Monthly Archives: November 2012

Type 2 Diabetes: Scope of the Problem

Posted on November 30, 2012 | Comments Off on Type 2 Diabetes: Scope of the Problem

97 mg/dl. Yippee!

Type 2 diabetes is the most important public health problem in the U.S. and most of the developed world. The U.S. Centers for Disease Control and Prevention predicts that one of every three Americans born in the year 2000 will develop diabetes.

The most common form of diabetes by far is type 2, which describes at least 85% of cases. It’s less serious than type 1 diabetes. Type 1 diabetics have an immune system abnormality that destroys the pancreas’s ability to make insulin. Type 1’s will not last long without insulin injections. On the other hand, many type 2 diabetics live well without insulin shots.

The epidemic of diabetes in the U.S. and the developed world overwhelmingly involves type 2, not type 1.

“Prediabetes” is what you’d expect: a precursor that may become full-blown type 2 diabetes over time. Blood sugar levels are above average, but not yet into the diabetic range. One in four people with prediabetes develops type 2 diabetes over the course of three to five years. Researchers estimate that 35% of the adult U.S. population had prediabetes in 2008. That’s one out of every three adults, or 79 million. Only 7% of them (less than one in 10) were aware they had it.

In the U.S. as of 2010, 26 million folks have diabetes. That includes 11% of all adults.

The rise of diabetes parallels the increase in overweight and obesity, which in turn mirrors the prominence of refined sugars and starches throughout our food supply. These trends are intimately related. Public health authorities 40 years ago convinced us to cut down our fat consumption in a mistaken effort to help our hearts. We replaced fats with body-fattening carbohydrates that test the limits of our pancreas to handle them. Diabetics and prediabetics fail that test.

Dr. Richard K. Bernstein, notable diabetologist, wrote that, “Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.”

We’re even starting to see type 2 diabetes in children, which was quite rare just thirty years ago. It’s undoubtedly related to overweight and obesity. Childhood obesity in the U.S. tripled from the early 1980s to 2000, ending with a 17% obesity rate.  Overweight and obesity together describe 32% of U.S. children.

Diabetes is important because it has the potential to damage many different organ systems, deteriorating quality of life. It can damage nerves (neuropathy), eyes (retinopathy), kidneys (nephropathy),  and stomach function (gastroparesis), just to name a few.

Just as important, diabetes can cut life short. Compared to those who are free of diabetes, having diabetes at age 50 more than doubles the risk of developing cardiovascular disease—heart attacks, strokes, and high blood pressure. Compared to those without diabetes, having both cardiovascular disease and diabetes approximately doubles the risk of dying. Compared to those without diabetes, women and men with diabetes at age 50 die seven or eight years earlier, on average.

Diabetic complications and survival rates will improve over the coming decades as we learn how to better treat this ancient disease.

Steve Parker, M.D.

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Posted in Causes of Diabetes, Diabetes Complications

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Could Acellular Carbohydrates Be the Cause of Obesity?

Posted on November 28, 2012 | 12 comments

Ivor Goodbody in a recent tweet reminded me of an interesting nutrition science article.  Ian Spreadbury hypothesizes that carbohydrate density of modern foods may be the cause of obesity.  Refined sugars and grains—types of acellular carbohydrates—are  particularly bad offenders.

Harvesting acellular carbs

These acellular carbs may alter our gut microorganisms, leading to systemic inflammation and leptin resistance, etc.  Our Paleolithic ancestors had little access to acellular carbohydrates.

Read more about it in “Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity,” in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2012, vol. 5, pp. 175-189.

To reverse our modern obesity epidemic, we need better understanding of the underlying pathophysiology.

—Steve

PS:  For Spreadbury’s formal definition of acellular carbohydrates, see my long comment below.

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Random Thoughts On Fitness

Posted on November 21, 2012 | 2 comments

A couple years ago, I was thinking about putting together a fitness program for myself.  My goals were endurance, strength, less low-back aching, flexibility, longevity, and being able to get on my horse bareback without a mounting block or other cheat.

I spent quite a bit of time at Doug Robb’s HeathHabits site.  He has a post called The “I don’t have time to workout” Workout.  I ran across some paper notes I made during my time there.  Doug recommended some basic moves to incorporate: air squat, Hindu pushup, dragon flag, shuffle of scissor lunge, Spiderman lung, hip thrust/bridge, swing snatch, dumbbell press, Siff lunge, jumping Bulgarian squat, band wood chops, stiff leg deadlift.  Click the link to see videos of most of these exercises.  The rest you can find on YouTube.

Another post is called “Do you wanna get big and strong? -Phase 1”.  The basic program is lifting weights thrice weekly.  Monday, work the chest and back.  Tuesday, legs and abs/core.  Friday, arms and shoulders.

  • Chest exercises: presses (barbell or dumbell, incline, decline, flat, even pushups with additional resistance  – your choice
  • Back: chins or rows
  • Legs: squats or deadlifts
  • Arms and shoulders: dips, presses, curls

Doug is a personal trainer with a huge amount of experience.  He’s a good writer, too, and gives away a wealth of information at his website.

Around this same time of searching a couple years ago, I ran across Mark Verstegen’s Core Performance, Mark Lauren’s book “You Are Your Own Gym,”  and Mark Sisson’s free fitness ebook that also  features bodyweight exercises. Lauren is or was a Navy Seal trainer.  His plan involves 30 minutes of work on four days a week and uses minimal equipment.  Lots of good reviews at Amazon.com.

I did the Verstegen program for 15 weeks and saw major improvements in my fitness and low-back aching.  It’s a good program.  The only drawback is that it required six hours a week of my time.

Newbies to vigorous exercise should seriously consider using a personal trainer.

If you’ve had any experience with these regimens, please share.  Or is there another you like?

Steve Parker, M.D.

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Posted in Exercise, Genetics

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QOTD: Fish and Mercury Contamination

Posted on November 17, 2012 | Comments Off on QOTD: Fish and Mercury Contamination

Has anyone even bothered to ask why the tuna are eating mercury?

—Jim Gaffigan

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Annual Hospital Care Cost of Diabetes in U.S. Is $83 Billion (USD)

Posted on November 14, 2012 | Comments Off on Annual Hospital Care Cost of Diabetes in U.S. Is $83 Billion (USD)

“Let’s hope this thiazolidinedione doesn’t give you bladder cancer.”

At least according to the Agency for Healthcare Research and Quality.

-Steve

PS: The article above says diabetes is the fifth leading cause of death in the U.S.  Not so, according to the Centers for Disease Control and Prevention, which lists diabetes in seventh place.  I suspect it’s not even as high as that.  I fill out my share of death certificates, and I rarely list diabetes as the primary cause of death.

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14 Indispensable Weight-Loss Tips

Posted on November 8, 2012 | Comments Off on 14 Indispensable Weight-Loss Tips

These have worked for lots of my patients.  Take what works for you and discard the rest.

1) Plan on grocery shopping, meal preparation, and taking meals to your workplace.

2) Keeping a record of your food consumption is often the key to success.

3) Accountability is another key.  Do you have a friend or spouse who wants to lose weight?  Start the same program at the same time and support each other.  That’s one of many ways to have accountability.

4) If you tend to over-eat or snack too much, floss and brush your teeth after you’re full.  You’ll be less likely to go back for more anytime soon.

5) Eat at least two or three meals daily.  Eat breakfast every day.  Ignore the diet gurus who say you must eat every two or three hours.

6) Eat slowly and allow yourself time to enjoy the delicious recipes in this book; you’ll also be a better judge of when your’re full.

7) Don’t eat while watching TV.

8) Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost.  Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc.  Choose the reward in advance, to give you something to work toward.

9) Don’t start a diet during a time of stress.

10) Maintain a consistent eating pattern throughout the week and year.

11) If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while.  Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.

12) Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase.  Weekly thereafter.

13) Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then.  That’s normal.  Just get back on your original weight-loss plan for a month or two.

14) Tell your housemates you’re on a diet and ask for their support.  You may also need to tell your co-workers and others with whom you spend significant time.  If they care about you, they’ll be careful not to tempt you off the diet.

—Steve

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Found Another Paleo-Friendly Dietitian: Kelly O’Connell Schmidt, RD

Posted on November 5, 2012 | 1 comment

And she has type 1 diabetes, too.  I look forward to some free time so I can peruse her site, Paleo Infused.  Kelly’s twitter handle is @kellyOC.

—Steve

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Posted in Diabetic Diet, Testimonials

Dr. Frassetto Discusses Paleo Diet and Diabetes

Posted on November 5, 2012 | 6 comments

Not Dr. Frassetto

Dr. Lynda Frassetto is a Professor of Medicine and Nephrology at the University of California San Francisco.  She and her colleagues have completed a study of the Paleolithic diet as a treatment for diabetes (type 2, I think).  As far as I know, details have not yet been published in the medical literature.

Dr. Frassetto spoke at the Ancestral Health Symposium-2012 earlier this year.  You can view the 35-minute video here.

She is convinced that a paleo diet, compared to a Mediterranean-style diet, is better at controlling blood sugars and “reducing insulin” in diabetics (presumably type 2s).  Insulin sensitivity is improved, particularly in those with insulin resistance to start with.  The paleo diet group saw an average drop of fasting glucose by 23 mg/dl (1.3 mmol/l).  One slide you’ll see in the video indicates the paleo diet reduced absolute hemoglobin A1c by 0.3%, compared to 0.2% with the “Mediterranean” diet.  (Let me know if I got the numbers wrong.)

Color me underwhelmed so far.

Questions raised by the video include:

  • what is the UCSF version of the paleo diet?
  • how many participants were in her study?
  • how long did her study last?
  • did she study only type 2 diabetics?
  • what exactly was the control diet?
  • how severe were the cases of diabetes studied?

For answers, we await publication of the formal report.

Steve Parker, M.D.

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Posted in Diabetic Diet, Paleo Diet

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Artificial Sweeteners and the Paleoista

Posted on November 3, 2012 | 9 comments

Did you know babies under one year of age shouldn’t be given honey?  I saw that warning on a honey container recently and didn’t know why.  Honey may contain bacterial spores that cause botulism in the wee ones.

A pinch of salt helps reduce bitterness in coffee

Paleo diet aficionados can satisfy a sweet tooth with honey or fruit.  Unfortunately for people with diabetes, those items can spike blood sugars too high.  Honey, for instance, has 17 grams of carbohydrate in one tablespoon (15 ml), which is more carb than in a tablespoon of white granulated table sugar.

Most diabetics eating paleo-style will need some limit on consumption of honey and fruit.  Or they could take more diabetes drugs to control blood glucose elevations.  Again, unfortunately, we don’t know the long-term health effects of most of our diabetes drugs.

How about getting a sweet fix with artificial sweeteners?  Paleo purists would say “fuggedaboudit.”  In theory, that’s fine.  But many paleo followers with diabetes won’t forget about it.  They’ll use artificial sweeteners, aka sugar substitutes.

If you’re gonna use ’em, think about stevia.  It’s derived from a natural source, the leaves of a plant in South America.  Admittedly, our forebears in eastern Africa wouldn’t have had access to it 50,000 years ago.  After the plant has been processed, it’s certainly a highly refined product going against the grain of the paleo movement.  Furthermore, one of the stevia market leaders in U.S. (Truvia) is mixed with erythritol.  To help you feel better about the erythritol (a sugar alcohol), note that it is found naturally in some fruits.  Another stevia commercial product in the U.S. is Pure Via.

Dietitian Brenna at her Eating Simple blog reviewed sugar impostors in January, 2012.  She favored stevia over the others, at least for non-diabetics who were tempted.  Brenna also linked to a Mayo Clinic review of artificial sweeteners.

Note that sugar alcohols like erythritol have the potential to raise blood sugar levels.  They shouldn’t raise it as much as table sugar, however.  With regard to sugar alcohols, Dr. Richard K. Bernstein urges caution, if not total avoidance.  Use your meter to see how they effect you.

If you’re in the habit of using one or two teaspoons of honey to sweeten tea or coffee, you’re blood sugar levels should be more stable and manageable if you use stevia instead.  Dr. Bernstein gives the green light to stevia powder or liquid, along with saccharin tablets or liquid, aspartame tablets, and sucralose tablets, acesulfame-K, and neotame tablets.  Stevia is the only one close to “natural.”

Steve Parker, M.D.

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Posted in Supplements, Uncategorized

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Ancestral Diet May Improve Diabetes in Pima Indians

Posted on November 1, 2012 | 2 comments

Saguaro cactus fruit is edible

I ran across a 1991 New York Times article by Jane Brody discussing the benefits to Pima Indians of returning to their ancestral diet.  The Pima have major problems with obesity and diabetes.  (I frequently treat Pima Indians in the hospital.)  Some quotes:

Studies strongly indicate that people who evolved in these arid lands are metabolically best suited to the feast-and-famine cycles of their forebears who survived on the desert’s unpredictable bounty, both wild and cultivated.

By contrast, the modern North American diet is making them sick. With rich food perpetually available, weights in the high 200’s and 300’s are not uncommon among these once-lean people. As many as half the Pima and Tohono O’odham (formerly Papago) Indians now develop diabetes by the age of 35, an incidence 15 times higher than for Americans as a whole. Yet before World War II, diabetes was rare in this population.

Pima Indians traditionally ate a diet of tepary beans, mesquite seeds, corn, grains, greens, and other high-fiber/low-fat foods.  The switch to a diet high in sugar, refined grains, and other highly processed convenience foods may well be responsible for the current high rates of obesity and diabetes.  Australian aborigines have the same problem.

Steve Parker, M.D.

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Posted in Genetics, Grains, Overweight, Paleo Diet

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