12/06/2017 11:00 AM – As usual, I will return to build in additional content in this new section as I have time. The initial and primary focus will be on Type 2 Diabetes Mellitus–since the disease can largely be prevented and treated with proper dietary and lifestyle choices; and since the prevalence of diabetes worldwide is growing at an alarming rate. The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014, and is expected to surpass 700 million by 2025 (1). This doesn’t include the additional number of people who are already, often ignorantly pre-diabetic and hyperinsulinemic. It’s a problem… we have a problem.
Diabetes Mellitus: a variable disorder of carbohydrate metabolism caused by a combination of hereditary and environmental factors and usually characterized by inadequate secretion or utilization of insulin, by excessive urine production, by excessive amounts of sugar in the blood and urine, and by thirst, hunger, and loss of weight
Low Carbohydrate Diets Can Prevent and Treat Type 2 Diabetes Mellitus and Hyperinsulinemia
“It is nonsensical that we’re expected to prescribe these techniques to our patients while the medical guidelines don’t include another better, safer and far cheaper method: a diet low in carbohydrates.
Once a fad diet, the safety and efficacy of the low-carb diet have now been verified in more than 40 clinical trials on thousands of subjects. Given that the government projects that one in three Americans (and one in two of those of Hispanic origin) will be given a diagnosis of diabetes by 2050, it’s time to give this diet a closer look.”
[…]
“Encouraging patients with diabetes to eat a high-carb diet is effectively a prescription for ensuring a lifelong dependence on medication.
At the annual diabetes association convention in New Orleans this summer, there wasn’t a single prominent reference to low-carb treatment among the hundreds of lectures and posters publicizing cutting-edge research. Instead, we saw scores of presentations on expensive medications for blood sugar, obesity and liver problems, as well as new medical procedures, including that stomach-draining system, temptingly named AspireAssist, and another involving “mucosal resurfacing” of the digestive tract by burning the inside of the duodenum with a hot balloon.
We owe our patients with diabetes more than a lifetime of insulin injections and risky surgical procedures. To combat diabetes and spare a great deal of suffering, as well as the $322 billion in diabetes-related costs incurred by the nation each year, doctors should follow a version of that timeworn advice against doing unnecessary harm …”
Study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5048014/
PDF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5048014/pdf/nutd201636a.pdf
Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus
Conclusions:
The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients.
Study: http://circoutcomes.ahajournals.org/content/9/5/504
PDF: http://circoutcomes.ahajournals.org/content/9/5/504.full.pdf?download=true
Glycemic Control for Patients With Type 2 Diabetes Mellitus: Our Evolving Faith in the Face of Evidence
Conclusions:
Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications. This discordance may distort priorities in the research and practice agendas designed to improve the lives of patients with type 2 diabetes mellitus.
Article: http://www.cbc.ca/news/health/study-type-2-diabetes-questions-medical-dogma-no-evidence-1.3762658
New study questions Type 2 diabetes treatment
No evidence glucose-lowering drugs help ward off long-term complications, researchers say
Meta Analysis: https://www.researchgate.net/publication/305074768_Efficacy_and_safety_of_insulin_in_type_2_diabetes_Meta-analysis_of_randomised_controlled_trials
PDF: https://www.researchgate.net/profile/Remy_Boussageon2/publication/305074768_Efficacy_and_safety_of_insulin_in_type_2_diabetes_Meta-analysis_of_randomised_controlled_trials/links/57e9196708aed0a2913015d1/Efficacy-and-safety-of-insulin-in-type-2-diabetes-Meta-analysis-of-randomised-controlled-trials.pdf
Efficacy and safety of insulin in type 2 diabetes: Meta-analysis of randomised controlled trials
Results: Twenty RCTs were included out of the 1632 initially identified studies. 18 599 patients were analysed: Insulin had no effect vs. hypoglycaemic drugs on all-cause mortality RR = 0.99 (95 % CI =0.92–1.06) and cardiovascular mortality RR = 0.99 (95 % CI =0.90–1.09), nor vs. diet/placebo RR = 0.92 (95 % CI = 0.80–1.07) and RR = 0.95 (95 % CI 0.77–1.18) respectively. No effect was found on secondary outcomes either. However, severe hypoglycaemia was more frequent with insulin compared to hypoglycaemic drugs RR = 1.70 (95 % CI = 1.51–1.91).
Conclusions: There is no significant evidence of long term efficacy of insulin on any clinical outcome in T2D. However, there is a trend to clinically harmful adverse effects such as hypoglycaemia and weight gain. The only benefit could be limited to reducing short term hyperglycemia. This needs to be confirmed with further studies
Dr. Peter Attia: What if we’re wrong about diabetes?
Sarah Hallberg: Reversing Type 2 diabetes starts with ignoring the guidelines
At 10:45 AM on October 5, 2013 at Diabetes Innovation 2013 in Washington, D.C., a symposium organized by the Joslin Diabetes Center (Joslin is an independent, non-profit institution affiliated with Harvard Medical School, and one of only 11 NIH-designated Diabetes Research Centers in the U.S.), a moderator and three panelists presented and debated “Evidence-Based Approaches to Nutrition and Its Effects on Diabetes and Obesity.”
Moderator:
Osama Hamdy, MD, PhD, FACE
Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management, Joslin Diabetes Center, Assistant Professor of Medicine, Harvard Medical SchoolPanelists:
David Ludwig, MD, PhD
Director, New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital; Professor, Pediatrics, Harvard Medical School; Professor, Nutrition, Harvard School of Public HealthTimothy Noakes, MD
Professor, Discovery Health Chair of Exercise and Sports Science, University of Cape Town; Director, UCT/MRC Research Unit for Exercise Science and Sports Medicine, Co-Founder, Sports Science Institute of South AfricaJeff Volek, PhD, RD
Professor, University of Connecticut
“Carbohydrates restriction was particularly successful before the discovery of insulin, where Elliot P. Joslin successfully treated his patients diagnosed with fatty diabetes (later known as type 2 diabetes) with a diet that contained only 2 % carbohydrates and 75 % fat. His eccentric diet was reincarnated later as the Atkins diet. Such extreme reduction of carbohydrates, despite being successful in treating type 2 diabetes, was shown to be associated with side effects like constipation, headache, bad breath, and muscle cramps. Although the amount of carbohydrates intake was significantly relaxed after the insulin discovery, it never exceeded 40 % of daily caloric intake—an amount that was shown to reduce the glucose and triglycerides area under the curve by around 40 %. Since 2003, many clinical trials confirmed that reducing carbohydrates was superior to reducing fat in decreasing body weight and in improving glycemic control. It was later shown that reducing carbohydrates for patients with diabetes improves insulin sensitivity, reduces visceral fat and triglycerides, and increases HDL-cholesterol. More recently, a metaanalysis showed that reducing carbohydrates load and glycemic index was associated with a reduced risk of developing type 2 diabetes.”
On November 5, 2014, Osama Hamdy, after conducting additional research and considering the evidence, pivoted from his prior opinion and published the following:
Nutrition Revolution—The End of the High Carbohydrates Era for Diabetes Prevention and Management
Abstract: Increased dietary carbohydrates contributed to the escalating prevalence of obesity and type 2 diabetes. From the late seventies, several medical societies recommended reducing fat intake and replaced it with carbohydrates. These mistaken recommendations contributed to poor diabetes control, abnormal lipid profile and increasing insulin resistance without reduction in cardiovascular mortality. Over the last few years, strong evidence suggest reducing carbohydrates intake for patients with type 2 diabetes to less than 40%. The era of high carbohydrates came to an end.
Disclosure: Osama Hamdy, MD, PhD is receiving research support from Neurometrix and Metagenics and is consultant to Abbott Nutrition. No funding was received for the publication of this article
Received: November 05, 2014 Accepted December 12, 2014
Correspondence: Osama Hamdy, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA. E: Osama.hamdy@joslin.harvard.edu
In 1977, the select committee on nutrition and human needs of the US Senate recommended increasing carbohydrates intake to 55–60 % of the total caloric intake, while reducing fat consumption from approximately 40–30 % of the total daily calories.(1) The aims of these recommendations were to reduce health care costs and to maximize the quality of life of Americans as stated by George McGovern, the chairman of that committee. The proposed cost saving was related to the possible reduction in the in incidence of heart disease, cancer, and stroke, among other killer diseases. Despite being controversial recommendations, which were based on weak scientific evidence, the United States Department of Agriculture (USDA) created a food pyramid and placed carbohydrates at its base.(2) The nation embarked on a vast nutritional experiment as stated by Philip Handler, the President of the National Academy of Science at that time. It was not a surprise that since then the prevalence of obesity went up significantly(3–5) and, in contrary to the main aim of the recommendations, the prevalence of diabetes and cardiovascular disease also went up. Physiologically, this was explained by the increased insulin response to carbohydrates, which through its lipogenic effect increases storage of fat. It was later shown that accumulation of fat in the visceral area is associated with chronic subclinical inflammation that is directly related to insulin resistance, endothelial dysfunction, and atherosclerosis.(6) Before these recommendations and from the turn of the twentieth century, diabetes was predominantly defined as a carbohydrate intolerance disease and was mainly treated by reducing carbohydrates intake. Thus, it was absurd that the American Diabetes Association (ADA) also agreed, at that time, to recommend increasing carbohydrates intake for patients with diabetes. Carbohydrates restriction was particularly successful before the discovery of insulin, where Elliot P. Joslin successfully treated his patients diagnosed with fatty diabetes (later known as type 2 diabetes) with a diet that contained only 2 % carbohydrates and 75 % fat.(7) His eccentric diet was reincarnated later as the Atkins diet. Such extreme reduction of carbohydrates, despite being successful in treating type 2 diabetes, was shown to be associated with side effects like constipation, headache, bad breath, and muscle cramps.(8) Although the amount of carbohydrates intake was significantly relaxed after the insulin discovery, it never exceeded 40 % of daily caloric intake—an amount that was shown to reduce the glucose and triglycerides area under the curve by around 40 %.(9) Since 2003, many clinical trials confirmed that reducing carbohydrates was superior to reducing fat in decreasing body weight and in improving glycemic control.(10–12) It was later shown that reducing carbohydrates for patients with diabetes improves insulin sensitivity, reduces visceral fat and triglycerides, and increases HDL-cholesterol.(13) More recently, a metaanalysis showed that reducing carbohydrates load and glycemic index was associated with a reduced risk of developing type 2 diabetes. After weight reduction, maintaining a diet lower in glycemic index and higher in protein was shown to maintain weight loss for a longer duration.(14)
Now, it is obvious that increasing carbohydrates in the diet increases glucose toxicity and consequently increases insulin resistance, triglycerides level, and reduces HDL-cholesterol. Recently, the ADA departed from the recommendation of high carbohydrates intake and recommended individualization of the nutrition needs. It is clear that we made a major mistake in recommending the increase of carbohydrates load to >40 % of the total caloric intake. This era should come to an end if we seriously want to reduce the obesity and diabetes epidemics. Such a move may also improve diabetes control and reduce the risk of cardiovascular disease. Unfortunately, many physicians and dietitians across the nation are still recommending high carbohydrates intake for patients with diabetes, a recommendation that may harm their patients more than benefit them.
References:
1. U. S. Government Printing Office: Stock No. 052-070-03913-2/ catalog No. Y 4.N95:D 63/3 . Available at http://zerodisease.com/ archive/Dietary_Goals_For_The_United_States.pdf. Last accessed December 1st, 2014
2. U.S. Department of Agriculture and U.S. Department of Health and Human Services, Nutrition and Your Health: Dietary Guidelines for Americans. Home and Garden Bulletin No. 232, 1980. Available at: http://naldc.nal.usda.gov/naldc/download.xhtml?id=CAT8721365 0&content=PDF. Last accessed December 1st, 2014.
3. Flegal KM, Carroll MD, Kuczmarski RJ, and Johnson CL, Overweight and obesity in the United States: prevalence and trends, 1960- 1994, Int J Obes Relat Metab Disord, 1998;22(1):39–47.
4. Hedley AA, Ogden CL, Johnson CL, et al., Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002, JAMA, 2004;291(23):2847–50.
5. Flegal KM, Carroll MD, Kit BK, and Ogden CL, Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010, JAMA, 2012;307(5):491–7.
6. Aldhahi W and Hamdy O, Adipokines, inflammation, and the endothelium in diabetes, Curr Diab Rep, 2003;3(4):293–8.
7. Westman EC, Yancy WS, Humphreys M. Dietary Treatment of Diabetes Mellitus in the Pre-Insulin Era (1914-1922). Perspect Biol Med. 2006;49(1):77-83.
8. Yancy WS Jr, Olsen MK, Guyton JR, et al., A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial, Ann Intern Med, 2004;140(10):769–77.
9. Gannon MC, Nuttall FQ, Saeed A, et al., An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes, Am J Clin Nutr, 2003;78(4):734–41.
10. Foster GD, Wyatt HR, Hill JO, et al., A randomized trial of a lowcarbohydrate diet for obesity, N Engl J Med, 2003;348(21):2082–90.
11. Stern L, Iqbal N, Seshadri P, et al., The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial, Ann Intern Med, 2004;140(10):778–85.
12. Gardner CD, Kiazand A, Alhassan S, et al., Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A to Z weight loss study: a randomized trial, JAMA, 2007;297(9):969–77.
13. Miyashita Y, Koide N, Ohtsuka M, et al., Beneficial effect of low carbohydrate in low calorie diets on visceral fat reduction in type 2 diabetic patients with obesity, Diabetes Res Clin Pract, 2004;65(3):235–41.
14. Larsen TM, Dalskov SM, van Baak M, et al., Diets with high or low protein content and glycemic index for weight-loss maintenance, N Engl J Med, 2010;363(22):2102–13.
PDF: http://www.touchendocrinology.com/sites/www.touchendocrinology.com/files/OsamaHamdy_0.pdf
Diabetes Management Editorial © TOUCH MEDICAL MEDIA 2014 Source: http://www.touchendocrinology.com/articles/nutrition-revolution-end-high-carbohydrates-era-diabetes-prevention-and-management
Quick primer on Type 3 Diabetes Mellitus (T3DM): T3DM is built-up insulin resistance and related inflammation in the brain. Evidence is mounting and revealing this “diabetes of the brain” is what leads to [is] degenerative dementias, Alzheimer’s disease being one of the most common forms. More on this soon. – Bobby
more to come…