A half cup of sliced bell pepper has about 2 grams of digestible carbohydrate
Laura Dolson over at About.com has a helpful list of low-carb veggies. Helpful if you experience excessive blood sugar spikes from high-carb items, or if you’re restricting carbs for weight management.
-Steve
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Posted in Diabetes, Weight Loss
Tagged blood sugar, Laura Dolson, low-carb vegetables, weight management
Type 1 diabetics diagnosed in childhood and born between 1965 and 1980 have an average life expectancy of 68.8 years. That compares to a lifespan average of 53.4 years for those born earlier, between 1950 and 1964. The figures are based on Pittsburgh, PA, residents and published in a recent issue of Diabetes.
Elizabeth Hughes, one of the very first users of insulin injections, lived to be 73. She started on insulin around 1922.
Average overall life expectancy in the U.S. is 78.2 years—roughly 76 for men and 81 for women.
Don’t be too discouraged if you have diabetes: you have roughly a 50:50 chance of beating the averages, and medical advances will continue to lengthen lifespan.
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Tagged diabetic life expentancy, Elizabeth Hughes, type 1 diabetes, US life expectancy, US lifespan
From 1935 to 1996, the prevalence of diagnosed type 2 diabetes [in the U.S.] climbed nearly 765%.
This shocking statistic is from the Centers for Disease Control and Prevention as cited in Increased Consumption of Refined Carbohydrates and the Epidemic of Type 2 Diabetes in the United States: an Ecologic Assessment, American Journal of Clinical Nutrition, 2004, vol. 79, no.5, pp: 774-779.
I thought 765% might be a misprint, so I did some digging. A similar figure is in DHHS Publication No. (PHS) 82-1232 published in 1981:
This is a six-fold increase. The major part of the upward trend started in 1960. Interestingly, that’s when corn syrup started working its way into our food supply. Coincidence? The authors of the Department of Human Services paper write:
Preliminary evaluation of these trends suggests that the change in the prevalence of known diabetes has resulted from improvements both in detection of diabetes among high-risk groups and in survivorship among persons with diabetes.
Like type 1 diabetics, many type 2’s need insulin shots
To me, it sounds like they weren’t considering an true increase in the number of new diabetes cases (incidence), but better detection of existing cases and improved longevity of existing patients (prevalence). Incidence and prevalence are often confusing. Wikipedia has a clarifying article. These days, both incidence and prevalence of type 2 diabetes are greatly increased over 1935 levels.
In January of 2011, the U.S. Centers for Disease Control and Prevention released the latest estimates for prevalence of diabetes and prediabetes.
Even if type 2 diabetes runs in your family, you may well be able to avoid it. Here’s a post about prevention of type 2 diabetes.
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Posted in Diabetes
Tagged diabetes prevalence over time, diabetes prevention, type 2 diabetes, US diabetes incidence, US diabetes prevalence
Elizabeth Woolley reviews most of them at her About.com column on type 2 diabetes. I don’t endorse everything there; just thought you might be interested.
I still see doctors at the hospital order “ADA diet” (American Diabetes Association) for their patients with diabetes.
There is no ADA diet.
-Steve
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Posted in Diabetes
Tagged diabetes, diabetic diet, Elizabeth Woolley
In June, 2012, the journal Pediatrics had an article stating that the incidence of diabetes and prediabetes in U.S. adolescents increased from 9% in 1999 to 23% in 2008. The finding is based on the NHANES survey of 12 to 19-year-olds, which included a single fasting blood sugar determination.
The investigators offered no solution to the problem. I’m no pediatrician, but my guess is that the following measures would help prevent adolescent type 2 diabetes and prediabetes:
PS: I scanned the article quickly and don’t remember if the researchers broke down the diabetes cases by type 1 and type 2. I’d be shocked if type 1 diabetes rose this much over the last decade.
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Posted in Diabetes, Low-Carb Mediterranean Diet
Tagged adolescent diabetes, adolescent prediabetes, diabetes prevention, Mediterranean diet
![MPj04031620000[1]](https://diabeticmediterraneandiet.files.wordpress.com/2009/10/mpj040316200001.jpg?w=172&h=117 "MPj04031620000[1]")
Nut consumption is strongly linked to reduced coronary heart disease, with less rigorous evidence for several other health benefits, according to the American Journal of Clinical Nutrition.
This is why I’ve included nuts as integral components of the Ketogenic Mediterranean Diet and the Advanced Mediterranean Diet.
Regular nut consumption is associated with health benefits in observational studies of various populations, within which are people eating few nuts and others eating nuts frequently. Health outcomes of the two groups are compared over time. Frequent and long-term nut consumption is linked to:
The heart-protective dose of nuts is three to five 1-ounce servings a week.
Reference: Sabaté, Joan and Ang, Yen. Nuts and health outcomes: New epidemiologic evidence. American Journal of Clinical Nutrition, 89 (2009): 1,643S-1,648S.
Posted in Coronary Heart Disease, Diabetes, Nuts
Tagged coronary heart disease, diabetes, nuts
At the beginning of my 30-year medical career, egg consumption was condemned as a cause of heart attacks. Heart attacks can kill. How did eggs kill? It was thought to be related to the cholesterol content – 200 mg per egg – leading to higher serum cholesterol levels, which clogged arteries (atherosclerosis), leading to heart attacks.
Fifteen years ago the pendulum began to swing the other direction: Egg consumption didn’t seem to matter much, if at all.
The evidence is usually collected in observational, epidemiologic studies of large groups of people. The groups are analyzed in terms of overall health, food intake (e.g., how many eggs per week), healthy lifestyle factors, etc. Egg consumption of the group is broken down, for example, into those who never eat eggs, eat 1-4 eggs per week, eat 5-10 per week, or over 10 eggs weekly. A group is followed and re-analyzed over 10-20 years and rates various diseases and causes of death are recorded. Researchers don’t follow just 25 people like this over time. You need thousands of participants to find statistically significant differences.
The debate about eggs was re-opened (although never really closed) by the publication in April, 2008, of an article in The American Journal of Clinical Nutrition. Scientists of the Physicians’ Health Study suggest that consumption of seven or more eggs weekly is associated with significantly increased risk, over 20 years, of all-cause mortality. Interestingly, this level of consumption did not cause heart attacks or strokes. Study participants, by the way, were 21,327 Harvard-educated male physicians. 5,169 deaths occurred during 20 years of follow-up. If you’re not a Harvard-educated male physician, the study results may not apply to you.
When physicians with diabetes – type 2’s mostly, I assume – were analyzed separately, consumption of even less than seven eggs per week was associated with higher all-cause mortality.
Several other observational studies looking at this same issue have found no association between egg consumption and cardiovascular disease, heart attacks, and all-cause mortality.
Bottom line? If you worry about egg consumption, limit to 7 or less per week. If you have type 2 diabetes, consider limiting to 4 or less per week.
I wouldn’t be surprised if a study were published next week saying “eat as many eggs as you want; they don’t have adverse health effects.”
Remember, all the cholesterol is in the yolk. Try making an omelet using the whites only. But in our lifetimes you’ll never see an observational study looking at egg white consumption and mortality rates.
I’m still not convinced egg consumption is worth losing sleep over. “More studies are needed…”
Steve Parker, M.D.References:
Posted in Coronary Heart Disease, Diabetes, Longevity
Tagged cholesterol, death, eggs, heart attacks
The traditional Mediterranean diet has long been associated with lower risk of developing cardiovascular disease, cancer, and dementia. The diet is rich in olive oil, fruits, nuts, cereals, vegetables, and fish but relatively low in dairy products and meat. Several studies suggest the Mediterranean diet may also help prevent type 2 diabetes.
Researchers at the University of Navarra in Spain followed 13,380 non-diabetic university graduates, many of them health professionals, over the course of 4.4 years. Average age was 38. I assume most of the study participants lived in Spain, if not elsewhere in Europe (the article doesn’t say). Dietary habits were assessed at the start of the study with a food frequency questionnaire. Food intake for each participant was scored by adherence to the traditional Mediterranean diet. Participants were labelled as either low, moderate, or high in adherence. Over an average follow-up of 4.4 years, 33 of the study participants developed type 2 diabetes. Compared to the participants who scored low on adherence to the Mediterranean diet, those in the high adherence category had an 83% lower risk of developing diabetes. The moderate adherence group also had diminished risk, 59% less.
How could the Mediterranean diet protect against diabetes? The authors note several potential mechanisms: high intake of fiber, low amounts of trans fats, moderate alcohol intake, high vegetable fat intake, and high intake of monounsaturated fats relative to saturated fats. Olive oil, loaded with monounsaturated fats, is the predominant fat in the Mediterranean diet. In summary from the authors:
Diets rich in monounsaturated fatty acids improve lipid profiles and glycaemic control in people with diabetes, suggesting that a high intake improves insulin sensitivity. Together these associations suggest the hypothesis that following an overall pattern of Mediterranean diet can protect against diabetes. In addition to having a long tradition of use without evidence of harm, a Mediterranean diet is highly palatable, and people are likely to comply with it.
Please give serious consideration to the Mediterranean diet, especially if you are at risk for developing type 2 diabetes. Major risk factors include sedentary lifestyle, overweight, and family history of diabetes.
Steve Parker, M.D.
I often talk to people interested in improving their health or losing weight via lifestyle modification, mostly changes in diet and exercise. Many of them are motivated by health-related facts. Here is a smattering of facts I compiled in 2008 (so some are outdated), starting out worrisome and ending hopeful:
65% of U.S. adults are overweight or obese. Half are overweight, half are obese.
12% of deaths in the U.S. are due to lack of regular physical activity – 250,000 deaths yearly.
11% of U.S. adults have diabetes mellitus.
24 million in the U.S. have diabetes. Another 57 million have pre-diabetes, a condition that increases your risk for diabetes.
23% of U.S. adults over 60 have diabetes.
85% of people with type 2 diabetes are overweight.
200,000 yearly deaths in the U.S. are due to obesity.
Excess body fat causes 14 to 20% of all cancer-related deaths in the U.S.
550,000 people die yearly of cancer in the U.S.
Obesity-related cancers in men: prostate and colorectal. Obesity-related cancers in women: endometrial (uterine), cervix, ovary, breast. Both sexes: kidney, esophageal adenocarcinoma.
20% of us in the U.S. will die of cancer.
Lifetime risk of developing invasive cancer in the U.S. is four in 10 (a little higher in men, a little lower in women).
At least one-half of high blood pressure cases are caused by excess body fat. Every 20 pounds of excess fat increases blood pressure by two to three points.
Peak aerobic power (a measure of physical fitness) decreases by 50% between age 20 and 65.
Middle-aged and older people through regular exercise can increase their aerobic power by 15 to 20%, equivalent to a 10 or 20-year reduction in biological age.
Regular aerobic exercise reduces blood pressure by 8 to 11 points.
Have you already had a heart attack? If so, regular exercise reduces the odds of fatal recurrence by 25% and adds two to three years to life.
The Mediterranean diet is associated with lower incidence of cancer (colon, breast, prostate, uterus), cardiovascular disease (e.g., heart attacks), and dementia (both Alzheimers and vascular types).
High fruit and vegetable consumption protects against cancer of the lung, stomach, colon, rectum, oral cavity, and esophagus. The protective “dose” is five servings a day.
Coronary artery disease is the cause of heart attacks and many cases of sudden cardiac death. Legume consumption lowers the risk of coronary artery disease. The protective dose is four servings of legumes a week.
Whole grain consumption is associated with reduced risk of coronary artery disease (e.g., heart attacks), lower risk of death, lower incidence of type 2 diabetes and several cancers. The protective dose is three servings a day.
The good news is that we can significantly reduce our risk of premature death and common illnesses such as high blood pressure, cancer, diabetes, coronary artery disease, and dementia. How? Weight management, diet modification, and physical activity.
Steve Parker, M.D.
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Posted in Diabetes, Exercise, Heart Disease, Longevity, Overweight & Obesity, Stroke
I’ve written about glycemic index (GI), glycemic load (GL), and glycemic diets in preparation for today’s post.
The concept of glycemic index was introduced by Jenkins et al in 1981 at the University of Toronto.
Studies investigating the association between disease risk and GI/GL have been inconsistent. By “inconsistent,” I mean some studies have made an association in one direction or the other, and other studies have not. Diseases possibly associated with high-glycemic diets have included diabetes, cardiovascular disease, cancer, gallbladder disease, and eye disease.
“Diet” in this post refers to a habitual way of eating, not a weight loss program.
Researchers with the University of Sydney (Sydney, Australia) identified the best-designed published research reports investigating the relationship between certain chronic diseases and glycemic index and load. The studied diseases were type 2 diabetes, coronary heart disease, stroke, breast cancer, colorectal cancer, pancreatic cancer, endometrial cancer, ovarian cancer, gallbladder disease, and eye disease.
Methodology
Literature databases were searched for articles published between 1981 and March, 2007. The researchers found 37 studies that enrolled 1,950,198 participants ranging in age from 24 to 76, with BMI’s averaging 23.5 to 29. These were human prospective cohort studies with a final outcome being occurrence of a chronic disease (not its risk factors). Twenty-five of the studies were conducted in the U.S., five in Canada, five Europe, and two in Australia. Ninety percent of participants were women [for reasons not discussed]. Food frequency questionnaires were used in nearly all the studies. Individual studies generated between 4 to 20 years of follow-up, and 40,129 new cases of target diseases were identified.
Associations between GI, GL, and risk of developing a chronic disease were measured as rate ratios comparing the highest with the lowest quantiles. For example, GI and GL were measured in the study population. The population was then divided into four groups (quartiles), reflecting lowest GI/GL to medium to highest GI/GL diets. The lowest GI/GL quartile was compared with the highest quartile to see if disease occurrence was different between the groups. Some studies broke the populations into tertiles, quintiles, deciles, etc.
Findings
Comparing the highest with the lowest quantiles, studies with a high GI or GL independently
Overall, high GI was more strongly associated with chronic disease than was high GL
So low-GI diets may offer greater protection against disease than low-GL diets.
Comments from the Researchers
They speculate that low-GI diets may be more protective than low-GL because the latter can include low-carb foods such as cheese and meat, and low-GI, high-carb foods. Both eating styles will reduce glucose levels after meals while having very different effects in other areas such as pancreas beta cell function, free fatty acid levels, triglyceride levels, and effects on satiety.
High GI and high GL diets, independently of known confounders, modestly increase the risk of chronic lifestyle-related diseases, with more pronounced effects for type 2 diabetes, coronary heart disease, and gallbladder disease.
Direct quotes:
. . . 90% of participants were female; therefore, the findings may not be generalizable to men.
There are plausible mechanism linking the development of certain chronic diseases with high-GI diets. Specifically, 2 major pathways have been proposed to explain the association with type 2 diabetes risk. First the same amount of carbohydrate from high-GI food produces higher blood glucose concentrations and a greater demand for insulin. The chronically increased insulin demand may eventually result in pancreatic beta cell failure, and, as a consequence, impaired glucose tolerance. Second, there is evidence that high-GI diets may directly increase insulin resistance through their effect on glycemia, free fatty acids, and counter-regulatory hormone secretion. High glucose and insulin concentrations are associated with increased risk profiles for cardiovascular disease, including decreased concentrations of HDL cholesterol, increased glycosylated protein, oxidative status, hemostatic variables, and poor endothelial function
Low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases. In diabetes and heart disease, the protection is comparable with that seen for whole grain and high fiber intakes. The findings support the hypothesis that higher postprandial glycemia is a universal mechanism for disease progression.
My Comments
Studies like this tend to accentuate the differences in eating styles since they compare the highest with the lowest post-prandial (after meal) glucose levels. Most people are closer to the middle of the pack, so a person there has potentially less to gain by moving to a low-GI diet. But still some to gain, on average, particularly in regards to avoiding type 2 diabetes and coronary heart disease.
(To be fair, many population-based studies use this same quantile technique. It increases the odds of finding a statistically significant difference.)
Only two of the 37 studies examined coronary heart disease, the cause of heart attacks. One study was the massive Nurses’ Health Study database with 75,521 women. The other was the Zutphen (Netherlands) Elderly Study which examined men 64 and older. Here’s the primary conclusion of the Zutphen authors verbatim:
Our findings do not support the hypothesis that a high-glycemic index diet unfavorably affects metabolic risk factors or increases risk for CHD [coronary heart disease] in elderly men without a history of diabetes or CHD.
So there’s nothing in the meta-analysis at hand to suggest that high-GI/GL diets promote heart disease in males in the general population.
However, the recent Canadian study in Archives of Internal Medicine found strong evidence linking CHD with high-glycemic index diets. Although not mentioned in the text of that article, Table 3 on page 664 shows that the association is much stonger in women than in men. Relative risk for women on a high-glycemic index/load diet was 1.5 (95% confidence interval = 1.29-1.71), and for men the relative risk was 1.06 (95% confidence interval = 0.91-1.20). See reference below.
Nine of the 37 studies examined the occurrence of type 2 diabetes. Only one of these studied men only – 42,759 men: the abstract is not available online and the Sydney group does not mention if high-GI or high-GL was positively associated with onset of diabetes in this cohort. Two of the diabetes studies included both men and women, but the abstracts don’t break down the findings by sex. (I’m trying to deduce if the major overall findings of this meta-analysis apply to men or not.)
I don’t know anybody willing to change their diet just to avoid the risk of gallstones. It’s only after they develop symptomatic gallstones that they ask me what they can do about them. The usual answer is surgery.
The report is well-done and seems free of commercial bias, even though several of the researchers are authors or co-authors of popular books on low-GI eating.
References:
Barclay, Alan W.; Petocz, Peter; McMillan-Price, Joanna; Flood, Victoria M.; Prvan, Tania; Mitchell, Paul; and Brand-Miller, Jennie C. Glycemic index, glycemic load, and chronic disease risk – a meta-analysis of observational studies [of mostly women]. American Journal of Clinical Nutrition, 87 (2008): 627-637.
Brand-Miller, Jennie, et al. “The New Glucose Revolution: The Authoritative Guide to the Glycemic Index – The Dietary Solution for Lifelong Health.” Da Capo Press, 2006.
Mente, Andrew, et al. A Systematic Review of the Evidence Supporting a Causal Link Between Dietary Factors and Coronary Heart Disease. Archives of Internal Medicine, 169 (2009): 659-669.
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Advanced Mediterranean Diet 