ATTN Larry W: Unexpected onset of Diabetes

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Quoted message said:

I have taken the last week off from my usual triathlon training due to the flu and these blood
sugar problems, but I would like to remain competitive if possible, or at least active enough to
remain in good health. This is another area where the low carb diet is causing problems. I know
that I'll need to eat some carbs before, after, or during training, it's just a question of how
much and when. I certainly do not want to get into a situation where a flat tire on a bike could
cause me to go into blood sugar shock because I've carb-loaded a few minutes before the ride.

Ethan Turner

Ethan, I don't have type II Diabetes, but I have been on the Atkins diet for 8 weeks now and have
lost 20 pounds. I have never had the problems you are reporting as being due to eating low carbs. I
have been riding swimming and riding bikes---yesterday it was 32 miles out in the hot Texas sun.
Last Saturday, I rode 42.52 miles (with two 30 mile rides during the week) and the Saturday before
that, 50 miles (with two 30 mile rides during the week). There were absolutely no ill effects from
being in ketosis. I suggest that something else is going on which you are blaming on "low carbs" or
maybe just the entire syndrome you are in is to blame. I don't know for sure, but I can tell you
that just eating low carbs has not caused me any problems. I rarely even get hunger pains, and I
haven't "bonked" or "hit the wall" either. I am not eating ANY carbs during training, so that is not
a necessity to perform well. A friend of mine has been on the Atkins diet for 9 weeks now, and he
has lost 25 pounds. His morning blood sugar (he is type II ) has been 94 or 97---never over 100
since he started the diet. He spends his lunch hour speed walking without any problems.

I am hoping you get all of this straightened out fairly soon, as I know it can be frightening not
to know what the heck is going on with your body. Good luck,

Pat in TX

To: "Radioactive"

Firstly, you are definitely a victim of some bad luck. As was, for example, Gary Hall, Jr.
and numerous other twenty to thirty-somethings who suddenly are diagnosed with diabetes, out
of the blue.

At their extremes, the distinctions between Type I (typically youth onset) and Type II (typically
adult onset) diabetes are pretty dramatic. Type Is are young people, often quite thin. The major
problem is that their pancreas doesn't secrete enough insulin. Treatment is primarily insulin
replacement.

Type IIs are prototypically older and obese. The problem is not enough secretion of insulin to
compensate for coexisting insulin resistance. There is a bit of a chicken/egg debate (see below) as
to whether the primary defect is insufficient insulin-producing capacity or if the primary defect is
insulin resistance.

There are also in between patients, such as you. You are not a kid, but you are still relatively
young. You are certainly not obese, although, by the acturarial tables, you are at least borderline
overweight. But you are muscular and not fat. You are more like Gary Hall, Jr. than like the typical
Type II diabetic. And Gary Hall, Jr. is more like the typical Type I diabetic (albeit older). I
suspect (but obviously have no way of knowing) that your primary problem is not that your diet is
bad or that you are all that overweight. Rather, I suspect that you've got insufficient insulin
production by your pancreatic islet cells.

Since you ask for (unofficial -- don't sue me) opinions, here they are:

First, you need to see a bona fide diabetes specialist...an endocrinologist...the best one you can
locate and afford. It is absolutely crucial to obtain the most excellent, long-term management of
what will be a long-term problem. This makes all the difference between peacefully coexisting with a
threatening disease for decades (or until a true cure emerges, as it well may over the next 10 or 20
years) and being maimed and/or killed by the disease.

Second, you need to educate yourself about the disease, so that you become a true expert, which is
well within your capacity. For starters, I'm reproducing 4 relevant, very contemporary abstracts.
The first has to do with the question of carbohydrate vs fat; the next three are general medical
reviews. Any hospital library or university library will have the last three references. You may
have to go to a large hospital or medical school library to find the first.

Your diabetes wasn't caused by your diet.

There have been, to my knowledge, no published studies of the Atkins Diet in diabetics. Certainly no
long term studies. Certainly no controlled studies. If it were me, I wouldn't do it. I'd clearly go
the ultra-low fat, high fiber, low gylcemic, etc. approach. Avoiding particularly trans fats and
saturated fats. Like you were doing, only more so. Regular exercise (supervised/monitored; not ad
hoc triathlon training). As I said, I feel that your problem is vastly more likely to be related to
pancreatic islet cell failure than to diet and obesity related insulin resistance.

1: Curr Opin Clin Nutr Metab Care. 2003 Mar;6(2):165-76.

Comment in: Curr Opin Clin Nutr Metab Care. 2003 Mar;6(2):127-31.

Fat versus carbohydrate in insulin resistance, obesity, diabetes and cardiovascular disease.

Hung T, Sievenpiper JL, Marchie A, Kendall CW, Jenkins
DJ.

Faculty of Medicine, and Department of Nutritional Sciences, Faculty of Medicine, University of
Toronto, Ontario, Canada. [email hidden]

PURPOSE OF REVIEW: This review assesses the relative effect of fat versus carbohydrate and the
differences between fatty acids and types of carbohydrate on insulin resistance and associated risk
factors for diabetes and cardiovascular disease. RECENT FINDINGS: The debate continues over whether
high-carbohydrate or high-fat diets have the more deleterious metabolic effects. Large randomized
controlled trials have shown that a reduction of fat intake as part of a healthy lifestyle combined
with weight reduction and exercise reduce the risk of type 2 diabetes. Carbohydrate as fruit and
vegetable together with low-fat dairy products reduce blood pressure. The results of trials of fatty
acid type continue to favor the use of monounsaturated fats. However, the advantages over
carbohydrate have not always been clear. In terms of carbohydrate, the glycemic index appears to be
a better predictor of the metabolic effects of a diet than the sugar content. The fiber content of
the carbohydrate food appears to confer benefits in terms of diabetic control. Lower cholesterol and
postprandial blood glucose results are associated with viscous fibers. SUMMARY: Diets that are
higher in monounsaturated fatty acids, fiber and low glycemic index foods appear to have advantages
in insulin resistance, glycemic control and blood lipids in a number of studies. The division of
nutrients into total fat (regardless of fatty acids) versus carbohydrate (type and quantity not
specified) appears to be less helpful in predicting outcomes.

2: Mayo Clin Proc. 2003 Apr;78(4):459-67.

Comment in: Mayo Clin Proc. 2003 Apr;78(4):411-3.

Pharmacological management of type 2 diabetes mellitus: rationale for rational use of insulin.

Chan JL, Abrahamson MJ.

Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Boston, Mass 02215, USA.

Type 2 diabetes mellitus is a chronic metabolic disorder associated with high morbidity and
mortality from long-term microvascular and macrovascular complications. Evidence from randomized
controlled trials indicates that aggressive treatment directed at improving glycemic control reduces
the incidence of diabetes-related microvascular complications. Traditionally, oral monotherapy for
type 2 diabetes is initiated when diet and exercise do not control hyperglycemia, followed by the
sequential, stepwise addition of oral agents as glycemic control deteriorates. Insulin is the last
therapeutic option used, generally reserved for advanced stages of the disease when multiple oral
combination treatment fails. Despite a better understanding of the pathophysiologic disease
mechanisms in the past decade, the expanded armamentarium of targeted oral antidiabetic drugs, and
the conclusive evidence of the benefits of stringent glycemic control, actual treatment outcomes in
clinical practice remain suboptimal relative to established treatment goals (glycosylated hemoglobin
A1c level <7%). Earlier detection and aggressive treatment are critical to address the natural
progression of diabetes because multiple defects (insulin resistance, insulin insufficiency,
glucotoxicity, and lipotoxicity) and vascular complications may be present at the time of diagnosis.
Acknowledging the inadequacy of traditional strategies and underscoring the importance of insulin as
an integral part of the therapeutic armamentarium, clinical trends are moving toward earlier use of
insulin combined with 1 or more oral agents. Such strategies can address the multiple abnormalities
present early in the disease course and may restore optimal control. A new treatment paradigm for
patients with type 2 diabetes to achieve and maintain near-normal glycemic control is warranted.

3: Mayo Clin Proc. 2003 Apr;78(4):447-56.

Comment in: Mayo Clin Proc. 2003 Apr;78(4):411-3.

Contributions of insulin-resistance and insulin-secretory defects to the pathogenesis of type 2
diabetes mellitus.

Gerich JE.

Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
14642, USA.

Controlled clinical trials have shown that optimal glycemic control can prevent the microvascular
complications of type 2 diabetes mellitus; considerable epidemiological data suggest that this may
also be true for macrovascular complications. However, this is frequently not achieved.
Consequently, research efforts have been undertaken to better understand the pathophysiology of
this disorder. It is now well recognized that 2 factors are involved: impaired beta-cell function
and insulin resistance. Prospective studies of high-risk populations have shown insulin-resistance
and/ or insulin-secretory defects before the onset of impaired glucose tolerance. Thus, there has
been a long-standing debate whether an alteration in insulin sensitivity or in insulin secretion is
the primary genetic factor. Most of the available evidence favors the view that type 2 diabetes is
a heterogeneous disorder in which the major genetic factor is impaired beta-cell function and
insulin resistance is the major acquired factor. Superimposition of insulin resistance on a beta
cell that cannot appropriately compensate leads to deterioration in glucose tolerance. Therefore,
clinicians managing type 2 diabetes must reduce insulin resistance and augment and/or replace
beta-cell function.

4: JAMA. 2003 May 7;289(17):2254-64.

Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review.

DeWitt DE, Hirsch IB.

Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle,
USA. [email hidden]

CONTEXT: Newer insulin therapies, including the concept of physiologic basal-prandial insulin and
the availability of insulin analogues, are changing clinical diabetes care. The key to effective
insulin therapy is an understanding of principles that, when implemented, can result in improved
diabetes control. OBJECTIVE: To systematically review the literature regarding insulin use in
patients with type 1 and type 2 diabetes mellitus (DM). DATA SOURCES: A MEDLINE search was performed
to identify all English-language articles of randomized controlled trials involving insulin use in
adults with type 1 or type 2 DM from January 1, 1980, to January 8, 2003. Bibliographies and experts
were used to identify additional studies. STUDY SELECTION AND DATA EXTRACTION: Studies were included
(199 for type 1 DM and 144 for type 2 DM, and 38 from other sources) if they involved human insulins
or insulin analogues, were at least 4 weeks long with at least 10 patients in each group, and
glycemic control and hypoglycemia were reported. Studies of insulin-oral combination were similarly
selected. DATA SYNTHESIS: Twenty-eight studies for type 1 DM, 18 for type 2 DM, and 48 for
insulin-oral combination met the selection criteria. In patients with type 1 DM, physiologic
replacement, with bedtime basal insulin and a mealtime rapid-acting insulin analogue, results in
fewer episodes of hypoglycemia than conventional regimens. Rapid-acting insulin analogues are
preferred over regular insulin in patients with type 1 DM since they improve HbA1C and reduce
episodes of hypoglycemia. In patients with type 2 DM, adding bedtime neutral protamine Hagedorn
(isophane) insulin to oral therapy significantly improves glycemic control, especially when started
early in the course of disease. Bedtime use of insulin glargine results in fewer episodes of
nighttime hypoglycemia than neutral protamine Hagedorn regimens. For patients with more severe
insulin deficiency, a physiologic insulin regimen should allow lower glycemic targets in the
majority of patients. Adverse events associated with insulin therapy include hypoglycemia, weight
gain, and worsening diabetic retinopathy if hemoglobin A1C levels decrease rapidly. CONCLUSIONS:
Many options for insulin therapy are now available. Physiologic insulin therapy with insulin
analogues is now relatively simple to use and is associated with fewer episodes of hypoglycemia.

Larry Weisenthal

Certitude is poison; curiosity is life

Thank you Larry for your informative post on diabetes! Ginger

Let me just say Radioactive man how sorry I am that you have had this bad luck. I look forward to
your posts here. I just wanted to say this even though I am sure it doesn't apply to you. Drugs that
are prescribed by doctors can effect the blood sugar in mysterious ways. My friend's son just died
of hyperglycemia and she is positive was caused by Xyprexa. There have been articles in the NYT and
the Wall Street Journal about this side effect of Xyprexa. Apparently, there is no warning on the
label. It is Elli-Lilly's best seller and is often prescribed for things other than schitzophrenia
for which he was taking it.

Radioactive Man <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

I am a 6'0" 31 year-old male triathlete with a weight typically in the high 180's (where it has
stayed for the last 5 years or so), much of it due to having a medium frame and large muscles in
the thighs, lats, and chest (from previous years of weightlifting). I have no family history of
diabetes and, as of last week was in better shape than I've ever been in my life, in terms of what
I could do on the swim and bike ride. I have normally been training 7 - 10 hours per week and
eating what I thought was a fairly reasonable diet: low fat, moderate protein, and plenty of
complex / low-glycemic index carbs spread out over the course of the day in small to moderate
portions. For carbs, I was eating such things as whole-wheat pancakes with reduced-sugar syrup,
granola bars, salads, weight-watchers' microwavable dinners, oriental and mexican dinners with
rice, vegetables, tofu, chicken, etc. I seldom to never even kept the bad carbs (doughnuts,
cookies, etc.) in my house and only ever ate them in small amounts on special occasions (races,
parties, etc.)

But, in spite of all this, I was diagnosed with type 2 diabetes yesterday by my doctor (a general
/ family practice doctor) based on blood glucose levels and symptoms I reported to him. He
strongly recommended that I go on the Atkins diet and also prescribed some oral medications.
Several weeks before this, I had taken an occupational medical exam showing a non-fasting blood
glucose level of 215 and "2+" glucose in the urine several hours after eating a snack. They
disqualified me from wearing a respirator due to these results. Since I was not familiar with the
normal blood sugar ranges and symptoms of high blood sugar and did not see myself as at-risk for
diabetes, I initially questioned the results. On Tuesday afternoon of this past week, I began to
experience some of the symptoms I had just been reading about in my attempt to question the exam
results. These symptoms included extreme thirst, frequent urination, and blurry vision. At that
point, I became very concerned and ate nothing at all for the remainder of the afternoon and drank
only water. Four hours after eating lunch, I came home, walked up the street to the home of my 70
year-old mother-in-law who is a type 2 diabetic and checked my blood sugar with her monitor and
found it to be 306. At that point, I did a very slow and easy 3 mile run, stopping every 5 minutes
or so to drink water. This brought it down to 145.

That evening, I spoke with my wife and some of the ER staff in the hospital where she works (as a
pharmacy tech.) and it was decided that I should go to the ER that evening. I told them everything
and I offered to continue fasting, but they said to go ahead and eat. I ate a small meal with 1/2
cup of parboiled rice and 1 cup of vegetables and tofu. Several hours later the ER found my blood
sugar to be 167 and no glucose or ketones in the urine. They released me, but advised me to watch
what I eat and visit my regular doctor ASAP (which turned out to be yesterday morning).

From the time I left the ER until I visited my doctor yesterday, I monitored my blood sugar and
steadily reduced the amount of carbs I was eating. During this time, I was (and still am)
progressing through the symptoms of a flu (coughing, runny nose, stuffy nose, mild fever, etc). At
this point, my blood sugar is fairly well controlled, but I am rapidly losing weight and having to
eat about like the maintenance phase of the Atkins diet. Even though my blood sugar has never been
below the normal range, this low carb diet is causing me to run around in a mental fog. I have
difficulty focusing and often forget things I saw or heard just a minute before. My fasting blood
sugar level is typically in the low to high 120's, based on several tests with the home monitor.

Last night, I went out with my family to eat at a Thai restaurant where we have been regulars for
several years. I told them I now had diabetes, thus needed something low in carbs. I ended up with
a dish of tofu, vegetables, and soy noodles, but it still turned out to be too high in
carbs/noodles, so I only ate about 2/3 of it. My blood sugar went to 195 after 45 minutes and I
also noticed the beginnings of symptoms. Knowing that exercise can bring it down, I spent the next
~45 minutes rapidly walking laps around the parking lot and drinking lots of water while my family
shopped. The symptoms gradually disappeared, so I did not feel the need to check it again.

I have taken the last week off from my usual triathlon training due to the flu and these blood
sugar problems, but I would like to remain competitive if possible, or at least active enough to
remain in good health. This is another area where the low carb diet is causing problems. I know
that I'll need to eat some carbs before, after, or during training, it's just a question of how
much and when. I certainly do not want to get into a situation where a flat tire on a bike could
cause me to go into blood sugar shock because I've carb-loaded a few minutes before the ride.

My point in approaching you with this matter is not to ask you to diagnose my condition or
second-guess my doctors, but I thought you might take an interest in and/or be able to offer some
insight into this matter. The fact is that I just do not fit the profile of a type 2 diabetic and
I have not had any results from previous years' exams that even suggest that I was at risk. Do you
know of many other similar cases? Do you know of any doctors in my area (Oak Ridge, TN) or
anywhere within the southeast whom I should consider seeing?

If you have any questions, please let me know. Thanks and God bless.

Ethan Turner [email hidden]

(Larry Weisenthal) said:

To: "Radioactive"

Firstly, you are definitely a victim of some bad luck. As was, for example, Gary Hall, Jr. and
numerous other twenty to thirty-somethings who suddenly are diagnosed with diabetes, out of
the blue.

At their extremes, the distinctions between Type I (typically youth onset) and Type II (typically
adult onset) diabetes are pretty dramatic. Type Is are young people, often quite thin. The major
problem is that their pancreas doesn't secrete enough insulin. Treatment is primarily insulin
replacement.

Type IIs are prototypically older and obese. The problem is not enough secretion of insulin to
compensate for coexisting insulin resistance. There is a bit of a chicken/egg debate (see below)
as to whether the primary defect is insufficient insulin-producing capacity or if the primary
defect is insulin resistance.

There are also in between patients, such as you. You are not a kid, but you are still relatively
young. You are certainly not obese, although, by the acturarial tables, you are at least
borderline overweight. But you are muscular and not fat. You are more like Gary Hall, Jr. than
like the typical Type II diabetic. And Gary Hall, Jr. is more like the typical Type I diabetic
(albeit older). I suspect (but obviously have no way of knowing) that your primary problem is not
that your diet is bad or that you are all that overweight. Rather, I suspect that you've got
insufficient insulin production by your pancreatic islet cells.

Since you ask for (unofficial -- don't sue me) opinions, here they are:

First, you need to see a bona fide diabetes specialist...an endocrinologist...the best one you can
locate and afford. It is absolutely crucial to obtain the most excellent, long-term management of
what will be a long-term problem. This makes all the difference between peacefully coexisting with
a threatening disease for decades (or until a true cure emerges, as it well may over the next 10
or 20 years) and being maimed and/or killed by the disease.

Second, you need to educate yourself about the disease, so that you become a true expert, which is
well within your capacity.

I echo Larry's advice, My mother and oldest sister both needed insulin from age about 40 (following
pregnancy) Sister is coping well, but my mother suffered from most of the complications as hers
wasn't controlled very well. (by urine tests as against the current frequent self administered blood
tests, and once or twice daily insulin). A nephew also suffers but was diagnosed as a child and
copes very well. Older cousins have succumbed to the non insulin type. My wife's grandfather
(despite being a doctor) survived the then usual two years from diagnosis, he was amongst the first
on insulin, but how to use it wasn't well researched then. With good control, side effects wil be
minimal, but with education, keeping to diet, with diet, excercise and insulin in balance should
very much minimise any problems.

1930s wifes Grandfather - 2 years.

1940s Mother survived 30 years.

1960s sister and nephew, my sister now aged 70+ has slight problems, my nephew now aged 39 is still
fine, he used to do Triathlon at high level with no problems after careful planning beforehand.

2000s who knows? even less problems?

Larry's advice above is very sound.

--
Brian D

Larry,

Thanks for the info and God bless. Now, for an update:

Over the last few days, I have been able to control my blood sugar to normal ranges by eating only
about 100 g carbs per day. The downside is that I get very sick of always eating the same things and
sometimes get a kind of nervous and anxious feeling when I don't eat enough carbs, even when my
blood sugar is normal (120's). I have been on oral meds for 3 days now, so it is hard to tell if
they are helping yet.

My fasting glucose levels (which I check every morning) have quickly fallen from their initial highs
in the 130's to the normal range (~110, 101, then 86 this morning). The highest blood sugars I've
had over the last few days have been in the 160's. What remains to be seen is how much, if any, the
low-carb diet and medication will improve my blood sugar / insulin response to a set portion of
carbs. For example, today, I ate a Glucerna bar (32 g carbs), saw a high of 167 after ~ 1 hour, then
it dropped to 126 after ~2 1/4 hours.

In hindsight, I now realize that the onset was probably not as sudden as I had initially thought.
Even before the exam 3 weeks ago, I had the classic symptoms of thirst, hard to control drowsiness,
and frequent urination after a meal, although not as severe as last week. I also have a slightly top
heavy shape, characteristic of those at risk for type 2. I believe the onset took place over a
period of months, not days.

I have a theory that I was always at risk for type 2 and my high carb diet that I was using to put
in the long hours of training might have been a contributing factor. If it weren't for the amount of
training I was doing, I would have surely had an obese top-heavy shape with the amount of carbs I
was eating.

I am scheduled to see an endocrinoligist next week. Is there any test that will conclusively
determine whether my problem is one of insufficient insulin (type 1) or insulin resistance (type 2)?

Ethan Turner

Radioactive Man said:

Larry,

Thanks for the info and God bless. Now, for an update:

Over the last few days, I have been able to control my blood sugar to normal ranges by eating only
about 100 g carbs per day. The downside is that I get very sick of always eating the same things
and sometimes get a kind of nervous and anxious feeling when I don't eat enough carbs, even when
my blood sugar is normal (120's). I have been on oral meds for 3 days now, so it is hard to tell
if they are helping yet.

You don't always have to eat the same things. You can eat anything that is low in carbs or
high in fiber.

Quoted message said:

My fasting glucose levels (which I check every morning) have quickly fallen from their initial
highs in the 130's to the normal range (~110, 101, then 86 this morning). The highest blood sugars
I've had over the last few days have been in the 160's. What remains to be seen is how much, if
any, the low-carb diet and medication will improve my blood sugar / insulin response to a set
portion of carbs. For example, today, I ate a Glucerna bar (32 g carbs), saw a high of 167 after ~
1 hour, then it dropped to 126 after ~2 1/4 hours.

The Atkins book advises to avoid any carbs that cause the insulin level to spike, which basically
means to avoid all refined sugar and flour foods. Nuts and berries are good because they have some
fiber and are not too high in carbs. Note that the Atkins diet does not mean you can't eat carbs. It
is based on the strategy of controlling your weight by controlling your intake of carbs as opposed
to controlling your intake of calories. That doesn't mean you can stuff yourself with fat and
protein; you still have to be aware of how much you are eating, but eating a higher percentage of
protein and fat and a lower percentage of carbs, and almost no refined sugar or flour, seems to make
your desire to eat too much just stop.

Quoted message said:

In hindsight, I now realize that the onset was probably not as sudden as I had initially thought.
Even before the exam 3 weeks ago, I had the classic symptoms of thirst, hard to control
drowsiness, and frequent urination after a meal, although not as severe as last week. I also have
a slightly top heavy shape, characteristic of those at risk for type 2. I believe the onset took
place over a period of months, not days.

I have a theory that I was always at risk for type 2 and my high carb diet that I was using to put
in the long hours of training might have been a contributing factor. If it weren't for the amount
of training I was doing, I would have surely had an obese top-heavy shape with the amount of carbs
I was eating.

I am scheduled to see an endocrinoligist next week. Is there any test that will conclusively
determine whether my problem is one of insufficient insulin (type 1) or insulin resistance
(type 2)?

Ethan Turner

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

Larry Weisenthal said:

Here's the argument in favor of the Atkins Diet for diabetes:

usnews.com14diabetes.htmOpen ↗

If it were me or a close family member, I wouldn't go on the Atkins Diet, if I had newly diagnosed
diabetes.

Firstly, there are no data on long term effects of the diet, even in healthy, non-diabetics.

But the long term Atkins diet is effectively a normal, healthy diet. ie a diet without refined sugar
and white flour.

Quoted message said:

Secondly, the recently published NEJM study showed that the early advantages of the Atkins Diet
diminished by the end of even the first year, such that there were no differences between the
Atkins Diet and a more traditional, moderately fat controlled diet.

What do you mean no differences? No differences in weight loss, or no differences in diet (which is
what you wrote)? The difference the dieter is looking for is the difference in diet before the
weight loss and after the weight loss. It should be obvious that if he goes back to eating his old,
unhealthy diet, he will gain the weight back.

Quoted message said:

Thirdly, I don't like the idea of being a guinea pig in a situation where I have a chronic,
non-emergent condition. It's one thing to volunteer for a clinical trial when you have advanced
cancer which has failed to respond to conventional, state of the art approaches. It's quite
another to do so when you've got a very chronic condition, with which you have every likelihood of
controlling very well with state of the art conventional medicine for decades.

But a lot of people control diabetes with diet and exercise, right?

Quoted message said:

In 5 years or so, there will actually be some longer term data coming out and there will be
specific data in diabetics. If there are advantages to the Atkins Diet in diabetics, they will
be known and published in plenty of time for a newly diagnosed, young diabetic to take advantage
of them.

Well, if he doesn't have to lose weight, then I agree, but if he has to lose weight anyway, then
Atkins will get him there. Also, even if he doesn't need to lose weight, if his doctor recommends
Atkins and is willing to monitor his progress, then it makes sense to me.

Quoted message said:

If, as I suspect, there are drawbacks, such as the development of increased insulin resistance
over time (one thing clearly shown to be highly beneficial to diabetics is high fiber, and the
Atkins Diet is low fiber;

No it isn't. The book recommends carbs that are high in fiber. The carb counter book lists for each
food: carbs, fiber, and net carbs, which is carbs - fiber. As you reach your goal weight and add
more carbs back into your diet, you are better off choosing carbs that are high in fiber.

Quoted message said:

Atkins dieters must take vitamin supplements, but these may not include important phytochemicals;
adipocytes may become more saturated with triglycerides over time, which may contribute to insulin
resistance, and many more things that might go wrong that just cannot be predicted in advance,
etc.)...anyway, if there are drawbacks, then these will also become known over time.

This is really a case, I believe, where the devil you know is better than the devil you
don't know.

If it were me, I'd go on a very low fat/only healthy fat; high fiber; low glycemic index diet,
based largely around vegetables and lean protein sources (very lean meat and fish). And exercise.
And monitor my blood sugar very closely to make certain that my medication regimen (which may well
include insulin) was keeping my blood sugar under very tight control.

And support research efforts to find "the cure," be it pancreatic islet cell transplants,
immunotherapy, insulin sensitizing drugs, implantable chips to monitor glucose levels and dispense
insulin, or what not.

Larry Weisenthal

Certitude is poison; curiosity is life

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

"Larry Weisenthal" <[email hidden]> wrote in message
"]news:[email hidden]... <snip>

Quoted message said:

If it were me, I'd go on a very low fat/only healthy fat; high fiber; low glycemic index diet,
based largely around vegetables and lean protein

sources

Quoted message said:

(very lean meat and fish). And exercise.

<snip>

Larry - what you recommend here is almost indistinguishable from an Atkins diet in
maintenance phase.

Larry Weisenthal said:

Here's the argument in favor of the Atkins Diet for diabetes:

usnews.com14diabetes.htmOpen ↗

If it were me or a close family member, I wouldn't go on the Atkins Diet, if I had newly diagnosed
diabetes.

Firstly, there are no data on long term effects of the diet, even in healthy, non-diabetics.

But there is an absence of long term negative data, apparently. The Atkins diet has been in use for
about 30 years now. If there were some major negative effect, as in long term use of steroids or
long term use of Fen-Phen, it is unlikely it could have been hidden.

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

Larry Weisenthal said:

I'd rather not use this forum to get into a debate about the merits of the Atkins Diet at
this time.

I wasn't doing that.

Quoted message said:

I was specifically asked a specific question, and I responded as honestly as I could. I answered
the questions. I said what I would do were it me or a family member, and for what reasons. Asked
and answered, as they say in court.

Owing to the seriousness of the current situation (we are talking about a serious medical problem
and not just about the best way to lose weight), I do want to clarify just a few points.

Firstly, the NEJM study with the one year follow-up.

There was an initial advantage to the Atkins diet over a "conventional" diet (moderate calorie
restriction, 60% carbohydrate, 25% fat, 15% protein), in terms of weight loss, at three months and
6 months in the Atkins Diet group, but, by 12 months, there was no difference between the two
groups. Thus, if one asks the question "is there any evidence that the Atkins Diet results in
greater permanent weight loss than a 'conventional' diet?", the answer is no, there is not.

But there are two points about that statement. First, it is irrelevant given your "Owing to the
seriousness of the current situation" remark, since whether the diet works for permanent weight loss
is not relevant to using it to manage diebetes by controlling diet. Second, what is permanent weight
loss? I'm under the impression that no diet can offer permanent weight loss, so to say they are all
equal with respect to permanent weight loss doesn't say much. There is no such thing as permanent
weight loss. Obviously, if the weight you lose on any diet comes back on after you stop the diet, it
isn't the fault of the diet.

Quoted message said:

Again, that doesn't mean that Martin shouldn't continue his self-experiment with the Atkins
Diet. It is clearly working for him, and I have no doubts that it may well work for selected,
motivated individuals long-term. Just like Weight Watchers works for selected, motivated
individuals long term. Just like my ultra low fat/very high carb diet has worked very well for
me for more than 20 years.

Wait a minute. What are selected, motivated individuals? Is a selected, motivated individual
different from a motivated individual? I don't think so. Obviously, you have to be motivated to lose
weight, but you don't have to be selected. Or do you mean that different people have different
chemistries, so that low carb works for some chemistries and high carb works for others?

Quoted message said:

When it comes to recommending a diet for a newly diagnosed diabetic, the stakes are much higher
and the burden of proof is also much higher. Since I quoted the US News&World Report article which
made the case for the Atkins Diet, I also want to recall the US News&World Report editorial,
written by Dr. Bernadine Healy, former Director of the National Institutes of Health, in which
Dr. Healy concluded that, were the Atkins Diet a drug, it would not obtain Food and Drug
Administration approval, as there is proof neither of efficacy or safety (this was written
_after_ the publication of the NEJM randomized studies).

The latter point brings up Martin's statement that, were the Atkins Diet harmful, then surely we'd
know about it by now (e.g. Fen-Phen). This, is, however, inadequate reasssurance.

It wasn't meant to be adequate reassurance. It was meant as a fact to note, given that serious
problems do show up and given that the Atkins diet has been in use for 30 years. And, Radioactive
man's doctor recommended that he use the Atkins diet to manage his diabetes. That would mean, I
assume, that Radioactive man's doctor was recommending that he use the Lifetime Maintenance phase of
the diet, which is the 4th phase, and not either of the weight loss phases or even the
pre-maintenance phase. The Lifetime Maintenance phase is pretty much just a healthy diet, but devoid
of junk food.

Quoted message said:

In the absence of a formal study, there is simply no way of knowing the long term effects of the
Atkins Diet. Colon cancer is a relatively common disease, for example, which is clearly related to
the consumption of animal fat.

High fat. A healthy diet is not high in fat, and the Lifetime Maintenance phase isn't particularly
high in fat. To the extent it is higher than your diet in fat, it is also high in fiber and very low
in sugar and white flour.

Quoted message said:

It is a disease which doesn't start to show up for decades after carcinogenic initiation. What if
the Atkins Diet doubles the risk of colon cancer (which it very well may).

Your question implies high fat, but high fat is used during the weight loss phases.

Quoted message said:

We really won't know this for decades and, then, only if the proper, formal studies are carried
out. What if the Atkins Diet actually increases insulin resistance over a 10 - 20 year period
(which it might; we have no way of knowing)? What if it increases the risk of vascular
complications or kidney disease in diabetics who are very susceptible to these? We just don't
know. Hormone replacement therapy (HRT) in women was thought for decades not to increase breast
cancer. It was thought to reduce the risk of heart disease and Alzheimer's Disease. Only when
massive, long term studies were carried out was it learned that HRT increased breast cancer,
increased heart disease, and increased Alzheimer's.

But controlling blood sugar and insulin is a problem right now for radioactive man. You have
recommended that he not follow his doctor's advice, and your recommendation is based on the simple
fact that we don't have long term data on possible other dangers.

Quoted message said:

My own opinion is that Atkins was an innovative, insightful pioneer, willing to go against the
grain of the establishment, and persistent enough to stick to his guns. Owing to his persistence,
he finally succeeded in getting the establishment to take him seriously. I'm sorry that he didn't
live to see how this all ends up; but I'm certain that, in another 5 years, we'll have learned
much more about his diet than we learned in the previous 30 years. In 10 years, we'll probably
begin to know if it's something which may make a difference, one way or the other, in diabetics,
long-term. In 30 years, we'll learn whether or not Atkins Dieters who stick with the plan for that
long have a higher or lower incidence of cancer, Alzheimer's, kidney disease, etc.

I did not and would not recommend the conventional "ADA" type diet. I recommended an ultra low
fat, high fiber, low gylcemic plant, non-fat dairy, and ultra lean meat based diet. I'd go this
route and monitor how I was doing (with all the relevant medical parameters) and await the more
definitive studies which I believe will begin to come out within the next 5 years.

The diet you recommend is the Lifetime Maintenance phase of Atkins except for the ultra low fat. Why
do you recommend ultra low fat for a Type 2 diabetic who is trying to manage his problem with diet?
The Atkins book, of course, specifically lists Type 2 diabetics as one of the groups of people who
should use the Atkins diet. Since the long term data you require does not exist, but the Atkins
recommendation is clearly made based on a lot of experience with Type 2 diabetics, your
recommendation is based on less information than radiactive man's doctor's recommendation.

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

Maybe I'm just missing the point, or uninformed, but I thought the whole idea behind the Atkins
diet was regular prolonged periods of ketosis. Given this I certainly wouldn't recommend it for
anyone ill, metabolic related disease or no, without a lot of research specific to their condition.
Am I wrong?

--Mike

Mike Edey said:

Maybe I'm just missing the point, or uninformed, but I thought the whole idea behind the Atkins
diet was regular prolonged periods of ketosis.

For losing weight, yes, but losing weight is only the first problem. Keeping it off is the long term
problem, and the Atkins model is based on the idea that managing weight is managing insulin is
managing blood sugar. Managing insulin and blood sugar is also the Type 2 diabetic's problem.

Quoted message said:

Given this I certainly wouldn't recommend it for anyone ill, metabolic related disease or no,
without a lot of research specific to their condition. Am I wrong?

No, you're not wrong, but the confusion is between the weight loss phase and the weight management
phase. Ketosis is important in the weigtht loss phase. Well, it depends also on how much exercise
you do, I think. Ketosis becomes very important for obese people who don't exercise. I've never
measured it in my case and wouldn't be surprised to learn I'm not ketoting, or whatever the correct
term is. Still, I've managed to lose 7 kilos.

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

Larry Weisenthal said:

But the point is that there is no published research on the long term effects of the Atkins diet
in anyone, and specifically not in diabetics.

When you say "Atkins diet," what do you mean exactly?

I have the impression you mean high protein/high fat/very low carbs forever. You even claimed that
the Atkins diet is low in fiber, which is false. The only people who stay on the high protein/high
fat/very low carb diet for a long period are those people who have quite a lot of weight to lose.
Apparently, radioactiveman doesn't have any weight to lose at all.

Quoted message said:

There is only a single paper which describes short term (limited to 6 month) effects (showing
benefit compared to a traditional type of moderate fat diet). In the single 12 month study, there
was no difference in insulin resistance in subjects on the Atkins Diet versus subjects on the 60%
carbohydrate diet.

But 6 months is longer than most people would have to stay on the weight loss part of the diet. I've
been on the weight loss part for a little less than one month, and I probably will finish this week
or next. I want to lose one more kilo.

So what does long term effects even mean in my case? After I stop trying to lose weight, I will not
go back to my high carb (sugary, floury) diet. I will be eating more protein than I did before the
diet and more fat than I ate before the diet, but not high fat. I will be eating more fiber than I
did before the diet, but I will be eating less carbs than I did before the diet, particularly less
sugar and flower. I will be eating a significant part of my carbs immediately after training, when
they will be immediately stored as glycogen and not as fat.

Essentially, my post Atkins diet (which is the fourth phase of the Atkins diet) will be a normal,
*healthy* diet, certainly lower in carbs than the average American diet, but the average American
diet is not a normal, helathy diet. And I will certainly be eating more fat and less carbs than your
diet, but your diet is not a normal, healthy diet either.

Quoted message said:

My reason for saying that I, myself, would go the ultra low fat, low gylcemic, plant-based carb
(but al dente pasta is OK, too, as it is a low glycemic index food), nonfat dairy, high fiber
route if I had newly diagnosed Type 2 diabetes is based on what I consider to the be the best
evidence available from published research, not from the assertions of private practioners running
for profit diabetic clinics who want to attract patients by offering something new and ostensibly
easy. Or by non-specialists who are too influenced by lay literature and very limited and
preliminary short term data.

Here are some of the more relevant papers which support my own personal choice in the approach to
the management of a "motivated/selected" newly-diagnosed patient with Type 2 diabetes.

I probably wasn't clear. What I meant by my question was What does very low fat have to do with
controlling diabetes? I understand the low glycemic index part. Atkins is compatible with that. But
what does ultra low fat have to do with controlling diabetes? It seems to me that by reducing fat
to an abnormally low level, you require more carbs because you don't get the advantage of the high
calorie density of fat. Eating more carbs then puts the diabetic at more risk for an unstable
insulin/blood sugar situation, right? Especially if he is an athlete doing intense training for
long periods? As I understand Atkins, the idea of eating fat is that it makes stabilizing blood
sugar, and therefore insulin, easier than by eating a lot of carbs. Clearly, it is carbs that cause
the blood sugar problem, not fat. Is that right? If so, what does ultra low fat contribute to
managing diabetes?

Quoted message said:

By the way, motivated/"selected" refers to (1) a person who is motivated to do it right and to
stick with it, long-term, (2) someone who is sophisticated and intelligent (e.g. capable of
reading and understanding nutritional content labels), and (3) someone who enjoys good results
while on the diet and exercise program in question. Not everyone will "succeed" on a given
program. So you monitor how you are doing and, if it is working, you keep doing it. If it isn't
working, you go to plan B. That's what I mean by "motivated/selected."

Then saying a diet works for selected, motivated people means the same as saying Some people make
the diet work. In other words, when you say a diet doesn't work, you mean most people who try the
diet were doomed to fail no matter what diet they tried because your 1, 2, and 3 did not apply. Then
saying a diet doesn't work says nothing about the diet.

On the other hand, I'm sure Atkins works (for losing weight) because the diet itself significantly
diminishes stress hunger and craving for surgar to the point where your number 1 applies to a lot
more people.

Quoted message said:

Here is the research (note: none of which has ever been refuted, contradicted, or challenged). The
reason why the Pritikin/Ornish diet/exercise programs are not more universally recommended is that
they take a highly motivated and sophisticated (see above) person to stick with them. This is not
a "lowest common denominator" type of diet. I would not be at all surprised to learn that more
people can stick with the Atkins approach than with the Pritikin/Ornish approach. But that doesn't
mean that the latter shouldn't be used in the "motivated"/selected individuals who can and do
benefit.

I've done Pritikin, and so I know it works. But it was much harder to stick with, and boring. But I
still don't see why you recommend this for diabetics. It seems to me that eating more carbs, even
low glycemic ones, is increasing the possibility of instability, whereas replacing some of those
carbs with fat increases stability.

martin

--
Martin Smith email: [email hidden] Vollsveien 9 tel. : +47 6783 1188
P.O. Box 482 mob. : +47 932 48 303 1327 Lysaker, Norway

Larry,

Once again. Thanks for the information here. I think the most important thing at this point is
getting a correct diagnosis (LADA - Latent Autoimmune ? ? vs. Type 2), since it will affect the
course of treatment and management. If it is tritely LADA, then there would be no harm in going on
insulin and back to a more normal diet immediately, since there is no danger of insulin resistance.
If, on the other hand, it is type 2, then I'm already on the right course of treatment. But the
thing that strikes me as being strange is the amount of carb restriction I must do (about 100 - 120
g per day) in order to maintain normal blood sugar levels. I've talked with some older people who've
been living with type 2 for many years and they seem to have far greater tolerance for carbs than I
do. If I ate the same things tomorrow that I ate 2 weeks ago, I would be hospitalized or dead within
a matter of days.

Ethan Turner [email hidden]

(Larry Weisenthal) said:

My reason for saying that I, myself, would go the ultra low fat, low gylcemic, plant-based carb
(but al dente pasta is OK, too, as it is a low glycemic index food), nonfat dairy, high fiber route
if I had newly diagnosed Type 2 diabetes is based on what I consider to the be the best evidence
available from published research, not from the assertions of private practioners running for
profit diabetic clinics who want to attract patients by offering something new and ostensibly easy.
Or by non-specialists who are too influenced by lay literature and very limited and preliminary
short term data.

I do not in any way have diabetes, I was on a pure Pritikin-type diet for years.

But blood pressure was rising and I was always feezing cold and hungry I think blood sugar was
rising a little too, as was weight. I was mainly eating to try and stay warm. I think a Protikin
diet has too little protain.

Now I have added some fish and it makes a world of difference. I cetainly do not eat a high-protein
diet though. Most protein I get comes from cooked peas. I have lost weight too (not that I needed
to) and am not hungry all of the time.

I do swim every day and need to be warm enough to do so.

So my own suggestion would be a Pritikin type diet BUT with SOME added protein.

I am sorry if this is terribly off topic for this group but I could not resist commenting....

Radioactive Man wrote

Quoted message said:

If it is tritely LADA, then there would be no harm in going on insulin and back to a more normal
diet immediately, since there is no danger of insulin resistance.

I don't know why you use "tritely", but going back to your "normal" diet as describe at the
beginning would not be a good idea. (see below)

This has been a very interesting thread and the first time I have ever done something like this.

I am a Type 1 diabetic of 34 years and though slightly overweight, have no complications from it. I
only recently found out about how carbs affect blood sugar levels and about insulin resistance.
After 31 years of 4-a-day shots, I have now lived on an insulin pump for the past 3 years. The pump
requires that I count the carbs and take a scaled amount of insulin according to the amount of carbs
eaten. (.1 unit per carb) The type of carb does not matter in how much I take, but some carbs
metabolize differently than others, so I may need to take the amount over a longer period of time.

Ethan, if you ever run into a time when your blood sugar is too low (<50), I have found that milk is
the best thing. Because of the protein content it brings the sugar level up and stays with you
longer without spiking like orange juice or other remedies. Of course, most people have trouble
functioning when their blood sugar gets that low, but because of the length of my having diabetes I
am still able to function (get something to eat) at 30 but I would not recommend this to anyone!

Also, BEWARE of these low sugar levels, I found out that the liver holds a reserve of sugar and if
a low goes untreated for too long the liver will dump this reserve into the blood stream where
there usually isn't enough insulin to take care of it this makes for a very high and sudden high,
250 or above.

As far as tests my endocronologist uses fasting blood sugars and a test call glycohemogobin (sorry
about the spelling) to monitor my progress. This second test is new in the last 10 years and is used
to monitor your long range control, usually over the past 4-6 weeks. The normal range is between
4.0-6.4 at my lab, but each lab differs so check the lab result sheet for the range at your lab.

Also, when you are giving blood to the lab techs (I teasingly call them my vampires), make sure you
ask them to send you a copy of the report, it is your right and helps you keep track along with
your doctor.

Good luck, keep your head up and remember ~~ if you can do a triathalon, you can manage your
diabetes, it just takes guts.

MaryLea

(Larry Weisenthal) said:

Which is why I can say with some confidence that your diet did not cause your diabetes (although
so called "latent" diabetes can remain in a subclinical state in the presence of optimum diet,
exercise, and weight).

You were right. I just got an emergency page from my endocrinologist on Friday after he had received
the lab results from my bloodwork. He stated that I tested positive for antibodies (presumably GADA
or ICA) and that there was a 98% certainty that I have type 1 diabetes. He also instructed me to
stop taking the oral medications (metformin) and start on a regular insulin schedule.

So far, I have managed to control my blood sugars well by combining small doses of insulin with
gradual increases in the amount of carbs I am consuming. Before I started the insulin, I controlled
it with a low-carb diet (~120 g per day). What I am desperately seeking at this point is a drug that
will halt the progression of my type 1 diabetes and further destruction of beta cells. These types
of drugs do not reverse the process, but they would make it much easier to control blood sugars over
the long-term, since my pancreas is still producing enough insulin to handle over 100 g of sugars
per day. So far, every drug I've found with the potential for halting the progression of type 1 has
still been in the experimental phase.

I apologize for taking so long to respond. These last several weeks have been a difficult time for
me. I am still following this thread, your posts in particular.

Ethan Turner [email hidden]