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.
