Category Archives: Diabetes

Is Hypertension a True Risk Factor for Serious Illness from #COVID19? #Coronavirus

“I’ll practice extreme social distancing even after house-arrest is lifted for others.”

BREAKING NEWS: Gray hair is a risk factor for serious COVID-19 infection.

I keep reading that hypertension (high blood pressure) makes one vulnerable to COVID-19. For instance, many patients hospitalized in New York  had hypertension. The implication is that something about hypertension weakens your immune system such that you’re more likely to die.

In the study linked above, average age of all hospitalized was 63. Fifty-seven percent of them had hypertension. Most healthcare providers know that the prevalence of hypertension rises with age. So you’d expect lots of 63-year-olds to have hypertension. At least 25% of them, right?

With just ten seconds of googling, I found that the prevalence of hypertension in the U.S. for those 60 and older is 63%. I fully expect my blood pressure would be higher than it is now if I lived in New York City, which I’ll never do.

If you’re 63-years-old and hospitalized in New York City for anything, odds are you’re likely to have hypertension. Just like you’re more likely to have gray hair than someone younger. Hypertension and gray hair are incidental markers for advancing age. They don’t per se increase your risk of serious illness from COVID-19.

Now, that being said, be aware that uncontrolled hypertension can damage some major organs that are important for health and longevity. That’s why we treat it. That damage can weaken your heart, kidneys, arteries, and brain. You need those systems to help you fight off any serious infection, not just COVID-19. If you already have organ damage from uncontrolled hypertension, I’ll bet that increases your chances of a bad outcome from any serious infection. Regarding hypertension and function of the immune system, I’m not aware of any good data or connection.

My first link above was to a JAMA Network article detailing the co-morbidities of over 5,000 New York City area residents hospitalized with COVID-19. A few other data points from it:

  • 42% were obese. What’s the obesity rate for 63-year-olds in New York City? I don’t know. Among all adults in New York state, the prevalence of obesity is 28%. This is about 3 points lower than the national average.
  • 34% had diabetes. The study authors don’t make it easy to find, but I bet this is mostly type 2 diabetes. I don’t know the prevalence of diabetes in New York City. In the U.S. overall, among those 65 or older, the prevalence of diabetes is 27%. I’d say at least 90% of that is type 2 diabetes. That 27% includes the 5% who don’t know they have it.
  • Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. Those mortality rates are scary high, but let’s not put too much emphasis on them yet since some of these folks were still in the hospital at the time the report was prepared.

Tracheal intubation in prep for mechanical ventilation

Bottom Line

If I were a 30-years-old and had well-controlled hypertension or gray hair, I wouldn’t worry much about my risk of COVID-19. On the other hand, if I were obese, I’d work on fixing that, starting NOW. Regarding diabetes, if you can’t cure it, keep it under control.

Steve Parker, M.D.

PS: Did you know the definition of hypertension changes over time? Even the one below is outdated. The linked CDC report above used this definition:

Hypertension: Systolic blood pressure greater than or equal to 140 mmHg or diastolic blood pressure greater than or equal to 90 mmHg, or currently taking medication to lower high blood pressure.

PPS: Admittedly, “60 and older” includes 93-year-olds.   You may argue that the incidence of hypertension among 93-year-olds is 85% compared to 45% in 60-70 year-olds. Please do the research and show your work. I’m out of time.

PPPS: Overall prevalence of hypertension in the U.S. is 29%. Curious about the incidence of hypertension in other U.S. age groups?

  • age group 18-39: 7.5%
  • age 40-59: 33.2%
  • 60 and over: 63.1%
Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Click pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

Ketogenic Diet: Evidence for Optimism From Dr David Ludwig

Sous vide chicken and sautéed sugar snap peas. This meal is allowed on a ketogenic diet.

From The Journal of Nutrition:

Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.

Source: Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

PS: If you have the 2nd edition of The Advanced Mediterranean Diet, you already have the Ketogenic Mediterranean Diet.

Click pic to purchase book at Amazon.com. E-book versions are also at Smashwords.com.

Is Type 2 Diabetes Caused by Ultra-Processed Foods?

 

One example of UPF

A recent observational study done in France found an association between incidence of type 2 diabetes and consumption of ultra-processed foods.

What are ultra-processed foods? From the study at hand, “Ultraprocessed foods (UPF) (ie, foods undergoing multiple physical, biological, and/or chemical processes, among which mostly of exclusive industrial use, and generally containing food additives) are widespread worldwide and especially in Western diets, representing between 25% and 60% of total daily energy [calories].”

These results suggest an association between UPF consumption and type 2 diabetes risk. They need to be confirmed in large prospective cohorts in other settings, and underlying mechanisms need to be explored in ad hoc epidemiological and experimental studies. Beyond nutritional factors, nonnutritional dimensions of the diet may play a role in these associations, such as some additives, neoformed contaminants, and contact materials. Even if a causal link between UPF and chronic diseases cannot be established so far, the accumulation of consistent data leads public health authorities in several countries such as France or Brazil to recommend privileging the consumption of unprocessed/minimally processed foods, and limiting the consumption of UPF in the name of the precautionary principle.

Source: Ultraprocessed Food Consumption and Risk of Type 2 Diabetes Among Participants of the NutriNet-Santé Prospective Cohort | Lifestyle Behaviors | JAMA Internal Medicine | JAMA Network

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Intermittent Fasting Is Probably Good For You

Eating within a 10-hour window shouldn’t be too hard. Breakfast at 7 AM, finish dinner by 5 PM. That’s right, we don’t need to be eating every 3–4 hours. Do you think our ancestors over the last 200,000 years have been eating three meals a day? I don’t. The probably went 24–48 hrs without much food on a regular basis.

From LA Times:

In an early effort to explore the benefits of daily fasting in humans, researchers have found that people who are at high risk of developing diabetes improved their health in myriad ways when they ate all of their meals over a span of just over 10 hours, then fasted for the remainder of their 24-hour day.

Source: Variant of intermittent fasting improved health in new study – Los Angeles Times

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

Prediabetes Is a Problem for U.S. Adolescents and Young Adults

Great exercise but with risk of concussions, broken bones, and torn menisci

Obesity is a risk factor for type 2 diabetes in adults and also plays a significant role in the development of the disease at younger ages. Obesity is highly prevalent among US adolescents and young adults. Many adolescents and young adults with obesity already have blood sugar metabolism abnormalities, which is of great public health concern in view of the sharp increase in type 2 diabetes in adolescence.

From JAMA Network:

In the United States, about 1 of 5 adolescents and 1 of 4 young adults have prediabetes. The adjusted prevalence of prediabetes is higher in male individuals and in people with obesity. Adolescents and young adults with prediabetes also present an unfavorable cardiometabolic risk profile, putting them both at increased risk of type 2 diabetes and cardiovascular diseases.

Source: Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016 | Adolescent Medicine | JAMA Pediatrics | JAMA Network

Steve Parker, M.D.

PS: Regular exercise and loss of excess fat weight are two great ways to prevent both prediabetes and type 2 diabetes. They also help with treatment.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

A practical guide to the Mediterranean diet – From Harvard

There are myriad reasons the traditional Mediterranean diet is considered one of the healthiest diets. From Harvard Medical Publishing, an article written by a Registered Dietitian:

The Mediterranean diet has received much attention as a healthy way to eat, and with good reason. The Mediterranean diet has been shown to reduce risk of heart disease, metabolic syndrome, diabetes, certain cancers, depression, and in older adults, a decreased risk of frailty, along with better mental and physical function. In January [2019], US News and World Report named it the “best diet overall” for the second year running.

Source: A practical guide to the Mediterranean diet – Harvard Health Blog – Harvard Health Publishing

Ready to get started? Click the link above.

Ready to lose weight and start a fitness program, too? Click the pic below.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com.

 

Substitution of Tea or Coffee for Sugar-Sweetened Beverages Linked to Lower Type 2 Diabetes Incidence in Europe

Green tea

Sugar-sweetened beverages (SSBs) increase the risk of developing type 2 diabetes. If you want to avoid T2 diabetes, what should you substitute? The study at hand looked at milk, juice, coffee, and tea. Why not water?

From The Journal of Nutrition:

These findings indicate a potential benefit of substituting coffee or tea for SSBs for the primary prevention of T2D and may help formulate public health recommendations on beverage consumption in different populations.

Source: Estimated Substitution of Tea or Coffee for Sugar-Sweetened Beverages Was Associated with Lower Type 2 Diabetes Incidence in Case–Cohort Analysis across 8 European Countries in the EPIC-InterAct Study | The Journal of Nutrition | Oxford Academic

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diets in one book, including the Ketogenic Mediterranean Diet

Mediterranean Diet Reduced Pregnancy-Related Diabetes and Weight Gain

You can read the whole study at PLOS. The conclusion:

A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain [but not by much] and the risk of gestational diabetes [by 35%].

Source: Mediterranean-style diet in pregnant women with metabolic risk factors (ESTEEM): A pragmatic multicentre randomised trial

PS: Don’t try to lose weight during pregnancy without professional help.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Eating Mediterranean Diet During Pregnancy Reduces Gestational Diabetes Risk

Wouldn’t be surprised if she had gestational diabetes.

From Newsweek:

Eating a Mediterranean diet while pregnant could prevent women at risk of gestational diabetes from developing the condition, a study has found.

The women who took part in the study followed a Mediterranean-style diet, by eating more nuts, extra virgin olive oil, fish, white meat and pulses; while cutting their levels of red meat, butter, margarine, and cream. Researchers also asked the women to avoid sugary drinks, fast food, and those high in animal fats.

Source: Eating Mediterranean Diet During Pregnancy Could Cut Gestational Diabetes Risk: Study

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com

Higher HemoblobinA1c Levels Linked to Cognitive Decline Over Time

HgbA1c (hemoglobin A1c) is a blood test that reflects average blood sugar levels over the previous three months. From a 2018 study:

In this community-based population, we observed a significant trend for cognitive decline over a 10 year period among individuals aged ≥50 years with normoglycaemia, prediabetes or diabetes at baseline. Additionally, HbA1c levels were linearly associated with subsequent cognitive decline in memory and executive function (but not orientation) irrespective of diabetes status at baseline.

Source: HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing | SpringerLink

h/t to Jan at The Low-Carb Diabetic

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Click the pic to purchase at Amazon.com in the U.S.