Cyclical Ketogenic Diets Review

4 Cycle Fat Loss Solution

This new and innovational approach to dieting created by Shaun Hadsall might be what people need. Shaun believes that when people do not provide their body with the right amount of nutriments, diet plan, exercises and vitamins, their weight escalates with time. The main idea is to force your body into using stored fat (instead of carbs and protein) as your primary source of energy via precision dieting. That is, the exact schedule and timing of your diet is as important as what foods your diet contains. 4 Cycle Fat Loss Solution is a 100% healthy and results-oriented plan to eat right, to drop off unwanted weight and to stay physically fit forever. With the 4 Cycle Fat Loss Solution, you learn about how your body works with high carb foods and why the information that you have been told about them is simply false. The methods taught in the program have been proven over many years and are backed by science. More here...

4 Cycle Fat Loss Solution Overview


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What Is The Scientific Basis For Recommending High Carbohydrate Intake

There is no doubt that the goal of increasing carbohydrate intake was actually to reduce fat consumption, especially saturated fat. People with diabetes were no longer dying of diabetic ketoacidosis but coronary heart disease. In fact, some experts suspected that the prescribed high-fat (and high saturated fat) diabetic diets might actually be partly responsible for the heightened risk of cardiovascular disease among people with diabetes. Several well-designed intervention studies in diabetic subjects were undertaken and showed that high-carbohydrate diets (55-70 energy) could result in lower blood cholesterol and TG levels with no deterioration in glycaemic control compared to traditional 'diabetic' diets containing less carbohydrate and more saturated fat (12-14, 21-25). Indeed, much to their surprise, HbA1c, glucose tolerance and fasting glucose were often improved following treatment with a high-carbohydrate diet. This implied that insulin sensitivity was improved on a higher...

The low carbohydrate group

These diets are based on the claim that carbohydrates promote hunger. By reducing or eliminating them, you lose your hunger as you lose your weight. The first of them, the Atkins Diet, promotes any kind of protein, including protein high in fat. Naturally, other diets were developed promoting very little carbohydrate but less fatty protein. Here are your choices Atkins Diet This plan allows any quantity of meats, shellfish, eggs, and cheese but doesn't permit high-carbohydrate foods like fruits, starchy vegetables, and pasta. Small quantities of the forbidden foods are added in later. The program does recommend exercise but doesn't suggest changes in your eating behavior. South Beach Diet This diet restricts carbohydrates while the recommended proteins are low in fat, unlike the Atkins Diet. Daily exercise is an important component, but the plan doesn't suggest any changes in eating behavior. Over time some carbohydrate is reintroduced into the diet. Zone Diet In this diet, you have...

Low Carbohydrate Diets

Given that very-low-fat diets typically are high in carbohydrates, it is interesting that in recent years, low-carbohydrate (low-carb) diets have become extremely popular. Two of the most popular low-carbohydrate diets are the Atkins and the South Beach Diets. The books that describe these diets are currently among the bestselling books in the country. The Atkins Diet has been through several versions, but all of them encourage eating red meat, which is rich in saturated, unhealthy fat. More recent high-fat diets have begun to emphasize foods that have healthier forms of fat. Nevertheless, the low-carb diets must include relatively higher fat and protein content. It may seem peculiar even perverse that these weight loss programs would recommend a high-fat-content diet, considering that most of the evidence (reviewed in Chapters 1 and 2) strongly supports high-fat diets as being part of the cause of the epidemic of obesity and diabetes. But the low-carb, high-fat programs are based on...

Historical Perspectives On Carbohydrate

Before the discovery of insulin in 1922, diets prescribed for diabetes were very low in carbohydrate, around 5 of energy, and very high in fat, around 75 reviewed by Truswell (11) . Even after the advent of insulin, doctors were cautious and very low carbohydrate diets continued. By 1930, diet prescriptions of carbohydrate had risen to 15 of energy. In the 1940s and 1950s, carbohydrate allowances had come up to 25-30 of energy and carbohydrate exchange lists came into use. There was little questioning of the principle that carbohydrates were bad for people with diabetes and focus was on the insulin treatment. By the 1970s pharmaceutical treatments had expanded with the introduction of oral hypoglycaemic drugs and the average carbohydrate intake rose to about 40 energy. Prohibition of sucrose was now the main message. With extreme caution, several experimental studies compared higher carbohydrate diets (> 50 energy) with the traditional diabetes diet and found improved glucose...

Recent Developments

Low-carbohydrate diets are not recommended for routine management of patients with diabetes.5 This is because carbohydrates are important sources of energy and carbohydrate-containing foods also contain other important nutrients. The concept of glycaemic load has emerged. This is a notional product of the amount of carbohydrate consumed and the availability of the carbohydrate. High glycaemic load predisposes to obesity and glucose intolerance. Low glycaemic index (GI) diets, in which the carbohydrate is slowly broken down and released, are currently very popular. A recent randomized, controlled trial of a low GI diet6 confirmed the potential of such diets to improve glycaemic control in patients with type 2 diabetes.

Carbohydrate and Type Diabetes

The recommended intake of carbohydrate for people with diabetes is 45 to 60 of total energy intake (Table 2). Provided that foods rich in fiber and with low-glycemic index predominate, there are no known deleterious effects with this range of carbohydrate intake. When carbohydrate intakes are at the upper end of the proposed range, restriction of carbohydrate to around 45 of total energy and a partly replacement of carbohydrate by monounsaturated fat may be tried for some patients with unsatisfactory glycemic control. However, there is concern that increased fat intake might promote weight gain and potentially contribute to insulin resistance. The advice for carbohydrate intake should therefore be individualized, based on nutrition assessment, metabolic results and treatment goals, however, there is no justification for the recommendation of very low-carbohydrate diets in persons with diabetes (8,43).

Comments on figure

In each of these tests the input was 12 grams of glucose and a cup of hot decaffeinated tea with dairy creamer, which included about 6 grams of carbohydrate. The tests were taken during a period when the BG control was being improved by means of a low-carbohydrate diet. The results do not show any increase in body sensitivity to glucose when a low-carbohydrate diet is in place, as reported for some healthy individuals elsewhere 6 . In fact just the opposite occurred. My body was better able to accommodate a glucose challenge when it had enjoyed a rest period with reduced BG values. Of particular interest is the slower initial increase in BG in the most recent test, as if my basic body response has been improved. These results lend support to the expectation that insulin resistance will decrease and some beta cells will recover when a lower BG environment is maintained 7 .

Improvement of endothelial function

Endothelial dysfunction leads to defects in insulin-mediated glucose uptake. Blockade of vascular nitric oxide synthesis with L-arginine analogue also impairs endothelial dependent va-sodilation. Endothelial function improves with exercise, a low-fat, low-carbohydrate diet, and with use of statins and ACE inhibitors (Table 5) 29,59,67 . Angiotensin I blockade has not shown any improvement of endothelial dysfunction, but benefit has been noted with peroxisome pro-liferator activated receptor gamma (PPAR-y) stimulator, antioxidants, hormone replacement therapy, and L-arginine 66,68,69 . In addition, the ACE inhibitor quinapril significantly improved endothelial function in multiple studies, both in normotensive volunteers and in subjects with coronary artery disease 70-77 .

Experiments Varying The Bodys Dietary Inputs

This section describes my responses to various foodstuffs. It consists primarily of graphs that are labeled to indicate the substances under test. Each test is briefly discussed. The actual data points are given and connected by straight lines. In some of the graphs this gives rise to small perturbations, rather than a smooth curve. No explanations are attempted for these perturbations. They are believed to be real and not simply the result of meter errors. However, it is easy to visualize a smooth curve interpolated between the points to give the average BG, which is the prime interest. The main focus of the work took place over a period of about 12 months and involved testing many different foodstuffs. There is a chronological factor to be considered in the results because as time progressed I observed improvements in my glucose system response because of the integrated effects of a different diet. Thus, for example a BG response in November 1996 will not appear as favorable (low)...

Keeping A Check On Your Progress

4 15 97 5833 Start good' control using low carbohydrate diet. 1. A low carbohydrate diet to achieve good BG control initially improved my response to a glucose stimulus. However, I'm still a type 2 diabetic and must maintain good BG level control to prevent my diabetes from worsening. 3. Over a 3 -year period my response to a glucose stimulus has worsened a little, but use of a low carbohydrate, low glycemic index diet to achieve near normal HbA1c appears to have prevented significant deterioration in my diabetes condition.

Dietary nutrient composition in type diabetes

There is considerable evidence in support of high fat, relatively low-carbohydrate (but high sugar), low-fibre diets of Western societies being a major aetiological factor in susceptible individuals. Excess dietary fat is more easily converted to adipose tissue lipid stores than carbohydrate (Flatt, 1985) diet-induced thermogenesis is less with fat than carbohydrates or protein thus inducing lower metabolic rates with high fat diets (Lean and James, 1988 Lean et al., 1989) dietary fat has minimal effects on both appetite and satiety (Caterson and Broom, 2001) hyperinsulinaemia has been associated with high fat intakes possibly through components of the hormonal enteroinsular axis (Grey and Kip-nes, 1971). The associated hyperinsulinaemia will favour further fat deposition and aggravate the insulin resistance of type 2 diabetes, increasing the associated metabolic dysregulation, e.g. dyslipidaemia (Figure 6.3). Table 6.2 Advantages of high carbohydrate versus high fat intake in...

Meal replacement therapy

Many companies offer meal replacement techniques in an effort to reduce weight. Such therapies can be based on standard low energy intakes but are nutrient complete (e.g. Slimfast) or are based on low-carbohydrate intakes (e.g. Modifast, Cambridge Diet, etc.). The success of such treatments remains to be confirmed and appropriate trials in this area are sadly lacking, especially in the management of type 2 diabetes. Recently 'Diet Trials' on BBC television examined in detail meal replacement therapies and found these to be as good as but no better than other weight loss strategies when compared to no therapeutic approach. (Truby, personal communication.)

What are the general nutritional principles in DM

The nutritional recommendations for diabetic patients have been the object of various studies, discussions and revisions over the last 80 years. Before the discovery of insulin in 1921, the nutritional recommendations concerned 'hunger-diets' and an almost complete deprivation of food. After the discovery of insulin, the fear that 'sugar is bad' in DM led to diets of low carbohydrate and high fat content, until it was realized that the high content of fat in the diet, and particularly saturated fat, was what really harmed diabetic patients and led to the complications of the disease, mainly from the cardiovascular system. Today the recommendations for DM have been re-evaluated and include a more liberal approach with regard to carbohydrates and mono-unsaturated fat (basically olive-oil), but more limited with regard to saturated (animal) fat. Also, the supply of plenty of dietary fibre in the diet is considered very important.

Nutrients That Can Help

Gadek, M.D., of Ohio State University Medical Center, found that respiratory distress syndrome in hospitalized patients had significant improvements after they were fed a low-carbohydrate formula with vitamins E and C, beta-carotene, omega-3 fatty acids, and gamma-linolenic acid.

Composition Of Specialist Feeds For The Management Of Hyperglycaemia

Coulston has recently reviewed the clinical experience of modified enteral formulas for managing diabetic patients. Most of the evidence used to support the use of specialised enteral feeds in diabetic management has been extrapolated from the general diabetic literature and is aimed at avoiding hyperglycaemia (11). Promotional literature from the different nutritional companies is primarily based on dietary guidelines and not based on clinical studies. Although some studies have looked at the glycaemic effect of different liquid formulas given as oral test meals (high-fibre, low-carbohydrate, standard formula) (13), long-term studies are lacking. Only short-term studies have been carried out using specialised oral diets in which carbohydrate content is reduced by increasing MUFA content. These short-term studies have been undertaken either as single test meals or over short periods of time involving relatively few subjects.

How Well Do They Really Work

Research comparing the low-carb, high-fat Atkins Diet the high-protein, moderate-carb Zone Diet the very-low-fat, high-carb Ornish diet and the low-fat Weight Watchers diet has shown that each of these helps people lose weight. Why Because each one helps people take in fewer calories. program.) In this study, all of the diets lowered cholesterol levels however, the Ornish diet reduced the LDL cholesterol (bad cholesterol) by 10 percent, whereas the Atkins Diet reduced LDL cholesterol by 2 to 3 percent. Other recent studies have compared the low-carb, high-fat Atkins Diet (20 to 30 grams carbohydrates per day) to a moderately low-fat diet (25 to 30 percent fat and 500-calorie-per-day deficit). The results may remind you of the story of the tortoise and the hare. At six months, those assigned to the Atkins Diet had lost more weight than those assigned to the low-fat diet. Yet at one year, there was no significant difference in the weight loss between those on the Atkins Diet and those...

Carbohydrate And Plasma Lipids

High-carbohydrate diets are reported to increase TG, mainly in short-term studies (29). However, most of these studies have been poorly controlled and have been very short term and thus the evidence is poor. Turley et al. (30) recently demonstrated that free-living healthy subjects randomised to a high-carbohydrate diet (59 ) had no detrimental effect on fasting TG concentrations over a six-week period.

What Are The Potential Adverse Effects Of Highcarbohydrate Diets

During the 1980s and 1990s, a number of controlled intervention studies in healthy individuals who maintained their body weight showed that high-carbohydrate diets often resulted in higher blood TG levels and lower HDL-cholesterol levels - changes that are atherogenic and increase the risk of coronary heart disease - despite improved total and LDL-cholesterol levels (29). These findings sparked particular concern for people with diabetes because their lipid abnormalities tended to be higher TG and lower HDL-cholesterol level rather than the high total and LDL-cholesterol typically observed in non-diabetic individuals (18). Hence the magnified risk of atherosclerosis in people with diabetes might be related to blood lipid risk factors that are specifically worsened by high-carbohydrate diets. The biochemical mechanisms responsible for increased plasma TG levels following low-fat, high-carbohydrate diets remain uncertain but are clearly different to those responsible for elevated TG...

The Scientific Basis For Recommending Highmufa Diets For Diabetes

Many diabetes experts argue in favour of allowing a higher MUFA intake for people with diabetes, on the grounds that high-carbohydrate diets can increase blood glucose, insulin and TG levels and reduce HDL-cholesterol levels. A meta-analysis of nine studies with a total of 133 subjects comparing these two approaches to diet therapy in patients with diabetes revealed that high-MUFA diets (22-33 of energy intake total fat 37-50 energy) improved lipoprotein profiles as well as glycaemic control (19). Compared to high-carbohydrate diets (50-60 energy intake), high-MUFA diets reduced fasting TG and VLDL-cholesterol levels by about 20 and caused a modest increase in HDL-cholesterol (4 ) but had no effect on LDL-cholesterol. There was no evidence that high-MUFA diets induced weight gain in these tightly controlled studies. However, there are several limitations that need to be raised before deciding whether they provide sufficient evidence to formulate recommendations for therapeutic diets...

Diets For Weight Control Is The Amount And Type Of Carbohydrate Important

Weight loss is usually a major treatment goal in Type 2 diabetes, but the ideal dietary composition for weight control is still the subject of debate. Many health professionals are concerned that high-fat diets, irrespective of the type of fat, might promote weight gain. The prevalence of obesity is often lower in people with high carbohydrate consumption (expressed as a percentage of energy) than in those with high fat intakes (but this is not always true). In animal studies, high-fat diets induce faster weight gain and greater insulin resistance compared with high-carbohydrate diets, whether fed ad libitum or isocalorically (50). In humans, several studies have shown that ad libitum

Current Recommendations For Carbohydrate Intake

For the past 20 years, most diabetes associations around the world have recommended high-carbohydrate diets that are low in fat and high in fibre for people with diabetes (15,16). The British Diabetic Association's recommendations state that carbohydrate should provide 50-55 of the total energy content of the diet while fat should contribute 30-35 of energy intake, of which < 10 should be saturated fat, < 10 polyunsaturated fat (PUFA) and 10-15 monounsaturated fat (MUFA) (17). However, there is concern in some quarters that 50-55 of the total energy intake as carbohydrate may have adverse effects on blood triglyceride (TG), HDL-cholesterol and glucose levels compared with high-fat diets (> 35 total energy) enriched with MUFA (18,19). During the 1990s, this issue has been the focus of much research. On the basis of the resulting evidence, the American Diabetes Association's guidelines now recommend that 60-70 of energy be divided between carbohydrate and monounsaturated fat,...

The Inflammation Syndrome Connection

The high-sugar and high-carbohydrate diets that lead to obesity raise glucose levels, and elevated glucose spontaneously generates large numbers of free radicals. These free radicals stimulate the inflammatory response, which can increase the risk of coronary artery disease, cancer, Alzheimer's, and many other diseases. In addition, abdominal fat cells secrete large quantities of pro-inflammatory interleukin-6 and C-reactive protein. In overweight and obese people both of these substances help maintain a state of chronic inflammation.

The Satiety Value Of Highcarbohydrate Diets

The satiating capacity of high-carbohydrate diets may be the major explanation for weight control benefits. The energy density of foods strongly influences the amount of food people consume and consequently influences body weight (61). High-fat foods are energy dense, very palatable and less satiating, a combination which makes them easy to 'passively overconsume' (62). On the other hand, less refined, 'natural' high-carbohydrate foods (legumes, wholegrains, fruits and starchy vegetables) are more bulky and difficult to overeat. In laboratory studies comparing the short-term filling powers of equal-calorie portions of different foods, the weight of food per 1000 kJ was the strongest determinant of short-term satiety (63). However, many new reformulated low-fat foods on the market (e.g. snack products, biscuits, ice cream, yoghurt) are as energy dense as their full-fat counterparts and unlikely to offer weight control benefits.

Von Willebrand Factor

Interestingly, the concentration of vWF significantly decreases in patients who consume a diet high in monounsaturated fat (77), although no changes were observed in patients placed on a high-carbohydrate diet. Whether or not the effects of monounsaturated fat are secondary to their ability to decrease susceptibility of LDL to oxidation in vitro and presumably in vivo is not known, but it should certainly be considered because of the numerous reports connecting oxidized LDL to endothelial dysfunction.

The Evidence That Low Glycaemic Index Highcarbohydrate Diets Are Superior

The GI of foods is highly relevant to the management of Type 1 and Type 2 diabetes. In nine well-designed long-term studies in diabetic subjects, low-GI diets (GI values < 55 ) were shown to reduce glycosylated proteins (HbA1c and or fructosamine) by an average of almost 11 over periods ranging from two to 12 weeks (38). At the end of the low-GI, high-carbohydrate diet, urinary C-peptide levels (a measure of endogenous insulin demand) fell by an average of 20 , daytime blood glucose levels decreased by 16 , and total cholesterol and TG were reduced by 6 and 9 , respectively (39). Triglyceride levels fell to a much larger extent (by up to 20 ) in patients with overt hypertriglyceridemia. In a recent, randomised, cross-over study, clotting factors were normalised in patients with Type 2 diabetes by a low-GI, high-carbohydrate diet, but unchanged by a high-GI diet containing similar amounts of energy, protein, fat, carbohydrate, starch and fibre (40). Studies comparing the effects of...

The Optimal Mix Of Dietary Carbohydrate And Fat For

Favour high-carbohydrate diets with a low glycaemic response. It is the authors' belief that promoting diets that actively limit carbohydrate over fat sends out the wrong lifetime educational message. Clinical studies suggest that it is the type of carbohydrate and fat rather than the absolute amount that dictates the glycaemic and metabolic responses to a meal. As a degree of gastric stasis is common in pregnancy, the glycaemic response of many carbohydrates is blunted.

The aGlucosidase Inhibitors

A-Glucosidase inhibitors are modestly effective in treating diabetes with hemoglobin A1-C reductions of 0.5-1 and can be particularly effective in patients who consume high-carbohydrate diets. Adverse effects of a-glucosidase inhibitors are gastrointestinal and include abdominal bloating, pain, diarrhea, and flatulence, occurring in up to 70 of patients. Although these adverse effects tend to dissipate in 4-6 weeks, they are to be a major reason for discontinuation of medications.

Diabetes And Carbohydrates

Although carbohydrates, like monounsaturates, do not have significant effects on cholesterol, they can have significant effects on lipoprotein metabolism. This is because high-carbohydrate diets stimulate the synthesis of very low-density lipoprotein (VLDL) and triglycerides and subsequently can raise serum triglyceride levels. This usually effects HDL in a reciprocal fashion, with decreased levels of HDL. Removal of fats from the diet and replacement with carbohydrates reduces LDL levels despite the lowering effects of HDL. A significant volume of information does support the effectiveness of a high-fiber, low-fat, and low-carbohydrate diet in the prevention and treatment of diabetes. Thus, choosing carbohydrates from the lower end of the glycemic scale seems advisable. Highfiber diets are associated with improved ability to handle blood sugar. Dietary fibers can slow the rate of food progression through the intestine, thus attenuating postprandial glucose excursions. This is in...

Nutritional Considerations

A high susceptibility to obesity may also be the result of unlimited availability of palatable and high-calorie-density foods. Laboratory adult rats fed a ''supermarket diet'' consisting of high-carbohydrate high-fat foods (i.e., chocolate chip cookies, marshmallows, peanut butter, etc.), gained 2.5 times more weight than normal controls (402). In some animals, the weight gain was not reversed after the rat was switched back to chow. It is believed that supermarket diets increase the number and size of fat cells. In children the portion size offered and the type of food given also play a role. Repeated exposure to a larger portion size of macaroni and cheese resulted in 25 more calorie intake when compared with feedings of an age-appropriate serving size, particularly in older children (403). Therefore, while younger children may be better at regulating the amount of food consumed they may lose this ability as they grow older if exposed to large portion sizes (404). High-carbohydrate...

Management Of The

Insulin sensitivity can also be influenced by diet composition (101,102). There is evidence that a higher saturated fat intake is associated with impaired insulin action, some of which may be mediated by changes in body weight. In contrast, a high-monounsaturated-fat diet significantly improves insulin sensitivity compared to a high-saturated-fat diet. Independent of its effects on insulin sensitivity, diet composition can influence the factors clustering in the metabolic syndrome. Dietary carbohydrate increases blood glucose levels, particularly in the post-prandial period, and consequently also insulin levels and plasma triglycerides. The detrimental effects of a high-carbohydrate diet on plasma glucose insulin, triglyceride HDL or fibrinolysis occur only when carbohydrate foods with a high glycemic index are consumed, while they are abolished if the diet is based largely on fiber-rich, low-glycemic-index foods. Mono-unsaturated fats and ro-3 fatty acids can reduce plasma...

Dietary control of conventional risk factors cholesterol blood pressure type diabetes and obesity

This was the basis of a new 'diet-heart hypothesis' in which cholesterol was not the central issue.36,123 In fact, the first dietary trials designed for the secondary prevention of CHD were based on the hypothesis that a cardioprotective diet should primarily reduce cholesterol.36 While the investigators succeeded in reducing cholesterol, they failed to reduce CHD mortality.41 This was mainly attributed to an insufficient effect of the tested diets on cholesterol, and the conclusion was that cholesterol-lowering drugs should be preferred. However, none of the diets tested in these old trials was patterned from the traditional diets of populations protected from CHD (e.g. vegetarian, Asian or Mediterranean), although these diets are associated with low cholesterol.119,122 Also, no trial was aimed at testing the cholesterol-lowering effect of a typical Mediterranean diet, probably because this diet was (and often still is) mistakenly regarded as a high-fat diet, allegedly not...

What Are Overweight and Obesity

Often ignored is that diet can serve to exacerbate or moderate a preexisting metabolic disorder. In addition, the source of calories is at least as important as the overall quantity of calories. That is because protein is far less likely than carbohydrate to be stored as fat. In general, high-sugar and high-carbohydrate foods trigger a stronger insulin response, compared with protein-rich foods, and insulin helps promote the accumulation of body fat. High-sugar and high-carbohydrate foods also tend to be short on fiber, protein, omega-3 fatty acids, and vitamins and minerals that either buffer the absorption of carbohydrates or aid in the body's metabolism of them.

Program for Early Diabetics

The high-carbohydrate, high-plant-fiber (HCF) diet popularized by James Anderson, MD, has substantial support and validation in the scientific literature as the diet of choice in the treatment of diabetes (Anderson JW et al 2004 Hodge AM et al 2004). And is very similar in many ways to what I practice and recommend. The HCF diet is high in cereal grains, legumes, and root vegetables and restricts simple sugar and fat intake. The caloric intake consists of 50 to 55 percent complex carbohydrates, 12 to 16 percent protein, and less than 30 percent fat, mostly

Modification of dietary intake

Bariatric surgery results in a substantial reduction in nutrient intake which may account for the normalization of plasma glucose reported. In a recent study, a sham operated individual who followed the same strict postoperative diet recommended to Roux-en-Y gastric bypass patients showed similar improvements in insulin and glucose levels. This suggests that calorific restriction is a major factor in promoting glycaemic control after weight loss surgery (Pories et al., 1995). Furthermore, there are some indications that gastric bypass may alter the type of food patients ingest. Induction of the 'dumping syndrome' or postoperative changes in taste and food preference result in a preferential reduction in carbohydrate ingestion (Sugarman et al., 1992). This may enhance diabetic control because it is known that obese individuals with a high carbohydrate intake (especially simple sugars), have increased insulin secretion. Hyperinsulinaemia favours anabolic metabolism (Woods et al., 1974...

T Spinach Ricotta Gnocchi

Here's a great twist on the traditional gnocchi, or potato pasta. Chef Christopher Fernandez at Poggio in Sausalito, California (see Appendix A), has creatively substituted the white flour base to this usually high-carbohydrate food for ricotta cheese, a significant source of protein. In doing so, the gnocchi will have far less of an effect on your blood sugars and allow you to once again eat what you might have once considered sinful Enjoy this with your favorite red Italian pasta sauce.

Clinical studies nonrandomized

Both participation in physical activity (primarily walking for 30 minutes per day) during the programme (OR 0.41, (CI 0.19-0.87) and less psychological stress were seen in people who did not develop diabetes. No effect was seen for dietary adherence to a high-carbohydrate, high-fiber, low-fat (20 ) diet or, in this subset, for weight loss or family history (comparing two parents with diabetes to one parent with diabetes, since everyone had a family history). The nested retrospective design has important limitations, since diet and physical activity adherence and measures of stress were collected only at the last examination rather than prospectively, making them subject to potential recall bias. It is also not clear whether the subjects were aware of their OGTT results at the time of the interview.

What are the acute metabolic and hormonal effects of exercise on the body

At rest, the main metabolic energy substrate for the muscles is derived from oxidation of blood free fatty acids (FFAs). Muscles have stored glucose inside them, in the form of a polysaccharide, called glycogen. This is the main energy source for the muscles during the first 5-10 minutes of exercise. Anaerobic degradation and metabolism of glycogen produces lactate. This then quickly supplies energy (ATP) to the exercising muscle. It should be noted that muscular glycogen (represents around 1100 kcal in a 70 kg man) differs from hepatic glycogen (around 400-500 kcal for a 70 kg man) in the sense that the muscles lack the enzyme glucose-6-phosphatase and thus cannot liberate the glucose phosphate that is derived from glycogen degradation into the circulation. In this way muscle glycogen is trapped inside the muscle and can be used only as a source of energy for the muscle and not for contributing to the increase of blood glucose pool. As exercise continues and muscular glycogen is...

Fat And Insulin Sensitivity

Himsworth first made the association between increased dietary fat and insulin resistance in the 1930s and since then much has been published on these effects. In a recently published review on the subject by Storlien et al. (22), the premise was developed that the type of fatty acids eaten may be as important as the quantity of fat in the diet. High-fat diets, particularly high saturated fat, are associated with the development of Type 2 diabetes and glucose intolerance, while the intake of long-chain fatty acids, in particular n-3 fatty acids, seems protective.

Red Wine to Defy Aging

New evidence from two studies suggests that resveratrol can slow the aging process. In one from Harvard University, published in the Journal of the American Medical Association, middle-aged mice were fed a high-fat diet. Some were also given resveratrol while others were not. Those given resveratrol were less likely to die early. Another study from a group in France, published in Cell, similarly showed that mice fed a high-fat diet and high doses of resveratrol were protected from the metabolic syndrome (see Chapter 5) and did not gain weight compared to mice not fed resveratrol.

Healthy and Unhealthy Fats

Whether you are considering a low-carb, high-fat diet or a more conventional higher-carb, low-fat diet, you will have fat in your diet. Are all fats the same For many years fat in the diet has been demonized. Grocery stores are filled with foods labeled low fat. In the past twenty years, Americans have reduced the percentage of calories that we get from fat. However, the total calories and grams of fat we consume have actually increased and remain substantially higher than in most places in the world. What have we been told is wrong with fat We've been told that there are more calories in each gram of fat than in each gram of carbohydrate 146, or protein, which is true. But the impression has been left that,

Endogenous Inhibitor of Nitric Oxide

There is evidence that serum levels of ADMA appear to be dynamically regulated. One group reported that plasma ADMA increased with the administration of a high-fat diet in patients with type 2 DM (97). This was also associated with a temporally related impairment of endothelial vasodilation. Experimental hyperhomocysteinemia increases ADMA levels, and is associated with impairment of flow-mediated vasodilation (98). On the other hand, Paiva's group recently found that although higher plasma levels of ADMA were associated with lower glomerular filtration rate in subjects with type 2 diabetes, but, as a whole, diabetic subjects had lower plasma levels of ADMA than healthy controls (99). Hence, whether ADMA is a true pathological contributor to diabetic vasculopathy, or just a marker of vascular disease in this diverse patient population remains to be conclusively defined.

Adaptation of pCell Mass to Insulin Resistance Mechanisms of Growth and Proliferation

Although changes in P-cell function are observed under conditions of increased secretory demand, the volume of P-cells also increases. In rodents fed a high-fat diet for 12 months to induce obesity and insulin resistance, islet size increases as a result of an increase in the number of P-cells rather than a change in P-cell size, and new islets do not form 36 . NEFAs rather than glucose may mediate this increase in P-cell mass for review, see 30, 37 . In contrast, human studies suggest that P-cell volume is increased by about 50 in healthy obese individuals, which, however seems to be more dependent on hypertrophy of existing cells than proliferation 38, 39 . Interestingly, in the long-term increased dietary fat feeding study in rats, P-cell mass increased but glucose-induced insulin release did not, which indicates a dissociation between P-cell mass and the secretory function 36 . Increased signaling by insulin and or insulin-like growth factor 1 (IGF-1) could also underlie the...

An integrated analysis

Detailed analysis of the interactions between intake, activity and obesity in humans is difficult because of the flaws in the assessment of lifestyle behaviours. However, a study conducted under controlled conditions in a whole-body calorimeter provides a quantitative insight into the vulnerability of the homeostatic mechanisms which regulate body weight. Here, a group of lean young men were exposed to a low or high fat diet, together with sufficient exercise to maintain habitual activity levels or required to remain sedentary in a 2 x 2 design (Murgatroyd et al., 1999). The results show that energy balance was close to zero on the low-fat diet with habitual activity. The imposition of a sedentary behaviour pattern or the provision of a high-fat diet each created net energy gains (of +2.55 and +1.07MJ day, respectively). However, when imposed together, the two effects appeared to be more than additive, creating a positive imbalance of +5.13 MJ d. This amounts to almost 50 per cent of...

Correlation of altered nutritional experience in early life to subsequent high incidence of obesity and metabolic

The spontaneous transfer of the HC phenotype to the progeny and results from our studies of maternal high-fat diet-induced effects in the next generation indicate that maternal obesity primes obesity in progeny. Our results suggest that females that are overnourished or exposed to increased carbohydrate intake in infancy may be obese and insulin resistant during pregnancy and, due to an unfavorable intrauterine environment, are at increased risk for the establishment of a vicious cycle of transmission of their metabolic phenotype to their progeny.

Factors modifying the relationship between obesity and diabetes

Dietary factors appear to have effects independent of those on obesity on the development of type 2 diabetes. Increasing fat in the diet is associated with both obesity and the development of diabetes (West, 1978), but much of this link is explained simply by the high energy intake that accompanies high fat diets. However, some populations with high-fat diets (e.g. Eskimos and the Japanese) have a relatively low prevalence of diabetes compared with that expected from their obesity rates and this may be explained by a high intake of omega-3 polyunsaturated fatty acids (Malasanos and Stacpoole, 1991). A recent large prospective study of diet in women aged 34 to 59 years without diabetes at baseline and followed for 14 years found that total fat intake was not associated with risk of type 2 diabetes, but for a 5 per cent increase in energy from polyunsaturated fat, the relative risk was 0.63 and for a 2 per cent increase in energy from trans fatty acids the relative risk was 1.39...

Central Visceral Obesity

Acute reductions in caloric intake has been shown to improve insulin sensitivity, and weight reduction further improves insulin action while both decreasing 24hour insulin secretion and enhancing insulin clearance, thus reducing demand on the beta-cell, particularly in the post-absorptive state (Kelly 1995). In addition, studies have shown that obese individuals with IGT may be prevented from developing diabetes through weight reduction. In a 6-year follow-up study of 109 individuals with IGT and clinically severe obesity who lost more than 50 of their bodyweight after bariatric surgery, only one individual developed diabetes, in comparison to the control group in which 6 out of 27 subjects became diabetic within 5 years (Long, O'Brien and MacDonald 1994). Another study involved 35 non-diabetic elderly men who achieved a 9 kg weight loss after a low-fat, hypocaloric diet maintained over a 9-month period (Colman et al 1995). Of 20 subjects with IGT, glucose intolerance was normalized...

Glucose Transporters as Components of the Glucose Sensing Machinery

The arcuate hypothalamic POMC and NPY AgRP neurons play significant roles in the regulation of energy and glucose homeostasis. Some POMC neurons utilize AMPK and Katp channel to increase their activity when glucose concentration rises 41, 42 . NPY AgRP neurons are altered by rising glucose levels 39, 41 but they do not utilize the Katp channel for glucose-sensing. In POMC neurons, glucose-sensing was disrupted by mutation of the Kir6.2 subunit of their KATP channel 42 . This genetic manipulation impaired the whole-body response to a systemic glucose load, demonstrating a role for glucose-sensing by POMC neurons in the overall physiological control of blood glucose. Parton et al. 42 also found that glucose-sensing by POMC neurons became defective in obese mice on a high-fat diet, suggesting that loss of glucose-sensing by neurons has a role in the development of type 2 diabetes. The mechanism for obesity-induced loss of glucose-sensing in POMC neurons involves uncoupling protein 2...

The Natural History Of Type Diabetes

Although the triple disturbance of insulin resistance, increased hepatic glucose production, and impaired insulin secretion critical to the development of type 2 diabetes has received a great deal of attention in research, the etiological sequence of events resulting in the diabetic state is also of compelling interest . Accelerated hepatic gluconeogenesis and glycogenolysis do not seem to exist in the state of impaired glucose tolerance, where insulin resistance and impaired insulin secretion predominate in fact, these two abnormalities precede the onset of hyperglycemia in the diabetic type 2 phenotype. Prediabetic individuals have severe insulin resistance, whereas insulin secretion tends to be normal or increased in the prediabetic or impaired glucose tolerant state, including first-phase insulin responses to intravenous challenges. Thus, the type 2 diabetic phenotype evolves from the individual with impaired glucose tolerance and insulin resistance. Although the genetic factors...

Applying the SGI Table

Once you establish your own SGI factors you have a unique view of how specific foodstuffs affect your own body. In some cases one can anticipate the SGI value from a similar type of food. For example the SGI for cabbage is expected to be similar to that for cauliflower. If there is any doubt then a test is recommended. Occasionally I introduce a completely new type of food into my diet. If it is a high-carbohydrate food, I first consult the basic GI data 8 and page 15. Personal SGI testing requires a certain commitment of time, but then so does diabetes control in general. I now have an adequate database to predict results such that I only need to test once a day, unless something unusual happens to my meal plans.

Can Weight Loss and Exercise Improve NAFLD

Dietary composition may be another important but frequently overlooked aspect related to excessive hepatic fat deposition, as been suggested in single case reports (361) and small case series (n 5) (362) in which low-carbohydrate diets were of particular benefit to rapidly reduce steatosis and elevated ALT in subjects with NAFLD. Recently, Ryan et al. (363) examined the effect of two hypocaloric diets containing either 60 carbohydrate 25 fat or 40 carbohydrate 45 fat (15 protein) for 16 weeks in 52 insulin-resistant obese subjects. While both diets resulted in significant decreases in weight, insulin resistance, and serum ALT concentrations, the low carbohydrate diet improved all three parameters significantly more than the high carbohydrate diet. Reduction of steatosis and of plasma triglycerides concentration by low carbohydrate diets is likely related to downregulation of hepatic sterol regulatoryelement-binding proteins (SREBP) activity by the amelioration of chronic...

Tracers for the study of triglyceriderich lipoprotein kinetics Chylomicrons

Chylomicrons are large lipoprotein particles that are formed by the small intestine during fat absorption. The amount of lipid fuel that traverses the circulation in the form of chylomicrons obviously varies with dietary fat consumption. In individuals on high-fat diets, however, it can equal or exceed FFA flux (Miles et al. 2004). The triglyceride transported in chylomicrons is metabolised by LPL, which is widely distributed in tissues but is most abundant in adipose tissue and skeletal muscle (Eckel 1989). Nascent chylomicrons have a short residence time in the circulation, with a half life of approximately five minutes (Park et al. 2001). Chylomicron half life is prolonged at higher chylomicron triglyceride concentrations (Park et al. 2001).

Secretion and Action of Incretin Hormones in Physiology

Glp Receptor Physiology

The main functions of GIP are the glucose-dependent augmentation of insulin secretion during periods characterized by physiological hyperglycemia, the incretin function sensu strictu 8,9,18,66,67 . Animal experiments suggest that GIP receptors on adipose tissue are essential for adipocyte triglyceride storage after meal ingestion GIP receptor knock-out mice do not become obese when fed a high-fat diet 53 .

Split Mixed Insulin Therapy

In addition to generating a nonphysiologic insulin profile, split-mixed therapy also affords the patient less flexibility in dose adjustment in response to the quantity and timing of meals and exercise. Changes to insulin dosing may need to be anticipated hours in advance of the event, as only two injections per day are given. Large changes in the basal component of each dose risk provoking hypoglycemia or hyperglycemia for example, increasing the prebreakfast NPH in anticipation of a high-carbohydrate breakfast may result in hypoglycemia before lunch. An alternate solution is to keep the timing and carbohydrate content of meals constant from day to day so that dose adjustment is not required.

Fat Diversion from Adipose to Nonadipose Tissue and Lipotoxicity

In summary, adipose tissue storage and release of fatty acids, and particularly the control of these processes by insulin, is grossly abnormal in insulin resistant states. In the postabsorptive period, basal adipose tissue lipolysis is elevated, and suppression by insulin is diminished. In the postprandial period there is likely to be some diversion of fat away from adipose tissue depots and towards nonadipose tissues owing to less efficient fatty acid uptake and storage by insulin resistant adipocytes. FFA efflux from an enlarged and lipolytically active visceral fat depot may not contribute quantitatively to the majority of circulating FFAs, but because of its anatomical location and intrinsic properties appears to play an extremely important role in the manifestations of insulin resistance and type 2 diabetes. A high capacity for efficient triglyceride accumulation in adipose as well as nonadipose tissue may have presented a survival advantage in the past, during times of...

Overcoming the Manifestations of Syndrome X

Dietary recommendations to reduce CHD have until quite recently been based upon the principle that hypercholesterolemia (more specifically, an elevated LDL cholesterol level) is the only CHD risk factor that needs to be addressed. The result has been almost total emphasis on the use of low-fat-high-carbohydrate (CHO) diets. More to the point, advice to replace saturated fat (SF) with CHO in order to lower LDL cholesterol concentrations continues to be given, regardless of how insulin resistant the individual. Unfortunately, this dietary approach will make all of the manifestations of syndrome X worse. The greater the CHO content in an isocaloric diet, the more insulin must be secreted in order to maintain glucose homeostasis. This poses no danger to insulin-sensitive individuals, but low-SF high-CHO diets will significantly increase the already high day-long plasma insulin concentrations in patients with syndrome X. As a consequence, fasting plasma TG concentrations will increase, as...

Effects of PPARy Ligands Independent of Changes in Blood Glucose Levels

Transcription Factors Ppar

Increase in oxidative stress is observed in renal glomeruli and a variety of the vascular and nonvascular tissues exposed to hyperglycemia (99-101). Emerging evidence suggests that oxidative stress may contribute to the development of diabetic complications, possibly through activating DAG-PKC pathways. As stated before, D-a-tocopherol can inhibit the diabetes-induced activation of DAG-PKC pathway in addition of its antioxidant properties (102). Troglitazone, which has D-a-tocopherol moiety, has potent antioxidant effects in suppression of phosphoenolpyruvate gene expression in vitro and in scavenging reactive oxygen species in vivo (103). It also normalizes the decrease of plasma lipid hydroperoxide concentration and increase of superoxide dismutase activity in Otsuka Long-Evans Tokushima Fatty rats, a type 2 diabetes animal model, and improves decreased skin blood flow in STZ-induced diabetic rats (81,104,105). Pioglitazone also can reduce renal oxidative stress in alloxan-induced...

Insulin Resistance Vs Betacell Dysfunction

Investigators next turned to cross-sectional and natural history studies of 6-cell function versus insulin resistance. They confirmed that insulin resistance is already present when glucose values are within the normal glucose tolerance range (49,50). There are a number of potential reasons in some people this is presumably owing to a genetic abnormality that affects insulin sensitivity, and in others lifestyle factors, such as obesity, lack of exercise, high fat diets, aging, etc., may play a major role. Thereafter, insulin resistance is relatively unchanging. Therefore, a change in the degree of insulin resistance could not explain blood glucose values progressing from normal to IGT to diabetes. Instead, worsening 6-cell function is causative. These natural history studies observed a biphasic pattern initial hyperinsulinemia, with blood glucose values maintained in the normal range or only mildly impaired, and, subsequently a falling insulin level (P-cell failure), resulting in...

Effects of FFA on Hepatic Glucose Metabolism

Feeding a high fat diet has been shown to increase basal HGP in overnight fasted rats (166). In addition, in the same model, prolonged elevation of FFAs increased HGP despite elevation of insulin secretion and higher insulin levels (151). From these observations it appears that the auto-regulation is not effective when glycogen stores are depleted. It may be hypothesized that elevated FFAs induce hepatic insulin resistance in the basal state, with impaired insulin-mediated suppression of glycogenolysis as a consequence. Along the same line, reduction of FFAs by nicotinic acid in type 2 diabetic subjects did not lead to reduced gluconeogenesis (167), and net HGP was increased owing to absence of induction of the glycogenolytic pathway. Thus, altered hepatic auto-regulation was paralleled by, and likely owing to, impairment of insulin sensitivity.

Diseases Caused by Mutations of Glucose Transporters

The GLUT1-deficiency syndrome defines a group of disorders resulting from impaired glucose transport across blood-tissue barriers. In 1991, de Vivo et al. 24 described 2 children with infantile seizures, developmental delay and acquired microcephaly. Analysis of the cerebrospinal fluid (CSF) showed an unexplained hypoglycorrhachia (low glucose concentration in CSF) in the presence of normoglycemia (CSF blood glucose ratio < 0.4), while lactate concentrations were low to normal in the CSF, suggesting intact intracellular pathways for glucose utilization. Based on these findings, a defect in GLUT1-mediated glucose transport across the blood-brain barrier was assumed. Since 1991, more than 70 patients and numerous heterozygous mutations resulting in GLUT1 haploinsufficiency have been identified 25 . Clinical features are variable and include seizures, delayed development, acquired microcephaly, hypotonia, and motor disorders including elements of ataxia, dystonia and spasticity 25 ....

Possible Effects of Incretin Mimetics and DPP Inhibitors on pCell Mass

Not only GLP-1 and its analogues, but also the DPP-4 inhibitors have been shown to exert beneficial effects on P-cell mass and turnover. Along these lines, Pospisilik and colleagues reported a significant increase in P-cell mass in strepozotocin-induced diabetic rats following 7 weeks of treatment with the DPP-4 inhibitor P32 98 207 , and recently a significant increase in P-cell mass was reported after treatment with des-fluoro-sitagliptin in high-fat diet (HFD) streptozotocin (STZ)-induced diabetic mice 208 .

The Role of the Liver in Fasting and Postprandial Glycaemia

After the meal may result in glucose accumulation in blood, which is not metabolised before bedtime, and this may add to fasting hyperglycaemia through overnight hyperglycaemia. This hypothesis is supported by the finding that reduction of postprandial glycaemia by diet (low carbohydrate) alone also results in reduction of fasting blood glucose. As a consequence, treatment of fasting hyperglycaemia may not primarily aim to reduce HGP overnight, but rather aim to improve the insulin-mediated glucose disposal postprandially.

Body fat distribution and insulin resistance Skeletal muscle intramyocellular lipids

The first part was shown to be true in the case of a three days (Bachmann et al. 2001) high fat diet and intravenous intralipid heparin infusion induced peripheral insulin resistance (Bachmann et al. 2001 Boden et al. 2001). Researchers could observe a parallel increase of IMCL content, relatively more pronounced in the tibialis anterior muscle of young healthy humans (Bachmann et al. 2001 Boden et al. 2001). Similar results, accompanied by molecular adaptations favouring fat storage in muscle, were found in another study after one week of high fat diet (Schrauwen-Hinderling et al. 2005). Inducing insulin resistance by i.v. amino acid infusion during euglycaemic-hyperinsulinaemia (Krebs et al. 2001) was met by a subtle increase of IMCL content in soleus muscle. IMCL content decreased with increasing insulin sensitivity due to 8-10 months of leptin replacement in patients generalised lipodystrophy (Simha et al. 2003) and 6 months of caloric restriction with or without exercise in an...

The DaQing Study Pan et al

In clinics assigned to dietary intervention, the participants were encouraged to reduce weight if BMI was > 25 kg m2, aiming at < 24kg m2, otherwise a high-carbohydrate and low-fat diet was recommended. Counselling was done by physicians and also group sessions were organized weekly for the first month, monthly for 3 months and every 3 months thereafter. In clinics assigned to physical exercise, counselling sessions were arranged at a similar frequency. In addition, the participants were encouraged to increase their level of leisure-time physical activity by at least 1-2 'units' per day. One unit would correspond, for instance, to 30min slow walking, 10min slow running or 5min swimming.

Weight Reduction

Carbohydrate restriction leads to ketosis, with fat from adipose tissue being the major source of energy. Ketosis can suppress appetite and have a diuretic effect. The low-carbohydrate diets are usually associated with quick weight loss in the first 1-2 weeks. A study comparing low-carbohydrate diets (< 30 g day) with a low-fat, calorie-restricted diet in 132 severely obese patients with a mean BMI of 43 and a high prevalence of diabetes and the metabolic syndrome showed that after 6 months, the 43 patients still on the low-carbohydrate diet lost a mean of 5.8 kg, compared with 1.9 kg lost by the 36 patients still on the low-fat, low-calorie diet. At least for the first 6 months of a high-fat, low-carbohydrate diet, there seem to be no adverse effects on risk factors for atherosclerosis, although carotid intimal thickening can occur if high-saturated fat alternatives to carbohydrates are chosen. Ketosis can cause bad breath and prolonged ketosis may increase the risk of osteoporosis...

No Carbohydrates

Some popular diets, particularly the Atkins diet, treat carbohydrates as if they are evil, the root of all body fat and excess weight. While there is some evidence that a low carbohydrate diet may help people lose weight more quickly than a low fat diet, no one knows the long-term effects of eating little or no carbohydrates. Equally worrisome is the inclusion of unhealthy fats in some of these diets.

Other Factors

In practice a low-carbohydrate diet, which reduces the BG level, may result in increased protein consumption to maintain caloric needs. Possible effects of protein input on kidney performance are addressed by J. Whitaker, M.D. 6 . Creatinine results give one measure of kidney performance, and my creatinine levels remained within the normal ranges on a low-carbohydrate input. Bernstein provides significant discussion of the kidney issue and includes a number of reference papers that make me very comfortable with the low-carbohydrate diet. However, your situation may be different. Once my BG level was lowered to the point where it rarely exceeded 140 mg dL, the number of daily bathroom visits was greatly reduced. In fact I made a point of increasing my water input just to keep my kidneys active.

Blood Assays

At different times laboratory blood tests were ordered to give a more detailed review of my clinical parameters. Table 3 gives blood assays, which provide a chronological view of my progress over a period of 12 months, in which the last 4 months were on a low-carbohydrate diet. The improvements in BG and cholesterol levels with the introduction of a lower- carbohydrate diet in June 1997 are very gratifying. To achieve low HbA1c levels it is desirable to prevent higher than normal blood glucose at all times. Dr. Richard K. Bernstein is a proponent of a low-carbohydrate diet and wrote that he has a target BG level of 85-90 mg dL for type 2 diabetics depending upon whether or not they are using insulin. However, he points out that it is not possible to secure precise BG values if you are not using insulin since set points are determined in part by the patient's own physiology. My initial personal goal of keeping my peak transient BG level from ever exceeding 140 mg dL is not as...

What Is Diabetes

What messes up things People evolved eating low-carbohydrate foods, which only moderately raise glucose and insulin levels. The consumption of refined carbohydrates and sugars rapidly boosts glucose levels, and the body responds by secreting large amounts of insulin to move the glucose from the blood to cells. However, after a number of years of dealing with large amounts of glucose, cells become resistant to insulin's actions, with the consequence being chronic elevation of both glucose and insulin levels. Insulin resistance is the chief characteristic of diabetes.


Much confusion is generated by the carbohydrate content of alcoholic drinks. Very sweet drinks should be avoided, but otherwise there is no particular benefit in using low-carbohydrate products (e.g. beers) as the carbohydrate has been turned to alcohol by further brewing. Although the total calorie content should be considered if the patient needs to lose weight, it is better to ignore the carbohydrate contribution of alcoholic drinks.

Diabetes And Protein

In cases of insulin deficiency, gluconeogenesis can be stimulated when protein intake does not exceed 20 of the total daily consumption. There is no increased risk of diabetic nephropathy although long-term consumption of greater than this amount has not been studied, the ADA recommends avoiding such excess protein intake. The safety and long-term efficacy of low-carbohydrate, high-protein diets remains unknown and has not been widely studied, although these diets can produce short-term weight loss and improve glycemic control.


This is a new approach since the American Diabetes Association guidelines state that low carb diets are not recommended in the management of diabetes. They recommend an intake of 45 to 65 of total calories from carbs. In addition, both the Joslin and the ADA's guidelines mention that because the brain and central nervous system have an absolute requirement for glucose as an energy source, restricting total carbohydrate to less than 130 g day is not recommended. The American Diabetics Association goes so far as to say to treat all carbohydrates the same. This is part of the ongoing controversy of high-carb vs. low-carb diets and, if you read Dr. Richard Bernstein's Diabetes Solution, you will notice that he recommends an average of 15g of carbs per meal, which is extremely low carb. Even lower is the recommendation from Dr Barry Grove who would have us eliminate all carbohydrates. It is interesting to note that both Dr Bernstein, and Dr Grove try to classify some foods as no carb foods...

Protein Restriction

At this point in time, the general consensus is to prescribe a protein intake of approximately the adult recommended dietary allowance of 0.8 g kg d (approx 10 of daily calories) in the patient with nephropathy. However, it has been suggested that once the GFR begins to fall, further restriction to 0.6 g kg d may prove useful in slowing the decline of GFR in selected patients (103). It is also recommended that patients with diabetes and nephropathy be counseled against utilizing a high-protein diet such as the Atkins diet to attain weight loss or glycemic control.


The proportion of energy derived from carbohydrate is related to the level of fat intake. Recommendations in the past have tended to be narrow and precise with regard to fat and carbohydrate intake. Although good diabetes control can be achieved with a range of carbohydrate intake (45-60 ), it can be difficult to maintain a high-carbohydrate low-fat balance in practical terms. The current emphasis is on a more flexible approach dependent upon the individual's lifestyle, habits and diabetes management. To minimise the risk of hypertriglyceridaemia and an associated increased risk for cardiovascular disease, high-carbohydrate diets for people with diabetes should incorporate a high intake of soluble fibre and resistant starch (30).

The Future

Currently, many health professionals on both sides of the carbohydrate debate tend to believe that there is an ideal diet for everyone with diabetes - the 'one diet fits all' approach. But the future is likely to see the percentage of carbohydrate in the diabetic diet 'individualised' to increase compliance and take account of usual food habits. Emphasis on changes in the types of carbohydrate foods and types of oils and margarines may be more important to overall diabetes control than the amount of carbohydrate versus fat per se. While there is consensus that type of fat is important, there is less recognition of the major effects of fibre and rate of digestion of carbohydrate on glucose and lipid metabolism. There is sufficient evidence to say that a high-carbohydrate diet based on high-glycaemic index foods (even wholemeal versions) is probably not desirable in the management of diabetes. The glycaemic load (GI of the diet x carbohydrate content) of the diet needs to be considered...

Dietary Manipulation

The Stanford group led by Reaven, as well as groups led by Katan, Grundy and Willet have argued for many years that guidelines for CHD and diabetes should be changed from the historic high-carbohydrate low-fat diet philosophy. They recommend lowering the carbohydrate level and increasing energy from monounsaturated fats which do not demonstrate the postulated detrimental effects of carbohydrate on TG (21).

Individual Foods

The conclusions from table 4 are straightforward. Not all high-carbohydrate foods have the same effect, and protein foods have only a small effect on my BG. These are similar to the conclusions that I developed and quantified in section 9. I routinely use the relative value for SGI, and the GI 8 , to help select appropriate foods which do not raise my BG level unduly. For example, looking at table 4 it is clear why I incorporate egg omelets in my diet. Also by the same reasoning it is clear why I avoid eating bread.


Existing renal disease or unusually high carbohydrate intake, blood glucose concentrations of 500 to 600 mg dL imply that dehydration is of sufficient severity to diminish the glomerular filtration rate by approximately 30 to 40 . Blood glucose concentrations more than 800 mg dL suggest that the glomerular filtration rate is decreased by 50 or more 58 .

Dietary Management

The dietary management of diabetes is focused on measures that will improve glycaemic control. The high-fibre, high-carbohydrate and low-fat advice advocated is a type of dietary regimen which should also encourage weight loss. Increasingly, attention has also been given to the glycaemic index (GI) within the dietary management of diabetes. It is interesting to note that diets based on low glycaemic foods have been shown not only to improve blood glucose control but also to cause greater weight loss than diets based on high GI meals (49).

Diabetes And Fats

Fat intake should clearly be individualized with monounsaturated fat and carbohydrates providing 60-70 of total energy intake. For example, low-saturated fat diets (supplying < 10 of energy), along with high-carbohydrate intake, increased postprandial glucose levels, insulin, triglycerides, and decreased HDL when compared with isocaloric high-monounsaturated fat diets. However, high-monounsaturated fat diets have not been shown to lower hemoglobin A1-C values or have a beneficial effect on fasting plasma glucose. Thus, these high-monounsaturated fat diets may result in weight gain and increased energy intake in an uncontrolled setting.


Nutrition has always played a central role in the treatment of diabetes. Before the discovery of insulin, people with type 1 diabetes could be kept alive for a few months by severely restricting carbohydrate intake and eating mostly fats and protein (a ketogenic diet). After the discovery of insulin in 1921, patients were able to eat more carbohydrates. However, the lack of home glucose monitoring and fast-acting insulins meant that there still were significant dietary restrictions. People with diabetes had to restrict carbohydrates and spread them throughout the day by eating three meals and three snacks. With the use of the new insulins analogs and blood glucose monitoring systems, the dietary restrictions are much less of a problem, but there are still some limitations, which I discuss in this chapter.


Another problem that may be associated with kidney failure is too much cholesterol in your blood. High levels of cholesterol may result from a high-fat diet. Cholesterol can build up on the inside walls of your blood vessels. The buildup makes pumping blood through the vessels harder for your heart and can cause heart attacks and strokes.

Gestational Diabetes

Glueck's group further examined the effects of metformin combined with a high-protein diet in preventing GDM and found a similar reduction in rates of GDM in patients taking metformin for both primary and secondary prevention (170). Metformin did not result in any congenital malformations or fetal hypoglycemia. The authors hypothesized that metformin reduces development of GDM by reducing pregnancy-associated insulin resistance and that prevention of GDM with metformin may reduce the subsequent development of type 2 diabetes later in life, although this remains speculative (170). Metformin plus a high-protein, low-carbohydrate diet may also help prevent excessive weight gain during pregnancy, which can also reduce the risk of GDM (170). Nutrition during pregnancy is reviewed in detail in Chap. 14 of this text.

Dietary Approaches

The gold standard in the dietary treatment of obese patients with type 2 diabetes is a balanced moderately energy-restricted diet. The energy deficit is between 500 and 800 kcal day. The most important single measure is the reduction in fat intake, particularly in saturated fatty acids. It is generally recommended to prefer a high-carbohydrate low-fat diet. As shown recently, a diet rich in fiber and complex carbohydrates has some beneficial effects on parameters of glucose and lipid metabolism but these effects may be small and possibly of limited clinical importance (34). The concept of a high-carbohydrate, low-fat diet was, however, challenged by clinical studies showing that replacement of saturated fat by monounsaturated fat compared to high-carbohydrate intake is equally favorable or has even some minor advantages with regard to glycemic response and lipids (35). For these reasons, there is convincing evidence that energy content rather than nutrient composition is the major...


Strenuous and protracted exercise is not confined to sport and may occur during recreational activities, such as prolonged and vigorous dancing. These social events may also involve the consumption of alcohol, another potential cause of promoting and protracting hypoglycaemia. Some 'recreational' drugs such as amphetamines have been associated with promoting frenetic behaviour and increased metabolic rate, which may then induce hypoglycaemia in people treated with insulin (Jenks and Watkinson, 1998). Young people with type 1 diabetes who attend clubs or parties often avoid the potential risk and embarrassment of hypoglycaemia by not taking their insulin before the social event. Although this may seem to be a pragmatic approach, the problem with this strategy is that exercise may worsen the pre-existing hyperglycaemia, and could promote development of ketoacidosis. A modest reduction of insulin dose, combined with appropriate high carbohydrate snacks and the judicious consumption of...


The strong conclusion of this article reflects the potential importance of this enzyme in abdominal obesity Increased expression of llb-HSD-1 in abdominal adipose tissue may represent a common molecular etiology for visceral obesity and the metabolic syndrome (113).

Fat or carbohydrate

For the majority of patients (diabetic and non-diabetic) who have a problem with weight maintenance, targeting fat in the diet is appropriate for the reasons outlined above. This is also the sensible option for Government to adopt as far as population targets are concerned. It must be realized, however, that high carbohydrate intakes can also lead to marked obesity and consequently increase the likelihood of the development of type 2 diabetes. Individual patient therapy may therefore differ from that applied to population or generally applied to achieve weight reduction. Where increased carbohydrate is identified as the main dietary energy substrate involved in the aetiology of obesity in an individual, strategies to reduce weight based on increased carbohydrate intake are likely to fail. Cognizance must therefore be taken of other approaches to reduce weight and optimize metabolic control. There is considerable controversy over the use of low-carbohydrate, highprotein diets...

Insulin Resistance

Ingestion of high fat diets and development of obesity is associated with increased triglyceride storage at sites other than adipose tissue, including skeletal muscle, the heart, kidney, and liver. These changes are often associated with chronic elevations in circulating free fatty acids and TAG. This has led to the widely accepted notion that obesity-associated tissue dysfunction, including insulin resistance and cell death, is a direct consequence of chronic exposure of tissues to elevated lipids and resultant accumulation of toxic by-products of lipid metabolism. Whereas much evidence continues to support this concept, as will be highlighted in later sections of this chapter, recent work suggests the presence of other, more indirect pathways for development of muscle insulin resistance driven by events in distant tissues such as liver and adipose. Alterations in metabolic function in liver can also lead to changes in insulin sensitivity in muscle, constituting a second inter-organ...

Low Carb Diets Explained

Low Carb Diets Explained

You can burn stored body fat for energy and shed excess weight by reducing the carbohydrate intake in your diet. Learn All About The Real Benefits of Low Carb Diets And Discover What They Can Really Do To Improve The Quality Of Your Life Today.

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