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Old 10-21-2004, 04:04 PM   #1
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Dangers of High-Protein, Low Carb - Diabetes

Extract from the Johns Hopkins White Paper on Diabetes:

The Dangers of High-Protein, Low-Carbohydrate Diets for People With Diabetes

Maintaining a healthy body weight is important for both the prevention and treatment of diabetes. Excess body weight increases the risk of developing diabetes; for overweight people with the disease, losing weight can improve blood glucose control and reduce the risk of long-term complications.

Losing weight is difficult, however, and many people resort to fad diets. Among the most popular ones today are high-protein, low-carbohydrate diets that promise rapid weight loss by following a food plan that is high in protein but limits foods rich in carbohydrates, such as fruits, vegetables, and grains. Some examples are Dr. Atkins' New Diet Revolution by Robert C. Atkins, M.D., Protein Power by Michael R. Eades, M.D. and Mary Dan Eades, M.D., Sugar Busters! by H. Leighton Steward, M.S. and coauthors, and The Zone by Barry Sears, Ph.D. According to the authors of these diets, high levels of insulin cause obesity by promoting the storage of calories as body fat. They claim that when a person reduces the amount of carbohydrate in the diet, the body produces less insulin and weight loss occurs.

People do lose weight on high-protein, low-carbohydrate diets, though the weight loss is due to water loss and reduced calories, not to lower insulin levels as the authors claim. Even so, nutrition experts do not recommend these diets. First, the weight loss is difficult to maintain over the long term. Second, there is some evidence that these diets may increase the risk of coronary heart disease (CHD) and kidney damage—conditions for which people with diabetes are already at high risk.

Weight Loss Is Difficult To Maintain

High-protein, low-carbohydrate diets may produce greater weight loss than other diets. But this weight loss is mostly water—rather than fat—and weight is quickly regained when you go off the diet. Why? A decreased intake of carbohydrates depletes carbohydrate stores in your body, and the water associated with these stores is released from the body. When you start eating carbohydrates again, the water returns. In addition, because high-protein, low-carbohydrate diets restrict food choices, people cannot follow these diets for long periods of time, and the lost weight is ultimately regained.

Increased Risk of Coronary Heart Disease

Diets high in protein tend to be high in fat, particularly saturated fat. For example, the Atkins diet and Protein Power provide about 20% to 25% of calories from saturated fat. In comparison, the American Diabetes Association recommends that less than 10% of calories come from this type of fat.

Diets high in saturated fat can raise blood cholesterol levels, which in turn increase the risk of CHD. In a study of the Atkins diet, published in the Journal of the American Dietetic Association in September 1980, people who followed the diet for eight weeks experienced an increase in blood cholesterol levels, even though they had lost weight. (Weight loss is known to decrease cholesterol levels.) In a more recent study in the October 2000 issue of the Journal of the American College of Nutrition, researchers calculated that long-term use of the Atkins diet would result in a 25% increase in blood cholesterol levels, which translates to an increased risk of CHD of more than 50%.

High-protein, low-carbohydrate diets can also increase your risk of CHD because they tend to be low in fiber, owing to the restrictions on fruits, vegetables, and grains. While the American Diabetes Association recommends 20 to 35 g of fiber per day, the Atkins diet and Protein Power supply only 5 to 10 g. Research shows that foods high in soluble fiber, such as oat bran, legumes, and apples, can decrease cholesterol levels and protect against CHD.

Increased Risk of Kidney Dysfunction

The American Diabetes Association recommends that people with diabetes consume no more than 20% of calories from protein. High-protein, low-carbohydrate diets exceed these recommendations: Protein makes up 35% of the calories in the Atkins diet and Protein Power, and 28% of the calories in Sugar Busters and The Zone. Such high levels of protein may increase the risk of kidney damage in people with diabetes and exacerbate existing kidney disease.

Another way that high-protein, low-carbohydrate diets may cause kidney problems is through a process called ketosis. Ketosis, which occurs when you do not eat enough carbohydrates, results in the production of acidic substances known as ketones that may build up in the bloodstream in people with type 1 diabetes. This can lead to a diabetic emergency known as diabetic ketoacidosis.

The Best Weight Loss Plan

The best way to lose weight—and to keep it off—is not to look for a "quick fix" but to make lifestyle changes that involve reducing the total number of calories you eat while increasing your level of physical activity. Remember, it is excess calories, not excess carbohydrates, that make you fat.

So eat a variety of foods to ensure that you get all the essential nutrients that your body needs. By choosing foods that are higher in carbohydrates and fiber and lower in fat, you can also improve blood glucose control and decrease your risk of CHD and kidney damage.



From The 2002 edition of the Johns Hopkins Diabetes White Paper.

Last edited by ty123; 10-21-2004 at 04:05 PM.

 
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Old 10-21-2004, 08:17 PM   #2
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Re: Dangers of High-Protein, Low Carb - Diabetes

Kinda funny how one part of Johns Hopkins claims that ketogenic diets like Dr. Atkins can be harmful while another part uses a similar very low carbohydrate ketogenic diet for treatment of epilepsy.

From the Johns Hopkins Epilepsy Center: http://www.neuro.jhmi.edu/Epilepsy/keto.html

"The Ketogenic Diet is a carefully calculated diet, high in fat, low in protein, and virtually carbohydrate-free which is used for the treatment of difficult-to-control seizures in children. This diet was first formulated in the early 1920's and has proven to be very effective. However, many centers stopped using the diet to control seizures as new medications were developed. We have continued to use the ketogenic diet at Johns Hopkins and have refined the methodology to produce a text and a computer disc which enables families to calculate the diet more easily.

The diet is a medical therapy and should be used only under the careful supervision of a physician and/or dietician. The diet carefully controls caloric input and requires that the child eat only what has been included in the calculations to provide 90% of the day's calories as fats. The diet is currently offered only to children and adolescents although protocols are being planned for adults."

And from the Johns Hopkins Childrens Center: http://www.jhu.edu/~gazette/2003/15dec03/15atkins.html

"In a limited study of six patients, including three patients 12 years old and younger on the Atkins regimen for at least four months, two children and one young adult were seizure-free and were able to reduce use of anticonvulsant medications. Findings of the study, presented Dec. 9 at the American Epilepsy Society Meeting in Boston, also showed that seizure control could be long-lasting on the diet, with the three patients continuing to be seizure-free for as long as 20 months.

The researchers caution that because of the small number of study subjects, their look at the relationship between the Atkins diet and seizure control should not lead to its routine use in children with epilepsy, nor at this point should the Atkins diet be used to replace the ketogenic diet, the rigorous high-fat, low-carbohydrate diet already proven to reduce or eliminate difficult-to-control seizures in some patients.

The common elements in both diets are high-fat and low-carbohydrate foods that alter the body's glucose chemistry. The ketogenic diet mimics some of the effects of starvation, in which the body first uses up glucose and glycogen before burning stored body fat. In the absence of glucose, the body produces ketones, a chemical byproduct of fat that can inhibit seizures. Children who remain seizure-free for two years on the ketogenic diet often can resume normal eating, and often their seizures don't return. The Atkins diet, while slightly less restrictive than the ketogenic diet, also produces ketones.

Also, because the Atkins diet was designed originally for weight loss, Kossoff said it is possible that patients following the diet to reduce seizures may lose weight in the process. If that does occur, and a patient's weight has reached unhealthy levels, the patient should be instructed to increase calorie intake by eating more fats and proteins, he said.

In the Johns Hopkins study, patients began with 10 grams of carbohydrates per day, more than the typical amount provided on the ketogenic diet but fewer than used in the induction phase of the Atkins diet, which is 20 grams a day. Carbohydrate intake was gradually increased for some patients. Five of the six patients attained ketosis (the state of producing ketones) within days of starting the Atkins diet and maintained moderate to large levels of ketosis for periods of six weeks to 24 months."

More from Johns Hopkins: http://www.hopkinsmedicine.org/healthnewsfeed/HNF_694.HTM

"Safe and rapid weight loss is the goal of scale-watchers everywhere. But it rarely comes easy, especially to kids.

One diet does seem to work, however. It's called a ketogenic diet, an eating plan that's also been used to treat epilepsy. A version of it was recently tested in South Carolina on a small group of very overweight children ages 12 to 15. The kids were put on foods high in protein, low in fat and low in carbohydrates for a two-month period. They lost an average of 34 pounds, and better yet, slimmed down all parts of the body. They also enjoyed lower levels of cholesterol."

Hmmm. You would think that if a high fat, low carbohydrate diet was as harmful as those dieticians at Johns Hopkins claim in the white paper that they wouldn't use it on kids to treat epilepsy and obesity.
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Old 10-22-2004, 05:06 AM   #3
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Re: Dangers of High-Protein, Low Carb - Diabetes

The opinions stated in this white paper are the standard treatment recommendations of the American Diabetes Association. There are many endocrinologists and diabetologists both in the U.S. and internationally who strongly disagree with the ADA's diet recommendations for the treatment and control of diabetes. The above white paper contains several inaccurate statements and half-truths concerning diabetes treatment and makes no distinction between Type 1 or Type 2 diabetics. It also doesn’t address the advantages of low carb diets for Type 2 diabetics who are successfully controlling their diabetes without drugs or insulin.

Dr. Bernstein is a Type 1 diabetic for 58 years and a world renowned diabetologist and medical school professor who has repeatedly stated that the ADA's high carb sugar diet recommendations have been killing diabetics for many years. He is speaking from his years of experience and training at a major teaching hospital diabetes clinic and from his experience of treating diabetics from around the world in his private practice.

I would suggest that if you are a diabetic or just interested in learning something about diabetes treatment that you read the information on his "Diabetes Solution" and "Diabetes in Control" websites. I would also recommend that you read his book "Dr. Bernstein's Diabetes Solution: A Complete Guide to Achieving Normal Blood Sugars - Revised and Updated Edition!" if you are looking for accurate information concerning diabetes.

Last edited by ZippyDawg; 10-22-2004 at 05:13 AM.

 
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Old 10-22-2004, 05:49 AM   #4
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Re: Dangers of High-Protein, Low Carb - Diabetes

You can find "doctors" that support chelation and even Cortaslim, and its a good idea to stay informed, but to the extent that you seek an alternative treatment instead of one that is recommended by most doctors and institutions you're on your own...just you and the radical websites preaching your treatment.

 
Old 10-22-2004, 06:16 AM   #5
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Re: Dangers of High-Protein, Low Carb - Diabetes

Diabetes Diet War

The nutrition advice given to most diabetics might be killing them

By Dara Mayers

The bible says "make starches the star." That's the Diabetes Food and Nutrition Bible, published by the American Diabetes Association. "Grains, beans, and starchy vegetables form the foundation of the Diabetes Food Pyramid. The message is to eat more of these foods than of any of the other food groups." For 17 million Americans with diabetes, diet is a crucial part of treatment, And what the ADA bible preaches, many doctors, nutritionists, and patients believe.

But what if the ADA's high-starch diet--another way of saying high-carbohydrate--is not healthy for people with diabetes but harmful to them instead?

This possibility is now the source of heated debate in the diabetes community. It is "the most controversial aspect of diabetes treatment today," says Scott King, editor-in-chief of Diabetes Interview magazine. How controversial? "Malpractice!" is how physician and diabetes specialist Lois Jovanovic, chief scientific officer of the Sansum Medical Research Institute in Santa Barbara, Calif., describes conventional high-carb nutrition advice.

Carb consequences. These arguments are more intense than the nutrition wars over low-carb, Robert Atkins-like diets taking place in mainstream culture. For people with diabetes, the battle is about more than waistlines. As far as bodies are concerned, carbohydrates equal sugar. And complications from Type I and Type II diabetes, which are caused by high blood-sugar levels, include amputation, heart disease, blindness, and kidney failure. Often they are lethal. The illness is not necessarily a disaster, because people with diabetes who maintain close to normal blood sugar can effectively avoid these problems. A number of doctors and people with diabetes, however, believe the high-carb diet is a recipe for trouble.

"There are a number of myths surrounding diet and diabetes, and much of what is still considered sensible nutritional advice for diabetics can over the long run be fatal. I know, because it almost killed me," writes physician Richard Bernstein in his book Diabetes Solution. Bernstein, a Type I, or insulin-dependent, diabetic for the past 57 years, has been at war with the medical establishment since the 1970s. At that time, his failing health caused him to wonder why someone whose body couldn't process carbs--which are chains of sugar molecules--was repeatedly being told to eat a lot of them. Should people with diabetes be eating a diet that is, essentially, 50 percent to 60 percent sugar?

The reason, historically, has been fear of fat and the cardiovascular problems that plague diabetics. As the cholesterol-fat-heart-disease links moved doctors to recommend a low-fat diet, the amount of carbohydrates recommended for diabetics gradually increased to fill the void. In 1994, the ADA stated that people with diabetes could eat anything, including sugar itself. "There is no longer a diabetic diet. People with diabetes eat the exact same foods as anyone else," says Nathaniel Clark, national vice president for clinical affairs at the ADA. "We do not believe there is any harm in eating carbohydrates."

Bernstein does. He prescribes an extremely low carbohydrate diet--approximately 30 grams of carbs over three meals for diabetics to achieve normal blood-glucose readings round-the-clock. "In my experience," he says, "the ADA diet does not work for anyone."

He's not alone. "Diabetes is a disease of `carbohydrate intolerance.' Thus, meal plans should minimize carbohydrates because people with diabetes do not tolerate carbs," says Sansum's Jovanovic. She prescribes food considerably lower in carbohydrates than does the ADA.

Some patients are discovering low-carb benefits for themselves. Nancy Humeniuk, a 70-year-old retiree and Type II diabetic from Monterey, Tenn., was put on the ADA diet under the direction of a diabetes educator. "While I was following the diet, my blood-glucose levels were completely out of control," Humeniuk says. "They told me I was being noncompliant--but I was following the diet exactly. I was scared." After three months, Humeniuk switched to low carb. "Within three days of going low carb, my blood sugars were normal. And they have been for the past six years." Her cholesterol profile is also very good. "My doctor told me that whatever I was doing, I should keep it up," she says.

The ADA, however, remains firm in its stance. "A diet that is very low in carbohydrates is significantly higher in protein and in fat, and there are specific risks to people with diabetes from high-protein diets in regard to kidney disease and from high-fat diets in regard to cardiovascular disease," Clark says. The ADA is far from alone in its position. "We recommend that 45 to 60 percent of calories come from carbs," says Karen Chalmers, director of nutrition services at the Joslin Diabetes Center in Boston.

"Healthy fats." Scientific evidence supporting the low-carb approach has been thin. But some recent studies have refuted the idea that an Atkins-like diet increases cholesterol, or lipid, problems. "Our data would suggest that you don't get a negative lipid pattern with the Atkins diet," says James Hill, director of the Center for Human Nutrition at the University of Colorado, where a recent study compared the Atkins diet with a standard low-fat, high-carb diet. Cholesterol levels in the Atkins dieters were actually better after a year. Frank Hu, associate professor of nutrition and epidemiology at the Harvard School of Public Health, also believes that lower-carb diets are beneficial to some people with diabetes. He is careful to point out, however, that carbohydrates should be replaced with "healthy fats," such as the mono- and polyunsaturated fats found in olive oil, nuts, and avocados.

The kidney-disease claim is also disputed. "There is no evidence that in an otherwise healthy person with diabetes eating protein causes kidney disease," says Frank Vinicor, director of diabetes research at the Centers for Disease Control and Prevention.

Some people hope that the new data will have an impact. "The ADA is responsive to new scientific data and is likely to incorporate this information into new dietary guidelines with a lower proportion of carbohydrates," says ADA board member Barbara Kahn, a physician and diabetes expert at Harvard Medical School. Kahn has seen how difficult it is for people with diabetes to gain control while following current recommendations, so she is pushing for changes. Still, the ADA Web site and all of its literature continue to tell people with diabetes and the thousands of medical professionals who treat them to make starches "the centerpiece of the meal." Revising a bible is never easy, so it may be quite some time before this bit of medical gospel sees real change.

 
Old 10-22-2004, 06:25 AM   #6
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Re: Dangers of High-Protein, Low Carb - Diabetes

Diabetics on Dr. Ornish's program found that they could reduce or eliminate their diabetic medication. Carbohydrates were indeed the problem, but the key was eliminating simple carbs with complex ones.

It is certainly possible that a low carb diet may be better than eating processed carbohydrates, but a better diet is likely to eliminate nearly all simple carbohydrates and then eat a balanced diet as prescribed the the American Diabetic Association.

 
Old 10-22-2004, 06:55 AM   #7
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Re: Dangers of High-Protein, Low Carb - Diabetes

"There are a number of myths surrounding diet and diabetes, and much of what is still considered sensible nutritional advice for diabetics can over the long run be fatal. I know, because it almost killed me," writes physician Richard Bernstein in his book Diabetes Solution. Bernstein, a Type I, or insulin-dependent, diabetic for the past 57 years, has been at war with the medical establishment since the 1970s. At that time, his failing health caused him to wonder why someone whose body couldn't process carbs--which are chains of sugar molecules--was repeatedly being told to eat a lot of them. Should people with diabetes be eating a diet that is, essentially, 50 percent to 60 percent sugar?

The reason, historically, has been fear of fat and the cardiovascular problems that plague diabetics. As the cholesterol-fat-heart-disease links moved doctors to recommend a low-fat diet, the amount of carbohydrates recommended for diabetics gradually increased to fill the void. In 1994, the ADA stated that people with diabetes could eat anything, including sugar itself. "There is no longer a diabetic diet. People with diabetes eat the exact same foods as anyone else," says Nathaniel Clark, national vice president for clinical affairs at the ADA. "We do not believe there is any harm in eating carbohydrates."

Bernstein does. He prescribes an extremely low carbohydrate diet--approximately 30 grams of carbs over three meals for diabetics to achieve normal blood-glucose readings round-the-clock. "In my experience," he says, "the ADA diet does not work for anyone."

He's not alone. "Diabetes is a disease of `carbohydrate intolerance.' Thus, meal plans should minimize carbohydrates because people with diabetes do not tolerate carbs," says Sansum's Jovanovic. She prescribes food considerably lower in carbohydrates than does the ADA.


Before you launch one of your attacks against Dr. Jovanovic as just another low carb nut job perhaps you should review her credentials as a physician who specializes in the treatment of diabetes.

Lois Jovanovic, M.D. - Endocrinology and Metabolism

Dr. Lois Jovanovic is an internist specializing in endocrinology and metabolism. She became Director of the Sansum Medical Research Institute in Santa Barbara in 1996 and is Clinical Professor of Medicine in the Division of Endocrinology at the University of Southern California in Los Angeles. She directed the Diabetes Program at the Santa Barbara Cottage Hospital and currently is the Chief of the Department of Medicine.

Dr. Jovanovic has been actively involved in research for many years. She was Principal Investigator of the Cornell University Medical College Program for both The Diabetes Control and Complications Trial and The Diabetes in Early Pregnancy Study. She also developed the Diabetes and Pregnancy Program and protocols of intensive insulin delivery, which became the basis for many of the systems of insulin delivery today. Her work in the field of diabetes and pregnancy has become the mainstay of therapy for all diabetic pregnant women, and the protocols she developed have increased the chances of diabetic pregnant women having a healthy infant from only 20% to the same chances as non-diabetic women.

Dr. Jovanovic has authored over 200 articles, including 76 for refereed journals, and 25 books on the topic of diabetes and pregnancy and islet cell transplantation. She serves on the editorial boards of Diabetes Self-Management, Human Sexuality, Clinical Pharmacology and Therapeutics, and the American Journal of Perinatology and is a contributing editor for the Journal of the American College of Nutrition and special editor for Endocrine Practice, the Journal of the American Association of Clinical Endocrinology. In addition, Dr. Jovanovic serves on the national board of directors of the American Diabetes Association and is a member of their Publication Policy Committee.


Board Certifications

American Board of Internal Medicine - 1976
ABIM Subspecialty Board, Endocrinology - 1979

Healthwise Knowledgebase Topics Reviewed
Gestational Diabetes


Education

M.D.: Albert Einstein College of Medicine, New York - 1973
Internship in Internal Medicine, The New York Hospital, Cornell Medical University Medical College, 1973 - 1974
Junior Resident in Internal Medicine, The New York Hospital, Cornell Medical University Medical College, 1974-1975
Senior Resident in Internal Medicine, The New York Hospital, Cornell Medical University Medical College, 1975 - 1976
Research Fellow in Endocrinology and Metabolism, Cornell University Medical College, 1976 - 1978


Academic Appointments

Assistant Attending Physician, The New York Hospital, 1978 - 1985
Cornell University Medical College:
• Instructor in Medicine, 1978 - 1979
• Assistant Professor of Medicine, 1979 - 1985
• Associate Professor of Medicine, 1985 - 1986
• Assistant Professor in Obstetrics/Gynecology, 1979 - 1985
Associate Professor in Obstetrics/Gynecology, 1985 - 1986 Rockefeller University:
• Guest Investigator, 1977 - 1978
• Assistant Adjunct Professor, 1979 - 1985
• Assistant Physician, 1977 - 1980
• Associate Physician, 1980 - 1985
Associate Adjunct Professor of Medicine, University of California, Irvine, 1986 - 1988
Clinical Associate Professor of Medicine, University of Southern California, Los Angeles Medical Center, 1986 - 1989
Faculty member, University of Barcelona, Spain, 1994
University of Southern California, Los Angeles Medical Center:
• Clinical Associate Professor of Medicine, 1986 - 1989
• Clinical Professor of Medicine, 1989 -
Research Biologist, University of California Santa Barbara, 1990
Hospital Appointments
Associate Director, Clinical Research Center, New York Hospital, Cornell University Medical Center, 1980- 1985
Santa Barbara Cottage Hospital:
• Faculty in Internal Medicine and staff member, 1986 -
• Director, Diabetes Program, 1987 -
• Co-director, Nutrition Support Team, 1990 -
• Chief, Division of Endocrinology, 1992 -
• Vice Chair, Department of Medicine, 1994 -
• Chair, Peer Review, Department of Medicine 1994 -
• Chair, Department of Medicine, 1997 - 1999


Professional Affiliations

American College of Endocrinology
American College of Nutrition
American College of Physicians
American Federation of Clinical Research
American Medical Women's Association
Association for Program Directors
Endocrine Society
American Diabetes Association and Council on Diabetes and Pregnancy
European Association for the Study of Diabetes
International Advisory Council, Fundacion Diabetes, Endocrinologiay Metabolismo
National Kidney Foundation
Society for Endocrinology, Metabolism and Diabetes of Southern Africa
Society for Experimental Biology and Medicine
Society of Obstetric Medicine


Selected Publications

1. Jovanovic-Peterson L, Peterson CM (1996). Vitamin and mineral deficiencies which may predispose to glucose intolerance of pregnancy. Journal of the American College of Nutrition 15: 14 - 20.
2. Bashoff EC, Johnson LM, Jovanovic L, et al. (1998). Women and diabetes: Special health concerns. Patient Care 32: 112 - 135.
3. Jovanovic L (1998) Sex and the diabetic woman: Desire versus dysfunction. Diabetes Reviews 6: 65 - 72.
4. Jovanovic L (1998). Management of diet and exercise in gestational diabetes mellitus. Prenatal Neonatal Medicine 3: 534 - 541.
5. Mills JL, Jovanovic L, Knopp R (1998). Physiological reduction in fasting plasma glucose concentrations in the first trimester of normal pregnancy: The diabetes in early pregnancy study. Metabolism 47: 1140 - 1144.
6. 5. Jovanovic L, Ilic S, Pettitt DJ, Hugo K, Gutierrez M, Bowsher RR, Bastyr EJ, Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care 22:1422-1427, 1999.
Selected Textbooks/Chapters
1. Jovanovic-Peterson L, Levert S (1993, revised 1996). A Woman Doctor's Guide to Menopause. New York: Hyperion.
2. Jovanovic L, Sperling MA, Schover LR, et al. (1998). Women's Sexual Health. The Uncomplicated Guide to Diabetes Complication. Levin ME and Pfeiffer MA, eds. Alexandria, VA: American Diabetes Association.
3. Jovanovic L, Arsham G (1998). Diabetes Spectrum, From Research to Practice: Diabetes in Women and Men. Alexandria, VA: American Diabetes Association.

Last edited by ZippyDawg; 10-22-2004 at 07:42 AM.

 
Old 10-22-2004, 07:34 AM   #8
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Re: Dangers of High-Protein, Low Carb - Diabetes

I think there is food for thought in the above article, although you and I are never going to agree that there is a difference between simple and complex carbohydrates. Ornish had real success with diabetes as well by eliminating simple carbohydrates.

BTW: you caution me not to attack "Dr. Sansum", and then provide significant background on Lois Jovanovic. I assume you meant to say Dr. Jovanovic, although there is some reference to "sansum's jovanovic" above that. Probably not important, Jovanovic's bona fides are impressive.

Certainly, if I had diabetes, I'd be interested in tweaking the balance between complex carbs, protein, and fat to see how it affected my blood sugar, but I'd be focused on keeping fat, especially saturated fat low, eliminating simple carbs, and perhaps stretching out protein a little.

 
Old 10-22-2004, 08:05 AM   #9
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Re: Dangers of High-Protein, Low Carb - Diabetes

Thanks for the correction. Dr. Lois Jovanovic is the Director of the Sansum Medical Research Institute.

Dr. Bernstein also graduated from the Albert Einstein College of Medicine and currently is or was a Professor of Medicine who also has an impressive resume.

What he has to say about simple/complex carbohydrates:

The Basic Food Groups OR MUCH OF WHAT YOU’VE BEEN TAUGHT ABOUT DIET IS PROBABLY WRONG

CARBOHYDRATE

I’ve saved carbohydrate for last because it’s the food group that adversely affects blood sugar most profoundly. If you’re like most diabetics— or virtually everyone who lives in an industrialized society — you probably eat a diet that’s mostly carbohydrate. Grains. Fruit. Bread. Cake. Beans. Snack foods. Rice. Potatoes. Pasta. Breakfast cereal. Bagels. Muffins. They look different, but dietarily speaking, they’re essentially the same.

If you are already obese, you know and I know that you crave— and consume—these foods and probably avoid fats. As studies show, you would be better off eating the fat than the carbohydrate. Fat alone will be burned off. A combination of high-carbohydrate foods and fat will foster fat storage.

It is, therefore, a myth that Americans are overweight due to excessive fat consumption. Americans are fat largely because of sugar, starches, and other high-carbohydrate foods.

According to statistics released by the U.S. Department of Agriculture, added sugar consumption hit an all-time high in 1999 (the last year for which statistics were available), at a whopping 158 pounds per American per year, an increase of 30 percent over 1983. The key word here is “added.” This doesn’t account for starches and sugars naturally present in food. According to a report from the Oregon Health Sciences University, a 12-ounce Starbucks Grande Caramel Mocha drink contains 45 teaspoons of added sugar.

This increase not coincidentally corresponds with the timing of recommendations to eat less fat. It was 1984 when the National Institutes of Health (NIH) began advising everyone within shouting distance to cut fat intake. It also corresponds quite neatly with the creation of a whole new, multibillion-dollar industry in low- and nonfat foods, many of which are extremely high in sugar. For more than ten years, the government had planned to issue a report once and for all damning
fat as the demon some scientists were sure it was. The problem was, researchers couldn’t “reverse engineer” the actual data to make the science fit the assumption. Unfortunately, the program to indict fat was left to die a quiet death, and not so much as a press release was
issued to say, “We were wrong.”And so many of us still don’t know the truth. They were wrong.

No doubt the popular media have made you aware of the endless procession of books and diets and advertisements for foods all touting the value of high “complex carbohydrate” in the diet. Athletes “carboload” before big games or marathons. TV and radio commercials extol the virtues of Brand X sports drink over Brand Y because it contains more “carbos.”

As stunning as it sounds—and unbelievable, given the popular media’s recent love affair with a high “complex carbohydrate,” low-fat diet—you can quite easily survive on a diet in which you would eat no carbohydrate. There are essential amino acids and essential fatty acids, but there is no such thing as an essential carbohydrate. Furthermore, by sticking to a diet that contains no carbohydrate but has high levels of fat and protein, you can reduce your cardiac risk profile—
serum cholesterol, blood lipids, et cetera—though you’d deprive yourself of all the supposed “fun foods” that we crave most.* We’ve all been trained to think that carbohydrates are our best, most benign source of food, so how can this be?

What if I, a physician, told you, a diabetic, to eat a diet that consisted of 60 percent sugar, 20 percent protein, and 20 percent fat? More than likely, you’d think I was insane. I’d think I was insane, and I would never make this suggestion to a diabetic (nor would I even make it to a nondiabetic). But this is just the diet the ADA recommended to diabetics for decades. On the surface, these recommendations seemed to make sense because of kidney disease, heart disease, and our elevated lipid profiles. But this is what is known as single-avenue thinking. It
seemed logical to insist that dietary intake of protein and fat be reduced, because no one had looked at elevated blood sugars and the high levels of insulin necessary to bring them down as the possible culprits.

So if you eat very little fat and protein, what’s left to eat? Carbohydrate. As I discovered in my years of experimentation on myself, and then in my medical training and practice, the real dietary problem for diabetics is not only fast-acting carbohydrate but also large amounts of any carbohydrate. In either case, the result is high blood sugars requiring large amounts of insulin to try to contain them. So what are carbohydrates?

 
Old 10-22-2004, 08:06 AM   #10
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Re: Dangers of High-Protein, Low Carb - Diabetes

So what are carbohydrates?

The technical answer is that carbohydrates are chains of sugar molecules. The carbohydrates we eat are mostly chains of glucose molecules. The shorter the chain, the sweeter the taste. Some chains are longer and more complicated (hence, “simple” and “complex” carbohydrates), having many links and even branches. But simple or complex, carbohydrates are composed entirely of sugar.

“Sugar?” you might ask, holding up a slice of coarse-ground, sevengrain bread. “This is sugar?”

In a word, yes, at least after you digest it.
With a number of important exceptions, carbohydrates, or foods derived primarily from plant sources that are starches, grains, and fruits, have the same ultimate effect on blood glucose levels that table sugar does. (The ADA has recently recognized officially that, for example, bread is as fast-acting a carbohydrate as table sugar. But instead of issuing a recommendation against eating bread, its response has been to say that table sugar is therefore okay, and can be “exchanged” for other carbohydrates. To me, this is nonsense.) Whether you eat a piece of the nuttiest whole-grain bread, drink a Coke, or have mashed potatoes, the effect on blood glucose levels is essentially the same— blood sugar rises, fast.

* You’d also be missing the vitamins and other nutrients contained in lowcarbohydrate vegetables, so a zero-carbohydrate diet is not in my ball game.

As noted in the introduction to this chapter, the digestion process breaks each of the major food groups down into its basic elements, and these elements are then utilized by the body as needed. The basic element of most carbohydrate foods is glucose. We usually think of simple carbohydrates as sugars and complex carbohydrates as fruits and grains and vegetables. In reality, most fruit and grain products, and some vegetables, are what I prefer to talk about as “fast-acting” carbohydrates. Our saliva and digestive tract contain enzymes that can rapidly chop the chains down into free glucose. We haven’t the enzymes to break down some carbohydrates, such as cellulose, or “indigestible fiber.” Still, our saliva can break starches into the shorter chains on contact and then convert those into pure glucose.

Pasta, which is often made from durum wheat flour and water (but can also be made from plain white flour and egg yolks, or other variants), has been touted as a dream food—particularly for runners carbo-loading before marathons—but it quickly becomes glucose, and can raise blood sugar very rapidly for diabetics.

In the type 2 diabetic with impaired phase I insulin response, it takes hours for the phase II insulin to catch up with the postprandial levels of glucose in the blood, and day after day, during that time, the high blood sugars can wreak havoc. In the diabetic who injects insulin, there is a tremendous amount of (rarely successful) guesswork involved in finding the proper dosage and timing of insulin to cover a carbohydrate-heavy meal, and the injected insulin not only doesn’t work fast enough, it is highly unpredictable when taken in large doses in attempts to cover large amounts of carbohydrate (see Chapter 7, “The Laws of Small Numbers”).

Some carbohydrate foods, like fruit, contain high levels of simple, fast-acting carbohydrates. Maltose and fructose—malt sugar and fruit sugar—for example, are slower-acting than sucrose—table or cane sugar—but they will cause the same increase in blood sugar levels. It may be the difference between nearly instant elevation and elevation in 2 hours, but the elevation is still high, and a lot of insulin is still required to bring it into line. And, if the insulin is injected, there’s
the further problem of guesswork in timing and dosage. Despite the old admonition that an apple a day keeps the doctor away, I haven’t had fruit since 1970, and I am considerably healthier for it. Some whole-plant vegetables, that is, those that come mostly from the stalks and leaves, are of value to the diabetic and nondiabetic alike because they contain considerable amounts of vitamins, minerals, and other nutrients. (The recipe section of this book shows you a number of
tasty and satisfying ways to work these vegetables into your diet.)

As noted previously, most Americans who are obese are overweight not because of dietary fat, but because of excessive dietary carbohydrate. Much of this obesity is due to “pigging out” on carbohydraterich snack foods or junk foods, or even on supposed healthy foods like whole-grain bread and pasta. It’s my belief that this pigging out has little to do with hunger and nothing at all to do with being a pig. I’m convinced that people who crave carbohydrate have inherited this problem. To some extent, we all have a natural craving for carbohydrate— it makes us feel good. The more people overeat carbohydrates, the more they will become obese, even if they exercise a lot. But certain people have a natural, overwhelming desire for carbohydrate that doesn’t correlate to hunger. These people in all likelihood have a genetic predisposition toward carbohydrate craving, as well as a genetic predisposition toward insulin resistance and diabetes. (See page 181, “The Thrifty Genotype.”) This craving can be reduced for many by eliminating such foods from the diet and embarking upon a lowcarbohydrate diet.

In light of the above, you might guess that I advocate a nocarbohydrate diet. In fact, in the next chapter you’ll discover that I include small amounts of carbohydrate in my meal plan. Back in 1970, as I was still experimenting with blood sugar normalization, I remembered that during the twentieth century a new vitamin had been discovered every fifteen years or so. While there may be no such thing as an essential carbohydrate, it seemed reasonable to conclude that, since our prehistoric ancestors consumed some plants, plant foods might well contain essential nutrients that were not yet present in vitamin supplements and had not even been discovered. I therefore added small amounts of low-carbohydrate vegetables (not starchy or sweet) to my personal meal plan. All of a sudden I was eating salads and cooked vegetables instead of the bread, fruit, cereal, skim milk, and pasta that I had been eating on my prior ADA diet. It took a while to get used to salads, but now I relish them. Only recently, in my lifetime, have phytochemicals (essential nutrients found in plant foods) been discovered. Phytochemicals are now incorporated into some vitamin pills, but research on the use of isolated phytochemicals is still in its early stages. You may have heard of such phytochemical supplements as lutein, lycopene, and so on. It would appear that many chemicals— large numbers of which are likely not even known about yet—work together to provide beneficial effects. So at this point, it certainly
makes sense to eat low-carbohydrate salads and vegetables. (Although fruits contain the same phytochemicals as vegetables, they are too high in fast-acting carbohydrate to be part of a restricted-carbohydrate diet, as the next chapter will explain.)

Last edited by ZippyDawg; 10-22-2004 at 08:07 AM.

 
Old 10-22-2004, 08:49 AM   #11
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ty123 HB User
Re: Dangers of High-Protein, Low Carb - Diabetes

"As noted previously, most Americans who are obese are overweight not because of dietary fat, but because of excessive dietary carbohydrate. Much of this obesity is due to “pigging out” on carbohydraterich snack foods or junk foods, or even on supposed healthy foods like whole-grain bread and pasta."

I disagree with about 2/3 of that, and by the way the American Heart Association, the organization you just quoted previously doesn't agree with him either.

Americans are indeed fat in part from eating carbs...donuts, crackers, etc, and fat is a HUGE part of the ingredients in carb snacks.

Nobody in America is getting fat eating a green salad, and he says as much. I agree that some tweaking in cases of diabetes is a good idea, but balance seems to be indicated, and that is all the ADA and AHA seems to be calling for. Now, whether the optimal diet for diabetes is also the optimal diet to avoid atherosclerosis is another question, and I think part of the reason for balancing a diet is not only to prevent unhealthy affects from too much protein on the organs, but also to avoid other health problems such as heart disease, the focus implicit in this board's title.

Last edited by ty123; 10-22-2004 at 08:53 AM.

 
Old 10-22-2004, 09:27 AM   #12
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Re: Dangers of High-Protein, Low Carb - Diabetes

I plotted data showing carbs and glycemic load. It was interesting to note a very close correlation, except for a few data points. I should go back and take a look at those data points to see if maybe they had higher then normal fiber levels.

 
Old 10-22-2004, 12:15 PM   #13
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ARIZONA73 HB UserARIZONA73 HB UserARIZONA73 HB UserARIZONA73 HB User
Re: Dangers of High-Protein, Low Carb - Diabetes

Has anyone ever heard or read anything about "Cleave's Rule of 20 Years"? It has been shown that whenever refined carbohydrates are introduced into the diet of those countries which had never previously consumed them, the incidence of heart disease, diabetes, and other degenerative diseases become far more prevalent after 20 years. This phenomenon occurs regardless of fat intake. For example, Iceland, a nation which consumed a very high fat diet, still had a low incidence of heart disease, that is, until the introduction of refined carbohydrates. Those in mainstream medicine never seem to bring this up, but the evidence seems quite compelling.

 
Old 10-23-2004, 07:40 AM   #14
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Re: Dangers of High-Protein, Low Carb - Diabetes

Lots of changes happen when a societ is changed from stem to stern by dragging it into the 20th (or 21'st century.)

Apparent observations often have very little to do with peovable cause and effect.

Last edited by zip2play; 10-23-2004 at 07:44 AM.

 
Old 10-23-2004, 09:23 AM   #15
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ARIZONA73 HB UserARIZONA73 HB UserARIZONA73 HB UserARIZONA73 HB User
Re: Dangers of High-Protein, Low Carb - Diabetes

Actually, this phenomenon has even been observed in more recent years in other countries where refined carbohydrates had been introduced into the diet. For example, since refined carbohydrates were introduced into their diet in 1970, Saudi Arabia has gone from being a country that had virtually no diabetes before 1970 to having one of the highest rates of diabetes in the world. Cleave's Rule of Twenty had been right on schedule. In Saudi Arabia, diabetes and associated heart disease have emerged almost exactly twenty years after refined carbohydrates and a more Westernized diet became the norm. Of course, this is not meant to be an indictment of all carbohydrates, just refined carbohydrates. This in itself may not provide absolute proof, but it should be enough to raise a few eyebrows and cause us to maybe reconsider some of our eating habits.

 
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