These included record-breaking opioid settlements, a new treatment for cystic fibrosis, the promise and peril of large IT brands like Google and Apple moving into the healthcare space, and a devastating outbreak of serious lung disease in healthy young persons from vaping illicit THC.
But in terms of the health story with the greatest potential for taming sickness and the ballooning cost of healthcare, a case can be made for the recognition by health officials in 2019 of the ketogenic diet as a first line-treatment for type 2 diabetes.
The ketogenic diet, as many by now know, is a low-carb diet on steroids, a calorically-unrestricted eating pattern in which just 10-20% of daily calories (or less than 50 grams) come from carbohydrates, with dietary fat making up the majority of remaining energy (roughly 70% of daily calories).
Type 2 diabetes, on the other hand, is an acquired metabolic disorder affecting 340,000 Minnesotans and 30 million Americans, one that currently extracts $250 billion in direct costs each year in the US, and which can lead to heart disease, hypertension, Alzheimer’s, amputation, blindness and cancer.
Because it is often accompanied by obesity, type 2 diabetes is routinely attributed to overeating and lack of exercise, but a more precise description of its mechanism comes down to an elevation of the body’s hormone insulin. Given that the body only releases insulin in response to dietary carbohydrates, type 2 diabetes is arguably a food-borne illness, with the food in question being carbohydrates. That is the rationale, in any event, for treating the predominant illness of our time with a ketogenic diet.
“We need to recognize that conventional diets have not worked well, and reduce the scientific barriers to studying novel approaches, like the ketogenic diet,” says Dr. David Ludwig, an endocrinologist at Boston Children’s Hospital and professor of pediatrics at Harvard Medical School, in an email to Forum News Service. “These long-term studies will provide the definitive data to understand effectiveness for various chronic conditions, and potential side-effects.”
Ludwig recently authored a paper in the Journal of Nutritioncompiling the evidence for ketogenic diets, past and present, a paper complete with a section heading noting there is no human requirement for dietary fiber or carbohydrate. “A century ago,” he reminds readers, “the ketogenic diet was a standard of care in diabetes, used to prolong the life of children with type 1 diabetes and to control the symptoms of type 2 diabetes in adult.”
It was only following the discovery of insulin in the 1920s, Ludwig writes, that high carbohydrate diets gave us our present day medication protocols for type 2 diabetes, treatments anchored by the use of pricey commercial insulin analogs and daily ingestion of glucose-control medications.
Ludwig says he wrote the article to counter “a spate of negative articles (that) have been rewritten about the ketogenic diet by nutrition experts,” articles focusing on rare side-effects.
‘Viable approach’
The case for keto in 2019 kicked off in May, when the American Diabetes Association released a Consensus Report calling low carbohydrate or very low carbohydrate diets a “a viable approach” for certain patients with T2D, including those hoping to reduce medications.
Describing the diets as “among the most studied eating patterns for type 2 diabetes,” the nation’s diabetes authorities added the caveat that ketogenic therapy for diabetes generally requries medical oversight to prevent hypoglycemia. In other words, keto can work so effectively in diabetics that should patients fail to carefully taper medications with medical guidance as their condition improves, they can become dangerously overmedicated.
June of 2019 saw the release of still more arguments for keto, in the form of second-year trial results by researchers from Indiana University Health and Verta Health. Their non-randomized clinical trial of the diet produced data showing that more than half of 262 patients studied had reversed their illness on a remote-monitored ketogenic diet, with many having discontinued the need for all medications except for Metformin.
While noting that the Verta Health results should be interpreted with caution, Ludwig says these “exceptional outcomes at two years, with many participants coming off diabetes medications and improving blood glucose control, highlights the exciting possibility that diabetes can be reversed without bariatric surgery.”
The arrival of keto for type 2 diabetes comes along at a time when the standard of care is increasingly coming up short. The year saw widespread shortages and price hikes for insulin, leading politicians to threaten price control legislation and stirring insurers to issue competing press releases touting their full- or highly discounted insulin coverage packages.
As endocrinology researchers from Mayo Clinic recently wrote in the journal BMJ, “the body of evidence shows no meaningful benefit” for intensive glucose-lowering regimens when it comes to the health outcomes that matter most to patients. And as researchers from Norway confirmed in 2018, telling high-risk individuals the advice to eat more “fiber and polyunsaturated fat,” plus the familiar five servings of fruit and vegetables with “plentiful intake” of beans, wholegrain and low-fat dairy, produced no improvement either.
For its part, the device industry is taking steps to build a ketogenic diabetes care product line, offering portable ketone breath meters and continuous glucose monitors allowing patients to see the effects on their blood sugar of carbohydrate rich foods in real time.
Still to be determined is whether dietary officials will heed the call by groups like the Low-Carb Action Network to include a true low-carbohydrate diet in the next installment of the dietary guidelines. Under the current USDA definition, diets up to 45% carbohydrates, are deemed low-carbohydrate, a too-high allowance for carbohydrates potentially washing out the ability of researchers to accurately test the intervention for disease reversal and prevention.
Its new research on an old method. As Ludwig notes, “before insulin was discovered, a very-low-carbohydrate diet was considered the standard of care for diabetes. From this perspective, modern nutrition science may be in the process of ‘rediscovering the wheel,’ so to speak.”
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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