Pollution May Be Causing T2 Diabetes and Obesity

It sounds like Jerome Ruzzin is convinced that’s the case. I put some thought into it last August and was skeptical—still am, but I’m keeping an open mind. Mr. Ruzzin has a review article published in 2012 at BMC Public Health (“Public health concern behind the exposure to persistent organic pollutants and the risk of metabolic diseases”). Here’s his summary:

The global prevalence of metabolic diseases like obesity and type 2 diabetes, and its colossal economic and social costs represent a major public health issue for our societies. There is now solid evidence demonstrating the contribution of POPs [persistent organic pollutants], at environmental levels, to metabolic disorders. Thus, human exposure to POPs might have, for decades, been sufficient and enough to participate to the epidemics of obesity and type 2 diabetes. Based on recent studies, the fundaments of current risk assessment of POPs, like “concept of additive effects” or “dioxins and dl-PCBs induced similar biological effects through AhR”, appear unlikely to predict the risk of metabolic diseases. Furthermore, POP regulation in food products should be harmonized and re-evaluated to better protect consumers. Neglecting the novel and emerging knowledge about the link between POPs and metabolic diseases will have significant health impacts for the general population and the next generations.

Read the whole enchilada.

The cold-water fatty fish I so often recommend to my patients could be hurting them. They are major reservoirs of food-based POPs.

Steve Parker, M.D.

Should “Low-Carb” Be the Default Diet for Diabetes?

Yes….according to a manifesto to be published soon in Nutrition. The abstract:

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines.

The benefits of carbohydrate restriction in diabetes are immediate and well-documented. Concerns about the efficacy and safety are long-term and conjectural rather than data-driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss) and leads to the reduction or elimination of medication and has never shown side effects comparable to those seen in many drugs.

diabetic diet, low-carb diet, paleobetic diet

Low-Carb Brian burger and bacon Brussels sprouts (in the Paleobetic Diet)

The lead author is Richard Feinman. Others include Lynda Frassetto, Eric Westman, Jeff Volek, Richard Bernstein, Annika Dahlqvist, Ann Childers, and Jay Wortman, to name a few. Some of them disclose that they have accepted money from the Veronica and Robert C. Atkins Foundation. That doesn’t bother me.

I’m familiar with most of the supporting literature they cite, having read it over the last decade.

Read the whole enchilada.

Steve Parker, M.D.

PS: The linked article is preliminary and may undergo minor revision over the coming months.

Do Processed Red Meats Reduce Lifespan?

They were linked to higher risk of death in this Swedish study. Regular non-processed red meats had no association with shorter life, however. 

 

 

Dr. Richard Feinman Doubts Red Meat Causes T2 Diabetes

This looks healthful to me, despite the red meat

This looks healthful to me, despite the red meat

At least one recent study implicated red meat consumption as a cause of type 2 diabetes. Dr. Richard Feinman at his blog takes a close look at the 2013 study and points out the great difficulty in making the leap from red meat to diabetes. I think Dr. Feinman’s point is best made by his graph about half way through the post, showing steadily decreasing red meat consumption as T2 diabetes takes off over the last four decades. (I assume all the figures are based on U.S. data.)

For the opposing viewpoint, read the original study (linked at Dr. F’s blog) or search at Fanatic Cook.

Do I worry that red meat causes diabetes? Not much. I await definitive research.

Steve Parker, M.D.

Dr. Briffa on Carbohydrate Restriction for Diabetics

Diabetes UK is a prominent charity in Britain. It recommends that diabetics eat generous servings of carbohydrates: 5–14 daily servings of lower-glycemic-index items. Dr. Briffa strongly disagrees:

I can categorically state here that when individuals with diabetes cut back on carbohydrates, they almost always see significant improvement in their blood sugar control. They usually lose weight, and see improvements in markers of disease too. I’m most certainly not the only person to have noticed this. Just yesterday I met a most wonderful general practitioner who has come to the low-carb approach quite late in his career, but has used it to utterly transform the health of his patients. He showed me a variety of graphs from several patients pre- and post-adoption of a lower carbohydrate diet. He relayed a few stunning anecdotes too of people who believe eating a lower-carb diet has given them their health and their lives back.

***

I won’t mince my words and state here that I believe these recommendations [of Diabetes UK] are utterly mad. My experience tells me they will generally just entrench diabetics in their condition and the need for medical care. Compared to a lower-carbohydrate diet, the regime advocated by Diabetes UK stands to worsen blood sugar control and increase the need for medication and risk of complications. If Diabetes UK is serious about helping diabetics, I suggest it starts by ceasing to recommend a diet that, in my view, is utterly unsuitable for diabetics.

 

QOTD: J. Stanton on Weight Loss and Exercise

Let me be clear. Exercise is not important because it burns calories! Exercise without calorie restriction is a remarkably ineffective weight loss intervention, because it usually makes us hungry enough to replace the calories we burn. Exercise is important because it restores your ability to oxidize fat—both when fasting and after meals. And we can tie this in with mitochondrial dysfunction by noting that exercise is proven to increase mitochondrial volume.

J. Stanton

How Has the U.S. Diet Changed Over the Last Century?

paleo diet, paleo meal, recipe, stone age diet, paleo food, hunter-gatherer food

One of the paleo meals I took to the hospital to eat mid-shift

Medical student Kris Gunnars has an article at Business Insider, of all places, that shows graphically many of the major U.S. dietary changes of the last hundred years or so. In this case, transmogrification may be a better term than mere  “changes.” In short, we’ve moved even further away from the Paleolithic diet. I suspect much of the entire Western world diet has evolved in similar fashion.

You need to read the article and ponder the graphs if you question why we have so much obesity, type 2 diabetes, heart disease, hypertension, and perhaps cancer. You’ll see dramatic increases in consumption of added sugars, industrial seed oils (esp. soybean), soda pop and fruit juice (added sugar!), total calories, and fast food. You’ll see how much we’ve increased dining away from home. Butter consumption is down drastically, but doesn’t seem to have done us much good, if any.

Sugar cane

Sugar cane

 

There’s fairly good evidence that coronary artery disease (CAD; the cause of most heart attacks) was very prominent between 1960 to 2000 or so, but it’s been tapering off in recent years and didn’t seem to be very common 100 years ago. Understand that you can have it for 20 years or more before you ever have symptoms (angina) or a heart attack from it. In fact, the disease probably starts in childhood. I’ve always wondered about the cause of the CAD prevalence trends, and wondered specifically how much of the long-term trend was related to trans-fat consumption. But I’ve never been able to find good data on trans-fat consumption. Kris came up with a chart of margarine consumption, which may be a good proxy for trans-fats. Another of his charts includes shortening, a rich source of trans-fats and probably also a good proxy. Shortening consumption increased dramatically from 1955 until dropping like a rock around 2000.

The timeline curves for trans-fat consumption (by proxy) and prevalence of coronary heart disease seem to match up fairly well, considering a 20 year lag. In the early 1990s, we started cutting back on trans-fats, and here we are now with lower mortality and morbidity from coronary artery disease. (CAD is very complex; lower rates of smoking surely explain some of the recent trend.)

Read the whole enchilada. Very impressive. Highly recommended.

Steve Parker, M.D.

Evolutionary Aspects of Obesity, Insulin Resistance, and Cardiovascular Risk

paleo diet, Paleolithic diet, hunter-gatherer diet

Huaorani hunter in Ecuador

Spreadbury and Samis have a review-type article in Current Cardiovascular Risk Reports. Here’s the abstract:

Cardiovascular disease (CVD) is still virtually absent in those rare populations with minimal Western dietary influence. To date, exercise, altered fats, fibre, anti-oxidants or Mediterranean diet do not appear to overcome the discrepancy in CVD between hunter-gatherer and Western populations. The CVD risk factors of obesity and diabetes are driven by increased caloric intake, with carbohydrates potentially implicated. Paradoxically, non-Westernized diets vary widely in macronutrients, glycemic and insulinemic indices, yet apparently produce no obesity or CVD regardless, even with abundant food. ‘Ancestral’ grain-free whole-food diet may represent the best lifestyle intervention for obesity and CVD. Such diets are composed of the cells of living organisms, while Western grains, flour and sugar are dense, acellular powders. Bacterial inflammation of the small intestine and vagal afferents appears a crucial step in leptin-resistance and obesity. Therefore it may be important that the Western diet resembles a bacterial growth medium.

You may remember Spreadbury’s name from his theory about acellular carbohydrates causing obesity via alterations in gut microorganisms. Spreadbury is with the Gastrointestinal Diseases Research Unit, Queen’s University, Kingston, Ontario, Canada.

You can read the articles for yourself. The following are a few of the authors points I found interesting or want to remember.

Does physical activity explain differences in CVD between Westernized and non-Westernized Peoples? They say “maybe.”

Throughout the article are references to aboriginals like the Hadza, Kitavans, Ache, Shuar, Australian aborigines, and Inuits. I always take comparisons of them to modern Europeans with a grain of salt, because of potential genetic differences between the populations. Moreover, diet and activity levels are only two of myriad cultural differences.

Australian Aborigine in Swamp Darwin

Australian Aborigine in Swamp Darwin

Can dietary changes reduce the incidence of CVD? They say it’s unclear.

Regarding modern paleo diet trials, “All the studies with ad libitum eating [eat all you want] have reported a spontaneous reduction in caloric intake in the order of 15-30%.” (Three references.) “The reduced food intake appeared driven by a satiety increase that was apparently not explicable by energy density, fiber or macronutrient content.” (One reference.)

“In those eating a Westernized diet, carbohydrates are increasingly recognized as being associated with poor metabolic health.” Evidence? Only one reference cited: Zienczuk’s 2012 article on high arctic Inuits.

“…non-Westernized populations with excellent metabolic and cardiovascular health almost invariably have negligible dietary contribution from grains, as well as refined sugar.” No citations.

“For ‘western-style’ diets and most obesogenic diets tested, gut microbiota appear to play a crucial role in obesity.” That’s a bold statement. References? Only one, a mouse study.

The rest of the article is about Spreadbury’s acellular carb/obesity theory. He suggests that small intestine bacteria play a more prominent role than colonic germs. Bacterial-driven inflammation….

The authors provide an example of a grain-free whole-food diet. It’s unrestricted in fruit, leafy or root vegetables, unprocessed meats, eggs, fish, nuts (except peanuts), mushrooms, herbs and spices. Occasional foods to be eaten in moderation are legumes, rice, yogurt, milk, cheeses, sweet corn, palm oil/lard/olive oil, and salt. Avoid almost all processed foods, breads, cereals, cakes/cookies/donuts etc., refined sugars, dried or processed fruits, vegetable/seed oils, and processed meats. They advise a vitamin D supplement. I’m not sure if they came up with this diet on their own, or it’s S. Lindeberg’s outline.

A final quote:

The macronutrient independence of the health from ancestral diet suggests whole foods are more important to health than their macronutrient or other chemical components, and that good health is associated with unprocessed cellular foods. Flour, sugar and processed foods appear to be important drivers of Western metabolic dysfunction, overweight and inflammation, and may prove to have a profound impact on, or even be the initiators of cardiovascular disease.

I’m sure Spreadbury and Samis would agree we need more basic science and clinical research into these issues, involving human test subjects. Maybe I’m prejudiced, but I’m more interested in Asians, Africans, and Europeans than Shuar people.

Steve Parker, M.D.

Reference: Spreadbury, Ian and Samis, Andrew J.S. Evolutionary aspects of obesity, insulin resistance, and cardiovascular risk. Current Cardiovascular Risk Reports, April 2013, vol. 7, issue 2, pp. 136-146.

Highly Muscular Action Hero Actors: How Do They Do It?

She doesn't have enough testosterone to get bulky muscles, but that's OK

She doesn’t have enough testosterone to get bulky muscles, but she can get bigger and stronger

Logan Hill has an interesting article in Men’s Journal on how actors get that muscled-up lean action hero body. He talks about how an impressive physique is almost a bare minimum criterion to make it in Hollywood these days. It’s not like the good ol’ days when acting chops and charisma were enough. Note the difference between the James Bond of Sean Connery and Daniel Craig (photo at the link). A quote:

Even the type of muscle has changed. “In the Eighties, it was the bigger, the better,” says director Tim Burton. “Think of that shot from Rambo of Sly holding the machine gun and the veins in his forearms bulging.” Actors rarely bulk up like that anymore; they’re all trying to be Tyler Durden.

Every trainer interviewed for this story cited Brad Pitt’s ripped physique in 1999’s Fight Club as an inspiration. Previously known for his lush, golden hair, the girls’ guy Pitt was reborn as Durden, a sinewy, predatory man’s man. “Brad Pitt in Fight Club is the reference for 300,” says Mark Twight, who trained the cast for 300. “Everyone thought he was huge, but he was, like, 155 pounds. If you strip away fat and get guys to 3, 4 percent body fat, they look huge without necessarily being huge.”

To get that hungry look, trainers stress calorie-conscious diets and exercises that pump up fat-burning metabolism. No actor can gain 10 pounds of muscle in a six-week period, but he can lean down to reveal the muscle underneath. Trainers talk about the “lean out” – the final, preshoot crash period when actors drop their BMI (body-mass index) to its bare minimum and unveil muscle definition.

You’ll read about insane commitment to exercise, high-protein diets, rapid weight loss and muscle definition, HGH, anabolic steroids, and even insulin. I imagine a $6 million paycheck is a good motivator. Warning: it’s a fairly long article.

Read the whole enchilada.

Steve Parker, M.D.

QOTD: Dobzhansky on Evolution

Nothing in biology makes sense except in the light of evolution.