Why Aren't Low-Carb Diets Official Advice for Type 2 Diabeti

CharlieLopez2005

Here's what I don't understand: compared to a non-diabetic, a type 2 diabetic's body doesn't handle carbohydrate intake that well, but instead of the obvious, logical response of dispensing a low-carb diet, the Conventional Wisdom advice is to recommend a low-fat diet instead (which ipso facto usually means a higher-carb intake to compensate). Why is there this wide disconnect? Am I somehow missing the evidence that upping carb intake (via a low-fat diet) for a Type 2 Diabetic improves their overall health?

At my heaviest, when my doctor thought I was on the road to prediabetes (with the 2-hour glucose tolerance reading at 138), he sent me to the dietician who in turn recommended that I cut my FAT intake to 50g per day. Not even a whisper about carbs. And my mom, who through years of Type 2 Diabetes, has End Stage Renal failure and is currently on kidney dialysis, still has her doctors recommend that she consume lots of fruits, like oranges. One time, I was actually with my mom at the hospital when her nephrologist made this same recommendation. I interjected, "but doctor, you know that my mom has a long history of Type 2 Diabetes and kidney failure, isn't eating an orange for her potentially dangerous?" He responded that "Well, it's natural sugars instead of processed sugars." I said, "Ah, how exactly is her body able tell the difference once digested?" to which he thought for a minute and recommended that she see a dietician instead (who would probably dispense the same advice with a different title).

Alisha_countrymama

It's like Dr's walk around with a Paper bag over their heads when it comes to the dangers of carbohydrate intake! After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day. Those 90 calorie packs of chips, cookies, little cups of fruit filled with sugar, and the list goes on.

What doctors don't realize is that by restricting carb intake, getting a grip on blood sugar levels becomes much easier!

LadyKT

Yep, this kind of stuff annoys me as well. I'm not diabetic, but have it in my family. My step sister is type 1, her husband type 2. None of their 4 kids have either but I am going to go on a wild guess and say that my one nephew will probably develop type 2 as he takes after his dad, is a bit overweight and eats pretty much anything he wants. My step sis has kidney issues and is now "vegan", to which she says cutting meat helped her ::sigh::. If that's the case then why is the kidney function test result coming back too high?

I told her cutting carbs would probably be the best thing for her, and she just scoffed and said "shes never felt better" being vegan. That may be the case but her test results don't reflect that.

::end rant::

rainman3k

You are spot on! In February of this year my doctor put me on a low cal/low fat 1800 calorie diet. My blood sugar was in the high 90's, I followed that diet and of course in hindsight it was loaded with carbs.

In September I had another visit and my blood sugar had climbed to the 150's and their answer was I must be cheating on my diet, no mention of carbs, nothing.

I joined MFP that week and through my friends, self research and meeting with another dietitian, I was able to determine carbs was playing into my issue. I slowly started to decrease and have reached a point where I am now at about 20% carbs and I have felt the best ever. No crashes, lots of energy and most important my morning glucose test comes in right about 80.

BeeElMarvin

I took a nutrition class for diabetics after I was diagnosed and they did recommend low carb, carb counting, whatever you want to call it. I live in Backwoods USA, so maybe Dr.'s aren't following that advice, but the official word is controlled carb.

Acg67

It's like Dr's walk around with a Paper bag over their heads when it comes to the dangers of carbohydrate intake! After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day. Those 90 calorie packs of chips, cookies, little cups of fruit filled with sugar, and the list goes on.

please stop with this nonsense, what are the dangers of carbohydrate intake?

correlation =/= causation

I'm sure people becoming more sedentary and increasing overall caloric intake played no part in the rising obesity rate, it was all the evil evil carbs

BeeElMarvin

It isn't nonsense for diabetics. Nobody said anything about evil carbs (here we go again). Diabetics are unable to process carbs properly. Yes, exercise is vital, but limiting high carb / low fiber foods helps too. I am under no delusions as to what caused my diabetes, it was a sedentary lifestyle mixed with poor nutrition - a diet too high in calories and unhealthy carbs (NOTE: I did not say all carbs are unhealthy, or that I can't have any carbs - I have to limit my bad foods and move more).

LadyKT

It's like Dr's walk around with a Paper bag over their heads when it comes to the dangers of carbohydrate intake! After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day. Those 90 calorie packs of chips, cookies, little cups of fruit filled with sugar, and the list goes on.

please stop with this nonsense, what are the dangers of carbohydrate intake?

correlation =/= causation

I'm sure people becoming more sedentary and increasing overall caloric intake played no part in the rising obesity rate, it was all the evil evil carbs

I do believe that person's point was the low fat/low calorie, not "evil carbs".

Acg67

It isn't nonsense for diabetics. Nobody said anything about evil carbs (here we go again). Diabetics are unable to process carbs properly. Yes, exercise is vital, but limiting high carb / low fiber foods helps too. I am under no delusions as to what caused my diabetes, it was a sedentary lifestyle mixed with poor nutrition - a diet too high in calories and unhealthy carbs (NOTE: I did not say all carbs are unhealthy, or that I can't have any carbs - I have to limit my bad foods and move more).

you are talking about people with a metabolic disorder, the poster that i quoted associated increasing rates of obesity with a single macronutrient, carbohydrates. So yes she did essentially say carbs were evil and the reason for rising rates of obesity

Acg67

It's like Dr's walk around with a Paper bag over their heads when it comes to the dangers of carbohydrate intake! After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day. Those 90 calorie packs of chips, cookies, little cups of fruit filled with sugar, and the list goes on.

please stop with this nonsense, what are the dangers of carbohydrate intake?

correlation =/= causation

I'm sure people becoming more sedentary and increasing overall caloric intake played no part in the rising obesity rate, it was all the evil evil carbs

I do believe that person's point was the low fat/low calorie, not "evil carbs".

but that is not what she said

After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day.

LadyKT

but that is not what she said

After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day.

No, again you're not getting the point. She mentioned all those "100 calorie snack packs". Those are horrible for anyone. Also - don't knock someone else's plan if it's working for them. We're not knocking you, are we? Please, if you don't agree with something because something worked for YOU, don't assume it will work FOR SOMEONE ELSE.

JujiBean

CharlieLopez2, I have always wondered exactly the same thing. As the mother of a diabetic (and therefore responsible for her diet when she was young) I observed that her blood sugars were astonishingly stable and within a healthy range when she restricted her carb intake to approximately 15 carbs per meal. However, when she followed the recommended ADA diet (high carb / low fat) her blood sugars would swing wildly and she would careen out of control.
I began to wonder just what was going on. Why would her doctors and nutritionists recommend a diet packed with oatmeal, milk, bananas, bread, potatoes, pasta.....when the evidence of the benefits of a low carb regimen is SO clear?
My daughter is a type 1, but the benefits are the same for a type 2.

Acg67

but that is not what she said

After pushing Low Fat/ Low Calorie diets, the obesity rate went up!!! Why is that? Because people are eating an insane amount of carbs a day.

No, again you're not getting the point. She mentioned all those "100 calorie snack packs". Those are horrible for anyone. Also - don't knock someone else's plan if it's working for them. We're not knocking you, are we? Please, if you don't agree with something because something worked for YOU, don't assume it will work FOR SOMEONE ELSE.

i didn't knock anyone's plan, i did point out that it is nonsensical to single out CHO as the reason for increasing rates of obesity, which is what she stated.

and 100 calorie snack packs are horrible for everyone? how so? without taking into consideration of their toal diet, how can you say 1 single food item and a low cal one at that is horrible for someone

and low carb diets have no metabolic advantage over other diets

jrditt

So I am a nurse getting my masters to be a nurse practitioner and worked with hundreds of diabetics over the last couple of months. There are two things that are recommended, first is to lose weight because the adipose (fat) tissues leads to more glucose tolerance, the second part is carb counting, especially for those that are injecting insulin. These doctors are probably recommending the fat loss first because that could literally fix everything. We have all heard about type 2 diabetics getting off all their meds. Obviously it's a little different for someone in renal failure and a type 1 diabetic.

Fruits are different than processed sugars although obviously diabetics shouldn't go crazy with them and still need to count them as sugar and carbs but it doesn't make your glucose level spike as much.

AdAstra47

The short answer to the original question is "lobbyists." The wheat and corn industries are huge influencers of congress and of public policy, including our dietary standards and research grants. It's more complicated than that, of course, but I think big business and the almighty dollar deserve a lot of the blame.

For example, corn is quite obviously a grain. It is grown just like wheat or barley or oats. Its starch & carb & nutrient levels are similar to other grains. Herbologists and biologists all agree that it is a grain. Yet our government & school lunch programs classify it as a vegetable. There is NO scientific reason for this. It's entirely due to the efforts of lobbyists.

As for doctors, I think most of them are trying to get their patients to lose weight, which it's true, will help their diabetes. But they tell them to lose weight by not eating fat, because that's the conventional wisdom. Whether you agree with that theory or not, what the doctors forget is that their patients, by definition, have abnormal metabolisms. So just "not eating fat" or just eating a calorie deficit is not going to help them lose weight. I tried that for 20 years and gained weight steadily. My doctors just accused me of lying about following the diet and exercising, and gave me the same useless advice over & over again, because our culture conditions them to equate obesity with laziness and gluttony and lack of discipline. The patient is always to blame for being fat.

Once a doctor realizes that her patients really are doing as they're told and they're still not seeing results, that's when she may have the epiphany that maybe she's giving the wrong advice. As seen here:

http://www.diabetesnewsstand.com/vissue/vernon/titlepage.html

BeeElMarvin

So I am a nurse getting my masters to be a nurse practitioner and worked with hundreds of diabetics over the last couple of months. There are two things that are recommended, first is to lose weight because the adipose (fat) tissues leads to more glucose tolerance, the second part is carb counting, especially for those that are injecting insulin. These doctors are probably recommending the fat loss first because that could literally fix everything. We have all heard about type 2 diabetics getting off all their meds. Obviously it's a little different for someone in renal failure and a type 1 diabetic.

Fruits are different than processed sugars although obviously diabetics shouldn't go crazy with them and still need to count them as sugar and carbs but it doesn't make your glucose level spike as much.

this makes sense, thanks.

CharlieLopez2005

So I am a nurse getting my masters to be a nurse practitioner and worked with hundreds of diabetics over the last couple of months. There are two things that are recommended, first is to lose weight because the adipose (fat) tissues leads to more glucose tolerance, the second part is carb counting, especially for those that are injecting insulin. These doctors are probably recommending the fat loss first because that could literally fix everything. We have all heard about type 2 diabetics getting off all their meds. Obviously it's a little different for someone in renal failure and a type 1 diabetic.

Fruits are different than processed sugars although obviously diabetics shouldn't go crazy with them and still need to count them as sugar and carbs but it doesn't make your glucose level spike as much.

Good luck with your masters! Your insight makes perfect sense if we assume that a doctor recommending a low-fat (high-carb) diet to a Type 2 diabetic is the only or best way to lose weight (in particular, adipose tissue) for people with this condition. However, I would think following a diet that provokes higher blood sugars in a body not able to control it, makes losing weight an almost impossible feat. It seems like it would make more sense to not unnecessarily provoke higher blood sugar levels (i.e. via diet choices) and therefore be less reliant on insulin and other meds to control blood sugar levels in a body with an impaired insulin response system. How do you advise a typical Type 2 diabetic patient in terms diet?

CyberEd312

Well I Am a Type 2 diabetic (diagnosed in May 2009) I had A1c of 9.9 which is blood sugars running at a 250 avg.. I was pretty much home bound at 560 lbs. My first visit with my Endocrinologist went like this: "If you don't lose the weight you will be dead within the next few years, but if you lose the weight I will guarantee you that all your Diabetes number will be back to normal." So I started working with a Diabetic dietician, we had to change my whole mentality when it came to food. I had to replace all the bad carbs (enriched flour, junk food, chips, candy, etc) with good complex carbs (whole grains, fruits, veggies, legumes) trying to avoid the simple carbs that cause blood sugar spikes. I had to work with a therapist to over come my food addictions but I learned the differences between the good and bad carbs and made the switch. Fast forward 29 months and a weightloss of 288 lbs. and My last 4 visits / 4 months checkups had my A1C at 5.6, 5.5, 5.6 , and last was 5.4 which are all prediabetic levels. I am off all my Diabetes meds except for metformin which is more for protecting what receptors I have left ( the longer my receptors are protected the longer the time between me and insulin shots.... ) As far as limits on carbs or so called low carb diets, My dietician set me on carb counting and we adjusted the numbers to allow for a 2 lb. a week weightloss. The first few weeks I was losing 11, 6, 8 lbs. respectfully but we got it adjusted, so I presently consume 70-80 grams of Carbs at my man meals and 20-25 grams at my snacks. So my opinion is alittle biased because of what works for me. I feel alot of diabetes complications can be helped with the right mindset of Healthy eating and the benefits of Exercise can not be understated...... Just my 2 cents....

jrditt

I certainly am not recommending a diet high in carbs. I always recommend more vegetables and protein and if they are going to eat carbs to go for lower carbohydrate options and sugar free options. We send a lot of our patients to a diabetes clinic where they learn about carb counting and how many carbohydrates they should eat per day.

We also recommend, especially at first in the prediabetic stage and later when glucose levels are out of control, to test their blood sugars before eating, as well as an hour or two afterward so that you know what is impacting your blood sugar and you can slowly remove these foods. It's a lot of testing at first but then you know how your body is going to react and how to keep your glucose as close to 100 as possible.

if you're not happy with how your doctor or NP is telling you to eat, go research, ask to be referred to an endocrinologist or a diabetes clinic. If they aren't willing to do that and help your health then maybe they aren't the doctor for you. There are a lot of options out there.

jrditt

EdDavenport, you are an inspiration and you should look in to talking to those with type 2 diabetes because we can harp at them all day but they need to hear from someone that has been through it.

kschhr

I don't have diabetes, and this isn't necessarily true for them (as I don't know enough about it and haven't experienced it).
BUT, after skimming most of the posts.. there's nothing wrong with carbs. As long as you're getting good, complex carbs.. they're healthy. Saying you're eating too many carbs is ridiculous. It's not the potato that makes you fat, it's the butter and sour cream and bacon you eat with it.

willnorton

acg67...are you a diabetic..i didnt think so....


walk in our shoes and then talk to us about carbs...test your blood sugar 5 to 0 times a day....

then talk to all of us about carb intake...

until you walk in our shoes, do a little more research..

if you are a diabetic, my apologies to you..
if you arent....point made!

Bill type 2 sine 2005

Acg67

acg67...are you a diabetic..i didnt think so....


walk in our shoes and then talk to us about carbs...test your blood sugar 5 to 0 times a day....

then talk to all of us about carb intake...

until you walk in our shoes, do a little more research..

if you are a diabetic, my apologies to you..
if you arent....point made!

Bill type 2 sine 2005

please reread AlishaGates's post, she makes no mention at all of people dealing with a metabolic disorder, including diabetes. She states that the rise in obesity is due to increased carb intake, while leaving out the fact that we've become more sedentary as a population as a whole and overall have increased caloric intake. My post was simply challenging her assertion, you'll notice nowhere did i say low carb is not beneficial to those with certain metabolic disorders

LilMissFoodie

Because low carb diets are questionable at best. I don't really necessarily mean that as an insult to low carb diets, I mean that the research is just not there. Why is it not there? Because the decent research we do have largely suggests that low carb diets or certain characteristics of low carbs diets would potentially be dangerous so it's unethical to do a proper trial.

willnorton

acg...you are so right...my apologies to you.....

that is another side effect of being diabetic... sometimes we speak before we should...we are very passionate about our problem and we get crazy about the carb thing..


its not easy being diabetic...

again you are right about the original post..

my bad

Merry Christmas!

QueenStromba

Because low carb diets are questionable at best. I don't really necessarily mean that as an insult to low carb diets, I mean that the research is just not there. Why is it not there? Because the decent research we do have largely suggests that low carb diets or certain characteristics of low carbs diets would potentially be dangerous so it's unethical to do a proper trial.

What characteristics of low carb diets are dangerous exactly?

busterbluth

Because low carb diets are questionable at best. I don't really necessarily mean that as an insult to low carb diets, I mean that the research is just not there. Why is it not there? Because the decent research we do have largely suggests that low carb diets or certain characteristics of low carbs diets would potentially be dangerous so it's unethical to do a proper trial.

That's not necessarily true for everyone, as there HAVE been trials: http://www.hopkinsmedicine.org/news/media/releases/Modified_Atkins_Diet_Can_Cut_Epileptic_Seizures_in_Adults

I was going to try this but I found a med that worked. I'm not sure if I'd rather be on seizure meds for the rest of my life or a ketogenic diet. . .neither sounds ideal, but neither does a seizure d/o.

tidmutt

Because low carb diets are questionable at best. I don't really necessarily mean that as an insult to low carb diets, I mean that the research is just not there. Why is it not there? Because the decent research we do have largely suggests that low carb diets or certain characteristics of low carbs diets would potentially be dangerous so it's unethical to do a proper trial.

Eh? Wow, please, if you are going to make a bold claim like that please back it up with some references...

TrainingWithTonya

Okay, from the standpoint of someone who has taken the coursework for becoming a registered dietitian but without taking the internship that would allow me to sit for the test, it's because diabetics don't have to avoid carbs, they just have to modify the way they eat carbs. That's why the RD's at hospitals call it a carb controlled diet and not a low carb diet. You have to eat any high glycemic carbs with protein or fat in order to slow the spike of blood sugar. They can still have just as many carbs as the average person, but they have to learn how to combine their foods to avoid the spikes of blood sugar. That is done by limiting the grams per meal and eating more often (where the 6 meals per day that has gained widespread popularity originated) then the standard 3 meals per day.

The reason a low fat diet is recommended is because 70% of type 2 diabetics also have high blood pressure which when combined with high cholesterol can lead to a heart attack or stroke. So, they recommend a low fat diet to decrease this risk. Actually, because of the fact that many diabetics increase protein so much and have high blood pressure (which is also linked to the kidneys) they make up the majority of End Stage Renal Disease patients too, so they should be watching their protein intake too in order to protect their kidneys. That's why I was taught to recommend a diet of 0.8 grams per kilogram of body weight of protein and figure out the percentage of calories that would be and then give a moderate fat percentage and filling in the rest with carbs for diabetic patients. Then teaching them about heart healthy oils (ones like Olive that have shown to reduce cardiac health risk) and combining foods.

And the reason that doctors don't do this or know how to recommend any diet plan for any diseased population is because they have usually only taken 1 nutrition class, if that. They don't know squat about about nutrition. I don't go cutting people open or prescribing antibiotics for people with pneumonia because that is not in my scope of practice, I refer them to a doctor. The professional courtesy should run both ways and doctors should refer patients who need weight loss or special exercise or diet plans to the properly trained professionals as well. Unfortunately, some of them don't and don't realize they may be harming their patients because of it.

Grokette

Here's what I don't understand: compared to a non-diabetic, a type 2 diabetic's body doesn't handle carbohydrate intake that well, but instead of the obvious, logical response of dispensing a low-carb diet, the Conventional Wisdom advice is to recommend a low-fat diet instead (which ipso facto usually means a higher-carb intake to compensate). Why is there this wide disconnect? Am I somehow missing the evidence that upping carb intake (via a low-fat diet) for a Type 2 Diabetic improves their overall health?

At my heaviest, when my doctor thought I was on the road to prediabetes (with the 2-hour glucose tolerance reading at 138), he sent me to the dietician who in turn recommended that I cut my FAT intake to 50g per day. Not even a whisper about carbs. And my mom, who through years of Type 2 Diabetes, has End Stage Renal failure and is currently on kidney dialysis, still has her doctors recommend that she consume lots of fruits, like oranges. One time, I was actually with my mom at the hospital when her nephrologist made this same recommendation. I interjected, "but doctor, you know that my mom has a long history of Type 2 Diabetes and kidney failure, isn't eating an orange for her potentially dangerous?" He responded that "Well, it's natural sugars instead of processed sugars." I said, "Ah, how exactly is her body able tell the difference once digested?" to which he thought for a minute and recommended that she see a dietician instead (who would probably dispense the same advice with a different title).

I would find another Nephrologist and QUICK. My mom was on dialysis for over 13 years and her doctor told her to watch how much fruit such as oranges, grapefruit and bananas especially.

Also, there are some Nephrologists out there that are treating kidney disease and reversing the damage with a high fat, moderate protein, low carb eating plan.

Please read below.

http://healthimpactnews.com/2011/low-carbohydrate-high-fat-ketogenic-diet-may-reverse-kidney-failure-in-people-with-diabetes/

Grokette

Okay, from the standpoint of someone who has taken the coursework for becoming a registered dietitian but without taking the internship that would allow me to sit for the test, it's because diabetics don't have to avoid carbs, they just have to modify the way they eat carbs. That's why the RD's at hospitals call it a carb controlled diet and not a low carb diet. You have to eat any high glycemic carbs with protein or fat in order to slow the spike of blood sugar. They can still have just as many carbs as the average person, but they have to learn how to combine their foods to avoid the spikes of blood sugar. That is done by limiting the grams per meal and eating more often (where the 6 meals per day that has gained widespread popularity originated) then the standard 3 meals per day.

The reason a low fat diet is recommended is because 70% of type 2 diabetics also have high blood pressure which when combined with high cholesterol can lead to a heart attack or stroke. So, they recommend a low fat diet to decrease this risk. Actually, because of the fact that many diabetics increase protein so much and have high blood pressure (which is also linked to the kidneys) they make up the majority of End Stage Renal Disease patients too, so they should be watching their protein intake too in order to protect their kidneys. That's why I was taught to recommend a diet of 0.8 grams per kilogram of body weight of protein and figure out the percentage of calories that would be and then give a moderate fat percentage and filling in the rest with carbs for diabetic patients. Then teaching them about heart healthy oils (ones like Olive that have shown to reduce cardiac health risk) and combining foods.

And the reason that doctors don't do this or know how to recommend any diet plan for any diseased population is because they have usually only taken 1 nutrition class, if that. They don't know squat about about nutrition. I don't go cutting people open or prescribing antibiotics for people with pneumonia because that is not in my scope of practice, I refer them to a doctor. The professional courtesy should run both ways and doctors should refer patients who need weight loss or special exercise or diet plans to the properly trained professionals as well. Unfortunately, some of them don't and don't realize they may be harming their patients because of it.

Thanks to Ancel Keys you were taught very wrong and outdated information.

Fat and cholesterol has nothing to do with heart disease, high blood pressure or any other cardiovascular issues.

In fact, it is the carbs that causes the inflammation that leads to heart disease and other issues, not fat.

Researchers, doctors and other scientists are starting to find out the truth about Ancel Keys lies and things in terms of thinking will change.

Everything you think you know will turn out to be a big fat lie.