Monthly Archives: April 2012

Book Review: The Blood Sugar Solution

A few months ago, I read The Blood Sugar Solution: The UltraHealthy Progam for Losing Weight, Preventing Disease, and Feeling Great Now!  Published in 2012, the author is Dr. Mark Hyman. I give it three stars per Amazon’s rating system (“It’s OK”).  Actually, I came close to giving it two stars, but was afraid the review would have been censored at the Amazon site.

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The book’s promotional blurbs by the likes of Dr. Oz, Dr. Dean Ornish, and Deepak Chopra predisposed me to dislike this book.  But it’s not as bad as I thought it’d be.

The good parts first.  Dr. Hyman favors the Mediterranean diet, strength training, and high-intensity interval training.  His recommended way of eating is an improvement over the standard American diet, improving prospects for health and longevity.  His dietary approach to insulin-resistant overweight/obesity and type 2 diabetes includes 1) avoidance of sugar, flour, processed foods, 2) preparation of your own meals from natural, whole food, and 3) keeping glycemic loads low.  All well and good for weight loss and blood sugar control.  It’s not a vegetarian diet.

The author proposes a new trade-marked medical condition: diabesity. It refers to insulin resistance in association with (usually) overweight, obesity, and/or type 2 diabetes mellitus.  Dr. Hyman says half of Americans have this brand-new disorder, and he has the cure.  If you don’t have overt diabetes or prediabetes, you’ll have to get your insulin levels measured to see if you have diabesity.

He reiterates many current politically correct fads, such as grass-fed/pastured beef, organic food, detoxification, and strict avoidance of all man-made chemicals, notwithstanding the relative lack of scientific evidence supporting many of these positions.

Dr. Hyman bills himself as a scientist, but his biography in the book doesn’t support that label.  Shoot, I’ve got a degree in zoology, but I’m a practicing physician, not a scientist.

The author thinks there are only six causes of all disease: single-gene genetic disorders, poor diet, chonic stress, microbes, toxins, and allergens.  Hmmm… None of those explain hypothyroidism, rheumatoid arthritis, systemic lupus erythematosis, tinnitus, migraines, irritable bowel syndrome, Parkinsons disease, chronic fatigue syndrome, or multiple sclerosis, to name a few that don’t fit his paradigm.

Dr. Hyman makes a number of claims that are just plain wrong.  Here are some:
– Over 80% of Americans are deficient in vitamin D
– Lack of fiber contributes to cancer
– High C-reactive protein (in blood) is linked to a 1,700% increased probability of developing diabetes
– Processed, factory-made foods have no nutrients
– We must take nutritional supplements

Furthermore, he recommends a minimum of 11 and perhaps as many as 16 different supplements even though the supportive science is weak or nonexistent.  Is he selling supplements?  You betcha!

After easily finding these bloopers, I started questioning many other of the author’s statements.

I was very troubled by the apparent lack of warning about hypoglycemia (low blood sugar).  Many folks with diabetes will be reading this book.  They could experience hypoglycemia on this diet if they’re taking certain diabetes drugs: insulin, sulfonylureas, meglitinides, pramlintide plus insulin, exenatide plus sulfonylurea, and possibly thiazolidinediones, to name a few instances.

If you don’t have diabetes but do need to lose weight, this book may help.  If you have diabetes, strongly consider an alternative such as Dr. Bernstein’s Diabetes Solution or my Conquer Diabetes and Prediabetes.

In the interest of brevity, I’ll not comment on Dr. Hyman’s substitution of time-tested science-based medicine with his own “Functional Medicine.”

Steve Parker, M.D.

FDA Approves Exenatide for Once Weekly Injection

Once-weekly injection of exenatide, sold in the U.S. as Bydureon, has been approved for use by the U.S. Food and Drug Administration.  It’s the first-ever once-weekly drug for type 2 diabetes.  Bydureon’s main competitors are Byetta (exenatide  injected twice daily) and Victoza  (liraglutide).  Byetta and Bydureon are made by the same company, Amylin Pharmaceuticals.  Bydureon is a slow-release formulation of exenatide.

Victoza is the one that celebrity chef Paula Deen endorsed about a month ago, around the same time she revealed she’s had type 2 diabetes for three years.  Victoza’s injected once daily.

The New York Times has a January 27, 2012, article on Bydureon, focusing on business and investing.  The new drug is expected to retail for $4,200 (USD) a year.

Click for complete prescribing information.

Click for a press release approved by Amylin.

David Mendosa is excited about Bydureon.

These drugs are in a class called GLP-1 receptor agonists, which mimic the effect of glucagonlike peptide-1, a hormone that increases insulin secretion by the pancreas when blood sugar levels are high.  They are prescribed as adjuncts to diet and exercise in adults with type 2 diabetes.

Steve Parker, M.D.

173 Years of U.S. Sugar Consumption

Thanks to Dr. Stephan Guyenet and Jeremy Landen for this sugar consumption graph.  I’d never seen one going this far back in time. 

 Dr. Guyenet writes:
It’s a remarkably straight line, increasing steadily from 6.3 pounds per person per year in 1822 to a maximum of 107.7 lb/person/year in 1999.  Wrap your brain around this: in 1822, we ate the amount of added sugar in one 12 ounce can of soda every five days, while today we eat that much sugar every seven hours.
The U.S. Department of Agriculture estimates that added sugars provide 17% of the total calories in the average American diet.  A typical carbonated soda contain the equivalent of 10 tsp (50 ml) of sugar.  The average U.S. adult eats 30 tsp  (150 ml) daily of added sweeteners and sugars.
 
Note that added sugars overwhelmingly supply only one nutrient: pure carbohdyrate without vitamins, minerals, protein, fat, antioxidants, etc.
 
Do you think sugar consumption has anything to do with diseases of affluence, also known as diseases of modern civilization?  I do.
 
Was our pancreas designed to handle this much sugar?  Apparently not, judging from skyrocketing rates of diabetes and prediabetes.
 

Famous People With Diabetes

dLife maintains a list of famous, prominent, or noteworthy folks who have or had diabetes.  I mention it here in case you have diabetes and sometimes feel like it’s got you by the throat and is ruining your life.  Be inspired.

Steve Parker, M.D.

B.B. King is No.3 on Rolling Stone’s list of 100 Best Guitarists of All Time.  King has diabetes.

PS: Who has a list of infamous diabetics?

Right Diet Preserves Brain Function and Size

mp9004223691.jpgThe journal Neurology reports that the proper diet seems to help prevent age-related brain shrinkage and cognitive decline.

From the press release:

People with diets high in several vitamins or in omega 3 fatty acids are less likely to have the brain shrinkage associated with Alzheimer’s disease than people whose diets are not high in those nutrients, according to a new study published in the December 28, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

Those with diets high in omega 3 fatty acids and in vitamins C, D, E and the B vitamins also had higher scores on mental thinking tests than people with diets low in those nutrients. These omega 3 fatty acids and vitamin D are primarily found in fish. The B vitamins and antioxidants C and E are primarily found in fruits and vegetables.

So the dietary pattern linked to preservation of brain size and function in this study is: high omega-3 fatty acids and vitamins B, C, D, and E. I don’t know if study participants were getting these nutrients from supplements or from food or a combination. (I haven’t read the full article.)

To find foods high in the aforementioned nutrients, you can use NutritionData’s Nutrient Search Tool.

Note that the time-honored Mediterranean diet is also associated with lower rates of dementia and slower rate of age-related mental decline.

I previously reported that a supplement cocktail of three B vitamins slowed the rate of brain shrinkage.

Steve Parker, M.D.

Reference: Bowman, G.L., et al. Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging. Neurology. doi: 10.1212/WNL.0b013e3182436598

h/t to Randall Parker at FuturePundit

Baseline Measurements Before Starting a Fitness Program

Impressive jump!

Before beginning or modifying a fitness program, it’s important to take some baseline physical measurements. Re-measure periodically. That way you’ll know whether you’re making progress, holding steady, or regressing. Seeing improvement in the numbers also helps to maintain motivation.

Not taking measurements would be like starting a weight loss plan without a baseline and subsequent weights.

Around this time last year, I finished a home-based, 15-week, six-days-a-week fitness program called Core Performance, designed by Mark Verstegen. I was pleased with the results. The only problem is that it’s very time-consuming. Perhaps fitness just has to be that way.

I regret that I didn’t take any fitness measurements before and after starting Core Performance.

For much of the last year, I modified Core Performance to a thrice weekly, then twice weekly program, until a couple months ago when I pretty much abandoned it. I miss the benefits now, but just didn’t want to put in the time to achieve them. In other words, I lost my motivation.

Who needs this much flexibility?

Intellectually, I know that regular exercise is important. I’m starting to get motivated again. Not sure why. Perhaps because I’ve read that you can be fairly fit with as little as 30 minutes of exercise a week. I’m not convinced yet. I’ll be test-driving some of these time-efficient programs soon.

This new style of fitness is promoted by the likes of Dr. Doug McGuff, Chris Highcock, Skyler Tanner, Nasim Taleb, and Jonathan Bailor, among others.

What to Measure

  1. Weight
  2. Blood pressure
  3. Resting heart rate (first thing in the AM before getting out of bed)
  4. Waist circumference (upright and supine)
  5. Height
  6. Body mass index
  7. Mid-arm circumference, both arms, hanging relaxed at your sides
  8. Maximal calf circumference, both calves, while standing at ease
  9. Maximum number of consecutive pull-ups
  10. Maximum number of consecutive push-ups
  11. Maximum number of consecutive sit-ups
  12. Run/walk one mile as fast as you can
  13. Maximum vertical jump (stand by a tall wall then jump and reach up as high as you can with one arm, noting the highest point above ground your fingers can reach)
  14. Can you touch your toes? Stand up straight, locking knees in extension, then bend over at your waist and touch your toes with your fingertips. If you can touch toes, can you flatten your palms against the floor? If you can’t reach your toes, measure the distance from your fingertips to the floor.
  15. Optional blood work for special situations: fasting blood sugar, hemoglobin A1c, triglycerides, cholesterols (total, HDL, LDL, sub-fractions)

The particular aspects of fitness these measure are strength and endurance in major muscle groups, cardiovascular and pulmonary endurance, a little flexibility, and a hint of body composition.

You may appreciate an assistant to help you measure some of these.

Record your numbers. Re-test some or all of these periodically. If you’re in fairly poor condition at the outset, you’ll see some improved numbers after a couple or three weeks of a good exercise program. It takes months to build significant muscle mass; you’ll see improved strength and endurance before mass.

Am I missing anything?

Steve Parker, M.D.