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Questioning Carbohydrate Restriction in Diabetes Management
From Diabetes in Control www.diabetesincontrol.com http://www.diabetesincontrol.com/index.php?option=com_content&v....
Patients with type 2 diabetes are usually advised to keep a low-fat diet. Now, a study shows that food with a lot of fat and few carbohydrates could have a better effect on blood sugar levels and blood lipids.
Sixty-one patients were included in the study of type 2, or adult-onset diabetes. They were randomized into two groups, where they followed either a low-carbohydrate (high fat) diet or a low-fat diet.
In both groups, the participants lost approximately 4 kg on average. In addition, a clear improvement in the glycemic control was seen in the low-carbohydrate group after six months. Their average blood sugar level dropped from 7.5 to 7.0A1c (58.5 to 53.7 mmol/mol). This means that the intensity of the treatment for diabetes could also be reduced, and the amounts of insulin were lowered by 30%.
Despite the increased fat intake with a larger portion of saturated fatty acids, their lipoproteins did not get worse. Quite the contrary -- the HDL, or 'good' cholesterol, content increased on the high fat diet.
No statistically certain improvements, either of the glycemic controls or the lipoproteins, were seen in the low-fat group, despite the weight loss.
Dr. Fredrik Nyström, who was part of the study, said, "You could ask yourself if it really is good to recommend a low-fat diet to patients with diabetes, if despite their weight loss they get neither better lipoproteins nor blood glucose levels."
In the low-carbohydrate diet, 50% of the energy came from fat, 20% from carbohydrates, and 30% from protein. For the low-fat group the distribution was 30% from fat, 55-60% from carbohydrates, and 10-15% from protein, which corresponds to the diet recommended by the Swedish National Food Agency.
The participants were recruited from two primary health care centers and met for four group meetings during the first year of the study. All 61 participants remained in the study for the follow-up.
Dr. Hans Guldbrand who was also part of the study says, "In contrast to most other studies of this type, we lost no patients at all, which vouches for the good quality of our data."
The results of a two-year dietary study led by Hans Guldbrand, general practitioner, and Fredrik Nyström, professor of Internal Medicine, Diabetologia, May 2012
Peetie nakes important and I as 30 + years as type 2 think valid.
Prior to getiing to that and why I think his comments are most important, I have some key pre-thoughts.
1. Having ones diet super sized by science upgrading the energy content and availability of energy/glucose in refined foods and high fructose corn sugar and at same breath dropping the energy burn due to all the computers, labor saving devices and couch potato games, entertainment and tools and then on top of that blaming said individual it was his life style causing T2 is height of arrogance.
2. On top of that after being to a support meeting where I was told it was my fault, insult was added to injuey by ignoring the fact that my liver decided every morning it needed to do massive dawn effect and in rest of day add extra glucose when it was supposed to be fasting. I see, that was my fault as well. Horse pucky.
3. As Peetie points out that many of the modern drugs and just add tons of insulin on a T2 makes matter worse. i.e. actos, starlix, gylyburide et all.
The work done initially on T1's has in many ways been a great place to start for T2 as well as look for solutions.
My take is that because T1's had none,low, poorly working insulin, low carb diets are/were most critical in controlling glucose levels until insulin discovered from animals and then we figured out how to engineer - manufacturer artificial insulin.
My sense is that T1's do not generally suffer from glucose saturation due to the insulin problem.
Type 2's; I believe in fact get saturation from insufficient energy burn, excess ingestion of energy as well as leaky recalcitrent livers wanting to send us daily on a french foreign legion survival march into the Sahara each and every day.
I agree with Peetie that adding more carbs back into type 2 diet has been a disaster.
Ruder folks compare that to adding gasoline to a house fire. Reduced fats while maybe admirable; really for T2 allow gut and intestine to roar thru the carbs faster and peak glucose levels harder and faster, and higher. Simple experiment - eat boiled rice one time and fried rice in olive oil next time and watch the cgms.
Thus in type 1 and type 2; carbs control is critial for both types of diabetes for two different and opposed problems. Type 1 cannot store the dam stuff - glucose efficiently and type 2's are saturated and need to reduce ingested calorie/glucose as there is no more room to store any more glucose. The end result for both types is that glucose backs up in the blood system rotting out viens and arteries and corresponding organs, limbs, eyes.
Metformin - ditto - It simply stops the excess liver glucose release as it normally is adding on top of digestion sugar release levels making far worse as seen on CGMS. See Salk institute and John Hopkins Childrens research on how met works.
I alomost rotted out till I in last 4 years got on 1200 calorie diet, 2 miles walking and my doctor scheduling metformin doses. I was not looking for cure but about 5 to 6 months; I suddenly am yanking starlix first and second yanking 26 units of 75/25 humalog daily dose; and as for reasons escape me, my own insulin went back on the job. Thank god I had the cgms watching this riot.
I was originally on Lantus and found my self reducing doses from 12 to 5 to 2 to 0 units as my pancreas was kicking butt. This after 26 years on the other crap(excluding met)
As an engineer, the part that angers me is that there seems to be this thinking that the human body for T2 is an infinite motion machine being able to store endless amounts of energy/glucose in the skeletal muscles/liver and why by god, if it won't, your insulin is defective and just add more insulin/actos. Notwithstanding due to wear / tear, aging; a person may need insulin boost tactic just the same to assist the body along.
Worse than that, as bodies continue to rot out; much new research, work done on bariatric surgery, starvation diets, intestine liner, metformin gets shoved/stalled in an Indiana Jones Movie warehouse like the Ark of the Covenent.
What seems like the biggest proble about the carbs "debate" is that there isn't much of one, there's just "the guidelines" which seems to be where the problem lies. The guidelines weren't made up with any notion of controlling BG (LOL...), just to make sure that people "don't have too much fat because fat= heart disease" however little actual evidence there is to support that contention. The benefits of eating less carbs extend well beyond controlling T1 and T2 and other affiliated conditions as it seems as if, according to Gary Taubes anyway, there's benefits to heart disease, hyperlipidemia, etc. that are beyond what would be "just" diabetes. Perhaps the biggest problem is that people with diabetes of any sort are going to have a lot more information than their doctor can process in any but the most grossly oversimplified manner. At the same time, few doctors are willing to admit "you know what? I don't have a clue what you do..." so they act as if the patient is the problem whenever there's a problem.
I assume and possibly wrong you are referring to the ADA April 19, study.
I don't refer to any studies as I am way too lazy to look studies up, although I may have chatted about it here if there was a thread?
I just know what I have experienced (AR "I have lost 40 lbs and would like to lose more" CDE+ dietitian [both] "you aren't eating enough, you should be eating 180-270G/ day) and what I've read here, doctors generally won't discuss food and refer people to dietitians to discuss food, pile on the carbs, "hey, 140 is great!" BG wise. To me, particularly w/ a pump and CGM, I've found that eating less carbs is a lot less work and that fine adjustments to insulin ratios and basal rates will make a pretty significant difference? If I adjust mine say .05U/ hour, it will generally mean the difference between low or high and where I want it to be so I watch that stuff closely. Not because my doctor says "you'd better keep an eye on that!" but because I have interests besides diabetes that are much easier to participate in when my BG is closely controlled. It works out ok healthwise so far too but I am not really engaged in the this study vs. that study as I haven't seen any discussion of studies reporting "we watched 100 people with diabetes who kept their A1Cs at 5.5 or less for a year and 25 of them had severe hypoglycemic reactions and 2 died" as it doesn't seem like medicine is interested in pushing that envelope.
I know that people have tragic accidents with diabetes but is 1,000,000 people feeling poorly worth a few people crashing and burning? I dunno, it's an interesting question to me, since if I actuarialized my lifestyle, I'd probably be at a higher risk of crashing and burning than say someone following the ADA/ CDA/ AACE/ etc. guidelines more closely?
Notwithstanding a few knotheads who are always determined to prove the wrong thing; I consider as others have here the insulting term "lifestyle" disease as ones own fault as useless, hurtful, misleading and overlooking key facts.
Jims, That statement and the rest of that post was one of the best I have ever seen concerning lifestyle and T2 diabetes. We are after all still hunter gatherers it just that now what we gather has been modified by science to contain way to many carbs for the average person.
Was it science though? The Taubes books make a pretty interesting case that the science "proving" fat to be bad is not actually correct? In which case it's something else. My way-out-there theory is that the "food pyramid" is engaged with the birth of the modern Republican party...
Acid, you are a hoot!..RED state= RED meat?.. HAHA
Sadly, the food pyramid all started with the ill-fated McGovern commission report in 1977. Taubes talked about this, much of it was written by a vegetarian staffer who knew litle about nutrition and, by everyones admission at the time, it did not reflect scientific concensus.
George McGovern was a Democrat his whole career. I liked McGovern generally, but on this he made mistakes.
I do recall the McGovern commission bits from the books, but I recall that the low fat research (sic)was taking place during the late 50s or the more Republican era. Presumably agricultural interests would have been funding research supporting eating carbs, particularly since the research doesn't seem to support that not eating fat is good for you? Clearly a very circumstantial "case" in my head!
Well at least Cheney took the high carb/low fat advice to heart!
Special thanks for kind comments. I beleive you have summarized in a clear, succint staement the key issue.
I would add that if the pharohs had available the incredible rich carbs and grains we have today they would have built the pyramids twice as big and higher.
Most kind thanks for taking time and patience to read my comments and expand and enhance as well as further clarify upon those.
Best wishes and good health.