Overweight Individuals with T2DM | Keto Diet vs Plate Method Diet


Recently a study was conducted by Saslow LR and colleagues to study whether a very low carbohydrate ketogenic diet with lifestyle factors (intervention) or a “Create Your Plate” diet (control) recommended by the American Diabetes Association (ADA) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes mellitus (T2DM).

This article was published in February 2017 in a very reputed journal ‘Journal of Medical Internet Research’. In 2017, the impact factor of this journal was 4.671. For those of you who don’t know what an impact factor is or have never heard of, it simply means the number of times recent articles published in that journal in a year was cited by others. If the impact factor is high, it is considered to be a highly ranked journal.

Now coming back to the study, it was a parallel-group, balanced randomization (1:1) trial. This trial was approved by the University of California, San Francisco, Institutional Review Board and registered with ClinicalTrials.gov (NCT01967992).

In this study, glycemic control, operationalized as the change in glycated hemoglobin (HbA1c) was the primary outcome.

They also assessed body weight, cholesterol, triglycerides, diabetes-related distress, subjective experiences of the diet, and physical side effects.

During the study, the participants were asked to measure urinary acetoacetate (one type of ketone bodies that can be measured in urine) test kits (KetoStix). Basically, there are three types of ketone bodies. Other two types of ketone bodies are acetone and beta-hydroxybutyrate.

The other group i.e. the control group were asked to follow “Create Your Plate” diet recommended by ADA. What does this ADA diet consist of? Well, ADA recommends a low-fat diet which includes green vegetables, lean protein sources, and limited starchy and sweet foods. Most of the doctors worldwide follow ADA guidelines and recommend this particular diet to their patients.

As mentioned earlier the investigators divided the eligible participants into two groups (intervention group and control group).

In fact, when I was diagnosed with T2DM my diabetologist also recommended a low-fat diet with a caloric restriction of 1800 calories. But he never advised me how to restrict my calories to 1800 or what should I eat.  I was totally confused.

Also, he prescribed a couple of oral antidiabetic drugs and a statin. I followed his instructions for a couple of weeks and the result was that within 2 weeks I developed side effects of the drugs. I immediately STOPPED all my medications and started following a keto diet. Finally, I was able to reverse my T2DM. Anyway, that’s a separate story.

Coming back to the study, all the parameters were measured at baseline before randomization in both the groups. Again, all the parameters were measured after 16 and 32 weeks of intervention.

So what conclusions were drawn from this study. Let me list the results of this study in bullet points for better understanding.

  • The investigators observed that there were significantly greater reductions in HbA1cthose who followed the ketogenic diet after 16 as well as 32 weeks
  • Similarly, those who were on keto diet lost more weight than those who followed conventional ADA diet (12.7 kg versus 3 kg)
  • Also, triglycerides level was much lower in the ketogenic group compared to ADA diet followers

This study showed that those who followed a ketogenic diet had several health benefits including lower HbA1c, body weight, and triglyceride levels.

There were few limitations in this study. The number of participants was very less (25 participants) and the follow-up duration of the study was not long.

Despite all limitations, the conclusion we can draw from this study is that low-carbohydrate ketogenic diet and lifestyle changes are beneficial in individuals who are overweight with T2DM.

If you have any queries or any experience to share please type in the comment box. I will try to reply to all your queries.

If you have enjoyed reading this article, I would request you to share with your friends and colleagues who are diagnosed with T2DM. I am sure by reading this article, they will be motivated that it’s not the end of the world if they are diagnosed with T2DM.

With dietary and lifestyle modifications, it is possible to reverse your T2DM.

iGlarLixi combination injection reduces HbA1c, body weight


Adults with poorly controlled type 2 diabetes assigned a combination insulin glargine and lixisenatide injection saw greater glycemic control, modest weight loss and no additional hypoglycemia risk vs. patients assigned insulin glargine alone, according to data presented at the American Diabetes Association Scientific Sessions.

In a randomized, open-label, parallel-group trial, researchers comparing the efficacy and safety of iGlarLixi (Sanofi Aventis), a titratable fixed-ratio combination of Lantus (basal insulin glargine 100 U/mL) and Lyxumia (lixisenatide), a glucagon-like peptide-1 receptor agonist, vs. insulin glargine alone found the drug was well tolerated over 30 weeks, with a low rate of nausea and vomiting reported in patients.

“There’s high interest in looking at the combination of basal insulin with GLP-1 receptor agonists for their complementary effects on fasting glucose and postprandial glucose,” Vanita R. Aroda, MD, director of the MedStar Community Clinical Research Center at the MedStar Health Research Institute, said while presenting her findings, “as well as for the potential mitigating factors to their individual use.”

Vanita Aroda

Vanita R. Aroda

Aroda and colleagues analyzed data from 736 patients with poorly controlled type 2 diabetes on either basal insulin aloneor with up to two oral antidiabetic drugs (mean age, 60 years; 53% women; 92% white; mean diabetes duration, 12 years; average basal insulin therapy use, 3 years; mean BMI, 31 kg/m²). Within the cohort, the mean insulin dose prior to randomization was 35 units; 52% were taking metformin; 32% were taking metformin and sulfonylureas. Included patients remained in poor control (HbA1c greater than 7% despite a morning fasting plasma glucose of 140 mg/dL or less) following a 6-week run-in phase where insulin glargine was either introduced or optimized; any oral antidiabetic agents with the exception of metformin were discontinued prior to the start of the trial.

Researchers randomly assigned patients to iGlarLixi (self-injected once daily in the hour before breakfast) or insulin glargine alone for 30 weeks. Researchers assigned patients taking an insulin dose of less than 30 units daily prior to randomization to “pen A,” delivering insulin glargine and lixisenatide at a 2:1 ratio (20 units; 10 mg lixisenatide). Patients on a daily insulin dose of at least 30 units daily prior to randomization were assigned “pen B,” with a 3:1 ratio of insulin glargine and lixisenatide (30 units; 10 mg lixisenatide), Aroda said.

Primary outcome was change in HbA1c from baseline to week 30.

From screening to baseline (after run-in), mean HbA1c for the cohort fell from 8.5% to 8.1% in both groups. Over the treatment period, patients assigned iGlarLixi saw a further decrease in HbA1c to 6.9% vs. 7.5% for those assigned insulin glargine alone (mean treatment difference, .52%; P < .0001); 55% of iGlarLixi patients achieved an HbA1c of 7% or less vs. 30% of insulin glargine patients.

Patients in the iGlarLixi group also experienced a decrease in body weight (–0.7 kg), whereas the insulin glargine group saw a mean increase of 0.7 kg. (mean difference, 1.4 kg; P < .0001). Both groups experienced similar rates of documented hypoglycemia (40% vs. 42%). Treatment was well tolerated; however, patients in the iGlarLixi group reported more adverse gastrointestinal events (10%) vs. those assigned insulin glargine alone (0.5%).

“This improvement in glycemic control likely reflected the combined effect of insulin glargine on fasting glucose and lixisenatide on postprandial glucose control,” Aroda said during her presentation. “This paradigm of basal insulin with GLP-1 receptor agonist therapy appears to be efficacious, well tolerated with complementary physiologic effects.”

An FDA advisory panel voted 12-2 in favor of recommending approval of iGlarLixi in May. – by Regina Schaffer

FDA approves Saxenda injection therapy for weight management.


The FDA granted approval to liraglutide 3-mg injection as the first once-daily human glucagon-like peptide-1 analogue to help manage obese or overweight patients, according to a press release from the agency.

Liraglutide 3-mg injection (Saxenda rDNA origin, Novo Nordisk) is approved for adults with obesity with BMI ≥30 kg/m2 or overweight adults with BMI ≥27 mg/m2 and at least one weight-related comorbidity including hypertension, type 2 diabetes or high cholesterol dyslipidemia to use along with diet and physical activity, according to the press release.

“Saxenda, used responsibly in combination with a healthy lifestyle that includes a reduced-calorie diet and exercise, provides an additional treatment option for chronic weight management for people who are obese or are overweight and have at least one weight-related comorbid condition,” James Smith, MD, MS,acting deputy director, Division of Metabolism and Endocrinology Products, FDA Center for Drug Evaluation and Research, said in the press release.

The therapy should not be used in combination with other drugs belonging to this class of glucagon-like peptide-1 (GLP-1) receptor agonists, including liraglutide recombinant 18 mg (Victoza, Novo Nordisk) designed to treat type 2 diabetes, according to the statement.

The safety and efficacy of liraglutide 3 mg were evaluated in three clinical trials involving approximately 4,800 patients with obesity and overweight; the patients, both with and without significant weight-related conditions, also received counseling on lifestyle modifications for reduced-calorie diet and regular physical activity.

In a clinical trial that enrolled patients without diabetes, average weight loss from baseline was 4.5% with treatment vs. placebo at 1 year; 62% of patients treated with liraglutide lost ≥5% of their body weight compared with 34% of patients treated with placebo.

In another clinical trial that enrolled patients with type 2 diabetes, average weight loss from baseline was 3.7% with treatment vs. placebo over the same period; 49% of patients treated with liraglutide lost ≥5% of their body weight compared with 16% of patients treated with placebo.

Patients receiving liraglutide 3 mg should be evaluated after 16 weeks, according to the release, if <4% of baseline body weight is not lost, the patient is unlikely to achieve and sustain clinically meaningful weight loss and therapy should be discontinued.

A boxed warning indicates thyroid gland tumors have been observed in rodent studies, but it remains unknown whether it has the same effect in humans. The drug is contraindicated for patients with personal/family history of medullary thyroid carcinoma (MTC) or those with multiple endocrine neoplasia syndrome type 2, according to the statement.

The most common side effects observed in patients during clinical trials were nausea, diarrhea, constipation, vomiting, hypoglycemia and decreased appetite. Other reported side effects include pancreatitis, gallbladder disease, renal impairment and suicidal thoughts. The drug can raise heart rate and should be discontinued if increased resting heart rate continues.

Post-marketing studies required by the FDA include: trials for dosing, safety and efficacy in pediatric patients; a case registry of ≥15 years to identify any treatment-related increase in medullary thyroid carcinoma; and ongoing trials to evaluate potential breast cancer risk.

“Obesity has many root causes and there is a clear need for additional treatment options to help health care professionals better address our patients’ individual conditions and goals for weight management,” Donna Ryan, MD, professor and associate director of clinical research at the Pennington Biomedical Research Center, said in a press release. “The approval of Saxenda provides us with a new therapeutic approach for helping our patients achieve and maintain a healthier body weight.”

 

The skinny on cocaine. Insights into eating behavior and body weight in cocaine-dependent men.


Abstract

There is a general assumption that weight loss associated with cocaine use reflects its appetite suppressing properties. We sought to determine whether this was justified by characterizing, in detail, alterations in dietary food intake and body composition in actively using cocaine-dependent individuals. We conducted a cross-sectional case-control comparison of 65 male volunteers from the local community, half of whom satisfied the DSM-IV-TR criteria for cocaine dependence (n = 35) while the other half had no personal or family history of a psychiatric disorder, including substance abuse (n = 30). Assessments were made of eating behavior and dietary food intake, estimation of body composition, and measurement of plasma leptin. Although cocaine users reported significantly higher levels of dietary fat and carbohydrates as well as patterns of uncontrolled eating, their fat mass was significantly reduced compared with their non-drug using peers. Levels of leptin were associated with fat mass, and with the duration of stimulant use. Tobacco smoking status or concomitant use of medication did not affect the significance of the results. Weight changes in cocaine users reflect fundamental perturbations in fat regulation. These are likely to be overlooked in clinical practice but may produce significant health problems when cocaine use is discontinued during recovery.

 

 

Food intake and childhood obesity: accurate estimation of requirements?


The first two decades of life are biologically unique because of the complex interaction between genes and environment driving, partly via hormones, the mature phenotype of an individual. During this time, body weight and composition change rapidly and are particularly sensitive to obesity-promoting factors. In The Lancet Diabetes & Endocrinology, Kevin Hall and colleagues1 present a model that allows for the simulation of body weight and energy balance dynamics in children and adolescents.

Their model showed that, contrary to common perception, the energy needed to accrue body weight in excess of that gained through normal growth is higher than the energy content of the extra mass accumulated. This finding is explained by the higher energy requirement associated with increased body weight. Higher fat-free mass increases basal energy requirements;2 higher body mass increases energy requirements for physical activity (ie, weight-bearing activities);3 and higher food intake (as a result of increased energy requirements accompanying weight gain) increases the energy used for digestion, absorption, and processing of food ingested (ie, meal-induced thermogenesis).4 Increased energy is also spent on synthesis of new tissue.5 Therefore, the requisite energy to gain extra weight rises as the amount of weight gained increases.6 All these factors reduce the positive energy balance, thereby decreasing the speed and intensity of energy-storing processes during the dynamic phase of obesity development.

Hall and colleagues’ model showed that the extra energy intake required for excess weight gain in children is higher than that required in adults, emphasising that, in general, the dynamic phase of excess weight gain in children results from a pronounced increase in energy intake with respect to energy requirements for healthy-weight, age-matched peers. This observation contrasts with those on which standard clinical practice is based and has important consequences. Obese children and adolescents usually report similar food intake to non-obese peers. However, the results of studies78 in which stable isotopes are used to measure total energy expenditure in normal life show that the food intake of overweight or obese children and adolescents is under-reported. Furthermore, the accuracy of parents’ awareness of children’s portion sizes and reporting of children’s food intake is only moderate.910 Reduced awareness of food intake in obese or preobese children and their parents is an important limiting factor in the modification of nutritional behaviour, and associated under-reporting of food intake adversely affects clinicians’ planning of adequate dietary strategies. This issue should be addressed with the family as a crucial target of behavioural intervention, because it is not plausible to expect diet adherence when awareness of portion size and daily food intake is low.

Another important simulated finding of Hall and colleagues’ model is the difference between sexes in terms of changes in body composition with weight loss at puberty. At puberty, fat-free mass increases much more in boys than in girls, and thus the energy requirements of boys increase more than those of girls. Thus, if energy intake is kept constant, overweight boys could reach a healthy body composition after maturation (ie, outgrow obesity). However, attainment of healthy body composition for overweight girls through maintenance of a constant energy intake is more difficult without weight loss. The practical implication of this finding is that dietary treatment of obese and preobese children at puberty should differ between sexes and be tailored to individual energy requirements.

Hall and coworkers’ results support more accurate assessment of energy intake and comparison of these estimates with energy requirements calculated specifically for each child. They also provide suggestions for public health strategies for the prevention and treatment of childhood obesity. In particular, their results suggest that the best time for intervention is before puberty, especially in females. The energy imbalance gap is different for universal prevention, prevention in at-risk individuals, and treatment of obesity. Hall and colleagues’ model might help to identify expected energy requirements and, by extension, to calculate the energy imbalance gap to target. However, to translate into practice these desired changes in energy balance, it will be necessary to increase families’ knowledge and awareness of energy content and composition of childrens’ diets by designing effective and sustainable educational programmes about nutrition.

Source: Lancet

Bodyweight Exercise Is Perfect for Everyone, Everywhere, on Every Budget and Every Fitness Level.


Story at-a-glance

  • Effective exercise doesn’t require equipment. Workouts using nothing but your own body weight are an efficient way to get cardiovascular, and strength benefits. It’s also an easy way to strengthen your core
  • Research shows bodyweight exercise can benefit stroke patients, and it’s It’s adjustable to suit virtually everyone, from the least fit to the professional athlete
  • Bodyweight apps for your iPad or phone can help you devise your own customized workout for your current skill and fitness level
  • The burpee is a bodyweight exercise that is both aerobic and anerobic; it’s like a strength and cardiovascular workout in one exercise, and helps burn fat.
  • stress-exer

Many exercise systems often sound great at first glance, but in reality simply will not make a good fit for your life. Thankfully, there is something else you can try called bodyweight exercise, which is so flexible that it answers every possible concern you might have, including time constraints, prohibitive cost, and location concerns.

It got its name because your own body provides all the resistance needed to take you to the peak of fitness… and it does so at your own pace, without requiring a personal trainer to design the perfect system for your lifestyle and fitness level.

You likely already know that exercise is necessary for good health and a long life. What is not always clear is how you should go about it. There are a countless number of different plans and theories about how to exercise.

Of course researching and careful reflection is important, but it’s confusing.  What’s the best plan? How hard or easy should your workout be? Then, there’s the day-to-day reality, and the inevitable challenges of implementing an exercise regimen:

Not enough time… The equipment is too expensive … Traveling to the gym or other facility … You like outdoor exercising, but it’s snowing.

Bodyweight exercises resolve all of these problems! You can do them anywhere, anytime, at your own pace and level, alone or with a friend—even if you and your friend are at different levels. It doesn’t cost a single penny.

Yet, you can get a perfect workout as if it had been designed just for you.  That’s because it has—you will have designed it yourself!

It is not a newfangled idea. It’s well researched, so you do not need to be concerned that you might hurt yourself. Bodyweight exercising uses your own body to provide resistance, so you do not even need weights—though you can use them if you wish. The method is not only effective, allowing you to train every muscle in your body, but is simple and let’s you work out at your own pace.

Health Benefits of Bodyweight Exercise

In the Huffington Post Greatest series, Dave Smith discusses some of bodyweight exercising’s benefits1.

  • Workouts are highly efficient. As Dave points out, the goal is fitness, not to look like “Arnold circa 1977”. No equipment means that there’s minimal time transitioning from one exercise in your self-defined set to the next, so your heart rate is boosted quickly and keeps pumping.
  • You get both cardiovascular and strength training. It is not necessary to do two separate workouts to achieve both types of fitness.  Simply alternating exercise sets from cardiovascular to strength training keeps your pulse up.2
  • Your core strength is improved.  The Mayo Clinic tells us that 29 muscle pairs located in the pelvis, abdomen and lower back form the core that’s needed to support your body and maintain balance.3  Your athletic ability, posture and all the little things you do every day—like just plain sitting or doing the laundry—will be improved when your core is strengthened and stabilized.4
  • You’ll be more flexible. Increased strength without improved flexibility won’t do you much good. Good posture and athletic performance require good flexibility.5 Inability to stretch and bend is related to lack of flexibility.6
  • Your balance will improve. As you progress into more difficult variations of exercises, your ability to balance is trained. Better balance helps give better body control.7 Since age and infirmity do not usually hinder performance of bodyweight exercises, they can be a great way for the elderly to maintain and improve balance.8

Almost Anyone Can Improve Fitness Health

Bodyweight exercise can be done by just about anyone. A study has documented that it benefits stroke patients.9 In fact, if bodyweight exercise can help someone who’s suffered a major stroke and has difficulty walking, it’s apparent that nearly anyone can benefit. Adaptability is what makes this system so good: It’s adjustable to almost anyone, from the least fit to the professional athlete. Just learn the basics and try different approaches until you find what works best for you. If you get bored doing the same thing all the time, you can vary your workout. As your strength and endurance develop, you can modify the program. It’s the ultimate personalized system—as if you had your own personal trainer. In fact, you do… yourself!

Personal Benefits of Bodyweight Exercise

Aside from the improvements to your physical state, bodyweight exercise provides some other goodies:

  • Fat is burned quickly. If you want to shed a few pounds, bodyweight training can help simply by including some burpees—which I’ll tell you more about a bit later. You’ll be amazed at how the metabolic increase will help melt the pounds.10
  • It’s convenient. So often, the reason people do not exercise is simply that it’s inconvenient. You have to go to a gym, or go outside when it’s raining, or stay inside when it’s beautiful outdoors. You do not need to pull equipment out and get set up. You do not need to fit exercise into a particular schedule. You just do it when it’s convenient and fits your schedule.
  • It’s cheap. There is no equipment required. Your own body is all the equipment you’ll need.
  • It’s fun! There’s no boredom because you can vary your workout if doing the same old thing makes you want to quit. As the above video of demonstrates, there are all sorts of variations that you can try… and keep in mind that the video doesn’t show every possible exercise you could do.
  • It’s satisfying. You’ll see and feel results quickly. Your mind will be sharper. You’ll feel better. If overweight, you’ll probably start losing weight quickly. You’ll look better. Your energy levels will increase.

Do the Burpee for a Concentrated Workout

The burpee is a bodyweight exercise developed by Dr. Royal H. Burpee. It’s both aerobic and anerobic, and provides both strength and cardiovascular workouts in one exercise. Doing burpees can shorten exercise time because it burns 50% more fat in short bursts. Like other bodyweight exercises, there are burpee variations that can make it easier or harder, depending on your requirements. All you need to know about it, including step-by-step instructions and a video demonstrating the burpee and variations can be seen here, along with all sorts of fun facts about it.

Technology to Support Bodyweight Workouts

Okay, it does seem a bit contradictory to suggest that these workouts, which do not require any more equipment than your own body, can be helped with technology. In today’s world, though, we do have technological allies in fitness.

With prices ranging from free to $3.99, a previous article brings you information about six bodyweight apps for your iPad or phone. One helps you work out your own customized workout for your skill and fitness level. Another can keep your body challenged. Other non-bodyweight training apps help you track your progress in jogging or running, keep track of your workouts, or calculate heart rate with a range of tools to keep you on track. Technology lets you bring your own personal trainer along on every workout!

Proper Form for Maximum Benefit and Injury Avoidance

Bodyweight exercise is effective and frees you from the expenses and restrictions of most other exercise programs. However, it’s critical to understand that you shouldn’t just go slinging your body around or acting as if you’re immune to injury. If you obey proper form, you will gain the most benefit and avoid injuries.

Two of the best strength-producing exercises are pull-ups and push-ups. To gain the most out of either one requires performing them properly. Men tend to focus on pull-ups and push-ups, but women, who often lack upper body strength, should give them a go, too.

Pull-ups are not the same thing as chin-ups. They’re not as hard, but if you do them correctly, they’re more beneficial. Not only do they build strength in upper back muscles, but they’re also good for the central body core. Be sure to watch a recent video we did that shows you the proper form for doing pull-ups. If you aren’t able to do full pull-ups yet, the article also gives information on how to work your way into them.

Believe it or not, if you want to strengthen your midsection, a great exercise is push-ups. They do, of course, increase upper body strength, but when done properly, you must keep your abdominals still, which requires keeping them taut. We also have a video that shows you how to do push-ups correctly. You’ll learn how to target other muscle groups while doing perfect push-ups.

No One ‘Correct’ Way to Exercise

Every person is different, so there’s not just one “correct” way to exercise. With all the exercise plans out there, it can be confusing and zap your motivation to even try to get started. So when you learn about the bodyweight system, which resolves all those excuses for not exercising, it can still be difficult to overcome the inertia to get started. To help you get through that difficulty and start making exercise a regular part of your life, Chris Freytag has offered 12 Steps to help you get going.

Because we’re all different, what works for one person does nothing for another. You may need to set aside the same time every day, while your co-worker does better by keeping the time flexible. It will require, though, that you make a real commitment to exercise regularly and make it a routine part of life.

Bodyweight exercising is terrific for many with tight time or financial budgets or schedules—but it isn’t right for everyone.  Some people do better exercising in gyms with trainers. Some do not care what the weather is like. Cold or hot, wet or dry, they want to be outside on a regular basis, so they can best bring exercise into their outdoor activities.

Source: mercola.com