HeartWire at TheHeart.Org on October 18, 2010, posted an article about use of the Atkins diet for people with diabetes. You might enjoy the ongoing lively debate among (mostly) physicians and researchers.
Steve Parker, M.D.
I must give credit to Dr. Robert C. Atkins for popularizing an approach – carbohydrate restriction – that helps people with diabetes control their disease, and likely helps prevent type 2 diabetes in others. Mary C. Vernon and Jacqueline Eberstein do a great job explaining his program in their 2004 book, Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes.
On the Amazon.com five-star rating scale, I give this book four stars.
I can best summarize this book by noting that it is the standard Atkins diet with a few modifications: 1) special supplements 2) you add additional carbs to your diet more slowly 3) the warning that diabetics may well end up with a lower acceptable lifetime carbohydrate intake level.
By way of review, the Atkins diet is a very low-carb diet, particularly in the two-week induction phase. “Very low-carb” means lots of meat, chicken, fish, eggs, limited cheese, and 2-3 cups daily of salad greens and low-carb veggies like onions, tomatoes, broccoli, and snow peas. After induction phase, you slowly add back carbs on a weekly basis until weight loss stalls, then you cut back on carbs.
As an adult medicine specialist, I have no expertise in pediatrics. I didn’t read the two chapters related to children.
The authors present “complimentary medicine”in a favorable light. Unsuspecting readers need to know that much of complementary medicine is based on hearsay and anecdote, not science-based evidence. In that same vein, the two chapters on supplements for diabetes and heart disease recommend a cocktail of supplements that I’m not convinced are needed. I don’t know a single endocrinologist or cardiologist prescribing these concoctions. Then again, I could be wrong.
Vernon and Eberstein provide two excellent chapters on exercise.
A month of meal plans and recipes are provided for 20, 40, and 60-gram carbohydrate levels. [The average American is eating 250-300 g of carbs daily.] The recipes look quick and easy, but I didn’t prepare or taste any of them.
The 5-hour glucose and insulin tolerance test (GTT, paged 61) that Dr. Atkins reportedly ran on all patients who came to him is rarely done in other medical clinics. This doesn’t mean it’s wrong, but certainly out of the mainstream. The authors admit that at least a few people will have to count calories – specifically, limit total calories – if the basic program doesn’t control diabetes, prediabetes, and the metabolic syndrome. Limiting portion size will speed weight loss, they write.
What we don’t know with certainty is, will long-term Atkins aficionados miss out on the health benefits of higher consumption of fruits, vegetables, legumes, and whole grains? Much of the scientific literature suggests, “Yes.”
What if we compare the long-term outlooks of a diabetic Atkins follower with a poorly controlled diabetic who’s 80 pounds overweight and eating a standard American diet? The Atkins follower is quite likely to be healthier and live longer.
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.
Ninety-seven overweight and obese adults, 78% women and 40% black, were randomly assigned to either:
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%.
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.
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
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.