Real Food Versus Enriched Flour

The New York Times today adding quite a zinger into the article, A Growing Debate Over Folic Acid in Flour - where it was stated, "Blood levels of folate among women have been declining, according to a C.D.C. study released last January, perhaps because of worsening obesity and the popularity of low-carbohydrate diets."

This is what happens when one believes the best source of folic acid is enriched white flour, an ingredient universally shunned by those following a low carbohydrate diet. It's important to note that folic acid is the synthetic form of folate which is found naturally in vegetables, citrus fruits, legumes and even liver.

So why the worry about a low carbohydrate diet?

It seems the powers that be fail to appreciate just how easy it is to meet and exceed folate recommendations with food alone. Rather than express real concern over the poor dietary habits in the United States, they'll push for more fortification of the nutritionally bankrupt food being consumed.

The current recommendation for folic acid/folate is 400mcg a day. Want to see just how easy it is to meet that intake with real food?

A salad made with 2-cups shredded romaine, 1/4 cup shredded red cabbage, 4 cherry tomatoes and 1/3 of a medium cucumber along with 1-cup cooked spinach provides 437.5mcg of folate before any other folate containing foods are included in the day.

That is what someone following a low carbohydrate diet might choose to eat in a day since it provides just 84-calories, 15g total carbohydrate and 8g of fiber, providng just 7g net carbohydrate in their day.

Once they add in other options to their day their intake of folate will rise, although how much they consume at the end of the day will depend upon their choices.

But one thing is clear here - with a salad and a cup of spinach, they've met and exceeded the recommended intake!

I've said it many times - eat real food, eat good food and eat foods rich with nutrients. In this case, eating your non-starchy vegetables is a great way to meet and exceed requriements for folate!

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You are what your body does with what you eat

A newly published study, in the journal Lipids - Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation - found that subjects given a low-carb diet experienced "profound alterations in fatty acid composition and reduced inflammation compared to a low fat diet."

The press release, issued from SUNY Downstate, sums it up completely:

Metabolic syndrome is a condition afflicting one quarter to one third of adult men and women and is an established pre-cursor to diabetes, coronary heart disease, and other serious illnesses. Patients have long been advised to eat a low-fat diet even though carbohydrate restriction has been found to be more effective at reducing specific markers, such as high triglycerides, characteristic of the syndrome. Now, a new study indicates that a diet low in carbohydrates is also more effective than a diet low in fat in reducing saturated fatty acids in the blood and reducing markers of inflammation.

While there have been contradictory and confusing messages directed at health conscious consumers about dietary recommendations, most researchers agree on the need to limit inflammatory agents. In a report published today in the on-line version of the journal Lipids, researchers at the University of Connecticut, SUNY Downstate Medical Center in Brooklyn, and the University of Minnesota show much greater improvement in inflammatory markers in patients with metabolic syndrome on a very low carbohydrate approach compared to a low fat diet.

Lead researcher Jeff S. Volek, PhD, RD, associate professor of kinesiology at the University of Connecticut, describes the study as “adding to the evolving picture of improvement in general health beyond simple weight loss in keeping blood glucose and insulin under control.” The work is part of a larger study (currently under review) showing numerous improvements in blood lipids.

The current work concludes that “lowering total and saturated fat only had a small effect on circulating inflammatory markers whereas reducing carbohydrate led to considerably greater reductions in a number of pro-inflammatory cytokines, chemokines, and adhesion molecules. These data implicate dietary carbohydrate rather than fat as a more significant nutritional factor contributing to inflammatory processes.”

Richard Feinman, PhD, professor of biochemistry at SUNY Downstate Medical Center, adds, “The real importance of diets that lower carbohydrate content is that they are grounded in mechanism: carbohydrates stimulate insulin secretion which biases fat metabolism towards storage rather than oxidation. The inflammation results open a new aspect of the problem. From a practical standpoint, continued demonstrations that carbohydrate restriction is more beneficial than low fat could be good news to those wishing to forestall or manage the diseases associated with metabolic syndrome.”

One of the remarkable effects in the data presented that may have contributed to the results is that despite the three-fold greater saturated fat in the diet for the low carb group, saturated fat in the blood turned out to be higher in the low fat group due to the process known as carbohydrate-induced lipogenesis.

Dr. Volek points out that “this clearly shows the limitations of the idea that ‘you are what you eat.’ Metabolism plays a big role. You are what your body does with what you eat.”

How Do You Feel on Low-Carb?

An interesting short-term study published in this month's American Journal of Clinical Nutrition, Low- and high-carbohydrate weight-loss diets have similar effects on mood but not cognitive performance, sought to assess differences in mood following a high-carbohydrate diet compared with a low-carbohydrate diet.

In the study, ninety-three subjects were randomized into two groups:

• The high-carbohydrate dieters consuming a calorie restricted diet with 46% carbohydrate, 24% protein and 30% fat. Women consumed approximately 1429-calories each day, or 164g carbohydrate, 48g fat and 86g protein. Men consumed approximately 1667-calories each day, or 192g carbohydrate, 56g fat and 100g protein.
  
• The low-carbohydrate dieters consuming a calorie restricted diet with approximately 4% carbohydrate, 35% protein and 61% fat. Women consume approximately the same calories as above (there was no statistically significant difference for calories consumed in the study), or 15g carbohydrate, 97g fat and 125g protein. Men consumed approximately the same calories as above, or 17g carbohydrate, 113g fat and 146g protein.

Throughout the study, over the course of eight weeks, foods were provided to subjects and every two-weeks weight was taken and mood measured. Compliance by those following the low-carb diet was verified by measuring urinary ketone levels.

Both diets resulted in statistically significant weight loss.

The low-carbohydrate diet resulted in a statistically significant greater weight loss over the eight-week period than the high-carbohydrate diet, with low-carb dieters losing an average of 7.8kg (17.2-pounds) compared to 6.4kg (14.1-pounds) in the intent-to-treat analysis (p=0.04).

Both groups showed improvements in psychological well-being (p=0.01 for time) and there was no significant difference in working memory. The researchers noted "[t]here was some evidence for a smaller improvement in cognitive functioning with the LCHF diet with respect to speed of processing, but further studies are required to determine the replicability of this finding."

Rule Seven: Use Your Smarts!

It's almost impossible to miss the recommendation to read labels on food packages these days. It's good advice no matter what dietary approach you decide to follow, and is front and center in the Rule of Induction (Atkins) too, found in rule number seven.

Rule 7:

• Don't assume any food is low in carbohydrate - instead, read labels. Check the carb count (it's on every package) or use a carbohydrate gram counter.

This rule establishs a lifelong habit that, as you continue along with a controlled-carb diet, will be invaluable to you. You're expected to make it a habit to read labels and take responsibility for your food choices at the start of a low-carb diet and as you continue along and lose weight.

Once firmly rooted as a part of your food selection process, reading labels makes you a smart and savvy shopper - with an ability to quickly identify packaged foods that are not your best bets nutritionally.

While the first couple weeks has an underlying encouragement to limit foods to those which are fresh, it is possible to include a wide variety of prepared and/or packaged foods, thus the potential to derail success if you're not careful with your choices. So, in the first couple of weeks this rule is invaluable anytime you're including packaged processed foods in your menus.

The reality is that most people will include some packaged foods, whether salad dressings or prepared foods, from the start; so making it a habit to read labels reinforces the requirement that one take responsibility for what they eat.

Over time, reading labels helps to develop a keen eye while enabling one to make good choices among the packaged foods they include in their day-to-day menus. As more and more variety is added to a low-carb diet, it is critically important to be in the habit of reading nutrition labels - not only for carbohydrate content, but to understand ingredients used since differing brands of same-type items varying greatly not only in carbohydrate content, but ingredients used in the preparation of the packaged or prepared food.

The Devil in the Details - Low-Carb High Protein Diet Kills

A study - Low-carbohydrate–high-protein diet and long-term survival in a general population cohort - published in the May edition of the European Journal of Clinical Nutrition (originally available ahead of print, November 2006), concluded that "Prolonged consumption of diets low in carbohydrates and high in protein is associated with an increase in total mortality."

When I read the first publication of the study, back in November, I decided not to write about it since I was focused on penning articles about diabetes throughout National Diabetes Month and this study wasn't about diabetes. It remained on my pile of studies to consider, but as time passed, it seemed less and less important to write about. Now, with it hitting the print edition, and a renewed interest in the findings, it's time to take a look at what the researchers found and how they reached their conclusions.

Jake Young, who writes at Pure Pedantry, thought it worthwhile to take a look too. In summing up the design of the study, he wrote "[j]ust to cross the t's and dot the i's, they also control sex, age, years of schooling, smoking, BMI, physical activity, ethanol intake, and (in the data I am going to talk about) energy intake;" thinking, I believe, that adjusting for these confounding variables leads to higher quality conclusions.

Except in this case, adjusting for some of these variables led to a leap-of-faith extrapolation from the data because without making adjustments there was no significant finding to speak of, "[i]n model 2, the LC/HP score (absolute values) was positively associated with mortality, although the association did not reach statistical significance (P=0.14)." [emphasis mine]

In other words the association was statistically due to chance and therefore a null finding.

But, let's not let that get in the way of a good chance to find statistic significance!

Rather than take the data at face value for absolute intake (what people were eating), the researchers decided to adjust energy intake and considered this adjustment "as they should be, isocaloric..." to show how, after adjusting for energy intake variables things change.

And change they did.

With this one adjustment, statistical significance magically appears and now "mortality was significantly associated with reduction of energy-adjusted carbohydrate intake and nonsignificantly with increasing protein intake."

But still, how exactly to find protein problematic?

Ah, one more adjustment just might do it.

The researchers noted that their "model 3" "does not specify the complementary changes that have to be introduced for the preservation of total energy intake, when carbohydrates and proteins change." So, they created "model 4" and said it was "the most appropriate" since it was both isocaloric (adjusted for energy intake) and now adjusted to reflect changes from less carbohydrate and more protein.

Viola!

"In this model, increasing LC/HP score was significantly associated with mortality (P=0.001)."

Except, no one in the cohort ate like the adjusted diet, the statistically significant findings are not from real people eating real food (absolute intake), but are only found upon adjustment of energy and intake from protein and carbohydrate. The researchers justified this adjustment as necessary with "[i]ndeed, many of contemporary public health policies rely on extrapolations, so that if something is detrimental at a certain exposure level, its effect is likely to be more detrimental at a more extreme level."

Perhaps this is part of the problem with our public health policy? We're basing recommendations on extremes, extrapolated from adjusted models, rather than real world eating habits.

This is how the American Heart Association comes up with recommending less than 7% saturated fat to all Americans, even those at low risk for heart disease; they take data from studies that found no benefit from reducing saturated fat to 10% or less of calories and do the mental gymnastics to leap to an idea that benefit will be seen when saturated fat is less than 7% of calories. No data, just pure extrapolation and wishful thinking.

But, I digress...

There'd be nothing to talk about with this study if the researchers only went with their cohort and their habitual diet. Remember, when the absolute intake data was crunched, there was no statistically significant finding.

It's only after the researchers play with the data and make adjustments - adjustments outside the "norm" of their population cohort - into the extreme models, that they find significance.

In the real world you'll be hard pressed to find someone eating a diet within the extreme models they created. That's because the fundamental flaw in their model adjustment was the belief that decreasing carbohydrate means increasing protein. As the researchers noted in their paper, their adjustment model "relies on opposite changes of two nutrients with equivalent energy values and tends to be unrelated to total energy intake."

Simply put, the assumption was that reduction of carbohydrate translates to an isocaloric increase in protein.

The problem with this is that in the real world, increasing protein beyond what the body needs is extremely difficult due to satiety hormones that effectively shut down hunger when protein intake is adequate and carbohydrate is restricted. So the idea that one is effectively replacing carbohydrate with protein has a limit. A limit that seems beyond the grasp of this research group, who didn't seem to ask the important question - why did those with higher LC/HP (low-carb/high-protein) scores consume less calories than those eating a higher carbohydrate diet?

Rather than delve into this, they adjusted protein as if this group could and would consume more calories and more protein in a linear progression, adjusted their habitual intake to reach an isocaloric level comparable with their higher carboydrate counter-parts. But, because protein is such a sating macronutrient, this adjustment is not based on reality, but is purely hypothetical; and a hypothetical situation that one is likely to find impossible in a real world eating situation.

My take - the researchers would have been better off publishing their findings from the absolute intake data and letting the data stand as it is rather than make various adjustments to convoluted extremes and try to make headlines. Nice try though.

Diet for Diabetes Mired in Half-Truths

"A half-truth is a whole lie."
Yiddish Proverb

If you want to see a truly stupendous exercise in smoke-and-mirrors and misdirection, look no further than people like Hope Warshaw, or organizations like the American Diabetes Association -- they've practically cornered the market on rhetorical tricks and red herrings.

Of course, that's almost understandable since everything recent scientific studies have to say about their most popular punching bag, carbohydrate restricted diets, directly contradicts their doom-and-gloom predictions that no one can eat that way, or should.

Case in point, the recent Diabetes Health article penned by, none other than, Hope Warshaw, The Optimal Eating Plan for Type 2 Diabetes?

Let me first say, Ms. Warshaw is quite proud of her accomplishments and offers visitors to her website the following information in her biography detailing her direct work with "McNeil Nutritionals, LLC, a Johnson & Johnson Company; Mead Johnson Nutritionals, a division of Bristol-Myers Squibb; Roche Diagnostics and Novo-Nordisk Pharmaceuticals. She writes consumer and professional materials for brochures, newsletters and websites. Hope has worked with PR [public relations] companies on nutrition-related campaigns, such as Barkley Evergreen & Partners, Fleischman Hillard, Inc., Paine PR, Edelman, RF Binder and Hunter Public Relations."

I point this out to highlight the fact that Ms. Warshaw is well schooled in media and marketing, or should I say "spin"? Simply put, she's no novice when it comes to creative persuasion, that is how to craft a message that hits on all cylinders of your emotions.

Keep in mind as we move on, feelings do not change facts.

In her recent addition to the media fodder attempting to discredit carbohydrate restricted diets, she sets the stage quite brillantly to avoid fact by littering her piece with half-truths designed to appeal to fear.

Bottom line - statements with half-truths are deceptive; they're partly true, but not the whole truth; they present a verifiable piece of information that is true, but in context is not representative of the truth. Some might say they're lies, others might say they're stretching the truth, and still others may say that a half-truth is really just being economical with the truth.

They've been with us for generations. We find them littering food packaging and in advertisements for many different things; sometimes stated, sometimes implied, and sometimes even admitted to in the fine print no one reads. Half-truths are so prevalent in our daily lives, is it any wonder that when one appears in an article about health, no one seems to notice?

Ms. Warshaw sets the stage by setting readers minds to believe her article is the truth about the "optimal" diet for those with diabetes; and uses a number of literary tricks - rhetorical statements, imaginative prose and pursuasive words to trigger a desired response in readers. She leads with our base knowledge that dieting is hard and we should "be realistic and take a long-term perspective in this “which diet is best” debate, rather than wasting time quibbling over extremes - from low-carb to vegan."

With this one sentence she's already working hard to influence readers by bringing them into her world while employing empathy, *we all know* it's a waste of time to quibble over diet, that vegan and low-carb are *extreme* diets, and that, as the title of her article hints, *we know* the optimal diet for those with diabetes.

Forget about data, there isn't even room for debate.

Since that isn't quite enough, she then adds a message driver, a logical fallacy to drive this message home by appealing to fear, one of our strongest emotions.

Fear of being a loser, on the losing team, on the team that no one wants to be a part of anyway, the team that everyone quits because it's so bad.

"A Team’s No Good If All the Players Quit"

Think about that statement for a moment.

A Team’s No Good If All the Players Quit.

It conjures up cliches we all know - quitters never win, be a team player, teamwork works, winners never quit...and it stirs up fear - the fear of failure.

So with that in play, she then moves in with the half-truths - "A number of studies that compare low carb diets to conventional diets demonstrate early initial weight loss and improvement in other health parameters, such as blood glucose control. But studies of low carb diets that last longer than six months do not show significantly more weight loss. They do show that many study subjects drop out of the study and are unable to stick with the diet."

She cites two studies to support her assertion and show veracity of her statements:

1. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill D, Mohammed S, Szapary PO, Rader DJ, Edman JS, Klein S.: A randomized trial of a low-carbohydrate diet for obesity. NEJM 348(21): 2082-90, 2003.

2. Bravata, DM, Sanders L, Kuang J, Krumholz HM, Olkin I, Gardner CD, Bravata D: Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 289: 1137 – 1850, 2003.

When we review these studies, we find her statements are accurate, but more accurately they are smoke and mirrors because they do not present the whole truth since the two studies are not trials specifically investigating dietary approaches for those with diabetes.

Indeed the studies she cites - one is an investigation comparing low-carb and low-fat diets for obesity, the second is a meta-analysis reviewing some of the published studies up to one year comparing low-carb and low-fat diets for obesity. So while weight loss was a key part of the studies cited, they are not the most relevant available to us to examine for those with diabetes.

You see, the two studies above, while they included subjects who were obese, they were not diabetic subjects; and the second was not a research study, but a meta-analysis review of studies that included the first study cited.

But a casual reader wouldn't know that - they only see two references which lends credibility to her statements and makes them appear to be important in determining dietary recommendations for those with diabetes.

Now consider this - how would her statement need to change if she included Beneficial effects of ketogenic diet in obese diabetic subjects?

In this study, subjects with and without diabetes, were grouped by blood sugar levels and the study lasted 56-weeks (one year, one month) and there were no drop outs - that is all who started the study completed it. With across the board improvements in total cholesterol, HDL, LDL, triglycerides, and fasting blood sugar in both groups, along with significant weight loss over the period of a year (a 54-pound average weight loss for both groups!) is it any wonder she didn't cite this one?

Or how about Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up, a study over a period of almost two years that compared a low-fat diet to a low-carb diet in those with diabetes; and at six months, those following the low-fat diet abandon it when they saw the results of those following the low-carb diet? Oh, yeah, there were also significant improvements to risk factors including blood sugars (with elimination of medications) and weight loss and weight maintenance.

Two longer term studies, both ignored for this particular article. But a casual reader doesn't know they exist and Ms. Warshaw isn't going to tell.

So she moves on to the statement "Low-carbohydrate diets are not recommended by the American Diabetes Association for two key reasons. First, avoiding carbohydrate, as some low carb diets suggest, does not entirely return blood glucose levels to the normal range after meals. Second, an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber;" and offers two more citations to support her words, both references are ADA statements.

So again we find half-truth, but not the whole truth.

This is because Warshaw sees the world though the prism of ADA truth making it impossible to take her seriously on any level.

Does she really believe someone with diabetes will not, or more accurately, can not give up consuming sugar or excessive carbohydrate that she feels it necessary to portray the dietary approach as one where "avoiding carbohydrate" is a problem rather than the solution?

Many, if not all, carbohydrate controlled plans restrict total carbohydrate each day, but no plan says you must avoid all carbohydrate or eliminate it completely. Maybe she has a problem with a diabetic avoiding sugar and foods that quickly raise blood glucose?

Second, her statement that avoiding carbohydrate..."does not entirely return blood glucose levels to the normal range after meals" implies that what she's going to present to readers will do just that - just ignore the smoke, just ignore the mirrors, as she continues with "an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber."

Ignore the fact that all carbohydrate restricted plans include and encourage a high intake of non-starchy vegetables (rich with nutrients, fiber and minerals); no the message by now is clear - low-carbohydrate diets are for losers, they're unhealthy, nutrient deficient, make you avoid something with no reward for the effort (normal blood sugars after meals) and you're not going to lose weight with a low-carb diet anyway, move along now and don't pay to much attention to the fact she opened with two "extremes" low-carb and vegan but only attempts to discredit one.

Afterall we can't have anyone consider a low-carb diet, because "diets that force people to dramatically change their eating style are not maintained over the long haul. These diets require too dramatic change compared to the common, albeit not healthy, eating habits of the 21st century."

Take a good look at the last sentence - it's too big a change from the "unhealthy" eating habits we have, but by golly, a person with diabetes deserves to eat whatever they want and they can continue on with their common ways!

What she is saying is that no person with diabetes is willing to change their unhealthy ways, so why bother.

She then has the nerve to present to readers more rubbish - "Research from numerous studies, including the Diabetes Prevention Program and the National Weight Control Registry, show that people can lose weight and keep it off successfully for three years and five years, respectively, by reducing dietary fat and total calories."

Two is not "numerous" it's a couple.

And one is from subjects at risk for diabetes, the other a self-selected group of dieters who are followed in a national database because they lost weight not because they have diabetes and are in good glycemic control and maintaining weight loss!

Ms. Warshaw is pretty confident you won't check or think critically, and that you'll take her half-truths and believe a low-carb diet is impossible to follow for the long-term.

She's so sure of this in fact, she has no worry saying you can't diet on your own anyway - you need help, "you need knowledge and skills to make lifestyle changes, as well as help in setting behavioral goals, not to mention ongoing and long-term support...Ask your health care provider to refer you to a diabetes education program."

Her writing is chock-full of manufactured criticism, dead-wrong assumptions, half-truth evidence, and child-like ignorance of the emotional universe inhabited by men and women with diabetes.

She hopes no one notices that what is more important is the quality of pertinent research published, not the crafty presentation.

She relies heavily on logical fallacies - appeal to authority (the ADA) and appeal to fear - to grab and hold readers' attention, then offers clever cliches to play emotions without presenting pertinent facts to help an individual with diabetes understand the hard data.

The truth is modifying your diet is difficult, losing weight may be hard, and maintaining weight after it's lost can be a challenge; having diabetes is also a challenge and managing everything that comes with a diagnosis is no small endeavor - everything from blood glucose levels to HbA1c to cholesterol to body weight is monitored, tracked and managed; not for a week or a month, but for the rest of your life.

Ms. Warshaw contends that modifying diet too is too much to ask, too much for a person to do, too much for anyone to have to do over the long-term.

She offers the status quo - the ADA position that one deserves to be able to eat normally (even though she admits this "normal" is unhealthy); afterall a low-carb diet requires "too dramatic change" in eating habits.

Notice she hasn't said a word about the dramatic change one must make to include their medication each day; self-monitor blood sugar levels; keep doctor, opthamologist and podiatrist appointments; adjust medications as complications arise; injecting insulin each day; careful wound care; and more.

Notice she hasn't said a word about what dietary modification is necessary with the ADA recommendations.

Notice she presents no evidence to support the implication that normal blood sugars are achieved when one follows this "optimal diet."

That's because normal blood sugars do not happen when one follows the dietary recommendations of the ADA.

In fact, the ADA position is that medication is the first line defense upon diagnosis because their dietary approach fails over the long-term.

Oh, Ms. Warshaw didn't include that, did she?

No, she's done a run-around the evidence, fully aware the casual reader won't know the published data well enough to spot her half-truths or question the depth of her statements.

She stays on the surface rather than digging deep and offering a compelling look at the truth.

The truth is, those with diabetes deserve to know they have options.

They deserve a full disclosure of the data to allow them to make an educated decision about what they can and cannot do with diet; what they will and will not do to manage their diabetes.

They deserve to know that not only do blood sugars normalize in many with diabetes who adhere to a carbohydrate restricted diet, but medication is often eliminated or reduced.

They deserve to know a dietary approach is available that may indeed provide normal blood sugars!

They deserve no less than full patient autonomy, something Ms. Warshaw seems to know nothing about.

They deserve the whole truth!

Weight Loss, Cholesterol and Blood Sugar Improvements - What's the Wonder Drug Now?

While the media is hot and heavy to lead their headlines with junk science complete with amateurish conclusions, a study was quietly published Friday in the journal, Molecular and Cellular Biochemistry - Beneficial effects of ketogenic diet in obese diabetic subjects (abstract) - that's remains ignored.

No fanfare, no ballyhoo, in fact, not one headline to call attention to the significant findings, over the course of a year, of a dietary trial in obese subjects with and without type II diabetes.

Findings that included:

For both groups, diabetic and normal glucose:

• Weight loss of 24.55kg in 56-weeks (that's 54-pounds)
• Total Cholesterol down 19.3%
• LDL down 28.2%
• HDL up 52.3%
• Triglycerides down 59%
• Fasting Blood Glucose down 31%

For those with type II diabetes:

• Weigth loss of 24.4kg in 56-weeks (that's 53.7-pounds)
• Total Cholesterol down 28.5%
• LDL down 33%
• HDL up 63.4%
• Triglycerides down 40.8%
• Fasting Blood Glucose down 50.9% (yes, glucose fell more than 50%)

So, what exactly did the researchers have these subjects do that led to such impressive improvements over the course of 56-weeks?

Sixty-four subjects were divided into two groups - thirty one had abnormal glucose levels (type II diabetes) and the remaining thirty-three had normal glucose levels. Both groups were instructed to modify their diet to include only 20g of carbohydrate a day from a list of foods allowed along with 5-tablespoons of olive oil on salads, and allowed 80g-100g of protein from meat, eggs, fish, poultry and full-fat cheese each day. No alcohol was consumed by participants. At week 12, participants were allowed to increase carbohydrate to 40g per day. Throughout the 56-weeks some foods were forbidden - flour, bread, rice, macaroni, noodles, honey, sugar, sweets, cakes, potatoes, all fruit juices and all soft drinks.

Yes, shocker - the study was designed to measure the effects of a ketogenic diet in subjects with and without type II diabetes.

So, with the above findings, it's no wonder this one is being quietly ignored.

While the media, government policy makers and leading health organizations keep wishing for negative findings from studies of low carbohydrate diets, the opposite keeps happening - the pile of studies finding significant improvement keeps growing higher and higher.

How profound were the changes in real numbers?

Those with diabetes had baseline fasting blood glucose levels of 188.64mg/dl; by the end of the trial, at week 56, their fasting blood glucose averaged 87.66mg/dl. Even those with normal blood glucose, who started with a baseline fasting blood glucose of 92mg/dl, saw improvement; at the end of the trial they had a fasting blood glucose of 85mg/dl.

There is not one drug on the market today, recommended for those with diabetes, that shows such significant improvement in fasting blood sugar, sustained over a period of more than a year!

Oh, but it gets better. Cholesterol improvements in this trial were unmatched by any drug trial.

Those with diabetes:

Baseline Week-56

Total Cholesterol 265 190
LDL 203 131
HDL 39 62
Triglycerides 418 89

Those with normal glucose:

Baseline Week-56

Total Cholesterol 214 181
LDL 156 109
HDL 47 63
Triglycerides 160 77

No cholesterol medication reduces LDL by 33% while also increasing HDL by 63.4%; and reducing triglycerides by 59%.

If the above finding were for a new drug, not only would the headlines be screaming for everyone with dyslipidemia to be prescribed it immediately, but every last expert in the country would be making the rounds in the media to be heard about this new wonder drug!

Sadly this isn't a new wonder drug rich with potential for profits. Instead it's simple dietary therapy, with no bottomline enhancement for anyone, save for a few farmers and ranchers.

So no headlines, no urgent call to take a look at the data which validates previous studies, no demands for reviewing the evidence; nope, the powers that be will continue along, fingers in ears, singing "La La La" as they hope no one notices the mountain of evidence growing.

If you have diabetes, or are at risk for developing diabetes, get to know what a carbohydrate restricted diet is and how to integrate it into your health management, it may save your life.

UPDATE 4/24/2007

A reader brought to my attention a pretty glaring error in reporting of reduction of triglycerides. I posted the numbers from the full-text above as published - a reduction in triglycerides in those with high blood glucose = -40.8%

A review of the actual numbers shows a reduction over the 56-week period from 4.681mmol/l to 1.006mmol/l - a 78.72% reduction in those with high blood glucose; and from 1.827mmol/l to 0.861mmol/l in those with normal blood glucose - a 54.01% reduction.