Type 2 Diabetes and a Low Carb Diet – Essential or Dogma?

The newest diabetes diet recommendations came out a few days ago: eat more carbs, and use drugs to keep your blood glucose under control. Scary stuff.

Common Recommendations Tell Diabetes It's Okay to Eat Sugar
Does Weight Loss Help With Blood Glucose Control?
Or is that Just Dogma?

Diabetes Health Magazine recently ran an article by Hope Warshaw entitled:

“Type 2 Diabetes: From Old Dogmas to New Realities – Part 2.”

In that article, Warshaw first focuses on and ridicules weight loss for diabetics in connection with better glucose control, and then likewise attacks a low carb diet – calling both of them old dogma.

For those who have actually studied the principles and science behind carbohydrate restriction and/or have put them to the test, adversity against our own personal truth and experience isn’t new. But when someone looked to as an authoritative voice presents that a minimum carbohydrate intake of 45% of daily calories is the new reality for diabetics, it’s hard to walk away and let that be.



Is Weight Loss for Diabetics Really Dogma?


When I was first diagnosed with pre-diabetes, my physician believed that if I could just lose 10 pounds, my fasting blood glucose levels (121 mg/dl) would correct themselves, and I would escape diabetes.

In fact, he was so sure that was true, he never retested me to back up his view.

Warshaw pegs that perspective as dogma, but the issue of weight loss and diabetes is far more complex than to shove it aside just because “research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis.

Why?

Because Insulin Resistance sits at the heart of Type 2 Diabetes. It literally drives pre-diabetes forward, and sets the stage for glucose toxicity.

While “the biggest bang for the effort per pound is likely in the pre-diabetes phase,” as Warshaw says, that’s only because most physicians and patients don’t know anything about how and why a low carb diet works.

And that makes articles like this one potentially dangerous.

Tell a Type 2 Diabetic that weight loss for him or her is fruitless, and you’re going to have hundreds of overweight and obese individuals giving up their efforts to overcome the effect of the obesity epidemic in their lives.

Tell a Type 2 Diabetic (who has elevated insulin levels by definition) that “it’s time to progress to blood glucose-lowering medication(s), because it’s doubtful that weight loss alone will get and keep blood glucose under control,” and you’re going to end up with a world full of fat, sick, diabetics suffering needlessly with diabetic complications.
  • If you’re no longer pre-diabetic, just give up.
  • Stop trying to diet.
  • Just use drugs.
It all sounds like a Big Pharma commercial to me.


The sad thing is this:

People shove insulin injections away for as long as possible for a reason. A good reason. A reason low carb dieters are very aware of – that higher and higher insulin levels (when insulin resistant, rather than insulin deficient) mess with your hormone balance and encourage you to eat more.

While it’s true that calories count (even Dr. Atkins himself said that), when the body wants to up its fat reserves, it simply slows down the metabolism to do it.

Is a Low Carb Diet for Diabetes Old Dogma or Essential?


While going on Metformin at diagnosis has been standard medical practice for as long as I can remember, and a med that hardly anyone fights against, the scary thing about this article is what it says about low carb diets:

They are no longer essential to achieve good blood glucose control, because that’s "old dogma."

The new advice?

Nutritional 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.

Now that’s scary . . .

Because:

The fastest way to lower elevated insulin and blood glucose levels is with a low carb diet.


Telling people with Type 2 diabetes that they should be eating more carbohydrate foods than their body can personally process, rather than less, sets them up for not only persistent overweight and obesity, but also serious diabetic complications. 

Yet the article proposes a diabetic toss away carb restriction in favor of eating a minimum of 45% of their daily calories in carbohydrates.

At 1,900 calories a day (my current maintenance level for 160 lbs), 45% of my calories would be 214 grams of carbohydrates per day, or over 71 grams per meal.

Please note:

That's for each meal. Not for the full day!

71 grams per meal is twice the amount of carbs it takes for me to maintain good blood glucose control! And four times the carbs it takes to bring my blood glucose levels back down to normal quickly, if elevated.

Now, in all fairness, I am not diabetic.

I’ve only been diagnosed with pre-diabetes.

The classification that Warshaw says can be helped through dietary control.

However, were I to eat at the levels this article recommends – 45% to 65% of my daily calories in carbohydrates – I would be diagnosed as diabetic (with post-meal blood glucose levels over 200 mg/dl) because that’s how high my blood glucose levels would soar.

The only reason why I am not diabetic today is because my current physician only diagnoses diabetes from an A1c test, and I’ve been following a lower carb diet since January of 2007. 

"Yeah, but the article says a low carb diet works to prevent diabetes progression," you may say.

True.

But give me the level of carbohydrates that this article recommends (over the course of a few days so the enzymes needed to digest that amount of carbs up-regulates), and my post meal blood glucose levels would be over the line for a diabetes diagnosis.


How do I know?

Because the last time I ate 60 grams of carbohydrates per meal consistently, starting from a base level of a normal 84 mg/dl, my post meal blood glucose levels rose to 210 mg/dl, my fasting blood glucose to 127, and my basal levels to 110.

Were I to eat 71 grams of carbohydrate or more at each and every meal, day after day, what do you think would happen?

Has the American Diabetes Association Made a U-Turn?


I was particularly shocked to hear Warshaw say:

The ADA supports the current U.S. Guidelines for healthy non-diabetics as a ruler for those with metabolic issues because their 2011 guidelines for diabetics talks about metabolic individuality, self management, and how important it is to find the “best mix of carbohydrate, protein, and fat” for any particular individual to help them “meet the metabolic goals and individual preferences of the person with diabetes.

In fact, when it comes to low carb diets themselves, they even said that “Monitoring carbohydrates, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.

And that “In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1c with a low-carbohydrate diet than with a low-fat diet.

So why is there so much negativity directed towards a low carb diet?

Why is Warshaw suddenly announcing that the ADA has changed their mind, and now wants to put all diabetics on a level of carbohydrates that will guarantee them perpetual glucose toxicity?

Glucose toxicity KILLS beta cells!

But an even bigger puzzle is that according to the ADA:

The RDA for digestible carbohydrate is 130 g/day and is based on providing adequate glucose as the required fuel for the central nervous system without reliance on glucose production from ingested protein or fat.

Now, if that’s true, then why or why is Warshaw recommending such a high carbohydrate level for diabetics?

A hundred-and-thirty grams a day is quite a bit less than 45% of our daily calories.

The Same Old, Same Old Argument: No Long Term Low Carb Studies


At the end of her article, Warshaw uses an old, tired argument to manipulate her readers to move to her side of the fence.

She says that:

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.

While her argument is technically true, (most low-carb studies do fit within the time period she holds up), the lack of data isn’t because those of us who have been following a low carb diet for years are unwilling to come forth with our stories and medical records.

It’s because most scientific studies-to-date use individuals who are not interested in adopting a permanent low carb lifestyle. They go off the diet when the study ends or when the study instructs them to move to maintenance, return to their old eating habits, and gain the weight back.

Well…duh!!!

Shortly after my brother-in-law went in for triple by-pass surgery, my husband and I went through thorough physical testing ourselves – from initial simple blood work to rather expensive stress and heart artery tests.

The results amazed our personal physician as well as the cardiologists. In fact, the main cardiologist told me he had never seen arteries as clean as mine were. And while my husband’s arteries were labeled in good shape, my personal physician told me that mine were considered excellent.

The difference between my husband and I? A low-carb diet!!!

At that time, my pre-diabetes was UN-diagnosed by my physician because it had completely reversed itself.

In fact, my physician told me at that time, that I was the healthiest patient she had ever seen. She was totally amazed. And while she was in full support of my low-carb diet, she didn’t understand how or why it worked.

The Bottom Line: A Low Carb Diet is Essential for Diabetics!


I’d like to say that after my test results, I was sold on low-carb diets, and that my husband and I have lived happily ever after. But like all of those other scientific study patrons to date, I became a wayward low-carb child this past year, and basically ran away from home.

This rogue-attitude was due partially to being sick from a serious flea bomb exposure, and partly because my husband and I found out that we both have celiac disease. My hope was that gluten was behind my metabolic issues.

Maybe initially it was. And maybe it wasn’t. There’s no way to tell. But running away from home only made things worse for me.

Like I said above, if I choose to eat too many carbs at a single meal, my blood glucose levels will soar into diabetic ranges. But if I keep my carbs to a maximum of 15 to 20 grams for breakfast and lunch, and a maximum of 40 grams for dinner, my glucose levels remain normal.

On an ordinary day, I eat fewer carbs than that – that’s just the maximum I can have, that will keep my Neuropathy from surfacing, and my weight stable at 160 pounds.

What I have on my side so far is that a lower carb diet does keep my blood glucose levels within tight targets.

I don’t eat anything that causes my levels to rise above 140 mg/dl at one hour, or to stay elevated above 120 mg/dl at two hours.

Most of the time, I try to eat what keeps my levels at or below 120 mg/dl at all times, because that’s a more normal blood sugar target.

Were I to follow the advice given me in this article, that kind of drugless control would not be possible.

My Neuropathy would have me on pain medication, and Big Pharma would be supporting me with Metformin and/or insulin injections.

If the bottom line (according to this article) is really to:

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,then I can honestly say that a low carb diet has helped me to do exactly that.

The Nutrition and Metabolism Society is Working to End the Madness


The goal of the NM Society is to fight against all of the misinformation presented these days against the effectiveness of low carb diets – false and dangerous information, such as the madness introduced in this article.

Ridiculing low carb and calling it old dogma hurts diabetics, and those suffering from the complications of overweight and obesity, because low-carb diets offer a way to correct the metabolic imbalances at the heart of many of those problems.

If you wish to join with the Nutrition and Metabolism Society in the fight for truth, consider paying a visit to their website, and join in their cause and goals. Your help can make a difference in the world.

*I am not being paid by the Nutrition and Metabolism Society. All views presented in this blog post are my own.



Comments

  1. Vickie,
    Thanks for your article. You might also enjoy some of Jennie Ruhl's writing on this topic. She encouraged me to get in the 5% Club for my HbA1c, and I've managed to stay there for two years now following the Southbeach diet, trying to walk every day, regularly testing about 2 hours after eating and making adjustments, and using just metformin oral medication. I lost about 90 pounds the first year, too. Thanks again for sharing your perspective.
    Melanie

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  2. Thanks Melanie,
    I am familiar with Jennie's website, since she regularly posts to Low Carb Friends. At one point, my Neuropathy was so bad I couldn't walk without shoes. Following her advice put my Neuropathy into remission.

    Congrats on getting into the 5% Club.

    ReplyDelete
  3. This is years after you first wrote this blog, but I came across it while researching for something similar. I agree with you on the overmedication part of things for sure. When my A1C was 7.1, my doctor wanted to put me on medication, but I said I wanted to wait to see what I can do in 3 months. My LDL was at 169. 3 months later, my A1C was 149, my LDL was 149, and my microalbumin was 32. My doctor said good on the A1C, but she wanted to put me on medication for the LDL and possibly for the microalbumin. I said to wait on both. I took the microalbumin test 1 month later, and it was 20, so she said no medication but still wanted for the LDL, so I reminded her that I wanted to wait another three months. I'm not sure I can bring that down to under 100 in 3 months, but my point is that if I just rolled over on Day 1, I would be on 3 medications by now!

    I know mine is not due to heredity but due to my original bad food/drink choices and lack of exercise, so I know it will get better. I just hate the fact that once you're diagnosed, you're forever labeled as diabetic.

    ReplyDelete
  4. Thank you so much for your comment. It's always nice to hear about the experience of others. I really appreciate you sharing your thoughts.

    ReplyDelete
  5. Hi Vicky
    I am very much enjoying reading your posts and appreciate the way you convey what is quite a complex subject.
    I was especially interested to read how you are keeping your neuropathy under control by reducing blood glucose levels. I had been to my doctor several months ago with numb toes and blurred vision. All the blood tests came back "normal" including fasting glucose reading of 4.9 mmol/L. My doctor didn't, therefore, make any connection between blood glucose and my symptoms. It was only when the neuropathy got worse after a couple of weeks of eating a lot of dried fruit that I realised that sucrose/fructose might be the culprit.
    Consequently, I adopted a ketogenic diet with around 25gms of carbohydrate, 75gms of protein and however much fat is needed to keep my weight stable at 155lbs. After several weeks what has concerned me is that fasting blood glucose has been rising and is now at 6.3 mmol/L, well into prediabetic territory! Eyesight has improved but not the neuropathy.
    I have seen several reports, including on the Hyperlipid website, of a ketogenic diet increasing blood glucose levels which is the opposite of what you would expect. Do you have any thoughts as to why this might happen? I can't also work out where all this glucose is coming from!! Maybe it is actually worth trying an increased carbohydrate intake?
    Many thanks
    Terry

    ReplyDelete
    Replies
    1. Similar things happened to me. Couldn't figure it out for a long time. I ended up raising my carbs to get my glucose back under control. That's one of the reasons why I was eating at 15 to 20 carbs for breakfast and lunch and 30 for dinner here.

      Over the years, I've discovered that a lot of different things affect blood glucose level. Not just carbs. For me, celiac disease was a major factor as well as Grave's Disease. Recently, I've heard it suggested that it means you're not fat adapted yet, but I don't know if that's true. There are so many theories within the low-carb community being passed on as fact.

      Delete

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