Carb Restriction--A New Study

Food Nutrition
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Questioning Carbohydrate Restriction in Diabetes Management

From Diabetes in Control www.diabetesincontrol.com http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=12814&catid=1&Itemid=17.

Patients with type 2 diabetes are usually advised to keep a low-fat diet. Now, a study shows that food with a lot of fat and few carbohydrates could have a better effect on blood sugar levels and blood lipids.

Sixty-one patients were included in the study of type 2, or adult-onset diabetes. They were randomized into two groups, where they followed either a low-carbohydrate (high fat) diet or a low-fat diet.

In both groups, the participants lost approximately 4 kg on average. In addition, a clear improvement in the glycemic control was seen in the low-carbohydrate group after six months. Their average blood sugar level dropped from 7.5 to 7.0A1c (58.5 to 53.7 mmol/mol). This means that the intensity of the treatment for diabetes could also be reduced, and the amounts of insulin were lowered by 30%.

Despite the increased fat intake with a larger portion of saturated fatty acids, their lipoproteins did not get worse. Quite the contrary -- the HDL, or 'good' cholesterol, content increased on the high fat diet.

No statistically certain improvements, either of the glycemic controls or the lipoproteins, were seen in the low-fat group, despite the weight loss.

Dr. Fredrik Nyström, who was part of the study, said, "You could ask yourself if it really is good to recommend a low-fat diet to patients with diabetes, if despite their weight loss they get neither better lipoproteins nor blood glucose levels."

In the low-carbohydrate diet, 50% of the energy came from fat, 20% from carbohydrates, and 30% from protein. For the low-fat group the distribution was 30% from fat, 55-60% from carbohydrates, and 10-15% from protein, which corresponds to the diet recommended by the Swedish National Food Agency.

The participants were recruited from two primary health care centers and met for four group meetings during the first year of the study. All 61 participants remained in the study for the follow-up.

Dr. Hans Guldbrand who was also part of the study says, "In contrast to most other studies of this type, we lost no patients at all, which vouches for the good quality of our data."

The results of a two-year dietary study led by Hans Guldbrand, general practitioner, and Fredrik Nyström, professor of Internal Medicine, Diabetologia, May 2012

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Wow,about time... a vindication to what some of you have been saying for years!! I accepted the idea of low carb being better for bg very quickly, but still had trouble with the idea of high fat being good for either weight loss or cholesterol and since I have had issues with both I decided to not fret over fat when I found a good high fat but low carb food (like nuts or nut butter), but still stick with low fat or no fat when it made no difference to the product like milk and yogurt. I'm going to keep doing that because it just goes against my instinct to eat fat I don't need...old dog new trick thing I guess..lol.

Thanks for posting this, Gerri!

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It's hard to accept saturated fat as healthy when we've been brainwashed for decades to avoid it. Interestingly, the saturated fat phobia doesn't have the science to back it up. But, say something enough times, it becomes truth. Vegetable oils, with the exception of virgin palm & virgin coconut oil, are quite unhealthy when heated because they're not stable at high temps. Only saturated fat remains stable.

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Interestingly McDonald's used to make their french fries in a mixture of about 7 percent cottonseed oil and 93 percent beef tallow. But because of the crusade against saturated fat they switched to 100% vegetable oil.

Hard to say if a french fry can ever be made healthy, but the switch in oils probably didn't improve the situation.

Things seem to be coming full circle here's an article titled Lard: The New Health Food from a foodie website extolling the many virtues of lard. Incidentally the lard commonly available in the store is hydrogenated and thus decidedly not a health food.

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Perhaps I'm brainwashed."Phobia" sounds like a very strong word! I don't go around avoiding fat like the plague, but I'm still not going to intentionally eat unnecessary fat. As someone who gains weight if I just think about it, I'm willing to hedge my bets all around. And at my level of carb reduction I really don't have the need to add fat to my diet, so why would I? YMMV.

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I wasn't suggesting that you should. We've all been brainwashed to avoid saturated fats. Low-fat is the song that's sung & been sung for a very long time. Low fat has been marketed & written about in every health sector. From what I've seen, people do have a phobia about eating saturated fat as the most unhealthy thing to ingest & throw up walls when it's suggested to be healthy & necessary. Fat's been vilified. Hormones need fat to function properly.

It's not just carbs because people should look at calories when weight is a concern. Several well-known LC advocates have gained a lot of weight because of eating a load of protein. Quite calorie dense.

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I don't consider myself to have been brainwashed nor suffering from a "fat phobia". I've been around long enough to see dietary trends (similar to fashion) come and go - often replaced by their exact opposite! So I take it all with a grain of salt (or no salt!). I pretty much do what feels instinctively right for me. I hardly eat a fat free diet; I love nut butter and cheese is a staple for me. And I agree it's a hard balance to watch weight and blood sugar at the same time...so many factors!But I'm quite comfortable with low fat yogurt, milk, sour cream, cream cheese. We've had this discussion before - avoiding fat is one thing, consciously seeking it out is quite another.

I did start out responding to this thread by saying I'm glad that the study validates what many of the low carbers have been saying for awhile. But it's easy to forget that other people make other choices, because they are right for them, not because they're the victims of "brainwashing".

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Thanks for this, Gerri. Very interesting.

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I thought that fat basically is "necessary" if you cut carbs, if only b/c there's only 3 things the food can be, carb/ protein/ fat and, if you cut carbs, it has to be made up for by the other two groups? I'm not "low" but have cut carbs and bumped up fat w/o any increase in cholesterol or BP or any of that stuff...

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You got it, AR. For diabetics who LC, it's low carb, moderate protein & high fat. People who LC strictly for weight loss also do moderate protein & high fat because excess protein puts on weight. Doesn't mean that that there still shouldn't be portion control & that's where Atkins is misinterpreted. Not an Atkins expert by any stretch, but he stressed moderate protein.

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I personally find few absolutes in this world. And I get a bit nervous when people start talking about "THE TRUTH" and absolutes. When I look at my lifetime, let alone back into history, I see many views of things such as what makes up a healthy diet, change, evolve, and sometimes return to the original view. I think there is so much we have learned about things like nutrition and medicine but as we learn more we will once again see things differently. I also think concerns with weight are hard to understand by naturally thin people just as diabetes is hard to understand by those who have never experienced it.

I value this site in part because there is "no one right way" and we support each other's individual understandings and choices.

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I know that vegies are, ultimately carbs as well, AR, but it seems like they should be a separate category, because you can cut your carb intake in the sense of fast acting carb heavy foods like pasta, rice, cereal, sugar and replace it with increased amounts of healthy vegies. I also have reduced carbs by the way I eat. For example for dinner tonight I'm having spring rolls with peanut sauce where one of my favorite peanut sauce recipes was a cold pasta salad with peanut sauce and vegies. For people who ate pretty high carb, I think some of us have found that we just ate more than we needed in general, so have learned portion control and to not seek that satiated (bloated feeling) I'm not low either - maybe it's more necessary to replace with fat when you go true low carb. I guess I eat more fat now because my lunches for example will have more cheese than if I ate a grilled cheese sandwich, but I haven't increased fat on those things that come in high/low or no fat.

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While this seems to be a well designed study, I just want to point out that the sample size was 61, the patients were all T2 and there is nothing in the linked article to indicate the composition of the fat (saturated, mono-unsaturated, polyunsaturated) in people's diets.

The next step is to reproduce the results in another study and to see if similar results are obtained in a study of T1s.

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The full study is available. The title says it all. In type 2 diabetes, randomisation to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss
http://www.springerlink.com/content/b56453v536503166/fulltext.html
HbA1c improved by 0.4% in the LC group at six months but was back to the starting level at 2 years.LF group increased theirs from baseline by 0.2%.
There was no difference in weight reduction at the end of the study.
They do give the macronutrient breakdowns and fat composition of those that completed the required diaries but 4/31 of the LF group and 10/30 LC group failed to complete them.

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I agree that veggies are a separate category and I don't think that 8G of I dunno, potato chips or bread (small portions, of course...) would have the same impact as 8G of carbs from broccoli or whatever?

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There is actually a lot of interesting work going on in Sweden. As Dr. Jay Wortman writes:

" the Swedish government investigated another low-carb physician, Dr Anna Dahlquist, who was publicly advocating ketogenic diet for the treatment of diabetes. A couple of nutritionists made a formal complaint of malpractice against her which compelled the Swedish Ministry of Health to investigate. When the report was published, it exhonorated the doctor and found that the low-carb diet approach she was using was a valid treatment option. This appears to have galvanized a resurgence of low-carb dieting in Sweden."

A significant portion of the Swedish population is now following a low carb diet, one of the popular figures is Dr Andreas Eenfeldt, who blogs at www.dietdoctor.com. And finally, since low carb is accepted as a valid treatment, research is finally being funded. And this latest study is an example of this work.

It is a shame that the US is so backwards.

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And here more about Canadian Dr. Jay Wortman , bsc is referring to http://www.cbc.ca/thelens/bigfatdiet/wortman.html.
CDA Clinical Practice Guidelines : Type 2 Diabetes in Aboriginal Peoples , page S187 Expert Committee members includes Dr Jay Wortman .
http://www.diabetes.ca/for-professionals/resources/2008-cpg/

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Interesting the CDA Clinical Practice Guidelines says:

"Sucrose intake of up to 10% of total daily energy (e.g.
50 to 65 g/day in a 2000 to 2600 kcal/day diet) is acceptable,
as there is no evidence that sucrose intake up to this level has
any deleterious effect on glycemic control or lipid profile in
people with type 1 or type 2 diabetes."

In a separate section they recommend carb restriction for Aboriginal people.

Really? its Ok for a T2 to eat 50 to 65 grams of sucrose, if you are part of the general population, but for Aboriginal's Carb restriction is advised. Granted we are all different, but 65g of sugar would be an absolute blood glucose disaster for me.

Actually this is probably progress. It's not too much of a leap from what they are saying now, to say that the metabolism of members of the general population vary and some, perhaps those of us prone to T2, have more of a hunter gatherer metabolism and should perhaps adjust their diet to include carb restriction.

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The CDA is giving all PWD an opportunity to give ideas and thoughts about changes/suggestions one sees fit to happen . I quote :
" http://www.diabetes.ca/diabetes-and-you/living/assessment/
Background: This survey is one of several research and assessment methods in a major project for us: We are currently conducting a review of our current program offerings to develop strategies for people living with type 1, type 2, gestational and pre-diabetes according to their needs, and a scan of resources available from other sources. From this work, we will determine which programs should be developed, expanded, or retired over the next 12-24 months.
Request: As people affected by diabetes and familiar with our programs, we would be grateful for your completion of this survey, and forwarding it to others who are similarly interested." end quote and posted as well in the Canadian Group ...
Do get involved , if you want to see changes for the better , is my motto !

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BadMoon ...not related to diabetes but about choices as this lady did in her younger days , however she did :
http://lifestyle.ca.msn.com/video/?cp-documentid=aab7bdea-00fe-43c6-b0e1-e15d80343656
or this story I read in a Vancouver paper on the weekend of a chap down the road from me and he did ....his choice http://www.theprovince.com/news/Abbotsford+Ivan/6647610/story.html