Dr. Bray Links

Thursday, May 10, 2018

Very Low-Carbohydrate Diet Beneficial in Type 1 Diabetes

The study included 316 individuals, of whom 54% were adult patients and 42% were parents of children with type 1 diabetes. All were part of an international Facebook group for people with type 1 diabetes who follow Bernstein's recommended VLCD diet.

The approach includes a weight-based carbohydrate prescription of no more than 30 grams/day, derived from fibrous vegetables and nuts with a low glycemic index. High-protein foods are substituted for carbohydrates, and insulin doses adjusted empirically by postprandial and fasting glucose levels.  

Most of the participants were from the United States, Canada, Europe, or Australia, the majority (88%) were white, and 84% were college graduates. Mean age at diabetes diagnosis was 16 years, diabetes duration was 11 years, and time following the VLCD diet was 2.2 years.

Confirmatory data were obtained from diabetes care providers and medical records, including a multi-tiered investigation to ensure all participants had type 1 diabetes — not type 2 diabetes or a genetic variant. However, not all data points were available for all respondents.  

Participants reported consuming an average of 36 grams/day of carbohydrate. The mean reported HbA1c was 5.67%, a drop of 1.45 percentage points following adoption of the VLCD (P < .001). Average blood glucose level was 104 mg/dL in the 137 patients who had continuous glucose monitoring data.

In a regression analysis, carbohydrate intake goal was the only significant predictor of variation in HbA1c (P = .001), with an increase in HbA1c of 0.1% per 10 g of carbohydrate consumed. The mean daily insulin dose was 0.40 U/kg/day.

https://www.medscape.com/viewarticle/896288

Tuesday, May 1, 2018

Tick and Mosquito Infections Spreading Rapidly, C.D.C. Finds - The New York Times

The real case numbers were undoubtedly far larger, Dr. Petersen said. For example, the C.D.C. estimates that about 300,000 Americans get Lyme disease each year, but only about 35,000 diagnoses are reported.

The study did not delve into the reasons for the increase, but Dr. Petersen said it was probably caused by many factors, including two related to weather: ticks thriving in regions previously too cold for them, and hot spells triggering outbreaks of mosquito-borne diseases.

Other factors, he said, include expanded human travel, suburban reforestation and a dearth of new vaccines to stop outbreaks.

More jet travel from the tropics means that previously obscure viruses like dengue and Zika are moving long distances rapidly in human blood. (By contrast, malaria and yellow fever are thought to have reached the Americas on slave ships three centuries ago.)

A good example, Dr. Petersen said, was chikungunya, which causes joint pain so severe that it is called "bending-up disease."

In late 2013, a Southeast Asian strain arrived on the Dutch Caribbean island of St. Maarten, its first appearance in this hemisphere. Within one year, local transmission had occurred everywhere in the Americas except Canada, Chile, Peru and Bolivia.

Tickborne diseases, the report found, are rising steadily in the Northeast, the Upper Midwest and California. Ticks spread Lyme disease, anaplasmosis, babesiosis, Rocky Mountain spotted fever, rabbit fever, Powassan virus and other ills, some of them only recently discovered.

Ticks need deer or rodents as their main blood hosts, and those have increased as forests in suburbs have gotten thicker, deer hunting has waned, and rodent predators like foxes have disappeared.

https://mobile.nytimes.com/2018/05/01/health/ticks-mosquitoes-diseases.html