Can drinking alcohol help prevent and treat type 2 diabetes?

It is commonly believed that drinking alcohol will worsen blood sugar control in type 2 diabetes but the evidence shows otherwise.   In an analysis of the available randomized studies that compared patients with diabetes who drank alcohol with those that did not, alcohol was found to make no difference to blood sugar control [1].  Furthermore, there are important potential benefits for moderate alcohol intake (up to one drink daily) in patients with type 2 diabetes:

§  Better sleep and improved markers of cardio-metabolic risk control, especially with red wine [2]

§  Less risk of death from any cause [3]

§  Less heart disease and stroke [3]

§  Less risk of kidney disease [4]

In addition, for people without type 2 diabetes, moderate alcohol consumption significantly reduced the risk of developing diabetes [5] and has anti-inflammatory benefits. [6]

My recommendation:

For those who can avoid drinking to excess, with or without type 2 diabetes, one 5-ounce serving of red wine with a meal remains a reasonable choice. For more information on alcohol and health, see Good Food, Great Medicine (3^rd edition) page 39.

Miles Hassell MD

 

[1] Hirst, J.A. et al. Diabet Med 2016; doi:10.1111/DME.13259

[2] Gepner, Y. et al. Ann Intern Med 2015;163:569-79

[3] Blomster, J.I. et al. Diabetes Care 2014;37:1353-59

[4] Dunkler, D. et al. JAMA Intern Med 2013;173:1682-92 (ONTARGET)

[5] Huang, J. et al. J Diabetes Investig 2016;doi:10.1111/jdi 12537

[6] Mathews, M.J. et al. NutritionJournal 2015;14:1-12

 

Strange but true: heart disease and cancer rates are falling!

An interesting trend has come to light that definitely seems surprising: less people are dying from heart disease and cancer, and the incidence of cancer is dropping!  According to a recent study in the New England Journal of Medicine [1] age-specific heart disease deaths worldwide dropped by 39% between 1990 and 2013 and the SEER database reports that over the last 10 years of records, cancer incidence in the U.S. has fallen an average of 0.9% per year.  Also, cancer death rates have trended down and 5-year survival has improved. [2]  

The reason these diseases are becoming less common is most likely multifactorial: better lifestyle choices, better diagnostic abilities, and better treatments probably all play a role.  However, it’s important to note that one of those factors is patient-powered – better lifestyle choices.  The most profound impact we can have on our own heart disease or cancer risk is what we choose to put in our shopping carts and on our table, and our choice to stay active and get enough sleep.  For a wealth of practical strategies to help incorporate those choices into your own life and transform your health with lifestyle medicine, see Good Food, Great Medicine. 

Miles Hassell MD

[1] Roth, G.A. et al. NEJM 2015;372:1333-41

[2] http://seer.cancer.gov/statfacts/html/all.html

Over-the-counter pain relievers: don't assume they're harmless

A commonly underrated hazard is the use of pain medication, including over-the-counter favorites like acetaminophen (Tylenol and others).  Patients often take them for fairly minor pain, sometimes with the idea that the “anti-inflammatory” or some other effect will improve healing.  However, a new study [1] in the Annals of the Rheumatic Diseases (ARD) warns that even standard doses of acetaminophen (or paracetamol, as it’s known in the UK) taken regularly can damage kidney function, especially with higher dose levels.  This doesn’t mean we shouldn’t take any pain medicine for an injury, or that acetaminophen is especially harmful compared to other pain relievers; it does remind us to be respectful of harmful side effects from these medications, and to only use them when necessary.  (Although this 2015 study only looked at acetaminophen, most pain relievers have been found to have comparable risks.)  Some steps to consider are applying heat, ice, massage, physical therapy, supplements, or activity modification – for example, if something hurts when you move, rest it as much as possible.  Any persistent pain needs appropriate medical evaluation, but talk to your physician about other alternatives to over-the-counter pain medications. 

Miles Hassell MD

[1] Roberts, E. et al. Ann Rheum Dis 2015;0:1–8. doi:10.1136/annrheumdis-2014-206914 

Read this only if you’re getting older

We all want to maintain healthy brains and well-functioning bodies as we age.  So how do we do it?  The most powerful tool available to us appears to be a Mediterranean diet rich in good fat, and yet another 2015 study agrees. [1]  In a four-year randomized controlled trial studying age-related cognitive decline, participants 55–80 years old were divided into three groups.  Two groups followed a Mediterranean diet supplemented with either 1 liter of extra-virgin olive oil per week or 30 grams of mixed nuts (walnuts, almonds, and hazelnuts) daily, and the third group followed a careful low-fat diet.  Those on the Mediterranean diet with nuts or olive oil had better brain function at the end of four years than those on the low-fat diet.  This builds on 60 years of high-quality studies supporting an omnivorous Mediterranean diet pattern.  The low-fat doctrine has dominated the past half-century, but it’s time to face the good fat facts!  Want a quick Mediterranean diet summary?  See Fat Is Good, Bagels Are Bad.  For a practical and easy-to-read resource on the day-to-day application of Mediterranean diet principles see Good Food, Great Medicine (3^rd edition – especially pages 15-16 on Aging Gracefully).  It also includes 185 recipes featuring plenty of raw nuts and extra-virgin olive oil. 

Miles Hassell MD

[1] Valls-Pedret C. et al. JAMA Intern Med 2015;doi:10.1001/jamainternmed.2015.1668

Know anyone with atrial fibrillation?

You might – atrial fibrillation (AF) is a heart rhythm disorder we are seeing more and more frequently.  AF carries a high risk of stroke, and there are many treatments to lower this risk and reduce symptoms; the most common treatments include anticoagulants to make the blood less likely to clot.  While these blood thinners reduce stroke risk, they have their own dangerous side effects (including, not surprisingly, a bleeding risk), often require frequent blood tests for monitoring, and do not completely eliminate the stroke risk.  Happily, our chance of developing AF is much lower if we choose to eat well and stay active.  There is also good news for those who have atrial fibrillation and are overweight: if you make sensible food choices and do moderate exercise to achieve at least 10% weight loss, and maintain those habits, you are 76% more likely to have AF disappear without using drugs or other interventions!  This is based on the results of a 5 year study of 355 overweight patients with AF, published last month in the Journal of the American College of Cardiology.[1]  It reminds us that good lifestyle choices are critical in treating disease as well as preventing it.  Using lifestyle medicine, people can often not only reverse AF and many other diseases, but also avoid the cost and side effects of drugs and medical procedures.  What a deal! 

Miles Hassell, MD
 

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[1] Pathak, R. et al. J Am Coll Cardiol 2015;doi:10.1016/j.jacc.2015.03.002

Chili (con Beans and con Carne)

Chili (con Beans and con Carne) Page 235

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This can be simple or complex, fancy or plain, vegetarian or not.  You can use whatever beans you like.  I cook my own beans (see page 198) or use canned pinto beans.  You can make it hot, or tame like this version.  You also may prefer a soupier chili than this one.  We generally serve chili over brown rice, but a decadent alternative is to serve it over Easy, Cheesy Polenta (page 217).   

(Serves 4 – 6)

¼ cup extra-virgin olive oil

2 medium-large onions, ¼-inch dice (6 cups)

1–2 bell peppers, diced (1½–3 cups)

Optional: 1–2 jalapenos, seeded, finely diced

1–2 tablespoons freshly crushed garlic

 2 tablespoons chili powder

1 tablespoon ground cumin

1 teaspoon oregano

1 fat tablespoon honey

2 teaspoons salt

1 teaspoon freshly ground pepper

1 pound ground or chopped meat (see note)

-or- chopped leftover cooked meat, especially leftover Ono Oven Smoked Pig (page 240)

1 can (28 ounces) crushed tomatoes    

3 cups cooked beans (15-ounce can is about 1½-cups drained beans)

Optional:  1 cup chopped cilantro, if available

Onions, bell peppers, and jalapenos sauteing
in extra-virgin olive oil.

Sauteed vegetables cooking with garlic
and an assortment of spices.

This chili is hearty and delicious with the addition
of flatiron steak.

Here I am quickly browning the meat.

This is the finished chili after simmering for
30 minutes over very low heat. 

1.     Heat oil in 6-quart heavy pot over medium high heat and sauté onions briskly for about 8 minutes, then add peppers (and jalapenos, if you have them) and cook for 5 more minutes, or until onions and peppers are tender.  Stir in garlic and seasonings and cook for another few minutes.

2.  Keeping heat at medium-high, push vegetables to the sides of the pot and add meat.  Sauté briskly until browned. 

3.  Add tomatoes and drained beans.  Bring to a simmer and cook very gently, uncovered, for about 30 minutes, stirring from time to time.  Avoid letting the chili boil.  Keep in mind that the longer you cook it, the drier it gets.  Taste for flavor – the chili may need a dose of bottled fire of your choice, depending on the amount of beans and/or meat you ended up using. 

4.  Add cilantro within an hour of serving, to maintain color and flavor, or serve on the side.  (If made in advance, let cool completely, uncovered, before storing in refrigerator.)

Note:

4 I like to either serve chili with sides of Pico de Gallo and Avocado Salsa (both on page 175) or with side dishes of topping options like grated sharp cheddar cheese, sliced green onions or diced mild white onions, diced avocado, extra chopped cilantro, and minced fresh jalapenos.

Chopped meat versus ground meat

Ground beef or pork (or whatever meat you like) works fine, but I like to chop my own – the texture is completely different than ground meat.  My choice is flatiron steak, which is fairly tender and rich, and I use a very sharp chef’s knife – mine is 11 inches, which makes easy work of it.  I ignore the tough connective tissue that always seems to run across the underside of the steak – I chop it finely and it is unnoticeable.  The meat is even easier to chop if you put it in the freezer until it’s semi-frozen – at least 30 minutes.  (The flatiron steak I get is sold in handy vacuum packs, which makes it easy to just slip it in the freezer.)  The almost-frozen meat is steadier under the knife and faster to chop.  It’s worth the extra work, in my opinion.   

Take a walk on the sunny side

Even after years of running I can still feel that familiar wave of dread as I laced up my tennis shoes and walked in to P.E. class. That terrifying moment when my gym teacher announced we would be doing timed sprints that day, and escape was futile. The instant I heard the whistle my mouth would go dry, my legs turned to jelly, and my lungs would burn as I tried to keep up with my classmates. Running on the playground was fun! Running for physical fitness was pure agony. I understand how daunting exercise can seem, and how easy it is to avoid. However, I also know that there is no denying (as hard as I might try) the immeasurable benefits of living an active lifestyle. For those of us that need convincing, here is an excerpt from Good Food Great Medicine (p. 50) listing some of the rewards of exercise:

• Reduces overall risk of a heart attack by 47% and lowers risk of premature death in those with heart disease by 26%.
• Is equal or superior to medications for managing risk for heart disease, stroke, and type 2 diabetes.
• Prevents and treats peripheral vascular disease.
• Reduces cancer, depression, and dementia.
• Reduces risk of osteoporosis.
• Improves heart disease risk factors including LDL and HDL cholesterol, triglycerides, blood pressure, and lipid oxidation.
• Improves flexibility in the arterial walls and blood clotting function, and helps the heart repair damaged blood vessels and from new arteries when necessary- the “do-it-yourself coronary artery bypass” effect.
• Improves neurohormonal function, insulin resistance, weight management, and immunity, and slows aging within the genetic material of your cells.
• Eases symptoms of pain and stiffness, lowers inflammatory load, and improves energy.
• Improves sleep. 

Are you also haunted by repressed exercise memories? Never fear! Nowadays there are so many ways and places to exercise that it doesn’t have to be the scary ordeal of my childhood. Even everyday tasks like weeding, vacuuming, and swinging a hammer count. Here are a few ways that I like to fit exercise into my life: Running the stairs at work, walking during lunch or while I make phone calls, walking to the grocery store, lifting free weights at home, or doing lunges, squats and toe lifts whenever I get a chance. I also belong to a local gym and enjoy trying new classes. My favorite motivational tool is an exercise buddy to hold me accountable. Avoiding the gym becomes a bit trickier when a friend is there waiting for me.

My running buddy is about three feet tall, 55 pounds,
and has no qualms about using the side of the trail as a public restroom.
 His name is Bruce, Bruce the dog. I have found no limit to his energy,
 which has done wonders for my exercise habits. 

These are two of my human running buddies on a beautiful day in Forest Park.
Bruce was nice enough to take the picture. 

Miles’ Postscript: 

The extraordinary range of benefits for daily exercise are so great that they seem to many people to be unbelievable. We would all do well to look again at Malea’s list above, and take a moment (or two) to think about the difference daily exercise could make in each of our lives. Let’s consider just the cancer, depression and dementia bullet. Look at the numbers: 30% reduction in cancer risk, a benefit for depression that exceeds that for antidepressants, and about a 50% reduction in dementia. Whoa! That’s the payoff associated with just one of those 10 bullet points! So quit reading and go take a walk. RIGHT NOW! Get going!