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

Posted on May 6, 2018 | Comments Off on 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.

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

Posted in Dietary Carbohydrate

Increase Protein Consumption to Help With Weight Loss

Posted on April 25, 2018 | 2 comments

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

2 Comments

Posted in Weight Loss

Julia Belluz Wonders Why Diets Succeed or Fail

Posted on April 20, 2018 | 2 comments

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

2 Comments

Posted in Weight Loss

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

Posted on April 10, 2018 | Comments Off on 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

 

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

Posted in Drugs for Diabetes, Supplements

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

Posted on April 4, 2018 | 3 comments

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.

3 Comments

Posted in Uncategorized

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

Posted on April 1, 2018 | 1 comment

…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

 

1 Comment

Posted in Bariatric Surgery

Physician Organizations Fight Over How Aggressively to Treat Diabetes

Posted on March 26, 2018 | 1 comment

If you’re a patient, you probably don’t like to hear this. You like to think that doctors have looked carefully at the appropriate scientific studies, understand  the underlying pathophysiology in detail, then reach a consensus on treatment. Sorry, but not in the case of diabetes. NPR has the story. For example:

A major medical association today suggested that doctors who treat people with Type 2 diabetes can set less aggressive blood sugar targets. But medical groups that specialize in diabetes sharply disagree.

Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines.

The American College of Physicians has reviewed those guidelines to provide its own recommendations, published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C.

“There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets,” says Dr. Jack Ende, president of the ACP. “And for that reason, this is not the kind of situation where the college could just sit back and ignore things.”

The ACP, which represents internists, recommends that doctors aim for an A1C in the range of 7 to 8 percent, not the lower levels that other groups recommend.

Source: The American College of Physicians Recommends A1C Levels Between 7 And 8 Percent : Shots – Health News : NPR

I come down in favor of the lower HgbA1c values.

1 Comment

Posted in Drugs for Diabetes

Even short bursts of exercise can reduce risk of disease and death

Posted on March 25, 2018 | 1 comment
Steve Parker MD

Bouts of 5 minutes may be enough

From ABC News:

The old benchmark of 150 minutes per week of moderate activity (or 75 minutes of vigorous activity) originated in 1995. The “rules”: Each time you exercise, it should be for at least 10 minutes.

“For about 30 years, guidelines have suggested that moderate-to-vigorous activity could provide health benefits, but only if you sustained the activity for 10 minutes or more,” an author of the research, William E. Kraus, M.D., of the Duke University School of Medicine, said in a press release. “That flies in the face of public health recommendations, like taking the stairs instead of the elevator, and parking farther from your destination. Those don’t take 10 minutes, so why were they recommended?

“The new study finds that the length of each bout or episode of exercise is unrelated to the benefit seen in living longer. Five minutes of jogging, researchers said, “counts” toward better health.

Source: Even short bursts of exercise can reduce Americans’ risk of disease and death, study says – ABC News

1 Comment

Posted in Exercise, Longevity

Do You Know Anything About Nutritics?

Posted on March 24, 2018 | 3 comments

I’m thinking about using Nutritics for my nutrient analysis, rather than some of the free options like SparkPeople or FitDay. NutritionData still seems to be very popular, too, but they don’t keep up with new versions of the USDA database (currently on Release 28). The fine print at NutritionData shows they use Release 21. FitDay doesn’t say.

I looked up two cups of broccoli florets at FitDay and NutritionData, and was surprised to see zero grams of fiber. How could that be correct? Nutritics shows 3.3 grams, as does the USDA Nutrient Database. I believe Nutritics and USDA on this one. The free nutrient analysis tools you find on the internet all use some version of the USDA database as far as I know.

Click the link below to see Nutritics’ report.

https://www.nutritics.com/app/rec/4b82cb50b2

In that report you’ll see “%RI”, which I assume is short for  percentage of Dietary Reference Intake. The National Health Institutes defines DRI or Dietary Reference Intake:

DRI is the general term for a set of reference values used to plan and assess nutrient intakes of healthy people. These values, which vary by age and gender, include:

  • Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%-98%) healthy people.

  • Adequate Intake (AI): established when evidence is insufficient to develop an RDA and is set at a level assumed to ensure nutritional adequacy.

  • Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.

So what does Nutritics mean by %RI? I don’t know yet.

And by the way, Nutritics isn’t free like the other sources I mentioned above.

Any comments on Nutritics, or your source for nutritional analysis?

Steve Parker, M.D.

3 Comments

Posted in Uncategorized

Which Foods Cause Obesity?

Posted on March 18, 2018 | 4 comments

At my Advanced Mediterranean Diet website a few years ago I asked visitors to answer a poll question. 2,367 responded thusly:

What single food category makes you gain the most fat weight?

Fatty foods like bacon, butter, oils, nuts:
5%
Protein-rich foods: meat, eggs, fish:
0%
Sugary sweet items:
23%
Starches: bread, potatoes, peas, corn:
16%
Carbohydrates:
30%
Pastries, cake, pie, cookies:
25%
Other:
1%

Total Votes: 2367

Yes, I know it’s not a scientific poll, but it’s something. I’m not surprised at the results. I’m wishing I’d offered nuts as a choice since there are at least a few folks who gain weight on nuts, perhaps not realizing that nut calories are mostly from fat. To participate in the poll, click the link above.

Steve Parker, M.D.

4 Comments

Posted in Overweight