Category Archives: Dietary Fat

Dietary Fat Influences Insulin Requirements in Type 1 Diabetes

Posted on January 8, 2020 | 1 comment

Is this pane di casa?

Everyone with diabetes—whether type 1 or type 2—should know that the amount of carbohydrate in meals has an impact on blood sugar levels and insulin requirements. In general, the more carbs, the more insulin you need, whether that insulin comes from a pharmacy or your pancreas. Less well known is that dietary protein and fat also have an effect on insulin requirements. It’s complicated, and there’s quite a bit of variation from one individual to another. The study at hand involved folks with type 1 diabetes using an insulin pump. The test meal was a piece of bread (pane di casa, 45 g carb) plus avocado and other fats in varying amounts.

From Diabetes Care:

The current study has two important outcomes. First, the type of fat has no statistically or clinically significant impact on postprandial glycemia, but the amount of fat has a significant, dose-dependent effect. Second, the insulin delivery pattern, and in some cases total dose, needs to be adjusted based on the amount of fat in order to minimize the risk of early postprandial hypoglycemia and late postprandial hyperglycemia.

Source: Amount and Type of Dietary Fat, Postprandial Glycemia, and Insulin Requirements in Type 1 Diabetes: A Randomized Within-Subject Trial | Diabetes Care

Steve Parker, M.D.

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Posted in Dietary Fat, Dietary Protein, Drugs for Diabetes

2019 ADA Conference Recommendations on Medical Nutrition Therapy (Diet)

Posted on November 9, 2019 | 1 comment

Shrimp Salad

I’m astounded by how many people with diabetes I meet who pretty much eat whatever they want. Others, when I ask if they’re on a particular diet, say, “I watch what I eat.” Which usually just means avoiding obvious sugar bombs.

The American Diabetes Association in 2019 hosted a conference on nutrition therapy for diabetes. I assume the ADA endorses the panel’s recommendations. The big news is continued movement toward carb-restricted eating. Some excerpts:

Today, there is strong evidence to support both the efficacy and cost-effectiveness of nutrition therapy as a key component of integrated management of individuals with diabetes. This is increasingly relevant as it is evident that “one-size-fits-all” eating plan is not suitable for prevention or management of diabetes, also considering diverse cultural backgrounds, personal preferences, comorbidities, and socioeconomic settings. The American Diabetes Association (ADA) is now emphasizing that medical nutrition therapy (MNT) is fundamental for optimal diabetes management, and the new report also includes information on prediabetes.

***

One of the key recommendations is to refer adults living with type 1 or type 2 diabetes to individualized, diabetes-focused MNT [medical nutrition therapy] at diagnosis and as needed throughout the life span, particularly during times of changing health status to achieve treatment goals.

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The new consensus recommendations consider that a variety of eating patterns are acceptable for the management of diabetes.

In the absence of additional strong evidence on the comparative benefits of different eating patterns in specific individuals, healthcare providers should focus on the key factors that are common among the patterns, including emphasizing non-starchy vegetables, minimizing added sugars and refined grains, and preferring whole foods over highly processed foods.

Reducing overall carbohydrate intake for individuals with diabetes is associated with the most evidence for improving glycemia and may be applied in a variety of eating patterns.

For selected adults with type 2 diabetes who are not meeting glycemic targets or where reducing anti-glycemic medications is a priority, reducing overall carbohydrate intake with low or very low carbohydrate eating plans is also a viable approach.

***

Regarding weight loss in overweight or obese folks with diabetes or prediabetes:

…a low carbohydrate diet is now recognized as a safe, viable, and important option for patients with diabetes, and the other is that greater emphasis is now placed on weight loss in patients who are overweight/obese for the prevention of diabetes and its treatment.

Indeed, in type 2 diabetes, 5% weight loss is recommended to achieve clinical benefits, with a goal of 15%, when feasible and safe, in order to achieve optimal outcomes.

In prediabetes, the goal is 7–10% for preventing progression to type 2 diabetes.

“Metabolic surgery,” better known as bariatric surgery, and medication-assisted weight loss (aka weight-loss drugs) should be considered in some cases.

***

Best approach for optimizing blood sugars:

For macronutrients, the available evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with or at risk for diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

[Self-monitoring of carbohydrate consumption is important.]

People with diabetes and those at risk for diabetes are encouraged to consume at least the amount of dietary fiber recommended for the general population; increasing fiber intake, preferably through food (vegetables, pulses (beans, peas, and lentils), fruits, and whole intact grains) or through dietary supplement, may help in modestly lowering HbA1C.

***

What about sugar-sweetened beverages?

Firstly, sugar-sweetened beverages should be replaced with water as often as possible.

Secondly, if sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources.

***

Is alcohol forbidden? No.

…educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended.

To reduce hypoglycemia risk, the importance of glucose monitoring after drinking alcohol beverages should be emphasized.

Steve Parker, M.D.

PS: I note that William Yancy, M.D., was on the expert panel.

PPS: Bold emphasis above is mine.

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Posted in Dietary Carbohydrate, Dietary Fat, Dietary Protein

Bix Sez: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes

Posted on September 8, 2016 | Comments Off on Bix Sez: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes

“So, we’ve known for at least 30 years, 60 years by the looks of that 1955 Lancet study, that low-fat diets could arrest the symptoms of diabetes or prevent the disease altogether.

Robbins’ “Diet For A New America” was a popular lay-person’s book (1st edition sold over a million copies), not a medical tome. It was in the social realm. Why isn’t its low-fat advice common knowledge? I’ll tell you … It’s for reasons that induce stores like Natural Grocers to ban Dr. Greger’s plant-based book. It’s because having people eat a low-fat, high-fiber diet would hurt sales of animal food: beef, pork, chicken, fish, eggs, and all manner of dairy food – cheese, yogurt, milk, butter, cream. That’s why. And you know how the meat and dairy industries keep a lid on the science that could really help people? They come out with their own studies, often meta-analyses which go back in time and cherry pick studies that defend their position.”

Source: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes | Fanatic Cook

One of the references Robbins uses to support his contention is a 1979 article in American Journal of Clinical Nutrition. It’s a study of 20 men, all of whom were on insulin for what I assume is type 2 diabetes. What’s odd is that the men were all “lean.” In real life, at least 85% of type 2 diabetics are overweight or obese. Not lean. Nevertheless, many of the men were able to stop insulin on the low-fat/high fiber diet. But these weren’t typical T2 diabetics.

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Posted in Diabetic Diet, Dietary Fat

Dietary Saturated Fat Doesn’t Influence Future Course of Coronary Heart Disease

Posted on October 1, 2015 | 2 comments
kkk

Most heart attacks occur in folks with pre-existing coronary artery disease that’s been present for years

If you already have coronary artery disease, Dr. Axel Sigurdsson says that ongoing saturated fat intake probably doesn’t matter, in terms of future cardiac events (like heart attacks) or risk of death from any cause.

Dr. Sigurdsson is a cardiologist in Iceland.

Some quotes from his blog:

For decades, cardiologists have advised patients with heart disease to restrict the intake of saturated fats and dietary cholesterol. Many patients still believe this to be the cornerstone of their lifestyle modification.

The main reason for avoiding saturated fats is the assumption that they adversely affect the lipid profile of our patients.

*   *   *

Recent studies suggest that the recommendation to avoid saturated fats may have been premature and not based on solid scientific evidence.

Now, a recently published Norwegian study shows that dietary intake of saturated fatty acids was not associated with risk of future events or death among patients with established coronary artery disease.

It is important to keep in mind that most of the patients were receiving secondary prevention drug therapy including aspirin, beta blockers and statins.

Anyhow, the results of the study certainly suggest that high intake of saturated fats is not a risk factor among patients with coronary heart disease receiving modern-day treatment.

These recent scientific data don’t imply hat we should urge our patients to consume high amounts of saturated fats. They only tell us that there is no association and accordingly, restriction won’t help.

So, it’s certainly a lifeline for those who believe red meat, whole-fat milk, cheese, cream, butter and eggs can be a part of a healthy diet.

On the other hand we must realise that scientific studies often provide contradictory results. A US study published last year suggested that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality following acute heart attack.

It appears the jury is still out…

RTWT.

Steve Parker, M.D.

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Posted in Dietary Fat, Heart Disease

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Why Everybody Should Eat Nuts

Posted on December 7, 2013 | 4 comments
Nuts with more omega-3 fatty acids (compared to omega-6) may be the healthiest

Nuts with the lowest omega-6/omega-3 fatty acid ratios may be the healthiest. In other words, increase your omega-3s and decrease omega-6s.

Conner Middelmann-Whitney explains in her recent post at Psychology Today. In a nutshell, they are linked to longer life and better health. For example:

In the largest study of its kind, Harvard scientists found that people who ate a handful of nuts every day were 20% less likely to die from any cause over a 30-year period than those who didn’t consume nuts. The study also found that regular nut-eaters were leaner than those who didn’t eat nuts, a finding that should calm any fears that eating nuts will make you gain weight.

The report also looked at the protective effect on specific causes of death. “The most obvious benefit was a reduction of 29% in deaths from heart disease—the major killer of people in America,” according to Charles S. Fuchs, director of the Gastrointestinal Cancer Treatment Center at Dana-Farber, the senior author of the report and a professor of medicine at Harvard Medical School. “But we also saw a significant reduction—11% —in the risk of dying from cancer,” added Fuchs.

Read the whole enchilada.

Nuts are integral to my Advanced Mediterranean Diet, Low-Carb Mediterranean Diet, Paleobetic Diet, and Ketogenic Mediterranean Diet.

Walnuts seem to have the lowest omega-6/omega-3 fatty acid ratio of all the common nuts. That may make them the healthiest nut. The jury is still out. Macadamia nuts have a good ratio, too. Paleo dieters focus on cutting out omega-6s and increasing omega-3s. Julianne Taylor has a great post on how to do that with a variety of foods, not just nuts.

Steve Parker, M.D.

4 Comments

Posted in Dietary Fat, Nuts

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A Default Position on the Omega-6/Omega-3 Debate

Posted on December 1, 2012 | 5 comments

ASBMB Today has a well-written balanced article on the omega-6/omega-3 fatty acid ratio debate written by Rajendrani Mukhopadhyay.  A fair amount of it is understandable to non-science majors.  The main question is whether the high consumption of omega-6 fatty acids in Western societies is unhealthy.

It’s estimated that throughout most of human evolution, our dietary omega-6/omega-3 ration has been around 3:1 or 2:1.  Today, it’s about 15:1, thanks to a large increase in omega-6 consumption.  Are our bodies adapted for the lower ratio?  A hard-core paleo diet like Dr. Cordain’s aims for that lower ratio.

Both sides of the debate agree that we would probably be better off eating more omega-3 fatty acids, as found in cold-water fatty fish.

I’m an omega-6/omega-3 ratio agnostic at this point.  I’ve never studied it in depth, so I have no strong opinion either way.

Here are a couple excerpts from the article to pique your interest:

No one is disputing that we’re eating more omega-6 than our predecessors did. Over the past 100 years, consumption of linoleic acid [an omga-6] has increased dramatically in the U.S., mainly through the use of soybean oil. Soybean oil intake has gone up from being 1 percent of calories in the American diet to as much as 10 percent, according to Hibbeln. Lands, Salem and others contend that the rise, driven by the processed food and agriculture industries, has happened without anyone knowing its effects. “If I were now to try to get permission to change 10 percent of the calories in the U.S. diet, I would need a very large body of data unequivocally proving that it was safe,” says Hibbeln. “No such body of data exists for soybean oil. But it’s in our diet. We’re the experiment. It’s been a very large, uncontrolled intervention.”

Experts like Harris and Willett say this increase has been to our benefit. “We have seen a massive decline in cardiovascular disease mortality and huge increase in life expectancy,” says Willett. “Not all the benefit is due to the increase in linoleic acid, but almost certainly much of it is. It was not an absolute disaster.” But the lipid biochemists counter that it’s not just cardiovascular disease at stake. They say diabetes, obesity and even psychiatric disorders are some outcomes of a diet heavy on omega-6s.

I’ve never before heard anybody credit linoleic acid with a major role in our  “huge increase in life expectancy” over the last century.  I doubt that’s the case.  I vote more in favor of better sewage systems, cleaner water, better hygiene, antibiotics, or improvements in surgery and medical care.

Evolutionary biologist Theodosius Dobzhansky said, “Nothing in biology makes sense except in the light of evolution.”  If that’s true, the default position is that lower amounts of omega-6 fatty acid are better than our current high consumption.  It’s up to the high-consumption proponents to prove otherwise.

Steve Parker, M.D.

h/t David Despain

PS: Dobzhansky was a Christian, by the way.

PPS: A Twitter reader (@pronutritionist) suggested that the modern Western dietary omega-6/omega=3 ratio is 9.6, not 15:1, citing Amer J Clin Nutr.  My source for 15:1 is Journal of Nutrition and Metabolism, vol. 2012, article ID 539426, doi 10.1155/2912/539426, by E. Patterson et al. I admit it’s not a great reference. Cordain’s 2002 book, The Paleo Diet, says 10:1.  Maybe it is closer to 10:1.  I’m sure there’s lots of inter-person variability.

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Posted in Dietary Fat, Paleo Diet, Paleo Theory

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What Happened to Lard?

Posted on May 25, 2012 | 5 comments

Lard? Wut choo talkin’ ’bout, Willis?

Lard may be making a come-back. An NPR article reviews its fall from grace, with mention of Crisco, Upton Sinclair, and Procter and Gamble.

Steve Parker, M.D.

h/t Laura Dolson

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Posted in Dietary Fat

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What’s Our Preferred Fuel?

Posted on May 16, 2012 | 2 comments

Dr. Jay Wortman has been thinking about whether our bodies prefer to run on carbohydrates (as a source of glucose) or, instead, on fats. The standard American diet provides derives about half of its energy from carbs, 35% from fats, and 15% from proteins. So you might guess our bodies prefer carbohydrates as a fuel source. Dr. Wortman writes:

Now, consider the possibility that we weren’t meant to burn glucose at all as a primary fuel. Consider the possibility that fat was meant to be our primary fuel. In my current state of dietary practice, I am burning fat as my main source of energy. My liver is converting some of it to ketones which are needed to fuel the majority of my brain cells. A small fraction of the brain cells, around 15%, need glucose along with a few other tissues like the renal cortex, the lens of the eye, red blood cells and sperm. Their needs are met by glucose that my liver produces from proteins. The rest of my energy needs are met with fatty acids and these come from the fats I eat.

Dr. Wortman, who has type 2 diabetes, in the same long post also writes about oolichan grease (from fish), an ancestral food of Canandian west coast First Nations people.

Drs. Jeff Volek and Stephen Finney have done research on athletes using a low-carb, high-fat diet.

Steve Parker, M.D.

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Posted in Dietary Fat, Exercise, Low-Carb

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Right Diet Preserves Brain Function and Size

Posted on April 12, 2012 | 1 comment

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

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Posted in Dietary Fat, Supplements, Vitamins

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Sources of Calories in U.S. Diet Over Last Four Decades

Posted on March 20, 2012 | 3 comments

Italian seaside totally unrelated to this post

Do you ever wonder how many of the total calories in the aveage U.S. diet come from added sugars? Grains? Dairy products? Added fats?

You’d have to do some detailed nutrient analysis to get your personal numbers, but if you’d like U.S. averages, see this cool infographic at Civil Eats.

The graph also shows how many calories are or were available for consumption per capita over time (without accounting for wastage in restaurants). It’s based on U.S. Department of Agriculture data.

A superficial glance suggests that U.S. per capita daily calorie consumption has increased by about 600 from the 1970s until now. But remember, these numbers don’t discount for restaurant wastage. Nor do I see an adjustment for children versus adults. I’ve seen other calculations of an extra daily 150 calories (women) to 300 calories (men). Even the lower numbers could explain our explosion of overweight and obesity.

Steve Parker, M.D.

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Posted in Dietary Fat, Grains, Overweight

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