ally5555 said:Ka - mon - thank you for telling us your experience. I am certain there are many more like you! In my own practice I see pts very quickly after diagnosis and I am convinced this makes a huge difference. I take a moderate approach and I am seeing many pts with excellent control - why is this without the need to cut carbs to an extremenly low level. I think it is early intervention, portion control and advice that is sustainable.
Perhaps later I will post a dietary calculation showing how carbs are worked out - but for now I am off to my public duty - I am on jury service!
Allyx
Why is carbohydrate important?
All carbohydrate is converted into glucose and will have an impact on blood glucose levels. As this is the case, some people with diabetes wonder if it would be better not to have any
carbohydrate in their diet to keep their glucose levels under control. This is not recommended as:
• glucose from carbohydrate is essential to the body, especially the brain
• high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut
• some carbohydrates may help you to feel fuller for longer after eating.
How much do I need?
The actual amount of carbohydrate that the body needs varies depending on your age, weight and activity levels, but it should make up about half of what you eat and drink. For good health most of this should be from starchy carbohydrate, fruits and some dairy foods, with no more than one fifth of your total carbohydrate to come from added sugar or table sugar.
(See pages 11–13 for a clearer guide.)
IanD said:The big problem is D UK's official advice.
When you look at pages 11-13, it would be quite difficult to eat the amount we SHOULD eat daily:
the equivalent of
7 - 14 slices of bread;
14 - 28 new potatoes;
14 - 42 tablespoons of mashed potato or rice
etc.
On the last point about long term research studies, it could also be argued that there is also a lack of long term studies, specifically relating to people with diabetes, which confirm patient safety of the Department of Health’s recommended diet.
Taken as a stand alone statement this seems to imply that this is the only way that fat is broken down. Surely this can not be so!"If carbohydrate intake is severely restricted and glucose stores are exhausted, the fat stores will be broken down and used as energy. During this process ketones are produced and excreted in the urine: this is known as ketosis. Approximately 50–70g per day of carbohydrate is required to prevent ketosis "
"Low-carbohydrate diet: less than 130g per day (26%) of a 2000kcal diet"
So you can officially low carb in the range 70-130g per day and stay clear of the ketosis line.
"When glycogen stores are not available in the cells, fat (triacylglycerol) is cleaved to give 3 fatty acid chains and 1 glycerol molecule in a process called lipolysis. Most of the body is able to use fatty acids as an alternative source of energy in a process called beta-oxidation. One of the products of beta-oxidation is acetyl-CoA, which can be further used in the Krebs cycle. During prolonged fasting or starvation, acetyl-CoA in the liver is used to produce ketone bodies instead, leading to a state of ketosis.
During starvation or a long physical training session, the body starts using fatty acids instead of glucose. The brain cannot use long-chain fatty acids for energy because they are completely albumin-bound and cannot cross the blood-brain barrier. Not all medium-chain fatty acids are bound to albumin. The unbound medium-chain fatty acids are soluble in the blood and can cross the blood-brain barrier.[1] The ketone bodies produced in the liver can also cross the blood-brain barrier. In the brain, these ketone bodies are then incorporated into acetyl-CoA and used in the Krebs cycle.
The ketone body acetoacetate will slowly decarboxylate into acetone, a volatile compound that is both metabolized as an energy source and lost in the breath and urine."
"Nutritional adequacy should be considered ensuring that optimal amounts of vitamins, minerals and fibre are supplied by the diet."
"Preferred foods in all categories are whole, unprocessed foods with a low glycemic index, although restrictions for low glycemic carbohydrates (black rice, vegetables, etc.) are the same as those for high glycemic carbohydrates (sugar, white bread)."
"Cutting out highly processed carbs and bulk fillers such as mashed potatoes, sugars, rice, pasta, cakes etc. can help to reduce weight and improve blood glucose control.
Care must be taken, however, to ensure that adequate vitamins, minerals and fibre are included in the diet from sources such as beans, pulses, and raw and cooked vegetables."
"Moderate-carbohydrate diet: 130–225g per day (26–45%) of a 2000kcal diet"
"For the purpose of this position statement, the term “low-carbohydrate” is used as a collective term to describe any amount of carbohydrate restriction which is less than the dietary reference value of 45% of total energy."
IanD said:According to this link DRN 026 (Diet and weight loss) the study was completed in 2005 & published. That study is NOT included in the D UK "Position Statement." Can anyone locate it?catherinecherub said:According to this page from DUK, there is a 2yr. study going on.
http://www.diabetes.org.uk/Research/Arc ... c_control/
Royal Devon and Exeter Trust. Reducing carb intake for achieving weight loss and risk factor control in Type 2 Diabetes.
This study will aim to see if a LCD can work for up to two years, both in losing weight and keeping it off.
I have clicked on your link, & looked at the D UK "Research project directory." That Exeter study would not appear to be current.
Abstract
Objective
This study sought to examine the effects of a 3-month programme of dietary advice to restrict carbohydrate intake compared with reduced-portion, low-fat advice in obese subjects with poorly controlled Type 2 diabetes.
Research design and methods
One hundred and two patients with Type 2 diabetes were recruited across three centres and randomly allocated to receive group education and individual dietary advice. Weight, glycaemic control, lipids and blood pressure were assessed at baseline and 3 months. Dietary quality was assessed at the end of study.
Results
Weight loss was greater in the low-carbohydrate (LC) group (−3.55 ± 0.63, mean ± sem) vs. −0.92 ± 0.40 kg, P = 0.001) and cholesterol : high-density lipoprotein (HDL) ratio improved (−0.48 ± 0.11 vs. −0.10 ± 0.10, P = 0.01). However, relative saturated fat intake was greater (13.9 ± 0.71 vs. 11.0 ± 0.47% of dietary intake, P < 0.001), although absolute intakes were moderate.
Conclusions
Carbohydrate restriction was an effective method of achieving short-term weight loss compared with standard advice, but this was at the expense of an increase in relative saturated fat intake.
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