Tag Archives: prediabetes

TV’s Biggest Loser Plan Improves Diabetes and Prediabetes

TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and pre diabetics, according to an article May 30, 2012, in MedPage Today.  Some quotes:

For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.

In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…

The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.

Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.

At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.

“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”

Of the 35 participants in this study, 12 had prediabetes and six had diabetes.  This is a small pilot study, then.  I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place.  Of course, that’s not very realistic.  A chance to win $250,000 (USD) is strong motivation for lifestyle change.

Steve Parker, M.D.

PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.

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Latest Research: 1) Sleep Patterns and Diabetes, 2) Drop Metformin When You Start Insulin?

1) Lack of sleep coupled with disrupted day-night cycles predisposes to diabetes and prediabetes.  Night-shift workers take note.

2) Compared to those using metformin alone, type 2 diabetics who also took insulin needed less insulin and had better blood sugar levels.  Real-world benefits are not entirely clear.

Steve Parker, M.D. 

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173 Years of US Sugar Consumption

US Sugar Consumption: 1822-2005

 Thanks to Dr. Stephan Guyenet and Jeremy Landen for this sugar consumption graph.  I’d never seen one going this far back in time. 
 
Dr. Guyenet writes:
It’s a remarkably straight line, increasing steadily from 6.3 pounds per person per year in 1822 to a maximum of 107.7 lb/person/year 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.
The U.S. Department of Agriculture estimates that added sugars provide 17% of the total calories in the average American diet.  A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.  The average U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.
 
Note that added sugars overwhelmingly supply only one nutrient: pure carbohdyrate without vitamins, minerals, protein, fat, antioxidants, etc.
 
Do you think sugar consumption has anything to do with diseases of affluence, also known as diseases of modern civilization?  I do.
 
Was our pancreas designed to handle this much sugar?  Apparently not, judging from skyrocketing rates of diabetes and prediabetes.
 
 

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Filed under Carbohydrate, Causes of Diabetes, Sugar

Can Diabetes Be Prevented?

Not Paula Deen

Paula Deen’s recent announcement of her type 2 diabetes got me to thinking about diabetes prevention again.  If you’re at high risk of developing diabetes you can reduce your risk of full-blown type 2 diabetes by 58% with intensive lifestyle modification.  Here’s how it was done in a 2002 study:

The goals for the participants assigned to the intensive lifestyle intervention were to achieve and maintain a weight reduction of at least 7 percent of initial body weight through a healthy low-calorie, low-fat diet and to engage in physical activity of moderate intensity, such as brisk walking, for at least 150 minutes per week. A 16-lesson curriculum covering diet, exercise, and behavior modification was designed to help the participants achieve these goals. The curriculum, taught by case managers on a one-to-one basis during the first 24 weeks after enrollment, was flexible, culturally sensitive, and individualized. Subsequent individual sessions (usually monthly) and group sessions with the case managers were designed to reinforce the behavioral changes.

Although the Diabetes Prevention Program encouraged a low-fat diet, another study from 2008 showed that a low-fat diet did nothing to prevent diabetes in postmenopausal women

I don’t know Paula Deen.  I’ve never watched one of her cooking shows.  She looks overweight and I’d be surprised if she’s had a good exercise routine over the last decade.  I’m sorry she’s part of the diabetes epidemic we have in the U.S.  I wish her well.  Amy Tenderich posted the transcript of her brief interview with Paula, who calculates her sweet tea habit gave her one-and-a-half cups of sugar daily).

  • 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

I think excessive consumption of concentrated sugars and refined carbohydrates contribute to the diabetes epidemic.  Probably more important are overweight, obesity, and physical inactivity.

The Mediterranean diet has also been linked to lower rates of diabetes (and here).  Preliminary studies suggest the Paleo diet may also be preventative (and here).

Greatly reduce your risk of type 2 diabetes by eating right, keeping your weight reasonable, and exercising.

Steve Parker, M.D.

PS: Paula, if you’d like a copy of Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, have your people contact my people.

Reference:  Diabetes Prevention Program Research Group.  Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or MetforminNew England Journal of Medicine, 346 (2002): 393-403.

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Book Review: Sugar Nation – The Hidden Truth Behind America’s Deadliest Habit and the Simple Way to Beat It

I recently read Sugar Nation, by Jeff O’Connell, published in 2011.  Per Amazon.com’s rating system, I give it five stars (“I love it”). 

♦   ♦   ♦

With the U.S. Centers for Disease Control predicting that one of every three citizens born in 2000 will become diabetic, this book is “just what the doctor ordered.”  Already,  one in three of all adults has prediabetes.  The numbers are even scarier if we look at those over 65: HALF have prediabetes, while two in ten have diabetes.  I treat diabetes every day; trust me, you don’t want it.

I agree with O’Connell that over-consumption of sugar and refined starches often leads to type 2 diabetes and prediabetes, particularly when combined with obesity, a sedentary lifestlye, and genetic predisposition.  (Our bodies easily and quickly convert potatoes and refined starches like white flour and white rice into blood sugar.) Yearly sugar consumption in the U.S. was five pounds per person in the 1800s, but is now up to 160 pounds a year. 

O’Connell was motivated to write this because of his personal diagonosis of prediabetes in 2006.  Later he was also diagnosed with reactive hypoglycemia.  Furthermore, his father died of the ravages of type 2 diabetes.  O’Connell’s physician in 2006 didn’t offer much managmement advice, so the author did his own research and shares it with us here.  The author’s personal approach has been a fairly intense exercise program and major reduction in consumption of sugar and other carbohydrates, particularly ones that are quickly converted to blood sugar.  He eats 80 or less grams of carb daily, compared to the average American’s 275 grams.  I agree these management options can be extremely helpful for prediabetes and type 2 diabetes, particularly if applied early in the course of the condition.

O’Connell is critical of most physicians and the American Diabetes Association (ADA) for not knowing about carbohydrate restriction and for inadequately promoting exercise.  He accuses the pharmaceutical industry of having too much influence over physicians and the ADA.  While admitting that “…taking a pill [is] much easier than reengineering the way you lead your life,” he mostly lets patients off the hook in terms of taking control of diet and physical activity.  I can understand that to a degree; physicians should be leading the way.  I don’t see that happening soon.  Patients need to take charge now; many have already done so.  Compared to a five-minute lecture in a doctor’s office, this book will be a much more effective motivator for change.

(Patients taking drugs with the potential to cause hypoglycemia need their doctors’ help adjusting dosages while making these lifestyle changes.)

The author tells us that we in the U.S. spent $12.5 billion on drugs for diabetes in 2007, nearly double the amount spent in 2001.  It’s only going to get worse going forward.  We have 11 classes of drugs for diabetes now.  Surprisingly, we don’t know all of the potential adverse long-term side effects of most of these drugs.  Phenformin was pulled from the U.S. market years ago due to fatal lactic acid build-up.  Earlier this year, rosiglitazone prescribing was greatly restricted in view of adverse heart effects.  If we can effectively address diabetes and prediabetes with diet and exercise, why not?  (Clearly, diet and exercise don’t always work, and type 1 diabetics always need insulin.) 

For those who won’t or can’t exercise regularly, be aware that carb restriction alone is a powerful approach.

I heard more about reactive hypoglycemia a couple decades ago than I do now.  It could be a precursor to type 2 diabetes.  I think physicians lost interest in it because too many people were using it as a excuse for odd behavior when they really didn’t have hypogylcemia.  This book may spark a resurgence in interest.

O’Connell implies that the high revenues generated by diabetic drug manufacturers may not be justifiable.  In fairness, I must point out that the same companies spend hundreds of millions of dollars just to get a drug on the market, and millions more on research for drugs that fail and never see the light of day.

I was glad to see the author mention low-carb beers: Michelob Ultra and MGD 64.  I’ve had trouble finding carb counts on many beers.

O’Connell recommends supplements: leucine, cinnamon, protein powder, chromium, alpha lipoic acid, biotin, magnesium.  I’ve not done in-depth research on most of those.  What I’ve read in the science literature about cinnamon and chromium has not been very positive or definitive.

My favorite sentence: “Along with a low-carb eating plan, a gym memership is the most potent antidote to type 2 diabetes.”  Nevertheless, don’t let this turn you off; you can do the essential exercise without a gym membership.

This book was a pleasure to read; professional, well-organized, touching all the right bases in understandable terms.  I can well understand how he makes a living as a journalist. 

Steve Parker, M.D., author of Conquer Diabetes and Prediabetes: The Low-Carb  Mediterranean Diet   

Disclosure: I don’t know the author.  The publisher’s representative provided me with two free copies of the book, otherwise I recieved nothing of value in exchange for this review.  I gave one of the books to a contest-winner at my Advanced Mediterranean Diet blog.  The contest was to be the first reader to e-mail me with the name for “wisps of precipitation streaming from a cloud but evaporating before reaching the ground.”

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Book Review: Carbohydrates Can Kill

I recently read Carbohydrates Can Kill, by Robert K. Su, M.D., written in 2009.  Per Amazon.com’s rating system, I give it four stars ( I like it).

♦   ♦   ♦

Many developed Western societies have a love affair with carbohydrates, particularly concentrated sugars and highly processed grains and starches.  The U.S. is a good example.  Our skyrocketing rates of overweight and obesity (68% of adults) are testament to that.  Obesity is strongly linked to cancer, high blood pressure, heart attacks, diabetes, strokes, and premature death.  It’s not too much of a stretch to blame carbohydrates for at least a portion of these diseases and others.  Dr. Robert Su thoroughly reviews these connections in Carbohydrates Can Kill.

Blissfully unaware of his prediabetes

Blocked heart arteries are the No.1 cause of death in developed countries.  A growing trend among the experts is to abandon the theory that total and saturated fats cause heart disease, pointing instead to excessive consumption of sugars and processed grains and other starches.  Dr. Su makes a fairly convincing case for the carbohydrate theory of heart disease.  He’s also convinced that carbs cause high blood pressure, dementia, many cancers, diabetes, overweight, perhaps even most diseases. 

This book addresses overweight, adverse health effects of obesity, nutrition and digestion in detail, and numerous scientific studies supporting his ideas.

One of the most interesting things to me was Dr. Su’s personal medical story.  At age 62, he found himself 40 pounds (18 kg) overweight, blood pressure 205/63, and having apparent reversible heart pains (angina) when stressed or exercising.  The combination of salt restriction and exercise didn’t help.  Reducing carbs to 60-70 g/day and continued exercise (walking and stair-climbing) did the trick, helping him lose 30 pounds and controlling angina and high blood pressure.  I expected him at any time to reveal he had a heart attack, stroke, or heart bypass surgery, but he dodged those bullets.  His problems at 62 were a wake-up call.  He didn’t want to end up prematurely dead or disabled, a burden to his family and unable to spend quality time with them.  So he undertook major lifestyle changes.  Very inspirational. 

In addition to a medical degree, Dr. Su has a degree in pharmacy.  He knew he’d be put on multiple drugs if he went to a doctor for treatment of his symptoms.  Like me, he’s wary of drug side effects and wanted to avoid them, opting for diet and exercise instead.  He gambled and won.  I’m sure at least a few others would not be so lucky.

Dr. Su cites evidence that high blood sugars cause inflammation, which can predispose to cancer.  Diabetics do indeed have a higher risk of certain cancers, yet he didn’t mention that diabetics have a lower risk of prostate cancer. 

Dr. Su is anti-alcohol.  The studies are mixed on the overall health effects of alcohol, but the bulk of the studies link low-to-moderate consumption of alcohol with less cardiovascular disease and longer lifespan.  Clearly, heavy drinking can be lethal.

Like all books, CCK isn’t perfect.  First, it could have used better editing to eliminate grammatical errors and wordiness.  Next, I suspect Dr. Su is getting a little ahead of the science when he states that “….most diseases, if not all, are directly or indirectly caused by too much blood sugar.”  If carbohydrates are so deadly (mediated via high blood sugar), why do the Kitavan’s of Melanesia have such low rates of heart attack, stroke, overweight, and diabetes, despite a diet deriving 69% of total calories from carbohydrates?  (Calories from carbohydrates in the U.S. are about 50% of the total.)  Granted, Kitavan’s carbs are mostly unrefined.  Could the Kitavans be genetically protected from carb toxicity? 

So, what do we do if carboydrates are so dangerous?  Dr. Su recommends limiting carb consumption to a maximum of 100 grams a day.  (By way of reference, average U.S. carb consumption is 250 grams a day.)  Simple sugars and highly processed grains and starches should be avoided.  Additionally, he recommends a yearly glucose tolerance test to determine fasting blood sugar, then blood sugar readings every 15-20 minutes after an unspecified meal for two or three hours.  I wonder if a single hemoglobin A1c blood test would suffice.  I agree with Dr. Su that fasting blood sugars should be under 110 mg/dl (6.1 mmol/l)—if not lower—and all blood sugars after meals under 150 mg/dl (8.3 mmol/l).

Dr. Su is a tireless advocate for carbohydrate-restricted eating.  Visit his website: carbohydratescankill.com.  If his diet and exercise ideas were widely adopted in the U.S., we’d be a healthier country.  This book is a worthy read for anyone with overweight, obesity, diabetes, prediabetes, or otherwise enamored of concentrated sugars and highly processed grains and other starches.  Note that one of every three U.S. adults has prediabetes, including half of all those over 65, and most of them are unaware.

Steve Parker, M.D.

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Pilot Study: Paleo Diet Is More Satiating Than Mediterranean-Style

Swedish researchers reported recently that a Paleolithic diet was more satiating than a Mediterranean-style diet, when compared on a calorie-for-calorie basis in heart patients.  Both groups of study subjects reported equal degrees of satiety, but the paleo dieters ended up eating 24% fewer calories over the 12-week study.

The main differences in the diets were that the paleo dieters had much lower consumption of cereals (grains) and dairy products, and more fruit and nuts.  The paleos derived 40% of total calories from carbohydrate compared to 52% among the Mediterraneans.

Even though it wasn’t a weight-loss study, both groups lost weight.  The paleo dieters lost a bit more than the Mediterraneans: 5 kg vs 3.8 kg (11 lb vs 8.4 lb).  That’s fantastic weight loss for people not even trying.  Average starting weight of these 29 ischemic heart patients was 93 kg (205 lb).  Each intervention group had only 13 or 14 patients (I’ll let you figure out what happened to to the other two patients).

I blogged about this study population before.  Participants supposedly had diabetes or prediabetes, although certainly very mild cases (average hemoglobin A1c of 4.7% and none were taking diabetic drugs)

As I slogged through the research report, I had to keep reminding myself that this is a very small, pilot study.  So I’ll not bore you with all the details.

Bottom Line

This study suggests that the paleo diet may be particularly helpful for weight loss in heart patients.  No one knows how results would compare a year or two after starting the diet.  The typical weight-loss pattern is to start gaining the weight back at six months, with return to baseline at one or two years out.

Greek investigators found a link between the Mediterranean diet and better clinical outcomes in known ischemic heart disease patients.  On the other hand, researchers at the Heart Institute of Spokane found the Mediterranean diet equivalent to a low-fat diet in heart patients, again in terms of clinical outcomes.  U.S. investigators in 2007 found a positive link between the Mediterranean diet and lower rates of death from cardiovascular disease and cancer

We don’t yet have these kinds of studies looking at the potential benefits of the paleo diet.  I’m talking about hard clinical endpoints such as heart attacks, heart failure, cardiac deaths, and overall deaths.  The paleo diet definitely shows some promise.

I also note the Swedish investigators didn’t point out that weight loss in overweight heart patients may be detrimental.  This is the “obesity paradox,” called “reverse epidemiology” at Wikipedia.  That’s a whole ‘nother can o’ worms.

Keep your eye on the paleo diet.

Steve Parker, M.D.

Reference: Jonsson, Tommy, et al.  A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart diseaseNutrition and Metabolism, 2010, 7:85.

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Unleashing “Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet”

My idea behind this blog has been to create an adaptation of the healthy Mediterranean diet for people with type 2 diabetes.  The Mediterranean diet alone has too many carbohydrates for the average diabetic. 

The initial adaptation has been done and available free here for many months.  The whole shebang is now available in book and ebook form, entitled Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet

You’ll find the printed version at Amazon.com and CreateSpace.  The ebook is available in multiple formats at Smashwords, and the Kindle version is at the Kindle Store.

Compared with jumping from page to page at this website and using your own printer, the book’s a pretty good deal.  It runs $16.95 (USD) at Amazon, and the ebook is $9.99.

What’s In the Book?

 Here’s the news release:

Dr. Steve Parker has created the first-ever low-carbohydrate Mediterranean diet, designed for people with type 2 diabetes and prediabetes.  His science-based plan blends the healthy components of the traditional Mediterranean diet with the ease and effectiveness of low-carb eating.  Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet teaches how to lower blood sugars naturally, reduce or eliminate diabetic medications, and lose excess weight if needed.

Type 2 diabetics and prediabetics have lost the ability to process carbohydrates safely.  Carbohydrates have become poisonous for them.  Carb toxicity too often leads to numb and painful limbs, impaired vision, kidney failure, amputations, cancer, and premature heart attacks, strokes, and death.

Nutrition experts worldwide agree that the Mediterranean diet is the healthiest way of eating for the general public.  It prolongs life and reduces rates of heart attack, stroke, cancer, and dementia.  The only problem for diabetics is that it provides too many toxic carbohydrates.

Dr. Parker initially recommends a very-low-carb ketogenic diet for 12 to 18 weeks, then teaches the reader how to gradually add more healthy carbohydrates depending on blood sugar and body weight changes.  Due to the toxic nature of carbohydrates in people with impaired blood sugar metabolism, most diabetics won’t be able to tolerate more than 80-100 grams of carbohydrate daily.  (The average Western diet provides 250 grams.)  

The book provides recipes, a week of menus, instruction on exercise, discussion of all available diabetic medications, advice on prevention of weight regain, lists of delicious doctor-approved foods, 71 scientific references, an annotated bibliography, and an index. All measurements are given both in U.S. customary and metric units.

Steve Parker, M.D., is a leading medical expert on the Mediterranean diet and author of the award-winning Advanced Mediterranean Diet: Lose Weight, Feel Better, Live Longer.   He has over two decades’ experience practicing Internal Medicine and treating patients with diabetes and prediabetes.

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Using Hemoglobin A1c to Diagnose Diabetes

In July, 2009, an expert committee composed partially of representatives from the American Diabetes Association proposed that hemoglobin A1c be used as a diagnostic test for diabetes in non-pregnant adults and children. 

The expert committee proposed that diabetes is present when hemoglobin A1c is 6.5% or greater.  The test should be repeated for confirmation unless the individual has clear symptoms of diabetes.

The committee also recommended that the term “prediabetes” be phased out.  They indicated that a person with hemoglobin A1c of at least 6% but less that 6.5% is at risk (high risk?) of developing diabetes, yet they don’t want to give that condition a name (such as prediabetes). 

In December, 2009, the American Diabetes Association established a hemoglobin A1c criterion for the diagnosis of diabetes: 6.5% or higher.  Diagnosis of prediabetes involves hemoglobin A1c between 5.7 and 6.4%.  These numbers don’t apply to pregnant women. 

Previously established  blood sugar criteria can also be used to diagnose diabetes and prediabetes.

This step is a major change in the diagnosis of diabetes.   

Steve Parker, M.D.

Reference:  International Expert Committee.  International Expert Committee report on the role of the A1c assay in the diagnosis of diabetesDiabetes Care, 32 (2009): 1-8.

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Prediabetes Ignored Way Too Often

Only half of Americans with prediabetes take steps to avoid progression to diabetes, according to a recent report in the American Journal of Preventive Medicine.

Prediabetes is defined as:

  1. fasting blood sugar between 100 and 125 mg/dl (5.56–6.94 mmol/l) or
  2. blood sugar level 140–199 mg/dl (7.78–11.06 mmol/l) two hours after drinking 75 grams of glucose

Prediabetes is a strong risk factor for development of full-blown diabetes.  It’s also associated with increased risk for cardiovascular disease such as heart attack and stroke.  One of every four adults with prediabetes develops diabetes over the next 3 to 5 years.  The progression can often be prevented by lifestyle modifications such as dietary changes, moderate-intensity exercise, and modest weight loss.  

Investigators looked at 1,402 adult participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) who had fasting blood sugar tests and oral glucose tolerance tests diagnostic of  prediabetes.  

The researchers estimate that 30% (almost one out of every three) of the adult U.S. population had prediabetes in 2005-2006, but only 7% of them (less than one in 10) were aware they had it.

Only half of the prediabetics in this survey reported attempts at preventative lifestyle changes in the prior year.  Only one of every three prediabetics reported hearing about risk reduction advice from their healthcare provider.

People, we’ve got to do better! 

My fellow physicians, we’ve got to do better!

The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in 2000 will develop diabetes.  The great majority of this will be type 2 diabetes.  You understand now why James Hirsch, author of Cheating Destiny, calls diabetes America’s leading public health crisis.  I agree.

Steve Parker, M.D.

Reference:  Geiss, Linda S., et al.  Diabetes risk reduction behaviors among U.S. adults with prediabetesAmerican Journal of Preventive Medicine, 38 (2010): 403-409.

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Filed under Causes of Diabetes, coronary heart disease, Overweight and Obesity, Prevention of T2 Diabetes, Stroke, Weight Loss