A low-carbohydrate diet may prevent end-stage renal failure in type 2 diabetes. A case report

An obese patient with type 2 diabetes whose diet was changed from the recommended high-carbohydrate, low-fat type to a low-carbohydrate diet showed a significant reduction in bodyweight, improved glycemic control and a reversal of a six year long decline of renal function. The reversal of the renal function was likely caused by both improved glycemic control and elimination of the patient's obesity. Insulin treatment in type 2 diabetes patients usually leads to weight increase which may cause further injury to the kidney. Although other unknown metabolic mechanisms cannot be excluded, it is likely that the obesity caused by the combination of high-carbohydrate diet and insulin in this case contributed to the patient's deteriorating kidney function. In such patients, where control of bodyweight and hyperglycemia is vital, a trial with a low-carbohydrate diet may be appropriate to avoid the risk of adding obesity-associated renal failure to already failing kidneys

Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up

<p>Abstract</p> <p>Background</p> <p>Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of obese patients with type 2 diabetes. We previously reported that a 20% carbohydrate diet was significantly superior to a 55–60% carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months. The present study documents the degree to which these changes were preserved in the low-carbohydrate group after 44 months observation time, without close follow-up. In addition, we assessed the performance of the two thirds of control patients from the high-carbohydrate diet group that had changed to a low-carbohydrate diet after the initial 6 month observation period. We report cardiovascular outcome for the low-carbohydrate group as well as the control patients who did not change to a low-carbohydrate diet.</p> <p>Method</p> <p>Retrospective follow-up of previously studied subjects on a low carbohydrate diet.</p> <p>Results</p> <p>The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. At 44 months average weight has increased from baseline g to 93.1 ± 14.5 kg. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower weight at 44 months than at start. The initial mean HbA1c was 8.0 ± 1.5%. After 6, 12 and 22 months, HbA1c was 6.1 ± 1.0%, 7.0 ± 1.3% and 6.9 ± 1.1% respectively. After 44 months mean HbA1c is 6.8 ± 1.3%.</p> <p>Of the 23 patients who have used a low-carbohydrate diet and for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have suffered several cardiovascular events.</p> <p>Conclusion</p> <p>Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control.</p

Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up

BACKGROUND: Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect. We previously reported that a 20 % carbohydrate diet was significantly superior to a 55–60 % carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control. METHOD: Retrospective follow-up of previously studied subjects on a low carbohydrate diet. RESULTS: The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. Seven of the 16 patients (44%) retained the same bodyweight from 6 to 22 months or reduced it further; all but one had lower weight at 22 months than at the beginning. Initial mean HbA1c was 8.0 ± 1.5 %. After 6 and 12 months it was 6.6 ± 1.0 % and 7.0 ± 1.3 %, respectively. At 22 months, it was still 6.9 ± 1.1 %. CONCLUSION: Advice on a 20 % carbohydrate diet with some caloric restriction to obese patients with type 2 diabetes has lasting effect on bodyweight and glycemic control

Metabolic effects of low glycaemic index diets

The persistence of an epidemic of obesity and type 2 diabetes suggests that new nutritional strategies are needed if the epidemic is to be overcome. A promising nutritional approach suggested by this thematic review is metabolic effect of low glycaemic-index diet

Policaptil Gel Retard® significantly reduces body mass index and hyperinsulinism and may decrease the risk of type 2 diabetes mellitus (T2DM) in obese children and adolescents with family history of obesity and T2DM

BACKGROUND: Treatments for childhood obesity are critically needed because of the risk of developing co-morbidities, although the interventions are frequently time-consuming, frustrating, difficult, and expensive. PATIENTS AND METHODS: We conducted a longitudinal, randomised, clinical study, based on a per protocol analysis, on 133 obese children and adolescents (n = 69 males and 64 females; median age, 11.3 years) with family history of obesity and type 2 diabetes mellitus (T2DM). The patients were divided into three arms: Arm A (n = 53 patients), Arm B (n = 45 patients), and Arm C (n = 35 patients) patients were treated with a low-glycaemic-index (LGI) diet and Policaptil Gel Retard®, only a LGI diet, or only an energy-restricted diet (ERD), respectively. The homeostasis model assessment of insulin resistance (HOMA-IR) and the Matsuda, insulinogenic and disposition indexes were calculated at T(0) and after 1 year (T(1)). RESULTS: At T(1), the BMI-SD scores were significantly reduced from 2.32 to 1.80 (p < 0.0001) in Arm A and from 2.23 to 1.99 (p < 0.05) in Arm B. Acanthosis nigricans was significantly reduced in Arm A (13.2% to 5.6%; p < 0.05), and glycosylated-haemoglobin levels were significantly reduced in Arms A (p < 0.005). The percentage of glucose-metabolism abnormalities was reduced, although not significantly. However, the HOMA-IR index was significantly reduced in Arms A (p < 0.0001) and B (p < 0.05), with Arm A showing a significant reduction in the insulinogenic index (p < 0.05). Finally, the disposition index was significantly improved in Arms A (p < 0.0001) and B (p < 0.05). CONCLUSIONS: A LGI diet, particularly associated with the use of Policaptil Gel Retard®, may reduce weight gain and ameliorate the metabolic syndrome and insulin-resistance parameters in obese children and adolescents with family history of obesity and T2DM

Incremental change and transformational governance: a case study of the promotion testing process for firefighters in the city of New Haven in the context of Ricci v. DeStefano (2009)

The recent U.S. Supreme Court ruling in Ricci v. DeStafano (2009) has raised a multitude of concerns about how cities develop and administer promotion tests for civil servants. The Ricci case involved the city of New Haven’s efforts to administer a promotion exam for firefighters in the city, with an explicit attempt to promote social equity in the upper reaches of the city’s fire department. Briefly, when no minority firefighters scored high enough on the promotion exam for the positions of Captain and Lieutenant, the city refused to certify the exam. White firefighters who passed the exam filed suit against the city claiming they had been discriminated against on the basis of their race. The High Court ruled against the City and for the white firefighters. In light of the Ricci ruling, the purpose of this paper is to provide an in-depth review of the administrative process conducted by government officials of the City of New Haven with regard to the promotion testing process for firefighters. There are four main goals for this paper. The first aim is to provide a historical framework for the analysis; the second goal is to conduct an analysis of relevant literature and provide an account of the actual case. The third goal is to evaluate and elaborate on the concerns that arose from the case, and the fourth purpose of the study is to provide suggestions of how things could have been done differently. In an attempt to make the City’s public workforce more diverse, a select group of public administrators, including the mayor, John DeStefano, engaged in an unconventional course rather than a deliberative process to create a fire department that was more representative of the current ethnic makeup of the City of New Haven. Many government programs are only modestly successful over the long term, are hard to evaluate on more than anecdotal evidence, and the public is the final jury on government policy outcomes. And, as a result, public administrators are often in a position to create policy that reflects political and economic realities. They have to constantly weigh the purposefulness of program inputs as well as the strength of program outputs. In addition to strong, evidence-based data and the presence of politically sensitive, good will interventions, transparency and deliberative evaluation is imperative for a meaningful policy process. It is posited in this case study that while eliminating adverse and disparate impact from promotion testing is an urgent goal to create workplace diversity and representativeness, it can be accomplished through an incremental process. In a sense it has to be conducted this way because of the following three reasons: 1. Scientific findings in the area are incremental with several findings but no firm conclusions. In fact, over 60 years of rigorous study on the subject by the University of California have yielded statistically mixed results basically indicating that schools in lower and higher income areas continue to provide disparate preparation for tests. 2. Democracies change policies almost entirely through incremental changes, rather than in leaps and bounds (Lindblom, 1959). In principal every citizen has an equal say in our political and policy process. Because we have different perspectives and values, and because American citizens highly prize individualism, we support a participatory decision making process. 3. The public as a whole prefers homeostasis rather than crisis. Unless there is overwhelming, supportive public opinion for change, in general, the public prefers deliberation on an issue rather than a sudden shift in policy. While in this case, some administrators in New Haven thought that there was no time like a crisis to make a substantive change in promotion testing policy, there was no collective opinion on how this should be accomplished. Instead, a sudden reaction to the crisis provoked suspicion, alienation and resentment on the part of stakeholders and the general public. What was seen by the Mayor of New Haven as a representative and transformational move in a decision to not certify promotion test results, was instead perceived by others as an exploitive abuse of his personal power and privilege to make a change that he personally supported and possibly to burnish his image as a change maker. Whatever Mayor DeStefano's decision, his position would have been strengthened with both the courts and the various constituencies to which he was responding had he engaged in a deliberative process. As it was, he turned the case over to the City's Civil Service Board. Although the Board was divided and held hearings, given its political makeup, the outcome of these discussions was never really in doubt. The function of these hearings, then, was to bypass a genuinely deliberative process rather than to facilitate it. This process might have led to the same conclusion-- to reject the test. And given its conservative makeup, the Supreme Court might still have found that the City was in violation of the law. Even so, the City's case would have been far stronger and it might have set a precedent for other cities to follow, allowing an incremental process to lead to a more representative city workforce. Using a qualitative evaluation approach, a case study was conducted of the City of New Haven promotion policy decision making process for its firefighters in the context the U.S. Supreme Court’s ruling in Ricci v. DeStefano (2009). Data was collected through interviews with a select group of administrators in New Haven, a review of testimony before the City’s Civil Service Board, and a review of related documents regarding the promotion testing of a group of classified civil servants in the city’s fire department in 2003.Ph. D.Includes bibliographical referencesIncludes vitaby Gwyn A. Sondik

Does a High-Protein Diet Improve Weight Loss in Overweight and Obese Children?

Objective: To evaluate the effect of a high-protein diet on anthropometry, body composition, subjective appetite, and mood sensations in overweight and obese children attending a residential weight-loss camp. Research Methods and Procedures: Children (120; BMI, 33.1 5.5 kg/m2; age, 14.2 1.9 years) were randomly assigned to either a standard or high-protein diet group (15% vs. 22.5% protein, respectively). All children were assessed at baseline and at the end of the camp for anthropometry, body composition, blood pressure, biochemical variables (n = 27), and subjective appetite and mood sensations (n = 50). Results: Attendance at the weight-loss camp resulted in significant improvements in most measures. Campers lost 5.5 2.9 kg in body weight (p < 0.001) and 3.8 5.4 kg in fat mass (p < 0.001) and reduced their BMI standard deviation score by 0.27 0.1 (p < 0.001) and their waist circumference by 6.6 2.8 cm (p < 0.001). Subjective sensations of hunger increased significantly over the camp duration, but no other changes in appetite or mood were observed. There were no significant differences between the two diets on any physical or subjective measures. Discussion: Weight-loss camps are effective in assisting children to lose weight and improve on a range of health outcomes, independently of the protein content of the diet. The implications of an increase in hunger associated with weight loss needs to be considered. Further work is warranted to investigate whether higher levels of dietary protein are feasible or effective in longer-term weight-loss interventions of this type