Ryan Bradley, ND, MPH is a doctor of naturopathic medicine in San Diego, CA. Diabetes is an area of both research and clinical specialization for Dr. Bradley. He practices integrative care for diabetes and heart health as the Director of the Center for Diabetes & Cardiovascular Wellness at the Bastyr University California.
A Few Things that Have Caught My Eye
Over the past month, several research headlines have caught my attention. Because they may impact your health care and your lifestyle choices, I wanted to be sure you were aware of the following “hot” reports. I hope your early fall is off to a healthful start. In health- Ryan Bradley, ND
Results of the Western Norway B-vitamin Intervention Trial (WENBIT) were recently presented at the European Society of Cardiology Congress showing no benefit (or harm) from using B vitamins B12, B6 and folic acid to lower homocysteine (See Complementary Corner November 2007 for more information on the homocysteine hypothesis). This trial is the third clinical trial released in the past two years that has demonstrated homocysteine lowering does not have an effect on short term cardiovascular events, i.e. it does not appear to reduce heart attacks, angina or cardiovascular-related death. A small trend for reduced risk of stroke was seen; hopefully this question will be answered from the results of several large stroke prevention trials currently underway.
As this is the third trial demonstrating these findings (all three have been consistent), I am convinced homocysteine remains a biomarker and does not significantly contribute to vascular disease as a short-term cause; its long-term effects remain unknown, but these results suggest they are minor. (Source: Medscape WENBIT: Another Negative B Vitamin Trial; accessed online 8-22-08).
Diabetes Action Research and Education Foundation is committed to supporting innovative research in diabetes, including research into promising integrative and alternative treatments, to improve patient health. At the annual American Association of Naturopathic Physicians convention in Arizona, Dr. Erica Oberg presented the status of her clinical trial evaluating the effects of a naturopathic, whole-foods oriented approach to eating with diabetes compared to the American Diabetes Association recommended diet. In addition to standard measures of glucose reduction, Dr. Oberg is also measuring the participants’ experience with eating, their overall quality of life, and changes in self-care. I am involved in this study as well and will be evaluating the effects of these two dietary approaches on markers of antioxidant status and oxidative stress.
The two most commonly used oral medications for diabetes care may increase the risk of cardiovascular hospitalization and death when used in combination according to a meta-analysis published in this month’s Diabetes Care. Although the study did not find a significant effect of the combination on cardiovascular-related death or mortality alone, when these two measures were put together the authors found a 43% increased risk of either being hospitalized for heart-related reasons or death. Because adding a sulfonylurea drug such as Glipizide® and Glyburide® to ongoing metformin therapy is a standard practice in medicine, this finding should be repeated in additional studies.
Given the limitations on currently available pharmacologic therapy for diabetes, following a good diet, getting daily exercise and reducing stress remain the best treatments. (Source: Rao et al., Diabetes Care 2008;31:1672-167)
There is mixed news on the new medication exenatide (Byetta®) for the treatment of diabetes. Byetta® acts by replacing a key hormone-like messenger called glucagons-like peptide 1 (GLP-1), a messenger that is deficient in the pancreas of people with long-standing diabetes. GLP-1 normally tells the liver to stop producing its own sugar and helps signal the pancreas to release insulin normally. Byetta® typically results in weight loss and improved blood glucose. However Byetta® recently received an FDA warning on its package due to increased reports of pancreatitis, a potentially life-threatening, inflammation of the pancreas.
If you take Byetta® and are experiencing any symptoms of pancreatitis since beginning this medication, including severe abdominal pain, nausea, vomiting and possible fever, you should go to your physician to discuss your symptoms. (Source: U.S. Food and Drug Administration; accessed 8-20-08).
Mentioned briefly in last month’s Complementary Corner, the DIRECT trial recently challenged the value of a low fat diet, compared to a low carbohydrate diet and a Mediterranean diet pattern, for weight loss. 322 moderately obese participants were randomized to either a low fat diet, low carb diet or a Mediterranean diet and followed for two years. The average weight loss was 4.7 kilograms a(10.3 pounds) in the low carb group and 4.4 kilograms (9.7 pounds) in the Mediterranean diet group, but only 2.9 kilograms (6.4 pounds) in the low fat group. Interestingly, the low carb diet and Mediterranean diet also had better effects than the low fat diet on lipids, including higher healthy HDL cholesterol, lower triglycerides, and lower harmful LDL cholesterol. Compared to the low fat diet, both the low carb diet and the Mediterranean diet resulted in lower C-reactive protein, an important measure of vascular inflammation. When the effects of each diet for those participants with diabetes were examined, the Mediterranean diet had better effects on fasting blood sugar, fasting blood insulin, and improvements in insulin sensitivity.
These findings confirm my long-standing feelings that when selecting one dietary pattern for a healthy lifestyle, the Mediterranean Diet is the best choice, with short-term use of low carbohydrate diets being okay when more rapid weight loss is desired. (Source: Shai et al. New England Journal of Medicine. 2008. 359. 229-41)