Dear Maryanna, You said:
<<Can a diabetic go on the carbyhydrate diet?..I have been researching this and found that some have an issue with diabetics going on the carbohydrate diet as it causes too much protein for the kidneys to handle...This isn't something that you can ask your doctor about as they only advocate the diabetic exchange diet..I have been checking this out because I feel that the carbohydrate diet is something that would help me...However, kinda makes me wonder if I should as I don't want to damage my kidneys further..It is a controversial issue it seems...Any and all help needed....>> Physicians who object to the "low carb" diet are uninformed about it. It is not a high protein diet. Your protein that you eat now does not need to change. I say most, because that will suffice. What will change is that you will eat many more fresh vegetables. These can be raw or cooked. There is a sub-group (Dr. Atkins' fans) who believe one has to go very low carb. That needn't be. As long as you eliminate grains, bread, flour-type products, sugar, etc. you will find it has a positive effect on your blood sugar. I'm assuming the disbetes is diabetes mellitus. If so, the reason this happened is because your body got to a point that it was insulin-resistant. This type of diet is exactly what is indicated for insulin resistance and diabetes mellitus. Here are a couple of articles with the 2nd one showing a modified low carb diet. DG-DISPATCH - ENDO 99: Diabetics Improve Health With Very High-Fat, Low Carb Diet By Cameron Johnston Special to DG News SAN DIEGO, CA -- June 15, 1999 -- A very high-fat, low-carbohydrate diet has been shown to have astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles. The results of three studies involving such a diet, which is similar to, but has a few key differences from the famous "Dr. Atkins Diet", were presented today at the annual meeting of the Endocrine Society. Dr. James Hays, an endocrinologist and director of the Limestone Medical Center in Wilmington, DE, admitted that the concept of a high-fat diet in people who are already at higher risk of cardiovascular disease might seem incongruous. Nonetheless, this study of 157 men and women with type 2 diabetes showed an impressive benefit in body mass index (BMI) triglycerides, HDL, LDL and HbA1c. Most people are encouraged to reduce the amount of fat in their diets, particularly saturated fats, and diabetics in particular are advised to reduce their overall caloric intake, Dr. Hays explained in an interview in San Diego during the conference. Whereas a normal diet would be in the order of 1800 to 2100 calories, with 60 percent of calories coming from carbohydrates and 30 percent from fat, patients in this diet were restricted to 1800 calories per day and were encouraged to get 50 percent of their caloric intake from fat, and just 20 percent from carbohydrates. The balance of 30 percent would come from proteins. A whopping 90 percent of the fat content in their diets was saturated fat, compared with just 10 percent that was monounsaturated fat. "I think this is at least worth considering for any diabetic," Dr. Hays said in an interview. "The thing many diabetics coming into the office don't realize is that other forms of carbohydrates will increase their sugars, too. Dieticians will point them toward complex carbohydrates ... oatmeal and whole wheat bread, but we have to deliver the message that these are carbohydrates that increase blood sugars, too." Higher-fat diets, on the other hand, seem to make the person feel full faster so they eat less; higher-fat diets also tend to reduce postprandial hypoglycemia so the patients feel better after eating. "Every diabetic comes home from the doctor with instructions as to what their diet should consist of, but they're not getting the information from dieticians about what complex carbohydrates they should eat," Dr. Hays said. "The important thing here is no ketosis. We absolutely don't want people to become ketotic, and so we said they had to have so many exchanges of fresh fruits and vegetables and we specified the ones they could eat." They were able to eat all the meat and cheese they wanted, but as for carbohydrates, they are restricted to eating unprocessed foods, mainly fresh fruit and vegetables, he added. Subjects recruited into the study (84 men, 73 women) were all type 2 diabetics and were required to undergo a standard American Diabetes Association modified diet for one full year before entry into the trial. Over the course of one year, the subjects achieved a mean decline in total cholesterol of between 231 and 190 mg/dl. Triglycerides declined from 229 to 182 mg/dl. Low-density lipoproteins (LDL cholesterol) fell from 133 to 105 mg/dl, while HDL increased from 44 to 47 mg/dl. HbA1c, which at the start of the study averaged 3.34 percent above normal, declined to the point that at one year, the mean was just 0.96 percent above normal. The average weight loss among subjects in the study was in the order of 40 pounds, Dr. Hays said. By the end of the one-year study, he added, 90 percent of the patients had achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and triglycerides. Even among juvenile diabetics, he said, they might not be overweight and they might have more or less normal lipid levels, but when they are on this kind of diet it is possible to treat them with lower doses of insulin and make their lives a little safer, he said. As for the response from cardiologists who see a high-fat diet as anathema to what they have been instructing their patients for years now, Dr. Hays said he has three cardiologist patients who are now on the diet. "If you have a diet that results in weight loss, lower cholesterol, and a better lipid profile, eventually, everybody will be eating that way. It's going to come whether we like it or not." ---------------------------------------------------------------------------- -- 60th Scientific Sessions of the American Diabetes Association Day 1 - June 10, 2000 The Effect of Fat vs Carbohydrates on the Etiology of Type 2 Diabetes James Lenhard, MD The diet and macronutrient composition that is most beneficial for preventing diabetes and obesity is becoming an increasingly complex and contentious topic of discussion. The heated public debates between the proponents of a high-carbohydrate diet and a high-protein diet are akin to the theatrics of professional wrestling. It is not surprising that the public is confused and that clinicians struggle to find sensible advice to provide to patients. To address this issue, organizers of the 60 th Scientific Sessions of the American Diabetes Association gathered a distinguished panel to explore the role of diet in the development of type 2 diabetes. [1] However, the speakers may have raised as many questions as they answered. Diet and Type 2 Diabetes: Types of Fat and Types of Carbohydrates The first speaker, Frank B. Hu, MD, PhD, of the Harvard School of Public Health began the session by pointing out that in the United States obesity and diabetes have become epidemic in the last decade, even though the percentage of fat in the US diet has decreased. [2] Dr. Hu contends that more focus should be placed upon the type of fat and the type of carbohydrate consumed, rather than only the amount. The following table shows some of the reported physiologic effects of dietary fats obtained from different sources: Table. Physiologic Effects of Dietary Fats Type of Fat Source Effect Saturated Fat Meat, dairy Increase low-density lipoproteins (LDL); decrease high-density lipoproteins (HDL) Trans fatty acids Vegetable oils Increase LDL and triglycerides; decrease insulin sensitivity Monounsaturated fats Olive oil Decrease LDL; increase HDL n-3 fatty acids (fish) Seafood Decrease triglycerides; increase insulin sensitivity; antiarrythmic n-3 fatty acids (plants) Soybeans, walnuts Antithrombotic; antiarrythmic Dr. Hu also described clinical trials that have examined the association between the intake of dietary fat and the development of cardiovascular disease. The Nurses' Health Study, now in its 25 th year of follow-up, suggests that a diet high in saturated fat and trans fatty acids will increase the risk of coronary heart disease (CHD). The Nurses' Health Study, [3] as well as several others, also showed a reverse association between nut consumption and CHD. This underscores the point that the type of fat may be more important than the amount of fat. Dr. Hu presented data suggesting that fish consumption may offer protection against developing CHD and type 2 diabetes. Furthermore, replacing saturated and transunsaturated fats with unhydrogenated monounsaturated and polyunsaturated fats may be more effective in preventing CHD than reducing overall fat intake. The type of carbohydrate also seems to be important. Carbohydrates were formerly classified as simple and complex. The new classification is based on the glycemic index (GI), which ranks foods based on their ability to increase blood glucose. For example, glucose has a GI of 100, baked potatoes have a GI of 93, carrots 49, pasta (remarkably) 39, and peanuts 14. Dr. Hu suggested that using the GI, or another similar measure called the glycemic load, could help predict risk of developing disease. The data from the Nurses' Health Study suggest that a high dietary glycemic load from refined carbohydrates increases the risk of CHD, whereas an increased intake of whole grains may protect against CHD. In his concluding remarks, Dr. Hu recommended avoiding the mantras "fat is bad" or "carbohydrate is bad" and instead suggested focusing on the types of fat and carbohydrates rather than the total amounts. Evidence for Dietary Fat as a Risk Factor for Type 2 Diabetes Barbara Howard, PhD, of the MedStar Research Institute, Washington, DC, examined the connection between fat consumption and the risk of developing diabetes. [4] She presented data from 4 studies that examined the relationship between dietary fat consumption and the occurrence of type 2 diabetes. Although several prospective studies have shown a positive correlation between fat intake and diabetes other prospective studies, including the Nurses' Health Study, have failed to show this connection. The ongoing Women's Health Initiative may provide some answers. Dietary Fat, Insulin Resistance, and Obesity Dr. Howard remarked that studies have also failed to show a connection between the amount of dietary fat and in insulin sensitivity. However, she also presented data suggesting that the kind of fat consumed can make a difference in insulin sensitivity. People who consume a large amount of monounsaturated fat have demonstrated an increase in insulin sensitivity, whereas those consuming a large amount of saturated fat will be more insulin resistant. The association between dietary fat and obesity is more clear. Data suggest that increased fat consumption leads to obesity, although carefully controlled trials have suggested that the increase in weight is more modest than might be expected. However, the relationship between dietary fat and the development of diabetes is likely through the influence of obesity. Is Surplus Carbohydrate Converted to Fat? Marc K. Hellerstein, MD, PhD, of the University of California at San Francisco [5] examined the metabolic consequences of consuming a high carbohydrate diet on the manufacturing of new fat, or de novo lipogenesis. Eucaloric replacement of dietary fat by carbohydrate does not induce hepatic de novo lipogenesis to any substantial degree. But how are carbohydrates metabolized? Carbohydrates may either be stored as glycogen or oxidized as fuel. Because there is a limited capacity to store carbohydrates as glycogen, the majority of carbohydrates are oxidized. Dr. Hellerstein presented a schematic showing how carbohydrates induce metabolic processes that allow carbohydrate oxidation to increase and match carbohydrate intake. However, there are no "free calories." If the amount of carbohydrate consumed exceeds the ability to burn it as fuel, it will be converted to fat. Dr. Hellerstein presented research showing that consumption of high levels of carbohydrate may lead to a decrease in LDL, but an increase in triglycerides and a decrease in HDL. Carbohydrates may also impair clearance of lipids from the circulation. It appears that dietary carbohydrate is a double-edged sword, with both advantageous and deleterious effects. Dietary Regulation of Insulin Resistance Gerald Shulman, MD, PhD, [6] of Yale University School of Medicine, New Haven, Connecticut closed the symposium by reviewing data which suggest that healthy offspring of parents with type 2 diabetes are most prone to developing diabetes themselves. In addition, the offspring who have an increased level of free fatty acids are most susceptible. Dr. Shulman presented some very detailed research that suggests that fatty acids directly inhibit insulin action. His research indicates that this occurs through glucose transporter-4 (GLUT-4), the transporter that brings glucose into the muscle cell. Summary: Implications for Clinical Practice The type of fats consumed may be more important than the amount. Saturated and trans fatty acids should probably be consumed in small amounts, whereas monounsaturated fats should be emphasized. Similarly, the type of carbohydrate is important. Carbohydrates with a low ability to raise the blood glucose (low GI) should be emphasized over carbohydrates that lead to a large increase in glucose levels (high GI). Monounsaturated fat may improve insulin sensitivity. (extra virgin olive oil) Consumption of dietary fat has not yet been proven to lead to a risk for developing type 2 diabetes, but it does seem to lead to the development of obesity. High consumption of carbohydrate, in a eucaloric setting, does not lead to storage of the carbohydrates as fat. Instead, the carbohydrates are preferentially utilized as oxidizable fuel. Dietary carbohydrates may lead to a decrease in LDL, an increase in triglycerides, a decrease in HDL, and a decrease in insulin sensitivity. References Mayer-Davis EJ. Does diet play a role in the etiology of type 2 diabetes? Fats versus carbohydrates. Presented at the 60th Scientific Sessions of the American Diabetes Association; June 10, 2000; San Antonio, Texas. Hu FB. Diet and type 2 diabetes: types of fat and types of carbohydrates. Presented at the 60th Scientific Sessions of the American Diabetes Association; June 10, 2000; San Antonio, Texas. Hu FB, Stampfer MJ, Manson JE, et al. Frequent nut consumption and risk of coronary heart disease in women: prospective cohort study. BMJ. 1998 Nov 14;317(7169):1341-1345. Howard BV. Evidence for dietary fat as a risk factor for type 2 diabetes. Presented at the 60th Scientific Sessions of the American Diabetes Association; June 10, 2000; San Antonio, Texas. Hellerstein MK. Metabolic influences of dietary carbohydrate: lipogenesis, triglycerides, metabolism, fat balance and insulin sensitivity. Presented at the 60th Scientific Sessions of the American Diabetes Association; June 10, 2000; San Antonio, Texas. Shulman G. Dietary regulation of insulin resistance. Presented at the 60th Scientific Sessions of the American Diabetes Association; June 10, 2000; San Antonio, Texas. Regards, Catherine -- The silver-list is a moderated forum for discussion of colloidal silver. 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