As we're all aware, type II diabetes is a progressive, degenerative disease, that takes its toll over the long-term; leading to blindness, amputation of limbs, kidney failure, cardiovascular disease and more. Management of the disease is time consuming and often painful, with daily blood sugar monitoring and oral medication; and as the disease progresses, daily insulin injections.
Recently an American Diabetes Association consensus statement acknowledged the lifestyle intervention that includes a carbohydrate-rich diet, recommended for decades by the organization to those diagnoised with type II diabetes, has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes.
In the statement, a new algorithm of management, starting at diagnosis, includes the same failed dietary intervention, now with the addition of pharmaceuticals.
As I've previously written, on the one hand we have the ADA acknowledging its dietary advice is worthless; on the other we have the ADA refusing to adopt, even cautiously, a dietary recommendation shown to improve blood sugars, insulin and HbA1C, and reduce risk markers for diabetic complications - a low-carb diet.
It seems part of the disconnect between the data in studies and the recommendations made by experts in the field is one of convenience. And no, in this instance I'm not talking about conveniently ignoring evidence or the inconvenience of data. In this instance, I'm talking about inconveniencing a patient diagnoised with type II diabetes.
For some reason, it seems, we have no problem inconveniencing a patient with the daily tasks of managing their disease. Inconvenience the patient with monitoring their blood sugars daily - just don't take away their bread; inconvenience the patient with remembering to take their medication each day - just don't take away their potatoes; inconvenience the patient with their daily insulin injections - just don't take away their pasta.
Do we even consider such insanity when someone has alcoholism? Seriously, do we consider anything but abstinence in an effort not to inconvenience the alcoholic?
Do we consider such nonsense when someone is diagnoised with celiac disease? Seriously, do we dream up ways a person with celiac disease can eat wheat so they don't have to give it up in their diet?
Why then are we even having a debate about the recommended dietary intervention for those daignosed with type II diabetes?
A low-carb diet has been shown, in study after study, to improve blood sugars, insulin levels and HbA1C, often to within the normal range of a non-diabetic; improve risk markers for complications associated with type II diabetes; and even eliminate the need for medication. Diet alone.
The ADA position, articulated by ADA spokesman Nathaniel G. Clark in June of this year, "We want to promote a diet that people can live with long-term. People who go on very low carbohydrate diets generally aren't able to stick with them for long periods of time," is based on the assumption that a patient won't want to live with giving up potatoes, rice, pasta, bread, cake, cookies or sweets; that such a diet is too restrictive and impractical in the life of someone already on the road to progressive deterioration due to their disease.
The ADA is not alone in this position.
Many prominent diabetes experts are of the opinion that expecting a person diagnoised with diabetes to make a radical change to their diet is unrealistic and potentially damaging to their self-confidence.
Yes, it's true.
It seems Dr. Howard Wolpert, MD believes that educating a patient about the potential of a low-carb diet to reverse HbA1c to non-diabetic levels is an "over idealized" goal and just too hard for a patient to follow. He doesn't let the inconvenient fact that Dr. Richard K. Bernstein, MD has done just that with thousands of patients over decades of practicing medicine assault his sensibility - patients want their pasta and without it, they're doomed to low self-esteem.
As Dr. Bernstein said in the recent debate, available for viewing on dLife, after starting a low-carb diet, "when patients see the pay off they stick with it."
The pay-off is improvement; often with reduction or elimination of medication.
Take a moment and see the dLife segment highlighting the debate of what good diabetes control really is.
Then if you'd like to see real people, with real results, check out Dr. Bernstein's Diabetes Forum online.