Archive for November, 2006
“Words are, of course, the most powerful drug used by mankind”
— Rudyard Kipling
Read between the lines.
You are being convinced, slowly and deliberately that any dietary approach or course of treatment that deviates from the American Diabetes Association position for medical nutrition therapy, even when scientifically valid and supported by hard data, is dangerous; be afraid, be very afraid.
Add doublespeak to the mix and what was healthful is now “dangerous”; what is inherently toxic is now good for you; and remember, you can just medicate any nasties away with a handful of drugs.
The mission of the ADA is to “prevent and cure diabetes and to improve the lives of all people affected by diabetes.”
As data mounts from longer term studies, the number of researchers and physicans challenging the ADA Medical Nutrition Therapy recommendations, and the media points to contradictions in the standards of care, we’re seeing intensified attempts at damage control by the ADA; the latest message being one of fear.
Fear that simply writing about the success some patients have with treatment, by physicians, who are not towing the party-line and following the ADA recommendations, well, it’s blasphemy! – just writing about it, highlighting the success of an alternative dietary approach, is endangering the lives of millions of Americans!
The message to those interested in preventing or managing diabetes must be clear and maintained – pharmaceutical drugs are necessary, that no one wants to or can follow a diet without sugar, that carbohydrate-rich foods are necessary for health, and that only “proper consultation” with a dietitian can help one acheive their goals in managing their disease with lifestyle modification and pharmaceuticals.
Perhaps you’ve become aware of this upside-down logic?
If not, I offer you a few examples of how the ADA is working hard to create a state of fear in those at risk for or diagnosed with diabetes, who even think a low-carbohydrate diet may work for them after reading about significant improvements in the media about research studies or in clinical practice. The ADA has slowly moved from discouraging anyone from thinking they can follow a low-carb diet to implying any communication that they might see improvement if they do follow a carbohydrate restricted diet is dangerous and will not be tolerated.
While agreeing that carbohydrate restriction helps people with type 2 diabetes control their blood sugar, ADA spokesman Nathaniel G. Clark, MD, tells WebMD that the ADA does not recommend very low-carb diets because patients find them too restrictive.
“We want to promote a diet that people can live with long-term,” says Clark, who is vice president of clinical affairs and youth strategies for the ADA. “People who go on very low carbohydrate diets generally aren’t able to stick with them for long periods of time.”
Message – low-carb diets work, but no one can do it anyway.
Pearls for Practice:
- Type 2 diabetes may best be controlled through diet by lowering total caloric intake to achieve weight loss. The best mix of macronutrients in this diet may depend on the individual patient, but low-carbohydrate diets are not recommended for all patients.
- The current recommendations state that healthy patients with diabetes may consume the same amounts of protein, alcohol, and nonnutritive sweetener as the general population.
Message – have your cake and eat it too; why follow low-carb, you can have sugar just like anyone else.
ADA Letter to the Editor, Men’s Health Magazine:
“…your publication printed dangerous information that could potentially jeopardize the lives of millions of Americans with diabetes or at risk for diabetes.”
Message – writing about patients who effectively control their diabetes with a carbohydrate restricted diet is dangerous, a public health threat, it endanagers the lives of millions!
The ADA Letter to the Editor is nothing more than an attempt at damage control – every time someone in the media, a physician in practice, or researchers and their data challenge the ADA dogma and expose the contradictions (especially the “you have high blood sugars, a disorder of blood sugar metabolism, but keep eating sugar”), the ADA must respond and must do all it can to preserve itself as the authority of what is “right” and “wrong” for someone with diabetes.
Rudyard Kipling was right: Words are, indeed the most powerful drug used by mankind!
The ADA has made it abundantly clear, it’s dangerous – a public health threat – to even write about patients’ that have successfully managed their diabetes with a carbohydrate restricted diet; forget about the existence of hard data, ignore the mountain of studies piling up, and don’t even think of exploring the potential of carbohydrate restriction as an alternative – just shut up and eat your carbohydrates!
Reprinted with permission, The Fitness Insider, Adam Campbell, November 29, 2006. I have added “ADA” in red to clarify what was from the ADA letter since my formatting is different from Adam’s.
The ADA Responds… And So Do I
As expected, the American Diabetes Association responded to my diabetes story.
I’ve posted it here, along with a few responses of my own. (Click the link for a PDF of the letter: Download ADA_Response.pdf)
ADA: Dear Editor,
In fairness to Men’s Health readers, we would like to clarify some of the issues presented in your December 2006 article, “The Cure for Diabetes.” This article was an opportunity to educate your readers about the greatest health crisis of the next quarter century – the alarming growth of diabetes. Unfortunately, your writer presented an unbalanced story on a disease that affects 10.5 percent (10.9 million) of all men aged 20 or older – with nearly one-third of them not knowing they have it.
AC: In fairness to people with diabetes, we wanted to clarify some of the issues presented in your 2006 Nutrition Recommendations, published in the September issue of Diabetes Care. You had an opportunity to provide diabetes and healthcare providers with unbiased, scientific recommendations, yet you presented an unbalanced report on the efficacy of low-carbohydrate diets in the prevention and treatment of diabetes. Our story intended to raise awareness on this relevant and important topic, and encourage physicians, scientists, and major health organizations to enter into a serious and objective discussion on the use of low-carbohydrate diets as a potential medical nutrition therapy for diabetes.
For instance, in your 2006 report, you stated, “Although there are no data specifically in patients with diabetes, diets restricting total carbohydrate to Duke University study in our story, which concludes, “The [low-carbohydrate diet] improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants.” Does this not qualify as “data?” If your answer, is “No,” then that begs the question, “Why not?” It’s one thing to acknowledge that data exists, but doesn’t meet your qualifications; it’s another to simply deny its existence.
Perhaps you should have said, “There’s no data over 22 months on people with diabetes.” Otherwise, you’ve also denied the existence of this study from Jorgen Vestin Nielsen and Eva Joensson, which found that advising patients to consume a low-carbohdrate diet resulted in improved measures of long-term blood sugar, and that there was no occurrence of heart disease in these patients (23 patients in all). Unfortunately, heart disease did occur in 3 out of 5 patients who didn’t adopt the diet.
In addition, this study, from Guenther Boden and colleagues at Temple University, found that “In a small group of obese patients with type 2 diabetes, a low-carbohydrate diet followed for 2 weeks resulted in…much improved 24-hour blood glucose profiles, insulin sensitivity, and hemoglobin A1c; and decreased plasma triglyceride and cholesterol levels. The long-term effects of this diet, however, remain uncertain.” As you would no doubt point out, the authors stress that this was short-term, but there’s another way to think about this: If you can achieve these benefits in just 2 weeks on a low-carbohdyrate diet, what are the potential long-term benefits? While we whole-heartedly agree that more research is needed in are of medical nutrition therapy for diabetes, we can’t understand why there isn’t a movement by the ADA to better understand low-carbohdyrate diets.
ADA: The article glosses over the difference between type 1 and type 2 diabetes. Between 5-10 percent of Americans have type 1 diabetes, which occurs when the body does not produce insulin. Patients with type 1 must take insulin for the rest of their lives in order to survive. Because it is an autoimmune disorder, type 1 diabetes is not preventable – an important distinction from type 2 diabetes.
AC: We certainly understand this, and by no means intended to trivialize the seriousness of type 1 diabetes. However, this story was about type 2 diabetes. That said, many physicians have effectively used low-carbohydrate diets along with adequate insulin as a therapy for type 1 diabetes. Just ask Richard Bernstein, M.D., who has had type 1 diabetes for 55 years, and has not only successfully treated himself, but also thousands of patients. But again, like Mary Vernon, M.D., the doctor featured in my story, the ADA has chosen to disregard this observational evidence from practicing physicians.
Here are a few additional studies, including a couple that are based on patient data from Dr. Bernstein and Dr. Vernon. Again, according to the ADA, these data don’t count.
Gannon MC, Nuttall FQ: Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes.Diabetes 2004, 53:2375-2382.
The Effects of a Low-Carbohydrate Regimen on Glycemic Control and Serum Lipids in Diabetes MellitusDaniel F. O’Neill, Eric C. Westman, Richard K. BernsteinMetabolic Syndrome and Related Disorders Dec 2003, Vol. 1, No. 4: 291-298.
A Pilot Trial of a Low-Carbohydrate, Ketogenic Diet in Patients with Type 2 DiabetesWilliam S. Yancy Jr., Mary C. Vernon, Eric C. Westman.Metabolic Syndrome and Related Disorders Sep 2003, Vol. 1, No. 3: 239-243
Clinical Experience of a Carbohydrate-Restricted Diet: Effect on Diabetes MellitusMary C. Vernon, John Mavropoulos, Melissa Transue, William S. Yancy Jr., Eric C. WestmanMetabolic Syndrome and Related Disorders Sep 2003, Vol. 1, No. 3: 233-237
ADA: For the past five years, the cornerstone of ADA’s message has been that lifestyle modifications are the first line of defense against the development of type 2 diabetes and diabetes complications. The landmark Diabetes Prevention Program study (DPP) in 2001, funded in part by the ADA, showed a 58 percent reduction in progression to type 2 diabetes among people who had maintained a healthy lifestyle, compared to the control group. This healthy lifestyle includes physical activity and weight loss.
AC: It’s interesting that you bring up the Diabetes Prevention Program. It’s a great example of how lifestyle intervention (diet and exercise) can be more effective than even medication for the prevention of diabetes. In fact, the conclusions from the DPP state: “The lifestyle intervention reduced the incidence [of diabetes] by 58 percent, and metformin [reduced it] by 31 percent… [so] the lifestlye intervention was signifcantly more effective than metformin.”
Now, there are a couple of points to make in regard to this.
1. The first is that the DPP doesn’t support the ADA’s recommendations for a low-fat diet, particularly for people with diabetes. That’s because although all participants were at high risk for diabetes when the study started, they were still all non-diabetic. And 4.8 percent of the people on the ADA’s lifestyle intervention developed diabetes while on the program, compared to 7.8 percent of those taking metformin, and 11 percent who did nothing.
2. The DPP study states that participants were encouraged to lose 7 percent of their body weight through a low-fat diet and by engaging in exercise for 150 minutes a week. The results: Overall, the dieters ate, on average, 249 fewer calories a day, while 58 percent (does this number look familiar? See above) adhered to the 150-minute/week exercise quota, and 50 percent lost 7 percent of their body weight. So what can we conclude? That exercising and dieting for weight loss reduces your risk of diabetes. Wow! Fascinating stuff. I guess I’m not sure why this is being brought up in response to my story. I clearly pointed out in the story that the ADA recommends to “cut calories and add exercise to reduce insulin resistance.” I can’t say that anyone in the world debates this advice. Which is why it wasn’t the point of the story. My story centered on the specific nutrition recommendations which encourage people with diabetes to eat a diet that features carbohydrates, the only nutrient that signficantly raises blood sugar, the defining marker of the disease. In fact, if you’re diagnosed with diabetes, one of the first things they do is teach you to count carbohydrates. Why? So that you can adjust your medication. More carbohydrates equals more medication. And as I wrote in the story, the need for more medication usually indicates that a disease is worsening.
3. It seems to me that the DPP is an informative academic study, but not really relevant in practical terms because it’s what the ADA has been recommending for years, and yet we still have an “epidemic” of diabetes. Shouldn’t the ADA take some responsibility for what’s happened? The ADA’s Dr. Buse told me that ultimately, exercise and dieting won’t work long-term, so it’s best to go ahead and get them on medication right away. (You can read about it in this position statement.) This is well meaning, as the idea is to help people lower their blood sugar even if they won’t help themselves (through diet and exercise). But overall, it’s a bit like they’re blaming the patients for the fact that their therapy isn’t working. True, not everyone who develops diabetes is going to change their diet or start exercising, but shouldn’t they be given all of their options first? I would have thought that because of the seriousness of this disease, the ADA would be looking for alternatives to the current recommendations, since clearly they aren’t working. Especially an alternative as logical as reducing carbohydrates, which automatically reduces the need for some, if not all, medication in many cases.
ADA: It is important for a person with diabetes to consult with a dietitian to develop a food plan that will reflect the needs, tastes, preferences, and lifestyle of the individual. Proper consultation can result in the achievement of desired goals for weight loss or maintenance, blood pressure, blood cholesterol and blood glucose.
AC: You’re preaching to the choir on this one. However, just because a person with diabetes might have a “taste” for sugar, doesn’t mean they should be encouraged to go ahead and eat it. That seems to be the gist of the ADA’s recommendations when they state, “Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucoselowering medications.”
ADA: The scientifically-based meal plan recommended by the ADA includes a variety of foods containing carbohydrates from whole grains, legumes, fruits, vegetables, and low-fat milk. These foods are important sources of fiber, vitamins, and minerals.
AC: Sure, but it’s based on high-starch foods like grains. And as I pointed out in the story, and you in your 2006 position statement (although worded differently), starch is no better than sugar when it comes to controlling blood glucose. It’s also hard to accept the vitamin and mineral argument when compared to medication. For instance, perhaps a person would rather take a multi-vitamin instead of metformin or an insulin shot.
ADA: While low-carbohydrate diets have been a popular and controversial topic, current research does not support the long-term effectiveness and safety of low-carbohydrate diets for the treatment and management of diabetes. Diabetes is a progressive, life-long disease that must be managed long-term. It is not wise to rely on short-term study results for a disease that will always remain a part of that person’s life. The effects of such diets on kidney and cardiovascular disease risks are especially concerning, considering these are two of the biggest diabetes-related complications.
AC: Please show me the research that raises the concern. I understand that the ADA practices evidence-based medicine, so please produce the evidence that shows low-carbohydrate diets increase kidney and cardiovascular disease risk in patients with type 2 diabetes. In fact, it would be enlightening to see the evidence that shows the increase in kidney and cardiovascular risk in non-diabetics. For instance, Ron Krauss’ work (1, 2, 3, 4, 5) shows that eating more carbohydrate and less fat increases the risk of cardiovascular disease. And as I showed in the story, more than a dozen studies over the last 5 years have shown that low-carbohydrate, high-fat diets are as effective or, in most cases, more effective at lowering overall heart disease risk than low-fat diets (which are high-carb by nature)–particularly because they raise HDL (good) cholesterol while simultaneously lowering triglycerides. Not to mention that lead to greater weight loss.
Here are several of those studies (many of the links include full text of the study):
Brehm, B. J., Seeley, R. J., Daniels, S. R. & D’Alessio, D. A. (2003) A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women.
J. Clin. Endocrinol. Metab. 88:1617-1623. Sondike, S. B., Copperman, N. & Jacobson, M. S. (2003) Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents.
J. Pediatr. 142:253-258. Samaha, F. F., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, T., Williams, M., Gracely, E. J. & Stern, L. (2003) A low-carbohydrate as compared with a low-fat diet in severe obesity.
N. Engl. J. Med. 348:2074-2081 Foster, G. D., Wyatt, H. R., Hill, J. O., McGuckin, B. G., Brill, C., Mohammed, B. S., Szapary, P. O., Rader, D. J., Edman, J. S. & Klein, S. (2003) A randomized trial of a low-carbohydrate diet for obesity.
N. Engl. J. Med. 348:2082-2090 Volek, J. S., Sharman, M. J., Gomez, A. L., Scheett, T. P. & Kraemer, W. J. (2003) An isoenergetic very low carbohydrate diet improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol ratio and postprandial pipemic responses compared with a low fat diet in normal weight, normolipidemic women.
J. Nutr. 133:2756-2761 Volek, J. S., Sharman, M. J., Gomez, A. L., DiPasquale, C., Roti, M., Pumerantz, A. & Kraemer, W. J. (2004) Comparison of a very low-carbohydrate and low-fat diet on fasting lipids, LDL subclasses, insulin resistance, and postprandial lipemic responses in overweight women.
J. Am. Coll. Nutr. 23:177-184 Sharman, M. J., Gomez, A. L., Kraemer, W. J. & Volek, J. S. (2004) Very low-carbohydrate and low-fat diets affect fasting lipids and postprandial lipemia differently in overweight men.
J. Nutr. 134:880-885 Brehm, B. J., Spang, S. E., Lattin, B. L., Seeley, R. J., Daniels, S. R. & D’Alessio, D. A. (2005) The role of energy expenditure in the differential weight loss in obese women on low-fat and low-carbohydrate diets.
J. Clin. Endocrinol. Metab. 90:1475-1482 Meckling, K. A., O’Sullivan, C. & Saari, D. (2004) Comparison of a low-fat diet to a low-carbohydrate diet on weight loss, body composition, and risk factors for diabetes and cardiovascular disease in free-living, overweight men and women.
J. Clin. Endocrinol. Metab. 89:2717-2723 Stern, L., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., Williams, M., Gracely, E. J. & Samaha, F. F. (2004) The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial.
Ann. Intern. Med. 140:778-785 Yancy, W. S., Jr, Olsen, M. K., Guyton, J. R., Bakst, R. P. & Westman, E. C. (2004) A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.
Ann. Intern. Med. 140:769-777 Aude, Y. W., Agatston, A. S., Lopez-Jimenez, F., Lieberman, E. H., Marie, A., Hansen, M., Rojas, G., Lamas, G. A. & Hennekens, C. H. (2004) The national cholesterol education program diet vs a diet lower in carbohydrates and higher in protein and monounsaturated fat: a randomized trial.
Arch. Intern. Med. 164:2141-2146Seshadri, P., Iqbal, N., Stern, L., Williams, M., Chicano, K. L., Daily, D. A., McGrory, J., Gracely, E. J., Rader, D. J. & Samaha, F. F. (2004) A randomized study comparing the effects of a low-carbohydrate diet and a conventional diet on lipoprotein subfractions and C-reactive protein levels in patients with severe obesity.
Am. J. Med. 117:398-405 McAuley, K. A., Hopkins, C. M., Smith, K. J., McLay, R. T., Williams, S. M., Taylor, R. W. & Mann, J. I. (2005) Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women.
Diabetologia 48:8-16 Dansinger, M. L., Gleason, J. A., Griffith, J. L., Selker, H. P. & Schaefer, E. J. (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.
J. Am. Med. Assoc. 293:43-53 Daly, M.E., Paisey, R. Paisey, R. Millward, B.A., Eccles, C., Williams, K., Hammersley, S., MacLeod, K.M., Gale, T.J. (2006) Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes–a randomized controlled trial.
As for kidney disease, the concern you voice has never been shown, and it’s inappropriate for the ADA to state this, especially since carbohydrate restriction leads to an improvement in blood glucose levels, which REDUCES the risk for kidney disease.
ADA: As a result of improperly addressing these crucial components of diabetes management, not only did your publication provide a disservice to your readers by suggesting that a low-carbohydrate diet is the only safe solution to the prevention and treatment of type 2 diabetes, your publication printed dangerous information that could potentially jeopardize the lives of millions of Americans with diabetes or at risk for diabetes.
AC: We didn’t suggest that a low-carbohydrate diet is the only safe solution. But we did present another side to the story–that many people with diabetes have had and are having great success in controlling their blood sugar with a low-carbohydrate diet, despite the fact that the ADA doesn’t recommend this as a therapy. The truth is, we think patients who can be successful with ADA recommendations should follow them, but we don’t see any great success. In fact, we see a worsening of the problem.
ADA: Larry C. Deeb, MDPresident, Medicine & Science, American Diabetes Association
Richard R. Rubin, PhD, CDEPresident, Health Care & Education, American Diabetes Association
John B. Buse, MD, PhD, CDE, FACEPresident-Elect, Medicine & Science, American Diabetes Association
AC: So that’s one letter. I’ve gotten a bunch of other letters, too. Here are a few:
Your article accurately reflects the rapidly changing scientific understanding of diet and diabetes, as well as the “oral tradition” of diet therapy before medications were available. Congratulations on a job well-done.
Eric C. Westman, MD MHS
Associate Professor of Medicine Duke University Medical Center
I am living proof of Mr. Campbell’s conclusion about carbs and diabetes. I feel very fortunate that I was able to discover this relationship and not rely on the information provided by the ADA. If his article saves one person it would, in my opinion, accomplish more than the $51,000,000.00 spent last yr. by the ADA. Keep up the great work!
That was a great article about diabetes. I identified with it completely. At 32 extremely overweight 220#, 5’9” and lazy as hell I developed insulin dependant diabetes. The starches have to go, but that’s OK there’s a world of great alternatives out there to eat, which will actually make you look and feel like new again. Stop poisoning yourself one mouthful at a time. Now at 48 a 27 year civil servant at @165# and an 8 pack, I run 15 or so 5K?s and 2, 1/2 marathons a year, additionally I routinely place in weight lifting competitions at the local YMCA and the MWR gyms on the Navy Base where I work. That?s’ 1st – 4th place in pull-ups, dips, pushups, sit-ups and bench. By the way that’s against college students, mid twenties sailors and marines. There are worse hobbies!
I just finished reading the article on diabeties and agree wholeheartedly with the doctor 3yrs ago I was told I was diabetic my glucose count was 320, my acia blood test was 9 and i tipped the scale at 364 I went on a low carb diet and got immediate results Today my glucose is always between 80 and 100 my acia test is between 5 and6 which is normal and i have lost 120pounds i also include a daily exercise routine in my program and do not take any meds at all This diet plan definetly works!!
You are right on! We work with Dr. Bernstein and produced the Secrets to Normal Blood Sugars by Dr. Bernstein. As a pharmacist and diabetes educator, I have seen time and time again, that by reducing carbs, blood sugars go down and people get off of meds. And if you add a little phyical activity to the mix, the results are even greater. It will probably take another 5-10 years for the medical community to accept the obvious. But it will happen!Your Friend in Diabetes Care,
On Friday I wrapped up the first of two posts with:
The fatal flaw in the dietary recommendations is that it’s not the fat – it’s the excessive carbohydrate and sugar in our diets that is causing our chronic, degenerative diseases.
The fatal flaw is that we’re specifically recommended a dietary pattern that increases the risk of higher than optimal blood sugars – advising the population that such a diet is going to reduce their risk, when it is increasing their risk!
I’ve written many times that the dietary recommendations to the population at large are flawed; I honestly cannot believe that it’s intentional, but they’re flawed nonetheless, and until we go back to the drawing board and tackle the flaws we’re not going to see much change in the rates of obesity or alarming prevalance of diabetes.
How did we get so entrenched in the notion that dietary fat is the critically important macronutrient to modify in our diet to reduce risks?
For that history, an article by Gary Taubes, The Soft Science of Dietary Fat, is a good place to start.
Since its publication in 2003, two large, long-term studies have been published that found no increased risk in those who consumed more total fat and/or more saturated fat than recommended. The first was the Women’s Health Initiative study, published earlier this year; the second was just published and examined the data from the Nurses’ Health Study.The response to the findings in both were eye-opening. In various articles reporting the WHI findings, the mainstream experts contended the null findings were because dietary fat intake was not lowered enough to make a difference; the response to the Nurses’ Health Study data contended that neither dietary pattern (low-carb or low-fat) was healthy.
For whatever reason, those deeply committed to the diet-heart theory cannot accept the idea the foundation of the theory is flawed, that perhaps it isn’t dietary fat per se, but the total context of diet that really matters most.
In the last few years we have witnessed some very subtle massaging of the message about what we should eat though, although it is often stated as if this were what we’ve been told all along! The most obvious changes in the message are two things: dietary fat isn’t all bad, in fact you can consume up to 35% of total calories from fat as long as you limit intake of saturated fat to less than 7% of calories and keep intake of trans-fat as low as possible (1% of total calories or less) and concentrate on vegetable sources of fat instead of animal sources; and we’re now told about “good carbs” and “bad carbs” and told we should eat complex, low glycemic index carbohydrates and limit refined carbohydrates.
Evidence for these changes to the message? Scant, but that didn’t stop anyone in the past from perpetuating the idea a low-fat, predominantly plant-based diet is optimal, so why would it now?How do we keep getting it wrong?
Let me say this – changing the message about quality of carbohydrate isn’t an all bad thing, it’s just incomplete.
That’s because it really doesn’t matter if you eat complex carbohydrate or refined carbohydrate when it comes to rising blood sugars and release of insulin. Oh, to be sure, complex carbohydrate works in the metabolism slower, but 100g of carbohydrate – complex or refined – is still 100g of carbohydrate to convert to blood glucose. As noted in previous posts, blood glucose, HbA1c, high insulin, high triglycerides and such are all correlated with poor health outcomes over the long-term.
Yet we continue to preach dietary advice that raises blood sugars, triglycerides and insulin, and over time increases percentage of HbA1c when an individual has become insulin resistant.
The flaw is our focus on dietary fat and the belief we require the majority of our energy from carbohydrates.
What to we keep dismissing as critical in the equation of good health and diet?
Protein, specifically complete protein that provides for our essential amino acid requirements.
Now many counter that protein stimulates insulin too, thus protein is a moot arguement in the dietary debate; besides we eat too much protein anyway!
But do we?
Data published from the NHANES surveys tell us something really interesting – over the last few decades our intake of protein has remained stable, level, not increased; and deficiency in critical nutrients is increasing amongst the population, with too many Americans failing to meet requirements for Vitamin E, C, A and D, selenium, magnesium and potassium.
A study published in May 2006 analyzed the newly updated food pyramids and found they were nutritionally deficient.
How does that happen? Everything these days is fortified or enriched to protect against nutrient deficiency!
It happens because the guidelines are not adequately designed to meet nutrient requirements, they’re not focused on essential nutrients, but macronutrients as a percentage of calories; designed to promote reducing fat intake, choosing plant-based proteins over animal foods and convincing you to consume carbohydrates as the major source of your calories.
Did you know protein requirements are based on your weight, not a fixed gram intake that meets everyone’s needs like other nutrients?
How often have you heard or read you only need 54g of protein each day? That’s what it works out to if you do the math based on the Nutrition Facts panel on every packaged food and are targeting a 2,000-calorie per day diet. (2,000-calories, total fat 65g or 585-calories, total carbohydrate 300g or 1200-calories – leaves 215-calories from protein, or just 53.75g).
If we actually look at the recommendations from the Institutes of Medicine, we find protein intake is not based on a percentage of calories, but on an individuals body weight. So, 53.75g is adequate when you weigh 148-pounds. If you weigh more, you need more each day. The RDA is set at 0.8g/kg of body weight; the IOM acknowledges “much less than most people are typically consume,” yet government agencies claim “Americans eat too much protein” in educational documents, including ones that target children.
It comes back to the deeply entrenched fear of dietary fats – if you want to reduce fat intake, specifically saturated fat, you have to promote the idea to consume less meat, whole dairy, eggs and other animal foods. What happens, at the same time though, is that both the quality of protein intake and the absolute grams of intake is impacted – both are reduced.
But hey, you did reduce fat intake!
Even with the recent concession that it isn’t necessarily total fat intake in the diet, the concurrent reduction in limits on satutated fat means an absolute need to reduce animal foods which come neatly packaged with saturated fats, monounsaturated fats and polyunsaturated fats. Oh, yeah, few highlight the fact that meat, like beef, has a majority of its fat calories from monounsaturated fat, not saturated fat.
Plant-based foods can be complete when consumed together to get over the limiting protein in one or the other, but they’re simply not as rich with nutrients as animal-based proteins. Meats, eggs, liver, fish, whole dairy – excellent sources of not only complete protein (essential amino acids), but also zinc, selenium, vitamin B-12, potassium, magnesium and other B-vitamins.
When you choose plant-based proteins you’re also eating more calories to consume the same amount of protein – that’s because plant-based foods are not rich with protein, they’re rich with carbohydrate.
So, what happens when you miss your daily requirement for essential amino acids (EAA)?
Well, if it’s a day here or a day there, it probably won’t have much impact on your health in the long-term. But, if it’s the norm, not an occasional miss, it will have an effect since amino acids are the building blocks to repair and build throughout your body. As the Biology Project at University of Arizona highlights, “Failure to obtain enough of even 1 of the 10 essential amino acids, those that we cannot make, results in degradation of the body’s proteins—muscle and so forth—to obtain the one amino acid that is needed. Unlike fat and starch, the human body does not store excess amino acids for later use—the amino acids must be in the food every day.”
Our dietary guidelines specifically encourage a diet that is deficient in adequate protein and complete amino acids. Each time a study is released finding protein is critical in satiety, hunger regulation, ease of calorie restriction, and weight management – it is pooh-poohed and we’re cautioned too much protein is bad for us and to stick with the recommendation to choose plant-based protein!
This leads us to consume excess carbohydrates, even when we think we’re eating healthy. Excess is any level of intake above and beyond what we actually need each day.
Now answer this honestly – do you really think we need to consume 500g of carbohydrate each day for energy?
That’s what we’re currently averaging in the United States; who is consuming the 400g+ that I’m not?
The fatal flaw is in our fear of fat, we are not meeting our protein requirements, thus we keep eating in an attempt to do so, and the foods we’re choosing are poor sources of complete protein and often littered with unnecessary calories from fats and oils.
The beauty of a carbohydrate restricted diet is this – isuch a diet forces you to make protein your focus each day and strictly limits the carbohydrate foods you do it to non-starchy vegetables, low sugar fruits, nuts, seeds – all rich sources of vitamins, minerals and trace elements; and when tolerated, whole grains and legumes as desired and within calories consumed.
A carbohydrate restricted diet is not making you eat more fat or more protein; in fact, odds are better than good that you’ll be eating exactly the same amount of protein and fat as you did before you limited carbohydrate! What you’re eliminating isn’t vegetables, fruits, nuts or seeds – in fact, you’ll most likely increase your intake of non-starchy vegetables; what you are eliminating is the nutrient-poor higher carbohydrate foods that provide too much carbohydrate and too little nutrition for those calories.
Many wring their hands trying to figure out what you replace carbohydrate calories with when you’re on a carbohydrate restricted diet.
The answer is – you don’t replace them with anything, you simply swap out the nutrient-poor carbohydrates for the nutrient-rich ones; and encourage non-starchy vegetables, nuts, seeds and low-sugar fruits as the foods to replace the potatoes, rice, beans, pasta and other high-carbohydrate foods.
A simple example is, the typical American lunch might include a cheeseburger on a bun, french fries with ketchup and a soda. A carbohydrate restricted lunch would instead be a cheeseburger sans the bun, a salad with ranch dressing and water or iced tea with a slice of lemon, no sugar.
Both will satisfy the appetite; both are providing identical complete protein; one is significantly less calories and less carbohydrate – all because a salad is swapped for the french fries and water/iced tea replaces the soda.
Now to be fair, we’re told the standard American diet (burger, fries and a soda) is unhealthy; but we’re also told the carbohydrate restricted meal is just as bad, if not worse for us.
If Americans aren’t going to stop eating burgers, why are we not encouraging them to at least eat them in a way that provides a better nutritional profile with less calories?
It all comes back to the fatal flaw – the dietary fat.
Until we get past the fear of dietary fat, not much is going to change. :::sigh:::
Let me take a moment to highlight additions to the list of resources in the sidebar:
Blogs and support forum links that no longer appear in my sidebar were removed, for the most part, for lack of timely updates. It should be noted that I don’t always agree with those I link to – keeps things interesting! – but each blog or forum I do provide a link to does have compelling content and is a good read!
If there is a blog you host or know of that you think others might enjoy, email me for consideration – I update my sidebar about once a month.
A letter to the editor in the Kennebec Journal (Maine) had this gem:
Physicians don’t address diabetes the right way
On Nov. 4, the Kennebec Journal discussed the epidemic of diabetes. Diabetes is a nutritional disease. Dr. Sears said that this was a “societal problem” due to less activity and bigger portions.
But the Centers for Disease Control Health Report shows we are more active and many of us eat fewer calories than we did in 1994. Clearly calories in, calories out is oversimplified. Eating equivalent calories from carrots or coke will do profoundly different things to the body. Doctors must address the individual needs of patients, checking thyroid levels, stress levels, sleep deprivation and simple carbohydrate intake. But 72 percent of overweight patients are never even told by their doctors to lose weight (Nov. 7, KJ).
On Nov. 9 in the newspaper, we learned a low-carb diet is “not a risk” for heart disease. Protein sparing fasts have been shown to lower: “Fasting plasma glucose and HbA1c.” In clinical practice, I have seen blood sugars drop into the normal range when patients change their diets. In effect, we have the cure for type II diabetes and we are not training our doctors to use it. Even in 2006, only 30 percent of medical doctors have ever taken a separate course on nutrition. These are the specialists who are trying every drug possible when the diet of their patients is literally killing them.
Dr. Christopher Maloney
Way back in July 2002 Gary Taubes article in the New York Times, What if its All Been a Big Fat Lie, was a big fat headache for those deeply commited to the decades old dietary dogma.
Well, get ready for another firestorm of controversy about dietary recommendations! In the December 2006 issue of Men’s Health magazine, Adam Campbell takes on the American Diabetes Association in his special report The Cure for Diabetes.
He teases us with his opening sentences…
What if the American Heart Association endorsed the trans-fat diet? Problem, right?
Look at what the American Diabetes Association is spoon-feeding people with diabetes: sugar.
Not to worry: We’ve got the solution right here.
…and leads in with the controversial approach to managing and reversing diabetes of one small town doctor in Kansas, Mary Vernon, MD.
Her secret weapon against the disease? A low-carb diet.
There’s no question Dr. Vernon is trouble – but for whom? Not her patients, that’s for certain. They just won’t stay sick. People walk into her office afflicted with type II diabetes and, by every objective medical measure, walk out cured. There’s $51-million that says that isn’t supposed to happen, not in a clinic in Kansas, and definitely not the result of cleaning out the refrigerator.
If Dr. Vernon and a growing cadre of researchers are correct about carbohydrates, we may be looking at an epic case of ignorance on the part of the medical community. That, however, pales next to the implications for the American Diabetes Association, namely that the very organization dedicated to conquering diabetes is rejecting what could be the closest thing we have to a cure.
This is one of those must read articles!
Go on…..go and read it now!
Part 2 of Fatally Flawed Health & Risk Paradigms is rescheduled for posting tomorrow!