Tag Archives: Weight Loss

Another Good Reason to Lose the Fat: Stop Urine Leakage

For overweight and obese women, loss of between five and 10% of body weight significantly reduces urine leakage.  According to the research report in a recent Obstetrics & Gynecology journal, weight loss should be the first approach to urine leakage in overweight and obese women.

The other word for urine leakage is incontinence: an involuntary loss of urine.  It’s a major problem that isn’t much talked about.  It’s not exactly dinner-party conversation material.  You can imagine its effect on quality of life.  In the U.S., leakage of urine on at least a weekly basis is reported by one in 10 women and one in 20 men.  It’s more common at higher ages and in women.  Just looking at non-pregnant women, incontinence affects 7% of women aged 20-39, 17% of those aged 40-59, and 23% of women 60-79 years old.

The study at hand involved 338 overweight and obese women: average age 53 (minimum of 30), average body mass index 36, average weight 92 kg (202 lb).  For participation, they had to have at least 10 incontinence episodes per week.  On average, they reported 24 leakage episodes per week (10 stress incontinence, 14 urge incontinence).  All women were given a “self-help incontinence behavioral booklet with instructions for improving bladder control.”  They were randomized to two different weight-loss programs, but I won’t bore you with the details.  The diets were the standard reduced-calorie type.  One diet group had many more meetings than than the other.

The women kept diaries of leakage, and even collected urine soaked pads for weighing.

Results

Eight-five percent of the women completed the 18-month study.

By six months, 89 of the women has lost five to 10% of body weight; 84 lost over 10%.  As expected, when measured at 18 months, only 61 women were in the “five to 10% loss” category; 71 were in the “over 10%” group. 

Greater amounts of weigh loss were linked to fewer episodes of leakage.  Maximal improvement in leakage episodes were seen in the women who lost between five and 10% of body weight, with no additional benefit to greater degrees of weight loss, generally.

Women who lost 5-10% of their body weight were two to four times more likely to achieve at least a 70% reduction in total and urge incontinent episode frequency compared with women who gained weight at 6, 12, and 18 months.

Weight loss works better for stress incontinence than for urge incontinence.

Three of every four women who lost five to 10% of body weight said they were moderately or very satisfied with their improved bladder control.

Bottom Line

Weight loss is usually not a cure for incontinence, but a reasonable management option for overweight and obese women.  It’s going to take loss of five or 10% of body weight.  Other options  include drugs, surgery, Kegel exercises, and just living with it.

Five or 10% weight loss for a 200 pound woman is just 10 or 20 pounds.  That degree of weight loss is also linked to lower risk of diabetes and hypertension: even more reason go for it.  

Does it work for men?  Who knows?

Steve Parker, M.D.

Reference: Wing, R.R., et al.  Program to Reduce Incontinence by Diet and Exercise: Improving urinary incontinence in overweight and obese women through modest weight loss. Obstetrics and Gynecology, 116 (2010): 284-92 PMID: 20664387

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Weight-Loss Drug Meridia Pulled From U.S. Market

MedPageToday reported October 8, 2010, that Abbott is voluntarily removing Meridia from the U.S. market. I had written on October 8 about the higher incidence of stroke and heart attack in Meridia users who had underlying cardiovascular disease.

Meridia, also known as sibutramine, has an estimated 100,000 users in the U.S. Abbott recommends that they stop taking the drug and consult their physicians about other weight-loss programs.

Here are a some options I like:

  1. Advanced Mediterranean Diet
  2. Ketogenic Mediterranean Diet
  3. Low-Carb Mediterranean Diet

This would be a good time for Meridia ex-users to review “Prepare For Weight Loss.”

Steve Parker, M.D.

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Heart and Stroke Patients: Avoid Weight-Loss Drug Sibutramine (Meridia)

The weight-loss drug sibutramine (Meridia) should be withdrawn from the U.S. market, suggests an editorialist in the September 2, 2010, New England Journal of Medicine.  Based on a clinical study in the same issue, it’s more accurate to conclude that sibutramine shouldn’t be prescribed for people who aren’t supposed to be taking it in the first place.

Sibutramine is sold in the U.S. as Meridia and has been available since 1997.  Judging from the patients I run across, it’s not a very popular drug.  Why not?  It’s expensive and most people don’t lose much weight.

The recent multi-continent SCOUT trial enrolled 9,800 male and female study subjects at least 55 years old (average age 63) who had either:

  1. 1) History of cardiovascular disease (here defined as coronary artery disease, stroke, or peripheral artery disease)
  2. 2) Type 2 diabetes plus one or more of the following: high blood pressure, adverse cholesterol levels, current smoking, or diabetic kidney disease.
  3. Or both of the above (which ended up being 60% of the study population)`.

Here’s a problem from the get-go (“git-go” if you’re from southern U.S.).  For years, Meridia’s manufacturer and the U.S. Food and Drug Administration have told doctors they shouldn’t use the drug in patients with history of cardiovascular disease.  It’s not the scary “black box warning,” but it’s clearly in the package insert of full prescribing information.

Half the subjects were randomized to sibutramine 10 mg/day and the other half to placebo.  All were instructed in diet and exercise aiming for a 600 calorie per day energy deficit.  They should lose about a pound a week if they followed the program.  Average follow-up was 3.4 years.

What Did the Researchers Find?

Forty percent of both drug and placebo users dropped out of the study, a very high rate.

As measured at one year, the sibutramine-users averaged a weight loss of 9.5 pounds (4.3 kg), the majority of which was in the first 6 weeks.  After the first year, they tended to regain a little weight, but kept most of it off.

Death rates were the same for sibutramine and placebo.

Sibutramine users with a history of cardiovascular disease had a 16% increase in non-fatal heart attack and stroke compared to placebo.  To “cause” one heart attack or stroke in a person with known cardiovascular disease, you would have to treat 52 such patients.

Folks in the “diabetes plus risk factor(s)” group who took sibutramine had no increased risk of heart attack or stroke.

So What?

Average weight loss with sibutramine isn’t much.  Nothing new there.  [Your mileage may vary.]

People with cardiovascular disease shouldn’t take sibutramine.  Nothing new there either.

Steve Parker, M.D.

Reference:  James, W. Philip, et al.  Effect of sibutramine on cardiovascular outcomes in overweight and obese subjects.  New England Journal of Medicine, 363 (2010): 905-917.

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Low-Fat and Low-Carb Diets End Battle in Tie After Two Years, But…

Dieters on low-fat and low-carb diets both lost the same amount of weight after two years, according to a just-published article in Annals of Internal Medicine.  Both groups received intensive behavioral treatment, which may be the key to success for many.  Low-carb eating was clearly superior in terms of increased HDL cholesterol, which may help prevent heart disease and stroke.

The study was funded by the National Institutes of Health and was carried out in Denver, St. Louis, and Philadelphia.

How Was It Done?

Healthy adults aged 18-65 were randomly assigned to either a low-fat or low-carbohydrate diet.  Average age was 45.  Average body mass index was 36 (over 25 is overweight; over 30 is obese).  Of the 307 participants, two thirds were women.  People over 136 kg (299 lb) were excluded from the study—I guess because weight-loss through dieting is rarely successful at higher weights.  Diabetics were excluded. 

The low-carb diet:  Essentially the Atkins diet with a prolonged induction phase (12 weeks instead of two).  Started with maximum of 20 g carbs daily, as low-carb vegetables.  Increase carbs by 5 g per week thereafter as long as weight loss progressed as planned.  Fat and protein consumption were unlimited.  The primary behavioral goal was to limit carb consumption.

The low-fat diet:  Calories were limited to 1200-1500 /day (women) or 1500-1800 (men).  [Those levels in general are too low, in my opinion.]  Diet was to consist of about 55% of calories from carbs, 30% from fat, 15% from protein.  The primary behavioral goal was to limit overall energy (calorie) intake. 

Both groups received frequent, intensive in-person group therapy—lead by dietitians and psychologists—periodically over two years, covering such topics as self-monitoring, weight-loss tips, management of weight regain and noncompliance with assigned diet.  Regular walking was recommended.

Body composition was measured periodically with dual X-ray absorptiometry.

What Did They Find?

Both groups lost about 11% of initial body weight, but tended to regain so that after two years, both groups average losses were only 7% of initial weight.  Weight loss looked a little better at three months in the low-carb group, but it wasn’t statistically significant. 

The groups had no differences in bone density or body composition.

No serious cardiovascular illnesses were reported by participants.  During the first six months, the low-carb group reported more bad breath, hair loss, dry mouth, and constipation.  After six months, constipation in the low-carb group was the only symptom difference between the groups.

During the first six months, the low-fat group had greater decreases in LDL cholesterol (with potentially less risk of heart disease), but the difference did not persist for one or two years.

Increases in HDL cholesterol (potentially heart-healthy) persisted throughout the study for the low-carb group.  The increase was 20% above baseline.

About a third of participants in both groups dropped out of the study before the two years were up.  [Not unusual.]

My Comments

Contrary to several previous studies that suggested low-carb diets are more successful than low-fat, the study at hand indicates they are equivalent as long as dieters get intensive long-term group behavioral intervention. 

Low-carb critics warn that the diet will cause osteoporosis, a dangerous thinning of the bones that predisposes to fractures.  This study disproves that.

Contrary to widespread criticism that low-carb eating—with lots of fat and cholestrol— is bad for your heart, this study notes a sustained elevation in HDL cholesterol (“good cholesterol”) on the low-carb diet over two years.  This also suggests the low-carbers  followed the diet fairly well.  The investigators also note that low-carb eating tends to produce light, fluffy LDL cholesterol, which is felt to be less injurious to arteries compared to small, dense LDL cholesterol.

A major strength of the study is that it lasted two years, which is rare for weight-loss diet research.

A major weakness is that the investigators apparently didn’t do anything to document the participants’ degree of compliance with the assigned diet.  It’s well known that many people in this setting can follow a diet pretty well for two to four months.  After that, adherence typically drops off as people go back to their old habits.  The group therapy sessions probably improved compliance, but we don’t know since it wasn’t documented. 

How often do we hear “Diets don’t work.”  Well, that’s just wrong.

Overall, it’s an impressive study, and done well. 

Individuals wishing to lose weight on their own can’t replicate these study conditions because of the in-person behavioral intervention component.  There are lots of self-help calorie-restricted balanced diets (e.g., Sonoma Diet, The Zone,  Advanced Mediterranean Diet) and low-carb diets (e.g., Atkins Diet, Banting’s Letter on Corpulence, Low-Carb Mediterranean or Ketogenic Mediterranean Diets).  On-line support groups—e.g. Low Carb Friends and SparkPeople and 3 Fat Chicks on a Diet—could supply some necessary behavioral intervention strategies and support.  

Choosing a weight-loss program is not as easy as many think.  [Well, I’ll admit that choosing the wrong one is easy.]  I review the pertinent issues in my “Prepare for Weight Loss” page.

Steve Parker, M.D.

Reference: Foster, Gary, et al.  Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Annals of Internal Medicine, 153 (2010): 147-157   PMID: 20679559

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London’s Low-Carb Diet Fad of 1865

Dr. Robert Atkins didn’t invent low-carb dieting.  William Banting (1797-1878) sparked a low-carb diet craze in London with his low-carb weight-loss diet, first published in 1863.  Even that probaby wasn’t the first low-carb diet.

According to Wikipedia, Banting was a distant relative of Frederick Banting, the co-discoverer of insulin in 1921.

Mr. Banting attributes his successful program design to a “medical gentleman,” Mr. Harvey, of Soho Square, London. 

Click to read Mr. Banting’s 1865 “Letter on Corpulence” at Internet Archive.

Steve Parker, M.D.

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Individual Response to Weight-Loss Diet May Depend on Genes

Dieters with particular genetic make-up respond better or worse to specific types of weight-loss diets, suggest researchers who presented data at the 2010 Cardiovascular Disease Epidemiology and Prevention /Nutrition, Physical Activity, and Metabolism conference.  Findings are preliminary, but may explain the common phenomenon of two people going on the same diet, but only one achieving good results. 

I’ll bet you can imagine several other explanations.

Several years ago, the “A to Z” study compared the weight loss of 311 overweight women on one of four diets:  Atkins (low-carb), Ornish (very low fat, vegetarian), Learn (low-fat), and Zone (moderate carb restriction, high protein, moderate fat).  Atkins was a bit better than the other diets, in terms of long-term (one year) weight loss.  But within each diet group, some women lost 40–50 pounds (18–23 kg), whereas others gained over 10 pounds (4.5 kg).

Stanford University researchers obtained DNA from 138 of the 311 women and noted the occurence of three genes—ABP2, ADRB2, and PPAR-gamma—that had previously been shown to predict weight loss via diet-gene interactions.  For example, a particular mix of these genes predict better weight loss with a low-fat diet; a different mix predicts more loss with a low-carb diet.

Women who had been randomly assigned to one of the A to Z diets tended to lose much more weight if they happened to have the gene mix appropriate for that diet (compared to those on the same diet with the wrong gene mix).  The difference, for example, might be loss of 12 pounds versus two pounds.

The lead researcher, Dr. Mindy P. Nelson, told TheHeart.Org that the proportion in the general population genetically predisposed to the low-fat versus low-carb approach is about 50:50.

Take-Home Points

These results, again, are preliminary; additional testing is necessary for confirmation.  If they had been able to test the DNA of the other 178 women in the A to Z study, the results could have been either stronger or shown no diet-gene interaction.  The study hasn’t even been published in a peer-reviewed journal yet.

Men may or may not be subject to similar diet-gene interaction.

If a genetic test is ever clinically available to tell a dieter which type of weight-loss diet would be more successful, it will likely be cheaper to just try a particular diet first and see if it works over 4–6 weeks.  Successful long-term weight loss is like smoking cessation—most smokers try 5–7 different times or methods before hitting on one that works for them.

This potential diet-gene interaction could be a major finding that will stop the arguing about which is the single best way to lose excess fat.  Many paths may lead to the mountaintop. 

Steve Parker, M.D.

Reference:  O’Riordan, Michael.  Dieting by DNA?  Popular diets work best by genotype, reseach shows.  HeartWire by TheHeart.Org, March 8, 2010.

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Do You Hari Hachi Bu?

I loved the sound of this phrase—hari hachi bu—even before I knew what it meant.

“Hari hachi bu” comes from the Japanese islands of Okinawa.  It refers to eating a meal until you’re only 80% full, then stop eating.  It’s a method to control weight. 

Okinawa, remember, is one of the longevity hot spots in Dan Buettner’s Blue Zones

But would it really work for many in Western culture?  Probably not.  We don’t have the discipline to stick with it long-term.  Maybe for a day.

One of the currently popular dieting gimmicks is to eat every 3-4 hours while awake.  The rationale is, “you need the energy.”  If you eat 5–6 meals a day, you’re not cutting back on total calories even if you eat only until 80% full.

As long as you’re eating a fair amount of carbohydrates, you can store plenty of energy as glucose in glycogen—in your liver and muscles—to easily live without eating for at least 8–12 hours.  So, there’s no “need” to eat every 3–4 hours.  If there were, we would have gone extinct years ago.  At rest, you’re getting about 60% of your energy supplied by metabolism of fats, not carbohydrates.  Most people can live without all food, but not water, for about two months.

Plenty of people have said, “I’m going to lose weight by just cutting back on food consumption.”  I don’t have scientific data to back it up, but I’d bet that a food diary works better.

A simple weight-loss or management plan that would work better than “just cutting back” would be:

Don’t eat anything man-made

So off limits are bread, rolls, soft drinks, table sugar, high fructose corn syrup, pancakes, pizza, potato chips, Pringles, pies, cookies, cake, casseroles, cannolis, Doritos, Ding-Dongs, Snickers, etc.  I’d complicate it just a bit by avoiding naturally starchy foods like potatoes and corn.

For those who don’t like the negativity of “don’t eat that,” here’s the positive spin:

Eat only natural, minimally processed food

In other words, eat fresh fruit, vegetables, eggs, meat, chicken, fish, olive oil, nuts, etc.  These are God-made foods, not man-made.

Steve Parker, M.D.

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My Ketogenic Mediterranean Diet and Low-Carb Eating: Six-Month Summary

I started my Ketogenic Mediterranean Diet on September 1, 2009.  After two months, I stopped compulsive record-keeping and food measurement and made a few other intentional tweaks: fish five times a week instead of seven miminum, more nuts (often two ounces a day—I like nuts and they’re convenient), less salad, more dark chocolate.  Otherwise the last four months have been similar to the initial two months of strict KMD.  My daily digestible carbohydrate intake has probably crept up to 40 g compared to 20-25 g on the strict KMD—this is still considered very low-carb. 

Accomplishments

Starting weight was 170 pounds (77.3 kg) on September 1.   After two months—8.6 weeks—my weight clearly stabilized at 155 lb (70.5 kg).  I lost the 15 lb (6.8 kg) over the first six weeks then just hovered around 155 lb.  So average weekly weight loss over the six weeks was 2.5 pounds.  Also lost a couple inches (5 cm) off my waist.

For the last four months—November through February—I’ve been eating the aforementioned liberalized KMD.  Weight has stayed around 155-157 lb (71 kg).  No calorie counting.  I eat as much as I want, except for carbs.  The experience of the first two months taught me how to eat 20-25 g of carbs in a day; it’s the gauge by which I estimate I’m eating 40 g daily now.

Has It Been Easy?

Yeah, relatively easy.  Two other adults in my house are also eating low-carb, which definitely helps.  Blogging here also helps me maintain compliance.  I promised myself to report everything—the good, the bad, and the ugly—honestly.  Accountability is important. 

Staying with the program may be easier for me than for others because I am heavily invested in it, psychologically and time-wise. 

It’s also been helpful for me to participate at two low-carb online communities: LowCarbFriends and Active Low-Carber Forums.  We support each other.  Thanks, guys.

I took diet holidays twice, for three days at both Thanksgiving and Christmas.  Gained three to five pounds (1.8 kg) each time on high-carb eating, but lost it over the next week by returning to the strict KMD.

Any Surprises?

Induction flu.  I’d never heard of it before.  Occurs typically on days 2–5 of very low-carb dieting: achiness and fatigue.  Others also experience headaches and dizziness, and it may last 1–2 weeks.

Rapid weight gain during my diet holidays (aka cheat days).  I was not gorging.  I figure the weight was mostly new glycogen in liver and muscle.  And water.

Eating fish more than once a day is a lot of fish!  Quickly boring, even unappetizing.  But that’s just me.  I need to be a more creative.  Most of my fish lately has been canned tuna.

Assuming that the Daily Values of various nutrients recommended by the U.S. Food and Drug Administration are valid, the KMD foods come up short in many vitamins and minerals.  I bet this is an issue (a problem?) with many, if not most, very low-carb diets if supplements aren’t used.  Those Daily Values are debatable, of course.  For instance, Gary Taubes argues that you don’t need much vitamin C if eating few carbs.  My nocturnal leg cramps and constipation were proof enough for me that I needed at least some supplements.  The recommended KMD supplements remedy the DailyValue shortfall in vitamins and minerals.  Dr. Richard K. Bernstein has a 30-gram carbohydrate diet for his diabetic patients and himself, as outlined in his Diabetes Solution book: no supplements are required.  

As time passes, I worry less about getting enough of various micronutrients.   I feel fine.  I’m still taking the recommended KMD supplements (5 pills a day) plus sugar-free Metamucil.   

I never had hunger that I couldn’t satisfy within the guidelines of the diet. 

No major trouble with cravings or longing for carbs.  I’ve gone six months now without whole grain bread, oatmeal, pizza, and pasta—very unusual for me.  I’d be OK never eating them again.  What I do miss are sweet, often fat-laced, carbohydrates: pie, cookies, cinnamon rolls, candy bars, cake, ice cream.  I doubt that desire will ever disappear, although it does for some who eat very low-carb.   

I counted calories only during the first two months of this experiment.  Remember, fats and proteins are unlimited.  Nevertheless, I ate fewer calories than my baseline intake.   This calorie reduction is a well-documented effect of very low-carb diets.  Fats and proteins are more satiating than carbohydrates.  It’s possible I’ve limited total calories subconsciously. 

[An interesting experiment would be to try to gain weight by over-eating fats and proteins while keeping total digestible carbs under 30 g/day.  Has it been done already?]

What’s Next?

I’d like to answer some intriguing questions.

Why did my weight loss stop where it did, at 155 lb (70.5 kg)? 

If I’d started the KMD at 270 lb (123 kg) instead of 170 lb (77.3 kg), would my weight loss have stopped at 255 lb (116 kg), 210 lb (95.5 kg) or 155 lb (70.5 kg)? 

Will two people, 300 lb each (136 kg), end up at the same final weight when following the program religiously?  Probably not, but why not?    

Six months ago, I believed many scientific studies supported the idea that a higher intake of carbohydrates is healthier, long-term, than the very low-carb Ketogenic Mediterranean Diet and other very low-carb diets.  Studies seemed to support higher carbohydrate intake in the form of traditional fruits, vegetables, legumes, and whole grains.  After reviewing the scientific literature over the last few months, I’m not so sure that higher carb consumption is necessary or beneficial for long-term health and longevity.  The evidence is weak.  Nearly all the pertinent studies are observational or epidemiologic—not the most rigorous science. 

On the other hand, I still can’t help feeling that the recommended eating styles of people like Monica Reinagel, Darya Pino, and Holly Hickman may be healthier than the KMD over the long run, at least for people free of diabetes and prediabetes.  What features unify those three?  Food that is minimally processed, fresh, locally produced when able, including a variety of fruits, vegetables, nuts, whole grains, and legumes. 

It seems that the human body is marvelously designed to survive, even thrive, with multiple ways of eating—but not all ways.   

The strongest evidence for higher carb consumption supports whole grains as a preventative for heart disease (coronary artery disease).  But the effect is modest. 

The argument against higher carb consumption is simple for people with diabetes and prediabetes: carbs raise blood sugar levels, sometimes to an unhealthy degree.  

I don’t see much role for highly processed, refined carbohydrates except as a cheap source of energy (calories).

What’s next for me is to formalize an opinion on which carbs, if any, and in what amount, to add back into the diet of those who have lost weight with the Ketogenic Mediterranean Diet.  The answer will probably be different for two groups:

  1. those who have diabetes, prediabetes, or metabolic syndrome
  2. healthy people who just need to control weight

The goal is to maximize health and longevity without tipping over into excessive carb intake that leads to overweight and obesity with associated illnesses.  

The traditional Mediterranean diet—long associated with health and longevity—is rich in carbohydrates.  The Ketogenic Mediterranean Diet—much lower in carbs—has great potential to help with loss of excess weight and control of blood sugar levels.  Does the KMD incorporate enough of the healthy components of the Mediterranean diet?  We may never know for sure.

Steve Parker, M.D.

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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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Low-Carb Ketogenic Diet Beats Low-Glycemic Index Diet in Overweight Type 2 Diabetes

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Avoid the needle with a low-carb ketogenic diet

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.

Methodology

Ninety-seven overweight and obese adults, 78% women and 40% black, were randomly assigned to either:

  • a very low-carb ketogenic diet (Atkins induction phase, as in Atkins Diabetes Revolution) or
  • a low glycemic-index index calorie-restricted diet (The GI Diet by Rick Gallop). 

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%. 

Results

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.

My Comments

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.

Steve Parker, M.D.

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 mellitusNutrition & Metabolism 2008, 5:36   doi:10.1186/1743-7075-5-36

Additional Reading

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.

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Filed under Carbohydrate, Glycemic Index and Load, ketogenic diet, Overweight and Obesity