Canibais e Reis

Vídeo: Moody’s Junk Mail.

"I respectfully ask Ms. Warsaw, Ms. Al-Samarrie, and those diabetes experts with USDA, American Diabetes Association, American Dietetic Associations, American Heart Associations a few questions below that are related to biochemistry you all and I have taken and passed its examination. (1) What do dietary carbohydrates, other than indigestible fibers, become after they are absorbed into my blood circulation? (2) Whatever the metabolites are converted from carbohydrates, isn’t it true the more carbohydrates I consume the higher level of these metabolites are? (3) If I want to keep a lower level of these metabolites, isn’t it logical for me to restrict the consumption of carbohydrates and avoid the need of medication? Robert Su, Pharm.B., M.D."

Comentário do Dr. Robert Su.

Em resposta ao artigo "Type 2 Diabetes: From Old Dogmas to New Realities - Part 2 - Diabetes Health",  publicado recentemente no Diabetes Health pela nutricionista low-fat da ADA Hope Warshaw, recomendando um aumento (sim, um aumento!) dos hidratos de carbono na diabetes, um artigo que certamente passou despercebido às agências de rating, porque se não era imediatamente considerado LIXO, tal como Portugal, levantou-se um coro de protestos (muitos dos quais foram censurados pelo Diabetes Health). Algo perfeitamente expectável, tendo em conta a absurdidade que são as recomendações oficiais da ADA, em total dissonância com a mais recente e/ou antiga ciência alimentar em torno da diabetes, e a insistência nesse mesmo paradigma falhado. Ficam aqui alguns artigos elucidativos sobre este assunto, mais um exemplo do legado tóxico do nutricionismo low-fat para a saúde humana, neste caso para os diabéticos:

Lista de comentários desfavoráveis ao artigo da nutricionista Hope Warshaw
Lista de comentários desfavoráveis ao artigo de Nadia Al-Samarrie
Where Is The ‘Hope’ For Diabetics, Ms. Warshaw?
Is Diabetes Health Magazine helping people with diabetes?
Stand Up And Say “Nuts!”
The Hope Warshaw Issue
Professional Ignorance about Type II Diabetes
Is there any Hope for Diabetes?
The Warshaw-DiabetesHealth Thing – Invitation to Discuss

Fad Diets in the Treatment of Diabetes (pdf)

Feinman RD.
Department of Cell Biology, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, 11203, USA, .

Abstract

Use of the term "fad diet" reflects the contentious nature of the debate in the treatment of diabetes and generally targets diets based on carbohydrate restriction, the major challenge to traditional dietary therapy. Although standard low-fat diets more accurately conform to the idea of a practice supported by social pressure rather than scientific data, it is suggested that we might want to give up altogether unscientific terms like "fad" and "healthy." Far from faddish, diets based on carbohydrate restriction have been the historical treatment for diabetes and are still supported by basic biochemistry, and it is argued that they should be considered the "default" diet, the one to try first, in diseases of carbohydrate intolerance or insulin resistance. The barrier to acceptance of low-carbohydrate diets in the past has been concern about saturated fat, which might be substituted for the carbohydrate that is removed. However, recent re-analysis of much old data shows that replacing carbohydrate with saturated fat is, if anything, beneficial. The dialectic of impact of continued hemoglobin A(1c) versus effect of dietary saturated fat in the risk of cardiovascular disease is resolved in direction of glycemic control. Putting biased language behind us and facing the impact of recent results that point to the value of low-carbohydrate diets would offer patients the maximum number of options.

 

Nutrition. 2010 Oct;26(10):915-24.

In the face of contradictory evidence: report of the Dietary Guidelines for Americans Committee. (pdf)

Hite AH, Feinman RD, Guzman GE, Satin M, Schoenfeld PA, Wood RJ.
Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Abstract

Concerns that were raised with the first dietary recommendations 30 y ago have yet to be adequately addressed. The initial Dietary Goals for Americans (1977) proposed increases in carbohydrate intake and decreases in fat, saturated fat, cholesterol, and salt consumption that are carried further in the 2010 Dietary Guidelines Advisory Committee (DGAC) Report. Important aspects of these recommendations remain unproven, yet a dietary shift in this direction has already taken place even as overweight/obesity and diabetes have increased. Although appealing to an evidence-based methodology, the DGAC Report demonstrates several critical weaknesses, including use of an incomplete body of relevant science; inaccurately representing, interpreting, or summarizing the literature; and drawing conclusions and/or making recommendations that do not reflect the limitations or controversies in the science. An objective assessment of evidence in the DGAC Report does not suggest a conclusive proscription against low-carbohydrate diets. The DGAC Report does not provide sufficient evidence to conclude that increases in whole grain and fiber and decreases in dietary saturated fat, salt, and animal protein will lead to positive health outcomes. Lack of supporting evidence limits the value of the proposed recommendations as guidance for consumers or as the basis for public health policy. It is time to reexamine how US dietary guidelines are created and ask whether the current process is still appropriate for our needs.

 

Lipids. 2010 Oct;45(10):947-62. Epub 2010 Sep 7.

Limited effect of dietary saturated fat on plasma saturated fat in the context of a low carbohydrate diet. (pdf)

Forsythe CE, Phinney SD, Feinman RD, Volk BM, Freidenreich D, Quann E, Ballard K, Puglisi MJ, Maresh CM, Kraemer WJ, Bibus DM, Fernandez ML, Volek JS.
Department of Kinesiology, University of Connecticut, Unit 1110, Storrs, CT 06269-1110, USA.

Abstract

We recently showed that a hypocaloric carbohydrate restricted diet (CRD) had two striking effects: (1) a reduction in plasma saturated fatty acids (SFA) despite higher intake than a low fat diet, and (2) a decrease in inflammation despite a significant increase in arachidonic acid (ARA). Here we extend these findings in 8 weight stable men who were fed two 6-week CRD (12%en carbohydrate) varying in quality of fat. One CRD emphasized SFA (CRD-SFA, 86 g/d SFA) and the other, unsaturated fat (CRD-UFA, 47 g SFA/d). All foods were provided to subjects. Both CRD decreased serum triacylglycerol (TAG) and insulin, and increased LDL-C particle size. The CRD-UFA significantly decreased plasma TAG SFA (27.48 ± 2.89 mol%) compared to baseline (31.06 ± 4.26 mol%). Plasma TAG SFA, however, remained unchanged in the CRD-SFA (33.14 ± 3.49 mol%) despite a doubling in SFA intake. Both CRD significantly reduced plasma palmitoleic acid (16:1n-7) indicating decreased de novo lipogenesis. CRD-SFA significantly increased plasma phospholipid ARA content, while CRD-UFA significantly increased EPA and DHA. Urine 8-iso PGF(2α), a free radical-catalyzed product of ARA, was significantly lower than baseline following CRD-UFA (-32%). There was a significant inverse correlation between changes in urine 8-iso PGF(2α) and PL ARA on both CRD (r = -0.82 CRD-SFA; r = -0.62 CRD-UFA). These findings are consistent with the concept that dietary saturated fat is efficiently metabolized in the presence of low carbohydrate, and that a CRD results in better preservation of plasma ARA.

 

Lipids. 2009 Apr;44(4):297-309. Epub 2008 Dec 12.

Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. (pdf)

Volek JS, Phinney SD, Forsythe CE, Quann EE, Wood RJ, Puglisi MJ, Kraemer WJ, Bibus DM, Fernandez ML, Feinman RD.
Department of Kinesiology, University of Connecticut, 2095 Hillside Road, Storrs, CT 06269-1110, USA.

Abstract

We recently proposed that the biological markers improved by carbohydrate restriction were precisely those that define the metabolic syndrome (MetS), and that the common thread was regulation of insulin as a control element. We specifically tested the idea with a 12-week study comparing two hypocaloric diets (approximately 1,500 kcal): a carbohydrate-restricted diet (CRD) (%carbohydrate:fat:protein = 12:59:28) and a low-fat diet (LFD) (56:24:20) in 40 subjects with atherogenic dyslipidemia. Both interventions led to improvements in several metabolic markers, but subjects following the CRD had consistently reduced glucose (-12%) and insulin (-50%) concentrations, insulin sensitivity (-55%), weight loss (-10%), decreased adiposity (-14%), and more favorable triacylglycerol (TAG) (-51%), HDL-C (13%) and total cholesterol/HDL-C ratio (-14%) responses. In addition to these markers for MetS, the CRD subjects showed more favorable responses to alternative indicators of cardiovascular risk: postprandial lipemia (-47%), the Apo B/Apo A-1 ratio (-16%), and LDL particle distribution. Despite a threefold higher intake of dietary saturated fat during the CRD, saturated fatty acids in TAG and cholesteryl ester were significantly decreased, as was palmitoleic acid (16:1n-7), an endogenous marker of lipogenesis, compared to subjects consuming the LFD. Serum retinol binding protein 4 has been linked to insulin-resistant states, and only the CRD decreased this marker (-20%). The findings provide support for unifying the disparate markers of MetS and for the proposed intimate connection with dietary carbohydrate. The results support the use of dietary carbohydrate restriction as an effective approach to improve features of MetS and cardiovascular risk.

 

Nutr Metab (Lond). 2008 Apr 8;5:9.

Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. (pdf)

Accurso A, Bernstein RK, Dahlqvist A, Draznin B, Feinman RD, Fine EJ, Gleed A, Jacobs DB, Larson G, Lustig RH, Manninen AH, McFarlane SI, Morrison K, Nielsen JV, Ravnskov U, Roth KS, Silvestre R, Sowers JR, Sundberg R, Volek JS, Westman EC, Wood RJ, Wortman J, Vernon MC.

State University of New York Downstate Medical Center, Brooklyn, New York, USA. .

Abstract

ABSTRACT: Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology. The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations which are primary targets. Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss. Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.