Diets and Denominators

News non-flash: comparison of various diets (low carb/Atkins, low carb + low fat/South Beach, low calorie/Weight Watchers, and whatever-the-hell-the-Zone-diet is/protein-carb ratio) shows no difference in long term outcomes, defined as sustained weight loss, with the attendant presumed decrease in cardiovascular risk factors and events. Sorry; no great surprise here. But I think it’s because nutrition research has a huge blind spot: not adequately controlling for type 2 diabetes/metabolic syndrome. Let me explain. I have a hypothesis that people with the inborn error of metabolism (insulin resistance) that in the setting of dietary carb overload and low levels of physical activity result in overt glucose intolerance and, eventually, diabetes, respond better to low-carb diets than people born with normal carbohydrate metabolism. By not carefully screening them out in the research, negative results are meaningless. Current definitions of diabetes, “pre-diabetes”, metabolic syndrome, and so on center on blood sugar levels in both the short term (fingerstick glucose measurements) and long term (the 3-month horizon afforded by the hemoglobin A1c). The problem with this is that the increased cardiovascular risks from these conditions appear to manifest independently of actual blood sugar levels. Witness the disappointing results of studies of so-called “tight control”: modest reduction in microvascular disease (kidney failure and retinopathy) but no ...
Source: Musings of a Dinosaur - Category: Primary Care Authors: Tags: Medical Source Type: blogs