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.
    Full-text · Article · Feb 2012 · Cholesterol
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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.
    Full-text · Article · Feb 2008 · Nutrition & Metabolism
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    ABSTRACT: In 2000, India revoked the ban on production and sale of non-iodised salt. We conducted a study in the north 24 parganas district in the state of West Bengal to assess the prevalence of goitre, status of urinary iodine excretion (UIE) level and to estimate iodine content of salts at the household level. We surveyed 363 school children aged eight to ten years selected using a multistage cluster sampling technique. We estimated goitre prevalence and urinary iodine excretion (UIE) using methods and criteria recommended by the World Health Organization. We estimated the iodine content of salt samples collected from the households of the study subjects using spot iodine testing kit. Of the 363 children, 73 (20%) had goitre. The median UIE was 160 □g/l (normal: ≥ 100 □g/l) and only 6% children had a level below 50 μg/l. Only 253 of 363 salt samples (70%) were sufficiently iodised. The combination of high goitre prevalence with normal median urinary excretion indicates that the North 24 Parganas district is in transition from iodine deficient to iodine sufficient state. However, the persistence of non-iodised salt consumption indicates that an intensification of universal salt iodisation program is needed.
    Full-text · Article · Dec 2006 · Asia Pacific Journal of Clinical Nutrition
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