Impact of a low-carbohydrate versus low-fat breakfast on blood glucose control in type 2 diabetes: a randomized trial

BACKGROUND

In type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest.

OBJECTIVE

We investigated if a low-carbohydrate (LC) breakfast (∼465kcal: 25g protein, 8g carbohydrates, 37g fat) could improve glucose control in people with type 2 diabetes when compared to a low-fat control (CTL) breakfast (∼450kcal:20g protein, 56g carbohydrates, 15g fat).

METHODS

Participants with T2D (N=121, 53% female, mean age 64 years) completed a remote 3-month parallel-group randomized controlled trial comparing a LC versus standard low-fat guideline CTL breakfast. Change in hemoglobin A1c (HbA1c) was the pre-specified primary outcome. Continuous glucose monitoring, self-reported anthropometrics and dietary information were collected for an intention-to-treat analysis.

RESULTS

HbA_1c was reduced (-0.3%, 95% CI: -0.4% to -0.1%) after 12 weeks of a LC breakfast, but the between group difference in HbA_1c was of borderline statistical significance (-0.2, 95% CI: -0.4 to 0.0; P=0.06). Self-reported total daily energy (-242 kcal, 95% CI -460 to -24 kcal; P=0.03) and carbohydrate (-73g, 95% CI: -101 to -44 g; P<0.01) intake were lower in the LC group but the significance of this difference is unclear. Mean and maximum glucose, area under the curve, glycemic variability, standard deviation, and time above range were all significantly lower, and time in range was significantly higher, in the LC group compared to CTL (all P<0.05).

CONCLUSIONS

Advice and guidance to consume a LC breakfast appears to be a simple dietary strategy to reduce overall energy and carbohydrate intake and improve several CGM variables when compared to a CTL breakfast in persons living with T2D.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT04550468.

Impact of Coffee Containing Medium-Chain Triglyceride Oil and Ghee on Markers of Cellular Inflammation in Young Healthy Humans

Objectives

Low-carbohydrate, high-fat “ketogenic” food supplements have become increasingly popular in recent years with claims of improving body composition and cognition, while reducing hunger. However, acute consumption of high-fat foods has been shown to promote dietary endotoxemia; the release of bacterial lipopolysaccharide from the gut into the blood, which is linked to proinflammatory responses through activating toll like receptor (TLR) 4 on circulating monocytes. Bulletproof Coffee is a popular high-fat beverage consisting of coffee, medium chain triglyceride (MCT) oil, and grass-fed ghee. The purpose of this study is to determine whether consuming this high-fat coffee beverage would impact cellular inflammation assessed by increases in the number of circulating monocytes and monocyte surface TLR4 expression. We hypothesize that consuming one high-fat “Bulletproof Coffee” will elevate concentrations of circulating monocytes and increase TLR4 expression when compared to a black coffee comparator drink.

Methods

This study is a single-blind (researcher), randomized crossover design wherein participants consume either a freshly prepared coffee (1 pod with 12oz water; ∼1 kcal), or high-fat bulletproof coffee (1 pod with 12 oz water containing 1 tbsp MCT oil and 1 tbsp ghee; 27 g fat; ∼250 kcal) separated by ∼7 days. Participants provided blood samples in the fasted state and at 60- and 180-minutes following beverage consumption. Blood samples were analyzed by flow cytometry.

Results

Six healthy adults (n = 5 females) aged 25 ± 8 years who consume coffee regularly have completed both conditions. Preliminary statistical analysis using a linear mixed model has shown no significant time x condition interaction (P = 0.184) or main effect of time (P = 0.211) for the concentration of circulating monocytes. Similarly, no interaction (P = 0.675) or main effects of time (P = 0.337) were observed for monocyte surface TLR4 expression.

Conclusions

Preliminary data suggests that consuming a single high-fat bulletproof coffee does not appear to increase circulating monocyte concentrations or monocyte TLR4 expression. Further research will be required to determine whether acute consumption of a high-fat coffee beverage impacts inflammation in humans.

Funding Sources

This study is funded by a Natural Sciences and Engineering Research Council (NSERC) of Canada grant.

Investigating the Effects of a High-fat Coffee Beverage Containing Medium-Chain Triglyceride Oil and Ghee on Cognitive Function and Measures of Satiety

Objectives

To test the hypotheses that Bulletproof Coffee (a blended drink containing coffee, medium-chain triglyceride [MCT] oil, and grass-fed ghee) will acutely improve cognitive function and lead to greater satiety when compared to black coffee.

Methods

This study uses a single-blind, counterbalanced, randomized cross-over design with each participant completing two visits ∼7 days apart. The researchers are unaware of the beverage consumed by the participant, however, distinct differences in taste and texture between the Bulletproof Coffee (10 oz freshly brewed coffee, 15 ml MCT oil, 15 ml grass-fed ghee, ∼250 kcal) and black coffee (10 oz freshly brewed coffee, ∼1 kcal) prevented participant blinding. At the time of COVID-19 in-person research curtailment on our campus, six young, healthy participants (n = 5 females, age = 25 ± 8) who are regular coffee consumers had completed both trials and we are presenting the preliminary data here. During each trial participants complete baseline fasted measurements of cognitive performance (Digit Substitution Task [DSST], Stroop Task and Speed Task, all performed on a tablet computer), hunger/fullness, cognitive arousal, and gastrointestinal distress and then consume one of the two test beverages. The same measures are obtained again at 60- and 170-minutes post-consumption.

Results

Preliminary results suggest that there is no difference in cognitive function between the two conditions measured by number correct on the DSST (P = 0.44). Results suggest that there is a significant condition by time interaction resulting in greater measurements of fullness (P = 0.04) over the visit and a lower perceived prospective food consumption (P = 0.02) in the Bulletproof Coffee condition when compared to black coffee.

Conclusions

To our knowledge, this is the first study to examine the effects of Bulletproof coffee on cognitive performance. Preliminary data suggests that there may be no benefit of Bulletproof coffee over black coffee for improving cognitive performance. However, consuming one Bulletproof coffee containing 250 kcal, as compared to black coffee, does appear to increase feelings of fullness and result in a reduction in perceived prospective food consumption after 3 hours.

Funding Sources

Natural Sciences and Engineering Research Council (NSERC) of Canada.

Renal rehabilitation: keys to success. Case study of the anemic patient

Rehabilitation of dialysis patients was an original goal of the Medicare End-stage Renal Disease (ESRD) program. Since this program's inception, advances in technology (e.g., better dialysis equipment) and pharmacology (e.g., maintenance of an optimum hematocrit with Epoetin alfa) have greatly improved the care of patients with ESRD and increased the potential for successful rehabilitation. Recognizing the importance of rehabilitation, many health providers and patients have focused attention on developing innovative programs that can help improve outcomes. A key component of successful programs is the formation of a multidisciplinary team that actively plans, directs, and participates in the rehabilitation effort. This article provides case study overviews from three dialysis centers, including key steps that can ensure a continual focus on rehabilitation.

Benefit-cost analysis of rubella vaccination policy

To analyze rubella vaccination strategies we calculated benefits and costs of prevention or rubella. With no vaccination, lifetime expenditures for congenital rubella syndrome in offspring of females are greater than $35 per female (present value). Expenditures for acute rubella are less than $2.70 per person. Cost, when monovalent vaccine is used, is $3.00 per person. Vaccination of females at 12 years of age yields net benefits 80 per cent larger than vaccination of children at two. When only 80 per cent of the target group accepts vaccine, vaccination at 12 years reduces congenital rubella by 30 per cent more than vaccination at six or two. Vaccination at two and revaccination at 12 (with 80 per cent acceptance at each age) reduces expected natural infections by 80 per cent and expected congenital rubella by 95 per cent. Either single vaccination of females at 12 years or vaccination at two ages would be better than current United States practice of vaccinating children once at an early age.