EDIT from later in the day. I put this comment up on Stan's blog after reading the full text:
Stan, I think we have to note that weight gain post study was almost a kilo a week (average gain 3.1kg in the first month post study) and three patients were clinically diabetic again by this time (a quarter of the participants). Long term there is no hope for any of them unless they keep themselves so hungry as to have a low carbohydrate intake while ever they eat a "balanced diet". Some might do it, the Iron Few... Most cannot live with this sort of hunger. The fact that the rise in insulin was statistically ns should not blind us to the fact this is a product of small numbers and the routine wide SD in plasma insulin levels. The p < 0.05 fall in FFAs says insulin is physiologically elevated and easily explains the weight gain.
And predicts catastrophe.
Peter
END EDIT
House move time again. Glasgow house is sold, time to buy in Norfolk. Not sure how much blogging will be happening and we're moving to a non broadband area. Dial-up here we come, but there will be a garden with room for chickens!
This one will be fun when the full text becomes available. At 600kcal/d this is a low carbohydrate diet in anyone's book. A low protein diet, a low fat diet, it has it all...
My immediate reaction is to ask what a type 2 diabetic of initial BMI 23 would look like after eight weeks on 600kcal/d! Dead skinny? Skinny dead?
Of course even if the diet was 50% carbohydrate it would only be 66g/d of carbohydrate per day. Some one should tell these folks they can do as well on this level of carbohydrate restriction without all of that nasty hunger if they ate some decent fat and protein along side their carbohydrate restriction.
Peter
From the Sky article:
Retired lorry driver Gordon Parmley, from Stocksfield in Northumberland, spent four years on daily medication for type 2 diabetes despite being only 2st overweight.
[and if he had not been overweight at all?????]
The diet worked and 18 months later he is still free of diabetes and does not have to take any tablets.
"It was very tough. I was hungry all the time. It was a starvation diet and food was on your mind all the time," he said.
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33 comments:
Peter,
I wonder if they did an OGTT?
Dodger
Peter,
Here's the link to the article: http://www.springerlink.com/content/68rmr50h7j024525/fulltext.pdf
Dodger
I just posted a longer discussion of this dangerous "cure" on the Diabetes Update blog.
Diabetes Update: Idiotically Dangerous Diet
"Reverses Diabetes" but So Does Moderate Carb Restriction Without Calorie Restriction
A seasonal period of hunger is probably something that humans are adapted to. Really low calorie diets would simulate that.
Moderate carbs and unrestricted calories hmmm. What recurring situation for hunter-gatherers or farmers would that correspond to I don't know how natural that is.
The impressive results actually show up after ONE week, but who's gonna believe that :P
But how long does it last after going off the diet?
Severe calorie restriction leads to weight loss and improvement in laboratory markers in patients with DM2. And this is news!!
Ken, periodic calorie restriction will have occurred seasonally, but for many H-G groups the rest of the time their diet will have been moderate or low carbs and unrestricted calories (they stopped eating when they were sated!).
paleodoc
Famines were once extremely common in northern Europe. They only ended in the 1840s when railways made the transport of food easy. The majority of northern Europeans would have faced several months of severe calorie restriction every year prior to the Industrial Revolution.
In fact this enforced diet was probably the main reason most poor westerners (80% of the population population) didn't develop modern lifestyle diseases. The poor typically ate very high carbohydrate diets consisting mostly of bread, starchy vegetables and copious amounts of alcohol.
Jenny,
it is absurd to compare this trial with Keys Minnesota experiments.
In this recent study none of the subjects was starved. They merely lost excess weight. All of them were provided with adequate protein, electrolytes, vitamins and minerals. I doubt anyone suffered any serious complications.
In the Keys experiment the subjects were:
a) all healthy males of normal weight.
b) forced to eat a very poor quality diet based on starchy vegetables for a period of 24 weeks. This was followed by a further 12 weeks of calorie restricted re-feeding.
d) engaged in hard physical labour.
e) starved to 25% below their natural weight.
The Japanese have successfully treated vast numbers of patients for a wide variety of medical conditions by totally starving them for 4-6 weeks (combined with meditation and isolation). They are only provided with electrolytes, vitamins and minerals. Complications are minimal.
Hi Peter,
Looks like we spotted that study at the same time 8-:)
The full article pdf is linked here in my recent blog post.
Yes they must have all been hungry like hell yet they all burned 227g of pure (body) fat a day! It does basically show that a low carb ketogenic diet does reverse diabetes, just like dr. Kwasniewski and other heretics have been saying for decades!
No they absolutely did not have to starve during those 8 weeks, they could have simply eaten half of that fat (~110g/d) as part of their meats, fish or poultry dishes while losing only half of the weight loss in 8 weeks (instead of the total 15.3kg).
Best regards,
Stan (Heretic)
Ta Dodger,
We agree Jenny,
Ken, normal human eating behaviour is not good enough to patch up the breaks in your metabolism once you are diabetic. Be the breaks in the brain, liver, pancreas or adipocytes, carb restriction is the only solution long term...
Hi Yurgh, BG normalises after 3 days water fasting.
Muchadoaboutnothing, less than 4 weeks for a quarter of the participants.
Paleodoc, agree. Carb restriction by starvation is inhumane!
Stan, crossed posts! I've just put up a comment on your blog, I'll stick it up as an edit in the main post here
Peter
@Stan,
a ketogenic diet is not metabolically identical to extended severe calorie restriction. It is nonsensical to say it is.
Ad lib VLC diets are beneficial but they never induce the extreme levels of anabolism and fat mobilisation that occur with acute calorie restriction. Your body must "think" it is in a life and death situation to achieve this. That is why bodybuilders virtually starve themselves for 2-3 weeks before a competition.
It is quite possible to gain a substantial amount of body fat on a VLC. According to Stefansson most older Inuit women were quite fat despite a lifetime of <20g/day carbohydrates.
The primary benefit of VLC vs calorie restriction is that VLC is much easier to maintain over a long period.
Unfortunately much of the paleo community has the approach that any discomfort must be harmful. The human body evolved to take plenty of short term punishment. If it didn't our species would have dissappeared lpong ago.
I went for a 10 day total fast last year (apart from tea, coffee, vitamins, minerals and fish oil. I was quite easy and took nothing but a bit of will power.
@blogblog
It would have been easier had you not eaten anything, not even the supplements. If you eat anything, it is not starvation, it is semi-starvation. There's a distinction. Ancel Keys showed us that distinction. Everything he found in that experiment can be replicated as is. The deep constant hunger, the emaciation, the neurosis.
For argument's sake, it would be helpful to read about starvation (i.e. fasting) and semi-starvation (i.e. caloric restriction). For example, it is much more true to say that cutting out carbs is more similar to outright fasting than it is to caloric restriction. There's the absence of hunger and the increased lipolysis and the clarity of thought for example.
It is not clear how fasting works on blood glucose it may be a case of hormesis (small doses of poisons improve glucose metabolism, that may be how chromium 'supplements' work).
As we don't know the pathway I'd be chary of merely restricting rather than eliminating carbs while eating all the fat you want. That may have the disadvantage that it does not turn on adaptive stress responses in the same way that fasting does.
I think that could be dangerous if you are eating as much fat as you want to merely restrict carbs because that is a very unusual balance between carbs and fat. There is no telling what the effect of that would be.
Regularly fasting for a day or two a week seems to have scientifically attested benefits. Totaling eliminating carbs for a time is also said to have a hormetic effect.
Very low calorie diets are not the same thing as low carb
Peter,
I hope you can continue to blog, but I understand that dial-up is a problem. I have spent the last month reading all your posts and all the comments. Your blog and the comments are intelligent, informative and scathing at times. I spend more time reading posts here than any other alternative or conventional health/diet blog. Please keep posting! I will be lost without the Hyperlipid.
@Ken
Who is it not clear for, yourself? The pathway is known, though again maybe not to you. What danger is there to cut out carbs completely? Who is it very unusual for, yourself? So fasting seems to have been explored scientifically, but not the complete absence of dietary carbs? According to who, yourself?
So, a small amount of dietary glucose induces hypothetical hormesis (hormesis is hypothetical), but then you say so does the complete absence of dietary carbs? The quantity "none" does not fit the definition of hormesis. We can't consider the quantity "none" as a variable since there is only one state to "none" and that's absolute.
The flip side of hypothetical hormesis is the very real principle of toxicity: The dose makes the poison. According to that principle, the substance is not considered poisonous a priori, but only when the dose is high enough. When it comes to dietary glucose, or carbs in general, that seems to be the consensus. For example, in Taubes' GCBC, we learn that 70g/day/20 years of refined sugar/starch seems to be the threshold for diabetes type 2. That threshold is for population level, therefore the individual level can be less and more than that. Now consider that we advise everybody to eat at least 300g/day of carbs irrespective of refined state. That means you can fill that number with 100% pure white table sugar.
Peter,
It is true that they cannot be considered truly cured of diabetes after just 8 weeks. Just "reversed". Their insulin sensitivity is still poor so any return to a high carb diet is bound to return the symptoms. In my case (hypoglycemia, not diabetes) took a year and a half to completely reverse. Until then, every time I added even as little as 50g of carbs in any form - I felt it immediately! My normal tolerable dose was about 25g a day.
It takes time. I can well believe that for a diebetic the time necessary to _cure_ diabeitc (t2) insulin resistance is als oat least as long if not longer, given their age.
It is IMHO one of the main source of confusion experienced by the diebetics trying to reverse on a LC: they do not give it enough timne and start relapsing to their old bad ways after just a couple of months. It was not that easy for me even though mine was just a mild form of carbohydrate intolerance. It must be much more difficult for them.
blogblog,
240g of fat has to be metabolically similar regardless where it cames from: body or external. However, the endocrine and psychosomatic effects may be different! For sure, had they been eating just half of that fat in form of butter cream and lard they would have experienced ZERO hunger! I did just that! In the first 2 years my caloric intake was average ~1500kcal/day and 120g of dietary fat (100% animal fat). 25g of carbs and about 70g of protein. No hunger, ever! I first lost 3kg in 6-12 months (from 64kg down to 61kg which was bad, way too thin, but typical on a ketogenic diet), then I regained 3kg plus another 3kg and stayed that way for the next 10 years till now. Without changing anything in the diet.
Notice the time scale: something changes profoundly with the metabolism after about 12 +/-6 months (but not after 2). If they were real scientists they should have been studying it!
Stan
@Martin,
paleolithic hunter-gatherers would have never experienced true starvation (zero calories) because some food is always available - even if it only insects and leaves.
However unavoidable calorie restriction would have been a normal part of hunter gather life.
Severe hunger is simply an adaptation to motivate food seeking. Any food is worthwhile because it provides some electrolytes, vitamins, minerals and protein. It is invariably deficits of essential nutrients that causes death by "starvation" rather than a shortage of calories.
@blogblog
> paleolithic hunter-gatherers would have never experienced true starvation (zero calories) because some food is always available - even if it only insects and leaves.
Um, what? Given that non-human omnivorous animals starve to death in the wild at a non-zero rate, how can you assert that?
> It is invariably deficits of essential nutrients that causes death by "starvation" rather than a shortage of calories.
Again, what? You appear to be asserting that you could eat nothing but water and vitamin supplements and live comfortably "forever".
I don't understand any of your comment. Most of it seems false on the face of it, and most of your comments usually make much more sense to me, so: am I missing something?
Peter,
Another interesting "tidbit" regarding how very difficult it is to lose bodyweight via exercise. In the March 11 issue of National Gepgraphic, Andrew Skurka tells his story of covering 4,679 miles hiking, kayaking, skiing, etc., sort of around the perimeter of Alaska. He kept copious notes and one of the outcomes that surprised him was that he lost only 5 lbs. from his 170 lbs. body. His caloric intake was 4,760 calories. The moral of the story is that for almost everyone, if you want to lose weight, you better figure out a diet that works for you, preferably one you can stick with (low carb). I personally believe there are many positive attributes to exercise and maybe tuning up the metabolism is one of them, but this young man proves yet again that the human body is marvelously efficient. Brad
@Larry,
wild land mammals (except hibernators) typically have only 1% body fat. The only energy reserve they have is muscle tissue.
[Wild mammals are now largely confined to very marginal habitats and are unable to migrate to new food sources which greatly increases the risk of starvation.]
A 1960s study of Khoisan hunters in the Kalahari desert showed that they were barely affected by the worst drought in decades. Humans (and other predators) often benefit from extreme conditions such as droughts which concentrate game make hunting and scavenging even easier. Humans are far more versatile and resourceful than any other mammal.
Real world death by "starvation" normally occurs by disease or deficiencies of essential nutrients such as electrolytes or water soluble vitamins long before the enrgy stored in fat and muscle resources is depleted. The provision of adequate vitamins and minerals can add months to survival times.
Thousands Australian and British soldiers survived more than four years in Japanese run prisoner of war camp during WW2. They survived on a severely restricted calorie deficient diet consisting mostly of white rice (the medical staff cultured fungi to provide B group vitamins). They lost on average half their bodyweight.
Thought you might find this link interesting:
http://pubs.acs.org/cen/coverstory/85/8531cover.html
"Glycoimmunology specialist Jamey D. Marth of Howard Hughes Medical Institute at the University of California, San Diego, and coworkers have found that reductions in oligosaccharide branching and the consequent loss of cell-surface carbohydrates can also cause a diabetes-like disorder. They discovered that a particular glycosyltransferase enzyme must be active for a glucose transporter glycoprotein to stay on the surface of pancreatic β cells, the cells that manage blood glucose levels.
When expression of this glycosyltransferase is knocked out in mouse pancreatic β cells, glycosylation of the glucose transporter is reduced, its branching becomes less complex, and the glycoprotein is not retained on the cell surface. This causes a glucose-transport deficiency that makes the cells unresponsive to glucose and unable to secrete insulin when they should, thereby causing a diabetes-like condition. Marth and coworkers found that high-fat diets also knock down the enzyme's expression, showing how such diets might lead to diabetes."
Peter,
luckily you won't have any of these super-destructive "chickens" in your backyard. I get up to a dozen of them visiting each day summer. They will uproot an entire garden in a few hours and pile it in one spot.
http://en.wikipedia.org/wiki/Australian_Brush-turkey
M
I guess that's why the French, who've been eating a high fat diet for centuries, have such a high rate of this "diabetes like condition." And the Masai, who eat mostly animal fat and protein. And the Inuits who eat their traditional high fat diet. (Only those who switch to a western WOE develop diabetes.)
Experiments in mice are interesting, but only go so far--one can't' always extrapolate to humans.
@blogblog
"It is invariably deficits of essential nutrients that causes death by "starvation" rather than a shortage of calories."
In lay terms, enumerate such "essential nutrients" once again for me/us.
Hello and nice conversation as for diabetic Nutrition plays a vital role for securing. one should always take care of it to avoid many of the troubles.
http://pubs.acs.org/cen/coverstory/85/8531cover.html
Here, once again, I get to bitch about ignorant researchers. This study purports to show that a hi-fat diet can cause or contribute to diabetes.
The mouse food, however, is D12331. 58% of the calories comes from hydrogenated coconut oil.
Here's the article:http://www.ncbi.nlm.nih.gov/pubmed?term=Dietary%20and%20genetic%20control%20of%20glucose%20transporter%202%20glycosylation%20promotes%20insulin%20secretion%20in%20suppressing%20diabetes
What's new here. A diet of transfat is bad for mice? What a discovery!
Okay, that got screwed up. Here's the article:
Dietary and genetic control of glucose transporter 2 glycosylation promotes insulin secretion in suppressing diabetes
Cell. 2005 Dec 29;123(7):1307-21
@Big Whiskey
Essential nutrients are anything the body can't manufacture:
water
electrolytes (potassium/sodium)
vitamins
minerals
essential fatty acids
essential amino acids
In any real world starvation situation people will die from a lack of (in order):
water (1-7 days)
electrolytes (~4 weeks)
water soluble vitamins (>4 weeks)
essential amino acids
However it is usually a combination of effects that is fatal eg diarrhoea from a lack of vitamin B3 causing loss of electrolytes and severe dehydration
In many cases extended starvation causes irreversible organ damage - particularly in children - leading to death.
@blogblog,
Thanks for the response.
Michael, Margaretrc and M,
the links are very interesting, lots of reading on general glycosylation in the Marth article. Of course the high fat Surwit diet is sucrose/maltodextrin based with fully saturated (no trans fats) MCT oil. Aimed for hyperglycaemia. It's hard to mess up glycation when your particular high fat diet has minimal sucrose and induces normoglycaemia....
Peter
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