Category Archives: Carbohydrate

ADA Promoting Low-Carb Eating

Conquer Diabetes and Prediabetes, Steve Parker MD
A very low-carb meal

Interestingly, the American Diabetes Association (ADA) is selling to healthcare providers Low Carbohydrate and Very Low Carbohydrate Eating Patterns in Adults with Diabetes: A Guide for Health Care Providers

About:

The American Diabetes Association has identified low-carbohydrate (LC) and very low-carbohydrate (VLC) eating patterns as options that can improve outcomes in adults with type 2 diabetes.  This 28-page guide was designed to assist registered dietitians, certified diabetes care & education specialists, and other health care practitioners in assessing the appropriateness of a LC or VLC intervention for their patients.  Additionally, it provides strategies and sample meal plans for implementing a LC or VLC eating pattern as an evidence-based intervention in adult with type 2 diabetes.

In my world, “very low-carbohydrate” means ketogenic.

Steve Parker, M.D.

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Low-Carb Diet OK for Heart

Roasted Radishes and Brussels Sprouts

A recent scientific article supported low-carb eating for heart health.

Link to article

ABSTRACT

Background

Carbohydrate restriction shows promise for diabetes, but concerns regarding high saturated fat content of low-carbohydrate diets limit widespread adoption.Objectives

This preplanned ancillary study aimed to determine how diets varying widely in carbohydrate and saturated fat affect cardiovascular disease (CVD) risk factors during weight-loss maintenance.

Methods

After 10–14% weight loss on a run-in diet, 164 participants (70% female; BMI = 32.4 ± 4.8 kg/m2) were randomly assigned to 3 weight-loss maintenance diets for 20 wk. The prepared diets contained 20% protein and differed 3-fold in carbohydrate (Carb) and saturated fat as a proportion of energy (Low-Carb: 20% carbohydrate, 21% saturated fat; Moderate-Carb: 40%, 14%; High-Carb: 60%, 7%). Fasting plasma samples were collected prerandomization and at 20 wk. Lipoprotein insulin resistance (LPIR) score was calculated from triglyceride-rich, high-density, and low-density lipoprotein particle (TRL-P, HDL-P, LDL-P) sizes and subfraction concentrations (large/very large TRL-P, large HDL-P, small LDL-P). Other outcomes included lipoprotein(a), triglycerides, HDL cholesterol, LDL cholesterol, adiponectin, and inflammatory markers. Repeated measures ANOVA was used for intention-to-treat analysis.

Results

Retention was 90%. Mean change in LPIR (scale 0–100) differed by diet in a dose-dependent fashion: Low-Carb (–5.3; 95% CI: –9.2, –1.5), Moderate-Carb (–0.02; 95% CI: –4.1, 4.1), High-Carb (3.6; 95% CI: –0.6, 7.7), P = 0.009. Low-Carb also favorably affected lipoprotein(a) [–14.7% (95% CI: –19.5, –9.5), –2.1 (95% CI: –8.2, 4.3), and 0.2 (95% CI: –6.0, 6.8), respectively; P = 0.0005], triglycerides, HDL cholesterol, large/very large TRL-P, large HDL-P, and adiponectin. LDL cholesterol, LDL-P, and inflammatory markers did not differ by diet.

Conclusions

A low-carbohydrate diet, high in saturated fat, improved insulin-resistant dyslipoproteinemia and lipoprotein(a), without adverse effect on LDL cholesterol. Carbohydrate restriction might lower CVD risk independently of body weight, a possibility that warrants study in major multicentered trials powered on hard outcomes.

Parker here. No surprise to me.

Steve Parker, M.D.

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Rice: Avoid or Eat, and How Much

Eliza Skoler addresses this issue in an interesting article at Diatribe:

Rice. Billions of people around the world eat it every single day, for multiple meals a day – and it’s a primary food for many populations, with research showing that it provides about 20% of the world’s calorie intake. From beans and rice to stir fry with rice, from sushi to risotto to sweet rice desserts, this simple ingredient is a staple across the globe and across cultures.

Unfortunately, rice presents a key challenge for people with diabetes: it’s a spiky carb. Spiky carbs are foods that cause glucose to quickly increase, and they can create unpredictable swings in glucose levels. If you or someone you know has diabetes, you may be wondering how to manage your glucose when faced with this dietary staple.

https://diatribe.org/rice-and-diabetes-how-great-risk

I find that many of my patients have better glucose control if they eat less than the daily carb grams mentioned in this article.

Steve Parker, M.D.

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How Could Low-Carb Diets Be Better Than Others for Weight Loss?

Roasted Radishes and Brussels Sprouts

Low-carbohydrate diets help many folks, but not all, lose excess fat weight. When low-carb diets help, it may be related to Total Energy Expenditure (TEE). When you read “energy,” think calories. TEE is a combination of calories needed for 1) basic life processes (i.e., basal metabolic rate, as needed to maintain heart beats, breathing, steady body heat, growth and repair of tissues, etc.), 2) processing of ingested food (dietary thermogenesis), and 3) physical exercise.

Here’s the abstract of an article in The Journal of Nutrition that examines the headline question. It’s complicated and I haven’t read the full study yet.

Many obesity experts believe that to lose excess fat weight, you have to ingest fewer calories than you burn on a daily basis for physical exercise and basal metabolic rate. This creates a calorie (energy) deficit. Your body satisfies that deficit by converting fat tissue to weightless energy. The authors of the study at hand are essentially saying that, after 2-3 weeks, a low-carb diet “revs up your metabolism” to burn more calories. That can help you lose weight or maintain weight loss, unless you over-eat.

Here you go, nutrition nerds:

Background

The effect of macronutrient composition on total energy expenditure (TEE) remains controversial, with divergent findings among studies. One source of heterogeneity may be study duration, as physiological adaptation to lower carbohydrate intake may require 2 to 3 wk.

Objective

We tested the hypothesis that the effects of carbohydrate [expressed as % of energy intake (EI)] on TEE vary with time.

Methods

The sample included trials from a previous meta-analysis and new trials identified in a PubMed search through 9 March 2020 comparing lower- and higher-carbohydrate diets, controlled for EI or body weight. Three reviewers independently extracted data and reconciled discrepancies. Effects on TEE were pooled using inverse-variance-weighted meta-analysis, with between-study heterogeneity assessed using the I2 statistic. Meta-regression was used to quantify the influence of study duration, dichotomized at 2.5 wk.ResultsThe 29 trials ranged in duration from 1 to 140 d (median: 4 d) and included 617 participants. Difference in carbohydrate between intervention arms ranged from 8% to 77% EI (median: 30%). Compared with reported findings in the prior analysis (I2 = 32.2%), we found greater heterogeneity (I2 = 90.9% in the reanalysis, 81.6% in the updated analysis). Study duration modified the diet effect on TEE (P < 0.001). Among 23 shorter trials, TEE was reduced on lower-carbohydrate diets (−50.0 kcal/d; 95% CI: −77.4, −22.6 kcal/d) with substantial heterogeneity (I2 = 69.8). Among 6 longer trials, TEE was increased on low-carbohydrate diets (135.4 kcal/d; 95% CI: 72.0, 198.7 kcal/d) with low heterogeneity (I2 = 26.4). Expressed per 10% decrease in carbohydrate as %EI, the TEE effects in shorter and longer trials were −14.5 kcal/d and 50.4 kcal/d, respectively. Findings were materially unchanged in sensitivity analyses.

Conclusions

Lower-carbohydrate diets transiently reduce TEE, with a larger increase after ∼2.5 wk. These findings highlight the importance of longer trials to understand chronic macronutrient effects and suggest a mechanism whereby lower-carbohydrate diets may facilitate weight loss.

Source: Do Lower-Carbohydrate Diets Increase Total Energy Expenditure? An Updated and Reanalyzed Meta-Analysis of 29 Controlled-Feeding Studies | The Journal of Nutrition | Oxford Academic

In the Discussion section the authors write:

This finding supports a prediction of the carbohydrate-insulin model and suggests a mechanism whereby dietary carbohydrate reduction could aid in the prevention and treatment of obesity. According to this model, the high insulin-to-glucagon ratio with a diet high in glycemic load (mathematical product of glycemic index and carbohydrate amount) shifts the partitioning of metabolic fuels from oxidation in lean tissue to storage in adipose tissue. If the effects observed here persist over the long term, then reducing dietary carbohydrate intake by half from 60% of energy intake (a typical level for low-fat diets) would increase energy expenditure by ∼150 kcal/d, counterbalancing (if not compensated for by other factors) much of the secular increase in energy intake thought by some to underlie the obesity epidemic.

Steve Parker, M.D.

PS: Yes, this book is a low-carb diet.

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If You’re Gonna Eat Grains, Minimally-Processed May Be Better for You

Brown color may be food coloring rather than minimal processing

From Diabetes Care:

Consuming less-processed whole-grain foods over 2 weeks improved measures of glycemia in free-living adults with type 2 diabetes compared with an equivalent amount of whole-grain foods that were finely milled. Dietary advice should promote the consumption of minimally processed whole grains.

Source: Whole-Grain Processing and Glycemic Control in Type 2 Diabetes: A Randomized Crossover Trial | Diabetes Care

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

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Carbohydrate-Restricted Eating Increased Risk of Type 2 Diabetes!?

Eating this reduces risk of type 2 diabetes?

This is a real head-scratcher for me, just based on the abstract. I can’t explain or write-off the researchers findings at this point. I hope they administered the food frequency questionnaire more than once. If not, I can’t take this seriously.

Highlights

•Of 9689 middle-aged Australian women, 10% developed type 2 diabetes over 15 years.

•Carbohydrate restriction was associated with a 27% higher risk of type 2 diabetes.

•This association was attenuated after adjustment for BMI.

•The association was comparable for women with and without prior gestational diabetes.

•Women should be advised to avoid carbohydrate restricted diets low in fruit and grains.

Abstract

Background and aims

Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.

Methods and results

Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women’s Health in 2001 (aged 50–55) and 2013 (aged 62–67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).

Conclusion

Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

Source: Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study – Nutrition, Metabolism and Cardiovascular Diseases

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

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Diabetic Diet: When Low Carb Eating Backfires

Caprese salad: mozzarella cheese, tomatoes, basil, extra virgin olive oil

Healthline has an article by Christina Crowder Anderson, a certified diabetes educator and pediatric registered dietitian nutritionist. It’s worth your time. A snippet:

While I was in my dietetic internship at Duke University, I met a person with diabetes who had morbid obesity and who had participated in Dr. Eric Westman’s “low carb clinic.” They did well on that regimen until they ended up gaining back all the weight plus some, along with a resurgence in their type 2 diabetes.

At that moment, my iron-clad nutrition paradigm started to shift, as the sadness and shame from “diet failure” was palpable. Most individuals would say they “didn’t try hard enough.” But when you meet an actual person and hear their story, you’ll learn there are many factors that play into their success with a specific dietary approach.

Even though I was moved by this experience, my practice philosophies still didn’t change in terms of my recommended dietary approach for type 1 or type 2 diabetes — low carbohydrate. Over the next few years as I worked in a pediatric and adult endocrinology clinic, I steered most patients toward the more severe end of the “low carbohydrate spectrum” and was enthralled by the ability of the low carb approach to produce a flat line continuous glucose monitor (CGM) tracing.

That was, until I worked with 10 young adults in a clinical trial (for my graduate thesis), who chose to participate for a total of 8 months: 3 months on the low carbohydrate diet (60 to 80g day), 2 months of a “washout” period back on their own preferred diet, and another 3 months on the “standard diabetes diet” of >150 g carbs per day.

Source: When Low Carb Eating Backfires for Diabetes

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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Do Low-Carb Diets Cause Psychological Disorders? #LCHF

Not in Iranians at least (that’s where the study was done). From Nutrition Journal:

Adherence to the low carbohydrate diet, which contains high amount of fat and proteins but low amounts of carbohydrates, was not associated with increased odds of psychological disorders including depression, anxiety and psychological distress. Given the cross-sectional nature of the study which cannot reflect causal relationships, longitudinal studies, focusing on types of macronutrients, are required to clarify this association.

Source: Adherence to low carbohydrate diet and prevalence of psychological disorders in adults | Nutrition Journal | Full Text

At Longhorn Steakhouse in Amarillo, TX

I’d have been surprised if the researchers did find a linkage. But you don’t know for sure until y0u do the science.

Steve Parker, M.D.

low-carb mediterranean diet

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords.com.

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Both Low- and High-Carb Diets May Kill You

In the research at hand, low-carb was defined as under 40% of calories from carbohydrate, and high-carb was over 70% of calories.

Garlic Naan, a type of flat bread, definitely high-carb

The longevity sweet spot was 50-55% of calories from carbs. You know what? That’s the typical carb percentage in the traditional Mediterranean diet.

If you want to eat low-carb, read more below to identify the possibly healthier substitutions for carbs. Tl;dr version: Eat plant-derived protein and fats.

From a 2018 study in The Lancet Public Health:

Background

Low carbohydrate diets, which restrict carbohydrate in favour of increased protein or fat intake, or both, are a popular weight-loss strategy. However, the long-term effect of carbohydrate restriction on mortality is controversial and could depend on whether dietary carbohydrate is replaced by plant-based or animal-based fat and protein. We aimed to investigate the association between carbohydrate intake and mortality.

Methods

We studied 15 428 adults aged 45–64 years, in four US communities, who completed a dietary questionnaire at enrolment in the Atherosclerosis Risk in Communities (ARIC) study (between 1987 and 1989), and who did not report extreme caloric intake (4200 kcal per day for men and 3600 kcal per day for women). The primary outcome was all-cause mortality. We investigated the association between the percentage of energy from carbohydrate intake and all-cause mortality, accounting for possible non-linear relationships in this cohort. We further examined this association, combining ARIC data with data for carbohydrate intake reported from seven multinational prospective studies in a meta-analysis. Finally, we assessed whether the substitution of animal or plant sources of fat and protein for carbohydrate affected mortality.

Findings

During a median follow-up of 25 years there were 6283 deaths in the ARIC cohort, and there were 40 181 deaths across all cohort studies. In the ARIC cohort, after multivariable adjustment, there was a U-shaped association between the percentage of energy consumed from carbohydrate (mean 48·9%, SD 9·4) and mortality: a percentage of 50–55% energy from carbohydrate was associated with the lowest risk of mortality. In the meta-analysis of all cohorts (432 179 participants), both low carbohydrate consumption (70%) conferred greater mortality risk than did moderate intake, which was consistent with a U-shaped association (pooled hazard ratio 1·20, 95% CI 1·09–1·32 for low carbohydrate consumption; 1·23, 1·11–1·36 for high carbohydrate consumption). However, results varied by the source of macronutrients: mortality increased when carbohydrates were exchanged for animal-derived fat or protein (1·18, 1·08–1·29) and mortality decreased when the substitutions were plant-based (0·82, 0·78–0·87).

Interpretation

Both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% carbohydrate intake. Low carbohydrate dietary patterns favouring animal-derived protein and fat sources, from sources such as lamb, beef, pork, and chicken, were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter, and whole-grain breads, were associated with lower mortality, suggesting that the source of food notably modifies the association between carbohydrate intake and mortality.

Source: Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis – The Lancet Public Health

Steve Parker, M.D.

PS: These types of studies are often unreliable.

 

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

 

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Dr David Unwin Explains Why He Favors Low-Carb Eating as Best Diet for Type 2 Diabetes

 

diabetic diet, Paleobetic diet, diabetes,

Sunny’s Super Salad

The Diet Doctor website posted a video interview of Dr David Unwin (in the U.K.) discussing his experience with low-carb diets in folks with diabetes (type 2, I assume). If  you’re short on time, just read the transcript. Thanks, Diet Doctor!

I took note of Dr Unwin’s transformation from a run-of-the mill follow-the-herd practitioner to a low-carb advocate. This happened around 2012 when Dr Unwin was 55 years old and on the threshold of retirement. Here it is:

Dr David Unwin speaking: ….There was one particular case I’ve talked about before where there was a patient who – so in 25 years I’d never seen a single person put their [type 2] diabetes into remission, I had not seen it once. I didn’t even really know it was possible.

Dr Bret Scher speaking:  We were not [taught] that it’s possible.

Dr Unwin:  No, my model was that the people with diabetes… It was a chronic deteriorating condition and I could expect that they would deteriorate and I would add drugs and that’s what would be normally going to happen. And then one particular patient wasn’t taking her drugs and she actually went on the low-carb diet and put her diabetes into remission.

But she confronted me with, you know, “Dr. Unwin, surely you know that actually sugar is not a good thing for diabetes.” “Yes, I do.” But then she said, “But you’ve never once in all the years mentioned that really bread was sugar, did you.” And, you know, I never did. I don’t know what my excuse was. So this this lady had done this wonderful thing and she’d also changed her husband’s life as well.

She’d sorted his diabetes out and she’d done it with a low-carb diet and that really made me think I didn’t know much about it. I didn’t know much about it. So I found out what she’d been on… on the low-carb forum of diabetes.co.uk and to my amazement there was 40,000 people on there, all doing this amazing thing. And I was blown away but then I was very sad because the stories of the people online were full of doctors who are critical of these people’s achievements.

***

Dr Unwin: And that original case that showed me you could put into remission; if you could repeat that, how wonderful for people… And when I now – because I think we’ve done 60 patients who put their type 2 diabetes into remission. So I’m able to say with confidence to people, you know, you stand a good chance. In fact I can say that of my patients who take up low-carb, about 45% of them will put their diabetes into remission which is amazing.

At no point does the transcript indicate they’re talking about type 2 diabetes rather than type 1, but that must be the case. Nor does it mention the amount of required carbohydrate restriction. I figure it’s between 20 and 100 grams/day of digestible carbohydrate, depending on one’s metabolic health and how many years of diabetes.

I’ve mentioned Dr Unwin before.

Source: Diet Doctor Podcast #33 – Dr. David Unwin – Diet Doctor

Steve Parker, M.D.

Click the pic to purchase at Amazon.com. E-book versions also available at Smashwords. com

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