In an interesting twist this week, in an updated WedMD article, American Diabetes Association spokesman Nathaniel G. Clark, MD acknowledged in an interview that carbohydrate restricted diets help people with type II diabetes control blood sugar.
In previous articles, I've stated evidence-based medicine must be the gold standard used for making for recommendations; I've pointed to the consensus driven, dogmatic position of the ADA; and I've stated in no uncertain terms that the ADA must be held accountable for the health harming position, based on opinion not data, it takes.
Now the excuse from the ADA is that they do not recommend controlling carbohydrate because patients find them too restrictive. "We want to promote a diet that people can live with long-term," says Clark, who is vice president of clinical affairs and youth strategies for the ADA. "People who go on very low carbohydrate diets generally aren't able to stick with them for long periods of time."
The WebMD update was prompted by the publication of Low-carbohydrate diet in type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up, in the peer-reviewed journal, Nutrition & Metabolism.
The study started as a six month study to compare the effect of a low-carb or low-fat diet in those with type II diabetes. The original study data was published in 2005. In the present study, the researchers wanted to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. They also noted that 2/3 of the original low-fat group modified their diet after the study term and also showed improvement after making the dietary change. At the 22-month mark it was concluded that the improvements found at six months had a lasting effect on both body weight and glycemic control.
Noteworthy is that this is the first "long-term" study - one that didn't even include intensive follow-up and tracking for compliance - at almost two years. Without dietary counseling those who experienced the dramatic improvements stuck with the diet - even the majority of those subjected to the low-fat diet saw the results in the group following the low-carb diet and jumped at the chance to follow a low-carb diet and experienced the improvements too in the period between six months and twenty-two months.
So, it's now difficult for the ADA to say there's no data. What they're doing now is changing their tune - patients don't want to follow the diet, it's too hard.
Again we see the ADA purposely avoiding evidence-based medicine standards.
Quite frankly, it doesn't matter if a patient can or will follow the dietary protocol the evidence shows is superior to the current recommendations. Evidence-based medicine demands these findings be not just acknowledged in an interview, but presented to the patient as a line of defense in their management of the disease.
It's nothing but pure arrogance for the ADA to arbitrarily decide that it will not fully disclose the benefits of a carbohydrate restricted diet, as shown by the evidence, to patients because it feels patients won't want to follow the diet.
Since when does the ADA or any other medical organization decide what a patient wants?
Those with type II diabetes, those with pre-diabetes, and those at risk for developing insulin resistance which will lead to diabetes must be given all the facts so they can make a decision based on the full data available - anything less fails the standard of informed consent.
This study shows that individuals, when given an opportunity to experience the health changing effects of carbohydrate restriction, stick with it for the long-term. And who wouldn't? Just imagine what their health would be today if they never enrolled in the study and never were given the information about how to properly follow a carbohydrate restricted diet - they'd be progressively deteriorating!
Instead, their improvements are persisting - because they chose to continue eating a carbohydrate restricted diet.
It's time the ADA takes the evidence-based approach seriously and abandons this notion they know what a patient wants.
At the end of the day, you'll be hard pressed to find a majority of those with diabetes willingly opting for more medication and progressive deterioration rather than just give up the bread, pasta, rice and potatoes!