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[IP] Fw: Florida Diabetes V2000 #34
This is how I have lost 36 pounds and decreased my insulin requirements from
130 unit per my pump
down to 40-50 units. My husband as a type II has lost 83 pounds and MDI
went from 48 of R and 100units
of NPH to NO R and 20 units of NPH!! Our Labs are perfect!!!
What works for some, may not work for others---Consult your MD
> Date: 17 Mar 2000 14:41:15 -0500 (EST)
> From: email @ redacted
> Subject: [florida_diabetes] Diabetes News: Low Carb Diet's (An Overview)
> NEWS a weekly e-newsletter for people with diabetes
> Copyrighted 1999, Diabetes Interview
> Low-Carbohydrate Diets
> Are They Right For People With Diabetes
> by Juliette Chen and Sharon Mulry
> "I'm not saying what's wrong. I'm not saying what's right," Joy Pape, RN,
> CDE, told her fellow diabetes educators at the 1999 American Association
> Diabetes Educators (AADE) annual meeting. "What I'm saying today is that
> we've got patients on these diets, and they're saying, 'I'm doing
> Pape was referring to a new trend of low-carbohydrate diets espoused by a
> growing number of people with diabetes.
> High-protein, low-carbohydrate diets came under attack at the annual
> American Dietetic Association (ADA) meeting in Atlanta in mid-October.
> Kathleen Zelman, a registered dietitian and ADA spokeswoman, called these
> diets a "nightmare." "Think of it on a global perspective-the world at
> large survives on grains," says Zelman. "If we didn't have carbohydrates,
> we would not be able to survive."
> Pape, however, urges health care providers to keep an open mind. At the
> AADE meeting, she told her audience that these "radical" diets are not
> going away, and that regardless of nurses' personal opinions, health care
> professionals cannot ignore this trend.
> Pape was intrigued when a physician in her hometown of Columbia, Missouri,
> recommended "Dr. Atkins' New Diet Revolution," a popular,
> high-protein diet-lifestyle plan. The physician told Pape, "It will make
> sense to you with your diabetes background."
> "It was the opposite of what I had been taught and what I had been
> teaching, but it started to make sense," says Pape. Once she read the
> she started to hear from many people who had achieved good results with
> diet. It started her thinking: "If we administer insulin based on
> carbohydrate intake, could eating fewer carbohydrates mean that we
> have to take so much insulin?" Although Pape came to accept that these
> diets might work for healthy people, she resisted the idea that they would
> work for people with diabetes. She was also disturbed at the lack of
> research. To find some answers to these questions, Pape set out on an
> 18-month cross-country trip to visit the authors of some of the most
> popular books on low-carbohydrate diets. She also talked to their patients
> and reviewed medical histories. Pape was shocked to find that some people
> with diabetes did well on these diets.
> What is a Low-Carbohydrate Diet?
> For her fact-finding trip, Pape whittled her choices down to the six most
> popular books advocating low-carbohydrate diets. Collectively, these books
> attempt to address the question of why Americans are getting fatter,
> despite a national obsession with low-fat diets during the last 10 to 15
> years. While there are differences among the books, they shared some basic
> * Eating right means balancing insulin and glucagon levels. Carbohydrates
> break down into sugar which stimulates insulin release. Protein stimulates
> the release of glucagon, a hormone which raises the level of blood glucose
> and counteracts with the actions of insulin (see sidebar on page 34).
> * Since protein stimulates glucagon action, if you do not eat enough
> protein, you will end up with too much insulin and not enough glucagon.
> * Eating the right kinds of fat does not make you fat.
> * There are hidden sugars everywhere-potatoes, carrots, bread--not just in
> sweet foods. The body makes sugar from many food sources.
> * Eating fewer carbohydrates is good for you because the body converts
> carbohydrates into fat.
> The authors of these books say our bodies do not need many carbohydrates
> for energy. Instead, it is insulin that makes us fat. If you have diabetes
> and you eat the mainstream diet, with its high proportion of complex
> carbohydrates, you will have to take more insulin and/or oral medications
> to manage your diabetes.
> These diets are controversial because their recommendations for
> carbohydrate intake is much lower, and for protein much higher, than the
> guidelines of the medical establishment.
> "Protein Power" by Michael R. Eades, MD, and Mary Dan Eades, MD (Bantam
> Books, 1997)
> Like the other five books reviewed here, "Protein Power" stresses the
> relationship between insulin and glucagon. A high-protein,
> diet helps maintain this balance.
> How does food influence the balance of insulin and glucagon?
> * Carbohydrates stimulate insulin but have no effect on glucagon.
> * Protein stimulates insulin and glucagon.
> * Fat does not affect either insulin or glucagon.
> * However, fat in combination with carbohydrates will stimulate insulin,
> but not glucagon.
> * In combination, protein and fat will stimulate both insulin and
> "Protein Power" advises prospective dieters to first determine their daily
> protein needs and then plan their meals around it. In the initial phase of
> the diet, only 30 gm. of carbohydrates or less are consumed daily. This
> stage of the diet is for people who are overweight by 20 percent or more,
> have hypertension, high cholesterol and triglycerides, low LDL, type 2
> diabetes or a combination of these.
> Additional guidelines include:
> * Choose healthy fats such as nut oils, olive oil and avocado.
> * Drink 8 glasses of water daily.
> * Don't let yourself get hungry; snacks are fine, just subtract the
> carbohydrate grams from the next meal.
> * Drinking a glass of wine or light beer daily is fine but remember to
> count the carbohydrates.
> * Take high-quality multi-vitamins and at least 90 gm. of potassium. Some
> people on these diets have experienced leg cramps if they did not take
> potassium because of the diuretic effects of decreasing insulin levels.
> Potassium is only needed for the first few weeks on the diet.
> * Artificial sweeteners and diet sodas are fine in moderation but the
> authors recommend temporarily cutting out all sugars and starches,
> including potatoes, beans and corn.
> * Pick low-carbohydrate fruits such as berries, melon and peaches.
> * When in doubt, choose lean meats, fish, fowl and salad.
> * Exercise, such as resistance training or anything that makes you sweat,
> is recommended.
> The authors make no attempt to forbid certain foods, feeling people will
> more likely to remain on the diet if they are allowed to eat foods, in
> moderation, that they like.
> Although Pape did not meet the authors of "Protein Power" when she visited
> the Colorado Center for Metabolic Medicine in Boulder, she met Ron
> Rosedale, MD, who specializes in caring for people with diabetes.
> One of Rosedale's patients left a strong impression on Pape: a type 2
> patient who had extremely high triglycerides levels of 7,000, and who had
> been hospitalized numerous times for pancreatitis.
> "No matter what she did, nothing improved," says Pape, "until her doctor
> gave her 'Protein Power.'"
> After being on the plan, the patient's triglycerides levels dropped to
> In the course of her visit, Pape also came across cases of other
> insulin-dependent type 2s who were able to stop using insulin after
> subscribing to the "Protein Power" plan.
> "The Schwarzbein Principle" by Diana Schwarzbein, MD et. al. (Health
> Communications, 1999)
> An endocrinologist in Santa Barbara, California, Schwarzbein was
> with conventional care for type 2 diabetes. She had been taught that
> insulin levels, hypertension, obesity, diabetes and heart disease were all
> genetic. She knew that an excess of carbohydrates increases blood sugars
> which in turn increase insulin levels.
> There was, however, a surprise in store for her when she taught her
> patients the conventional high-carbohydrate, low-fat diet. Schwarzbein
> discovered that those patients who confessed to cheating on their diets by
> eating steak, eggs, cheese or mayonnaise were the ones who showed
> This led her to think that perhaps insulin resistance was related to the
> aging process and to degenerative diseases. She does not rule out
> but is saying that degenerative diseases can also be acquired and that
> eating and lifestyle habits can cause these diseases. Because the
> systems of the body are interconnected, when one part is out of sync it
> cause a chain reaction of other imbalances.
> "Schwarzbein says a genetic predisposition to disease is not a guarantee
> that you will develop that disease," says Pape. "Instead, what you do and
> how you live your life determines your risk for developing insulin
> resistance and the degenerative diseases of aging."
> It is very deflating when people are told that their poor health is
> inherited-they may become resigned, depressed, lethargic and gain weight.
> Instead, Schwarzbein empowers her patients, telling them that type 2
> diabetes is not their fate. As Pape describes it, "teaching people that
> health and vitality are within their grasp and showing them how to achieve
> optimum health is the key. When people understand that they have control
> over their health, they are motivated to make significant changes in
> Schwarzbein's dietary program focuses on reducing carbohydrate intake, and
> on the use of fat and protein to reduce insulin resistance. Like the other
> authors mentioned here, Schwarzbein also speaks of the balance between
> insulin and glucagon. Think of insulin as a fat-storing hormone, she
> explains, whereas glucagon is a fat-mobilizing hormone.
> During the initial stages of Schwarzbein's diet, the low carbohydrate
> intake allows the body to store sugars and replace insulin receptors,
> heralding the start of the reversal of insulin resistance.
> The nutritional maintenance program is the second stage, and is designed
> prevent a relapse of old problems. It is intended for healthy adults and
> children, and its aims are to promote good health and delay insulin
> The only difference between the two programs is that on the maintenance
> diet the carbohydrate intake is not less than metabolic levels.
> is not an advocate for ketosis; she wants to make sure you are not
> Schwarzbein says the USDA food pyramid implies a hierarchy of food.
> Instead, she advocates the Schwarzbein square which contains 4 basic
> nutrient groups: proteins, fats, non-starchy vegetables and carbohydrates.
> Every meal should contain elements from all four groups. Stay away from
> processed foods, however, because Schwarzbein believes such foods can make
> people sick. Ideally, we should all eat "real" foods that we can "pick,
> gather, milk, hunt or fish."
> For people with type 2 diabetes, Schwarzbein recommends limiting
> carbohydrates to 15 gm. for each meal and two 7.5-gm. carbohydrate snacks
> daily. Each meal should also contain non-starchy vegetables, fat and
> While in Santa Barbara, Pape had met some type 2 patients on Schwarzbein's
> diet who were able to discontinue their medications and who were achieving
> HbA1cs around 5.8%.
> Schwarzbein advocates good lifestyle habits as well: exercise, stress
> management, the elimination of stimulants and other drugs, and hormone
> therapy replacement for women.
> "Dr. Atkins' New Diet Revolution" by Robert C. Atkins, MD (Avon Books,
> With his original book, "Dr. Atkins' Diet Revolution," Atkins was
> low carbohydrates 20 years ago in the face of heavy criticism from the
> medical establishment. In this newer version, Atkins blames obesity on
> hyperinsulinemia, or too much insulin in the blood. Since the body
> carbohydrates into fat, a low-fat diet is meaningless as long as
> carbohydrate intake remains high. Atkins calls insulin "the fat-producing
> hormone," and claims that the consumption of fewer carbohydrates reduces
> fat deposits and results in fewer food cravings.
> Atkins says overweight people have an eating disorder and a 50 percent
> chance of developing insulin resistance and hyperinsulinemia, which are
> first signs of glucose disorder. Hyperglycemia, pre-diabetes and type 2
> stages of the same disease, he says. Insulin and glucose disorders
> accelerate the growth of atherosclerosis-the harmful buildup of fat in the
> arteries. Stop the insulin-based chain of events, Atkins reasons, and you
> can extend your life and protect your heart.
> There are four phases to the Atkins diet:
> * The Induction Diet usually lasts 2 weeks. At this stage Atkins wants to
> create a state of ketosis or lipolysis (also known as benign dietary
> ketosis) to burn fat. He starts with 20 gm. of carbohydrates a day,
> accompanied by pure protein, pure fats and supplements.
> * The Ongoing Weight Loss Maintenance Diet. This stage is more
> individualized. Once the critical carbohydrate level is decided, a maximum
> carbohydrate level that will still allow for weight loss is maintained. It
> consists of 50 to 60 gm. of carbohydrates a day, with the emphasis on
> low-carbohydrate fruits, nuts and other foods that allow ketosis.
> * The Pre-Maintenance Diet. At this level, carbohydrate intake is
> until weight loss is less than a pound a week.
> * The Maintenance Diet. This phase is very individualized. By this stage,
> those on the diet should ask themselves: at which level of carbohydrates
> I feel best? Carbohydrate intake should be in the range of 25 to 90 gm.
> Atkins claims 50 percent of people on insulin can get off it and 98
> of those on oral medicines can be weaned from them. After looking at the
> charts of Atkins' patients, Pape concedes, "I saw improvements in lipid
> profiles and glucose levels."
> "Dr. Bernstein's Diabetes Solution" by Richard K. Bernstein, MD (Little
> Brown & Company, 1997)
> A type 1 for over 50 years, Richard Bernstein, MD, FACE, FACP, CWS, of the
> Diabetes Center in Mamaroneck, New York, worked as an engineer for most of
> his adult life. When he started getting diabetic complications, a
> low-carbohydrate diet and resistance training exercise helped normalize
> blood sugars and reversed his emerging kidney disease. He wanted to spread
> the word to other people with diabetes, but thought that no one would take
> medical advice from an engineer. At age 45, he went to medical school and
> is now a practicing endocrinologist.
> According to Bernstein, "High blood sugar levels and the high levels of
> insulin...cause the complications associated with diabetes. Only through
> eating a low-carbohydrate diet can blood sugars become truly normal."
> Bernstein speaks of the "laws of small numbers." He gives an example: two
> cars on a deserted highway will not have much chance of colliding but if
> you add more cars, you lose your predictability. This is the principle he
> uses for carbohydrate intake, insulin administration and timing. He
> recommends a very low-carbohydrate diet and when he treats with insulin,
> uses very small doses.
> He recommends eating small amounts of slow-acting carbohydrates. Even the
> slowest-acting carbohydrates, however, can outpace one's injected or own
> insulin if eaten in greater amounts than are needed.
> Bernstein haggles with his patients over the amount of carbohydrates they
> should consume. Pape observes wryly, "If you see how small the amounts
> you can see why he needs to negotiate with his patients."
> According to Bernstein, protein does have an effect on blood sugars.
> Therefore, he includes protein in his plan when he teaches carbohydrate
> counting. His book gives meticulous instructions on how to give precise
> amounts of insulin to keep blood sugars normal 24 hours a day.
> He recommends 6 gm. of carbohydrates for breakfast, 12 gm. for lunch and
> gm. for dinner. He says protein should be added to satisfy. He also urges
> people who do not eat dairy products to take 1 gm. of calcium citrate for
> every 10 gm. of protein to prevent bone loss. In a higher-protein diet,
> phosphorus binds with calcium and the ingestion of calcium citrate would
> prevent that. In a high-fiber diet, too, the fibers can also bind with
> While visiting Bernstein at his office, Pape observed his exceptional
> diabetes control.
> "When he took his blood sugars he would show me the meter, and it would be
> in the 80s or 90s," she reports. Pape says Bernstein works very closely
> with all of his patients. Most of them were spilling protein when they
> first came to him, but stopped once they were regulated. "One man came in
> to see Dr. Bernstein with peripheral neuropathy. He had no feeling in his
> feet. He came back two weeks later, and told Dr. Bernstein that he was so
> glad to feel the temperature of the tiles he was walking on again."
> "Sugar Busters" by H. Leighton Steward, Morrison C. Bethea, MD, Sam S.
> Adams, MD, and Luis A. Balart, MD (Ballantine Books, 1998)
> "Sugar is toxic," these authors say. As those in the diabetes world know,
> sugar does not just mean candy bars. It means potatoes, carrots and
> all of which mean more insulin. Using probably the simplest explanations,
> this book advocates a low-sugar diet to produce normal weight, cholesterol
> levels and blood sugars.
> "Sugar Busters" prescribes a 40-30-30 diet designed to reduce insulin
> secretion and enhance glucagon secretion:
> * 40 percent carbohydrates;
> * 30 percent protein;
> * 30 percent fat (10 percent saturated and 20 percent polyunsaturated
> Additional suggestions include:
> * Pick complex, high-fiber carbohydrates that are low on the glycemic
> index, meaning they do not raise blood sugars as much as refined sugars.
> * In general, avoid refined foods.
> * No need to count calories, sugar or protein grams.
> * Pick lean meats and unsaturated fats.
> * Eat moderately and do not fill up your plate or go for seconds.
> * Low glycemic fruits make good snacks.
> * Finish dinner by 8 p.m.
> Samuel S. Adams, MD, one of the authors and an endocrinologist in New
> Orleans, says the diet is very easy to follow, and his diabetic patients
> have done well on it. A physician whom Pape knew concurs; whenever he had
> patient who might not understand the other programs, he would give them
> "Sugar Busters" and they would have no problem understanding and following
> "Enter The Zone" by Barry Sears, PhD (HarperCollins, 1995)
> The zone here is a tight range of safe insulin levels. To enter this safe
> zone, you must have that proper balance of insulin and glucagon, which can
> be achieved by Sear's recommended amounts of protein and carbohydrates at
> every meal.
> Sears says, "The food you eat is probably the most powerful drug you will
> ever encounter. Learn to administer the food at the right time and dosage
> to keep insulin in a tight zone--not too high and not too low."
> The Anti-Aging/Zone pyramid prescribes lots of water, vegetables, fruits,
> low-fat protein and monounsaturated fats, as well as moderate exercise and
> meditation. Carbohydrates such as bread, pasta and grains should be used
> sparingly; Sears recommends using them as condiments, rather than as a
> part of the meal.
> Sears uses a ratio of 9 gm. of carbohydrates to 7 gm. of protein to 1.5
> of fat. Pape prefers this method: you can have the same amount of protein
> as the size and thickness of your palm. If they are favorable
> carbohydrates, have twice as much as that (along with vegetables and
> fruits). If they are unfavorable carbohydrates, have only half that
> Sears said his book was never intended for the general reading public, and
> he was surprised at the book's commercial success. On the heels of
> however, came criticism that the book was difficult to understand. Sears
> has since come up with other books to explain his diet to the lay public.
> Sears claims that the Zone diet is not a high-protein diet, but a
> protein-adequate diet. Not all proteins are the same, he says, and low-fat
> ones are preferable.
> There are no essential carbohydrates, the way there are essential fatty
> acids and amino acids. The body can make carbohydrates from protein and
> fat. You can eat unfavorable carbohydrates but only in moderation. Use
> monounsaturated fats. Fats play a critical role in providing building
> blocks for essential fatty acids for the production of the most important
> hormones in the body-eicosanoids, which are a group of 100 or so powerful
> substances that control almost all physiological actions in the body. If
> these eicosanoids are not in balance, serious health problems such as
> disease and cancer may result. The right diet can help keep eicosanoids in
> There are four basic Zone rules:
> * Eat small meals;
> * Always have some protein at every meal;
> * Always have fruits and vegetables;
> * Take cod liver oil. The EPA (eicosapentaenoic acid; an omega-3 fatty
> acid) in cod liver oil keeps insulin under control by working on
> The Zone diet is designed to keep all three hormonal systems-insulin,
> glucagon and eicosanoids-working smoothly by treating food with the same
> respect as that given to prescription drugs. According to Sears, a
> hormonally correct diet will lead to a loss of excess body fat, increased
> energy and well-being, and reduced fasting insulin and glycosylated
> hemoglobin levels.
> The very low levels of carbohydrates recommended by Atkins (20 gm. daily)
> and Bernstein (24 gm. daily) prompt concerns about ketoacidosis, a
> potentially dangerous condition whereby the body starts using stored fat
> for energy, and ketone bodies build up in the blood. There are definitely
> two schools of thought on ketosis: some, like Atkins, want energy to come
> from ketones, or the fat-burning system. Atkins says you can avoid
> ketoacidosis if you watch your blood sugars.
> Critics are also uncomfortable with the higher levels of proteins that
> these diets promote. Kidney disease is a looming threat in the diabetes
> world. Doubts about these diets include suspicions that high protein
> causes kidney disease. However, these suspicions have not been proven in
> studies. They should also use soy protein or egg whites instead of other
> kinds of protein. Bernstein is working with a leading nephrologist on his
> diet, operating on the premise that if high glucose levels can be reduced,
> it would improve kidney function.
> The diets have also been hampered by the lack of research, although that
> beginning to be remedied. Other common complaints are that the diets are
> hard to follow, too radical, too time-consuming and expensive. Also, there
> are worries that their higher fat content will cause heart disease and
> Calories, Not Carbohydrates
> Marion Franz, MS, RD, CDE, is a critic of low-carbohydrate plans. She says
> that insulin is not to blame for insulin resistance. "It's the other way
> around," says Franz. "Obesity makes you insulin-resistant. People are
> not because they eat too many carbohydrates, but because they eat too many
> Franz says that low-carbohydrate plans do not have any scientific backing,
> that only personal testimonials support these diets. Following them
> long-term is a problem, because some healthy foods are missing, like
> and whole grains.
> It is not what you eat but how much you eat that matters, according to
> Franz, who points to vegetarians as an example. Recent studies have shown
> that vegetarians with diabetes have excellent control, and they eat lots
> Dean Edell, MD, who has a syndicated TV and radio medical advice column,
> agrees with Franz. "Almost all dietitians say that high-protein diets are
> not the best way to lose weight," he said on a radio news show recently.
> Pape looks to established research to prove the efficacy of
> low-carbohydrate programs, predicting that such studies will come out
> For Pape, the low-carbohydrate approach is more than just a diet, but a
> lifestyle plan. "They're whole programs," she says. "They talk lifestyle,
> exercise, and stress reduction."
> Most importantly, regardless of the lack of scientific data supporting
> these diets, people with diabetes are choosing these diets, warns Pape.
> we rule them out? Do we say 'No, you cannot do this?'" she asks. "Or, if
> works for some people, are we going to look at it?"
> What's a Doctor or Diabetes Educator to Do?
> "A physician needs to be open and informed," says Pape. "A lot of people
> will need a change in medication in the first few days or weeks. Check lab
> values at the start, and at four- or eight-week intervals."
> Insulin, Glucophage, Avandia, Actos and Rezulin will work with these
> programs, but avoid sulfonylureas, Pape says, because these can increase
> insulin levels and can cause beta cell burnout.
> At the AADE meeting Pape also advised her fellow diabetes educators to be
> well-informed about these diets and encourage patients to, above all,
> blood sugars frequently. If necessary, tailor diets to individual needs.
> "When you have a physician who has ordered a patient to come to us with
> these diets, do you call the doctor and say, 'You can't do that?'" she
> asks. "More and more patients are adopting these diets, whether those in
> the healthcare industry like it or not. Don't be afraid to give people a
> * * * * * * * * * *
> Moderators Note:
> The comments and reviews exo=pressed within this article are those
> of the authors. As with any medical advise, you should consult with a
> health care professional before making any adjustments, or modifications
> of your diabetes regiment
> End of Florida Diabetes V2000 #34
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