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DG-DISPATCH - ENDO 99: Diabetics Improve Health With Very High-Fat, Low Carb Diet

By Cameron Johnston
Special to DG News

SAN DIEGO, CA -- June 15, 1999 -- A very high-fat, low-carbohydrate diet has been shown to have astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles.

The results of three studies involving such a diet, which is similar to, but has a few key differences from the famous "Dr. Atkins Diet", were presented today at the annual meeting of the Endocrine Society.

Dr. James Hays, an endocrinologist and director of the Limestone Medical Center in Wilmington, DE, admitted that the concept of a high-fat diet in people who are already at higher risk of cardiovascular disease might seem incongruous. Nonetheless, this study of 157 men and women with type 2 diabetes showed an impressive benefit in body mass index (BMI) triglycerides, HDL, LDL and HbA1c.

Most people are encouraged to reduce the amount of fat in their diets, particularly saturated fats, and diabetics in particular are advised to reduce their overall caloric intake, Dr. Hays explained in an interview in San Diego during the conference.

Whereas a normal diet would be in the order of 1800 to 2100 calories, with 60 percent of calories coming from carbohydrates and 30 percent from fat, patients in this diet were restricted to 1800 calories per day and were encouraged to get 50 percent of their caloric intake from fat, and just 20 percent from carbohydrates. The balance of 30 percent would come from proteins.

A whopping 90 percent of the fat content in their diets was saturated fat, compared with just 10 percent that was monounsaturated fat.

"I think this is at least worth considering for any diabetic," Dr. Hays said in an interview. "The thing many diabetics coming into the office don’t realize is that other forms of carbohydrates will increase their sugars, too. Dieticians will point them toward complex carbohydrates ... oatmeal and whole wheat bread, but we have to deliver the message that these are carbohydrates that increase blood sugars, too."

Higher-fat diets, on the other hand, seem to make the person feel full faster so they eat less; higher-fat diets also tend to reduce postprandial hypoglycemia so the patients feel better after eating.

“Every diabetic comes home from the doctor with instructions as to what their diet should consist of, but they’re not getting the information from dieticians about what complex carbohydrates they should eat,” Dr. Hays said.

“The important thing here is no ketosis. We absolutely don’t want people to become ketotic, and so we said they had to have so many exchanges of fresh fruits and vegetables and we specified the ones they could eat.”

They were able to eat all the meat and cheese they wanted, but as for carbohydrates, they are restricted to eating unprocessed foods, mainly fresh fruit and vegetables, he added.

Subjects recruited into the study (84 men, 73 women) were all type 2 diabetics and were required to undergo a standard American Diabetes Association modified diet for one full year before entry into the trial. Over the course of one year, the subjects achieved a mean decline in total cholesterol of between 231 and 190 mg/dl. Triglycerides declined from 229 to 182 mg/dl.

Low-density lipoproteins (LDL cholesterol) fell from 133 to 105 mg/dl, while HDL increased from 44 to 47 mg/dl.

HbA1c, which at the start of the study averaged 3.34 percent above normal, declined to the point that at one year, the mean was just 0.96 percent above normal.

The average weight loss among subjects in the study was in the order of 40 pounds, Dr. Hays said.

By the end of the one-year study, he added, 90 percent of the patients had achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and triglycerides.

Even among juvenile diabetics, he said, they might not be overweight and they might have more or less normal lipid levels, but when they are on this kind of diet it is possible to treat them with lower doses of insulin and make their lives a little safer, he said.

As for the response from cardiologists who see a high-fat diet as anathema to what they have been instructing their patients for years now, Dr. Hays said he has three cardiologist patients who are now on the diet.

"If you have a diet that results in weight loss, lower cholesterol, and a better lipid profile, eventually, everybody will be eating that way. It’s going to come whether we like it or not."

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