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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."

Why the stricture against ketosis? There is no connection between ketosis and diabetic induced ketoacidosis.

Funny that Atkins got his ideas from the then-current (1963) diabetes diet recommendations.

The article is from 1999. I guess this guy's research went nowhere and he was unable to re-discover low-carb.

Because in this study they were all Type 2 diabetics. With high blood sugars, and a relative lack of insulin sensitivity, there's some risk (probably small) of ketoacidosis. The combination of high blood sugar, and a 'relative' insulin deficiency is what does it. Doesn't apply in 'normal' folks.

But these were diabetics, after all.

maybe they couldn't tell the difference between lyposis ketosis and ketoacidosis, and so erred on the side of caution. I didn't realized how old this was when I posted it, sorry, but I find this part interesting.

"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."

Apparently, that doesn't count if enough money is thrown at it. ie whoever doesn't want the food pyramid to change. Not to mention the hurting it would put on pharmacuticles (sp) After all, they would lose millions in revenue from people no longer needing to inject insulin, or take statins or blood pressure meds. Makes ya go hmmmm!!

I thought it was very interesting BECAUSE it was from 1999. One could ask the guy, "What happened to you? You were on the right track." It would be a great article.

Look at Dr Eades' blog today (http://blog.proteinpower.com/drmike/) on the French SUVIMAX study. They propose the opposite solution in the face of even stronger data. It must help with funding or something.

Dr Hays, in fact has continued to publish original research on this same regimen, and continues to treat his patients this way.

http://www.ncbi.nlm.nih.gov/entrez/...1690&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/...3629&query_hl=1

Trouble is, he's having difficulty getting funding for additional studies -- the people holding the purse strings aren't interested if there's no drug potential attached.


And likewise, the physician's community is still stuck in the high-carb mode even for diabetics. Some are starting to come around, but only a few.

I didn't mean he really gave up on it. I meant society as a whole. We don't change easy. And there are too many people who will push that it worked for them. Perhaps too many doctors getting a kick-back on drugs, or, the government. This would turn our whole food structure literally upside down. But, can't they just let me buy Stevia in the grocery store? It would bring the cost down if it weren't such a pain to get it in, and it can only be sold through Health Food Stores. Not that I want HFSs to go out of business, but it's ridiculous that you can buy sugar but not Stevia. They both come from plants. They aren't chemically created. (Not that that's necessarily a bad thing). But, it's ridiculous. Kinda like years ago. I was a cashier in a grocery store. People with food stamps could come in and buy soda and potato chips, but not cold medicine or toilet paper.. I know, it's not classified as a food. But, you DO ingest cold medicine!

I do feel it's criminal though, to continue to TRAIN Doctors that the current food pyramid is correct.. My BIL is diabetic and he is encouraged to eat lots of fruits and vegetables and LOW FAT. It's really hard too, as he is mentally challenged and I can't convince him that "in this instance" the Doctor is wrong..

I'm sure grocery stores could sell stevia if they wanted to. I know Trader Joe's does. I bet there's just not enough of a market for it to be sold in grocery stores.

I'm sure it's also because T2 diabetics are also at high risk of kidney damage. There was a dialysis unit at the hospital where I worked and most of the patients were diabetics. Now I'm sure that when your blood sugar is as well controlled as it is in low carbers, it's not actually an issue, but that's probably still part of the reason they want to avoid ketosis.

Basicly all the chain grocery stores here in my area sell stevia.

Grocery stores here all sell stevia too, but because of the laws it is not with the sugar, Equal & Splenda, it is with the supplements and doesn't say that it is a sweetener.

be because I live in a rural area. They only sell it in Health Food Stores here. I've searched the Wal Mart herbal aisle as I figured since they sell those (milk thistle, etc) they'd carry Stevia, but they don't. Maybe I will make some other people happy too and request it.. I've searched Winn Dixie, which barely has any herbs. And Kash & Karry.. Other than stuff like this though, I like living in the sticks. Many more places to ride my horse!! I haven't been there in a while, but GNC didn't even carry it..

A new paper in Nutrition and Metabolism advocates a ketogenic diet for type 2 diabetes, exactly what the people who wrote this article say to avoid.