Small low-carb study...

[eevee]

NEW YORK (Reuters Health) Sept 23 - Intake of a high-protein, low-carbohydrate diet for 5 weeks was associated with a marked reduction in blood glucose levels in patients with untreated type 2 diabetes, according to a small study published in the September issue of Diabetes.

"Potentially, this could be a patient-empowering way to ameliorate hyperglycemia without pharmacological intervention," co-authors Dr. Mary C. Gannon and Dr. Frank Q. Nuttall, from the University of Minnesota in Minneapolis, note. However, further studies are needed to evaluate the long-term effects of such a diet, they add.

The findings stem from a crossover study of eight men with type 2 diabetes. For 5 weeks, the subjects consumed a diet with a carbohydrate to protein to fat ratio of either 20:30:50 (test diet) or 55:15:30 (control diet). After a 5-week washout period, the subjects then consumed the opposite diet for 5 weeks.

The test diet, designed to be weight maintaining and nonketogenic, was referred to as the low-biologically-available-glucose (LoBAG) diet.

The average 24-hour glucose levels at the end of the LoBAG and control diet phases were 126 and 198 mg/dL, respectively. The corresponding HbA1c percentages were 7.6 and 9.8.

The HbA1c percentage was still falling at the end of the LoBAG diet phase. Based on this, the researchers estimate that the final HbA1c percentage was between 6.4 and 5.4.

Other changes associated with the LoBAG diet included decreased insulin levels and increased glucagon levels. By contrast, no change in the cholesterol level was observed.

"A LoBAG diet can dramatically reduce the 24-hour integrated glucose concentration and consequently the percentage of glycohemoglobin in people with type 2 diabetes," the investigators conclude.

Diabetes 2004;53:2375-2382

Cheers.....Eve

[Ashtur]

I'm not positive, but I believe that's a study I'd seen some prelim work on a few months ago, and if I'm right, it's worth noting that it was pretty heavily protein shifted.... low carb, low (to low-mod) fat, and more protein... things like turkey.

[MarkMunday]

This is interesting. That a LoBAG diet should reduce blood glucose levels is to be expected. After all, glucose is what makes blood sugars go up in the first place. What is more significant is that eating more protein and fat didn't change cholesterol levels.

Cheers,

Mark

[eevee]

What is more significant is that eating more protein and fat didn't change cholesterol levels...
...'cause excess cholesterol is 'manufactured' from excess carbs ....

Also noteworthy is the fact that no-one disappeared into hypo land (a place where few diabetics want to visit) by eater a smaller proportion of carbs, and that the HbA1c continued to improve.

Eve

[KLD]

This is exactly what I've been describing as my own experience with a low carb diet - normal, stable blood sugar control and better than normal cholesterol/triglycerides. I've also seen my blood pressure improve greatly (approximately 115/73), the neuropathy in my feet reverse itself over a period of a few months, and my energy level and general feeling of well-being improve significantly. So I wasn't at all surprised by the results of this study - I'd have been surprised if the results had been different.

Karen

[pacon]

Originally posted by eevee
Also noteworthy is the fact that no-one disappeared into hypo land (a place where few diabetics want to visit) by eater a smaller proportion of carbs, and that the HbA1c continued to improve.

Eve

Am I missing something here? The test persons had untreated typ2 diabetes. From what could they get hypos?

[eevee]

Of course a T2 can have a hypo...just do extra, unexpected 'exercise'and/or unwittingly cut out carbs, and it will be no problem......a defective pancreas is a defective pancreas, whomever it belongs to.

Eating fewer carbs is what all diabetics fear... a fear placed in us by the high-carb advocates (i.e. most diabetes assn..). Eating practically unlimited carbs (..and cover with meds/insulin/..lol..) is exactly the regimen that has brought about today's major problems with treated/untreated diabetes----T1 or T2 ..!!

The only winners in a high carb diet are the pharmaceuticals, and potato and wheat growers.

If one believes that low-carb necessarily means Atkins, then my suggestion of lower carbs is misunderstood...low and lower are two quite different adjectives.

Try actually, genuinely, lowering carbs for a week and then tell me I am wrong. Just cutting bread and spuds will do it..!!

Eve

[Harold]

Originally posted by eevee
Of course a T2 can have a hypo...just do extra, unexpected 'exercise'and/or unwittingly cut out carbs, and it will be no problem......a defective pancreas is a defective pancreas, whomever it belongs to.

From endocrineweb (http://www.endocrineweb.com/diabetes/) ; Diabetes is correctly divided into two major subgroups: Type 1 diabetes and Type 2 diabetes. This division is based upon whether the blood sugar problem is caused by insulin deficiency (Type 1) or insulin resistance (Type 2). Insulin deficiency means there is not enough insulin being made by the pancreas due to a malfunction of their insulin producing cells. Insulin resistance occurs when there is plenty of insulin made by the pancreas (it is functioning normally and making plenty of insulin) but the cells of the body are resistant to it's action which results in the blood sugar being too high.
So by definition Type 2's have a normal functional pancrease. An actual hypo for a type 2 will not happen unless there is some other agent to cause it as in an oral med or injected insulin.

Eating fewer carbs is what all diabetics fear... a fear placed in us by the high-carb advocates (i.e. most diabetes assn..).
Back,not that long ago, when the only medication was insulin or one of the sulfonylureas I would have agreed, but not today we have better tools. What possible logic would make doctors reccomend eating foods that make glucose levels higher when high levels are the problem. It did not seem logical at first glance so I gave it some thought and here is what I speculate happened. When insulin was first developed, for Type 1 diabetes, the medical profession had trouble in figuring out how much insulin should any person take. The varience between people in the ratio of how much protein and fats were converted to glucose was too great, and sometimes varied in the same person over time. This made taking insulin like playing Russian Roulette. Carbohydrates conversion to glucose however are the same for everyone and consistant day in and day out. So recomending a very high carb diet, higher than recomended for a normal, negated the varience from proteins and fats to the point they did not need to be figured in to figure out how much insulin to take. This gave the profession a tool that made it easier to prescribe for and safer for type 1's to take insulin. Unfortunately for Type 2's the medical profession decided this was the best way to treat us. Completely disrgarding that eating high levels of carbs would increase insulin resistance and contribute to the progression of this desease.

Does this make any sense to anyone else?

[MarkMunday]

That is an interesting hypothesis, Harold. But, because consuming fat doesn't increase blood sugar, it doesn't work. Fat gets converted into ketones. And ketones can be used as a source of energy without insulin being required. Nutritionists and doctors have always been aware of this.

The problem arose because of a misunderstanding about the supposed dangers of consuming oils and fats. Fats got a bad rep because it was thought that consumption of them raises colesterol and leads to heart disease. Once this position had become entrenched, making carbohydrates the key source of energy in the diet seemed like the logical and sensible thing to do.

We now know better. Most of your cholesterol is manufactured in your liver. Consumed fat is really not responsible for heart disease. And high carbohydrate diets cause terrible metabolic problems.

It is becoming clear that adherence to the traditional USDA food pyramid has had disasterous public health consequences. But changing direction is proving challenging, to say the least ... :confused:

The Harvard School of Public Health Healthy Eating Pyramid (http://www.hsph.harvard.edu/nutritionsource/pyramids.html) represents a major change in nutrition thinking. And it is surprising that the diabetes care establishment hasn't been at the forefront of this revolution.

Cheers,

Mark

[Harold]

That is an interesting hypothesis, Harold. But, because consuming fat doesn't increase blood sugar, it doesn't work. Fat gets converted into ketones. And ketones can be used as a source of energy without insulin being required. Nutritionists and doctors have always been aware of this.
I've heard you say this before. Do you have a reference?

Fats are broken down into two components glycerol and fatty acids then these are then used to make triglycerides. Triglycerides may be stored in fat cells or burned in muscles. Reference (http://home.howstuffworks.com/food4.htm)

How fats get converted to glucose is a process called gluconeogenesis. Reference (http://www.howstuffworks.com/fat-cell4.htm)

Note of interest. The last referenced page states that brain cells only use glucose for energy. I have read somewhere that brain cells do not need insulin to use glucose. Does anyone have a link to a reference?

[Harold]

More on GLUCONEOGENESIS AND THE FORMATION OF KETONE BODIES. Found a couple of pages that give a better explanation of what's going on.

GLUCONEOGENESIS AND KETOGENESIS (http://academic.sun.ac.za/med_physbio/med_physiology/dept/footnote.htm)

POST-EXERCISE KETOSIS (http://academic.sun.ac.za/med_physbio/med_physiology/dept/ketosis.htm)

In the absense or low levels of blood glucose a process called gluconeogenesis occurs converting proteins and fats to glucose as well as ketones as a by product.

[JasonSmithMT]

Originally posted by Harold
Note of interest. The last referenced page states that brain cells only use glucose for energy. I have read somewhere that brain cells do not need insulin to use glucose. Does anyone have a link to a reference?

I have a couple references for you. First one from an 2001 article in Diabetes (http://www.findarticles.com/p/articles/mi_m0922/is_10_50/ai_80392926/pg_1).

Here is some text from what I consider one of the bible's of diabetes information Ellenberg and Rifkin's Diabetes Mellitus (Sixth ed. 2003):

page 117
Although there is some simple nosaturable diffusion of glucose across the blood-brain barrier, most transport across these membranes is effected by the facilitative glucose transporter GLUT-1. GLUT-1is also referred to as the red blood cell transporter, and is contrast to GLUT-4 is insensitive to the action of insulin.

…

Although the mail fuel supply of brain tissue is undoubtedly glucose originating from the bloodstream, there is increasing evidence that neurons may be able to metabolize nonglucose fuels. A number of alternate substrates may support neuronal metabolism in brain slice studies in which the blood-brain barrier is absent. During in vivo human studies, lactate and the ketone ß-hydroxybutyrate have been demonstrated to support, at least in part, brain metabolism and cognitive function during hypoglycemia. For some substrates , the physiological relevance of their metabolism by brain tissue is questionable. However, lactate appears to be a genuine brain fuel, with some in vivo studies even suggesting that lactate may be preferred over glucose neurons.

Jason

[lilly]

Fats are broken down into two components glycerol and fatty acids then these are then used to make triglycerides. Triglycerides may be stored in fat cells or burned in muscles.

its odd you should make that statement about fats being responsible for making triglycerides Harold as when i cut down my carbs and increased my dietrey fat,my tri's plummeted to next to nothing,in my opinon,its the carbs that cause high tri's,
http://www.healingdaily.com/conditions/triglycerides.htm

Contrary to popular belief, a low fat diet is NOT the solution to lowering high triglycerides levels. The researchers Van Horn and Lichtenstein extensively reviewed the low-fat approach a few years ago (5). Their research suggests that a low-fat diet will produce a result opposite to the desired effect: triglyceride levels will actually increase. This phenomenon is not surprising if one considers that insulin resistance may be one of the driving factors behind elevated triglyceride levels. In fact, insulin resistance may be the cause of many of the problems observed in high-triglyceride states.(6,7)

[KLD]

I posted my latest blood lipid levels in another thread recently, but I'll just repeat here that my triglyceride level dropped from 0.8 mmol/L (71 mg/dL)) to 0.6 (53) since my last test. That's after over two years on a low-carb, moderate-protein, high-fat diet. Since "normal" is considered 2.3 (200) or less, I'm very happy with that. That number, combined with my stable, normal blood sugars (last A1C was 5.0%) is all the evidence I need that this is the best way for me to manage my diabetes, and I'm sure I'm not the only one.

Karen

[lilly]

quote;
The only winners in a high carb diet are the pharmaceuticals, and potato and wheat growers.

If one believes that low-carb necessarily means Atkins, then my suggestion of lower carbs is misunderstood...low and lower are two quite different adjectives.

Try actually, genuinely, lowering carbs for a week and then tell me I am wrong. Just cutting bread and spuds will do it..!!'


i'm with you Eve,after over 4 years of low carbing,i know the effects it gives first hand,and thats with a very high fat,moderate protein and 30cgs a day diet,i have good cholesterol levels,no weight problems,live life to the full,have stable,very good bgs.like Karen too,what more could we ask for,we could go on citing studies about our respective WOE's all day but we can only really rely on the studies we do ourselves that we've proved works,high fat/low carb works for me,and many others,each to their own,i have no regrets about going low carb,its the best thing i ever did.

[MarkMunday]

Harold,

We may have been talking at cross purposes. In my earlier post, I was responding to your suggestion that insulin is required to process dietary fat. I didn't say that fats can't be used to synthesise glucose. As you rightly pointed out, the body synthesises glucose from other materials if no carbohydrate is available.

I was making the point that consuming fat doesn't increase blood sugar. You can test it for yourself by using this method. So consumption of fat does not affect the amount of insulin required to process carbs.

Cheers,

Mark

[eevee]

Thanks everyone for making this a most interesting thread....
.........Eve

[KLD]

It was interesting, Eve. Thanks for starting it.

Karen

[JasonSmithMT]

I'm curious to get a feel for what amount of carbs a day that some of you low carbers are consuming. I'm especially curious about those that are diet controlled only T2s.

In the study, assuming a 2000/calorie a day diet, the test diet would be 100g of carbohydrates/day and the control diet would be 275g of carbohydrates/day. That is if my math is correct.

Jason

[KLD]

I control my blood sugars with just diet, Jason, and have for more than two years now. The test diet referred to in the study is still higher in carbs than what many "low carbers" eat. The doctor who wrote the book I follow recommends 6 grams for breakfast and 12 grams for lunch, dinner, and a snack, if you need one. I have a snack of up to to 12 grams before I go to bed. So my total amount of carbs for the day is under 50 grams. As the forum doesn't allow promotion of commercial products, I have been asked not to "promote" the book on the forum, but if you're interested, send me a pm, and I'll give you more information, including a website. It's written by a medical doctor who has been a type 1 diabetic himself for over 60 years, but his advice is intended for diabetics of both types. I have found it incredibly helpful and strongly recommend it to all diabetics, whether they're interested in following a low carb diet or not. It is just so full of useful, practical information about diabetes that I think we all be aware of.

Karen

[eevee]

So by definition Type 2's have a normal functional pancrease
An actual hypo for a type 2 will not happen unless there is some other agent to cause it as in an oral med or injected insulin..

I said "...of course t2s can go hypo..." and they can..!!

Eve

[Harold]

Jason great article, yes I read the whole thing except for the footnotes. I was aware that there has been some disagreement over the function of insulin and glucose in respect to brain cells in the past. When I saw in in the page I linked to thought it was a good time to ask about it. The ability of brain cells to use other sources was a bonus. Do you have a link to the bible you quoted? Would you PM me the link if you do.

Thanks Harold

[Harold]

Lilly, No I did not mention HIGH TRIGLYCERIDE LEVELS nor was I implying it. It was how the HOW STUFF WORKS web site explained how the body processes fats. After reading the second site's explanation I decided the first one was oversimplified. Which was why I posted the second site. :cool:

[Harold]

Mark,

My hypothesis was about why recomend a high carb diet. In short I concluded it gave doctors a simple tool to use in prescribing insulin dosages for everyone back in the 20's or there abouts when insulin was developed. Difficult job for a doctor to do when different people are eating different ratios of fats/proteins:carbs. Your right about the high carb diet becoming entrenched when they started to recomend eating low fat to avoid HD, but this really did not happen untill about thirty or forty years later when there was an alarming increase in heart desease. Which really was a result of an increase in the use of processed vegetable fats and a decrease in physical activity due to a shorter work week and TV.

Other than the amount of glucose derived from proteins and fats insulin is not required. Does the glucose derived from fats increase blood glucose? Where else would the glucose go? However since this process shuts down, or nearly so, in the presence adequate glucose levels it will not cause or contribute to hyperglycemia.

So consumption of fat does not affect the amount of insulin required to process carbs. Think I said this in the original post like this; "negated the varience from proteins and fats to the point they did not need to be figured in to figure out how much insulin to take."

[Shalyndria]

Originally posted by eevee
I said "...of course t2s can go hypo..." and they can..!!

Eve
No one's arguing that they can, from what I can see, Eve. However the study is in regards to untreated type 2's and Harold's statement clearly says that Hypoglycemia is only induced in Type 2's as a result of a peripheral agent, such as oral meds. In which case, Hypo's would not be an issue with regards to the ppl in this study.
pacon made a very good point.

Shy

[Jenny]

I am a pre-diabtic with insulin resistance (which will probably lead to ful blown T2 later on) and I get lows even without the meds. But when on the meds and I drink any alcohol at all or forget to eat I also get them .

[eevee]

I said, T2s can go hypo .....a statement in it's own right and not dependent on any qualification.
In Jenny's experience, one doesn't even have to be dx T2..!!

Cheers............Eve

[Harold]

Originally posted by Jenny
I am a pre-diabtic with insulin resistance (which will probably lead to ful blown T2 later on) and I get lows even without the meds. But when on the meds and I drink any alcohol at all or forget to eat I also get them . Yes, you can force yourself to go low, but not hypoglycemic which would be really very low. You may get the shakes, sweats, and some of the other symptoms, but you don't have to worry about going into a coma from a low unless you take one of the orals or insulin. Like most things there are exceptions and some people have hypoglycemia and do not have diabetes, but they often do develope diabetes later in life.

[Harold]

Originally posted by eevee
I said, T2s can go hypo .....a statement in it's own right and not dependent on any qualification.
In Jenny's experience, one doesn't even have to be dx T2..!!

Cheers............Eve

Please define hypo. A quantity and/or should help us understand your meaning. :cool:

[eevee]

Please define hypo
Sorry Harold...I thought you would know....

hy·po·gly·ce·mi·a (hp-gl-sm-)
n.

An abnormally low concentration of glucose in the blood.


Source: The American Heritage® Stedman's Medical Dictionary
Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.

It is not really up to me to quantify it .....but most of us recognise it when it visits....

Cheers...Eve

[Jenny]

The lowest I have gone is 54 off meds. I don't know what that is considered though. I have had all the symptoms of lows also. I don't remember what my lowest was on the meds.However, the T2 runs on my moms side of the family very strongly and I had an uncle on my dad's side who was hypoglycemic and he would get those bad lows to where he would pass out. I guess I am kinda in the middle:rolleyes:

[Jenny]

Originally posted by Harold
but you don't have to worry about going into a coma from a low unless you take one of the orals or insulin.

Whew! That is good. ;)

[Harold]

An abnormally low concentration of glucose in the blood.

Abnormal Not typical, usual, or regular; not normal; deviant., from the The American Heritage® Dictionary of the English Language: Fourth Edition. 2000. An excellent example of an obtuse generic definition. Which may be interpreted as to ones experiences or wishes.

For the purpose of discussion from WebMD; What is hypoglycemia? (http://my.webmd.com/hw/diabetes_1_2/rt1055.asp)
"Hypoglycemia is low blood sugar. It occurs when the level of sugar, or glucose, in the blood drops too low to fuel the body."

What causes hypoglycemia? (http://my.webmd.com/hw/diabetes_1_2/rt1055.asp?pagenumber=2)
"Hypoglycemia is most commonly a complication of diabetes treatment (diabetic hypoglycemia). You can develop hypoglycemia by taking too much insulin or other diabetes medications."

For those Dealing with low blood sugar (hypoglycemia) from medications for type 2 diabetes. (http://my.webmd.com/hw/diabetes_1_2/tp16400.asp?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}) Could not find one for those not on medication ;) , but the treatment should be the same if your worried.

Blood Sugar Range (http://my.webmd.com/content/article/5/1680_51025.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348})
"The normal range for blood sugar is about 60 mg/dL (milligrams of glucose per deciliter of blood) to 120 mg/dL, depending on when a person last ate. In the fasting state, blood sugar can occasionally fall below 60 mg/dL and even to below 50 mg/dL and not indicate a serious abnormality or disease. This can be seen in healthy women, particularly after prolonged fasting. Blood sugar levels below 45 mg/dL are almost always associated with a serious abnormality."

Yes I knew, just want to clear the air and get all of us on the same track. :thumbsup:

[eevee]

Wow..!!
Thanks for clearing the mystery up Harold...

Cheers........Eve

[kctowers]

WOW,WOW,WOW!!

All this technical stuff is mind-blowing to me, a newbie with the disease. I still think that a balanced diet is the only healthy option, not just for diabetics, but for everyone. By balanced I mean getting into sensible eating habits. Balanced portions. My problem is I love carbs, I'm not too fussed about the protein stuff, except for chicken, which I could eat until I grew feathers, and fish until I develop gills. The other meats and cheeses I eat sparingly. Thankfully, I am not a lover of pasta, or that would just add to my carbohydrate addiction. Cutting down potatoes has been a nightmare for me.

I now try and adjust my carbs in any given meal to below or equal to the level of protein on my plate, i.e. about 2 ounces of each(Guesswork - I don't weigh). I still eat the same meals as I used to, but less of it.

I also think buying organic whenever possible (especially vegetables) is a good idea. God only knows what the chemicals in the other stuff are doing to our bodies.

Keith

[Joss]

KCTOWERS wrote "Thankfully, I am not a lover of pasta, or that would just add to my carbohydrate addiction. Cutting down potatoes has been a nightmare for me". I hear you KC - i had the same experience with giving up potatoes.

Thankfully I found a subsititute which is steam half a head of cauliflower, mash it up in a food processor or by hand. add around 2 oz of grated cheese and mix again with a wee dash of cream to whip it up. Season with pepper. It will blow you away, it tastes so much like potato it is amazing. The trick is to not get the cauliflower wet ie don't immerse it in water, but steam it, and don't use too much cheese or it will taste cheesy instead of like potato. It works from frozen cauli as well as fresh.

I eat it every day almost and I really don't feel deprived of my potatoes. This low carb dish does nothing to my BG levels so is a safe way to eat. Cauliflower is a vegetable on the low glycemic index.

Joss