Wrong Dietary Advice For Diabetics 'May Have Killed Millions'

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The article, Obesity, Gastric Bypass: A Rock Or A Hard Place, touched on the fact that weight-loss operations are seen as a solution to curb the problem of obesity and type-2 diabetes. Of course, if you are stuck in the ‘wisdom’ that once you are a diabetic you will always be a diabetic, then you may think it makes sense to look at ‘high-tech’ (and I’ll add high-risk) solutions such as gastric bypasses, pancreatic transplantation or stem cell therapy (which are all options that are considered in the fight against diabetes).

Despite the growing incidence of type 1 and 2 diabetes and the accelerating cost of the resources needed to monitor and treat these patients, there is obviously very little success in reducing either the number of people affected or the severity of the complications of these conditions.

Yet there is a simple, effective, low-cost strategy that proves to work with diabetes: reduce the amount of sugar and starch in the diet.

Back to the beginning

Remember the primary problem with diabetes is that the body is not handling sugar well so blood sugar levels tend to be raised.

Diabetes is a disorder of carbohydrate metabolism: the body is not able to use sugars effectively, and glucose builds up in the blood. These high levels of blood glucose cause many of the complications we associate with diabetes. The primary underlying factors here will be some resistance to the hormone insulin (insulin not working as it should) and/or inadequate insulin secretion as a result of an ‘exhausted’ pancreas.

However, the standard recommendations for diabetics include a diet that is relatively high in carbohydrate. Although clearly these recommendations help some, many people with diabetes and pre-diabetes find that (sometimes from the beginning and sometimes after a year or two) a low-carb diet is the only dietary routine that enables them to achieve stable blood glucose. (No wonder some become confused, if not bewildered, when their doctors and dieticians would prefer that they take more medication rather than reduce carbohydrates.)

It actually makes perfect sense for diabetics to follow a low-carb diet: The lower the carbohydrate consumed the less insulin is needed for type 1 diabetics and the less hard the pancreas has to work for type 2 diabetics.

According to Dr. Katharine Morrison, Principal GP from the Ballochmyle Medical Group, insulin dependent diabetics can expect to reduce their insulin requirements by a half or to a third once they apply a low-carb diet. Less insulin injected results in more predictable blood sugars and less hypoglycaemia.

What is required (according to the dusty rule book)

According to the American Diabetes Association, the primary goals of medical nutrition therapy for diabetes are:

• Normal blood glucose, blood lipids (cholesterol and triglycerides), and blood pressure - or as close as possible to these.
• Prevention of complications associated with diabetes
• "To address individual nutrition needs," according to such factors as motivation and cultural preferences.
• "To maintain the pleasure of eating by only limiting food choices when indicated by scientific evidence."

Note that a low-carb diet can potentially address the first three goals very well. In study after study, people have improved blood glucose, blood lipids, and blood pressure by reducing carbohydrate in their diets.

Since blood glucose control is the most important element in preventing complications of diabetes, the second goal is easily addressed. Motivation is vital when it comes to controlling blood glucose by diet, but many people have proved that eating a low-carbohydrate diet in a healthy way can be achieved and sustained.

Fuelling controversy

In January this year the Cochrane review (which collated data from 11 randomised trials in 402 patients), confirms a shift in the evidence in recent years, with a number of recent studies suggesting a low-carb diet could offer long-term benefits to diabetics. These benefits include sustained weight loss with no significant effect on glycaemia or lipid levels. This review will fuel a long-running controversy over what dietary advice doctors should give to patients with diabetes, and it challenges the traditional belief that a low-fat, high-carb diet is best.

The Cochrane review shows that patients on a diet of foods with a low glycaemic index – including foods extremely low in carbohydrates such as lentils, beans and oats – had an HbA1c level (average blood glucose level) 0.5 per cent lower than controls. There were also significantly fewer episodes of hypoglycaemia in patients on a low-GI diet, with a reduction of 0.8 episodes per patient per month achieved in one trial.

Dr Malcolm Kendrick, a GP in Macclesfield who advocates a high-fat, low carbohydrate diet in patients with diabetes, said the study’s conclusions should encourage GPs to reject the conventional wisdom. He said: ‘The reality is that over the years, and around the world we have killed literally millions of diabetics by advising them to eat a high-carb diet and avoid fats... Only now is it being recognised that previous advice was and remains useless, dangerous and scientifically illiterate. The authors of this Cochrane review should be applauded for taking the fist step on a path that will, inevitably, result in the destruction of the nonsense.’

What should your diet really do for you?

Clearly, the time has come to stop feeding patients a diet of junk science and start feeding them food that makes them well and that will keep them well.

As a diabetic your diet should really do the following for you:

• prolongs pancreatic function in type two diabetics;
• promotes a healthy weight;
• reduces need for insulin;
• reduces need for oral hypoglycaemic drugs;
• promotes high HDL and low triglycerides;
• Reduces hypoglycaemia;
• Reduces development of glucose intolerance to type two diabetes;
• optimises glycaemic control including post prandial (after a meal) blood sugars.

All of the above can be reached with a well-planned low-carb diet that suits your specific diabetic dietary and nutritional needs.

If you are diabetic and your doctor or health care giver has not yet discussed a low-carb diet with you, then it may be a good idea to alert him or her to the fact that the approach to dietary requirements for diabetics are changing.

Related Reading:

Diabetes: The link between diet and diabetes
Diabetes: Lower the risk with natural remedies
Diabetic Diet: Important Dietary Advice For Type 2 Diabetics

Sources:

‘Can diabetes be cured?’ by Dr.Briffa, published 15.04.09, drbriffa.com

‘Low carbohydrate diets for diabetes control’, by Dr. Katharine Morrison, published 01.11.05, British Journal of General Practice, pubmedcentral.nih.gov

‘Diabetes and Low-Carb Diets’ by Laura Dolson, published 23.08.09, lowcarbdiets.about.com

‘Low-carbohydrate diets better for diabetes patients’ By Lilian Anekwe, published 22.01.09, www.pulsetoday.co.uk