Re: If you ran the ADA...

On 21 Mar 2006 17:56:51 -0800, "Kurt"
<kurtwheeling1965@xxxxxxxxxxx> wrote:

Alan,

My first question is: Did you post this over at the ADA message boards?
I think you should.

Feel free. I have enough on my plate at the moment, in the
final stages of trip-planning and the scar tissue on the
forehead is still healing (from butting my head against
brick walls:-)

The study is interesting, as all studies are, and I thank you for
posting it. However, I have a couple of comments:

- The main thing that sticks out to me is this: "Intervention: Usual
diets for 7 days followed by a low-carbohydrate diet for 14 days." So,
what was their "usual" diet composed of?

See below.

Since the study says they
were overweight, one might guess not too good, at least for most of
them. One might also be willing to venture that ANY diet compared to a
bad one would yield similar results, be it low-carb or not.

No, one wouldn't, as the link you post later amplifies.
Read those results again:

"Mean 24-hour plasma profiles of glucose
levels normalized, mean hemoglobin A1c decreased from 7.3%
to 6.8%, and insulin sensitivity improved by approximately
75%. Mean plasma triglyceride and cholesterol levels
decreased (change, 35% and 10%, respectively)."

Averaged across ten patients:
A1c down 0.5% in fourteen days - think how long it usually
takes to get that much improvement in A1c.
Insulin sensitivity improvement 75%.
Trigs down 35%.
Total chol 10%.

That is fairly dramatic in my opinion. Oh, and weight loss
as well.

Name the other documented diets for type 2 diabetics that
will achieve that in two weeks. Yeah - it may not be
sustained. "May" being the critical word. So where is the
ADA (or any governmet or sponsor) continuation money to
track those patients? Were they followed up, given advice,
encouraged, tracked, in the same way that an approved
dietician would encourage a low-fat dieter?

- In what you posted, there was no specific mention of what they
considered "low-carb."

I posted a link.
http://www.annals.org/cgi/reprint/142/6/403.pdf
Did you read it in depth? That's why it was posted. I may
blithely ignore copyright at times - but I don't usually
post a long study report in full.

Another snippet:
"Usual Diet (Days 1 to 7)
We instructed patients to continue their usual diet
(Table 2). The clinical research center kitchen provided all
food and beverages, and we weighed and recorded everything
that was consumed. The food was prepared in the
hospital kitchen, as well as in the clinical research center
kitchen, and also included foods from local fast food
establishments.
Participants selected from standard hospital
menus each day during their usual diet; participants were
also encouraged to request food from the ?outside.? To
supplement the hospital menus, we used brand-name foods
or fat foods for which nutrient data were available (for
example, McDonald?s sandwiches, donuts from Dunkin?
Donuts, and Oreo cookies). To maintain their usual physical
activity, the patients walked in the hospital with a
nurse or used a stationery exercise bike, lifted weights, or
did calisthenics. Each morning, we determined body
weights, vital signs, and fasting blood glucose levels and
collected 24-hour urine samples (for measurement of ketone
bodies and nitrogen)."

Low-Carbohydrate Diet (Days 8 to 21)
We reduced carbohydrate intake to approximately 21
g/d, but patients could eat protein and fat as much and as
often as they wanted (Table 2). Participants chose food
items from a modified hospital diet that included only
allowable foods without sauces, gravies, or other
ingredients that contain carbohydrates. These items included
beef patties, ground turkey patties, chicken breasts, turkey
slices, fresh ham slices, raw or steamed vegetables, butter,
and diet gelatin. We allowed limited amounts of cheese
and cream cheese. As with their usual diets, participants
could request allowable items that were not available from
the hospital kitchen, such as fresh fish, eggs, various cuts
of beef, cream, and additional vegetables. In addition,
specific brands of salad dressings and snack foods suggested
by Dr. Atkins were made available on request, including
Atkins brand foods. We weighed and recorded all food
consumed, and we determined body weights, vital signs,
fasting plasma glucose levels, and 24-hour urine outputs
daily."

This is my own version of table 2, modified to fit here. I
found the full table confusing and have taken some liberties
in rounding and averaging numbers, so I may be mistaken;
read the original for specifics. maybe a statistiican here
can clarify.

Table 2. Diet Composition
Variable Control Group Low-Carbohydrate Group

Carbohydrates 267.5 21.5
Simple carbohydrates 108.5 10.5
Complex carbohydrates 163 7
Fiber 18.5 4
Protein 132.5 148
Fat 158.5 161.5
Saturated fatty acids 52.5 57
Monounsaturated fatty acids 45 46
Polyunsaturated fatty acids 21 12
Transaturated fatty acids 2.9 0.74
Other fats 35 46.5

As I understand it - the control group was the same group
during the first seven days.

I think that this was a very significant comment, so I'll
post it again: "We reduced carbohydrate intake to
approximately 21 g/d, but patients could eat protein and fat
as much and as often as they wanted (Table 2)"

Now look at those numbers again.

Of particular interest, apart from the enormous drop in
carbs, is the only moderate increase in protein and nominal
increase in fat, with a very significant DROP in trans-fats.
So much for the oft-repeated stereotype of low-carb dieters
pigging out on pork chops and butter.

- The ADA had partial funding of this study in the form of a mentor
grant. We don't know what that means in terms of their involvement,
if any, beyond providing monies.

Jim has made that fairly clear. And a grant that size, to be
honest, gives some idea of their commitment to this area of
research. Pathetic. If I sound up-tight it's because there
are very few areas of research where such dramatic
improvements could be made in the health of millions of type
2s as this area - correct nutrition used to empower
diabetics to attack the disease, not just to mitigate it.
But entrenched attitudes and blinkered vision is starving it
for funds. No money to be made by drug companies or some of
the other sponsors in this field.

It never occurs to them that, say ten years from now, a
properly researched book/DVD published and promoted by the
ADA could make more money for them than all their sponsors -
and, along the way, save and improve a lot of lives.

- Should they use this to balance other studies on their site?
Absolutely. I did find this study on their site that is similar in its
small sample. Too small a sample and too short of a duration to really
take it that serious, IMO.
http://www.diabetes.org/diabetes-research/summaries/sharman-lowcarb.jsp

From the link:

"The study was only 6 weeks long with just 15 participants.
A similar, longer-term study with more participants is
needed to better understand this issue."

So, okay, that was the pilot. So was the one we are
discussing. So where is the ADA "Nutrition for type 2"
long-term study - and related studies? One which actively
pursues comaprisons of all the variants - high this, low
that , moderate other - until they finally do enough
iterations to get it, if not right, not so dramatically
wrong.

You can have a seperate one for type 1 - but I stress the
focus on type 2 for this one. The more I read, the more I
see a need to separate the types when it comes to diet and
nutrition.

To summarize, yes I think the ADA could do more to investigate and
perhaps advise more low carbohydrate and low-bad fat approach for Type
2 diabetics.

That, in my view, is the understatement of the 21st century.

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg
--
Everything in Moderation - Except Laughter.
.

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