A newly published study (Food consumption and the actual statistics of cardiovascular diseases: an epidemiological comparison of 42 European countries).
The results of our study show that high-glycaemic carbohydrates or a high overall proportion of carbohydrates in the diet are the key ecological correlates of CVD risk. These findings strikingly contradict the traditional ‘saturated fat hypothesis’, but in reality, they are compatible with the evidence accumulated from observational studies that points to both high glycaemic index and high glycaemic load (the amount of consumed carbohydrates × their glycaemic index) as important triggers of CVDs (1, 32–34). The highest glycaemic indices (GI) out of all basic food sources can be found in potatoes and cereal products (Supplementary Table 2), which also have one of the highest food insulin indices (FII) that betray their ability to increase insulin levels.
The role of the high glycaemic index/load can be explained by the hypothesis linking CVD risk to inflammation resulting from the excessive spikes of blood glucose (‘post-prandial hyperglycaemia’) (35). Furthermore, multiple clinical trials have demonstrated that when compared with low-carbohydrate diets, a low-fat diet increases plasma triglyceride levels and decreases total cholesterol and HDL-cholesterol, which generally indicates a higher CVD risk (36, 37). Simultaneously, LDL-cholesterol decreases as well and the number of dense, small LDL particles increases at the expense of less dense, large LDL particles, which also indicates increased CVD risk (27). These findings are mirrored even in the present study because cereals and carbohydrates in general emerge as the strongest correlates of low cholesterol levels.
The Glycemic Index rates food based on their impact on blood glucose levels with white bread coming in at 100. In theory, a system like that sounds like a great deal for Diabetics who need to control their blood sugar levels. If you eat foods which produce smaller increases in your blood sugar you shouldn’t have the excursions into the highs that damage people. And that is true, but is it enough?
As often used, the Glycemic Index puts food into two categories – either good (Low GI), or bad (High GI). This GI chart breaks it into three categories:
In a sense, a Ketogenic diet is the ultimate form of a Low Glycemic index diet. Keto only has food that have very, very low Glycemic Index items. The diet eliminates all of the food on the chart including most Low GI foods. Of course the chart is way out of proportion with actual food usages. Jellybean candy has its own value listed. Some other items, like French Fries, occupy a huge portion of the American diet through fast food.
By way of comparison, Meat has a GI of 0, most nuts have a GI of 10 and vegetables which grow above ground have a GI of 20. You can’t beat that for Low GI.
But why not just eat the Low GI foods? Well, for diabetics they aren’t quite good enough. As the last study listed shows, they do help, but not nearly as well at getting people off T2D medications.
Which is better for T2D subjects, a ketogenic diet or a low glycemic index diet? Both are touted to help diabetics. The last study (on the previous post) showed a modest improvement in HbA1C using the Glycemic Index (about .5).
A 24-week study was done just to answer that question (The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus).
The study subjects were:
Eighty-four community volunteers with obesity and type 2 diabetes
The subjects were randomized and given:
either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID).
The goal of the study was to determine which group had the best HbA1C control. Once again, the Low Carb (Ketogenic) diet came out on top.
The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).
The Glycemic Index diet subjects had comparable results to the other study with an HbA1C drop of 0.5. More impressively around 50% more of the ketogenic dieters were able to reduce or eliminate diabetic medications.
I was eating a lot of chicken wings thinking they are Low Carb. And when it comes to carbs, they are. Well, sorta. Here is the nutritional information for chicken wings. Note they took away the skin which has fat.
A wing without skin has 43 calories where 24 of the calories come from Protein. 15 Calories come from Fat. That’s only 35% of calories from fat. Not LCHF at all. That’s LCHP, not the goal for a diabetic.
What happens with the Protein? Suppose you have 6 wings. That’s 36 grams of Protein. But half of that gets converted to Glucose. That’s 18 grams of carbs (equivalent).
Leaving the skin on helps quite a bit. It is the best part after all. Here’s the wing with the skin.
Fat is 5.4*9=48.6 calories from fat = 60%
Protein is 29.8 calories from protein = 37%
A half dozen whole wings is 44 grams of protein with the glucose equivalent of 22 grams of carbs. No wonder I used to need to pump under such a protein load. It wasn’t spread out like my carb load was. It would last around twice as long. But it still had a load for Insulin response.
The ADA site has an interesting study listed. The conclusions state:
No association was observed between glycemic index and SI, fasting insulin, AIR, disposition index, BMI, or waist circumference after adjustment for demographic characteristics or family history of diabetes, energy expenditure, and smoking.
This is a bit hard to accept but I have to question the results. How do they adjust for a family history of diabetes? I get the other categories but how does the American Diabetes Association (ADA) adjust for diabetes? Isn’t this what they are supposed to be figuring out?
Associations observed for digestible carbohydrates and glycemic load, respectively, with SI, insulin secretion, and adiposity (adjusted for demographics and main confounders) were entirely explained by energy intake.
This is true at least in part. The LCHF diet is most just LC and not so much HF. It’s easy to eat meats and miss the high fat sources. The end result of cutting out carbs is a lower energy intake than not dieting. Lower energy intake leads to lower body weights.
So this finding does in fact support a LC diet. It’s easier than counting calories.
Here’s the next interesting point:
In contrast, fiber was associated positively with SI and disposition index and inversely with fasting insulin, BMI, and waist circumference but not with AIR.
Fiber continues to look to be a good thing but if you are not eating a lot of plant roughage then you need to take it in supplement form. I think Dr Atkins recommended psyllium husk. But that would be another BLOG post…