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:
This is a cool new study, that in a rigorous way, shows that without changing macronutrient (carbohydrate, fat, protein) proportions of a diet, ie. even if keeping carbohydrate intake high, there’s still benefit from eating un-processed (“real / whole”) food.
This paper, written by european researchers, describes a newer way to estimate insulin sensitivity (or it’s unhealthy opposite, insulin resistance) using commonly obtained lab values. Here’s the equation…
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.
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.
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.
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.
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
Real Visibility Is Transgender People Living Openly And Authentically | HuffPost, @BrynnTannehill Today is Transgender Day of Visibility (#TDOV2018): The International TDoV is an annual holiday celebrated around…
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.”
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.
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.