Tag Archive for: prediabetes

What Not to Do When You Want to Lose Weight

/in /by

How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.

Weight Loss Is Always Possible

/in /by

After last week’s Memos, you may think that you have to do something radical to address your body weight or some other health situation, but that’s not the case. You can lose weight under the most extreme conditions, even if you’re completely sedentary. Let me tell you about my mother-in-law, Ruth Jones.

My mother-in-law struggled with her weight for decades. I don’t know what her peak weight was, but I would estimate around 240 pounds. She maintained around 200 pounds for most of the time I knew her. She had severe arthritis in her knees and because she wouldn’t have been able to do the rehab, the decision was made to replace them both at once. She did great at lifestyle and occupational therapy, but she never quite got the complete mobility she thought she would get because the physical therapy was more of a challenge than she could handle. She was able to get around the house but used a wheelchair or scooter in public.

A few years later, she had a very bad reaction to a new statin that damaged a great deal of muscle mass, and she remained in long-term care until she died several years later. But here’s the thing. Even though wheelchair bound, she was able to lose 30 or so pounds; that’s discounting the last few months before she died when she lost interest in eating.

How? How was she able to do it?

How about you—are you ready to make a change in your weight? Blood pressure? Prediabetes? Then you really don’t want to miss Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

It’s Still All About the Calories

/in /by

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

/in /by

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

How the Quality of Your Diet Changes Your Mycobiome

/in /by

In the experiment I told you about on Tuesday, the researchers established that environment—exposure to light, temperature, and other environmental factors—affects the microbiome, including the fungi or mycobiome. The researchers then tested the changes in the mycobiome (the fungus part of the microbiome) after feeding the mice a highly processed diet compared with mice eating conventional mice chow. They also monitored changes in body composition, triglycerides, and other hormones related to obesity.

After eight weeks on the highly processed diet, there were differences in the quantity of fungi. Some groups of related organisms increased while others decreased. Because not every group has known roles in digestion and metabolism, the researchers examined metabolic changes in response to the dietary change; they found an increase in body fat and triglycerides in the male mice along with concurrent changes in hormones that signified a move toward prediabetes. (For some reason, the female mice in this species are protected from those effects.)

After examining the composition of the highly processed chow, I’d like to have seen one more group of mice in the experimental group. Because the highly processed chow had no fiber, it would have been helpful to see what would happen to the entire microbiome if the amount of fiber was the same in the processed chow as the conventional chow. Maybe it wouldn’t have impacted the fungi at all, or the change could have been significant.

The Bottom Line

What lessons can we learn from this study? We’re not mice after all. I think it means that a highly processed, highly-refined carbohydrate diet may cause undesirable changes in our microbiome, including the fungal levels as well. For example, Candida albicans is a primary fungus in our digestive system, but it can cause all kinds of problems if it gets out of control. Reducing refined carbohydrates has a beneficial impact on keeping that fungus at beneficial levels.

Regardless of your current age, a better diet is part of Aging with a Vengeance. Reducing processed food, especially carbohydrates, can benefit your microbiome and all that it impacts. Time to start now.

What are you prepared to do today?

        Dr. Chet

Reference: Comm Bio (2021).4:281 https://doi.org/10.1038/s42003-021-01820-z

How Your Microbiome Affects Exercise Benefits

/in /by

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.

A New Approach to HbA1c

/in /by

Type 2 diabetes is a significant problem in North America and it’s spreading throughout the entire world. The treatment standard has always focused on controlling blood sugar, especially HbA1c. Normal is less than 5.7%. For most individuals, reducing the HbA1c to under 6.5% has been the goal for pharmacologic treatment.

HbA1c is a protein found on red blood cells that indicates blood glucose levels over the past 90 days. It develops when hemoglobin, a protein within red blood cells that carries oxygen throughout your body, bonds with glucose in the blood. Think of it as the sugar you ate over the last three months getting stuck to your red blood cells; the higher your HbA1c, the worse your control of your blood sugar has been. For a prediabetic, that means your days of diabetes meds and finger pricks is getting closer. For a diabetic, that opens the door to many of the worst consequences of diabetes, such as heart and kidney disease, blindness, and nerve damage.

Recently, the American College of Physicians published new guidance statements for the use of medications for controlling HbA1c. A committee of physicians examined the data behind the current standards of treatment for four of the major physician organizations including the American Diabetes Association. In the simplest terms, they wanted to know what benefits or hazards occur when treating adults with type 2 diabetes with medications. Should the goal be to get the HbA1c as low as possible with drugs? Or should the individual be part of the treatment equation?

This is an important issue and the topic for this week. I’m going to review evidence-based medicine on Thursday. You can get the entire story by listening to the Straight Talk on Health on evidence-based medicine, normally available only to Members and Insiders; I cover the entire concept of how EBM began and what it was intended to be. For those of you who haven’t chosen a membership yet, get more info here.

What are you prepared to do today?

Dr. Chet

 

Reference: Ann Intern Med. doi:10.7326/M17-0939.

 

The Science Behind Holiday Spices: Cinnamon

/in /by

As you enjoy that cider spiced with cloves and nutmeg, we’ll finish with the most traditional spice of the holiday: cinnamon. It’s used in many sweet and savory dishes all year long, but when it comes to smells that conjure up the holidays, no spice really does it better than cinnamon. Not only does cinnamon add a characteristic flavor to many foods, it’s one of the most researched spices in health today.

Cinnamon is a spice obtained from the inner bark of several tree species from the genus Cinnamomum. Harvesting the cinnamon involves removing branches from a . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

The Answer to the Sugar Conundrum

/in /by

Whether you have prediabetes, type 2 diabetes, or are just concerned about the calories in the sugary treats this holiday season, what should you do? Go without and feel deprived, or indulge and pay some sort of price? Let’s take a look by beginning with a few questions.

Why do you want to reduce your sugar intake? Do you want to reduce your caloric intake? Is it because you know you have prediabetes or type 2 diabetes? Are you concerned about gaining weight over the holiday season? Once you know why you want to avoid sugar, you can start . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.

The Sugar Conundrum

/in /by

During the holiday season, there are plenty of sugary snacks available. Candy, cookies, pies, all kinds of treats. But can something as simple as jam on toast, let alone the holiday treats, be an issue for someone with prediabetes or type 2 diabetes? With close to half of all adults afflicted with one condition or the other, any kind of sugar stops them in their tracks. I see people reading labels carefully in the grocery store and often hear the words “No good. It has sugar!” In the prediabetes and diabetes groups I . . .

We're sorry, but this content is available to Members and Insiders only.

If you're already a DrChet.com Member or Insider, click on the Membership Login link on the top menu. Members may upgrade to Insider by going to the Store and clicking Membership; your membership fee will be prorated automatically.