New Evidence Supports Extreme Carbohydrate Restriction in Type 2 Diabetes

Low-Carb Spaghetti Squash With Meat Sauce

Diabetes is a disease of carbohydrate intolerance. Doesn’t that suggest to you that diabetics should reduce or avoid dietary carbohydrates?

The new study at hand was done in Indiana, involving 262 folks with type 2 diabetes. Characteristics of the study subjects:

  • average age 54
  • 66% women
  • BMI 41 (very fat)
  • average Hemoglobin A1c 7.6%

The authors don’t use the term “ketogenic diet,” preferring instead “a diet designed to induce nutritional ketosis” (I’m paraphrasing). For most folks, that’s a diet with under 30 grams of carbohydrate daily, according to the researchers. The study lasted for only 10 weeks.

The drop-out rate was about 10% (25 participants), which is not bad.

Results:

  • Hemoglobin A1c (a test of diabetes control) dropped to 6.5%, a move in the right direction and equivalent or better than that seen with many diabetes drugs.
  • Average weight loss was 7.2% of initial body weight.
  • No severe symptomatic hypoglycemic events.
  • Number and dose of necessary diabetes drugs were reduced “substantially.”

What’s not to love? Why isn’t this the standard of care?

Click the link below to look for details of the Virta Clinic program used in this study.

I put together a Ketogenic Mediterranean Diet for my patients with diabetes. It reduces dietary carbs to 20-30 grams/day. There’s a free version, but consider the low-cost version that includes recipes and extensive initiation and management advice.

Steve Parker, M.D.

McKenzie AL, Hallberg SJ, Creighton BC, Volk BM, Link TM, Abner MK, Glon RM, McCarter JP, Volek JS, Phinney SD
A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
JMIR Diabetes 2017;2(1):e5
DOI: 10.2196/diabetes.6981

low-carb mediterranean diet

Front cover of book

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Upcoming Changes

I need to reach more people. Last fall I tripled my blogging frequency and it did nothing to increase viewership. I plan to cut back on written blogging and Tweeting, but will be doing more videos. It’s an experiment.

I’ll try to keep all videos under six minutes out of respect for your time.

This video mentions the topics I’ll be covering. If they sound interesting, please subscribe to the pxHealth YouTube Channel.

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How Walter White lost weight in “Breaking Bad”

Raw Brussels Sprouts, one of many low-carb vegetables.
Photo Copyright: Steve Parker

In 2014 Howard Stern interviewed Bryan Cranston and asked how he lost weight so quickly for his role as Walter White on Breaking Bad:

“Stern: When you had chemo and was getting sick playing the part of Walter White, in order to go through rapid weight loss you deliberately didn’t eat for 10 days? True or false?

Cranston: False.

Stern: How’d you lose all that weight?

Cranston: No carbohydrates. I just took out all the carbohydrates.

Stern: How much weight did you drop?

Cranston: 16 pounds, in ten days.

Stern: Painful?

Cranston: No. The first three days are really hard, ’cause your body’s changing and craving sugar and wants, you know, and then you deprive it of the sugar and it starts burning fat.”

Source: How Walter White lost weight in Breaking Bad, it wasn’t chemo – High Steaks

h/t Tom Naughton

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Karl Denninger Says He Can Cut Medicare’s Budget by 25% With One Simple Measure

Karl’s no physician, I don’t even think he has diabetes, but he’s a smart guy:

“You simply have to allow me to make the following policy change with regards to one disease — Diabetes:

  • For those with Type II diabetes we will provide unlimited metformin (cheap, off-patent generic medicine that costs pennies a day) to anyone with the disease.
  • We will provide no other care of any sort for Type II. You want or “need” it, pay cash or die. Period.
  • We will also make changes to how we deal with Type I diabetics’ insulin requirements, as detailed below, that will cut said requirements dramatically.

Now before you scream in horror that I’m a monster, listen up.

Instead of medicine and, inexorably, amputations, dialysis, hospitalization and death we’re going to prescribe a lifestyle of eating no more than 50g of carbs a day, all in green vegetables high in vitamin C (e.g. broccoli, brussels sprouts, etc.)

Caloric intake is to otherwise be 70% saturated (animal) fat and 20% protein. Sugars, grains and starches, including but not limited to “white” foods (pasta, potatoes, breads, etc) are all prohibited. Zero-calorie / zero-carb spices and condiments are unrestricted, of course.

In short you eat (and don’t eat) what’s described in this post, less the fruits (since they are all fairly high-glycemic and the vitamin C requirement is taken care of.)

For most Type II diabetics eating this way will reduce their need for other drugs, including insulin, to a literal zero and since their blood sugar will normalize their need for many-times-a-day testing will also disappear, getting rid of both the pain of sticking one’s finger repeatedly and the cost.

For those who it doesn’t the metformin is there to help.

We will also accommodate all actual, documented exceptions — that is, those people for whom this lifestyle change legitimately doesn’t work.

Those who claim “it doesn’t work” will be locked in an isolation ward where they will be fed that diet for two weeks (with no access of any sort to any other source of sustenance) and be able to prove that for them, individually, it doesn’t work. If they’re right then they will get whatever medication or other intervention is necessary provided they keep to the lifestyle change. But if that empirical test shows that it does work (and it will for virtually everyone) then their ass will be discharged, the fact that they refuse to change what they eat will be noted in their chart and further complaints of “impossibility” will be ignored.”

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Mediterranean Diet With Extra Olive Oil May Prevent Breast Cancer

From my pantry...

From my larder…

A Mediterranean-style diet with supplemental extra-virgin olive oil seemed to reduce the incidence of breast cancer in a Spanish population. This is consistent with prior observational studies that link the Mediterranean diet with lower rates of breast and other cancers (colon, prostate, uterus, and melanoma).

The study population involved 4,000 women who were followed for five years. Thirty-five new cases of breast cancer occurred in this PREDIMED study sub-analysis.

The comparison diets were a reduced-fat diet and Mediterranean diet supplemented with mixed nuts.

This is a relatively small study, so results may not be entirely reliable.

Action Plan

If you’re a woman hoping to avoid breast cancer, consider the Mediterranean diet and be sure to eat plenty of extra-virgin olive oil. A good way to do this is to use home-made vinaigrettes.

Steve Parker, M.D.

PS: Even if you think Spaniards are jovial, you won’t find any in my books.

Reference: Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial. JAMA Internal Medicine, 2015. doi: 10.1001/jamainternmed.2015.4838

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DPP-4 Inhibitors Increase Risk of Pancreatitis

…although the risk of getting pancreatitis is pretty small in any case.

DPP-4 inhibitors are sometimes called gliptins. They’re used to treat type 2 diabetes.

From Diabetes Care:

“CONCLUSIONS Treatment with gliptins significantly increased the risk for acute pancreatitis in a combined analysis of three large controlled randomized trials.”

Source: Diabetes Care

Speaking of risk reduction, lower your risk of being prescribed a gliptin by reducing your carbohydrate consumption.

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Mediterranean Diet Limits Weight Gain in Adolescents

"I may not make wine with all of my grapes, but when I do, it's red wine."

“I may not make wine with all of my grapes, but when I do, it’s red wine. Don’t give it to children.”

Overweight and obesity are increasing in U.S. adolescents, which may hamper their health as adults. In fact, some experts predict that we will see a decrease in average life expectancy because of lifelong excess weight.

Youths who follow a Mediterranean diet pattern don’t see as much increase in body mass index as others.

From the International Journal of Obesity:

“Among adults, the Mediterranean dietary pattern (MDP) is inversely related to body mass index (BMI) [i.e., as the Mediterranean diet is followed more closely, we see less increase in body weight.]. Data are lacking on adherence to the MDP among youth in the United States and whether the MDP is related to weight change in that group.”

Now we have some data, and it looks good for the Mediterranean diet.

In other words, if you want to keep your kid from getting fat, the Mediterranean diet will help. Fo you adults, the Low-Carb Mediterranean Diet also helps control diabetes.

Source: International Journal of Obesity – Abstract of article: Adherence to the Mediterranean dietary pattern and BMI change among US adolescents

Steve Parker, M.D.

low-carb mediterranean diet

Front cover of book

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