We have laws that help protect us from medical misinformation given out by people who aren’t licensed to practice medicine and who don’t actually examine us. When we rely on friends, relatives, or anyone who voices an opinion on the Internet, we risk our health and even our lives.
But no laws can protect us from medical misinformation that our doctors, nurses, and nutritionists can sometimes give us. We have to remember that medicine is still largely an art rather than a science. Medical knowledge, particularly knowledge of nutrition, is always growing. It hasn’t yet arrived at total truth. We also have to remember that our medical team works for us, which means that we don’t have to obey them.
Of course, I don’t know the total truth either. Nobody does. Besides, as we often say, “YMMV,” which stands for “your mileage may vary,” meaning that everyone’s body reacts a little different for anyone else. That’s why they call us individuals.
While I can’t dispense medical information, I can tell you a story. The moral of the story is to encourage you to learn as much as you can about your body and about diabetes. Fortunately, Big Brother, the authoritarian character in George Orwell’s novel, Nineteen Eighty-Four, can’t stop me from telling a story or stop you from learning and thinking and deciding for yourself how you want to live.
This story starts, as many stories that I tell nowadays, with an email message that someone who reads my posts here wrote. “I was recently diagnosed with an A1C of 6.3, and I've read several of the books you recommend,” Rachel began. “I am testing many times a day, and I am finding that my BG ranges between 77-163, with spikes rare but primarily after ‘healthy carbs’ like brown rice and steel-cut oats. I am exercising, have lost 14 pounds since my diagnosis a month ago, and have followed the diet my nutritionist gave me.”
That diet, Rachel wrote, has 210 grams of carbs per day. Not surprisingly, her blood glucose levels are all over the place.
“I am interested in a low carb diet,” Rachel writes. “But my nutritionist tells me that it will be really bad for my liver, and without enough glucose, my liver will start producing glucose, and I will put stress on that organ.
“She also says I will stress out my kidneys and gave me all kinds of scary info about that. Despite that, I really want to see some BG stabilization and it seems like low carb is the way to do that. I saw your article dated 2008 about eating low carb and the benefits you have experienced, and I wondered if it is still working for you.”
My reply told Rachel that I continue to follow a low-carb diet. It is indeed working very well for me both to manage my blood glucose level and my weight. I take no medicine for my diabetes or cholesterol or blood pressure. The only medicine I take is for hypothyroidism. I remain very healthy and active at age 76.
In a nutshell, I see her question as having two parts. “First you have to persuade yourself that a very low-carb diet is safe and healthy, no matter what your nutritionist believes,” I wrote her.
That means she can’t rely on anybody’s opinion. She simply has to become more familiar with the literature. It was the same for me as I wrote in the 2008 article that she mentioned. I had to study the book Good Calories, Bad Calories by Gary Taubes. I suggested that she read that as soon as she could.
Meanwhile, I told her that I would contact an expert on the liver question. The kidney question implies that her nutritionist doesn’t understand a very low-carb diet, thinking that it means a high protein diet. It isn’t. Too much protein may well be hard on the kidneys for people who already have kidney problems, but it is not relevant to a low-carb diet.
The expert who I contacted on Rachel’s behalf was Ron Rosedale, M.D. His were the brains behind my recent series of articles on coconut oil and other medium-chain triglycerides starting with “The Trouble with Saturated Fat.” Dr. Rosedale also wrote one of the best diet books I ever read, The Rosedale Diet.
“The paleo community has perpetuated a myth about ‘glucose deficiency’ when on a very low carbohydrate diet,” he replied. “I rebutted this and other very low carbohydrate myths recently in my blog. Anyway, in no shape, way, or form is a very low carbohydrate diet bad for the liver and certainly not from gluconeogenesis. In fact, a higher carbohydrate diet will, in fact, cause greater gluconeogenesis as the liver becomes resistant to insulin that normally would suppress this. Furthermore, eating a higher carbohydrate diet forces the burning of, and therefore dependence on, glucose. Therefore, when one doesn’t eat, such as when one is sleeping, the liver is forced into making lots of glucose to feed the ‘habit’ since we store relatively little, and that which we do store we reserve for anaerobic emergencies. Instead, when one gets habituated to burning fat, then that is what one will do even when one sleeps and does not eat.
“Lastly, Rachel needs a new and different nutritionist. She herself has seen the detriment of eating carbohydrates -- when one eats sugar it raises blood sugar. I believe that any nutritionist that does not understand that should not be a nutritionist. I congratulate her for taking control of her own health.”
When I wrote Rachel about Dr. Rosedale’s message, she sent her thanks to him and to me while expressing some concern about fat. I told her that I certainly can understand her fear of fat. After all, that’s simply mirroring what much of the American medical establishment has taught for half a century. Still, during that time we Americans have become much fatter and have much more diabetes. That is no coincidence.
You must have noticed that I turned to a medical doctor to rebut the medical misinformation Rachel got from her nutritionist. To me, Dr. Rosedale makes the most sense. But who should we believe?
No one. We must believe our bodies and what they tell us. When the diet that our nutritionists tell us to follow makes our blood glucose levels go up, that is valuable information. But when our diet keeps our levels low, that is the story that we need to obey.