TRI TIMO KUUSELAN BLOGI JATKUU TÄSTÄ....

Lääketieteen tohtori Timo Kuusela kirjoittaa blogissaan ajatuksiaan terveydestä, ravitsemuksesta ja lääketieteestä.

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Timo Kuusela
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TRI TIMO KUUSELAN BLOGI JATKUU T?ST?....

ViestiKirjoittaja Timo Kuusela » 10 Tammi 2009 22:49

Nykyaikaa ja historiaa
L??ketieteellinen aikakauskirja DUODECIM raportoi lyhyesti vuoden 2009 ensimm?isess? numerossa: Non-HDL on se paha kolesteroli. Sill? tarkoitetaan seerumin kokonaiskolesterolin ja HDL-kolesterolin erotusta. N?kemys perustuu Kastelein JP ym:n Circulation lehdess? ilmestyneeseen julkaisuun (2008).
Non-HDL-kolesteroliin luetaan LDL:n lis?ksi VLDL-, IDL- ja Lp(a)- lipoproteiinit, maksan verenkietoon tuottamat de novo rasvat.
"Voisi olla selke?mp?? valita Non-HDL-kolesteroliarvo "kolesterolin" hoitotavoitteeksi LDL:n sijasta" (puhumattakaan kokonaiskolesterolista - yli 5 mmol/l kuuluu hoitaa!). Non-HDL-kolesterolin raja-arvo voisi olla 2,6 mmol/l. (Pid?n t?t? korkeana).
Non-HDL tietenkin sis?lt?? niin vaarattomat kuin vaaralliset lipoproteiinit.
Nyt kuitenkin t?rm?t??n hoidolliseen ongelmaan. Statiinien vaikutus kohdistuu etup??ss? LDL-lipoproteiiniin. Sill? ei ole juurikaan vaikutusta korkeaan trigyseridiin. Kunnon tuloksen saavuttamiseksi hoitoarsenaalia pit?isi kasvattaa etsetimidill?, nikotiinihapolla, fibraatilla ja t?ss? yhteydess? mainitaan jo kalarasvat.
Muistelen itsekin aikaisemmin kirjoittaneeni Non-HDL-kolesterolista.
P??asia on, ett? n?kemykset tarkentuvat.
Er??nlainen keh?? kiert?v? ajattelu on "kolesteroli"-ongelmassa vallinnut viitisen vuosikymment?.
Onnituin saamaan aika vanhoja tutkimuksia, 1950 ja -60 lukujen vaihteesta. Ancel Keys ja Henry Blackburn pohtivat yhdess? sepelvaltimotaudin taustoja (Progress in Cardiovascular Diseases Vol., 6, No. 1 (July) 1963) T?m? ty? lienee kaikkien kolesteroliteorian kannattajien arkistoissa ja mieliss?.
Albrink - Man julkaisivat v?h?? aikaisemmin (1958) hyv?n tutkimuksen, jossa triglyseridi osoitettiin n?ytt?v?sti todenn?k?isimm?ksi syyksi infarktipotilailla. Se ei paljoa painanut. Nyt taas painaa.
Rasvan sy?ti? sitten opittiin kammoksumaan. Pakko se oli jollakin korvata. Valkuaisesta ei ole korvaajaksi. Piti painottaa (sokeri)hiilihydraatteja. T?ll? lihavuutta, SV-tauteja ja II-diabetest? lis??v?ll? tiell? olemme Suomessa edelleen. Muusta ei saa puhua tai kirjoittaa, ei ainakaan julkaista. USA:ssa ja Ruotsissa v?itell??n ankarasti. Suosituksestkin siell? muuttuvat.
Timo Kuusela, LKT, radiologi, eläk.

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Timo Kuusela
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ViestiKirjoittaja Timo Kuusela » 20 Tammi 2009 11:53

Lis?? tutkittua tietoa:
On kulunut vajaa kuukausi siit?, kun Amerikan diabetesliitto (ADA) julkaisi my?s t?ss? blogissa kommentoimani edistyksellisen ravintopyramidin.
T?n? aamuna luin samasta julkaisusta tutkimuskommentin:

DiabetesHealth 14.01.2009:

More than 95 % of the patients on the extreme low-carb diet were able to reduce or even eliminate their diabetes medications. The catch is that they restricted their carb intake to 20 or fewer grams per day, a radical amount compared to the ADA?s recommended daily minimum of 130 grams
Extremely Low-Carb ?Ketogenic Diet? Leads to Dramatic Reductions in Type 2 BG Levels, Medications
Jan 14, 2009
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Two diets - one severely restricting carbohydrate intake but with no limit on calories, and the other emphasizing low-glycemic carbohydrates and low calories - allowed high percentages of obese type 2 patients in a university study to reduce or even eliminate their diabetes medications (95.2 percent of the patients on the extreme low-carb diet and 62.1 percent of the patients on the low-glycemic diet).

Researchers at Duke University Medical Center assigned 84 patients to one of two diets over a 24-week period. The first, called a "ketogenic diet," restricted carbohydrate intake to 20 or fewer grams per day, a radical amount compared to the ADA's recommended daily minimum of 130 grams and even to low-carb advocate Dr. Richard K. Bernstein's 30-grams-per-day recommendation.

In a ketogenic diet, the body is forced to use fat to provide energy, a process that produces a metabolic product called ketones.

The other diet stressed the consumption of low-glycemic foods, which are absorbed slowly by the body and do not cause spikes in blood sugar levels. The diet also severely restricted daily caloric intake to 500 calories. That drastically low number came about because the study was designed to test intense approaches to treating obese people with diabetes whose previous forms of diet and management had not worked.

Although both diets produced substantial improvements in patients, the ketogenic diet was clearly more effective. While Duke researchers did not always spell out the actual measurements produced by each diet, they said that the ketogenic group enjoyed lowered A1cs, greater weight loss, and a larger increase in "good" cholesterol compared to the low-glycemic group.

The medical center quoted Dr. Eric C. Westman, who led the study, as saying, "It's simple. If you cut out the carbohydrates, your blood sugar goes down and you lose weight, which lowers your blood sugar even further. It's a one-two punch." In fact, reports Reuters, the Duke researchers concluded that "lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes."
Timo Kuusela, LKT, radiologi, eläk.

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Timo Kuusela
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ViestiKirjoittaja Timo Kuusela » 27 Tammi 2009 12:56

On mielenkiintoista seurata Amerikan diabetesliiton (ADA) ajattelutavan kehityst?.
Korostan taas kerran, ett? tuollaisten ry-tyyppisten yhdistysten pystyss? pit?minen vaatii tehokasta varainhankintaa. Sama koskee kotoista Diabeteliitto ry:t?. Mainosmarkat ovat budjetissa iso tekij?. Mainostajia on kohdeltava ymm?rtav?isesti ja niinkuin n?ytt?? sielunsakin myyden.
(Sokeri)hiilihydraatteja rajoittava ravitsemuslinjaus n?kyy voimakkaimmin uudessa supermodernissa ravintopyramidissa (yll?).
T?h?n kopioin DiabetesHealth-lehdest? bongaamani artikkelin. Mukana ei ole kuvia ja valitettavasti kieli ei kaikille avaudu.

Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat
Richard D. Feinman, PhD
Dec 25, 2008
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Richard D. Feinman, PhD, is Professor of Biochemistry at State University of New York Downstate Medical Center, co-editor-in-chief of the journal Nutrition & Metabolism, and Director of the Nutrition and Metabolism Society (www.nmsociety.org).

Diabetes may be described as a disease of glucose intolerance: high blood glucose is both the characteristic indicator and the cause of complications.

The loss of control of glucose metabolism is what makes a low carbohydrate diet a good therapeutic approach, and it's why I'm astonished that experts encourage people with diabetes to eat carbohydrates and then "cover" them with insulin [1].

I am also surprised to hear negative reactions to carbohydrate restriction from people who have actually seen the deleterious effects of high dietary carbohydrate on people with diabetes. On that note, I offer my personal rebuttal to Hope Warshaw's recent article, "Why You Don't Want to Go Low Carb or Vegan," April/May 2007.

Ms. Warshaw's argument is that "avoiding carbohydrate, as some low carb diets suggest, does not entirely return blood glucose levels to the normal range after meals." Well, depending on the patient, sometimes blood glucose does return to normal. In any case, ingesting carbohydrate raises blood glucose.

Ms. Warshaw goes on to say, "Second, an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber." I thought fuel is just what we are trying to reduce. And does anybody think that having to take a vitamin supplement is in the same ballpark as injecting insulin? And how healthy is an eating plan that requires medication?

At the 2004 Brooklyn conference on the Nutritional and Metabolic Effects of Low Carbohydrate Diets, William Yancy, Jr., of Duke University described his research with type 2 patients. After sixteen weeks on a low carbohydrate diet, seven of the 21 patients discontinued their medication and ten of the 21 reduced their medication. During the post-lecture discussion, two physicians "warned" that doctors should not put diabetic patients on a low carbohydrate diet without first reducing their medication.

Of course, if you are taking medication, you should reduce carbohydrates only with medical supervision. In most diseases, however, a reduction in medication is considered a sign of improvement. Why would Ms. Warshaw recommend a diet that requires more medication?

It strikes me as odd that what most experts know about metabolism - diabetes is, after all, a metabolic disease - they learned in medical school from somebody like me [2]. The first thing we teach medical students at Downstate Medical Center is that there is no biological requirement for carbohydrate.

It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose.
Figure 1A. Macronutrient consumption during the diabetes epidemic. Data from National Health and Nutrition Examination Survey (NHANES). Absolute caloric consumption from surveys for indicated years. Top of charts: per cent consumption from 1971-74 vs. 1999-2000.
Figure 1B. Incidence of diabetes by year. Data from National Center for Health Statistics.

The second thing we teach medical students is that almost all the increased caloric intake during the ongoing epidemic of obesity and diabetes has been due to an increase in consumption of carbohydrate and a decrease in the consumption of fat (Figures 1A and B). When you look at the foods whose consumption increased during the diabetes epidemic, you see that cereals and grains are among the major ones. (Of course, almost everything increased except red meat and eggs.)

So what is Ms Warshaw's complaint? Well, she points out that "studies that compare low carb diets to conventional diets demonstrate early initial weight loss and improvement in other health parameters, such as blood glucose control ([3]). But studies of low carb diets that last longer than six months do not show significantly more weight loss."

Something's wrong here. Because low carb diets do the same as traditional diets after one year, then you don't want to be on a low carb diet? If they are equal, why doesn't that mean that you don't want to be on a traditional diet? In any case, what is rarely mentioned is that in the study in reference [3], the diets were quite different at six months; as the study proceeded, however, the low carb group added back more carbohydrate. The lesson is clear: the more carbohydrate, the worse the weight control. And the long-term outcomes were not the same. Triglycerides and HDL (healthy cholesterol) were much better on the low carb diet than the low fat diet (Figure 2).
Figure 2. Results at 6 months and 1 year for a multicenter study in which obese men and women were assigned at random to a low-carbohydrate diet or a conventional low-fat diet. Data from reference [3].

Reference [3] is important for showing the general health benefits of low carb diets even when a difference in weight was not maintained, but that study did not include people with diabetes. What happens in those people? Figure 3 shows the results from a controlled ward study of ten diabetic patients before and after three weeks on a strict low-carbohydrate diet [4]. The figure shows the dramatic reduction in insulin fluctuation and, on average, the "return of blood glucose levels to the normal range after meals." Patients were content with the diet, lost weight, had improved lipid profiles, and increased insulin sensitivity by 75 percent.

I don't know of any study on any other diet that shows such good effects on controlling glucose and insulin without increasing drugs. And it's not just the glycemic control. We recently summarized data in the literature showing that all of the features of the so-called metabolic syndrome-high triglycerides, low HDL, hypertension and obesity-are exactly the features that are improved by low carbohydrate diets [5]. If we had been describing a drug, everybody would have rushed out to buy stock in our pharmaceutical company.
Figure 3. Glucose and insulin levels for patients before or after 3 weeks of a low carbohydrate diet. Data from reference [4].

Ms. Warshaw's complaint is that these studies "show that many study subjects drop out of the study and are unable to stick with the diet." She does not mention that the drop-out rate from the low fat diet was the same as from the low carb diet; that's generally true of the many low carbohydrate studies. In any case, wouldn't it be good for diabetes counselors to encourage compliance rather than to dissuade people from a strategy that actually works for the many people who follow it?

You might want to think twice before you let Ms Warshaw tell you what you don't want to do. "You'll have type 2 diabetes for the rest of your life, and you'll likely struggle with weight management throughout your life as well." She seems to be saying that you may as well go ahead and eat candy because it's all hopeless. There are, however, several sites on the Internet that provide a more hopeful look at managing diabetes with carbohydrate restriction; for example, D-solutions (www.dsolve.com) and Dr. Richard Bernstein's forum (http://www.diabetes-book.com).

I am most concerned that if Ms. Warshaw really had something positive to offer, she wouldn't need to dissuade people from making their personal choice. Candy followed by insulin is not good enough.

1. American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes-2006. Diabetes Care 2006, 29:2141-2157.
2. RD Feinman, M Makowske: Metabolic Syndrome and Low-Carbohydrate Ketogenic Diets in the Medical School Biochemistry Curriculum. Metabolic Syndrome and Related Disorders 2003, 1:189-198.
3. GD Foster, HR Wyatt, JO Hill, BG McGuckin, C Brill, BS Mohammed, PO Szapary, DJ Rader, JS Edman, S Klein: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003, 348:2082-90.
4. G Boden, K Sargrad, C Homko, M Mozzoli, TP Stein: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005, 142:403-11.
5. JS Volek, RD Feinman: Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005, 2:31/ Available without subscription at (www.nutritionandmetabolism.com/content/ ... 5-2-31.pdf)
Timo Kuusela, LKT, radiologi, eläk.

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ViestiKirjoittaja Timo Kuusela » 31 Loka 2010 20:03

Pitk?ksi ven?hti kirjoitusv?li sivuston uusimisen vuoksi. No ei haittaa.
Meill? painotetaan voimakkaasti liikunnan autuaaksi tekev?? terveysvaikutusta. Tuli sit?kin kokeilluksi:

L?hdimme Malagasta ajelemaan kohti koti-Suomea 26.10. Suomen laivaan (ms Sealady) kirjauduttiin illalla 28.10. Kolmessa p?iv?ss? tuli siis ajetuksi (omak?tisesti) melko tarkkaan 1000 km p?iv?etapit eli yhteens? hilkun vajaat 3000 km.
Ajov?li?in? piti tietenkin yritt?? lepoa hotellissa. Seniili petipako piti siit? huolen, ett? y?uni j?i 2 - 3 tuntiin. En k?yt? unil??kkeit?. Matkan j?lkeen yksi 10 tunnin nukuttu y? riitti toipumiseen ja t?n??n on aloiteltu halkosouvia.
Varmaan sitten liikunta pit?? kunnossa.
Timo Kuusela, LKT, radiologi, eläk.

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ViestiKirjoittaja Timo Kuusela » 01 Marras 2010 17:30

Uutisvuoto raportoi rajusti:

ILTALEHTI/Keskustelut

Viimeisin juttu tuntui tutulta. Oli siell? muitakin kansan kaikuja.

En pid? tilannetta hyv?n?. L??ketiede on menett?m?ss? uskottavuuttaan. Kohta hoidossa ei luoteta kuin leikkaaviin partureihin ja kirurgeihin.
Timo Kuusela, LKT, radiologi, eläk.

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ViestiKirjoittaja Timo Kuusela » 01 Marras 2010 17:43

Pari viikoa sitten halvaantuva vanhus odotti l??k?rin pyyt?m?? ambulanssikuljetusta 2,5 tuntia - ja halvaantui ilmeisesti vuoteessa hoidettavaksi (jos s?ilyi hengiss?). Liuotushoidon etsikkoaika on lyhyt.
Asiasta p??tti h?lytyskekuksen ty?ntekij? - ohjettensa puitteissa. Osaamista n?iss? asioissa ei en?? tarvitakaan. Asiaa tutkitaan. Kai pieni virkaihminen saa satikutia? Tuskin ylempi? byrokraatteja tukistetaan. N?inh?n asia yleens? etenee.

L??k?rilehdess? oli uutinen, jonka mukaan vammaiset reagoivat. T?m?h?n saatta nykytulkinnan mukaan koskettaa ket? hyv?ns?, joka asustaa miss? hyv?ns? (tuki)asuntomuodossa paitsi kotonaan.

Vammaisfoorumi huolestui ensihoidosta
Julkaistu 01.11.2010 12.51
Vammaisfoorumi muistuttaa, ettei ket??n saa asettaa huonompaan asemaan ensihoidon saamisessa vamman tai sairauden tai asuinpaikan perusteella.
Vammaisfoorumi ry korostaa lausunnossaan ensihoitopalveluista annettavasta asetuksesta, ett? ensihoito-ohjeiden on perustuttava perustuslakiin.
Asetusluonnoksen mukaan sairaanhoitopiirin tulee laatia ensihoitopalvelun toiminta-alueen h?lytys- ja muuta ensihoitopalvelua koskevat ohjeet. Lis?ksi ensihoitopalvelun palvelutasop??t?ksess? m??ritell??n palvelun saatavuus, taso ja sis?lt?.
Vammaisfoorumin mukaan ohjeisto ei saa rajoittaa hoitoa ihmiselt? esimerkiksi sen perusteella, ett? h?nell? on jokin vamma tai sairaus tai ett? h?n asuu hoitolaitoksessa, palveluasunnossa tai muussa vastaavassa yksik?ss?.
? Ensihoito-ohjeissa ja esimerkiksi kiireellisyysluokituksissa tulee ottaa perustuslain s??nn?kset huomioon. Ket??n ei saa asettaa huonompaan asemaan esimerkiksi sen perusteella, ett? h?nell? on jokin vamma tai sairaus tai ett? h?n asuu hoitolaitoksessa, palveluasunnossa tai muussa vastaavassa yksik?ss?. Kaikilla kansalaisilla pit?? olla samanlainen mahdollisuus saada ensihoitoa, todetaan Vammaisfoorumin lausunnossa sosiaali- ja terveysministeri?lle.
Vammaisfoorumin 28 j?senj?rjest?? edustavat yhteens? noin 320 000 vammaista ja pitk?aikaissairasta henkil?
Timo Kuusela, LKT, radiologi, eläk.


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