Intensive Program Extended Life By Eight Years in T2 Diabetes

MedPageToday has some details:

“Type-2 diabetics lived nearly 8 years longer when treated with an intensive, multifactorial approach that employed behavioral and pharmacological interventions.

The 160 patients with type-2 diabetes mellitus and microalbuminuria, now followed for 21 years, received either conventional or intensified therapy.

Thirty-eight intensive-therapy patients died during the follow-up period compared with 55 conventional-therapy patient deaths during the same time. This translated to a median survival period 7.9 years longer for the intensive-therapy cohort, as well as a median delay of 8.1 years to a first cardiovascular event, the investigators reported in the journal Diabetologia.

“The outcome of our study is very encouraging and emphasizes the need for early and intensified treatment of multiple modifiable risk factors for a poor prognosis of patients with type 2 diabetes,” said lead study author Peter Gaede, MD, of the University of Southern Denmark in Odense, in a statement.”

Source: Intensive Program Extends Lifespan in T2D Patients | Medpage Today

Parker here.

Study participants were northern Europeans (Danes) who had small amounts of protein (albumin) in their urine and were mostly in their 50s when the long-term study started.

Medical intervention included diet changes, drugs for diabetes/blood pressure/lipids, and exercise. Therapy for the intensive therapy group was “target-driven, with stepwise implementation of both behavioral and pharmacological treatment following a structured approach.”

If you’re a researcher and want to test how my diabetes diets would perform in a study like this, contact me for a discount on books.

Steve Parker, M.D.

Meet Dr. Priyanka Wali, Low-Carb Diet Advocate (interviewed by Ivor Cummins)

Dr. Wali is an internist in San Francisco. In her medical practice, she saw first-hand how standard “diabetic diets” weren’t helping her patients and many others who have carbohydrate intolerance. Welcome to the club, Dr. Wali!

PS: She’s also a good stand-up comedian,which is rare for an internist.


Joe Friel on Age-Related Weight Gain

Steve Parker MD

Not Joe Friel

Joe is an endurance athlete and a trainer of the same. His specialty is cycling. Last I heard, he lives in southern Arizona, probably close to me.

Anyway, he wrote a blog post in 2013 about how he tended to gain 10 lb every winter once he hit his 60s, heavier than he wanted to be. Counting calories to lose the weight didn’t work very well for him because of hunger. So he put together a low-carb paleo-style diet that did the trick. And without a loss of athletic performance.

Joe sez:

“The primary change I made was greatly reducing sugar and cutting back on fruit. I used to eat 5 to 7 servings of fruit a day. That’s roughly 600 calories of carbs from fruit, about 20 to 25% of my calories for the day. I now eat less than one serving per day on average. Foods high in fat I now eat a lot more of are olive oil, coconut milk, nuts, nut butter, eggs, avocado, and bacon along with the normal Paleo foods I’ve eaten since 1994 — animal products, especially fish and poultry, and vegetables. Foods high in fat I eat only a little of are dairy products. I avoid as best I can trans fats (“hydrogenated” on the label) and omega 6 oils (for example, soy, peanut, cottonseed, corn, safflower). Both categories are found in almost all processed and packaged foods in the grocery, especially junk foods. I seldom eat grains — probably less than one serving per month. I once used these as recovery foods on an almost daily basis.”

Click to RTWT: Joe Friel – Aging: My Race Weight

You’re Reading a Top 100 Diabetes Blog


A company named Feedspot has judged this blog to be one of the top 100 on diabetes.

How I ranked higher than The Low Carb Diabetic I’ll never understand.

It’s good to get validation now and then!

Steve Parker, M.D.

PS: I don’t know Feedspot. If you detect anything scammy or spammy about them, let me know. I’m alway suspicious of Internet awards.

Study Finds No Survival Advantage for Eight Classes of Type 2 Diabetes Drugs


A waste of money?

A waste of money?

A multinational group of researchers tried to determine which drugs for type 2 diabetes were better at prolonging life and preventing cardiovascular deaths. They reviewed the existing literature (i.e., they did a meta-analysis of prior clinical studies.

There are no clear winners. Placebo worked as well as the eight drug classes examined!

Unfortunately, the abstract doesn’t say how long the clinical studies lasted, only mentioning that they were at least 24 weeks long. It’s quite possible it would take at least three to five years to see an effect on death rates.

Selected quotes:

“Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.Researchers analyzed 301 randomized clinical trials of patients with type 2 diabetes, and found that, metformin outperformed some other drug classes for its effect on hemoglobin A1c levels, there were no significant differences in mortality — including when placebo was included as a drug class.”


“A central finding in this meta-analysis was that despite more than 300 available clinical trials involving nearly 120,000 adults and 1.4 million patient-months of treatment, there was limited evidence that any glucose-lowering drug stratified by coexisting treatment prolonged life expectancy or prevented cardiovascular disease,” the authors wrote.”


“The authors wrote that their findings are consistent with guidelines from the American Diabetes Association, which — like the algorithm from the American Association of Clinical Endocrinologists — recommend that metformin monotherapy be used for the initial treatment of patients with type 2 diabetes. “Based on this review, clinicians and patients may prefer to avoid sulfonylureas or basal insulin for patients who wish to minimize hypoglycemia, choose GLP-1 receptor agonists when weight management is a priority, or consider SGLT-2 inhibitors based on their favorable combined safety and efficacy profile,” the authors wrote.”

Source: No Clear Survival Benefit Seen Among Diabetes Drugs | Medpage Today

What Are Our Ancestral Sleep Patterns?


He got up before sunrise

Here are some answers in the summary of an article in Current Biology:

How did humans sleep before the modern era? Because the tools to measure sleep under natural conditions were developed long after the invention of the electric devices suspected of delaying and reducing sleep, we investigated sleep in three preindustrial societies. We find that all three show similar sleep organization, suggesting that they express core human sleep patterns, most likely characteristic of pre-modern era Homo sapiens. Sleep periods, the times from onset to offset, averaged 6.9–8.5 hr, with sleep durations of 5.7–7.1 hr, amounts near the low end of those industrial societies. There was a difference of nearly 1 hr between summer and winter sleep. Daily variation in sleep duration was strongly linked to time of onset, rather than offset. None of these groups began sleep near sunset, onset occurring, on average, 3.3 hr after sunset. Awakening was usually before sunrise. The sleep period consistently occurred during the nighttime period of falling environmental temperature, was not interrupted by extended periods of waking, and terminated, with vasoconstriction, near the nadir of daily ambient temperature. The daily cycle of tem- perature change, largely eliminated from modern sleep environments, may be a potent natural regulator of sleep. Light exposure was maximal in the morning and greatly decreased at noon, indicating that all three groups seek shade at midday and that light activation of the suprachiasmatic nucleus is maximal in the morning. Napping occurred on <7% of days in winter and <22% of days in summer. Mimicking aspects of the natural environment might be effective in treating certain modern sleep disorders.


Does Red Meat Cause Kidney Failure?

I don't know about these, but some fish have white meat (flesh), too

:Lobster meat is white, too

If you hear elsewhere about a recent study blaming red meat for kidney failure, be aware that the headline should read “pork.” Read on for details.

Wait, what? I thought pork was “the other white meat.”

First they told us red meat caused cancer. Then cardiovascular disease. Then diabetes. And now kidney failure. Why eat it at all? I still do, but in moderation.

You have to take studies like this with a grain of salt. There are numerous confounding factors that may invalidate results. For instance, if you’re not Chinese and living in Singapore, results of this study may not apply to you. For another instance, Chinese pork may be different from English, Indian, Canadian, and U.S. pork.

A quote from the article at MNT:

“Researcher Woon-Puay Koh and her team delved into data from the Singapore Chinese Health Study, which included more than 63,000 adults, aged 45-74. They linked the data with the Singapore Renal Registry, which holds the records of all Singapore ESRD patients [ESRD = end-stage renal disease]. The overall aim was to uncover the role of different protein sources on kidney health outcomes.

“We embarked on our study to see what advice should be given to chronic kidney disease patients or to the general population worried about their kidney health regarding types or sources of protein intake,” explains Koh.

In China, the primary red meat is pork, accounting for 97 percent of red meat intake. Other popular protein sources included eggs, dairy, shellfish, fish, soy, legumes, and poultry.

The participants were followed up for an average of 15.5 years. During that time, 951 cases of ESRD occurred; the resultant data showed a clear trend.

Red meat intake was associated with a dose-dependent increased ESRD risk. Individuals who consumed the highest amounts of red meat – the top 25 percent – showed a 40 percent higher risk of developing ESRD than those who consumed the least red meat – the bottom 25 percent.”

Source: Red meat consumption linked to kidney failure – Medical News Today

“Everything we love to eat is a scam” 

tuna, fishing, Steve Parker MD, paleo diet, tuna salad

Free-range bluefin tuna

I thought “langostino” was Spanish for lobster…Guess I’m wrong.

Click the link below for details.

“Unless your go-to sushi joint is Masa or Nobu, you’re not getting the sushi you ordered, ever, anywhere, and that includes your regular sushi restaurant where you can’t imagine them doing such a thing, Olmsted says. Your salmon is probably fake and so is your red snapper. Your white tuna is something else altogether, probably escolar — known to experts as “the Ex-Lax fish” for the gastrointestinal havoc it wreaks.

Source: Everything we love to eat is a scam | New York Post

Modern U.S. Women Weigh as Much as the Average Man of 1960


Way over 166 lb

Way over 166 lb

But women now are also about a half inch (2.2 cm) taller, so that explains it, right? Not by a long shot. The author of the article below blames unhealthy food, too much of it, plus physical inactivity. Since 1960, women’s average weight is up 18.5%, and men’s up 17.6%.

Click the link below for details. I quote:

The average American woman weighs 166.2 pounds, according to the Centers for Disease Control and Prevention. As reddit recently pointed out, that’s almost exactly as much as the average American man weighed in the early 1960s.

Men, you’re not looking too hot in this scenario either. Over the same time period you gained nearly 30 pounds, from 166.3 in the 60s to 195.5 today.

Source: The average American woman now weighs as much as the average 1960s man – The Washington Post

Steve Parker, M.D.

PS: You wanna do something about it? Send my book to someone you love.

PPS: Men are also a half inch taller.

Professor Tim Noakes: A Nutrition Heretic and His Low-Carb Epiphany

Paleo-compliant low-carb meal. I almost used this for my Paleobetic Diet book cover.

Paleo-compliant low-carb meal. I almost used this for my Paleobetic Diet book cover.

“I argue that the very reason we are facing an uncontrollable global diabetes/obesity pandemic at the moment, is because we have promoted dietary guidelines that are based solely on “evidence” from associational studies without acknowledging that RCTs [randomized controlled trials] have either not supported those conclusions or might have actively disproved them.

The solution in my mind is that we need to give dietary advice to persons with diabetes, T2DM [type 2 diabetes] especially, based on our understanding of the underlying patho-physiology of the condition, not on false information provided by associational epidemiological studies that are unable to prove causation.  I suggest that we know a number of features of the abnormal biology of T2DM with absolutely certainty.”

—Tim Noakes