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Re: cancer and mortality, can we lower diabetes risk Too much?

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Posted 4/17/2019 7:38 PM (GMT 0)
An interesting study I just came upon. Bobbiesan has a current thread asking if we can lower LDL and triglycerides TOO much. I'm not sure of the answer, considering that both have functions in the body. I'd say the answer is probably yes, but how little is too little would still be a wide open question. I made the point there that when it comes to triglycerides, lower triglycerides(but not cholesterol, especially LDL) seem to go hand-in-hand with all the things that lower the risk of T2 diabetes and the insulin resistance and high blood levels of insulin which are a part of the very definition of type II diabetes. This thread is related to Bobbiesan's post and question, but I wanted to start a new thread so that others might be able to see the importance of the subject. And yes, this does relate to cancer and possibly even PC.

So here is a study of 208 folks that simply looked at people on the basis of their insulin resistance and then following them for about seven years and tallying up the various diseases and major health issues the group came down with. And then seeing if there was any difference between those in the lowest insulin resistance(IR) groups, the middle, and the highest. It appears that the groups were pretty well matched and all considered otherwise healthy at the start.
"To select apparently healthy individuals for this prospective study, the population to be evaluated was limited to volunteers recruited during the period from 1988–1995, who met the following criteria: more than 30 yr of age; body mass index (BMI) less than 30 kg/m2; no history of hypertension (HT), and blood pressure less than 145/90 mm Hg, normal physical examination and routine clinical chemistries, and a normal oral glucose tolerance test (OGTT) (14)...........................Measurements at baseline included weight, height, sitting blood pressure, and fasting lipid and lipoprotein concentrations (1). In addition, level of habitual physical activity was assessed by questionnaire based on reporting the number of activities per week that resulted in sweating (15)."

The primary difference in the pretty well matched groups was the amount of insulin resistance that was shown at the beginning of the study. They were looking for such as this at the end of the study: "The study endpoints were the development of HT(high BP), coronary heart disease (CHD), stroke, type 2 diabetes, or cancer. ......".

Now, here is a problem with the study. Even though they sought healthy volunteers, at base line, those with the greater IR already were less healthy. " The baseline clinical characteristics of the 3 groups are given in Table 1. Subjects in the highest SSPG tertile were older and had a higher BMI, diastolic blood pressure, plasma TG, total cholesterol, and low-density lipoprotein (LDL) cholesterol concentrations.".

Which, if IR is related to health, makes perfect sense. If you have higher IR, you would be expected to be less healthy. Then again if you are already less healthy, you would already be expected to do worse during the next seven years. So there's a bit of "Chicken or the egg" thing going on here. Still, the beginning differences–other than IR - we're not at all great, compared to the end results, which were huge in my opinion. Median age from lowest IR to highest was 48 vs 53. Smoking was 9% versus 11%. I say those were the biggest differences, and indeed as we get older there's a tendency for an increase in insulin resistance(IR), just like so many other or health outcomes. But again, not huge differences, maybe enough to account for somewhat poorer health outcomes. By the way, the numbers used for many of the lab and other measurements are in different units then what we are accustomed to and I'm not going to bother to try to translate them.

But, if you scroll down to figure 1 and look at the graph of incidents, the difference is almost overwhelming.
"Fig. 1 illustrates the number of clinical events in the 3 SSPG( IR ) tertiles. The most striking observation is that none of the 5 endpoints occurred in the most insulin-sensitive tertile. In marked contrast, 25 individuals in the most insulin-resistant tertile (36% of the group) had a total of 28 clinical events. Clinical endpoints were also observed in 12 individuals in the middle SSPG tertile, but it should be noted that only 1 individual in this group (1.4%) had CHD, compared with 6 of those in the most insulin-resistant tertile (8.6%). The rate of developing age-related diseases was significantly different in the 3 tertiles (P < 0.002). Deaths were also confined to the 2 most resistant tertiles, with 2 observed in the middle (infection and cancer), and 4 in the upper (2 cardiovascular and 2 cancer-related).".

28 to zero highest IR vs lowest IR. 12 to zero in the middle group. 4 deaths(highest IR) vs 2(middle) vs zero(lowest).

Finally, look down at table 5 where they try to adjust for all those other variables at the start of the study, such as higher age or BP, and how much they contributed to the results. "These results are seen in Table 5, and they again document the highly significant relationship between insulin resistance (SSPG concentration) and the aggregate of clinical events (P< 0.02), CHD +stroke (P < 0.02), and cancer (P < 0.05). It is also clear, from these data, that the impact of insulin resistance on all of these outcomes is independent of BMI.". Notice that looking at all of the various events as a group, age at base line made you 1.05 greater risk, BMI 1.13, activity .97, LDL no correlation( 1.0), and insulin resistance, 40. (FORTY)
"Discussion
This study was initiated to evaluate the hypothesis that insulin resistance would predict the development, over time, of clinical syndrome that might be best subsumed under the heading of age-related diseases (HT, CHD, stroke, cancer, and type 2 diabetes). Although the results provide substantial support for this point of view, perhaps the most striking finding was that none of these events were seen in the third of the population that was most insulin-sensitive. Given the fact that the period of observation ranged from 4–11 yr, with an average follow-up of 6.3 yr, the fact that not one clinical event took place in the insulin-sensitive tertile seems to be truly remarkable. If the ability of insulin sensitivity to decrease risk of developing age-related diseases can be confirmed in subsequent studies, the public health implications are enormous.".

Any one remember previous studies I posted that showed from 3 to 8 times worse PC for high IR and waist line vs lowest?

Is there any single health related thing we can do(including our fight against cancer and PC) that is as important as making sure we are not insulin resistant, hyperinsulemic, pre diabetes or diabetic? There were 9 folks that came down with cancer, including 3 PC brothers, but NONE in the lowest insulin group. What more can I say?



https://academic.oup.com/jcem/article/86/8/3574/2848584

Posted 4/18/2019 4:54 AM (GMT 0)
Just a quick summary in case all of that was too long and too much detail: 7 years later, the folks with the highest(worst) insulin resistance(usually obtained with higher carb eating) but otherwise healthy had 28 times more serious health events than did the lowest insulin resistance group. Actually more than 28 times, since the number of adverse events, which included prostate cancer, was zero in the lowest insulin group.

If you want your pancreas to make more insulin leading to more insulin resistance, easy, just eat more carbs and sugar.
Posted 4/18/2019 2:10 PM (GMT 0)
BB, thanks for the TLDR version in your second post, very helpful. As you know, I have high interest in many of the topics you are posting on, and the cliff notes help
Posted 4/18/2019 8:12 PM (GMT 0)

Pratoman said...
BB, thanks for the TLDR version in your second post, very helpful. As you know, I have high interest in many of the topics you are posting on, and the cliff notes help

You're welcome, Ken! I know I have a bad habit of beating points to death, rather than just caressing them! A failing of mine. But I would be amazed if many people did not find such results very interesting at the least. I mean, how strong do results have to be? At the very least some other researcher should be jumping on this to confirm or deny, IMO. But I'm OK without more confirmation. There is enough evidence for me, at least until some one flat out disproves the concept that blood insulin levels and IR are MAJOR players in the battle with multiple disease states. But I'm not holding my breath for the study that disproves this concept.
Posted 4/18/2019 9:43 PM (GMT 0)
Yeah I agree with you bb
Posted 4/20/2019 3:36 PM (GMT 0)
"Just a quick summary in case all of that was too long and too much detail: 7 years later, the folks with the highest(worst) insulin resistance(usually obtained with higher carb eating) but otherwise healthy had 28 times more serious health events than did the lowest insulin resistance group. Actually more than 28 times, since the number of adverse events, which included prostate cancer, was zero in the lowest insulin group. "

Maybe there is something wrong with me. As I find results such as this very fascinating, but so often they generate almost zero interest. Is it that people would just much rather be cut, radiated or drugged than deal with some dietary changes? Probably not, maybe it is just that people simply don't believe the results, and are more prone to believe the info that comes from their doctors and the drug companies and FDA? I guess I can understand that. And let's face it: our doctors - whether because they don't know about it, don't believe it, or are simply not interested, rarely ever mention such to us.

Heck, for that matter, most diabetes specialists don't at all push the dietary changes needed to reverse T2 diabetes, they simply prescribe drugs and then more drugs. Drugs that can actually finally (once it escalates to insulin or insulin boosting drugs) worsen the underlying condition that lead to the 28 to zero score in this study. They probably mention dietary change, watch the sugar, probably say "reduce the fat", but most don't really emphasize what you need to know: : "reduce carbs a lot, thus automatically reducing insulin and IR". Any pounding the table for that is pretty rare, I suspect.

But whether people believe such results or not ( and 28 to zero over 6 years is indeed a pretty staggering result, can any drug match such as that? ) , the results are consistent every time some one looks at this. I have earlier posted links showing between 3 and 8 to 1 for PC's relationship to IR(also generated very little interest). But while all cancers(and other health issues) were much worse in the highest and even middle insulin resistant groups vs the lowest, there was also PC specific relationship to this.

One person used to tell me that it had been proven that neither sugar nor insulin had anything to do with PC, because some studies with some drugs that suppressed insulin like growth factor(IGF-1, etc) showed no benefits. As if some drug that suppressed IGF-1 was actually the same thing as removing the root cause for high blood insulin and insulin resistance, which can easily be done without drugs and their unwanted SEs. But here once again, the relationship showed up for PC in this study. In the group of 208 (but only 98 males), there were 3 cases of PC, with ZERO cases in the lowest IR group. In fact, there were ZERO cases of anything in the lowest IR group, and even the middle group only had 12 events compared to 28 in the highest! The score was 9 to zero for cancers in the highest 2 groups vs the lowest

Even in the middle group, there was no stroke, no T2D, and almost no Coronary Heart Disease. Some, but much less than the highest IR group. ( see figure 1 in the link )
"Clinical endpoints (n = 40) were identified in 37 individuals of those evaluated, including 12 with HT, 9 with cancer, 7 with CHD, and 5 with type 2 diabetes, 3 of which also had high blood pressure, and 4 with stroke. The cancers were distributed as follows: 3 prostate , 2 gastric, 1 breast, 1 colon, 1 bladder, and 1 renal. There were six deaths reported: 2 cardiovascular, 3 cancer related, and 1 due to infection. Search through the State of California Death Registry was negative for those individuals lost to follow-up. It should be emphasized that the period of observation after baseline was 6.2± 0.2 yr, 6.3 ± 0.2 yr, and 6.5 ± 0.2 yr in tertile 1, 2, and 3, respectively."

It seems to me this( i.e. doing what we can to make sure we are not insulin resistant ) is more important than almost anything else we can do for our over all health and prostate cancer specifically. Do Y'all disagree?

Why do you think Metformin is supposed to be helpful in PC? It just so happens that Metformin reduces insulin resistance, what a coincidence! But Metformin can not match the ability of significantly lowering carbs to reduce insulin resistance. It can not match reducing or removing the root cause of the IR in the first place. In which case no Metformin, and certainly no insulin injection, is even needed.

Post Edited (BillyBob@388) : 4/20/2019 9:41:29 AM (GMT-6)

Posted 4/20/2019 3:52 PM (GMT 0)
I agree totally. Not only as it relates to PC, but to heart disease, obviously diabetes, and many many other ailments.
The challenge is putting this into practice without sacrificing quality of life, of which food is a big part for many people.
Posted 4/20/2019 5:53 PM (GMT 0)

Pratoman said...
I agree totally. Not only as it relates to PC, but to heart disease, obviously diabetes, and many many other ailments.
The challenge is putting this into practice without sacrificing quality of life, of which food is a big part for many people.

Yes. Same problem with the non meat approaches, for many of us. I love carbs, so staying away from the stuff- enough to be helpful- can be a real challenge.

To whoever might read this, I need to clear up something. I did not mean to say that I was surprised in a lack of interest in my threads and posts in general. I often get plenty of response, both pro, con and neutral. No doubt more than I deserve, particularly considering my long winded nature. But what surprises me is an apparent lack of interest in this subject: the probable effect of excess blood insulin levels on not only at least 1/2 dozen major health issues, but on cancer in general and yes, even PC specifically. It is beyond me how anything that consistently is implicated in many times ( from 3 to 8 or most recently 28 to zero, or 3 to zero in the case of PC) can generate so little interest.

I guess I must blame it on my long posts. But, I do highlight, in bold, the most important aspects or summaries so any one just skimming it can see those. But maybe people will not even skim a long post. Still, knowing of this problem, I think I have forced myself to just post a brief summary and a link in the past, but still very little interest expressed in
this subject. Which I find astounding, as I don't know of anything else in the ballpark for this vs multiple cancers or PC. The only thing I see in about the same class in a heavy smoker vs never smoker for lung cancer. And that appears to be about 24% vs .2%. https://www.verywellhealth.com/what-percentage-of-smokers-get-lung-cancer-2248868 The results for IR vs about everything, considering it was only over a 6 year period, are powerful indeed and should grab the attention of all of us.

Post Edited (BillyBob@388) : 4/20/2019 12:34:24 PM (GMT-6)

Posted 4/20/2019 7:59 PM (GMT 0)
I am very interested and have cut my carbs for the last few weeks.
Questions that I have would include:
1. If you eat low carb, does it matter the type of fat or protein you eat? In other words, is insulin resistance the culprit of bad things or does red meat and other animal fat also contribute to poor health (or has it received a bad reputation by mistake).
Cashless has attempted to be low carb and very healthy fat minimizing foods that are reportedly carcinogenic or inflammatory.
2. Does ultra-low fat in the long run, health or should be look at a more moderate approach?
3. Is insulin resistance the primary cause of heart disease or is the lipid model the better prognosticator.

Paul
Posted 4/20/2019 9:00 PM (GMT 0)

PDL17 said...
I am very interested and have cut my carbs for the last few weeks.
Questions that I have would include:
1. If you eat low carb, does it matter the type of fat or protein you eat? In other words, is insulin resistance the culprit of bad things or does red meat and other animal fat also contribute to poor health (or has it received a bad reputation by mistake).
Cashless has attempted to be low carb and very healthy fat minimizing foods that are reportedly carcinogenic or inflammatory.
2. Does ultra-low fat in the long run, health or should be look at a more moderate approach?
3. Is insulin resistance the primary cause of heart disease or is the lipid model the better prognosticator.

Paul

Paul, excellent questions indeed, and thanks for your comments. Quick answer: YES, it is the insulin resistance above all else like red meat. Long winded answer follows(sorry guys, I must present the evidence and it takes a bit)

Maybe I will try to break my response up into multiple posts, to avoid WAY too long posts.

"Questions that I have would include:
1. If you eat low carb, does it matter the type of fat or protein you eat? In other words, is insulin resistance the culprit of bad things or does red meat and other animal fat also contribute to poor health (or has it received a bad reputation by mistake).".
Well, that is certainly debatable depending on who you ask. For ex, you may recall posts I have done lately from a lady psychiatrist who I believe has eaten almost all meat for a couple of years. Because she became convinced that all of this cholesterol and fat phobia was causing rises in various neurological diseases like Alzheimer's. Partially because the brain and nervous system is mostly fat and cholesterol. She insists she has never been this healthy in her life as she has been since she made the switch. But who knows about her coronary arteries, right?

But bottom line for me, with the studies I have read and the personal experiences of me and several friends, the answer is YES, IR is THE culprit. It is the bottom line root cause of a multitude of ailments. Now, does that mean that red meat, or even possibly saturated fat, are not also a problem? It does not! But it has become my opinion that whatever major health issues we are dealing with, IR is the main driving culprit, and dealing with that will provide faster and more obvious benefits than getting rid of red meat(if indeed red or any other meat is a problem). And another thing is: some vegetarians and vegans, if they emphasize vegetables over bread/pasta, actually end up lowering their IR by way of less NET carbs. If pasta is replaced with lots of broc type foods, net carbs go down. Which makes me wonder: how much of the claimed benefits for vegans is actually just a reduction in IR from a reduction in NET carbs as well as calories?

I.E. if I go on a LCHF diet with plenty of meat, and my BP drops 30 points, would you say I now was likely over all more healthy with less risk of stroke and MI despite having increased my saturated fat and red meat? I would.

Or, how about if I also brought my TGLs down from > 200 to < 60, and brought my HDL up from 30 to 50? And reduced my blood sugar a bit? And dropped my waistline quite a bit? And all of that at the same time? Would you say I was probably lower risk for a lot of diseases despite the red meat and saturated fat? Well, I would, and these are results commonly seen no matter how much fat or red meat is eaten. Could results be improved even more by cutting the red meat? Or even finding a way to do it vegan style? Maybe. But rarely does anything have those kinds of results unless the IR is slashed because the net carbs are slashed. Slashing red meat alone and/or lowering saturated fat is unlikely to have those kinds of observable benefits.

Finally, what if I cured or improved my T2 diabetes, evidenced by a reduction or elimination of my diabetes meds as well as my measured insulin and IR levels? If I did this with plenty of meat, would you say I had improved my outlook for a lot of disease, knowing the outlook for diabetics? I would! So have a look at these studies, I won't quote them much here, already gone too long. But, these studies indicate "YES it's the insulin", even if there might be other factors. (Oh, and don't forget the OP. Those patients were strictly divided on the basis of their IR. Very likely, within all 3 groups, their was a variety of diets. But just based on the starting IR, the outcomes were vastly different)

EDIT: wrong link corrected:
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5865541/ "Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes.......The LCK participants experienced larger reductions in diabetes-related medication use; of participants who took sulfonylureas or dipeptidyl peptidase-4 inhibitors at baseline, 6/10 in the LCK group discontinued these medications compared with 0/6 in the MCCR group (p = .005). In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.".

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3981696/
"A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabetes...............At 3 months, mean HbA1c level was unchanged from baseline in the MCCR diet group, while it decreased 0.6% in the LCK group; there was a significant between group difference in HbA1c change favoring the LCK group (−0.6%, 95% CI, −1.1% to −0.03%, p = 0.04). Forty-four percent of the LCK group discontinued one or more diabetes medications, compared to 11% of the MCCR group (p = 0.03); ...................31% discontinued sulfonylureas in the LCK group, compared to 5% in the MCCR group (p = 0.05). "

Post Edited (BillyBob@388) : 4/20/2019 9:20:15 PM (GMT-6)

Posted 4/20/2019 9:38 PM (GMT 0)

PDL17 said...
.....................................
2. Does ultra-low fat in the long run, health or should be look at a more moderate approach?
3. Is insulin resistance the primary cause of heart disease or is the lipid model the better prognosticator.

Paul

re: Q2
If people are curing or significantly improving diabetes(as in the previously linked to studies from my last post) - by eating Low carb high fat vs low fat/moderate carb, including getting off of diabetic meds at a far higher rate, which would you say is the healthier long term approach? Eating low fat and keeping the diabetes and diabetic meds? Or eating more fat and no longer needing diabetes meds? Which category would you choose?
re Q3:
Without question IMO, the insulin is the more important factor by a good bit. For example, my doc wanted me on statins because my LDL and TCL were high, but he dropped the argument when the Calcium scoring test he wanted me to take came back at a perfect score( even for a 16 year old) of zero. So, question: if the lipids are all that good at predicting cardiac risk, how in the heck could mine be bad while I had a perfect Calcium scoring scan? The Calcium score far outweighs the lipid as a predictor.

But no matter, if you prefer the lipids, fine. By dropping your fasting insulin and IR(however you can do it, but lCHF certainly gets there, look at the details in the previous links), you will most likely slash your TGLs, raise your HDL, and possibly convert much of your LDL- which may increase slightly- to a protective type, rather than the riskier type. Plus, your BP will probably drop. Over all, an improvement in risk per lipids is seen.

But even if it's not seen, don't you figure that the 208 folks in the OP study had a variety of cholesterol readings? They did, and in fact, the lowest group had a median LDL cholesterol of (mm) 2.62 ± 0.08 vs 2.86 ± 0.1 for the middle and 2.91 for the highest IR. I don't know what units these are, but the high IR already has a higher LDL, by about 10% or so, right? And the high IR guy's HDL ran lower(as I would expect) by about 20%, HDL cholesterol (mm) 1.51 lowest IR, 1.38 ± 0.04 middle IR, 1.20 highest IR . But the difference in cardiac events 6 years later was an astounding 6 in the highest group, to about 2 or 3 in the middle group to ZERO in the lowest group. (see the graph in fig 1) Over all, about 9 to zero in favor of the low IR group.

So IR seems a better predictor to me, even if reducing IR did not also improve most lipids, which it does. Paul, what is your opinion? You are a pharmacist, right?

Post Edited (BillyBob@388) : 4/20/2019 10:05:26 PM (GMT-6)

Posted 4/21/2019 12:54 AM (GMT 0)
Billybob,

I'm not sure where I fall yet. I spent years training future pharmacists the traditional thought regarding causes of heart disease and metabolic syndrome. What I tend to believe now is that after "poisoning" ourselves with a very high carbohydrate-low fat diet, touted as healthy, has resulted in producing generations of type 2 diabetics. In patients that are already pre-diabetic, a low carbohydrate diet seems reasonable. However for patients not affected, I don't believe a drastic cut in carbs is necessary. The Zone type Diet 40-30-30 would probably prevent most people from developing insulin resistance particularly if lower glycemic carbs are recommended. In other words, I don't believe we need to switch to the Keto Diet for everybody (I would assume most would agree with this).
Diet seems to be a better way to manage an insulin resistant type 2 diabetic (those that still have functioning pancreases) than with drugs that make the matter worse (such as with sulfonylureas and insulin). Metformin and Glucagon-like peptide-1 receptor drugs reduce insulin resistance and can be used when diet alone does not work. I don't see a need to use drugs like Micronase or Amaryl anymore.

Good post Billybob. This is very important stuff. In my opinion.....much more important than vitamin D (said with respect and not sarcastically).

Paul
Posted 4/21/2019 3:16 AM (GMT 0)
Paul, thanks for your thoughts and comments. I was extra interested in your take what with you being a pharmacist, trained as I was(anesthesia/CRNA) in the traditional drug based approaches to most problems. I pretty much agree with all or most of your post. Although I highly suspect that the evidence(so far) points to vitamin D probably being pretty important, I agree that this is much more important. The more I ponder it, the more I become convinced that it is the most important factor which we can have some control over, rather before diagnoses with a dread disease, or even after while under going treatments and after treatments are done.

I also agree that for most of us, those not already pre diabetic or with T2D, metabolic syndrome, or morbidly obese, it does not take all that much, nor does it take full on keto, to deal with thus stuff, even to improve our prognosis with cancer. Something like the Zone(which I have done) will probably keep you protected. After all, in the OP study, even the middle IR group did significantly better than the highest group, and zero strokes or T2D, and very little CHD, 6 years later, significantly better than the highest IR group. And who even knows where the lowest group fell as far as ketosis goes, they probably were not even in ketosis and most were probably not even on very low carb diets. All we know is that, on a relative basis, they were in the lowest 3rd of IR, for whatever reason, compared to the other 2 groups.

BTW, I forgot to point it out in the last 2 studies that I linked to for diabetics vs different diets, although you probably noticed it in the titles: the comparison was NOT very low carb vs high carb, but rather "a medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet (MCCR) consistent with guidelines from the American Diabetes Association (n = 18) or a very low carbohydrate, high fat, non calorie-restricted diet whose goal was to induce nutritional ketosis ". So it was mod carb/low cal/low fat vs low carb/high fat.

Pretty much the same for both studies. Since the very low carb diet got significantly better results with these diabetic patients WHO WERE NOT EATING HIGH CARB, BUT ONLY MODERATE CARB, it makes me wonder what the results would have been comparing to a standard American high carb diet with 300-400 net gms of carb per day? The kind of diet many Americans are on before they get a bad diagnosis. Also, I posted the same link for both of those studies in my previous post, I am correcting that now. It was 2 different studies.

Post Edited (BillyBob@388) : 4/21/2019 4:19:40 PM (GMT-6)

Posted 4/21/2019 3:47 AM (GMT 0)
Earlier, regarding the 2 studies linked to a few posts back- I mentioned that, though they were able to reduce or eliminate diabetes meds (a probable sign of reduction of IR and over all health improvement) much better in the low carb diets vs the other, even though the other was already a moderate carb diet. For example, in the study titled "Twelve-month outcomes ............", both groups- being diabetics under treatment- both were already at fairly low carb intake compared to most Americans. From figure 1, at baseline, the low carb group averaged 176 gms carb vs 184 vs the moderate carb group. Already not really high.

After 12 months of intervention, the low carb group was at 76 gms/d(44 at 6 months) while the moderate carb group was at 150. So, 150 gms of carb is nowhere near 200-400+ gms consumed by many of us, but still there were significant improvements in most parameters by getting that down to between 44-76 gms. So how great do you suppose the improvements might have been if comparing to several hundred gms of carb, a more typical American diet?

Post Edited (BillyBob@388) : 4/21/2019 4:24:31 PM (GMT-6)

Posted 4/21/2019 4:21 PM (GMT 0)
I find it easier just to agree with BB - the man knows his s**t...
Posted 4/21/2019 6:23 PM (GMT 0)

InTheShop said...
I find it easier just to agree with BB - the man knows his s**t...

Ditto....with the caveat that on Easter Sunday, eat all the carbs you want. They don't count today!
Posted 4/21/2019 10:05 PM (GMT 0)

garyi said...

InTheShop said...
I find it easier just to agree with BB - the man knows his s**t...

Ditto....with the caveat that on Easter Sunday, eat all the carbs you want. They don't count today!


..........................................................................................................................................................................................
Kudos to you guys for simply taking the obviously easier path, the path of least resistance. ;) Anyway, folks who disagree with me might then have to read all of that voluminous s**t I post, to find exactly where I have gone mad, and that could take some serious time. So easier on every one to just agree with me.

And, I did participate in the Easter Sunday orgy of carbs, knowing they don't count on this day. At least I fasted until eating time at about 1:30PM, and took it easy yesterday. But I think I managed to over compensate in that one meal. There was a delicious and fairly carb rich meal followed by a large serving of strawberry shortcake. It was very tasty, and I was very full.

Post Edited (BillyBob@388) : 4/21/2019 4:26:33 PM (GMT-6)

Posted 4/22/2019 3:50 PM (GMT 0)
An interesting 2017 study. My quick summary of the summary I have copied below: fat OK or good, high carb bad:

"Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study....................................
Findings
During follow-up, we documented 5796 deaths and 4784 major cardiovascular disease events.

Higher carbohydrate intake was associated with an increased risk of total mortality (highest [quintile 5] vs lowest quintile [quintile 1] category, HR 1·28 [95% CI 1·12–1·46], p trend=0·0001) but not with the risk of cardiovascular disease or cardiovascular disease mortality.

Intake of total fat and each type of fat was associated with lower risk of total mortality (quintile 5 vs quintile 1, total fat: HR 0·77 [95% CI 0·67–0·87], p trend<0·0001; saturated fat, HR 0·86 [0·76–0·99], p trend=0·0088; monounsaturated fat: HR 0·81 [0·71–0·92], p trend<0·0001; and polyunsaturated fat: HR 0·80 [0·71–0·89], p trend<0·0001).

Higher saturated fat intake was associated with lower risk of stroke (quintile 5 vs quintile 1, HR 0·79 [95% CI 0·64–0·98], p trend=0·0498). Total fat and saturated and unsaturated fats were not significantly associated with risk of myocardial infarction or cardiovascular disease mortality.

Interpretation
High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality.

Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings. "
https://www.thelancet.com/journals/lancet/article/piis0140-6736(17)32252-3/fulltext
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