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July 6, 2011

People with diabetes should eat more carbohydrates???

I must not have read this correctly. Read this article from Hope Warshaw, MMSc, RD, CDE, in Diabetes Health.

She calls low carb "old dogma" and says that people with diabetes should follow diets closer to the new USDA recommendations, which suggest 45 - 65% carb. That is, according to her, more than the typical American now eats!

??????????????????????????????????????????????????????? People with diabetes, a disease of carbohydrate intolerance, should eat MORE carbs?

I don't have diabetes. I'm very grateful that I don't, and I also engage in exactly the kinds of behaviors that prevent type 2 diabetes. I eat a low carb, but also low calorie diet with very little nutritionless junk and lots of vegetables. I exercise. I maintain a healthy weight.

The comments on the article were fantastic, but I think even more interesting was the response of the editor, Nadia Al-Samarrie. Her response if worth reading. She remembers a time when Atkins and Bernstein were blacklisted in the medical community, a time we should all remember much the same way my colleagues on the left remember the McCarthy era. When ideology takes over to the point that anyone is blacklisted, truth is probably already a casualty of war.

I a no expert in diabetes care, but it does seem intuitive that *increasing* carbohydrates, with no rationale as to why (perhaps some people lose more weight on a high carb diet?) makes no sense. The Warshaw article asserts that diabetics should follow a higher carb diet than that consumed (according to her) by the average American as of now, but offers no evidence for this other than that other authorities supposedly recommend it. I hope that people with diabetes do more research before deciding on a diet.

It's quite true that no one diet works for everyone. I've experimented with a lot of diets, and found that a high protein, relatively high fat diet works best for me. Cutting out junk carbs, which include most "whole grains" was really key to me in controlling appetite and losing weight. But that's one person's experience, and I agree with Ms. Al-Samarrie that it's important to consider all points of view.

The danger I think of Ms. Warshaw's article is that it prescribes an increase in carbohydrate intake for diabetics, who are in a much more dangerous state day to day than someone like me who can experiment with diet with few to no short term health consequences. Carb intake for diabetics isn't just a matter of opinion, it's a matter of life and death. There's nothing wrong with offering an opinion, but a recommendation that diabetics increase carb intake to higher than what a typical American *now* consumes should be backed up with more facts and evidence than Ms. Warshaw offers.

When considering these questions of health, I often marvel at how fortunate I am to be a) a relatively healthy person b) blessed with excellent health care though my excellent job c) living in 2011 d) surrounded by, at least electronically, some of the best minds in medicine and medical research who are willing to take their valuable time to answer my questions, even when inane. How do people who don't have these resources navigate? The answer, I fear, is that they rely on the recommendations of the government, the ADA, and the AHA. That gives these agencies a great responsibility to be right when they recommend, at least as right as is possible given the (true) current state of the science. That's why we call on the ADA to acknowledge the validity of a low carb diet as, while not the only vehicle for treating type 2 diabetes, a powerful and important tool.

Posted by april at July 6, 2011 9:53 AM

Comments

I agree 100% - Thank you April.
I hope that everyone who reads this post will pass it on, post it on Facebook, Twitter & everywhere possible. It may help save a life!

Posted by: laurie at July 6, 2011 11:00 AM

Are you familiar with the work of Dr. Neal Barnard and the Physicians Committee for Responsible Medicine? He recommends a moderate-to-high carb diet for diabetics as well. I've found his reasoning pretty convincing. My boyfriend's diabetic mother is on his plan right now, actually, and has dropped 15 lbs in 6 weeks AND has already needed to reduce her diabetes meds. She hopes to be rid of them completely eventually, and she's heading in that direction.

But as you said, every body is different, and biochemical individuality must always be taken into account,

Posted by: Amber Shea @Almost Vegan at July 6, 2011 3:27 PM

I have a co-worker who has BOTH type 1 and type 2 diabetes. He must lie to his doctor about what he eats, since he lives off pasta, sandwiches, ramen noodles, and a balance of both diet and regular Mountain Dew, based on what his blood sugar is doing. And goldfish crackers. And, yet, he says the doctor doesn't think he could make any improvements, diet-wise, and so has put him on yet another medication. To my credit, even though I don't particularly like him, I have mentioned some stuff about lower-carb diets for diabetes-sufferers.

Posted by: Kyniska at July 8, 2011 1:54 PM

Great post April, you might like to read this marvelous response to Hopeless Warhsaw by Tom Naughton
http://www.fathead-movie.com/index.php/2011/07/07/nuts-to-the-nutty-diabetes-expert/
...and Amber don't get me started on Neal Barnard, just read the comments on this page (FYI the last comment is from me)
http://www.thelivinlowcarbshow.com/shownotes/2909/dr-neal-barnard-on-vegetarian-and-vegan-diabetes-control-episode-415/
(apologies for lack of hyperlinks you may need to copy n paste)

Posted by: Steve Wilson at July 8, 2011 7:26 PM

Correct me if I'm wrong, but isn't the whole issue with diabetics the fact that they can't clear sugars out of their blood normally? For type I, that's caused by lack of insulin production. Insulin is necessary for glucose transport into cells. For type II, that's caused by lack of function on the receiving end.
In either case, the problems are caused by the elevated blood sugar. Therefore, it seems very clear that any high-glycemic load meal would be bad--and that would include high-carbohydrate (percentage of caloric intake) diets. And therefore, there seems to be little basis for advising a high-carb diet.

Unless I'm mistaken, it seems like Warshaw doesn't know how diabetes works; for a medical worker (especially one writing an article giving dietary advice to diabetics), that shocks me. I get that no diet is right for everyone, but in this case it seems like the --um-- wrongness? of high-carb diets has a very sound mechanistic basis.

Posted by: Marie at July 11, 2011 7:56 AM

In working with diabetics with out of control blood sugars and often multiple hospitalizations for ketoacidoses, I find their meal plans to be just like a non-diabetic meal plan. Simplified, you count the carbs up for the meal or food about to be eaten and give the prescribed amount of insulin for those carbs- one unit of humalog per 15g of carb, for example. Also insulin coverage would be prescribed to correct high blood sugars at certain times of the day using a sliding scale dosing. New methods of insulin administration and also new types of insulin seem to control blood sugars alot better than in the past, and allow the diabetic to eat a "normal" diet.

Posted by: dal at July 15, 2011 10:36 AM

April, and all:

It's worth noting that, as of 2008, the ADA has quite substantially moderated its position on macronutrient intake for diabetics:

http://www.longecity.org/forum/topic/38285-is-the-national-institute-on-aging-helpful-at-all/page__view__findpost__p__384311

Dal: yes, you're right -- but arguably, that's just the problem. Is it not more reasonable to suggest that people cease and desist from the lifestyle habits that are causing them metabolic mayhem, than to optimize the drug protocols to compensate for them? The same could be said of statins, BP meds, etc. A healthy body with no drugs is better than a sick body forced to behave more healthily with them.

Amber: Barnard is a politely foaming-at-the-mouth ideologue, whose dietary recommendations are driven by his "animal rights" agenda, not by careful consideration of the evidence. Their position on fish oil in patients with heart disease is particularly head-shaking.

Posted by: Michael at August 24, 2011 2:29 PM

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