A confession, I haven’t given the primary document my full attention …… yet. My bad, of course, but since this is one disease state where thankfully I don’t appear to show any signs (low fasting glucose, A1c within normal limits and, possibly even more important, HOMA-IR showing high insulin sensitivity) I don’t feel quite the level of urgency so it’ll have to wait.
Mentioned in the abstract, though, is the tid-bit that T2D that is not secondary to overweight/obesity is associated with more severe outcomes. Might be due to a different pathogenesis…..but, as also mentioned, could mean that a degree of supervised neglect takes place when there’s the appearance of a healthy lifestyle/bodyweight against the growing backdrop of the opposite.
Take home message ……. don’t ignore the Red Flags just because your healthcare provider does.
Thanks for sharing this. My younger sister (who is a super-health-conscious Size 6 who follows a keto diet) is concerned because her glucose levels are climbing into the pre-diabetic range (110 mg/dl). She is 68 years old. She weighs only 106 pounds but has noticed a redistribution of body fat to her abdomen. She had her heart checked after my aortic valve was replaced last year and things seem to be OK.
Back when I decided that I was going to reassure myself that my past primary care physicians etc had been correct …… and my “borderline LDL-C” wasn’t the problem that maybe an endocrinologist or intervention cardiologist would think ……. along with the CAC scan and asking for Lp(a) and Apo-b to be added to the Usual Suspects on my lipid profile, I also asked for a fasting insulin measurement.
Absolutely nothing in my metabolic profile to suggest an issue (fasting blood glucose in the low-mid 90s, A1c toggling around 5.4/5.5) but here’s the thing……what these numbers don’t reflect is the early departure from healthy homeostasis that any degree of insulin resistance might reflect. It’s easy/reasonable to infer that situation from my personal rap sheet when the only hiccup was the LDL-C…..but it is an inference that could’ve been dead wrong. There was actually no way of knowing for sure if those healthy A1c numbers were the result of a normal insulin production and response to a healthy diet alongside normal insulin sensitivity or if it was an illusion because insulin production was high.
With his transplant patients, my husband has routinely performed an Oral Glucose Tolerance Test (still the Gold Standard) to assess metabolic function…..for the simple reason that too much departure from healthy homeostasis there without intervention is a killer for a transplanted liver. Since Peter Attia claims to do this with his patients, I asked dh if he’d do one for me should our new-to-the-practice PCP show reluctance (if only to shut me up!!!) “Why not just do a fasting insulin and HOMA-IR?”, was his question. Why not indeed??? Who knew…..certainly not I? FWIW, I don’t believe that I’m the one who’s supposed to!!
As it turned out, my particular issues were less fixable by my own efforts but now I know what I know, there’s no way I’d be sitting on an A1c that was not measurably below the arbitrary upper limit of “healthy”.
And it may very well be that your dad returned to a healthy metabolic state. The thing to be aware of…..and the linked article highlights …… in addition to pre-diabetes in and of itself being enough of a departure from healthy homeostasis to be considered disease-worthy (think of every heart beat sending super insulin rich blood coursing through the cardiovascular system pretty much every minute of the day and the damage that state of affairs inflicts on the vessels) even “no longer pre-diabetic” might not actually be “metabolically healthy”. In the unlucky subsets of individuals who’re genetically predisposed to damage……and aren’t even aware……the Usual Suspects on a metabolic profile might not be enough to identify the high risk individuals before the spit hits the fan.
Most people can not cope with medical information. It is very difficult. Things are told to people at the last.
It is not just exercise and diet: most lifestyles are dangerous to individual health.
Recently I come back in my thoughts to a report on the Mediterranean diet. Our version is light on the meat. That is not so around the Mediterranean, where people eat plenty of different meats, including red meat. It is not like they are sparing.
The difference might be better explained by reduced stress. The advanced European society without the stresses of German industrialization.
In the US, we go down south to escape some of the stresses, but the diet and exercise can be fouled up if you look at the statistics tables. We are not talking red meat alone; we are now in chicken-fried steak and pork rinds country.
I have a picture in my mind from a trip to Florida of retired folks sitting around a Dunkin Donuts for hours on end drinking coffee and smoking cigarettes. Life is what you make of it. You get to shorten it. The heat that October was 90 degrees by mid day.
Well, The Mediterranean Diet ™ is a moniker that I believe first saw the light of print in this book (as you can see, circa 1959……subsequent iterations and Margaret Keys’s cookbook actually mention “the Mediterranean Way” in the titles)
The whole Mediterranean Diet that’s morphed into a “product” centers on the dietary habits that Ancel Keys observed in Southern Italy and Crete where, at the time, meat consumption was somewhat low as compared to what it may be now (haven’t been back to Crete since 1978) since local production was comparatively low in animal products. Crete is a very dry, rocky island and the vegetation didn’t support intensive farming (not to mention the effects of German occupation during WWII having an impact on perceived dietary habits.)
The fact is that diverse populations are heathy eating very different diets depending what exists where they live. What is common to these native people is that they don’t eat industrial foods. Before the 20th century most of the current illnesses did not exist in America and neither did most of the current industrial foods. Dietary illnesses seem to be highly correlated with industrial foods.
The secret, then, is not what one should eat but what one should avoid eating, highly processed industrial foods that our grand parents did not get to know and suffer.
In a previous thread I posted in error
I live in a metric universe talking to a mostly imperial audience. I should have posted 20 plus kilos which is close to 50 plus pounds.
Did you mean “that our grandparents did not get to know and suffer”?.
Although it’s true that ASCVD…..especially secondary to obesity and its consequences….was lower in our **grandparents day, it’s a mistake to imagine that as a disease it was non existent. Obviously with fewer people overeating, there are just as obviously going to be fewer cases of diseases such as T2D, ASCVD etc when they’re 100% caused by craptaculous lifestyle choices (as in folk with no or minimal genetic predisposition)…..the folk with a strong genetic predisposition have always been there, though. With infectious disease being so prevalent, there would be fewer folk living to the age where heart disease presents itself even in the folk who’ve followed the Righteous Path where eating and exercise habits are concerned.
I’ve had cause to make this observation in response to the nonsensical claim that illnesses such as ASCVD etc didn’t exist before the 20th century. In case the topic was missed before, here’s but one article on the subject….
** I am actually pegging my maternal grandfather as the culprit with my FH. He died suddenly in his early 60s towards the tail end of WWII and, not only did he not experience the ultra processed foods phenom, he wasn’t lardy or sedentary either.
Interesting that this discussion is happening today. I had a blood test last week (actually had two because the first lab said they couldn’t do some of the items on the list, so I did the first stuff first and then the rest of the items a few days later at a different lab). One of the results surprised me. My glucose is 108 (well, it was 109 on Monday and 108 on Friday) which is considered high (for a fasting blood test) and is higher than last test (101).
And my cholesterol is still a little high (215), but lower than last test (228). Of course my cardiologist is still hot on statins (and I am not).
Meanwhile, LP(a) is very low (8.8) and apparently nothing to worry about yet. This is my first LP(a) test.
There’s also something called Apolipoprotein B that measures high (103). I’m not even sure what that is yet.
How have you managed to maintain that level of ignorance, given that I’ve beaten the drum repeatedly over the past 4 years…..emphasizing the growing understanding of this lipoprotein as the most atherogenic particle identified to date that’s grouped under the lipoprotein umbrella? Hinting non too subtly that any whiff of an elevated total cholesterol warrants further investigation in this direction.
If you know you’re going to ignore advice from someone who’s knowledgeable about cardiovascular disease(as in lipid lowering therapy) why bother with testing in the first place? That’s like asking for financial advice for future security when you know you’re going to continue spending like a drunken sailor. I don’t understand that, either🤔
I haven’t given it my full attention but have noticed that growing insulin resistance powering an elevation of this lipoprotein is mentioned. This was the reason that, although my fasting glucose was not on a trajectory to worrisome levels or my A1c at a concerning level, I wasn’t willing to trust to luck that I was metabolically healthy…..hence the fasting insulin measurement along with the Lp(a) and Apo-b, and the CAC scan and subsequent Coronary CTangiogram that revealed the extent of my coronary artery disease.
….and repeated, overandoverandover again. Almost a perfect example of what I mentioned in the thread on “Why do people lie on the internet”…..that pointing out the “lie”/bamboozle results in a doubling down.
It’s a bit like the anti vaxx sentiments you can read online…..eerily similar iterations from seemingly different sources (oftentimes right down to misspelled words…..a dead giveaway to, say, a 6th grade teacher looking for cheating or plagiarism in a class book report)
It’d be an amusing project for someone with time to waste…..to set about tracking down the first example of such nonsense/historical revisionism.
My best friend believes that some tribes never had tooth decay. He thinks he has all the evidence. Imagine the internet agrees with him.
Then there were the three out of 38 Passovers that are beloved host mentioned studies that Jews were not in Egypt because the evidence had slaves eating pork. Bones were found from pigs. He was saying this out of the side of his mouth as humor. What we failed at that time to realise, Moses set the laws upon exodus from Egypt. Of course Jews were eating pork until Exodus.
Dad has bad teeth his entire life. More dentist’s bills than are conceivable, but he’s a doctor and was seen for free by the first dentist. Then the dentist’s son saw him for free or half price for years.
My teeth are excellent. I have had one root canal and no cavities since age 18. I am 62.
That is a conclusive study of 3 people. On the internet, it is worth 20 pounds of gold, minimally. We just need more believers.
