Source: Weight of the Evidence Blog
Jørgen Vesti Nielsen, Eva Jönsson, Anette Ivarsson
Department of Medicine, Blekingesjukhuset, Karlshamn, Sweden
Due to failure to achieve control twenty-two patients with type 1 diabetes with sympto- matic fluctuating blood glucose started on a diet limited to 70-90 g carbohydrates per day and were taught to match the insulin doses accordingly. The caloric requirements were covered by an increased intake of protein and fat. The purpose was to reduce the blood glucose fluctuations, the rate of hypoglycaemia and to improve HbA1c.
DOWNLOAD: Low-carb in type 1 diabetes
Eric C Westman, Richard D Feinman, John C Mavropoulos, Mary C Vernon, Jeff S Volek, James A Wortman, William S Yancy, and Stephen D Phinney
The persistence of an epidemic of obesity and type 2 diabetes sug- gests that new nutritional strategies are needed if the epidemic is to be overcome. A promising nutritional approach suggested by this thematic review is carbohydrate restriction. Recent studies show that, under conditions of carbohydrate restriction, fuel sources shift from glucose and fatty acids to fatty acids and ketones, and that ad libitum–fed carbohydrate-restricted diets lead to appetite reduction, weight loss, and improvement in surrogate markers of cardiovascular disease. Am J Clin Nutr 2007;86:276–84.
DANIEL F. O’NEILL,1 ERIC C. WESTMAN, M.D., M.H.S.,1 and RICHARD K. BERNSTEIN, M.D.2
The Diabetes Complications and Control Trial (DCCT) established that diabetic complica- tions could be reduced by improvement in glycemic control. The ideal diabetes treatment protocol would maintain blood glucose levels in normal ranges without resulting in frequent hypoglycemia. Because several studies suggest an inverse relationship between carbohydrate consumption and the level of glycemic control, the effects of an intensive treatment program, which included dietary carbohydrate restriction, are examined in this paper. A chart review was performed of 30 patients who self-reported the consumption of 30 g of carbohydrate daily, followed a strict insulin regimen, monitored blood glucose levels at least four times daily, and had follow-up clinical visits or phone calls with their physician. For both type I and type II diabetics, there were significant improvements in glycemic control and mean fast- ing lipid profiles at follow-up. The mean hemoglobin A1c decreased by 27.8% from 7.9 to 5.7 (p < 0.001). The LDL cholesterol decreased by 16.5%, from 155.4 to 129.7 mg/dL (p = 0.004). The triglycerides decreased by 31.1%, from 106.8 to 73.6 mg/dL (p = 0.005). The HDL cholesterol increased by 43.3%, from 50.4 to 72.2 mg/dL (p < 0.001). The cholesterol/HDL ratio decreased by 31.5%, from 4.99 to 3.42 (p < 0.001). A carbohydrate-restricted regimen improved glycemic control and lipid profiles in selected motivated patients. Therefore, further investigation of the effects of this protocol on treating diabetes mellitus should be considered. Additionally, the reduction of insulin afforded by this diet could theoretically lead to a reduction in hypo- glycemic events.
Reprinted from DIABETES CARE, VOL. 3, NO. 1, JANUARY-FEBRUARY 1980 Copyright 1980 by the American Diabetes Association, Inc.
RICHARD K. BERNSTEIN
The author, diabetic for 33 yr, has used a novel technique for maintaining blood glucose (BG) in the 60— 120 mg/dl range and HhA1~ in the 3.95— 6.4% range, thereby lowering serum triglycerides from 200+ to 29 mg/dl, cholesterol from 250+ to 130 mg/dl, and insulin dosage from 80 to 25 U/day.
A low fat, high carbohydrate diet in combination with regular exercise is the traditional recommendation for treating diabetes. Compliance with these lifestyle modifications is less than satisfactory, however, and a high carbohydrate diet raises postprandial plasma glucose and insulin secretion, thereby increasing risk of CVD, hypertension, dyslipidemia, obesity and diabetes. Moreover, the current epidemic of diabetes and obesity has been, over the past three decades, accompanied by a significant decrease in fat consumption and an increase in carbohydrate consumption. This apparent failure of the traditional diet, from a public health point of view, indicates that alternative dietary approaches are needed. Because carbohydrate is the major secretagogue of insulin, some form of carbohydrate restriction is a prima facie candidate for dietary control of diabetes. Evidence from various randomized controlled trials in recent years has convinced us that such diets are safe and effective, at least in short-term. These data show low carbohydrate diets to be comparable or better than traditional low fat high carbohydrate diets for weight reduction, improvement in the dyslipidemia of diabetes and metabolic syndrome as well as control of blood pressure, postprandial glycemia and insulin secretion. Furthermore, the ability of low carbohydrate diets to reduce triglycerides and to increase HDL is of particular importance. Resistance to such strategies has been due, in part, to equating it with the popular Atkins diet. However, there are many variations and room for individual physician planning. Some form of low carbohydrate diet, in combination with exercise, is a viable option for patients with diabetes. However, the extreme reduction of carbohydrate of popular diets (<30 g/day) cannot be recommended for a diabetic population at this time without further study. On the other hand, the dire objections continually raised in the literature appear to have very little scientific basis. Whereas it is traditional to say that more work needs to be done, the same is true of the assumed standard low fat diets which have an ambiguous record at best. We see current trends in the national dietary recommendations as a positive sign and an appropriate move in the right direction.
Below are a number of free resources provided by Dr. Richard Bernstein including many free chapters of his book as well as some audio excerpts.
Dietary Carbohydrate, Protein and Fat for People With
Glucose Metabolism Disorders. Just What is
A collection of research, studies, science, facts, and opinions.
Dr Katharine Morrison.