Cure and prevent diabetes mellitus with diet, not drugs

Introduction There are many conditions in Western industrialised societies today that were unheard of, or at least very rare, just a century ago. The same conditions are still unheard of in primitive peoples who do not have the 'benefits' of our knowledge. There is a very good reason for this: They eat what Nature intended; we don't. The diseases caused by our incorrect and unnatural diets are those featured on these pages.

both say:
People with diabetes have a greater risk of developing heart disease and/or hardening of the arteries.Try and cut down on the fat you eat, particularly saturated (animal) fats. . .Use less butter, margarine, cheese and fatty meats. Choose low fat dairy foods like skimmed milk and low fat yogurt. Grill, steam or oven bake instead of frying or cooking with oil or other fats. Choose a diet with plenty of grain products, vegetables, and fruits. These foods should provide the mainstay of what you eat. Eat regular meals based on starchy foods such as bread, pasta, chapatis, potatoes, rice and cereals. Whenever possible, choose high fibre varieties of these foods, like wholemeal bread and wholemeal cereals.

In other words, they say that diabetics should eat a carbohydrate-based, lowfat diet.

BUT THE EVIDENCE ACTUALLY SAYS:

Coulston AM, et al.American 'it seems prudent to avoid the use of low-fat, high-carbohydrate diets containing

Journal of Medicine 1987;

82: 213-220. Garg A, et. al. New England

moderate amounts of sucrose in patients with non-insulindependent diabetes mellitus.'

Journal of Medicine 1988;

319: 829-34.

'As compared with the high-carbohydrate diet, the highmonounsaturated-fat diet resulted in lower mean plasma glucose levels and reduced insulin requirements, lower levels of plasma triglycerides and very low-density lipoprotein [LDL - the 'bad']cholesterol , and higher levels of high-density lipoprotein [HDL - the 'good'] cholesterol. Levels of total cholesterol did not differ significantly in patients on the two diets.'

Hays J.Paper presented to the 81st Annual Meeting of the Endocrine Society, 15June1999.

"A very high-fat, low-carbohydrate diet has been shown to have astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles."

Dr. James Hays, an endocrinologist and director of the Limestone Medical Center in Wilmington, DE, presented the results of three studies of men and women with type 2 diabetes involving very high-fat, low-carbohydrate diet at the annual meeting of the Endocrine Society. His study showed an impressive benefit in body mass index (BMI), triglycerides, HDL, LDL and HbA1c. Patients were able to eat all the meat and cheese they wanted, but as for carbohydrates, they are restricted to eating unprocessed foods, mainly fresh fruit and vegetables. Whereas in a normal diet 60 percent of calories would come from carbohydrates and 30 percent from fat, patients in this diet were encouraged to get 50 percent of their caloric intake from fat, and just 20 percent from carbohydrates. A whopping 90 percent of the fat content in their diets was saturated animal fat, compared with just 10 percent that was monounsaturated oil. Dr Hays told his audience that: Over the course of one year, the subjects achieved

a mean decline in total cholesterol from 231 to 190 mg/dl LDL (the 'bad' cholesterol) fell from 133 to 105 mg/dl, Triglycerides declined from 229 to 182 mg/dl. declined to just 0.96 percent above normal HDL (the 'good' cholesterol) increased from 44 to 47 mg/dl. HbA1c, which at the start of the study averaged 3.34 percent above normal, Average weight loss was in the order of 40 pounds.

By the end of the one-year study 90 percent of the patients had achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and triglycerides. As for the response from cardiologists who see a high-fat diet as anathema to what they have been instructing their patients for years now, Dr. Hays said he has three cardiology patients who are now on the diet. And concluded: "If you have a diet that results in weight loss, lower cholesterol, and a better lipid profile, eventually, everybody will be eating that way." Above you have seen some of the evidence that suggests that DiabetesUK and the American Diabetes Association have got it completely wrong. This is also my finding from over twenty years of research. In these pages you will find why the conventional treatment of Diabetes, is resulting in increased morbidity, the evidence that DiabetesUK and the ADA have got it completely wrong, and the evidence to support the introduction of a radical departure: a high-fat, low-carb diet to control both type 1 and type 2 diabetes. Proof that it works! I was in New Zealand in 1999, two months before my book, Eat Fat, Get Thin! was published. While there I visited a friend's cousin. NL was seventy-five years old, overweight, with high blood pressure and diabetic. During the conversation, my book was mentioned and I said I would send her a copy although, she told me, as it advocated a high-fat diet, she thought her diabetes would prevent her from using it. Here is an extract from a letter I received five months after I sent the book: 'When your book arrived I read it immediately and gave myself permission to think it might, just might, work for me, despite the diabetes factor which I had said to you could possibly complicate blood sugar results. You assured me that it was more possible that these would improve. 'I changed my diet in February and in that and the following month my weight dropped by eight pounds. It was such a luxury to be eating all the hitherto "naughty" things that had been such a "no-no" and being rewarded for my sins. I felt better in all ways and my blood sugars became far more stable, and lower than they had been for years. 'I had meant to write before . . . but as it was getting close to my annual full diabetic general check-up, I thought I might have medical evidence to confirm my feelings of improved well-being. Prior to my G.P.'s appointment I had been for a variety of blood tests and also an ophthalmologist's examination - retinal photography and pressure measurements. 'First major surprise - the pressure behind my eyes which had for many years been border-line glaucoma, had reduced - "excellent" result. Cholesterol (total), HDLcholesterol and triglycerides had all improved, my glycosated haemoglobin was down by 1.5 and blood pressure was down from 160/90 in June last year to 130/74 - the lowest I can ever remember having. Naturally my G.P. was very confused by my "second coming" and her tut-tutting lacked conviction when I told her of meeting you, receiving your book and becoming a convert to and practitioner of what you advocate.

So count me as one of your most loyal disciples.'

And from a health professional in the private medical sector

I was diagnosed with Type 2 diabetes in October 2000, at the age of 37. At this time, my weight was registering an all-time high of 14 stone, BP was 142/92, with an HbA1c of 8%+. I was issued with the standard low-fat high carbohydrate diet sheet and duly went home and followed the dietary advice to the letter. I also bought a blood glucose meter and was astonished to find that my blood sugar registered 13+ after each and every so-called "healthy" meal. I felt tired and extremely unwell, and so, to cut a long story short, I decided to do some of my own research. Literally 2 days later, I had discovered the low carb approach. . . . I put this regime into practice, kept a food diary and carried out 5 blood tests a day for 6 months. At the end of the 6 months, I returned to my local Diabetic Clinic at Edinburgh Royal Infirmary for my checkup. Tests revealed that my BP had dropped to 123/74, my HbA1c was 5.5 and I had lost 2 stone. More importantly, I felt fantastic, had loads of energy, and had lost count of the number of people who commented on how well I looked. My consultant was amazed, but not particularly interested in my methods. I was astonished that he didn't want to know more ? so that he could pass on the information to others. (Naive of me, I know!) Instead he informed me that Diabetes is a progressive disease, and that I'd need to start a drugs regime within the next couple of years, perhaps even insulin. It is my intention to prove him wrong. My next HbA1c, 6 months later, was under 6, with BP and cholesterol well within normal limits. At this point, my consultant announced that I would only be required to attend the Clinic on a yearly basis. So, in summary, I am very happy with my results, and with the way I feel physically. Incidentally, my father was diagnosed with Type 2 diabetes 6 months ago, and he has followed my advice as opposed to his doctor's, which is unlike him. His HbA1c has also reduced from over 8% to 5.7 in the space of 6 months. His doctors are astonished, as at diagnosis, a random blood sugar test revealed a reading of 24. However, the fact that both my father and myself are in the best of health is not enough for me. The "I'm all-right Jack" scenario is not acceptable to me, and my dream is to see ALL diabetics given the correct advice at diagnosis ? it would then be up to the individual as to whether to comply or not. At present, unless they are blessed with decent research skills, diabetics will continue to suffer poor health and are destined for a premature death. During the past 18 months, I have tried, in my own way, to get the message out. Recently, I attended a large conference on diabetic care in Edinburgh, and

somehow found the courage to stand up in front of hundreds of so-called Diabetes experts ? consultants, dieticians, and Practice nurses, and briefly told my story. I was publically lambasted by an indignant dietician who stood up and declared loudly that "everyone knows the treatment for Type 2 Diabetes is a high carbohydrate diet". A couple of weeks ago, in response to a report in a national newspaper on the subject of obesity, and the rising tide of Type 2 diabetes, I wrote to the 3 quoted "experts", to comment on their continual obsession with the evils of fat as opposed to sugar. So far I have received no response! I am the Training Manager for a large nursing agency based in Edinburgh, and as such am responsible for buying places on appropriate courses for our nurses. I have recently made the decision not to send any more of our staff on Diabetes updates run by Lothian Primary Healthcare Trust, after I obtained a copy of their training syllabus, which revealed a less than enlightened approach to diet. I am therefore currently putting together a training pack on diabetes for one of our nurses to deliver informally within her own hospital. It goes without saying that I will have no hesitation in including information on the low-carb approach, together with appropriate references for staff to be able to do their own research. F N, 9 June 2002 These letters are typical of my experience with overweight diabetics. So we need to ask: Why does DiabetesUK still insist on low-fat, carbohydrate diets for diabetics?

Conclusion

We may be approaching the end of the disastrous practice of advocating low-fat, carbohydrate-based diets for weight loss in diabetics.

Conventional Treatment mens a progression to ill health

Introduction
Conventionally, as diabetics are more at risk of heart disease and other cardiovascular complications, they are advised to eat 'healthily' and treated with a diet based on carbohydrates bread, pasta, cereals and "five portions of fruit and vegetables a day". They are also told to cut down their fat intake. Conventional wisdom also says that 80% of Type-2 Diabetes is associated with obesity which in turn is said to be directly related to the increasing weight and decreasing physical activity of the population. It is believed by DiabetesUK that their low-fat, carbohydrate-based diet will help diabetics lose weight as this has enormous benefits. So let us look at what a newly diagnosed diabetic patient can expect from following the advice of DiabetesUK and the American Diabetic Association.

Conventional Risk Factors for Type-2 are:

Increasing age

Physical inactivity Greater obesity Longer duration of obesity hyperinsulinaemia

Unfavourable body fat distribution (Note hyperinsulinaemia for later)

There is little we can do about the first 'risk factor' as the alternative to getting older is dying young. Most of the rest are concerned with overweight. Aim of Diabetes Treatment It is the complications brought on by diabetes that are the real problem. Most of these involve the cardiovascular system through the glycosylation of haemoglobin (the coating of haemoglobin in the blood with sugar). Diabetics know this as HbA1c it is not a desirable condition and the lower its measurement the better. As most diabetic complications concern the cardiovascular system, the aim is to:

Control hyperlipidaemia Control hyperglycaemia Control 'risk factors' to prevent diabetes

Lose weight lose diabetes If you are overweight, and most diabetics are, weight loss is normally the first concern for, if maintained, the potential benefits of weight loss are remarkable.(1) A weight loss of 10 kg:
glycaemic drug) Reduces HbA1c more than Metformin (the most commonly used antiReduces diabetes-related deaths

Improves blood lipids, without drugs

Conventional Method In the last century, diabetics were treated with a high-fat, low- or nocarbohydrate diet. But that regime was revised when 'healthy eating' was introduced by the COMA report of 1984. Diabetics are more likely to suffer from ischaemic heart disease than people without diabetes. Under these circumstances, it seemed unwise to continue the highfat recommendations. And so DiabetesUK recommends a 'healthy'diet based largely on carbohydrates and low in fat. Conventional Advice American Diabetic Association For most people with diabetes, dietcontrol is the key to managing this complicated disease. It is also extremely difficult. The current state of the diabetic diet is in flux, and at this time, there is no single diet that meets all the needs of everyone with diabetes. There are some constants, however. All people withdiabetes should aim for healthy lipid (cholesterol and triglyceride) levels and

Improves blood pressure, without drugs

control of blood pressure. People with type 1 diabetes and type 2 diabetics on insulin or oral medication must focus on controlling blood glucose levels by coordinating calorie intake with medication or insulin administration, exercise, and other variables. Adequate calories must be maintained for normal growth in children, for increased needs during pregnancy, and after illness. For overweight type 2 diabetics who are not taking medication, both weight lossand blood sugar control are important. A reasonable weight is usually defined as what is achievable and sustainable, rather than one that is culturally defined as desirable or ideal. And the general rules for healthy eating apply to everyone: limit fats (particularly saturated fats and transfatty acids), protein, and cholesterol, and consume plenty of fiber and fresh vegetables. Patients should meet with a professional dietitian to plan an individualized diet that takes into consideration all health needs. Conventional Advice DiabetesUK: In a similar way, DiabetesUK say:

for everyone."

"The healthy diet for people with diabetes is the healthy diet recommended "Foods can be divided into five main groups. In order for us to enjoy a

And like the American Diabetic association they lay things out in groups this time on a plate (left) But note that in both these two pictures the foods recommended to form the basis of all meals are predominantly carbohydrates starches and sugars in the form or bread, pasta, breakfast cereals, rice, fruit and vegetables. These between them fill two-thirds of the plate. At the bottom, in the smallest section we have fats and sugars although fruit is mainly sugar and, thus should, presumably be there as well. As we will see in Part 4, I believe that this is really nonsensical.

balanced diet we need to eat foods from these groups."

Glucose tolerance test To test for diabetes, patients are often given a glucose tolerance test. In this test, they drink a quantity of glucose and then their blood glucose is checked to see:

How high it rises and

At the right you can see a typical glucose tolerance test for a healthy person. Note that a similar tolerance test using fat does not raise blood glucose

How long it takes for their blood glucose to return to a normal level.

The effect on insulin If we look at the effects of the two tolerance tests on blood insulin, we see a similar pattern. Because high levels of glucose in the blood are harmful, this rapid release into the bloodstream causes the pancreas to dump a large amount of insulin into the bloodstream to bring that level down. As you can see, insulin is produced very quickly but it stays high much longer than necessary. This means that when the blood glucose is down to a normal level, after about 80 minutes, insulin is still near its highest point. The consequence of this is that blood glucose is driven abnormally low, you become hypoglycaemic, soon feel hungry, and so need to snack. In this way, you eat more than your body needs, while the excess is stored out of the way as fat.

And, just as fat doesn't raise blood glucose, it also doesn't raise insulin. This is why fats are so much healthier than carbs for a diabetic. Are carb meals yo-yo tolerance tests? But 100g of glucose is not dissimilar to the amount of carbohydrate starches and sugars that would be consumed in a 'healthy' meal. And their effect on blood glucose levels would be similar to that of the glucose tolerance test. This means that every time you have a 'healthy' meal of pasta, and fruit, with midmorning and mid-afternoon snacks of biscuits and/or sweets, your blood glucose level will be continually rising and then brought down again by your body's insulin a form of yo-yo dieting by the hour, with your pancreas working overtime. What actually happens is that Carbohydrate Meals:

Raise blood glucose levels.

This in turn elevates levels of insulin on the blood And that energy stored as fat. THE RESULT is: weight gain!

That insulin takes excess energy (glucose) out of bloodstream.

But insulin also inhibits use of energy from fat cells.

But, of course, weight loss is one of the major aims of the exercise. And it gets worse: Consequences of High Insulin Demand As the pancreas is continulally being called uponn to produce large amounts of insulin, the following sequence of events takes place:

THE RESULT IS: no weight loss!

Body demands for more insulin to reduce excessive blood glucose increase, that demand.

Beta cells in the pancreas up-regulate or increase in size or capacity to meet Continual carb meals and insulin production leads to hypersensitivity.

loads. The flatter curve in the graph on the left demopnstrates that for the same stimulus far more insulin is produced.

This leads to an exaggerated insulin response to even small carbohydrate

resistance in fat and muscle cells.

Hyperinsulinaemia (high levels of insulin in the bloodstream) leads to insulin This increases glucose intolerance and insulin resistance.

The pancreas has to produce even more insulin to be effective

Until eventually, the pancreas is no longer able to cope and it gives up.

A senior NHS diabetic dietician, who must remain anonymous for obvious reasons, admitted that she had NEVER seen ANYONE with type 2 diabetes able to control blood sugar on the standard high carb diet!

So Bring on the Drugs!

As dietary control fails, drugs are employed to reduce glucose levels. There are basically four classes of drug used to reduce levels of glucose in the blood: 1. Alpha-glucosidase inhibitors retard glucose uptake from the intestines (Acarbose) 2. Biguanides augment muscular uptake of glucose (Metformin) 3. Sulphonylureas stimulate insulin production by pancreas (Glimepiride) 4. Prandial glucose regulators stimulate insulin release from pancreas The first class of drugs slow down the rate at which glucose enters the bloodstream and the second takes it out of the bloodstream for storage in the muscles as glycogen. But the body can only store so much glycogen. So other drugs (3 and 4) are used to increase the amount of insulin in the blood. This increases the removal of glucose but, as it does so by storing the excess glucose as fat, this results in weight gain the exact opposite of what doctors are trying to achieve. Polypharmacy May Be Unavoidable And weight gain is not the only problem. Because of the increased risk that diabetics have of complications, polypharmacy, (the use of many drugs together) is a real concern. A paper published in the British Medical Journalpointed out that: (2) Given the cardiovascular risk profile of type 2 diabetes, up to 10% of patients could require:

Two or three hypoglycaemic agents (ultimately including insulin), At least three antihypertensive agents, Two hypolipidaemic agents, And aspirin.

"It is difficult to see how we can realistically expect patients to comply for long with such a draconian regimen requiring so many separate drugs." ID-NIDDM? Polypharmacy is only part of the deterioration in quality of life a diabetic on conventional treatment can expect. As conventional low-fat diets and drugs fail and glycaemic control deteriorates, eventually insulin is prescribed. Over time, therefore, some non-insulin dependent diabetics end up requiring insulin injections. So they are now insulin dependent, noninsulin dependent, diabetics! This elevates insulin levels in the blood even further it's a condition called hyperinsulinaemia. And it is not a healthy progression as it increases the risk of even more serious disease. And remember that hyperinsulinaemia is also a risk factor for diabetes!!

disease and coincidental unrelated chronic disease."

"A high proportion will also require treatment for coexistent cardiovascular

The complications of Insulin Firstly, insulin puts on weight. Its purpose is to take energy out of the bloodstream and store it as fat the very thing that conventional treatment is aimed at stopping. For this reason:

Insulin is the most fattening hormone.

Diabetics who have to inject insulin find it almost impossible to lose weight. But weight gain is not the only complication of insulin use, as insulin:

Increases risk of thrombosis Increases plaque formation Prevents plaque regression Stimulates IGF-1
(3)

Stimulates connective tissue synthesis

Insulin elevates blood pressure by:

Kidney Na+ retention Enhancing flow of Na+ and Ca++ to vascular smooth muscle cell with systolic and diastolic BP
(4)

Fasting and postprandial insulin levels have significant positive associations

Hyperinsulinaemia (high blood insulin level) is also known to be involved in:

Polycystic ovarian syndrome (PCOS) Prostate cancer, breast cancer. Endometrial cancer,

And it is suspected in relation to:

Gestational hypertension Preeclampsia and Osteoporosis

(5)

Insulin increases heart disease risk The most important complication of diabetes is the large increase in risk of a heart attack. A recent study of subjects in Framingham, Massachusetts demonstrated that a blood clot is much more likely to occur if insulin levels are increased. This effect was present in individuals who did not have diabetes, but was more profound in individuals who did have diabetes. (6) Blood clots (thromboses) are a recognised cause of heart attacks, strokes, blockages in other arteries and deep vein thrombosis.

Insulin increases cancer risk Breast cancer patients with high levels of insulin in their blood seem to be more likely to die of their disease. Researchers found that insulin may predict whether a woman's breast cancer recurs after therapy and whether she will die. In a study of 535 breast cancer patients followed for up to 10 years, those with the highest insulin levels were more than eight times more likely to die and were almost four times as likely to have their cancer recur at a distant site. (7) Although many of the women in the study were obese, and obesity is known to affect both breast cancer prognosis and insulin levels, obesity alone did not completely explain the link between insulin and poorer cancer survival. Insulin normally helps promote cell growth. Researchers hypothesize that in the breast, insulin can spur the growth of both normal and cancerous cells. The insulin/cancer risk found confirmation in another study conducted at the Samuel Lunenfeld Research Institute, Mount Sinai Hospital. This study demonstrated that patients with the highest levels of insulin in their blood were twice as likely to have their cancer spread and more than three times as likely to die of the cancer compared to patients with low levels of insulin in their blood. (8)

Why carbs are the wrong foods for diabetics

Obviously something has gone very wrong with the conventional treatment of Type2 diabetesand a growing number of nutritionists and nutritionally oriented doctors are beginning to question the conventional wisdom behind the standard diabetic diet. In this part we discuss what that might be. What Is Diabetes? I believe we need another definition of Type-2 diabetes. And that is: Diabetes mellitus is a chronic disorder of carbohydrate metabolism The chief substance in the body responsible for keeping blood-sugar levels in check is the hormone insulin. In diabetes, either there is insufficient insulin or the insulin simply doesn't do its job. Between 5% and 10% of diabetics has what is known as type 1 diabetes, where the body fails to make sufficient quantities of insulin. In the more common type 2 diabetes, there is usually plenty of insulin around the problem is that the body has become resistant to its effects. Whatever the precise nature of the diabetes, eating a diet that helps to keep bloodsugar levels on an even keel is of obvious importance. Until recently, the traditional view has been that sugar, because it causes surges in blood-sugar levels, should be limited in the diet. On the other hand, starches such as bread, potato, rice and pasta are recommended by doctors and dieticians because of the long-held belief that they

give slow, sustained releases of sugar into the bloodstream. Fruit is also recommended because it is believed the sugar fruit contains fructose also does not raise insulin levels. And this approach shows better than anything just how little the diabetesestablishment understands about diabetes because, biochemically, it makes no sense whatsoever. Let me give you a short chemistry lesson. Sugars The first and most important point to make is that all carbohydrates are sugars , although we do not normally call them that, but differentiate between those that taste sweet, which we call 'sugar', and those that don't, which we call 'starch'. The simple sugars in foods that are most important to human nutrition are called sucrose, fructose, lactose, and maltose. But the body is only interested in the simple sugar called glucose, so these other simple sugars break apart in the digestion to become glucose. Sucrose is the white granulated stuff we call 'sugar' and put in bowls on the table. Sucrose is the form of sugar we are most familiar with. It is obtained from sugar cane, sugar beets, and the syrup from sugar maple trees. It is also naturally present in some amounts in most fruits and vegetables, along with higher amounts of other sugars. Whenever the word 'sugar' is used in common conversation, it is usually sucrose that is being referred to. Sucrose is a disaccharide (meaning 'two sugars') which hydrolyses to glucose and fructose. Fructose is the form of sugar found in fruits, honey, and corn syrup. It is 1.7 times as sweet as sucrose. In recent times fructose, which is every bit as much a sugar as sucrose, has been added to processed foods so that the manufacturers can say on the packet that their product 'has no added sugar'. It's a legal loophole as fructose is a sugar. Fructose is a monosaccharide (meaning 'one sugar') which is absorbed intact and changed into glucose by the liver. Diabetics are told that they can eat fruit so, presumably fructose is thought to be all right. Lactose is the sugar found in milk and cottage cheese. A disaccharide, it is hydrolysed into glucose and galactose. The galactose is changed into glucose in the liver Maltose is a disaccharide sugar found in grains. It hydrolyses into glucose and glucose. Thus, for diabetics it seems to be the worst 'sugar'. Note that all these sugars end in 'ose'. Anything you see on the label of a product ending with these three letters is almost certain to be a sugar. Dextrose, for example, is merely another name for glucose. The only exception is cellulose, which, while it is a complex sugar molecule, is the material that plant cell walls are made of. Cellulose only has a food value for a herbivore. It is inedible to a carnivore and as the human digestive system has no enzyme to digest it, cellulose has no nutritional value and passes straight through you. It used to be called 'roughage'; we now call it fibre.

Dietary Nonsense Next we need to understand how the current recommendations are actually based on what I can only describe as dietary nonsense.

Note that DiabetesUK recommendations are to eat at least five servings of fruit and vegetables every day and base meals and snacks on starchy foods. Also note that on the plate (left) sugar is lumped together with fats at the bottom. Now this is why this is nonsense: You are told to 'Cut down on . . . sugary foods' The chemical name for sugar the white granulated stuff you put in your tea is sucrose. Sucrose is adisaccharide , which means two sugars. Its chemical formula, C 12 H 22 O 11, means that it is made up of twelve atoms of carbon, twenty-two atoms of hydrogen and eleven atoms of oxygen. When it is digested, it enters the bloodstream as the blood sugar, glucose, whose formula is C 6 H 12 O 6 . In this process one molecule of C 12 H 22 O 11 ends up as two molecules of C6 H 12 O 6 . But you will notice that sucrose has only twenty-two hydrogen and eleven oxygen atoms, before it can become glucose, it must gain two hydrogen atoms and one oxygen atom somehow. It does this very simply by combining with water whose chemical formula is H 2 O (which means it has two hydrogen atoms and one oxygen atom exactly what we need). The process is illustrated thus:
C
12

1 Sucrose + 1 Water == 2 glucose

22

11

+ H 2 O == 2 C 6 H

12

The addition of the water molecule to the sugar molecule increases the total energy content. In this way, 100g of sugar, which you would think contains 400 kcals, ends up as 105g of glucose or 420 kcals. 'Base meals and snacks on starchy foods' The situation is similar with starches. Dieticians call starches 'complex carbohydrates' or polysaccharides , which means many sugars. Our digestion also converts these into glucose but, in this case, the formula is a little different. Starch is made up of strings of thousands of sugar molecules fastened together. The formula

for each of these individual sugar molecules is C 6 H 10 O 5 so, to make it into C 6 H 12 O 6, it again needs to find two hydrogen atoms and one oxygen atom. So one molecule of water, H 2 O, is combined with each of the starch sugars. In this way:
C 6H
10

But as the atoms from the water now form a greater proportion of the total in this equation, 100g of starch actually become 111 g of glucose or 444 calories. That's more than the sugar! So if you are taking DiabetesUK's advice for weight loss and trying to reduce your calorie intake, basing meals on starchy foods doesn't look like a very clever thing to do. And the second piece of advice appears to be no more sound: Q: What are diabetics told to eat? A: "5 portions of fruit and vegetables a day" Q: What carbohydrate do fruit and vegetables contain? A: FRUCTOSE which is a sugar! Ah, yes . . . but . . . glucose raises blood levels very quickly (Fructose is preferred to glucose because it is thought to take longer to raise blood sugar). Earlier I lied . . . well didn't tell the whole truth. You see C 6 H 12 O 6 is the formula for both glucose and fructose Sucrose hydrolyses to 50% glucose and 50% fructose. In other words, table sugar is half fructose . . .whereas starch hydrolyses to glucose alone. So does that make sugar healthier than fruit? Perhaps not . . . You might point out that, on DiabetesUK's plate, equal emphasis is given to both glucose-producing starch and fructose-producing fruit and veg. In the USA, the American Diabetes Association places a bigger emphasis on starches, telling diabetics to eat 6 to 11 portions of bread, pasta and so forth a day so is that healthier in the USA than fruit? The belief seems to be that glucose raises blood levels and, consequently, insulin levels quickly but, as fructose doesn't require insulin, it is healthier. But again it isn't that simple. The aim of diabetes treatment is to reduce the complications, the major one being heart attacks. In this respect fructose does not seem to be a good choice because: Fructose Increases CHD Risk!

Starch + Water == glucose

O 5 + H 2 O == C 6 H

12

be important because glycosylation (as well as oxidation) of other proteins, including LDL & HDL particles, may increase the growth rate of atheroma..

(2)

fructose glycosylates haemoglobin 7 times faster than glucose.

(1)

This may

elevating LDL-C.

Fructose also appears to increase Total Cholesterol (TC) primarily by

(3)

expense of starch increased Total Cholesterol by 9% and LDL by 11%.

Increasing dietary fructose from 3% to 20% of calories at the

1%. Swanson et al say that "There is now reason to believe that dietary fructose will increase the risk of atherosclerosis."

It appears that every 2% increase in dietary fructose raises LDL by more than

The glycosylation of proteins is also responsible for the other complications of diabetes which were listed in Part 1 So one has to ask: why are diabetics at such risk told to "Eat five portions of fruit and vegetables a day"?

Conclusion

Diabetes mellitus is a disease of incorrect nutrition. The disease develops as a result of a high intake of carbohydrates the 'healthy' diet. Since 'healthy eating' was introduced, type 2 diabetes has become epidemic to such an extent that it now affects children. This increase at such a time is NOT a coincidence it is cause and effect. The reason conventional treatment of diabetes fails is because authoritative bodies such as DiabetesUK and the American Diabetes Association promote the very diet that caused the disease in the first place a diet that actually makes the condition worse. Fortunately Type-2 diabetes is easily treated without the need to resort to drugs by: A strategy that offers the prospect of cure or successful treatment for diabetes is one that limits hyperinsulinaemia by restricting carbohydrate intake the exact opposite of the conventional approach. Part 5 looks at some of the evidence that eating a low-carb, high-fat diet is better for diabetics.

References

1. Bunn HF, Higgins PJ. Reaction of monosaccharides with proteins: possible evolutionary significance. Science 1981;213:222-9. 2. Bierman EL. Arteriosclerosis and Thrombosis 1992;12:647-646. 3. Swanson JE, Laine DC, Thomas W, Bantle JP. Metabolic effects of dietary fructose in healthy subjects. Am J Clin Nutr 1992;55:851-6.

The evidence that a low-carb, saturated fat diet better for diabetics

Since the adoption of a low-fatdiet as "healthy" in the early 1980s, diabetics have been put on such diets. Nobody thought to actually test whether they worked, with the results we see now of rising diabetes and obesity throughout the Western world. However, there were more enlightened scientists who saw the way things were going. Despite the expense and difficulty gettingfunding for trials which would not be of commercial benefit to drug and food producers, tests have been conducted into low-carbohydrate, high fat diets indiabetes. They have demonstrated pretty convincingly that a high-fat diet is far healthier for diabetics than the conventional "five portions of fruit and vegetables a day" advice diabetics usually get. Here is some of the evidence. The evidence on this page is very recent. But this evidence is not new we really have known some of it for over a century (see the story of William Banting and the studies which followed. And there never has been any convincing evidence that a fatty diet causes heart disease (see The Cholesterol Myth and Gary Taubes' article, The Soft Science of Dietary Fat )
In the 3 August 2002 edition of the British Medical Journal an editorial entitled "Prevention and cure of type 2 diabetes: Weight loss is the key to controlling thediabetes epidemic" ( BMJ 2002;325:232-233), said just that. It is generally accepted that weight loss is probably the best way to treat diabetics who, usually are overweight, because: a reduction in weight of 10kg (22 lbs): Reduces Hba1c more than Metformin Reduces diabetes-related deaths Improves blood lipids, without drugs

Improves blood pressure, without drugs The difficulty is to reduce weight without increasing the risk of a heart attack or by reducing carbohydrates and increasing fats:

damaging arteries. So with that in mind here are two studies which do just that

Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, Volek JS. A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr 2002; 132: 187985 Human Performance Laboratory, University of Connecticut, Storrs 062691110, USA. Very low-carbohydrate (ketogenic) diets are popular yet little is known regarding the effects on serum biomarkers for cardiovascular disease (CVD). This study examined the effects of a 6-wk ketogenic diet on fasting

and postprandial serum biomarkers in 20 normal-weight, normolipidemic men. Twelve men switched from their habitual diet (17% protein, 47% carbohydrate and 32% fat) to a ketogenic diet (30% protein, 8% carbohydrate and 61% fat) and eight control subjects consumed their habitual diet for 6 wk. Fasting blood lipids, insulin, LDL particle size, oxidized LDL and postprandial triacylglycerol (TAG) and insulin responses to a fat-rich meal were determined before and after treatment. There were significant decreases in fasting serum TAG (-33%), postprandial lipemia after a fat-rich meal (-29%), and fasting serum insulin concentrations (-34%) after men consumed the ketogenic diet. Fasting serum total and LDL cholesterol and oxidized LDL were unaffected and HDL cholesterol tended to increase with the ketogenic diet (+11.5%; P = 0.066). In subjects with a predominance of small LDL particles pattern B, there were significant increases in mean and peak LDL particle diameter and the percentage of LDL-1 after the ketogenic diet. There were no significant changes in blood lipids in the control group. To our knowledge this is the first study to document the effects of a ketogenic diet on fasting and postprandial CVD biomarkers independent of weight loss. The results suggest that a short-term ketogenic diet does not have a deleterious effect on CVD risk profile and may improve the lipid disorders characteristic of atherogenic dyslipidemia. COMMENT: with a diet in which 61% of calories came from fat, you might expect that cholesterol, etc, would rise. In fact, it did just the opposite. The figures are:
fasting serum triacylglycerol - 33% postprandial lipaemia - 29% postprandial insulin - 34% HDL +11.5% Total cholesterol was unchanged

Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE. Effect of 6month adherence to a very low carbohydrate diet program.Am J Med 2002 Jul;113(1):30-6 Division of General Internal Medicine, Duke University, Durham, North Carolina To determine the effect of a 6-month very low carbohydrate diet program on body weight and other metabolic parameters. Fifty-one overweight or obese healthy volunteers who wanted to lose weight were placed on a very low carbohydrate diet (less than 25 grams per day), with no limit on total calorie intake. They also received nutritional supplementation and recommendations about exercise, and attended group meetings at a research clinic. The outcomes were body weight, body mass index, percentage of body fat (estimated by skinfold thickness), serum chemistry and lipid values, 24-hour urine measurements, and subjective adverse effects.

Forty-one (80%) of the 51 subjects attended visits through 6 months. In these subjects, the mean (+/- SD) body weight decreased 10.3% +/- 5.9% (P <0.001) from baseline to 6 months (body weight reduction of 9.0 +/- 5.3 kg and body mass index reduction of 3.2 +/- 1.9 kg/m(2)). The mean percentage of body weight that was fat decreased 2.9% +/- 3.2% from baseline to 6 months (P <0.001). The mean serum bicarbonate level decreased 2 +/- 2.4 mmol/L (P <0.001) and blood urea nitrogen level increased 2 +/- 4 mg/dL (P <0.001). Serum total cholesterol level decreased 11 +/- 26 mg/dL (P = 0.006), low-density lipoprotein cholesterol level decreased 10 +/- 25 mg/dL (P = 0.01), triglyceride level decreased 56 +/- 45 mg/dL (P <0.001), high-density lipoprotein (HDL) cholesterol level increased 10 +/- 8 mg/dL (P <0.001), and the cholesterol/HDL cholesterol ratio decreased 0.9 +/- 0.6 units (P <0.001). There were no serious adverse effects , but the possibility of adverse effects in the 10 subjects who did not adhere to the program cannot be eliminated. A very low carbohydrate diet program led to sustained weight loss during a 6month period. COMMENT: Over the period of the diet, the participants lost an average of 21.3 pounds, and showed a 6.1% drop in cholesterol, and almost a 40% drop in the level of triglycerides in their blood. In addition, their HDL levels increased by about 7%. This is all good stuff. In an interview for Reuters Health, the study's main author, Dr Eric Westman said he was surprised that patients' cholesterol levels improved by the end of six months as it was an unexpected a finding. "We were somewhat surprised to find that patients' blood lipid profiles improved, even though there was much more fat in the diet," he said. "We had thought the fat in the diet would increase the cholesterol." This statement disappoints me for it shows how little is read of the literature on this subject. As long ago as 1930 the Journal of Biological Chemistry published the results of a trial conducted in Bellevue Hospital, New York, on Dr Viljalmur Stefansson and Dr Karsten Anderson, who lived on an all-meat (with its fat) diet for a year. As well as other benefits, their blood cholesterol fell by 1.3 mmol/l (50mg/dl). I do welcome, however, another quote from Dr Westman: "The diet lowers cholesterol and triglycerides and raises HDL . . . which may represent an entirely new approach to the control and prevention of heart disease," They are starting to get the message.

Dr James Hays initially presented his work with high fat diet at ENDO 99 in San Diego, CA, and was censured for it (see below). Here, three years later, he has clearly chosen a more "acceptable" approach (i.e., the use of a drug with dietary modification). As his results without the drug were very impressive, I wonder why he included drugs (research grant perhaps?). Nevertheless, the figures show that his high-saturated fat diet had much greater beneficial effects than the drugs. NOTE: Until now, studies into the effect of reducing carbohydrates in the diets of diabetics have played safe and followed the party line that saturated fats are harmful. This has meant that the fats used to replace starches have been "beneficial" monounsaturated fats. In the

study below, a starch-reduced, saturated fatty diet is compared to one in which the fats were monounsaturated. As you can see from this abstract, the effects from the saturated fats were much better.

Hays JH, Gorman RT, Shakir KM. Results of use of metformin and replacement of starch with saturated fat in diets of patients with type 2 diabetes. Endocr Pract 2002 May-Jun;8(3):177-83 ih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12113629&dopt=Abs tract Christiana Care Health Services, Inc., Cardiology Research, Newark, Delaware 19718, USA. OBJECTIVE: To improve glycemic control by substituting saturated fat for starch, to identify any adverse effect on lipids masked by the extensive use of metformin and lipid-lowering drugs, and to attempt to separate dietary effects from effects of multiple drugs. METHODS: We undertook a retrospective review of medical records of patients who completed 1 year of follow-up after dietary prescription. The study subjects included 151 patients in the diet group (whose dietary instructions included high saturated fat but starch avoidance ) and 132 historical control subjects (who were allowed unlimited monounsaturated fat but had restriction of starch in their diets). RESULTS:

Hemoglobin A1c (HbA1c) levels improved in both study groups (-1.4 +/- 0.2% [P <0.001]; 95% confidence interval [CI], -1.9 to -0.9). Use of metformin was associated with a decrease in HbA1c ( 0.12 +/- 0.003%/mo [P <0.001]; 95% CI, -0.17 to -0.07). The diet group had an additional decrease of -0.7 +/- 0.2% (P <0.001; 95% CI, -1.1 to -0.3). Weight increase was associated with the use of insulin(+0.3 +/- 0.07 kg/mo [P <0.001]; 95% CI, 0.2 to 0.5), sulfonylurea (+0.18 +/- 0.06 kg/mo [P<0.01]; 95% CI, 0.05 to 0.30), and troglitazone (+0.7 +/- 0.2 kg/mo [P <0.005]; 95% CI, 0.3 to 1.2). Although not statistically significant, metformin therapy showed a trend for weight loss (-0.14 +/- 0.08 kg/mo; P = 0.07). An additional weight loss was noted in the diet group (-2.65 +/- 0.62 kg [P <0.001]; 95% CI, 3.87 to -1.44). Hydroxymethylglutaryl-coenzyme A reductase inhibitor [statin] use was associated with reduced total cholesterol level ( -1.7+/- 0.6 mg/dL per month [P <0.005]; 95% CI, -2.9 to -0.5). The diet group had an additional decrease of -13.0 +/- 4.5 mg/dL (P <0.001; 95% CI, -21.9 to -4.1). No significant effect of the diet on triglyceride, low-density lipoprotein, or high-density lipoprotein levels was detected. CONCLUSION: Addition of saturated fat and removal of starch from a high-monounsaturated fat and starch-restricted diet improved glycemic control and were associated with weight loss without detectable adverse effects on serum lipids. COMMENT: 1. Diet reduced HbA1c by six times as much as drugs. 2. Diet reduced weight where drugs had little effect. 3. The high-fat diet reduced total cholesterol seven times as much as statins (the drug of choice).

As more and more children are becoming increasingly overweight and also developing Type 2 diabetes, weight reduction is increasingly important for them as well. Never was it more

true than in diabetes that prevention is better than cure. The following study looks at reducing the weight and, thus, the likelihood of contracting diabetes in children.

Sondike S, Jacobson, Copperman. The ketogenic diet increases weight loss but not cardiovascular risk: A randomized controlled trial. J Adolescent Health Care 2000; 26: 91. Schneider Children's Hospital in New Hyde Park, N.Y This study was conducted on overweight children aged 12 to 18. They were between 20 and 100 pounds overweight. The children were split into two groups. One group ate a conventional low-fat, carbohydrate based "slimming" diet composed of whole grains, fruits and vegetables with fat-free dairy products, low-fat meats, poultry and fish. Their total intake was limited to 1,100 calories per day. The other group ate a high-fat, low-carb diet in which they were allowed to eat as many calories as they wanted in the form of untrimmed meat, cheese, eggs, poultry and fish. Their carbohydrates came from two salads a day and minimal other carbs. RESULTS Despite consuming on average 66% more calories per day, after 12 weeks the children consuming the low-carbohydrate diet lost more weight than those following the low-fat, high-carb plan:

Calorie intake Weight loss HDL Triglycerides

Low-carb 1830 19 lbs Increased -52%

Low-fat 1100 8.5 lbs Decreased -10%

As high-protein/fat diets are thought to have adverse effects on kidneys and liver, kidney and liver functions were regularly monitored. They were found to be unaffected by this diet.
COMMENT: Six to twelve months later, most of the low-carb dieters had maintained their new lower weight. This study provides additional evidence for the efficacy of a low-carb weight loss programme specifically for the most vulnerable group teenagers.

The study above was not the first to show that low-calorie diets are not the best for weight loss. In 1997 a study concluded that such diets actually increased weight. Its authors concluded that: "Reduced fat and calorie intake and frequent use of low-calorie food products have been associated with a paradoxical increase in the prevalence of obesity" (Heini AF, Weinsier RL. Divergent trends in obesity and fat intake patterns: the American paradox. Am J Med 1997; 102: 259-64) In the following report, Dr James Hays, an endocrinologist and Director of the Limestone Medical Center, Wilmington, DE, presented the results of three studies using a "very high fat diet" on diabetics. It is reported that his submission did not meet with favour with the other delegates. Such a reaction is very common whenever anyone bucks the trend.

Hays J.Paper presented to the 81st Annual Meeting of the Endocrine Society, 15 June1999. "A very high-fat, low-carbohydrate diet has been shown to have astounding effects in helping type 2 diabetics lose weight and improve their blood lipid profiles." Report of three studies of men and women with Type 2 diabetes involving very high-fat, low-carbohydrate diet to measure ite effect on body mass index (BMI), triglycerides, HDL, LDL and HbA1c. METHODS. A diet with unlimited meat and cheese; carbohydrates restricted to eating unprocessed foods, mainly fresh fruit and vegetables. At least 50% of calories from fat, of which 90% was saturated and 10% monounsaturated; no more than 20% of calories from carbohydrates. RESULTS. After 12 months:
Total cholesterol declined from 231 to 190 mg/dl LDL (the 'bad' cholesterol) fell from 133 to 105 mg/dl, HDL (the 'good' cholesterol) increased from 44 to 47 mg/dl. Triglycerides declined from 229 to 182 mg/dl. HbA1c, which at the start of the study averaged 3.34 percent above normal, declined to just 0.96 percent above normal Average weight loss was in the order of 40 pounds.

By the end of the one-year study 90 percent of the patients had achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and triglycerides. CONCLUSION "If you have a diet that results in weight loss, lower cholesterol, and a better lipid profile, eventually everybody will be eating that way. It's going to come whether we like it or not."
COMMENT: I couldn't agree more!

This is one of the earliest trials which looked at increasing dietary fats at the expense of carbohydrates. Because it was not politically correct to raise fats (they raise cholesterol levels, don't they?), fats were only raised to a modest 45%. Nevertheless there was a noticeable benefit, and it was a start.

Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Raatz SK, Brinkley L, Chen YD, Grundy SM, Huet BA, et al Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. JAMA 1994; 271: 1421-8 Center for Human Nutrition, University of Texas Southwestern Medical

Center at Dallas 75235-9052. OBJECTIVE To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non-insulin-dependent diabetes mellitus (TYPE-2). DESIGN A four-center randomized crossover trial. SETTING Outpatient and inpatient evaluation in metabolic units. PATIENTS Forty-two TYPE-2 patients receiving glipizide therapy. INTERVENTIONS A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a highmonounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks. MAIN OUTCOME MEASURES Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels. RESULTS The site of study as well as the diet order did not affect the results. Compared with the high-monounsaturated-fat diet, the highcarbohydrate diet increased fasting plasma triglyceride levels and very lowdensity lipoprotein cholesterol levels by 24% (P < .0001) and 23% (P = .0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P = .03), 12% (P < .0001), and 9% (P = .02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks. CONCLUSIONS In TYPE-2 patients, high-carbohydrate diets compared with high-monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.
COMMENT: This study showed that a higher-fat diet was better than the usual high-carbohydrate diets.

Pregnant women are more susceptible to a form of diabetes called "gestational diabetes". As the following study demonstrates, this condition also benefits from a low-carbohydrate diet

Major CA, Henry MJ, De Veciana M, Morgan MA. The effects of

carbohydrate restriction in patients with diet-controlled gestational diabetes. Obstet Gynecol 1998 Apr;91(4):600-4 University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Orange 92686, USA. OBJECTIVE: To determine the effect of carbohydrate restriction on perinatal outcome in patients with diet-controlled gestational diabetes mellitus (GDM). METHODS: Women with diet-controlled GDM were divided non-randomly into two groups based on their dietary carbohydrate content: those with low dietary carbohydrate content (below 42%) and those with high dietary carbohydrate content (exceeding 45%). Subjects kept dietary accounts and were followed with daily fasting and postprandial glucose assessments. Subjects also were tested daily for urinary ketones. Glycosylated hemoglobin, mean fasting and postprandial glucose values, incidence of macrosomia and large for gestational age (LGA) infants, cesarean deliveries for cephalopelvic disproportion and macrosomia, and need for insulin therapy were compared between the groups. RESULTS: The two groups were identical in terms of demographic characteristics. Significant reductions in the postprandial glucose values were seen among subjects in the low-carbohydrate group. Fewer subjects in the low-carbohydrate group required the addition of insulin for glucose control (P < .047; relative risk [RR] 0.14; 95% confidence interval [CI] 0.02, 1.00). The incidence of LGA infants was significantly lower in the lowcarbohydrate group (P < .035; RR 0.22; 95% CI 0.05, 0.91). Subjects in the low carbohydrate group also had a lower rate of cesarean deliveries for cephalopelvic disproportion and macrosomia (P < .037; RR 0.15; 95% CI 0.04, 0.94). CONCLUSION: Carbohydrate restriction in patients with diet-controlled GDM results in improved glycemic control, less need for insulin therapy, a decrease in the incidence LGA infants, and a decrease in cesarean deliveries for cephalopelvic disproportion and macrosomia.

Diabetic patients often find themselves in hospital. Many of them will be maintained on a special formula diet. The common feed in this case is one high in the carbohydrate, glucose. In the following study, this was replaced with a low-carbohydrate, high-fat feed with 50% of calories as fat. As you can see, the low-carb feed was better for diabetic patients.

Sanz-Paris A, Calvo L, Guallard A, Salazar I, Albero R. High-fat versus high-carbohydrate enteral formulae: effect on blood glucose, Cpeptide, and ketones in patients with type 2 diabetes treated with insulin or sulfonylurea. Nutrition 1998 Nov-Dec;14(11-12):840-5

Endocrinology and Nutrition Unit, Miguel Servet Hospital, Zaragoza, Spain. Recently, two commercial enteral formulae for diabetic patients have been made available in Spain: a high-complex-carbohydrate, low-fat formulation (HCF) and a low-carbohydrate formulation (RCF). This study compares the effects of the two enteral nutritional formulae in patients with non-insulindependent diabetes mellitus (type 2 diabetes) treated with sulfonylurea or insulin. Fifty-two type 2 diabetes patients were randomly assigned to receive one of the two enteral formulae. Test enteral formula breakfast (250 cc) were consumed at approximately 0900 h after routine medications (insulin or oral agents) had been taken. Venous blood samples were obtained during fasting, before medication, and at 30 and 120 min after the start of the meal. The glycemic response of patients to the HCF was significantly greater than to RCF, but lower than in the sulfonyl type 2 diabetes treated groups. The incremental glucose response was within acceptable levels except in insulin treatment type 2 diabetes patients given HCF. Glucose, insulin, and C-peptide responses were higher in HCF than RCF groups. Two-factor analysis of variance on mean increments of blood glucose and C-peptide from basal levels to 30 min show the type of enteral nutrition as the main factor (P = 0.0010 and P = 0.0005, respectively). The RCF formula supplies 50.0% of energy as fat and 33.3% as carbohydrates, so it may be a ketogenic diet. It was found that both ketone bodies were higher after RCF than after HCF ingestion, but without statistical significance. We conclude that the partial replacement of complex digestible carbohydrates with monounsaturated fatty acids in the enteral formulae for supplementation of oral diet may improve glycemic control in patients with type 2 diabetes. The long-term effects of enteral diets high in monounsaturated fatty acids need further evaluation in patients with type 2 diabetes.

This is another of the early studies which replaced carbs with monounsaturated fat, this time from Australia where they are as cholesterolphobic as the Americans. As consequence, fats are only raised from 24% to 38% of calories. I would still class this as a low-fat diet, nevertheless, even with this small increase in fat, there was a noticeable improvement and, if nothing else the diet would be considerably more palatable.

Campbell LV, Marmot PE, Dyer JA, Borkman M, Storlien LH. The highmonounsaturated fat diet as a practical alternative for TYPE2. Diabetes Care 1994 Mar;17(3):177-82 Diabetes Centre, St. Vincent's Hospital, Camperdown, Sydney, New South Wales, Australia.

OBJECTIVE To examine the dietary preferences of and metabolic effects in patients with non-insulin-dependent diabetes mellitus (TYPE-2) of a home-prepared high-monounsaturated fat (HM) diet compared with the recommended high-carbohydrate (CHO) diet. RESEARCH DESIGN AND METHODS Ten men with mild TYPE-2 prepared HM and high-CHO diets at home alternately and in random order for 2 weeks each with a minimum 1-week washout. Before and after each diet, 24-h urine glucose, fasting lipids, fructosamine, and 6-h profiles of glucose, insulin, and triglycerides were measured. Dietary preferences were assessed by questionnaire. RESULTS In the HM diet, patients consumed 40% of energy intake as CHO and 38% as fat (21% monounsaturated) compared with 52 and 24%, respectively, in the high-CHO diet, with equal dietary fiber content. Body weight and total energy intake were similar in both. The HM diet resulted in significantly lower 24-h urinary glucose excretion, fasting triglyceride, and mean profile glucose levels. The fructosamine levels, the fasting total, lowdensity lipoprotein, and high-density lipoprotein cholesterol, and the prandial triglyceride concentrations did not differ significantly as a result of the diets. The two diets did not differ in ratings for overall acceptance, taste, cost, ease of preparation, variety, or satiety. CONCLUSIONS Prepared at home, the HM diet was, in the short-term, metabolically better in some aspects than the currently recommended diet for TYPE-2. It also provided a palatable alternative.

People are told to increase their intakes of fibre to prevent diabetes. Diabetics are told to eat bran and wholemeal cereal products as part of their treatment. Low carbohydrate diets usually reduce the amount of fibre eaten. So does that matter? I don't believe so and this study lends weight to that belief as it shows just how little evidence there is for this recommendation.

Marshall JA, Weiss NS, Hamman RF. The role of dietary fiber in the etiology of non-insulin-dependent diabetes mellitus. The San Luis Valley Diabetes Study. Ann Epidemiol 1993 Jan;3(1):18-26 Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262. To investigate the hypothesis that a low intake of dietary fiber could increase the risk of developing non-insulin-dependent diabetes mellitus (NIDDM), we ascertained prior dietary intake of 242 persons with known diabetes and 460 persons without a prior diagnosis of diabetes among 20to 74-year-old residents of two counties in southern Colorado from 1984 to 1986. When persons with diabetes were compared to nondiabetic controls, a higher reported fiber intake prior to diagnosis was found among

persons with diabetes. A decrease in fiber of 10 g/d was associated with a decrease in risk of NIDDM of 0.75 (95% confidence interval: 0.59 to 0.96), rather than an increase as hypothesized. However, when the diabetic group was limited to those with diabetes for less than 5 years, this association was no longer present. Two further analyses were carried out on 1317 persons without a prior diagnosis of diabetes seen between 1984 and 1988. Among these persons, current fiber intake was inversely associated with fasting plasma insulin concentration. However, fiber explained less than 1% of the variation in fasting insulin levels. When persons with previously undiagnosed NIDDM were compared to normal controls, the odds ratio relating a decrease in fiber consumption of 10 g/d to NIDDM was 1.21 (95% confidence interval: 0.70 to 2.10) adjusting for calorie and carbohydrate intake. All analyses were adjusted for age, sex, ethnicity, and body mass index. The inconsistent findings reported here do not support the hypothesis that increasing dietary fiber intake could reduce the future occurrence of NIDDM.

Here is another early study which demonstrates that cholesterol and other "risk factors" for heart disease in diabetics is lessened by increasing the fat content of their diets and reducing the carbs.

Garg A, Grundy SM, Unger RH. Comparison of effects of high and low carbohydrate diets on plasma lipoproteins and insulin sensitivity in patients with mild NIDDM. Diabetes 1992 Oct;41(10):1278-85 Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas 75235-9052. Previous studies indicate that diets rich in digestible carbohydrates improve glucose tolerance in nondiabetic individuals, but may worsen glycemic control in NIDDM patients with moderately severe hyperglycemia. The effects of such high-carbohydrate diets on glucose metabolism in patients with mild NIDDM have not been studied adequately. This study compares responses to an isocaloric high-carbohydrate diet (60% of total energy from carbohydrates) and a low-carbohydrate diet (35% of total energy from carbohydrates) in 8 men with mild NIDDM. Both diets were low in saturated fatty acids, whereas the low-carbohydrate diet was rich in monounsaturated fatty acids. The two diets were matched for dietary fiber content (25 g/day). All patients were randomly assigned to receive first one and then the other diet, each for a period of 21 days, in a metabolic ward. Compared with the low-carbohydrate diet, the high-carbohydrate diet caused a 27.5% increase in plasma triglycerides and a similar increase in VLDL-cholesterol levels; it also reduced levels of HDL cholesterol by 11%. Plasma glucose and insulin responses to identical standard breakfast meals

were studied on days 4 and 21 of each period, and these did not differ significantly between the two diets. At the end of each period, a euglycemic hyperinsulinemic glucose clamp study with simultaneous infusion of [33H]glucose revealed no significant changes in hepatic insulin sensitivity; and peripheral insulin-mediated glucose disposal remained unchanged (14.7 +/- 1.4 vs. 16.5 +/- 2.3 microM.kg-1.min-1 on the high-carbohydrate and low-carbohydrate diets, respectively). See also an abstract from the Journal of the American College of Cardiology In which the past President of the College says that the current dietary guidelines are the cause of diabetes and states that their defence is no longer tenable.

Recap on Conventional Approach

Major aims are:

Weight loss.

Control of cardiac risk factors.

BUT:

The conventional high-carb, low-fat diet results in hyperglycaemia. Hyperglycaemia causes hyperinsulinaemia. Excess energy is stored as body fat.

Thus conventional treatment for diabetes, using a diet based on breads, pasta and fruit is likely to do the exact opposite of what is aimed for and make the condition worse. Why that happens is explained in detail in Part 4: Why carbs are the wrong foods for diabetics

Weight gain is the norm and cardiac risks are increased.

References

1. Jung RT. Obesity as a disease. Br Med Bull 1997; 53: 307-21. 2. Winocour PH. Effective diabetes care: a need for realistic targets. BMJ2002;324:1577-1580 3. DeFronzo RA, Eleuterio F. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-91. and Meigs JB, Mieeleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglyceima, and impaired hemostasis. The Framingham offspring study. JAMA 2000;283:221-229. 4. DeFronzo RA, Eleuterio F. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidemia, and atherosclerotic cardiovascular disease. Diabetes Care 1991; 14: 173-91. 5. Bachman JM The low-carbohydrate diet in primary care ob/gyn. Prim Care Update Ob/Gyn. 2001; 8: 12-17 6. Meigs JB, Mieeleman MA, Nathan DM, et al. Hyperinsulinemia, hyperglyceima, and impaired hemostasis. The Framingham offspring study.JAMA 2000; 283: 221-229. 7. Annual meeting of American Society of Clinical Oncology, New Orleans, 23 May 2000 8. Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, et al. Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. J Clin Oncol 2002; 20: 42-51

The correct diet for a Type-2 diabetic, (or treatment without drugs)
Let's start from scratch and pull all the evidence together. Why Do Adults Become Diabetic? Adults and children develop Type-2 diabetes as a consequence of eating a highcarbohydrate diet and for no other reason.

As a diabetic, there is only one way to 'cure' the condition and lead a normal drug-free life again: stop doing the thing that caused the disease. Diabetes is caused by a chronic high intake of carbohydrates sugars and starches The current "healthy" dietary recommendation advise a chronic intake of carbohydrates The evidence says that a low-carb diet is healthier. The reason why is explained in part 5 and my vegetarian pages .

The Balanced Diet There is nothing so dear to a nutritionist's heart as the idea of a "balanced" diet. DiabetesUK say: "Foods can be divided into five main groups. In order for us to enjoy a balanced diet we need to eat foods from these groups." And the ADA say: "No single food will supply all the nutrients your body needs, so good nutrition means eating a variety of foods." Here is my definition of a balanced diet: A balanced diet is any diet that supplies all the nutrients the body needs in the correct proportions. If you accept that definition, then a diet entirely of meat so long as the organs (liver, kidney, etc) and fat are included is a balanced diet. Don't believe me? Then consider what the Inuit (Eskimos) eat, as conveyed in the Eskimo food "pyramid" cartoon above.

Main Points
Diabetes is not caused by obesity; both conditions are caused by the same thing Dietary carbohydrates cause obesity Dietary carbohydrates cause diabetes

Obesity is merely evident before diabetes

To reduce disease, reduce carbohydrates.

In Natural Health & Weight Loss I showed pictures of my wife, Monica, and how her weight had stabilised for more than 40 years on a low-carb diet. Similarly, I wrote about William Banting and the follow-up research which showed time and again that a low-carb, highfat diet was best for weight loss. Why? It's really quite simple. It's because that is our natural diet! Q. What have all wild animals got in common?

A. None is overweight and none gets diabetes Q. What have all primitive humans got in common? A. None is overweight and none gets diabetes Q. What have westernised industrial humans got in common? A. Many are overweight and many get diabetes Q. What have westernised industrial humans' pets got in common? A. Many are overweight and many get diabetes Do you see the pattern? What Is Our Natural Diet? For details see my pages on Vegetarianism .

Summary of Evidence

Agriculture very recent in history.

For 2.5 million years diet high-protein, high-fat, low-carb. 99.9% of our genes formed before advent of agriculture. We evolved eating an animal sourced diet.

The current concept of a "healthy' diet quite different and unnatural.

Now let's get back to sorting out the diabetes problem. The conventional approach to diabetes treatment is with dietary means PLUS drugs and there is a good reason why this is not a good idea Two Types of Disease There are two distinct types of disease. 1. Diseases caused by living organisms: (typhoid, measles, colds). In these cases drugs, to kill bacteria, viruses, etc are the best answer. 2. Diseases caused by environment / lifestyle: (obesity, diabetes, ischaemic heart disease). In this class of diseases, drugs are rarely successful. In these cases it is better to find and modify the cause. And the cause in pretty well all of them seems down to unnatural diet. The Alternative Approach For that reason I believe, and teach, that the correct way to treat diabetes is with weight loss by dietary means alone without the use of drugs. The strategy is to reduce excessive insulin with a very high fat, low-carb diet. Trials prove that it works see Part 5 . Forward to the Past All this isn't new. Before 1984, diabetics were treated with low-carb, high-fatdiet. Think about it: a low-carb, high-fat diet reduces postprandial (after meals) glucose spikes. If there are no glucose spikes there's no hyperinsulinaemia and with no hyperinsulinaemia there's no weight gain and no diabetes.

Summary of Protocol

The diet is explained in my book Natural Health & Weight Loss This book is written for people who are overweight but otherwise healthy. It advocates 60 grams of carbohydrate a day. For diabetics, this should be reduced to around 30-40 grams a day.

The amount of calories lost through cutting down on carbs must be made up in some way from other foods. It is important that you do not go hungry. It is equally important that these calories come from dietary fat NOT from protein. The aim is to reduce blood glucose and insulin levels. Our bodies will make glucose from protein they don't make glucose from fat. And fat is a much better fuel anyway (see my page on diet for athletes ). To help you here is a list of foods to avoid, a list of foods to eat and a simple carb counter Given this, the ratios you should adopt for your daily meals are: 10% 15% carbohydrate 20% 25% protein 60% 70% fat The amount of fat might seem too high to manage. In fact, it isn't too difficult if you fry as much as possible, buy the fattiest meat you can find and don't cut the fat off, eat full-fat cheeses, put cream on the small amount of fruit you are allowed and spread butter on cooked vegetables or fatless meat. As an example, here is an actual menu for my meals for one day:

Breakfast 8:00 am
72g extra large egg 120g fat bacon 70g mushrooms (these soak up fat) 15g lard 75g banana

Lunch 1:00 pm Evening 6:45pm 300g fat pork chop 140g brie cheese 40g carrots 75g apple 70g runner beans 50g cream (in drink) 60g squash

50g onion 70g single cream (in Butter on drink) vegetables C= 24.5g: P=37g: C=16g : P=57g F=67.2g C=13.9g : : F=90g P=31g : 781 cals F=45.9g 1098 cals 593 cals plus 2 litres of water as plain water or in tea/cocoa

Totals for the day Calories:

Carbs Protein Fats 54.4g 125g 203.1g 217.6 500 1827.9

Grand total 2545.5

Percentages of calories:

8.6%

19.7 71.7%

kcals 100%

That is an example of what I use as a slimming diet Does it really look so difficult to live on? Do I exercise to burn off all these calories? Not really, I spend most of my day in front of a computer. NOTE: There are two points from a diabetic point of view:

A diabetic should cut out the fruit at breakfast time if he/she notices the "Dawn Phenomenon" (higher blood glucose levels on waking than before going to bed). The small meal in the evening will ensure that blood glucose overnight and in early morning does not go too high

Diabetes: Suitable Foods for Diabetics

Diabetes affects different people in different ways, depending on their degree of diabetic complication, but, while different amounts of carbs may be eaten for this reason, the types of foods to eat and to avoid is the same for all. Below are lists of foods to avoid, and foods to eat. Below those are two lists of fruit and vegetables which give quantities that provide 10 grams or 5 grams of carbs. These lists are by no means exhaustive. They are here to help you to decide what and how much you can eat to eat to manage your condition. NOTE that the lists do not mention nuts. This is because nuts generally come in packets which list their carb content. The 'nuts' to beware of are peanuts as these are not true nuts, but legumes (like peas and beans) and have a higher ratio of carbs to protein and fat.
AVOID THESE FOODS Below is a list of foods to avoid. Some will be obvious others less so.

Sugar and artificial sweeteners, including honey. The only allowed sweetener is stevia. (Sugar is a problem as it is addictive. I suggest you cut down gradually until you can do without. The other option is to go 'cold turkey' and stop it altogether. This will give you withdrawal symptoms, just like stopping any other addictive drug. But this will wear off within about two weeks.) Sweets and chocolates, including so-called sugar-free types. (If

you want a chocolate treat, say once a week, then eat Continental dark chocolate with 70% or more cocoa solids, not the British stuff where sugar is the first named ingredient.) Foods which contain significant proportions of things whose ingredients end in -ol or -ose as these are sugars (the only exception is cellulose, which is a form of dietary fibre) "Diet" and "sugar-free" foods (except sugar-free jelly) Grains and foods made from them: wheat, rye, barley, corn, rice, bread, pasta, pastry, cakes, biscuits, pies, tarts, breakfast cereals, et cetera. Starchy vegetables: potatoes and parsnips in particular; and go easy with beet, carrots, peas, beans, et cetera and packets of mixed vegetables which might contain them Beans with the exception of runner beans Milk (except in small quantities) Sweetened, fruit and low-fat yogurts Cottage cheese (except in small amounts) Beware of commercially packaged foods such as TV dinners, "lean" or "light" in particular, and fast foods, snack foods and "health foods". Fruit juices, as these are much higher in carbs than fresh fruit. (If you like fruit juices as a drink, dilute about 1 part fruit juice with 2-4 parts water.)

Now that you think there is nothing left to eat, these are foods you can eat: All meat lamb, beef, pork, bacon, etc include the organ meats: liver, kidneys, heart, as these contain the widest range of the vitamins and minerals your body needs (weight for weight, liver has 4 times as much Vitamin C as apples and pears, for example); All poultry: chicken (with the skin on), goose, duck, turkey, etc. But be aware that turkey is very low in fat, so fat needs to be added. Continental sausage (beware of British sausage which usually has a high cereal content.) All animal and meat fats without restriction never cut the fat off meat. Fish and seafood of all types Eggs (no limit, but avoid "omega-3 eggs" as these have been artificially fed which upsets the natural fatty acid profile) All cheeses (except cottage cheese as this has a high carb content and very little fat) butter and cream (put butter on cooked veges instead of gravy; use cream in hot drinks in place of milk)

Plain, natural full-fat yogurt Vegetables and fruits as allowed by carb content. (See tables below) Condiments: pepper, salt, mustard, herbs and spices Soy products are allowed but, as many are toxic, I don't recommend them (seehttp://www.soyonlineservice.co.nz)

The following two lists of commonly available fruit and vegetables lists the amount of a food that gives either 10g (fruit) or 5 g (vegetables). Use these tables to determine how much of each you can eat. I suggest that you print them out and keep them handy as an easy reference.

The following quantities of fruit will give 10g of carbohydrate (raw weights):
75g/3ozs 100g/4oz Apples Apricots Blackcurrant Blackberries s Cranberries Blueberries Guavas Cherries Lemons Elderberries (peeled) Kiwi fruit Limes Kumquats Mulberries Loganberries Nectarine Mangoes Oranges Pears Papaya Pineapple (Pawpaw) Plums Peach Redcurrants Satsumas Strawberries Tangerines

150g/6oz 200g/8oz Coconut meat Gooseberries Avocados Rhubarb Grapefruit (white) Melon Raspberries

The following quantities of vegetables will provide 5g of carbohydrate (raw weights):

50g/2ozs 75g/3ozs Beetroot Leeks Carrots Squash Celeriac (winter) 100g/4oz Asparagus Aubergine Avocados Bean sprouts Cauliflower Chicory leaves

200g/8oz Broccoli Brussel sprouts Cabbage (all types) Celery Courgette (zucchini)

Chives Fennel bulb Flax seed Green beans Kale Kohlrabi Mangetout Mung beans (sprouted) Mushrooms Onions Peppers (sweet) Pumpkin Squash (summer) Tomato (fresh or canned) Turnip

Cucumber Endive Gherkins Gourd (calabash) Lettuce Marrow Mustard greens Okra Radishes Spirulina Spinach Spring greens Spring onions Squash (summer) Swiss chard Turnip greens Zucchini

Source USDA Nutrient Database for Standard Reference, Release 12.