Overweight Individuals with T2DM | Keto Diet vs Plate Method Diet

Recently a study was conducted by Saslow LR and colleagues to study whether a very low carbohydrate ketogenic diet with lifestyle factors (intervention) or a “Create Your Plate” diet (control) recommended by the American Diabetes Association (ADA) would improve glycemic control and other health outcomes among overweight individuals with type 2 diabetes mellitus (T2DM).

This article was published in February 2017 in a very reputed journal ‘Journal of Medical Internet Research’. In 2017, the impact factor of this journal was 4.671. For those of you who don’t know what an impact factor is or have never heard of, it simply means the number of times recent articles published in that journal in a year was cited by others. If the impact factor is high, it is considered to be a highly ranked journal.

Now coming back to the study, it was a parallel-group, balanced randomization (1:1) trial. This trial was approved by the University of California, San Francisco, Institutional Review Board and registered with ClinicalTrials.gov (NCT01967992).

In this study, glycemic control, operationalized as the change in glycated hemoglobin (HbA1c) was the primary outcome.

They also assessed body weight, cholesterol, triglycerides, diabetes-related distress, subjective experiences of the diet, and physical side effects.

During the study, the participants were asked to measure urinary acetoacetate (one type of ketone bodies that can be measured in urine) test kits (KetoStix). Basically, there are three types of ketone bodies. Other two types of ketone bodies are acetone and beta-hydroxybutyrate.

The other group i.e. the control group were asked to follow “Create Your Plate” diet recommended by ADA. What does this ADA diet consist of? Well, ADA recommends a low-fat diet which includes green vegetables, lean protein sources, and limited starchy and sweet foods. Most of the doctors worldwide follow ADA guidelines and recommend this particular diet to their patients.

As mentioned earlier the investigators divided the eligible participants into two groups (intervention group and control group).

In fact, when I was diagnosed with T2DM my diabetologist also recommended a low-fat diet with a caloric restriction of 1800 calories. But he never advised me how to restrict my calories to 1800 or what should I eat.  I was totally confused.

Also, he prescribed a couple of oral antidiabetic drugs and a statin. I followed his instructions for a couple of weeks and the result was that within 2 weeks I developed side effects of the drugs. I immediately STOPPED all my medications and started following a keto diet. Finally, I was able to reverse my T2DM. Anyway, that’s a separate story.

Coming back to the study, all the parameters were measured at baseline before randomization in both the groups. Again, all the parameters were measured after 16 and 32 weeks of intervention.

So what conclusions were drawn from this study. Let me list the results of this study in bullet points for better understanding.

  • The investigators observed that there were significantly greater reductions in HbA1cthose who followed the ketogenic diet after 16 as well as 32 weeks
  • Similarly, those who were on keto diet lost more weight than those who followed conventional ADA diet (12.7 kg versus 3 kg)
  • Also, triglycerides level was much lower in the ketogenic group compared to ADA diet followers

This study showed that those who followed a ketogenic diet had several health benefits including lower HbA1c, body weight, and triglyceride levels.

There were few limitations in this study. The number of participants was very less (25 participants) and the follow-up duration of the study was not long.

Despite all limitations, the conclusion we can draw from this study is that low-carbohydrate ketogenic diet and lifestyle changes are beneficial in individuals who are overweight with T2DM.

If you have any queries or any experience to share please type in the comment box. I will try to reply to all your queries.

If you have enjoyed reading this article, I would request you to share with your friends and colleagues who are diagnosed with T2DM. I am sure by reading this article, they will be motivated that it’s not the end of the world if they are diagnosed with T2DM.

With dietary and lifestyle modifications, it is possible to reverse your T2DM.

Editorial Claims Bad Rap for Saturated Fat, Disputes Dietary Dogma.

The contention that dietary saturated fats aren’t the bad guys that policies and guidelines have portrayed for decades has reemerged in the literature, this time in an “Observations” opinion piece in published in BMJ.

“The mantra that saturated fat must be removed to reduce the risk of cardiovascular disease has dominated dietary advice and guidelines for almost four decades,” according to the author, Dr Aseem Malhotra (Croydon University Hospital, London, UK). “Yet scientific evidence shows that this advice has, paradoxically, increased our cardiovascular risks.”

Moreover, he writes, “the government’s obsession with levels of total cholesterol, which has led to the overmedication of millions of people with statins, has diverted our attention from the more egregious risk factor of atherogenic dyslipidemia.”

To back his claims, Malhotra cites reports suggesting that:

·         Low-saturated-fat diets cut levels of lower-risk large, buoyant LDL particles rather than the small, dense LDL particles thought to worsen cardiovascular disease.

·         Dietary saturated fat may actually protect against cardiovascular risk.

·         Low-fat diets promote an atherogenic pattern of blood lipids and worsen insulin resistance.

·         Low total-cholesterol levels are “associated with cardiovascular and noncardiac mortality, indicating that high total cholesterol is not a risk factor in a healthy population.”

·         Even in secondary prevention, no cholesterol-lowering drug besides statins has shown survival benefit, supporting the hypothesis that the benefits of statins are independent of their effects on cholesterol.

·         The “Mediterranean diet” confers three times the survival benefit in secondary prevention, compared with statins; it led to a 30% improvement compared with a “low-fat” diet in the PREDIMED study.

“It’s risky to pick and choose studies on which to base judgments” and to tell only part of a large story, according to Dr Alice H Lichtenstein (Tufts University, Boston, MA), who directs her center’s Cardiovascular Nutrition Laboratory.

In just one example cited for heartwire , she said that “the PREDIMED trial did show that in high-risk people the Mediterranean diet achieved a 30% improvement over a ‘low-fat’ diet.” However, a low-fat diet in PREDIMED meant 37% of calories from fat, not the usual definition. “And the benefit was seen only for stroke, an outcome most closely associated with blood pressure, not plasma cholesterol levels,” Lichtenstein said.

She continued, “Based on the totality of the data, the best advice we can give is to consume a moderate-fat diet (25% to 35% of energy) and substitute polyunsaturated fat for saturated fat—that is, vegetable oils for animal fats, including meat and dairy—all within the context of a calorie intake that is consistent with achieving and maintaining a healthy body weight. Given the plethora of food choices currently available, that should not be a difficult task.”

Source: Medscape.com

Mediterranean Diet May Reverse Genetic Risk for Stroke.

Following a Mediterranean diet (MedDiet) may not only reduce fasting glucose concentrations and lipid levels in patients who are genetically at increased risk for type 2 diabetes but may also lower their risk for stroke, a new study suggests.

Polymorphisms of the transcription factor 7-like 2 (TCF7L2) gene are strongly associated with type 2 diabetes, as well as, in some studies, plasma lipids and cardiovascular disease. In this study, researchers looked at whether the MedDiet, which features olive oil, nuts, fish, whole grains, fruits, vegetables, and healthier fats, could moderate the genetic risk for cardiovascular outcomes associated with one of these polymorphisms, TCF7L2-rs7903146.

“Being on the Mediterranean diet reduced the number of strokes in people with 2 copies of the variant,” said study author José M. Ordovás, PhD, professor, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, in a press release. “The food they ate appeared to eliminate any increased stroke susceptibility, putting put them on an even playing field with people with one or no copies of the variant.”

The study results “support the benefits of a MedDiet, especially for genetically susceptible individuals and emphasize the importance of studying entire dietary patterns rather than individual components,” the authors, led by Dolores Corella, PhD, Department of Preventive Medicine and Public Health School of Medicine, University of Valencia, Spain, conclude.

The study was published online August 13 in Diabetes Care.

Genetically Susceptible

This analysis included 8018 older men and women entered in the PREvención con DIetaMEDiterránea (PREDIMED), a multicenter clinical trial aimed at assessing the effects of the MedDiet on the primary prevention of cardiovascular disease. Patients in the study had type 2 diabetes or at least 3 cardiovascular risk factors, such as hypertension, dyslipidemia, obesity, or smoking.

Previous reports from the PREDIMED study have shown that this diet reduced carotid plaqueimproved cognitive functionreduced cardiovascular events by about half, and also halved new-onset type 2 diabetes vs the low-fat arm of the study during the trial.

For this analysis, DNA was extracted from these patients and genetic variation in TCF7L2-rs7903146 was determined. About 14% of the participants were homozygous carriers, meaning they carried 2 copies of theTCF7L2 gene variant, a group referred to as TT.

Study patients were randomly assigned to the MedDiet supplemented with extra-virgin olive oil, to the MedDiet supplemented with mixed nuts, or to a control group that followed a low-fat diet. The groups were followed for a median of 4.8 years.

As expected, the TCF7L2-rs7903146 polymorphism presented a highly significant association with type 2 diabetes at baseline. Researchers also noted a highly significant association (P < .001) between this polymorphism and increased fasting glucose, although the statistical significance was lessened after adjustment for type 2 diabetes.

Their results showed significant gene-diet interactions. When adherence to the MedDiet prior to randomization in PREDIMED was low (below sample mean of 9 points), patients carrying the TT genotype had higher fasting glucose concentrations than those with other genetic variations (132.3 vs 127.3 mg/dL; P = .001). When adherence to the diet was high (≥9 points), there was no such increase.

This modulation by diet was also detected for total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels.

Stroke Risk

During the study period, 262 major cardiovascular events occurred, including 130 strokes.

When adherence to the MedDiet was low, TT patients presented a higher risk for stroke than those with other genetic variants (hazard ratio [HR] in the adjusted model that included diabetes, 2.44; 95% confidence interval [CI], 1.26 – 4.72). No higher risk was found when adherence to the MedDiet was high (HR, 0.99; 95% CI, 0.44 – 2.22).The mechanism of this effect is unknown, said the authors.

Importantly, the study showed that in the low-fat control diet, homozygous carriers were almost 3 times as likely to have a stroke as people with 1 or no copies of the gene variant (adjusted HR, 2.91; 95% CI, 1.36 – 6.19; P = .006).

Because modulation of stroke incidence by the MedDiet was similar in the group that received the diet supplemented with olive oil and the one supplemented with nuts, “our results suggest once again that it is the overall MedDiet pattern rather than specific foods that contribute to not increasing stroke risk in TT individuals,” said the authors.

“Our study is the first to identify a gene-diet interaction affecting stroke in a nutrition intervention trial carried out over a number of years in thousands of men and women,” commented Dr. Ordovás in the release. “The PREDIMED study design provides us with stronger results than we have ever had before. With the ability to analyze the relationship between diet, genetics, and life-threatening cardiac events, we can begin to think seriously about developing genetic tests to identify people who may reduce their risk for chronic disease, or even prevent it, by making meaningful changes to the way they eat.”

Although the study’s sample size was large, the interactive findings of stroke risk with the MedDiet rest on relatively few stroke cases, the authors point out.

Source: medscape.com

Mediterranean Diet Reduces Stroke Risk Even in Those with High Genetic Risk.

High risks for type 2 diabetes and cardiovascular complications conferred by variants in the TCF7L2 gene can be partially offset by strict adherence to a Mediterranean-style diet, according to a Diabetes Care study.

PREDIMED investigators followed some 7000 participants at very high risk for cardiovascular disease. Their genetic risks were determined by ascertaining the variant of the TCF7L2 gene they carried, with “TT” variants known to confer higher risk than “CT” or “CC” variants.

The subjects were randomized to Mediterranean or low-fat diets and followed for roughly 5 years. TT carriers who did not generally observe Mediterranean-style diets at baseline showed higher risks for cardiovascular events, although not significantly so. Furthermore, TT carriers randomized to and adhering to a Mediterranean diet had stroke rates similar to CT and CC carriers.

The authors conclude that their findings support the benefits of a Mediterranean diet, “especially for genetically susceptible individuals.”

Source: Diabetes Care