June 24, 2011

Idiotically Dangerous Diet "Reverses Diabetes" but So Does Moderate Carb Restriction Without Calorie Restriction

UPDATE: 2017

Though Dr. Taylor said he was going to publish a follow up to the "landmark" study discussed below that got so much press, but as of 2017, none has ever appeared. My guess is that no follow up was published because it was impossible for people with Type 2 diabetes to maintain blood sugar control for more than a year or two using the extreme diet strategy he promoted.  It is also likely they ended up much fatter than they started because that is what happens to people who go on starvation diets, which this is, even with medical supervision.
Original Post:

All last night and this morning my email inbox has been filling up with notes pointing me to this story:

Crash Course Diet Reverses Type 2 Diabetes in a week.

It is yet another example of the tragically flawed pseudo-science that damages the health of people with diabetes.

There's no mystery here, nor is the effect reported a result of "reducing fat in the pancreas" as the doctor who came up with this "cure" suggests. All he has done is craft a "balanced" diet that has so few calories it is also low in carbohydrates.

As all my readers know, most people with Type 2 diabetes--especially those recently diagnosed--can recover normal blood sugar control simply by cutting back their carbohydrate intake to somewhere between 30 and 100 grams of carbohydrate a day. The actual number varies with the size of the person, their gender (men can usually tolerate more carb), and the ability of the individual's beta cells to secrete insulin.

But a low carb diet with normal calories is a high fat diet, and doctors have been brainwashed to believe that high fat/low carb diets cause heart disease. They don't. You can read the research that has proven this HERE.

But doctors don't have the time to keep up with nutritional research, so they still believe it. And because of their fat phobia, the only way doctors can feel comfortable prescribing a very low carb diet is by pretending they aren't prescribing one--which they do by prescribing "balanced" diets, one like the one reported here, where the calories are so low that a diet that includes 33% of calories in the form of carbohydrate becomes a low carb diet.

Starvation Diets Like This One Are Dangerous

In fact, there's nothing new or healthy about the low cal diet this doctor has come up with. The starvation diet is well understood--and very expensive. It can only be pursued under the supervision of paid medical staff that includes trained nutritionists because cutting calories that low on your own can be extremely dangerous both to your body and your mind.

The classic research on ultra low calorie diets, the starvation research conducted by Dr. Ancel Keys during WWII showed that people eating very low calorie diets developed psychoses (i.e. severe mental illness) at a surprisingly high rate, as well as many other important health problems. Poorly crafted medically supervised low fat starvation diets have caused deaths in the past.

Very low calorie diets of all kinds are extremely hard on the heart because they can't supply enough protein to repair muscle, so the body ends up cannibalizing the heart muscle.

Even with careful nutritional supervision, when calories are that low, the thyroid and other parts of the system that regulate metabolism slow in order to make the best use of every available bit of energy and the result is that after a month or two on the very low calorie diet, the person who dieted so unwisely will find themselves gaining weight on a caloric intake so low that it should be a weight loss diet for someone their size.

Partially this is because some metabolic slowdown occurs in anyone who loses a significant amount of weight on any diet. I discussed this in a blog post that highlighted Dr. Liebel's research about metabolic slow down with weight loss.

But extreme calorie deprivation seems to intensify this effect. Some years ago, many denizens of the Low Carb Friends diet discussion board fell for scam diet, the so-called Kimkins diet, which was a low carb, low fat diet which was effective in taking off weight fast (and cutting blood sugar) because starvation diets WILL do that, but which also left quite a few of them with metabolisms so damaged that they started gaining weight eating as little as 1200 calories a day, their hair fell out, and they developed mood disorders and other severe deficiency problems. It took several years for some of them to get their health back.

The Gastric Bypass Model For the Diet is Misunderstood

The doctor in this study purporting to "reverse diabetes" justifies his approach by explaining that it duplicates what people eat when they have had gastric bypass, but what is forgotten is that people with gastric bypass often develop long lasting and severe nutritional deficiencies. The restricted diet enforced by weight loss surgery also appears to cause an unexpectedly high rate of suicide which goes along with what we know about severe calorie restriction causing severe mood disorders. This, sadly, is a subject you won't learn about in the enthusiastic plugs for it you read in the media which are supplied by press agents working for bariatric surgeons. Details HERE. Note that this important epidemiological study, published last September, got NO play in the health media.

What is also forgotten is that the research suggests that the real reason some people "reverse their diabetes" after gastric bypass is that they can no longer tolerate carbohydrates and will experience projectile vomiting if they eat enough carbohydrate to raise their blood sugar. Weight Loss Surgery therefore forces them to eat a very low carbohydrate diet and THAT is what "reverses" their diabetes.

Starvation Diets Like This One Are Unnecessary: It's All About The Carbs

What most doctors don't know and won't be told by the surgeons who are profiting so mightily from weight loss surgery is that people who "reverse" or "cure" their diabetes with weight loss surgery get their diabetes right back as soon as their stomachs stretch out to where they can eat enough carbohydrates to raise their blood sugar again. (You'll find studies proving this HERE.)

Clearly, there isn't any magic in the surgery or in calorie restriction that is what is supposedly "reversing" diabetes. Blood sugars come down only because these approaches remove the one component of the diet that raises blood sugars into the diabetic range: carbohydrates.

But as thousands of people with diabetes have learned, you can get the same effect by eating a diet that contains normal amounts of calories if you are willing to removed carbohydrates and replace them with healthy fats and protein. And when you do this you don't risk developing nutritional deficiencies or the possibility of developing a severe mood disorder.

It's Time for the Annual ADA Conference. Vendor-Sponsored "Research" Will Be Swamping the Health Media

It's not accidental that this study was published yesterday, tomorrow marks the beginning of the American Diabetes Association's so-called "Scientific Sessions". This is the annual conference where those who make their living selling goods and services to people promote their wares to doctors using poorly designed corporate-funded studies that twist the data to prove whatever will make the sponsor the most money.

High profile doctors the drug companies call "thought leaders"--each of whom receives huge fees from the drug companies--will give talks to their peers that purport to explain the mechanics of diabetes but which really do nothing but convince other doctors that the only treatments they should give people with diabetes are the most expensive new drugs.

So over this next week expect to see a lot of media reports about miraculous new drugs. You'll probably also be hearing a lot of praise for the miraculous effects of weight loss surgery, since the weight loss surgeons seem to have paid "charitable contributions" to the ADA to have bought a seat at the table previously dominated by drug merchants.

You'll see headlines suggesting that high fat diets cause diabetes in humans--all of which will have been conducted in rats bred to develop diabetes on high fat diets. (You can read more about this questionable methodology HERE.)

You'll read about dozens of "cures" of diabetes--all conducted in mice whose diabetes is caused by everything except the genes that cause diabetes in humans.

What you won't find at the ADA Scientific Sessions, ever, is any significant participation by people who HAVE diabetes and who have controlled it using strategies that don't cost an arm and a leg. Like carbohydrate restriction. The ADA has been fighting for decades for the right of its corporate food company sponsors to sell starchy breakfast cereal, soups, bread, and over processed juices to diabetics as "health food" for diabetics, and it will keep on doing it.

But the truth for most of us real people with diabetes who have maintained normal blood sugars for years without resorting to radical surgery or diets is that cutting way back on the carbohydrates we eat at meals will dramatically lower our blood sugars.

You can easily test this proposition at home. If you are new to this blog I urge you to read this page HERE and try the technique it suggests.

NOTE: Please click on the Comments link below to read more information and discussion based on the full text of the published study.

June 9, 2011

Avandia is sufficient to explain the excess deaths in ACCORD--the study being used to argue that normal blood sugars are dangerous.

If your doctor is telling you that research has "proved" that lowering blood sugars below an A1c of 6.5% is "dangerous" print out this letter, which was just published in the New England Journal of Medicine, and demand that your doctor read it:

Intensive Glucose Lowering and Cardiovascular Outcomes N Engl J Med 2011; 364:2263-2264 June 9, 2011

If you can't get the full letter to display here are the salient statements it contains. The quote refers to the ACCORD study where the intensive-therapy group was the group of people with Type 2 Diabetes who were urged to get their A1c down below 6.5%:
44.7% of subjects in the intensive-therapy group, as compared with 25.2% of patients in the standard-therapy group, received rosiglitazone [Avandia] just before the study transition date. According to the 2008 article summarizing the results of the ACCORD trial up to the point of protocol transition, 91.2% of subjects in the intensive-therapy group, as compared with 57.5% of patients in the standard-therapy group, had received rosiglitazone.
Although other differences in drug exposure warrant further analysis, we think that the authors[of the ACCORD publications] should consider (and address in a secondary analysis) the role of rosiglitazone in the excess deaths from cardiovascular causes, especially in the absence of biologic plausibility of a glucose-mediated effect. Given unbalanced exposure, we think that the ACCORD trial is inconclusive and that the recommendation to abandon lower glucose targets is not supported and has unknown consequences for the long-term management of diabetes. [Emphasis mine]
The signers of this letter are Almut G. Winterstein, Ph.D., University of Florida, Gainesville, FL, Susan R. Heckbert, M.D., Ph.D., University of Washington, Seattle, WA, and Morris Schambelan, M.D. University of California, San Francisco, CA.

This is a VERY important point. The ACCORD results have been used to justify doctors' and insurers' refusal to give people with Type 2 the medications and blood sugar meters they need to achieve normal blood sugars. Since it was published and interpreted as meaning that intensive efforts to your lower blood sugar will result in your having a higher risk of experiencing a heart attack I have heard from dozens of people whose doctors cautioned them to keep their A1c at 7.0% or higher and based their conclusions on this study.

This kind of toxic advice has been given to many thousands of people with Type 2 diabetes who will go on to suffer unnecessary diabetic complications that become inevitable at A1cs over 6.0% .

My guess is that the makers of Avandia had something to do with the fact that the health media blamed the excess heart attacks that occurred in the lower A1c group on their lower blood sugar rather than on these subjects' taking a drug that raises the risk of heart attacks.

It is odd, isn't it, that these journals did not make public in accessible form the numbers linking this exposure to Avandia with the excess deaths in ACCORD until now, after Avandia has been, for all practical purposes, taken off the market.

Coinicidental? I think not. Not with the power GlaxoSmithKline wields with its huge advertising budget and its research grants. No media outlet is going to risk losing those full two- and three- page drug company spreads just to save the limbs, vision and kidneys of a bunch of fat old people with diabetes.

Shame on the mainstream medical journals for not making this information public when they first knew of it.


June 7, 2011

News You Missed. WHI: Low Fat Diet Dramatically Worsens Diabetic Blood Sugars

Over the past month the media have been busy doing what they do best--reporting bady designed animal research as if it were human research. As a result we read "A high-fat diet during pregnancy may program a woman's baby for future diabetes, even if she herself is not obese or diabetic." This headline multiplied through the web appearing on dozens of newspaper sites.

Only by reading the full article do we learn that the researchers concluded this after an undisclosed, but probably low, number of "obesity-resistant rats" were "fed... either a high-fat or a control diet from the first day of gestation."

Rodents have evolved to eat a very different diet than humans and don't do well on high fat diets. They have very different pancreases and enzyme function than humans. And, of course, the "high fat diet" used in rat research is also a high carbohydrate diet. But that didn't deter the media from reporting this finding as if it were a human study.

Another study that was reported in the media claimed that "Pregnant women who tuck into fatty foods are at greater risk of having a stillbirth."

Further reading reveals that "The team studied two dozen pregnant Japanese macaque monkeys, an animal that has a placental structure similar to humans." Not mentioned here is the fact that Macaques, like other monkeys, have evolved to eat a very different diet from humans. They live mostly on fruits, herbs, and seeds, seasoned with the occasional insect, and can't tolerate the diet of fatty meat that humans evolved to not only tolerate but flourish on.

These are just a few of the animal research studies demonizing the impact of fat on females that appeared over the past month. But what about research that looked at the impact of fatty diets on female humans?

There was , it turns out, a blockbuster human study published this past month--an important study that described the impact of a low fat diet on real, live human women. Shockingly, it received no mention in the press at all.

But what a study it was! Unlike the studies that featured a dozen monkeys or a lab full of rats, this study tracked the outcomes for 2,263 human women, whose diet, blood sugar, and insulin were tracked for six full years.

And what it found was this: Low fat diets harm women with diabetes. Here's the study:

Effects of a low-fat dietary intervention on glucose, insulin, and insulin resistance in the Women's Health Initiative (WHI) Dietary Modification trial Shikany JM, et al. Am J Clin Nutr. 2011 May 11. [Epub ahead of print]

To understand how important a result this was, we need to back track a little and remind ourselves of what the largest and best designed study of the low fat diet has already proven, which is that in almost 49,000 middle aged women, tracked over eight years, the low fat diet was shown to have zero effect on preventing heart disease or stroke. None. Nada. Zip.

The earlier publication describing the WHI findings concluded
Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women.
You can find the report from that study here:

Low-Fat Dietary Pattern and Risk of Cardiovascular Disease:The Women's Health Initiative Randomized Controlled Dietary Modification Trial
Barbara V. Howard et al. JAMAVol. 295 No. 6, February 8, 2006

When this result hit the press in 2006, the media and the high profile doctors who have been promoting the low fat diet for decades responded by asserting that the diet used in the study must not have been low enough in fat, or that the study hadn't lasted long enough to demonstrate the benefits that the low fat diet must have. No one was willing to admit that maybe the study had proven what it looked like it proved--that the low fat diet was a useless intervention.

Doctors continue to recommend low fat diets. Dietitians continue to warn people with diabetes about the dangers of eating fat.

But now, this lastest analysis of the WHI data shows just how wrong-headed they are, because what the researches did here is to take the further step of analyzing the results for the subset of women for whom they had blood sugar measurements at the start of the study.

What they found was that for women with diabetes, the low fat diet wasn't just useless, it was dangerous, because it raised their blood sugar significantly--and I don't mean just statistically significantly. I mean it raised it a lot.

In the study's words, "...diabetic women had an increase in glucose that was 7.9 ± 20.3 mg/dL greater in the DM [diabetes]-I[ntervention, i.e. low fat diet group] than in the DM-C[ontrol] group (P for interaction <0.001).

In short, women with diabetes who didn't eat a low fat diet ended up with much better blood sugars, even though both groups were eating a high carbohydrate diet!

Since these were diabetic women who were likely to be taking medications to lower their blood sugar, the rise in blood sugar seen on the low fat diet is worse than it looks, because it takes into account the higher doses of medications they were probably taking.

Science doesn't get any clearer than this. This is a huge, well designed study. It found that the low fat diet caused significant harm in people with diabetes by raising their blood sugars. The broader study already confirmed that the low fat diet didn't do squat to prevent heart disease in anyone who participated in the study.

Yet not a word about this study made it into any major newspaper. I only found this study thanks to an alert reader who posted the link in the comments section of the previous post.

Is this shameful? Yes. Typical. Yes. Tragic for the millions of people with diabetes who get their health information, such as it is, from mainstream media. You tell me . . .


June 2, 2011

ADA: Eat Cupcakes for The Cure or Why You Should Hang up on ADA Telemarketers

When this email hit my in basket I thought it was one of my many correspondents indulging in a joke. But it was June 1, not April 1, and, sadly, the email turned out to be real.

It was sent by "Austin-based competitive food eater Hungry Todd Rungy" and it announced that in support of the American Diabetes Associations "Tour de Cure" Mr. Rangy would "attempt to break the world cupcake speed eating record at this year’s Cupcake Smackdown, on June 4th!"

The email continued, "By speed eating sugar-free cupcakes, Hungry Todd Rungy wants to bring attention to the Cure de Tour and their efforts to help stop a disease that affects over 23 million Americans, let people know what they can do to contribute to the American Diabetes Association..."

This, my friends, is a good example of why you should tell all your friends and family to hang up on the ADA telemarketers who are calling this month to raise money for the American Diabetes Association.

The sad truth is that this particular fundraises encapsulates everything that is wrong with the ADA. This extremely powerful organization, which dominates the discussion of diabetes and provides the treatment guidelines most family doctors follow, has a long, ugly history of working against the interests of people with diabetes.

Indeed, a case could be made that the ADA is the single worst thing that ever happened to people with diabetes. In brief here's why:

1. The American Diabetes Association is not working towards a cure. The organization is run by and serves the interests of the industries that profit from people with diabetes: drug companies, food companies, and doctors. It funds very little research of any kind, but concentrates on "education" which is centered on teaching people with diabetes that they can "eat normally" and, despite a decade of research contradicting this concept defines "tight control" as a blood sugar less than 180 mg/dl (10 mmol/L) two hours after a meal--a level that guarantees complications.

2. The ADA is headed by people who do not have diabetes and gives those of us who do no significant role in the organization except when it is time to raise funds. Most ADA executives were health industry lobbyists (i.e. big pharma stooges) before they got their very well paid jobs as ADA honchos. The few doctors involved are those "high profile" doctors who have received huge amounts of money from drug companies--the same doctors who urged patients to keep taking Avandia for a year after it was shown to raise the risk of heart attack, and who have fought for a generation against teaching people with diabetes that eating carbohydrates raises blood sugar and eating less carbohydrates lowers it.

Though the organization raises hundreds of millions of dollars in our name, The ADA shuts out people with diabetes who its chief executive has referred to as "poor victims." The ADA raises money in the name of those "victims" but gives them no voice in the organization except when its time to trot a few of them out as poster children. The role they assign people with diabetes is to shut up and do what they are told.

3. The ADA gives a false impression of how it uses the money it raises. The main function the ADA serves is supposedly "education." Most of that education turns out to promoting the toxic advice that teaches people with diabetes to dine on dietary abominations like this Havana Banana Cake you will find on the ADA web site.

Though you will see "carb counting" emphasized on its redesigned web site, the ADA urges people with diabetes to eat at least 50 grams of carbs per meal, an amount few Type 2s on oral drugs can metabolize without damagingly high blood sugars.

It could be argued that ADA's one useful educational function is that it publishes the journals Diabetes Care and Diabetes which are filled with reports of research studies that are ignored by the ADA's policy makers. But before you convince yourself that contributing to the ADA will help continue these publications, you should be aware that the ADA has made these journals a profit center. They are extremely expensive to subscribers--$395 a year, each.

But that's only the beginning, because these journals charge the researchers who publish in them hefty page fees. Currently they are as follows:
Page charges are assessed for Original Articles and Brief Reports to help defray costs of publication. The charge is $90 per page. As noted under Color Figure Approval (Section 4.5.), each color figure printed will incur a charge of $490.

4. The ADA's fundraising practices are among the worst in the charity industry. They use telemarketers who pocket one out of every five dollars raised. The Charity Navigator web site awards them one star out of a possible five. (View their rating HERE.)

5. The ADA has abrogated the role of defining how diabetes is diagnosed and how it should be treated despite the conflicts of interest implied in its corporate-influence funding and ex-drug company lobbyist leadership.

It has long set the diagnostic criteria arbitrarily in a way that ignores decades of reproducible research. (Details HERE.) The guiding principle seems to be to ensure that people with Diabetes continue to eat the junk foods produced by its sponsors and counteract the very high blood sugars they produce by taking as many expensive, poorly tested, oral drugs as possible.

The practice guidelines and diagnostic criteria the ADA publishes are treated as gospel by America's family practitioners and have a strong effect on WHO's recommendations too, even though study after study shows that their diagnostic criteria fail to diagnose large groups of people and that their recommended blood sugar targets are high enough to produce significant complications.

In fact, the American Association of Clinical Endocrinologists'(AACE) review of the relevant data have concluded tht the blood sugar targets the ADA recommends for people with diabetes are high enough to produce retinopathy (leading to diabetic blindness), kidney failure, and nerve damage. But the ADA has ignored the AACE blood sugar target recommendations for almost a decade now. Probably because it is impossible to reach the AACE targets without testing blood sugar after meals and lowering carbohydrate intake.

For those of you who wonder, the AACE recommends testing after meals and keeping blood sugars under 140 mg/dl at 2 hours. The data emerging from heart disease research suggests keeping blood sugars under 155 mg/dl (8.6 mmol/L) at one hour, and my recommendations based on that and many other research studies is to keep them under 140 mg/dl (7.7 mmol/L) at one hour, if possible.

The ADA also describes as "tight control" a fasting blood sugar of 129 mg/dl (7.2 mmol/L) though it warns it will be difficult and possibly dangerous to attain this. The AACE recommends a fasting blood sugar of less than 110 mg/dl (6.1 mmol/L).

Every time I see a death notice in my local paper where the grieving relatives suggest that contributions in honor of their loved ones be made to the American Diabetes Association, I feel the way I would if a victim of drug overdose was being asked to contribute to the funding of a Mexican drug cartel.

A better name for this toxic organization would be The American Association for the Preservation of Diabetes, because that is what it does--probably because without diabetes the corporations and professionals who support it would cease to profit.

So when the ADA telemarketer calls you, don't send this toxic organization your money--and make sure that the people those who care about you are also educated enough to do the same.

And, before I forget, someone really needs to warn Hungry Todd of the probable effect on his digestive system of eating a record setting number of sugar free cupcakes. Those of us who have experienced the sugar-alcohol total clean-out know what I'm talking about.