January 8, 2014 · 2:33 AM
Mt. Fuji in Japan
I don’ know anything about Japanese T2 diabetes. I’ve never studied it. Their underlying physiology may or may not be the same as in North American white diabetics, with whom I am much more familiar.
For what it’s worth, a small study recently found improvement of blood sugar control and triglycerides in those on a carbohydrate restricted diet versus a standard calorie-restricted diet.
Only 24 patients were involved. Half were assigned to eat low-carb without calorie restriction; the other half ate the control diet. The carbohydrate-restricted group aimed for 70-130 grams of carb daily, while eating more fat and protein than the control group. The calorie-restricted guys were taught how to get 50-60% of calories from carbohydrate and keep fat under 25% of calories. At the end of the six-month study, the low-carbers were averaging 125 g of carb daily, compare to 200 g for the other group. By six months, both groups were eating about the same amount of calories.
Average age was 63. Body mass index was 24.5 in the low-carb group and 27 in the controls. (If you did the research, I bet you’d find Japanese T2 diabetics have lower BMIs than American diabetics.) All were taking one or more diabetes drugs.
The calorie-restricted group didn’t change their hemoglobin A1c (a standard measure of glucose control) from 7.7%. The low-carb group dropped their hemoglobin A1c from 7.6 to 7.0% (statistically significant). The low-carb group also cut their triglycerides by 40%. Average weights didn’t change in either group.
This small study suggests that mild to moderate carbohydrate restriction helps control diabetes in Japanese with type 2 diabetes. The improvement in hemoglobin A1c is equivalent to that seen with initiation of many diabetes drugs. I think further improvements in multiple measures would have been seen if carbohydrates had been restricted even further.
Steve Parker, M.D.
Link to reference.
h/t Dr Michael Eades
May 30, 2012 · 6:20 PM
TV’s “The Biggest Loser” weight-loss program works great for overweight diabetics and pre diabetics, according to an article May 30, 2012, in MedPage Today. Some quotes:
For example, one man with a hemoglobin A1c (HbA1c) of 9.1, a body mass index (BMI) of 51, and who needed six insulin injections a day as well as other multiple prescriptions was off all medication by week 3, said Robert Huizenga, MD, the medical advisor for the TV show.
In addition, the mean percentage of weight loss of the 35 contestants in the study was 3.7% at week 1, 14.3% at week 5, and 31.9% at week 24…
The exercise regimen for those appearing on “The Biggest Loser” comprised about 4 hours of daily exercise: 1 hour of intense resistance training, 1 hour of intense aerobics, and 2 hours of moderate aerobics.
Caloric intake was at least 70% of the estimated resting daily energy expenditure, Huizenga said.
At the end of the program, participants are told to exercise for 90 minutes a day for the rest of their lives. Huizenga said he is often told by those listening to him that a daily 90-minute exercise regimen is impossible because everyone has such busy lives.
“I have a job and I work out from 90 to 100 minutes per day,” he said. “It’s about setting priorities. Time is not the issue; priorities are the issue.”
Of the 35 participants in this study, 12 had prediabetes and six had diabetes. This is a small pilot study, then. I bet the results would be reproducible on a larger scale IF all conditions of the TV program are in place. Of course, that’s not very realistic. A chance to win $250,000 (USD) is strong motivation for lifestyle change.
Steve Parker, M.D.
PS: Although not mentioned in the article, these must have been type 2 diabetics, not type 1.
December 14, 2011 · 3:30 AM
Probably not watching The Biggest Loser
Dr. Barry Sears (Ph.D., I think) recently wrote about a lecture he attended by a dietitian affiliated with “The Biggest Loser” TV show
. She revealed the keys to weight-loss success on the show. Calorie restriction is a major feature, with the typical 300-pounder (136 kg) eating 1,750 calories a day. On my Advanced Mediterranean Diet
, 300-pounders get 2,300 calories (men) or 1,900 calories (women).
Although not stressed by Dr. Sears, my impression is that contestants exercise a huge amount.
Go to the Sears link above and you’ll learn that all contestants are paid to participate. In researching my Conquer Diabetes and Prediabetes book, I learned that the actual Biggest Loser wins $250,000 (USD). Also, “The Biggest Loser” is an international phenomenon with multiple countries hosting their own versions, with different pay-off amounts. A former Biggest Loser, Ali Vincent, lives in my part of the world and still has some celebrity status.
This TV show demonstrates that the calories in/calories out theory of body weight still applies. Including the fact that massive exercise can help significantly with weight loss. In real-world situations, exercise probably contributes only a small degree to loss of excess weight. The major take-home point of the show, for me, is that you can indeed make food and physical activity choices that determine your weight.
Most of us watch too much
I know losing 50 to 10o pounds of fat (25–45 kg) and keeping it off for a couple years is hard; most folks can’t do it. Do you think you’d be more successful if I gave you $250,ooo for your success?
Steve Parker, M.D.
July 24, 2011 · 2:00 AM
I have a stack of scientific articles I’ve been meaning to review in depth and blog about. But I have to finally admit I don’t have the time. Here they are. Click through for details.
- Long-term calorie restriction in humans appears highly effective in reducing atherosclerosis risk factors (lab tests) and actual carotid artery atherosclerosis. Only 18 study subjects, however.
- A very-low-carbohydrate diet improved memory in older adults with mild cognitive impairment over six weeks. Twenty-three subjects were randomized to either high-carb or very-low-carbohydrate diet. The low-carbers improved verbal memory performance, lost weight, reduced fasting blood sugar and fasting insulin levels. Ketone levels were positively correlated with memory performance.
- A high-fat diet impairs cognitive function and heart energy metabolism in young men. Sixteen test subjects. Crossover study design with a five-day high-fat diet deriving 75% of energy from fat, compared to a low-fat diet deriving 23% of energy from fat. High-fat diet led to impaired attention, speed, and mood. I’m sure low-carb bloggers have been all over this. At first blush, it appears they were testing during “induction flu” phase of very-low-carb eating, between days 2 to 7 of a new ketogenic diet. It takes several weeks to adapt metabolism to running almost entirely on fat rather than standard carbohydrates. Suspect results would have been different if given time to adapt.
- Weight-loss with the laparoscopic gastric banding procedure has poor long-term outcome, according to Belgian surgeons reporting on 82 patients. Four in 10 patients had major complications. Nearly half of the 82 patients needed to have the bands removed, and six of every 10 required some kind of re-operation.
- Trust me, you DON’T want age-related macular degeneration. Women, reduce your risk of ARMD with a healthy lifestyle, including regular exercise, avoidance of smoking, and by eating abundant plant foods (vegetables [including orange and dark leafy green ones], fruits, and whole grains) and limit foods high in fat, refined starches, sugar, alcohol, and oils. At least according to these researchers.
- Leafy green vegetables and olive oil are linked to reduced heart disease (CHD) in Italian women. Fruit consumption had no effect. This is from a subset of the huge EPIC study, following 30,000 women over almost eight years.
- The Mediterranean diet protects against metabolic syndrome, reducing risk by about a third according to a huge meta-analysis from Greek and Italian investigators. It works best in Mediterranean countries.
- The Mediterranean diet was linked to slower rates of cognitive decline in Chicago residents over the course of almost eight years. The comparison diet was the Healthy Eating Index-2005. Of the 3,800 participants, about two-thirds were black. A Manhattan population showed lower risk of dementia when eating Mediterranean-style.
There ya’ go. This is better than letting the articles just sit in my briefcase for months on end, eventually to be thrown out.
Steve Parker, M.D.
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Tagged as atherosclerosis, calorie restriction, cognition, cognitive function, fruit, heart disease, high-fat diet, low-carb, Mediterranean Diet, memory, metabolic syndrome, mild cognitive impairment, Vegetables, very-low-carbohydrate