David and Goliath: Dr. Briffa Versus National Health Service on Low-Carb Diets

The United Kingdom’s National Health Service last year published guidelines favoring low-fat weight-loss diets over low-carb ones. Dr. John Briffa objects:

See here for a comprehensive review of 23 studies which demonstrates superior results achieved by low-carb diets with regard to weight loss and disease markers. To my mind, dietician Sian Porter and the NHS Choices website have done a bad job of communicating the facts and summarising the evidence. I wish to formally complain about the inaccuracies in this article and its (to me) clear bias and lack of balance.

Read the whole enchilada (plus this update).

Steve Parker, M.D.

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Does a Low-Carb High-Fat Diet Work for South Asian Indians With Diabetes?

Indian street seller selling tea - masala chai

Indian street seller selling tea – masala chai

Dr. Andreas Eenfeldt shares an email from Aniruddha Bhaduri, a 43-year-old diabetic living in New Delhi. He’s had type 2 diabetes for ten years.

Ani had poor control of his blood sugars despite following the dietitian-recommended high-carb diet and taking three diabetes drugs. In his frustration, Ani started doing research on his own and ran across Eenfeldt’s version of low-carb high-fat (LCHF) eating. After just one month of LCHF dieting, his blood sugars came down from 300+ mg/dl (16.7+ mmol/l) to an average of 97 mg/dl (5.4 mmol/l). His doctor reduced his drugs, too. Ani mentioned that eating LCHF in India is “a bit expensive.”

Although Ani’s high triglycerides dropped like a rock, I have a little concern about his total cholesterol and LDL cholesterol, both of which rose. That bears watching.

Click through to Dr. Eenfeldt’s blog and you’ll find a photo of Ani. Note that he’s not obese. Like East Asians, Indians develop T2 diabetes at lower degrees of body fat (BMI) than do Americans and Europeans. Could that be genetic? You bet.

This story is interesting to me because I had no definite evidence that LCHF eating was effective for Indian type 2 diabetes. Due to potential genetic differences between Indians and other ethnicities, it’s a mistake to simply assume they would respond to the diet like Europeans, for example. My Low-Carb Mediterranean Diet is a version of LCHF; no Indian has ever reported back to me whether it helped them or not. Now I have one anecdote to support LCHF eating in Indians.

Steve Parker, M.D.

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Are Obesity and Type 2 Diabetes Caused By Pollution?

Salmon is one the the cold-water fatty fish loaded with omega-3 fatty acids

Salmon is one the the cold-water fatty fish loaded with healthful omega-3 fatty acids, but also persistent organic pollutants

It sounds like Jerome Ruzzin is convinced that’s the case. I put some thought into it last August and was skeptical—still am, but I’m keeping an open mind. Mr. Ruzzin has a review article published in 2012 at BMC Public Health (“Public health concern behind the exposure to persistent organic pollutants and the risk of metabolic diseases”). Here’s his summary:

The global prevalence of metabolic diseases like obesity and type 2 diabetes, and its colossal economic and social costs represent a major public health issue for our societies. There is now solid evidence demonstrating the contribution of POPs [persistent organic pollutants], at environmental levels, to metabolic disorders. Thus, human exposure to POPs might have, for decades, been sufficient and enough to participate to the epidemics of obesity and type 2 diabetes. Based on recent studies, the fundaments of current risk assessment of POPs, like “concept of additive effects” or “dioxins and dl-PCBs induced similar biological effects through AhR”, appear unlikely to predict the risk of metabolic diseases. Furthermore, POP regulation in food products should be harmonized and re-evaluated to better protect consumers. Neglecting the novel and emerging knowledge about the link between POPs and metabolic diseases will have significant health impacts for the general population and the next generations.

Read the whole enchilada.

The cold-water fatty fish I so often recommend to my patients could be hurting them. They are major reservoirs of food-based POPs.

Steve Parker, M.D.

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Dr. Sarah Hallberg Makes the Case for Carbohydrate Restriction in Type 2 Diabetes

If you reduce carb consumption, what do you replace it with? Dr. Hallberg favors fat.

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Introducing Myself To South Asian Indian Diabetes

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

Gadi Sagar temple on Gadisar Lake, Jaisalmer, Rajasthan, India

“Asian Indian” as opposed to American Indian, aka Native Americans.

Since I have a number of blog visitors from India, I decided I need to know more about Indian diabetes. I started by reading “The current sate of diabetes mellitus in India.” I looked at a few other things, too, thanks to the Internet. Here are a few facts and issues:

  • India has at least 32 million diabetics (most of whom have type 2 diabetes); it’s the country with the most diabetics (data from 2000)
  • The population of India is 1.28 billion
  • By 2030, diabetics in India may number 79 million
  • The prevalence of diabetes in urban centers is perhaps 9% of the population; higher in southern locales, lower in the north
  • Indians tend to see type 2 diabetes at much lower BMIs compared to Western populations
  • India is rife with diversity: genetic, cultural, linguistic, socio-economic, among others
  • Poverty—or at least lack of affluence—is a major stumbling block to diagnosis, treatment, epidemiologic study, clinical research, and intervention
  • Vegetarianism is more common than in the West
  • I need to learn more about Indian cuisine and foods such as jowar, chappathis, and chana dal (aka Bengal gram dhal), to name just a few
Indian woman cooking chapati

Indian woman cooking chapati

It’s clear to me that I cannot assume that Indian type 2 diabetes is the same type 2 disease I treat here in Scottsdale, Arizona, an overwhelmingly non-Indian population.  If it’s not the same disease, the optimal treatment may be different. I hope to learn more about Indian diabetes over the next year.

Steve Parker, M.D.

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Thank You, My Readers From India

I’m not sure why, but lately I’m getting lots of blog visitors from India. Even more than from Canada and Australia. If you guys are looking for something in particular that you’re not finding here, let me know.

Steve Parker, M.D.

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QOTD: Exercise and Weight Loss

Let me be clear. Exercise is not important because it burns calories! Exercise without calorie restriction is a remarkably ineffective weight loss intervention, because it usually makes us hungry enough to replace the calories we burn. Exercise is important because it restores your ability to oxidize fat—both when fasting and after meals. And we can tie this in with mitochondrial dysfunction by noting that exercise is proven to increase mitochondrial volume.

J. Stanton

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