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

Posted Jul 06 2011 5:44pm
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.

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, 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) lock up body fat stores, and encourage the body to store more and more calories in your fat cells. While it’s true that calories count (even Dr. Atkins himself said that), when the body wants to up its fat reserves, (which insulin encourages), 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: that 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. And 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. That’s twice the amount of carbs it takes for me to maintain good blood glucose control! And four times the carbs 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 that 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 one particular individual that would 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 double 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. That 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.

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