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.

Increase Protein Consumption to Help With Weight Loss

Sous vide chicken and sautéed sugar snap peas. Chicken is a good source of high biologic value protein.

P.D. Mangan makes an argument for high-protein diets for those hoping to shed pounds of fat:

In humans, data collected from 38 different trials of food consumption that used widely varying intakes of protein, from 8 to 54% of energy, showed: “Percent dietary protein was negatively associated with total energy intake (F = 6.9, P < 0.0001) irrespective of whether carbohydrate (F = 0, P = 0.7) or fat (F = 0, P = 0.5) were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans.”

In obese humans, substitution of carbohydrate with protein leads to far greater weight loss, nearly twice as much.

In a human trial, decreasing the percentage of protein in food from 15% to 10% led to increased calorie intake of 12%. However, increasing the protein percentage from 15 to 25% did not affect calorie intake, which shows that humans may target a certain amount of protein, and eat no more or less when they get it.

There’s more at the link.

Source: Higher Protein for Greater Weight Loss – Rogue Health and Fitness

Julia Belluz Wonders Why Diets Succeed or Fail

You won’t gain weight from this meal

Julia Belluz has an interesting article at Vox regarding low-fat and low-carb diet success over the course of 12 months. Her focus is on a few individuals who participated and were outliers.

As I read this, I was reminded that successful long-term weight management starts and ends in the kitchen. It also took me back to 2009, when I determined that low-carb diets were just as legitimate as low-fat.

I don’t recall the author mentioning the typical pattern with 12-month weight loss studies: most folks lose significant weight in the first few month, then at six months they start gaining it back. Cuz they go back to their old eating habits. Sure, diets don’t work………..if you don’t follow them.

From Ms. Belluz:

As a longtime health reporter, I see new diet studies just about every week, and I’ve noticed a few patterns emerge from the data. In even the most rigorous scientific experiments, people tend to lose little weight on average. All diets, whether they’re low in fat or carbs, perform about equally miserably on average in the long term.

But there’s always quite a bit of variability among participants in these studies.Just check out this chart from a fascinating February study called DIETFITS, which was published in JAMA by researchers at Stanford.

The randomized controlled trial involved 609 participants who were assigned to follow either a low-carb or a low-fat diet, centered on fresh and high-quality foods, for one year. The study was rigorous; enrollees were educated about food and nutrition at 22 group sessions. They were also closely monitored by researchers, counselors, and dietitians, who checked their weight, waist circumference, blood pressure, cholesterol, and other metabolic measures throughout the year.

Overall, dieters in both groups lost a similar amount of weight on average — 11 pounds in the low-fat group, 13 pounds in the low-carb group — suggesting different diets perform comparably. But as you can see in the chart, hidden within the averages were strong variations in individual responses. Some people lost more than 60 pounds, and others gained more than 20 during the year.

Read the whole thing. It’s not long.

Source: Why do dieters succeed or fail? The answers have little to do with food. – Vox

The DIETFITS Trial

Is There a Role for Magnesium Supplementation in Type 2 Diabetes?

Not the magnesium used in the study at hand

I hadn’t thought so until I read about an experiment published in 2003. Now I’m wondering.

The study was done in northern Mexico and all participants were taking glibenclamide, a sulfonylurea known as glyburide in the U.S. Importantly, study participants had low blood magnesium levels at the outset.

So if you’re not a hypomagnesemic Mexican taking glibenclamide, results may not apply to you.

Nevertheless, results were impressive. Compared to the control group, magnesium supplementation…

  • reduced insulin resistance
  • fasting glucose was 144 mg/dl (185 in controls)
  • Hemoglobin A1c was 8% (10% in controls)

The experiment lasted 16 weeks and the specific form of magnesium used was magnesium chloride solution.

Maybe we should be checking magnesium levels more often. BTW, magnesium supplements are difficult for our bodies to absorb. I know of at least three magnesium compounds: oxide, citrate, and chloride. There are probably others. Degree of absorption varies from one to the other. Adding a supplement on top of kidney impairment could cause toxicity.

The researchers conclude:

Oral supplementation with MgCl2 solution restores serum magnesium levels, improving insulin sensitivity and metabolic control in type 2 diabetic patients with decreased serum magnesium levels.

Source: Oral Magnesium Supplementation Improves Insulin Sensitivity and Metabolic Control in Type 2 Diabetic Subjects | Diabetes Care

 

T1 Kelley Shares Her Details on U.S. Healthcare Costs

Kelley at her Below Seven blog writes about the sad state of the U.S healthcare “system,”  mostly about how insanely expensive it is for those of us not in a socialized program like Medicare or Medicaid. If you’re tempted to put the blame only on doctors, hospitals, and Big Pharma, know that insurance companies and politicians are also at fault. Politicians alone could solve the cost problem.

If you want to learn how to negotiate lower healthcare prices, check out this post at ZeroHedge. You could save thousands of dollars.

If you have 15 minutes to spare, read Karl Denninger’s article on comprehensive healthcare reform.

From Kelley:

This year, I have a deductible of $6,500, which means that I have to pay 100% of expenses until I reach that deductible.  I’m not sure if “healthy” people realize how much money a person with a chronic disease spends on healthcare each year, but $6,500 isn’t chump change.  That’s a whole lot of money!

Since my husband and I have our own company, we go through peaks and valleys when it comes to income.  Sometimes, it’s just not feasible to spend $3,000 in one month for diabetes supplies, which is when I’m thankful I was able to stock up so I can make it another month.

I’m not trying to write a woe is me post, but because I have to pay so much out of pocket, I am frustrated at how the health care system works.  You never get an exact price of how much something is going to cost before it goes through insurance.   But because of my insurance plan, I am on the hook for 100% of whatever they decide the cost is.

Source: Unknown Costs with Healthcare – Below Seven

Physicians are not immune to this malarky either. Health insurance for my family-of-four is about $12,000/year, with individual deductibles of $1000/year, family deductible of $3000/year, and family out-of-pocket maximum of $9000/year. And of course if I want to keep my out-of-pocket expenses at a mininum, I have to use the healthcare providers the insurer picks for me.

Steve Parker, M.D.

At Three Years, Gastric Bypass Superior to Intensive Medical Therapy for Obese Type 2 Diabetes

…in terms of weight loss, lowering of HgbA1c, and weight-related quality of life. The specific gastric bypass surgery used in the study is the Roux-en-Y version.

bariatric surgery, Steve Parker MD

Band Gastric Bypass Surgery (not the only type of gastric bypass): very successful at “curing” T2 diabetes if you survive the operation

Average initial weight of participants was 104 kg (229 lb). Bypass patients dropped their weight by 25 kg (55 lb)and HgbA1c decreased by 1.8% (absolute decrease), compared to intensive medical management participants who lost 10.3 kg (32 lb) and dropped HgbA1c only by 0.4%.

I doubt that intensive medical therapy included a low-carb Mediterranean or paleo diet.

Source: Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study | Diabetes Care