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?
Absolutely not!
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.
What?
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.
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I guess my only question is which definition of a low carb diet are we going to use?? While Dr Atkins has provided the most popluar version, is it any better than Protein Power, South Beach, the Zone, or any of the other of myriad interpretations of low carb when it comes to controlling blood sugar?. IS Ketosis necessary? or is simply reducing the carbs below a certain level, (what ever that may be), sufficient? IF low carb is the one true answer, then why has DEAN ORNISH also been successful?? The real culprit is not just the carbs, its the constant state of over consumption, compounded by a sedentary lifestyle. While I agree that a low/reduced/controlled carb diet should be offered as an option, its only opening up a whole new can of worms. If the low carb community can't agree amongst itself which plan is "right", how would you expect people who aren't overly fond of the idea of reduced carbs to fair? But then again, they may do a better job with it as they do not have the emotional attachment that so many low carbers have to their chosen plan
ReplyDeleteHaving just this month being diagnosed with Diabetes, I'm off looking for anything that can help to eliminate the need for medication. Friends (medical professionals) have recommended the ADA diet - but reading this gives me little reason to hope.
ReplyDeleteHaving listened to a mini-PSA by "Connie Dickman of the American Dietetic Association" on the value of the traditional "Food Pyramid" and the folly of the low-carb, high protein regimines, I am skeptical (to say the least) of anything coming from that source.
Interestingly enough, I did go Atkins for a few months last year. The results were staggering. Not only did I lose weight, but I also had energy, something I'd not had for years - and other aspects of my life improved immensely. Why did I stop? Well, fear. Fear that the high-protein would change my low cholesterol to a high state, and with heart disease, it scared me.
Perhaps another of the "plans" will provide the balance I need with the benefits I am seeking.
I have been doing low carb for 3 years but I happin to be 25 lbs under weight. I had islet cell cancer in the pacrease and had to have a whipple surgury which resulted in diabetes because I do not produce enough insulin. I do not have any insulen resistance and I have to take enzymes to absorb protien and fat. I tried the ADA diet and it made my blood sugar rise beyond beleif which would of put me on insulin. But following a low carb way of living has improved my health and made it so I take a minamum amount of medication. Jimmy Moore was actually my inspiration just for keeping on because I used to love my carbs and it was hard to break. I never did induction because I really do not need to burn fat. I can handle about 60 grams a day and go without meds. Thank you Regina and thank you to Jimmy also. These blogs are alway informative and inspiring.
ReplyDeleteHeart disease is mutli-factoral, and blood glucose is one of a myriad of factors, including cholesterol. The real question about cholesterol is, whether it indicates or causes inflamation which leads to CAD. The people who discount cholesterol completely are as misguided as the one who focus on it to the exclusion of all else. While you may not think defining what constitutes a low carb diet is important, if we are to prescribe them for treatment then a defined protocol will become necessary. Ketosis, while a useful tool for some, should be avoided by others. Additionally, all of this focus on dietary intervention is still only attacking the symptoms, not the root causes, over consumption and sedentary life style. You can be just as fat and unhealthy eating low carb as you can from eating sugar. The failure rate across all diets is pretty consisant. About 90pct of all people who start a diet(low carb included), quit. Why would we believe handing people a few xerox copies of example menus and telling people "eat like this" ( which is basicly what happens today) will be any more successfull with low carb than low fat? Until we are willing to commit the reasources to address the cultural, lifestyle and psycho-social issues regarding food, one diet is as likely to fail as the next.
ReplyDeleteI am a type 1 diabetic of 27 years (now 31). I have been on Dr. Bernstein's diet for one year just about and my A1c went from 8.0 to 5.0 in 6 months. I agree with Dr. B--the proof is in the pudding and I feel so much better there is no chance I will go back.
ReplyDeleteI highly recommend getting both of Dr. B's book if you are type 1 or type 2:
Diabetes Solution
The Diabetes Diet
Get on his forum to ask questions as Karen recommends at:
Dr. Bernstein Diabetic Online Forum
You can find me there as user "phishery".
Lastly, I recommend the following with respect to the cholesterol debate--I side with those that beleive it is largely poor science that was over zealous in proclaiming any semblance of an understanding and did more harm then good--this is a posting of mine with 2 good links to books on the topic, and a couple of useful websites in my opinion:
Phishery's blog with cholesterol books and links
Mark - email me privately - controlledcarb@aol.com
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