Subject: Re: AHA: high-protein diet dangerous for diabetics
Date: Sun, 14 Oct 2001 13:58:57 -0400
From: Malcolm Graham
Newsgroups: alt.support.diabetes,misc.health.diabetes

Your data is out of date (by about 20 years)... higher cholesterol levels are not associated with high protein diets.

High blood glucose levels are associated with higher cholesterol levels. A 1% increase in HbA1c increases cholesterol by 2.2% and triglycerides by 8%. Diabetics with high blood glucose levels have high LDL and low HDL. In addition, low-carb, high-fat diets have been shown to lower blood glucose levels and improve blood lipid levels.

What I've concluded is that most diabetics shoudn't eat a high-fat diet but a high-protein one, and restrict calories derived from fats to no more than 30%, with at least 50g of carbs/day, with all other calories needed coming from protein. Based on my own analysis of the current evidence, I think the most balanced diet is the ZONE with 30% calories derived from fat, 30% from protein, and 40% from carbohydrates; with individual diabetics reducing the carbohydrate percentage as needed to control their own blood glucose levels with the proviso that at least 50g/day of carbohydrates are eaten to avoid ketosis.

It is poor control of blood glucose levels that damages kidneys not the amount of protein eaten. When your blood glucose level is well controlled, and it has been brought under control before severe kidney damage has occurred, you can eat as much protein as you want and it will have no effect on your kidneys. In other words, protein does not cause diabetic nephropathy. Even people with significant nephropathy have shown a total reversal of kidney disease after normalization of their blood glucose levels. The only valid reason for a reduced-protein diet appears to be for diabetics on dialysis in order to reduce the number of weekly dialysis treatments (since protein increases the amount of nitrogen wastes that have to be removed from the blood and hence the frequency of dialysis treatments).

Sources? A good starting point is Appendix A in Dr Bernstein's Diabetes Solution book...

The Lipid Research Clinics Trial investigated the effect of a low-fat, high-carbohydrate diet (very close to the recommended ADA health diet) on 1900 middle-aged men over 7 years. Results? Total cholesterol down by 5% but triglycerides up by 10%! No significant correlation found between cholesterol levels and mortality rates.
National Health Examination Follow-Up Survey, involving 4710 people, in 1990 reported that there was no evidence that a high total cholesterol level affected mortality rates. What the survey did find was that high blood glucose levels was the major factor that affected mortality rates.
Proceedings of the 15th International Diabetes Foundation Satellite Symposium on "Diabetes and Macrovascular Complications", Diabetes 45, Supplement 3, July 1996
"Effects of Varying Carbohydrate Content of Diet in Patients with Non-Insulin Dependent Diabetes Mellitus", Garg et al., Jnl Amer Med Assoc 1994; 271: 1421-1428
"Molecular and Physiological Aspects of Nephropathy in Type 1 Diabetes Mellitus", Ruskin and Tamborlane, Jnl Diabetes and Its Complications, 1996, 10:31-37
"The effects of Dietary Protein Restriction and Blood Pressure Control on the Progression of Chronic Renal Disease", S. Klahr er al., New England Jnl Med, 1994, 330:877-884
"The Role of Dietary Protein restriction in Progressive Azotemia", editorial, New England Jnl Med, 1994, 330:929-930 8. "Dietary Fiber, Glycemic Load, and Risk of Non-Insulin-Dependent Diabetes in Women", Jnl Amer Med Assoc, 1997, 277:472-477 (Study of 65,177 nurses eating a high-carb diet and the development of Type 2 Diabetes)

Anne in Seattle wrote:
I think the message the AHA is trying to make is that high protein diets can cause kidney and liver damage (this may have to due with the higher cholesterol levels associated with high protein diets). After nearly 40 years (yeek I'm getting OLD) at this I can tell you the one single truth: Diabetes is about balance -- In food, exercise, meds, and in just the day-to-day acts of living. Our goal is not just to keep our bgs in a specific range but to prevent future complications. The balance of higher carbs may be more meds -- BUT that may not necessarily be a bad thing. It is not the this or the that that matters. It is the living that counts. We want to keep all the body parts working. How we do that isn't a contest. What good does it do to have perfect numbers if in the process our kidneys and liver are destroyed digesting our diet? What I want to know is where the line of diminishing returns is. -- Keep safe, Anne in Seattle --