A couple of days ago I received the August issue of Today's Dietitian and was excited to see "The Top 10 Diabetes Meal Patterns" on the cover. My excitement faded, however, when I realized that the list was the same one published by US News & World Report in January, which ranked the Atkins and Paleo diets 25 and 31, respectively. Still, I held out a glimmer of hope that something about the benefits of carbohydrate restriction for diabetes would be mentioned in this article. Unfortunately, that wasn't the case.
The author of the Today's Dietitian article reviewed the diets that made the Top 10 and included commentary by dietitians with expertise in diabetes management. With the exception of Dr. Andrew Weil's Anti-Inflammatory Diet and the Mediterranean Diet, all of the plans are low to very low in fat, and none are low in carbohydrates. The dietitians discussing the diets in the article seem to think that calories are more important than carbohydrates because "people with diabetes and prediabetes typically require weight loss." Perhaps that's why a Academy of Nutrition and Dietetics spokesperson gave high marks to the No.1 ranked Biggest Loser diet, which limits calories to 1200 per day and encourages vigorous exercise. I have several issues with the Biggest Loser approach to weight loss that will have to wait for another day, but for now I'll say that almost everyone with diabetes will get hungry eating a low-fat, high-carbohydrate diet that contains 1200 calories (I certainly would), so they're unlikely to stick to it for any length of time. In addition, not all people with diabetes or prediabetes require weight loss, and many will struggle to achieve adequate glycemic control eating 50+ grams of carbohydrate at every meal. And although it appears that the diets are being discussed in terms of their effectiveness for type 2 diabetes rather than type 1, this should have been clarified.
Several of the plans are plant-based: Engine 2, Flexitarian, Ornish, and Vegetarian. There is some positive research on plant-based diets for diabetes management, so I understand the inclusion of these diets here. If people with diabetes want to follow some form of vegan or vegetarian diet, that's certainly their right. But others will find it difficult to adhere to the diet. There are many studies supporting carbohydrate-restriction for diabetes as well, and it deserves a mention somewhere in the Today's Dietitian article. Perhaps after the following quote:
"Every year since 2010, US News & World Report has ranked the year’s most popular diets. Using a panel of experts, including RDs and physicians specializing in diabetes, heart health, and weight loss, diets are ranked in eight categories, such as diabetes and heart disease prevention and control, as well as easiness to follow and likelihood of weight loss. According to the 2013 ADA nutrition recommendations, there are several meal patterns that have shown good results in people with diabetes."
Or even better, after this one:
"The 2013 ADA nutrition recommendations show that the quantity and type of carbohydrate in food impacts blood glucose levels, and the total amount of carbohydrate eaten is the primary predictor of glycemic response."
I realize that acceptance of low-carbohydrate diets is difficult for many dietitians, but a it is listed in that ADA paper (page 6) as an option. I've written a few journal and magazine articles about the benefits of carbohydrate restriction for diabetes (listed on my About Me page), and last August Today's Dietitian published an excellent article on this subject authored by my friend and fellow dietitian Aglaee Jacob. We're not advocating anything extreme; we both believe in a whole-foods-based approach with a flexible range of carbohydrate intake based on personal tolerance, preferences, and goals. I'm going to be speaking about carb restriction for diabetes at the Low Carb Down Under conference in Melbourne later this month, and it's going to be great to meet another low-carb dietitian who's presenting at the event, Dr. Caryn Zinn from New Zealand, along with the other speakers. I'm also very encouraged by the number of dietitians I've been in contact with over the past couple of years who support a low-carbohydrate lifestyle for people with diabetes or are at least open to the idea.
The American Diabetes Association has taken a big step in the right direction by recognizing carb restriction as an option for the millions of people who struggle with this often devastating disease, and I'm hopeful that more dietitians will come around to realizing how effective and sustainable this way of eating can be before it's time to rank diets for US News & World Report's 2015 list.
Franziska Spritzler, RD, CDE