An Association Study Against LCHF

There is one study that looks bad for LCHF. It looks bad mostly based on the name of the study rather than the science (American Journal of Epidemiology, Volume 134, Issue 6, 15 September 1991, Pages 590–603. High-Fat, Low-Carbohydrate Diet and the Etiology of Non-Insulin-dependent Diabetes Mellitus: The San Luis Valley Diabetes Study. Julie A. Marshall Richard F. Hamman Judith Baxter).

The study (1990) suggests that High Fat diets are associated with onset of non-insulin dependent diabetes mellitus.

The findings support the hypothesis that high-fat, low-carbohydrate diets are associated with the onset of non-insulin-dependent diabetes mellitus in humans.

The problem is that, at least in the abstract, there’s no evidence that the people were on anything at all related to a Low Carbohydrate diet. That was inferred based on the High Fat. But you don’t need to go any farther than your local McD’s to know that french fries are both high in fat and high in carbs.

When you look close you can see that the study was an association study not a Randomized Control Trial. Association does not prove causation. Just because people who got diabetes at lower carb/higher fat diets doesn’t mean that the diet caused the diabetes.

This paper (Risk Factors for Non-Insulin Dependent Diabetes. Marian Rewers, MD, PhD, and Richard F. Hamman, MD, DrPH) lists quite a few studies on this subject (Table 9.6) and includes a helpful comment:

There are substantial methodological problems in measuring exposure to behavioral factors such as physical inactivity and diet pp 179-181. Most studies have used a single recording of activity or diet as a measure of exposure. While it is assumed that such point estimates are correlated with habitual exercise or intake, it is uncertain what period of time is necessary to obtain the most valid estimates

 

Status 2016-08-24

Saw an unbelievable sight when I woke up at 5 AM. My blood glucose reading was 100. I can’t remember ever seeing 100 when I was pumping Insulin.

Weight is down a couple of lbs in the past couple of days. Wish I had started tracking from the start. I am down 16 lbs from Aug 5th. My rough guess is about 20 lbs so far since I started IF on July 31.

My blood sugar readings average in the past 3 days has been 115. That’s down from my previous 7 day average of 125. Also, I did switch to the Bayer Contour Next and it reads a bit higher than the OneTouch UltraLink I was using before.

So, all of the trends are good. I’ve been trying hard on the diet to eat higher fat and lower protein. Seems to be paying off. Combining LCHF with IF looks to me to be the cure-all for Type 2 Diabetes. At least in me. Your mileage, as they say, may vary.

Still taking Metformin 2x, 625 mg. Stopped taking  Avorstatin. Considering stop taking Niacin since it is listed as raising blood sugar when taken in combination with Metformin.

 

Alcohol and LCHF+IF (Aug 23, 2016)

Lost my taste for alcohol and haven’t wanted one in a couple of days. Haven’t had one either. Wanted to want to have a beer last night and I know that the low calories I had eaten for dinner would leave me hungry so I tried to talk myself into going and getting a beer. Couldn’t do it.

Not sure if it is my desire to keep down carbs or just not enjoying the taste as much when I am on ketosis.

Surprised that it is noon and I am not feeling particularly hungry since my dinner was just a double paddy burger without a bun at Five Guys last night.

Starting to enjoy being in ketosis.

 

One Week Off Insulin (Aug 23, 2016)

I’ve been off Insulin for a full week now.

So why am I still alive? After all, I needed 100 units a day on the average just one month ago. But here I am. Still Alive!

So did I just decide to ignore my Blood Glucose levels and am I on the edge of dying? Hardly. I’m still checking multiple times a day – mostly now in disbelief at how well my blood sugar is being regulated by my body. My high today was 124 and my low so far today is 109. I never got numbers like that before day after day on Insulin.

For dinner last night I took the kids out to Five Guys Burgers and Fries. I skipped the fries. I ate a bunch of peanuts and more importantly had my burger “bunless”. The choice to replace the bun with lettuce was a good one since it took away about 40 grams of carbs and left about 1 gram. The fat ratio was good and the jalapenos, etc didn’t add much to the carb count but they did add to the flavor.

All of that made my Blood Sugar at 103 around bedtime.

Addendum : Still taking Metformin. Not out of the T2D woods yet.

Weight Loss Numbers

Weight Loss on LC-HF+IF is a very strange thing. It goes in real spurts. Yesterday I dropped two lbs. Last week I had two days in a row where I lost five lbs each day. Most days I am about the same or down just a fraction of a lb.

I am down 14 lbs from a couple of week ago. I didn’t weigh myself at the start so I don’t know what weight I was to start with. I think I weighted 292 on the work scale (clothed of course).

Comparison of Various Diets

A two-year long comparison of three diets was done in Israel (N Engl J Med 2008; 359:229-241. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Shahar, R.D., Ph.D., Shula Witkow, R.D., M.P.H., Ilana Greenberg, R.D., M.P.H., Rachel Golan, R.D., M.P.H., Drora Fraser, Ph.D., Arkady Bolotin, Ph.D., Hilel Vardi, M.Sc., Osnat Tangi-Rozental, B.A., Rachel Zuk-Ramot, R.N., et al., for the Dietary Intervention Randomized Controlled Trial (DIRECT) Group). Although the focus was on weight loss they looked at other lipids, etc. The participants were:

We conducted the trial between July 2005 and June 2007 in Dimona, Israel, in a workplace at a research center with an on-site medical clinic. Recruitment began in December 2004. The criteria for eligibility were an age of 40 to 65 years and a body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) of at least 27, or the presence of type 2 diabetes (according to the American Diabetes Association criteria) or coronary heart disease, regardless of age and BMI.

the mean age was 52 years and the mean BMI was 31. Most participants (86%) were men.

Patients were assigned one of three diets, Low-Carb, Mediterranean, and Low-Fat.

So, what happened to their weight?

The overall weight changes among the 322 participants at 24 months were −2.9±4.2 kg for the low-fat group, −4.4±6.0 kg for the Mediterranean-diet group, and −4.7±6.5 kg for the low-carbohydrate group.

Other measurements were

The waist circumference decreased by a mean of 2.8±4.3 cm in the low-fat group, 3.5±5.1 cm in the Mediterranean-diet group, and 3.8±5.2 cm in the low-carbohydrate group (P=0.33 for the comparison among groups).

Didn’t eating all that fat, meat and cheese cause them a cholesterol ratio problem? Not so much. Again LC came out on top since their HDL (good) number went up.

HDL cholesterol (Figure 3A) increased during the weight-loss and maintenance phases in all groups, with the greatest increase in the low-carbohydrate group (8.4 mg per deciliter [0.22 mmol per liter], P<0.01 for the interaction between diet group and time), as compared with the low-fat group (6.3 mg per deciliter [0.16 mmol per liter]).

Overall, the ratio of total cholesterol to HDL cholesterol (Figure 3D) decreased during both the weight-loss and the maintenance phases. The low-carbohydrate group had the greatest improvement, with a relative decrease of 20% (P=0.01 for the interaction between diet group and time), as compared with a decrease of 12% in the low-fat group.

The conclusions followed:

In this 2-year dietary-intervention study, we found that the Mediterranean and low-carbohydrate diets are effective alternatives to the low-fat diet for weight loss and appear to be just as safe as the low-fat diet. In addition to producing weight loss in this moderately obese group of participants, the low-carbohydrate and Mediterranean diets had some beneficial metabolic effects, a result suggesting that these dietary strategies might be considered in clinical practice and that diets might be individualized according to personal preferences and metabolic needs.

And.

The similar caloric deficit achieved in all diet groups suggests that a low-carbohydrate, non–restricted-calorie diet may be optimal for those who will not follow a restricted-calorie dietary regimen. The increasing improvement in levels of some biomarkers over time up to the 24-month point, despite the achievement of maximum weight loss by 6 months, suggests that a diet with a healthful composition has benefits beyond weight reduction.

As a note:

Labeling the “low-carbohydrate” diet as such is questionable, since 40 to 42% of calories were from carbohydrates from month 6 to month 24, and data regarding ketosis support this view.

Here is another great study on the same subject (N Engl J Med 2003; 348:2074-2081. A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity. Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D.).

 

Metallic Taste in your Mouth?

If you have done a Low Carb High Fat (LCHF) diet for more than a few days you entered ketosis and likely experienced that metallic taste in your mouth.  That taste is acetone. It is the marker that you are in ketosis. It’s being produced in your lungs (Acetone as biomarker for ketosis buildup capability–a study in healthy individuals under combined high fat and starvation diets).

Using a Fisher LDS pair-wise comparison, higher significant levels of acetone buildup were found for diets with 79% fat content and 90% fat content vs. 29% fat content (with p = 0.00159**, and 0.04435**, respectively), with no significant difference between diets with 79% fat content and 90% fat content.

Also,

In addition, independent of the diet, a significantly higher ketone buildup capability of subjects with higher resting energy expenditure (R(2) = 0.92), and lower body mass index (R(2) = 0.71) was observed during FK.

 

 

 

 

Sugar vs Aspartame vs Stevia

Adding more fuel to the fire about diet drinks. A study looked at the difference between sugar, Aspartame and Stevia as sweeteners (Appetite. 2010 Aug; 55(1): 37–43. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Stephen D. Anton, Ph.D., Corby K. Martin, Ph.D., Hongmei Han, M.S., Sandra Coulon, B.A., William T. Cefalu, M.D., Paula Geiselman, Ph.D., and Donald A. Williamson, Ph.D.).

The subjects were

Two sets of participants were recruited for the present study: 1)19 lean individuals (BMI = 20.0 – 24.9 kg/m2) and 2) 12 obese individuals (BMI = 30 – 39.9 kg/m2) with waist circumferences of at least 36 inches for females and 40 inches for males.

The test was:

completed three separate food test days during which they received preloads containing stevia (290 kcal), aspartame (290 kcal), or sucrose (493 kcal) before the lunch and dinner meal

The result was:

Stevia preloads significantly reduced postprandial glucose levels compared to sucrose preloads (p < .01), and postprandial insulin levels compared to both aspartame and sucrose preloads (p < .05).

 

Unfortunately they didn’t do this study with a placebo so there’s no proper baseline to determine the no-sweetner baseline. However, the conclusion can’t be missed that Aspartame, in this particular study, added to the Glucose level in the blood.

 

Numbers/Charts (Aug 18, 2016)

I shut off my Insulin Pump 36 hours ago.

My Blood Glucose numbers have been great.

This will be my last Insulin dosage chart since I am no longer on Insulin. I am still on Metformin.

I will probably post numbers like these:

7 day average – 123
14 day average – 124
30 day average – 137

The LC-HF plus IF dieting has been going great. Easy to do. I don’t get hungry until after 2 PM which is when my blood sugar goes down to around 104 or so.

 

Low Fat = Bad News

This is not exactly new news but the prevalent “low-fat is the best diet” keeps getting hit in the face by real studies.

Here’s a study from 2002 (Diabetes Care 2002 Apr; 25(4): 652-657. Effects of Energy-Restricted Diets Containing Increased Protein on Weight Loss, Resting Energy Expenditure, and the Thermic Effect of Feeding in Type 2 Diabetes. N.D. Luscombe, BSC HON1, P.M. Clifton, MD2, M. Noakes, MSC, PHD2, B. Parker, BSC HON1 and G. Wittert, MD).

The subjects were:

26 obese subjects with type 2 diabetes

The subjects:

consumed a HP (28% protein, 42% carbohydrate) or LP diet (16% protein, 55% carbohydrate) during 8 weeks of energy restriction (1,600 kcal/day) and 4 weeks of energy balance.

What was measured:

Body weight and composition and REE [ed: Resting Energy Expenditure] were measured, and the TEF in response to a HP or LP meal was determined for 2 h, at weeks 0 and 12.

Unlike what the low fat crowd would like us to hear:

In patients with type 2 diabetes, a low-fat diet with an increased protein-to-carbohydrate ratio does not significantly increase weight loss or blunt the fall in REE.

Ouch, that one has to hurt.

 

Freed from the Insulin Pump (August 17, 2016)

Yesterday morning I shut off my insulin pump and removed it from my body. Last night I removed the infusion set.

This afternoon my blood glucose is 114.

Life is good. Other than a cold I caught from my teenage son, that is and it will pass soon enough.