Low-Carb Diet Works In Overweight Japanese Type 2 Diabetes

This meal is low-carb, and probably low-calorie too

This meal is both low-carb and low-calorie

A randomized controlled clinical trial found superior results in diabetes with a moderate low-carb diet, judging from weight loss and hemoglobin A1c.

I don’t know how many carbs the typical Japanese person eats in a day. In the U.S., it’s 250-300 grams. Here’s how the study at hand was done:

“This prospective, randomized, open-label, comparative study included 66 T2DM patients with HbA1c >7.5% even after receiving repeated education programs on Calorie-Restricted Dieting (CRD). They were randomly allocated to either the 130g/day Low-Carb Diet (LCD) group (n = 33) or CRD group (n = 33). Patients received personal nutrition education of CRD or LCD for 30 min at baseline, 1, 2, 4, and 6 months. Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients (28× ideal body weight calories per day). [If I understand correctly, a 170-lb (77.2 kg) person would be recommended to eat 2160 calories/day.] Patients of the LCD group were advised to maintain the intake of 130 g/day carbohydrate without other specific restrictions. Several parameters were assessed at baseline and 6 months after each intervention. The primary endpoint was a change in HbA1c level from baseline to the end of the study.

At baseline, body mass index (BMI) and HbA1c were 26.5 and 8.3, and 26.7 kg/m2 and 8.0%, in the CRD and LCD, respectively. At the end of the study, HbA1c decreased by −0.65% in the LCD group, compared with 0.00% in the CRD group (p < 0.01). Also, the decrease in BMI in the LCD group [−0.58 kg/m2] exceeded that observed in the CRD group (p = 0.03).

Conclusions: Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with type 2 diabetes. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD.”

Source: A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control – Clinical Nutrition

The calorie-restricted diet did nothing for these folks in terms of glycemic  control.

Steve Parker, M.D.

PS: In case you’re wondering, the Low-Carb Mediterranean reduces digestible carbs to 20-100 grams/day.

low-carb mediterranean diet

Front cover of book

 

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How About a Whole Foods Plant-Based Diet?

Carb-rich whole-grain bread

New Zealand researchers found significant long-term weight loss and improved cholesterol levels over six and 12 months with a low-fat vegetarian diet. Surprisingly, this was accomplished without restriction on calories and without an exercise component. Weight loss measured at six months was 27 lb (12.1 kg) and they only gained a little back over the subsequent six months.

The authors think the successful weight loss was from “… the reduction in the energy density of the food consumed (lower fat, higher water and fibre). Multiple intervention participants stated ‘not being hungry’ was important in enabling adherence.”

I scanned the research report pretty quickly and don’t see that they referred to the diet as vegetarian. Here’s their test diet description:

We chose a low-fat iteration of the plant-based diet [7–15% if calories as fat] as this has been shown with previous research to achieve optimal outcomes, especially for heart disease and weight loss. This dietary approach included whole grains, legumes, vegetables and fruits. Participants were advised to eat until satiation. We placed no restriction on total energy intake. Participants were asked to not count calories. We provided a ‘traffic-light’ diet chart to participants outlining which foods to consume, limit or avoid. We encouraged starches such as potatoes, sweet potato, bread, cereals and pasta to satisfy the appetite. Participants were asked to avoid refined oils (e.g. olive or coconut oil) and animal products (meat, fish, eggs and dairy products). We discouraged high-fat plant foods such as nuts and avocados, and highly processed foods. We encouraged participants to minimise sugar, salt and caffeinated beverages.

Perfect diet compliance would make this a vegan diet. I didn’t catch it in the text of the article, but I’m guessing protein calories were 10–15% of the total, and carbohydrates were around 75%.

The researchers called their investigation the BROAD study. All study subjects were overweight or obese adults. A control group ate their regular foods. The intervention group eating the whole food plant-based diet numbered 33, including 7 with type 2 diabetes. All studies like this have people that drop out. I.e., they quit or otherwise get lost to follow-up. Of the intervention group, 75% lasted for six months, 70% stuck with it for the entire 12 months.

 

There weren’t enough diabetics in the study to make statistically significant conclusions, but the authors write, “Hemoglobin A1c reductions favoured the intervention and all intervention patients with a diabetes diagnosis improved while adherent, and two resolved their condition by HbA1c.”

I’d love to see these researchers repeat this study with 50–100 overweight or obese folks with T2 diabetes. Clearly, it’s a radically different diet than what I recommend for my patients with diabetes.

Steve Parker, M.D.

PS: For science nerds, here’s the study abstract:

Background/Objective: There is little randomised evidence using a whole food plant-based (WFPB) diet as intervention for elevated body mass index (BMI) or dyslipidaemia. We investigated the effectiveness of a community-based dietary programme. Primary end points: BMI and cholesterol at 6 months (subsequently extended).

Subjects: Ages 35–70, from one general practice in Gisborne, New Zealand. Diagnosed with obesity or overweight and at least one of type 2 diabetes, ischaemic heart disease, hypertension or hypercholesterolaemia. Of 65 subjects randomised (control n=32, intervention n=33), 49 (75.4%) completed the study to 6 months. Twenty-three (70%) intervention participants were followed up at 12 months.

Methods: All participants received normal care. Intervention participants attended facilitated meetings twice-weekly for 12 weeks, and followed a non-energy-restricted WFPB diet with vitamin B12 supplementation.

Results: At 6 months, mean BMI reduction was greater with the WFPB diet compared with normal care (4.4 vs 0.4, difference: 3.9 kg m−2 (95% confidence interval (CI)±1), P<0.0001). Mean cholesterol reduction was greater with the WFPB diet, but the difference was not significant compared with normal care (0.71 vs 0.26, difference: 0.45 mmol l−1 (95% CI±0.54), P=0.1), unless dropouts were excluded (difference: 0.56 mmol l−1 (95% CI±0.54), P=0.05). Twelve-month mean reductions for the WFPB diet group were 4.2 (±0.8) kg m−2 BMI points and 0.55 (±0.54, P=0.05) mmol l−1 total cholesterol. No serious harms were reported.

Conclusions: This programme led to significant improvements in BMI, cholesterol and other risk factors. To the best of our knowledge, this research has achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy intake or mandate regular exercise.

Source: Nutrition & Diabetes – The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes

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Type 2 diabetes: Exercise, diet better than medicine, says university study 

Exercise is more helpful for preventing weight gain than for inducing weight loss

From the Vancouver Sun:

“Taking medication to tightly control and lower blood glucose levels is the advice frequently given by doctors to the 400,000 British Columbia residents with Type 2 diabetes — but it’s a “misguided” approach, according to the University of B.C. Therapeutics Initiative [the TI].

More than $1 billion is spent annually on diabetes drugs in this province, but in its latest bulletin to doctors, the TI says a growing body of research casts doubt on the effectiveness of Type 2 diabetes treatment. Doctors should focus instead on prescribing lifestyle modifications such as weight loss, exercise and healthier diets instead of medications to many patients, it says.

Type 2 diabetes, characterized by resistance to insulin, is largely caused by obesity, lack of exercise, high-carbohydrate diets and aging.”

Source: Type 2 diabetes: Exercise, diet better than medicine, says UBC study | Vancouver Sun

Read the short article for an opposing viewpoint. Namely, some diabetes drugs may help prevent cardiovascular disease (I’m not yet convinced).

h/t The Low Carb Diabetic

Hey, I know a diet that helps!

LCHF Mediterranean diet

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Another Study Demonizes Red Meat: Justifiable?

I don't know about these, but some fish have white meat (flesh), too

Lobster meat is white, too

If you hear elsewhere about a recent study blaming red meat for kidney failure, be aware that the headline should read “pork.” Read on for details.

Wait, what? I thought pork was “the other white meat.”

First they told us red meat caused cancer. Then cardiovascular disease. Then diabetes. And now kidney failure. Why eat it at all? I still do, but in moderation.

You have to take studies like this with a grain of salt. There are numerous confounding factors that may invalidate results. For instance, if you’re not Chinese and living in Singapore, results of this study may not apply to you. For another instance, Chinese pork may be different from English, Indian, Canadian, and U.S. pork.

A quote from the article at MNT:

“Researcher Woon-Puay Koh and her team delved into data from the Singapore Chinese Health Study, which included more than 63,000 adults, aged 45-74. They linked the data with the Singapore Renal Registry, which holds the records of all Singapore ESRD patients. The overall aim was to uncover the role of different protein sources on kidney health outcomes.

“We embarked on our study to see what advice should be given to chronic kidney disease patients or to the general population worried about their kidney health regarding types or sources of protein intake,” explains Koh.

In China, the primary red meat is pork, accounting for 97 percent of red meat intake. Other popular protein sources included eggs, dairy, shellfish, fish, soy, legumes, and poultry.

The participants were followed up for an average of 15.5 years. During that time, 951 cases of ESRD [end-stage renal disease] occurred; the resultant data showed a clear trend.

Red meat intake was associated with a dose-dependent increased ESRD risk. Individuals who consumed the highest amounts of red meat – the top 25 percent – showed a 40 percent higher risk of developing ESRD than those who consumed the least red meat – the bottom 25 percent.”

Source: Red meat consumption linked to kidney failure – Medical News Today

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Dr. Fung’s Quick Start Guide to Diabetes Reversal

Dr. Fung is a nephrologist and huge advocate of intermittent fasting. He has an article over at DietDoctor that you may find interesting (link below). Beware: at the link you will find an accurate photo of a gangrenous foot that you may find nauseating or disturbing.

I see gangrene in the hospital once a month. It’s one of the things that keeps me motivated to help PWDs (people with diabetes) learn to conquer diabetes.

Another caveat. If you take drugs that have the potential to cause hypoglycemia, you may indeed suffer life-threatening hypoglycemia if you drastically cut back on sugar and other refined carbohydrates. You better know what you’re doing.

Dr. Fung writes:

“Once we understand type 2 diabetes, then the solution becomes pretty bloody obvious. If we have too much sugar in the body, then get rid of it. Don’t simply hide it away so we can’t see it. There are really only two ways to get rid of the excessive sugar in the body.

  1. Don’t put sugar in [nor refined starches]
  2. Burn it off

That’s it. That’s all we need to do. The best part? It’s all natural and completely free. No drugs. No surgery. No cost.”

Source: How to Reverse Type 2 Diabetes – The Quick Start Guide – Diet Doctor

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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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