Category Archives: Diabetes

Why Are Kidney Stones Increasingly Common?

Posted on May 25, 2012 | Comments Off on Why Are Kidney Stones Increasingly Common?

MedPage Today on May 24, 2012, reported a substantial increase (70%) in the prevalence of kidney stones in the U.S. over the last two decades. Stone prevalence rose from 5.2% to 8.8% of the population.  Prevalence was based on the periodic National Health and Nutrition Examination Survey, which asked participants, “Have you ever had kidney stones?”

Stone prevalence began rising even earlier.  Again according to the third NHANES, prevalence increased from 3.8 percent in the period 1976 to 1980 to 5.2 percent in the years 1988 to 1994.

Older studies estimated that one in 10 men and one of every 20 women will have at least one painful stone by the age of 70.

What are kidney stones make of?  

Three out of four patients with kidney stones form calcium stones, most of which are composed primarily of calcium oxalate or, less often, calcium phosphate.  Pure uric acid stones are less than 10 percent of all stones.

Why the increased stone prevalence?  Does diet count?

Unfortunately, the article doesn’t offer any reasons or even speculation as to why kidney stones are more prevalent.  Kidney stones have a genetic component, but our genes have changed very little over just two decades.  I have to wonder if diet plays a role.

UpToDate.com reviewed diet as a risk factor for kidney stones.  Some quotes:

There are several dietary factors that may play an important role in many patients: fluid, calcium, oxalate, potassium, sodium, animal protein, phytate, sucrose, fructose, and vitamin C intake. Lower intake of fluid, calcium, potassium, and phytate and higher intake of sodium, animal protein, sucrose, fructose, and vitamin C are associated with an increased risk for calcium stone formation. The type of beverage may also influence the risk. The effect of calcium intake is paradoxical, with a decreased risk with increased dietary calcium and an increased or no change in risk with calcium supplements.

The combination of dietary factors may also have a significant impact upon stone risk. As an example, the Dietary Approaches to Stop Hypertension (DASH) diet is high in fruits and vegetables, moderate in low-fat dairy products, and low in animal protein. Based upon an analysis of three large cohorts, adherence to a DASH-style diet lowered the risk for kidney stones among men, older women, younger women, high body mass index (BMI) individuals, and low BMI individuals. Thus, the DASH diet is a reasonable option in the attempt to reduce the risk of stone recurrence.

Higher sucrose [table sugar] intake is associated with an increased risk of stone formation in younger and older women.
Standard advice to prevent initial and recurrent kidney stones is to avoid low urine output.  Do that by drinking plenty of fluid.
Although I pay about $400 a year for access to UpToDate, they offer free public access to some of the website.  Here’s the UpToDate poop sheet on kidney stones.
Extra credit:  Medical conditions that predispose to kidney stones include primary hyperparathyroidism, obesity, gout, diabetes, and medullary sponge kidney.

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Dental Problems and Chronic Systemic Disease: A Carbohydrate Connection?

Posted on May 21, 2012 | 1 comment

Dentists are considering a return to an old theory that dietary carbohydrates first cause dental diseases, then certain systemic chronic diseases, according to a review in the June 1, 2009, Journal of Dental Research.

We’ve known for years that some dental and systemic diseases are associated with each other, both for individuals and populations. For example, gingivitis and periodontal disease are associated with type 2 diabetes and coronary heart disease. The exact nature of that association is not clear. In the 1990s it seemed that infections – chlamydia, for example – might be the unifying link, but this has not been supported by subsequent research.

The article is written by Dr. Philippe P. Hujoel, who has been active in dental research for decades and is affiliated with the University of Washington (Seattle). He is no bomb-throwing, crazed, radical.

The “old theory” to which I referred is the Cleave-Yudkin idea from the 1960s and ’70s that excessive intake of fermentable carbohydrates, in the absence of good dental care, leads both to certain dental diseases – caries (cavities), periodontal disease, certain oral cancers, and leukoplakia – and to some common systemic chronic non-communicable diseases such as coronary heart disease, type 2 diabetes, some cancers, and dementia. In other words, dietary carbohydrates cause both dental and systemic diseases – not all cases of those diseases, of course, but some.

Dr. Hujoel does not define “fermentable” carbohydrates in the article. My American Heritage Dictionary defines fermentation as:

  1. the anaerobic conversion of sugar to carbon dioxide and alcohol by yeast
  2. any of a group of chemical reactions induced by living or nonliving ferments that split complex organic compunds into relatively simple substances

As reported in David Mendosa’s blog at MyDiabetesCentral.com, Dr. Hujoel said, “Non-fermentable carbohydrates are fibers.” Dr. Hujoel also shared some personal tidbits there.

In the context of excessive carbohydrate intake, the article frequently mentions sugar, refined carbs, and high-glycemic-index carbs. Dental effects of excessive carb intake can appear within weeks or months, whereas the sysemtic effects may take decades.

Hujoel compares and contrasts Ancel Keys’ Diet-Heart/Lipid Hypothesis with the Cleave-Yudkin Carbohydrate Theory. In Dr. Hujoel’s view, the latest research data favor the Carbohydrate Theory as an explanation of many cases of the aforementioned dental and systemic chronic diseases. If correct, the theory has important implications for prevention of dental and systemic diseases: namely, dietary carbohydrate restriction.

Adherents of the paleo diet and low-carb diets will love this article; it supports their choices.

I agree with Dr. Hujoel that we need a long-term prospective trial of serious low-carb eating versus the standard American high-carb diet. Take 20,000 people, randomize them to one of the two diets, follow their dental and systemic health over 15-30 years, then compare the two groups. Problem is, I’m not sure it can be done. It’s hard enough for most people to follow a low-carb diet for four months. And I’m asking for 30 years?!

Dr. Hujoel writes:

Possibly, when it comes to fermentable carbohydrates, teeth would then become to the medical and dental professionals what they have always been for paleoanthropologists: “extremely informative about age, sex, diet, health.”

Dr. Hujoel mentioned a review of six studies that showed a 30% reduction in gingivitis score by following a diet moderately reduced in carbs. He mentions the aphorism: “no carbohydrates, no caries.” Anyone prone to dental caries or ongoing periodontal disease should do further research to see if switching to low-carb eating might improve the situation.

Don’t be surprised if your dentist isn’t very familiar with the concept. Has he ever mentioned it to you?

Steve Parker, M.D.

Reference: Hujoel, P. Dietary carbohydrates and dental-systemic diseases. Journal of Dental Research, 88 (2009): 490-502.

Mendosa, David. Our dental alarm bell. MyDiabetesCentral.com, July 12, 2009.

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Low-Carb Mediterranean Diet Beats Low-Fat For Recent-Onset Type 2 Diabetes

Posted on May 20, 2012 | 2 comments

A low-carbohydrate Mediterranean diet dramatically reduced the need for diabetic drug therapy, compared to a low-fat American Heart Association diet. The Italian researchers also report that the Mediterranean dieters also lost more weight over the first two years of the study.

Investigators suggest that the benefit of the Mediterranean-style diet is due to greater weight loss, olive oil (monunsaturated fats increase insulin sensitivity), and increased adiponectin levels.

The American Diabetes Association recommends both low-carbohydrate and low-fat diets for overweight diabetics. The investigators wondered which of the two might be better, as judged by the need to institute drug therapy in newly diagnosed people with diabetes.

Methodology

Newly diagnosed type 2 diabetics who had never been treated with diabetes drugs were recruited into the study, which was done in Naples, Italy. At the outset, the 215 study participants were 30 to 75 years of age, had body mass index over 25 (average 29.5), had average hemoglobin A1c levels of 7.73, and average glucose levels of 170 mg/dl.

Participants were randomly assigned to one of two diets:

  1. Low-carb Mediterranean diet (“MED diet”, hereafter): rich in vegetables and whole grains, low in red meat (replaced with poultry and fish), no more than 50% of calories from complex carbohydrates, no less than 30% of calories from fat (main source of added fat was 30 to 50 g of olive oil daily). [No mention of fruits. BTW, the traditional Mediterranean diet derives 50-60% of energy from carbohydrates.]
  2. Low-fat diet based on American Heart Association guidelines: rich in whole grains, restricted additional fats/sweets/high-fat snacks, no more than 30% of calories from fat, no more than 10% of calories from saturated fats.

Both diet groups were instructed to limit daily energy intake to 1500 (women) or 1800 (men) calories.

All participants were advised to increase physical activity, mainly walking for at least 30 minutes a day.

Drug therapy was initiated when hemoglobin A1c levels persisted above 7% despite diet and exercise.

The study lasted four years.

Results

By the end of 18 months, twice as many low-fat dieters required diabetes drug therapy compared to the MED dieters—24% versus 12%.

By the end of four years, seven of every 10 low-fat dieters were on drug therapy compared to four of every 10 MED dieters.

The MED dieters lost 2 kg (4.4 lb) more weight by the end of one year, compared to the low-fat group. The groups were no different in net weight loss when measured at four years: down 3–4 kg (7–9 lb).

Compared to the low-fat group, the MED diet cohort achieved significantly lower levels of fasting glucose and hemoglobin A1c throughout the four years.

The MED diet group saw greater increases in insulin sensitivity, i.e., they had less insulin resistance.

The MED group had significantly greater increases in HDL cholesterol and decreases in trigylcerides throughout the study. Total cholesterol decreased more in the MED dieters, but after the first two years the difference from the low-fat group was not significantly different.

Comments

The MED diet here includes “no more than 50% of calories from complex carbohydrates.” The authors don’t define complex carbs. Simple carbohydrates are monosaccharides and disaccharides. Complex carbs are oligosaccharides and polysaccharides. Another definition of complex carbs is “fruits, vegetables, and whole grains,” which I think is definition of complex carbs applicable to this study.

The editors of the Annals of Internal Medicine conclude that:

A low-carbohydrate, Mediterranean-style diet seems to be preferable to a low-fat diet for glycemic control in patients with newly diagnosed type 2 diabetes.

I’m sure the American Diabetes Association will take heed of this study when they next revise their diet guidelines. If I were newly diagnosed with type 2 diabetes, I wouldn’t wait until then.

This study dovetails nicely with others that show prevention of type 2 diabetes with the Mediterranean diet, reversal of metabolic syndrome—a risk factor for diabetes—with the Mediterranean diet (supplemented with nuts), and prevention of type 2 diabetes and pre-diabetes in people who have had a heart attack.

Studies like these support my Low-Carb Mediterranean Diet.

For general information on Mediterranean eating, visit Oldways.

Steve Parker, M.D.

Reference: Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.

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Alcohol Linked to Lower Risk of Type 2 Diabetes

Posted on May 19, 2012 | Comments Off on Alcohol Linked to Lower Risk of Type 2 Diabetes
Beautiful woman smiling as she is wine tasting on a summer day.

Judicious alcohol consumption is linked to lower risk of developing type 2 diabetes: 40% lower risk in women, 13% lower in men.

Why does this matter?

  • In 2009, 24 million in the U.S. had diabetes. Another 57 million had pre-diabetes, a condition that increases your risk for diabetes.

  • At least 23% of U.S. adults over 60 have diabetes.

In 2009, Diabetes Care reported the comparison of lifetime abstainers with alcohol drinkers. The protective “dose” of alcohol is 22–24 grams a day. I’ll leave it to you to figure out how much alcohol that is. Prior studies looking at overall health benefits of alcohol indicate that judicious consumption is ≤ one drink daily, on average, for women, and ≤ 2 drinks a day for men.

Of course, many people shouldn’t drink any alcohol.

Steve Parker, M.D.

Reference: Baliunas, D., et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 32 (2009): 2,123-2,132.

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Documented Health Benefits of the Mediterranean Diet

Posted on May 5, 2012 | Comments Off on Documented Health Benefits of the Mediterranean Diet

The enduring popularity of the Mediterranean diet is attributable to three things:

1.Taste

2.Variety

3.Health benefits

For our purposes today, I use “diet” to refer to the usual food and drink of a person, not a weight-loss program.

 

The scientist most responsible for the popularity of the diet, Ancel Keys, thought the heart-healthy aspects of the diet related to low saturated fat consumption.He also thought the lower blood cholesterol levels in Mediterranean populations (at least Italy and Greece) had something to do with it, too.Dietary saturated fat does tend to raise cholesterol levels.

 

Even if Keys was wrong about saturated fat and cholesterol levels being positively associated with heart disease, numerous studies (involving eight countries on three continents) strongly suggest that the Mediterranean diet is one of the healthiest around.See References below for the most recent studies.

 

Relatively strong evidence supports the Mediterranean diet’s association with:

■ increased lifespan

■ lower rates of cardiovascular disease such as heart attacks and strokes

■ lower rates of cancer (prostate, breast, uterus, colon)

■ lower rates of dementia

■ lower incidence of type 2 diabetes

 

 

Weaker supporting evidence links the Mediterranean diet with:

■ slowed progression of dementia

■ prevention of cutaneous melanoma

■ lower severity of type 2 diabetes, as judged by diabetic drug usage and fasting blood sugars

■ less risk of developing obesity

■ better blood pressure control in the elderly

■ improved weight loss and weight control in type 2 diabetics

■ improved control of asthma

■reduced risk of developing diabetes after a heart attack

■ reduced risk of mild cognitive impairment

■prolonged life of Alzheimer disease patients

■ lower rates and severity of chronic obstructive pulmonary disease

■ lower risk of gastric (stomach) cancer

■ less risk of macular degeneration

■ less Parkinsons disease

■ increased chance of pregnancy in women undergoing fertility treatment

■reduced prevalence of metabolic syndrome (when supplemented with nuts)

■ lower incidence of asthma and allergy-like symptoms in children of women who followed the Mediterranean diet while pregnant

Did you notice that I used the word “association” in relating the Mediterranean diet to health outcomes?Association, of course, is not causation.

 

The way to prove that a particular diet is healthier is to take 20,000 similar young adults, randomize the individualsin an interventional study to eat one of two test diets for the next 60 years, monitoring them for the development of various diseases and death.Make sure they stay on the assigned test diet.Then you’d have an answer for that population and those two diets.Then you have to compare the winning diet to yet other diets.And a study done in Caucasians would not necessarily apply to Asians, Native Americans, Blacks, or Hispanics.

 

Now you begin to see why scientists tend to rely on observationalrather than interventional diet studies.

 

I became quite interested in nutrition around the turn of the century as my patients asked me for dietary advice to help them lose weight and control or prevent various diseases.At that time, the Atkins diet, Mediterranean diet, and Dr. Dean Ornish’s vegetarian program for heart patients were all prevalent.And you couldn’t pick three programs with more differences!So I had my work cut out for me.

 

After much scientific literature review, I find the Mediterranean diet to be the healthiest for the general population.People with particular medical problems or ethnicities may do better on another diet. People with diabetes or prediabetes are probably better off with a carbohydrate-restricted diet, such as the Low-Carb Mediterranean Diet.

 

Dan Buettner makes a good argument for plant-based diets in his longevity book, The Blue Zones.The Mediterranean diet qualifies as plant-based.

 

Steve Parker, M.D.

 

     Sofi, Francesco, et al. Accruing evidence about benefits of adherence to the Mediterranean diet on health: an updated systematic review and meta-analysis. American Journal of Clinical Nutrition, ePub ahead of print, September 1, 2010. doi: 10.3945/ajcn.2010.29673

     Buckland, Genevieve, et al. Adherence to a Mediterranean diet and risk of gastric adenocarcinoma within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. American Journal of Clinical Nutrition, December 9, 2009, epub ahead of print. doi: 10.3945/ajcn.2009.28209

     Fortes, C., et al. A protective effect of the Mediterraenan diet for cutaneous melanoma. International Journal of Epidmiology, 37 (2008): 1,018-1,029.

Sofi, Francesco, et al. Adherence to Mediterranean diet and health status: Meta-analysis. British Medical Journal, 337; a1344. Published online September 11, 2008. doi:10.1136/bmj.a1344

     Benetou, V., et al. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. British Journal of Cancer, 99 (2008): 191-195.

Mitrou, Panagiota N., et al. Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population, Archives of Internal Medicine, 167 (2007): 2461-2468.

     Feart, Catherine, et al. Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. Journal of the American Medical Association, 302 (2009): 638-648.

Scarmeas, Nikolaos, et al. Physical activity, diet, and risk of Alzheimer Disease. Journal of the American Medical Association, 302 (2009): 627-637.

     Scarmeas, Nikolaos, et al. Mediterranean Diet and Mild Cognitive Impairment. Archives of Neurology, 66 (2009): 216-225.

Scarmeas, N., et al. Mediterranean diet and Alzheimer disease mortality. Neurology, 69 (2007):1,084-1,093.

     Fung, Teresa, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation, 119 (2009): 1,093-1,100.

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.

     Salas-Salvado, Jordi, et al. Effect of a Mediterranean Diet Supplemented With Nuts on Metabolic Syndrome Status: One-Year Results of the PREDIMED Randomized Trial. Archives of Internal Medicine, 168 (2008): 2,449-2,458.

     Mozaffarian, Dariush, et al. Incidence of new-onset diabetes and impaired fasting glucose in patients with recent myocardial infarction and the effect of clinical and lifestyle risk factors. Lancet, 370 (2007) 667-675.

     Esposito, Katherine, et al. Effects of a Mediterranean-style diet on the need for antihyperglycemic drug therapy in patients with newly diagnosed type 2 diabetes. Annals of Internal Medicine, 151 (2009): 306-314.

     Shai, Iris, et al. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. New England Journal of Medicine, 359 (2008): 229-241.

     Martinez-Gonzalez, M.A., et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. British Medical Journal, BMJ,doi:10.1136/bmj.39561.501007.BE (published online May 29, 2008).

     Trichopoulou, Antonia, et al. Anatomy of health effects of the Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal, 338 (2009): b2337. DOI: 10.1136/bmj.b2337.

     Barros, R., et al. Adherence to the Mediterranean diet and fresh fruit intake are associated with improved asthma control. Allergy, vol. 63 (2008): 917-923.

     Varraso, Raphaelle, et al. Prospective study of dietary patterns and chronic obstructive pulmonary disease among US men. Thorax, vol. 62, (2007): 786-791.

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Posted in Alzheimer Disease, Cancer, Coronary Heart Disease, Dementia, Diabetes, Heart Disease, High Blood Pressure, Longevity, Parkinson's Disease, Stroke

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Does Diabetes Cause Dementia?

Posted on May 2, 2012 | 1 comment

Contrary to popular belief among the experts, type 2 diabetes is not one of the causes of Alzeimer dementia. They may indeed be associated with each other, but that’s not causation.

An oft-repeated theory from Gary Taubes 2007 masterpiece, Good Calories, Bad Calories, is that many of the chronic diseases of modern civilization, including Alzheimer disease, are caused by abnormal blood sugar and insulin metabolism. Especially high insulin levels induced by a diet rich in refined carbohydrates. If that’s the case, you’d expect to see a high prevalence of Alzheimer disease in older type 2 diabetics.

Dr. Emily Deans (psychiatrist) looked at this issue last year at her great Evolutionary Psychiatry blog.

The brains of Alzheimer patients, under a microscope, are characterized by many senile plaques (aka neuritic plaques) and neurofibrillary tangles. That’s the gold standard for diagnosis. Nevertheless, brain biopsies are rarely done to diagnose Alzheimer disease in living patients, and even autopsies after death are rare. The diagnosis usually is clinical, based on ruling out other illnesses, etc.

Nearly all the studies associating diabetes with Alzheimers disease (and other dementias) are observational or epidemiologic. (The exception is the Honolulu-Asia Aging Study.) Establishing an association is helpful in generating theories, but establishing causation is the goal. At least five studies confirm an association.

Neurology in 2011 reported findings of Japanese researchers who examined the brains of 135 people who died between 1998 and 2003. They lived in Hisayama, a town with an incredibly high autopsy rate of 74%. These people before death had undergone an oral glucose tolerance test. Their insulin resistance was calculated on the basis of fasting glucose and fasting insulin (HOMA-IR). None of them showed signs of dementia at the time of study enrollment in 1988.

What Did They Find?

Twenty-one of the 135 subjects developed Alzheimer-type dementia. The investigators don’t say if the diagnosis was based on the brain examination, or just a clinical diagnosis without a brain biopsy or autopsy. How this got beyond the article reviewers is beyond me. [If I’m missing something, let me know in the comments section below.] It must be a clinical diagnosis because if you don’t act demented, it doesn’t matter how many senile plaques and neurofibrillary tangles you have in your brain.

Senile plaques, but not neurofibrillary tangles, were more common in those with higher levels of blood sugar (as measured two hours after the 75 g oral glucose dose), higher fasting insulin, and higher insulin resistance. People with the APOE epsilon-4 gene were at even higher risk for developing senile plaques.

The researchers did not report whether the subjects in this study had been diagnosed during life with diabetes or not. One can only hope those data will be published in another paper. Why make us wait?

Average fasting glucose of all subjects was 106 mg/dl (5.9 mmol/l); average two-hour glucose after the oral glucose load was 149 mg/dl (8.3 mmol/l). By American Association of Clinical Endocrinologists criteria, these are prediabetic levels. Mysteriously, the authors fail to mention or discuss this. [I don’t know if AACE criteria apply to Japanese.] Some of these Japanese subjects probably had diabetes, some had prediabetes, others had normal glucose and insulin metabolism.

As with all good research papers, the authors compare their findings with similar published studies. They found one autopsy study that tended to agree with their findings (Honolulu) and three others that don’t (see references below). In fact, one of the three indicated that diabetes seems to protect against the abnormal brain tissue characteristic of Alzheimer disease.

Botton Line

Type 2 diabetes doesn’t seem to be a cause of Alzheimer disease, if autopsy findings and clinical features are the diagnostic criteria for the disease.

If we assume that type 2 diabetics have higher than normal blood sugar levels and higher insulin levels for several years, then hyperglycemia and hyperinsulinemia don’t cause or contribute to Alzheimer dementia.

Type 2 diabetes is, however, linked with impaired cognitive performance, at least according to many of the scientific articles I read in preparation for this post. So type 2 diabetics aren’t in the clear yet. It’s entirely possible that high blood sugar and /or insulin levels cause or contribute to that. (Any volunteers to do the literature review? Best search term may be “mild cognitive impairment.”)

Type 2 diabetes is associated with Alzheimer disease, but we have no proof that diabetes is a cause of Alzheimers. Nor do we have evidence that high blood sugar and insulin levels cause Alzheimer disease.

Alzheimer disease is a major scourge on our society. I’d love to think that carbohydrate-restricted eating would help keep blood sugar and insulin levels lower and thereby lessen the devastation of the disease. Maybe it does, but I’d like to see more convincing evidence. It’ll be years before we have a definitive answer.

For now, we have evidence that the Mediterranean diet seems to 1) protect againstAlzheimers and other dementias, 2) prevent some cases of type 2 diabetes, and 3) reduce the need for diabetic medications in diabetics.

For more information on practical application of the Mediterranean diet, visit Oldways and the Advanced Mediterranean Diet website.

Steve Parker, M.D.

References:

Matsuzaki T, Sasaki K, Tanizaki Y, Hata J, Fujimi K, Matsui Y, Sekita A, Suzuki SO, Kanba S, Kiyohara Y, & Iwaki T (2010). Insulin resistance is associated with the pathology of Alzheimer disease: the Hisayama study. Neurology, 75 (9), 764-70 PMID: 20739649

Heitner, J., et al. “Diabetics do not have increased Alzheimer-type pathology compared with age-matched control subjects: a retrospective postmortem immunocytochemical and histofluorescent study.” Neurology, 49 (1997): 1306-1311. Autopsy study, No. of subjects not in abstract. They looked for senile plaques and neurofibrillary tangles, etc. The title says it all.

Beeri, M.S., et al. “Type 2 diabetes is NEGATIVELY [emphasis added] associated with Alzheimer’s disease neuropathology.” J. Gerontol A. Biol Sci. Med. Sci. 60 (2005): 471-475. 385 autopsies. The title again says it all.

Arvanitakis, Z., et al. “Diabetes is related to cerebral infarction but NOT [emphasis added] to Alzheimers disease pathology in older persons.” Neurology, 67 (2006): 1960-1965. Autopsy study of 233 Catholic clergy, about 50:50 women:men.

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Once Again, Mediterranean Diet Prevents Diabetes

Posted on May 1, 2012 | Comments Off on Once Again, Mediterranean Diet Prevents Diabetes

Spanish researchers report that the Mediterranean diet reduced the risk of developing diabetes by 50% in middle-aged and older Spaniards, compared with a low-fat diet.

Over 400 people participated in a trial comparing two Mediterranean diets and a low-fat diet. Over the course of four years, 10 or 11% of the Mediterraneans developed type 2 diabetes, compared to 18% of the low-fatters. One of the Mediterranean diets favored olive oil, the other promoted nut consumption.

We’ve seen previously that the Mediterranean diet prevents diabetes—not all cases, of course—in folks who have had a heart attack. It also reduced the risk of diabetes in younger, generally healthy people in Spain.

So What?

The study at hand is not ground-breaking. It expands the body of evidence that the Mediterranean diet is one of the healthiest around.

Learn how to move your diet in a Mediterranean direction at Oldways or the Advanced Mediterranean Diet website.

Steve Parker, M.D.

Reference: Salas-Salvado, J., Bullo, M., Babio, N., Martinez-Gonzalez, M., Ibarrola-Jurado, N., Basora, J., Estruch, R., Covas, M., Corella, D., Aros, F., Ruiz-Gutierrez, V., Ros, E., & , . (2010). Reduction in the Incidence of Type 2-Diabetes with the Mediterranean Diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized Trial Diabetes Care DOI: 10.2337/dc10-1288

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Chronic Alcohol May Impair Vision in Diabetics

Posted on April 28, 2012 | Comments Off on Chronic Alcohol May Impair Vision in Diabetics

MedPage Today recently reported that long-term consumption of alcohol may impair vision in diabetics. Drinkers performed less well on vision chart tests than non-drinkers. It’s not a diabetic retinopathy issue.

Beer and distilled spirits were riskier than wine.

The MedPage Today article didn’t comment on the potential health benefits of alcohol consumption. You can bet I’ll keep an eye on this.

Steve Parker, M.D.

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Prevalence Figures for Diabetes and Prediabetes

Posted on April 21, 2012 | 1 comment

In January of 2011, the U.S. Centers for Disease Control and Prevention released the latest estimates for prevalence of diabetes and prediabetes. The situation is worse than it was in 2008, the last figures available.

  • 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

The CDC estimates that one of every three U.S. adults could have diabetes by 2050 if present trends continue.

The press release from the CDC mentions that physical activity and avoidance of overweight will prevent some cases of diabetes. I believe that limiting consumption of refined carbohydrates like sugar and flour would also help.

Those who already have diabetes and prediabetes should consider carbohydrate-restricted Mediterranean-style eating, as in Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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Mediterranean Diet Good for Diabetics

Posted on April 8, 2012 | Comments Off on Mediterranean Diet Good for Diabetics

In 2009, Current Diabetes Reports published “The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes,” by Catherine M. Champagne, Ph.D., R.D., L.D.N. Unfortunately, the full article isn’t available to you at no cost. But I read it. Her article is a review of available scientific evidence related to the Mediterranean diet as applied to a diabetic population. Dr. Champagne wrote:

This diet is a viable treatment option; advisors should stress not only adherence to a fairly traditional Mediterranean eating plan but also a lifestyle that includes sufficient physical activity.

Dr. Champagne was very favorably impressed with the DIRECT trial of Shai et al, which I covered extensively elsewhere. DIRECT compared three diets over 24 months: Atkins, Mediterranean/calorie-restricted, and low-fat/calorie-restricted. Mind you, it was a weight loss study, but a fair number of diabetics participated. Mediterranean-style eating showed the most beneficial effects for diabetics.

I think the Mediterranean diet could be even healthier for people with diabetes if it had fewer carbohydrates. That’s why I composed the Low-Carb Mediterranean Diet.

Dr. Champagne also mentions evidence that a modified Mediterranean diet may help counteract the build-up of fat in the liver, seen in up to 70% of type 2 diabetics. I wrote recently about how a very-low-carb diet beat the low-fat diet so often recommended for this condition (hepatic steatosis or non-alcoholic fatty liver disease).

If you want full online access to Champagne’s 6-page article, you can purchase it for $34 (USD) at SpringerLink. I cite many of the same scientific sources and provide a whole lot more in my 216-page Conquer Diabetes and Prediabetes: The Low-Carb Mediterranean Diet, at Amazon.com for $16.95 or $9.99 (the Kindle edition) or in multiple ebook formats from Smashwords.

Steve Parker, M.D.

Reference: Champagne, Catherine (2009). The usefulness of a Mediterranean-based diet in individuals with type 2 diabetes. Current Diabetes Reports DOI: 10.1007/s11892-009-0060-3

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