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  1. https://www.diabetesdaily.com/blog/very-low-carbohydrate-diets-for-diabetes-ada-2018-580309/ Very Low Carbohydrate Diets for Diabetes (ADA 2018) By Maria Muccioli Ph.D. June 26th, 2018 A crowd overfilled the ballroom this Sunday afternoon at the ADA 78th Scientific Sessions to hear two presentations about very low carbohydrate diets (VLCD) for diabetes. In the first presentation, Dr. Jeannie Tay from the University of Alabama at Birmingham summarized the current knowledge on VLCD for type 2 diabetes (T2D) patients and presented new clinical trial results. In the second presentation, Dr. Martin I. de Bock of Princess Margaret Hospital discussed the limited data on VLCD for children with type 1 diabetes (T1D), including the benefits, hypothetical concerns, and areas for additional follow-up. Study Demonstrates Health Benefits for Patients with T2D Dr. Tay began her presentation by summarizing the available data on very low carbohydrate diets (VLCD) for patients with T2D. She defined VLCD as that containing between 20-70 grams of carbohydrate per day. She evaluated results from randomized controlled trials (RCTs) that followed patients for at least six months and highlighted that some data showed greater A1c improvements with the approach. The researcher noted that patients also experience an increase in HDL-C levels, a reduction in triglyceride levels, and improved insulin resistance. Dr. Tay explained that while some studies showed an increase in LDL-C levels in patients following a VLCD, other studies did not find this. She addressed that LDL-C is becoming a controversial metric to assess cardiovascular disease risk and that context is important when discussing its relevance as a risk factor. Dr. Tay noted that it is generally believed that LDL-C increases may be a result of the higher saturated fat content of some VLCD. Dr. Tay and colleagues set out to determine how a VLCD that is also low in saturated fat (LCLSF) compares against a high carbohydrate (HC) diet for the metabolic management of patients with T2D. RCT of HC vs. LCLSF Diet for T2D The researcher enrolled 115 adults with T2D and obesity with a mean A1c level of 7.3 +/- 1.1% and excluded patients with pre-existing renal conditions. The patients used a variety of methods to control their diabetes, including oral agents and/or insulin. They assigned the participants to either follow a HC diet (53% carbohydrate) or a LCLSF diet (14% carbohydrate, <10% saturated fat). Importantly, the diets were identical in calorie content. All participants followed the same exercise program and their adherence to the diet was closely followed via food logs, regular meetings with a dietician, as well as urinalysis for ketones and urea/creatinine. The researchers compared numerous parameters between the groups, including weight, body composition, A1c and markers for cardiovascular disease risk. Furthermore, they also used CGM technology to evaluate post-prandial blood glucose control and glycemic variability. The patients were followed for two years. Main Study Outcomes The drop-out rate (~50%) was not significantly different between the two groups, and the researchers confirmed that the remaining participants adhered to the prescribed diets. While the data showed a comparable reduction in A1c (~1%), weight, and similar body composition, the participants in the LCLSF group: Lowered their medication use by more than two-fold compared to the HC group Experienced a greater than two-fold reduction in glycemic variability parameters compared to the HC group Experienced a greater reduction in triglycerides than the HC group Both groups experienced comparable decreases in blood pressure, insulin use, insulin resistance, and c-reactive protein levels (a marker of inflammation). Additional Assessments The researchers also performed a very comprehensive evaluation of renal function and cognitive performance in the subjects following the low carbohydrate approach. The researchers found no difference between the HC and LCLSF groups in any of the measured outcomes, demonstrating its safety with regard to renal function and cognitive performance. Also, the researchers did not observe a significant difference in the LDL-C levels between the groups. Notably, the HC group experienced a significant drop in HDL levels during the study, while the HDL levels remained unchanged in the LCLSF group. Summary Dr. Tay stated that a very low carbohydrate diet offers a considerable advantage over a high carbohydrate approach for patients with type 2 diabetes. She noted that reducing medication use is not only cost-effective but can also safeguard from the considerable side effects of some second-line medications. She also explained that achieving less glycemic variability, which may be an independent risk factor for the development of diabetes-associated complications, is “of great clinical importance.” “It is a good diet to have if you have diabetes, and the data support that,” she concluded. Endocrinologist Discusses Considerations for Children with T1D Dr. de Bock began his presentation by describing what he believes to be the current political climate in discussing very low carbohydrate (VLC) approaches for children with T1D. “[It is] thorny, polarizing, and controversial,” he remarked. The speaker went on to explain that while he is no way against VLC approaches for children, the main purpose of his presentation was to identify putative concerns and areas that require additional study. “I am not a denier. One can get exceptional glycemic control on a very low carbohydrate diet,” he stated, also remarking that frequent blood glucose monitoring and dosing adjustments were key to achieving the results. Dr. de Bock believes that it is also possible to get “good control” on a high carbohydrate diet. To support this, he presented very limited blood glucose records for one teenage patient who consumes more than 300 g of carbohydrate per day, and also showed some data on pediatric A1c levels. Notably, while the A1c levels were below the average for that age group with T1D, they were still above normal. Dr. de Bock identified five areas that he believes to be of relevance regarding the potential concerns regarding children eating a VLCD: 1) growth; 2) long-term metabolic profile; 3) bones; 4) exercise and 5) psychosocial impact and conflict. As published data specific to VLCD in children with T1D is limited, the speaker presented some data from animal studies, case studies, and children with epilepsy who followed a ketogenic diet. Dr. de Bock did not define the specific nutrient distribution of VLCD and the data that he presented on varied greatly in the carbohydrate content, from “ketogenic” to “30% carbohydrate” for one particular case. Since data on the exact diet composition or on glycemic control for the case study subjects that experienced adverse outcomes was not presented, it was impossible to gauge whether these could be attributed to suboptimal glycemic control or the specific macronutrient distribution. Growth Dr. de Bock stated that the available data on pediatric growth on a low-carb diet is contradicting and requires further investigation. His main theoretical concern is that those on a VLCD may use less insulin, and insulin is very important for numerous physiological processes, including growth. However, he did not discuss the administration of insulin to account for protein consumption, which is an important consideration. Dr. de Bock also addressed the importance of identifying any nutritional deficiencies, in particular, iron. Long-Term Metabolic Profile Dr. de Bock presented some data about elevated LDL-C levels in individuals on a VLCD, although the study results were variable. He stated that for those individuals who experience an uptick in LDL-C, it is unclear whether the improved glycemic control mitigates the LDL-C increase. Notably, the LDL-C metric is a controversial one and needs to be considered in the context of triglycerides, HDL, and other metabolic parameters. Bones Dr. de Bock pointed to some studies on children with epilepsy who followed the ketogenic diet and exhibited low bone density. He noted that individuals with T1D are prone to low bone density, so it is an important parameter to follow. Dr. de Bock did not mention the relevance of optimizing glycemic control, as chronic hyperglycemia is a relevant factor in low bone density in patients with T1D. Exercise The speaker stated that the exercise capacity of children following a VLCD appears to be variable. He noted that some individuals do not have any problems, while others may experience fatigue. He believes the data on the subject is “inconclusive.” Careful assessment of the specific nutrient distribution of the diet to ensure appropriate nutrient intake may be at the heart of the matter. Psychosocial Impact and Conflict The speaker focused heavily on the potential mental and emotional implications of following a “restrictive” diet. He suggested that children (unlike adults) do not yet have the “executive thought” to make a rational decision to eat a VLCD. As such, he believes that children on a VLCD may feel deprived or resentful. “We are a society that celebrates with food,” de Bock pointed out, as a photograph of excited children gathered around a birthday cake appeared on his presentation slide. He stated that eating cake “may or may not result in a postprandial blood glucose excursion,” depending on the management, and did not discuss that low-carbohydrate dessert recipes are widely available. He also attempted to draw parallels between the perfectionism and idealism associated with the pursuit of very tight glycemic control on a VLCD and how these qualities are common to individuals who are at an increased risk for developing eating disorders. However, while there is no evidence to support that children on a VLCD are specifically at an increased risk for anxiety and eating disorders, there is evidence to suggest that these issues are more common in people with type 1 diabetes, in general, suggesting that they are likely related to glycemic control. Dr. de Bock did not address the tangible concerns of suboptimal blood glucose management in pediatric patients, or the potential psychological impacts of increased anxiety, depression, and resentment that may arise from frequently abnormal blood glucose levels and the associated physiological consequences. Summary Dr. de Bock does not deny that a VLCD for children with type 1 diabetes can help to achieve exceptional glycemic control, as recently demonstrated in a study showing normal average A1c levels in a large cohort of patients. The speaker remarked that the patients in that study had very low glycemic variability. He believes that more research needs to be conducted to evaluate the relevance of the potential concerns that he outlined. Until then, he advises parents of children who follow a VLCD to work closely with their medical care providers to monitor growth, cardiac, nutritional, and mental/emotional parameters. Concluding Remarks Undoubtedly, very low carbohydrate diets for the management of diabetes have been gaining popularity and acceptance in recent years. It is difficult to deny that they constitute an effective and important tool for optimizing glycemic control for both type 1 and type 2 diabetes patients. This symposium received considerable attention at the meeting and in social media channels. As always, we welcome your comments on the topic and hope that this review has been useful in summarizing the key points and relevant considerations in the broader context of the discussion.
  2. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes.https://www.ncbi.nlm.nih.gov/pubmed/29269731 The results are not surprising. Nutr Diabetes. 2017 Dec 21;7(12):304. doi: 10.1038/s41387-017-0006-9.Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes.Saslow LR1, Daubenmier JJ2, Moskowitz JT3, Kim S4, Murphy EJ4, Phinney SD5, Ploutz-Snyder R6, Goldman V4, Cox RM7, Mason AE4, Moran P4, Hecht FM4.Author information AbstractDietary treatment is important in management of type 2 diabetes or prediabetes, but uncertainty exists about the optimal diet. We randomized adults (n = 34) with glycated hemoglobin (HbA1c) > 6.0% and elevated body weight (BMI > 25) to a very low-carbohydrate ketogenic (LCK) diet (n = 16) or a moderate-carbohydrate, calorie-restricted, low-fat (MCCR) diet (n = 18). All participants were encouraged to be physically active, get sufficient sleep, and practice behavioral adherence strategies based on positive affect and mindful eating. At 12 months, participants in the LCK group had greater reductions in HbA1c levels (estimated marginal mean (EMM) at baseline = 6.6%, at 12 mos = 6.1%) than participants in MCCR group (EMM at baseline = 6.9%, at 12 mos = 6.7%), p = .007. Participants in the LCK group lost more weight (EMM at baseline = 99.9 kg, at 12 mos = 92.0 kg) than participants in the MCCR group (EMM at baseline = 97.5 kg, at 12 mos = 95.8 kg), p < .001. The LCK participants experienced larger reductions in diabetes-related medication use; of participants who took sulfonylureas or dipeptidyl peptidase-4 inhibitors at baseline, 6/10 in the LCK group discontinued these medications compared with 0/6 in the MCCR group (p = .005). In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.
  3. denzel

    Diabetes Education

    The Diabetes Association in the UK has switched its education towards Low Carb. Here is a link that might interest some people. https://www.diabetes.co.uk/lowcarb/?utm_source=hp...
  4. denzel

    Low Carb for Diabetes

    The Diabetes Association in the UK has switched its education towards Low Carb. Here is a link that might interest some people. https://www.diabetes.co.uk/lowcarb/?utm_source=hp&utm_medium=dd&utm_campaign=lcp Now for Australian Dietitians and AHPRA to come on board!
  5. "Very low carbohydrate diets in the management of diabetes revisited". From Gary Fettke No Fructose (The combination of Fructose, refined Carbohydrate and Polyunsaturated Oils create inflammation in every blood vessel and eve...ry organ of the body. A Low Carbohydrate and Healthy natural Fat diet (LCHF) can have an enormous benefit to your health. Dr Gary Fettke Orthopaedic Surgeon M.B.,B.S.(University NSW), F.R.A.C.S.(Orthopaedic Surgery), F.A.Orth.A Launceston, Tasmania, Australia www.NoFructose.com www.NutritionForLife.healthcare ) "How does diabetes affect you? There are only 3 groups of people out there. You either have diabetes, you are going to get diabetes or you are going to be caught up in the economic or personal costs of diabetes. Pretty simple - so it's worth paying attention to this topic. ...Whatever we are recommending for those with diabetes is not working. My New Zealand colleagues have just put this paper together for the New Zealand Medical Journal. Brilliant. For my patients, LCHF has given them their lives back!!!! Low Carb in Diabetes management and treatment works better than the current low fat/ high carb recommendations that currently exist. Eat what you want and chase it with medication is completely unsustainable. "We’re just continuing to make the point that low carb eating is a very sensible way to go for people with diabetes. The outcomes are better." "higher-carbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications." Take the link to read the whole paper." ABSTRACT Humans can derive energy from carbohydrate, fat, or protein. The metabolism of carbohydrate requires by far the highest secretion of insulin. The central pathology of diabetes is the inability to maintain euglycaemia because of a deficiency in either the action or secretion of insulin. That is, because of either insulin resistance often accompanied by hyperinsulinaemia, or insulin deficiency caused by pancreatic beta cell failure. In individuals dependent on insulin and other hypoglycaemic medication, the difficulty of matching higher intakes of carbohydrates with the higher doses of medication required to maintain euglycaemia increases the risk of adverse events, including potentially fatal hypoglycaemic episodes. Thus, mechanistically it has always made sense to restrict carbohydrate (defined as sugar and starch, but not soluble and insoluble fibre) in the diets of people with diabetes. Randomised clinical trials have confirmed that this action based on first principles is effective. The continued recommendation of higher-carbohydrate, fat-restricted diets has been criticised by some scientists, practitioners and patients. Such protocols when compared with very low-carbohydrate diets provide inferior glycaemic control, and their introduction and subsequent increase in carbohydrate allowances has never been based on strong evidence. The trend towards higher-carbohydrate diets for people with diabetes may have played a part in the modern characterisation of type 2 diabetes as a chronic condition with a progressive requirement for multiple medications. Here we will introduce some of the evidence for very low-carbohydrate diets in diabetes management and discuss some of the common objections to their use. https://scienceofhumanpotential.files.wordpress.com/2016/04/henderson-1998-nzmj-1432-final.pdf http://profgrant.com/2016/04/01/very-low-carbohydrate-diets-in-the-management-of-diabetes-revisited/
  6. Angel Butterfly

    World Diabetes Day

    14th November is World Diabetes Day. As most of you know, I am the Ambassador for Diabetes WA and have partaken in a few events for them this year educating the community about T2 Diabetes, I renamed their online magazine, I did the HBF Run for a Reason event and my story was published in the Diabetes Matters magazine and The West Australian newspaper. Tomorrow 21st October I am meeting a videographer who will be filming me in a video for World Diabetes Day. This international event will span across social media and television. The video plan is to have a placard with my catch phrase on it relating to Diabetes, then a video about my story will be linkable next to the image. I am excited and a little nervous but this is something my WLJ has been building too. When I have something to share and show, I will let you all know. Diabetes of all forms is a chronic illness shared by millions worldwide and is at near epidemic proportions. We have the ability to change the future of how it is viewed and managed. Thanks AB x
  7. MONDAY, Sept. 28, 2015 (HealthDay News) -- Soft drinks and other sugar-sweetened beverages can seriously damage heart health, a new review finds. The added sugar in sodas, fruit drinks, sweet teas and energy drinks affects the body in ways that increase risk of heart attack, heart disease and stroke, said review author Vasanti Malik, a nutrition research scientist at Harvard's T.H. Chan School of Public Health in Boston. Consuming one or two servings a day of sugar-sweetened beverages has been linked to a 35 percent greater risk of heart attack or fatal heart disease, a 16 percent increased risk of stroke and as much as a 26 percent increased risk of developing type 2 diabetes, the report concluded http://www.medicinenet.com/script/main/art.asp?articlekey=190885&ecd=mnl_day_092915
  8. Sugar: Public Health Enemy No. 1, Researchers Say Read Latest Breaking News from Newsmax.com http://www.newsmax.com/Health/Headline/sugar-public-enemy-1/2015/09/24/id/693200/#ixzz3muu4yj5e
  9. Hi my fellow bandits, I wanted to share with you all a book that I read over the weekend that has literally changed my world. I've made no secret on this forum of my slow weight loss, Insulin Resistance, struggles with even losing 500g, eating extremely low calories - you get the picture! On Saturday I read "The Insulin Resistance Diet - revised and updated: how to turn off your body's fat-making machine" by Cheryle R Hart and Mary Kay Grossman. For the first time I have actually understood Insulin Resistance and how my eating (or lack thereof) is contributing to my not only losing weight slowly, but losing and then putting on, losing and putting on. The basic principle is to eat using the link and balance method, which helps control the affect carbs have on our body. Linking means adding protein to your diet, and balancing means making sure you have the right ratio of carbs to protein. The formula is that for every 15g of carbohydrates that you eat, you need to add 7g of protein. The guideline is no more than 30g of carbohydrates, balanced with at least 14g of protein, in any 2-hour time period. You may have more than 14g of protein if you wish, and you may have more veggies/salad. The restriction is on the carbs. And the 2 hour break from carbohydrates is important, as they call this the 2 hour fat window, whereby if you eat carbs during that time it will be stored immediately as FAT. I know there's a few others on this forum with Insulin Resistance, so I can't recommend this book highly enough. I have started linking and balancing from today and will see how it goes. If you use Google to have a browse around you can see how this has worked for thousands of women world-wide suffering with Insulin Resistance and PCOS to not only lose the stubborn weight without going on a fad diet, but to maintain. I hope to be one of these success stories. So, are there any other link and balancers out there?
  10. Hi everyone, I am t2 diabetic on metaformin and lantus, 91 kilos, 35 BMI, does anyone with diabetes have any stories to share. Would love to hear your experiences with lap band and how it changed your life Ta
  11. NeddyBear

    How times have change

    Yesterday I spent 17 hours replacing 5 stumps under my house and except for my muesli at 4.00am I had nothing else to eat all day and I felt fine. Now only 10 months ago if I had of attempted this I would have been in a diabetic coma and would have probably died.. I'm just about to head outside to finish concreting 2 stumps before going to Clean Up Australia. Who else had the diabetes before having the band fitted and now with the diabetes in remission there's no holding you back.
  12. Nikkiii

    The best laid plans..........

    So I toddled off to visit with the Surgeon, head brimming with information about the Obera System and brim full of the joy and ease of it all. Within 20 minutes I was collecting my account and chatting with the girls at the desk about a surgery date for Laparascopic Banding!!!!! S-C-R-E-E-C-H WHAT ? ? ? ? ? The Surgeon pointed out a couple of small problems with my thinking:- I had already demonstrated an ability to lose the weight but it always came back. The Obera System is a temporary (6 Month) system allowing you to lose the weight. The ball is then removed and..oh oh....back comes the weight! I already had (proven on scan) a rather large Gall Stone, that was causing frequent debilitating attacks and needed removal. We chatted about Gastric Banding and despite my lower BMI I fit the selection criteria due to my obesity related comorbidities. These were medication controlled high blood pressure, Gall Stone(s), pre-diabetes (I had Gesational Diabetes with both my pregnancies), sleep problems and very low self esteem to name a few.The Surgeon explained that recent evidence strongly suggests that weight loss surgery is an effective option for those people who are overweight but have not yet reached a BMI above 35. Suddenly Obera was out and banding was in and I was discussing having surgery. Another factor which helped me decide was that Obera is not even partially covered by Medicare and at $6,000 a pop was not a cheap option anyway. So with thoughts of how much is this going to cost & how much time off will I need I headed home to my trusty computer to do a spot of research>
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