Review Article Supports Tight Control in Diabetes

Posted on August 27, 2019 | Comments Off on Review Article Supports Tight Control in Diabetes

What are reasonable blood sugar and HgbA1c goals for folks with diabetes? The experts continue to debate. If I had diabetes, I’d want my glucose levels as close to normal as possible. On the other hand, if I had terminal cancer, I’d be fine with higher levels.

In Diabetes Care:

Glycated hemoglobin targets have been given in guidelines for the last three decades, mostly without change at around 6.5–7.0% (47–53 mmol/mol). Personalization of such targets has also long been advocated, but often with little and inappropriate guidance. More recently some have suggested higher targets might be indicated, and more specifically lower targets avoided, even in those in whom they are easily attained without seeming burden or risk. Prospective data from randomized and observational studies, in people with type 2 diabetes and indeed those without diabetes, find cardiovascular and mortality risk are uniformly lowest at lower levels including into the normal range. In some studies with large populations, a high proportion of people are found to attain such levels, and the UK Prospective Diabetes Study (UKPDS) and more recent studies appear to confirm the importance of starting low and continuing long. Studies of cardiovascular events and mortality in people with diabetes will already factor in any effect of hypoglycemia, which therefore should not be double-counted in setting targets. Nevertheless, some factors should lead to modification of target levels, and these will include experience of hypoglycemia where therapy change and glucose monitoring cannot ameliorate it and sometimes prospectively in those at social or occupational risk. The fact that clinical experience will modify targets emphasizes that targets will not be stable over time but will change, for example, with occurrence of adverse events or perceptions of increase/decreased burden of therapy. The evidence suggests that glucose control takes 5 years or more to have any impact on vascular outcomes or mortality, so targets may also be higher in those with shorter life expectancy or higher health burden or simply reflect individual preferences. This article discusses the evidence behind these conclusions.

Source: Controversies for Glucose Control Targets in Type 2 Diabetes: Exposing the Common Ground | Diabetes Care

Steve Parker, M.D.

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Posted in Drugs for Diabetes

U.S Is #1 in Diabetes Drug Prices

Posted on August 26, 2019 | 1 comment

I don’t have the resources to confirm the figures below, but I won’t be surprised if accurate. From Public Interest on Twitter:

https://platform.twitter.com/widgets.js

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Posted in Drugs for Diabetes

Gut microbiome response to a modern Paleolithic diet

Posted on August 18, 2019 | Comments Off on Gut microbiome response to a modern Paleolithic diet

From PloS One:

Abstract

The modern Paleolithic diet (MPD), featured by the consumption of vegetables, fruit, nuts, seeds, eggs, fish and lean meat, while excluding grains, dairy products, salt and refined sugar, has gained substantial public attention in recent years because of its potential multiple health benefits. However, to date little is known about the actual impact of this dietary pattern on the gut microbiome (GM) and its implications for human health. In the current scenario where Western diets, low in fiber while rich in industrialized and processed foods, are considered one of the leading causes of maladaptive GM changes along human evolution, likely contributing to the increasing incidence of chronic non-communicable diseases, we hypothesize that the MPD could modulate the Western GM towards a more “ancestral” configuration. In an attempt to shed light on this, here we profiled the GM structure of urban Italian subjects adhering to the MPD, and compared data with other urban Italians following a Mediterranean Diet (MD), as well as worldwide traditional hunter-gatherer populations from previous publications. Notwithstanding a strong geography effect on the GM structure, our results show an unexpectedly high degree of biodiversity in MPD subjects, which well approximates that of traditional populations. The GM of MPD individuals also shows some peculiarities, including a high relative abundance of bile-tolerant and fat-loving microorganisms. The consumption of plant-based foods-albeit with the exclusion of grains and pulses-along with the minimization of the intake of processed foods, both hallmarks of the MPD, could therefore contribute to partially rewild the GM but caution should be taken in adhering to this dietary pattern in the long term.

Source: Gut microbiome response to a modern Paleolithic diet in a Western lifestyle context. – PubMed – NCBI

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Posted in Paleo Diet, Paleo Theory

Alternate-Day Fasting Reduced Insulin Resistance Better Than Daily Calorie Restriction

Posted on August 17, 2019 | Comments Off on Alternate-Day Fasting Reduced Insulin Resistance Better Than Daily Calorie Restriction

Horses, like Java, also get Metabolic Syndrome but it’s not quite the same as in humans. Java had to lose weight and change his diet.

Body tissue resistance to the effect of insulin is considered harmful by many experts. For instance, it may contribute to obesity, high blood pressure, type 2 diabetes, and cancer. BTW, if you have Metabolic Syndrome, you probably have insulin resistance. Regular exercise and loss of excess body fat are two ways  to reduce insulin resistance. Fasting also has an effect, but is it better than daily calorie restriction?

From a small study in the journal Obesity:

Abstract

Objective

This study compared the effects of alternate‐day fasting (ADF) with those of daily calorie restriction (CR) on body weight and glucoregulatory factors in adults with overweight or obesity and insulin resistance.

Methods

This secondary analysis examined the data of insulin‐resistant individuals (n = 43) who participated in a 12‐month study that compared ADF (25% energy needs on “fast days”; 125% energy needs on alternating “feast days”) with CR (75% energy needs every day) and a control group regimen.

Results

In insulin‐resistant participants, weight loss was not different between ADF (−8% ± 2%) and CR (−6% ± 1%) by month 12, relative to controls (P < 0.0001). Fat mass and BMI decreased (P < 0.05) similarly from ADF and CR. ADF produced greater decreases (P < 0.05) in fasting insulin (−52% ± 9%) and insulin resistance (−53% ± 9%) compared with CR (−14% ± 9%; −17% ± 11%) and the control regimen by month 12. Lean mass, visceral fat mass, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol, triglycerides, blood pressure, C‐reactive protein, tumor necrosis factor α, and interleukin 6 values remained unchanged.

Conclusions

These findings suggest that Alternate-Day Fasting may produce greater reductions in fasting insulin and insulin resistance compared with Calorie Restriction in insulin‐resistant participants despite similar decreases in body weight.

Source: Differential Effects of Alternate‐Day Fasting Versus Daily Calorie Restriction on Insulin Resistance – Gabel – – Obesity – Wiley Online Library

It would be interesting to compare the compliance and drop-out rates between the two groups studied. Is a daily 24% calorie deficit easier to stomach than a 75% reduction every other day?

Steve Parker, M.D.

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Posted in Insulin, Weight Loss

Why Is Rapid Weight Loss Dangerous?

Posted on August 13, 2019 | Comments Off on Why Is Rapid Weight Loss Dangerous?
paleobetic diet, low-carb, diabetic diet, paleo diet

Totally unrelated – my horse Java

P.D. Mangan posted a good article on the risks of rapid weight loss. I agree with him that a max of 1–2 pounds a week is a reasonable weight-loss goal, and that a bit more than that is OK in the first week but highly inadvisable for the long run. Most folks do well if they settle into one pound a week.

From P.D.:

Slower Metabolism

A slower metabolism is another side effect of losing weight too quickly; since your body’s metabolism is essentially determining how much fuel you are needing to burn every day based on your activities and food intake, dropping calories out of your diet can considerably lower your metabolism. While this might not seem like a big deal, it is! A lower metabolism essentially causes your body to burn fewer calories each day than it typically would, and some research even shows up to a 23% decrease in calories that are burned each day. This doesn’t always go away when you stop losing weight quickly, either, your metabolism might take a while to get back on track and burning appropriately, which could affect your health and weight for a long time.

Muscle Loss

Lastly, your body could end up losing muscle as part of your quick weight loss routine. Granted, eliminating calories from your diet will have you lose weight, yes, but aside from a lot of that weight being water, some of it can also be muscle. A recent study done with people on a 500 calorie diet versus a 1250 calorie diet showed significant results; by the end of the trial, the participants on the 500 calorie diet lost six times more muscle than those on the 1250 calorie diet – an astounding loss in muscle in just a five-week span of time.

Source: Risks of Losing Weight Too Quickly – Rogue Health and Fitness

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Posted in Weight Loss

Paleo Diet Helps With Weight Loss, BMI, and Waist Circumference 

Posted on August 6, 2019 | Comments Off on Paleo Diet Helps With Weight Loss, BMI, and Waist Circumference 

Wim Hof’s ancestor?

I may have mentioned this meta-analysis before. Click the link below for fulll text of the report. Here’s the abstract:

Background

The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis.

Methods

What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated.

Results

The summary of the effect showed a loss of − 3.52 kg in the mean weight (CI 95%: − 5.26; − 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference.

Conclusion

The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits.

Source: Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis | Nutrition Journal | Full Text

Steve Parker, M.D.

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Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis. 

Posted on July 30, 2019 | Comments Off on Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis. 

He has no interest in meta-analysis.

From Nutrition Journal:

Abstract

BACKGROUND:

The Paleolithic diet has been studied in the scope of prevention and control of chronic noncommunicable diseases (CNCD). The objective of this study was to analyze the influence of the Paleolithic diet on the prevention and control of CNCD in humans, specifically on anthropometric markers, through a systematic review with meta-analysis.

METHODS:

What is the effect of the Paleolithic diet on anthropometric parameters (weight, body mass index and waist circumference) compared to other control diets based on recommendations in adults? We included only randomized studies with humans that used the Paleolithic Diet in the prevention and control of CNCD published in Portuguese, English or Spanish. The search period was until March 2019, in the LILACS, PubMed, Scielo, Science Direct, Medline, Web of Science and Scopus databases. The abstracts were evaluated by two researchers. We found 1224 articles, of which 24 were selected and 11 were included in the meta-analysis. The effect of dietary use on body weight, body mass index and waist circumference was evaluated.

RESULTS:

The summary of the effect showed a loss of - 3.52 kg in the mean weight (CI 95%: - 5.26; - 1.79; p < 0,001; I2 = 24%) of people who adopted the Paleolithic diet compared to diets based on recommendations. The analysis showed a positive association of adopting the Paleolithic diet in relation to weight loss. The effect was significant on weight, body mass index and waist circumference.

CONCLUSION:

The Paleolithic diet may assist in controlling weight and waist circumference and in the management of chronic diseases. However, more randomized clinical studies with larger populations and duration are necessary to prove health benefits.

Source: Influence of Paleolithic diet on anthropometric markers in chronic diseases: systematic review and meta-analysis. – PubMed – NCBI

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Is Targeting Gum Disease Bacteria a Legitimate Treatment or Preventative for Alzheimer’s Dementia?

Posted on July 30, 2019 | 2 comments

Most cavemen didn’t live long enough to get dementia

Several respected researchers think that Alzheimer’s dementia may primarily be an infectious disease, particularly related to gum bacteria.

From MedScape:

LOS ANGELES — As more disappointing results emerge from anti-amyloid drug trials in Alzheimer’s disease (AD), there is growing interest in novel treatment approaches for this condition.

One such approach is based on the hypothesis that Porphyromonas gingivalis (Pg), the bacteria involved in periodontal disease, may cause AD. The biopharmaceutical company Cortexyme Inc is testing this theory with an investigational agent COR388, which targets gingipains, the toxic proteases released by Pg.  Early results show the drug is well tolerated and promising in terms of biomarker findings. Organizers hope that a phase 2/3 trial of the treatment now under way will provide definitive efficacy results.

Source: Gum Disease Bacteria a Novel Treatment Target for Alzheimer’s?

Steve Parker, M.D.

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Training for Fitness In Midlife and Beyond

Posted on July 22, 2019 | Comments Off on Training for Fitness In Midlife and Beyond

You won’t see her at your home gym

From American Partisan:

If you have chronic pain or have been out of the gym a long time, build up volume (number of sets x number of reps x weight) slowly.  Pick weights you can lift without pain and increase weight and volume in pain-free steps.  The great thing about weight training is it allows you to easily control training variables in a safe, measurable, and repeatable manner while building work capacity and strength.  If one exercise hurts, substitute for another.  For example, if it hurts to back squat, substitute for a front squat….Right now, for example, I’ve built up a bit of pain in my biceps so I’ve substitute pull-ups for chin-ups which seem to take the stress off my biceps due to the weird angle between my upper and lower arms.

Cardio is built-up in a similar manner.  If one thing hurts, do something else or do it only within a pain-free time-interval and intensity to prevent pain flare-ups.  Develop a large variety of ways of doing cardio rather than do the same thing every day since training benefits heavily from novelty.  For example, you can use the assault bike one day, the agility ladder the next, barbell complexes a third day, and agility ladders a fourth day.  If you’re very overweight, start with walking.

Source: Fitness through midlife | American Partisan

The article recommends a book by Bill Hartman called All Gain No Pain. The numerous five-star reviews (and very few with lesser stars) at Amazon.com seem a bit fishy to me due to over-the-top praise and few details. Do you have an opinion on the book?

Check out the quality of Amazon.com book reviews at ReviewMeta.com.

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Posted in Exercise

Higher Blood Levels of Omega-3 Fatty Acids Linked to Lower Risk of Heart Failure

Posted on July 20, 2019 | 3 comments

Salmon, a cold-water fatty fish, is a rich source of omega-3 fatty acids

Here’s the abstract from JACC: Heart Failure:

Objectives

The aim of this study was to determine if plasma eicosapentaenoic acid (EPA) abundance (%EPA) is associated with reduced hazard for primary heart failure (HF) events in the MESA (Multi-Ethnic Study of Atherosclerosis) trial.

Background

Clinical trials suggest that omega-3 polyunsaturated fatty acids (ω3 PUFAs) prevent sudden death in coronary heart disease and HF, but this is controversial. In mice, the authors demonstrated that the ω3 PUFA EPA prevents contractile dysfunction and fibrosis in an HF model, but whether this extends to humans is unclear.

Methods

In the MESA cohort, the authors tested if plasma phospholipid EPA predicts primary HF incidence, including HF with reduced ejection fraction (EF) (EF <45%) and HF with preserved EF (EF ≥45%) using Cox proportional hazards modeling.

Results

A total of 6,562 participants 45 to 84 years of age had EPA measured at baseline (1,794 black, 794 Chinese, 1,442 Hispanic, and 2,532 white; 52% women). Over a median follow-up period of 13.0 years, 292 HF events occurred: 128 HF with reduced EF, 110 HF with preserved EF, and 54 with unknown EF status. %EPA in HF-free participants was 0.76% (0.75% to 0.77%) but was lower in participants with HF at 0.69% (0.64% to 0.74%) (p = 0.005). Log %EPA was associated with lower HF incidence (hazard ratio: 0.73 [95% confidence interval: 0.60 to 0.91] per log-unit difference in %EPA; p = 0.001). Adjusting for age, sex, race, body mass index, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, albuminuria, and the lead fatty acid for each cluster did not change this relationship. Sensitivity analyses showed no dependence on HF type.

Conclusions

Higher plasma EPA was significantly associated with reduced risk for HF, with both reduced and preserved EF. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487)

Source: Predicting Risk for Incident Heart Failure With Omega-3 Fatty Acids | JACC: Heart Failure

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Posted in Heart Disease