Tag Archives: low-carb diet

Low-Carb Diet Works in Japanese With Type 2 Diabetes

Mt. Fuji in Japan

Mt. Fuji in Japan

I don’t know much about Japanese T2 diabetes. I’ve never studied it. Their underlying physiology may or may not be the same as in North American white diabetics, with whom I am much more familiar. Physiologic differences are suggested by the fact that Japanese develop type 2 diabetes at lower BMIs (body mass index) than do Western caucasians.

For what it’s worth, a small study recently found improvement of blood sugar control and triglycerides in those on a carbohydrate restricted diet versus a standard calorie-restricted diet.

Only 24 patients were involved. Half were assigned to eat low-carb without calorie restriction; the other half ate the control diet. The carbohydrate-restricted group aimed for 70-130 grams of carb daily, while eating more fat and protein than the control group. The calorie-restricted guys were taught how to get 50-60% of calories from carbohydrate and keep fat under 25% of calories. At the end of the six-month study, the low-carbers were averaging 125 g of carb daily, compare to 200 g for the other group. By six months, both groups were eating about the same amount of calories.

Average age was 63. Body mass index was 24.5 in the low-carb group and 27 in the controls. All were taking one or more diabetes drugs.

The calorie-restricted group didn’t change their hemoglobin A1c (a standard measure of glucose control) from 7.7%. The low-carb group dropped their hemoglobin A1c from 7.6 to 7.0% (statistically significant). The low-carb group also cut their triglycerides by 40%. Average weights didn’t change in either group.

Bottom Line

This small study suggests that mild to moderate carbohydrate restriction helps control diabetes in Japanese with type 2 diabetes. The improvement in hemoglobin A1c is equivalent to that seen with initiation of many diabetes drugs. I think further improvements in multiple measures would have been seen if carbohydrates had been restricted even further.

Steve Parker, M.D.

Link to reference.

h/t Dr Michael Eades

Recipe: Apple, Pecan, Blueberry Lunch Bowl

paleobetic diet, diabetic diet, low-carb diet

So simple even a redneck can make it (I are a redneck)

Ingredients:

2.5 oz (70 g) apple, diced (“red delicious” variety works well) (this is half a medium-sized apple)

2.5 oz (70 g) pecans, crumbled into small pieces

2.5 oz (70 g) raw blueberries

Instructions:

Mix all together in a bowl, then enjoy. I know a lotta you bros will just eat all the components individually—but try the mix once for new flavors.

Servings: 1

Nutritional Analysis:

76% fat

20% carb

4% protein

570 calories

30 g carbohydrate

10 g fiber

20 g digestible carb

1.4 mg sodium

421 mg potassium

Prominent features: Quick and easy. Rich in copper, manganese, and thiamine. Inadequate protein to get you through the day, but you’ll make up for it at breakfast or dinner.

Recipe: Beef Soup, Roasted Asparagus, and Blackberries

low-carb diet, paleobetic diet, diabetic diet

Dinner time!

The entree is a cross between stew and soup; stoup, if you will.

Ingredients:

2 lb (0.9 kg) stew meat, lean, bite-sized chunks (tenderized by the butcher if able)

1 garlic clove, finely minced

6 sprigs cilantro, de-stemmed, whole leaves

2 oz (58 g) sweet onion, diced (1/2 of a small onion)

1/4 of a medium-size green bell pepper, de-seeded, diced (medium bell pepper weighs about 5.5 oz or 155 g)

8 oz (227 g) canned tomato sauce

2.5 cups (590 ml) water

1.25 tsp (6.2 ml) table salt

freshly ground black pepper to taste (1/4 tsp or 1.2 ml?)

16 oz (454 g) fresh raw asparagus, no larger in diameter than your little finger, with any dry or woody stalk cut off and discarded

1.5 tbsp extra virgin olive oil

7.5 oz (213 g) raw blackberries

Instructions:

Stoup first. In a frying pan or electric skillet, place the stew meat, cilantro, garlic, bell pepper, onion, and cook over medium heat (350º F or 177º C) until the meat is done. Then add the tomato sauce, two cups of the water, one tsp of the salt, and pepper to taste. Simmer for two hours, then add a half cup water to replace evaporation loss.

low-carb diet, paleobetic diet, diabetic diet

Cooking stew meat. NOTE: this is double the amount the recipe calls for.

paleobetic diet, low-carb diet, diabetic diet

Meat is done and the “gravy” has magically appeared

low-carb diet, diabetic diet, paleobetic diet

Appearance after addition of the tomato sauce and 2 cups water

Now the asparagus. Preheat oven to 400º F or 204º C. Place asparagus on a cooking sheet covered with foil, brush the asparagus with the olive oil, then lightly salt (1/4 tsp?) and pepper to taste. (If you don’t mind cleaning up, just use a baking dish without the foil.) Roast in oven for 8–15 minutes; thicker asparagus takes longer. It’s hard to tell when it’s done just by looking; if it’s still hard, it’s not done. Click for another post I wrote on cooking asparagus and brussels sprouts.

paleobetic diet, low-carb diet, diabetic diet

Asparagus roasted at 400 degrees F for 12 minutes

Enjoy the berries for desert.

low-carb diet, diabetic diet, paleobetic diet

2.5 oz or 1/2 cup of blackberries

Servings: 3 [one serving is 1.5 cups (355 ml) of soup, a third of the asparagus (5 oz (140 g), and 2.5 oz (70 g) berries]

Nutritional Analysis:

40 % fat

12 % carbohydrate

48 % protein

590 calories

19 g carbohydrate

8.5 g fiber

10.5 g digestible carb

1,557 mg sodium

1,778 mg potassium

Prominent features: Rich in protein, B6, B12, copper, iron, niacin, phosphorus, selenium, and zinc

low-carb diet, paleobetic diet, diabetic diet

The fresh cilantro is a nice touch

Recipes: Spaghetti Squash

low-carb diet, spaghetti squash, paleobetic diet, diabetic diet

The smallish yellow spaghetti squash is at the top. It’s related to pumpkins and zucchini.

It’s hard to give up pasta. Many diabetics who don’t notice that their blood sugar levels spike too high when they eat pasta. What’s too high? In general, I’d say over 150 mg/dl (8.33 mmol/l) measured one hour after a meal, or over 130 mg/dl (7.22 mmol/l) two hours after the meal.

Other experts disagree and propose other numbers.

An alternative to spaghetti pasta that shouldn’t raise blood glucose levels as high is spaghetti squash. It’s all about the carbohydrates. A cup of cooked spaghetti squash has 10 g of carb; a cup of cooked spaghetti has 43 g. The fiber grams are about the same. Numbers are from FitDay.com.

Spaghetti squash is a classic low-carb vegetable. If you’ve never tried it, you should. As vegetables go, it’s one of the largest, heaviest, and most interesting to prepare. Easy, too. The spaghetti squash season is autumn and winter in the northern hemisphere. Purchasing in spring and summer may be iffy.

In my part of the world, supermarket spaghetti squashes weigh between two and five pounds. We cooked a three-pounder (1.4 kg) that yielded five cups; a five-pounder (2.3 kg) gave us 12 cups. A serving size is one, maybe two cups. What you don’t eat immediately stays fresh in the refrigerator for at least several days. Re-heat by microwaving or stir-frying.

Like pasta and potatoes, the squash by itself is bland. It’s a great substrate for sauces or seasonings.

low-carb diet, paleobetic diet, diabetic diet, spaghetti squash

Raw squash cut in half lengthwise

Here’s how we cook it at the Parker Compound. Preheat the oven to 375º F 0r 190º C. Very carefully slice the squash in half lengthwise. Spoon out and discard the guts (seeds and membranes like a pumpkin; it even smells like a pumpkin). Put the halves flat-side down in a pan, then add a half inch (1.3 cm) of water to the pan. Cover with foil and bake until the outer shell (rind) is fairly easily pierced with a paring knife. This will be about 45 minutes for a two-pound squash (0.9 kg); 90 minutes for a four-plus pounder (2.3+ kg). Then turn them over, re-cover with foil, and cook 15 minutes more, until very tender. Remove from the oven and allow them to cool for a few minutes. Then use a fork to pull the strands away from the rind.

Other cooks simplify the process and just place the squash halves flat-side down on a baking sheet and cook for 30-60 minutes. Some leave the seeds in while cooking and spoon them out just before the stranding step.

Now what?

You got options.

Our first experiment was with l0w-carb spaghetti sauce.

paleobetic diet, low-carb diet, diabetic diet, spaghetti squash

Low-carb spaghetti

Next we took three cups squash (710 ml) and mixed in 2 tbsp (30 ml) extra virgin olive oil, 2.5 tbsp (37 ml) chopped parsley, 1/2 tsp (2.5 ml) minced fresh garlic, 1/2 tsp (2.5 ml) salt, and 1/8 tsp (0.6 ml) black pepper.

low-carb diet, diabetic diet, paleobetic diet

Seasoned with parsley, olive oil, garlic, salt, pepper

Finally, we took a cup (240 ml) of the squash and added minced celery (4 inches or 10 cm of stalk), 3 minced black olives, 5/8 oz (18 g) of minced sweet (bell) pepper, 1/2 clove of minced garlic, salt (a dash), and pepper to taste.

paleobetic diet, diabetic diet, low-carb diet, spaghetti squash

Seasoned with sweet peppers, black olives, garlic, celery, and salt

These last two options I consider side dishes. By the way, they taste good either cold or warm. They would go well with a number of entrees, such as steak or salmon.

I’ve read that this squash is good with pesto, or just with salt and (non-paleo) butter.

Nutrition facts from FitDay.com:

One cup of cooked spaghetti squash has 75 calories (I’ve seen 42 elsewhere), 10 g of carbohydrate, 2 g of fiber, 8 g of digestible carb, 4 g of fat (predominantly MUFA), minimal protein, and a fair amount of vitamins A, niacin, B6, and C. Plus 8% of your RDA for manganese.

 

What’s the Single Best Diet for T2 Diabetics?

Thinking about it...

Thinking about it…

DietDoctor has some ideas based on a recent scientific study:

new exciting Swedish study provides us with strong clues on how a person with diabetes should eat (and how to eat to maximize fat burning). It’s the first study to examine in detail how various blood markers change throughout the day depending on what a diabetic person eats.

The study examined the effects of three different diets in 19 subjects with diabetes type 2. They consumed breakfast and lunch under supervision in a diabetes ward. The caloric intake in the three diets examined was the same, but the diets differed in the following manner:

  1. A conventional low-fat diet (45-56% carbs)
  2. A Mediterranean diet with coffee only for breakfast (= similar to 16:8 intermittent fasting) and a big lunch (32-35% carbs)
  3. A moderate low-carbohydrate diet (16-24% carbs)

All participants tested all three diets, one diet each day in randomized order.

Click through for results. Hint: Carbohydrate restriction works.

Steve Parker, M.D.

Physician With Type 1 Diabetes Thriving on Low-Carb Paleo-Style Diet

"Put down the bread and no one will get hurt!"

Could you give up bread for life?

ABC Radio provides the audio and transcript of an interview with Dr. Troy Stapleton, who was diagnosed with type 1 diabetes at age 41. He lives in Queensland, Australia. At the time of his diagnosis, he says…

I was advised to eat seven serves of bread and cereals, two to three serves dairy, fruit, starchy vegetables, and to balance that intake with insulin. If you add up all those serves, they were recommending a diet of up to about 240 grams of carbohydrates a day, and to balance it with insulin. I was going to be the best patient, and there has been some important trials that show that if you do control your blood glucose well then you can reduce your incidence of the complications.

Dr. Stapleton believes we evolved on a very low carbohydrate diet; the Agricultural Revolution led to our current high carb consumption. He was concerned about the risk of hypoglycemia with standard diabetic diets.

There was a different approach where essentially you went on a very low carbohydrate diet, this made a little bit of sense to me. Why would I eat carbohydrates and then have to balance it with insulin?

Here’s what the diabetes educators told him:

What they say is you need to estimate the amount of carbohydrate you’re going to eat, and then you need to match that carbohydrate dose essentially with an insulin dose. So you sort of look at your food and you go, okay, I’m having 30 grams of carbohydrate and I need one unit of insulin per 15 grams of carbohydrate, so two units. It sounds really quite straightforward, except that it’s very, very difficult to estimate accurately the amount of carbohydrate you’re eating. The information on the packets can be out by 20%. Most people say that your error rate can be around 50%.

And then of course it changes with what you’ve eaten. So if you eat carbohydrates with fat and then you get delayed absorption, then that glucose load will come in, and then the type of carbohydrates will alter how quickly it comes in to your bloodstream. And then of course your insulin dose will vary, your absorption rate will vary by about 30%. Once you think through all the variables, it’s just not possible. You will be able to bring your blood glucose under control, but a lot of the time what happens is you get a spike in your glucose level immediately after a meal, and that does damage to the endothelium of your blood vessels…

Norman Swan: The lining.

Troy Stapleton: That’s correct, it causes an oxidative stress to your endothelium, and that is the damage that diabetes does, that’s why you get accelerated atherosclerosis.

Here’s what happened after he started eating very low carb:

It’s been amazing, it’s been the most remarkable turnaround for me and I just cut out carbohydrates essentially completely, although I do get some in green leafy vegetables and those sorts of things. My blood sugar average on the meter has gone from 8.4 [151 mg/dl] down to 5.3 [95 mg/dl]. My HbA1c is now 5.3, which is in the normal range. My blood pressure has always been good but it dropped down to 115 over 75. My triglycerides improved, my HDL improved, so my blood lipid profile improved. And I would now have a hypoglycaemic episode probably about once a month after exercise. [He was having hypoglycemia weekly on his prior high carb diet with carb counting insulin adjustments.]

He was able to reduce his insulin from about 27 units a day down to 6 units at night only (long-acting insulin)! He admits his low insulin dose may just reflect the “honeymoon period” some type 1s get early on after diagnosis.

Norman Swan: So when you talk to your diabetes educator now, what does he or she say?

Troy Stapleton: Look, they’re interested, but they’ll tell me things and I’ll say, well, that’s actually not true. I’m quite a difficult patient, Norman.

He says he’s eating an Atkins-style diet. Combining the transcript and his notes in the comments section:  1) he doesn’t eat potatoes or other starchy vegetables or bread, 2) he eats meat, eggs, lots of non-starchy vegetables, some berries and tree nuts, olives, and cheese, 3) an occasional wine or low-carb beer, 4) coffee, and 5) he eats under 50 g/day of carbohydrate, probably  under 30 g. This is a low-carb paleo diet except for the cheese, alcohol, and coffee.  Cheese, alcohol and coffee are (or can be) low-carb, but they’re not pure paleo.

He notes that…

There is an adaption period to a very low carbohydrate diet which takes 4–6 weeks (ketoadaption). During this time symptoms include mild headaches, lethargy, cramps, carb cravings and occasional light headedness. These symptoms all pass.

Read or listen to the whole thing. Don’t forget the comments section. All the blood sugars you see there are in mmol/l; convert them to mg/dl (American!) by multiplying by 18.

Steve Parker, M.D.

The Case for Carbohydrate Restriction In Diabetes

MB900402413In 1797, Dr. John Rollo (a surgeon in the British Royal Artillery) published a book entitled An Account of Two Cases of the Diabetes Mellitus. He discussed his experience treating a diabetic Army officer, Captain Meredith, with a high-fat, high-meat, low-carbohydrate diet. Mind you, this was an era devoid of effective drug therapies for diabetes.

The soldier apparently had type 2 diabetes rather than type 1.

Rollo’s diet led to loss of excess weight (original weight 232 pounds or 105 kg), elimination of symptoms such as frequent urination, and reversal of elevated blood and urine sugars.

This makes Dr. Rollo the original low-carb diabetic diet doctor. Many of the leading proponents of low-carb eating over the last two centuries—whether for diabetes or weight loss—have been physicians.

But is carbohydrate restriction a reasonable approach to diabetes, whether type 1 or type 2?

What’s the Basic Problem in Diabetes?

Diabetes and prediabetes always involve impaired carbohydrate metabolism: ingested carbs are not handled by the body in a healthy fashion, leading to high blood sugars and, eventually, poisonous complications.  In type 1 diabetes, the cause is a lack of insulin from the pancreas.  In type 2, the problem is usually a combination of insulin resistance and ineffective insulin production.

Elevated blood pressure is one component of metabolic syndrome

Elevated blood pressure is one component of metabolic syndrome

A cousin of type 2 diabetes is “metabolic syndrome.”  It’s a constellation of clinical factors that are associated with increased future risk of type 2 diabetes and atherosclerotic complications such as heart attack and stroke. One in six Americans has metabolic syndrome. Diagnosis requires at least three of the following five conditions:

■  high blood pressure (130/85 or higher, or using a high blood pressure medication)

■  low HDL cholesterol:  under 40 mg/dl (1.03 mmol/l) in a man, under 50 mg/dl (1.28 mmol/l) in a women (or either sex taking a cholesterol-lowering drug)

■  triglycerides over 150 mg/dl (1.70 mmol/l) (or taking a cholesterol-lowering drug)

■  abdominal fat:  waist circumference 40 inches (102 cm) or greater in a man, 35 inches (89 cm) or greater in a woman

■  fasting blood glucose over 100 mg/dl (5.55 mmol/l)

Metabolic syndrome and simple obesity often involve impaired carbohydrate metabolism. Over time, excessive carbohydrate consumption can turn obesity and metabolic syndrome into prediabetes, then type 2 diabetes.

Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally.

Carbohydrate Intolerance

Diabetics and prediabetics—plus many folks with metabolic syndrome—must remember that their bodies do not, and cannot, handle dietary carbohydrates in a normal, healthy fashion. In a way, carbs are toxic to them. Toxicity may lead to amputations, blindness, kidney failure, nerve damage, poor circulation, frequent infections, premature heart attacks and death, among other things.

Diabetics and prediabetics simply don’t tolerate carbs in the diet like other people. If you don’t tolerate something, you have to give it up, or at least cut way back on it. Lactose-intolerant individuals give up milk and other lactose sources. Celiac disease patients don’t tolerate gluten, so they give up wheat and other sources of gluten. One of every five high blood pressure patients can’t handle normal levels of salt in the diet; they have to cut back or their pressure’s too high. Patients with phenylketonuria don’t tolerate phenylalanine and have to restrict foods that contain it. If you’re allergic to penicillin, you have to give it up. If you don’t tolerate carbs, you have to give them up or cut way back. I’m sorry.

Carbohydrate restriction directly addresses impaired carbohydrate metabolism naturally.

But Doc, …?

1.  Why not just take more drugs to keep my blood sugars under control while eating all the carbs I want?

We have 11 classes of drugs to treat diabetes.  For most of these classes, we have little or no idea of the long-term consequences.  It’s a crap shoot.  The exceptions are insulin and metformin.  Several big-selling drugs have been taken off the market due to unforeseen side effects.  Others are sure to follow, but I can’t tell you which ones.  Adjusting insulin dose based on meal-time carb counting is popular.  Unfortunately, carb counts are not nearly as accurate as you might think; and the larger the carb amount, the larger the carb-counting and drug-dosing errors.

2.  If I reduce my carb consumption, won’t I be missing out on healthful nutrients from fruits and vegetables?

No.  Choosing low-carb fruits and vegetables will get you all the plant-based nutrients you need.  You may well end up eating more veggies and fruits than before you switched to low-carb eating.  Low-carb and paleo-style diets are unjustifiably criticized across-the-board as being meat-centric and deficient in plants.  Some are, but that’s not necessarily the case.

3.  Aren’t vegetarian and vegan diets just as good?

Maybe.  There’s some evidence that they’re better than standard diabetic diets.  My personal patients are rarely interested in vegetarian or vegan diets, so I’ve not studied them in much detail.  They tend to be rich in carbohydrates, so you may run into the drug and carb-counting issues in Question No. 1.

Steve Parker, M.D.

PS:  The American Diabetes Association recommends weight loss for all overweight diabetics. Its 2011 guidelines suggest three possible diets: “For weight loss, either low-carbohydrate [under 130 g/day], low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to two years).”  The average American adult eats 250–300 grams of carbohydrate daily.

Nephrologist and Type 1 Diabetic Keith Runyan Tried the Paleo Diet

Jimmy posted a recent interview with type 1 diabetic Dr. Keith R. Runyan, who is a nephrologist and internist.

Dr. Runyan is training for the Great Floridian Triathlon this coming October so he naturally has a great interest in high level athleticism as it intersects with diabetes.  He fuels his workouts with dietary fats and proteins rather than the standard carbohydrates.

Dr. Runyan’s current carb consumption level didn’t come up specifically in the interview, but his website indicates he’s on a ketogenic diet heavily influenced by Dr. Richard Bernstein.  I figure he’s eating under 50 grams of digestible carbohydrate daily.  He also tried Loren Cordain’s paleo diet; my sense is that it didn’t help much with his diabetes, but perhaps some.  My sense is that he incorporates at least a few paleo features into his current eating plan.

People with type 2 diabetes can probably tolerate a higher level of carbohydrates, compared to type 1’s, generally speaking.  This didn’t come up in the podcast interview.

Overall, the interview strongly supports carbohydrate-restricted eating for folks with diabetes.  Definitely worth a listen for anyone with diabetes who’s not sold on a very-low-carb diet.  If you’re sitting on the fence, at least check out Dr. Runyan’s “About Me” page.

Steve Parker, M.D.

Triathlon: run, swim, bike