Follow-up
Report:
Our
recent article “Do low-carb diets work and are they dangerous to your
health and do you use them?
generated
a lot of response. The
overwhelming factor was the importance of finding a program that worked
for the individual patient and not lumping everyone together.
Shauna
Roberts, Ph.D. wrote the following article in the May Issue of Diabetes
Forecast
The
article, “Low-Carb Diets
Win Converts, But At What Cost?, discusses
why Low-Carb diets such as the Atkins’ diet, The Zone diet and
the Sugar Busters program, are in general, not good for health.
The
Article goes on to say that low-carb diets sometimes do result in some
weight loss, for two reasons:
1.
Low-carb
diets restrict such a large number of foods that most people on them do
consume fewer calories.
2.
These
diets disturb the fluid balance of the body.
People may then weigh less, not because they’ve lost some fat,
but because they’re dehydrated.
The
article states that there is more to a good weight-loss plan than merely
taking off pounds. An
eating plan needs to include a variety of tasty foods or it will be hard
to stick to. That is where
many fad diets, including low-carb diets, slip up.
Avoiding most carbohydrates makes for boring meals, so many
people find it hard to stick to these diets over any length of time.
According
to the article there has been much research focused on the relationship
between food and disease. Thirty-three percent of cancers are related to
diet. Diets that are high
in fat but low in fruits, vegetables, and whole grains have been linked
to high rates of breast cancer, colon cancer and cervical cancer.
Cancer researchers are suggesting that at least two-thirds of
your diet should be plant based. Also
heart and blood vessel disease are linked to eating habits and diets
high in saturated fat are closely linked to increased rates of heart
attack.
The
author states that the research indicates that the diet that best lowers
the risk of disease is the one publicized by
the U.S. government as the Food Guide Pyramid which, stresses plant
foods, especially whole grains, fruits, and vegetables.
It also limits saturated fats.
The
article goes on to say that low-carb diets fly in the face of what
research suggests is the best for overall health.
They are high in artery-clogging saturated fat but restrict many
nutrient-rich fruits and vegetables.
As a result, nutrition experts warn that low-carb diets may cause
inadequate intake of various vitamins, calcium and potassium.
They may also boost a person's'’ risk of heart disease, stroke
and cancer-—all of which are linked to eating lots of protein and fat
but not much fiber.
But
the author also states that NO SCIENTIFIC Data supports the claim that
low-carb diets don’t harm health.
And so far, NO STUDIES HAVE BEEN DONE on the long-term effects of
low-carb diets. We can only
guess what their effects might be---and the author's guess is that, like
high-fat, low produce diets in general, they are not good for health.
We
contacted Dr. Roberts and asked the following specific questions (Her
answers are in red)
What
was the basis for your study and what is your experience with low carb
diets and your patients?
I
did substantial research on diet while writing a book on the subject a
few years ago (Barbara C. Hansen and Shauna S. Roberts, The Commonsense
Guide to Weight Loss for People with Diabetes, Alexandria, VA: The
American Diabetes Association, 1998). I have written many articles on
diet for people with diabetes since then, so to write this brief
article, my research was not particularly extensive: I did a Medline
search to make sure I hadn't missed any relevant research (if I had, it
didn't show up in the search) and then based much of my article on the
article:
Karen
Stein: "High-Protein, Low-Carbohydrate Diets: Do They Work?"
Journal of the American Diabetic Association 2000;100:760-761.
Her
article is about low-carb diets in general, but she specifically cites
as the most popular diets the Carbohydrate Addict's Lifespan Program,
Dr. Atkins New Diet Revolution, Sugar Busters!, and The Zone.
Since
I am a science writer and not a dietitian or doctor, my Diabetes
Forecast articles are based on reading research reports and reviews and
weighing the evidence, not on experience with
patients.
What
do you consider the cutoff number for a low carb diet?
I
think the cut-off for low carb is pretty fuzzy.
Dr.
Atkins Diet Revolution has four stages; the first one supposedly allows
4 grams of carbs per day (that's no typo--four grams) and the fourth
stage, 40 to 60 g/d. (Those figures are from the Stein article I cited
in my last email; I could not find them myself in his book on a quick
look-through.)
I
do not have books for
the Carbohydrate Addict's, Sugar Busters!, or Zone diets, and Stein does
not give the carbohydrate grams for these diets. However, she says The
Zone sets proportions of 40% carbohydrates, 30% protein, and 30% fat.
I
do have Dr. Bernstein's Diabetes Solution book (by Richard K.
Bernstein). He recommends a limit of 6 g of slow-acting carbs for
breakfast, 12 for lunch, and 12 for dinner, for a total of 30 grams of
slow-acting carbs a day.
What
is your own idea on using diet to control diabetes and weight?
The
key to losing weight is to take in fewer calories than one burns. There
are plenty of ways to do that, including wacky ones such as cabbage soup
diets. Low-carb diets are no exception. If people go on a low-carb diet
and cut out a lot of the foods they usually eat, they will lose weight
because they temporarily reduce their calorie intake. (I say temporarily
because, human nature being what it is, people soon find ways to stick
to the rules while increasing their calorie intake--discovering pork
rinds as a snack, for example.) So the test of a weight-loss plan is
NOT whether people can lose weight on it.
Rather,
the success or failure of a weight-loss plan to my mind rests on whether
it can accomplish two goals:
*The
person is able to stick with the plan for the long term and make
permanent changes in habits.
*The
person's risk factors for health problems are reduced (lower glucose,
lower LDL cholesterol, higher HDL cholesterol, lower blood pressure
*Second,
the foods on the restricted lists of low-carb diets vary from diet to
diet, but tend to be among the foods best for health. Vegetable foods in
general contain lots of vitamins, minerals, and phytochemicals that
lower the risk of various diseases. Although the evidence is somewhat
skimpy so far, some researchers believe that oxidation plays an
important role in aging and diabetes and so the antioxidants
in vegetables may actually slow aging and diabetes complications.
People
on low-carb diets thus are cutting back on the most nutritious foods and
replacing them with fattier foods that are linked to a higher risk of
cardiovascular disease and cancer. In theory, one would expect that
people who stay on low-carb diets for long periods woud have more heart
disease, strokes, and cancer than other people. If so, low-carb diets
are particularly bad for people with diabetes because their risk of
cardiovascular disease is already several times that of a nondiabetic
person.
Although
Ms. Roberts did a great job researching the liturature she seemed to
lump all programs together without regard for the number of carbs
allowed. While the Atkin’s program allows between 20 to 60 grams a
day, and Bernstein allows 30 grams, she had no definitive numbers on
Sugar Busters or Carb Addicts. In addition her association of the Zone
Diet with these is odd as Dr. Sears calls for 150 carbs a day.
In
addition there is no mention in her article concerning Post Prandial
Glucose lowering or how the decrease in PPG from lower carb consumption
affects HbA1c’s.
She
did however mention the most important part.
The
test of a weight-loss plan is NOT whether people can lose weight on it.
Rather, the success or failure of a weight-loss plan to my mind rests on
whether the person is able to stick with the plan for the long term and
make permanent changes in habits.
This
article points out the glaring errors that occur when we try to make one
program work for every one and why every patient should work with a
medical professional to find a program that is safe effect and they can
adhere to long term.
We
tried to contact all the authors of the programs that Dr Roberts
mentioned. Our only response was from Richard K. Bernstein, M.D.,
F.A.C.E., F.A.C.N., a well-known diabetologist and himself a 55-year
veteran of the disease.
Dr
Bernstein wrote,
“There
is nothing at all wrong with restricting foods, as long as they’re
inappropriate foods. And
there’s nothing wrong with consuming fewer calories if weight loss is
desired. That’s the
nature of diets. One
problem is that none of the diet books the author mentions are, as far
as I know, designed for diabetics. The
issue for diabetics is blood sugar control, and a nutritious,
low-carbohydrate diet offers the diabetic the best means for such
control, reducing insulin needs (insulin is the major fat-building
hormone), and preventing or reducing the incidence of diabetic
complications.”
The
article goes on to state that “These [low-carb] diets disturb the
fluid balance of the body. People
may then weigh less…because they’re dehydrated.
Dr. Bernstein maintains that this claim reflects a
misunderstanding of the metabolization of fats.
“Metabolizing fat releases carbon dioxide, ketones, and water.
The water that is lost in this process is not tissue fluid, but
merely a metabolite of fat. Far
worse for the diabetic are high blood sugar levels, which lead to the
cycle of frequent thirst and urination—well known warning signs of the
disease. The loss of tissue
fluids in this process can be very dangerous.”
Ms.
Roberts, the author, also states that “low-carb diets fly in the face
of what research suggests is best for overall health.
They are high in artery-clogging saturated fats, but restrict
many nutrient-rich fruits and vegetables.”
Dr. Bernstein differs. “I
advocate diabetics eating a wide variety of vegetables, so long as they
aren’t loaded with simple starches and sugars.
Many fruits and vegetables can, however, cause serious spikes in
blood sugars, necessitating the use of more insulin, thereby reducing
the ability to control blood sugars, and building fat.
As to ‘artery-clogging saturated fats,’ this reflects a
misunderstanding of cholesterol, 85 percent of which is not dietary but
manufactured by the body. You
can maintain a very low fat diet and still have high cholesterol. The
fact is, you can maintain a low-carb diet that is tasty and satisfying,
that won’t put your blood sugars out of control, and that will help
you to lose weight. I’ve
seen patients lose half their body weight and step back from death’s
door.
In
addition Dr Bernstein provided us with a list of references. These can
be found at the end of this feature
We
wanted your feedback as to how your professional experiences and your
patient’s experiences with these programs worked.
The
overwhelming response was that many of you had tried some sort of
reduced carbohydrate program with your patients and we would like to
share those results with you. As you read these please understand
that working with each patient to find a program that works for them is
top priority.
Your
Responses:
Patients
with Type 2 Diabetes should definitely keep their high sugar carbs such
as pasta, potatoes and crackers at a low portion size especially
those on the high gylcemic index. But people, in general do not
understand that vegetables, greens, fiber are all carbs too. We
need to distinquish to the general public exactly what that means in
relation to the good carbs, fat sand lean proteins. Variety such
as a 40-30-30 diet is good. But there is a difference in what
carbs you use in relation to good glucose control. I think there
needs to be more emphasis in basic education on this subject. Also,
the patients need to get those monitors out if there is any doubt.
Her
second paragraph that alludes to people who "prefer pork rinds and
steak to carrots and beets ", is so typically skewed. The
low-carb diets rely *heavily* on lots of vegetables(cauliflower,
cabbage, broccoli, spinach, all greens, green beans, asparagus, sprouts,
etc.!) There is lots of great fiber here! All low-carb diets have
drinking lots of water as a component. The diets I have reviewed
are moderate fat (in quantity not %), moderate protein (again quantity
not%) and yes low carb - both in quantity and %. These are
diets high in vegetables and greens as far as the quantity of food
eaten. The use of nuts is super too for the monounsaturated fats,
taste and fiber they add to foods. For people with diabetes, they
are a godsend. As far as lipids go,Ms Roberts is whistling up a
tree. She needs to get some before and after labs from a DMer who
was on the ADA diet and now is on a low-carb way of eating. Her's
is uninformed, knee jerk reporting. Most DMers find they can
incorporate strawberries, melon ,blueberries, etc into the diet as well
- with real cream, even. The ADA would do better to really
investigate, rather than assume a low-carber is pigging out on steaks,
butter, etc. Most meals will have grilled chicken or fish with
veggies, and omelets etc. But NO pasta, flour products, rice
,fruit juice or high> starch veggies. The meters and lipid
panels don't lie!
It was not long ago that the ADA (and the world) thought only 'sugar'
was a BG (blood glucose) problem.
I am a
Registered Dietitian at the Marshall University School of Medicine
Diabetes Center. I have been working with a pediatric
endocrinologist (not yet board certified) who is replicating a study
from a University in
Louisiana (maybe Louisiana State University) of obese children. In
this study, the children are restricted to 30 grams of carbohydrate per
day and protein is unrestricted. The diagnosis of the patients
range from hyperinsulinism to hyperlipidemia to hypertension. The ages
are from 5 years to 17 years both male and female. The
short-term results show that the majority of the patients who stay with
the program and follow up are successful. The abstract of the study
was accepted for presentment at the Society for Pediatric Research.
I deliver the education for
the children and parents. I really believe, however, that they
could get similar results if eating habits such as fast food and regular
soda pop consumption were decreased and more fruits and
vegetables were increased.
Low
carb diets work to promote weight loss because they significantly reduce
one's calorie level. Over the long term they have not been successful.
Though low-fat diets are difficult to follow over the long term also,
they have been more successful than the low carb because they provide
more volume of food. In a recent study of ~2000 people who were
successful at maintaining a weight loss over a significant period of
time, only 1% were following a low carb diet. Also, low carb diets often
remove nutrients, i.e. vitamins, minerals, and phytochemicals, that have
consistently shown to be beneficial to one's health. Consistently
studies have shown that diets high in saturated fat are associated with
increased risk of CVD, which is the leading cause of death in all
people, especially people with diabetes.
There
is no question that increased levels of carbohydrate increase one's
blood sugar, so it is very importance to space one's carb intake over
time. However, I have also found that patients who follow a low-fat diet
have a higher tolerance for more carb because most will lose weight.
The challenge is to help people stay consistent with a low-fat intake.
There are no easy answers, as we all know. Maybe using the
glycemic index in conjunction with low-fat, moderate carb is the best
bet.
Lets
define "low carb." I use reduced carb diets and carb
counting for my diabetic patients and it works. Americans have a problem
with obesity and if we don't start taking steps to reduce carbs our
waist line and health risk will continue to rise. I try to keep
my patients carbs to 150g to 170g per day. You would be
surprised how many people eat way over that amount. I
consider this reduced carb not low carb. And
I always promote low fat eating along with this. No fried
high fat foods!
I
have seen friends and clients do well on the Atkins like diets.
However I have already seen one person mysteriously now quite
underweight, unable to have children and often very sick. At what
cost do people want to loss weight. Don’t people realize a high
protein diet will cause less frequent bowel movements due to not bulk
(fiber in diet) thus probably increase their risk of colon cancer.
People just need to
learn to cut back and quit trying to back an overnight statement.
I
am an actuary, not a medical professional. I have been following a
low-carb way of eating for over 2 1/2 years as a result of diagnosis as
atype 2 diabetic. I generally eat less than 30 g.
carbohydrates/day an dgenerally (but not always in detail) follow Dr.
Bernstein's recommendations.
My experience has been that
my blood glucose levels reached normal levels within about a month of
starting this way of eating and have remained at normal levels without
medication (current HbA1c = 5.1). In addition, my weight has
remained in control, and my lipid levels improved and stayed at the
improved levels. Total cholesterol decreased from 225 at diagnosis
to 163 now, with Triglycerides = 43, HDL = 52, LDL = 102.
There are many of us (not just a few outliers) who have experienced such
positive long term results, contrary to the tone of this article. I do
have some knowledge of the nature of "studies," and the lack
of a study does not prove anything. The existence of so many of
us is real "scientific" evidence that this approach works for
at least a substantial subset of the population.
I
feel we need to re-evaluate our dietary information. There are
many sources out there of people who have followed a high protien, low
carb diet for many years! I am not saying this is the best diet,
but I do feel for a certain population, this may be the best diet.
People need to find what works for them in helping them control their
blood sugars. There are more and more companies producing low
carb foods to be able to give a larger variety of foods available.
Health care providers need to be more open about low carb diets.
Not all low carbohydrate diets
are the same. I anm an educator and I have read most of the book, The
Zone. The main difference in the ratio of protein to fat when compared
to ADA guidelines is that the Zone recommends 30% protein and 40% CHO.
The protein recommended is always used in combination with CHO and fat
(30%). The protein source should be lean proteins including chicken,
fish, low saturated fat red meats, monosaturated nuts and seeds,
and nonfat or very low fat dairy products.
Fruits and vegetables make up a bulk of the recommended
carbohydrates along with modified amounts of high fiber grains. It
always surprises me when the Zone diet is always lumped into the other
more rigid low CHO diets. It is nothing like the Atkins diet.
Having tried the diet for a month the weight did come off. The
difficult part, like any food behavior change, was maintaining the
consistency in always combining the 3 major food groups in the
recommended portions. Others I have talked to who follow the
recommendations, lost weight. The challenge is to maintain this eating
behavior as a permanent lifestyle. Exercise is also part of the Zone's
recommendation. Incidentally, mankind survived for ages with fruit,
vegetable/root family and some meat sources. It was not until much later
that processed grains were thrown into the mix. Lack of fiber continues
to be a problem today with so many prepared carbs low in fiber. These
low fiber carbs are the mainstay in the American diet. Shame on us.
I
have been teaching my diabetes patients to cut back on carbohydrates to
at least 40% or less of calories and that is helping them to control
their blood glucose levels. This is especially helpful for those
patients with
insulin resistance. I find that over 90% of my patients are
overeating on carbohydrates, not protein, when I do their meal
history checks.
When
I first starting working in diet modifications and diabetes therapy in
1980 we were, as a society, still dealing with the 1970's (original)
low carb diets. I spent many years trying to 'unbrainwash' people
and
teach them that items like bread, pasta and potatoes were healthy foods,
and could be used in a balanced diet. Finally, by the 1990's I saw less
of this and as a dietitian/nutritionist, was glad
to see that this message was not only more accepted, but
supported by the Heart, Diabetes and Cancer Associations and research.
The re-emergence of this fad, thanks to Dr. Atkins and all the other
people making money on unscientific books, is putting us back 20 or more
> years of progress. I find that I am again trying to 'unbrainwash'
people
about these foods. Nothing bothers me more than to hear that someone
has stopped eating a carrot, an apple, a glass of milk or a hearty
whole grain bread because of this. In other words, I think one of
the most damaging results of these low-carb type of diets is that if
teaches people to be fearful of healthy foods. It is no wonder so many
people are confused about what to eat.
People
with DM use low carb diets to control BG, not to lose weight. Since the
way to avoid complications is to mainain normal BG this is the most
important goal for a
diabetic. A low carb diet makes this much easier and usually requires
much less medication or insulin. I follow a modified Bernstien
program, 50 - 60 gms. of carbs./day, and keep post meal BG below 150
with HbA1c below > 6.
The
low carb diet has worked great for me. I am 6'2" and went
from 210 to 190 pounds in one month and have maintained it for 10
months.that's a long to be dehydrated, isn't it?? The scientific
basis of low carbs makes
so much sense..keep your insulin levels low to prevent fat storage.
Also the diet is very tasteful and you are not hungry. I have
added carbs back into my diet, but I avoid bread and pasta.....it works!
I
have been following the Atkins regimen for thirty years with the
exception of 1 year that I tried low fat (resulted) in a serious weight
gain. From an initial weight of 304 and a low of 148 (took under a year
to
accomplish) I have maintained 182-3 for years now. The only adverse
effect has bee elavated LDLs which happened 1 year ago, my physician and
I attribute this to genetics as I had been of the same nutritional
regimen for so long. I work in healthcare and believe that whatever
works to reduce obesity is valuable as obesity is the number one
complicating factor in virtually every disease and is given credit for
being the reason that
diabetes is attaining epidemic status.
I have not had any patients who have followed the Atkin's-like diets
with success. Those who like fruits and starches hated the diet and
complained of having no energy and being constipated. The meat lovers
who were able tostick with it lost weight, but regained it back when
they went off the diet .None of them included exercise as part of their
weight loss strategy.
A low-carb diet may promote
weight loss and improve blood glucose, but I feel it is not
nutritionally balanced for overall good health. Besides, diet is not the
only component of managing diabetes. Exercise and properly taking
medications are also essential to good glycemic control. I may start
some of my patients on a moderate carbohydrate diet (30-45 g/meal, 15-30
g/snack) if they are in very poor control, but I increase their
carbohydrate intake as the activity increases and the weight and glucose
come down.
As
a RD I think many of my patients get confused about this issue, they
often think a 250 gram carb diet is low because they are used to 400 per
day. I need to
review that they are not on a low carb or no carb diet, just a balanced
carb diet. Like anything, many patients assume less is better, so
we educate them on the essential functions these foods have to health.
I am
not a medical professional; however, I am my mother's diabetes
caretaker, and have been since April, 2000. She
is following Dr. Richard Bernstein's program, and has been since
April of 2000.
She's been a diabetic for
25+ years, and on insulin for> over 10 years. Her A1c in Feb
2000 was 10.6. In November, > it was 5.8. She requires
minimal insulin doses now, and most times does not need any insulin
during the day.
Her
blood pressure is now 110s/60s, without meds. She's lost 60
pounds, but I guess according the the experts
at the ADA, she's lost 60 pounds of water. Her triglyceride level is 55,
and HDL 81. Her kidney function has improved. Her cognitive
function has improved. Do the ADA experts really think my mother
was in better health on the ADA diet, with her hypertension, obesity,
excess insulin doses,> high glycohemoglobins, increasing cognitive
dysfunction, low HDL and
high triglycerides and increasng kidney dysfunction?
I've seen my mom's health effects from both camps. The ADA
diet was killing her. Low carb has given her back her life.
These ADA experts will have to show me their unrefutable evidence that
low carb is dangerous. In fact, I challenge them to do so, because
I know from my own 2 years of intense research that they cannot prove
their position.
Reference:
Increase
in Fat Oxidation on a High-Fat Diet is Accompanied by an Increase in
Triglyceride-Derived Fatty AcidOxidation
DIABETES, VOL 49:640:-646,
APRIL 2000
The aim of
this study was to investigate the mechanisum behind the slow increase in
fat oxidation on a high-fat diet. Therefore,
the 24-hr substrate oxidation was determined using respiration chambers
and the rate of appearance and oxidation of plasma-derived fatty acids
in seven healthy nonobese men. Before
testing, thy consumed a low-fat diet (30% fat, 55% carbohydrate) at home
for 3 days. Measurements
were performed after 1 day consumption of either a low-fat diet (LF), a
high-fat diet (HF1, 60% fat, 25% carbohydrate), or a high-fat diet
preceded by a glycogen-lowering exercise test (HF1 + exercise), and
after 7 days on a high-fat diet (HF7).
After an overnight fast, an infusion was started that allowed a
measurement of whole body fat oxidation.
Conclusion: The results from this study suggest that triglyceride
derived fatty acid oxidation (VLDL or intramuscular triglycerides) plays
a role in the increase in fat oxidation on a high-fat diet in lean
subjects. And
plasma-derived fatty acids remain the major source for fat oxidation.
Why Do
Low-Fat High-Carbohydrate Diets Accentuate Postprandial Lipemia in
Patients With NIDDM?
Diabetes Care, Vol 1M
Number 1, January 1995
Objective-
To understand why low fat high-carbohydrate (CHO) diets lead to higher
fasting and postprandial concentrations of triglyceride (TG) rich
lipoproteins in patients with non-insulin-dependent diabetes mellitus (NIDDM)
CONCLUSIONS—
A low-fat high-CHO diet in patients with NIDDM led to 1) higher day
long plasma glucose, insulin and TG concentrations: 2) postprandial
accumulation of TG-rich lipoproteins of Intestinal origin, 3) increased
production of VLDL-TG and 4) increased post heparin lipoprotein lipase
activity. These data
provide a mechanism for the hyper-triglyceridemic effect of CHO-enriched
diets in patients with NIDDM and demonstrate that multiple risk factors
for coronary heart disease are accentuated when these individuals
consume diets recommended to reduce this risk
Effects
of Varying Carbohydrate Content of Diet in Patients With
Non-Insulin-Dependent Diabetes Mellitus
JAMA, May
11, 1994—Vol 271. No. 18
Objective:
To study effects of variation in cartbohydrate content of diet on
glycemia and plasma lipoproteins in patients with NIDDM
Design:
A four-center randomized crossover trial
Setting:
-Outpatient and inpatient evaluation in metabolic units
Patients:
--Forty-two NIDM patients receiving glipizide therapy.
Interventions
- A high-carbohydrate diet containing 55% of the total energy as
carbohydrates and 30% as fats was compared with a
high-monounsaturated-fat diet containing 40% carbohydrates and 45% fats.
The amounts of saturated fats, polyunsaturated fats, cholesterol,
sucrose and protein were similar.
Results:
The site of study as well as the diet order did not affect the
results. Compared with the
high-monounsaturated-fat diet, the high-carbohydrate diet in measured
fasting plasma triglyceride levels and very low-density lipoprotein
cholesterol levels by 24% and 23%, respectively and increased plasma
triglyceride, glucose, and insulin values by `10%, 12%, and 9%.
Respectively. Plasma total
cholesterol, low density lipoprotein cholesterol and high-density
lipoprotein cholesterol levels remained unchanged.
The effects of both diets on plasma glucose, insulin, and
triglyceride levels persisted for 14 weeks.
Conclusions:
In NIDDM patients, high-carbohydrate diets compared with
rich-monounsaturated-fat diets caused persistent deterioration of
glycemic control and accentuation of huyperinsulinemia, as well as
increased plasma triglyceride and very-low-density lipoprotein
cholesterol levels, which may not be desirable.
Dietary
protein and risk of ischemic heart disease in women1,2,3
1 From the
Departments of Nutrition and Epidemiology, Harvard School of Public
Health, Boston; the Channing Laboratory, Boston; and the Division of
Preventive Medicine, Department of Medicine, Brigham and Women's
Hospital and Harvard Medical School, Boston.
Background: Ingestion
of animal protein raises serum cholesterol in some
experimental models but not in others, and ecologic studies
have suggested a positive association between animal protein
intake and risk of ischemic heart disease. Prospective data
on the relation of protein intake to risk of ischemic heart disease
are sparse.
Objective: The
objective was to examine the relation between protein intake
and risk of ischemic heart disease.
Design: The study was
a prospective cohort study.
Results: We examined
the association between dietary protein intake and incidence
of ischemic heart disease in a cohort of 80082 women aged
34–59 y and without a previous diagnosis of ischemic heart
disease, stroke, cancer, hypercholesterolemia, or diabetes in
1980. Intakes of protein and other nutrients were assessed
with validated dietary questionnaires. We documented 939
major instances of ischemic heart disease during 14 y of follow-up.
After age, smoking, total energy intake, percentages of
energy from specific types of fat, and other ischemic heart disease
risk factors were controlled for, high protein intakes were
associated with a low risk of ischemic heart disease; when extreme
quintiles of total protein intake were compared, the relative
risk was 0.74 (95% CI: 0.59, 0.94). Both animal and vegetable
proteins contributed to the lower risk. This inverse association
was similar in women with low- or high-fat diets.
Conclusions: Our data
do not support the hypothesis that a high protein intake
increases the risk of ischemic heart disease. In contrast,
our findings suggest that replacing carbohydrates with
protein may be associated with a lower risk of ischemic heart
disease. Because a high dietary protein intake is often accompanied
by increases in saturated fat and cholesterol intakes, application
of these findings to public dietary advice should be
cautious.
Type 2 Diabetes in An Aviator, Protein Diet vs. Traditional Diet:
Case Report.
Aviat
Space Environ Med 2001 Mar;72(3):219-20
28th Aeromedical Dental Squadron, Ellsworth AFB, SD 57706, USA.
An experienced helicopter pilot with hypertension, hyper-triglyceridemia,
elevated cholesterol, obesity, and diabetes is treated with a
high-protein, low-carbohydrate diet. In 3 months, he loses 35 lbs, is
normotensive without medication, cholesterol and triglycerides show
significant reduction, fasting blood glucose and 2-h post glucose load
are normal. At follow-up 1 yr later he has maintained hemoglobin A1C in
the low 5 range. The protein diet is discussed and compared with the
traditional dietary approach for type 2 diabetes.
High
Protein vs High Carbohydrate Hypoenergetic Diet for the Treatment of
Obese Hyperinsulinemic Subjects
Internatl
Jnl Obesity, Nov 1999, vol 23 no. 11, pp 1202-1206
Objective:
to test the hypothesis that hyperinsulinemic obese subjects would
respond differently to changes in the composition of hypoenergetic diets
Design: A
6 week reandomized dietary invervention trial
Subjects:
Thirteen male obese hyperinsulinemic normoglycemic subjects were divided
into two groups and fed hypoenergetic diets providing 80% of their
resting energy expenditure (REE). One
group received a high-protein diet )HP; 45% protein, 25% carbohydrates,
and 30% fat as percent of dietary energy) and the other a
high-carbohydrate diet (HC: 12% protein, 58% carbohydrates and 30% fat.
Measurements:
Anthropometry, body composition, fasting serum insulin and
lipids, and REE were performed before and after the feeding period.
Results:
Weight loss was higher in the HP than HC group.
There was a decrease in body fat in both groups, whereas body
water decreased significantly more in the HP group.
REE decreased more in the HC THAN THE hp GROUP.
Serum total cholesterol, triglycerides and LDL cholesterol
decreased significantly to a similar extent in both diet groups, while
HDL cholesterol, triglycerides and LDL cholesterol decreased
significantly to a similar extent in both diet groups, while HDL
cholesterol was decreased significantly only in the HP group.
Mean fasting insulin decreased significantly in both diet groups
and reached the normal range only in the HP group.
Conclusion:
A low carbohydrate (LC). HP
hyupoenergetic diet could be the diet composition of choice for a
weight-reducing regimen in obese hyperinsulinemic subjects
Go
Against Grains For Better Diet
More protein, fewer
carbohydrates help fight fat, study says
A new study, presented this
week during the annual meeting of the Federation of American Societies
for Experimental Biology in Orlando, Fla., says carbohydrates are the
culprits that increase blood sugar and trigger that hungry feeling.
Finding the right balance of
food groups has always been a challenge, says Donald Layman, professor
of nutrition at the University of Illinois and lead author. But he takes
exception to the current federal dietary guidelines.
Those guidelines recommend a
diet made of 60 percent carbohydrates, 30 percent fat and 10 percent
protein.
One of the problems is
people haven't figured out the questions. The real question is what
protein is needed for people who are overeating calories. The better
balance for losing or maintaining weight is a diet made up of 40 percent
carbohydrates, 30 percent fat and 30 percent protein.
Layman's research team
studied 24 overweight women, ages 45 to 56. Half followed the federal
recommendations. The others ate the same foods and calorie levels, but
in different amounts, adding protein and subtracting carbohydrates.
After 10 weeks, both groups
lost about 16 pounds on the 1,700 calorie-a-day diets. But the
high-protein group lost 12.3 pounds of body fat and just 1.7 pounds of
muscle mass, compared to 10.4 pounds of body fat and 3 pounds of muscle
mass lost by the other group.
The high-protein diet also
tended to increase the level of HDL, or "good" cholesterol,
and decreased the level of triglycerides, or fat in the blood. A higher
measure of a thyroid hormone in the protein group also suggests a higher
metabolism rate, Layman says, so calories might burn off faster.
The high-protein group
reported they had more energy and felt more satisfied between meals,
Layman says, and that's the key.
"Carbohydrates
translate into sugar," he explains. "A high-carbohydrate diet
includes a lot of refined carbs. It's not built on vegetables, not built
on fruits, but on refined grains, breads, rices and fruit juices."
All these carbohydrates
produce high insulin responses, as the body tries to control the level
of blood sugar. A few hours later, when blood sugar falls, the feelings
of hunger return.
With protein, Layman says,
blood sugar levels don't rise as much, and "it creates a longer
feeling of satiety." The longer they feel satisfied, the less they
are inclined to grab that snack to tide them over to the next meal.
Keeping those insulin levels
under control has even greater implications, Layman adds: "I also
believe the high-carbohydrate diet is leading to high insulin levels,
and perhaps to the insulin resistance associated with obesity. It's
leading to overeating."
But Nadine Pazder, a
registered dietitian at Morton Plant Hospital in Florida and spokeswoman
for the American Dietetic Association, says there's no reason to abandon
the government's food pyramid as a guide to healthy eating.
"While Layman's
40/30/30 ratio is certainly not a carbohydrate-free diet, you can
certainly get many of the dietary recommendations in. You can still get
fruits, vegetables, grains," she says. And she doesn't think the
differences in loss of muscle mass are statistically significant.
However, making sure there's
some protein at each meal, she agrees, may be "more satisfying and
encourage long-term compliance with a meal plan."
Layman says he's not
recommending any drastic dietary changes, but says you should
concentrate on your breakfast and lunch, and be careful about the amount
of carbohydrates in each meal.
"We have to look for
ways to eat higher protein meals -- dairy, cheese, nuts -- be conscious
about total fats, eat lean deli meat," he says. "Two percent
milk is actually a very good addition. It has the right balance for high
degree of satiety."
Striking a balance, Layman
says, is a very individualized thing.
"If we are stuck on a
diet that's meant for all, we're going to fail," he says.
"There are a lot of ways to get the right amount of calories, and
we have to recognize how to adjust for individual metabolisms."
Pazder agrees.
"One of the
philosophies of the American Dietetic Association is one diet doesn't
fit everybody. It may very well be that higher (above 50 percent) carbs
may be detrimental for some individuals, if they're carbohydrate
sensitive in terms of triglycerides. But carbohydrates do not cause
glucose intolerance and weight gain."
Links to sites on
Carbohydrates
http://www.diabetes-normalsugars.com/
http://members.aol.com/lowcarbs/diabetes/index.htm
http://maelstrom.stjohns.edu/archives/lc-diabetes.html
