A Face of Diabetes: Alan, Committed to Control

Back in January I wrote about how Diabetics Must Demand Accontability from the ADA and put it bluntly - "Rather than admit their dietary recommendations are contributing to the progressive degeneration of those with diabetes, they remain staunch that this type of “treatment” is the best we have."

When the ADA updated their Medical Nutrition Therapy (MNT) in August, I took the position the ADA has Become Irrelevant and wrote "After decades of research time, millions of dollars, and billions of manhours - the ADA has not only failed find a solution to prevent diabetes, it is also currently unable to curtail the epidemic of diabetes.

While admitting the "current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal health care status for people with diabetes," they continue down the very same path that leads to slow, insidious progression of the disease."

I followed up with Should we Debate Diet for Diabetes? and included "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."

Earlier this week I learned of a gentleman in Australia, Alan, who has type II diabetes and who blogs at Type II Diabetes - A Personal Journey. His blog is fairly new and provides insight about his experience learning how to manage his diabetes. A post made on November 2, 2006 caught my attention - Diabetes Authorities and Diet. In that post he includes a letter he sent a couple of years ago to the Editor of Conquest: Diabetes Australia (a quarterly magazine).

Rather than summarize what he wrote, here is the post in it's entirety (with permission):

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What follows is a copy of a letter I wrote a couple of years ago to the Editor of Conquest, the Diabetes Australia (DA) quarterly magazine. Since then, nothing has changed - so I'll repeat it as sent. Because my opinion hasn't changed either. For accuracy, I will note that I have added 1000mg metformin daily since writing the letter, so I can no longer claim to "take no diabetes medications". But that doesn't change the thrust of my argument.

To be clear, I think that both DA and the American Diabetes Association are marvellous, worthy organisations doing sterling work for diabetics in both countries. My only disagreement is specifically to do with their dietary and testing guidelines. The dietary advice and guidelines promoted by DA is effectively a rubber-stamp of that issued by the ADA; so the same comments apply to both.

I never received a reply.

I am eternally grateful for the work the pioneers at Diabetes Australia did in helping us get the NDSS and the support system that we now have. The organisation continues to do a great job. But I have a basic difficulty with the logic of the dietary advice recommended by your dieticians.

I see their advice like this:

1. Dieticians advise high complex carbohydrate consumption, apparently for heart, kidney and vascular health;

2. High complex carbohydrate consumption causes high blood glucose levels;

3. High blood glucose levels cause diabetic complications such as retinopathy, neuropathy, nephropathy and heart disease;

4. DA dieticians therefore recommend balancing the high complex carbohydrate consumption with medication or insulin to control blood glucose levels.

This advice appears to be in line with the recommendations of overseas organisations such as the American Diabetes Association (ADA).

Specific examples can be found on the DA web-site at http://www.diabetesaustralia.com.au/multilingualdiabetes/healthpros/FoodNut/healthy.htm

or the ADA web-site at
http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp

My difficulty in understanding this is because no-one seems to be investigating the alternative approaches. I don't mean herbs and supplements, just a better diet for diabetics, together with exercise, to enable minimal medication.

To me, the most obvious alternative is to search for a diet for the diabetic which provides adequate nutrition for good health but does not cause high blood glucose levels. If such a diet is possible it would minimise the need for medication, particularly for type 2, with side benefits for overall health and health costs. I can attest that it is possible; I've done it, as have many others. However, when diabetics write to give examples, such as K ...... in the Autumn issue, they are dismissed and told that their improvement must be because of exercise, or weight loss, or some other factor.

The method I followed, as a type 2, was simple. I started with a standard, sensible diet to lose weight. Then, as I followed that diet, I tested everything I ate one hour and two hours after I ate it. If I consistently found that something led to high blood glucose, I changed it. Sometimes I changed the food, sometimes the quantity, sometimes the timing, but always the aim was to minimise "spikes". Gradually I found I was eating significantly less carbohydrates, a little more protein and a little more "good" oils. And I did a little "lazy man's" exercise along the way. I also gradually reduced the high level of initial testing as results became predictable.

After attaining a degree of control over my blood glucose, I now progressively review my diet to ensure there are no missing nutritional requirements and to further improve lipids etc. At diagnosis in 2002 my HbA1c was 8.2, now it's 5.9 and I take no diabetes medications. It's a long time since I've seen a "spike" over 8, rarely over 7.5. The improvements continued long after I reached my target weight. And my heart, blood pressure, lipids, kidneys and so on are also in good shape.

Why do your dieticians continue to promote high carbohydrate consumption? What is it I'm missing, apart from complications?

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter