Tag Archives: Diabetes

Diet, Gene Expression and Diseases

How Diet Affects Gene Expression

A new study from the Norwegian University of Science and Technology – Trondheim has mapped the way that diet affects gene expression. Gene expression is the “process where information from a gene’s DNA sequence is translated into a substance, like a protein, that is used in a cell’s structure or function.”

The study found that different types of foods cause different reactions in the cells themselves. Some of these reactions are considered good, and some are destructive, leading to increases in inflammation. As Dr. Steve Parker has noted, inflammation is thought to have a role in developing atherosclerosis (the cause of heart attacks and strokes), type 2 diabetes, and some cancers.

Bad News for Calories In/Calories Out

The idea that a “calorie is a calorie” and that the secret to losing weight and a healthy lifestyle is “eat less, move

How Calories Are Measured
A "bomb calorimeter" is used to determine the calories in food

more” assumes that all food is equal. The solution for a calorie counter is to simply induce a “calorie deficit” by burning more energy than you eat. When you have a calorie deficit of 3,500, you lose a pound of fat. This approach does work for some people, most notably young, healthy males, but rarely works as well for those in middle age. And women have an especially hard time losing weight this way.

As I noted in Eating Fat Does Not Make You Fat, it does matter what foods you eat. In that article we show that in every single test of a low carb vs. low fat diet, the low carb group has no calorie restriction. Yet they lose more weight, faster, than any other diet. The low fat diet proponents claim the low carb diet folks are “cheating” by spontaneously eating fewer calories.

This new study should put the final nail in the coffin for “calories in / calories out” mantra from a health perspective. It does matter what you eat, even more than how much you eat.

How The Study Was Conducted

The main study included 28 slightly overweight men and women who ate two different powdered diets. This type of controlled study on actual people, rather than a meta-analysis of statistics from other studies, shows actual cause-and-effect of the different diets for this group of men and women. A “cleansing period” of a week allowed the participants to eat normally between the diets. The researchers had the participants drink the liquid diet six times a day, with each participant’s caloric intake calculated to maintain their current weight.

The first powdered diet provided 65 percent of the calories from carbohydrates, 15 percent from protein and 20 percent from fat. For a 2,000 calorie diet, that’s 1,300 calories from 325 grams of carbohydrates, 300 calories from 75 grams of protein, and 400 calories from 44 grams of fat. That is very close to the USDA recommendations for a “well balanced diet”.

The second powdered diet  provided calories close to one-third carbohydrates, protein and fat. For our 2,000 calorie diet, that would translate into 667 calories for each macro-nutrient, with 167 grams each of carbohydrates and protein, and 74 grams of fat.

Blood tests were conducted before and after each diet period. All of the measurements of changes in gene expression were done so that each individual’s difference in gene expression was compared with that person alone. The results were then compiled.

Johnson says the studies resulted in two important findings. One is the positive effect of many meals throughout the day, and the details about the quality and composition of components in an optimal diet, including omega-3 and omega-6 fatty acids. The second is that a carbohydrate-rich diet, regardless of whether or not a person overeats, has consequences for genes that affect the lifestyle diseases, she says.

It’s important to remember that this is not a weight loss study, as the liquid diets were carefully measured to keep the participants at a steady weight. This prevents the temporary “bad effects” of weight loss from showing in the blood samples (those effects are explained clearly by Dr. Davis in his post about the alarm some dieters have after losing weight and seeing blood test results).

What the Study Found

For many health issues, there isn’t a single controlling gene. The researchers had to compare multiple genes to see how they reacted to the different diets. The article quotes professor of biology Berit Johansen:

“We are talking about collecting a huge amount of information,” says Johansen.

“And it’s not like there is a gene for inflammation, for example. So what we look for is whether there are any groups of genes that work overtime. In this study we saw that an entire group of genes that are involved in the development of inflammatory reactions in the body work overtime as a group.”

The lower carbohydrate diet not only reduced inflammation, but reduced activity of the genes associated with type 2 diabetes, cardiovascular disease, Alzheimer’s disease and some forms of cancer.

“It was interesting to see the reduction in genetic activity, but we were really happy to see which genes were involved. One set of genes is linked to cardiovascular disease. They were down-regulated in response to a balanced diet, as opposed to a carbohydrate-rich diet,” she says. Another gene that was significantly differently expressed by the diets that were tested was one that is commonly called “the youth gene” in the international research literature.

“We haven’t actually stumbled on the fountain of youth here,” Johansen laughs, “but we should take these results seriously. The important thing for us is, little by little, we are uncovering the mechanisms of disease progression for many of our major lifestyle-related disorders.”

Problems with the Article

The article shows that the idea of “calories in / calories out” is at best a simpleton’s approach to healthy eating, as it ignores the micro-nutrient composition of the foods we eat. It also provides direct evidence that the low fat diet is dangerous even though it is often prescribed as a way to reduce cardiovascular heart disease and presented as the “healthy alternative” to the standard American diet. But the good professor veers off the rails with some unsubstantiated advice:

The professor warns against being caught up in the fat trap. It’s simply not good to cut out carbs completely, she says. “The fat/protein trap is just as bad as the carbohydrate trap. It’s about the right balance, as always.”

She says we must also make sure to eat carbohydrates, proteins and fats in five to six smaller meals, not just for the main meal, at dinner.

“Eating several small and medium-sized meals throughout the day is important. Don’t skip breakfast and don’t skip dinner. One-third of every meal should be carbohydrates, one-third protein and one-third fat. That’s the recipe for keeping inflammatory and other disease-enhancing genes in check,” Johansen explains.

The problem with this portion of the article is that there is no evidence presented for her claim that a “balanced” intake of the three macro-nutrients is better than a lower carb variant. The study tested only a high carb / low fat diet against a lower carb diet. In order to make the claim above she would have to actually test the hypothesis that getting one-third is better than getting one-fifth of your calories from carbohydrates, as a typical 100 gram per day “maintenance level” low carb diet would provide. While there’s always the possibility that the professor has done such as study, and her statement is based on that prior study, I suspect she is “thinking linearly”. She really has no way to conclude that one-third carbohydrates is better than one-fifth carbohydrates until she tests it.

The study does provide direct evidence that the diet advice given to the American people by the USDA, that 65 percent of their calories should come from carbohydrates, is actually dangerous. Rather than reducing the risk for cardiovascular disease, type 2 diabetes, Alzheimer’s disease and some forms of cancer, the high carbohydrate diet “turns on” the genes associated with those chronic health problems.

The article also does not provide a citation for the idea that eating six times daily is better than three or four times (more frequent meals are usually recommended in higher carb diets to try and control the wild blood sugar spikes that occur). Many paleo / primal dieters find that eating “when hungry” leads them to fewer meals, often only two, in a typical day.

It Could Work

Even with my reservations, having someone adopt a true “balanced diet”, with one-third of their calories from carbohydrates, protein and fat, would undoubtedly lead to better health than the Standard American Diet. If the goal is to lose weight, reducing carbohydrates further, to 20 percent of total caloric intake, will usually result in slow, steady weight loss. To lose weight at the rate of 1 to 2 pounds per week, a true low carbohydrate diet, below 50 grams of carbs per day, will result in the best results for most people.

 

15 Months Later

15 months ago I weighed 247 pounds, took hydrochlorothiazide (HCZT) for high blood pressure, Prilosec OTC for GURD, and had triglycerides of 344. My BP was 140/96, my waist size was creeping up on 42″, my HDL cholesterol was 20 and my fasting glucose level was 103. I had more than three of the indicators of “metabolic syndrome” — in fact, I had them all — increasing my risk for heart disease, stroke and diabetes:

According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:

  • Blood pressure equal to or higher than 130/85 mmHg
  • Fasting blood sugar (glucose) equal to or higher than 100 mg/dL
  • Large waist circumference (length around the waist):
    o Men – 40 inches or more
    o Women – 35 inches or more
  • Low HDL cholesterol:
    o Men – under 40 mg/dL
    o Women – under 50 mg/dL
  • Triglycerides equal to or higher than 150 mg/dL

I wanted to avoid taking statins, a class of drug that has some side effects for some people. In my About page I have the course of action taken over a few years to try and get the situation under control. But nothing seemed to work until my doctor suggested I try reducing carbohydrates to see if I respond. I picked up Protein Power from the local bookstore, started the diet, and responded, very quickly. I then bought The Protein Power Lifeplan, the updated book, and found it a great help. (If you are only going to buy one, get Protein Power Life Plan).

Now, 15 months later, I have lost 44 pounds down to 203 (still 10 – 15 pounds overweight, but progress nonetheless). My size 36 pants are just starting to get a little loose, and I long ago abandoned the size 42, 40 and 38 size pants I wore over the past year and a half. I haven’t taken the HCZT for high blood pressure in over a year … today, it was 122 / 62 … and I stopped taking Prilosec OTC right after starting the diet. My triglycerides dropped first to 103 (from 344), then rose back to 143 as I have transitioned into the maintenance phase of the diet. My fasting glucose is now under 100, at 98. My HDL cholesterol, once at 20, is now 34, just 6 points shy of the desired 40.

My doctor is pleased, I am pleased, but more importantly, I feel great. The low carb way of eating is one I can tolerate long term, and plan to continue on this diet for the rest of my life.

Greate Diabetes Resource

Another great resource for those with type I or II diabetes, LADA diabetes or low carb dieters interested in the peer-reviewed research is created and maintained by Janet “Jenny” Ruhl at http://www.phlaunt.com, and is called “Blood Sugar 101.”

Jenny explains the reason the site exists:

After losing 30 pounds with a low carb diet, I have maintained that weight for many years. My current BMI is within the normal range for my height. At one point I exercised daily for a year and got my body fat down to 24%, which put me into the “Fitness” category for a woman my age. Despite what my doctors had told me, weight loss and intense fitness didn’t do a thing for my blood sugars, which got worse.

This raised my curiosity. I started tracking through the research articles available for free on the web. (many of them, now, alas, are no longer free, but I was lucky that I started my research back in 2004 when they were.)

The information I found, much of it differing dramatically from what doctors were telling patients about what caused diabetes and how it should be treated, became the kernel of this web site. My goal was to answer these questions: What do scientists actually know about Type 2 diabetes? Why do doctors miss diabetes diagnoses until long after people already have diabetic complications? And what blood sugar levels are truly low enough to prevent further damage to the organs and beta cells?

The site is a treasure trove of information. While Low Carb Age attempts to provide the latest news chronicling the end of the low fat craze, Jenny’s site provides a wide and expansive view of the research spanning back decades. Under the general heading of blood sugar control, Jenny ventures into nearly every area a low carb dieter is concerned about. The site is extensive enough to have been put out in book format:



Jenny maintains a blog also at Diabetes Update where new information is presented.

Both the blog and the Blood Sugar 101 website are highly recommended.

Preventable, yet “Encouraged”

Stunning statistics from a study published in the December issue of Diabetes Care, as reported by Health Day News:

The number of people with diabetes in the United States is expected to double over the next 25 years, a new study predicts.

That would bring the total by 2034 to about 44.1 million people with the disease, up from 23.7 million today.

At the same time, the cost of treating people with diabetes will triple, the study also warns, rising from an estimated $113 billion in 2009 to $336 billion in 2034.

The increase is from adult onset, or type II diabetes. Health Day attributes the increase to obesity:

Factors driving the increase in diabetes cases include the aging population and continued high rates of obesity, both of which are risk factors for type 2 diabetes, in which the body does not produce enough insulin or the cells don’t use it correctly. In the study, the researchers assumed that the obesity rate would remain relatively stable, topping out at about 30 percent in the next decade and then declining slightly to about 27 percent in 2033.

The problem is that the official stance towards this problem has little hope of solving the underlying issue: our addiction to carbohydrates. While the general consensus is that people would not be diabetic if they lost weight, telling people to lose weight has proven to be a dismal failure. The reason is that very few people will starve themselves voluntarily.

The standard American diet is one rich in refined, processed foods (i.e., carbs). The “optimum” diet recommended by nutritionists is one that is low in dietary fat and eschews refined, processed foods in favor of “complex carbohydrates, such as whole grains, cereal, rice, pasta, potatoes, dry beans, carrots and corn”, with calorie reduction necessary to lose weight. It doesn’t work because you are always hungry on that diet.

Hungry people eat. And if they eat “complex carbs” that are “low in fat” they never feel sated, and will never stop eating.

Try this experiment … go to the sugar bowl and spoon out a scoop of sugar onto the counter. Then another. And another. Keep going, and when you have 22 spoonfuls of sugar on the counter, you have the average American’s intake of sugar. But what if you cut out all the added sugar found in soft drinks, cookies, candy and other snacks (even low fat ones)?

If you follow the various guidelines by the USDA, American Heart Association, et. al., you’ll limit fat to 20% of your dietary intake, and get adequate protein, making up the rest of your diet with those complex carbohydrates. Let’s take an example of a 2,000 calorie diet, and see how that works out in grams of each micro nutrient:

  • Fat, 44g at 9 calories each = 20% of calories
  • Protein, 100g at 4 calories each = 20% of calories
  • Carbohydrates, 300g at 4 calories each = 60% of calories

Carbohydrates turn to sugar (glucose) in your gut in a very short time, within 2 to 4 hours. Even “complex carbs” turn to sugar.

Spoon out another 75 teaspoons of sugar onto your counter. That is the amount you are asking your body to metabolize when you eat 300g of carbohydrates per day.

Here’s a layman’s explanation of what is happening: The body needs sugar to run, but if it can’t use it in a very short time, it is stored as fat. Blood sugar spikes in 2 to 4 hours after eating carbs, and the body reacts by releasing insulin to drive the sugar into the cells so they can use it for energy. If the cells have enough, they refuse insulin’s prompting, and the sugar is stored as fat. As you abuse this system by overloading it with sugar, the cells become more and more resistant to insulin, and the body sends out more and more. When the sugar is pushed into fat cells, your blood sugar level drops, and hunger returns even though you ate only a few hours ago. So you eat again, and start the process all over again (if you eat a diet “rich in complex carbohydrates”). Sound familiar?

The emphasis on low fat, high carbohydrate diets has caused our expanding waistlines, and emphasizing that people should continue to eat this way but reduce calorie intake is counter intuitive. Survival depends on getting enough to eat, and your body will betray you if it thinks it is starving.

A better approach is to limit carbohydrates to about 1/3 of all calories if you are at your goal weight and otherwise healthy. For a 2,000 calorie diet, that’s about 167 grams of carbs. The rest of your calories can come from fat and protein. It is best to calculate your minimum protein requirement, usually calculated at about a half gram per pound of lean body weight. “Lean body weight” is your weight minus your fat (take your body fat percentage times your weight, and deduct that from your total weight to get your “lean body weight”). The book The Protein Power Lifeplan has this approach as a “maintenance diet”, and people can tolerate it for life … because you don’t get hungry.

And if you need to get to your goal weight, the first phase of the diet can help you do that without getting hungry. You can short-circuit the vicious cycle of carb intake, insulin response, fat storage and premature hunger by eating a diet that is tuned to your needs.

Dieting for Risk Factors

With the usual caveat that I am not a medical professional, I want to propose an idea for your consideration. I would encourage you to discuss this idea with your doctor before embarking on any diet plan.

I think it makes sense to first identify your individual risk factors for the things that kill us. The Centers for Disease Control (CDC) publishes charts showing the leading causes of death for men and for women. Looking at the charts you see that heart disease is the leading cause of death at about 27% of all deaths. We tend to focus on those stats and work to minimize our chances of dying from heart disease. That’s certainly the approach taken on a society-wide level with the low-fat diet recommendations (the low fat diet is thought to reduce serum cholesterol levels leading to less heart disease, although many of us find that it increases cholesterol instead.) What I think we are ignoring is that our individual risk factors may be for something entirely different. Remember, that heart disease is not the cause of death for a majority of the people … 73% of them, in fact. Are we increasing our risk of dying early by trying to reduce our risk for heart disease?

The American Heart Association (AHA) identifies the risk factors for heart disease in two categories, those you can change and those you cannot. The categories are a mistake, in my view. It is the risk factors you cannot change that may be the most susceptible to changes in diet: age, sex and heredity. 83% of the deaths due to heart disease happen after age 65, so time is on your side if you are younger than that. Males are more susceptible to heart disease, and have a higher incidence of dying younger than that age 65 statistic. And family history, including race, plays a factor.

The factors you “can change”, according to the AHA, are things like tobacco use, obesity, high blood pressure, serum cholesterol levels, activity levels, and diabetes.

The standard treatment to reduce risk factors for heart disease is a low fat, relatively high carbohydrate diet and prescription drugs to lower cholesterol. The prescription drugs are necessary because many people find a low fat, high carbohydrate diet raises cholesterol (especially triglycerides). Low carb diet advocates challenge this view, and note that many people find a low carb diet improves their lipid profile without the use of prescription drugs (as well as improving weight, high blood pressure and other factors).

The problem is that there is no easy way to score these factors. Do you check off each factor, and if you have more than three, start to worry? Or is family history such an important factor that it, by itself, compels you to work to reduce your risk? Certainly, if your parents and all your siblings died of heart attacks, you probably realize it “runs in your family.” But for most of us, even getting the full list of risk factors isn’t enough to tell us if we, personally, are at risk.

The place to start is a doctor who knows your medical history. Ask him point blank: what do you think I’m going to die from? The answer will be about risk factors for the diseases on those CDC charts, and which one your history indicates the greatest risk for you. Heart disease and cancer are at the top, by a large margin. But as you read down the list, you see stroke, respiratory disease, and diabetes.

Its interesting that diabetes is a risk factor for heart disease, and diabetes itself is the 6th leading cause of death.

My largest risk factor, given my family history and age, sex and physical condition is diabetes. Several people in my family, a brother and my mother, have adult-onset diabetes. I’m male, over 50, and have more than two of the markers for “metabolic syndrome” (pdf file from CDC on metabolic syndrome). In contrast to that, I have very little heart disease in my immediate family.

My doctor recommended a low carb diet to reduce my high triglyceride level; success is shown by lowering triglycerides from 462 to 113 on my last blood test. I’m staying on it to lower my weight and blood glucose level, as well as meet the other cholesterol goals (HDL, LDL, etc., as shown on the About Page).

The term “diet” is often associated with a reduced calorie, temporary eating regimen that you abandon after reaching a weight goal. The problem with this approach is that it ignores the very real impact your diet has on your health. The real goal should be to live longer, not simply to lose weight and “look good”. A pretty corpse is still dead.

Your diet should reflect the best bet to protect against your individual risk factors, and not to fulfill a broad societal goal.

Site Updates

We added a Heart Disease research page, linking in an important recent study showing low carb eating providing significant benefits.

And a new article has been added to our Diabetes research page.

I evaluated and added three new links. These links are to sites I think provide high quality information. I try to avoid the overly commercial sites hawking their own goods with little additional content. You’ll find these sites updated frequently with interesting content.

First, a medical blog, Dr Biffa. Dr. Biffa is a British physician with an active practice where the low carb lifestyle is actively promoted.

Next up, the blog for the movie Fat Head. That may seem like an unusual choice, but writer/comedian Tom Naughton brings both humor and clear writing to the subject, a great combination.

Finally, Laura Dolson’s resource rich About.com Low Carb Diets site. There is a blog there that is frequently updated, but Laura also provides recipes, links to articles, a low carb glossary, and more.

Diabetes and Low Carb Success

There are several studies showing superior results obtained with low carb diets over other approaches for patients with type II diabetes (see our new Diabetes Page for references). Dr. William Davis on The Heart Scan Blog notes success he sees with his patients:

This is precisely what I see in practice: Elimination of wheat and sugars yields dramatic effects on basic lipids, especially reductions in triglycerides of up to several hundred milligrams, increased HDL, reduced LDL.

Beneath the surface, the effects are even more dramatic: reductions or elimination of small LDL particles, reduction or elimination of triglyceride-containing lipoproteins, elimination of the marker for abnormal post-prandial (after-eating) lipoproteins, IDL, reduced c-reactive protein. Add weight loss from abdominal fat stores and reduced blood pressure.

But some patients experience rising blood sugar levels no matter what they do. And its possible that they have been misdiagnosed and are part of what may be a hidden epidemic affecting up to 10% of the people diagnosed with type II diabetes. Jenny at Diabetes Update Blog describes several emails she has received lately:

They have blood sugars that continue to climb no matter what they eat. They ask me why when they eat no carbs at all their blood sugars are still over 140 mg/dl hours after a meal.

They are on all the oral drugs and sometimes even Byetta, but their blood sugars still go into the 300s.

Some have histories of Gestational Diabetes that came on when they were thin. Some gained a lot of weight very recently but were normal weight before that.

All have relatives with diabetes. Some have relatives with Type 1 diabetes. Most have relatives with other autoimmune disease.

And all of them, it turns out, though diagnosed with Type 2 diabetes and given the miserably ineffectual medical treatment doctors give people with Type 2, turn out to have LADA.

I have included a section for LADA in our Diabetes Research Page. Its certainly worth talking to your doctor about if you are one of the few who cannot lower blood sugar by restricting carbs.