Category: Now Reading

Just Read: Lifestyle Management, Standards of Medical Care in Diabetes 2019, American Diabetes Association (behavior, a little less strange – low carbohydrate eating now included)

I had noted previously that non-adherence to the latest evidence around nutrition has resulted in strange behavior on the part of nationally respected organizations, who do things like endorse sugar sweetened cereals and pure fruit juice, or advise the consumption of high amounts of dietary carbohydrate in the setting of dietary carbohydrate intolerance. Some of this may be related to visible conflicts of interest.

I recently read the 2019 Standards of Medical Care in Diabetes and see there has been a change in approach, which I’m calling a little less strange, and quite welcome. I clipped the relevant pages in the slide above, and what they contain are:

Just Read: Dietary and nutritional approaches for prevention and management of type 2 diabetes, via #Food4Thought18

This is a good overview of how to think about nutrition for various populations, via the #Food4Thought18 series.

Unlike the previous paper in the series that I just read (Just Read: Dietary fat and cardiometabolic health evidence, controversies, and consensus for guidance (written by the team of non-usual collaborators…)), I don’t know how often this group of authors collaborates.

I know and visited Will Yancy, MD, (@DrWillYancy) recently at the Duke Diet and Fitness Center (@DukeDFC), and was really impressed with what I saw (Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century)

Just Read: Dietary fat and cardiometabolic health evidence, controversies, and consensus for guidance (written by the team of non-usual collaborators…)

This paper is part of a pretty remarkable series published by BMJ (which you can access here).

If you know the names of the people in the nutrition space, these are not names that appear on papers together usually (ever)? Their cred in this space precedes them. I’m sure many would love to be on the conference calls or emails where the piece was being formulated.

The papers are tied to a remarkable dialogue hosted by @SwissRe last week, which you can also access here.

Just Read: 55% of Californians have Insulin Resistance

As the title of the post says.

This data comes from the UCLA Center for Health Policy Research (@UCLAchpr) and used a combination of interviews and statistical modeling from the US based NHANES survey (which does retrieve blood samples). The paper cites a figure of 90% of people who do not know they are insulin resistant.

Here’s the summary along with required terms of use statement (data used under the terms of use on the site).

Just Read: Insulin Access and Affordability Working Group: Conclusions and Recommendations

I read this paper and prepared a few slides relevant to a presentation I am putting together for a meetup I am organizing. As the title states, a working group convened by the American Diabetes Association convened a workgroup to examine the (significant) problem of insulin affordability.

I’ve placed stories next to the data to show the impact of the near tripling of insulin prices since 2003. For more information about the impact, you can follow the #insulin4all hashtag on twitter.

Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century

The first few sentences of this paper tell the story to those who aren’t aware of the history here.

I learned about the paper while visiting one of its authors, Will Yancy, MD (@DrWillYancy) who’s the Director of the Duke Diet and Fitness Center (@DukeDFC), in Durham, North Carolina. This is one of the places in the United States that has been on the forefront of innovating in science-based lifestyle change. Since 1969.

Just Read: The State of US Health, 1990-2016 – Noticing: Significant Fasting Plasma Glucose Increase, Impact of Current Dietary Recommendations, Non-mention of (non-acoholic) Liver Disease + (Mis)Understanding Washington, DC

This paper is lengthy and well covered throughout the social media sphere, so I won’t repeat what’s already been said.

A few things haven’t been said that I’m commenting on:

1. Significant Increases in Fasting Blood Glucose and Current Dietary Recommendations
2. Diabetes is increased, Non-alcoholic fatty liver disease is unaccounted for
3. Continued misconceptions about Washington DC as a high sociodemographic index (SDI) future-State

In the body of the paper, phenomena of increases in fasting blood glucose is not connected to current dietary recommendations, which promote carbohydrate intake and may be partially responsible for this increase. See this paper for more (More from my trip to the Library of Congress and incredible US News and World Report photo collection: 1968’s Harried Housewife Preparing Convenience Foods (and how her diet was re-engineered to be carbohydrate-rich))

Just Read: Stable Coronary Artery Disease: Treatment (American Family Physician) – Role of diet?

There is one mention of diet in the treatment of coronary artery disease and it’s here:

“Management of Risk Factors and Comorbidities
Risk reduction to prevent cardiovascular events includes blood pressure (BP) control and management of cholesterol and glucose levels. Lifestyle modifications (e.g., smoking cessation, increased physical activity, weight control, healthy diet) and management of comorbid conditions such as hypertension and diabetes mellitus can reduce overall and CVD-related mortality.”

…it’s just the words “healthy diet.”

Just Read: Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes

Still catching up on the threads of not this recent #LCB18 but the more distant #LowCarbSanDiego, and this paper on the prevalence of the disease the medical profession is just starting to understand, non-alcoholic fatty liver disease, or NAFLD.

NAFLD is important in the context of diabetes reversal and nutrition.

There is no currently known drug treatment for NAFLD. Its causes are related to nutrition, and specifically high-carbohydrate/low-fat nutrition, and recent studies are showing it abates with nutrition approaches:

Just Read: The USDA is opening the door to saturated fats and low-carbohydrate diets for 2020-2025 Dietary Guidelines

There proved to be many, what I called “gaspworthy” moments at Low Carb Breckenridge #LCB18. This is one of those after the fact.

In this release USDA and HHS Announce New Step Toward Added Transparency in Development of 2020-2025 Dietary Guidelines | Food and Nutrition Service and related documents, most notably Dietary Guidelines | Center for Nutrition Policy and Promotion new questions are under consideration.

Just Read: Temporal Trends in Gender-Affirming Surgery Among Transgender Patients, Insights from Study Authors, Evidence that Providing Medical care is more Cost-effective than Denying It

This paper, published in JAMA Surgery last week, provides important evidence of the value of providing medically-necessary care to people who are trasngender or gender nonconforming.

he primary importance of this paper is as the first study to our knowledge that broadly evaluates national temporal trends in gender-affirming surgery for transgender patients in the United States.

The importance to physicians and the people we serve is the above plus the data in Table 1: “Characteristics of Patients Who Have a Diagnosis Code for Transsexualism or Gender Identity Disorder in the National Inpatient Sample”

Of the 37,827 inpatient encounters in the sample, 14,128, or 40.5 % are for Mental Health. This dwarfs the number for actual treatment-related reasons, such as gender affirming surgery.