DrMirkin's eZine: Diabetes treatment and prevention, booster data, more . . .
Published: Thu, 04/21/22
April 24, 2022
A healthful plant-based diet can help to cure Type II diabetes if you already have it, or help to protect you from developing diabetes in the first place. People who eat the healthful plant-based foods — vegetables, fruits, whole grains, beans, nuts and other seeds – are far better protected than those who eat the “unhealthful” plant-derived foods, such as refined grains, fried potatoes and sugar-added foods (Diabetologia, April 8, 2022).
For this Diabetes Prevention Study from Harvard, researchers used data on 8,827 participants in three prospective studies: the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study. The authors applied numbers to foods to rate diets on the basis of a food's ability to help control blood sugar levels. The higher the healthful plant-based diet index score, the less likely a person was to develop diabetes. Foods were classified as:
• healthful plant-based foods, including whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and unsweetened tea and coffee
• unhealthful plant-based foods, including bakery products and other refined grains, fruit juices, potatoes, sugar-sweetened beverages, and any foods with added sugar
• animal-based foods, including animal fats, dairy, eggs, fish, meat and other animal products.
An earlier study called the DIRECT Trial found that 46 percent of 149 diabetics who were not on insulin became non-diabetic through a one-year, plant-based weight-loss program (Lancet, Feb 10, 2018;391(10120):541-551). Those who lost 33 pounds or more were most likely to go into remission. Two years later, one third of those in remission kept the extra weight off and remained cured of their diabetes (Lancet Diabetes Endocrinol, May 2019;7(5):344-355). Diabetics in the DIRECT study, who followed a strict 800-calorie-per-day diet and lost a lot of weight, were also able to lower their high blood pressure (Diabetologia, May 31, 2021:10.1007/s00125-021-05471-x). Many of these patients were able to stop taking all blood pressure medications, as long as they did not regain their lost weight and their blood pressure and blood tests for diabetes remained normal.
Liver Fat More Important than Total Weight in Reversing Diabetes
Researchers found that weight loss reversed Type II diabetes in participants whose weight (body mass index or BMI) was in a moderate range (BMJ, July 7, 2021;374:n1449). The authors believe that lowering levels of fat around the liver is more important than just lowering body weight. The vast majority of diabetics are insulin-resistant, which means that their livers don’t respond to insulin. When blood sugar levels rise, the pancreas releases insulin which lowers blood sugar by driving
sugar from the bloodstream into the liver. However, if the liver is full of fat, it does not accept the sugar and drives blood sugar levels even higher to cause diabetes.
Who is at Risk for Diabetes?
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 29 million North Americans have diabetes, and at least 25 percent of these people do not know they have it. Another 86 million adults (one in three) have pre-diabetes and thus are at high risk for dementia, heart attacks, cancers, nerve damage, blindness, deafness and the many other side effects of
diabetes. People most likely to develop diabetes are those who:
• have a family history of diabetes
• are overweight
• store fat primarily in the belly, rather than the hips
• have small, narrow hips
• have triglycerides >150
• have low levels of the good HDL cholesterol (<40 mg/dL)
• have a fasting blood sugar greater than 100 mg/dL
• have a blood sugar over 145 mg/dL two hours after eating
• have a HBA1c greater than 5.5 (HBA1c is a blood test that measures how much sugar is stuck on cells and predicts cell damage from high blood sugar levels)
• have a fatty liver (shown by abnormal liver blood tests and a sonogram of the liver)
• have small particle HDL and LDL cholesterol
• have high blood pressure
• smoke
• take more than one alcoholic drink a day or binge drink
• have small muscles
• do not exercise
• in men, a thick neck or male pattern baldness
• in women, excess hair on the face or body, or have diabetes during pregnancy
Four types of drugs used to prevent heart attacks increase diabetes risk: statins, niacin, thiazide diuretics, and beta blockers (Am Heart J, April 2014:421-428). If you are taking any of these drugs, discuss this with your doctor.
Lifestyle Changes to Prevent or Treat Diabetes
Type II diabetes shortens lives by causing high blood pressure, strokes and heart attacks, and many types of cancers (Circulation, 2019;139:2228–2237). If you have any of the risk factors for diabetes listed above, you should start a diabetes prevention program that includes:
• avoid all sugared drinks including fruit juices
• severely restrict all sugar-added foods and other refined carbohydrates
• restrict fried foods
• avoid red meat (blocks insulin receptors)
• avoid processed meats
• avoid smoking and being around smokers
• avoid alcohol or take no more than one drink a day
• lose weight if overweight
• eat a wide variety of vegetables, fruits and other healthful plant-based foods
• keep hydroxy vitamin D above 30 ng/mL
• exercise
My Recommendations
If your blood sugar level is greater than 145 mg/dL one hour after you eat a meal, you are diabetic and can suffer all the serious side effects of that disease, even if your fasting blood sugar level is normal.
• If you have any of the signs of diabetes listed above, start the diet and lifestyle changes immediately. People who already have diabetes can become non-diabetic if they follow these lifestyle changes rigorously and permanently.
• Whatever your age and weight, you can help to protect yourself from developing diabetes by following these same rules.
After two initial Pfizer vaccine doses and one booster dose, a study showed that 182,122 adults ages 60 and over who received a second booster dose gained 52 percent protection against asymptomatic infection and 76 percent protection against COVID-related death 14 to 30 days after the booster was given (N Engl J Med, April 13, 2022). Protection against harm from COVID-19 increased as days after vaccination increased. The highest protection occurred at days 14 to 30 after receiving the second booster dose.
Boosters Reduce Hospitalization: The COVID-19 mRNA vaccines’ two-dose primary series appeared to provide less protection against hospitalization from Omicron variant infections than Alpha and Delta infections (JAMA, April 12, 2022;327(14):1323). A booster dose, however, was associated with increased effectiveness against Omicron hospitalizations at the same high levels achieved against earlier variants with two doses. The study included data from 11,690 adults admitted to 21 U.S. hospitals from March 11, 2021, to January 14, 2022. The two doses of vaccine increased prevention of hospitalization by 85 percent during Alpha and Delta infections, but only 65 percent during Omicron infections. Adding a third booster dose increased prevention of hospitalization to 86 percent. Vaccines reduced all types of COVID-19 severity significantly (BMJ, Mar 9, 2022; 376: e069761).
Most Reactions to COVID-19 Vaccines are Mild: The CDC reports that during the first six months of the U.S. COVID-19 vaccination program, most adverse events were mild and short-lived (Lancet Infectious Diseases, March 7, 2022). Almost 300 million mRNA vaccine doses were administered in the U.S. between December 14, 2020, and June 14, 2021 (JAMA, April 12, 2022;327(14):1323). Of the 340,522 reports of vaccine side effects, 92.1 percent were classified as non-serious; 6.6 percent as serious but not resulting in death; and 1.3 percent were deaths. The most common serious reports were shortness of breath, fever, fatigue, and headache. The most common cause of death was heart disease. The less serious reactions were more common after the second dose, compared to the first dose.
COVID-19 Vaccination Reduces Infectious Viral Load: Usually the more virus in a person infected with COVID-19, the more serious the disease. Viral load was measured in 600 infected symptomatic patients (Nature Medicine, April 14, 2022). The Delta variant caused a higher viral load than the original virus or the Omicron variant. Vaccination dramatically reduced viral load for Delta and Omicron infections, but a booster dose was necessary for the Omicron infections. Omicron’s very high infectiousness is caused by factors other than viral load alone.
Note: I have been following data on efforts to control the COVID-19 pandemic or to deal with it as an endemic disease. My earlier entries can be found here: The Latest on COVID-19. I uppdate the page frequently, so if you are interested, check back often.
Early on the morning of July 2, 1961, sixty-one year old Ernest Hemingway, one of America’s greatest writers and the winner of both the Nobel Prize and Pulitzer Prize, sat in the foyer of his home and shot himself in the head with a double-barreled shotgun. I believe that his suicide was caused by his doctors’ complete failure to diagnose hemochromatosis, a hereditary disease that was so well known and so easy to treat that he could have had no suffering at all (Front Neurol Neurosci, 2010;27:174-206). In 1961, the time of his death, I was a senior in medical school and I remember seeing hemochromatosis described clearly in just about every medical textbook, including all of the signs and symptoms that Hemingway’s doctors missed. The disease is common, affecting about a million people in North America, and it has a simple treatment that would have prevented virtually all of his disability.
How His Doctors Failed Him
Doctors are supposed to take a family history on just about every patient they see. Other members of Hemingway’s family who committed suicide included his grandfather, his father, his sister Ursula and his brother Leicester (and later, his granddaughter Margaux). All of them most likely had the same highly-treatable disease. Read more
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