with higher risk of developing pancreatic cancer. This is important because you can take action today to lower your fasting blood sugar level, which may lower your risk of pancreatic cancer over the long-term. The researchers conclude that…

“Every 0.56 mmol/L [10 mg/dl] increase in fasting blood glucose is associated with a 14% increase in the rate of pancreatic cancer.”

In the developed world, your risk of getting an invasive cancer is roughly one in four. Pancreatic cancer is the most lethal. Surgery is the way to cure it, but at the time of diagnosis only two in 10 patients are candidates for surgery because the cancer has already spread. Pancreatic cancer is the fourth leading cause of cancer death in the USA and the fifth in the UK. Nevertheless, pancreas cancer is not terribly common; the US has 50,000 new cases annually. As a hospitalist, I run across one or two new cases of pancreas cancer every year.

We’ve known for years that type 2 diabetes is linked to pancreatic cancer, with diabetics having twice the risk of nondiabetics.

What if you have elevated fasting blood sugars? There’s no proof that reducing them to the normal range will reduce your risk of pancreatic cancer. But if it were me, that’s what I’d shoot for.

Other that type 2 diabetes and prediabetes, some other risk factors for pancreas cancer are:

  • heredity
  • smoking
  • sedentary lifestyle
  • body mass index over 30 (obesity in other words)

You can alter most of those risk factors. Why not get started now?

Steve Parker, M.D.

PS: If you’re not sure if your fasting blood sugar’s elevated, click here.

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Very Low-Carb Diet Beats ADA Diet in Type 2 Diabetes According to New Study

Compared to a mildly carbohydrate-restricted American Diabetes Association diet, a very-low-carbohydrate ketogenic diet was more effective at controlling type 2 diabetes and prediabetes, according to University of California San Francisco researchers.

Some non-starchy low-carb vegetables

Some non-starchy low-carb vegetables

Details, please!

Thirty-four overweight and obese type 2 diabetics (30) and pre diabetics (4) were randomly assigned to one of the two diets:

  1. MCCR: American Diabetes Association-compliant medium-carbohydrate, low-fat, calorie-resticted carb-counting diet. The goals were about 165 grams of net carbs daily, counting carbohydrates, an effort to lose weight by eating 500 calories/day less than needed for maintenance, and 45–50% of total calories from carbohydrate. Protein gram intake was to remain same as baseline. (Note that most Americans eat 250–300 grams of carb daily.)
  2. LCK: A very-low-carbohydrate, high-fat, non-calorie-restricted diet aiming for nutritional ketosis. It was Atkins-style, under 50 grams of net carbs daily (suggested range of 20–50 g). Carbs were mostly from non-starchy low-glycemic-index vegetables. Protein gram intake was to remain same as baseline.

Baseline participant characteristics:

  • average weight 100 kg (220 lb)
  • 25 of 34 were women
  • average age 60
  • none were on insulin; a quarter were on no diabetes drugs at all
  • most were obese and had high blood pressure
  • average hemoglobin A1c was about 6.8%
  • seven out of 10 were white

Participants followed their diets for three months and attended 13 two-hour weekly classes. Very few dropped out of the study.

Results

Average hemoglobin dropped 0.6% in the LCK group compared to no change in the MCCR cohort.

A hemoglobin A1c drop of 0.5% or greater is considered clinically significant. Nine in the LCK group achieved this, compared to four in the MCCR.

The LCK group lost an average of 5.5 kg (12 lb) compared to 2.6 kg (6 lb) in the MCCR. The difference was not statistically significant, but close (p = 0.09)

44% in the LCK group were able to stop one or more diabetes drugs, compared to only 11 % in the other group

31% in the LCK cohort were able to drop their sulfonylurea, compared to only 5% in the MCCR group.

By food recall surveys, both groups reported lower total daily caloric intake compared to baseline. The low-carbers ended up with 58% of total calories being from fat, a number achieved by reducing carbohydrates and total calories and keeping protein the same. They didn’t seem to increase their total fat gram intake;

The low-carbers apparently reduced daily carbs to an average of 58 grams (the goal was 20-50 grams).

There were no differences between both groups in terms of C-reactive protein (CRP), lipids, insulin levels, or insulin resistance (HOMA2-IR). Both groups reduced their CRP, a measure of inflammation.

LCK dieters apparently didn’t suffer at all from the “induction flu” seen with many ketogenic diets. They reported less heartburn, less aches and pains, but more constipation.

Hypoglycemia was not a problem.

If I recall correctly, the MCCR group’s baseline carb grams were around 225 g.

Bottom Line

Very-low-carb diets help control type 2 diabetes, help with weight loss, and reduce the need for diabetes drugs. An absolute drop of 0.6% in hemoglobin A1c doesn’t sound like much, translating to blood sugars lower by only 15–20 mg/dl (0.8–1 mmol/l). But remember the comparator diet in this study was already mildy to moderately carbohydrate-restricted. At least half of the type 2 diabetics I meet still tell my they don’t watch their carb intake, which usually means they’re eating around 250–300 grams a day. If they cut down to 58 grams, they most likely will see more than a 0.6% drop in hemoglobin A1c after switching to a very-low-carb diet.

This is a small study, so it may not be reproducible in larger clinical trials and other patient populations. Results are consistent with several other similar studies I’ve seen, however.

Steve Parker, M.D.

Reference: Saslow, Laura, et al (including Stephen Phinney). A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or PrediabetesPLoS One. 2014; 9(4): e91027. Published online Apr 9, 2014. doi: 10.1371/journal.pone.0091027     PMCID: PMC3981696

PS: When I use “average” above, “mean” is often a more accurate word, but I don’t want to have to explain the differences at this time.

PPS: Carbsane Evelyn analyzed this study in greater detail that I did and came to different conclusions. Worth a read if you have an extra 15 minutes.

 

 

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Filed under Carbohydrate, Glycemic Index and Load, ketogenic diet, Prediabetes

Napping Linked to Diabetes and Prediabetes

…in Chinese retirees according to a article at Diabetes Self-Managment. In the study population, 70% of retirees took naps. I’d be surprised if that many U.S. retirees take naps. It’s unclear whether napping causes type 2 diabetes and prediabetes znc whether results apply to non-Chinese ethnic groups.

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Book Review: The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes

I just finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face on a daily basis. His science-based recommendations are familiar to me since I reviewed many of his references at my blog, Diabetic Mediterranean Diet.

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a gym, although some home gyms will have them also. His regimen is easily done in 15-20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics. It may be that it just hasn’t been studied in type 2 diabetics yet.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review.

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Filed under Book Reviews, Exercise, Prediabetes, Prevention of T2 Diabetes

Diabetes: Scope of the Problem

97 mg/dl. Yippee!

Type 2 diabetes is arguably the most important public health problem in the U.S. and most of the developed world. The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in the year 2000 will develop diabetes.

The most common form of diabetes by far is type 2, which describes about 85% of cases. It’s less serious than type 1 diabetes. Type 1 diabetics have an immune system abnormality that destroys the pancreas’s ability to make insulin. Type 1’s will not last long without insulin injections. On the other hand, many type 2 diabetics live well without insulin shots.

“Prediabetes” is what you’d expect: a precursor that may become full-blown type 2 diabetes over time. Blood sugar levels are above average, but not yet into the diabetic range. One in four people with prediabetes develops type 2 diabetes over the course of three to five years. Researchers estimate that 35% of the adult U.S. population had prediabetes in 2008. That’s one out of every three adults, or 79 million. Only 7% of them (less than one in 10) were aware they had it.

In the U.S. as of 2010, 26 million folks have diabetes. That includes 11% of all adults.

The rise of diabetes parallels the increase in overweight and obesity, which in turn mirrors the prominence of refined sugars and starches throughout our food supply. These trends are intimately related. Public health authorities 40 years ago convinced us to cut down our fat consumption in a mistaken effort to help our hearts. We replaced fats with body-fattening carbohydrates that test the limits of our pancreas to handle them. Diabetics and prediabetics fail that test.

Dr. Richard K. Bernstein, notable diabetologist, wrote that, “Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.”

We’re even starting to see type 2 diabetes in children, which was rare just thirty years ago. It’s undoubtedly related to overweight and obesity. Childhood obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate.  Overweight and obesity together describe 32% of U.S. children.

Diabetes is important because it has the potential to damage many different organ systems, deteriorating quality of life. It can damage nerves (neuropathy), eyes (retinopathy), kidneys (nephropathy),  and stomach function (gastroparesis), just to name a few.

Just as important, diabetes can cut life short. Compared to those who are free of diabetes, having diabetes at age 50 more than doubles the risk of developing cardiovascular disease—heart attacks, strokes, and high blood pressure. Compared to those without diabetes, having both cardiovascular disease and diabetes approximately doubles the risk of dying. Compared to those without diabetes, women and men with diabetes at age 50 die seven or eight years earlier, on average.

Diabetic complications and survival rates will undoubtedly improve over the coming decades as we learn how to better treat this ancient disease.

Steve Parker, M.D.

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