New Review of Macronutrients for Diabetic Nutrition
For years, the legacy of the ADA (American Diabetes Association) and the ADtA (American Dietetic Association) (now staking the claim to the name Academy of Nutrition and Dietiecs (AND)) dietary recommendations have held up, arguing that diabetics should follow a high carb, low fat diet. The flag for this fight was handed off from the ADA to AND, but the individuals involved pretty much remained the same (a group of old guard non scientists with representation from industry).
The latest incarnate of their recommendations can be read in the JADA article "The Evidence for MNT for Type 1 and Type 2 Diabetes in Adults". I read through it and found it terribly flawed, just like its predecessor. And we continue to get flawed dietary advice based on this work. This is the core substantiation that is used to educate us on appropriate nutrition for managing our diabetes.
But the cracks may be widening. The latest salvo appears in the Diabetes Care issue with the article "Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes, A systematic review of the literature, 2010" Key findings on carbohydrates seem in total opposition to the AND assessment above.
Low Carb Findings (Up to 30% of calories from carbs)
In studies reducing total carbohydrate intake, markers of glycemic control and insulin sensitivity improved, but studies were small, of short duration, and in some cases were not randomized or had high dropout rates. Serum lipoproteins typically improved with reduction of total carbohydrate intake but, with the exception of HDL cholesterol, were not statistically greater than with the comparison diet. The contribution of weight loss to the results was not clear in some of these studies.
Moderate (40-65% of calories/carbs) to High (> 65%) Carb Findings
RCTs presenting information on moderate- and high-carbohydrate diets are diverse in terms of fat and protein content as well as length of study. Only two RCTs found significant differences in A1C between groups, with one study finding significantly lower A1C with the higher-carbohydrate diet only in a subgroup analysis, and the other study finding significantly lower A1C with the lower-carbohydrate diet. In terms of CVD risk factors, LDL cholesterol improved more with a high-carbohydrate diet in one study, whereas two studies found TGs improved more with a lower-carbohydrate diet.
Based on this assessment, it seems like a no brainer. The results suggest clear improvements in blood sugar control and no identified lipid problems with low carb diets. But no research seems to support the effectiveness of high carb diets. It doesn't really help your blood sugar control and it doesn't help your lipids either. The key argument has always been that low carb diets are a CVD risk because of adverse affects on lipids. Even if you believe the lipid hypothesis, this suggestst that low carb diets are heart healthy.
What do you all think of this? Is it progress? Will Hope Warshaw read it and understand it? Will it help lead to more progressive diet assessments and recommendations?
In either case, for those of you who have to deal with nutritionists and dieticians, print this journal article out. If you get harrassment from your medical team about following a low carb diet, you can pull this study out and show them that you are following a diet with some compelling evidence behind it.
Tags: ADA, Carbohydrates, Controversy, Diet, Evidence, Nutrition
Replies to This Discussion
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Permalink Reply by Randy on -
Bravo and ditto. My wife has the same experience and she is not diabetic.
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Permalink Reply by LaGuitariste on -
High five to your wife, Randy. It's great to find something that actually work. Theories are nice; results ROCK. ;0)
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Permalink Reply by Judith on -
My husband, the same, Randy: he lost 35 pounds and got off his BP med!.....
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Permalink Reply by Randy on
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My wife has been low carb for almost 10 years without much in the way of breaks. That's one thing that made it much easier for me. We already had a pretty good understanding of what to do and pretty much all of our common meals were already LC. Now I'm the one that is a stickler about the carbs!
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Permalink Reply by Brian (bsc) on
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My wife adopted a low carb diet in the last year. She is a self-admitted carb addict. I do all the cooking, it was easy for her, she just had to choose what I made. And she lost a lot of weight.
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Permalink Reply by smileandnod on -
Hooray for husbands who cook! :) My hubby does all the cooking also...he says it's therapy for him and it's a chore for me. He cooks, I clean up; works great for us! He's been on the low carb band wagon too and weighs less than he has in 10 years.
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Permalink Reply by Equestrian on -
bcs, I have followed your posts in the past as they, in my opinion, are accurate and precise. I have just reviewed Bernstein's book "Diabetic Solutions" 2011 revised. As a 46 year T1 diabetic, saddled with an insulin pump and cgm, I agree low carb is the only way to control blood sugars and to starve off standard deviations. However, I need to know how low carb does a T1 have to go before they see control to arrive at an A1C at 6 or less. Bernstein promulgates 6-12-12, but I find it too restrictive. What carb level do you use personally and is it successful in keeping your blood sugars in the 80-120 range which Bernstein says is optimal? Thanks for your input.
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Permalink Reply by Randy on
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Hi Laura, I agree BSC delivers some great stuff. My answer to your question is around 100. I eat to my meter and activity. I'm on MDI. Take 36 units of Lantus in the morning. Most days I use between 4 and 6 units of Apidra. Rarely over 145 or under 65. For the last year my average A1c is 5.5 (the highest being 5.6). I try to stay with low GI foods, but I do indulge, in small quantities, from time to time. I have also been doing a lot of experimenting with different foods. I know a lot of people work really hard to get a better A1c and I truly was shocked when my first one came back at 5.6 after being 12.3 at diagnosis. I really don't know why it works for me, but I'm not complaining. I don't know that it makes any difference, but I consume the majority of my carbs with snacks and not with meals. Most meals are pretty much no carb except for whatever the veggies have. The only other thing that may come into play is that I take 1000 units of r-ala each day, split between morning and evening. They say it mimicks insulin, but I have never been able to corallate that. I take it for my PN and that I can tell you is a YES it does make a difference.
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Permalink Reply by Brian (bsc) on
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Double ditto on the R-ALA and it helps with any neuropathy as well.
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Permalink Reply by Brunetta on -
I agree. I stopped taking Lyrica( crossed eyes, swollen feet, weight gain) and the R-ala does the trick with NO side effects.
God Bless,
Brunetta
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Permalink Reply by Brian (bsc) on
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I think you should choose a carb level that suits you. Everyone is different. I choose my own targets and make my own choices about carb levels, I set aggressive targets and I am willing to spend extra time and effort on foods. I eat 50-100 g/day (I use MDI) and prepare much of my own food. I can eat food that is wonderfully tasty and satisfying and keep my blood sugar tightly controlled. But everyone is different and has a different situation. I just want to be able to make a low carb dietary choice and not be considered a pariah.
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