Low-carb diets improve type II diabetes
I just read an article in the Family Practice News that shows once again that the low-carb diet is the Rodney Dangerfield of diets: it gets no respect. Especially not from the press.
The Family Practice News (FPN) is one of the so-called throw-away journals that are sent to physicians free of charge. The FPN is also one of the few of the zillions of these things that I get that I actually don’t throw away until after I’ve read it. Reporters working for the FPN seem to haunt the types of medical meetings I would attend if I could afford the time to attend every one I wanted to. Their reporting is pretty sharp and concise and for the most part honestly portrays the research it reports.
The December 1 issue contains an article on a poster presentation at the NAASO meeting a couple of months ago that I found interesting on a number of levels and wanted to pass along.
To set the stage, let’s go over a couple of things. First, NAASO stands for the North American Association for the Study of Obesity, which now goes by the name The Obesity Society. NAASO is the academic obesity research society. It’s members are primarily scientists working in academia on obesity research. But not all are academic researchers. They let me in. I have been a member since the mid 1980s and have attended numerous meetings.
Second, a few months ago I posted on a presentation from the last meeting of the American Heart Association (AHA) that received huge press coverage. This was the so-called study (it was actually a poster presentation just like the NAASO one I’m going to write about here shortly) that seem to indicate that the Atkins diet caused blood vessel damage. The findings of this ‘study’ were presented by the press in wide, wide coverage as an indictment of low-carb diets. As my analysis showed this wasn’t really a study, and the diet wasn’t really the Atkins diet. In fact, it wasn’t even really a low-carb diet.
In October 2007 (at about the same time the AHA meeting was taking place) NAASO had its national meeting in New Orleans. MD and I go to as many of these as we can, but we had a scheduling conflict that made us miss this one. Unlike the AHA, NAASO doesn’t publish an online compilation of the abstracts of all the presentations. You get a hard copy at the meeting, but no online resource. So, unless you’re there, you don’t really know what got presented.
A group from Duke presented a poster showing the results of their ongoing research comparing the effects of two different dietary regimens for weight loss. One of the groups of subjects were randomized to a low-carb dietary protocol – the other to a low-fat diet plus the drug orlistat (Xenecal or in OTC form called Alli).
The study, which is planned to last 48 weeks, includes 146 outpatients from the Durham Veterans Affairs Medical Center. All have a body mass index 27 kg/m2 or greater, and 46 of the patients also have type 2 diabetes. Their mean age is 56 years (range, 48–64 years); the majority are male, and roughly half are black.
In the 6 months that the trial has been ongoing, weight loss with both regimens has been similar (10–12 kg) and so has the reduction in waist circumference.
So, we’ve got patients on two radically different diets who have lost about the same amount of weight and, presumably, from the same areas. Yet the subgroup of these patients who have type II diabetes did radically better on the low-carb diet.
After 24 weeks, the mean HbA1c among the 22 type 2 diabetes patients in the low- carb arm dropped from 7.5% to 6.8%, a significant reduction. The HbA1c in the 24 type 2 diabetes patients in the orlistat arm went from 7.6 to 7.4, and did not fall significantly from baseline.
And more of the patients on the low-carb diet were able to get completely off their diabetic meds.
These are pretty impressive statistics when you consider that all the changes can be attributed to the diet composition and not simply the weight loss since both groups lost the same weight.
Is it just me or do you also find it interesting that this study wasn’t picked up by the press and disseminated everywhere as the Atkins diet study was? I wonder why not? It was the same type of presentation – a poster – at a major scientific meeting attended by hordes of reporters. Yet this study never made prime time news – only a throw-away medical journal.
Type II diabetes has reached staggering epidemic proportions in this country, and even kids are now starting to get what used to be called Adult Onset Diabetes (type II). It seems like the results of this study would be big news to those fighting the disease. Could it be that the press has an anti-low-carb bias? It certainly makes one wonder.
I read that the ADA in Dec. 07 finally has acknowledged the low Carb diet as an option for physicians as an alternative for weight loss in diabetics, but has stopped short of saying anything about the (bigger and more easily demonstrated) impact of the low carb diet on improving blood glucose control because of lack of conclusive evidence.
Pretty sad really. I now know how much hard evidence there was to support the current high carb/ low fat ADA diet and glybluride combination for 3 years that drove me into the type-2 that I am living with now.
Most people believe their doctors without question. I used to. I am afraid that I am way too cynical about doctors and researchers now … shouldn’t be that way.
Hi Guru–
It really is too bad that you can’t trust your doctor on health issues, when he/she should be the go-to person for this information. But as long as Big Pharma controls the supply of information, I fear things won’t change any time soon.
Cheers–
MRE
When a study came out alleging that a vegan diet was good for diabetics, I first read about it in the Washington Post. In reality, the vegan diet did better than the ADA diet (no suprise there), but neither diet reduced A1C below 7%.
Yet you had the typical hype. Some were proclaiming that a vegan diet beat Atkins, even though it wasn’t tested against Atkins. Yet true success on low carb is minimized. Now the ADA recognizes that low carb may be good for weight loss (up to a year), but still recommends low fat for those with type 2. Rodney Dangerfield has it right.
I’m new here but I’m learning a lot. Thank you for the information. Here is a video of Gary Taubes on Charlie Rose I thought your readers might like to view. I got upset watching Barbara Howard from the American Heart Association, she does not have clue. Does a high carbohydrate diet cause that fatty heart Dr. OZ demonstrates?
http://www.charlierose.com/shows/2002/07/26/1/an-hour-about-obesity-in-america-with-guest-host-dr-mehmet-oz
This was an appearance Gary made before he wrote his latest book. I got so steamed watching it that I couldn’t bring myself to see it through. I don’t know what kind of fatty heart Oz demonstrated because I never got that far.
Hi,
About 3 minutes and 30 seconds into the video, Dr. Oz pulls a heart covered with fat out of a bucket. The heart is from a patient during a transplant. Just wondering what caused the fat on that heart. Thank you.
http://www.youtube.com/watch?v=JPyme62niYM
I hung in there despite the lag between the film and the sound to see what you were talking about. The heart he pulled out is obviously a diseased heart if it was removed during a transplant procedure. But it is normal for there to be some fat around the heart. I don’t know that the heart shown was all that abnormal in appearance. It’s just that most people don’t know what a heart looks like. Go to a butcher shop and ask to look at a cow’s heart. It will look the same and it will be from a cow that consumed very little saturated fat in its diet and ate a totally plant-based diet. And didn’t live very long – a couple of years at most. Yet it will still have some fat on it. Fat that goes into the mouth doesn’t necessarily end up around the heart or in the arteries.
I wonder if there is a difference between a grass fed cow’s heart and a grain fed cow’s heart.
I’ve never compared them, so I can’t say. Maybe others can.
Dear Dr. Eades,
I am from India (Bangalore) and am at the threshold! of type2 diabetes (fasting blood sugar
in the range of 110 – 150 mg/dl from last 4 years). Struggled hard to reduce weight and blood sugar levels with high complex carb.+low fat regime with little success. Recently started Glycomet 250 mg twice daily on Doctor’s advice. Now, I have discovered your wonderful book ‘Protein Power’, and as expected, a couple of doctors with whom I discussed it did not
show any enthusiasm (FAT IS BAD!). Since I am so convinced with your book, I ignored that advice and started on your diet plan last week. It is working like a charm on my weight problem and energy levels. Will check the sugar level may be after a couple of weeks. I would like to thank you for such a great job. Request you to keep up the good work.
Just need a piece of advise. Should I stop Glycomet right away or wait for a while
for the blood sugar to stabilize?
Regards,
Subbu
44 years old male, 10% overweight, Ovolactoveg., strong family history of Type 2 diabetes.
Fasting blood sugar before starting PP = 150 mg/dl
Hi Subbu–
Glycomet is metformin, which is a blood-sugar-lowering medicine that can be taken with a low-carb diet without lowering sugars too much. It’s okay if you stay on it while on the diet, but work with your physician to get you weaned off as your blood sugar stabilizes at the lower level.
I’m glad to hear you’re doing so well.
MRE
How do you explain the radical vegans’ assertion that a low fat, high carb, vegan diet can reverse diabetes as well? See: http://www.pcrm.org/magazine/gm06autumn/diabetes.html
The radical vegan diet hardly reversed diabetes. In fact, the minimal reduction in HbA1c over 22 weeks isn’t particularly remarkable.
Take a look at this study that lasted for 22 months. These subjects were on a low-carb diet and had much greater reduction of HbA1c. If any diet ‘reversed’ diabetes it would certainly be the low-carb diet, not the vegan one.
I see what you mean, it doesn’t look at all like the vegan diet reverse diabetes. But the Low Carb diet did. Interesting.
hello my name is Jess I am almost 16.
i have been overweight most of my life and have recently been undergoing blood work for a couple of months. my doctor says that i may have the pre signs of type 2 diabetes. I was told that if i lose weight there is a chance that i could save myself from actually having type 2 diabetes. i was wondering if you knew any good diets that i could try to help me in the process.
please and thank you
Jess
Hi Jess–
Grab a copy of Protein Power or the 30-Day Low-Carb Diet Solution. These books should tell you everything you need to know.
Good luck.
MRE
sorry i forgot to mention that i am insulin resistant… insulin is storing in my fat cells
thanks
Same recommendations.
Hi Dr Mike,
I was wondering if you knew of any studies done on type 1 diabetics and carb restricted diets. I remember reading one a few years back but can’t find it anywhere now. I think it was a Swedish study.
Clint
Although the low-carbohydrate diet was the mainstay of treatment for type I DM before the discovery of insulin, there haven’t been a lot of studies in modern times. Here is a link to one. You can find others by going to PubMed and putting ‘low carbohydrate diet AND type 1 diabetes mellitus’ in the search function. You can also find out more info by reading Dr. Richard Bernstein’s book.
Hi
I have been struggling to lose weight for a long time.Now my doctor tells me to start with glycomet 500mg as i have developed insulin resistance.But my blood sugar levels are normal.Is it advisable to take glycomet for weightloss.
Many doctors prescribe glycomet (the generic of Metformin) for weight loss. Give it a whirl. It should affect your blood sugar levels much, if at all, if they are normal.
Hello –
I am a 6′ 175 lb male in good shape – I strength train in the Arthur Jones / high intensity style. I eat low carb all the time (sometimes I use the ‘Anabolic Diet’ which consists of carb consumption one day per week while eating <30 grms / day all other days). My fasting blood sugar is ALWAYS above 100. sometimes it’s 102, sometimes it’s 110, etc. I am convinced that my liver must be churning out blood sugar via gluconeogenesis. My HbA1c is around 5.2, which isn’t bad, but I’d like it to be lower. I’m a bit confused about a couple of things –
1 – wouldn’t being in the glucagon dominant phase create glucagon insensitivity in the same way that Insulin dominance produces insulin insensitivity? also, wouldn’t the cells that produce glucagon get worn out the same way that the beta cells get worn out churning out insulin?
2 – if I eat virtually no carbohydrate and am in glucagon dominance, how does blood sugar ever get lowered? If gluconeogenesis is rampant, how will I ever lower my blood sugar, since I have very little insulin circulating due to the low carbohydrate diet?
Sometimes I think I need to eat something that stimulates a lot of insulin just to get my blood sugar down. I’m sure I’m confused about these things, so maybe you could help enlighten me.
Thanks Doc,
Peter
The short answer is: Don’t worry about it.
Insulin is so much more dominant than glucagon that you’re not going to get in trouble with excess glucagon or runaway gluconeogenesis. If glucagon were to drive the gluconeogenic pathways to produce an excess amount of glucose, that little bit extra would stimulate the release of insulin, which would then shut down gluconeogenesis.
Excess blood sugar – whether it originates from the diet or from gluconeogenesis – stimulates the production and release of insulin, which then decreases the blood sugar. If you have normally functioning beta cells, i.e., you’re not a type I diabetic, you won’t run your sugar too high by gluconeogenesis.
Dr. Mike -
Thanks for the response – but wouldn’t you think fasting blood sugar of 102 – 110 is high? My normal doctor was a bit concerned that I may be borderline diabetic. I’ve been thin all my life and have been avoiding sugar and simple carbs since I was 15 (I’m now 47). I’ve been doing low carb constantly since 2002. Whaddaya think? (also – don’t some type II diabetics have a problem with abnormally high fasting blood sugar from gluconeogenesis – I thought that’s one of the things Metformin was supposed to help?)
Thanks,
Peter
But are you a type II diabetic? I wouldn’t just look at fasting blood sugar levels by themselves. You need to consider HgbA1c levels as well. HgbA1c levels represent an average of blog sugars over a couple of month period, and are a more accurate measure of what’s going on overall blood sugar-wise than is a single fasting blood sugar.