Tag Archives: type 2 diabetes

Mediterranean Diet Fights Inflammation In Type 2 Diabetes

 

Santorini, Greek seaside

Santorini, Greek seaside

Blood markers of inflammation in our bodies are linked to higher rates of type 2 diabetes. One such marker is C-reactive protein: the higher the CRP, the greater the risk of T2 diabetes. Another inflammatory marker is adiponectin, a protein secreted by fat cells. Adiponectin levels are inversely related to ongoing inflammation: higher levels of adiponectin indicate lower levels of inflammation. Folks with higher adiponectin levels are at lower risk of type 2 diabetes.

Italian researchers affiliated with the MEDITA clinical trial took 215 men and women with newly diagnosed type 2 diabetes and randomized them to eat either a Mediterranean diet or a low-fat diet. Hemoglobin A1c and inflammatory markers were followed for up to eight years. (I’m not sure, but I think these were relatively mild diabetics from the get-go, probably with HgbA1c under 7%.)

At the end of year one, CRP dropped by 37% and adiponectin rose by 43% in the Mediterranean diet group. In other words, inflammatory markers moved in a healthful direction.

Levels in the low-fat group were unchanged.

For individual Mediterranean dieters who were deemed diet failures (HgbA1c over 7%) at one year, CRP levels were higher and adiponectin levels were lower than their counterparts without diet failure.

Values were also measured two and four years after baseline, but results are not easy to summarize, and I don’t give too much credence to a diet modification purported to last that long. After six to 12 months of a new diet, most folks drift back to their usual way of eating.

Grapes are a time-honored component of the Mediterranean diet

Grapes are a time-honored component of the Mediterranean diet

Action Plan

If you have type 2 diabetes or want to avoid it, consider a Mediterranean-style diet.

Steve Parker, M.D.

PS: Even if you think inflammation is important, you’ll find no shortage of chapters in my books.

Reference: Anti-inflammatory effect of Mediterranean diet in type 2 diabetes is durable: 8-year follow-up of a controlled trial. Diabetes Care, 2016. doi: 10.2337/dc15-2356

low-carb mediterranean diet

Front cover of book

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David Mendosa Loves Chana Dal

Indian woman cooking chapati

Indian woman cooking chapati, a type of wheat-based bread

Chana’s not a woman’s name.

Chana dal is a particular legume popular in India. It seems to be a variety of chickpea. Dal is an Indian term for legumes: beans and peas. A serving of most legumes has a relatively high carbohydrate count, which could spike blood sugar too high if you have diabetes.

David Mendosa has type 2 diabetes. As far as I know, he’s still a vegetarian, but somehow manages to restrict dietary carbohydrates. He notes that regardless of carb grams, chana dal has very little effect on his blood sugar. Maybe that’s because of relatively high fiber content. Chana dal’s glycemic index is only eight, which is very low, especially for a legume.

You may be aware that a third or so of Indians in India are vegetarian of one stripe or another. Dals (legumes) are a very important source of protein for them. Dals are usually consumed with meals that include bread or rice.

Chana dal is a Hindi word. The British English equivalent is Bengal gram dal. In Bengali, it’s chholar dal. BTW, over 50 languages are spoken in India.

The nutritional analysis of chana dal is a matter of some debate. Here’s one that David found. In 100 g of dry chana dal:

  • 3.7 g fat
  • 25.4 g protein
  • 47.4 g carbohydrate3.2 g ash (inorganic material, such as minerals)
  • 11.2 g crude fiber
  • 327 calories

See David’s post for much more detail, including recipes and sources of chana dal. I think he’s been working on this post since 2001 and has revised it several times. He notes that in recipes calling for garbanzo beans (aka chickpeas), chana dal can be substituted. (I assume garbanzo beans have a much higher glycemic index.)

If you’ve had chana dal or try it in the future, I’d love to hear your comments on it, especially how it affected your serum glucose levels.

Steve Parker, M.D.

PS: If this post is closed for comments, you can reach me at steveparkermd (at) gmail (dot) com.

 

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What About a Low-Carb Vegetarian Diet for Diabetes?

Spaghetti squash with parsley, olive oil, snow peas, garlic, salt, pepper

Spaghetti squash with parsley, olive oil, snow peas, garlic, salt, pepper

It works for David Mendosa, who’s been doing it for three years. He shares some ideas on how to do it at the link below. From the intro:

About nine years ago, I started to eat only food low in carbohydrates that don’t have a high glycemic index.  I knew that this was the only proven way to bring my blood glucose level down where I wanted it to be without using drugs or supplements. My most recent A1C test showed that my level is 5.1 percent, well within the range considered normal.

While continuing to eat this way, about three years ago I added the further restriction of eating no meat, fish, or seafood. This was a substantial shift in what I was eating, and I made it mainly because I don’t want to be intentionally responsible for the death of animals or other sentient beings. Only later did I begin to realize its health benefits.

Source: How to Manage Your Diabetes with a Low-Carb Vegetarian Diet – Diabetes

David seems to adhere to the lacto-ovo strain of vegetarianism, rather than vegan or pesco-vegetarian. In other words, he’ll eat eggs and milk products but not fish. I suspect he eats under 40 grams/day of digestible carbohydrate.

Here are more of David’s ideas on implementation of a very low-carb vegetarian diet.

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No Clear Survival Differences Seen Between Diabetes Drugs

"How about this one?"

“How about this one?”

A multinational group of researchers tried to determine which drugs for type 2 diabetes were better at prolonging life and preventing cardiovascular deaths. They reviewed the existing literature (i.e., they did a meta-analysis of prior clinical studies.

There are no clear winners. Placebo worked as well as the eight drug classes examined!

Unfortunately, the abstract doesn’t say how long the clinical studies lasted, only mentioning that they were at least 24 weeks long. It’s quite possible it would take at least three to five years to see an effect on death rates.

Click the source link at the bottom of the page for details at MPT.

Selected quotes:

“Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.Researchers analyzed 301 randomized clinical trials of patients with type 2 diabetes, and found that, metformin outperformed some other drug classes for its effect on hemoglobin A1c levels, there were no significant differences in mortality — including when placebo was included as a drug class.”

***

“A central finding in this meta-analysis was that despite more than 300 available clinical trials involving nearly 120,000 adults and 1.4 million patient-months of treatment, there was limited evidence that any glucose-lowering drug stratified by coexisting treatment prolonged life expectancy or prevented cardiovascular disease,” the authors wrote.”

***

“The authors wrote that their findings are consistent with guidelines from the American Diabetes Association, which — like the algorithm from the American Association of Clinical Endocrinologists — recommend that metformin monotherapy be used for the initial treatment of patients with type 2 diabetes. “Based on this review, clinicians and patients may prefer to avoid sulfonylureas or basal insulin for patients who wish to minimize hypoglycemia, choose GLP-1 receptor agonists when weight management is a priority, or consider SGLT-2 inhibitors based on their favorable combined safety and efficacy profile,” the authors wrote.”

Source: No Clear Survival Benefit Seen Among Diabetes Drugs | Medpage Today

Open wide!

Open wide!

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“The World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: The Keto Diet”

Odd cover, huh?

Odd cover, huh?

Men’s Fitness has an article extolling the virtues of ketogenic diets, particularly as they relate to athletic performance. Sadly, the piece doesn’t mention my Ketogenic Mediterranean Diet, which is incorporated into The Advance Mediterranean Diet (2nd ed.) and Conquer Diabetes and Prediabetes.

The article focuses on Professor Timothy Noakes (who also has an M.D. degree. Some quotes:

“Noakes’s war on sugar goes back a generation, to when his father developed type-2 diabetes. Type-2 is a disease in which the body gradually loses its ability to regulate blood sugar through the production of the hormone insulin. It’s linked to genetics, but also to diet—particularly sugar and refined carbs—as well as obesity and inactivity. Diabetes experts estimate that the disease speeds up the aging process by roughly a third, damaging the body from the inside out. Too much blood sugar slowly destroys blood vessels, with results ranging from mild—early wrinkling of skin—to catastrophic: heart disease, blindness, stroke, amputations due to poor circulation, and even Alzheimer’s disease (more on that later).

Noakes’ father eventually died from type-2, but because Noakes himself followed a low-fat diet, exercised regularly (he’s run upward of 70 marathons, as well as a handful of ultras), and didn’t smoke, he figured he’d be spared. To be sure, as he got older he put on some weight, and his energy sagged, but he was in good shape.

Regardless, in 2010, Noakes was diagnosed with type-2 diabetes. Though he didn’t know it yet, a lifetime of well-intentioned carbo- loading for his athletic endeavors had set him up for a fall.”

Source: The Truth Behind the World’s Most Cutting-Edge Fat-Burning Performance Meal Plan: The Keto Diet

CDP front cover_Amazon

AMD-2-EBook-Front Cover

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Are These Two Diabetes Drugs Better Than the Others?

Better living through chemistry

Empagliflozin is a pill. Liraglutide is a once-daily subQ injection.

The two drugs in question are empagliflozin (aka Jardiance) and liraglutide (aka Victoza). Both are used to treat type 2 diabetes, not type 1.

A major problem we have with most diabetes drugs is that while they do lower blood sugars, we don’t have much evidence on whether they actually prolong life and prevent bad outcomes like heart attacks, strokes, cancer, blindness, kidney failure, amputations, and serious infections. It gets even more complicated. For instance, a given drug may eventually be proven to prolong life by a year via prevention of death from heart disease, while at the same time increasing the risk of spending that last year bedridden from a stroke.

It’s extremely difficult and costly to suss out these issues. It requires large clinical trials wherein half of the PWDs (people with diabetes) are treated with a particular drug, and the other half are treated with “standard therapy.” Five or 10 years later you compare clinical endpoints between the two groups. A couple studies have done this recently.

A blogger I follow, Larry Husten, wrote the following:

But it was the secondary goal of these trials that led to the transformation of the field. Baked into the trial design was the provision that if they were able to establish noninferiority then the trial investigators were permitted to test for superiority. The second phase began when Empa-Reg became the first trial to convincingly show a clear benefit, including a reduction in cardiovascular death and a reduction in hospitalization for heart failure. with empagliflozin (Jardiance, Merck). Then, more recently, the LEADER trial showed a significant reduction in cardiovascular events with liraglutide (Victoza, Novo Nordisk). In both trials nearly all the patients had significant established cardiovascular disease—precisely the population that cardiologists are likely to see.

Click the embedded links above for more details. Even better, read the original research reports if you have the time and knowledge. I support my family with a full-time job taking care of patients, so it will be a while (if ever) before I can dig into this further. (When my book sales make me independently wealthy, I’ll have more time for this!)

diabetic diet, low-carb Mediterranean Diet, low-carb, Conquer Diabetes and Prediabetes

Analyzing clinical reports requires a good grasp of logic, statistics, and basic science

Are the LEADER and Empa-Reg trials valid? Yeah, maybe. In an ideal world, other investigators would try to replicate the results with additional clinical trials. Are the published results free of fraud and bias? I don’t know.

Because we don’t know the long-term effects of many of our diabetes drugs, I favor doing as much as possible to control blood sugars with diet, exercise, and weight management.

Stay tuned for future developments.

Steve Parker, M.D.

PS: Just because one drug in a class of drugs reduces bad clinical outcomes, it doesn’t mean all drugs in the class do.

PPS: If it’s hard for you to pronounce empagliflozin and liraglutide, some of my books don’t even have them.

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FDA Revises Guidelines for Use of Metformin In Those With Kidney Impairment

Conquer Diabetes and Prediabetes

Metformin is the most-recommended drug for type 2 diabetes

Recently the U.S. Food and Drug Administration revised their guidelines for physicians regarding use of metformin in patients with kidney impairment. This may make more patients candidates for the drug.

Physicians have been advised for years that type 2 diabetics with more than minimal kidney impairment should not be given metformin. Why? Metformin in the setting of kidney failure raises the risk of lactic acidosis.

The traditional test for kidney impairment is a blood test called creatinine. When kidneys start to fail, serum creatinine rises. Another way to measure kidney function is eGFR, which takes into account creatinine plus other factors.

By the way, you can’t tell about your kidney function simply from the way you feel; by the time you have signs or symptoms of renal failure until the process is fairly advanced.

The FDA now recommends not using  metformin if your eGFR (estimated glomerular function rate) is under 30 ml/min/1.73 m squared), and use only with extreme caution if eGFR drops below 45 while using metformin. Don’t start metformin if eGFR is between 30 and 45. Your doctor can calculate your eGFR and should do so annually if you take metformin.

Steve Parker, M.D.

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