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From: Nicky on 6 Jul 2008 03:54
http://www.nutritionandmetabolism.com/content/5/1/14

"Of the total of 10 controls, who have switched diet, 2 persons after
a weight reduction of 20 kg each are free of all signs of diabetes
after 3 and 2 years respectively i.e. HbA1c below 5.0%, fasting blood
glucose below 5.0 mmol/l and free of any blood glucose lowering
medication."

These guys are on the diet I'm following - carbs from veg, salad and
rye crackers, under 90g CHO daily. It's only a small study - 16
patients in the intervention group - but it's certainly matching my
experience. The incidence of cardiovascular disease against that from
the high-carb controls is good too.

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.4% BMI 25
From: Jefferson on 6 Jul 2008 16:12
Nicky wrote:

> http://www.nutritionandmetabolism.com/content/5/1/14
>
> "Of the total of 10 controls, who have switched diet, 2 persons after
> a weight reduction of 20 kg each are free of all signs of diabetes
> after 3 and 2 years respectively i.e. HbA1c below 5.0%, fasting blood
> glucose below 5.0 mmol/l and free of any blood glucose lowering
> medication."

Most of the positive effects on weight were in the first 6 months. The
average weight overall after that point was weight gain. See figure 1.
Individual changes in bodyweight in 16 obese patients with type 2
diabetes. The average is misleading however.

"Bodyweight

The mean reduction in bodyweight over the first six months was 11.3 � 4
kg (controls: 1.8 � 3.8 kg). Ten patients (62%) but none of the controls
lost more than 10% of bodyweight.

Mean bodyweight increased from 6 to 22 months by 2.7 � 4.3 kg. The total
mean increase from month 6 to 44 has been 3.9 � 5.6 kg. Five of the
patients have maintained bodyweight from 6 to 44 months or reduced it
further (see figure 1). However, five patients have increased mean
bodyweight by 10 kg. In 7 patients (43%) the bodyweight is still 10% or
more below their original weight."

Frank
From: Nicky on 6 Jul 2008 17:39
On Sun, 06 Jul 2008 16:12:41 -0400, Jefferson <Jefferson(a)comcast.net>
wrote:

>Nicky wrote:
>
>> http://www.nutritionandmetabolism.com/content/5/1/14
>>
>> "Of the total of 10 controls, who have switched diet, 2 persons after
>> a weight reduction of 20 kg each are free of all signs of diabetes
>> after 3 and 2 years respectively i.e. HbA1c below 5.0%, fasting blood
>> glucose below 5.0 mmol/l and free of any blood glucose lowering
>> medication."
>
>Most of the positive effects on weight were in the first 6 months. The
>average weight overall after that point was weight gain. See figure 1.
>Individual changes in bodyweight in 16 obese patients with type 2
>diabetes. The average is misleading however.

Again, that matches the pattern I see in myself - eventually, you stop
thinking "diet" and start thinking "way of eating", and experiment to
see where the envelope boundaries are. Some experiments are good, and
are kept; others are bad. Either way, you might have weight
fluctuation whilst you're playing, and because you're now eating at
maintenance carb levels, it won't come off until you tighten up again.
Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.4% BMI 25
From: Alan S on 6 Jul 2008 21:24
On Sun, 06 Jul 2008 08:54:18 +0100, Nicky
<ukc802466929(a)btconnect.com> wrote:

>http://www.nutritionandmetabolism.com/content/5/1/14
>
>"Of the total of 10 controls, who have switched diet, 2 persons after
>a weight reduction of 20 kg each are free of all signs of diabetes
>after 3 and 2 years respectively i.e. HbA1c below 5.0%, fasting blood
>glucose below 5.0 mmol/l and free of any blood glucose lowering
>medication."
>
>These guys are on the diet I'm following - carbs from veg, salad and
>rye crackers, under 90g CHO daily. It's only a small study - 16
>patients in the intervention group - but it's certainly matching my
>experience. The incidence of cardiovascular disease against that from
>the high-carb controls is good too.
>
>Nicky.
>T2 dx 05/04 + underactive thyroid
>D&E, 100ug thyroxine
>Last A1c 5.4% BMI 25

Full free pdf (272kb) here:
http://www.nutritionandmetabolism.com/content/pdf/1743-7075-5-14.pdf

There were a couple of small sections that I feel could be
improved if, and hopefully when, this study is repeated as a
large-scale study:

"The patients were counselled not to eat between meals." I
would delete that and counsel them on adjusting main meals
to balance snacks if they graze.

"The patients monitored their own blood glucose 4 times a
day and were counselled by telephone over the first few
weeks for further reductions of medications". One wonders
what post-prandial tests were done and what they were
advised to do as a consequence of those tests.

But apart from that, reading this paper has made my day. At
long last it is starting to happen. Yes, it is only small
number of subjects, but they note and I agree "The work
presented here suggests the importance of funding large
scale long term trials as well as the benefits and limited
risk in using low carbohydrate diets now."

To make the importance of this paper a little clearer to
those without broad-band to download it I'll repeat the
discussion section in a following post.

Cheers, Alan, T2, Australia.
--
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com
http://www.flickr.com/photos/alan_s/
http://loraltravel.blogspot.com (On Indian Roads)


From: Alan S on 6 Jul 2008 21:33
On Sun, 06 Jul 2008 08:54:18 +0100, Nicky
<ukc802466929(a)btconnect.com> wrote:

>http://www.nutritionandmetabolism.com/content/5/1/14

Copied from the discussion and summary of the paper:

"Discussion

A summary of the implications of the current work:

1. This year, for the first time, the ADA accepted the value
of carbohydrate-restricted diet for weight loss. The text of
their guidelines, however, continues previous guidelines in
finding fault with such diets and, in fact, does not cite
most of the recent publications supporting their use [2].
Other health agencies have similarly insisted on low fat
approaches. There is reason to believe that these guidelines
are not followed in practice. A perusal of internet diabetes
sites suggests that the major dietary emphasis is on
carbohydrate control.

2. The major barrier to official acceptance is the stated
lack of long term trials although it has never been stated
what the features of successes in short term trials suggest
that they would not be maintained.

3. The work presented here suggests the importance of
funding large scale long term trials as well as the benefits
and limited risk in using low carbohydrate diets now.

4. Several studies have shown that low fat diets can be
successful but overall, it would be difficult to say they
are inherently reliable.

5. In the studies reported here, patients in the two groups
had, despite all possible support, failed in achieving an
acceptable control of bodyweight and hyperglycemia on
traditional low fat diets.

8. An important issue is the fact that some patients do
become completely free of disease as soon as they are
presented with a low-carbohydrate option. It is unknown what
factors make these persons succeed now despite complete
failure in the past.

In the low-carbohydrate group bodyweight and HbA1c is
still significantly lower than before start. The bodyweight
of 7 patients (43%) is still 10% below the initial weight,
the original goal of the study. The success rate almost 4
years later is thus 43% as compared to zero in the control
group.

Five of 16 patients in the intervention group have had
stable bodyweight 38 months after the conclusion of the 6
months study period without any special follow-up.

Weight increase has been preceded by an increased intake of
carbohydrates in those cases where it has occurred. It is
clear that the high-carbohydrate diet followed before the
study has been an important, probably the central,
contributing cause of their condition.

One rationale for a low-carbohydrate diet is the
experimentally observed reduction in hunger [8] Patients
generally reported that hunger was absent on the
intervention diet and only after increasing dietary
carbohydrates did it return.

The intensity of hunger has been reported to be positively
correlated to the proportion of carbohydrates in obese men
over a 4 week period [9].

We believe that the close follow-up was important.
Patients had many questions at each meeting and concerns
about the diet that might have hindered adherence were
cleared up. In additions individual patients received
support from the group.

There is now little evidence for the claim that a
fat-reduced diet for weight reduction has any particular
value beyond caloric counting [10]. On the other hand, six
randomised studies have shown that carbohydrate restriction
with adlibitum energy intake confers a significant benefit
with regard to weight loss in obese persons [11-16]. The
current study is consistent with these reports and suggests
that
high-starch, high-carbohydrate diets excessively stimulate
appetite and disturb energy balance in patients with the
metabolic syndrome and type 2 diabetes [3]. A reduction of
carbohydrates normalises the balance, reduces insulin
concentrations and favours utilization of stored fat as fuel
as well as significantly reducing insulin resistance [3].
Considering the solid evidence for the negative effect of
hyperglycemia on diabetes complications as well as
cardiovascular disease the present high-carbohydrate dietary
advice resulting in unnecessary hyperglycemia and insulin
resistance seems difficult to support [17-19] and for
diabetes patients, current dietary recommendations seem to
be a major part of their problem rather than being part of
the solution. Carbohydrate restriction, however, reverses or
neutralises all aspects of the metabolic syndrome
[20,21].

Summary: A reduced carbohydrate diet is effective in
motivated patients and can be recommended for overweight
overweight patients with type 2 diabetes. There has been no
sign of a negative cardiovascular effect."

Cheers, Alan, T2, Australia.
--
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com
http://www.flickr.com/photos/alan_s/
http://loraltravel.blogspot.com (On Indian Roads)


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