It didn’t in this 16-week study. I don’t know what they ate nor how many calories.
Tag Archives: Weight Loss
A ketogenic diet was safe and effective for weight loss in children and adolescents, according to a small study in the Journal of Pediatric Endocrinology and Metabolism. Fifty-six children were placed on either a ketogenic diet or a calorie-restricted diet. The investigators judged the low-carb ketogenic diet more effective.
I don’t treat children, so I don’t normally monitor the pediatric scientific literature. Thanks to Diet Doctor Andreas Eenfeldt for bringlng this to my attention. I’ve not read the full research report.
In 2010 I reported on research showing a low-carb, high-protein diet was safe and effective for severely obese adolescents.
So, you’ve got diabetes. You’re trying to deal with it or you wouldn’t be here. You’ve got a heck of a lot of medical information to master.
Unless you have a good diabetes specialist physician on your team, you may not be getting optimal care. Below are some guidelines you may find helpful. The goal is to prevent diabetes complications. Many primary care physicians will not be up-to-date on the guidelines. Don’t hesitate to discuss them with your doctor. Nobody cares as much about your health as you do.
The American Diabetes Association (ADA) recommends the following items be done yearly (except as noted) in non-pregnant adults with diabetes. (Incidentally, I don’t necessarily agree with all ADA guidelines.) The complete ADA guidelines are available on the Internet.
- Lipid profile (every two years if results are fine and stable)
- Comprehensive foot exam
- Screening test for distal symmetric polyneuropathy: pinprick, vibration, monofilament pressure sense
- Serum creatinine and estimate of glomerular filtration rate (MDRD equation)
- Test for albumin in the urine, such as measurement of albumin-to-creatinine ratio in a random spot urine specimen
- Comprehensive eye exam by an ophthalmologist or optometrist (if exam is normal, every two or three years is acceptable)
- Hemoglobin A1c at least twice a year, but every three months if therapy has changed or glucose control is not at goal
- Flu shots
Other Vaccinations, Weight Loss, Diabetic Diet, Prediabetes, Alcohol, Exercise, Etc.
Additionally, the 2013 ADA guidelines recommend:
- Pneumococcal vaccination. “A one time re-vaccination is recommended for individuals >64 years of age previously immunized when they were <65 years of age if the vaccine was administered >5 years ago.” Also repeat the vaccination after five years for patients with nephrotic syndrome, chronic kidney disease, other immunocompromised states (poor ability to fight infection), or transplantation.
- Hepatitis B vaccination to unvaccinated adults who are 19 through 59 years of age.
- Weight loss for all overweight diabetics. “For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).” For those on low-carb diets, monitor lipids, kidney function, and protein consumption, and adjust diabetic drugs as needed. The optimal macronutrient composition of weight loss diets has not been established. (Macronutrients are carbohydrates, proteins, and fats.)
- “The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.” “It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goal.”
- “A variety of dietary meal patterns are likely effective in managing diabetes including Mediterranean-style, plant-based (vegan or vegetarian), low-fat and lower-carbohydrate eating patterns.”
- “Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.”
- Limit alcohol to one (women) or two (men) drinks a day.
- Limit saturated fat to less than seven percent of calories.
- During the initial diabetic exam, screen for peripheral arterial disease (poor circulation). Strongly consider calculation of the ankle-brachial index for those over 50 years of age; consider it for younger patients if they have risk factors for poor circulation.
- Those at risk for diabetes, including prediabetics, should aim for moderate weight loss (about seven percent of body weight) if overweight. Either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). Also important is exercise: at least 150 minutes per week of moderate-intensity aerobic activity. “Individuals at risk for type 2 diabetes should be encouraged to achieve the U.S. Department of Agriculture (USDA) recommendation for dietary fiber (14 g fiber/1,000 kcal) and foods containing whole grains (one-half of grain intake).” Limit intake of sugar-sweetened beverages.
- “Adults with diabetes should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate), spread over at least 3 days/week with no more than two consecutive days without exercise. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week.”
- Screening for coronary artery disease before an exercise program is depends on the physician judgment on a case-by-case basis. Routine screening is not recommended.
Obviously, some of my dietary recommendations conflict with ADA guidelines. The experts assembled by the ADA to compose guidelines were well-intentioned, intelligent, and hard-working. The guidelines are supported by 528 scientific journal references. I greatly appreciate the expert panel’s work. We’ve simply reached some different conclusions. By the same token, I’m sure the expert panel didn’t have unanimous agreement on all the final recommendations. I invite you to review the dietary guidelines yourself, discuss with your personal physician, then decide where you stand.
General Blood Glucose Treatment Goals
The ADA in 2013 suggests these therapeutic goals for non-pregnant adults:
- Fasting blood glucoses: 70 to 130 mg/dl (3.9 to 7.2 mmol/l)
- Peak glucoses one to two hours after start of meals: under 180 mg/dl (10 mmol/l)
- Hemoglobin A1C: under 7%
- Blood pressure: under 140/80 mmHg
- LDL cholesterol: under 100 mg/dl (2.6 mmol/l). (In established cardiovascular disease: <70 mg/dl or 1.8 mmol/l may be a better goal.)
- HDL cholesterol: over 40 mg/dl (1.0 mmol/l) for men and over 50 mg/dl (1.3 mmol/l) for women
- Triglycerides: under 150 mg/dl (1.7 mmol/l)
The American Association of Clinical Endocrinologists (AACE) in 2011 proposed somewhat “tighter” blood sugar goals for non-pregnant adults:
- Fasting blood glucoses: under 110 mg/dl (6.11 mmol/l)
- Peak glucoses 2 hours after start of meals: under 140 mg/dl (7.78 mmol/l)
- Hemoglobin A1C: 6.5% or less
The ADA reminds clinicians, and I’m sure the AACE guys agree, that diabetes control goals should be individualized, based on age and life expectancy of the patient, duration of diabetes, other diseases that are present, individual patient preferences, and whether the patient is able to easily recognize and deal with hypoglycemia. I agree completely.
A low-carbohydrate ketogenic diet is safe, effective, and superior to a low-calorie diet in type 2 diabetics, according to a report last year in Nutrition.
Kuwaiti researchers gave 102 adult overweight diabetic men and women their choice of diet: 78 chose ketogenic, 24 went low-calorie. Average age was 37, average weight 211 lb (96 kg). The study lasted six months. The ketogenic diet was very much Atkins-style, starting out at 20 grams of carbohydrate daily. Once good weight-loss progress was made, and if carb cravings were an issue, dieters could increase their carbs in small increments weekly.
This is all they said about the low-calorie diet: “Participants in the low-calorie diet group were given appropriate guidelines and a sample low-calorie diet menu of 2200 calories is presented in Table 1” (it’s typical and reasonable).
What Did They Find?
The low-carb ketogenic dieters lost 12% of body weight, compared to 7% lost by the low-calorie dieters. Furthermore, the ketogenic dieters showed significant lowering of total cholesterol, LDL cholesterol (bad cholesterol), and triglycerides. HDL cholesterol (good cholesterol) rose. The low-calorie dieters seem to have had a significant drop in LDL cholesterol, but no changes in the other lipids.
Fasting blood sugar levels dropped significantly in both groups, but more in the ketogenic dieters. Both groups started with fasting blood sugars around 162 mg/dl (9 mmol/l) and fell to 108 mg/dl (6 mmol/l) in the ketogenic group and to 126 mg/dl (7 mmol/l) in the low-calorie group.
Glycosylated hemoglobin (hemoglobin A1c) levels fell in both groups, more so in the ketogenic dieters. The drop was statistically significant in the ketogenic group, but the authors were unclear about that in the low-calorie dieters. It appears hemoglobin A1c fell from 7.8% to 6.3% with the ketogenic diet (the units given for glycosylated hemoglobin were stated as mg/dl). In the low-calorie dieters, hemoglobin A1c fell from 8.2 to 7.7%.
What’s Odd About This Study?
The title of the research report indicates a study of diabetics, but only about 25% of study participants had diabetes (total subjects = 363). (The figures I share above are for the diabetics only.)
Glycosylated hemoglobin, a test of overall diabetes control, is reported in Fig. 1 in terms of mg/dl. That’s nearly always reported as a percentage, not mg/dl. Misprint?
None of the participants dropped out of the study. That’s incredible, almost unbelievable.
The low-calorie diet was poorly described. Were 140-lb women and 250-lb men all put on the same calorie count?
Food diaries were kept, but the authors report nothing about compliance and actual food intake.
Clearly, some of these diabetics were on insulin and other diabetic drugs. The authors note necessary reductions in drug dosages for the ketogenic group but don’t say much about the other dieters. They imply that the drug reductions in the low-calorie group were minimal or nonexistent.
Calorie-restricted diets are effective in overweight type 2 diabetics, but ketogenic diets are even better.
The effectiveness and safety of ketogenic diets for overweight type 2 diabetics has been demonstrated in multiple other populations, so this study is not surprising. We’ve seen these lipid improvements before, too.
The favorable lipid changes on low-carb ketogenic diets would tend to reduce future heart and vascular disease.
I know little about Kuwaiti culture and genetics. Their contributions to the results here, as compared with other populations, is unclear to me. Type 2 diabetes is spreading quickly through the Persian Gulf, so this research may have wide applicability there.
Reference: Hussain, Talib, et al. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition, 2012; 28(10): 1016-21. doi: 10.1016/j.nut.2012.01.016
Remember Shai et al’s 2008 DIRECT study that compared weight loss over two years on either a low-carb, low-fat, or Mediterranean diet? I reviewed it at length in 2008.
The same Isreali researchers now report the results of an additional four years of follow-up. Do you know of any other weight loss study over that length of time? I don’t.
Of the 322 original study participants, 259 were available for follow-up for an additional four years. Of these, 67% told researchers they had continued their originally assigned diet.
Over six years, the weight loss was as follows:
- 0.6 kg (about a pound) in the low-fat group
- 1.7 kg (almost 4 pounds) in the low-carb cohort
- 3.1 kg (almost 7 pounds) in the Mediterranean group
The difference between the low-carb and Mediterranean groups was not statistically significant.
Almost all the original study participants (86%) were men, so it’s debatable whether these results apply to women. I bet they do. I assume most of the participants were Israeli, so you can also debate whether results apply to other nationalities or ethnicities.
For long-term weight management, Mediterranean and low-carb diets appear to be more effective than traditional low-fat, calorie-restricted dieting.
Incidentally, my Advanced Mediterranean Diet (2nd Edition) book features both a traditional Mediterranean diet and the world’s first low-carb Mediterranean diet.
These have worked for lots of my patients. Take what works for you and discard the rest.
- Plan on grocery shopping, meal preparation, and taking meals to your workplace.
- Keeping a record of your food consumption is often the key to success.
- Accountability is another key. Do you have a friend or spouse who wants to lose weight? Start the same program at the same time and support each other. That’s one of many ways to have accountability.
- If you tend to over-eat or snack too much, floss and brush your teeth after you’re full. You’ll be less likely to go back for more anytime soon.
- Eat at least two or three meals daily. Eat breakfast every day. Ignore the diet gurus who say you must eat every two or three hours.
- Eat slowly and allow yourself time to enjoy your food; you’ll be a better judge of when your’re full.
- Don’t eat while watching TV.
- Give yourself a specific reward for every 10 pounds (4.5 kg) of weight lost. Consider a weekend get-way, jewelry, new clothes, an evening at the theater, a professional massage, etc. Choose the reward in advance, to give you something to work toward.
- Don’t start a diet during a time of stress.
- Maintain a consistent eating pattern throughout the week and year.
- If you know you’ve eating enough at a meal to satisfy your nutritional requirements yet you still feel hungry, drink a large glass of water and wait a while. Or try a sugar-free psyllium fiber supplement: three grams of fiber in 8 oz (240 ml) of water.
- Weigh yourself frequently: daily during your active weight-loss phase and during the first two months of your maintenance-of-weight-loss phase. Weekly thereafter.
- Be aware that you’ll probably regain five or 10 pounds (2.3 or 4.5 kg) of fat now and then. That’s normal. Just get back on your original weight-loss plan for a month or two.
- Tell your housemates you’re on a diet and ask for their support. You may also need to tell your co-workers and others with whom you spend significant time. If they care about you, they’ll be careful not to tempt you off the diet.
Indispensable? OK, maybe that’s a little over the top. But each of these tips has proven indispensable to at least one of my patients.
Researchers are constantly searching for safe, effective weight loss pills. More helpful would be a pill that prevents weight regain. Weight loss is relatively easier.
Regain of lost body fat is the most problematic area in the field of weight management. Whoever solves this problem for good will win a Nobel Prize in Medicine. Why do most diets ultimately fail over the long run? Because people go back to their old habits. Here are the two secrets to prevention of weight regain:
- Restrained eating
- Regular physical activity
“Successful losers” apply self-restraint on an almost daily basis, avoiding food they know will lead to weight regain. They limit how much they eat. They consciously choose not to return to their old eating habits, despite urges to the contrary.
The other glaring difference is that, compared to regainers, the successful losers are physically active. Oftentimes, they exercised while losing weight, and almost always continue to exercise in the maintenance phase of their program. This is true in at least eight out of 10 cases. It’s clear that regular exercise isn’t always needed, but it dramatically increases your chances of long-term success.