In Diabetics, Paleo Diet Plus Supervised Exercise Sessions Preserves Muscle Mass While Losing Fat Weight

Posted on September 14, 2016 | Comments Off on In Diabetics, Paleo Diet Plus Supervised Exercise Sessions Preserves Muscle Mass While Losing Fat Weight

Here’s the study abstract:

BACKGROUND: Means to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.

METHODS:Thirty-two patients with type 2 diabetes (age 59 ± 8 years) followed a Paleolithic diet for 12 weeks. Participants were randomized to either standard care exercise recommendations (PD) or 1-h supervised exercise sessions (aerobic exercise and resistance training) three times per week (PD-EX).

RESULTS:For the within group analyses, fat mass decreased by 5.7 kg (IQR: -6.6, -4.1; p < 0.001) in the PD group and by 6.7 kg (-8.2, -5.3; p < 0.001) in the PD-EX group. Insulin sensitivity (HOMA-IR) improved by 45% in the PD (p < 0.001) and PD-EX (p < 0.001) groups. HbA1c decreased by 0.9% (-1.2, -0.6; p < 0.001) in the PD group and 1.1% (-1.7, -0.7; p < 0.01) in the PD-EX group. Leptin decreased by 62% (p < 0.001) in the PD group and 42% (p < 0.001) in the PD-EX group. Maximum oxygen uptake increased by 0.2 L/min (0.0, 0.3) in the PD-EX group, and remained unchanged in the PD group (p < 0.01 for the difference between intervention groups). Male participants decreased lean mass by 2.6 kg (-3.6, -1.3) in the PD group and by 1.2 kg (-1.3, 1.0) in the PD-EX group (p < 0.05 for the difference between intervention groups).

CONCLUSIONS:A Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness. Copyright © 2016 John Wiley & Sons, Ltd.

Study authors include J. Otten and M. Ryberg.

Source: Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled… – PubMed – NCBI

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Posted in Exercise

Who’s Buried in Grant’s Tomb?

Posted on September 9, 2016 | 2 comments

Thomas Twining started selling tea in London in 1706. His eponymous company has been doing it for 300 years, then. You’d think they know tea if anyone does. Here’s Twinings Green Tea:

Not to me

Green? Brown?  Golden brown? Tea-colored? Flax? Tannin? Purple? Polka-dotted?

Does that look green to you? I guess they specialize in black tea (which I bet isn’t black after brewing).

My quest for green “green tea” continues. I already found one: Kirkland Ito En Matcha Blend Japanese Green Tea from Amazon.

Steve Parker, M.D.

PS: If you don’t like green, you’ll find none of it inside my books.

PPS: The remains of Ulysses S. Grant and his wife are in a mausoleum referred to as Grant’s tomb. They are above ground, so technically they aren’t buried.

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Bix Sez: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes

Posted on September 8, 2016 | Comments Off on Bix Sez: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes

“So, we’ve known for at least 30 years, 60 years by the looks of that 1955 Lancet study, that low-fat diets could arrest the symptoms of diabetes or prevent the disease altogether.

Robbins’ “Diet For A New America” was a popular lay-person’s book (1st edition sold over a million copies), not a medical tome. It was in the social realm. Why isn’t its low-fat advice common knowledge? I’ll tell you … It’s for reasons that induce stores like Natural Grocers to ban Dr. Greger’s plant-based book. It’s because having people eat a low-fat, high-fiber diet would hurt sales of animal food: beef, pork, chicken, fish, eggs, and all manner of dairy food – cheese, yogurt, milk, butter, cream. That’s why. And you know how the meat and dairy industries keep a lid on the science that could really help people? They come out with their own studies, often meta-analyses which go back in time and cherry pick studies that defend their position.”

Source: We’ve Known For Decades That Low-Fat Diets Can Reverse Diabetes | Fanatic Cook

One of the references Robbins uses to support his contention is a 1979 article in American Journal of Clinical Nutrition. It’s a study of 20 men, all of whom were on insulin for what I assume is type 2 diabetes. What’s odd is that the men were all “lean.” In real life, at least 85% of type 2 diabetics are overweight or obese. Not lean. Nevertheless, many of the men were able to stop insulin on the low-fat/high fiber diet. But these weren’t typical T2 diabetics.

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Posted in Diabetic Diet, Dietary Fat

Is Global Warming Causing the Diabetes Epidemic?

Posted on September 7, 2016 | Comments Off on Is Global Warming Causing the Diabetes Epidemic?

You’ll want to keep reading if you have diabetes and are sedentary and overweight or obese, because odds are good that you have insulin resistance. Insulin resistance makes it harder to control your blood sugars.

I thought I knew a lot about diabetes, but I’m still learning from P.D. Mangan:

“It looks like we can add cold exposure to the list of interventions that increase insulin sensitivity.

Type 2 diabetes is positively associated with ambient temperature. The warmer the weather, the more diabetes. Up to about 30% of the variation in diabetes can be explained by  temperature.

Curiously, no effect of temperature was seen on obesity, although other studies have found that there is one.

The authors believe that activation of brown adipose tissue (BAT) may contribute to this effect. BAT is a type of fat tissue that increases its metabolism for the sole purpose of generating body heat.

Cold thermogenesis has many health benefits, although helping you to lose weight probably isn’t one of them, for the same reason that aerobic exercise is not very effective for weight loss.

The connection between cold exposure and insulin sensitivity isn’t just an association either: acclimation to the cold causes a substantial increase in insulin sensitivity.

Eight people with type 2 diabetes were exposed to cold temperatures, 14 to 15 C (57 to 59 F) for 6 hours a day for 10 days. Insulin sensitivity increased 43%.”

Source: Cold Exposure Increases Insulin Sensitivity – Rogue Health and Fitness

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Are These Two Diabetes Drugs Better Than the Others?

Posted on September 6, 2016 | 1 comment
Better living through chemistry

Empagliflozin is a pill. Liraglutide is a once-daily subcutaneous injection.

The two drugs in question are empagliflozin (aka Jardiance) and liraglutide (aka Victoza). Both are used to treat type 2 diabetes, not type 1.

A major problem we have with most diabetes drugs is that while they do lower blood sugars, we don’t have much evidence on whether they actually prolong life and prevent bad outcomes like heart attacks, strokes, cancer, blindness, kidney failure, amputations, and serious infections.

It gets even more complicated. For instance, a given drug may eventually be proven to prolong life by a year via prevention of death from heart disease, while at the same time increasing the risk of spending that last year bedridden from a stroke.

It’s extremely difficult and costly to suss out these issues. It requires large clinical trials wherein half of the PWDs (people with diabetes) are treated with a particular drug, and the other half are treated with “standard therapy.” Five or 10 years later you compare clinical endpoints between the two groups. A couple studies have done this recently.

A blogger I follow, Larry Husten, wrote the following:

But it was the secondary goal of these trials that led to the transformation of the field. Baked into the trial design was the provision that if they were able to establish noninferiority then the trial investigators were permitted to test for superiority. The second phase began when Empa-Reg became the first trial to convincingly show a clear benefit, including a reduction in cardiovascular death and a reduction in hospitalization for heart failure. with empagliflozin (Jardiance, Merck). Then, more recently, the LEADER trial showed a significant reduction in cardiovascular events with liraglutide (Victoza, Novo Nordisk). In both trials nearly all the patients had significant established cardiovascular disease—precisely the population that cardiologists are likely to see.

Click the embedded links above for more details. Even better, read the original research reports if you have the time and knowledge. I support my family with a full-time job taking care of patients, so it will be a while (if ever) before I can dig into this further. (When my book sales make me independently wealthy, I’ll have more time for this!)

diabetic diet, low-carb Mediterranean Diet, low-carb, Conquer Diabetes and Prediabetes

Analyzing clinical reports requires a good grasp of logic, statistics, and basic science

Are the LEADER and Empa-Reg trials valid? Yeah, maybe. In an ideal world, other investigators would try to replicate the results with additional clinical trials. Are the published results free of fraud and bias? I don’t know.

Because we don’t know the long-term effects of many of our diabetes drugs, I favor doing as much as possible to control blood sugars with diet, exercise, and weight management.

Stay tuned for future developments.

Steve Parker, M.D.

PS: Just because one drug in a class of drugs reduces bad clinical outcomes, it doesn’t mean all drugs in the class do.

PPS: If it’s hard for you to pronounce empagliflozin and liraglutide, some of my books don’t even have them.

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My Green Tea Is Brown

Posted on September 3, 2016 | 2 comments
At least the box is green

At least the box is green

I’ve been reading for years how green tea is or might be particularly healthful for us. It’s not just hearsay. Respected journals like the American Journal of Clinical Nutrition suggest green tea’s virtues: longevity and less risk of type 2 diabetes, heart disease, and dementia, to name a few off the top of my head.

I’ve never been a tea drinker. Oh, sure, I’ve drunk iced tea at restaurants now and then. That’s black tea.

I drink coffee, about five cups a day. I work a fair number of night shifts, and the caffeine helps wake me up and keep me alert.

On a lark recently, I thought I’d cut back on the coffee and try green tea. In case you’re wondering, green tea has a third of the caffeine content of coffee.

So I go to the supermarket tea section and pick up a box of Bigelow green tea bags. There were five or 10 other options. Why Bigelow? I think I’ve heard the name before. Or the box appealed to me subconsciously. I brew it up easy-peasy per directions and this is what I see:

Mild, pleasant flavor but may not have the phytonutrients I seek

Mild, pleasant flavor but may not have the phytonutrients I seek

WTF?!

Does that look green to you?

I didn’t think so.

Naturally I start googling. The rest of this paragraph may or may not be true, like everything you read on the Internet. Green tea by tradition should be green. The supermarket teas are not traditional. They are oxidized, not fresh, or processed incorrectly. They’re a bastardization of traditional green teas with primary goals of mass distribution and adequate shelf life. They don’t have much of the “healthy” components you are looking for: anti-oxidants, polyphenols, EGCG, catechins, etc. Phytonutrient content of teas varies from batch to batch. The epidemiological studies that support green tea as healthful involved mostly Asian populations, often Japanese, who were drinking traditional green tea that’s green. Brewing is important: 170°F (77°C) for no more than 2–3 minutes. The fresher the tea leaves, the better. Special packaging may help preserve freshness. A Japanese-sounding brand may use tea grown outside of Japan.

I don’t know any avid green tea drinkers. So I go to Amazon.com and start reading reviews. Apparently there’s a whole world of green tea culture and I’ve just scratched the surface. I’ve already spent three hours on this green tea thing. Judging from Amazon reviews, here are some green teas that might be worth trying: Kirkland Ito En Matcha Blend Japanese Green Tea Bags and Yamamotoyama Green Tea—Sushi Style. (Kirkland is a Costco brand.) I probably also need to seek out a local Japanese ethnic food store and see what they’ve got or recommend.

I’m not raggin’on Bigelow green tea specifically. I bet most supermarket green teas in the U.S. will come out brown. For all I know, Bigelow may be jam-packed with healthy phytonutrients that will help you live to 110. It has a mild pleasant taste that I enjoyed. I didn’t miss the higher caffeine load of coffee. But it’s not traditional green tea.

I still want to try a green tea habit. If you can give me some pointers, please do so below or email me at steveparkermd AT gmail DoT com. (Do we still have to hide email addresses from bots?)

Steve Parker, M.D.

PS: Just because green tea may be healthful for Southeast Asians, that’s no guarantee it works for other ethnicities.

PPS: I’m not at all convinced that green tea is a panacea that will help me stay healthy or live longer.

PPPS: Green tea is one of Franziska Spritzler’s low-carb beauty foods.

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Excessive Loose Skin After Massive Weight Loss Is a Problem 

Posted on September 1, 2016 | Comments Off on Excessive Loose Skin After Massive Weight Loss Is a Problem 

None of my patients has ever lost 650 lb (295 kg), but I’ve no doubt that skin that has been stretched out for decades doesn’t spring back into place.

NYT has an interesting article on it:

“It has been more than six years since Paul Mason, who once weighed 980 pounds and could not move from his bed, pulled himself back to life with gastric bypass surgery and his own strength of will. But he still carries his past with him.

On Wednesday, Mr. Mason, who is 55 and now lives in rural Athol, Mass., took another important step in a process that has been long and uneven, marked by small triumphs and unexpected setbacks. He had the second of two surgeries to eliminate the excess skin that enveloped his body like a shroud. Fifty pounds of it was removed from his abdomen last year; this time, about 10 pounds’ worth was excised from his arms and hip in a multihour operation in Manhattan.”

Source: Hundreds of Pounds Lighter, and Now Shedding Another Burden of the Past – The New York Times

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Doctors Underestimate Patient Willingness to Get to Target A1c Quickly 

Posted on August 31, 2016 | 1 comment

DiaTribe has a brief report on a recent survey sponsored in part by Sanofi, a maker of at least five diabetes drugs.

From diaTribe:

“Of the 1,000 adults with type 2 diabetes surveyed, 55% said they were willing to do more to accelerate progress toward their A1c goal, including more frequent doctor visits and changing medications. Meanwhile, of 1,004 endocrinologists, primary care physicians, and other medical professionals surveyed, only 18% thought people with type 2 diabetes would be willing to make such efforts. That’s an alarming three-fold discrepancy!”

Source: Goal Mismatch: Doctors Underestimate Patient Willingness to Get to Target A1c Quickly | diaTribe

The survey was online. Whether online survey-takers are similar to usual clinic patients is a matter of debate.

Steve Parker, M.D.

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The paleo diet may reduce the risk of cardiovascular disease via IL-10

Posted on August 30, 2016 | Comments Off on The paleo diet may reduce the risk of cardiovascular disease via IL-10

Interleukin-10 is a cytokine that tends to limit inflammation and also controls some aspects of our immune systems. Increasing interleukin-10 levels may be healthful.

“Chad Dolan, of the Laboratory of Integrative Psychology at the University of Houston, TX, and colleagues found that healthy adults who swapped from a Western diet to a Paleo diet experienced an increase in interleukin-10 (IL-10) levels, indicating a lower risk of heart attack and cardiovascular disease.”

Source: The Paleo diet: Could it reduce the risk of cardiovascular disease? – Medical News Today

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Paleo diet is too expensive and causes diarrhea

Posted on August 27, 2016 | 2 comments

“The Paleolithic diet has been receiving media coverage in Australia and claims to improve overall health. The diet removes grains and dairy, whilst encouraging consumption of fruits, vegetables, meat, eggs and nuts. Our aim was to compare the diet to the Australian Guide to Healthy Eating (AGHE) in terms of compliance, palatability and feasibility.”

Source: Compliance, Palatability and Feasibility of PALEOLITHIC and Australian Guide to Healthy Eating Diets in Healthy Women: A 4-Week Dietary Intervention. – PubMed – NCBI

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