Many of these are faulty analogies, as it has NOT been demonstrated that eating a high carb diet is equivalent to a person who experiences anaphylactic shock from an allergen continuing to eat that food or to a person who is celiac eating wheat.
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I think it is important to understand that most doctors receive broad instruction in medical school. They get very little education on diabetes or nutrition. A recent study of medical nutrition education in the US found that on average less than 40% of medical schools even achieved the 25 hours of instruction recommended by the National Academy of Sciences. 25 hours is basically three full days of instruction, not exactly a level which would give a future doctor much deep competency on nutrition, let alone appropriate diets for managing diabetes. I’m just sayin, our doctors are not “deep experts,” we all would likely do better by learning on our own and finding dietary patterns that work for us.
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I agree that doctors are not typically experts in nutrition – although I would hope that an endo keeps up with at least some of the latest research. Though I did notice an interesting disconnect at our clinic. I heard a talk where the head endo at our clinic said something interesting. He’s actually quite knowledgeable and up to date on the latest research in general. When asked if kids should go “low carb” he said no and the typical “the body needs carbs for fuel” but that everyone in society needs to eat fewer carbs. But then when asked what that level was, he said “you should speak with our dietitians and nutritionists about it.” Apparently he doesn’t know what his nutritionists are actually telling people, because these are the same nutritionists who said 2-year-olds need to eat 150 grams of carbs per day, which I’m hard pressed to believe is what he meant by carb reduction.
I actually think dietitians are the ones who have deficient training, not doctors. I wouldn’t expect a doctor to be able to give me detailed advice about what to eat. I would expect a dietitian to be able to do so. I saw a dietitian this summer specifically to ask about diet and weight loss. I was already eating a low-carb diet when I saw her. Her advice? Eat 45-60 grams of carbs per meal and that “we don’t count calories anymore” so she told me to go download MyFitnessPal to figure out how many calories to eat.
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Makes perfect sense to me… 
You’re right, I’m not sure what training dietitians get or how often they’re required to update it, but I notice this when I make my calls for stories. Depending on which dietitian I talk to, I can get wildly different recommendations – way more so than I’d expect with, say, doctors talking about the appropriate treatment for a condition.
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Okay . . . not bashing anyone here, but most dietitians are seriously behind the times regarding LCHF. It’s basically anathema to what they have been taught during their formal training, That is just a fact on the ground, and one more reason why each of us has to become our own expert in what works and what doesn’t.
I remember one clinic where I consulted with my endo. The standard practice was to seat me in a room and the CDE/dietitian would do a 15 minute interview before I saw the doc. I didn’t particularly like this practice but I tried to go with the flow and maintain good humor.
After doing this 4x/year for a few years, the CDE/dietitian was giving me a sincere compliment on my A1c, but more importantly on the CGM data that she looked at. I don’t think she often saw a low average, with low variability, and few hypos. She asked how I was able to achieve this. I said that it was only possible because I followed a carb-limited diet well under the 130 gram/day minimum that her dietetic professional association, AND, recommended.
She insisted that the brain needs a minimum 130 grams of carbs per day. I responded that that is not true and the body adjusts nicely without carbs as the liver converts protein to glucose via gluconeogenesis. She was flustered with my pushback and she disappeared until returning with the doctor.
Since I knew she had a hallway conversation with the doc about my “unhealthy food habits,” I raised the point that I’ve been following a carb limited diet happily and that it was the primary driver of the good results I get. She offered some limited defense of her colleague and quickly moved on. While I give this doctor high marks for her good communication and listening skills, her style when I raised a low carb diet was to be quiet and change the topic. That was OK. I didn’t need her permission and she could clearly see the results I was getting.
I started to see that same doctor at another clinic. I think the CDE/dietitian was happy to see me leave.
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One extra little factoid that many people don’t know—even a few doctors, since it’s a moderately recent discovery—is that the brain keeps its own emergency cache of glycogen handy. It’s good for about 15 to 20 minutes, generally. Look up “astrocytes”.
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I bet we eventually learn that the diet that’s best for a growing T1 diabetic child isn’t necessarily the best for a middle-aged T2. I can tell you have to deal with a lot more subtleties than I do, practically a full-time job.
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This article irritated me no end. Kolata interviewed a couple big-wigs and showed her ignorance of low-carb approaches to controlling blood sugar. I’ve always liked her stuff but now my skept-o-meter has been recalibarted.
Oh my. Ignorance and misinformation galore.
Here’s one of the parts that set my hair on fire:
But multiple studies have found that when it comes to weight loss — the only proven way to help with blood sugar control over the long term — there is no difference among diets that restrict calories, fat or carbohydrates.
First, the article behind the link doesn’t say what she says it says: they were evaluating the effects of fat restriction, not carbohydrate restriction.
Second, it just ain’t true. 150 years of experience says the exact opposite.
Grrrr.
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I have the same thing engrained in me: stay away from fat. I’m T2 and try hard to eat low carb. I’m a good weight and good A1c, but I struggle everyday to “stay on track”.
I find the more good fats I eat the lower my cholesterol and other lipids go. It has taken me a while to start enjoying butter, cheese, olive oil, etc.
And weight loss is “the only proven way to help with blood sugar control
over the long term”??? What if you have reached your ideal weight and
still have bs control issues? Keep on losing weight til your BMI is what, 5?