Dietary Treatment of Diabetes Mellitus in the Pre-Insulin Era (1914-1922)

Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27705, USA.
Perspectives in biology and medicine (Impact Factor: 0.48). 02/2006; 49(1):77-83. DOI: 10.1353/pbm.2006.0017
Source: PubMed


Before the discovery of insulin, one of the most common dietary treatments of diabetes mellitus was a high-fat, low-carbohydrate diet. A review of Frederick M. Allen's case histories shows that a 70% fat, 8% carbohydrate diet could eliminate glycosuria among hospitalized patients. A reconsideration of the role of the high-fat, low-carbohydrate diet for the treatment of diabetes mellitus is in order.

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    • "Food politics always had a great influence on dietary recommendations. It is noteworthy that before LFHC diets became popular, carbohydrates had been blamed for decades as the main culprit for diabetes, obesity, and coronary heart disease (CHD) [19]. High-quality evidence from meta-analyses of controlled nutrition intervention studies [20] [21] has now contradicted the traditional assumption that LFHC diets are the best recommendation to improve blood lipids. "
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    ABSTRACT: THE CHARACTERISTICS OF PATIENTS WITH CVD HAVE CHANGED: whereas smoking prevalence declines, obesity and metabolic syndrome are on the rise. Unfortunately, the traditional low-fat diet for the prevention of cardiovascular disease (CVD) still seems to be the "mainstream knowledge" despite contradicting evidence. But lowering LDL-cholesterol by the wrong diet even may be counterproductive, if sd-LDL is raised and HDL is lowered. New insights into the pathophysiology of insulin resistance and its influence on the effects of dietary changes have led to a better approach: (1) the higher a patient's insulin resistance, the more important is the glycemic load of the diet. (2) Fat quality is much more important than fat quantity. (3) The best principle for a reduced calorie intake is not fat counting, but a high volume diet with low energy density, which means fibre rich vegetables and fruits. (4) And finally, satiation and palatability of a diet is very important: there is no success without the patient's compliance. Thus, the best approach to the dietary prevention of CVD is a Mediterranean style low-carb diet represented in the LOGI pyramid. Dietary guidelines for the prevention of CVD should to be revised accordingly.
    Cholesterol 02/2012; 2012(1):367898. DOI:10.1155/2012/367898
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    • "Type 2 diabetes reflects a disturbance in the glucose-insulin axis of metabolism and has insulin resistance as a defining feature. As such, it is expected that carbohydrate restriction would be the first line of attack and, in one form or another, this was the primary approach before the discovery of insulin [1]. In addition, at least anecdotally, some degree of carbohydrate reduction is a component of much clinical treatment. "
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    ABSTRACT: Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of obese patients with type 2 diabetes. We previously reported that a 20% carbohydrate diet was significantly superior to a 55-60% carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months. The present study documents the degree to which these changes were preserved in the low-carbohydrate group after 44 months observation time, without close follow-up. In addition, we assessed the performance of the two thirds of control patients from the high-carbohydrate diet group that had changed to a low-carbohydrate diet after the initial 6 month observation period. We report cardiovascular outcome for the low-carbohydrate group as well as the control patients who did not change to a low-carbohydrate diet. Retrospective follow-up of previously studied subjects on a low carbohydrate diet. The mean bodyweight at the start of the initial study was 100.6 +/- 14.7 kg. At six months it was 89.2 +/- 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 +/- 4.2 kg to an average of 92.0 +/- 14.0 kg. At 44 months average weight has increased from baseline g to 93.1 +/- 14.5 kg. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower weight at 44 months than at start. The initial mean HbA1c was 8.0 +/- 1.5%. After 6, 12 and 22 months, HbA1c was 6.1 +/- 1.0%, 7.0 +/- 1.3% and 6.9 +/- 1.1% respectively. After 44 months mean HbA1c is 6.8 +/- 1.3%.Of the 23 patients who have used a low-carbohydrate diet and for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have suffered several cardiovascular events. Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control.
    Nutrition & Metabolism 02/2008; 5(1):14. DOI:10.1186/1743-7075-5-14 · 3.26 Impact Factor
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    ABSTRACT: Selenium has important roles as an antioxidant, in thyroid hormone metabolism, redox reactions, reproduction and immune function, but information on the selenium status of Thai children is limited. We have assessed the selenium status of 515 northeast Thai children (259 males; 256 females) aged 6 to 13 years from 10 rural schools in Ubon Ratchthani province. Serum selenium (n=515) was analyzed by Graphite Furnace Atomic Absorption Spectrophotometry and dietary selenium intake by Hydride Generation Absorption Spectrophotometry from one-day duplicate diet composites, from 80 (40 females; 40 males) randomly selected children. Inter-relationships between serum selenium and selenium intakes, and other biochemical micronutrient indices were also examined. Mean (SD) serum selenium was 1.46 (0.24) micro mol/L. Concentrations were not affected by infection or haemoglobinopathies, but were dependent on school (P< 0.001), sex (P=0.038), and age group (P=0.003), with serum zinc as a significant covariate. None of the children had serum selenium concentrations indicative of clinical selenium deficiency (i.e. <0.1 micro mol/L). Significant correlations existed between serum selenium and serum zinc (r= 0.216; P < 0.001), serum retinol (r = 0.273; P < 0.001), urinary iodine (r = -0.110; P = 0.014), haemoglobin (r = 0.298; P <0.001), and haematocrit (r = 0.303; P< 0.001). Mean (SD) dietary selenium intake was 46 (22) micro g/d. Children with low serum selenium concentrations had a lower mean selenium intake than those with high serum selenium concentrations (38 +/- 17 vs.51 +/- 24 micro g/d; P< 0.010). In conclusion, there appears to be no risk of selenium deficiency among these northeast Thai children.
    Asia Pacific Journal of Clinical Nutrition 12/2006; 15(4):474-81. · 1.70 Impact Factor
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