Life Expectancy for Type 1 Diabetics Much Improved

Posted on October 13, 2013 | Comments Off on Life Expectancy for Type 1 Diabetics Much Improved

…but we’ve got a long way to go.

When I started my medical career three decades ago, it was rare to see a type 1 diabetic exceed 60 years of age. Thank God that has been changing for the better! A recent Scottish study found life expectancy in type 1 diabetics, compared to the general population, was 11 years shorter for men and 14 years shorter for women. In 1975, the gap was 27 years. One of the investigators was quoted by the article at MedPageToday:

“There is absolutely no doubt that glucose control is important for long-term outcomes in people with type 1 diabetes.”

From the Framingham Heart Study: Compared to those without diabetes, women and men with diabetes at age 50 died 7 or 8 years earlier, on average. This study population was a mix of type 2 and type 2 diabetes, with type 2 predominating, I’m sure.

Steve Parker, M.D.

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Posted in Longevity

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Another Dentist Blames Neolithic Diet For Cavities

Posted on October 11, 2013 | 2 comments

I found another dentist who believes cavities (dental caries) are a neolithic disease caused by a mismatch between the standard Western diet and human evolutionary biology. Meet Dr. Mark Burhenne:

It is generally well accepted that tooth decay, in the modern sense, is a relatively new phenomena. Until the rise of agriculture roughly 10,000 years ago, there was nearly no tooth decay in the human race. Cavities became endemic in the 17th century but became an epidemic in the middle of the 20th century (1950).

If we understand that tooth decay started when people started farming, rather than hunting and gathering, it’s clear that tooth decay is the result of a mismatch between what we’re eating and what our bodies are expecting us to eat based on how they evolved.

***

The recent changes in our lifestyle create a “mismatch” for the mouth, which evolved under vastly different environments than what our mouths are exposed to these days. Our mouths evolved to be chewing tough meats and fibrous vegetables. Sugar laden fruit was a rare and special treat for our paleolithic ancestors. Now, our diets are filled with heavily processed foods that take hardly any energy to chew — smoothies, coffees, and sodas high in sugar, white bread, and crackers to name just a few.

Read the whole thing.

It’s disconcerting that Dr. Burhenne says Streptococcus mutans (a germ linked to cavities) is the same germ that causes strep throat. That’s not right. Strep throat is usually caused by Streptococcus pyogenes, aka Group A Strep.

Steve Parker, M.D.

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Scarlett Johansson Switches From Paleo to Raw Vegan Diet

Posted on October 8, 2013 | 4 comments

Click for details. Unfortunately, there aren’t many pictures. A snippet:

“Right before we started [‘The Avengers’] I was lifting all these weights and eating raw vegan,” said Scarlett. “But the only reason I was doing that was to fix my previous diet because that was a Paleo diet, so I’ve had the extreme of everything. After lots of training and raw vegan food you can fit into a catsuit.”

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Posted in Uncategorized

What’s Gestational Diabetes?

Posted on October 7, 2013 | 2 comments
You can't tell if she has it just by looking

You can’t tell if she has GD just by looking

In a recent article Amy Campbell over at Diabetes Self-Management defines gestational diabetes and goes over risk factors, diagnosis, and why it’s important. Subsequent posts cover management principles.

Here’s my review from 2010.

In terms of the best diet, a recent study found no significant outcome differences on a 40% carb diet compared to a standard 55% carb diet. I would have guessed the lower-carb diet would be better.

To my knowledge, the paleo diet has never been studied systematically as an approach to gestational diabetes.

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European Guidelines Reject Very Low Carbohydrate Diets for Diabetes

Posted on October 3, 2013 | Comments Off on European Guidelines Reject Very Low Carbohydrate Diets for Diabetes
Conquer Diabetes and Prediabetes

“Really?”

A recent diabetes treatment guide from European doctors states “there is no justification for the recommendation of very low carbohydrate diets in diabetes mellitus.”

I disagree.

The 2013 guidelines are from the European Society of Cardiology and the European Association for the Study of Diabetes. I compiled the following articles in favor of carbohydrate restriction a couple years ago. You won’t find anything newer listed. Admittedly, all or nearly all of the patients involved had type 2 diabetes, not type 1. We do have a handful involving type 1s.

Enjoy!

♦  ♦  ♦

Accurso, A., et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutrition & Metabolism, 9 (2008). PMID: 18397522. One of the watershed reports that summarize the major features and benefits, based on 68 scientific references.

Boden, G., et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of Internal Medicine, 142 (2005): 403-411. In these 10 obese diabetics, a low-carb diet spontaneously reduced calorie consumption from 3100 daily to 2200, accounting for the weight loss—1.65 kg (3.63 pounds) in 14 days. Blood sugar levels improved dramatically and insulin sensitivity improved by 75%.

Daly, M.E., et al. Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes—a randomized controlled trial. Diabetes Medicine, 23 (2006): 15-20. Compared with a low-fat/reduced-calorie diet, weight loss was much better in the low-carb group over three months, and HDL ratio improved.

Davis, Nichola, et al. Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes. Diabetes Care, 32 (2009): 1,147-1,152. The Atkins diet was superior—for weight loss and glycemic control—when measured at three months, when compliance by both groups was still probably fairly good. After one year, the only major difference they found was lower HDL cholesterol in the low-carb eaters. 

Elhayany, A., et al. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes, Obesity and Metabolism, 12 (2010): 204-209. In overweight type 2 diabetics, a low-carbohydrate Mediterranean diet improved HDL cholesterol levels and glucose control better than either the standard Mediterranean diet or American Diabetes Association diet, according to Israeli researchers.

Haimoto, Hajime, et al. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutrition & Metabolism, 6:21 (2009). DOI: 10.1186/1743-7075-6-21. A low-carbohydrate diet is just as effective as insulin shots for people with severe type 2 diabetes, according to Japanese investigators. Five of the seven patients on sulfonylurea were able to stop the drug. 

Nielsen, Jörgen and Joensson, Eva.  Low-carbohydrate diet in type 2 diabetes: stable improvement of body weight and glycemic control during 44 months follow-up. Nutrition & Metabolism, 5 (2008). DOI: 10.1186/1743-7075-5-14. Obese people with type 2 diabetes following a 20% carbohydrate diet demonstrated sustained improvement in weight and blood glucose control, according to Swedish physicians. Proportions of carbohydrates, fat, and protein were 20%, 50%, and 30% respectively. Total daily carbs were 80-90 g. Hemoglobin A1c, a measure of diabetes control, fell from 8% to 6.8%. These doctors had previously demonstrated that a 20% carbohydrate diet was superior to a low-fat/55-60% carb diet in obese diabetes patients over six months.

Vernon, M., et al. Clinical experience of a carbohydrate-restricted diet: Effect on diabetes mellitus. Metabolic Syndrome and Related Disorders, 1 (2003): 233-238. This groundbreaking study demonstrated that diabetics could use an Atkins-style diet safely and effectively in a primary care setting.

Westman, Eric, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism, 5 (2008). DOI: 10.1186/1743-7075-5-36. Duke University (U.S.) researchers demonstrated better improvement and reversal of type 2 diabetes with an Atkins-style diet, compared to a low-glycemic index reduced-calorie diet.

Yancy, William, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes [in men]. Nutrition & Metabolism, 2:34 (2005). DOI: 10.1186/1743-7075-2-34. A low-carb ketogenic diet in patients with type 2 diabetes was so effective that diabetes medications were reduced or discontinued in most patients. The authors recommend that similar dieters be under close medical supervision or capable of adjusting their own medication, because the diet lowers blood sugar  dramatically.

Yancy, W., et al. A pilot trial of a low-carbohydrate ketogenic diet in patients with type 2 diabetes.  Metabolic Syndrome and Related Disorders, 1 (2003): 239-244. This pioneering study used an Atkins Induction-style diet with less than 20 grams of carbohydrate daily.

So there!

Steve Parker, M.D.

h/t to Reijo Laatikainen for tweeting the European article.

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Physician With Type 1 Diabetes Thriving on Low-Carb Paleo-Style Diet

Posted on October 1, 2013 | 2 comments
"Put down the bread and no one will get hurt!"

Could you give up bread for life?

ABC Radio provides the audio and transcript of an interview with Dr. Troy Stapleton, who was diagnosed with type 1 diabetes at age 41. He lives in Queensland, Australia. At the time of his diagnosis, he says…

I was advised to eat seven serves of bread and cereals, two to three serves dairy, fruit, starchy vegetables, and to balance that intake with insulin. If you add up all those serves, they were recommending a diet of up to about 240 grams of carbohydrates a day, and to balance it with insulin. I was going to be the best patient, and there has been some important trials that show that if you do control your blood glucose well then you can reduce your incidence of the complications.

Dr. Stapleton believes we evolved on a very low carbohydrate diet; the Agricultural Revolution led to our current high carb consumption. He was concerned about the risk of hypoglycemia with standard diabetic diets.

There was a different approach where essentially you went on a very low carbohydrate diet, this made a little bit of sense to me. Why would I eat carbohydrates and then have to balance it with insulin?

Here’s what the diabetes educators told him:

What they say is you need to estimate the amount of carbohydrate you’re going to eat, and then you need to match that carbohydrate dose essentially with an insulin dose. So you sort of look at your food and you go, okay, I’m having 30 grams of carbohydrate and I need one unit of insulin per 15 grams of carbohydrate, so two units. It sounds really quite straightforward, except that it’s very, very difficult to estimate accurately the amount of carbohydrate you’re eating. The information on the packets can be out by 20%. Most people say that your error rate can be around 50%.

And then of course it changes with what you’ve eaten. So if you eat carbohydrates with fat and then you get delayed absorption, then that glucose load will come in, and then the type of carbohydrates will alter how quickly it comes in to your bloodstream. And then of course your insulin dose will vary, your absorption rate will vary by about 30%. Once you think through all the variables, it’s just not possible. You will be able to bring your blood glucose under control, but a lot of the time what happens is you get a spike in your glucose level immediately after a meal, and that does damage to the endothelium of your blood vessels…

Norman Swan: The lining.

Troy Stapleton: That’s correct, it causes an oxidative stress to your endothelium, and that is the damage that diabetes does, that’s why you get accelerated atherosclerosis.

Here’s what happened after he started eating very low carb:

It’s been amazing, it’s been the most remarkable turnaround for me and I just cut out carbohydrates essentially completely, although I do get some in green leafy vegetables and those sorts of things. My blood sugar average on the meter has gone from 8.4 [151 mg/dl] down to 5.3 [95 mg/dl]. My HbA1c is now 5.3, which is in the normal range. My blood pressure has always been good but it dropped down to 115 over 75. My triglycerides improved, my HDL improved, so my blood lipid profile improved. And I would now have a hypoglycaemic episode probably about once a month after exercise. [He was having hypoglycemia weekly on his prior high carb diet with carb counting insulin adjustments.]

He was able to reduce his insulin from about 27 units a day down to 6 units at night only (long-acting insulin)! He admits his low insulin dose may just reflect the “honeymoon period” some type 1s get early on after diagnosis.

Norman Swan: So when you talk to your diabetes educator now, what does he or she say?

Troy Stapleton: Look, they’re interested, but they’ll tell me things and I’ll say, well, that’s actually not true. I’m quite a difficult patient, Norman.

He says he’s eating an Atkins-style diet. Combining the transcript and his notes in the comments section:  1) he doesn’t eat potatoes or other starchy vegetables or bread, 2) he eats meat, eggs, lots of non-starchy vegetables, some berries and tree nuts, olives, and cheese, 3) an occasional wine or low-carb beer, 4) coffee, and 5) he eats under 50 g/day of carbohydrate, probably  under 30 g. This is a low-carb paleo diet except for the cheese, alcohol, and coffee.  Cheese, alcohol and coffee are (or can be) low-carb, but they’re not pure paleo.

He notes that…

There is an adaption period to a very low carbohydrate diet which takes 4–6 weeks (ketoadaption). During this time symptoms include mild headaches, lethargy, cramps, carb cravings and occasional light headedness. These symptoms all pass.

Read or listen to the whole thing. Don’t forget the comments section. All the blood sugars you see there are in mmol/l; convert them to mg/dl (American!) by multiplying by 18.

Steve Parker, M.D.

2 Comments

Posted in Diabetic Diet, Dietary Carbohydrate, Low-Carb, Testimonials

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The Nine Causes of Obesity

Posted on September 30, 2013 | 2 comments
So easy to over-eat!

So easy to over-eat!

Isn’t obesity simply caused by eating too much and exercising too little, both due to lack of discipline and willpower?

Science writer David Berreby has an article at Aeon suggesting it’s way more complicated than that. Even if we do eat too much, why do we? Some quotes:

And so we appear to have a public consensus that excess body weight (defined as a Body Mass Index of 25 or above) and obesity (BMI of 30 or above) are consequences of individual choice. It is undoubtedly true that societies are spending vast amounts of time and money on this idea. It is also true that the masters of the universe in business and government seem attracted to it, perhaps because stern self-discipline is how many of them attained their status. What we don’t know is whether the theory is actually correct.

***

As Richard L Atkinson, Emeritus Professor of Medicine and Nutritional Sciences at the University of Wisconsin and editor of the International Journal of Obesity, put it in 2005: ‘The previous belief of many lay people and health professionals that obesity is simply the result of a lack of willpower and an inability to discipline eating habits is no longer defensible.’

Like liver, skeletal muscle, and brain, our body fat is a tissue that is carefully regulated by genes, hormones, enzymes, etc., which I’ll lump together as “metabolism.” Regulatory metabolic processes for liver, muscle, and brain will be different from each other and from fat tissue. Some processes aid fat storage, others lead to fat breakdown and weight loss.

Mr. Berreby discusses various trendy factors that may directly alter fat tissue metabolic processes, leading to overweight and obesity. Here’s his list:

  • lack of sleep
  • viruses (e.g., Ad-36)
  • stress
  • bacteria (e.g., Methanobrevibacter smithii in the large intestine)
  • industrial chemical contaminants (e.g., BPA, heavy metals, detergents, sunscreen, fire retardants, cosmetics)
  • electrification (e.g., too much light exposure, especially at night)
  • heat and air conditioning
  • undernutrition (“starvation”) during pregnancy: the children hatched are more likely to be overweight or obese as adults
  • intergenerational influence (epigenetic)

Read all about it.

2 Comments

Posted in Overweight

The Argument Against Starches, Safe or Otherwise

Posted on September 29, 2013 | 1 comment

Lifextension argues it as well as anyone I’ve read. Some quotes:

Chimpanzees produce salivary amylase to digest fruit; similarly, carnivores also possess amylase in order to process the glycogen residing in muscle meat. Moreover, animals fed alternatives to their natural diet will produce amylase in amounts corresponding to the quantity of carbohydrates consumed. Humans too have their own primordial amylase gene copy; we have possessed it ever since we were primates. The second copy mutation occurred somewhere between 100 – 200,000 years ago, however this may have resulted even more recently, as single nucleotide polymorphisms and copy number mutations can result in just thousands of years. The additional – and currently incomplete – copies occurred at the very most, around 25,000 years ago, but most plausibly they came about around 10,000 years ago, concurrent with the onset of agriculture, and confirming that high starch consumption was a historically late phenomenon. Many present day human populations from low-starch consuming ancestries still only have two copies, indicating that adaptation to high-starch consumption was not globally widespread.

***

Moreover, the current evidence engendered from nitrogen stable isotope analysis of hominin bone data – being studied by Professor Michael Richards and the Max Planck Institute for Evolutionary Anthropology – has confirmed that our human ancestors truly were high-level carnivores. In fact, one-hundred percent of the early hominin bones studied from Upper Palaeolithic Europe reveal an even more carnivorous stable isotope footprint than that of foxes and wolves; while, comparatively, the data from omnivores such as pigs or the Brown Bear validates that these species truly did have an omnivorous diet.

Read the whole enchilada. The debate continues.

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Posted in Paleo Diet, Paleo Theory

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Amanda Torres Turns Her Life Around With Paleo/Primal Lifestyle

Posted on September 28, 2013 | 4 comments

This is the old Amanda:

In December 2009, I was 25 years old and weighed 210 lbs. I was obese for my 5’5″ frame, never felt well, and was popping handfuls of pills every day just to get by. I was taking 2 anti-depressants, anxiolytics, prescription sleeping pills, courses of Prilosec once or twice a month, acid-blocking pills or antacid tablets 1-3 times a day, anti-diarrhea pills several days a week, and I was constantly catching respiratory infections and frequently took courses of antibiotics. In fact, I was put on chronic antibiotics by a dermatologist to treat rosacea, acne, and a truly horrible condition known as hidradenitis suppurativa (acne inversa). I would take them for several weeks at a time, until everything calmed down, but inevitably within a few weeks more I would end up with another debilitatingly painful HS boil and would need to start up the antibiotics again. I also got either a yeast infection or a urinary tract infection almost once a month. In the summer of 2008 I was diagnosed as pre-diabetic with metabolic syndrome and hypertension, so by the end of 2009 I was quite probably a full-fledged type II diabetic, I just never got an official diagnosis. I was falling apart mentally and physically, and scared to death of a miserable future full of multiple chronic illness and scary prescription medications, so I decided to make some drastic changes in my lifestyle. I resolved to do  my research over the holidays, and begin in 2010 with my new way of life.

She ran across Mark Sisson’s website and the rest is history.

Read about her transformation.

 

h/t Julianne Taylor

4 Comments

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How Much Exercise Does It Take To Improve Insomnia?

Posted on September 26, 2013 | Comments Off on How Much Exercise Does It Take To Improve Insomnia?
Paleobetic diet

Better to exercise than take a sleeping pill

It doesn’t take much exercise: 30 minutes of aerobic exercise thrice weekly.

The Well blog at the New York Times has details. The study at hand involved only 11 women with insomnia, mostly in their 60s. A key take-away is that it took as long as four months for some  to see an improvement. So don’t get discouraged and stop exercising too soon.

Read the whole thing (it’s brief).

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Posted in Exercise, Sleep, Uncategorized