The gauntlet has been thrown!

MKChitown · 2017-02-12 18:13:31 UTC

Hello - My lovely boyfriend, an internal medicine doc, took me out to dinner last night for valentine’s day. He googled ‘most romantic restaurant in Chicago’ and made reservations there. Turns out, it was an Italian place that was known for homemade pasta. Oopsie. I did okay, got pork belly app and steak with broccoli rabbi.

Okay - so, he’s like “you are never going to eat carbs again”? I told him all the wonderful benefits of Keto, and how we don’t need processed carbs (incidental are okay). All of his years of Western Medical training and medical practice refute all of the stories and benefits I am telling him. He will ONLY believe peer-reviewed medical studies or something published in NEJM.

So, I’m in the process of gathering some research to send to him – some real medical studies. BUT, if you have any medical research regarding benefits of keto please do send my way. I will look for the stuff from Richard as well.

thank you!!! I am hoping to turn him. He laughed at me.

richard · 2017-02-12 18:28:02 UTC

Tim Noakes narrative on the evidence is a good summary

http://bjsm.bmj.com/content/51/2/133

Richard Feinman’s paper is also good

ncbi.nlm.nih.gov

Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base.

RD Feinman, WK Pogozelski, A Astrup, RK Bernstein, EJ Fine, EC Westman, A Accurso, L Frassetto, BA Gower, SI McFarlane, JV Nielsen, T Krarup, L Saslow, KS Roth, MC Vernon, JS Volek, GB Wilshire, A Dahlqvist, R Sundberg, A Childers, K Morrison, AH Manninen, HM Dashti, RJ Wood, J Wortman and N Worm, Nutrition (Burbank, Los Angeles County, Calif.), Jan 2015

The inability of current recommendations to control the epidemic of diabetes, the specific failure of the prevailing low-fat diets to improve obesity, cardiovascular risk, or general health and the persistent reports of some serious side effects of commonly prescribed diabetic medications, in combination with the continued success of low-carbohydrate diets in the treatment of diabetes and metabolic syndrome without significant side effects, point to the need for a reappraisal of dietary guidelines. The benefits of carbohydrate restriction in diabetes are immediate and well documented. Concerns about the efficacy and safety are long term and conjectural rather than data driven. Dietary carbohydrate restriction reliably reduces high blood glucose, does not require weight loss (although is still best for weight loss), and leads to the reduction or elimination of medication. It has never shown side effects comparable with those seen in many drugs. Here we present 12 points of evidence supporting the use of low-carbohydrate diets as the first approach to treating type 2 diabetes and as the most effective adjunct to pharmacology in type 1. They represent the best-documented, least controversial results. The insistence on long-term randomized controlled trials as the only kind of data that will be accepted is without precedent in science. The seriousness of diabetes requires that we evaluate all of the evidence that is available. The 12 points are sufficiently compelling that we feel that the burden of proof rests with those who are opposed.

This is a good overview

and this a good summary of it’s neuroprotective benefits

richard · 2017-02-12 18:46:21 UTC

Also Chris Gardners ATOZ study compared 4 diets ranging from ornish plant based high carb to atkins low carb

ncbi.nlm.nih.gov

Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial.

CD Gardner, A Kiazand, S Alhassan, S Kim, RS Stafford, RR Balise, HC Kraemer and AC King, JAMA, Mar 2007 07

Popular diets, particularly those low in carbohydrates, have challenged current recommendations advising a low-fat, high-carbohydrate diet for weight loss. Potential benefits and risks have not been tested adequately.To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables.Twelve-month randomized trial conducted in the United States from February 2003 to October 2005 among 311 free-living, overweight/obese (body mass index, 27-40) nondiabetic, premenopausal women.Participants were randomly assigned to follow the Atkins (n = 77), Zone (n = 79), LEARN (n = 79), or Ornish (n = 76) diets and received weekly instruction for 2 months, then an additional 10-month follow-up.Weight loss at 12 months was the primary outcome. Secondary outcomes included lipid profile (low-density lipoprotein, high-density lipoprotein, and non-high-density lipoprotein cholesterol, and triglyceride levels), percentage of body fat, waist-hip ratio, fasting insulin and glucose levels, and blood pressure. Outcomes were assessed at months 0, 2, 6, and 12. The Tukey studentized range test was used to adjust for multiple testing.Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months, and mean 12-month weight loss was significantly different between the Atkins and Zone diets (P<.05). Mean 12-month weight loss was as follows: Atkins, -4.7 kg (95% confidence interval [CI], -6.3 to -3.1 kg), Zone, -1.6 kg (95% CI, -2.8 to -0.4 kg), LEARN, -2.6 kg (-3.8 to -1.3 kg), and Ornish, -2.2 kg (-3.6 to -0.8 kg). Weight loss was not statistically different among the Zone, LEARN, and Ornish groups. At 12 months, secondary outcomes for the Atkins group were comparable with or more favorable than the other diet groups.In this study, premenopausal overweight and obese women assigned to follow the Atkins diet, which had the lowest carbohydrate intake, lost more weight at 12 months than women assigned to follow the Zone diet, and had experienced comparable or more favorable metabolic effects than those assigned to the Zone, Ornish, or LEARN diets [corrected] While questions remain about long-term effects and mechanisms, a low-carbohydrate, high-protein, high-fat diet may be considered a feasible alternative recommendation for weight loss.clinicaltrials.gov Identifier: NCT00079573.

Weight loss was better on atkins but the secondary outcomes were too

jfricke · 2017-02-12 18:47:58 UTC

Looks like the good doctor has some educational reading ahead of him.

larry · 2017-02-12 20:44:40 UTC

Very nice of him; but he might also be advised to Google “Valentine’s day”.

MKChitown · 2017-02-12 21:23:16 UTC

He did say he would read everything I sent him that was “credible”. He doesn’t believe this reversesT2D!! He doesn’t believe N=1 experiments.

We’ll show him the science!! Thanks for all your input. I’ll let you know when he’s done with his homework.

Aqua_chonk · 2017-02-12 21:43:07 UTC

After years of attempting to educate the smug on various glaring truths, I’ve arrived at the position: “It’s not my job to make you smarter, that’s your job.” Then, I let nature sort things out.

NelleG · 2017-02-13 05:55:37 UTC

can’t wait to see how this plays out. Hoping you educate the good Doc!

Fiorella · 2017-02-13 06:10:32 UTC

Michelle,
I’m delighted to see that you are taking a positive attitude towards all this. And the doctor is in a great position to use this new knowledge to be a more effective doctor and save more lives. Your effort in this is quite remarkable. You are not being militant or egotistical about the subject, as in to win the argument, but instead you are approaching it with a positive “show me the science” perspective. Great job. How can he not look at the studies now?

Oh yeah…I hope the relationship continues to blossom. How charming

valdivia.marc · 2017-02-13 13:27:45 UTC

Sorry, I was away from my email yesterday afternoon…
This isn’t so much about the benefits of Keto, such much as the negative impact of a high sugar diet (opposite of Keto) to heart disease. This appeared in JAMA Internal medicine a little bit ago:

From the article:

The NEJM (New England Journal of Medicine) review served the sugar industry’s interests by arguing that epidemiologic, animal,and mechanistic studies associating sucrose with CHD (coronary heat disease) were limited, implying they should not be included in an evidentiary assessment of the CHD risks of sucrose.

I need to organize these articles…

richard · 2017-02-13 13:34:44 UTC

Good. Neither do I. Except when I am the “1”, and I find those experiments to be unusually compelling

He’d have to define what he thinks T2D is .

The standard definition is glycostasis. We diagnose pre-diabetes when HbA1c goes above 5.7%, and T2DM once HBA1c goes over 7.5 for subsequent quarterly draws.

My HbA1c has been 5.2% for 3 years, it was 11.2%. By that criteria I am not type 2 diabetic. But that really is a symptomatic treatment. He is welcome to dismiss my anecdote - but he has to first understand the mechanism it observes.

Diabetes (all kinds) is the inability to maintain glucose in a safe range by lowering high glucose. Diabetics have a broken homeostatic regulator (Insulin resistance or Auto-immune insulin insufficiency). However all humans have a functional homeostatic regulator that raises glucose (by making it in the liver) when it goes too low. All one has to do, to switch from the broken mechanism to the functioning one - is to inhibit dietary sugar or starch and the liver will maintain serum glucose in a safe range.

It’s a hack. One that gives diabetics tight glucose control. But to a diabetic a symptomatic treatment that lowers glucose is relevant. Every 1% decrease in HbA1c, causes a 37% decrease in risk of microvascular complications of diabetes ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC27454/ ) . So we can have a population of diabetics who have no symptoms of diabetes, and normoglycemia.

… or our health systems can succumb to the tsunami of type 2 diabetes on the horizon ( https://www.ncbi.nlm.nih.gov/pubmed/27197309 ).

As for a permanent reversal of T2DM, that will happen once the ectopic fat depositions in the pancreas are drawn down thanks to the drop in circulating triglycerides ( https://www.ncbi.nlm.nih.gov/pubmed/21656330 ).

valdivia.marc · 2017-02-13 13:53:07 UTC

From a doctor:

http://annals.org/aim/article/744700/effects-mediterranean-style-diet-need-antihyperglycemic-drug-therapy-patients-newly

etc.

LouiseReynolds · 2017-02-13 18:00:37 UTC

The UK public health collaboration has gathered 54 studies which compares the low fat to low carb diets. It is a fantastic resource: https://phcuk.org/about/ as it collates a range of studies. That should keep him busy!

MKChitown · 2017-02-15 13:57:11 UTC

Well, here’s his lame response. And for background, he eats everything he wants, with no care in the world. He never gains a pound. The man eats cereal at breakfast… kills me. He doesn’t believe that processed carbs are good on any diet (but yes, he eats them anyway).

Pasted his response below with a few clarifiers. I told him I would just show him more science.

“I didn’t realize that you had diabetes, obesity and/or a fatty liver. All of these articles lack any clinically valid endpoints (mortality benefit, disease incidence, etc), particularly in otherwise healthy individuals. Decreasing carb intake makes sense in those with insulin issues (obese, diabetics,…) but otherwise there is no evidence presented that demonstrates an advantage over any of the many other diets out there. In fact for purely health reasons, Jennifer’s vegan lifestyle (Jennifer is my vegan friend) has stronger evidence for health benefits for the general population (as does the multitude of other healthy diets). I did find this last line from the neuroprotective article abstract ironic: As the underlying mechanisms become better understood, it will be possible to develop alternative strategies that produce similar or even improved therapeutic effects without the need for exposure to an unpalatable and unhealthy, high-fat diet. Yes, listen to the science!”

snarky boyfriend…

Groversaurus · 2017-02-15 15:27:35 UTC

Unpalatable? Really? Have you taken a look at the recipes pages on here?

Unhealthy? Where’s the science to back that up?

MKChitown · 2017-02-15 15:33:39 UTC

IKR??? that was from this study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/

I’m wondering if it was from one of those drinks they used for epileptic patients and not real “keto” as it is today.

carolT · 2017-02-15 15:37:12 UTC

Yeeeeeah… that might be a while. A good doctor is never done.

carolT · 2017-02-15 15:46:54 UTC

Wait, I thought he said he didn’t believe in it for T2D? So now he does?
He’s moving the goalposts on you (us)!

[Would be interesting to see his or yours fasting insulin levels, too. No need to be a “diagnosed” diabetic.]

Kirkor · 2017-02-15 15:40:25 UTC

Even after he’s done all the reading (but it seems from that initial response that he’s already definitely made up his mind, and it’s kind of pointless to try to “convince” him at this point), you could do what I do when I just want to quickly explain to people why I avoid gluten even though I’m not Celiac — it’s a form of Pascal’s wager, and I’m just hedging.

MKChitown · 2017-02-15 15:58:52 UTC

Yes, I’m going to talk to him about his obtuse response. I did tell him that I’m doing Keto for disease prevention and keep telling him the perils of sugar. He knows, but won’t budge off his stance that cutting out one whole food group (carbs) is beneficial in the long run. I’m still going to throw more science at him and also keep asking for his support in my keto journey.