Thursday, July 28, 2011

The 600 Calorie Diet for Type 2 Diabetes



A British research group reported the following a few weeks ago. I had hoped the results would be a brief news report which would shortly go the way of many similar reports and disappear again. I was wrong. Suddenly new people are appearing on every forum I am on. They are either enthusiastically trying this new "miracle" diet or seriously considering it.

First, please take a moment to read the article:

Diabetologia
DOI 10.1007/s00125-011-2204-7

Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol

E. L. Lim & K. G. Hollingsworth & B. S. Aribisala & M. J. Chen & J. C. Mathers & R. Taylor

It becomes obvious on reading the article that it does not seem to have occurred to the worthy researchers that their extreme low-calorie diet was also a moderate low-carb diet.

"After the baseline measurements, individuals with type 2 diabetes started the diet, which consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day."

Allowing for the variations in choices of non-starchy fresh veges that works out to be a little over 70gms carb, 50 gms protein and 15 gms fat daily. To me that is extremely low-fat and moderately low in carbs and protein - but also about half the level of 130 gms carb that too many food scientists continue to suggest will cause our brains to starve of energy. They don't appear to have mentioned cognition in the paper.

One has to wonder if their results would have been similar and the individuals healthier if they had simply reduced the carbs and left the fat and protein levels of the participants alone.

Instead, by concentrating on calories rather than a specific macronutrient such as fat, carbs or protein their research is interesting but hardly news. Gannon and Nuttall showed years ago that an iso-caloric diet can have very significant results for improved diabetes control when carbs are reduced and fat and protein increased; see their LoBAG series. This is the LoBAG30 paper. There is also a later paper on LoBAG20.

In short, the low-cal paper shows some promise but has too many confounders. Finally, can any type two reading this seriously consider eating 600 calories daily for the rest of their lives? You will find an excellent critique (as usual) of this nonsense on Jenny Ruhl's blog.

Even if it is only applied for a short period there are other dangers no-one has mentioned. An acquaintance of mine on alt.support.diabetes went on a similar starvation diet a few years ago and reported on progress on that newsgroup. A dramatic A1c drop ensued. So did a major eye damage problem. That is a known but thankfully rare danger. It can happen when there may be existing retinopathy (which the patient may be unaware of) and very sudden changes in blood glucose levels occur.

In brief, I have always counselled against extreme regimens in type 2 diabetes management, regardless of whether that extreme method involves diet, exercise, medications or anything else. I consider a 600kcal regimen very dangerous for any significant period of time and advise strongly against trying it. If you must try it, then only do so under strict, close medical supervision.

In my opinion a balanced regimen over a lifetime, refined by post-prandial testing and adjusted when required, is a better course to follow.

Cheers, Alan, T2, Australia

Everything in Moderation - Except Laughter.

4 comments:

Natalie said...

That study confirms my saying that there was no Type 2 or obesity in the concentration camps, although those people died of a lot of other things. It's ridiculous to think anyone could survive and be healthy on that low an intake for any long period of time -- a few weeks proves nothing.

Kate said...

Hi Alan, good post. I was searching for other type 2 bloggers and found you. I also wrote about this study on my blog and couldn't agree with you more! Extreme solutions aren't solutions at all. Smoke and mirrors....it's much better to maintain a healthy, well-balanced diet.

Diabetes said...

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trinkwasser said...

"One has to wonder if their results would have been similar and the individuals healthier if they had simply reduced the carbs and left the fat and protein levels of the participants alone."

Works for me! And for many others over many years. Tastier too!