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Very Low-Carb Diets for Diabetes: Results of a Research Trial (Want to keep your heart & brain healthy as you age? See my other helpful, research-based posts in the Healthy Diabetes Living group forum (http://www.rvillage.com/group/878/diabetes-healthy-living) & the Healthy RVers (http://www.rvillage.com/group/80/healthy-rvers group forum at www.RVillage.com) ©2015, David Leonard, M.Ag., Nutrition Educator (retired), University of New Hampshire Cooperative Extension What You Can Learn From This Post 1. A quick review of why moderate-carb diets usually beat very low-carb diets (VLCD’s). 2. Results of a recent 12-month diabetes trial comparing an unusually healthy VLCD with a high-carb diet (HCD). I read the full journal article carefully and summarized the study & its conclusions (no distortions) 3. How to make the trial’s VLCD healthier if you want to try it Below is a quick recap on the downsides of most VLCD’s (RVillage members can see the full post at http://www.rvillage.com/groups/topic/view/group_id/878/topic_id/4316?query=P3RpdGxlPSZwYWdlPQ==): Too high in health-risky saturated fat, especially from red meat (see my 1/14/15 post at http://www.rvillage.com/groups/topic/view/group_id/80/topic_id/3515?query=P3RpdGxlPSZwYWdlPTM= ) Increased colon cancer risk Promotion of unhealthy inflammation which is linked to many diseases Too low in healthy carb sources like whole grains, whole fruit, veggies, and beans that are vital for overall wellness, especially protection against heart disease, high blood pressure, stroke, cancer, and dementia. But a well-designed VLCD can be reasonably healthy like the one used in a recent 12-month Australian trial with 110 obese adults (average wt. 224 lbs.) with type 2 diabetes and aged 35-68 (Journal reference: American Journal of Clinical Nutrition 2015;102:780-90 at http://ajcn.nutrition.org.libproxy.unh.edu/content/102/4/780.abstract ). They were randomly assigned to 2 groups: A VLCD diet (about 54-75 g carbs daily or about 14-17% calories from carbs. 1 g carbs = 4 cals. A “high-carb” diet (HCD) with about 202-218 g carbs daily or 50-52% cals. from carbs. The typical American diet averages 50%. Both diets aimed to reduce weight, so the calorie content was individually tailored to create a 30% deficit. So, if someone needed 2000 calories a day to maintain their current weight, they were prescribed 1400 calories. Both diets averaged 1430 cals. but varied from 1357-2143, depending on the person’s initial weight. Note that both groups did three 60-minute exercise sessions weekly (moderate intensity aerobics + strength training). The Trial’s Detailed Results (after one year) 1. Average weight loss for both groups was statistically equal (21.6 lbs. for the VLCD, 22.4 lbs. for the HCD). The same for reductions in body fat & waist circumference. 2. Average A1c fell by 1.0% in both groups. 3. 24-hour blood sugar stability improved in both groups, but the VLCD group did significantly better on 2 out of 4 types of tests used to measure blood sugar variability. This means they were likely to spend less time in the high blood sugar range (above 140 mg/dl). However, experts disagree on the validity & significance of these 2 tests called CONGA-1, CONGA-4. 4. Diabetes medication reduction: Despite the similar 1% A1c reduction in both groups, 52% of VLCD members were able to reduce their oral diabetes meds by 20% of more vs. 21% in the high-carb group. 5. Cholesterol & blood pressure med reduction: More VLCD than HCD participants were able to reduce these meds, but the difference wasn’t statistically significant. 6. Both groups equally improved their total cholesterol, LDL cholesterol, blood pressure, CRP (a measure of inflammation), and insulin sensitivity (how well your body’s own or injected insulin works). But the VLCD group had greater improvements in triglycerides (a 35 point drop vs. 1 pt. drop) and good HDL cholesterol (4 point rise vs. a 2.4 point rise). Overall Trial Summary 1. Both diet groups improved their scores on some 24 different health measurements compared to baseline. 2. There was no statistical difference between groups in weight loss, A1c reduction, and improvements in total cholesterol, LDL, blood pressure, and inflammation. 3. But the VLCD was better in improving HDL and triglycerides and also provided better blood sugar stability based on 2 out of 4 types of tests. 4. Over twice as many VLCD participants were able to reduce their diabetes meds than in the HCD group. And the Winner Is? So, is this unusually healthy VLCD is the way to go? Not necessarily. Consider This 1. The trial didn’t include a moderate-carb diet (about 40% cals. from carbs) which is recommended by Joslin Diabetes Center (Boston) and also backed by impressive research, especially if it’s Mediterranean-style (see my 2/6/15 post at http://www.rvillage.com/groups/topic/view/group_id/80/topic_id/3684?query=P3RpdGxlPSZwYWdlPTI= ). It might well have equaled the VLCD’s superior blood sugar stability while also providing a greater range of overall health benefits like cancer and dementia protection by including more healthy carb sources. For a description of a Mediterranean diet, go to http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid. NOTE: A diet with 40% cals. from carbs would equal 640 carb calories (160 g of carbs) in a 1600-cal. diet or 720 carb cals. (180 g of carbs) in an 1800-cal. diet). 2. If you want to try this healthy VLCD, consider adding some “tweaks” (see below) that will make it even healthier. The same with the HCD. CAUTION! Always check with your physician or registered dietitian before making dietary changes. 3. Participants were actively losing weight & exercising during the trial which tends to optimize a diet’s benefits, help overcome any downsides, and also aid weight loss. In fact, adding an extra 2 days a week of aerobics (5 days total) would likely help the HCD group lower triglycerides more and also enable more of them to reduce their diabetes meds. Details On the Trial’s VLCD 1. Fat: It was unusually low in health-risky saturated fat, averaging about 17-21 g daily, but not as low as the HCD (13-17 g). Both diets emphasized healthy polyunsaturated and monounsaturated fat. In both groups, sat. fat crept up over the months with the VLCD group exceeding recommended daily limits halfway through the trial. Solution: Eat more broiled/baked fish and skinless chicken and less pork & beef (Australians love their meat!). 2. Fiber: The VLCD had an unusually high & healthy 25 g from actual foods rather than supplements. The high-carb diet averaged 31 g. The typical American adult has about 17 g. 3. Grains: One ounce (about 80 calories) extra-high-fiber, low glycemic index cereal (type not specified but likely similar to ½ cup Kellogg’s All Bran Original (10 g fiber) or 1/3 cup All Bran Buds (13 g fiber). You could use oatmeal occasionally but its lower in fiber even though it’s whole grain. The HCD used about 1.3 oz. of high-fiber cereal (2/3 cup All Bran Original or just under 1 cup All Bran Buds). One high-fiber whole-grain crispbread like Wasa brand (2 g fiber, 60 cals.). The HCD used 5 crispbreads + 2 slices of whole wheat bread. 4. Major proteins sources: 9 oz. of lean chicken, red meat (pork & beef), and fish 3-4 times a week. Suggestion: Keep red meat to 3-4 oz. (about a deck of cards) 2-3 times weekly. Higher amounts are linked to higher mortality plus breast and colon cancer. Focus on skinless chicken and baked/broiled fatty fish like salmon, arctic char, sardines, pollock, rainbow trout which are rich in healthy omega-3 fat (see my 3/1/15 post at http://www.rvillage.com/groups/topic/view/group_id/80/topic_id/3847?query=P3RpdGxlPSZwYWdlPTI= ). The HCD used 3 oz. of red meat 4 times a week + 3 oz. of fish twice a week + 3 oz. of beans once a week. Consider replacing some meat with soy foods like tofu and textured vegetable protein (virtually no carbs) or with egg whites. 5. Nuts: About 1.5 oz. almonds (36 or just over ¼ cup) and ¾ oz. pecans (13 halves or just under ¼ cup). Could substitute walnuts (14 halves = 1 oz.), pistachios (49 kernels per oz.), or peanuts (just under ¼ cup per oz.). Cashews have fewer documented health benefits. (See my 4/7/15 post at http://www.rvillage.com/groups/topic/view/group_id/878/topic_id /3973?query=P3RpdGxlPSZwYWdlPTI= ). The HCD had no nuts but would have benefited from them. 6. Veggies: 3 cups low-starch veggies daily (omit potatoes, sweet potatoes, corn, but carrots, peas are OK). The HCD had the same amount but didn’t exclude starchy veggies. Focus on those with the best research-proven benefits: broccoli, dark green leafy veggies (like kale, pack choy, turnip greens), beets, garlic, carrots, winter squash. Note that it takes 3-4 cups of raw, leafy veggies to equal a cup of non-leafy veggies or cooked leafy veggies, so 3 cups of fluffy salad is a far cry from 3 cups of regular veggies. 7. No fruit, but it’s an important part of a healthy diet. No reason you can’t add modest amounts of lower glycemic index fruits like cherries, strawberries, blueberries, prunes, and plums. (See my 1/10/15 post at http://www.rvillage.com/groups/topic/view/group_id/80/topic_id/3484?query=P3RpdGxlPSZwYWdlPTM= ). The HCD had 14 oz. fruit daily (equal to 1 med. banana + 1 med. apple + ¾ cup blueberries) 8. Dairy Skim milk: Just under a cup. The HCD used 1 cup 1-2% milk. Diet yogurt: just under ½ cup. The HCD used about 2/3 cup non-diet reduced fat yogurt (no mention of whether plain or added sugar; plain with your own fruit is best). ¾ oz. regular cheese. Same with the HCD. 9. Fats & oils: 6 teaspoons vegetable oil high in monounsaturated fat like canola or olive oil or use a trans-fat-free spread. The HC diet used 5 teaspoons. Extra virgin olive oil has the most all-around health benefits which kick in at around 5 to 6 teaspoons. California Olive Ranch brand got good reviews by Consumer Reports and is available at Walmart. See my 5/17/15 EVO post at http://www.rvillage.com/groups/topic/view/group_id/80/topic_id/4450?query=P3RpdGxlPSZwYWdlPQ== IMPORTANT DISCLAIMERS The info presented in this post should not replace professional medical or dietary advice, diagnosis or treatment. Always consult your registered dietitian or physician before making any significant dietary changes. Don't ignore professional medical advice due to the info presented here