Newsgroup: it.scienza.medicina
Titolo: Dieta, sovrappeso e diabete: le strade del Signore...

...sono infinite, a quanto pare leggendo l'abstract di un recente
articolo scientifico, secondo cui vari tipi diverse di dieta -incluse
low carb, low glycemic, low fat vegane, low fat tradizionali, ecc.-
hanno mostrato efficacia nel controllo del peso, fattore chiave nella
gestione del diabete 2, e nessuna  dieta pu� vantare di essere
chiaramente la migliore. Probabilmente, la dieta pi� efficace � quella
pi� adatta al singolo paziente, quella con cui si trova meglio e con
cui resiste sul lungo periodo.
    Nutritional strategies in type 2 diabetes mellitus.
    Weight loss is a key goal in the management of patients with type
2 diabetes mellitus. There are conflicting weight-loss strategies,
including low-carbohydrate diets, low glycemic-index diets, low-fat
vegan diets, conventional low-fat diets, and high-protein and high-
monounsaturated fat diets. There is no evidence to suggest that 1
nutritional strategy is clearly the best. The most successful strategy
is one that the patient can adopt and follow in the long term. (c)
2009 Mount Sinai School of Medicine.
Mt Sinai J Med. 2009 Jun;76(3):257-68.
http://www.ncbi.nlm.nih.gov/pubmed/19421969
Contemporaneamente, un'altra ricerca (su quasi 5 mila over65 seguiti
per dieci anni) conferma  l'importanza dello stile di vita anche nelle
persone anziane nell'insorgenza del diabete. Chi si mantiene attivo
fisicamente, mangia fibre e grassi di qualit�, non indulge troppo in
Bacco e tabacco, e tiene a bada la ciccia e il girovita (92 cm max per
gli uomini, 88 per le donne), ha probabilit� inferiori dell'89
percento di manifestare il diabete.
    Lifestyle risk factors and new-onset diabetes mellitus in older
adults: the cardiovascular health study.
    Divisions of Cardiovascular Medicine, Department of Medicine,
Brigham and Women's Hospital, Harvard School of Public Health
[...]
 METHODS: We prospectively examined associations of lifestyle factors,
measured using repeated assessments later in life, with incident
diabetes mellitus during a 10-year period (1989-1998) among 4883 men
and women 65 years or older (mean [SD] age at baseline, 73 [6] years)
enrolled in the Cardiovascular Health Study.
Low-risk lifestyle groups were defined by physical activity level
(leisure-time activity and walking pace) above the median; dietary
score (higher fiber intake and polyunsaturated to saturated fat ratio,
lower trans-fat intake and lower mean glycemic index) in the top 2
quintiles; never smoked or former smoker more than 20 years ago or for
fewer than 5 pack-years; alcohol use (predominantly light or
moderate); body mass index less than 25 (calculated as weight in
kilograms divided by height in meters squared); and waist
circumference of 88 cm for women or 92 cm for men. The main outcome
measure was incident diabetes defined annually by new use of insulin
or oral hypoglycemic medications. We also evaluated fasting and 2-hour
postchallenge glucose levels. RESULTS: During 34,539 person-years, 337
new cases of drug-treated diabetes mellitus occurred (9.8 per 1000
person-years). After adjustment for age, sex, race, educational level,
and annual income, each lifestyle factor was independently associated
with incident diabetes. Overall, the rate of incident diabetes was 35%
lower (relative risk, 0.65; 95% confidence interval, 0.59-0.71) for
each 1 additional lifestyle factor in the low-risk group. Participants
whose physical activity level and dietary, smoking, and alcohol habits
were all in the low-risk group had an 82% lower incidence of diabetes
(relative risk, 0.18; 95% confidence interval, 0.06-0.56) compared
with all other participants. When absence of adiposity (either body
mass index <25 or waist circumference < or =88/92 cm for women/men)
was added to the other 4 low-risk lifestyle factors, incidence of
diabetes was 89% lower (relative risk, 0.11; 95% confidence interval,
0.01-0.76). Overall, 9 of 10 new cases of diabetes appeared to be
attributable to these 5 lifestyle factors. Associations were slightly
attenuated, but still highly significant, for incident diabetes
defined by medication use or glucose level. CONCLUSION: Even later in
life, combined lifestyle factors are associated with a markedly lower
incidence of new-onset diabetes mellitus.
Arch Intern Med. 2009 Apr 27;169(8):798-807.
http://www.ncbi.nlm.nih.gov/pubmed/19398692

 non indulge troppo in Bacco e tabacco,
Mi pare che ci sia una differenza. Le parole "never smoked
or former smoker more than 20 years ago or for fewer than
5 pack-years" significano che l'optimum � non avere mai fumato
o avere smesso da 20 anni o fumare meno di 5 pacchetti all'anno.
Invece le parole "alcohol use (predominantly light or moderate)"
mi sembra che significhino che chi beve poco � pi� protetto
di chi � astemio.
Bye,
  *GB* 

 chiaramente la migliore.
E della dieta del Paleolitico che ne pensi?
 
http://www.ncbi.nlm.nih.gov/pubmed/19604407
  (2009)
   Beneficial effects of a Paleolithic diet
   on cardiovascular risk factors in type 2 diabetes:
   a randomized cross-over pilot study.
 "Our aim was to compare the effects of a Paleolithic ('Old Stone Age')
 diet and a diabetes diet as generally recommended on risk factors for
 cardiovascular disease in patients with type 2 diabetes not treated
 with insulin. METHODS: In a randomized cross-over study, 13 patients
 with type 2 diabetes, 3 women and 10 men, were instructed to eat
 a Paleolithic diet based on lean meat, fish, fruits, vegetables, root
 vegetables, eggs and nuts; and a Diabetes diet designed in accordance
 with dietary guidelines during two consecutive 3-month periods."
 "Compared to the diabetes diet, the Paleolithic diet resulted in
 lower mean values of HbA1c (-0.4% units, p = 0.01), triacylglycerol
 (-0.4 mmol/L, p = 0.003), diastolic blood pressure (-4 mmHg, p = 0.03),
 weight (-3 kg, p = 0.01), BMI (-1 kg/m2, p = 0.04) and waist circumference
 (-4 cm, p = 0.02), and higher mean values of high density lipoprotein
 cholesterol (+0.08 mmol/L, p = 0.03). The Paleolithic diet was mainly
 lower in cereals and dairy products, and higher in fruits, vegetables,
 meat and eggs, as compared with the Diabetes diet. Further, the
 Paleolithic diet was lower in total energy, energy density, carbohydrate,
 dietary glycemic load, saturated fatty acids and calcium, and higher
 in unsaturated fatty acids, dietary cholesterol and several vitamins.
 Dietary GI was slightly lower in the Paleolithic diet (GI = 50) than
 in the Diabetic diet (GI = 55). CONCLUSION: Over a 3-month study period,
 a Paleolithic diet improved glycemic control and several cardiovascular
 risk factors compared to a Diabetes diet in patients with type 2 diabetes."
Notare che "lean meat" significa "carne magra". Credo che in quello
studio carne, pesce e uova fossero cotti (le uova magari fritte).
Ma secondo me, nel Paleolitico almeno le uova se le ingurgitavano
crude (e forse anche una parte del pesce lo mangiavano crudo).
Comunque, 3 donne e 10 uomini sono troppo pochi per dare una vera
significanza statistica a quello studio. Ma che gli ci voleva a
reclutarne di pi�? A volte mi chiedo se i fondi per le ricerche
non vengano dissipati deliberatamente...
Bye,
  *GB* 

 E della dieta del Paleolitico che ne pensi?
Credo che valga anche in questo caso quanto detto: le strade del
Signore... La dieta giusta � quella che funziona per te, quella con
cui ti trovi meglio e riesci davvero a seguire per lunghi periodi :)
Bisogna sempre fare i conti con l'adherence rate.
Ovvero, i conti vanno fatti non solo sui "successi" degli entusiasti,
ma anche su quelli che provano a seguire la dieta e falliscono, o non
ci provano nemmeno perch� non si incastra per nulla nel loro stile di
vita, nei loro gusti, nell'organizzazione sociale...
Ammesso che l'uomo "paleo" stia in gran forma, quanti riusciranno a
fare il paleo e quanto a lungo?