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Another great resource for those with type I or II diabetes, LADA diabetes or low carb dieters interested in the peer-reviewed research is created and maintained by Janet “Jenny” Ruhl at http://www.phlaunt.com, and is called “Blood Sugar 101.”

Jenny explains the reason the site exists:

After losing 30 pounds with a low carb diet, I have maintained that weight for many years. My current BMI is within the normal range for my height. At one point I exercised daily for a year and got my body fat down to 24%, which put me into the “Fitness” category for a woman my age. Despite what my doctors had told me, weight loss and intense fitness didn’t do a thing for my blood sugars, which got worse.

This raised my curiosity. I started tracking through the research articles available for free on the web. (many of them, now, alas, are no longer free, but I was lucky that I started my research back in 2004 when they were.)

The information I found, much of it differing dramatically from what doctors were telling patients about what caused diabetes and how it should be treated, became the kernel of this web site. My goal was to answer these questions: What do scientists actually know about Type 2 diabetes? Why do doctors miss diabetes diagnoses until long after people already have diabetic complications? And what blood sugar levels are truly low enough to prevent further damage to the organs and beta cells?

The site is a treasure trove of information. While Low Carb Age attempts to provide the latest news chronicling the end of the low fat craze, Jenny’s site provides a wide and expansive view of the research spanning back decades. Under the general heading of blood sugar control, Jenny ventures into nearly every area a low carb dieter is concerned about. The site is extensive enough to have been put out in book format:

Jenny maintains a blog also at Diabetes Update where new information is presented.

Both the blog and the Blood Sugar 101 website are highly recommended.

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The American Heart Association is now recommending a lower carb diet for prevention of cardiovascular heart disease, heralding the beginning of the Low Carb Age!

A new study, recently presented at the American Heart Association annual meeting in Orlando, FL, tested the effect of a low fat verses moderate fat diet. The low fat diet contained 20 percent of calories from fat, 65 percent from carbs and 15 percent from protein (this is the standard low fat diet that has been recommended for years). The “moderate fat diet” increases fat, and to keep the calories consistent, lowers the carbohydrate contribution. The moderate fat diet in the study has 40 percent of the calories from fat, 45 percent from carbohydrate and 15 percent protein. HealthDay, from the National Institutes of Health, quotes the AHA:

“This is a good study that essentially confirms that the current recommendations are appropriate,” said Alice Lichtenstein, a spokeswoman for the American Heart Association (AHA). “Since 2000, the AHA has been recommending not a low-fat diet, but one that is low in saturated fats and trans fatty acids.”

People with metabolic syndrome are glucose-intolerant, meaning they can’t process blood sugar well. Low-fat, high-carbohydrate diets exacerbate this condition, Lichtenstein explained.

The study is explained in more detail on our Diabetes and Metabolic Syndrome research page. The conclusion of the study gives the bottom line:

Conclusions: This is the first study to examine the effects of low fat vs. moderate fat diet in MetS. MF compared to LF diet improves the atherogenic dyslipidemia of MetS. MF diet is a preferable dietary intervention in people with MetS to improve CVD risk.

Whew. What the heck does that mean? Here’s a layman’s plain English translation:

This is the first study to examine the effects of low fat vs. a moderate fat diet with lower carbohydrates in patients with metabolic syndrome. The moderate fat diet compared to the low fat diet improves the heart disease related risks of various blood fats (VLDL, LDL, triglycerides, etc.) in people with metabolic syndrome. The moderate fat diet is therefore a better diet for people with metabolic syndrome.

Health Day goes on to quote other experts:

Experts familiar with the study aren’t surprised by the findings. “This sort of falls within the boundaries of what we used to call the Atkins diet, which was a high-lipid and low-carb diet. Normally this kind of diet suppresses appetite, improves diabetes,” said Dr. Alfred Bove, president of the American College of Cardiology. “This diet looks like it does a good job of altering the negative metabolic effects of early diabetes or high carbohydrate stimulation,” he said.

“Much of this we’ve known before, but the idea is that a moderate-fat diet is something most people can tolerate,” Bove said. “It probably affects the way insulin is released because if you have a lot of carbohydrates in the diet, you tend to generate a lot of insulin, and insulin is the hormone that lowers blood sugar,” Bove explained. “In addition to lowering blood sugar, it also increases appetite so a lot of people on high-carb diets are restimulated to eat more.”

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Stunning statistics from a study published in the December issue of Diabetes Care, as reported by Health Day News:

The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.

That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.

At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.

The increase is from adult onset, or type II diabetes. Health Day attributes the increase to obesity:

Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don’t use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.

The problem is that the official stance towards this problem has little hope of solving the underlying issue: our addiction to carbohydrates. While the general consensus is that people would not be diabetic if they lost weight, telling people to lose weight has proven to be a dismal failure. The reason is that very few people will starve themselves voluntarily.

The standard American diet is one rich in refined, processed foods (i.e., carbs). The “optimum” diet recommended by nutritionists is one that is low in dietary fat and eschews refined, processed foods in favor of “complex carbohydrates, such as whole grains, cereal, rice, pasta, potatoes, dry beans, carrots and corn”, with calorie reduction necessary to lose weight. It doesn’t work because you are always hungry on that diet.

Hungry people eat. And if they eat “complex carbs” that are “low in fat” they never feel sated, and will never stop eating.

Try this experiment … go to the sugar bowl and spoon out a scoop of sugar onto the counter. Then another. And another. Keep going, and when you have 22 spoonfuls of sugar on the counter, you have the average American’s intake of sugar. But what if you cut out all the added sugar found in soft drinks, cookies, candy and other snacks (even low fat ones)?

If you follow the various guidelines by the USDA, American Heart Association, et. al., you’ll limit fat to 20% of your dietary intake, and get adequate protein, making up the rest of your diet with those complex carbohydrates. Let’s take an example of a 2,000 calorie diet, and see how that works out in grams of each micro nutrient:

• Fat, 44g at 9 calories each = 20% of calories
• Protein, 100g at 4 calories each = 20% of calories
• Carbohydrates, 300g at 4 calories each = 60% of calories

Carbohydrates turn to sugar (glucose) in your gut in a very short time, within 2 to 4 hours. Even “complex carbs” turn to sugar.

Spoon out another 75 teaspoons of sugar onto your counter. That is the amount you are asking your body to metabolize when you eat 300g of carbohydrates per day.

Here’s a layman’s explanation of what is happening: The body needs sugar to run, but if it can’t use it in a very short time, it is stored as fat. Blood sugar spikes in 2 to 4 hours after eating carbs, and the body reacts by releasing insulin to drive the sugar into the cells so they can use it for energy. If the cells have enough, they refuse insulin’s prompting, and the sugar is stored as fat. As you abuse this system by overloading it with sugar, the cells become more and more resistant to insulin, and the body sends out more and more. When the sugar is pushed into fat cells, your blood sugar level drops, and hunger returns even though you ate only a few hours ago. So you eat again, and start the process all over again (if you eat a diet “rich in complex carbohydrates”). Sound familiar?

The emphasis on low fat, high carbohydrate diets has caused our expanding waistlines, and emphasizing that people should continue to eat this way but reduce calorie intake is counter intuitive. Survival depends on getting enough to eat, and your body will betray you if it thinks it is starving.

A better approach is to limit carbohydrates to about 1/3 of all calories if you are at your goal weight and otherwise healthy. For a 2,000 calorie diet, that’s about 167 grams of carbs. The rest of your calories can come from fat and protein. It is best to calculate your minimum protein requirement, usually calculated at about a half gram per pound of lean body weight. “Lean body weight” is your weight minus your fat (take your body fat percentage times your weight, and deduct that from your total weight to get your “lean body weight”). The book The Protein Power Lifeplan has this approach as a “maintenance diet”, and people can tolerate it for life … because you don’t get hungry.

And if you need to get to your goal weight, the first phase of the diet can help you do that without getting hungry. You can short-circuit the vicious cycle of carb intake, insulin response, fat storage and premature hunger by eating a diet that is tuned to your needs.

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Tom Naughton deconstructs the “obesity epidemic” at his blog Fat Head:

But what I found most interesting was the data on who’s “overweight” and by how much. Here are the numbers:

• More than 50 pounds overweight: 6%
• 21-50 pounds overweight: 17%
• 11-20 pounds overweight: 15%
• 1-10 pounds overweight: 24%
• At ideal weight: 18%
• 1-10 pounds underweight: 7%
• 11-20 pounds underweight: 3%
• More than 20 pounds underweight: 1%
• Undesignated: 9%

As we noted in our post Does Being Overweight Harm Your Health, all-cause mortality studies show that you have a 17% less chance of dying if you are in the “overweight” BMI (as compared to being “normal weight”). Even being “obese” was statistically even with being “normal weight” in these studies. The absolute worse thing you can do is be “underweight”, with a stunning 73% greater risk of dying than a “normal” weight person.

We have also noted our belief that individuals have to assess their own health needs and identify their individual risk factors, rather than focusing on a “society wide goal”. If your risk factors lean more towards developing diabetes II, then controlling blood sugar levels may be more important than being within 10 pounds of some goal weight. And as McNaughton notes, adult onset diabetes is at epidemic levels:

A different Gallup poll underscores another point I made in the film: there is a genuine epidemic out there, and it’s called diabetes. More than 11% percent of Americans adults have diabetes now, and more than 90% of those have type 2 diabetes, which is mostly preventable. The rate has more than doubled in the last decade alone. Among senior citizens, the numbers are even more harrowing: nearly one-quarter have diabetes. Just think of all the physical damage that’s causing. And even those numbers don’t count the pre-diabetics.

Nutritionists tend to focus on the weight end of the scale (so to speak), but they are missing the point. You can’t push a string. People are overweight because of their blood sugar levels (i.e., hyperinsulinemia, insulin resistance and related disorders leading to diabetes). They are not suffering from high blood sugar levels because of their weight. As Naughton sums it up:

The constant drumbeat about the obesity epidemic and the emphasis on losing weight is sending the wrong message. We need to tell people to get their blood sugar checked and keep it under control with the proper diet. If we do that, the 10 pounds will take care of itself. And if it doesn’t, well … so what? A bit of belly won’t kill you if it’s not the result of high blood sugar.

If your blood sugar is elevated, the way to get it under control is by adopting a low carb eating lifestyle. You will lose weight, but the most important thing is that you will live longer. And living longer is the goal.

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Diabetics and many people diagnosed as “pre-diabetics” may be helped by vitamin D supplementation, according to a new study previewed in our Diabetes Research Page.

Unlike studies that look at populations and try to determine the underlying factors for a certain health aspect, this study is a true randomized, double-blind study. One group of 42 insulin-resistant women were given 4000 IU of vitamin D3 and another group of 39 were given a placebo. As is standard in this type of study, neither the women or their doctors knew if they were getting the vitamin or the placebo. To further refine the study, all of the women were south Asian, to try and account for any racial or ethnic differences in the way the vitamin might be metabolized. The trial lasted 6 months, with direct testing of insulin levels.

The study will be published soon; the link above is to the synopsis and “preview” of the study’s results. The conclusion of the researchers is that supplementing vitamin D levels improved insulin resistance and made the cells more sensitive to insulin without affecting the pancreas’ insulin secretion (that’s a good thing). In addition, they didn’t note any change in overall lipid profile (cholesterol, triglycerides, etc.) or high sensitivity C-reactive protein, a measure of inflammation associated by some researchers with increased risk of coronary heart disease. Another good thing!

Diabetics should consult with their physician to see if supplementing with vitamin D can be a part of their treatment. If the vitamin D response is the same as found in this study, it may be possible to reduce of the amount of insulin needed daily.

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Tom Naughton of the Fat Head Blog has another funny article, this time about low carb enthusiast Jimmy Moore and his surprising cholesterol numbers. In the post, he talks about the worldwide study of average cholesterol rate and heart disease. This short video shows the concept (and Tom expands on it quite a bit in his blog piece):

Laura Dolson at Low Carb Diets takes a look at a new study in the Annuals of Internal Medicine comparing a semi-low carb Mediterranean-style diet with a low fat diet. Oh, the study calls it “low carb” but as Laura points out, getting 50% of your calories from carbs is not low carb in the same sense as a Protein Power or Atkins diet.

What was the outcome? Well, as the diets weren’t extremely different, it’s not surprising that in most ways there wasn’t a huge difference. Both groups lost and kept off a relatively small amount of weight, averaging 7-8 pounds by the end of the study. (This is interesting in an of itself, as the participants reported that they continued on their low-calorie diets.) Additionally, on average the participants had (mostly small) improvements in most of the markers they were looking for in the study – markers of blood glucose control and heart disease risk. But on each one of those markers (there were 13 in all) the lower-carb Mediterranean group had more improvement. And on perhaps the most important marker of all – how many participants required medications for diabetes, there was a huge difference. By the end of the study, 70% of the people on the low-fat diet were taking diabetes medication, whereas only 44% of the people on the lower-carb were.

The study would have been more interesting if they had included a third group, a real low carb, higher fat diet utilizing the same type of fats as a Mediterranean-style diet (olive oil, saturated fats, etc.)

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We added a few more links to our Research Pages, including two new studies showing that a low carb diet works better than the traditional low fat diet for metabolic syndrome (scroll to bottom for the section on metabolic syndrome).

I found these studies through a column that is good, but not great. The LA Examiner online has an article about low carb diets and CHD (coronary heart disease). The studies they link to regarding inflammation at the Cleveland Clinic do not mention high carbohydrate diets at all. It is a bit misleading; the author states categorically that inflammation is caused by several factors including “over consumption of processed carbohydrates”, and then links to the Cleveland Clinic article. But I cannot find that sentiment on any of the Cleveland Clinic’s linked pages; they advocate the low fat, high complex carbohydrate diet instead.

The article is valuable for the links to other studies and resources that do connect a low carb diet to reduced inflammation. If the reader checked the Cleveland Clinic source and went no further, he would have to conclude the author is incorrect and may dismiss the article. So check out the other links and information provided.

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There are several studies showing superior results obtained with low carb diets over other approaches for patients with type II diabetes (see our new Diabetes Page for references). Dr. William Davis on The Heart Scan Blog notes success he sees with his patients:

This is precisely what I see in practice: Elimination of wheat and sugars yields dramatic effects on basic lipids, especially reductions in triglycerides of up to several hundred milligrams, increased HDL, reduced LDL.

Beneath the surface, the effects are even more dramatic: reductions or elimination of small LDL particles, reduction or elimination of triglyceride-containing lipoproteins, elimination of the marker for abnormal post-prandial (after-eating) lipoproteins, IDL, reduced c-reactive protein. Add weight loss from abdominal fat stores and reduced blood pressure.

But some patients experience rising blood sugar levels no matter what they do. And its possible that they have been misdiagnosed and are part of what may be a hidden epidemic affecting up to 10% of the people diagnosed with type II diabetes. Jenny at Diabetes Update Blog describes several emails she has received lately:

They have blood sugars that continue to climb no matter what they eat. They ask me why when they eat no carbs at all their blood sugars are still over 140 mg/dl hours after a meal.

They are on all the oral drugs and sometimes even Byetta, but their blood sugars still go into the 300s.

Some have histories of Gestational Diabetes that came on when they were thin. Some gained a lot of weight very recently but were normal weight before that.

All have relatives with diabetes. Some have relatives with Type 1 diabetes. Most have relatives with other autoimmune disease.

And all of them, it turns out, though diagnosed with Type 2 diabetes and given the miserably ineffectual medical treatment doctors give people with Type 2, turn out to have LADA.

I have included a section for LADA in our Diabetes Research Page. Its certainly worth talking to your doctor about if you are one of the few who cannot lower blood sugar by restricting carbs.