Guess what - A Low Carb Diet Doesn't Work?

Type 2
1

Imagine my shock when reading the latest post on Diabetes Health, “Type 2 Diabetes: From Old Dogmas to New Realities - Part 2,” by Hope Warshaw, spokeswoman for not only the American Diabetes Association (ADA), but also the American Dietetic Association (ADtA). Apparently, we have been mistaken all along:

Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet.

New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines (1/31/11) for carbohydrate: about 45 to 65 percent of calories. (Americans currently eat about 45 to 50 percent of calories as carbohydrate–not a “high carb” intake.)

Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they’re carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods–all healthy sources of carbohydrate

It turns out the ADA/ADtA had been recommending a low carb diet for years and we didn’t know it! And things have changed. It turns out the nutrition authorities have “unveiled” an all new guideline, people with type 2 diabetes should eat 45-65% of their calores from carbs. Apparently “Countless” studies have failed to show a benefit to low carb diets. I don’t know what planet these people are on, but the studies are in, low carb diets have been shown to lead to both short term and long term improvements in blood sugar control (as well as improvements in cardiovascular risk biomarker such as blood pressure and cholesterol).

I am torn. I have gone through the supporting analysis by the USDA and the ADtA that was used to establish their recommendations. It is not objective, tragically flawed and completely untrustworthy. But I am not sure whether it is due to incompetence or outright corruption. In either case, I am angry that these falsehoods and lies continue. This article in Diabetes Health is “revisionist.” The ADA/ADtA has NEVER supported a low carb diet, that was never their “Old dogma.” Their new dogma is the same as always and it is a lie. And I feel compelled to call it out for what it is.

So I would urge you to go read the article and if you feel like I do, leave a comment for Hope Warshaw. Let her and the ADA/ADtA know your feelings on the matter. And when the ADA calls you yet again during the dinner hour, think about who should get the money your spend on charity, perhaps it is time to help tudiabetes, JDRF or Denise Faustman.

2

These people make me absolutely crazy. Having been diagnosed Type 2 diabetic recently I have had to wade through all of the confusing and contradictory advice. It is nuts that we have to experiment on ourselves in order to find any kind of answer.

I was sent to a dietitian who followed the ADA rules and prescribed a 300g carbohydrate diet for me. Now I am a 6’ 200lb man but still, this level of carbs is nuts. My fasting, much less any other, blood glucose levels did not budge from the mid-200 range on this crazy diet.

It wasn’t until I started to eat a significantly lower carb diet that my levels started to come down. They came down pretty quickly too.

I just don’t get why diets this high in carbohydrates for diabetics still have so much support.

3

I was thinking about this in the context of Jackson’s Valley campaign, when his troops marched 30 miles/ day for weeks on end, eating pretty much a “low carb diet” of a biscuit or tow and any varmints unfortunate enough to fall into their clutches. And, of course, Yankee supply trains? Admittedly not everyone is a young soldier on the march but there are countless reports of people achieving success without 300G of carbs.

I am mystified by the debate and efforts to discredit the idea of eating less carbs, blaming “sugar” I don’t even know what I do. Maybe “medium carb” is why I’m so happy? I rarely eat fruit. I don’t recall ever liking fruit very much. I run 3-4 times/ week (at least…) and usually have quite a bit (20-45G?) of refined sugar while doing so. I don’t think that matters that much either which, to me, suggests that it’s not what you eat but how many carbs and achieving a correct balance of carbs and BG. I sort of interpret the first hunk of her spiel as being “don’t eat less to avoid medication” which seems correct, if only based on a few things I’ve run into involving complications, stories here and some cases that I’ve encountered. It seems as if it can creep up on people and it seems like T2 might almost have more risk of that because of the strange way that doctors seem to communicate options and treatments and testing to people with T2? Test once every other day amazes me.

4

For me, diabetes has been and is a confusing ailment to deal with. First of all, when it came on, I did not know what was happening, and neither did the doctors. Diabetes came on me gradually, and I suppose the doctors I was consulting were not experienced enough to recognise gradual symptoms as opposed to full blown symtoms. When I was finally diagnosed with diabetes I was being treated for other ailments which have similar symptoms to diabetes. It was only through the grace of God during this time, another doctor was consulted by my neurologist. This other doctor was a problem solver, not a band aid doctor. He looked at tests as not “well all your tests are in normal ranges”, but as “your tests are in normal ranges, however, some are just barely above the lower limit, let’s look at these closer”. That’s how my diabetes was diagnosed and my quality of life started its way back to something resembling normalcy.
I do not understand diabetes, but I attempt to manage my diabetes. I am not satisfied in my mind that there are really any doctors who understand diabetes. Doctors can however, be of help. The degree of useful help, I suppose depends on the experience and analytical ability of the doctors. After knowing I was diabetic, the most useful information for dealing with diabetes has come from sharing information on the ailment with other diabetics, either in person or on a couple of diabetic forums. Of course, I keep my doctors informed of what I do, and so far have had no objections from them.
bsc, I guess this brings me to a couple of things in that article you referred to in starting this discussion, one “(The sad fact is that most people don’t know that they have prediabetes.)” I did not know, and did not know I had diabetes for several years.
And, two, “Bottom line: The most important new reality for prediabetes and type 2 diabetes is: Take action as early as possible after diagnosis. Don’t delay, don’t deny. Get and keep your blood glucose, blood pressure, and blood cholesterol into recommended target zones.” Even after I was diagnosed, even though I followed guidelines the doctor laid out, I was in denial. After getting over denial I started managing my diabetes better. At the onset of neuropathy, I was in denial again. After getting over denial, I am seeing some improvement there.
I do not believe doctors or maybe I should say the medical profession can manage my diabetes for me. I feel I am the only one who can manage my diabetes, and will attempt to do so through doctors, personal research, and sharing of information with other diabetics (compare notes and try to decide if what another diabetic is doing will be helpful to me, and if I think it might, then approach that with caution since we all seem to react just a little differently to the same things).

5

AR I think you raise some good points about fruit.



The militant low-carbers tell me I’m wrong to think that, say, T1 kids should eat some fruit as part of their diet, or that T1 kids should drink milk (it has lactose).



But the worries I’ve developed about carbs over the years also make me at least sometimes feel guilty for wanting a nice juicy yellow pear and taking a unit or two of insulin to deal with it.



I know, I’m not a kid today, but 30 years ago I was a kid with T1, and that’s probably the last time I ate a pear without feeling at least a little twinge of guilt. Today the guilt seems far greater.



Yet I don’t have those guilts chomping down on bacon. How did I get so messed up where I worry about a nice yellow pear and don’t worry about chomping down on bacon? It’s not that I don’t like bacon, but to quote Homer Simpson “mmm… Unexplained Bacon”… Homer isn’t exactly a role model in terms of a healthy diet!!!



I’m not sure where the boundary between “understanding carbs and effect on bg’s to help actively maintain good healthy bg control” and “being obsessed with carb counts to the point where bacon seems healthier than a pear” falls but sometimes I feel like I’m unhappily tripping over that boundary in my head.

6

Your points are well taken, but remember, Warshaw is talking specifically about T2 diabetes. One of the things I have been observing about the research is that low carb diets are markedly better for insulin resistant patients. Chrisopher Gardner made this point in his work. Well, for T2 patients, insulin resistance is a hallmark of the condition.

I don’t have any issue in suggesting that T1 patients can do great on a high carb diet or even the suggestion that T2 patients might do well on high carb diets. What drives me even more whacko than I already am is the suggestion that low carb diets have been disproven as effective. A statement that flies in the face of everything we see with our own eyes.

7

bsc your link to the studies in your OP would be enough to convince most people. This study cites 64 other studies to reach its conclusions, I’d call that overwhelming evidence. Low carb improves all aspects of metobolic syndrome/T2 diabetes.

The first sentence of the abstract states “Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited and therapy more generally relies on pharmacology.” It’s hard not to draw the cynical conclusion that the dietary advice promoted by Hope Warshaw is meant to spur the sales of diabetes drugs. If it’s not the reason, it’s certainly the result.

I believe there have been past posts here by dieticians who say they have trouble getting T2s to even consider low carb. Perhaps this is the other side of the coin. Being a good treatment strategy is useless if people won’t take the advice. A less cynical take on the ADA’s and ADtA’s stance is they are offering the best diet people will actually follow. Fair enough, just don’t call it healthy.

July 1st is my two year T2 diagnosis anniversary, I started low carbing within 6 weeks, I guess it’s going to quit working any day now.

8

I agree that getting people to follow a low carb diet could be part of the problem, but don’t say that it doesn’t work or studies don’t support it (and by “you”, I don’t mean you!). I am of the opinion that people need to be presented with the truth and if they want to ignore that, that is obviosly their option.

9

Did you see in the papers yesterday headline CURE FOR DIABETES 600 calories a day…if I did that I would be in a coma. This was a UK research project. Why the front page,. Crazy indeed.

10

I’ve been told that all T1’s are insulin resistant (just to different degrees). It seems that the inflammation associated with the autoimmune stuff in T1 is not all that different than the general inflammation often associated with metabolic syndrome and T2.

So I see a lot for me to learn from T2’s.

11

I registered and tried to post. It said they were posted but not there either. I tried to post anonymously and that said moderators had to review it before being posted. I have a feeling they are getting a lot of flack and holding them!

12

I remember you saying that. They are not very low-carb friendly over there! There used to be a couple low carbers but they moved on. You say low carb & it is a death sentence there!

13

I know I was included as a success story at our Diabetes Clinic. Lost weight and lowered numbers maintaining over 3 years!! Of course, they knew that I threw out their ridiculous diet and exercise plan and hired a personal trainer to do the low carb plan. I’m sure they left that out of their reports!

14

My experience is that on some articles, Diabetes Health moderates all comments. I’ve not had any comments be blocked, but they have taken as long as 3-4 days to appear. I’ve always tried to keep my comments appropriate, objective and not personal. Not always easy.

15

I’ve been running pretty regularly for a few years now and, over the years, I’ve encountered a couple of people getting around with walkers and I always make a point of giving them a big thumbs up and saying “looking good”. If they laugh, that’s probably good for them too! I am always lisetning to some sort of blaring music to pump myself off and don’t bother stopping to visit but I don’think that anybody loses out on exercising, T1, 2 or zero.

16

If just one person tries low carb and is successful and avoids complications that is reason enough to present it as a treatment option. If another chooses a different path, that is fine as long as they are well informed when they make their decision.

17

That is one hell of an interesting video! I am off for 3 days (and already lifted and rode 23 miles on my bike and tanned…so my ADD is satiated…) and am watching it and, while it’s quite a bit longer than my usual attention span, I am liking the presentation a lot. In my own experience, while I have lost weight over time, I don’t think I’d be looking too good in the study as I have been very slow about it. 95 lbs (today…a solid 180…down from 275 at my peak…but that was in like 2006? I don’t know if that even counts?)

18

Honestly this is why I have never followed ADA recommendations. First and foremost no countless number of studies will tell me that the 45% is nit too high to begin with, whichever way you look at it. Even to an imbecile will recognize the simple truth , If one has a problem metabolizing glucose which primarily comes from carbs, they ares well served by eliminating as many carbs from their diet as possible… enough said

19

Ok, now at the end of the video he contradicts Taubes’ suggestion that exercise doesn’t matter, citing a study that showed a sampling (not a study…) that showed that people who lost 30 lbs and kept it off all exercised an hour/ day? I’m not sure what to make of it but now I wish I’d studied this stuff more. It’s pretty interesting.

20

I followed the link you provided (the studies are in) and found a “journal” that I have never heard of before. I did a bit of research, and would like you to confirm whether what I found is correct.

The “journal” looks to be a traditional independent peer-reviewed journal, but it was one I hadn’t heard of before. What I found was that it is in fact an online-only site maintained by the “Nutrition and Metabolism Society” which has a vested interest in pushing low carb diet. From their website: “The Nutrition & Metabolism Society is dedicated to addressing the problems of obesity, diabetes and cardiovascular disease through public awareness and education. They’re specifically looking at the therapeutic potential of carbohydrate-restricted diets for the treatment of a variety of diseases and now believe this particular way of eating is under-investigated and under-utilized.”

As such this article and the others in the “journal” do not receive independent peer-review since they are peer-reviewed by those pushing a low carbohydrate diet.

That doesn’t necessarily make the article wrong, but it does seem to me that there is an obvious conflict of interest that makes me more cautious, and which I think should be noted when a link to what looks like an independently peer-reviewed article is provided.

I only did a quick search, so maybe I am wrong. Or am I? Do you know?