Tuesday, 29 July 2014

Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base, by Richard D Feinman et al.

Another Bookmarking post.
From https://dgeneralist.blogspot.co.uk/2013/11/the-low-carb-high-fat-diet.html

The study in question is Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base. Here are my comments on the 12 points.

Point 1 is wrong. For ~85% of people who have T2DM, hyper*emia is the salient feature, where * = glucose, TG's, cholesterol, NEFAs, uric acid etc. For ~85% of people who have T2DM, it's a disease of chronic excess.

Ad lib LCHF diet↓ Blood glucose & ↓ fasting TG's, but ↑ PP TG's, ↑ LDL-C, ↑ LDL-P & ↑ NEFAs. See Postprandial lipoprotein clearance in type 2 diabetes: fenofibrate effects.
↑ PP TG's is associated with ↑ RR of CHD.
↑ LDL-P is associated with ↑ RR of CHD.
↑ NEFAs are associated with ↑ RR of Sudden Cardiac Death.

Point 2: So? T2DM is a disease of chronic excess. Chronic over-consumption was caused by Food Industry marketing, not carbohydrates.

Point 3 is wrong. A caloric deficit is essential, to reverse liver & pancreas ectopic fat accumulation. See Reversing type 2 diabetes, the lecture explaining T2D progression, and how to treat it.

Point 4 is misleading. Feinman doesn't distinguish between different types of carbohydrates. Starches, especially resistant starches (e.g. Amylose) are beneficial. See Point 11.

Point 5 is moot. Prof. Roy Taylor found that motivation determines adherence. Prof. Roy Taylor's PSMF was adhered to. See Point 3.

Point 6 is correct. Prof. Roy Taylor's PSMF is ~1g Protein/kg Bodyweight, some ω-6 & ω-3 EFAs & veggies for fibre. See Point 3.

Point 7 is misleadingSiri-Tarino et al gave a null result by including low fat studies, also a dairy fat study which had a RR < 1 for increasing intake. Chowdhury et al gave a null result, as some fats have a RR > 1 for increasing intake and some have a RR < 1 for increasing intake.

Point 8 is irrelevant. ↑ Dietary fat ↑ 2-4 hour PP TG's. See Point 1.

Point 9 is partly correct. Microvascular, yes. Macrovascular, no. See Point 8.

Point 10 is mostly irrelevant. See Point 8.

Point 11 ignores results obtained with high-starch diets, where the starch contains a high proportion of Amylose. See Walter Kempner, MD – Founder of the Rice Diet and From Table to Able: Combating Disabling Diseases with Food.

Point 12 is misleading. The low-carbohydrate part is fine. It's the high-fat part that can cause problems. See Point 8.


Sue Staltari said...

Point 3 is wrong. A caloric deficit is essential, to reverse liver & pancreas ectopic fat accumulation. - this is what I am hoping for hubby who has lost a good amount of weight already after been diagnosed type II. He is not doing ketosis.

Nigel Kinbrum said...

Good stuff! I'm guessing that a PSMF is a step too far?

Sue Staltari said...

We started doing the Newcastle Diet but decided he wanted more food variety. But weight loss has been pretty fast. He is sticking to protein shake and banana for breakfast, protein and salad sometimes with a starchy carb for lunch and protein and vegies, starchy carb for dinner, sometimes yoghurt and fruit for dessert. Food has been what he likes to eat. Good amount of protein. Would have put him on low carb a few years ago but want him to be able to handle carbohydrates.

Nigel Kinbrum said...

At least it's not for forever! His liver function will return to normal. When that happens, he'll be able to eat a wider variety of foods.

billy the k said...

Overconsumption —> hyper-*YNI
*[you-name-it:  FBG, PP-BG, TG's, LDL-C, NEFA's, etc. i.e., every marker you'd like to be normal now AIN'T]
You said this in an earlier posting but it's worth repeating something when you haz hit the nail on the head.

Sue Staltari said...

He has lost 20 pounds in 5 weeks and body fat going down. Another 20 or so to go.

Nigel Kinbrum said...


Nigel Kinbrum said...

This Basmati rice, Beans 'n' Veg diet during the day seems to have set my brain alight.

Glucose, for the Win! :-D

Ketones, boo hiss! ;-)

RIchard Feinman said...

I don't think that we suggested that this is the ultimate approach for everybody but rather that the science pointed to some form of carbohydrate restriction as the place to start. We provided quite a rew links to high quality research. Do you see anything positive in the overall message? What do you suggest?.

Nigel Kinbrum said...

Hi, and thanks for commenting.

I totally agree with carbohydrate restriction for sedentary people and people with Insulin Resistance/Metabolic Syndrome/T2DM. However, carbohydrate restriction only solves part of the problem, and reductionism of complex problems to one main cause isn't going to solve them.

Managing a condition by carbohydrate restriction is no better than managing it with drugs. Until the low-carb movement accepts that Energy Balance counts, and that it's a chronic positive Energy Balance that produces ectopic fat deposits in organs such as the liver that causes T2DM in ~85% of cases, most people with T2DM will be denied the chance to reverse their condition. This is why I prefer Prof. Taylor's approach, which uses carbohydrate and fat restriction to produce a large negative Energy Balance, which rapidly depletes ectopic fat stores, resulting in rapid reversal of T2DM.

I think that my post is fair. I agree with you on certain points. Have I made any errors in the points on which I disagree?

You're now white-listed, so any future comments will appear immediately. Please read http://nigeepoo.blogspot.co.uk/2011/02/comments-enabled.html , if you haven't already done so.