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Treating Insulin Not Weightloss in Low Carbohydrates Diabetes Diet & Nutrition

David Mendosa Health Guide December 29, 2007
  • Low-carb advocates are already jumping all over the American Diabetes Association for the new "Nutrition Recommendations" that the organization published yesterday. That policy statement, published in a supplement to the January 2008 issue of Diabetes Care, provides only limited endorsement of a low-carb diet. It's good only for weight loss and only effective for up to a year, they maintain.

    The full-text of the statement is not yet free online. But Dr. Bill Quick, my friend and colleague here at Health Central, subscribes to Diabetes Care and sent me an electronic copy.

    "I am underwhelmed," writes Dr. Mary Vernon. "I am most saddened by the lack of understanding. Carbohydrate restriction and the resulting control of insulin secretion is much more than weight loss. It's not the weight -- it's the metabolic state your body is in that generates disease or well-being."


    "it makes you wonder how much longer they will drag their feet before realizing low-carb is about so much more than simple weight loss," comments Jimmy Moore.

    "The ADA hasn't changed their position nearly enough; they need to acknowledge that a lower carb intake is the normal way humans should eat," adds Anna.

    But the ADA's position statement is a lot more than it seems on the surface. It's a huge breakthrough, because for the first time the leading American diabetes organization broke ranks with the other major health groups like the American Medical Association, the American Heart Association, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture to give any support to low-carb diets.

    It's even much more than that. Let's consider what it means in practice to limit a low-carb diet to weight loss alone.

    More than 85 percent of American adults with diabetes are overweight or obese, says the U.S. Centers for Disease Control and Prevention. We are overweight when we have a Body Mass Index (BMI) of 25 or more. I've pointed out the 85 percent statistic several previous articles here, most recently in "Nutrition Scales."

    But that's just the tip of the weightberg. I wouldn't be a bit surprised if 99 percent of those of us who have diabetes and a normal BMI are also trying to lose weight. I know that I still want to lose a few pounds even after bringing my BMI down to 20.9 as of this morning with Byetta and a low-carb diet.

    Most of the group of people who weigh in as "normal" still have good reasons to bring their BMI below 25. Harvard's Nurses' Health Study showed us five years ago that a BMI of 23 or below is even healthier.

    More recently, a study by the World Cancer Research Fund and the American Institute for Cancer Research, recommends that all of us need to "be as lean as possible within the normal range of body weight" in order to minimize our risk of cancer. We have long known that being overweight leads to heart attacks and strokes, the major cause of death in this country, especially for people with diabetes. But until this report came out this year few of us were aware that taking off extra pounds is also the best way to dodge the number 2 killer, cancer.


  • But what about the ADA's limitation of a low-carb diet to just a year? "The optimal macronutrient distribution of weight loss diets has not been established," the position statement maintains. "Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets."

    "The low-carb and low-fat diets were not really the same at one year," points out Richard Feinman, a professor of biochemistry and medical researcher who studies nutrition and metabolism at SUNY Downstate Medical Center. "Look at Figure 1 in my paper with Jeff Volek. There is a drastic difference in HDL and triglycerides that show much greater improvement in the low-carb diet compared to the low-fat diet. Also, to prove that they were actually the same for weight loss at one year, the authors of the two studies [cited in the nutrition recommendations] had to use the remarkable statistical technique known as intention-to-treat, where you include the people who dropped out of the study in the data."

     

    Finally, the ADA's new position statement on nutrition says that "for patients on low-carbohydrate diets, monitor lipid proļ¬les (which includes cholesterol and triglycerides), renal function, and protein intake (in those with nephropathy) and adjust hypoglycemic therapy as needed." Of course, all of us with diabetes need to carefully monitor our lipid profiles and renal function no matter what our diet is.

     

    The position statement also implies that a low-carb diet is equivalent to a high-protein diet. Not true. For most of us it is a high-fat diet. Besides, we don't have any evidence that a high level of protein is a problem for anyone with who doesn't have kidney disease.

     

    Rather than regretting the ADA's apparently limited support of low-carb eating, we have reason to rejoice today. In its new nutrition recommendation the ADA has finally budged from its single-minded devotion to high-carb diets. It intends these recommendations to help physicians guide their patients in diabetes prevention and management. The diabetes world is different today.