Monday, February 11, 2008

High fat Dutch style

Thanks to erik for the link to the project outline for the dutch study looking at the influence of a high fat meal on cholecystokinin release. This looks to be part of the lead up to using high fat feeding to ameliorate the liver failure, loss of gut wall integrity and what looks like systemic inflammatory response syndrome in major trauma human patients.

A quick pubmed on the group leader gave this paper from when Greve was visiting Edinburgh. High fat syringe feeding by mouth before major blood loss in rats was the project. It improved all sorts of parameters, as any high fat eater would expect. But you have to be careful with these models of bled-out rats as it is hard to get a project license which allows the rats to live or die. Fair enough, I don't like rats suffering either. I'm very fond of rats. They make good pets. But ultimately improved survival is what is needed for human trauma patients and this cannot always be predicted by acute amelioration of lab findings in the first 24 hours.

But the fat will deliver! I believe... (sounding like a statinator here).

A quick look at the full text of one of the group's related papers gives an idea of what they mean by high fat feeding. It's about 50% of calories from olive oil. I feel 85% from beef dripping would be even better, but just try and get that through the nozzle of a 5ml syringe at room temperature!

Usually when the Dutch talk high fat they mean HIGH fat, just look at this paper on diabetes. Human clinical type 2 diabetics on 89% of calories from fat. They improve. Mind you, if you've eaten as much Utrecht cheese cake as I have, you'd realise why the Dutch are not afraid of fat.

It was a crossover study so you can see what the same patients were like on 89% of calories from carbohydrate. Just look at the basal figures on the left hand side of table 2. As a diabetic which would you prefer to be? Check the fasting glucose, look at the lipids if you care about them.

Just compare this to the Philadelphia approach to diabetes. I hit on this paper as it's the first related link to the Dutch one. It grabbed my attention as the high protein diet did badly! Luckily I have access to the full text and in Philly they essentially starved two groups of diabetics on 1300kcal/d (for people with BMI well over 30). Both groups were low fat (45g/d) and they were either high carb (138g/d) or very high carb (HC,170g/d). The merely high carb (138g/d) group was describes as a high protein diet (HP). Whatever. The high protein group did worse on an HbA1c basis, slightly surprisingly. This looks to have been because both groups ended up with similar final values (final HbA1c for HC of 6.9%, HP gave 6.6%). The higher protein group had a non significant drop from baseline as their starting value was lower (Initial HbA1c for HP 7.6%, for HC 8.2%). Would you have guessed that from the abstract?

BTW the HDL-C deteriorated in both groups, as you would expect on 45g of fat per day. No surprise there. Only the HC group had a fall which reached statistical significance. Bet you didn't see that in the abstract either.

What both Philadelphia groups needed was a Dutch 89% fat milkshake six times a day, with enough calories for weight stability. Of course, at that level of fat intake they wouldn't be hungry, so skipping the occasional shake would allow weight loss if so desired. Even without weight loss they'd still really get their HbA1c down.

And actually improve their lipids.


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