On Sun, 06 Jul 2008 08:54:18 +0100, Nicky
<ukc802466929@btconnect.com> wrote:
>http://www.nutritionandmetabolism.com/content/5/1/14
Copied from the discussion and summary of the paper:
"Discussion
A summary of the implications of the current work:
1. This year, for the first time, the ADA accepted the value
of carbohydrate-restricted diet for weight loss. The text of
their guidelines, however, continues previous guidelines in
finding fault with such diets and, in fact, does not cite
most of the recent publications supporting their use [2].
Other health agencies have similarly insisted on low fat
approaches. There is reason to believe that these guidelines
are not followed in practice. A perusal of internet diabetes
sites suggests that the major dietary emphasis is on
carbohydrate control.
2. The major barrier to official acceptance is the stated
lack of long term trials although it has never been stated
what the features of successes in short term trials suggest
that they would not be maintained.
3. The work presented here suggests the importance of
funding large scale long term trials as well as the benefits
and limited risk in using low carbohydrate diets now.
4. Several studies have shown that low fat diets can be
successful but overall, it would be difficult to say they
are inherently reliable.
5. In the studies reported here, patients in the two groups
had, despite all possible support, failed in achieving an
acceptable control of bodyweight and hyperglycemia on
traditional low fat diets.
8. An important issue is the fact that some patients do
become completely free of disease as soon as they are
presented with a low-carbohydrate option. It is unknown what
factors make these persons succeed now despite complete
failure in the past.
In the low-carbohydrate group bodyweight and HbA1c is
still significantly lower than before start. The bodyweight
of 7 patients (43%) is still 10% below the initial weight,
the original goal of the study. The success rate almost 4
years later is thus 43% as compared to zero in the control
group.
Five of 16 patients in the intervention group have had
stable bodyweight 38 months after the conclusion of the 6
months study period without any special follow-up.
Weight increase has been preceded by an increased intake of
carbohydrates in those cases where it has occurred. It is
clear that the high-carbohydrate diet followed before the
study has been an important, probably the central,
contributing cause of their condition.
One rationale for a low-carbohydrate diet is the
experimentally observed reduction in hunger [8] Patients
generally reported that hunger was absent on the
intervention diet and only after increasing dietary
carbohydrates did it return.
The intensity of hunger has been reported to be positively
correlated to the proportion of carbohydrates in obese men
over a 4 week period [9].
We believe that the close follow-up was important.
Patients had many questions at each meeting and concerns
about the diet that might have hindered adherence were
cleared up. In additions individual patients received
support from the group.
There is now little evidence for the claim that a
fat-reduced diet for weight reduction has any particular
value beyond caloric counting [10]. On the other hand, six
randomised studies have shown that carbohydrate restriction
with adlibitum energy intake confers a significant benefit
with regard to weight loss in obese persons [11-16]. The
current study is consistent with these reports and suggests
that
high-starch, high-carbohydrate diets excessively stimulate
appetite and disturb energy balance in patients with the
metabolic syndrome and type 2 diabetes [3]. A reduction of
carbohydrates normalises the balance, reduces
insulin
concentrations and favours utilization of stored fat as fuel
as well as significantly reducing insulin resistance [3].
Considering the solid evidence for the negative effect of
hyperglycemia on diabetes complications as well as
cardiovascular disease the present high-carbohydrate dietary
advice resulting in unnecessary hyperglycemia and insulin
resistance seems difficult to support [17-19] and for
diabetes patients, current dietary recommendations seem to
be a major part of their problem rather than being part of
the solution. Carbohydrate restriction, however, reverses or
neutralises all aspects of the metabolic syndrome
[20,21].
Summary: A reduced carbohydrate diet is effective in
motivated patients and can be recommended for overweight
overweight patients with type 2 diabetes. There has been no
sign of a negative cardiovascular effect."
Cheers, Alan, T2, Australia.
--
d&e,
metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com http://www.flickr.com/photos/alan_s/ http://loraltravel.blogspot.com (On Indian Roads)
Low-carb study followup to 44 months, great results still 
Linear Mode
