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Breakthrough on the food-guide front

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The American Diabetic Association has broken ranks with the other health organizations and is promoting a low starchy carb diet for weight loss.

Finally, a chink in the armour, a crack in the wall, a miniscule hole in the dike! All the major disease associations collectively have been saying for years that we should be eating lots and lots and lots of grains - that grains are supposedly the most important part of a healthy diet. We have been following that advice for years, and heart disease rates have climbed, diabetes rates have climbed, many kinds of cancers have climbed. Well, I am happy to announce that finally one association has put two and two together, and has broken ranks from the comforting solidarity of the other medical associations. Kudos to the American Diabetes Association for changing its food recommendations for Type 2 diabetics that need to lose weight. They are actually suggesting that lowering starchy carb intake for one year may be helpful. A rather meager start, but at least it’s something. Hopefully the American Medical Association, The Heart and Stroke Foundation, the American Heart Association, the US Food and Drug Admin, Health Canada etc. will see the light soon too.

I think it takes a lot of courage to put out recommendations that go against the flow so I can understand why they may not have wanted to push the envelope further. But low carb for one year only??? In the context of diabetes, lowering starchy carbs should not be hyped only for weight control, but rather for lowering blood sugar, which is the bottom-line source of the problem in diabetes. Losing weight is the nice side benefit. One gets the feeling the ADA simply doesn't get it. The low-starch concept should be recommended for all diabetics, Type 1 or Type 2 (and all the rest of us too!) in order to control blood sugar. Eating a diet high in starchy carbs leads to high blood sugar levels, so more insulin is needed to transport the sugar into the cells. No matter how the insulin gets into the blood stream, whether it is injected, or whether the body produces it, whether diabetic or not, high insulin levels damage arteries. High insulin levels also lead to insulin resistance, so both sugar and insulin remain in the blood. High blood sugar levels are also very damaging to arteries as the sugar tends to glycate (caramelize). Damaged arteries need to be repaired, so cholesterol is dispatched to the area to plug the pits and tears, and so cardiovascular disease begins.

So, by reducing one’s consumption of sugar and starchy carbohydrates like bread, pasta, potatoes, corn, white rice etc., one reduces one’s need for insulin, which in turn leads to happier arteries and reduced insulin resistance. This is the way to AVOID getting Type 2 diabetes in the first place, and to reduce one’s risk of getting cardiovascular disease as well.

Type 1 Diabetics used to be taught (I’m not sure what they are taught today) that they should eat some starch at every meal so that the injected insulin has some sugar to bring down. I simply don’t understand that. Why eat sugar to match the injected insulin? Why not reduce the insulin injected to match a lower sugar intake? It seems to me that keeping insulin levels low is health promoting. I am not a Type 1 Diabetic, so I have not had to live with the daily job of pin-prick glucose metering, and trying balance eating with insulin injections. Maybe if I lived that life I would change my tune. But to me it makes sense to eat lots of above-ground veggies and sea vegetables that don’t turn into sugar in the body quickly, perhaps some legumes in moderation as they have more protein than grains do, and
pasture fed meats, full-fat dairy, free-range poultry, and wild seafood. Contrary to Type 2 diabetics who are frequently overweight, losing too much weight may be a concern for Type 1 diabetics who tend not to be overweight, so they may not want to lower starch consumption. The counter to that would be to replace the starch with larger amounts of the other foods in the macronutrient ratio recommended by one's metabolic type. I would think that a diet that naturally keeps keeps blood sugar stable would require less insulin to be injected, which would not only improve health, but also the pocketbook.

Related posts
Blood-sugar regulation
Insulin, our storage hormone
Type 1 diabetes - a new discovery
Another “healthy heart guide” that got it wrong


American Diabetes Association Nutrition Recommendations and Diet Interventions for Diabetes: A Position Statement Diabetes Care, Vol. 31, Supp. 1, Jan. 2008.

David Mendosa ADA endorses low-carb for weight loss My Diabetes Central.Com, Dec. 27, 2007.

Washington Post.com Diabetes Group Backs Low-Carb Diets Friday, December 28, 2007.

Amy Tenderich The ADA and The Great Carb Debate Jan. 2008.

Thomas DE et al. Low glycaemic index or low glycaemic load diets for overweight and obesity. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD005105.

Nansel TR et al. Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens. Diabetes Care. 2008 Jan 17 [Epub ahead of print]

Riccardi G et al. Role of glycemic index and glycemic load in the healthy state, in prediabetes, and in diabetes. Am J Clin Nutr. 2008 Jan;87(1):269S-74S.

Wolever TM et al. The Canadian Trial of Carbohydrates in Diabetes (CCD), a 1-y controlled trial of low-glycemic-index dietary carbohydrate in type 2 diabetes: no effect on glycated hemoglobin but reduction in C-reactive protein. Am J Clin Nutr. 2008 Jan;87(1):114-25.

Ma Y et al. A randomized clinical trial comparing low-glycemic index versus ADA dietary education among individuals with type 2 diabetes. Nutrition. 2008 Jan;24(1):45-56.

Hermansen ML et al. Can the Glycemic Index (GI) be used as a tool in the prevention and management of Type 2 diabetes? Rev Diabet Stud. 2006 Summer;3(2):61-71. Epub 2006 Aug 10.

Maria Kalergis, MSC, RD1,2 et al. Impact of Bedtime Snack Composition on Prevention of Nocturnal Hypoglycemia in Adults With Type 1 Diabetes Undergoing Intensive Insulin Management Using Lispro Insulin Before Meals: A randomized, placebo-controlled,
crossover trial
Diabetes Care 26:9-15, 2003

Copyright 2008 Vreni Gurd

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