Is a Very Low-Carb Diet Reasonable for Type 1 Diabetes?

Posted on November 10, 2019 | 3 comments

Exercise was natural when we were kids

Bottom line: A very low-carb diet worked well for children and adults with type 1 diabetes in this relatively small study.

Abstract

OBJECTIVES:

To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD).

METHODS:

We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records.

RESULTS:

Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia.

CONCLUSIONS:

Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.

Source: Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet. – PubMed – NCBI

Steve Parker, M.D.

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Posted in Diabetic Diet, Low-Carb

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.

***

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

A Paleolithic Vegan Diet? News to Me

Posted on November 1, 2019 | 1 comment

Not many vegan foods here

From European Endocrinology:

Abstract

INTRODUCTION:

The Palaeolithic diet is designed to resemble that of human hunter-gatherer ancestors thousands to millions of years ago. This review summarises the evidence and clinical application of this diet in various disorders. An empiric vegan variant of it has been provided, keeping in mind vegan food habits.

REVIEW OF THE LITERATURE:

Different types of Palaeolithic diets in vogue include the 80/20, the autoimmune, the lacto, the Palaeolithic vegan and the Palaeolithic ketogenic. We have developed an Indian variant of the Palaeolithic vegan diet, which excludes all animal-based foods. The Palaeolithic diet typically has low carbohydrate and lean protein of 30-35% daily caloric intake in addition to a fibre diet from non-cereal, plant-based sources, up to 45-100 g daily. In different observational studies, beneficial effects on metabolic syndrome, blood pressure, glucose tolerance, insulin secretion, lipid profiles and cardiovascular risk factors have been documented with the Palaeolithic diet. Short-term randomised controlled trials have documented weight loss, and improved glycaemia and adipo-cytokine profiles. Few concerns of micronutrient deficiency (e.g. calcium) have been raised.

CONCLUSION:

Initial data are encouraging with regard to the use of the Palaeolithic diet in managing diabesity. There is an urgent need for large randomised controlled trials to evaluate the role of the Palaeolithic diet with different anti-diabetes medications for glycaemic control and the reversal of type 2 diabetes.

Source: Palaeolithic Diet in Diabesity and Endocrinopathies – A Vegan’s Perspective. – PubMed – NCBI

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Posted in Vegetarian Diets

But I thought we originated in northeast Africa: Paleontologists trace origins of modern humans to southern Africa

Posted on October 30, 2019 | Comments Off on But I thought we originated in northeast Africa: Paleontologists trace origins of modern humans to southern Africa

Where am I?

I’m skeptical, and I’m not the only one.

Oct. 29 (UPI) — The earliest ancestors of anatomically modern humans, Homo sapiens sapiens, emerged in southern Africa, according to a new study published this week in the journal Nature.

“It has been clear for some time that anatomically modern humans appeared in Africa roughly 200 thousand years ago,” lead researcher Vanessa Hayes, a professor of human genomics at the Garvan Institute of Medical Research in Australia, said in a news release. “What has been long debated is the exact location of this emergence and subsequent dispersal of our earliest ancestors.”

Hayes and her colleagues used mitochondrial DNA samples from indigenous Africans to trace the human family tree back to its roots. According to the genetic analysis, the earliest modern humans emerged in an area south of the Zambezi River, in what’s now Botswana.

Source: Paleontologists trace orgins of modern humans to Botswana – UPI.com

Steve Parker, M.D.

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Posted in Paleo Theory

Paleolithic diet during pregnancy: A potential beneficial effect on metabolic indices and birth weight

Posted on October 29, 2019 | Comments Off on Paleolithic diet during pregnancy: A potential beneficial effect on metabolic indices and birth weight
Paleobetic diet

“Think of me”

A paleo diet lowered glucose levels during pregnancy. Hmmm…I wonder if that would prevent to treat gestational diabetes. From the European Journal of Obstetrics, Gynecology, and Reproductive Biology:

Abstract

BACKGROUND:

Paleolithic diet has recently gained popularity due to its presumed health benefits. The favorable metabolic effects of this diet were assessed in non-pregnant population but its impact during pregnancy remains to be evaluated.

STUDY DESIGN:

A retrospective cohort study comparing two groups. Group A comprised of women with singleton low-risk pregnancy adherent to paleolithic diet throughout gestation (n = 37). Group B comprised low risk pregnant women on a regular diet (n = 39). Women were excluded if they had low adherence to diet, started paleolithic diet during pregnancy, and had pre-gestational diabetes mellitus or other types of metabolic syndrome such as pre gestational hyperlipidemia, hypertension or BMI > 35. Blood indices such as Glucose challenge test scores, hemoglobin, ferritin, and TSH levels were compared. Other pregnancy factors such as maternal weight gain, rest days during gestation and pregnancy complications such as IUGR, GDM or preeclampsia were compared. Lastly, obstetrical outcomes such as mode of delivery and complications such as high-grade tears, as well as neonatal factors such as birth weight and pH were compared between the two groups.

RESULTS:

General maternal characteristics such as age, BMI and parity were comparable between the two groups. Women who maintained a paleolithic diet had a significant decrease in glucose challenge test scores (95.8 mg/dL vs. 123.1 mg/dL, p < 0.01) and increase in hemoglobin levels (12.1 g/dL vs. 11.05 g/dL p < 0.01) and Ferritin (32.1 vs 21.3 mg/mL, p = 0.03) compared to women maintaining regular diet. Maternal pregnancy weight gain was also slightly decreased in group A (9.3Kg vs. 10.8 kg, p = 0.03). Birthweights were lower in group A (3098 g Vs.3275 g, p = 0.046) with no difference in adverse neonatal outcomes. We found no differences in other pregnancy complications or labor outcomes such as mode of delivery, shoulder dystocia or high grade perineal tears.

CONCLUSION:

Paleolithic diet maintained during pregnancy may have a beneficial effect on the glucose tolerance. It also may increase iron stores and hemoglobin levels. Neonates of women maintaining paleolithic diet are slightly lighter but appropriate for gestational age with no difference in neonatal outcomes.

Source: Paleolithic diet during pregnancy-A potential beneficial effect on metabolic indices and birth weight. – PubMed – NCBI

Steve Parker, M.D.

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Posted in Causes of Diabetes

Tagged

Marriage Linked to Longer Lifespan

Posted on October 28, 2019 | Comments Off on Marriage Linked to Longer Lifespan
dementia, memory loss, Mediterranean diet, low-carb diet, glycemic index, dementia memory loss

“Sweat Pea, let’s schedule you a check-up with Dr. Gupta.”

From UPI:

Married men in 2017 had an age-adjusted death rate of 943 per 100,000, compared to 2,239 for widowers. The death rate was 1,735 per 100,000 for lifelong bachelors and 1,773 for divorced men.

Married women had a death rate of 569 per 100,000, two-and-a-half times lower than the 1,482 rate for widows. The death rate was 1,096 for divorcees and 1,166 for never-married women.

*  *  *

While the death rate for married men and women declined by the same 7 percent, women’s overall death rate was much lower.

But the death rates among men in all other marital categories remained essentially the same between 2010 and 2017, researchers found.

On the other hand, the death rate for widowed women rose 5 percent, while the rate for never-married women declined by 3 percent and remained stable for divorced women.

Source: Marriage linked to longer lifespan, new data shows – UPI.com

Steve Parker, M.D.

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Posted in Longevity

Diet Quality Affects Risk of Cardiovascular Disease in Post-Menopausal Diabetic Women

Posted on October 26, 2019 | 1 comment

Not your average cave-woman

Regarding the mention of paleo diet below, I rather doubt the study at hand hand significant numbers of paleo diet followers. From the Journal of the American Heart Association:

ABSTRACT

Background Dietary patterns are associated with cardiovascular disease (CVD) risk in the general population, but diet-CVD association in populations with diabetes mellitus is limited. Our objective was to examine the association between diet quality and CVD risk in a population with type 2 diabetes mellitus.

Methods and Results

We analyzed prospective data from 5809 women with prevalent type 2 diabetes mellitus at baseline from the Women’s Health Initiative. Diet quality was defined using alternate Mediterranean, Dietary Approach to Stop Hypertension, Paleolithic, and American Diabetes Association dietary pattern scores calculated from a validated food frequency questionnaire. Multivariable Cox’s proportional hazard regression was used to analyze the risk of incident CVD. During mean 12.4 years of follow-up, 1454 (25%) incident CVD cases were documented. Women with higher alternate Mediterranean, Dietary Approach to Stop Hypertension, and American Diabetes Association dietary pattern scores had a lower risk of CVD compared with women with lower scores (Q5 v Q1) (hazard ratio [HR]aMed 0.77, 95% CI 0.65-0.93; HRDASH 0.69, 95% CI 0.58-0.83; HRADA 0.71, 95% CI 0.59-0.86). No association was observed between the Paleolithic score and CVD risk.

Conclusions

Dietary patterns that emphasize higher intake of fruits, vegetables, whole grains, nuts/seeds, legumes, a high unsaturated:saturated fat ratio, and lower intake of red and processed meats, added sugars, and sodium are associated with lower CVD risk in postmenopausal women with type 2 diabetes mellitus.

Source: Diet Quality and Cardiovascular Disease Risk in Postmenopausal Women With Type 2 Diabetes Mellitus: The Women’s Health Initiative. – PubMed – NCBI

Steve Parker, M.D.

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Posted in Heart Disease, stroke

Dog Ownership Reduces Risk of Premature Death

Posted on October 23, 2019 | Comments Off on Dog Ownership Reduces Risk of Premature Death
paleobetic diet, paleo diet for diabetes

Parker Compound guard dogs waiting for bacon

From UPI:

A pair of new reports found that dog owners have a lower risk of early death than people without canine companionship, particularly when it comes to dying from a heart attack or stroke.

Dog ownership decreases a person’s overall risk of premature death by 24 percent, according to researchers who conducted a review of the available medical evidence.

The benefit is most pronounced in people with existing heart problems. Dog owners had a 65 percent reduced risk of death following a heart attack and a 31 percent reduced risk of death from heart disease, the researchers said.

Source: Having a dog can lower risk of death from heart attack, stroke – UPI.com

Steve Parker, M.D.

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Posted in Longevity

Diet Can Prevent Chronic Kidney Disease and Albuminuria

Posted on October 18, 2019 | Comments Off on Diet Can Prevent Chronic Kidney Disease and Albuminuria

Folks with diabetes are at risk for chronic kidney disease, often heralded by albumin (a protein) in the urine.

The heathy diet describe in this Renal and Urology News article sounds like the Mediterranean diet to me, not a typical paleo diet. It will be years, if ever, before the paleo diet is tested as a preventative for chronic kidney disease. But anyway…

Adhering to a healthy diet may reduce the risk of chronic kidney disease (CKD) and albuminuria, according to a new systematic review and meta-analysis.

Such a diet is rich in vegetables, fruit, legumes, nuts, whole grains, fish, and low-fat dairy products and low in red and processed meats, sodium, and sugar-sweetened beverages.

Jaimon T. Kelly, PhD, of Bond University in Australia, and collaborators, analyzed 18 studies that included a total of 630,108 healthy adults followed for a mean 10.4 years. Their meta-analysis of low to moderate grade studies found that a healthy dietary pattern was associated with a 30% lower incidence of CKD and a 23% lower incidence of albuminuria, according to results published in the Clinical Journal of the American Society of Nephrology.

The dietary patterns that were most frequently studied included the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and US dietary guidelines.

Source: Healthy Diet May Prevent CKD, Albuminuria – Renal and Urology News

Steve Parker, M.D.

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Posted in Kidney Disease

Red Meat Not Quite as Deadly as Imagined

Posted on October 16, 2019 | 2 comments

From New York Times:

Public health officials for years have urged Americans to limit consumption of red meat and processed meats because of concerns that these foods are linked to heart disease, cancer and other ills.

But on Monday, in a remarkable turnabout, an international collaboration of researchers produced a series of analyses concluding that the advice, a bedrock of almost all dietary guidelines, is not backed by good scientific evidence.

Whew…What a relief! Dodged that bullet.

Click for Gina Kolata’s article.

Steve Parker, M.D.

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Posted in Cancer, Heart Disease, Longevity