A friend sent me a journal link to evaluate and now I have to rant! The journal article was reporting the results of a study comparing the effect on diabetic blood sugar control of a low-carb ketogenic vs a low GI diet:
My response to the study is, in a word: Grrrrr!
Q: So why would anyone, especially trans men, be interested in this study?
A: Diabetes and pre-diabetes are reaching epidemic levels of prevalence with no end in sight. Trans men especially have been observed to have a very high incidence of PCOS (58% in the first study I looked at) and PCOS predisposes one to these diseases of glucose metabolism. For those of us with a tendency for our blood sugar to get too high — whether we know it or not (!) — it behooves us to get this diet thing right because the quality of our lives down the road depends on it. Diabetes is devastating.
So, here’s the study conclusion:
The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.
Now that’s really outrageous in my eyes. You would presume from that conclusion that the better diet for a diabetic would be the very low carb, ketogenic diet. Well, if you made that presumption, YOU WOULD BE WRONG. Although every word of that conclusion is TECHNICALLY true, the best diet for a diabetic is really the low GI diet. And that part about reversing type 2 diabetes? Technically true but blatantly false to anyone that truly understands diabetes!!
Why do I say that? Because the low carb diet simply masks the symptoms of diabetes so that you no longer will have a diabetes diagnosis and will no longer qualify for insurance covered test strips (see below re free fatty acids). But not only does it fail to restore your glucose metabolism to its fullest functionality, the expected result is that whatever little remaining beta-cell functionality you had left, over the years with this diet will be gradually eroded.
And here’s what pisses me off. The best diet was already determined. Years ago. By the very carefully and ingeniously designed experiment I discussed here. And then in the years that followed was verified world-wide by the entire diabetes international scientific community over and over again. There was no reason in the world to do yet another (but very flawed) experiment on this. But here we are.
This is what I replied to my friend about it:
re the diabetes study, Grrrrr!!
The low carb ketogenic (LCKG) diet addresses the symptom of high glucose while keeping serum glucose under control so that the high BG doesn’t do any damage. Meanwhile, the high free fatty acids resulting from the high fat in that diet continue beta cell destruction, inflammation production, microbiome mismanagement, leptin resistance AND in a large segment of the population, gradually worsening LDL cholesterol control. 24 weeks is not enough time to observe the downside of this diet.
The LCKD will have better A1c at first because the glucose metabolism is never challenged and, thus, never forced to perform better or even exercised to capacity. “Use it or lose it” applies! In addition, they will always observe better HDLc with a high fat diet (HFD) because higher fat produces higher HDLs. But I don’t believe it’s ever been shown that HDLs raised by HFD alone will have a positive effect on coronary heart disease (CHD). Indeed, quite the opposite has been shown. Genetically high HDL does not confer CHD protection and googling “HDL raising drug fails” will show you all the HDL raising drugs that have failed to preserve life or health.
Meanwhile, according to the Aragon video debate you asked me to watch, 1/3 of people do NOT adjust well to a ketogenic diet, so these poor folks will suffer from diminished athletic performance as they slowly destroy their beta cells.
One further point is that in my experience introducing more carbs to a diabetic metabolism was very tricky and had to be carefully monitored to avoid setbacks from small increments in further beta cell loss due to accidental blood glucose surges.
Now, looking at the full study, the “low GI’ diet had 46% of cals from carb and 35% from fat. To achieve the full result offered by low GI, it should be 55% carb, 25% fat, with 60g of natural fiber. So they only went half way. But they went all out on the LCKD diet. In addition, they never say what the actual GIs were for the lo GI diet. Instead, “a registered dietitian instructed participants to follow a low-glycemic index, reduced-calorie diet with approximately 55% of daily caloric intake from carbohydrate.” So the study participants did not adhere to the instructions and unless you really understand how to achieve the low GI diet, you need more instruction than that and YOU WILL FAIL!
The experiments that showed the superiority of the low GI diet to any other diet for NIDDM have already been done, starting back in 1981. There is no need to redo the experiment, especially in a flawed, watered down version with poor dietary adherence.
OK. end of rant! If you stuck it out with me this far, you get a prize. I want to see if anyone will claim it in a comment below.