高蛋白和低糖饮食能改善糖尿病饮食

收藏分享 2009-10-19 17:17| 发布者: tianniao| 查看数: 90| 评论数: 0

2009 年10月6日（维也纳，奥地利） -减少碳水化合物的消耗量来控制糖尿病患者的高血糖降低了对大血管及微血管并发症的风险，据理查德费曼，博士，从下州医学中心的纽约市布鲁克林区。在接受饮食对糖尿病和其他专家公开讨论，他补充说，科学是没有争议，但有关政策在控制饮食是糖尿病。

在一个为糖尿病第45届年会的欧洲研究协会的研讨会上，教授费恩曼说，官方议会不愿意完全接受的数据支持，在糖尿病控制碳水化合物的作用，科学家代表，在实地研究低碳水化合物饮食和糖尿病的人数不足的政策小组。

“这些建议是比较高的碳水化合物。当您按反倾销协定[美国糖尿病协会的建议]，他们说他们没有具体的饮食，但实际上他们建议高碳水化合物[饮食]并给予勉强支持限制碳水化合物的饮食习惯。“

“我很想看到一个公正的科学家小组，不一定有任何营养的承诺，[如]物理学家或气象。目标将是对事实清楚的分析，制定各项方案，尤其是糖尿病患者。让病人和医生作出决定，“他宣称。

此外，在会议上发言，阿尔内阿斯楚普，医学博士，营养部的负责人在丹麦哥本哈根大学，解释说，反倾销协定的建议是一个持续的过程，应当不会改变每一项新的研究发表的时间。 “如果你坚持以证据为基础的原则，你就不会跳进新的极端的饮食。我认为反倾销协定是正确的保守。这是完全没有根据的，一个非常低碳水化合物的饮食安全和长期效益。我们需要2 - 4年的研究表明，这比其它现有的试验，如糖尿病预防计划的审判和芬兰糖尿病预防研究，有效。“

特鲁普博士介绍，从调查的8国饮食，肥胖与基因（欧根尼8）欧洲膳食干预研究，结果显示，在审判的548人当中，由于高蛋白质后减重饮食保持他们的减肥最成功的。在比较高有低血糖指数的饮食，对此保持体重的为低蛋白饮食的研究。 “我们一直脂肪含量不变，但略有增加蛋白质。我们减少碳水化合物略有下降，从正常的55％的热量为45％，但。。。20％要低得多。另外，我们发现，如果碳水化合物食用高纤维全麦（低血糖指数），也增加了一些利益，增加蛋白质含量。“

他补充说，欧根尼8研究将是非常有用的体重维持在减肥，体重也可能和增益的预防。 “我们没有测试糖尿病患者，但也有可能，这将作为饮食类和其他有效的2型糖尿病患者的饮食。相较于非常严格低碳水化合物的饮食，其实这是一个非常安全的食物，而不是一个崩溃的饮食，因为它提供了在一天结束的风险很小的所有营养。“

相反，教授费曼认为，大约20％的碳水化合物摄入量在糖尿病最有效的。不过，人们普遍担心，低碳水化合物饮食引起人们的吃更多的脂肪，这对心血管疾病（CVD）的影响。

费曼教授提出的理由，这不是一个问题。 “保持碳水化合物低实际上在本质上减少心血管疾病的危险。，在碳水化合物的存在脂肪是我们发现的问题，这是非常从没有脂肪的碳水化合物不同。”

他解释说，碳水化合物，直接或通过胰岛素，是在代谢控制元件。 “他们决定脂肪处置-是否储存或是否肥胖有对脂蛋白和血管的影响。减少碳水化合物的代谢作用是，它是诱发的脂肪氧化而不是把它，特别是糖尿病，它可以防止代谢高糖，高胰岛素，这是一刀切不利的状态。“

在提出初步报告数据的同事，包括玛丽甘农，博士，从美国明尼苏达大学教授费恩曼讨论了低碳水化合物饮食（20％的热量的影响）对血液与2型糖尿病人血糖控制。结果与在同一人后，取得5控制高碳水化合物（55％），饮食周的。低碳水化合物组显示，空腹血糖明显下降，接近正常，并在糖化血红蛋白下降。值得注意的是，在设计的膳食，使病人没有得到或减肥，这表明，即使在减肥没有好处。

论优点和不同饮食对糖尿病患者的利弊后，医生阿斯楚普说，在病人是否胰岛素敏感或胰岛素抵抗而定。 “如果有人更多的胰岛素抵抗，他们可能会受益于低碳水化合物饮食的，但胰岛素敏感患者，可能是更好地遵循low-fat/high- carbohydrate饮食，更适合自己。”

费曼教授赞同，鸢尾嘉曦，医学博士，从本古里安大学贝尔谢巴，以色列，补充说，最近几次干预，包括2年期膳食随机对照试验（直接），建议，地中海和低碳水化合物的研究，更有利于饮食比低，在改善长期高脂饮食长期血糖控制，甘油三酯，高密度脂蛋白胆固醇，总胆固醇/低密度脂蛋白胆固醇的比例，和重量。

“在第一年，大多数2型糖尿病患者，其最大的机会得到充分的控制饮食和身体活动单独推迟的降血糖药物治疗的需要。”只要我们在裁缝个人饮食策略，病人成功（即低脂肪/中低碳水化合物），根据他或她的偏好，目标和饮食历史，病人会更成功地坚持到他或她的方式生活。这意味着一个饮食不适合所有的，她说。

反倾销协定取得突破性释放时，在2008年小心声明的有效性和安全性低碳水化合物膳食去一年，博士嘉曦说。 “我相信，越来越多的证据为基础的医学最终将改变目前的饮食建议low-fat/high-carb看法。[当]病人可以坚持这一饮食，[它]可以帮助一些糖尿病患者的比例，这是限制热量饮食，“她总结说。

医学岛推荐原文：
High-Protein/Low-Carb Diet Effective for Weight Loss in Type 2 Diabetes, But Merits Remain Unsubstantiated

October 6, 2009 (Vienna, Austria) — Reducing carbohydrate consumption to control high blood glucose in people with diabetes reduces the risk for macrovascular and microvascular complications, according to Richard Feinman, PhD, from the Downstate Medical Center in Brooklyn, New York. In an open discussion with other experts on diabetes and diet, he added that the science is not controversial but policy regarding dietary control in diabetes is.

Speaking at a symposium at the European Association for the Study of Diabetes 45th Annual Meeting, Prof. Feinman said that official boards were reluctant to fully accept data supporting the role of carbohydrates in diabetes control and that scientists representing research in the field of low-carbohydrate diets and diabetes are underrepresented on policy panels.

"The recommendations are for relatively high carbohydrates. When you press the ADA [American Diabetes Association] for their recommendations, they say they do not have a specific diet, but in fact they recommend a high-carbohydrate [diet] and give grudging support to a restricted-carbohydrate diet."

"I'd really like to see an impartial panel of scientists that doesn't necessarily have any commitment to nutrition, [such as] physicists or meteorologists. The goal would be a clearer analysis of the facts, laying out the options, especially for people with diabetes. Let the patient and the physician make the decision," he asserted.

Also speaking at the meeting, Arne Astrup, MD, head of the Department of Nutrition at the University of Copenhagen in Denmark, explained that ADA recommendations are an ongoing process and should not change every time a new study is published. "If you stick to evidence-based principles, you wouldn't jump into new extreme diets. I think the ADA is correct in being conservative. It's completely unsubstantiated that a very-low-carbohydrate diet is safe and effective in the long term. We need 2- to 4-year studies to show that this is more effective than other existing trials, such as the Diabetes Prevention Program trial and the Finnish Diabetes Prevention Study."

Dr. Astrup presented findings from the 8-country Diet, Obesity and Genes (Diogenes 8) European dietary intervention study, which showed that, of the 548 people in the trial, those given the high-protein diet after weight loss maintained their weight loss most successfully. The study compared a high-protein diet with a low-glycemic-index diet, for which weight maintenance was less marked. "We kept fat content constant but increased protein slightly. We reduced carbohydrates slightly, from the normal 55% of calories to 45%, but . . . 20% is much lower. Also, we found that if the carbohydrates are consumed as high fiber and whole grains (low glycemic index), they add some benefit to the increased protein content."

He added that the Diogenes 8 study would be most useful for weight maintenance after weight loss, and probably also weight-gain prevention. "We didn't test diabetics but it is also likely that this diet would be as effective for type 2 diabetics as other diets. In contrast to the very restrictive low-carbohydrate diet, this is actually a very safe diet, not a crash diet, because it provides all the nutrients with little risk at the end of the day."

In contrast, Prof. Feinman suggested that a carbohydrate intake of around 20% is most effective in diabetes. However, there is a prevailing concern that low-carbohydrate diets cause people to eat more fat, which has implications for cardiovascular disease (CVD).

Prof. Feinman made the case that this is not an issue. "Keeping carbohydrates low would actually reduce the risk of CVD. In essence, fat in the presence of carbohydrate is where we find the problems, which is very different from fat in the absence of carbohydrate."

He explained that carbohydrates, either directly or through insulin, are control elements in the metabolism. "They determine the disposition of fat — whether stored for obesity or whether having an effect on lipoproteins and vasculature. The metabolic effect of reducing carbohydrates is that it predisposes to oxidizing the fat rather than storing it, and in diabetes specifically, it prevents the metabolic state of high glucose and high insulin, which is detrimental across the board."

In presenting data initially reported by colleagues, including Mary Gannon, PhD, from the University of Minnesota in Minneapolis, Prof. Feinman discussed the effect of a low-carbohydrate diet (20% of calories) on blood glucose control in people with type 2 diabetes. The results were compared with those obtained in the same people after 5 weeks on a control high-carbohydrate (55%) diet. The low-carbohydrate group showed a significant decrease in fasting glucose, to near normal, and a decrease in hemoglobin A1c. Significantly, the diets were designed so that patients did not gain or lose weight, indicating the benefit even in the absence of weight loss.

Discussing the pros and cons of different diets for diabetics, Dr. Astrup said that it depends on whether the patient is insulin-sensitive or insulin-resistant. "If someone is more insulin-resistant, they may benefit more from a low-carbohydrate diet, but for insulin-sensitive patients, it is probably better to follow the low-fat/high-carbohydrate diet that is more suitable for them."

Agreeing with Prof. Feinman, Iris Shai, MD, from Ben-Gurion University in Beer-Sheva, Israel, added that several recent intervention studies, including the 2-year Dietary Randomized Control Trial (DIRECT), suggest that Mediterranean and low-carbohydrate diets are more beneficial than a low-fat diet in improving long-term glycemic control, triglycerides, high-density-lipoprotein cholesterol, the total cholesterol/low-density-lipoprotein cholesterol ratio, and weight.

"Within the first year, most type 2 diabetic patients have their biggest chance to be adequately controlled by diet and physical activity alone and to delay the need for antihyperglycemic drug therapy." As long as we succeed in tailoring an individual diet strategy to the patient (i.e., low fat/med to low carbohydrate), according to his or her preferences, goals, and diet history, the patient will more successfully adhere to his or her way of life. This means that one diet doesn't fit all, she said.

The ADA made a breakthrough when releasing a careful statement in 2008 about the effectiveness and safety of low-carb diets out to 1 year, Dr. Shai said. "I believe that the growing evidence-based medicine will eventually change the current perception of the recommended low-fat/high-carb diet. [When] patients can stick to this diet, [it] could help some proportion of the diabetics, as it is a calorie-restricted diet," she concluded.

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