Tag Archive for: blood sugar

It’s Still All About the Calories

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The keto vs. Mediterranean diet study was interesting for a variety of reasons. The researchers deserve a lot of credit for even attempting to try a study of this magnitude; 40 subjects may not seem like a lot, but to provide food via delivery together with instructions on preparation is very expensive and labor intensive. It should be noted that a portion of the study took place during the lockdown phase of COVID-19; that delayed some testing, but to their credit, the subjects affected continued the particular diet they were on for the two weeks until testing could be scheduled. Here are my thoughts on the results.

Blood Lipids

  • Subjects on the keto diet showed a greater decrease in triglycerides (TG) than those on the Mediterranean diet.
  • On the other hand, those on the Mediterranean showed a greater decrease in LDL-cholesterol than did the keto diet subjects.

While the researchers discussed it at length, I don’t think it was relevant. All subjects began with average fasting TG in the normal range. While both diets decreased TG, that the keto diet reduced it slightly more isn’t earth shattering when you start at a normal reading.

The same holds true for the LDL-cholesterol. Yes, the Mediterranean diet reduced it while the keto diet increased it, but the net was 6 mg/dl over the initial readings. What could have been concluded was that neither diet reduced LDL-cholesterol by an amount that was clinically meaningful.

The Microbiome

There were no tests of the changes in the microbiome under each diet reported—at least not yet. Subjects had a definite decline in fiber intake, especially when they provided their own food in the keto diet. The Mediterranean diet saw an increase in fiber intake when subjects provided their own food.

Why mention this at all? The microbiome controls the initial processing of nutrients. In addition, the immune function begins in the gut. While the keto diet may have provided some benefit related to HbA1c, at what cost? We simply don’t know. What we do know based on other research is that the lack of fiber changes the probiotic content of the microbiome.

The Bottom Line

The data showed that the subjects averaged 200 to 300 fewer calories per day regardless of diet and maintained the reduction over both diets. They ate better, they ate less, and they lost weight.

I think this study was important because it leaves us with better questions to ask in the future, such as: how would health measures be affected if subjects reduced calories another way? It also proves what I’ve been saying for years. The average weight loss after the study was 13 to 17 pounds, and that was maintained during the follow-up period. This was not a weight loss study, yet regardless of the initial diet, the subjects lost weight. I’ve said it before and I’ll say it again: regardless of the type of diet, it’s still all about the calories.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Face-Off: Mediterranean vs. Keto

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Last week ended with the publication of an interesting study on two popular diets, Mediterranean and ketogenic, and their potential benefits for people with elevated HbA1c levels; HbA1c is a blood test that measures your average blood sugar levels over the past three months. I use the word “diet” as a description of the type of foods eaten, not as a weight loss program.

The researchers constructed what they termed the Well-Formulated Ketogenic Diet plan to compare with a Mediterranean diet. Both approaches reduced sugar, refined carbohydrates, and starchy vegetables; the Mediterranean diet added unprocessed whole grains, beans, and fruit. The subjects had either prediabetes or type 2 diabetes. The primary goal of the 36-week program was to monitor changes in HbA1c along with a variety of secondary measures including blood lipids.

The 40 subjects were randomly assigned to using the keto diet for 12 weeks and then switching to the Mediterranean diet for 12 weeks or vice versa. Food was delivered to all subjects for the first four weeks of both phases, which I think is brilliant—one of the hardest parts of learning a new way of eating is discovering how the foods can be combined and prepared, along with getting used to the different tastes. After those four weeks, they provided their own food that fit within the particular diet they were on at the time. The final 12 weeks were left up to the subjects.

The results demonstrated both dietary approaches reduced HbA1c about the same amount, and the decrease was maintained regardless of which diet they began with. However, there were some differences as well. I’ll give you those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Knowing Your Health Patterns

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The reason it’s important to track health variables is to find any patterns in the results. Remember the study on hs-CRP and cancer? Paula immediately looked up her CRP levels and found two things. First, it had gone down consistently over several years. Second, she hadn’t had it tested every year, but she will from now on.

Remember my blood pressure? I tracked it from that point (five weeks post-surgery) through today. From 177/107, it has come down appreciably though not in a consistent way; it’s consistently around 130/80 before exercise and 110/70 after exercise. That’s two patterns.

There are some other patterns that may be more relevant. For example, perhaps you’ve had heartburn after eating. Tracking what you eat may show a pattern that the higher the fat content, the worse the heartburn seems to be; the same may be true with constipation.

In short, you may find that one thing leads to another, but only under certain conditions. It’s knowing which conditions that’s most important to finding an answer to your health issue.

Patterns for Disease States

Many conditions have patterns of events that can be predictive of disease. For example, as bone density declines, your risk of a bone fracture increases. As blood pressure goes up, so does the risk of stroke. For type 2 diabetes, as blood sugar and HbA1c rise, so does the risk of prediabetes, type 2 diabetes, and all the accompanying complications.

Those types of patterns can be predictive of disease. Or they may not. As we’ve learned in the Memos, risk factors set the odds but they’re not cause and effect. But there’s another reason.

Your Pattern

The reason tracking to establish patterns of response is important to you is that it may just be your unique pattern—because while we’re all the same in many ways, we all have our unique variations. You may not know what’s unique about you because you haven’t tested it or tracked it to find your pattern. But whether it’s your blood pressure, your blood sugar, your response to foods, or some other variable, it simply may be your individual pattern and may be indicative of nothing.

That doesn’t mean you don’t get the issue checked out by a healthcare professional, but it may mean you don’t have a disease or condition as a general response would indicate. And since you know your pattern, you can track the results of any medication or other intervention your doctor prescribes.

The Bottom Line

Tracking variables to detect patterns is useful to us all. While it won’t help everyone who tries it, the goal is to know yourself better. You won’t have to do it forever, but if you’re concerned about a specific condition, this is a way to help yourself.

And it won’t necessarily be bad news; Paula was relieved to find her hs-CRP had been going down, and you may find an encouraging pattern as well. Even if the results are not what you’d hoped, better to know than not know, right? Because now you can take action.

If you have no idea where to begin, become an Insider or Member at DrChet.com. You’ll have exclusive access to me by email or phone, and I can guide you in checking out whatever factors could be related to the health issue you’re concerned about.

What are you prepared to do today?

        Dr. Chet

Track Your Health Issue

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Over the past few months, I’ve written about my blood pressure increasing from being sedentary for five weeks after my knee replacement. I’ve also written about hs-CRP in the study on inflammation and cancer. In addition, I’ve gotten questions about the impact of foods on the digestive system and the variation in blood sugar readings throughout the day.

While the questions vary, my answer is always the same: track it for a while. Whether it’s on a fitness watch, on a spread sheet, an app, or a notebook, record it somewhere. Doesn’t matter how you do it—just record the numbers along with other pertinent information, such as:

  • Date and time of day.
  • What you ate, if it’s important to the issue such as gastroesophageal reflux, or if you’re restricting calories for weight loss or longevity.
  • When you took your meds and supplements.
  • How well and how long you slept.
  • If it’s your blood pressure, record your anxiety or stress level as well as reading in relation to exercise.

The combination of factors is endless, and not every factor will be as obvious. If you continue to track it, you’ll have an edge determining what is and isn’t related to what you’re tracking.

Could this be a lot of work? Yes. Will you find an answer? Maybe, maybe not. What it can do is allow you to discover something that’s useful and I’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Want Fewer Medications? Change Your Lifestyle

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The study that we examined on Tuesday showed that a regular exercise program can help reduce the number of medications related to cardiovascular disease and type 2 diabetes. We’re not talking about youngsters; 51 subjects completed the study with an initial mean age of 54. There were some outcomes that were likely unexpected; for example, waist circumference did not change between the experimental group and control group over the five years. There was a significant decrease in body fat in the exercise group that explained the difference in body weight. Still, the control group lost about two pounds in five years while the exercise group lost about six pounds. That actually turns out to be a good thing, as I’ll explain a little later.

The Exercise Program

The high-intensity interval training was just as advertised: intense. It included a 10-minute warm up, followed by four 4-minute intervals at 90% of maximum heart rate (HRMax) interspersed with 3 minutes of active recovery. They finished with a 5-minute cooldown. They used percentage of HRMax as assessed in the exercise test, because that’s an intense level. The focus is on the 4 minutes but those 4 are brutal. You do get to rest, but then you have to do it over again, and that’s a significant challenge to the cardiovascular system. As people got fitter, the intensity would be changed to sustain the 90% level.

What surprised me was that there was no organized exercise activity in the other eight months of the year; they just kept track of activity levels using the activity monitors. There were no differences between the control group and the exercise group in the eight months with no organized activity. That’s interesting.

Most Variables Didn’t Change

This probably surprised the researchers, but it was a desirable outcome. There were no significant differences in body fat, waist circumference, BMI, or overall percentage of body fat. While the subjects probably would have liked to have lost more weight, the fact that they didn’t shows that the changes that occurred in the risk factors for cardiovascular disease, such as high blood pressure and low HDL cholesterol as well as a lower insulin levels, showed that the difference was the actual exercise program itself. The differences in distribution of nutrients in the diet and in the total caloric intake were insignificant. As I mentioned earlier, the number of steps per day and other activities were still even. That means, again, the changes could be attributed to the exercise program alone.

The Bottom Line

What is abundantly clear is that if you really want to reduce medications, you have to pay the price by changing your lifestyle. In this study they focused on one variable: exercise. If you add a change in dietary intake, and or a change in the distribution nutrients, you may get even more benefits. But for me, it answers the question that I started with. You want to reduce medications? Change your lifestyle.

Is it worth it? That’s your call. But that’s what Aging with a Vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.

Can You Reduce Your Medications?

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One of the questions that I get asked frequently goes something like this: “Dr. Chet, how can I reduce the medications I’m taking?” Along with that question is, “I don’t want to have to take medications for blood pressure or cholesterol or diabetes. What can I do?” As we proceed with a focus on Aging with a Vengeance, a recently published study illustrated at least a partial answer to these questions.

Researchers in Spain recruited 64 subjects for an exercise program. The exercise program was a high-intensity interval training (HIIT) program, three days a week, that ran for four months under staff supervision. The rest of the year these subjects were given activity monitors that automatically uploaded data on activity, sleep, etc. The researchers also took a variety of blood samples for testing metabolic variables, tested the subjects’ fitness levels, assessed anthropomorphic measures such as body weight and waist circumference, and recorded medications related to blood pressure, cholesterol, triglycerides, and blood sugars. The subjects were retested after two years and again after five years.

Over the period of five years, an amazing 51 subjects completed the exercise sessions and all the testing required. That, in and of itself, is remarkable—I’ve done this type of study, and holding on to the subjects is one of the main challenges.

The primary question was answered: those who exercised as the study required took fewer medications for blood pressure, cholesterol, and blood sugar control. As you might expect, that isn’t the entire story, so we’ll wrap this up on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: MSSE. 2021. 53(7):1319-1325.

How Your Microbiome Affects Exercise Benefits

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It seems every day, there are several studies on the microbiome and its impact on our health. At this point, they’re preliminary but the picture is emerging that as goes your gut, so goes your health. I’ve picked three new studies to review this week.

As an exercise physiologist who’s done research on this topic, I’ve always recommended exercise as a way to improve control of blood sugar for prediabetics; that’s why this study surprised me. Researchers assigned 39 prediabetic men who had never used medication to either a control group or a high-intensity exercise group for three months. All men in the exercise group had similar improvement in fitness and weight loss. But only 70% of the men demonstrated an improvement in insulin resistance.

The way the responders processed protein and carbohydrates was different from non-responders. The researchers collected stool samples and then transplanted the microbiome of responders and non-responders into a group of mice; the mice responded to exercise in the same way as the man whose microbiome they received. The microbiome somehow responded differently to exercise and modified the expected results.

We don’t know about dietary differences between subjects that might have impacted the outcome because the subjects were told to maintain their current diet, but the results were surprising nevertheless. But I would still give the same recommendation for exercise to all prediabetics. The only difference would be to make sure they tracked blood sugars to see how their blood sugar responded.

What are you prepared to do today?

        Dr. Chet

Reference: Cell Metabolism, DOI: 10.1016/j.cmet.2019.11.001.

Fasting: A Metabolic Do-Over

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The changes that occur during fasting are remarkable. Blood sugar is maintained within normal ranges. Protein and other breakdown products can be used to make glucose. And there’s one more significant finding: levels of purines and pyrimidines increased during the fast. These are some of the substrates for making proteins and nucleic acids used for making DNA.

What does that mean? Fasting isn’t just a one-way event where things are only broken down; some are being rebuilt. Prior research on cancer patients have shown that a 48–96 hour fast helps use up immune system remnants and rebuilds the immune system. In those cases, they were reduced to 500–800 calories under hospital conditions. The fast helped them do better during chemotherapy.

Before we get carried away, a couple of things. The study I reviewed had only four subjects, they were normal weight, and they were all 29–30 years old. We don’t know how this type of fast would impact an overweight 55-year-old with type 2 diabetes. There may be differences in which metabolites result, and the rebuilding process may be different. Still, it’s encouraging.

I felt fine throughout my fast, but I had a head start, albeit a forced one. I can’t say that I notice any major differences except for the eight-pound difference in the scale. But how can you say that you feel your immune system is stronger or that your DNA is being replicated with fewer errors? You can’t.

This was not the type of fasting that manipulates the schedule so people can eat within a four-hour window and “fast” the rest of the day. I know people feel better and may lose weight, but there’s no evidence of any metabolic changes as significant as these. What is being attempted is to fit the fast into our lifestyle instead of letting it go organically for a day or two, and the benefits are important even if they’re not as dramatic as those in the study. Another name for this type of fast: a cleanse. What I think it proves is that you don’t need anything other than the will to do it for you to see some benefits. You don’t even have to abstain from food. You just have to do it.

If you want some guidance on doing a fast/cleanse, get out your copy of Real-Life Detox and get going. If you don’t have one, get your copy today. It’s time for a metabolic do-over! What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41598-018-36674-9

Gluconeogenesis: Making Sugar

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On Tuesday, I said that blood sugars remained stable in all subjects throughout the study. How can that be when they would most likely use all their stored sugar in 24 hours or so? Their bodies made glucose out of protein and scraps from the breakdown of other substances.

Many hormones and connective tissue are made out of protein and are typically repaired after damage. The liver can use some amino acids from the damaged proteins to make metabolites that can enter the citric-acid cycle. When those remnants become scarce, the Number One source is muscle. Skeletal muscle is our protein storage facility, and while it isn’t preferred to use protein in this way, the body is protective of your blood sugar level and will protect it no matter what; it will make sugar for energy using whatever is available.

Use of fat as a fuel also increases, primarily in the mitochondria. While it’s complicated biochemistry, mitochondria are then stimulated to become more active and produce more free radicals. The good news is that researchers also observed an increase in antioxidant activity. Glutathione levels remained constant but an analog of glutathione called ophthalmic acid increased, keeping the rise in free radicals in check.

There was one more significant set of metabolites that were released. I’ll cover that on Saturday. What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1038/s41598-018-36674-9

A Case for Fasting

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During the food poisoning episode last week, I didn’t eat for 30 hours. Of course, I had slept most of that time and eating was the last thing I wanted to do. Even though I could have started eating again, I decided to continue the fast to at least 60 hours. I continued to drink fluids—I’m not going to live without coffee—but no food or drinks with calories.

Why do this? I had just scanned a research paper written by a Japanese research group who had four volunteers fast for that long. They observed interesting changes in metabolism by measuring by-products of metabolism in blood. They took blood samples before the study and then at 10 hours, 34 hours, and 58 hours. In prior research, they had discovered 14 changes in metabolites, but this time there were 30 more changes that occurred during the 58-hour fast.

It’s difficult to establish a time-course of events as they didn’t collect blood every two or four hours, but we can compare baseline numbers with the results of the other times blood was collected and analyzed. Initially the body relies on stored sugar in the form of glycogen, but eventually sugar gets used up and the body has to rely on fat stores. Here’s observation Number One: blood sugar was consistently maintained varying only 10 mg/dl over the observed times. Surprised? I’ll tell you why that happened on Thursday.

What are you prepared to do today?

        Dr. Chet