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Archived Comments for: Therapies for type 2 diabetes: lowering HbA1c and associated cardiovascular risk factors

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  1. It is the time to revisit dietary therapy for diabetes mellitus.

    Robert Su, Virginia Pain Clinic

    17 September 2010

    Congratulations to Kurukulasuriya LR & Sowers JR of University of Missouri on their excellent analysis, “Therapies for type 2 diabetes: lowering HbA1c and associated cardiovascular risk factors”, to detail the desirable therapeutic and undesirable effects of each antidiabetes agent of each category, in terms of glycemic control, body weight, lipid level, and blood pressure parameters, all of which are significant cardiovascular risk factors. However, selecting a perfect antidibetes agent is hardly an easy decision, even equipped with such an excellent analysis. Both Kurukulasuriya & Sowers, as well as many physicians including the diabetes experts have continued to ignore an excellent therapeutic alternative to the pharmacotherapy.

    Glycemic control is the key to treating diabetes mellitus and its concurrent complications, because the higher the glycemic concentration, the worse the outcome of the diseases will be. Besides, hyperglycemia is causal to gaining weight, dyslipidemia or atherosclerosis, and vasoconstriction or hypertension, in addition to inflammation, thrombosis, and glycation. Tight glycemic control is unequivocally the most important measure in preventing and treating diabetes mellitus and many concurrent diseases. [1]

    All physicians must understand the sources of glycemia that the major supply for glycemia is the carbohydrate foods especially those with high in glycemic indices and glycemic loads. The more the intake of carbohydrate foods, the greater the excursion of postprandial glycemia is. The focus of preventing and treating hyperglycemia is the same --- keeping a normal glycemic level. However, preventing hyperglycemia is far more superior to treating the disorder, because the former takes one step ahead of the development of disease, and the latter trails behind the course of disease.

    Having understood the sources of glycemia, to best prevent hyperglycemia is to reduce the supply from carbohydrate foods. Over a century ago, physicians had already discovered the positive relationship between carbohydrate foods, especially sugars and starchy foods, and the increase of glycosuria, which is the namesake of diabetes mellitus. [2] Since the discovery of insulin in 1921, and, more antidibetes agents during the past few decades, physicians have simply forgot the key supplier, carbohydrate foods, for the excursion of postprandial glycemia in a positive relationship. They must realize that the advancement in biotechnology does not and cannot alter the basic physiology and biochemistry.

    More than a century after Dr. Williamson' article, the American Diabetes Association, in ADA annual Clinical Practice recommendations at the end of 2007, lukewarmly suggested that individual diabetic patients might be benefited by low carbohydrate diet. [3] On August 24, 2009, the American Heart Association recommended Americans to reduce their daily consumption of added sugar from 22.2 teaspoons to 9 for men and 6 for women. However, It failed to address the need of restricting carbohydrates in its recommendations. [4]

    Several studies have revealed that restricting carbohydrates can control the glycemic level, and also can result in weight loss, improve lipid levels, and reduce the cardiovascular risk factors. Up to this date, many physicians continue to embrace several misconceptions that the body cannot live without carbohydrates, that carbohydrates are low in calorie and excellent for weight control, and that fats are causal to obesity, inflammation, coronary syndrome, and many. Refreshing their knowledge in biochemistry would help clear such baseless concerns. [5, 6, 7, 8, 9]

    An upcoming study on the effects of the Paleolithic diet on type 2 diabetes mellitus will be conducted by the investigators of University of California, San Francisco. One of the study co-investigator, Dr. Lynda Frassetto, has already found improvement in the diabetic symptoms with the Paleolithic diet, which is carbohydrate-restricted, in just a two short weeks. [10]

    With an impossible task in finding an ideal antidiabetes agent or agents for glycemic control, body weight, lipid level, and blood pressure parameters, it is the time to revisit the dietary therapy for diabetes mellitus.


    1. Su RK. “Carbohydrates Can Kill: Hyperglycemia is problematic but preventable by restricting carbohydrates.” The Blog Carbohydrates Can Kill. August 16, 23, 30, 2010.

    2. Williamson RT. ""On The Treatment Of Glycosuria And Diabetes Mellitus With Sodium Salicylate.” The British Medical Journal. Page 760-762. March 30, 1901.

    3. American Diabetes Association. “Executive Summary: Standards of Medical Care In Diabetes.” Diabetes Care. January 2008 31:S5-S11; doi:10.2337/dc08-S005

    4. American Heart Association. “Sugar: Frequently Asked Questions (Consumers.)” Learn and Live.

    5. Boden G, et al. “Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes.” Annals of Internal Medicine, Volume 142, Number 6, Pages 403-11. March 15, 2005.

    6. Nuttall FQ and Gannon MC. “The metabolic response to a high-protein, low-carbohydrate diet in men with type 2 iabetes mellitus.” Metabolism. Volume 55, Issue 2, Pages 243-251. February 2006.

    7. Gannon MC and Nuttal FQ. “Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition.” Nutrition and Metabolism. Volume 3, Number 1, Pages 16. 2006.

    8. Arora SK and McFarlane SI. “The case for low carbohydrate diets in diabetes management.” Nutrition & Metabolism, (Lond), 2005; Volume 2, Number 16. 2005. Published online 2005 July 14.

    9. Nielsen JV and Joensson E. “Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up.” Nutrition & Metabolism, (Lond), Volume 3, Number 22. 2006 Published online June 14, 2006.

    10. News Article. “Hunter-Gatherer Diet May Help Prevent And Treat Type 2 Diabetes.” Diabetes Center, University of California, San Francisco. Wednesday, June 25, 2008.

    Competing interests