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 http://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. Hyper*emia is the salient feature of T2DM, where * = glucose, TG's, cholesterol, NEFAs, uric acid etc. T2DM is a disease of chronic excess.

LCHF diet↓ Blood glucose & ↓ fasting TG's, but ↑ PP TG's, ↑ LDL-C, ↑ LDL-P & ↑ NEFAs. ↑ PP TG's & ↑ LDL-P are strongly associated with CHD risk.

Point 2: So?

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. Resistant starch (amylose) is 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 misleading. Meta-studies e.g. Siri-Tarino et al gave a null result by including LF studies, also a dairy fat study which had a RR < 1 for increasing sat fat intake.

Point 8 is irrelevant. ↑ Dietary fat ↑ 2-4 hour PP TG's. See Ultra-high-fat (~80%) diets: The good, the bad and the ugly.

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 is mostly amylose. See From Table to Able: Combating Disabling Diseases with Food.

Point 12 is misleading. The low-carbohydrate part is fine & dandy. It's the high-fat part that can be the problem. See Point 8.

8 comments:

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...

Yee-haw!

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! ;-)