Low-carbohydrate diet outperforms a low-glycemic index diet

The last few studies I’ve posted on here seem to have been designed by their authors to show that low-carb diets aren’t all they’re cracked up to be. Of course none of these studies have used real low-carb diets – they’ve all used diets that are called low-carb, but really aren’t. They’ve set up a low-carb straw man, knocked it down, then crowed about it. These antics have left us all longing to see a study using a real low-carb diet.

Fate has dropped two studies into our hands that clearly demonstrate the superiority of low-carbs diets when matched against the high-fiber, high-cereal diet beloved of so many in the nutritional establishment and even against low glycemic index (Low-GI) diets.

In the same couple of week period two studies came out – one you’ve probably read about; the other you likely haven’t. By combining the data from these studies, we can see how these three diets match up.

The first study was published in the Dec 17 edition of the Journal of the American Medical Association (JAMA) and was a comparison of the high-cereal, high-GI diet to the low-GI diet. You can get an overview of the study by reading the JAMA press release:

IN PATIENTS WITH DIABETES, LOW-GLYCEMIC DIET SHOWS GREATER IMPROVEMENT IN GLYCEMIC CONTROL THAN HIGH-FIBER DIET

CHICAGO—Persons with type 2 diabetes who had a diet high in low-glycemic foods such as nuts, beans and lentils had greater improvement in glycemic control and risk factors for coronary heart disease than persons on a diet with an emphasis on high-cereal fiber, according to a study in the December 17 issue of JAMA.

One dietary strategy aimed at improving both diabetes control and cardiovascular risk factors is the use of low-glycemic index diets, but there is disagreement over their effectiveness, according to background information in the article.

David J. A. Jenkins, M.D., of St. Michael’s Hospital and the University of Toronto, and colleagues assessed the effects of a low-glycemic index diet vs. a high-cereal fiber diet on glycemic control and cardiovascular risk factors for 210 patients with type 2 diabetes. The participants, who were treated with antihyperglycemic medications, were randomly assigned to receive 1 of the 2 diet treatments for 6 months.

In the low-glycemic index diet, the following foods were emphasized: beans, peas, lentils, nuts, pasta, rice boiled briefly and low-glycemic index breads (including pumpernickel, rye pita, and quinoa and flaxseed) and breakfast cereals (including large flake oatmeal and oat bran). In the high-cereal fiber diet, participants were advised to take the “brown” option (whole grain breads; whole grain breakfast cereals; brown rice; potatoes with skins; and whole wheat bread, crackers, and breakfast cereals). Three servings of fruit and five servings of vegetables were encouraged on both treatments.

The researchers found that hemoglobin A1c (HbA1c; a substance of red blood cells tested to measure the blood glucose level) decreased by -0.50 percent absolute HbA1c units in the low-glycemic index diet compared with -0.18 percent absolute HbA1c units in the high-cereal fiber diet. Significant treatment effects were observed for high-density lipoprotein cholesterol (HDL-C) and the low-density lipoprotein cholesterol (LDL-C):HDL-C ratio. HDL-C increased in the low-glycemic index diet group by 1.7 mg/dL and decreased by -0.2 mg/dL in the high-cereal fiber diet group. The LDL-C:HDL-C ratio showed a greater reduction in the low-glycemic index diet group compared with the high-cereal fiber diet group.

“Lowering the glycemic index of the diet improved glycemic control and risk factors for coronary heart disease (CHD). These data have important implications for the treatment of diabetes where the goal has been tight glycemic control to avoid complications. The reduction in HbA1c was modest, but we think it has clinical relevance,” the authors write. “Low-glycemic index diets may be useful as part of the strategy to improve glycemic control in patients with type 2 diabetes taking antihyperglycemic medications.”

“Pharmacological interventions to improve glycemic control in type 2 diabetes have often failed to show a significant reduction in cardiovascular events. In view of the 2- to 4-fold increase in CHD risk in participants with type 2 diabetes, the ability of a low-glycemic index diet to address both glycemic control and CHD risk factors increases the clinical relevance of this approach for patients with type 2 diabetes, such as those in this study, who are overweight and also taking statins for CHD risk reduction.”

The gist of this study is that diabetic subjects on the low-GI diet improved minimally as compared to those on the high fiber, high-GI diet.  As I’ve written in this blog and lectured on numerous times, I’m not a big believer in the virtues of the glycemic index.  As this JAMA study demonstrates, subjects switching to lower-GI carbs while keeping their overall carb intake the same gain slight improvement, but not enough, in my estimation, to make the change worthwhile.  In my opinion it is the overall carb intake that counts more, not simply switching to lower-GI carbs.

At about the same time the JAMA paper came out, a study performed at Duke University comparing a low-GI diet to a real low-carb diet appeared in the online journal Nutrition & Metabolism. Here is the Duke press release about that study:

LOW CARB DIETS PROVE BETTER AT CONTROLLING TYPE 2 DIABETES

Which works better at controlling type 2 diabetes: a diet low in carbohydrates or one that focuses on carbohydrates with a low glycemic index? That’s what Duke University Medical Center researchers sought to uncover when they compared the two over a six-month period.

Their findings, published online in Nutrition and Metabolism, indicate that a diet low in carbs with the lowest possible rating on the glycemic index scale leads to greater improvement in blood sugar control, according to lead author Eric Westman, MD, director of Duke’s Lifestyle Medicine Program. And, patients who followed the diet experienced more frequent reductions, and in some cases elimination, of their medication used to control type 2 diabetes.

“Low glycemic diets are good, but our work shows a no-glycemic diet is even better at improving blood sugar control,” he says. “We found you can get a three-fold improvement in type 2 diabetes as evidenced by a standard test of the amount of sugar in the blood. That’s an important distinction because as a physician who is faced with the choice of drugs or diet, I want a strong diet that’s shown to improve type 2 diabetes and minimize medication use.”

Eight-four volunteers with obesity and type 2 diabetes that were randomized to either a low carbohydrate ketogenic diet (less than 20 grams of carbs/day) or a low-glycemic, reduced calorie diet (500 calories/day). Both groups attended group meetings, had nutritional supplementation and an exercise regimen.

After 24 weeks, their glycemic control was determined by a blood test that measured hemoglobin A1C, a standard test used to determine blood sugar control in patients with diabetes. Of those who completed the study, the volunteers in the low-carb diet group had greater improvements in hemoglobin A1C and diabetes medications were reduced or eliminated in 95 percent of the volunteers, compared to 62 percent in the low-glycemic group. The low carb diet also resulted in a greater reduction in weight

“It’s simple,” says Westman. “If you cut out the carbs, your blood sugar goes down, and you lose weight which lowers your blood sugar even further. It’s a one-two punch.”

While the diet is easy for some to follow, it is not easy for everybody. “This is a therapeutic diet for people who are sick,” says Westman. “These lifestyle approaches all have an intensive behavioral component.  In our program, people come in every two weeks to get reinforcements and reminders. We’ve treated hundreds of patients this way now at Duke and what we see clinically and in our research shows that it works.”

The gist of this study is that those diabetic subjects following an honest-to-God low-carb diet achieved dramatic improvement as compared to those who simply switched to a low-GI diet, but kept their carb intake high.

Now, as you might expect, knowing as we all do the propensity for the mainstream media to ignore studies showing the superiority of the low-carb diet while glorifying carbs, the New York Times picked up on the JAMA press release, but ignored the Duke press release.  If you read the gushing Times article, it makes it sound like the low-GI diet absolutely stomped the high-GI diet. The truth is a little different, however, because the differences between them were minimal.

I went to the trouble of pulling the data from both studies and putting it in spreadsheet form so that it could be compared side by side. Then I decided to go to a little more trouble and display it graphically so that the differences could be seen much better.  What follows is a series of graphs comparing the high-GI diet on the left to the two low-GI diet groups in the middle (JAMA low-GI study on the left and the Nutrition & Metabolism low-GI diet study on the right) and to the low-carb diet on the right. The light-colored bar represents the value at the beginning of the study for the parameter under question and the darker-colored bar represents the changes after 6 months on the various diets.

First, let’s look at the amount of weight lost by the subjects over 6 months on the various diets.

As you can see, the subjects on the low-carb diet lost the most weight despite the fact that they were not counting calories, only carbs.  This is especially impressive when you consider that all the groups except for the low-carb group were encouraged to count calories and reduce food intake.  The low-carb group was instructed to restrict carbs to below 20 gm per day but to otherwise eat all they wanted.

Let’s look next at HgbA1c, a measure of blood sugar control.  The lower the HgbA1c, the lower the blood sugar.  Since all the subjects in both these studies were diabetic, all started with high HgbA1c levels.

The low-carb diet brought about a much greater lowering of HgbA1c than did either the high-fiber, high-GI diet or the low-GI diet, both of which are routinely recommended for people with diabetes.  Makes you wonder, doesn’t it?

Next, let’s consider total cholesterol.  It’s a pretty much meaningless number, but it was included in the data, so I’ll include it here.

In these studies the low-GI diet held its own with the low-carb diet in terms of total cholesterol lowering.  But since total cholesterol is only a lab parameter and doesn’t really have a lot to do with health, it really doesn’t matter.  What does matter, if anything does, is what that total cholesterol is made of.  Is it made of LDL-cholesterol, the so-called ‘bad’ cholesterol or is it made of HDL-cholesterol, ‘good’ cholesterol?  Let’s look.

Both the low-GI diets lower LDL cholesterol better than does the low-carb diet.   But it doesn’t beat it by all that much.  The data from these studies don’t show how much of the LDL-cholesterol is small particle size and how much is large particle size.   As readers of this blog know, small, dense LDL-cholesterol particles are associated with increased risk for heart disease, whereas large, fluffly LDL-cholesterol is protective.   Particle size wasn’t measured in these studies but other parameters were that are stand-ins or markers for particle size.   It’s well known that when triglycerides go down, LDL-cholesterol particle size goes up.  We’ll look at triglycerides shortly to see what happened with them, but before we do, let’s take a look at HDL-cholesterol.

We can certainly see where some of the gain in total cholesterol came from in the low-carb group.   It came because they increased their HDL-cholesterol so much.   The other groups either held steady or went up minimally whereas the low-carb group showed a huge increase in HDL-cholesterol, which also correlates with larger LDL-cholesterol particle size.

What about triglycerides?   Most readers of this blog can predict what happened there.  Let’s look.

As we would expect, there was a significant reduction in triglyceride levels in the low-carb group as compared to the others.   This lowering of triglyceride levels is important for a couple of reasons.   First, lower triglycerides correlates with greater insulin sensitivity.   And, second, it correlates with larger LDL-cholesterol particle size.   So, the slight increase in LDL-cholesterol we saw with the low-carb diet in a previous graph probably comes from an increased amount of large, fluffy LDL-cholesterol particles.

If we look at the important triglyceride/HDL ratio we see some major improvement in the low-carb group.

As expected, we find a humongous lowering of the triglyceride/HDL ratio with the low-carb diet.  The lower this ratio, the better, so the low-carb diet has brought about major improvement compared to the others.

Looking at the two other measurements both studies included, we find that blood pressure improved more on the low-carb diet than on the others.   First, we’ll look at systolic pressure, which is the first or top number in the blood pressure reading.   If your blood pressure is 120/75, the 120 is the systolic pressure.

Once again the low-carb diet brings about great results.  If we look at the more important diastolic measurement, we find even better news.

Yet again the low-carb diet emerges the champion.

These graphs should give you an idea of how much more potent the low-carb diet is as a tool to deal with diabetes than are low-calorie, high-fiber, high-GI diets and low-calorie, low-GI diets, both of which are the mainstays of mainstream diabetic diet therapy.

Remember, all of these studies were done on diabetic patients and all were conducted over a 6 month period, so were are comparing apples with apples here.  Based on the data shown in these graphs, the low-carb diet emerged the champion by a long shot. If these graphs told the whole story, the low-carb diet would be the hero.  But the graphs don’t tell the whole story.  Why not?  Because large numbers of subjects in all these study groups were on oral anti-diabetic medicines and/or insulin.  What happened to medication doses as these subjects progressed through the 6 month study.

The JAMA paper tells us the following about the subjects in the high-fiber, high-GI and the low-GI diets:

…of the 11 participants who reduced their diabetes medications, all 6 who had clear evidence of hypoglycemic symptoms or low blood glucose levels were taking low–glycemic index diets.

So, 11 study subjects were able to reduce their medications during the study.  This doesn’t seem like a lot when you consider that out of 210 study participants 208 were on diabetic medications at the start.  Virtually all were on antidiabetic meds of one kind or another and 11 of them were able to reduce these medicines.  Eleven out of 208 means that 5 percent of the subjects on these two diets reduced their diabetic drugs.

If we look at the low-carb study, we find a much greater rate of success:

Twenty of 21 (95.2%) LCKD [low-carb diet] group participants had an elimination or reduction in medication, compared with 18 of 29 (62.1%) LGID [low-GI diet] group participants.

To really get a feel for what happened with these subjects, let’s look at a table from the study showing insulin and medication reductions in those subjects who were on insulin therapy before starting the study.

A quick study of this table shows us that 3 subjects out of 29 taking insulin in the low-GI group reduced or discontinued insulin whereas 8 out of 21 reduced or eliminated insulin in the low-carb group.

I would say that given the substantial improvements in virtually all the parameters demonstrated by the graphs combined with the enormous difference in improvement in those taking medications, the low-carb diet didn’t just perform as a star, it was a super star.

It’s saddens me to think about how many doctors don’t know or understand these data and will continue to treat their patients in a much less effective manner, no doubt leading to more complications, greater medication usage and shorter lives.  It really is a shame.

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64 thoughts on “Low-carbohydrate diet outperforms a low-glycemic index diet

  1. Another Swedish progress report: 😉

    “Now, as you might expect, knowing as we all do the propensity for the mainstream media to ignore studies showing the superiority of the low-carb diet while glorifying carbs, the New York Times picked up on the JAMA press release, but ignored the Duke press release. ”

    After roughly a year of heavy debate in the medical press, broadsheets, TV and on blogs here in Sweden, low-carb/high-fat has broken out in the popular press as a “trendy” method of losing weight.

    Two blogs have been especially valuable in the debate:

    First, Annika Dahlqvist’s blog: http://blogg.passagen.se/dahlqvistannika/

    Annika Dahlqvist worked as a physician at a local health center, and prescribed a LCHF diet to her diabetes patients. She was forced to quit doing that by management two years ago, however, and she chose to leave her job. She was also reported to the Swedish National Board of Health and Welfare by two dietitians (surprise!).

    Her acquittal by the board early this year served as the starting point for the large Swedish LCHF debate of 2008. The National Board of Health and Welfare found that prescribing an LCHF diet for diabetes patients was “in accordance with science and good practice” (rough translation -“i överensstämmelse med vetenskap och beprövad erfarenhet.”)

    Second, Kostdoktorn (“The nutrition doctor”), run by GP Andreas Eenfeldt has been hugely valuable. (http://www.kostdoktorn.se/) He started up the blog last December to discuss HFLC issues, and has clocked roughly 700 000 visits and 13 000 comments since. He is a good writer and frequent poster. (He occasionally links to your site, natch!)

    Finally, TV 4 (channel 4) here in Sweden stepped up to the plate with a four-episode investigative reporting series on the “Fat Wars”, which was rather embarrassing to the low-fatters.

    http://www.tv4.se/1.586500/kalla_fakta?episodeId=1.700640

    So, on this side of the pond, the nutritional establishment is in full retreat. It seems as if the road away from high-carbing leads through “Mediterranean diets” (this is where the establishment has retreated to).

    Now we just need to flip the US too, but it seems as if you, Taubes, et al. are doing a good job 😉

    Thanks for the progress report. It’s enlightening. I think you are correct that the road away from high carb leads through the Mediterranean diet. It’s much easier for these folks to admit they’re wrong in tiny increments instead of going whole hog right off the bat.

  2. “A quick study of this table shows us that 4 subjects out of 21 taking insulin in the low-GI group reduced or discontinued insulin”

    From the table it looks like 3 out of 21 subjects?

    Thanks. Fixed it.

  3. I wonder why the mainstream has not yet latched onto the Duke study? I mean (and being very jaded here), it would seem that *this story* is actually the “big seller”. I can’t help but to think that the media is reluctant to report such findings to a general public who see’s “the Paleo way” as being too far-fetched, too — I don’t know — UFO-ish for their pragmatic sensibilities. This general public (and the so-called “informed” public)love affair with the “healthfulness” of carbohydrates really is a tough nut to crack.

    Thanks, btw, for bringing this study to light.

    You would think this would be a real man-bites-dog type of story that the media love, but, sadly, when low-carb looks good, the media look the other way. The idea that carbs are ‘healthful’ us doubtless one of the toughest nuts to crack. Makes me wonder often why it is that I keep on trying.

  4. Nice comparison Doc. Raises some questions, though. Why were the initial cholesterol and BP readings so different between the two studies?

    I am also surprised Triglycerides didn’t decrease more on the LCKD. At 20 g/d of carbs, I would have expected a number much lower than 140 or so. Cheating?

    I think the patients in the Duke study were a little sicker to begin with than those in the JAMA study. And when you randomize subjects into two groups, it’s difficult to get exact matches so that all the parameters line up perfectly.

    As for the triglyceride decrease, you’ve got to remember that these studies were done for six months. The people on these diets were free living and probably weren’t sticking to their specific diet – especially the low-carb diet -as well as they would were they really devotees of the program. It does show, however, that even a half-hearted lowering of carbs produces better results than a half-hearted low-GI diet.

  5. And to think, I thought you were just eating pecan pie and drinking coke over the holidays.

    Brian

    No pecan pie and coke, but two tiny pieces of mince meat pie and a fair amount of Jameson. Not together, though. 🙂

    Cheers

  6. Dr. Mike,

    Great program and blog. I decided to get serious about cutting the carbs and picked up PPLP and Slow Burn last month. Tough month to make it happen, but I have been doing my best and will get cranking after the new year.

    Typographical note — Dr. Westman’s reduced calorie diet hopefully was more like 1,500 kcal/day vice 500.

    I copied the press release exactly as it was written. If there is a typo, it is Duke’s. Based on the paper, what they mean is a 500 kcal reduction per day, not a 500 kcal/day low-calorie diet.

  7. Hi Dr. Eades,

    Articles and data like you present here are the reason why I’m starting medical school next fall. The impact on people’s lives that a low-carb diet provides is absolutely enormous, but the veil of conventional dogma it too heavy and opaque for most to see the truth.

    I was able to visit with family back home over the holidays and was witness to how many had put on 10, 15, 20 lbs in the last 6 months. I had to swallow hard. Every house we visited had multiple trays of fudge, chocolate clusters, cookies, cakes, pies, sweet potatoes, white breads…you name it. If it was a carb, they had it. It was like being in some twisted carb twilight zone. I’ve just about given up with family members. It’s tantamount to preaching about religion as I’m sure you know.

    Hope your holidays were enjoyable and restful and thanks again for all of your work.

    NJ

    I wish I had your opportunity to go to medical school again knowing what I now know about carbs. At the time I went, I didn’t know much about nutrition at all. Nor did I want to. All I wanted to do was operate on people. I loved it. Still sort of do, but don’t have the opportunity any longer. If someone had told me when I was in med school that I was going to turn out to be a nutritional guru, I would have looked at them as if they had two heads. Nothing could have been further from my plans then. Interesting how life works out sometimes.

  8. Absolutely fantastic post.

    No doubt, parsing the data and preparing the graphs took a lot of time — but the result is incredibly powerful.

    Thanks again for your efforts.

    Glad you enjoyed it.

  9. TOP 10 HEALTHIEST DIETS IN AMERICA:

    http://www.cnn.com/2008/HEALTH/12/29/healthiest.diets/index.html

    Yes, Dr. Ornish’s newest diet makes the cut. Very Sad.

    This is what you get when you “assemble a panel of experts.” And you are CNN. Speaking of CNN, a couple of days ago I saw an unspeakably idiotic quote from Ted Turner. Said he:

    “Not doing it [fighting global warming] will be catastrophic. We’ll be eight degrees hotter in ten, not ten but 30 or 40 years, and basically none of the crops will grow. Most of the people will have died and the rest of us will be cannibals.”

    How’s that for sheer breathtaking idiocy? It’s got to be a real quote (it was – he said it on the Charlie Rose show while promoting his autobiography) because no one could make something like this up.

  10. Tjena Huppla!

    I’m glad these life style recommendation is taking off in Sweden! I started to follow Protein Power in 1999, when I was still living in Sweden (I’m actually very attached to that country). I had to endure my friends’ criticism about my nutritional choices… sometimes criticism became ridiculous attacks but when they started to see the results (not just weight; cholesterol was my real problem), they tuned it down and started to ask more questions about the food I was eating. When I left Sweden in 2003, many of my friends enjoyed my ‘alternative’ desserts made ‘low-carb’ better than the ‘real thing’ and one of them actually adopted a low-carb lifestyle with the expected stellar results… she still follows it to this date.

    I have to admit that, even when I didn’t have much support from friends (or family), I had less trouble sticking to my nutritional choice when I lived in Sweden than when I moved to the US… I’ve always wondered why that was. It has proven easier for me to fall off the wagon here than when I lived in Sweden! For some reason, It seemed easier for me to cook low-carb over there (plenty of salmon bought in frozen blocks at the local ‘Vivo’, kesella… etc…). It is more stressful and fast paced here and perhaps that plays a role, especially when I think that I always had to cook meals in advance, and now I don’t seem to have enough time for that… who knows, I haven’t figured why I have more trouble here than in Sweden.

    Mike, what I like about Westman’s study is that people are not left on their own to figure out what a low-carb diet is. Very often when people that are new to this think they’re following a low-carb diet, they really aren’t. If it is not too much to ask, would you consider a future blog on possible aspects that constitute a barrier not to follow but to stick to a low-carb diet? Even though the evidence is there and we don’t need to be convinced, there may be other factors that we perhaps don’t take into account but may undermine our efforts. I’ve been dealing with this lately and when I compare to ‘how I did it in the past’, I remember that eating this way became second nature to me. The other difference, as mentioned above, is that I moved to the US (no, I’m not blaming it on that), but there have been changed in life style in terms of more stress (job-related) and I would like to know to which extent that may play a role. Any information on this will be highly appreciated, as always.

    Good idea for a post, Gabe. Let me ponder on it a bit. I think you’ve hit the nail on the head. Many people want to follow a quality low-carb diet, but, for whatever reason, just don’t do it in a committed way. I fall into the same category from time to time, but I never let myself get far enough gone so that I can’t get back where I belong weightwise in just a few days. At least not lately.

  11. Too bad most people who aren’t diabetic won’t think this applies to them. If only everyone knew that it’s all about the insulin – both for weight loss and optimal health. sigh.

  12. “reduced calorie diet (500 calories/day). ”

    Is this a typo? 500 cal/day???

    The caloric intake was reduced by 500 kcal/day not reduced to 500 kcal/day. I agree that the press release didn’t make this clear. It was clear to me, but I read the paper before I read the press release.

  13. Nice work at mining the facts from these two studies Dr. Eades. Timely too since I just got my latest blood work results.

    When I was diagnosed with Type II diabetes not quite 4 years ago my 12 hour fasting BG was 300 mg/dl. Triglycerides were 569 mg/dl. HDL was in the tank of course. My MD was so concerned he called me to ask me to come to his office right away. Some of my 2 hour PP BG readings were over 400 mg/dl – too high for accurate readings.

    The first thing I did was to run like hell from the CDA/ADA diet and medication protocols. Then I dropped my carbs. It took me some time to wind my way through all the misinformation on diabetic diets including the low glycemic concept. But I eventually found low carb and Protein Power. For the past year or so I have kept my carbs under 40 grams a day. Here are my latest test results:

    HgbA1c – 6.2 (normal range in Canada is 4.8 to 6.2. My goal is to get this well under 5)

    HDL – 243 mg/dl
    Triglycerides – 108 mg/dl
    Triglyceride/HDL ratio – 1.44
    Total cholesterol to HDL ratio – 3.8
    LDL (for what it’s worth which is not much) – 707 mg/dl

    All other tests including kidney tests were well within the normal range. My vision has actually improved. All neuropathy in my feet has completely disappeared and I now have excellent tactile sense on all aspects of both feet. My MD was duly impressed by my latest results but still suggested I go on statins. I told him that I wasn’t concerned about my LDL and he shouldn’t be either. Statins? I think not.

    Are you sure you listed your HDL and LDL readings correctly? If your triglyceride/HDL ratio is really 1.44 and your triglycerides are 108 mg/dl (which sounds about right on a LC diet) I calculate your HDL to be 75 mg/dl.

  14. Here’s the latest nonsense on high fat diets.

    http://www.sciencedaily.com/releases/2008/12/081228191054.htm

    Another Reason To Avoid High-fat Diet: It Can Disrupt Our Biological Clock, Say Researchers

    ScienceDaily (Dec. 28, 2008) — Indulgence in a high-fat diet can not only lead to overweight because of excessive calorie intake, but also can affect the balance of circadian rhythms – everyone’s 24-hour biological clock, Hebrew University of Jerusalem researchers have shown

    It is nonsense, indeed.

  15. Dr. Eades: Thanks for all your work to clarify these murky reports. They sure work hard to discredit low-carb, just as the drug cos. are constantly putting out reports about the ineffectiveness of supplements.

  16. re: the importance of systolic vs diastolic, in those over 50 yrs old

    from the American JNC-7 guidelines, found at:
    http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

    “The key messages of this report are: in those older than age 50, systolic blood pressure (SBP) of >140 mmHg is a more important cardiovascular disease (CVD) risk factor than diastolic BP (DBP)…”

    But the joint European Societies of Hypertension and Cardiology (ESH/ESC) 2007 guidelines are saying that SBP and DBP are of equal importance, though Pulse Pressure is the most dangerous to the elderly (in section 2.1)
    http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-AH-FT.pdf

    However, there was also a videoed presentation at the joint (European and International) ESH/ISH in Berlin this past summer, which reviewed all the data on CVD events and concluded that DBP can be outright ignored in those >50 and given little weight in those <50. Unfortunately, the site at hypertension2008.com is down, and they have no functional email address to contact their web “master”.

    Diastolic pressure is the pressure your arterial system is under all the time. Systolic pressure is the intermittent ‘pulse’ pressure that occurs every time your heart beats and pumps blood through the system. These pressures are important for different reasons. I don’t care what this or that agency of society has to say about it, I think the more important of the two in the long haul is the diastolic. I used to be a hydraulic engineer, so I’ll bet I know a little more about pipeline systems than most physicians that might set on such committees. Consequently, I’ll trust my instincts better than theirs.

  17. Great post; thanks for doing the media’s job for it and putting the numbers into a format anyone can understand.

    I recently had blood work done, and though I don’t have pre-low-carb numbers to compare to, my post-LC numbers look a lot like the above, just as you predict in your books: blood sugar normal, 45 pounds lost so far (40 to go), triglycerides at 75, HDL 47. (My LDL was 125, but I don’t care because I know that’s because they’re so huge and fluffy.) I’ve gotten information on low-carb from a lot of sources along the way, but I consider PP and PPLP to be at the top of that list, and I recommend them as much as possible. Thank you for your continued attempts to spread the truth.

    Glad to hear you’ve done so well. Keep it up. And thanks for the recommending the books – it helps me keep my high-maintenance wife living in the style to which she is suited. 🙂

  18. Wow..! I hope you poured yourself a good two fingers of that 18 year old after all that work. It seems that all the parameters that really matter, the LC group prevailed as always. But we know the talking heads will point to a rise in LDL. Have you seen peoples LDL go up when their trig’s go down ? I was working with someone recently and their trig’s went down significantly but their LDL jumped up maybe 50 points and total went from 230 ish to 280 ish and HDL’s improved between 10 and 20 points. Of course his gp prescribed him Lipitor. No one waits to see if the numbers will fall back in line after something is done or undone to change cholesterol numbers.

    I have seen LDLs go up when triglycerides go down. Many times, in fact. When I first encountered this years ago, I started getting LDL particle size studies on these folks. In every case, the particle size was the large type A kind. Since I didn’t get these tests going in, I don’t know what the starting particle sizes were. But I’ve read enough studies now where people have checked to be confident that a falling triglyceride level while on a low-carb diet is a marker for an increase in LDL particle size. Typically, I just go over this with patients, and they are fine with it. What I would not do is prescribe Lipitor.

  19. What a coincidence. Just this morning I was telling my husband “i överensstämmelse med vetenskap och beprövad erfarenhet.”

  20. Very interesting results… one comment, though. It looks to me like the low carb group was initially in worse shape than the Duke low GI group by several measures, particularly the triglyceride/HDL ratio. Any chance that that group improved more because they had a little more room for improvement?

    it could be, but I just think it’s an artifact of the randomization. In groups that aren’t enormous in number, it’s difficult to get every parameter to match perfectly.

  21. Thought this blog post might interest you. It is just appalling how this whole cooking of data thing has been allowed to become so prevalent. All for the sake of money. http://www.powerlineblog.com/archives/2008/12/022412.php

    Somehow reminds me of the nursery rhyme (just substitute truth for a nail):

    For want of a nail
    the shoe was lost.
    For want of a shoe
    the horse was lost.
    For want of a horse
    the rider was lost.
    For want of a rider
    the battle was lost.
    For want of a battle
    the kingdom was lost.
    And all for the want
    of a horseshoe nail.

    And a belated Merry Christmas and Happy New Year to you and MD. Thank you for all your commitment and hard work.

    A few days ago I read the article in the Telegraph that the blog post you linked to referenced. It was probably the best article I read over the holidays. Non-medical article, that is.

  22. Please correct me if I’m wrong, but aren’t the Duke studies being funded by the Atkins Foundation? I remember reading that a few years ago and if that’s the case that might be why the media is ignoring it. Remember in the diet world Atkins has become a dirty word.

    They are indeed funded by the Atkins Foundation. You are probably correct.

  23. Not a fan of mince meat but pecan pie is my weakness – 2 pieces over the holidays. Hurt so good. I’ve been eyeing the Jameson, which do you drink 12 or 18? I’ve been on a Glenlivet kick lately, usually the 15. I’d recommend it for a change up.

    Happy New Year!

    Brian

    In my own blind tasting of Jameson I prefer them in this order. 18 yo more than the 12 yo more than the regular. MD’s blind tasting showed just the opposite for her. But, I will drink any and all Jameson.

  24. These studies match my own experience. Thanks for taking the time to write this and all your previous blog posts. Your blog gives me hope. 🙂

    Do you count the carbs in erythritol? It is said to have no glycemic impact and the US labeling laws allow the manufacturers to claim zero calories, zero carbs. This blog post seems to suggest it should be counted. Should I count it or not worry?

    It’s a little controversial, but I just fudge and count it as a little. In other words, if something Ipm eating were to contain 8 gm of erythritol, I would probably count it as about 2 gm of carb.

  25. ME: Are you sure you listed your HDL and LDL readings correctly? If your triglyceride/HDL ratio is really 1.44 and your triglycerides are 108 mg/dl (which sounds about right on a LC diet) I calculate your HDL to be 75 mg/dl.

    Oops. You are right. I realized my mistake after I posted. Canadian test results are in mmol/L. So it have to convert the results to mg/dl. Still, I messed up on the maths.

    My HDL is 1.50 mmol/L = 270 mg/dl
    Triglycerides are 0.60 mmol/L = 108 mg/dl (range is 0.45 mmol/L to 2.29 mmol/L)
    Triglyceride/HDL ratio = 270/108 = 2.5

    LDL is 3.93 mmol/L = 707 mg/dl. So it was correct.

    Your conversion factors are incorrect. To convert cholesterol (total, LDL & HDL) from mmol/L to mg/dl you multiply the mmol/L figure by 38.67. Doing so gives you an HDL of (1.5 X 38.67) of 58 and an LDL of 152.

    To convert triglycerides from mmol/L to mg/dl you multiply the mmol/L figure by 88.57. That makes your triglycerides (0.6 X 88.57) come in at about 53.

    53/58 gives you a triglyceride/HDL ratio of about 0.9, which is very good.

  26. The Duke study is quite impressive – thanks for sharing. It would be interesting to take the low-carb group and split it, with one group being advised to get their fat from animal fats only, and the other allowed to use vegetable oils. My guess would be that those who omit the high-PUFA fats found in vegetable oils would have better outcomes, both for weight loss and overall health.

    I would guess the same way.

  27. To follow a low carb style of eating can’t you just eliminate grains/starches/sugar and be there? Isn’t as simple as consuming only meat, fish, poultry,chesse, fruits and vegetables? If i am correct then it would appear pretty easy to follow a low carb diet.

    It’s pretty simple but it’s not all that easy. If you do as you say, you would be following a pretty good low-carb diet. But many people find that difficult to do, for some reason.

  28. “In the high-cereal fiber diet, participants were advised to take the “brown” option (whole grain breads; whole grain breakfast cereals; brown rice; potatoes with skins; and whole wheat bread, crackers, and breakfast cereals).”

    What kind of lunatic disregards all scientific evidence and knowledge to feed *this* to a diabetic person?!

    “In another study, arsenic is shown to be hazardous to human health as all 24 patients die soon after ingesting large quantities of the substance.”

    The kind of lunatic who did this study and the thousands of doctors that will be prescribing this diet as a result.

  29. what about approaching it from a BB perspective. would low carbs still be useful.

    I hate to sound ignorant, but what is a BB perspective?

  30. It’s fascinating (although not surprising) that the newspapers continue to pick up on new studies that seem to confirm the propaganda they already spout, while conveniently overlooking the studies that back up the supposedly radical idea of protein/fat winning out over carbs.

    Funny how this radical idea has been the one that’s worked time and time again for hundreds if not thousands of years. I’ve been a big believer in the power of protein for years now, have found it the ONLY method to work with literally hundreds of clients over the years. I’m currently getting stuck into ‘Good Calories, Bad Calories’ and being reminded of the scientific reasoning for what I know to be true is just blowing my mind.

    This article serves as just another reminder of what we’re up against – keep up the good work.

  31. Thank you for providing us with the valuable counterpoint to all the misleading studies that continue to show up in the so-called “news”.

    Happy New Year to you and MD!

    Happy New Year to you, too.

  32. I think it is between meals that makes low carb hard to follow. For us office workers, when you feel you want something to eat mid morning, or at 3/4pm what are the choices? Nuts could be, but for someone like me that is not an option due to severe allergy. Peanuts are ok, but are they low carb? So what i would do is have Greek yogurt, or peanuts, or once in a blue moon raw sunflower seeds. But between meals is what i find others to say is the challenge.

    BTW: are there good low carb protein bar options? Someone mentioned Pure Protein bars as a choice,but i do not know.

    I like to eat jerky as a between-meals snack. When I eat between meals, that is.

  33. Dr. Mike, any chance you will ever tackle and offer possible solutions for the brain chemistry component that makes it SO hard for some people to go low carb. I believe there are physiological addiction patterns involved that make it more complicated than just ‘will power’ for some. I know plenty of people who have already gotten the ‘splotch’ on the x-ray that would scare the bejeezus and the carbs right out of most people, but they continue to struggle with controlling their diet. These are not weak people, it truly seems like they go a bit crazy trying to conform to low carb. Is there a ‘methadone’ type transition for these folks?

    I agree with you. I can be hard. But the nice thing is that once you really get started, it becomes easy to do. It’s the getting started that’s tough. People love carbs, and when they think they have to give them up, they don’t like it. And often don’t really give low-carb a real try. I may post on this because you and a couple of other commenters have made me start thinking about it. If I come up with anything profound, I’ll post on it.

  34. Thanks for the mmol/L to mg/dl conversion information. I didn’t know there were different factors for blood glucose, cholesterol, triglyceride values. The problem with having different measurement systems in Canada and the US is that it makes it hard to gauge values when comparing data. I knew that my triglycerides were low. But they are much better than I thought.

    As I wrote earlier, you multiply by 38.67 for any of the cholesterol mmol/L conversions, 88.67 for triglycerides and 18 for blood sugar. And you’re right, you values were much better than you thought.

  35. ME: I don’t care what this or that agency of society has to say about it, I think the more important of the two in the long haul is the diastolic.

    My gut instinct is that you are right. Yet, treatment initiatives often seem to be based on a high systolic pressure. Thus, a person with a BP of 142/78 would typically be prescribed an anti-hypertensive medication to bring the systolic pressure close to norm of 120. The net effect is a very low diastolic pressure as in something like 122/58. To me this does not seem to be a good thing.

    At some point could you please explain from a perspective of hydraulics why you believe diastolic is the important aspect of BP.

    The diastolic pressure is the pressure the vessel is under all the time. The systolic pressure is intermittent. More stress is put on the vascular wall if the diastolic pressure is higher because that’s a stress that is constant. Sometimes the systolic goes up because the blood vessels are already damaged a little. If they are stiffer, they don’t have as much give, and so the systolic pressure goes up because the vessel wall doesn’t absorb any of it.

  36. regarding the post about how difficult it is to follow a low-carb diet in North America vs. europe/scandanavia:

    my own experience being italian, growing up in a large city in canada has been that the most popular restaurants tend to be Italian, chineese, and straight up pizza joints.

    the italian food of north america represents the most unhealthy aspects of the cusine.
    the focus on pizzas, pastas and calzones/panzarotti, lasagna and meatballs while great tasting are just a fraction of the types of foods we eat. i believe this is due in large part to the fact that the vast majority of immigrants from italy to america/canada were from the more impoverished southern regions where these foods are more popular.

    (my father is from the north, where they eat much more meat, butter and cheese but that side of hte family is very slim, while my mother is from the south and they are much heavier, not surprisingly)

    fancy italian restaurants tend to be more focused on northern italian cuisine and it shows in the options of food. even rissotto which is very carby is only eaten as an appetiser in small portions and loaded with butter. people think radicchio is a typical salad for northern italians (my father is from the same region where radichio originates, they eat it twice a day) accept they probally dont know up until a few years ago the typical way to eat raddichio was to toss it quickly in melted lard. it grows in the winter time in cellars so farmers ate this year round when other veggies were scarce.

    southern italians are by and large heavier and eat more carbs than their northern counterparts by account of their most popular food choices. at least from my own observation of italians here and back there.

    another problem is the myth of the mediterainian diet as it applies to italians: it never made any sense to me. coming from a very food crazy family i have yet to see southern italians eat anything remotely close to the diet presented in north america as a “mediterainian diet”.

    there are lots of veggies and salads but they are often served as a side dish, the main courses of pasta are not simple tomoato sauces as most people understand. often a massive pot of tomatoes are stewed with meat at the bottom such as braciole, meatballs or pork. these are usually eaten after the pasta is done. while still carby a pasta sauce stewed w/ fatty cuts of meat is never mentioned in these mediterainian diet.

    pork sausages are a big part of southern italian food, along w/ sweets (dolce) like pastry and dried fruit preparation. whole wheat bread is not consumed the way we do in north america, though corn bread is popular.

    grilling is not as popular as youd suspect for a hot region, most meats are fried/ stewed or baked w/ added fat.

    —————

    as a side note consider nations like argentina and uruguay which have some of the highest meat consumption in the modern world and are healthy, there are many more northern italians in this region per capita than north america, to them the idea of “italian food” being pizza and pasta is ridiculous, thats north american italian fast food. im inclined to agree.

    thanks for this blog, its such a great resource!!!

    Thanks for the summary of the Italian food situation.

  37. As well as a refusal of main line researchers to fairly study low carb diets, there is another refusal little commented upon:

    There are, so far as I know, NO studies of the benefits of diabetes achieving truly normal or close to normal Blood Glucose levels or A1Cs. Normal is considered about 6.5, a level at which serious and life threatening complications are guaranteed.

    I suceed at staying under 100 for BGs (currently 92 – 90 is my goal), and A1Cs just below 5.

  38. Dr. Eades,
    I was wondering, how does low-carb eating affect skin blemishes – pimples etc on back, shoulders and arms, not to mention face? What has your experience shown you with patients who switch to low-carb eating? Also, would anyone else like to share their experience? My wife has started to control her carbs and eat more protein/healthy fats, but is experiencing this problem for the first time in her life (she’s 47).

    Dan

    It’s been my experience that most pimples and acne-like lesions improve on a low-carb diet. I can’t really say what’s happening in your wife’s situation because I’ve never had a patient with this experience. It could be coincidental or it could possibly be due to the diet, but I couldn’t say without a lot more info.

  39. You may have written about this before, but I saw one of those “Jared” ads for Subway, and it got me wondering about his diet, which is always trumpeted as a successful low-fat diet.

    So I looked up what he ate and crunched the numbers. Yes, it was of course a low-fat diet. But it was also a low-carbohydrate diet and a low-protein diet, if you go by current definitions. He only consumed about 150 carbs per day, and fewer than 50 grams of protein. Considering that he’s 6′ 2″ and started his diet at over 400 pounds, I think the following conclusions are rather obvious:

    1. Feed a tall, morbidly obese man a diet of 900 calories per day, and he’s going to lose weight.

    2. At fewer than 50 grams of protein per day, much of the weight he lost was muscle mass.

    3. Even 150 grams of carbohydrates per day was probably a drastic reduction in carb intake, and thus produced a drastic reduction in insulin.

    So, if today’s experts define 200 grams of carbs as “low carb,” why isn’t Jared’s diet ever cited as an example of how successful a truly low-carb diet can be? One could almost believe there’s bias at work.

    Your analysis makes sense. Let’s start a Jared’s-doing-low-carb movement.

  40. Thanks for this post. As a personal note when I first got into low carb and ultimately lost more than 70 pounds I was able to cut my BP meds substantially. About half. Low carb works!

    Thanks for teaching me something new. I was not aware of the large particle LDL cholesterol. This is new knowledge for me.

    Mike, did you ever think of conducting your own study? Alot of work, yes, but I’m sure you’d crush ’em. We’ll all take part.

    Jim

    Not just a lot of work, but a huge expense. The expense is why nutritional studies aren’t done more often. The drug companies can afford to underwrite enormously expensive studies, but not the nutritional industry. I would love to do a couple of studies, but can’t afford it on my own nickel. Thanks for the offer of volunteering.

  41. Mike,

    Have you seen this: http://www.nytimes.com/2008/12/31/business/31drug.html?_r=2&hp

    Jeremy

    Yes, I saw it. This is a step in the right direction. But, I got a lot of pens, cups, etc. from drug companies, none of which ever inspired me to prescribe their drugs. What would move me to prescribe their drugs was samples. I found that the drug reps who left the most samples that I could give to patients ended up getting their drugs prescribed more. I couldn’t bring myself to give patients a few samples of drug A then write them a prescription for a competing drug B, if they were both equal in efficacy. I’m sure drug reps will be able to continue sampling.

  42. I read that new york times article; as a type 1 diabetic it made me furious. The study missed the point entirely (low carb is vital for blood sugar control), but the results were being trumped up. There was a quote from some Joslin’s expert saying we should all start following low glycemic index diets now, as if the study gave us some surprising revelation. What a jerk.

    Thanks for putting the data together

  43. With regard to the question from “S.” above regarding the attractiveness of carbohydrates, Petro Dobromylskyj (“Peter”) at the Hyperlipid blog ( http://high-fat-nutrition.blogspot.com/ ) suggests that a craving for carbohydrates may be signaled to the human brain by gut bacteria through biochemical means (“by altering peptide neurotransmitters in our brain.”)

    See his five blog entries whose titles begin with “Fiaf” which stands for “fasting induced adipose factor”.

    The main point of the first “Fiaf(1)” blog is that gut bacteria survive by using the otherwise unusable (indigestible) fiber that we eat. They use this fiber as an energy source AND they send excess energy across the gut wall to be stored as fat by their host human. In this way they ensure that they AND their host survive. So we find that fat storage is somewhat under the control of gut bacteria. The net conclusion is that gut bacteria and by association dietary fiber is perhaps not as desirable as we have been led to believe – a point Dr Eades has made several times.

    In the second “Fiaf(2)” blog Peter describes how gut bacteria can only live on fermentable fiber and describes a paper (that unfortunately he can’t find again) which suggests that gut bacteria can influence our desire for carbohydrates as this is only food they can use. Again, one can conclude that gut bacteria and the fiber that feeds them may be undesirable.

    Through out his blog, Peter sights studies that cast fiber in a very negative light. Perhaps another pillar of the food pyramid is collapsing?

    Philip Thackray

    Thanks for the link. I’ll read these. It makes a sort of sense, but I’m not sure I’m ready to totally buy into it. I need to study it a little.

  44. S, you asked:

    “Dr. Mike, any chance you will ever tackle and offer possible solutions for the brain chemistry component that makes it SO hard for some people to go low carb.”

    I have tried five patients on low dose naltrexone for carb addiction and I’m sorry to say it did not work in any of them. Not so much an answer, but another promising dead end.

    I’ve read a lot about naltrexone and alcohol addiction and wondered if it might work for carbs. Based on your experience, it sounds like it doesn’t. I’ll put some thought into the mechanisms of carb addiction and see if I can come up with anything profound. If I do, I’ll post on it.

  45. Dr. Eades:
    “Falling triglyceride level while on a low-carb diet is a marker for an increase in LDL particle size.”
    “What I would not do is prescribe Lipitor.”

    Thanks for the insight.
    This issue is not clear for me per Dr. Davis @ heartscanblog.

    Matt

    Trig 55
    HDL 59
    LDL 176
    Total 245
    Slo Niacin 1.5g, D3 gel 6000iu, 4g fish oil, low-carb.

  46. The way this post evaluated and synthesized the two studies was brilliant. What a great way to end the year. You have my heartfelt thanks and my cheers to keep up the good work.

    Postscript: As I read it, n=29 for the low-GI group. So the fixed version still needs to be fixed to read “. . . 3 subjects out of 29 taking insulin in the low-GI group . . .”

    Thanks. I fixed it.

  47. One of the reasons it’s hard to give up carbs is that they are comfort food.
    http://lowcarb4u.blogspot.com/2008/07/comfort-food.html“>comfort food

    I agree that the tryptophan/insulin/serotonin situation is part of the carbohydrate allure, but I’m not sure it’s the entire reason people bolt for the carbs. Taking 5-HTP (a precursor of serotoin that doesn’t require insulin to get into the brain) doesn’t seem – at least in my experience – to strongly blunt cravings for carbs. Maybe a little, but not as much as would be expected if increased serotonin were the primary driving force behind relieving carb cravings. I suspect that carbs have a more opioid effect, which gives them their addictive nature.

  48. “I suspect that carbs have a more opioid effect, which gives them their addictive nature.”

    I’d also guess that part of the allure of carbs is that, at a basic biochemical level, the body adapts to using carbs–rather than fat and protein–as fuel. Once you’ve low carbed for awhile, your body begins to re-adapt to using proteins and carbs as fuel, and so they lose some of their allure. I don’t dispute their allure to opiate receptors, though.

    Yes, one of my comments was captcha’d. When it sees a mismatch, your captcha widget generates an error message converts the comment to “\.” Evidently someone’s “\” got published upthread.

    Sorry for the hassle. I didn’t realize there was a captcha feature on the comments. I just upgraded a couple of days ago to the latest version of WordPress, and the captcha must have come along with it.

  49. Dr Bernstein has an article on carb addiction. I think he found that whatever he treated it with had to be rotated with another method to remain effective. I don’t know what the patent stuff means, if we find for ex that chromium and glutamine help and we rotate the two substances to keep the cravings away do we have to send him a check?

    http://www.diabetes-book.com/articles/method_of_treatment.shtml

    It looks like Dr. Bernstein has what is called a use patent, which means that he has a method patented for using commonly available substances to reduce carb cravings. If someone tries to exploit this method by trying to sell an alternating schedule of these substances, Dr. Bernstein could challenge them with his patent and either force them to quit or to pay him a royalty. In the case you described, in which an individual alternates supplements to decrease his/her own carb cravings, said individual isn’t really violating the patent because he/she isn’t selling the method. However, if an individual does use this method successfully, it would be a friendly gesture on his/her part to send ME a check. All such checks will be cheerfully accepted. 🙂

  50. Dr. Eades, you said, “Taking 5-HTP (a precursor of serotonin that doesn’t require insulin to get into the brain) doesn’t seem – at least in my experience – to strongly blunt cravings for carbs.”

    Actually, in my experience (which is an “n” of one), it does. If you don’t mind my asking, how did you prescribe the 5-HTP? As a daily dose? PRN for “comfort”? And how much did you recommend?

    Along the same lines, I expect that you occasionally prescribe SSRIs. Do you notice that any of the SSRIs increase or decrease carb cravings?

    Well, you said it: you are an ‘n’ of one. Which doesn’t mean that it doesn’t work for you or that it won’t work for others. I’ve just found in my experience that it didn’t work as well as I thought it should. But it did work here and there, so I felt it was worthwhile trying if patients were fighting carb cravings. I usually prescribed it as a 100 mg dose daily at about 5 PM.

    I have used SSRIs. I found that Zoloft seem to have a little carb-craving blunting effect, but, again, not a whole lot. It didn’t seem to me that the other SSRIs worked as well as Zoloft.

  51. Thanks for your responses. If you’re in detective mode, here’s a factoid from my husband:

    He has noticed that the atypical antipsychotics (Risperdal, Zyprexa, Seroquel, and Abilify) *increase* carb cravings to the extent that patients often become diabetic as a result. I haven’t checked the mechanism of action, nor has he, but it might offer a clue about the brain chemistry involved.

  52. Okay, I did a little sleuthing. Several serotonergic receptor agonists are in clinical trials for the treatment of obesity.
    http://www.ingentaconnect.com/content/adis/dgs/2007/00000067/00000001/art00004

    Also, one of the many modes of action of the atypical antipsychotics is an antagonist effect on the 5-HT2C receptor. The ones that are the most potent antagonists are the worst as far as causing diabetes.

    So, I’ll shut up now and go back to undecorating the Christmas tree. 🙂 Happy New Year, and all the best to you and M.D.

  53. I can definitely say that Risperdal gave the the munchies. Badly. It’s one of many reasons why I’m no longer on it, and am on Zoloft and Neurontin instead, and trying to reduce the dosage on those.

    One thought on the carb addiction front: since I started Topamax a couple of years ago, not only have I gained a terrifying alcohol tolerance, but virtually all of my prior binge eating habits have disappeared. While I haven’t been very good on the diet front, I’ve still managed to lose about 35 lbs since mid-August, which isn’t so bad for doing it half-assed. Only about 130 left to go.

    I tested the alcohol thing once for kicks, and it took 9 shots in an hour to get me only sort of buzzed – I now have to ask what’s in a cocktail, as I fear for my poor abused liver.

    It’s interesting how poking around on the intarwebs can change your whole perspective – a few years ago, I was going to school as an English and linguistics major, and thanks to protracted illness and new priorities, am going back in biochem and mathematics. This stuff is just so cool.

    Would never have gotten here without your book, doc. My favorite physician ordered me to go out and pick up a low-carb diet and nutrition book (just not that Atkins!) when I was 13 and newly diagnosed with PCOS, and it reinforced every instinct about food I ever had, and made science class that much more interesting.

    Got some sauerkraut fermenting in the kitchen right now – tasty, real food, good for you, and a biology experiment, all in one cute little glass jar!

    Thanks for the work, doc.

  54. Thanks for the excellent graphical breakdown of these studies.

    Anecdotally over the years in many diabetes newsgroups and forums I have seen the same pattern emerge so often that I truly can’t understand the controversy any more.

    My trigs are a tenth of what they are and my HDL doubled between the Healthy High Carb Low Fat diet (which isn’t) and my current low carb WOE.

    There is often the downside that LDL increases – BUT my GP appears to agree with you, and others, that this is non-lethal in the absence of the trigs and low HDL. Curiously since starting to add more saturated fats my HDL has increased and LDL has decreased by about the same amount, so there are obviously non-simple things occurring.

    My next plan will be to drop my simvastatin for a month prior to my next lipid panel to see what my actual unmedicated numbers come out to, but I suspect I may need to continue it as it’s the only thing I’ve found so far to knock down the LDL, to half what it was. Maybe some individuals actually DO benefit from statins, just not nearly as many as they are marketed at?

    Meanwhile here in the UK we are currently being bombarded with this

    http://www.nhs.uk/Change4Life/Pages/default.aspx

    sponsored by Kelloggs Tescos and Unilever, so no bias there obviously

    There is no doubt that statins will reduce LDL levels – that isn’t in question. The question is, so what? A lower LDL doesn’t translate into lower all-cause mortality. If you are a female, statins don’t help irrespective of your age; if you’re a male, they only help (and then only minimally) if you are under 65 years old and have had a heart attack. If you are over 65 they don’t help, and if you are under 65 and haven’t had a heart attack, they don’t help. And just having elevated LDL levels IS NOT the same as having had a heart attack.

  55. And what’s worse, the current protocol here is to refuse Full Lipid Panel on grounds of cost and offer only TChol so neither you nor your health professional actually get to see the crucial components and ratios which IMO are trigs and HDL, then medicate anyway

    talk about spending pounds to save pennies