Tuesday, August 22, 2006

Should we Debate Diet for Diabetes?

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.

15 comments:

  1. 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

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  2. Having 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.

    Having 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.

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  3. 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.

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  4. WHERE IS YOUR COMPASION? Clearly, you do not understand the program. If we teach diabetics to return their bodies to a healthy pre-desise state through diet and lifestyle chanages alone, you are going STARVE many health care profesionals and pharmaceutical sales reps. Not to mention scads of ADA employees and consultants. I ask again, WHERE IS YOUR COMPASION. These SICK people are a victim of their disease, being SICK VICTIMS, they clearly need to consume health care services and drugs. (Well as long as they have insurance.)

    Wait, the poor don't contribute to the ADA, nor have good insurance. OK, you can teach them low carb, but NO ONE ELSE. Really, what's next... advising people to quite smokeing and wear helmets when they ride motorcycles?

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  5. Kevin Dill - any of the low carb diets will work just as well but the lower the carb intake the better if you have diabetes. Saying they don't all agree is just plain silly. & as for the poor brainwashed person worrying about cholesterol consumption - there is no evidence that links eating a high saturated fat diet with heart disease. the only consistent link to heart disease is sugar & foods that turn to sugar in your body that is high carb foods. Ornish has results if people eat so little they can actually lose weight on a low fat high carb diet but I have never liked the hungry feeling associated with this form of starvation & in the long run you still end up with diabetes, just ask any skinny person with the disease, eating the recommended diet. Blood sugars all over the place & a reliance on insulin to regulate the sugar levels. Eat low carb & you have no sugar spikes & less of a need to use insulin even if you are a type one diabetic - isn't it better to have stable blood sugar levels & have to use less insulin??

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  6. Heart 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.

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  7. I 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.

    I 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

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  8. The fallacy in several comments here is, that NO ONE DIET is right for everybody. I recommend for people to read the book "The metabolic typing diet", by William L. Wolcott and Trish Fahey. While some people need a high protein, low carb diet to be healthy, others are the other way round, and some in the middle. Now, the big problem is, that people think their carbs need to come from grains.

    For people who need more carbs and less protein, those should come primarily from vegetable and fruit sources, not grains. NOBODY needs any grains at all to be healthy. That is a myth perpetuated by our dear, all knowing governments and the farmers (wheat boards) who produce those grains. We have the same problem with milk, of course. Humans don't need milk after weaning any more than animals do.

    I need to eat animal protein for every meal, hardly any fruit, and limited vegetables. I will not have any energy at all if I don't get enough protein and fat (and I mean saturated fat, but never hydrogenized fat, as that is deadly poison to anybody's body).

    I have celiac disease, but in addition cannot tolerate any grains at all (actually, few people truly can, they just don't know it), have a lectin intolerance (that means, no grains, eggs, dairy, legumes and nightshades) as well as an intolerance to salicylates (almost all fruit, herbs, spices, honey, of course, Aspirin (it's pure salicylic acid), most oils, many vegetables), and I don't tolerate any starches very well, even if not from a grain.

    My diet is limited, but I manage. If I eat the forbidden foods, not only will I get severe gastrointestinal problems, but crippling fibromyalgia, requiring high doses of painkillers, including codeine.

    My mother, who undoubtedly had the same problems, was never diagnosed. She eventually developed diabetes, had a heart attack, and died of liver cancer at the age of 66. If somebody would have put her on a low carb, no grain diet, she would likely still be alive and well. Too bad doctors are so ignorant. Besides, the pharmaceutical companies wouldn't have made any money off her, poor people!

    There is no such a thing as diabetes and cancer in societies that still adhere to their ancestral diets. Those things start showing up, when these people start adopting a 'modern', westernized diet. In short, when they start consuming sugar and white flour, instead of what their ancestors ate.

    A very good example are native Americans. Their only grains used to be corn and wild rice, their only sweetener maple syrup. They were healthy, slim and hardy. Since they have developed the 'white man's' eating habits, their health has deteriorated, until now, their rate of diabetes is the HIGHEST IN THE WORLD! Those people simply cannot tolerate sugar and flour products.

    But instead of telling them to go back on their native diet to cure their diabetes, they get insulin, medicine, you know, whatever makes the most profit for doctors and big pharma.

    Their amputation rate is also extremely high, as are all the other complications from diabetes. It's truly saddening.

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  9. Just a off-topic note to thank you for writing a rebuttal to the Heart Research Institute study and associated reporting around the world about the dreaded "bite of burger".

    http://www.commonvoice.com/article.asp?colid=5615

    I am continually surprised by how tenacious the old dietary dogma really is. If I held up a Mars bar as an example of a high fat food, I'd expect 8 out of 10 people would nod their heads. Mass confusion.

    I would have thought Atkins and others would have made a bigger dent in the dogma by now.

    Still we soldier on.

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  10. This comment has been removed by a blog administrator.

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  11. Refer to Diabetes for
    useful information

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  12. HELP!!!

    I have known for a long time that I was "borderline" diabetic. Now my happy DR has confirmed it.

    I get the diet and all. To be honest with the massive, and I mean MASSIVE stress that has been my constant companion for the last 8-1/2 years I have absolutely not controlled my diet and excercise was limited to trying to get away from the stress.

    Well now I find myself single and "diabetic". I am intelligent. I am self employed. I am living with almost no stress these days, thought business occasionally provides some tension, that's okay.

    The thing is I know me. I can do anyting successfully as long as I can wrap my mind around it. Regarding anything remotely attached to the word "diet" I have not been able to do that. Somehing like this takes me time and several steps to understand.

    THere are more "voices" talking about diet than the Mormon Tabernacle Chior has had in their entire history. This one says this and that one says that. THen there are the creepy "Herbs are the only way, man" freaks. (I have my reasons for phrasing it that way)

    What the heck is the truth? If I can get to some sort of truth and I can work with someone that can step by step help me get my mind around the diet thing I believe I can lose this 90# that has been walking with me every step of every day. I beleive I can lower my BP, Chlesterol, Triglycerides, blood sugar and stay off of meds. I believe I will have more energy to excercise, walk or bike.

    I DO believe! But I need help getting my mind around the whole diet thing.

    I read most of the "Diabetic Solution" and I have been unable to find many of the foods recommended in the book.

    I digress to my opening.

    HELP!

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  13. Mark - email me privately - controlledcarb@aol.com

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  14. The Dicotomy
    Its interesting that the general thinking of the health world is that since we have problems with FAT in our systems (in our blood and on our bones) we must stop EATING fat.

    THIS makes sense. (its not true but it does seem like common sense).

    but THEN the 'establishment' says.

    Diabetes is a problem with SUGAR in our system.. in our blood. THEN instead of using the same common sense they again say the problem is we eat FAT!!!!

    i dont GET it.

    why for 50 years didnt people just say.. WAIT doctor.. i have sugar problems .. so i am not goint to eat ANY FRICKING SUGAR!!!!!!!

    imagine if more people had not put 'doctors' on a pedestal and said screw you. screw your science that you clearly treat like a religion .. i am NOT going to eat any carbohydrates. I see the eskimos did not die out.. so that is what I am going to do.

    I am here to say.. in may.. i had A1c of 11.9, total Cholesterol of 202 etc.. all bad numbers...

    4 months... let me say again.. 4 months later using a strict low carb diet.. (with peppers and onions and broccoli and CINNAMON) i am at normal numbers.

    A1C 5.4 TOTol Chol 151, Tri 61 LDL 91 HDL 48 (okay the HDL is low but stilll...)

    I don't mean to sound so angry at the medical community. but i am.

    I am glad to correspond with anyone about low carbing... i enjoy being creative about it...
    feel free to forward my email to anyone that is struggling.

    Kent chicago
    actorkent@yahoo.com

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  15. People who have a family history of diabetes as well as diabetes are at risk of developing type 2 diabetes. Also referred to as non-insulin dependent diabetes, type 2 diabetes is a condition wherein the body, over time, becomes resistant to insulin.
    http://diets-diabetes.blogspot.com

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