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- Flag of the United Nations
This is World Diabetes Day. See the International Diabetes Federation website for details.
Happy World Diabetes Day!
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Moderate Low-Carb Diet Just as Effective as Insulin Shots in Type 2 Diabetes
Mount Fuji
A low-carbohydrate diet is just as effective as insulin shots for people with severe type 2 diabetes, according to research recently announced by Japanese investigators.
Thirty-three uncontrolled Japanese type 2 diabetics, similar numbers of men and women, were placed on a low-carbohydrate diet for six months. The diet provided 30% of energy from carbs, 44% fat, and 20% protein. [By point of reference, the average American derives 55–60% of energy from carbs.] Average caloric intake was 1,852/day. [I’m not sure what provided the other 6% of calories – I suspect distilled liquor.] Average body mass index was 24 and did not change during the six months. The only adverse effect was mild constipation. Two people dropped out of the study before completion. Seven participants were on sulfonylurea drug therapy.
Protein and fat intake were unlimited. They were given a list of high-carbohydrate foods to avoid (see reference).
Results
Hemoglobin A1c, a standard test of diabetes control, fell from10.9% to 7.8% at three months and 7.4% at six months. Five of the seven patients on sulfonylurea were able to stop the drug. No patient required insulin therapy or hospitalization.
Comments
The low drop-out rate may be a testament to the palatability of this low-carb way of eating.
Japanese diabetes may not be exactly the same disease as American or European diabetes. For instance, Japanese diabetics are not as overweight. Only 3% of the Japanese population is obese (body mass index over 30), compared to 30% of the U.S. population.
The degree of carbohydrate restriction in this study is not nearly as severe as with the Ketogenic Mediterranean Diet. Yet the improvement in hemoglobin A1c was dramatic after just three months.
Being aware of genetic and other influences on disease, I’m always wary about generalizing research results from one race or ethnic group to others. When it comes to the efficacy of low-carb eating in people with type 2 diabetes, however, we’ve seen similar results already in white and black Americans.
Reference: Haimoto, Hajime, et al. Effects of a low-carbohydrate diet on glycemic control in outpatients with severe type 2 diabetes. Nutrition and Metabolism, 6:21 doi:10.1186/1743-7075-6-21
Filed under Carbohydrate
Which Drug Is Best for Treatment of Type 2 Diabetes?
Physicians now have an amazing array of drug therapies for control of type 2 diabetes. Until now, there has been no consensus as to which drugs to use, and when.
The American Association of Clinical Endocrinologists and the American College of Endocrinology have just issued a joint statement with specific drug recommendations. Their algorithm is quite detailed. Here are a few highlights you might not know about:
- Regular human insulin is not recommended
- NPH insulin is not recommended
- The following should be used earlier and more frequently: GLP-1 agonists (exenatide) and DPP-4 inhibitors (sitagliptin and saxagliptin)
- sulfonylureas are a lower priority
- metformin is still a key drug
In the U.S., exenatide is sold as Byetta; sitagliptin is Januvia; saxagliptin is Onglyza; metformin is Glucophage (among others).
If you have type 2 diabetes and are arguing with your physician about optimal drug therapy, this treatment algorithm may be a helpful tie-breaker.
Reference: Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: An algorithm for glycemic control. Endocrine Practice, 15 (2009): 540-559.
Filed under Drugs for Diabetes
Drink Vinegar and Lose 2-4 Pounds Effortlessly
Japanese researchers recently documented that daily vinegar reduces body weight, fat mass, and triglycerides in overweight Japanese adults.
Beverages containing vinegar are commonly consumed in Japan. The main component—4 to 8%— of vinegar is acetic acid. Vinegar can lower cholesterol levels, lower blood pressure, and limit increases in blood sugar after meals.
Japanese researchers studied the effects of vinegar on 175 overweight—body mass index between 25 and 30—subjects aged 25 to 60. Men totaled 111; women 64. Average weight 74.4 kg (164 pounds). They were divided into three groups that received either a placebo drink, 15 ml apple vinegar (750 mg of acetic acid), or 30 ml apple vinegar (1,500 mg acetic acid). Placebo and vinegar were mixed into 500 ml of a beverage, half of which was drunk twice daily after breakfast and supper for 12 weeks. Changes in body fat were measured with CT technology. Subjects were told to eat and exercise as usual.
Results
By the end of the 12 weeks, weight had decreased by 1-2 kg (2.2 to 4.4 pounds) in the vinegar drinkers, with 30 ml of vinegar a bit more effective. CT scanning showed that the lost weight was fat mass rather than muscle or water. Triglyceride levels in the vinegar groups fell by about 20%. The placebo drinkers saw no changes.
Four weeks after the intervention ended, subjects were retested: values had returned to their baseline, pre-study levels.
The scientists report that the acetic acid in vinegar inhibits production of fat and may stimulate burning of fat as fuel. Although vinegar contains many other ingredients, they think the acetic acid is responsible for the observed changes.
My Comments
It’s possible that apple vinegar components other than acetic acid led to the weight loss and lowered triglyceride levels. Further study could clarify this.
These results may or may not be applicable to non-Japanese races.
This study supports the use of vinaigrette as a salad or vegetable dressing in people trying to lose weight with diets such as the Ketogenic Mediterranean Diet. Vinaigrettes are combinations of olive oil and vinegar, often with various spices added. If you eat a salad twice a day, it would be easy to add 15 ml (1 tbsp) of vinegar to your diet daily.
With a little imagination, you could come up with other ways to add 15–30 ml (1–2 tbsp) of vinegar to your diet.
Reference: Kondo, Toomoo, et al. Vinegar intake reduces body weight, body fat mass, and serum triglyceride levels in obese Japanese subjects. Bioscience, Biotechnology, and Biochemistry, 73 (2009): 1,837-1,843.
Filed under Weight Loss
Low-Carb Ketogenic Diet Beats Low-Glycemic Index Diet in Overweight Type 2 Diabetes
Avoid the needle with a low-carb ketogenic diet
Duke University (U.S.) researchers demonstrated better improvement and reversal of type 2 diabetes with an Atkins-style diet, compared to a low-glycemic index reduced-calorie diet.
Methodology
Ninety-seven overweight and obese adults, 78% women and 40% black, were randomly assigned to either:
- a very low-carb ketogenic diet (Atkins induction phase, as in Atkins Diabetes Revolution) or
- a low glycemic-index index calorie-restricted diet (The GI Diet by Rick Gallop).
Thirty-eight were in the Atkins group; 46 in the low-glycemic index (low-GI) group. Seventeen dropped out of each group before the end of the 24-week study. Average weight was 234.3 pounds (106.5 kg); average body mass index was 37. The Atkins group averaged 13% of total calories from carbohydrate; the low-GI cohort averaged 44%.
Results
Both groups lost weight and had improvements in hemoglobin A1c, fasting insulin, and fasting glucose.
The Atkins group lowered their hemoglobin A1c by 1.5% (absolute drop, not relative) versus 0.5% in the other group.
The Atkins group lost 11.1 kg versus 6.9 kg in the other group.
The Atkins group increased HDL cholesterol by5.6 mg/dl versus no change in the other group.
All the aforementioned comparisons were statistically significant.
Diabetes medications were stopped or reduced in 95% of the Atkins group versus 62% of the low-GI group.
Total and LDL cholesterol levels were unchanged in both groups.
Triglycerides fell significantly only in the Atkins group.
My Comments
You may be interested to know that this study was funded by the Robert C. Atkins Foundation.
One strength of this study is that it lasted for 24 months. Many similar studies last only eight to 12 weeks. A drawback is that, with all the drop-outs, the number of participants is low.
The GI Diet performed pretty well, too, all things considered. Sixty-two percent reduction or elimination of diabetes drugs—not bad. For a six-year-old book, it’s still selling fairly well at Amazon.com. That may be why they chose it as the comparison diet.
The diet with fewer carbohydrates—Atkins induction—was most effective for improving control of blood sugars. So effective, in fact, that the researchers sound a note of warning:
For example, participants taking from 40 to 90 units of insulin before the study were able to eliminate their insulin use, while also improving glycemic control. Because this effect occurs immediately upon implementing the dietary changes, individuals with type 2 diabetes who are unable to adjust their own medication or self-monitor their blood glucose should not make these dietary changes unless under close medical supervision.
[Not all insulin users were able to stop it.]
Overall, lipids were improved or unchanged in the Atkins group, despite the lack of limits on saturated fat intake. A common criticism of the Atkins diet is that it has too much saturated fat, leading to higher total and LDL cholesterol levels, which might raise long-term cardiovascular risks. Not so, here.
When you reduce carbohydrate intake, the percentages of fat and protein in the diet also change. In this Atkins diet, protein provided 28% of daily calories, and fat 59%. In the low-GI diet, protein provided 20% of daily calories, fat 36%. The beneficial effects of the Atkins diet probably reflect the low carbohydrate consumption rather than high protein and fat.
The Atkins induction-phase diet was clearly superior to the low-glycemic index diet in this overweight diabetic sample, without restricting calories.
Reference: Westman, Eric, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & Metabolism 2008, 5:36 doi:10.1186/1743-7075-5-36
Additional Reading
Samaha, F., et al. A low-carbohydrate as compared with a low-fat diet in severe obesity. New England Journal of Medicine, 348 (2003): 2,074-2,081.
Boden, G., et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Annals of Internal Medicine, 142 (2005): 403-411.
Vernon, M., et al. Clinical experience of a carbohydrate-restricted diet: Effect on diabetes mellitus. Metabolic Syndrome and Related Disorders, 1 (2003): 233-238.
Yancy, W., et al. A pilot trial of a low-carbohydrate ketogenic diet in patients with type 2 diabetes. Metabolic Syndrome and Related Disorders, 1 (2003): 239-244.
Walnuts: More Evidence in Favor of Health Benefits
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Nuts are a time-honored component of the Mediterranean diet and may contribute to the lower risk of cardiovascular disease associated with the diet.
Regular nut consumption lowers total cholesterol and LDL (“bad cholesterol”) by 5 to 15%, which would tend to lower heart disease risk. Walnuts are particularly high in alpha-linolenic acid, an omega-3 fatty acid.
Bix over at Fanatic Cook links to three scientific studies showing that walnuts:
- improved arterial function in people with type 2 diabetes
- improved arterial function in people with high cholesterol eating a Mediterranean diet
- decreased fasting insulin levels in people with type 2 diabetes
- decreased LDL cholesterol in people with type 2 diabetes who were on a low-fat diet
The “dose” of walnuts in these studies was 1–2 ounces (28–56 g) daily.
For good reason, nuts have a prominent role in both the Advanced Mediterranean Diet and Ketogenic Mediterranean Diet.
I don’t know Bix, but he or she seems to base many of his/her nutrition opinions on scientific principles, which I appreciate.
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Filed under coronary heart disease, Mediterranean Diet, nuts, Shameless Self-Promotion
Eat Cod to Lose More Weight
Five servings of cod per week led to loss of an extra 3.7 pounds (1.7 kg) over eight weeks, according to a recent research report.
European researchers noted that cod consumption in a prior study increased weight loss. They wondered if that result could be reproduced, and whether the effect was “dose dependent.” In other words, would those eating more cod lose more weight than those eating less?
They studied 125 subjects between the ages of 20 and 40, with body mass index between 27.5 and 32.5. The abstract doesn’t mention sex of the participants. They were all placed on calorie-restricted diets with identical percentages of protein, fat, and carbohydrate, and were followed for eight weeks. Researchers divided the subjects into three groups:
- One group was given 150 g (a little over 5 ounces) of cod three times weekly
- Another group was given 150 g cod five times weekly
- The third group was given no seafood
Average weight loss overall was 11 pounds (5 kg). The more cod consumed, the greater the weight loss. Those eating five servings a week averaged 3.7 pounds (1.7 kg) more than the group not eating seafood.
It’s unclear whether other types of fish would produce similar results.
These results support the prominent role of fish in the Ketogenic Mediterranean Diet.
Reference: Ramel, A., et al. Consumption of cod and weight loss in young overweight and obese adults on an energy reduced diet for 8-weeks. Nutrition, Metabolism and Cardiovascular Diseases, 19 (2009): 690-696.
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Filed under Fish, Weight Loss
How Much Is a Good Reputation Worth?
"No weight-loss supplements for me!"
Recommended reading:
Janet Helm at her Nutrition Unplugged blog yesterday wrote about fitness guru Jillian Michaels’ endorsement of highly questionable weight-loss supplements.
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Lower My Risk of Diabetes? I’ll Drink to That!
- How many grams of alcohol are in this wine?
Judicious alcohol consumption is linked to lower risk of developing type 2 diabetes: 40% lower risk in women, 13% lower in men.
The latest issue of Diabetes Care reports the comparison of lifetime abstainers with alcohol drinkers. The protective “dose” of alcohol is 22–24 grams a day. I’ll leave it to you to figure out how much alcohol that is. Prior studies looking at overall health benefits of alcohol indicate that judicious consumption is ≤ one drink daily, on average, for women, and ≤ 2 drinks a day for men.
Of course, many people shouldn’t drink any alcohol.
Reference: Baliunas, D., et al. Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 32 (2009): 2,123-2,132.
Filed under Alcohol, Prevention of T2 Diabetes
Recommended Supplements for the Ketogenic Mediterranean Diet
I’ve finalized—at least for now—the latest supplements for dieters on the Ketogenic Mediterranean Diet, and tinkered with the original plan: Version 2.0 is published.
Daily supplements:
- 1 or 2 plain Centrum multivitamin/multimineral supplements (two if over 250 lb or 114 kg)
- Magnesium oxide 250 mg
- Calcium carbonate 500 mg elemental calcium (500 mg twice daily if over 250 lb or 114 kg)
- Extra vitamin D to reach total of 1,000–1,200 IU (each Centrum has 400 IU)
- Potassium gluconate 2,750 mg (450 mg elemental potassium) or Morton Salt Substitute (potassium chloride) ¼ tsp (1.2 g)
- If prone to constipation: sugar-free Metamucil powder 1–2 rounded tsp (5.8–11.6 g) in water
- At least three quarts or liters of water
The published version 2.0 of KMD has a misprint: “1,000–2,ooo IU of vitamin D.” Should be 1,000–1,200 IU. I’ll fix it soon and label it version 2.1.
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Diabetic Mediterranean Diet 