It appears that those following the half century old recommendations for a low fat diet if you want to avoid cardiovascular problems are losing ground fast. This is highly relevant for most people with diabetes, who are considered to be at high risk of heart attacks. A recent study in Spain, published in the New England Journal of Medicine, placed healthy people at risk of cardiovascular disease into one of three groups: A simple low fat diet; a relatively high fat Mediterranean diet supplemented with large amounts of extra virgin olive oil, and a Mediterranean diet supplemented with large amounts of walnuts, almonds and hazelnuts. Over a period of five years, the people in either of the groups following the Mediterranean diets had a 30 percent lower risk of suffering a heart attack than those in the low fat diet, the one currently recommended by many doctors and dieticians in the western world. According to the article in the medical journal, those responsible for the study met regularly with participants and even conducted blood and urine tests to ensure compliance with the study guidelines.
Noteably the Mediterranean diets included what many would consider to be healthy fats, avoiding transfats and the saturated fats that have been linked to cardiovascular disease.
I became aware of this study through the diabetes learning center at my local hospital, which in cooperation with the cardiology department at the hospital is sponsoring an intensive training course for people wanting to switch to a diet with a focus on healthy fats rather than a high amount of carbohydrates.
Thanks for your informative post. If I’m not mistaken you were counting carbs as a way of control. Will you be changing to the Mediterranean diet and if so which one oils or nuts . Nuts I have come to understand are high in Carbs so how would this play out? Please comment on this as I am intrigued by all this.
It has actually been quite a few years since I did the carb counting thing. I believe that method pretty much went out of fashion with the old 'a carb is a carb is a carb' way of thinking. Rather, my main focus in order to control blood sugars, has been a combination of selecting only carbohydrates that are low on the GI scale, like barley, Uncle Bens condensed rice, sweet potatoes, squash and beans.
I have however been limiting the amount of fat I eat. Based on the study referenced above, I think I am going to replace my standard crackers and ham snacks with nuts, and use a liberal amount of extra virgin olive oil in my daily salads.
What I was referring to was the old method of counting one carb, two carb, three carb that few people fully understood and even fewer were able to follow. I think that in newer times most people would go by grams e.g. 1 slice of bread is 15 grams, 100 grams of pasta is 60 grams of carbs etc. etc. and then add up over the day to correlate with their daily quotas.
I'm attaching - in pdf format - a copy of Saturday's article in our local paper that gives more details about the study in Spain.
The ADA have done a 180 degree turn around on fat as well
American diabetic association ( http://www.professional.diabetes.org/)
Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes;
therefore, goals should be individualized;
fat quality appears to be far more important than quantity.
In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.
I suppose that large organizations like the ADA will usually try to find a compromise between what is ideal and what it is realistic to expect that people will adapt to. Hence that they lag somewhat behind the 'cutting edge' when it comes to recommendations. However, compared to their position in past years - low fat high carb - no further questions asked or allowed - even for diabetics - what you mention above is a very good step ahead.
This article is confusing. I could not find this study and the study he did actually do was in another journal and was about delivering education virtually, it wasn't about diet. There are many proponents of a Mediterranean diet including Dr. Steve Parker. He has a lot of information on his site and in his writings.
I don't think the ADA has done a turn, they have done damage control as they realize that they have harmed thousands of people with their misguided nutrition advice. A few years ago they formally divested their dietary recommendations to the American Dietetic Association. Their current recommendations have a list of potential diets that include Mediterranean as the first item but then lists low fat, vegan and vegetarian before mentioning a "lower carbohydrate" diet. They can't even bring themselves to say "low carb."
I have an office in Amsterdam...no one is talking about walking and it's a big part of the Mediterranean diet. Do you walk 10 or 15 blocks to a restaurant, do you walk to the corner market? Do you buy enough food for a couple of meals at the corner market and walk home with it? Do you walk to the trolly or train station then after you get off maybe in a diffrent city do you walk or ride your bike which you carried with you to work? Then do it again when you get off from work stopping at the store and buying something for dinner or stopping at a local hangout and have a drink or a snack for dinner with friends no big meal.
It's a whole diffrent life style...It's not just a dietary change. Every time I go to Europe for a week I feel like I have gone through boot camp again...they burn more calories and eat a little more fat...one ounce of fat will take someone much farther down the road than 1 ounce of wheat.
Traditional wisdom changes glacially. The diet paradigm we've been living with for the past few decades is finally beginning to shift, and it's way past time. Most of what Americans have been told about diet for the past half century or so is politics, not science.
Since the 1950s, we have had drilled into us relentlessly that fat is the villain in the diet. Turns out it's really carbohydrate. Golly, who knew? (Rhetorical question, lots of people knew but they were just ignored.)
As for the ADA, Brian's take on it is absolutely spot on. After decades of encouraging diabetics to eat carbs (!) what they are doing now is essentially backpedaling. And if you think that's cynical, I'm keeping my true opinion to myself.
I grew up in Norway which is pretty close to Holland and as a general rule driving a car was a last resort because:
a. It was very expensive (e.g. your insurance rates are based on how far you drive and gas was about $7 a gallon).
b. There was a sense among most people that their feet were made for walking, a sense that in North America has shifted to 'feet are made for resting on a car pedal or on a sofa at home'
One other thing to keep in mind, for diabetics the most benefit from walking is if we do it right AFTER eating, going for a brisk walk BEFOTR eating can be counter productive since it often results in a glucose dump from the liver and elevated blood sugars, which will add to our post-meal readings.
You are right about the politics bit.
The food pyramid that the US government has been recommending for half a century and which has been mimicked in countless other countries, was driven by the US department of agriculture whose mandate is to help farmers sell wheat and other grains, not to abide by any science or health concerns.
Clinically it made since to count carbs and to just drop the 20% of our diet that was fat and hard to cover with the new fast insulin's...in the old days we used exchanges and the diet was balanced and the slower insulin covered the fat although managing was more difficult. Just eating carbs and dosing for them sounded good but with it came weight gain for me which I never had a weight gain problem when eating the strict exchange diet. Dumping the exchange diet brought freedom to our diet, but in the exchange days I never ran into an overweight Type1 but when I go to a meeting today, I see many type 1's with weight problems,,,again JMHO...
I think we need to consider a carb and calorie restricted diet, with a total glycemic dosing program based on any food that contains food energy.
Bolus insulin, of whatever type, is not intended to "cover" fat. Fat is not converted to carbohydrate by digestive processes. Protein is -- sometimes -- but not fat.
Stored fat can be converted to carbohydrate and used for energy, but that has nothing to do with meals, digestion, or bolusing. It's a completely separate and distinct biochemical process.
That being said, restricting carbs in the diet can be a real game-changer. It certainly has been for me, and many others here. And low-carb diets are not new; they were first popularized a century and a half ago. You'd never know that from listening to the popular media or most current "experts", though -- one more example of how politics trumps science.
David - I've read conflicting findings regarding dosing insulin to cover dietary fat. I haven't studied this issue closely or thoroughly but I did decide a few years back to use 10% of dietary fat grams as a basis for delivery of an extended bolus with my pump.
This video of a 2013 Joslin study examines the role of dietary fat and insulin dosing for type I diabetics. It found that more insulin was needed to metabolize a high fat meal versus a comparable low fat meal.
I'm still not sure what to conclude about this but my insulin dosing incorporating some of the fat in the calculation seems to work for me.
Well, dietary fat certainly affects bolus insulin requirements, but it's an indirect effect rather than a direct one. Example: lots of fat in the meal can retard absorption of the accompanying carbs very significantly -- in effect, temporarily lowering the glycemic index of the carb-rich foods. But current scientific understanding is that fat is not directly converted to glucose during digestion, as protein can be.
That being said, the critical word there is "current". Science is an unending process of discovery and turning over new leaves. Today's truism is often obsolete tomorrow. Despite all our scientific horsepower, we are far from knowing everything or having a perfect understanding. So it could turn out one day that the body is doing something with fat of which we are not presently aware. See my comment here.
I've been on the diet since October and my 30 day average is rising slowly from when I was on the lower carb diet (about 100 a day). My 30 day average has gone from 114 to 124. My A1c had improved on low carb from 5.9 to 5.5, but now I am afraid it will be back to 5.9 or higher when I get another A1C at the end of the month. The diet may be healthy and does promote healthy fats, but also encourages lots of fresh fruit and whole wheat, which I think led to higher glucose readings.
It is important to remember that all these diets are studied in non-diabetic populations where presumably they can tolerate higher levels of carbs. And while there may be cardiovascular and mortality benefits in the non-diabetic population there isn't a strong evidence base that it makes sense for PWD. In practice we should always remember in the face of these "cholesterol" based heart healthy recommendations that every time our A1c rises 1% our rates of cardiovascular disease double independent of cholesterol. If you adopt a "heart healthy diet" that says it will drop your cardiovascular risks by 10% but you end up raising your A1c by 0.5% you have done way more harm than good.
ps. That being said, you can adopt a Mediterranean style of eating, just drop the grains and fruit.
I can assure you that my body needs some insulin for all foods that contain caloric energy. Your right and most people do not cover fat or protein with meal bolus insulin. With a high carb diet you can just ignore the protein and fat but this is why many individuals cannot reach their BG targets. Todays proscribed insulin therapy's only deal with carbs in the high carb diet and drop the other 20% which includes protein and fat so many of the foods that contain higher percentages of fat and protein (Example: Pizza or a hamburger) are not recommended.
We should be dosing insulin for all of our total glycemic load all of the time but clinical evaluation has determined this to be complicated and most people cannot extend their bolus. Many of our Endos understand this but it's just complicated to prescribe, and the majority of patents lack the knowledge and data needed to calculate there total insulin needs. Many deal with fat and protein with correction insulin that's added in by their pumps and manual corrections after the fat and protein kicks in many hours later...my doctor thinks it is safer to correct after the fact.