Why did it take us so long to realise sugar, not fat, was the enemy? In a move that would make most big pharma companies proud, new research published in JAMA Internal Medicine found sugar companies paid to downplay the white stuff’s role in heart disease during the 1960s. Scary stuff, even more so because it’s had lasting effects on public perceptions. It’s time everyone woke up to the truth about fat and sugar. MH investigates…

This morning, as I do most days, I breakfasted on a three egg omelette cooked in coconut oil, with a whole milk coffee. I enjoyed a wedge of full fat cheese with my lunch, poured a liberal dose of olive oil on my evening salad and snacked on nuts throughout the day. In short, I ingested a fair amount of fat and, as a cardiologist who has treated thousands of people with heart disease, this may seem a particularly peculiar way to behave. Fat, after all, furs up our arteries and piles on the pounds – or at least that’s what prevailing medical and dietary advice has had us believe. As a result, most of us have spent years eschewing full fat foods for their ‘low fat’ equivalents, in the hope it will leave us fitter and healthier.

Yet I’m now convinced we have instead been doing untold damage: far from being the best thing for health or weight loss, a low fat diet is the opposite. In fact, I would go so far as to say the change in dietary advice in 1977 to restrict the amount of fat we were eating helped to fuel the obesity epidemic unfolding today. It’s a bold statement, but one I believe is upheld by an array of recent research.

These days I make a point of telling my patients – many of whom are coping with debilitating heart problems – to avoid anything bearing the label ‘low fat’. Better instead, I tell them, to embrace full fat dairy and other saturated fats within the context of a healthy eating plan. It’s an instruction that is sometimes greeted with open-mouthed astonishment, along with my request to steer clear of anything that promises to reduce cholesterol – another of those edicts we are told can promote optimum heart and artery health.

As we will see, the reality is far more nuanced: in some cases lowering cholesterol levels can actually increase cardiovascular death and mortality, while in healthy people over sixty a higher cholesterol is associated with a lower risk of mortality. Why, exactly, we will come to later.

First though, let me make it clear that until very recently, I too assumed that keeping fat to a minimum was the key to keeping healthy and trim. In fact, to say my diet revolved around carbohydrates is probably an understatement: sugared cereal, toast and orange juice for breakfast, a panini for lunch and pasta for dinner was not an uncommon daily menu. Good solid fuel, or so I thought, especially as I am a keen sportsman and runner. Still, I had a wedge of fat round my stomach which no amount of football and running seemed to shift.

That, though, wasn’t the reason I started to explore changing what I ate. That process started in 2012, when I read a paper called ‘The toxic truth about Sugar’ by Robert Lustig in the science journal Nature.  In it, Lustig, a Professor of Paediatrics who also works at the University of California’s Centre for Obesity Assessment, said that the dangers to human health caused by added sugar were such that products packed with it should carry the same warnings as alcohol. It was an eye-opener: as a doctor I already knew too much of anything is bad for you, but here was someone telling us that something most of us ate unthinkingly every day was, slowly, killing us.

The more I looked into it, the more it became abundantly clear to me that it was sugar, not fat, which was causing so many of our problems – which is why, along with a group of fellow medical specialists I launched the lobbying group Action on Sugar last year with the aim of persuading the food industry to reduce added sugar in processed foods.

Then earlier this year I had another light-bulb moment. In February Karen Thomson, the granddaughter of pioneering heart transplant surgeon Christian Barnard, and Timothy Noakes, a highly-respected Professor of Exercise and Sports Medicine at the University of Cape Town, invited me to speak at the world’s first ‘low carb’ summit in South Africa. I was intrigued, particularly as the conference hosts are both fascinating characters. A former model, Thomson has courageously battled a number of addictions including alcohol and cocaine, but lately it is another powder – one she labels ‘pure, white and deadly’ – that has resulted in her opening the world’s first carbohydrate and sugar addiction rehab clinic in Cape Town.

Noakes, meanwhile, has recently performed a remarkable U-turn on the very dietary advice he himself expounded for most of his illustrious career: that is, that athletes need to load up on carbohydrates to enhance performance. A marathon runner, he was considered the poster boy for high carbohydrate diets for athletes – then he developed Type 2 diabetes. Effectively tearing pages out of his own textbook, Noakes has now said athletes – and this goes for those of us who like to jog around the park too – can get their energy from ketones, not glucose. That is, from fat not sugar.

Alongside them were fifteen international speakers ranging from doctors, academics and health campaigners who between them produced an eloquent and evidence-based demolition of “low fat” thinking – as well as suggesting that it is carbohydrate consumption, not fatty foods, which is fuelling our obesity epidemic.

Opening the conference was Gary Taubes, a former Harvard physicist who wrote The Diet Delusion, in which he argued that it is refined carbohydrates that are responsible for heart disease, diabetes, obesity, cancer, and many other of our Western maladies. The book caused controversy when it was released seven years ago, but his message is finally gaining traction. And that message is this: obesity is not about how many calories we eat, but what we eat. Refined carbohydrates fuel the over production of insulin, which in turn promotes fat storage. In other words: it’s not calories from fat themselves that are the problem.

It’s a robust message that was reinforced time and again at the conference. Take Swedish family physician Dr Andreas Eenfeldt, In his home country, studies show that up to twenty three percent of the population are embracing a high fat, low carbohydrate diet. A ticking time bomb you might think – but contrary to expectations, while obesity rates are soaring everywhere else, they are now starting to show a decline there.

More research on this correlation is yet to be done – but in the meantime The Swedish Council on Health Technology has made its position clear. After a two year review involving sixteen scientists, it concluded that a high fat, low carb diet may not only be best for weight loss, but also for reducing several markers of cardiovascular risk in the obese. In short, as Dr Eenfeldt told the conference, ‘You don’t get fat from eating fatty foods just as you don’t turn green from eating green vegetables.’

This, of course, is a difficult message for many to swallow; particularly for heart patients, most of whom have spent years pursuing a low fat, low cholesterol diet as the best way to preserve heart health.

It’s a public health message that was first promoted in the sixties, after the globally respected Framingham Heart study sanctified high cholesterol as a major risk factor for heart disease. It’s a cornerstone of government and public health messages – yet what people didn’t know was that the study also threw up some more complex statistics. Like this one: for every 1mg/dl per year drop in cholesterol levels in those who took part in the study there was a 14% increase in cardiovascular death and an 11% increase in mortality in the following 18 years for those aged over 50.

It’s not the only statistic that doesn’t sit with the prevailing anti-cholesterol message: in 2013, a group of academics studied previously unpublished data from a seminal study done in the early seventies, known as the Sydney Diet Heart study. They discovered that cardiac patients who replaced butter with margarine had an increased mortality, despite a 13% reduction in total cholesterol. And the Honolulu heart study published in the Lancet in 2001 concluded that in the over-sixties a high total cholesterol is inversely associated with risk of death. Startling, isn’t it? A lower cholesterol is not in itself the mark of success, it only works in parallel with other important markers, like a shrinking waist size and diminishing blood markers for diabetes.

Conversely, a mounting slew of evidence suggests that far from contributing to heart problems, having full fat dairy in your diet may actually protect you from heart disease and type 2 diabetes. What most people fail to understand is that, when it comes to diet, it’s the polyphenols and omega 3 fatty acids abundant in extra virgin olive oil, nuts, fatty fish and vegetables that help to rapidly reduce thrombosis and inflammation independent of changes in cholesterol. Yet full fat dairy has remained demonized – until now.

In 2014, two Cambridge Medical Research Council studies concluded that the saturated fats in the blood stream that came from dairy products were inversely associated with Type 2 diabetes and heart disease. Meaning that in moderate amounts – no-one is talking about devouring a cheese board in one sitting here – cheese is actually a proponent of good health and longevity. The same study, incidentally, found that the consumption of starch, sugar and alcohol encourages the production of fatty acids made by the liver that correlate with an increased risk of these killer diseases.

It is around type 2 Diabetes, in fact, that the anti-fat pro-carb message of recent decades has done some of the greatest damage. A lot of patients suffering from Type 2 Diabetes – the most common kind – are laboring under the dangerous misapprehension that a low fat, starchy carbohydrate fuelled diet will help their medication work most effectively. They couldn’t be more wrong. Earlier this year, a critical review in the respected journal Nutrition concluded that dietary carbohydrate restriction is one of the most effective interventions for reducing features of metabolic syndrome.

It would be better to rename type 2 diabetes “carbohydrate intolerance disease”. Try telling this to the public though. Like the man who called into a national radio show in Cape Town on which I was taking part to discuss the relationship between diet and heart disease. Diagnosed with Type 2 diabetes, he was under the impression he had to consume sugar so his diabetes medications could ‘work’ – when in fact it was going to worsen his symptoms. And how many doctors and patients know that although some of these medications to control blood sugar may marginally reduce the risk of developing kidney disease, eye disease and neuropathy, they don’t actually have any impact on heart attack, stroke risk or reduce death rates? On the contrary dangerously low blood sugar from overmedicating on diabetes drugs has been responsible for approximately 100,000 emergency room visits per year in the United States.

But who can blame the public for such misguided perceptions? In my opinion a perfect storm of biased research funding, biased reporting in the media and commercial conflicts of interest have contributed to an epidemic of misinformed doctors and misinformed patients. The result is a nation of over-medicated sugar addicts who are eating and pill-popping their way to years of misery with chronic debilitating diseases and an early grave.

It’s why, these days, I very seldom touch bread, have got rid of all added sugars and have embraced full fat as part of my varied Mediterranean-inspired diet. I feel better, have more energy and – even though I didn’t set out to do so – I’ve lost that fatty tyre around my waist, despite reducing the time I spend exercising.

Perhaps you can’t face making all those changes in one go. In which case, if you do one thing, make it this: next time you are in the supermarket and are tempted to pick up a pack of low-fat spread, buy a pack of butter instead or, better still, a bottle of extra virgin olive oil. Your heart will thank you for it. The father of modern medicine Hippocrates once said, “let food be thy medicine and medicine be thy food”. It’s now time we let “fat” be that medicine.

Dr Aseem Malhotra is a cardiologist, founding member of the Public Health Collaboration and advisor to the National Obesity Forum. 



People Dying of Diabetes Who Never Knew They Had It, Study Finds

People who don’t know they have Type 1 diabetes may account for a surprising number of deaths from one complication of the condition, a new study says.

Nearly a third of people in Maryland who died over a six-year period from diabetic ketoacidosis, a condition of severe insulin deficiency, had no known history of diabetes, the study of autopsy results found.

While the researchers weren’t able to definitively tell whether those who died had Type 1 or Type 2 diabetes, their high blood sugar levels suggest they probably had Type 1, said study researcher Dr. Zabiullah Ali, the assistant medical examiner for the Office of Chief Medical Examiner in Maryland.

The finding highlights the need for regular physicals that include checking blood sugar levels, especially if warning signs of diabetes are present, the researchers said.

The study was published in the September issue of the American Journal of Forensic Medicine and Pathology.

What happens when the body runs out of sugar

Diabetic ketoacidosis is a complication of diabetes that occurs when body cells don’t have enough glucose (sugar) to use for energy, so they switch to burning fat instead. (Body cells need insulin in order to take up sugar from the bloodstream; in people with Type 1 diabetes, little or no insulin is produced.)

Breaking down fat for energy produces molecules called ketones, which are acids and can build up in the blood. If ketone levels climb too high, they can poison the body, causing chemical imbalances that can lead to coma, or death.

In the study, Ali and colleagues looked at 20,406 autopsies and found 107 people who had died from diabetic ketoacidosis, although only 92 had data available for further review.

Out of the 92 cases, they found that 60 people were previously diagnosed with diabetes, while 32 were not.

Nearly half of those who died with no history of diabetes were in their 40s. The researchers also found that 84 percent of these cases were men, and 53 percent were African-American.

Adults can be diagnosed with Type 1 diabetes too

Type 1 diabetes was long referred to as “juvenile diabetes,” because people tend to be diagnosed with the condition during childhood.

But now, “physicians are becoming more aware of the possibility of a diagnosis of Type 1 diabetes in the adult population,” said Dr. Mark S. Segal, a nephrologist at the University of Florida, who was not involved in the study.

“It’s relatively new that we’re seeing more adults are being diagnosed with Type 1,” Segal said.

Ali emphasized that people should pay attention to any warning signs that point to diabetes, such as needing to urinate frequently, constant thirst, nausea and vomiting.

People newly diagnosed with Type 1 diabetes may go through a “honeymoon period,” in which they may be able to function even thoughthey aren’t making insulin — but that period doesn’t last long, he said.

“Once the period ends, they get into trouble fast,” Ali said. Healthy people should have their blood sugar checked one or twice a year.

“But if you have symptoms, you should go to the doctor immediately,” he said.

Pass it on: Getting blood sugar levels checked could help prevent diabetes complications, such as diabetic ketoacidosis.



Think Twice Before Making That Diabetes Joke

I decided to do a little experiment. I went to the mall and asked strangers a question,
“When I say the word ‘diabetes,’ what is the first thing that pops into your

poster with people's answers to what word pops into their mind when they hear 'diabetes'

I got varied responses, but about half of the answers fell into the stigma. What is the stigma, you ask? The stigma is that people with diabetes are overweight, that people with diabetes ate too much sugar, that people with diabetes need to diet.

If we look at the things written down in the picture above, you’ll see about half of them appear to have a decent understanding. Yes, diabetes is an illness and a disease. Yes, for many it does involve needles. Some people thought of a family member who was affected. A couple of people even knew there was more than one type of diabetes.

So where does the problem come in? About half the responses included the word “sugar.” Most disturbingly, upon further discussion I learned this was literally all the knowledge some people had about diabetes.

I’m sure you’ve seen it before on social media. You see a picture of an indulgent dessert, and you click on the comments. “DIABETES,” someone said. You’re reading someone’s Facebook status and it reads, “If John had 20 candy bars, then Joe gave him 2, what does he have now? Diabetes. John has diabetes.” Again, you click on the comments to see that they’re full of “LOLs,” “HAHAHAs,” and praise for the hilarious joke. The thing is… it’s not hilarious. It’s horribly offensive.Diabetes is not a candy bar. Diabetes is a devastating disease that can happen
to anyone. It doesn’t matter if you have the healthiest diet on the planet and exercise multiple times a week. It doesn’t matter if you’re a professional athlete. Diabetes can happen to anyone, and it will change a life forever.

There are multiple types of diabetes, and none of them are OK to poke fun at. Type 1, which I have, is an autoimmune disease where the body attacks the insulin producing cells in the pancreas, leaving the body with no insulin production. There is no cure. Type 2 is a condition in which the body doesn’t produce enough insulin or the body doesn’t use the insulin it makes properly. Yes, extra weight can be a risk factor for this, however many other things can be as well, and you’ll find plenty of Type 2s who are not overweight. This is where genes come into play, and that is not something anyone can control.Life with diabetes is waking up at 3 a.m. shaking with a low blood sugar, stumbling to the kitchen and trying to grab something to treat it before you pass out. Life with diabetes is giving yourself injections, sometimes 10 times a day, or wearing an insulin pump. It is constantly working to make sure your blood sugar doesn’t go too low or too high. It is trying to prevent the devastating complications that can occur if you don’t take care of yourself properly. It is a full time job where one little slip up can cost you your life.

When you make jokes about this disease, you are adding to the stigma, which is already so widespread that correcting the world’s view on it is like moving a mountain. When you make jokes about it, you are trivializing the battle of children who cry at night because they don’t want to get another injection. And they’re going to have to repeat this for the rest of their lives or until there’s a cure.

So this is my plea to think twice before making a diabetes joke. This is my plea to educate people who only know the stigmatized version of diabetes. This is my plea to make the lives of people with diabetes a little easier to deal with and a little easier for the world to understand.



Can a low-carb, high-fat diet help fight diabetes?

The morning that Bob MacEachron went to meet his new weight-loss doctor, the one he hoped would help him shed some of his 370 pounds, he sat down to what he thought would be a breakfast of lasts. The last time he would eat three jumbo eggs fried in butter. The last time he would enjoy bacon. He poured heavy cream in his coffee, girding himself for what he feared would be the last time he would whiten the drink with anything other than skim milk.

And then he met his doctor, who asked what he had eaten at his last meal.

“Perfect breakfast!” responded Dr. Sarah Hallberg to MacEachron’s surprise.

Hallberg, medical director and founder of the medical weight-loss program at Arnett IU Health Lafayette, is a big proponent of low-carb, high-fat diets. But not just for weight loss. She also believes this diet can treat Type 2 diabetes, a disease affecting almost 10 percent of American adults.

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The former exercise physiologist took her message to the Internet last spring in a TEDxPurdueU talk that has drawn about 325,600 viewers online, more than any other video from the college speaker series’ three years. She packages her message with a strong jab at the American Diabetes Association, whose guidelines do not embrace the low-carb concept.

“This really makes us question a lot of these recommendations that we have been getting. Clearly they are not working. We keep getting fatter and sicker in this country,” Hallberg said in a recent interview with IndyStar. “Do we want to just continue throwing medications at people? Or do we want to get down to the root cause of their problem, which is the food that we’re eating?”

When Hallberg started the weight-loss clinic about three years ago, she at first focused on helping people shed unwanted pounds. She embraced a low-carbohydrate plan because she says evidence has shown it works best — not just at helping people lose weight but also on keeping it off.

The hallmarks of the diet Hallberg endorses emphasize fat over carbohydrates. People should eat no more than 75 total grams of carbohydrates or 10 to 15 teaspoons of sugar a day. To achieve this, Hallberg advocates eating no processed foods as well as no grains, potatoes or sugar.

So what can people who do away with carbs eat in their place?

“My patients eat fat and a lot of it,” Hallberg says in her TedX talk. “‘What?’ you say. ‘What’s going to happen when you eat fat?’ Let me tell you: You’re going to be happy because fat tastes great and it’s incredibly satisfying.”

That means nothing low-fat, fat-free or light. Plenty of proteins such as meat, eggs, nuts and seeds. Minimal fruits, if at all.

Within six months of a year of opening the weight-loss clinic, Hallberg noticed that her patients not only lost weight but that those who took diabetes medicines no longer needed to do so.

“Weight loss I consider a secondary goal at this time,” said Hallberg, who herself follows this diet and says that her weight — she was always slim — has not fluctuated on it. “Weight can be harder than the metabolic changes. We will see people who have lost very little weight but have a dramatic turnaround in their metabolic health.”

The program worked for MacEachron, 67, who originally saw Hallberg to lose about 80 pounds so he could have hip surgery safely. Within 30 days of his first visit, MacEachron stopped taking all his diabetes medicine. In nine and a half months, he lost 120 pounds — and did not cheat once, he said.

Buoyed by anecdotal evidence from patients like MacEachron, Hallberg partnered with a Purdue University nutrition professor on a pilot study, comparing 50 people who followed her method with 50 people who stayed on standard diabetes treatment, including medicine.

After six months both groups improved their hemoglobin A1C levels, a measure of how well diabetes is controlled in the long run. Those in the first group, however, had to take less medicine to achieve the result; those in the latter group took more medicine.

Such statistics leave Hallberg baffled as to why more health care providers don’t support a food-based approach to treating diabetes. Instead, she said, most diabetes doctors prescribe medicine after medicine to control the condition, buying into a billion-dollar pharmaceutical industry.

“What we’re choosing instead is to medicate people. … It boggles my mind,” she said. “I would say the goal for everyone is to go off medicine. It is a complete routine occurrence. We see multiple patients every day going off medicine

About 29.1 million people have diabetes, according to the Centers for Disease Control and Prevention, and 8.1 million of those do not even know they have the disease. An additional 86 million Americans have prediabetes, according to the American Diabetes Association.

Once a person has been diagnosed, medications and care for associated health problems such as heart or kidney disease can prove quite costly. Caring for those with diagnosed diabetes came to about $245 billion in 2012, according to the American Diabetes Association. About 18 percent of that number stems from the cost of medications.

Not everyone is as staunch of an advocate of Hallberg’s low-carb, high-fat approach.

Diabetes specialists can focus too much on medicine and ignore the role of food in managing diabetes, acknowledges Maggie Powers, president-elect of healthcare and education for the American Diabetes Association. That does not mean, however, that the answer lies solely in low-carb, high-fat diets. Rather than prioritizing one eating plan, the Association encourages treatments tailored to individuals.

“If she’s asking for the Diabetes Association to have all people limit their carbohydrates, that’s not going to happen because there’s no proof that that’s a healthy diet,” said Powers, a registered dietitian with the International Diabetes Center at Park Nicollet in Minneapolis. “It’s easy to say that someone or an entire organization is wrong. The American Diabetes Association … does not dictate a one-size-fits-all plan. We just don’t do that. There’s millions of people with diabetes, and they all cannot follow that food plan.”

Even Hallberg’s collaborator from Purdue expresses some reservation that the healthiest diet consists of low-carbs, high-fats. Wayne W. Campbell, a professor in Purdue’s nutrition science department, has studied many different diets, looking to see which one is healthiest in the long run.

A low-carb, high-fat diet has proved effective in the short term, Campbell said, but that does not necessarily mean that it’s the only way to achieve these results.

“There is no magical diet,” said Campbell, who describes his diet as healthy but not low-carb, high-fat. “The low-carb diet has been shown to be particularly effective at least in the short term because it is such a dramatic difference from what people eat.”

Low-carb diets work largely because of the way insulin, a fat storage hormone, operates in our bodies, Hallberg says. Insulin drives glucose or blood sugar into the cells. The more insulin we have, the more glucose we have. The more glucose over time, the more likely we are to develop diabetes.

Carbohydrates spike our insulin and glucose levels, Hallberg said. Fat, however, has no impact.

“At its root, diabetes is a state of carbohydrate toxicity,” Hallberg says in her TedX talk. “When our patients decrease their carbs, their glucose goes down and they don’t need as much insulin. So those insulin levels drop and fast.”

Now the question becomes what happens if a person sustains this diet in the long term.

Hallberg and Campbell are embarking on one of the largest studies of this diet ever to try to answer this. In the coming months, they will enroll 400 people, half in Lafayette and half in Indianapolis, who will follow the low-carb, high-fat approach. An additional 100 people will have standard care, which may include medication and dietary modifications that are not limited to low-carb, high-fat regimens.

The 200 people in Lafayette will come into Hallberg’s office regularly for assessments. The other 200 will be followed remotely. The trial is sponsored by a company involved with health technology, Hallberg said.

“The improvement she sees in lipid profiles, blood pressure, hemoglobin A1C are clinically significant, but they are well documented to occur with other types of weight loss programs,” Campbell said. “Is there a superiority to one program? At this point … we can’t answer that question.”

Some people who try the rigorous diet find that sticking with it can be tough.

Barbara Davies started in January of 2014 after her doctor told her she was at risk of developing diabetes. She stayed on to the diet for months even though she kept cooking foods like mashed potatoes for Jim, who also needed to lose weight but wasn’t ready to do so. Still, it was not easy.

“It’s very difficult to get the mindset. Fat’s not the enemy; it’s carbs. It’s not the butter; it’s the bread,” said Davies, 65, who is now on the diet with her 67-year-old husband, Jim.

When last Thanksgiving came, however, Barbara’s willpower left. Through the holidays and the start of this year, she went back to her old eating ways. She canceled two appointments with Hallberg and put back on 30 of the 55 pounds she had lost.

Four months ago, Jim decided that he would go on the diet with Barbara. They’ve been on it together ever since.

Barbara’s blood sugar levels are no longer in the danger zone for developing diabetes. And Jim, who has had the disease since he was 50, has lost 50 pounds. When he first started seeing Hallberg, he took six medicines to treat his diabetes. Now he’s down to three.



Fried, Grilled, Baked Foods May Up Diabetes Risk

FRIDAY, Sept. 2, 2016 (HealthDay News) — Changing the way you cook could help reduce your risk of getting type 2 diabetes, a new study suggests.

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Boiling, steaming and poaching look like the safest way to go, researchers say.
When you fry, grill or bake foods — also called dry-heat cooking — foods produce substances called advanced glycation end products (AGEs).

Higher levels of AGEs have been linked to insulin resistance, stress on the body’s cells and inflammation, according to the study authors. These are troublemakers in terms of diabetes risk.

Insulin is a hormone that helps blood sugar from food get into cells for energy. Without insulin, or with insulin resistance, too much sugar remains in the blood. This can lead to serious problems for the heart, eyes, kidneys and other organs.

“When you look at people with chronic diseases like type 2 diabetes or dementia put on a high-AGE diet or a low one, those on the low-AGE diet show signs of decreasing inflammation,” said the study’s lead author, Dr. Jaime Uribarri. He’s a professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City.

For this study, however, the researchers wanted to see if a low-AGE diet could offer protection to people already at risk of developing type 2 diabetes. Conversely, the researchers believed that a regular Western diet, which is generally high in AGEs, might contribute to the risk of type 2 diabetes.

The researchers randomly assigned study participants to one of two diet groups. The regular-AGE diet group included 49 people; the low-AGE diet group had 51.

All were at least 50 years old. And they had at least two of the following five health concerns (or were on medications for these problems): a large waist circumference (40 inches for men, 35 for women); high blood pressure; low HDL (good) cholesterol; high triglycerides (another type of blood fat); or elevated fasting blood sugar levels.

Those in the low-AGE group were given instructions on how to lower the AGE content in their foods. They were told to avoid frying, baking or grilling foods. Instead, they were encouraged to boil, steam, stew or poach their meals — in other words, cook with water

Some examples of the changes made included substituting boiled eggs for fried eggs, poached chicken instead of grilled chicken, or beef stew instead of grilled steak, according to the study.

The study volunteers completed a three-day food record so the researchers could take into account the types of foods they ate. The researchers specifically asked that the participants not change the types of foods they ate, just the preparation of those foods. They also were instructed to try to eat the same amount of calories a day.

A dietitian checked in with the low-AGE group twice a week, and met with each person every three months to review their cooking methods and to encourage low-AGE cooking.

The regular-AGE group was instructed to continue cooking as they already did. The study lasted one year.

In the low-AGE group, “all the parameters in stress and inflammation we tested for improved. And we showed that insulin resistance came down,” Uribarri said. “These findings are highly suggestive of a cause-and-effect relationship, but our study needs to be demonstrated again in a larger study with different sites, different populations and different habits.”
Body weight dropped slightly in the low-AGE group, and no side effects were seen, the authors said.

“We imagine the more you [cook with low-AGE methods], the better. We think it will be proportionate,” Uribarri said.

But one specialist thinks just switching cooking techniques isn’t enough to curb diabetes risk.

“We know that we have AGEs that are increased by cooking, but many foods themselves are also high in AGEs. So, in addition to changing how we cook, we also want to change what we’re eating,” said Samantha Heller. She’s a senior clinical nutritionist at New York University Langone Medical Center in New York City.

“I think it’s more important to focus on the quality of your food choices. Vegetables and other plant foods aren’t as high in AGEs,” she noted.

But, Heller added, nutrition experts often emphasize making small changes. And switching to lower-AGE cooking methods for at least some of your meals may be one way to start making small, healthy changes



diabetes treatment helps reduce weight in children with autism

Autism drugs often increase appetite, weight, diabetes drug helps

A new study shows significant evidence that a common drug used to treat type­2 diabetes — metformin — is also effective in helping overweight children and adolescents with autism spectrum disorder (ASD) who take antipsychotic medications maintain or reduce their body mass index (BMI).

“This is a very special group, as young people with ASD present with many unique challenges. By definition, they experience communication difficulties, and they’re reported to have more gastrointestinal (GI) difficulties than most other patient groups,” said Michael Aman, professor emeritus of psychology at The Ohio State University Wexner Medical Center’s Nisonger Center and lead investigator at Ohio State.

Results of the 16-week, multicenter clinical trial, which also showed metformin was well­tolerated and reduced BMI scores from the initial baseline significantly more than the placebo group, are published in the Journal of the American Medical Association Psychiatry.

“It’s critically important that we investigate new ways to support healthy outcomes as early as possible for those who are on these medications,” said Dr. Evdokia Anagnostou, principal investigator of the study and senior clinician scientist and co­lead of Holland Bloorview Kids Rehabilitation Hospital’s Autism Research Centre.

The double­blind, randomized clinical trial observed outcomes of 60 adolescents and children (ages 6­17)) with ASD who were overweight due to side effects of FDA­approved antipsychotic medications prescribed to treat irritability and agitation. Such medications can cause a significant increase in weight gain and BMI, which increases long­term risk of diabetes. Researchers explored the effectiveness of metformin in counteracting weigh gain associated with antipsychotics.

“Use of antipsychotics to help manage irritability associated with ASD can sometimes be long­term, which means we need to provide families with solutions that support lasting optimal health in their children,” Anagnostou said. “Our results showed that GI side effects occurred for more days in the metformin group compared to placebo group, but the large majority of children taking metformin were able to maintain their treatment. Importantly, the metformin didn’t cause behavioral changes, such as increased irritability,” Aman said.

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ASD is a common developmental disorder of childhood which has markedly grown in frequency in recent decades, and data shows adolescents with ASD are more likely to be overweight than those without developmental disabilities.

Researchers note that results from this study are promising in terms of weight management, as little research has examined treatment or prevention of weight gain in children and adolescents with ASD. In addition, food selection commonly associated with ASD adds to the challenge of weight management.

“It’s not the amount that’s eaten, rather the food choices that are a by­product of the cravings and linked to weight gain,” Aman said.


The above post is reprinted from materials provided by The Ohio State University Wexner Medical Center.


Impact of Carbohydrates in Diabetes Patients

Are very-low carbohydrate, low saturated fat diets the best choice for A1c control?

Adequate diet and exercise has become the cornerstone strategy for diabetes management. Different diet modalities have been investigated in order to achieve proper glycemic control in diabetes patients. A calorie-restricted diet might seem feasible based on its strong evidence of achieving adequate control. However, adherence seems to limit the use of this diet modality, as it may appear too complex for several patient populations. Other diets focus on reducing fat content due to evidence demonstrating rates of insulin resistance increasing proportionally to fat content. On the other hand, some diets focus on the carbohydrate content due to evidence suggesting that limiting the carbohydrate content can lead to improvements in glucose levels. However, food culture greatly impacts diet and exercise therapy. In the American population, it is estimated that approximately 50% of the total diet is comprised of carbohydrates, followed by fat (~34%) and protein (~16%), making it difficult to properly manage patients.

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In an open-label, two-arm, randomized controlled trial conducted in the Japanese population, Juko Sato and colleagues evaluated the safety and efficacy of 130 grams/day of carbohydrates in patients with diabetes who were poorly controlled despite receiving education about their disease state. Patients were ages 20-75 with inadequate A1c control (>7.5% for more than 3 months), and BMI >23 kg/m2, and received two education sessions on calorie-restricted diets. Patients were followed up for 6 months by the same clinician and dietitian. Sixty-six patients were recruited for the study, out of which 33 patients were placed in the low carbohydrate diet (LCD) group and 32 patients were part of the calorie-restricted diet (CRD) group. Once the study concluded, significant changes were noted in BMI and A1c. The decrease in A1c was by −0.65% (−1.53 to −0.10) in the LCD group and 0.00% (−0.68 to 0.40) in the CRD group (p < 0.01). The BMI decrease in the LCD group was greater than in the CRD group (p = 0.03). These findings suggest the usefulness of a low carbohydrate diet; however, challenges will rely on defining and standardizing carbohydrate content cut-offs.

In another research study, Thomas Wycherley et al., examined the effects of very low carbohydrate, low saturated fat diet compared to a high carbohydrate-fat content diet over a 12-month period. 115 patients with type 2 diabetes mellitus were randomized in two groups, one consuming a low carbohydrate diet and the other an isocaloric high carbohydrate diet while undergoing exercise three times weekly for 60 minutes. Both groups were followed for 52 weeks. Flow mediated dilation was measured in each group in order to understand the effect of fat saturation in endothelial function. At the end of the study, both groups obtained a reduction in weight regardless of dietary approach (10.6 ± 0.7 kg; p < 0.001); similar reductions were obtained in A1c (1.05 ± 0.10%; p < 0.001). FMD did not change from baseline, highlighting the possibility that changes in FMD are not affected by weight. Nonetheless, these findings warrant further studies in order to better understand the metabolic effects associated with diet and vascular injury.

These studies highlight the benefits of diet and exercise in patients with diabetes, with positive impacts on A1c and weight. The effects of low carbohydrate diet patterns can be translated to understanding cardiovascular disease risks and the potential role of decreasing these as part of diabetes management strategies. The pathophysiological effects of diabetes on the vascular endothelium can be improved with dietary approaches, including modified fatty acid content. For example, increasing unsaturated fats, while restricting saturated fat intake, can potentially favorably impact prognostic markers of FMD. However, this warrants further evaluation to provide stronger evidence. Marked improvements can be obtained in diabetes patients by providing a proper balance of carbohydrate, protein, and fat along with an adequate exercise routine. Therefore, the key to effectively managing diabetes in patients lies in preventing end-organ complications that can negatively impact health outcomes and overall quality of life. Proper education, more frequent follow-ups, and a personalized diet can help patients achieve their target goals and prevent these complications.

Practice Pearls:

  • Adequate diabetes management relies on individualized nutrition therapy.
  • Adjusting each patient’s carbohydrate content and incorporating exercise can help improve glycemic control and promote weight reduction in diabetes patients.
  • Fat saturation can potentially affect the vascular endothelium; therefore, a modified fatty acid content can help reduce cardiovascular risks in patients with diabetes.






I love nothing more than BBQs, farmer’s markets and family picnics. This season, why not try to keep things low in carbs while still enjoying the flavors you love?

This recipe is for Low-Carb Cauliflower “Potato” Salad, which tastes a lot like good old potato salad but is made with cauliflower instead of potatoes. Using cauliflower as the star of the show keeps the salad really low in carbs while you still get all the flavors of traditional potato salad. This one will help you avoid spiking your blood sugars and lets you fill up on veggies.

Low-Carb Cauliflower “Potato” Salad
1 medium head of cauliflower (about 2lbs), cored and leaves removed and florets and stems cleaned and cut into bite-size pieces
1 green bell pepper, chopped
1 red bell pepper, chopped
2 ribs of celery, chopped
2 hard-boiled eggs, shelled and chopped
½ small onion, chopped
¾ c. light mayonnaise (we used Hellmann’s)
¼ teaspoon of celery salt
Sea salt and black pepper to taste
Sprinkle of cayenne pepper (careful, a little goes a long way–it’s spicy!)

Boil water in a medium size stockpot. Once boiling, add cauliflower florets and stems. Boil until they are fork tender, this will take approx 8 – 10 minutes. Be careful not to overcook so you don’t end up with mashed cauliflower. Drain and rinse with cold water and drain again and set aside. In a large mixing bowl, combine the green and red bell peppers, celery, hard-boiled eggs, and mayonnaise. Add the cauliflower, celery and salt and pepper to taste and mix well. Sprinkle the top with a light dash of cayenne pepper for color and a little spice, if desired. Cover and chill for two hours. I like to sneak a bowl right away!

This salad is fantastic alongside some grilled chicken or a bunless burger for a delicious low-carb meal.

Yield: Approximately 8 servings.
Nutritional Info Per Serving: Calories: 94, Fat: 7g, Carbohydrates: 7g, Fiber: 2.5g, Protein: 3g



Revolutionary new diabetes treatment to be listed on PBS

Kiama Downs resident Peter Marrow and his wife Naomi have been on a sharp learning curve since he was diagnosed with Type 2 diabetes three months ago.

The 78-year-old has struggled with the treatment regime – which currently involves five injections of insulin a day as well as oral medication and constant testing.

However the listing of a revolutionary new diabetes treatment on the Pharmaceutical Benefits Scheme (PBS) from next month will make treatment far easier, and cheaper.

‘’It’s been overwhelming for us with multiple injections and finger-prick blood testing each day,’’ Mrs Marrow said.

‘’It’s painful for Peter and his stomach is black and blue from all the injections.

‘’This new treatment, as we understand, will take it back to one injection a week which will be fantastic.

‘’It will give us our freedom back, as we won’t have to structure our day around Peter’s treatment.’’

Up to 20,000 Australians with Type 2 diabetes will be better able to manage their condition with the listing of Exanatide (Bydureon) on the PBS from September 1.

Federal Health Minister Sussan Ley said the move would see patients save over $1600 per year.

“As one of our most prominent chronic diseases, Type 2 diabetes is placing a significant cost on the nation’s health and finances at nearly $1 billion per year,” Ms Ley said.

‘’Subsiding innovative medicines like these makes it easier for thousands of patients to keep on top of their diabetes and better manage their medication, while not only saving them time and money, but also the health system.’’

Diabetes Australia CEO Associate Professor Greg Johnson welcomed the PBS listing.

‘’The once-a-week injection pen is much easier to use, and has less intrusion on the day-to-day lives of people with diabetes,’’ Professor Johnson said. “It surprises some people to learn that the progressive nature of Type 2 diabetes means many people with (the condition) need injectable drugs when the oral treatments don’t work sufficiently.’’

Prof Johnson said  the discovery of exenatide was an example of the unpredictable path of diabetes research.

“Rather than being an entirely new substance, Exenatide is a synthetic form of a substance found in the saliva of a lizard – the Gila Monster, native to the south western USA and parts of Mexico,” he said.

“This goes to show that some medical solutions can be found in the most unlikely places.”




Diabetic gastroparesis is a disorder affecting people with both type 1 and 2 diabetes in which the stomach takes too long to empty its content. The vagus nerve controls the movement of food through the digestive tract.A damage vagus nerve prevents the muscles in the stomach and intestine from functioning, preventing food from moving through the digestive system properly. Often the cause of gastroparesis is unknown. In gastroparesis although the muscles of the stomach are weak all of the time, the muscle of the pylorus remain strong and contracted and the pylorus relatively closed. It was hypothesized that if the strength of the pyloric muscle was reduced, food might empty from the stomach more readily


In patients with severe gastroparesis sometimes only liquid meals are tolerated. It also is recommend that the Gastroparesis diet be allow in fiber due to the concern about the formation of bezoars and the fact that fibers slows gastric emptying .Doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest, so that you are more likely to get enough calories and nutrients from the food you eat. Your doctor might suggest that you try to

  • Chew food thoroughly
  • Eat smaller meals more frequently
  • Eat well cooked fruits and vegetables rather than raw fruits and vegetables.
  • Choose mostly low fat foods but if you can tolerate them add small serving of fatty foods to your diet


Following are the some Gastroparesis symptoms are given below

  • Malnutrition
  • Dehydration
  • Nausea feeling
  • Abdominal distention
  • Appetite loss
  • Weight loss
  • Vomiting
  • Bloating of abdomen
  • Upsetting stomach gastroparesis pain
  • Electrolyte imbalances
  • Poor blood sugar control


Gastroparesis Treatment begins with identifying and treating underlying condition. If diabetes is causing your gastroparesis your doctor can work with you to help you control it. Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations doctors may recommend a feeding tube be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents. Itstreatment include dietary measure, medications that accelerate emptying or blunt vomiting, non-medication interventions and psychological therapies.However a medicine named TRENICAL is introduced to solve this problem. It is 100% natural product. It works efficiently and quickly. It isa best treatment for this disease. This product is by the Natural Herbal Remedies.