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

Grokette

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?

Exactly? What part of a low carb plan is questionable or dangerous??????

Is it the protein? I don't think so and definitely not the fat.

Wait a minute. It must be the fresh vegetables and fruits that makes it dangerous. Yeah, that must be it. :grumble: :noway:

QueenStromba

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.

Could you point me in the direction of a journal article which shows that high cholesterol causes strokes? I'd also be quite interested in reading some papers which show a link between dietary fat and serum cholesterol levels.

Justforthebacon

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.

There is TONS of evidence that a low carb diet is healthy and safe. Check out Gary Taubes book -http://www.goodreads.com/book/show/1820055.Good_Calories_Bad_Calories
It is one of the most comprehensive and recent nutrition research books available.

Acg67

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.

There is TONS of evidence that a low carb diet is healthy and safe. Check out Gary Taubes book -http://www.goodreads.com/book/show/1820055.Good_Calories_Bad_Calories
It is one of the most comprehensive and recent nutrition research books available.

^ only read the above book if you want your head to be filled with nonsense (other then the section on the lipid hypothesis)

Sidesteal

^ I agree with Acg67.

peacehawk

If someone is already in renal failure, it is difficult for their bodies to metabolize a lot of protein, so a low carb regimine is not recomended. However, if one is not in renal failure, low carb is fine. But, even better is high fiber. this slows down the absorbtion of carbs, making it easier for your body to keep up on proper insulin production. the key to anything is balance and moderation. If you want a potato, eat a potato, but skip the pop. If you want the ice cream, eat a serving and not a pint and skip the potato. Carbs are not evil. Our brains absolutely need carbs to function properly, and our cells need carbs to create energy. However, too much of a good thing makes a bad thing. In general, according to my partner's dietitian, using the plate method is the best way to get what you need as a diabetic: half of a 7" plate should be veggies, 1/4 carb and 1/4 lean protein. This is a good balanced way to choose food. my diabetic partner has lost over 40 pounds using this method, she has gotten off of her short term insulin and has cut her long term insulin from 52 units per night to 10 and her sugars have been perfect. (This result is related to this food regimine and essential oils and suppliments.) Moderation moderation and paying attention.

peacehawk

Too many people equate low carb with no carb. Too much protein and not enough carbs can send a person into a condition called keytoacidosis, which can cause kidney damage. Our bodies need some carbs.

tigersword

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!

I hate to say this, but the numbers don't agree with that assessment. Total sugar consumption by Americans actually dropped by 1% between 1970 and 2007, while dietary fat consumption increased by 7%. And the average caloric intake increased by about 600 calories a day. As much as the "Low Carb Taliban" like to scream from the rooftops about how all the carbs are suddenly bad, the actual numbers show people are actually eating LESS carbs compared to 40 years ago, they're just eating much more food.

As for the original post, I am stumped, the doctor there is an idiot (granted most doctors don't get much nutrition education, other than nutritionists.) My mother had Diabetes for decades, and always ate a low sugar diet, not really low carb, just low simple sugars.

Although, re-reading and noticing the kidney failure, yeah, protein is bad for damaged kidneys, so a higher carb, lower protein diet would most likely be a decent plan.

Justforthebacon

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!

I hate to say this, but the numbers don't agree with that assessment. Total sugar consumption by Americans actually dropped by 1% between 1970 and 2007, while dietary fat consumption increased by 7%. And the average caloric intake increased by about 600 calories a day. As much as the "Low Carb Taliban" like to scream from the rooftops about how all the carbs are suddenly bad, the actual numbers show people are actually eating LESS carbs compared to 40 years ago, they're just eating much more food.

As for the original post, I am stumped, the doctor there is an idiot (granted most doctors don't get much nutrition education, other than nutritionists.) My mother had Diabetes for decades, and always ate a low sugar diet, not really low carb, just low simple sugars.

Although, re-reading and noticing the kidney failure, yeah, protein is bad for damaged kidneys, so a higher carb, lower protein diet would most likely be a decent plan.

Don't know where you are getting your figures from but you are wrong.
Americans now consume 19% more added sugar in their daily diet than they did in 1970, according to recent figures from the U.S. Department of Agriculture.
Read more: http://www.time.com/time/health/article/0,8599,1983542,00.html#ixzz1hPV0GkUa

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.

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

I hate to say this, but the numbers don't agree with that assessment. Total sugar consumption by Americans actually dropped by 1% between 1970 and 2007, while dietary fat consumption increased by 7%. And the average caloric intake increased by about 600 calories a day. As much as the "Low Carb Taliban" like to scream from the rooftops about how all the carbs are suddenly bad, the actual numbers show people are actually eating LESS carbs compared to 40 years ago, they're just eating much more food.

As for the original post, I am stumped, the doctor there is an idiot (granted most doctors don't get much nutrition education, other than nutritionists.) My mother had Diabetes for decades, and always ate a low sugar diet, not really low carb, just low simple sugars.

Although, re-reading and noticing the kidney failure, yeah, protein is bad for damaged kidneys, so a higher carb, lower protein diet would most likely be a decent plan.

Don't know where you are getting your figures from but you are wrong.
Americans now consume 19% more added sugar in their daily diet than they did in 1970, according to recent figures from the U.S. Department of Agriculture.
Read more: http://www.time.com/time/health/article/0,8599,1983542,00.html#ixzz1hPV0GkUa

in 1970 added sugars accounted for 18.5% of total kcal intake, in 2009 added sugars accounted for 16.9% of total kcal intake, a decrease of 1.6%

http://www.ers.usda.gov/Data/foodconsumption/spreadsheets/foodloss/Calories.xls

tigersword

http://www.alanaragonblog.com/2010/01/29/the-bitter-truth-about-fructose-alarmism/

I actually checked the studies that he used to get his information from personally, and they check out. Not sure where Time Magazine got their source from, since they didn't actually cite a study, just used the vague "this group said" line. Total calories consumed increased by 22%, so if people are eating 19% more sugar than they were in 1970, then technically it's still a 3% decrease. A quick line in a Time article, without any way of verifying the actual source, is not a very good source to trust, especially when the article's purpose is to alarm people, and get them frenzied.

EDIT - Acg67 with the actual study, thanks. :drinker:

BPayton27

I was diagnosed with diabetes a little over 2 months ago. 2 days after my appointment, I saw a diabetic nutritionist. Carbs is the FIRST thing she mentioned to me. She changed my life. I am now living a low carb lifestyle and have lost 35 lbs in about 70 days. Of course I am in the gym a lot, but cutting the carbs is no doubt what got the ball really rolling. I have no had a high blood sugar or fasting number in a over 7 weeks.

Debbe2

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).

The reason it is recommended to follow a low fat diet is due to the elevated risk for heart disease associated with both type 1 and type 2 diabetes. I am diabetic and have never been told that consuming "lots of fruits, like oranges" was recommended. To the contrary, I have always understood and been told that consuming fruit was exactly the same to my body as other sugars and to take it very slow and be cautious with fruits. They are not only ok to eat in moderation, our bodies utilize and need them. I understood to test often and record the results that different fruits and vegetables have on me. Eat small portions and a low calorie diet, low in saturated fat and be aware of the impact from the foods I eat. As important as the diet component is the exercise component which helps us burn off the foods we've eaten. This is what I have understood to be the recommendation from the medical field and from my own health care team.

heybales

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.

You been looking at news and studies reported in even the local papers? You are like 10 yrs ago.

Now, perhaps a difference in meaning when you say low carb you are thinking like 10-20 grams/day or none, whereas the studies are usually talking about lower percentage of carbs than fat or protein. Like 15-20%.

Just a few snippets.

http://www.webmd.com/cholesterol-management/news/20100802/low-carb-diets-improve-cholesterol-long-term

http://www.nejm.org/doi/full/10.1056/NEJMoa0708681

http://www.annals.org/content/153/3/147.abstract?aimhp

AZackery

Diabetics don't have to eat a low-carb diet. Carbohydrates is not the enemy. Diabetics should be eating low GI foods that's under 55. This is what their doctor should be telling them and giving them a list of low GI foods. If diabetics eat low GI foods, they can't go wrong. They can find low GI foods lists on the internet.

A diabetic diet is low GI foods. Nutrisystems have caught on to what low GI foods can do and that's why they base their meal plan off the low GI foods list. A lot of people that's not a diabetic are put on a diabetic diet. I have an aunt that's not a diabetic and her doctor has put her on a diabetic diet.

Diabetics should eat 45 grams of carbohydrates per meal and 15 grams of carbohydrates per snack. When a diabetic eats 55 plus GI foods, they will run into problems.

I suggest that diabetics that's not eating low GI foods to start eating low GI foods. Also, eat 45 grams of carbohydrates per meal and 15 grams per snack. You will notice a difference.

tigersword

No. GI is meaningless. Diabetes means an inability to process carbohydrates correctly. The human body doesn't care what arbitrary GI number a doctor gives a food. It still can't process the carbs properly. There's a reason most modern research seems to be completely discrediting the entire GI concept.

Diabetics can't just eat all the low GI foods they want, that's ridiculous. They need to limit carbs as much as possible.

Plus recommending a diabetic eat 180 grams of carbs a day is ridiculous. I eat that many carbs a day, and I don't have to restrict carbs.

alwardt

I'm pre diabetic and I'm fortunate to have a physician that recommends a low carb approach to controlling blood sugar. Carb tolerance varies widely among individuals. My approach has been to set 1 hour and 2 hour post meal blood sugar goals and then eat to the meter by reducing and balancing the carb load. Personally, I'm very carb sensitive. If I could get away with more, I would. However, I'm determined to avoid the meds as long as possible through dietary control. I've found Jenny Ruhl's "Blood Sugar 101" to be very helpful. She also has a very informative website http://www.phlaunt.com/diabetes/.

heybales

No. GI is meaningless. Diabetes means an inability to process carbohydrates correctly. The human body doesn't care what arbitrary GI number a doctor gives a food. It still can't process the carbs properly. There's a reason most modern research seems to be completely discrediting the entire GI concept.

Diabetics can't just eat all the low GI foods they want, that's ridiculous. They need to limit carbs as much as possible.

It's also the order of the food eaten that is more important than GI has shown anything.

Start out your egg, sausage, half whole wheat bagel breakfast with bagel first, and you just lost the benefit of the fat slowing the food absorption in general, and of the glucagon release for the protein balancing the insulin release for the carbs.

Some people in those studies have shown their bodies deal better with low GI foods with slower insulin response. Some, minority. Is the same small percentage present in diabetics? Meaning the advice for low GI might benefit a minority well, is that really the way to go about things for the majority?

I agree, advice about a balanced vegetable low-carb diet would benefit them all, even those that could tolerate low GI stuff well.

Sad. Kind of like true problems with sodium is a minority, but lets scare everyone.

AnneGenevieveS

have to be VERY careful because being in ketosis isn't really safe for someone with diabetes. Your body is probably already in ketosis because it is insulin resistant. It depends on the degree of your diabetes as to whether its safe or not to try extreme low carb. You should NOT do low carb without asking your doctor first or if you are needing insulin.

Counting carbs is different than eliminating carbs or extreme low carb.

Ever heard of ketoacidosis? Its life threatening. look it up.

Plus without carbs most people don't have any energy to do the things they should like exercise which is what will truly improve their overall cardiovascular health and make their body produce and use insulin properly.

If you don't need insulin injections, you can try low carb, but you are still eating fats and not having energy to exercise. South Beach low carb is a healthier version. Losing weight (while eating or not eating carbs) and exercising is what will improve your health long term.

AZackery

Diabetics should keep ketone sticks on hand at all times. A lot of glucometer machines let a diabetic know when ketone are present. Ketone is present in a diabetic, when they aren't getting enough carbohydrates. The body will start breaking down fat and making ketone when this happens and your blood sugar will be high. If you see ketone display on your glucometer, call your doctor or the hospital hot line to have a nurse call you back to tell you what to do. While you are waiting for a call back, test your urine to see how much ketone is in your urine.

A low carb diet will help anyone lose scale weight, but what about fat loss? Scale weight loss and fat loss aren't the same thing.

A diabetic needs to know what's going on with their body. If you are on a low carb diet and you are dropping weight fast, you need to check into why this is happening.

brister2004

What foods give you for energy but also helps you loose more weight?

sassiebritches

:drinker:

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

HonkyTonks

Someone at work was recently diagnosed with Type II diabetes and they were advised by their doctor to do carb loading / low GI stuff.

funkycamper

:flowerforyou: Yup, best answer in this discussion.

:drinker:

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

rico1923

From my personal experience (I was undiagnosed for years as having trouble with my blood sugar levels) I gotta say, grouping all carbs together is like grouping all fat together. Once I cut back on simple carbs (white sugar/flour, etc.)many symptoms that I developed from diabetes went away. I have just gotten to the point in my diet adjustment where I can start eating whole grain polenta(corn meal) and whole oats again. I guess by most standards I am eating a high protein/low fat/low carb diet but the carbs I allow myself are mostly complex carbs and by no stretch do I feel pressure to count them. By eating as a grazer(4-5 smaller meals/ day) and having a target of 40g of fiber/day my personal symptoms- hunger/binge eating, fatigue after eating, vision reduction/flashes, mood swings, etc.- are now being controlled with minimal drug support.
I do not know how my version of type 2 diabetes compares to anyone else's nor do I pretend to be an expert but by limiting cholesterol and sodium to DV standards, getting the 40g or more of fiber daily and eliminating simple carbs (can't say I eliminated all white foods since jicama is my favorite cracker substitute) seem to be doing the trick until I get some weight off; at which point I will see if I can re-adjust again so I can have real pizza instead of using a hollowed out Portabella Mushroom as pizza crust.

margojr4

My personal diabetic life is different than others. Then again, no two diabetics are exactly the same. How each of us manages our diabetes to how our bodies metabolize nutrients, it can differ.

I have type two diabetes, the hypoglycemic side of it. My mother was type one (the disease took her life in 2003) Our endocrinologist never mentioned low carb living. We were taught to eat a balance of micros / macros and exercise regularly. What nutrients worked for us may not work for others and vice versa? I eat plenty of carbs a day, mainly from dairy fruit and vegetables. I do enjoy couscous, brown rice and yes pasta (Dreamsfeild brand low gi) all in moderations and all in balance with other foods.

I love carbs. I do steer clear of refined sugars, though. No more cookies and cakes for this girl lol

funkycamper

I'm surprised because I used to have severe hypoglycemic episodes as well and lowering my carb intake was the only thing that stopped the cycle for me. I can eat veggie carbs but I have to be very careful with potatoes, rice, pasta, whole-grain breads, etc. I eat these in very limited amounts, not every day, and do best if I only eat them just before or just after a good exercise session, i.e. long session of sustained cardio or a shorter session of either HIIT or weights. If I ate them the way you seem to be able to, I'd be crashing several times a day.

kashmirkat

Interesting... My MIL is type 2 and has not been told to necessarily eat a low fat diet but one that is well balanced with COMPLEX carbs, rather than simple carbs - pretty much the way we should all be eating anyway... I had no idea it was commonplace for type 2 diabetics to be put on low fat diets with no consideration of the carb intake... I get the simple/refined carbs, being that it may as well be sugar to your body...

gonzalezmona

I really hope not to ruffle any additional feathers towards a topic that obviously many are quite passionate about. Dare I venture to say that if one already knows that carbs can cause an increase in blood sugars & its probably best NOT to follow the doctor's orders than why follow them? I would merely suggest "LISTENING" as to what the doctors may advise, but since they are individuals you are paying, you have every right to seek advice else where to make a better more sound choice for yourself or your family members. Yes I speak from experience. My daughter, 9 at the time, was diagnosed with diabetes. Her sugars often hit so high that glucose meters could not read them. She spent many a night hospitalized as doctors tried to determine how they should approach her diabetes. I became quite famiilar with the diabetic world & had to become the actual pin cushion. (So not fun) Through diet & yes plenty of carb counting, I am happy to report that my daughter has hit her 3rd honeymoon phase of diabetes (medically uncommon). My point is that if you know carb counting is best & you have access to research etc, than use YOUR information/research & challenge the doctors. They work for YOU...fire them if you don't agree with their medical advise.

laurastrait21

Maybe I'm stating the obvious, but lo-carb can be very dangerous if not matched to exogenous insulin intake or exercise output (many diabetics may require up to one extra carbohydrate exchange per 30min exercise, which is important to take into account if they are trying to lose weight). It's really an individual thing and if people aren't getting information they feel comfortable with from their doctors, go to a certifified diabetes educator.