Re: Very low fat versus very low carb diets

Statement of controversy:

Larry maintains that a Pritikin-type diet is healthful for many people
with Type II diabetes. Susan (and others) argue that it is unhealthful
(I presume Susan would maintain for virtually all) people with Type II
diabetes.

I will present my side of the argument in three parts, over the next
three days.

1. Direct evidence supporting my claim.
2. Explanation of why alleged evidence contradicting my claim is bogus.
3. Consideration of physiologic principles which indicate that my claim
is not only plausible, but also likely to be true.

I began by going through my files, but I was pleasantly surprised to
find a very comprehensive (409 peer-reviewed references, including 253
links to free, full text peer reviewed publications) and recent
(updated December 15, 2005) invited review published in the Journal of
Applied Physiology, by two well-published UCLA researchers.

Roberts, CK and Barnard (no, not the notorious PETA Barnard), R.J.
Effects of exercise and diet on chronic disease. J. Appl. Physiol.
98:3-30, 2005.

http://jap.physiology.org/cgi/content/full/98/1/3

The article costs $8.00 (which is a relative bargain in an era where
most journals charge $30 per article, and considering also that it does
contain 253 links to - free - recent, pertinent references).

This article is focused on the combined role of diet and exercise in
the genesis and treatment of coronary artery disease, hypertension,
diabetes, the metabolic syndrome, and cancer. It is particularly
pertinent to this debate, because it includes a detailed review of
studies of the Pritikin diet and exercise program in the setting of
Type II diabetes (as well as in heart disease and hyertension).

The Pritikin studies consisted largely of 26 day residential diet and
exercise intervention. Food consumption is ad libitum, and contains
10-15% calories as fat, 15-20% calories as protein, and 65-75% calories
as carbohydrate. The latter is in the form of high-fiber, whole grains
(5 or more servings per day), vegetables (4 or more servings), and
fruits (3 or more servings). Protein derives from plants, non-fat
dairy, and fish or chicken. It contains < 100 mg of dietary
cholesterol, and prohibits alcohol, tobacco, and caffeinated beverages.


The program also consists of 45 minutes to one hour per day of exercise
(treadmill) at which the heart rate is maintained at 70-85% of the
maximal heart rate obtained during a formal pre-enrollment treadmill
examination. Subjects also perform some resistance training.

All of the important publications were researched and written not by
Pritikin employees, but by independent UCLA researchers who had no
conflicts of interest. The Pritikin center was located in Santa Monica
(it has since moved to South Florida), in close proximity to the UCLA
medical school, facilitating the research.

Dealing ONLY with the diabetes data, 864 subjects were studied. There
were, overall, marked improvements in serum glucose, serum insulin,
blood pressure, triglycerides, and requirements for oral hypoglycemics
and insulin injections.

In a follow-up study (2 - 3 years post discharge), serum glucose remain
unchanged (markedly improved) in subjects continuing to adhere to the
program. However, in subjects who abandoned the program, medications
had been re-started.

These data (published in first rate journals) have never been
challenged or refuted.

I've got to go home and make dinner (two daughters home from college).
I'm making Italian style fish in red sauce, al dente pasta, salad,
vegetable, hearty Italian bread, and non-fat milk for the girls; a
glass of wine plus the milk for me.

Tomorrow I'll tell you the fatal flaws behind the studies that have
been cited to challenge the notion that high carbohydrate diets can,
indeed, be healthy for people with Type II diabetes.

- Larry W

.

Relevant Pages

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