Saturday, December 08, 2012

How Changing One Government Dietary Recommendation Could Greatly Reduce Healthcare Costs.

Those who know me know I am a little bit of a low-carb fanatic.  Off and on anyway.  I like cupcakes as much as the next person, but, periodically, I go on a low carb diet and, most of the time, I limit the amount of carbs that I eat.  I treat french fries, cupcakes and pasta the same-- they are all occasional treats not dietary staples for me.  I eat a low carb bread (Sara Lee's Delite ful brand that has about 5 carbs per slice) and have bacon and eggs for breakfast, not cereal.

The evidence is accumulating that for a person like me, who most likely has an inherited predisposition toward diabetes (both parents, older sister and cousin are diabetic), a low carb diet is the best way to prevent the onset of diabetes. I worry about diabetes enough that I bought my own glucose testing kit just so I wouldn't have to go to the doctor all the time to find out what my blood glucose is.  They are not necessarily expensive-- Walmart sells its cheapest one for less than twenty dollars.  So far so good for me.  My last Ha1c test was 4.5 which is, to quote my physician, stellar.  Harvard Researchers recommend lowering the glycemic index of your diet to help prevent or postpone diabetes.  Clinicians say, simply, your choice is medicine or lay off the carbs.  If you reduce your blood sugar levels you can prevent the onset of type 2 diabetes. Type 2 diabetes is also called adult onset diabetes.  It is a different disease from type 1 diabetes.  In type 1 diabetes your body doesn't make enough insulin to handle the carbs that you eat.  In type 2 diabetes your body manufactures plenty of insulin, but your cells, over time, develop a resistance to the insulin and don't use it properly.  The second type of diabetes can be prevented by keeping both your blood sugars and your insulin low.  When your body is functioning properly, it generates large amounts of insulin whenever you eat refined carbs and sweets.  That insulin can, over time, do damage to your organs just as the sugar in your blood can cause damage to your organs.  That accounts for the horrible diabetes related problems: kidney disease, heart disease, blindness and peripheral neuropathy which eventually cuts off circulation to your extremities.

After decades of recommending low fat diets to diabetics based on very questionable science, researchers have begun to perform clinical studies of the effect of diets on blood sugar for people who are pre diabetic or diabetic and not being treated with medication.  The results are stunning.  Even short term low carb diets reduce blood sugar very significantly.  Weight loss is also much greater, even while consuming the same number of calories, for people with metabolic syndrome who follow low carb vs. low fat diets.

Clinical trials where subjects are matched and one group follows one diet and one follows a comparison diet are the gold standard in scientific research for diets.   This study, published in the American Diabetes Association Journal shows that over a fairly short period the blood glucose for subjects following a diet with 20 percent carbohydrate (about 100 grams per day if you are eating a 2000 calorie diet, more if you are eating more), was dramatically lower than the blood glucose of those who followed a low fat diet.  119 vs, 198,  For those of us who follow these things, neither of those readings are terrific but 119 is a lot better than 198.  It is close to normal.

If clinical trials comparing like subjects are the gold standard, this study, performed with people in the clinic so that actual consumption of food could be closely monitored, is the platinum standard. It was performed in hospital so that energy expenditure and food consumption could be closely monitored.
It shows that women whose carbohydrate consumption was controlled, but who were allowed to eat as much protein and fat as they wanted, spontaneously ate less.  This is a claim made for low carb diets by both Atkins, and other proponents like Drs, Mary and Dan Eades who offer the Protein Power diet.  Put simply, the study concluded that people who have metabolic syndrome will be less hungry if they eat fewer carbohydrates, will eat less and will lose more weight simply because they are less hungry.

This study, sponsored by Jenny Craig, shows that low carb diets are more effective in achieving weight loss as well as helpful in reducing  insulin resistance (a precursor of diabetes).  I should note for the conspiracy theorists that Jenny Craig sells pre-packaged foods to help attain weight loss.  They have no investment in either low fat or low carb.  Their investment is in selling a combined counseling and weight loss program that actually works.  Doubtless, their research was designed to find out which approach was more likely to be effective so that they could incorporate it in their products.

There are many more studies than I have listed.  The three I have listed are more recent and closer to the gold standard of clinical trials than other studies so I cited them.  To be more specific, they came up on the first page of a google search and were from reputable sources.

If you look on the labels of many packaged foods that you buy, you will discover that the USDA (your government) recommends that 60 percent of your diet should consist of carbohydrates.  These studies show that such a diet, for people predisposed to diabetes or with diabetes, is not good for them.  Their blood sugar and all their other diabetes related measurements are better on a diet which is 20 percent carbohydrates.  Rather than consuming 300 grams of carbs a day, as recommended by USDA, if you are pre-diabetic, or have insulin resistance (which is probably the case if you are overweight) you should be limiting your carbs to 100 grams and making up the rest with proteins and fats.

And what would be the consequence if a significant percentage of the diabetes prone population would change their dietary habits in this fashion?  According to this congressional study, about 32% of Medicare expenditures are related to treatment of diabetes and the consequences of diabetes.  While the figure is a smaller percentage for the overall population it is still very high, about 10 percent of health care dollars for treatment of diabetes and another significant percentage for treatment of diabetes related illnesses.  Getting people to just change their diets could reduce medicare expenditures by  10 or 20 percent.

Can the government change people's behavior?  Yes, if the science supports it.  Tobacco use has dropped dramatically since the government and medical leaders began talking about the harm that smoking does to health.  More and more the science supports the recommendation that people who have diabetes or who are prone to diabetes should limit their carbs.  100 grams of carbs a day is, by the way, not all that low.  Protein Power recommends a maximum of 50 grams a day and Atkins starts you off with 20 grams a day.  100 grams a day would allow you to have 2 glasses of milk (26 grams) a small orange and an apple ( about 40  grams) and a couple of slices of bread or a small baked potato.  The rest of your diet would be fish, meat, eggs, leafy green vegetables, lower carb fruit (strawberries are very low in carbs) and nuts.  (Peanut butter without sugar added is pretty low in carbs).

People who call themselves nutritionists sometimes are adamantly opposed to low carb diets.  The new school lunch guidelines, supposedly designed to reduce obesity and the early onset of type 2 diabetes, advocate a diet that the research I cited above, is likely to CAUSE obesity and high blood sugars.  This is what happens when the self designated experts capture an agency.   Some of these zealots are people who advocate vegetarian eating almost like a religion, in the face of the substantial evident cited above and in other journals. For them, it is not so much that they are pro-carbs as it is that that is what you eat if you eschew animal based food. You can follow a low carb diet if you are a vegan.  It's just very difficult and consists of a lot of tofu and tempi.    Some may simply be in the pay of industrial giants like Kellogg, Archer Daniel Midlands, and General Mills.  The natural result of the widespread adoption of low carb diets by the diabetes prone would be a reduced consumption of grains and starchy vegetables.  Since I doubt that the potato farmers have a huge lobby, I am going to finger Archer Daniel Midlands and the cereal producers as the lobbyists who support the present dietary guidelines.   I don't have a lot of data to back it up, I admit.

If you are among the diabetes prone, you don't have to wait for the government to act.  Following a limited  carb diet will make you feel better fairly quickly and will reduce the chance that you will develop diabetes.  I want to point out for those of you who eat a high carb diet and have normal weight and blood sugars, that I am not advocating a low carb diet for everyone.  The evidence is strong that different people process carbohydrates differently and that diabetes is a genetically linked disease related to the processing of carbohydrates.  It just appears that a lot of us have that condition and should be aware of it and respond appropriately.

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