[xMenace]

Low-carb diets prove better at controlling type 2 diabetes

Low-carb diets prove better at controlling type 2 diabetes

DURHAM, NC -- In a six-month comparison of low-carb diets, one that encourages eating carbohydrates with the lowest-possible rating on the glycemic index leads to greater improvement in blood sugar control, according to Duke University Medical Center researchers.

Patients who followed the no-glycemic diet experienced more frequent reductions, and in some cases elimination, of their need for medication to control type 2 diabetes, according to lead author Eric Westman, MD, director of Duke's Lifestyle Medicine Program. The findings are published online in Nutrition and Metabolism.

"Low glycemic diets are good, but our work shows a no-glycemic diet is even better at improving blood sugar control," he says. "We found you can get a three-fold improvement in type 2 diabetes as evidenced by a standard test of the amount of sugar in the blood. That's an important distinction because as a physician who is faced with the choice of drugs or diet, I want a strong diet that's shown to improve type 2 diabetes and minimize medication use."

Eight-four volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate ketogenic diet (less than 20 grams of carbs/day) or a low-glycemic, reduced calorie diet (500 calories/day). Both groups attended group meetings, had nutritional supplementation and an exercise regimen.

After 24 weeks, their glycemic control was determined by a blood test that measured hemoglobin A1C, a standard test used to determine blood sugar control in patients with diabetes. Of those who completed the study, the volunteers in the low-carbohydrate diet group had greater improvements in hemoglobin A1C. Diabetes medications were reduced or eliminated in 95 percent of the low-carbohydrate volunteers, compared to 62 percent in the low-glycemic group. The low-carbohydrate diet also resulted in a greater reduction in weight.

"It's simple," says Westman. "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."

The diet is not easy for everybody. "This is a therapeutic diet for people who are sick," says Westman. "These lifestyle approaches all have an intensive behavioral component. In our program, people come in every two weeks to get reinforcements and reminders. We've treated hundreds of patients this way now at Duke and what we see clinically and in our research shows that it works."


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[art]

Now would somebody notify the ADA??

Art

[fgummett]

Quick... before this Dr Westman guy gets labeled as a maverick or even a "quack"

As I recall, there have been other studies which show improved lipids and BG on low-carb when compared to low-fat.

Let's see... we have a diet which is at least as effective at weight loss as the health establishment's party line, that also controls hunger cravings, improves lipids and BG... but for some reason it is vilified as dangerous or unhealthy

[Lloyd]

Well, 80 g of carbohydrate has worked for me. Weight loss that has been maintained, great lipids, and an average A1c for 2008 of 5.02.

I do feel it is not necessary to go as low as 20 g carb a day, as shown by my results.

I did tell the ADA! It is in my story in the Dec. Diabetes Forecast!

Success! | Diabetes Forecast

-Lloyd

[RedRD]

Originally Posted by fgummett

Quick... before this Dr Westman guy gets labeled as a maverick or even a "quack"

As I recall, there have been other studies which show improved lipids and BG on low-carb when compared to low-fat.

Let's see... we have a diet which is at least as effective at weight loss as the health establishment's party line, that also controls hunger cravings, improves lipids and BG... but for some reason it is vilified as dangerous or unhealthy

Duh. We know that not eating carbs means your BG levels won't go up as much, therefore less insulin/fewer meds are needed. Compliance is obviously an issue. And they even admit that is has to be strictly controlled and enforced.

How much weight have you lost Frank? Weight loss (no matter how you do it) results in less need for insulin/meds also.

[xMenace]

Great job Lloyd!



-------------------------


What strikes me about this article is that it comes from Duke University Medical Center researchers. To me it adds a lot of credibility. These are not some foreign scientists in a backwater university with unpronounceable names. Well they might be, but I want to believe otherwise. It also seems to be based on an active treatment practice. To me what really works beats any theoretical correctness.

[fgummett]

Yes! Nice job Lloyd

Cass posted this link - also by Dr Westman at Duke - on another thread: Is dietary carbohydrate essential for human nutrition? -- Westman 75 (5): 951 -- American Journal of Clinical Nutrition

[fgummett]

Originally Posted by RedRD

We know that not eating carbs means your BG levels won't go up as much, therefore less insulin/fewer meds are needed. Compliance is obviously an issue. And they even admit that is has to be strictly controlled and enforced.

Did you mean for this to sound like it is reason NOT to try low-carb? Is the health establishment party-line diet any better in terms of weight loss, BG control or compliance? I've tried them all by the way... I gained 100lbs on the prescribed the low-fat diet. For myself I have no issue with compliance... I do not miss or carve carbs anymore and do not feel deprived with what I now eat.

Originally Posted by RedRD

How much weight have you lost Frank? Weight loss (no matter how you do it) results in less need for insulin/meds also.

I have lost 60lbs since mid-August 2008 (starting at 300lbs): 25lbs of that was on very-low to zero-carbs and the rest has been since weight-loss surgery in October 2008; while still eating very-low to zero-carbs. I am now using 1/3 of the insulin I was using in August (30u of just basal compared to 90+ units of basal and bolus) but it dropped from 90u to 50u concurrently with cutting the carbs and BEFORE the weight loss.

Did you realise that insulin also stimulates appetite and has been used as a treatment for anorexia?

[ErikaA]

Originally Posted by fgummett

I gained 100lbs on the prescribed the low-fat diet. For myself I have no issue with compliance... I do not miss or carve carbs anymore and do not feel deprived with what I now eat.

If you don't mind the personal question....

How disciplined were you on the low fat diet and how restrictive was it?

I'm not doubting your success with low carb in the least. I waste away quite rapidly on it...so can't afford to eat like that...even though it gives me beautiful bgls.

But I'm also a scientist. You can't get fat if you're burning more than you're eating. It's a very simple equation. And it works very well with me. It doesn't matter what I eat, if I don't eat enough I get thinner.

So I'm interested to know if you are arguing that it is a better way to lose weight from an energy point of view or from a discipline point of view (ie easier to maintain for you?).

[REDLAN]

perhaps before people start getting tooo excited and hailing this as the definitive proof that low carb diets are the answer to diabetes, maybe they ought to check out the abstract on Pubmed first...

The effect of a low-carbohydrate, ketogenic diet v...[Nutr Metab (Lond). 2008] - PubMed Result

Researchers have to be a little more circumspect when it comes to subjecting their conclusion to their peers' scrutiny, than the rather uncritical eye of a press release.

when the authors say

The diet is not easy for everybody.

They weren't kidding. Only 58% of the study group made it to the end of the study. Bearing in mind this study only ran for 24 weeks, this does not bode well. High dropout rates do characterise ketogenic diets - they aren't tolerated particularly well. High dropout rates matter because they can bias the study's findings. What matters is why they drop out - it could be because they couldn't tolerate the diet, it could be because the diet didn't improve or maybe even worsened their control, it could be because they experienced significant weight regain. The point is that very often people drop out because the treatment does not work/makes things worse/or has unpleasant side effects. This effect can bias the results by making the treatment appear more effective because you are only measuring the people for whom the treatment work i.e. those who stay in.

The second bit concerns the weight loss - compare the 2. after 6 months the ketogenic diet group lost almost twice as much weight as the low GI group (11.1kg versus 6.9kg) There is nothing unusual in this result - low carb diets produce dramatic weight loss in the first 6 months, followed by more rapid weight regain. After 12 months however there is very little difference between a low carb diet and a standard low fat one.

The problem for the study in claiming that it is the ketogenic diet that causes the improvement in HBa1c is that weight loss is strongly correlated with improvement of symptoms for type 2. The differences in HbA1c reported by the study could be solely due to the differences in weight loss reported by the 2 groups.

"It's simple," says Westman. "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."

Unfortunately it isn't simple. Westman is rather overstating his case. The cochrane library reviewed the evidence on dietary interventions in type 2, and their conclusions are rather different than Westmans.

Dietary advice for treatment of type 2 diabetes mellitus in adults

When it came to comparing low-fat versus low-carb diets, they concluded that 5 out of the six studies that were eligible for inclusion were at high risk of bias - i.e. poorly designed and implemented - and therefore no firm conclusions could be drawn. If however you take time to read the results section, you will discover that long term (12+ months) there was little difference between low-fat and low-carb for either weight loss, or blood glucose control.

They did however discuss (briefly) the results achieved by Nielsen...

Low-carbohydrate diet in type 2 diabetes: stable i...[Nutr Metab (Lond). 2008] - PubMed Result

Unfortunately Nielson did not randomly select his patients for this study, meaning the study could not be included because it would be at too high a risk of bias.

Better studies are needed or as the Cochrane put it

more research is required on larger populations and with a strict control group.

Westman's study I'm afraid is left very much wanting.

[fgummett]

Originally Posted by ErikaA

If you don't mind the personal question....

How disciplined were you on the low fat diet and how restrictive was it?

I'm not doubting your success with low carb in the least. I waste away quite rapidly on it...so can't afford to eat like that...even though it gives me beautiful bgls.

But I'm also a scientist. You can't get fat if you're burning more than you're eating. It's a very simple equation. And it works very well with me. It doesn't matter what I eat, if I don't eat enough I get thinner.

So I'm interested to know if you are arguing that it is a better way to lose weight from an energy point of view or from a discipline point of view (ie easier to maintain for you?).

I guess the honest answer is that whenever I tried a low-fat and/or calorie-restrictive diet I constantly felt deprived and hungry... especially if I exercised as well BUT I did give it a fair try on more than one occasion. I hope you can tell from my passion and enthusiasm here, that when I set my mind to something I give it 100% and then some.

Ohh I'm sure there are some out there saying that I did not have sufficient will-power to see it through... or that some other failing on my part was the issue... couldn't be the diet.

In the same way I know many others that have failed to live up the promised results from the canned advice given them by their health-care teams, who promptly turn around and label them as "non-compliant" patients

Hunger - for me at least - is just like the need to breathe or drink water... it is a very low-level/primitive physiological drive. So if you say you just need will-power, I suggest you sit at the bottom of a deep swimming pool and see how long "will-power" will let you hold your breath.

Basically when I listened to the advice of the "experts" I not only failed to lose weight, but I actually gained more.

So after reading Gary Taubes and being reminded that you can't just take the word of an expert as fact; without some true science to back it up, and then finding out that not only does the low-fat (high-carb) diet not have any true scientific basis and does not help, but it could actually be harmful; I decided I had nothing to lose by trying the infamous and scary low-carb diet

Much to my surprise and relief, within 2 days I was no longer hungry all the time! I could eat freely of very tasty and invigorating foods; like bacon and eggs for breakfast or steak for supper...and not feel hungry between meals... I even skipped a few meals and still walked past a table of cakes and other "goodies" without being tempted... I also found I had more energy and desire to go for walks and start exercising again.

On top of that I then found that my BG levels were more stable and closer to normal, on less insulin - I rarely if ever need to bolus anymore, my lipids (cholesterol) have improved dramatically, and my weight began dropping quickly... 25 lbs in the first 2 months.

How could this be? Was I finally back in control of my own body after 25 years?

So pardon me if I am an advocate of low-carb

Yes I freely accept that it may not be the best way for everyone, but if some forward-thinking nutritionist/dietitian had offered it to me as even an option when I was struggling with my weight, who knows where my health would be today.

As for the old chestnut of the 1st law of thermodynamics: I do not believe that the human body is a simple engine where you shovel in x amount of coal and get out y amount of heat. Perhaps the law applies at the cellular level but to the overall body... no. I have read that without carbs and insulin the body is unable to store fat (ingested Glucose is required to make Glycerol to bond three fatty-acid molecules together as Triglycerides - the form in which fat is stored) so I defy anyone to eat 6,000 calories a day of just fat and protein and not even put on an extra ounce of fat.

I also don't believe that calorie counting helps: it defies logic that anyone can know to within 1% how many calories they have eaten and used on any given day - other than in totally enclosed laboratory conditions. So it follows that there is another mechanism in the body that maintains our weight.. even an obese person tends to maintain the same weight over many years.

Sorry if I went off topic but I haven't repeated much of this too much lately and it does need to be said. Maybe just one person will come along like I was 5 years ago who might get a better start than I did

[fgummett]

Originally Posted by REDLAN

perhaps before people start getting tooo excited and hailing this as the definitive proof that low carb diets are the answer to diabetes, ...
Westman's study I'm afraid is left very much wanting.

OK Mr Negativity All valid points... so what do you suggest we eat in the meantime... the low-fat health-establishment endorsed diet?

BTW I don't take any study as definitive... as you have so correctly pointed out before... a theory can only ever be dis-proven

I offer another suggestion for the high drop-out rate: scare-mongering by well-meaning friends, the media and other "experts" about what high-fat, ketones and protein can do to damage your body

[BlueSky]

Only the very highly motivated are able to stick to a diet that limits carbo consumption to 20 grams a day. The fact that 42%of study participants could not keep it up is really not surprising. Bear in mind that the purpose of the study was to distinguish between the glycemic control benefits of low-carb and low-glycemic ways of eating. And that, as Lloyd pointed out, you don't need to go so low to get major benefits from the low carb way of eating.

[ErikaA]

Originally Posted by fgummett

I guess the honest answer is that whenever I tried a low-fat and/or calorie-restrictive diet I constantly felt deprived and hungry... especially if I exercised as well BUT I did give it a fair try on more than one occasion.

Hunger - for me at least - is just like the need to breathe or drink water... it is a very low-level/primitive physiological drive. So if you say you just need will-power, I suggest you sit at the bottom of a deep swimming pool and see how long "will-power" will let you hold your breath.

I find the need to eat to be a rather inconvenient background noise that is easily ignored for way longer than is healthy. Diabetes is proving to be difficult for me because I have to eat to keep my bgls down.

Would I consider my will power stronger than yours? Not at all. I don't have enough will power/discipline to force myself to eat 3 meals a day every day. My diet is constructed around things I can face eating no matter how disinterested I am.

I find it incredibly hard to take medication when I don't feel sick. But the consequences repeatedly bite me on the bum so to speak. Will power in one thing doesn't mean you have it for everything. I find it mentally easier to go for a run than face eating a meal when I'm not hungry.

I guess my point is that it strikes me that your diet is primarily successful because you have found it easier to comply. So I'm thinking that the best diet in the case of successful weight loss (which I'd think is imperative for type 2 diabetics with high IR), is simply the diet that they can stick to (as long as you aren't sky high with carb abuse).

But I'm curious as to the prolonged effects. When you achieve healthy weight range, will you continue to eat that low carb?
Your breakfast is higher in calories than I eat in an entire day and I'm a very active person. Will you at some point be forced to reduce how much you eat in order to achieve further weight loss?
What about the concerns of bowel cancer and IBS and various other diseases? Will a lack of grains in your diet prove detrimental in some way that you are not currently monitoring?

[RedRD]

Originally Posted by fgummett

Did you mean for this to sound like it is reason NOT to try low-carb? Is the health establishment party-line diet any better in terms of weight loss, BG control or compliance? I've tried them all by the way... I gained 100lbs on the prescribed the low-fat diet. For myself I have no issue with compliance... I do not miss or carve carbs anymore and do not feel deprived with what I now eat.


I have lost 60lbs since mid-August 2008 (starting at 300lbs): 25lbs of that was on very-low to zero-carbs and the rest has been since weight-loss surgery in October 2008; while still eating very-low to zero-carbs. I am now using 1/3 of the insulin I was using in August (30u of just basal compared to 90+ units of basal and bolus) but it dropped from 90u to 50u concurrently with cutting the carbs and BEFORE the weight loss.

Did you realise that insulin also stimulates appetite and has been used as a treatment for anorexia?

Good for you on the weight loss. Curious - what surgery did you opt for? Bypass or band?

And your diet works for you, but would not for many people (for many different reasons). I know that my diet also would not work for many people, again for many different reasons. Which is why I am not forcing it on anybody, or being so ridiculous to suggest that it would work for everybody and is the only way to eat.

And yes, I am aware of insulin as a treatment for anorexia. Exogenous insulin in a non-diabetic drops the BG level to a point that stimulates the hunger response - that level is below normal. If my BG is below normal, I am also hungry. That is how the body is supposed to work!!!