How to Find a Study
Can someone tell me how to locate a research study on the internet? Is it free or do I have to have a subscription? Thanks for your help.
[B]Fat Paralyzes Insulin, Making Diabetes Worse[/B]
Dietary fat acutely increases glucose concentrations and insulin requirements in patients with type 1 diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management by Howard A. Wolpert, published November 2012 in the online issue of Diabetes Care, found that “this evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation…and suggest(s) that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes.”
Comment: In most people’s minds (including medical doctors), carbohydrate (sugar and starch) is the cause of diabetes. One result is that diabetics manage their disease and medications by “carbohydrate counting.” According the American Diabetic Association this meal planning technique is used to keep your blood sugar in control by keeping track of how many carbohydrates are consumed. Although carbohydrate calories do count in the sense that the blood sugar goes up right after eating a meal, this effect does not make the underlying disease of diabetes worse.
Diabetes (both type-1 and type-2) is due to the reduction of the metabolic effects of the hormone, insulin. Insulin is released from the pancreas after eating and causes body cells to take up carbohydrate and fat cells to take up fat (triglycerides). When the actions of insulin become insufficient the blood sugar rises and diabetes is diagnosed. This ineffectiveness is caused by lack of insulin production (as in classic type-1 diabetes) or is due to insulin resistance (as in type-2 diabetes). This study shows that dietary fat reduces insulin activity. (In this case the insulin injected by a person with type-1 diabetes, but the same is true for insulin produced by the pancreas, as in a person with type-2 diabetes.)
Contrary to popular belief, refined sugars actually make the body’s insulin work more efficiently. When the refined sugar content of an experimental diet of people with mild diabetes was doubled from 45 percent sugar to 85 percent sugar, every measurement of their diabetic condition, including fasting blood sugar, fasting insulin levels, and the oral glucose tolerance, showed that their diabetes improved.2 The researchers concluded, “These data suggest that the high-carbohydrate diet increased the sensitivity of peripheral tissues to insulin.” The increase in insulin’s sensitivity (efficiency) counteracted any blood sugar-raising effects from consuming more carbohydrates and calories.
Therefore, diabetics should be “fat-counting,” not “carbohydrate counting” in order to improve their underlying disease. Almost all type-2 diabetics can be cured of their disease by strictly avoiding fat (and the weight loss that follows eating starches, vegetables and fruits). Type-1 diabetics will find their insulin needs decreasing by about 30% when they avoid the fat and add the carbohydrate. All people, with or without diabetes, will find great improvements in their health from this simple dietary change.
1) Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM. Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management. Diabetes Care. 2012 Nov 27
2) Brunzell JD, Lerner RL, Hazzard WR, Porte D Jr, Bierman EL. Improved glucose tolerance with high carbohydrate feeding in mild diabetes. N Engl J Med. 1971 Mar 11;284(10):521-4.
Did you try Google Scholar?
In general, you can always find an abstract if you google the author and a few keywords. You only pay for the full article. If you can get into the library of the decent sized university, they usually have access to the full articles. In general, articles older than 1995 haven't been scanned and uploaded online unless they are a very major journal. (but more and more is going up every day.)
In the past, abstracts included the important data and the conclusions. They gave away the store, and you didn't need the full article. Recently, abstracts sound more like movie trailers and don't give away the ending because they want you to pay for the full article, so good luck.
That said, here are the abstracts for the references in the newsletter.
[b]Diabetes Care. 2012 Nov 27. [Epub ahead of print][/b]
Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management.
Wolpert HA, Atakov-Castillo A, Smith SA, Steil GM.
Joslin Diabetes Center, Boston, Massachusetts.
OBJECTIVECurrent guidelines for intensive treatment of type 1diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting. There is strong evidence that free fatty acids impair insulin sensitivity. We hypothesized that patients with type 1 diabetes would require more insulin coverage for higher-fat meals than lower-fat meals with identical carbohydrate content.RESEARCH DESIGN AND METHODSWe used a crossover design comparing two 18-h periods of closed-loop glucose control after high-fat (HF) dinner compared with low-fat (LF) dinner. Each dinner had identical carbohydrate and protein content, but different fat content (60 vs. 10 g).RESULTSSeven patients with type 1 diabetes (age, 55 ± 12 years; A1C 7.2 ± 0.8%) successfully completed the protocol. HF dinner required more insulin than LF dinner (12.6 ± 1.9 units vs. 9.0 ± 1.3 units; P = 0.01) and, despite the additional insulin, caused more hyperglycemia (area under the curve >120 mg/dL = 16,967 ± 2,778 vs. 8,350 ± 1,907 mg/dL⋅min; P < 0001). Carbohydrate-to-insulin ratio for HF dinner was significantly lower (9 ± 2 vs. 13 ± 3 g/unit; P = 0.01). There were marked interindividual differences in the effect of dietary fat on insulin requirements (percent increase significantly correlated with daily insulin requirement; R(2) = 0.64; P = 0.03).CONCLUSIONThis evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes.
[b]Improved Glucose Tolerance with High Carbohydrate Feeding in Mild Diabetes[/b]
John D. Brunzell, M.D., Roger L. Lerner, M.D., William R. Hazzard, M.D., Daniel Porte, Jr., M.D., and Edwin L. Bierman, M.D.
N Engl J Med 1971; 284:521-524March 11, 1971DOI: 10.1056/NEJM197103112841004
To evaluate the effect of increased dietary carbohydrate in diabetes mellitus, glucose and immunoreactive insulin levels were measured in normal persons and subjects with mild diabetes maintained on basal (45 per cent carbohydrate) and high carbohydrate (85 per cent carbohydrate) diets. Fasting plasma glucose levels fell in all subjects and oral glucose tolerance (0 to 120-minute area) significantly improved after 10 days of high carbohydrate feeding. Fasting insulin levels also were lower on the high carbohydrate diet; however, insulin responses to oral glucose did not significantly change. These data suggest that the high carbohydrate diet increased the sensitivity of peripheral tissues to insulin.
Thanks. So it looks like this is not good news for primal.
[url=http://www.drbriffa.com/2011/05/08/paleolithic-diet-much-better-for-diabetics-than-conventional-diabetes-diet/]Paleolithic diet much better for diabetics than conventional ‘diabetes diet’ | Dr Briffa's Blog - A Good Look at Good Health[/url]
[QUOTE=Wildapple;1048880]Thanks. So it looks like this is not good news for primal.[/QUOTE]
The low carbohydrate diet was 45% carbs. It is very hard to eat 45% of your calories from carbohydrate if your are Primal so the study does not really apply.
It seems like it is saying that a high carb diet is better for Diabetes patients.
It does seem to be saying that... but do you really consider a single small 10 day study the be all and end all of the debate?
When my grandmother was diagnosed as diabetic a dietitian prescribed a very low fat (only baked white, no skin, chicken or white fish and fat free dairy) diet along with lots of grains, vegetables, and daily fruit servings.
On this diet she was eating a large portion of her diet from carbs, the vast majority in fact. It was fallowed very closely as my Aunt masters degree level nurse and does all of her shopping. For that entire year my grandmother became worse and worse, requiring higher doses of medication to control her blood sugars and having serious increases in pain from peripheral neuropathy.
Want to know what stopped that... a specialist she was seeing for the PN pain told her to change the diet to high fat/low carb. My Aunt was very hesitant, but the doctor told her that she should just try it for a few months and see, and if it didn't help she could go back, "What does she have to lose?" That change stopped the blood sugar problems and the reduced the pain, though so much damage had been done by then that she will never be pain free at this point.
One small and SHORT study does not discount everything else that has ever come before it.
Things are much more complicated than that.
[QUOTE=Wildapple;1048928]It seems like it is saying that a high carb diet is better for Diabetes patients.[/QUOTE]
None of the diets are even remotely low carb or Primal.
As always, I love studies that offer opposing viewpoints :) This one is really interesting. I know two people who reversed their type 2 diabetes through eating a high fat, low carb diet. According to this study though,
[QUOTE]dietary fat reduces insulin activity[/QUOTE]
Although carbohydrate calories do count in the sense that the blood sugar goes up right after eating a meal, this effect does not make the underlying disease of diabetes worse.[/QUOTE]
Mark did do a post a while back on how not eating carbs can make you insulin resistant: [url=http://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/#axzz2Gp6c88Ws]Does Eating a Low Carb Diet Cause Insulin Resistance? | Mark's Daily Apple[/url]
It makes sense that fasting glucose would be higher on a low carb diet, as your body manufactures the glucose it needs from protein etc., making your glucose more stable. Stable glucose = less inflammation = healthier, no?
Like all studies, there is probably some truth in it, but it's a bit cloudy. They don't differentiate between fats for one thing.
It would be interesting to know who funded it.