Tag Archives: diabetic diet

Grant Schofield Defends the Paleo Diet for Diabetes

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Schofield is a Professor of Public Health at Auckland University of Technology and Director of the Human Potential Centre. Prof. Sofianos Andrikopoulos authored an anti-paleo diet editorial in the Medical Journal of Australia.

Schofield penned a rebuttal at Sciblogs. A sample:

“The paleo diet – the idea that we should be guided in human nutrition/public health nutrition by evolutionary history is steeped with controversy. Health experts and authorities are seemingly going well out of their way to make sure people are warned off such ways of eating.

Proponents are often mystified by this, because the idea of using human evolutionary history to understand human function is common in human biology. In fact its a guiding principle. As well, in the midst of a chronic disease epidemic, including diabetes and obesity which are potentially improved by this approach, you’d think approaches which are based on whole food eating, and appeal to at least some of the population would be welcomed.

I find it curious that other approaches such as vegetarianism, which are often based not around science, but religion and other beliefs are welcome in public health nutrition advice. Yet the paleo approach is not.

Yes, people who are follow this way of eating are restricted to eating much less processed food and often lower carbohydrate diets. Neither of these approaches are known to be anything but beneficial for human health, especially in the context of diabetes.”

Source: Sciblogs | Anti-paleo diet attacks miss the point Read the whole thing.

Steve Parker, M.D.

No degludec up in here!

Available worldwide

Moderately Low-Carb Diet Beats Calorie-Restricted “Balanced” Diet in Overweight Japanese Type 2 Diabetes

This meal is low-carb, and probably low-calorie too

This meal is both low-carb and low-calorie

A randomized controlled clinical trial found superior results in diabetes with a low-carb diet, judging from weight loss and hemoglobin A1c.

I don’t know how many carbs the typical Japanese person eats in a day. In the U.S., it’s 250-300 grams. Here’s how the study at hand was done:

“This prospective, randomized, open-label, comparative study included 66 T2DM patients with HbA1c >7.5% even after receiving repeated education programs on Calorie-Restricted Dieting (CRD). They were randomly allocated to either the 130g/day Low-Carb Diet (LCD) group (n = 33) or CRD group (n = 33). Patients received personal nutrition education of CRD or LCD for 30 min at baseline, 1, 2, 4, and 6 months. Patients of the CRD group were advised to maintain the intake of calories and balance of macronutrients (28× ideal body weight calories per day). [If I understand correctly, a 170-lb (77.2 kg) person would be recommended to eat 2160 calories/day.] Patients of the LCD group were advised to maintain the intake of 130 g/day carbohydrate without other specific restrictions. Several parameters were assessed at baseline and 6 months after each intervention. The primary endpoint was a change in HbA1c level from baseline to the end of the study.

At baseline, body mass index (BMI) and HbA1c were 26.5 and 8.3, and 26.7 kg/m2 and 8.0%, in the CRD and LCD, respectively. At the end of the study, HbA1c decreased by −0.65% in the LCD group, compared with 0.00% in the CRD group (p < 0.01). Also, the decrease in BMI in the LCD group [−0.58 kg/m2] exceeded that observed in the CRD group (p = 0.03).

Conclusions: Our study demonstrated that 6-month 130 g/day LCD reduced HbA1c and BMI in poorly controlled Japanese patients with type 2 diabetes. LCD is a potentially useful nutrition therapy for Japanese patients who cannot adhere to CRD.”

Source: A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control – Clinical Nutrition

The calorie-restricted diet did nothing for these folks in terms of glycemic  control.

Steve Parker, M.D.

PS: In case you’re wondering, the Paleobetic Diet reduces digestible carbs to 45-80 grams/day.

 

Dr. Jason Fung: How to Reverse Type 2 Diabetes – The Quick Start Guide 

Dr. Fung is a nephrologist and huge advocate of intermittent fasting. He has an article over at DietDoctor that you may find interesting (link below). Beware: at the link you will find an accurate photo of a gangrenous foot that you may find nauseating or disturbing.

I see gangrene in the hospital once a month. It’s one of the things that keeps me motivated to help PWDs (people with diabetes) learn to conquer diabetes.

Another caveat. If you take drugs that have the potential to cause hypoglycemia, you may indeed suffer life-threatening hypoglycemia if you drastically cut back on sugar and other refined carbohydrates. You better know what you’re doing.

Dr. Fung writes:

“Once we understand type 2 diabetes, then the solution becomes pretty bloody obvious. If we have too much sugar in the body, then get rid of it. Don’t simply hide it away so we can’t see it. There are really only two ways to get rid of the excessive sugar in the body.

  1. Don’t put sugar in [nor refined starches]
  2. Burn it off

That’s it. That’s all we need to do. The best part? It’s all natural and completely free. No drugs. No surgery. No cost.”

Source: How to Reverse Type 2 Diabetes – The Quick Start Guide – Diet Doctor

What About the Newcastle Diet?

Some of these are Newcastle-compliant

Some of these are Newcastle-compliant

In 2011, Prof. Roy Taylor and colleagues found they could “reverse” type 2 diabetes with a very low-calorie diet. How low? 600–800 per day for eight weeks. His program—often called the Newcastle diet—has achieved some prominence in the United Kingdom but I don’t hear about it much over here across the pond. The clinical study in support of the program was very small—only 11 participants: 9 men and 2 women (with an average BMI of 33.6). I’m sure hundreds, if not thousands, have tried it since then.

I’m not endorsing or recommending the Newcastle diet at this time. I haven’t studied it in detail. It probably requires careful medical and dietitian supervision. Prof. Taylor says:

Our research subjects found the diet challenging to stick to. Motivated people were selected, and support from the team was given frequently. Support from the families of the research volunteers was very important in helping them comply with the diet. Hunger was not a particular problem after the first few days, but the complete change in social activities (not going to the pub, not joining in the family meals etc.) was a challenge over the eight weeks.

The purpose of this post is simply to collect a few informational links for my own records and for my readers who want to know more.

Links:

The original program utilizes Optifast liquid meals (600 calories/day) plus vegetables for another 200 calories. Prof. Taylor notes that products equivalent to Optifast may be more readily available and just as effective, but I don’t know what those are. Ensure? Carnation Instant Breakfast? Boost? Jevity?

Very low calorie diets like this are often referred to as starvation diets or crash diets. Starvation diets can cause weakness and easy fatigue, headaches, dizziness, hair loss, gallstones, electrolyte (blood mineral) disturbances, palpitations, nutritional deficiencies, skin problems, gout, kidney failure, or worse.

Even if successful, transitioning away from the eight-week Newcastle diet better be done carefully or the diabetes will return. Prevention of weight regain is harder than losing weight.

Steve Parker, M.D.

Is Insulin Making You Hungry All the Time?

So easy to over-eat!

So easy to over-eat! Is it the insulin release?

No, insulin probably isn’t the cause of constant hunger, according to Dr. Stephan Guyenet. Dr. G gives 11 points of evidence in support of his conclusion. Read them for yourself. Here are a few:

  • multiple brain-based mechanisms (including non-insulin hormones and neurotransmitters) probably have more influence on hunger than do the pure effect of insulin
  • weight loss reduces insulin levels, yet it gets harder to lose excess weight the more you lose
  • at least one clinical study (in 1996) in young healthy people found that foods with higher insulin responses were linked to greater satiety, not greater hunger
  • billions of people around the world eat high-carb diets yet remain thin

An oft-cited explanation for the success of low-carbohydrate diets involves insulin, specifically the lower insulin levels and reduced insulin resistance seen in low-carb dieters. They often report less trouble with hunger than other dieters.

Here’s the theory. When we eat carbohydrates, the pancreas releases insulin into the bloodstream to keep blood sugar levels from rising too high as we digest the carbohydrates. Insulin drives the bloodstream sugar (glucose) into cells to be used as energy or stored as fat or glycogen. High doses of refined sugars and starches over-stimulate the production of insulin, so blood sugar falls too much, over-shootinging the mark, leading to hypoglycemia, an undeniably strong appetite stimulant. So you go back for more carbohydrate to relieve the hunger induced by low blood sugar. That leads to overeating and weight gain.

Read Dr. Guyenet’s post for reasons why he thinks this explanation of constant or recurring bothersome hunger is wrong or too simplistic. I agree with him.

The insulin-hypoglycemia-hunger theory may indeed be at play in a few folks. Twenty years ago, it was popular to call this “reactive hypoglycemia.” For unclear reasons, I don’t see it that often now. It was always hard to document that hypoglycemia unless it appeared on a glucose tolerance test.

Regardless of the underlying explanation, low-carb diets undoubtedly are very effective in many folks. And low-carbing is what I always recommend to my patients with carbohydrate intolerance: diabetics and prediabetics.

Steve Parker, M.D.

front cover

front cover

One Man’s N=1 Experiment Comparing Lower- Versus Moderate-Carb Diet For His Diabetes

Use the search box to find the recipe for this low-carb avocado chicken soup

Use the search box to find the recipe for this low-carb avocado chicken soup

Read his amazingly detailed post at Diatribe. Adam, who has type 1 diabetes, figured out during his college days that eating no more that 30 grams of carbs at a time was “a complete gamechanger” for improving his blood sugars. He experimented on himself to see if there was a difference between his usual lower-carb diet (146 grams/day) versus 313 grams/day.

A quote:

To my utter surprise, both diets resulted in the same average glucose and estimated A1c. But there were major tradeoffs:

The higher-carb, whole-grain diet caused four times as much hypoglycemia, an extra 72 minutes per day spent high, and required 34% more insulin. (A less healthy high-carb diet would have been far worse.)

Doubling my daily carbs also added much more effort and produced far more feelings of exhaustion and diabetes failure. It was not fun at all, and the added roller coaster, or glycemic variation, from all the extra carbs made it more dangerous.

See more at: http://diatribe.org/low-carb-vs-high-carb-my-surprising-24-day-diabetes-diet-battle#sthash.pZOgCWVl.dpuf

I think the lower-carb approach is healthier over the long run. Check with your own healthcare provider before making any drastic change in your diabetic diet.

Steve Parker, M.D.

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5

Long-Term T2 Diabetes Diet Trial: Low-Carb Edges Out High-Carb Eating

Paleo-compliant low-carb meal. I almost used this for my Paleobetic Diet book cover.

Paleo-compliant low-carb meal. I almost used this for my Paleobetic Diet book cover.

This is an important report because most diet studies last much less than one year. Details are in the American Journal of Clinical Nutrition.

Study participants were 115 obese (BMI 35) type 2 diabetics with hemoglobin A1c averaging 7.3%. Average age was 58. So pretty typical patients, although perhaps better controlled than average.

They were randomized to follow for 52 weeks either a very low-carbohydrate or a high-carbohydrate “low-fat” diet. Both diets were designed to by hypocaloric, meaning that they provided fewer calories than the patients were eating at baseline, presumably with a goal of weight loss. The article abstract implies the diets overall each provided the same number of calories. They probably adjusted the calories for each patient individually. (I haven’t seen the full text of the article.) Participants were also enrolled in a serious exercise program: 60 minutes of aerobic and resistance training thrice weekly.

Kayaking is an aerobic exercise if done seriously

Kayaking is an aerobic exercise if done seriously

The very low-carb diet (LC diet) provided 14% of total calories as carbohydrate (under 50 grams/day). The high-carb diet (HC diet) provided 53% of total calories as carbohydrate and 30% of calories as fat. The typical Western diet has about 35% of calories from fat.

Both groups lost weight, about 10 kg (22 lb) on average. Hemoglobin A1c, a reflection of glucose control over the previous three months, dropped about 1% (absolute reduction) in both groups.

Compared to the HC diet group, the LC dieters were able to reduce more diabetes medications, lower their triglycerides more, and increase their HDL cholesterol (“good cholesterol”). These triglyceride and HDL changes would tend to protect against heart disease.

SO WHAT?

You can lose weight and improve blood sugar control with reduced-calorie diets—whether very low-carb or high-carb—combined with an exercise program. No surprise there.

I’m surprised that the low-carb group didn’t lose more weight. I suspect after two months of dieting, the low-carbers started drifting back to their usual diet which likely was similar to the high-carb diet. Numerous studies show superior weight loss with low-carb eating, but those studies are usually 12 weeks or less in duration.

diabetic diet, low-carb diet, paleobetic diet

Low-Carb Brian Burger and Bacon Brussels Sprouts (in the Paleobetic Diet)

The low-carb diet improved improved lipid levels that might reduce risk of future heart disease, and allowed reduction of diabetes drug use. Given that we don’t know the long-term side effects of many of our drugs, that’s good.

If I have a chance to review the full text of the paper, I’ll report back here.

Steve Parker, M.D.

Reference: Jeannie Tay, et al. Comparison of low- and high-carbohydrate diets for type 2 diabetes management: a randomized trial. First published July 29, 2015, doi: 10.3945/​ajcn.115.112581    Am J Clin Nutr

Which Diet for a 41-Year-Old Asian Indian With Prediabetes?

The CulinaryRx blogger at MedPageToday asked two physicians what diet modifications they’d recommend for a 41-year-old Asian-Indian man with prediabetes. (To read the article you may need to do a free sign-up.)

The moderator asked his experts twice whether carbohydrate restriction is important, and never got a straight answer. These experts must not think it’s important since they push legumes, lentils, fruits, and whole grains. Dr. Nadeau said he believes there is no specific diet for folks with diabetes. I almost fell off my chair when I read one comment recommending cookies and sweets, because they’re traditional. They also recommend low glycemic load, nuts, higher protein consumption, vegetables, and “good oils” like olive oil (ghee not even  mentioned).

Read this blog post for prior comments that include advice from possible clinicians.

I’m confident that Dr. Ronesh Sinha in Silicon Valley, California, would disagree with the advice of MedPageToday’s experts. Dr. Sinha would likely recommend limiting digestible carbohydrates to 50–150 grams/day as the most important dietary step.

I’m still looking for clinical studies of various diets for South Asians with prediabetes and diabetes.

Steve Parker, M.D.

Paleobetic Diet Book Now Available

Paleobetic Diet-FrontCover_300dpi_RGB_5.5x8.5

 

 

 

I started this blog four years ago as an exploration of the Paleolithic diet as a therapeutic option in diabetes and prediabetes. Scientific studies from Ryberg (2013), Mellberg (2014), Boers (2014), and Masharani (2015) have convinced me that the paleo diet indeed has true potential to improve these conditions.

A couple years ago I published a bare-bones preliminary version of the Paleobetic Diet. Here’s an outline. I just finished a comprehensive fleshed-out version in book format.

The central idea is to control blood sugars and eliminate or reduce diabetes drugs by working with Nature, not against her. This is the first-ever Paleolithic-style diet created specifically for people with diabetes and prediabetes.

Also known as the caveman, Stone Age, paleo, or ancestral diet, the Paleolithic diet provides the foods our bodies were originally designed to thrive on. You’ll not find the foods that cause modern diseases of civilization, such as concentrated refined sugars and grains, industrial seed oils, and over-processed Franken-foods. Our ancestors just five generations ago wouldn’t recognize many of the everyday foods that are harming us now. On the Paleolithic diet, you’ll enjoy a great variety of food, including nuts and seeds, vegetables, fruit, meat, seafood, and eggs.

In the book you’ll find one week of meal plans to get you started, plus additional special recipes. Meals are quick and easy to prepare with common ingredients. You’ll find detailed nutritional analysis of each meal, including carbohydrate grams.

All measurements are given in both U.S. customary and metric units. Blood glucose values are provided as both mmol/l and mg/dl. Also included is information and advice on exercise, weight loss, all 12 classes of diabetes drugs, management of hypoglycemia, and recommended drug dose adjustments. All recipes are gluten-free.

 

Availability and Formats

You’ll find Paleobetic Diet at all major online bookstores. For example, Amazon (290-page paperback book in U.S.), Kindle ebook, and multiple ebook formats at Smashwords.

If you have diabetes or prediabetes, please give this program careful consideration. Help me spread the word if you know someone else who might benefit. Thank you.

Steve Parker, M.D.

Short-Term Paleo Diet Improves Glucose Control in Obese Type 2 Diabetes (the Masharani Study)

UCSF is here

UCSF is here

A three-week Paleolithic-style diet improved blood sugars and lipids in obese type 2 diabetics, according to researchers at the University of California—San Francisco. This is the Lynda Frassetto study I’ve been waiting over a year for. The first named author is U. Masharani, so I’ll refer to this work in the future as the Masharani study. Sorry, Lynda.

To understand the impact of this study, you need to know about a blood test called fructosamine, which reflects blood sugar levels over the preceding 2–3 weeks. You may already be familiar with a blood test called hemoglobin A1c: it tells us about blood sugars over the preceding three months. Blood glucose binds to proteins in our blood in a process called glycation. The higher the blood glucose, the more bonding. Glucose bound to hemoglobin molecules is measured in HgbA1c. Glucose bound to plasma proteins (predominantly albumin) is measured as fructosamine. It probably has nothing to do with fructose. Fructosamine is a generic name for plasma ketoamines.

If you’re doing a diabetic diet study over over 2–3 weeks, as in the report at hand, changes in glucose control will mostly be detected in fructosamine rather than HgbA1c levels.

How Was the Research Done?

Twenty-five obese diabetics in the San Francisco Bay area were randomly assigned to either a paleo-style diet or one based on American Diabetes Association (ADA) guidelines. They followed the diets for three weeks, with various measurements taken before and after intervention.

Participants were aged 50-69; you have to guess the sex breakdown. Average body mass index was 34. Over half (63%) were White/European American; there were three each of Asian, African American, and Hispanic ethnicity. They had normal blood pressures and diabetes was well controlled, with hemoglobin A1c’s around 7% and fructosamine levels close to normal. Four subjects were on no diabetes medications; 14 were taking metformin alone, five were on metformin and a sulfonylurea, one was on long-acting insulin and a sulfonylurea. No drug dosages were changed during the study.

Both intervention diets were designed for weight maintenance, i.e., avoidance of weight loss or gain. If participants lost weight, they were instructed to eat more. All food was prepared and provided for the participants. Three meals and three snacks were provided for daily consumption.

Fourteen subjects completed the paleo diet intervention. They ate lean meats, fruits, vegetables, tree nuts, poultry, eggs, canola oil, mayonnaise, and honey. No added salt. No cereal grains, dairy, legumes, or potatoes. Calorie percentages from protein, fat, and carbohydrate were 18%, 27%, and 58%, respectively. Compared to the ADA diet, the paleo diet was significantly lower in saturated fat, calcium, and sodium (under half as much), while higher in potassium (twice as much). These dieters eased into the full paleo diet over the first week, allowing bodies to adjust to higher fiber and potassium consumption. The paleo diet had about 40 grams of fiber, over twice as much as the ADA diet.

[I wonder why they chose canola over other oils.]

Ten subjects completed the ADA diet, which included moderate salt, low-fat dairy, whole grains, rice, bread, legumes, and pasta. Calorie percentages from protein, fat, and carbohydrate were 20%, 29%, and 54%, respectively (very similar to the paleo diet). I don’t have any additional description for you. I assume it included meat, poultry, eggs, and fruit.

Diet compliance was confirmed via urine measurements of sodium, potassium, pH, and calcium.

What Did the Researchers Find?

Both groups on average lost about 2 kg (4-5 lb).

Compared to their baseline values, the paleo group saw reductions in total cholesterol, HDL cholesterol, LDL cholesterol, HgbA1c (down 0.3% absolute reduction), and fructosamine. Fructosamine fell from 294 to 260 micromole/L. [The normal non-diabetic range for fructosamine is 190-270 micromole/L.]

Compared to their baseline values, the ADA diet group saw reductions in HDL cholesterol and HgbA1c (down 0.2% absolute reduction) but no change in fructosamine, total cholesterol, and LDL cholesterol.

Comparing the groups to each other, the difference in fructosamine change was right on the cusp of statistical significance at p = 0.06.

Within each group, insulin resistance trended down, but didn’t reach statistical significance. However, when they looked at the folks who were the most insulin resistant, only the paleo dieters improved their resistance. By the way, insulin resistance was measure via euglycemic hyperinsulinemic clamp instead of the short-cut HOMA-IR method.

Blood pressures didn’t change.

The authors don’t mention hypoglycemia at all, nor alcohol consumption.

They note that some of the paleo dieters complained about the volume of food they had to eat.

Errata

I found what I think are a couple misprints. Table 1 has incorrect numbers for the amount of sodium and potassium in the ADA diet. See the text for correct values. Table 2 give fructosamine values in mg/dl; they should be micromoles/L.

Final Thoughts

This particular version of the paleo diet indeed seems to have potential to help control diabetes in obese type 2’s, perhaps even better than an ADA diet, and despite the high carb content. Obviously, it’s a very small study and I’d like to see it tested in a larger population for several months, and in type 1 diabetics. But it will be years, if ever, before we see those research results. Diabetics alive today have to decide what they’ll eat tomorrow.

I wish the researchers had explained why they chose their paleo diet macronutrient breakdown: calorie percentages from protein, fat, and carbohydrate were 18%, 27%, and 58%, respectively. Perhaps they were trying to match the ratios of the ADA diet. But from what I’ve read, the average ancestral paleo diet carbohydrate energy percentage is 30-35%, not close to 60%. My experience is that reducing carb calorie consumption to 30% or less helps even more with glucose control. Reducing carbs that low in this study would have necessitated diabetes drug adjustments and increased the risk of hypoglycemia.

The authors wonder if the high fiber content of the paleo diet drove the lowered glucose levels.

High HDL cholesterol is thought to be protective against coronary artery disease and other types of atherosclerosis. Both diet groups here saw reductions in HDL. That’s something to keep an eye on.

The ADA diet group saw a drop in HgbA1c but not fructosamine. I can’t explain how HgbA1c goes down over three weeks without a change in fructosamine level.

You have to wonder if the paleo diet results would have been more impressive if the test subjects at baseline had been sicker, with poorly controlled blood pressures and HgbA1c’s of 9% or higher. And it sounds like some of these folks would have lost weight if not forced to eat more. The paleo diet is more satiating than some.

The article was well-written and a pleasure to read, in contrast to some I’ve suffered through recently.

Steve Parker, M.D.

Reference: Masharani, U., et al. Metabolic and physiologic effects from consuming a hunter-gatherer (Paleolithic)-type diet in type 2 diabetes. European Journal of Clinical Nutrition, advance online April 1, 2015. doi: 10.1038/ejcn.2015.39