It’s the Best Time Ever to Have Diabetes

Here’s a quote from a recent Diabetes Care:

Improved therapeutics and health care delivery have brought remarkable declines in the incidence of … complications, with a 50% reduction in amputations from their peak in 1997 and ∼35% reduction in the incidence of end-stage renal disease. Similarly, 10-year coronary heart disease risk dropped from 21% in 2000 to 16% in 2008.

Left, right, or straight ahead (the road less travelled)?

Left, right, or straight ahead (the road less travelled)?

Nevertheless, diabetes remains the leading cause of blindness, renal failure, non-traumatic lower-limb amputation, in adults 18 to 65 years of age.

Diabetes is expensive, too.   We spent $174 billion (USD) on diabetes in 2007 in the U.S.

The companion essay by Dr. Robert Ratner also notes 79 million Americans with prediabetes.

In addition to lower rates of major diabetes complications, we now have 11 classes of drugs for treating diabetes, compared with just three or four a generation ago.

I’m hopeful that future research will point to dietary changes that can help control or prevent diabetes on a wide scale.  The paleo diet and low-carb eating are two possible avenues.

—Steve

The Accelerating Pace of Human Evolution

…or at least mutations.  Wired.com has the article.  A quote:

It’s easy to think humans have stopped evolving, but nothing could be farther from the truth. Though modern medicine and civilization’s graces make the struggle to survive more subtle, evolution’s engine keeps churning. In the last few thousand years, in fact, a time when human evolution was once thought to have slowed, it may actually have sped up.

I like the very first comment from Platos Cave:

Nothing in this article refutes the idea that in civilized society, no matter how many mutations occur, there is no natural selection to reproduce the more successful mutation at a faster rate. A dullard with bad eyesight may not be as attractive, but is likely to have just as many kids as a genius with good genes, in fact the genius is more likely to use birth control and reproduce his genes at a lower rate..
Cultural and Technological evolution happen at such a ridiculously faster pace than biological evolution that it would be irrelevant even if it was happening, which it is not.

Unlike Plato, I think human evolution is occurring and natural selection is at play.  But medicine, technology, and culture mitigate or otherwise strongly influence the effect of natural selection.

We Should Eat More Offal

Offal includes tongue, heart, liver, kidney, intestine, pancreas, trotters, and ?

Offal includes tongue, heart, liver, kidney, intestine, pancreas, trotters, and ?

Offal is definitely paleo food.  Primitive hunting is often hard and dangerous.  I bet ancient hunters who harvested dangerous animals tended to eat most every part of the animal that was edible.

PrincipleIntoPractice wrote about her offal weekend.  Take a look.

 

PS: I saw a documentary about the Alaskan salmon run recently.  I was quite surprised to learn that grizzlies during this time of abundance strip off and eat the skin of the fish, discarding the meat.

A Report on the First “Physicians and Ancestral Health” Meeting

…in Salt Lake City.  Visit PrincipleIntoPractice for details.  An excerpt:

A word on research…  Physicians are not scientists (save for physician scientists, a truly minuscule blip in the Venn diagram of the ancestral health community) and while anecdotes can be powerful, they are not the kind of evidence that will sway physicians, scientists, and practice.

I’m surprised the conference didn’t attract a larger crowd.  As for me, I didn’t even hear about it until it was way too late to make plans.

Thanks to the medical student author of PrincipleIntoPractice.

How Do Your Body Cells Work?

Chris Highcock posted a one-minute explanatory video at his blog.

QOTD: Paul Johnson on Warren G. Harding and Recessions

The White House

As the U.S. considers a terrifying 2.3% federal budget cut via the “Sequester” next month, I’m reminded of this quote:

[U.S. President Warren G.] Harding inherited an absentee presidency and one of the sharpest recessions in American history.  By July 1921 it was all over and the economy was booming again.  Harding had done nothing except cut government expenditure….

—Paul Johnson, in his book, Modern Times, 1983 & 1991

Gene Therapy Cured Type1 Diabetes in Dogs: Humans Next?

ScienceDaily has the report.  This is exciting.  But hold your horses since human trials are years away.

Man’s Best Friend was also instrumental in the discovery of insulin.

h/t David Fisher RD

Low-Carb Research Update

Grain-based high-carb Neolithic food

Grain-based high-carb Neolithic food

The paleo diet averages about 30% of total calories from carbohydrates, with a range of about 22 to 40%.  That 30% average is much lower than the standard 50–60% in the developed world.  Is that lower percentage healthy or not?  It depends on the quality of the carbs and the remainder of the diet.  It most certainly can be healthy.

As much as possible, I base my nutrition and medical recommendations on science-based research published in the medical literature.  In the early 2000s, a flurry of scientific reports demonstrated that very-low-carb eating (as in the style of Dr. Robert Atkins) was safe and effective for short-term weight management and control of diabetes.  Eighty hours of literature review in 2009 allowed me to embrace low-carbohydrate eating as a logical and viable option for many of my patients. The evidence convinced me that the relatively high fat content of many low-carb diets was nothing to worry about long-term.

I’d like to share with you some of the pertinent low-carb research findings of the last few years.

Low-Carb Diets

  • Low-carb diets reduce weight, reduce blood pressure, lower triglyceride levels (a healtlhy move), and raise HDL cholesterol (another good trend).  These improvements should help reduce your risk of heart disease.  (In the journal Obesity Reviews, 2012.)
  • Dietary fat, including saturated fat, is not a cause of vascular disease such as heart attacks and atherosclerosis (hardening of the arteries).  (Multiple research reports.)
  • If you’re overweight and replace two sugary drinks a day with diet soda or water, you’ll lose about four pounds over the next six months.  (American Journal of Clinical Nutrition, 2012.)
  • United States citizens obtain 40% of total calories from grains and added sugars.  Most developed countries are similar.  Dr. Stephan Guyenet notes that U.S. sugar consumption increased steadily “…from 6.3 pounds [2.9 kg] per person per year in 1822 to 107.7 pounds [50 kg] per person in 1999.  Wrap your brain around this: in 1822 we ate the amount of added sugar in one 12-ounce can of soda every five days, while today we eat that much sugar every seven hours.”
  • A very-low-carb diet improves the memory of those with age-related mild cognitive impairment. Mild cognitive impairment is a precursor to dementia.  (University of Cincinnati, 2012.)
  • High-carbohydrate and sugar-rich diets greatly raise the risk of mild cognitive impairment in the elderly. (Mayo Clinic study published in the Journal of Alzheimers’ Disease, 2012.)
  • Compared to obese low-fat dieters, low-carb dieters lose twice as much fat weight.  (University of Cincinnati, 2011.)
  • Diets low in sugar and refined starches are linked to lower risk of age-related macular degeneration in women.  Macular degeneration is a major cause of blindness.  (University of Wisconsin, 2011.)
  • A ketogenic (very-low-carb) Mediterranean diet cures metabolic syndrome (Journal of Medicinal Food, 2011.)
  • For type 2 diabetics, replacing a daily muffin (high-carb) with two ounces (60 g) of nuts (low-carb) improves blood sugar control and reduces LDL cholesterol (the “bad” cholesterol). (Diabetes Care, 2011.)
  • For those afflicted with fatty liver, a low-carb diet beats a low-fat diet for management. (American Journal of Clinical Nutrition, 2011.)
  • For weight loss, the American Diabetes Association has endorsed low-carb (under 130 g/day) and Mediterranean diets, for use up to two years. (Diabetes Care, 2011.)
  • High-carbohydrate eating doubles the risk of heart disease (coronary artery disease) in women.  (Archives of Internal Medicine, 2010.)
  • One criticism of low-carb diets is that they may be high in protein, which in turn may cause bone thinning (osteoporosis).  A 2010 study shows this is not a problem, at least in women.  Men were not studied.  (American Journal of Clinical Nutrition.)
  • High-carbohydrate eating increases the risk of developing type 2 diabetes (American Journal of Clinical Nutrition, 2010.)
  • Obesity in U.S. children tripled from 1980 to 2000, rising to 17% of all children.  A low-carb, high-protein diet is safe and effective for obese adolescents.  (American Journal of Clinical Nutrition, 2010.

Steve Parker, M.D.

PS:  The paleo diet is also referred to as the caveman diet, Paleolithic diet, hunter-gatherer diet, Stone Age diet, and ancestral diet.

Are Rats Related to Tooth Decay?

From Karl Gruber at Scientific American:

You could be forgiven for thinking that tooth decay is an inevitable fact of life; even ancient Egyptians practiced dentistry. But the study of human teeth suggests that before our ancestors started cultivating plants for food, cavities were uncommon. Tooth decay, it seems, spread once we changed to an agricultural lifestyle.

New evidence from Omar Eduardo Cornejo Ordaz, a postdoctoral research fellow at the Stanford School of Medicine, and his colleagues back up this hypothesis. They analyzed the genomes of several strains of the prevalent caries-causing bacterium,Streptococcus mutans, to determine when new genes evolved in this species and its close relatives. The team’s statistical analyses suggest the bacteria’s population started expanding exponentially about 10,000 years ago, which coincides quite nicely with the birth of agriculture.

Smiling LipsThe article mentions Peter Brown, an Australian paleoanthropologist, who favors sugar and other refined carbohydrates as a cause of dental decay.  No need to invoke rats.  Australian aborigines and Japanese samurai in the Edo period saw deterioration of dental health after introduction of sugars and other refined carbs.

Maybe it’s true: No carbs, no cavities.

—Steve

h/t Amy Kubal

How Accurate Is Your Home Glucose Meter?

BDavid Mendosa reviewed some reviews on home blood glucose monitor accuracy and reproducibility.  He was motivated by an article in Consumer Reports.  You’ll want to click through his links for details.  The last time I looked into this, I found that a device could receive FDA approval if it could measure accuracy to within 20% of the actual blood sugar value as determined by a laboratory machine.  For a blood sugar of 200 mg/dl (11.1 mmol/l), the home device could give you a value anywhere between 160 and 240 mg/dl (8.9 to 13.3 mmol/l).  That doesn’t exactly inspire confidence, does it?

—Steve