Tag Archives: type 2 diabetes

Ketogenic Diets Poised for a Resurgence

 

Front cover

Front cover

Men’s Fitness has an article praising ketogenic diets, with a focus on effects on athletic performance. Inexplicably, the piece doesn’t mention my Ketogenic Mediterranean Diet. The KMD is also presented as an option in The Advanced Mediterranean Diet (2nd ed.). A quote:

“Timothy Noakes, M.D., is an emeritus professor in the Division of Exercise Science and Sports Medicine at the University of Cape Town. While his name may not ring a bell here in the U.S., he’s a full-blown celebrity in his native South Africa and one of the most accomplished exercise physiologists on the planet. You can’t walk by a restaurant in Cape Town that doesn’t offer a “Noakes option”—say, an avocado stuffed with breakfast sausage and eggs, or a double cheeseburger with lettuce sans bun—and evidence of his teachings seems to be everywhere, mostly in the form of the nation’s best-known athletes, including ageless golfing legend Gary Player and eight-time Ironman World Champion Paula Newby-Fraser. In fact, Noakes’ celebrity these days is such that he’s even been pulled into South African presidential politics: To echo the country’s papers of record, “Is President Jacob Zuma’s and his wife’s dramatic weight loss a result of the Noakes Diet?” No one is sure about the president, but his wife, definitely: She’s lost 66 pounds following the Noakes plan.

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

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Mediterranean Diet Reduces Inflammation in Type 2 Diabetes

 

Santorini, Greek seaside

Santorini, Greek seaside

Markers of inflammation that circulate in our blood 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

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Diabetes and Alzheimer’s Dementia: What’s the Connection?

dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“More basic research is critical.”

Several scientific studies, but not all, link type 2 diabetes with Alzheimer’s disease. Some go so far as to say Alzheimer’s is type 3 diabetes.

My Twitter feed brought to my attention a scientific article I thought would clarify the relationships between diabetes, carbohydrate consumption, and Alzheimer’s dementia (full text).

It didn’t.

Click the full text link to read all about insulin, amylin, insulin degrading enzyme, amyloid–β, and other factors that might explain the relationship between type 2 diabetes and Alzheimer’s dementia. You’ll also find a comprehensive annotated list of the scientific studies investigating the link between diabetes and Alzheimer’s.

Bottom line: We still don’t know the fundamental cause of Alzheimer’s disease. A cure and highly effective preventive measures are far in the future.

Action Plan For You

You may be able to reduce your risk of Alzheimer’s disease by:

  • avoiding type 2 diabetes
  • preventing progression of prediabetes to diabetes
  • avoiding obesity
  • exercising regularly
  • eating a Mediterranean-style diet

Carbohydrate restriction helps some folks prevent or resolve obesity, prediabetes, and type 2 diabetes. A low-carb Mediterranean diet is an option in my Advanced Mediterranean Diet (2nd edition).

Steve Parker, M.D.

Reference: Schilling, Melissa. Unraveling Alzheimer’s: Making Sense of the Relationship Between Diabetes and Alzheimer’s Disease. Journal of Alzheimer’s Disease, 51 (2016): 961-977.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

 

 

 

 

Alcohol Consumption May Protect Against Type 2 Diabetes

…according to an article in the American Journal of Clinical Nutrition. A review of the scientific literature looked at various populations at baseline, noting alcohol consumption,  then determined who developed type 2 diabetes over subsequent years. Folks with light to moderate alcohol consumption were 20% less likely to develop diabetes.

Beautiful woman smiling as she is wine tasting on a summer day.

Wine is one of the potentially healthy components of the Mediterranean diet

This doesn’t prove that alcohol prevents diabetes. Alcohol intake may instead just be a marker for other factors that do prevent diabetes. For instance, maybe drinkers are genetically less susceptible to diabetes, or they exercise more.

Steve Parker, M.D.

The Endocrine Society is Worried About Environmental Chemicals: You Should Be, Too

See text for mention of pancreatic alpha and beta cells

See text for mention of pancreatic alpha and beta cells

A panel of university-based scientists convened by The Endocrine Society recently reviewed the available literature on health effects of endocrine-disrupting chemicals (aka EDCs). The executive summary is available free online. Some excerpts:

The full Scientific Statement represents a comprehensive review of the literature on seven topics for which there is strong mechanistic, experimental, animal, and epidemiological evidence for endocrine disruption, namely: obesity and diabetes, female reproduction, male reproduction, hormone-sensitive cancers in females, prostate cancer, thyroid, and neurodevelopment and neuroendocrine systems. EDCs such as bisphenol A, phthalates, pesticides, persistent organic pollutants such as polychlorinated biphenyls, polybrominated diethyl ethers, and dioxins were emphasized because these chemicals had the greatest depth and breadth of available information.

*  *  *

Both cellular and animal models demonstrate a role for EDCs in the etiology of obesity and T2D [type 2 diabetes]. For obesity, animal studies show that EDC-induced weight gain depends on the timing of exposure and the age of the animals. Exposures during the perinatal period [the weeks before and after birth] trigger obesity later in life. New results covering a whole range of EDC doses have underscored the importance of nonmonotonic dose-response relationships; some doses induced weight increase, whereas others did not. Furthermore, EDCs elicit obesity by acting directly on white adipose tissue, al- though brain, liver, and even the endocrine pancreas may be direct targets as well.

Regarding T2D, animal studies indicate that some EDCs directly target 􏰁beta and alpha cells in the pancreas, adipocytes, and liver cells and provoke insulin resistance together with hyperinsulinemia. These changes can also be associated with altered levels of adiponectin and leptin— often in the absence of weight gain. This diabetogenic action is also a risk factor for cardiovascular diseases, and hyperinsulinemia can drive diet-induced obesity. Epide- miological studies in humans also point to an association between EDC exposures and obesity and/or T2D; however, because many epidemiological studies are cross-sectional, with diet as an important confounding factor in humans, it is not yet possible to infer causality.

RTWT.

Bix at Fanatic Cook blog says foods of animal origin are the major source of harmful persistent organic pollutants, some of which act as ECDs.

Keep your eyes and ears open for new research reports on this critically important topic.

Steve Parker, M.D.

Sugar-Sweetened Beverages May Cause 9% of Type 2 Diabetes Cases in U.S.

…according to a meta-analysis published in the British Medical Journal.

At this point, it’s more accurate to say the two are associated than to say the drinks cause diabetes.

Do Artificial Sweeteners Cause Overweight and Type 2 Diabetes?

We don’t know with certainty yet. But a recent study suggests that non-caloric artificial sweeteners do indeed cause overweight and type 2 diabetes in at least some folks. The study at hand is very small, so I wouldn’t bet the farm on it. I’m not even changing any of my recommendations at this point.

exercise for weight loss and management, dumbbells

“Too many diet sodas” doesn’t explain this whole picture

 

The proposed mechanism for adverse metallic effects is that the sweeteners alter the mix of germs that live in our intestines. That alteration in turn causes  the overweight and obesity. See MedPageToday for the complicated details. The first part of the article is about mice; humans are at the end.

Some quotes:

“Our results from short- and long-term human non-caloric sweetener consumer cohorts suggest that human individuals feature a personalized response to non-caloric sweeteners, possibly stemming from differences in their microbiota composition and function,” the researchers wrote.

The researchers further suggested that these individualized nutritional responses may be driven by personalized functional differences in the micro biome [intestinal germs or bacteria].

***

Diabetes researcher Robert Rizza, MD, of the Mayo Clinic in Rochester, Minn., who was not involved with the research, called the findings “fascinating.”

He noted that earlier research suggests people who eat large amounts of artificial sweeteners have higher incidences of obesity and diabetes. The new research, he said, suggests there may be a causal link.

“This was a very thorough and carefully done study, and I think the message to people who use artificial sweeteners is they need to use them in moderation,” he said. “Drinking 17 diet sodas a day is probably a bad idea, but one or two may be OK.”

I won’t argue with that last sentence!

Finally, be aware the several clinical studies show no linkage between human consumption of non-caloric artificial sweeteners and overweight, obesity, and T2 diabetes.

Steve Parker, M.D.

Four In Ten U.S. Adults Will Develop Diabetes

Like type 1 diabetics, many type 2's need insulin shots

Like type 1 diabetics, many type 2’s need insulin shots

Researchers affiliated with the U.S. Centers for Disease Control estimate that 40% of American adults will develop diabetes, mostly type 2. The CDC’s prior estimate was the one of every three Americans born in 2000 would develop diabetes. Some snippets from the article abstract:

On the basis of 2000—11 data, lifetime risk of diagnosed diabetes from age 20 years was 40·2% for men and 39·6% for women, representing increases of 20 percentage points and 13 percentage points, respectively, since 1985—89.

The number of life-years lost to diabetes when diagnosed at age 40 years decreased from 7·7 years in 1990—99 to 5·8 years in 2000—11 in men, and from 8·7 years to 6·8 years in women over the same period.

Years spent with diabetes increased by 156% in men and 70% in women.

The good news is that you can decrease your odds of type 2 diabetes via diet and exercise. I can’t prove it, but I bet the Advanced Mediterranean Diet prevents some cases of diabetes. The single most important issue in preventing type 2 diabetes is avoiding obesity.

Steve Parker, M.D.

 

Book Review: The Heart Healthy Lifestyle – The Prevention and Treatment of Type 2 Diabetes, by Sean Preuss

I recently finished an ebook, The Heart Healthy Lifestyle: The Prevention and Treatment of Type 2 Diabetes by Sean Preuss, published in 2013. Per Amazon.com’s rating system, I give it five stars (I love it).

♦   ♦   ♦

This is an invaluable resource for 1) anyone recently diagnosed with type 2 diabetes or prediabetes, 2) those who aren’t responding well to their current therapeutic regimen, and 3) type 2 diabetics who want to reduce their drug use.

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Strength Training Helps Get Excess Blood Sugar Out of Circulation

Mr. Preuss is a fitness trainer who has worked with many type 2 diabetics. He demonstrates great familiarity with the issues diabetics face on a daily basis. His science-based recommendations are familiar to me since I reviewed many of his references at on of my other blogs, Diabetic Mediterranean Diet.

Like me, Mr. Preuss recognizes the primacy of lifestyle modification over drug therapy for type 2 diabetes, as long as drugs can safely be avoided or postponed. The main lifestyle factors are diet and exercise. Too many physicians don’t spend enough time on these, preferring instead to whip out the prescription pad and say, “Here ya go. I’ll see you in three months.”

I have gradually come to realize that most of my sedentary type 2 diabetes patients need to start a work-out program in a gym where they can get some personal attention. That’s Mr. Preuss’s opinion, too. The clearly explained strength training program he recommends utilizes machines most commonly found in a gym, although some home gyms will have them also. His regimen is easily done in 15-20 minute sessions two or three times a week.

He also recommends aerobic activity, such as walking at least several days a week. He recommends a minimum of 113 minutes a week of low intensity aerobic work, citing evidence that it’s more effective than higher intensity effort for improving insulin sensitivity.

I don’t recall specific mention of High Intensity Interval Training. HIIT holds great promise for delivering the benefits of aerobic exercise in only a quarter of the time devoted to lower intensity aerobics. It may be that it just hasn’t been studied in type 2 diabetics yet.

I was glad to see all of Mr. Preuss’s scientific references involved humans, particularly those with type 2 diabetes. No mouse studies here!

Another strength of the book is that Sean tells you how to use psychological tricks to make the necessary lifestyle changes.

The author notes that vinegar can help control blood sugars. He suggests, if you can tolerate it, drinking straight (undiluted) red wine vinegar or apple cider vinegar – 2 tbsp at bedtime or before carbohydrate consumption. I’ve heard rumors that this could be harmful to teeth, so I’d do some research or ask my dentist before drinking straight vinegar regularly. For all I know, it could be perfectly harmless. If you have a definitive answer, please share in the comments section below.

I read a pertinent vinegar study out of the University of Arizona from 2010 and reviewed it at one of my blogs. The most effective dose of vinegar was 10 g (about two teaspoons or 10 ml) of 5% acetic acid vinegar (either Heinz apple cider vinegar or Star Fine Foods raspberry vinegar).  This equates to two tablespoons of vinaigrette dressing (two parts oil/1 part vinegar) as might be used on a salad.  The study authors also say that “…two teaspoons of vinegar could be consumed palatably in hot tea with lemon at mealtime.”

The diet advice herein focuses on replacement of a portion of carbohydrates with proteins, healthy oils, and vegetables.

I highly recommend this book. And sign up for Mr. Preuss’s related tweets at @HeartHealthyTw.

Steve Parker, M.D.

Disclosure: Mr. Preuss gave me a free copy of the book, otherwise I have received no monetary compensation for this review. I met him once, about two years ago.

Does Gastric Bypass Cure Type 2 Diabetes?

It does,…according to Seattle researchers.

Steve Parker MD, bariatric surgery

Band Gastric Bypass Surgery

They looked at over 4,000 type 2 diabetics who had gastric bypass surgery for weight loss, following their cases thereafter over many years. Almost seven in 10 had a “complete diabetes remission” within five years of surgery. (Remission was defined as non-diabetic lab values on blood tests and absence of diabetic drug use.) Of those going into remission, 35% redeveloped diabetes within five years of surgery. Those with the more severe or longstanding cases of diabetes before surgery were  more likely to have a recurrence of diabetes.

So it looks to me like, on average, gastric bypass surgery “cures” half of the cases of type 2 diabetes, as measured five years after surgery. As the years pass, even more failures will arise. Nevertheless, that’s an impressive improvement. Given the potential complications of bypass surgery, I’d try a very-low-carb diet before going under the knife. Examples are Dr. Bernstein’s Diabetes Solution and Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

PS: Cure or remission of type 2 diabetes could be defined in other ways. For instance, a more reliable definition of cure might include return of normal pancreas/insulin function as judged by insulin levels and insulin sensitivity. If you have normal blood sugar levels and hemoglobin A1c, yet have ongoing insulin resistance, you’re more likely to develop overt diabetes going forward.