Tag Archives: obese

Low-Carb Diet Helps Obese Swedes With Diabetes

Swedish boyObese people with type 2 diabetes following a 20% carbohydrate diet demonstrated sustained improvement in weight and blood glucose control, according to two Swedish physicians.  These doctors also have research experience with traditional low-fat diets in overweight diabetics, having demonstrated that a 20% carbohydrate diet was superior to a low-fat/55–60% carb diet in obese diabetes patients over six months.

What Was the Intervention?

Proportions of carbohydrates, fat, and protein were 20%, 50%, and 30% respectively.  Total daily carbs were 80–90 g. 

Recommended carbs were vegetables and salads. 

Rather than ordinary bread, crisp/hard bread was recommended (3.5 to 8 g carb per slice).  Starchy breads, pasta, potatoes, rice, and breakfast cereals were excluded. 

They were instructed to walk 30 minutes daily, take a multivitamin with extra calcium daily, and to not eat between meals. 

At the outset, diabetic medications were reduced by 25–30% to avoid low blood sugars.   

Results

The doctors followed 23 patients over the course of  44 months.  Average initial body weight was 101 kg (222 pounds).  After 44 months, average body weight fell to 93 kg (205 pounds).  Hemoglobin A1c, a measure of diabetes control,  fell from 8% to 6.8%. 

My Comments

In these pages over the last few months, we’ve seen the effectiveness of low-carb diets in people with type 2 diabetes in widespread populations: Japanese, U.S. blacks and caucasions, and, now, Swedes. 

The standard Western diet derives 55–60% of its energy from carbohydrates.  If you’ve been following this blog, we’ve looked at diets containing 40%, 30%, 20%, and 10% carbs.  Have you noticed the trend? 

Reducing the percentage of carbohydrates in the diet improves diabetic control and loss of excess weight.  And the more you reduce carbs, the greater the degree of diabetic control and weight loss.   

Steve Parker, M.D.

Reference:  Nielsen, Jörgen and Joensson, Eva.  Low-carbohydrate diet in type 2 diabetes: stable improvement of body weight and glycemic control during 44 months follow-upNutrition & Metabolism, 5:14   doi:10.1186/1743-7075-5-14

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Filed under Carbohydrate, Overweight and Obesity, Weight Loss

Low-Carb Diet Beats Low-Fat, Calorie-Restricted Diet

Body mass index 38

Body mass index 38

I found one of the early studies (2003) demonstrating the effectiveness and safety of an Atkins-style diet in the severely obese.  Doctors traditionally have been hesitant to recommend the Atkins diet out of concern for tolerability and potential increased atherosclerosis complication such as heart attacks, strokes, and poor circulation.

Methodology

The study enrolled 132 subjects with an average body mass index of 43, including 77 blacks and 23 women.  39% had diabetes, 43% had metabolic syndrome.  They were randomly assigned to either . . .

  1. a low-carb diet without caloric restriction (carbohydrates limited to 30 gm/day; vegetables and fruits with high ratios of fiber to carbohydrate were recommended), or
  2. a low-fat, calorie-restricted diet. 

Subjects followed their diets for six months.  The researchers never specified, but I’m assuming the diabetics were all type 2. 

Results

The drop-out rate was equally high in both groups: only 79 subjects completed the study.  The low-carb group lost 5.8 kg (13 lb); the low-fat group lost 1.9 kg (4 lb).  Analysis included the drop-outs, for reasons unclear to me.  White subjects lost more weight than blacks: 13 versus 5 kg (29 versus 11 lb).  Total cholesterol, HDL cholesterol, and LDL cholesterol levels did not change significantly within or between groups.  [HDL usually rises on a low-carb diet.]   Triglycerides fell 20% in the low-carb group and 4% in the other group.  For subjects with diabetes, glucose levels fell 26 mg/dl in the low-carb group compared to 5 mg/dl in the low-fat group.  Uric acid levels didn’t change in either group.  [Elevated uric acid levels can cause gout.]  No significant adverse reactions attibutable to the diets were recorded in either group.  Glycosylated hemoglobin fell from 7.8 to 7.2% in the low-carb group, with no change in the low-fat group.   

Take-Home Points  

It’s a small study, so results may not be very accurate or generalizable to other populations.

In this cohort with a high prevalence of diabetes, the low-carb diet was more effective than the low-fat/calorie-restricted diet for weight loss, with no adverse lipid changes to suggest increased long-term cardiovascular risk.  The low-carb diet helped control diabetes. 

Steve Parker, M.D. 

Reference:  Samaha, Frederick, 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.

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Filed under Carbohydrate, Overweight and Obesity, Weight Loss

High- vs Low-Protein Weight-Loss Diet in Type 2 Diabetes

 

Mucho protein, amigo

Mucho protein, amigo

A high-protein weight-loss diet yielded greater reduction in LDL cholesterol in both sexes, and greater loss of abdominal fat in overweight type 2 diabetics, compared to a lower-protein diet.  Lower LDL cholesterol levels are associated with lower risk of heart attack.

This scientific study caught my eye because it utilized a high-monounsaturated fat diet for weight loss.  The Mediterranean diet is rich in monounsaturated fats, mostly from olive oil.

Researchers in Australia ran a study to determine the effect of high- versus lower-protein wieght loss diets on fat and lean tissue, glucose levels, and blood lipids.  For perspective, remember that a typical American diet has about 15% of calories from protein, 30% from fat, and 55% from carbohydrates.

Methodology

This was their high-protein diet:  28% protein, 42% CHO, 28% fat (8% saturated fatty acids, 12% monounsaturated fatty acids, 5% polyunsaturated fatty acids).

The low-protein diet:  16% protein, 55% CHO, 26% fat (8% saturated fatty acids, 11% monounsaturated fatty acids, 5% polyunsaturated fatty acids).

They studied 54 obese men (19) and women (35) with type 2 diabetes during 8 weeks of energy restriction (1,600 kcal) and 4 weeks of energy balance.  Body composition was determined by dual-energy X-ray absorptiometry at weeks 0 and 12.

Results

Average weight loss for both groups was 5 kg.  However, women on the HP diet lost significantly more total (5.3 vs 2.8 kg) and abdominal (1.3 vs 0.7 kg) fat compared with the women on the LP diet, whereas, in men, there was no difference in fat loss between diets (3.9 vs 5.1 kg).  Total lean mass decreased in all subjects independently of diet composition.  LDL cholesterol reduction was significantly greater on the HP diet (5.7%) than on the LP diet (2.7%).  Blood glucose levels were reduced 5 or 10% by both diet interventions.  Trigylcerides dropped 20% in both groups.  Insulin concentrations were reduced in both groups.  Subjects lose 2.1% lean mass overall, with no difference between the groups.

Conclusions of the Study Authors

Both dietary patterns resulted in improvements in the cardiovascular disease (CVD) risk profile as a consequence of weight loss. However, the greater reductions in total and abdominal fat mass in women and greater LDL cholesterol reduction observed in both sexes on the HP diet suggest that it is a valid diet choice for reducing CVD risk in type 2 diabetes.

Take-Home Points

This was a relatively small study, so results may not be widely applicable.

Substituting proteins for carbs doesn’t seem to be detrimental to people with type 2 diabetes needing to lose weight, and may be advantageous:  greater total and abdominal fat loss in women, greater reductions in LDL cholesterol for both sexes.   At least in the short run.

Nephrologists will be concerned that the higher-protein diet, if sustained long-term, could lead to kidney damage.

Current dogma is that the lower-carb (high-protein) dieters should have had lower blood glucose, triglycerides, and HgbA1c levels:  not seen here.

Calorie-restricted diets tend to lower glucose levels and improve lipids, despite diet composition.

Reference:  Parker, Barbara et al.  Effect of a High-Protein, High–Monounsaturated Fat Weight Loss Diet on Glycemic Control and Lipid Levels in Type 2 Diabetes.  Diabetes Care,  25 (2002): 425-430.    From CSIRO Health Sciences and Nutrition, Adelaide, Australia.

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Filed under Carbohydrate, Protein, Weight Loss