Are Pills the Answer to Unhealthy Lifestyles?

paleobetic diet, low-carb diet, diabetic diet

“This is much easier than exercising and losing 30 pounds!”

Fiona Godlee, editor-in-chief of the British Medical Journal, has a heretical short article at BMJ. I recommend you read the whole thing. It starts thusly:

More than half of adults aged over 45 will be labelled as hypertensive if new US guidelines are adopted, concludes a study in The BMJ this week (doi:10.1136/bmj.k2357). This equates to 70 million people in the US and 267 million people in China being eligible for antihypertensive drugs, a marked increase on already high rates of drug treatment for high blood pressure. Furthermore, the study calculates that 7.5 million people in the US and 55 million in China would be advised to start drug treatment, while 14 million in the US and 30 million in China would be advised to receive more intensive treatment. The evidence from trials indicates some benefit from drugs in terms of reduced risk of stroke and heart disease, but is mass medication really what we want?

Hypertension is just one of the many heads of the lifestyle disease hydra. Another is type 2 diabetes. Once thought to be irreversible and progressive, it is now known to be potentially reversible through weight loss. This is the cautious conclusion of the review by Nita Forouhi and colleagues (doi:10.1136/bmj.k2234), part of our series on the science and politics of nutrition (bmj.com/food-for-thought). Whether by calorie or carbohydrate restriction, weight loss has been shown to improve glycaemic control, blood pressure, and lipid profile and is the key to treatment and prevention of type 2 diabetes, they say.

She goes on to talk about fatty liver disease (NASH) and offers an alternative, of sorts, to pills. Good luck with that.

Source: Pills are not the answer to unhealthy lifestyles | The BMJ

The dawn of bread, 14,000 years ago

Archaeologists working at Shubayqa 1, a site in northeastern Jordan, found tiny fragments of an ancient unleavened bread as they were excavating a hearth. The site was made by people of the Natufian culture, 14,400 years ago. The paper describing the discovery, by Amaia Arranz-Otaegui and coworkers, documents the use of a mixed unleavened dough to make bread more than 4000 years before the introduction of agriculture in this region of the world.

Source: The dawn of bread · john hawks weblog

Low-Carb Diet for Diabetes

This Avocado Chicken soup is low-carb. Use the search box to find the recipe.

Over at Diabetes Daily, Dr Maria Muccioli wrote about recent low-carb diet research as applied to diabetes, as discussed at a recent meeting of the American Diabetes Association. A couple excerpts to whet your appetite:

Dr. Tay stated that a very low carbohydrate diet offers a considerable advantage over a high carbohydrate approach for patients with type 2 diabetes.She noted that reducing medication use is not only cost-effective but can also safeguard from the considerable side effects of some second-line medications. She also explained that achieving less glycemic variability, which may be an independent risk factor for the development of diabetes-associated complications, is “of great clinical importance.”“It is a good diet to have if you have diabetes, and the data support that,” she concluded.

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What about VLC diet for children with type 1 diabetes?

Dr. de Bock does not deny that a VLCD for children with type 1 diabetes can help to achieve exceptional glycemic control, as recently demonstrated in a study showing normal average A1c levels in a large cohort of patients. The speaker remarked that the patients in that study had very low glycemic variability.

He believes that more research needs to be conducted to evaluate the relevance of the potential concerns that he outlined. Until then, he advises parents of children who follow a VLCD to work closely with their medical care providers to monitor growth, cardiac, nutritional, and mental/emotional parameters.

Source: Very Low Carbohydrate Diets for Diabetes (ADA 2018)

Are 4 of 10 Dietary Research Results Wrong?

paleo diet, paleolithic diet, caveman diet

Spewing mis-information?

It wouldn’t surprise me. That’s why I’m not as dogmatic as some of the other diet gurus out there. Patrick Clinton writes:

“There’s a reason everyone’s confused about whether coffee causes cancer, or whether butter’s good for you or bad. Food research has some big problems, as we’ve discussed here and here: questionable data,  untrustworthy results, and pervasive bias (and not just on the part of Big Food). There’s reason to hope that scientists and academic journals will clean up their acts, and that journalists will refine their bullshit detectors and stop writing breathlessly about new nutrition “discoveries” that are anything but.  Until that happens, though, we all need to get better at filtering for ourselves.”

Source: Almost 40% of peer-reviewed dietary research turns out to be wrong. Here’s why | New Food Economy

Dietitian Julianne Taylor Reviewed 9 Paleo Diet Studies…

“Overall results worth a mention:

Compared to baseline or other healthy diets, the paleo diet achieved better results in every singly study in all the following measures

  • Satiety and satiety hormones
  • Greater reduction in caloric intake without counting calories
  • Greater reduction in fat mass
  • Greater reduction in waist circumference
  • Greater improvements in insulin sensitivity and other markers of pre-diabetes and type 2 diabetes
  • Greater reduction in blood pressureGreater improvements in blood lipids”

Source: Paleo diets studies show increased satiety and decreased calorie intake | Julianne’s Paleo & Zone Nutrition

Will A Modified Paleo-Style Diet Improve Multiple Sclerosis?

Not Dr Wahls

Dr Terry Wahls for several years has advocated a radical diet for multiple sclerosis patients. She has (or had) the disease herself, and achieved a dramatic improvement with a diet, as I recall, fairly compliant with generally accepted paleo principles. She certainly seems to be a true believer.

I have yet to run across a patient in person who has even heard of the Wahls protocol.

In the video linked above, Dr Wahls says she saw improvement after three months of her new way of eating, with continued improvement over the next 3–9 months or longer.

Dr Wahls and associates are putting it to the test.

Abstract

BACKGROUND:Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and contributes to diminishing quality of life. Although currently available interventions have had limited success in relieving MS-related fatigue, clinically significant reductions in perceived fatigue severity have been reported in a multimodal intervention pilot study that included a Paleolithic diet in addition to stress reduction, exercise, and electrical muscle stimulation. An optimal dietary approach to reducing MS-related fatigue has not been identified. To establish the specific effects of diet on MS symptoms, this study focuses on diet only instead of the previously tested multimodal intervention by comparing the effectiveness of two dietary patterns for the treatment of MS-related fatigue. The purpose of this study is to determine the impact of a modified Paleolithic and low saturated fat diet on perceived fatigue (primary outcome), cognitive and motor symptoms, and quality of life in persons with relapsing-remitting multiple sclerosis (RRMS).

Source: Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perce… – PubMed – NCBI

Research Supports Very Low-Carb Diet for BOTH Adults and Children With T1 Diabetes

Hamburger-Avocado Salad with tomatoes, cucumbers, lettuce, salt/pepper, and olive oil vinaigrette. Yes, it’s very low-carb.

MedPage Today has a brief report that may interest you. A new study indicates that a very low-carb diet (VLCD) is beneficial to both adults and children with type 1 diabetes. No surprise to me, although I admit this was not an ideal study.

Among people with type 1 diabetes, following a very low-carbohydrate diet (VLCD) can aid in achieving glycemic control, researchers suggested.

Responses from an online survey of people with type 1 diabetes found that those who followed a VLCD reported very good glycemic control – a mean HbA1c of 5.67% ± 0.66%, according to the study by Belinda Lennerz, MD, PhD, of Boston Children’s Hospital, and colleagues. Overall, 97% of these participants achieved the recommended glycemic targets of the American Diabetes Association.

The average blood glucose levels among the subset of patients who reported these values were 104 ± 16 mg/dL, the researchers reported in Pediatrics.

Followers of this diet also noted very few adverse events, with only 2% of the total respondents reporting a diabetes-related hospitalization within the past year – 1% for ketoacidosis and 1% for hypoglycemia.

The survey included 316 responses from both adults with type 1 diabetes and the parents of children with type 1 diabetes. These individuals belonged to a Facebook group of people living with type 1 diabetes who adhere to a VLCD. While a VLCD is usually defined as ≤20 to 50 g per day of carbohydrates or ≤5% to 10% of daily caloric intake, the mean carbohydrate intake of these respondents was 36 ± 15 grams per day.

Source: Carb-Light Diet Helps T1D Patients Achieve Glycemic Control | Medpage Today

Click for the scientific citation.

Here’s more info from Maria Muccioli, Ph.D.

Steve Parker, M.D.

One in Eight Healthcare Dollars in the U.S. Goes for Diabetes Care

Healthcare dollars

Most of the numbers below won’t mean much to you because they are mind-boggling—and mind-numbing. Also note that most of the cost is caused by type 2 diabetes in people over 65. From Diabetes Care:

“The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion).”

Source: Economic Costs of Diabetes in the U.S. in 2017 | Diabetes Care

Drastically reduce your diabetes healthcare expenditures by incorporating the ideas in my books. The ball’s in your court.

Steve Parker, M.D.

Book Review: “The Diabetes Code” by Dr Jason Fung

From Shutterstock.com

Dr Jason Fung is best known for his advocacy of fasting and low-carb eating. I recently read his latest book, The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally, published this year.

*   *   *

I waffled between a four or five-star Amazon.com review, but settled on four-star because 1) I haven’t read all of the pertinent scientific literature, and 2) I’m not sure how feasible the Fung protocol is for the average type 2 diabetic (or PWD if you prefer).

When I mention diabetes or diabetic hereafter, it’s always type 2 diabetes, not type 1.

This book builds on the success of very low-carb eating as a therapeutic approach to type 2 diabetes. But it goes beyond that by advocating frequent prolonged fasts as a potential cure for diabetes. I’m talking about fasting for 30–36 hours at a stretch, for up to three times a week. On non-fasting days, his patients typically eat a low-carb diet, which makes sense to me. Two week-long sample meal plans are provided. Thus far, none of my patients have asked me about fasting. If the underlying science checks out, I’d seriously consider the Fung approach myself if I had T2 diabetes.

The longest fast I’ve done has been 24 hours. That’s pretty easy for me, probably because I eat low-carb, so my fat-burning cellular machinery is ready for action. In bro-science terms, I’m keto-adapted. I have no idea if fasting 36 hours would be any harder than 24. Maybe it’s easier if you’re obese.

Dr Fung shares many clinical vignettes from his Intensive Dietary Management Program in Canada. He doesn’t mention how many of his patients start the program and then drop out because it’s too difficult.

Why the intermittent fasting? Because it seems to be an efficient way to reverse the fat build-up in the liver and pancreas that cause the high blood sugars of diabetes. That fat build-up, in turn, is caused by high insulin levels, according to Dr Fung’s working theory of diabetes causation.

The author says the following is what causes diabetes and prediabetes. First, remember that dietary carbohydrates cause a release of insulin from the pancreas, in order to dispose of the carbohydrate as an immediate source of energy or for storage in the liver and skeletal muscles as glycogen. If the carb is not needed for immediate energy and if the glycogen tanks in liver and muscle are full, the glucose is converted to fat. That fat is ideally stored in specialized fat cells (adipocytes), but can also be stored in the liver and pancreas (called visceral fat). Excessive fat in the liver and pancreas eventually impairs function of those organs. To prevent this overload, cells have to become resistant to insulin’s effects. Diets rich in highly-processed, refined carbohydrates (especially fructose, sucrose, and starches) over-stimulate insulin release from the pancreas. Over time, this causes not only body fat, but also fat build-up in the liver and pancreas, impairing their function.

Intermittent fasting and very low-carb eating directly and immediately ameliorate the high insulin levels that cause diabetes. The fasting allows for extended periods of low insulin, which helps tissues regain or maintain sensitivity to insulin, he says.

Dr Fung rightfully points out that his program should be done under physician supervision, especially if you take drugs that can cause hypoglycemia. I can see patients taking this book to office visits and asking “Doc, can I try this?” Unfortunately, many doctors won’t take the time to read the book.

I wonder if this manifesto was actually written to convince physicians that what we’ve been doing for years is misguided, and that Fung’s approach is the way to go.

My favorite sentence: “…the very low-carbohydrate diet does remarkably well, giving you 71% of the benefits of the fasting without actual fasting.”

My least favorite sentence was regarding side effects (e.g., hunger pangs, muscle cramps, headaches) when starting fasting: “These side effects are often signs that the body is dumping its toxic sugar load.” No, that’s just good ol’ “induction flu,” more recently called keto flu.

I don’t know if Dr Fung’s causation theory of diabetes is correct or not. Maybe Dr Roger Unger’s glucagon-centric hypothesis is the reality. Ultimately what matters is whether his protocol actually reverses diabetes in significant numbers of folks, and does it safely. If the Fung protocol proves widely effective, and I hope it does, a Nobel Prize in Medicine may be in Dr Fung’s future.

Steve Parker, M.D.

 

Disclosures: I was given an Advance Reader’s Copy of the book by the publisher’s representative, otherwise I received no financial or other compensation. I don’t know Dr Fung.

Potential conflict of interest: I am a diet book author and blogger who advocates Mediterranean-style eating and low-carb eating for the general public and diabetics.

Verner Compares Dr David Unwin’s and Diabetes UK’s Diet Advice for T2 Diabetes

Shrimp Salad

Low-carb vs standard “diabetic diet”:

The most significant fact to emerge is that those who follow the advice of Dr [David] Unwin are so often successful.

In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice:

(1) Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg [20 lb], waist circumference fell by 15 cm [6 inches], blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but in common with prior observations for low-carbohydrate diets a significant improvement would have been anticipated.From the perspective of the practice, there has been a huge saving in the expenditure on drugs used for the treatment of diabetes. The actual figure is about £38,000 [$51,000 US dollars] per year against the regional average, which represents the lowest spend per 1000 patients in any of the 19 surgeries in the surrounding Southport (UK) and Formby area for which information was available. This saving should be seen against the extra costs of the Norwood Surgery diabetes intervention at just under £9,000 per year.

(2) There has also been an improvement in the obesity prevalence as determined by BMI. This has dropped from 9.4% before the initiative commenced to 8.4%. The National Health Survey for England shows that for adults there has been a steady increase in the prevalence of obesity in England between 2010 and 2015.

Source: 305. A Comparison between the approaches to Type 2 Diabetes (T2D) by Dr David Unwin and Diabetes UK | Verners Views

RTWT for diet details.