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Saturday, July 31, 2010

Atkins revisited

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The reason I decided to post this note today is the following discussion
thread: Atkins Meat and Millet Diet . Start reading with Dolores' posts.


My Cholesterol Bomba


I started experimenting with the high animal fat low carb nutrition in July 1999. It worked so well for me that it became my lifestyle ever since. Since it never caused me any trouble, I could never understand why were some people, especially diabetics, opting out after just a few months with lots of complains. Yet those were exactly the people for whom a high fat low carb diet was best suited (*) and could have been the most benefitial had they been able to persist. Why couldn't they?

I think I can probably answer this question now:

The most likely reason behind diabeitc's failures to follow Atkins lies in the induction stage being too short and Dr. Atkins unfortunate recommendation to increase carbohydrates beyond the ketogenic limit (about 20g) following the short induction stage, as well as the lack of restriction on the amount of protein! Diabetics need probably about 2 years to adapt, before they can add more carbohydrates and protein back to their HIGH FAT diet.   I needed 1.5 years before I could tolerate the average beyond 20g carbs a day!

Quote:

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Fat does not cause permanent insulin resistance. Under normal circumstance, it only does it while you eat it, not a few hors afterwards. Even if I eat lots of fat, I can have 100g of carbs on the next day (though I rarely do).

My body WAS insulin resistant intitially on the high fat diet, but I was able to increase my occasional consumption of carbs way above my initial 50g level [NOTE: this is an error, should be 25], gradually over time.

In the first year I could not exceed 25g of carbs (1 beer) without suffering a massive headache. Gradually after a couple of years my body recovered its usual flexibility and I am able to eat occasionally up to about 100g of carbs as vegetable, fruit and my two favored "truly essential macronutrients" - ice cream and chocolate.

For me a high fat low carb diet wasn't a road from bad to worse, it was from bad to normal!

I suspect that the reason behind Atkins diet #1 delayed (not immediate) blood glucose deterioration among some patient was his allowance to up the carbs after his initial induction stage. Some patients probably took it too liberaly and coupled with the then much stronger fatophobia than nowadays, may have resulted in overconsumtion of lean protein and carbs.

In my experience on the high fat, which is probably representative to many middle-aged adults ( 43 at that time) , my hormonal imbalance involving insulin resistance, with hypoglycemia and poor glucose regulation persisted throughout the first 1.5 year! Atkins induction period (6m ?) was probably not long enough for people with metabolic syndrome and with diabetes! It certainly was not long enough for me. In the first 1.5 years I could only tolerate 25g of carbs! Which was not a huge problem but I just had to remember to be strict. Whenever I ate more, even 50g would cause me a headache especially if I simultaneously exceeded protein as well! For example, I remember a massive headache I got from a plate full of salmon with potatoes!

Technically my capacity to consume carbs became in that initial period much reduced than before on the high carb diet, therefore technically you could argue that I had "deteriorated" from being insulin resistant to being virtually a diabetic! However, that is purely of academic interest (i.e of useless value) because I RARELY exceeded those 25g of carbs/day, and when I did stuck to those 25g I had absolutely no problem and my health continued improving. That 25g limit didn't bother or worry me at all! For example my intestinal sensitivities and dry eyes syndrome went away with weeks. My mild angina begun gradually abate and I was feeling stronger and more energetic with every passing months. That was the story of the first 1.5 years. Most Atkins patients I guess - would probably bail out during that stage, not understanding why they suddenly feel much worse the moment they add "little" bit more carbs after Atkins unfortunate recommendation!

The second stage of my adaptation to my high fat nutrition occured after 1.5 years. My mild angina completely disappeared, and I discovered that I am no longer carbohydrate intolerant!

I remember how surprized I was when after eating two full bowls of strawberries I did not get any sensations! I no longer would get a headache after drinking wine and especially beer.
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I recommend also to look back at this post Can ketogenic diet cure cancer?, please notice the two papers referenced:


Ketosis leads to increased methylglyoxal production on the Atkins diet.

A brief critical overview of the biological effects of methylglyoxal and further evaluation of a methylglyoxal-based anticancer formulation in treating cancer patients.

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References:

*) For example, see the following comments and papers:

1.  Beware of the carbs!


However, at least 22 experiments have documented the benefits of reducing the dietary intake of carbohydrates in type 2 diabetics.2-23 Most of them were controlled studies where a low- carbohydrate diet was compared with a low-fat diet, and almost all of them found that the former was better than the latter as regards weight reduction and glycemic control. In several of the low- carbohydrate groups patients were even able to reduce or stop their antidiabetic treatment.
Most of these studies were ignored by the Cochrane authors because their length was shorter than six months. However, to-day four studies with a length of six months or longer have been published and with similar benefits as in the short-term experiments.14, 15, 19, 23


2.  Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition

... A 30:20:50 [P:C:F] ratio diet resulted in a 38% decrease in 24-hour glucose area, a reduction in fasting glucose to near normal and a decrease in %tGHb from 9.8% to 7.6%. The response to a 30:30:40 ratio diet was similar.

Conclusion

Altering the diet composition could be a patient-empowering method of improving the hyperglycemia of type 2 diabetes without weight loss or pharmacologic intervention.


3. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal

Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.


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Sunday, July 11, 2010

China Study - Raw Data - more plant food = more heart disease!

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At last! Finally the Raw Data behind the infamous "The China Study..." book by Dr. TC Campbell from Cornell University has emmerged out of some obscure "unobtainium" publication and became available on-line on the Clinical Trial Service Unit at Oxford University web site!

http://www.ctsu.ox.ac.uk/~china/monograph/chdata.htm

Below are the links to blogs and sources.

#1. Denise Minger on China Study - long and in depth analysis of the raw data with graphs. See also her article on Tuoli county the only county in the China Study that consumed a high fat medium carb diet:

http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/

http://rawfoodsos.com/2010/06/23/tuoli-chinas-mysterious-milk-drinkers/

According to our prominent vegan theorists such as Drs Campbel, Ornish, McDougall, Esselstyne et al, the Tuoli people ought to have been very sick or dead. As you can read from Denise analysis nothing is farthest from truth. Tuoli seems to be healthier than in most other China counties!

#2. Fantastic comment by Richard Kroeker on Amazon forum,
- giving his own analyzis of the raw date similar to and corroborationg an analysis by Denise Minger.  Note: you should start reading from that post and then move on to #1 above, since Kroeker's article is much shorter.

http://www.amazon.com/Analyzing-the-China-Study-Dataset/forum/Fx1YJPR95OHW08P/TxY4S5EZD8Y2XE/1/ref=cm_cd_dp_ef_tft_tp?_encoding=UTF8&s=books&asin=1932100660&store=books

Quote:

... This is not at all what Campbell's book implied the data said. As I said above, I am an engineer (with a PhD) with heart disease simply trying to find out what to eat. You do the math...

My day-job is analyzing hard drive failure statistics that result from usage and stress testing; I get paid to make the problems being studied "go away". I have also recently had a triple bypass, ...

For instance, the people who ate the most animal protein had 68.9% less heart disease (at 95% confidence) than those people who ate the least animal protein. The people who ate the most plant protein had 64.9% more heart disease (at 89% confidence) than those people who ate the least plant protein.

I am quoting here some interesting correlation (actually the risk ratio between the extreme sample bins for a given variable, '-' means improvement, '+' means harm) from Kroeker's post, the first column numbers are univariate (single-variable, uncorrected against possible confounders) risk ratios in %, the most negative numbers (blue) = low mortality, the most positive numbers (red) = high mortality. The second number in brackets are the "confidence" estimates in % as per Kroeker's definition (see here in his methodology document). This is for mortality of all vascular disease age 35-69.



RISK% (CONFIDENCE%) - INDEPENDENT VARIABLE

-70.7% (93%) - PERCENTAGE OF CALORIC INTAKE FROM FAT
-68.9% (95%) - PERCENTAGE ANIMAL PROTEIN INTAKE
-60.8% (92%) - HDLCHOL plasma HIGH DENSITY LIPOPROTEIN CHOLESTEROL (mg/dL)
-57.0% (89%) - PERCENTAGE OF CALORIC INTAKE FROM ANIMAL
-55.6% (90%) - ANIMAL FOOD INTAKE (g/day/ref)
-55.1% (94%) - FOLATE plasma FOLATE (ng/mL)
-54.8% (89%) - ANIMAL PROTEIN INTAKE (g/day/ref)
-54.1% (90%) - FISH INTAKE (g/day/ref)

-49.5% (84%) - TOTAL LIPID INTAKE (g/day/reference man)

-49.1% (87%) - PERCENTAGE ANIMAL FOOD INTAKE (for refere
-48.4% (83%) - MEAT INTAKE (red meat and poultry) (g/day
-48.0% (83%) - CHOLESTEROL INTAKE (mg/day/reference man)
-46.6% (81%) - RED MEAT (pork, beef, mutton) INTAKE (g/d
-42.2% (82%) - SATURATED FATTY ACID INTAKE (g/day/ref)
-40.7% (89%) - RICE INTAKE (g/day/reference man, air-dry
-38.0% (84%) - TOTAL CAROTENOID INTAKE (retinol equivale
-36.0% (84%) - POULTRY INTAKE (g/day/reference man, as-c
-42.9% (82%) - Se plasma SELENIUM (ug/dL)
-42.8% (85%) - TOTPROT plasma 1989 TOTAL PROTEIN (g/dL)
-42.6% (86%) - APOA1 plasma APOLIPOPROTEIN A1 (mg/dL) (non-pooled analysis
-40.7% (88%) - Zn plasma ZINC (mg/dL)
-38.7% (76%) - B-CAROT plasma BETA CAROTENE (ug/dL)
-38.0% (82%) - ANHYDLUT plasma ANHYDRO LUTEIN (ug/dL)
-34.6% (81%) - TOTCHOL plasma TOTAL CHOLESTEROL (mg/dL)
-34.1% (79%) - NON-HDL plasma CHOLEST.(mg/dL)[=LDL+Trig/5]
...

32.4% (79%) - plasma LDL to HDL ratio
35.6% (75%) - PLANT FOOD INTAKE (g/day/reference man)
37.5% (82%) - POTASSIUM INTAKE (mg/day/ref)
39.3% (76%) - SPICE INTAKE (g/day/ref)
39.6% (84%) - TOTAL NEUTRAL DETERGENT FIBRE INTAKE (g/d/ref)
40.0% (84%) - MAGNESIUM INTAKE (mg/day/ref)
42.2% (80%) - MANGANESE INTAKE (mg/day/ref)
43.0% (90%) - OTHER CEREAL INTAKE (g/day/ref)
46.4% (93%) - TOTAL PROTEIN INTAKE (g/day/ref)
47.7% (91%) - COPPER INTAKE (mg/day/ref)

50.5% (87%) - IRON INTAKE (mg/day/ref)
54.3% (91%) - PERCENTAGE OF CALORIC INTAKE FROM CARBOHYDRATES
56.0% (87%) - PERCENTAGE PLANT FOOD INTAKE
58.9% (95%) - PLANT PROTEIN INTAKE (g/day/reference man)
62.4% (97%) - WHEAT FLOUR INTAKE (g/day/reference man)
64.9% (89%) - PERCENTAGE PLANT PROTEIN INTAKE (for ref)
65.7% (95%) - PERCENTAGE OF CALORIC INTAKE FROM PLANT PROTEIN


#3. Richard Nikoley's blog where I found the original links (thanks):

http://freetheanimal.com/2010/07/t-colin-campbells-the-china-study-finally-exhaustively-discredited.html

Stan (Heretic)

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Update 13-July-2010


HILLARIOUS response (and also the comment #505 here (*) that is  http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/#comment-505   ) by Dr. TC Campbell of Cornell University to Denise Minger!

No discussion of the data, instead plenty of ad-hominem attacks, pointing out her age, questioning her character integrity and weaving some conspiracy theory implying backing by some lobbying organization having "untold financial resources" such as Weston A. Price Foundation!   :)

Dr. TC Campbell of Cornell U. (probably) wrote:


"I find it very puzzling that someone with virtually no training in this science can do such a lengthy and detailed analysis in their supposedly spare time. I know how agricultural lobbying organizations do it–like the Weston A Price Foundation with many chapters around the country and untold amounts of financial resources. Someone takes the lead in doing a draft of an article, then has access to a large number of commentators to check out the details, technical and literal, of the drafts as they are produced. I have no proof, of course, whether this young girl is anything other than who she says she is, but I find it very difficult to accept her statement that this was her innocent and objective reasoning, and hers alone. If she did this alone, based on her personal experiences from age 7 (as she describes it), I am more than impressed."
- I am not!
H.

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*) If someone figured it out how to link to a comment by its number, on wordpress blog please let me know. Nothing obvious such as ?comment=505 etc seems to work.

Update 17-July-2010

Reordering and reformatting. It is interesting to notice that in China Study the higher total cholesterol, and the higher LDL+Triglycerides correlated with LOWER cardiovascular mortality; while higher HDL level correlated very strongly with lower cardiovascular mortality!

Update 29-July-2010

Added confidence levels in brackets (%) and a link to Rich Kroeker's methodology document.

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