It’s been a few weeks since I last blogged, so my apologies for that. I am hoping to fix that now that my schedule is starting to even out. I did want to make sure that I posted about this, however, as it is BIG NEWS. I first heard about it from Dr. Ken Berry and his YouTube channel. If you would like to see his video on it, you can click here. So, let’s start on going through the gist of this 38 page paper, shall we?
First, you can find the PDF article here: https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
Abstract of article
Starting with the abstract:
ABSTRACT: Cardiovascular disease remains the leading cause of death in patients with diabetes. Cardiovascular disease in diabetes is multifactorial, and control of the cardiovascular risk factors leads to substantial reductions in cardiovascular events. The 2015 American Heart Association and American Diabetes Association scientific statement, “Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence,” highlighted the importance of modifying various risk factors responsible for cardiovascular disease in diabetes. At the time, there was limited evidence to suggest that glucose-lowering medications reduce the risk of cardiovascular events. At present, several large randomized controlled trials with newer antihyperglycemic agents have been completed, demonstrating cardiovascular safety and reduction in cardiovascular outcomes, including cardiovascular death, myocardial infarction, stroke, and heart failure. This AHA scientific statement update focuses on (1) the evidence and clinical utility of newer antihyperglycemic agents in improving glycemic control and reducing cardiovascular events in diabetes; (2) the impact of blood pressure control on cardiovascular events in diabetes; and (3) the role of newer lipid-lowering therapies in comprehensive cardiovascular risk management in adults with diabetes. This scientific statement addresses the continued importance of lifestyle interventions, pharmacological therapy, and surgical interventions to curb the epidemic of obesity and metabolic syndrome, important precursors of prediabetes, diabetes, and comorbid cardiovascular disease. Last, this scientific statement explores the critical importance of the social determinants of health and health equity in the continuum of care in diabetes and cardiovascular disease.
https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
Ok, that’s a lot, so let me break it down for you. Obviously, there is a concern regarding the link between Type 2 Diabetes and Cardiovascular disease. The study looked at 3 things: the use of antihyperglycemic agents (aka prescriptions drugs for diabetes), Impact of blood pressure control on cardiovascular events, and the role of new lipid-lowering therapies. So the next question is, what were the findings?
T2D indicators
First, let’s go over some indicators. We know that T2Ds have a higher blood sugar level, but what causes that? Surprise: it’s not just eating too much sugar. According to the article:
progression to T2D includes metabolic syndrome and prediabetes with glucose dysregulation attributable to liver, skeletal muscle, and adipocyte insulin resistance, along with proinflammatory cytokines
This means that to get to T2D, you suffer from metabolic syndrome, inability to manage glucose (aka sugar), which can be attributed to liver, skeletal muscle, and adipocyte (cells that store fat) insulin resistance, and proinflammatory cytokines, aka small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells.
According to the International Diabetes Federation, metabolic syndrome is defined as having 3 or more of the following:
- a waist circumference ≥35 inches for women or 40 inches for men
- elevated triglycerides (≥150 mg/dL)
- a high-density lipoprotein cholesterol (HDL-C) <40 mg/dL in men or <50 mg/dL in women
- hypertension (≥130/85 mm Hg)
- elevated fasting plasma glucose (FPG; ≥100 mg/dL)
At one point in time, I suffered 4 of these 5.
The article then moves in to Lifestyle Management.
LIfe Management
In adults with T2D, greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of incident CVD and CVD mortality (Table 1). The table is on page 4 of the study posted above. But what does that mean? In a nutshell, it advises that an overall healthy lifestyle will likely put you at a lower risk of CVD and CVD mortality.
What the study showed is through an intensive life management change (calorie goal of 1200 to 1800 kcal per day (with <30% from fat and >15% from protein)), the patients lost more weight then just calorie deficit and lowered their A1C faster. In addition,
intensive lifestyle intervention yielded improvements in other cardiovascular risk factors, sleep apnea, fitness, renal disease, peripheral neuropathy, and depressive symptoms.
https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
There was not enough research on this study to confirm that it definitively will remove cardiovascular disease, but it is definitely in the right direction.
You know that I am a proponent of movement. This study found that
Physical activity
Increased physical activity and exercise have been shown to improve glycemic control, lipids, BP, insulin sensitivity, and inflammatory biomarkers in T2D
https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
This indicates that physical exercise (minimum of 3 times a week) also helps to lessen cardiovascular disease.
Nutrition
Here is where it starts to get interesting. To quote the article (again):
The Mediterranean, Paleolithic, low-carbohydrate, high-protein, vegetarian, and nut-enriched diets have demonstrated benefits on glycemic control and weight loss in T2D, with the Mediterranean diet producing the greatest improvements in glycemic control and a 29% CVD reduction over 4.8 years.
https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
Keto is low-carbohydrate, high-protein. Obviously, this statement does not limit to only Keto, but this is the first study from AHA that includes Keto, so that is quite exciting.
Very low–carbohydrate versus moderate carbohydrate diets yield a greater decrease in A1c, more weight loss and use of fewer diabetes medications in individuals with diabetes. For those who are unable to adhere to a calorie-restricted diet, a low-carbohydrate diet reduces A1c and triglycerides. Very low-carbohydrate diets were effective in reducing A1c over shorter time periods (<6 months) with less differences in interventions ≥12 months
https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001040
The study showed that very low-carb decreases A1C more than a moderate carbohydrate, as well as more weight loss and less medications. It also showed to reduce triglycerides (which are well known for being higher on a diet of pasta and rice). Note that the very low-carb diet was more effective in reducing A1C over a shorter amount of time. THIS is very exciting.
Summary
So, this is the first study that the AHA has published where they are acknowledging the benefits of a Ketogenic way of life. Eating ‘Keto’ will reduce your A1C faster then the previous recommended diets and will improve overall health. So, let’s get started on your road to health with a Ketogenic, keto-vore, or carnivore way of life.
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