Diabetes and Carbohydrates

[JeffN]

I decided to give atkins a try. Primarily because it fits with my lifestyle

Irrelevant. Shooting up heroin may "fit with my lifestyle"; that doesn't mean it's healthful.

I read his book and it makes sense to me.

No offense intended, but it "makes sense to you" because you're not aware of the reasons why it's crap. The Ptolemaic model of the universe, the phlogiston theory of combustion, and miasma and evil-spirit theories of disease all "made sense" to people too. (And in the latter case, many, many people were hurt as a result.) A few examples:


- Low-carbers claim that insulin is needed to store dietary fat as body fat. Actually, the most potent stimulator of triacylglycerol esterification in adipose tissue is acylation-stimulating protein (ASP), and it works just great in the absence of insulin. http://www.ncbi.nlm.nih.gov/pubmed/8492712 Guess what the primary regulator of ASP is? Dietary fat (chylomicrons). http://www.ncbi.nlm.nih.gov/pubmed/9694837 The body isn't that "stupid." Eat a caloric surplus, even with zero carbs, and the fat you eat is the fat you wear.


- On that basis, Atkins claims a "metabolic advantage" of dietary fat and that excess carbs turn to body fat. Actually there is a metabolic advantage -- in favor of carbs. First of all, de novo lipogenesis is an inefficient process that wastes about 1/4 of the energy. http://www.ajcn.org/cgi/reprint/62/1/19 Secondly, it basically doesn't happen in humans, at least with starch. (Fructose is different.) Your body will overstuff its glycogen stores and crank up thermogenesis before it will convert a gram of glucose to fat. See this study, where they fed subjects 2000 calories in a single meal:

http://www.ncbi.nlm.nih.gov/pubmed/6755166
The data imply that: (1) The capacity for glycogen storage in man in larger than generally believed, and (2) Fat synthesis from CHO will not exceed fat oxidation after one high-carbohydrate meal, even if it is uncommonly large. When a single high-carbohydrate meal is consumed, dietary CHO merely has the effect of reducing the rate of fat oxidation. These findings challenge the common perception that conversion of CHO to fat is an important pathway for the retention of dietary energy and for the accumulation of body fat.


- They simplistically assume that insulin response equals glycemic response. They also like to claim that mixing protein/fat with carbs blunts the insulin release, keeping it in a "Zone." Sorry, but that's been tested too:

http://www.ajcn.org/cgi/reprint/66/5/1264
Within each food group, there was a wide range of insulin responses, despite similarities in nutrient composition. The important Western staples, bread and potato, were among the most insulinogenic foods. Similarly, the highly refined bakery products and snack foods induced substantially more insulin secretion per kilojoule or per gram of food than did the other test foods. In contrast, pasta, oatmeal porridge, and All-Bran cereal produced relatively low insulin responses, despite their high carbohydrate contents. Carbohydrate was quantitatively the major macronutrient for most foods. Thus, it is not surprising that we observed a strong correlation between GSs and ISs (r = 0.70, P < 0.001). However, some protein and fat-rich foods (eggs, beef, fish, lentils, cheese, cake, and doughnuts) induced as much insulin secretion as did some carbohydrate-rich foods (eg, beef was equal to brown rice and fish was equal to grain bread). As hypothesized, several foods with similar GSs had disparate ISs (eg, ice cream and yogurt, brown rice and baked beans, cake and apples, and doughnuts and brown pasta).


- They claim that chronic high-carb diets make you insulin resistant. I already addressed that. Also, Jeff has cited the data showing fasting insulin dropping like a rock on high-carb diets.

... and on and on...

Beautiful!!!




In Health
Jeff

[bigbear]

I wasn't going to post anything else on this until I had been on ATKINS New Diet Revolution..but had to respond to you. What I do or don't as far as eating is none of your business. It's people like you the "radical know-it-alls" that give this board a bad name. Your diet is NOT the only way to go. Figure it out. Your choice is just that..your choice. You choose to eat this way..more power to you. I find it disgusting. You are eliminating such a large amount of food groups that I do indeed hope that you can get the proper nutrition. Just do me a favor..keep it to yourself. I have no need for you or your diatribe. ..Jeff, you are well spoken and reasonable, I appreciate you and have listened to you before and will continue to listen. The less "holier than thou" jugmental type people on this site, the more you might get some honest and helpful debate....bigbear..

[Steve]

It's people like you the "radical know-it-alls" that give this board a bad name. ..

Hi Bear. The quote above seems oddly familiar. Especially strange comment for someone who registered about a week and a half ago. Have you posted here before under other names?

Steve

[bigbear]

No steve, I have not posted before. I just have looked around and asked questions. Sorry I did as there are a lot of people on this board that want to shove their view of eating down everyone's throat, no pun intended. There are far too many "eating meat is evil" type of posters here that I find it not helpful in getting good information to make an informed decision. If you don't swallow what they are feeding you here then you are to be ridiculed and mocked. I did not come on this board for that. I do appreciate the people that have private messaged me as evidently there are a lot of folks that don't quite feel the way the "radicals" on this board do. bigbear....

[TanneryGulch]

Oh, boo hoo. Your handle ought to be bigbaby. Right off the bat your tone was argumentative and preachy ("How in the world...?" "This is just not healthy..." "I know my blood sugars..." etc.) as members tried patiently to explain. But you wouldn't hear it because you're "skeptical," we're all just cultists parroting our guru, etc.; you demanded independent, peer-reviewed cites. Fair enough. So Jeff cited Kempner and Pritikin, and I took the time to compile a bunch right out of mainstream journals that demolish Atkins' key BS premises. Now your feelings are hurt!!

Remember when Don Corleone slapped the blubbering Johnny Fontaine and told him to act like a man?


You know what's ironic? If you tried it, you'd find that the meat and cheese aren't hard to give up; it's the sweets that will give you fits -- and consequently, people with your tastes seem (just my impression here) to have the easiest adjustment and get the quickest results. "Star McDougaller" f1jim is an example.

But have fun pissing on your Ketostix.

[TanneryGulch]

Geoffrey and Marie: Regarding Bernstein (I've read his whole book except the chapters on diabetic foot care and stuff):

Being a lurker for a couple years on Dr. Davis' (Track Your Plaque) paid member forum, which is monopolized by low-carb mullahs, has been instructive. Besides the fact that most of them are staying fat and taking a bagful of supplements and drugs, there seem to be quite a few who got quick results with the biomarkers and then have gradually started to slide, having to up the fish oil, niacin, etc. and otherwise get creative. The small LDL particle counts start creeping back up, and you get puzzled responses and advice like, "Are you completely grain-free?? Consider cutting your fruit intake back to no more than 3 blueberries a week -- preferably not on the same day..."

Also, one guy noticed that after a bout of intense exercise his BG was shooting above 200 -- without eating. Fasting BG was good and postprandials were of course neatly controlled Bernstein-style, but there'd been this post-exercise spike for a few years, with the peaks getting progressively higher. (If I understand right, this is a known phenomenon among diabetics. Glucagon spike / liver glycogen dump in response to adrenaline/cortisol...? I don't know the physiology.) And ominously, he was starting to feel the first twinges of peripheral neuropathy. Clearly, the body isn't stupid, desperately needs glucose, and therefore has the endogenous means to get plenty of it. So I have doubts about whether you can go around with totally dysregulated insulin signaling yet "get away with it" by avoiding carbs.

BTW, I am willing to buy that the Bernstein "solution" might be the best strategy for a Type 1, for the reason he gives ("Law of Small Numbers"). On McD I often eat 150-200g+ of carbs in a single meal and, without a functioning pancreas, would have a hell of a time trying to match that with a Humalog bolus and get the postprandials to come out anywhere close to right. Whatever the long-term harm of high-fat may be, the hyperglycemia would kill you long before that, assuming you didn't overshoot and put yourself in a coma. But extrapolating this to T2D because the two share a superficial clinical feature (hyperglycemia) is really simplistic IMHO and neglects 1,001 other important physiological issues (of which I'm finally learning enough to have an inkling).

While we're at it, we might as well mention Fuhrman, who claims similar results on 20-40% fat (from nuts/seeds/avo). (Indeed, he claims better results and rips on McDougall, Barnard, Esselstyn, et al.) So even your notion of "pick fat or carbs, but don't cheat or you're screwed" has its counterexamples. But now we're back to Jeff's point that once you allow appeals to anecdote/hearsay, anything goes.

[TanneryGulch]

Some, I think esp of Native American, Inuit, and Polynesian ancestry will only function well on the high fat/low carb diet.

Hey GL, I've heard this claim too, but do you know of any real evidence for it? (Honestly curious, not being a smart-aleck.) Clearly those folks develop diabetes faster than Europeans on SAD, but the prime example I know of (Pima) serve yet again as evidence for McDougall: ancestral diet was high-carb (squash/corn/beans), genetic relatives across the border (Tarahumara) still eat it and are free of obesity/T2D, and some Pima have gone back to it and consequently gotten thin and reversed T2D. (Fuhrman mentions one by name in his Fasting book.)

[SactoBob]

No steve, I have not posted before. I just have looked around and asked questions. Sorry I did as there are a lot of people on this board that want to shove their view of eating down everyone's throat, no pun intended.

This guy came here with questions and now wants to argue with the responses and insult the people here who tried to help him. It is an unpleasant waste of time to argue by personal insults with people who do not want to learn. Bigbear has received (and scorned) our point of view. I don't care what he eats and don't care to get involved in a further exchange of personal insults. In my experience, the best way to deal with people like this is to ignore them unless and until they become more civil.

I think that the people here who understand and are doing great with this plan would be more effective responding to people who are open to this way of eating in other threads.

[bigbear]

TanneryGulch, I looked at the links you provided and also at all of the vast studies that completely contradicted the ones you happen to pick out. you and Sacto are just the kind of folks I was referring to, you remind me of liberals that when they lose an argument, all they can do is hurl names at their foes. Hey, you and sacto get your wish..I am gone..bye bye..will not post on your precious site again. I could get better information from a dumpster...have fun eating your rice and potatoes like good little boys..don't eat the evil meat..sheesh..what losers.. adios.....bigbear...

[TanneryGulch]

I looked at the links you provided and also at all of the vast studies that completely contradicted the ones you happen to pick out.

Great! Then you can cite them all for me. I'm always hoping to learn.

Cite one study.

[bigbear]

http://www.ncbi.nlm.nih.gov/pubmed/16340654
http://news.bbc.co.uk/2/hi/health/7882850.stm
http://www.nutraingredients.com/Researc ... dy?nocount
http://www.nutritionandmetabolism.com/c ... 5-6-10.pdf
http://www.ncbi.nlm.nih.gov/pubmed/1763 ... d_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/1734 ... d_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/1826 ... d_RVDocSum
http://www.atkins.com/Science/ScienceAr ... esity.aspx
http://www.ncbi.nlm.nih.gov/pubmed/1926 ... d_RVDocSum
http://content.nejm.org/cgi/content/full/360/9/859

[TanneryGulch]

Not one of those addressed the ones I cited or have anything to do with your question (Atkins' claims about carb metabolism as it relates to Type 2 diabetes). Still, a couple of points:


Eggs
It's a threshold effect. No, you don't see a huge effect in populations that already eat 700 mg/day cholesterol, average 215 mg/dL total serum cholesterol, and well over half of whom die prematurely of atherosclerosis. In populations that consume much lower amounts (<100 mg/day), you do see an effect (bad) on lipids and CVD risk. The only CVD reversal studies on record limited cholesterol to 0-5 mg/day. (Read this: http://www.drmcdougall.com/misc/2005nl/ ... ereggs.htm) Do you want your risk of a heart attack/stroke merely to be no worse than average (almost certain)?

Now put down your omelet and pay attention to this part because even the rosy picture above may not apply to you. A big Harvard study found, like yours, no huge risk of eggs in a "healthy" population. http://www.ncbi.nlm.nih.gov/pubmed/10217054 But buried in this finding, they also noticed that diabetic men who ate only one egg per day doubled their risk. For a clue as to why, check out this one (in healthy young men): http://www.ncbi.nlm.nih.gov/pubmed/16549459 "[H]igh cholesterol intakes increase the residence time of chylomicron remnants, as indicated by the 14C-CE kinetics..." It goes back to what I was saying before: with diabetes, both sugar and fat are getting stuck in the bloodstream after you eat. You just don't have a "lipometer" to go with your glucometer.


"A to Z" and similar diet shootouts
These have been addressed ad nauseam. Besides the eternal problems with dietary recall, etc., noncompliance totally confounded the results: the Ornish group didn't follow Ornish, the Atkins group didn't follow Atkins, etc., and in the end, nobody lost any weight. The differences may have been statistically significant, but they aren't significant in terms of disease risk. The one you linked where the teenagers went from obese to still-obese in 6 months on Atkins is just silly. Come on, man. Even as hard as I am on Atkins, I'll admit that if you actually stick to it you should lose more than 2 BMI points in 6 months!


We're all still learning (especially me). But I'm figuring out that the real science isn't as ambiguous as the media, diet book peddlers, and loudmouthed bloggers and make it seem. You're asking the right questions. Stick around, read like crazy, tone down the pugnacity a notch, and I'm convinced you'll be the next Star McDougaller.

[bigbear]

My point was not to directly dispute the studies you cited. My point was to show that there is scientific studies/evidence on both sides and they contradict each other. And...that maybe, just maybe, one way would work great for one person, and not another and vice-versa. The bottom line is the goal of achieving weight loss and "curing"..type 2 diabetes can accomplished with either way of eating...the evidence speaks for itself even without the scientific studies. My "tude" came from seeing such vitriol that was displayed not only to Dr Atkins but also to other posters that may have not drank the kool-aid of mcdougall. There is room for discourse, but the venom that I have read here was way over the top. You all may be right..this way of eating "works" for you and more power to you. But..people who eat differently than you yet acheive the same or better results aren't "the devil" or wrong..they are doing what works for them. Personally, I could not commit to this eating style and so I chose the one that would "fit" with my lifestyle and one that I could indeed commit to long-term....So far on Atkins (less than 2 weeks) I have lost 12 lbs, dropped my bp by 8-10 points both systolic and diastolic, my bg has not gone above 130 (checking 5-7 times daily) and normalized fasting bg is 94....without medication...dispute that!..bigbear..

[Nettie]

......So far on Atkins (less than 2 weeks) I have lost 12 lbs, dropped my bp by 8-10 points both systolic and diastolic, my bg has not gone above 130 (checking 5-7 times daily) and normalized fasting bg is 94....without medication...dispute that!..bigbear..

Hmmm. Wonder what your coronary blood vessels look like?

Nettie

[bigbear]

I dunno...what do yours look like..??