I'm very happy to share the article I recently wrote for Diabetes Self-Management magazine. Like many dietitians and CDEs, I read this publication regularly and think it's a great source of information for people with diabetes. However, I often don't agree with the nutrition articles written by the RDs, as they generally recommend using MyPlate as a foundation for meal planning. I contacted the editor to ask about writing a piece on carbohydrate restriction as an alternative to MyPlate, and somewhat to my surprise, she invited me to write this article. Even better, she made only a few minor changes prior to publishing it, so it's very similar to what I submitted. One thing that wasn't included, though, was a sidebar I created that had a list of resources for people with diabetes, including websites like Blood Sugar 101 and The Low Carb Diabetic and books like The Art and Science of Low Carbohydrate Living and The Rosedale Diet. I think this was likely due to lack of space. But overall, I'm pleased with the way the article turned out, and I hope that many people with diabetes -- as well as dietitians, nurses, CDEs, and doctors -- get a chance to read it and discover that a low-carbohydrate diet can be very safe, effective, and sustainable.
(The document below contains the cover of the March/April issue and my article. If you're interested in the other articles listed on the cover, you'll have to order the magazine from the publisher).
Copyright (c) 2014 Madavor Media
I love eating the types of natural whole foods my grandparents grew up on: a wide variety of meat and seafood, eggs, cheese, yogurt, fresh vegetables, nuts, and berries. Overall, I consider myself whole-foods based and concerned about food quality. However, for me, avoiding processed food is secondary to keeping carb intake very low, protein and fiber moderate, and fat fairly high, as this controls my blood sugar and makes weight maintenance easier as I age. As I mentioned in a previous post a few months back, I don't really identify as Paleo, Primal, or Ancestral. Carbohydrate restriction has had such a positive impact on my own life and that of countless others. I know many of you follow a Paleo/Primal way of eating, and in many respects I do as well. A typical food day for me is quite whole-foods based, as you can see from my intake yesterday:
Eggs and kale cooked in coconut oil
Berries with ricotta cheese
Coffee with cream
Arugula with Greek yogurt, avocado, olive oil, and sea salt
Hot cocoa tea
Salad made with diced turkey, cucumbers, tomatoes, olive oil, and vinegar
Square of unsweetened chocolate
Hot cocoa tea
But there are some decidedly non-Paleo items in my diet and lifestyle as well. Here are my food "confessions," although I don't really like using that term here because it implies I've done something wrong. If any of you can think of a better word, let me know, and I'll change it.
I use saccharin every day.
I mentioned using erythritol when I bake in the post referenced above, and explained that baking is a rare occurrence for me. I do have a cup of coffee and a few cups of sugar-free cocoa tea every day, though, and I use saccharin to sweeten them. But instead of Sweet 'n Low, which contains dextrose (sugar), I use Nectasweet, pure saccharin tablets with no carbohydrates. Saccharin has been around for over 100 years -- it was the original sweetener used by people with diabetes prior to the discovery of insulin -- and there is no evidence whatsoever that it increases cancer risk in humans. Each Nectasweet tablet provides the equivalent sweetening power of 1 teaspoon of sugar, at a cost of only a penny per serving. Yes, stevia comes from a plant and is therefore "natural," but we know less about its long-term safety than we do about saccharin, and it's much more expensive.
Here's my delicious and easy "Hot cocoa tea" recipe:
Pour boiling water over tea bag of choice (I like Rooibos red or vanilla) and let steep 2-3 minutes. Add 1 tsp unsweetened cocoa powder, 1 Nectasweet tablet, and 1 tablespoon heavy cream or half-and-half. Stir and enjoy.
I make my husband low-carb Cheez-its from processed cheese.
I have Laura Westman, Dr. Eric Westman's daughter, to thank for this one. I was telling her that one of my clients had asked about a substitute for crackers. "Have you heard about low-carb Cheez-its?" she asked. "You make them from American cheese, they're super easy, and they taste like the real thing!" Googling "Low-carb Cheez-its" led me to this recipe for Crispy Cheese Crackers. I've never been much of a Cheez-it fan, but I made a batch for my husband. He said they were very good, "pretty close" to the original, and I could make them again sometime, which I've done. That's high praise coming from my extremely finicky (but otherwise wonderful) husband. Yes, American cheese is technically a processed food, but it's not much different from regular cheese in terms of ingredients, and apparently none of them are controversial from a health perspective.
I like Shirataki noodles better than zucchini noodles.
I love zucchini. One of my favorite ways to prepare it is sautéed with mushrooms and onions topped with spicy beef chili. But while some people enjoy substituting zucchini and other vegetables for pasta -- by julienning them manually or using a "Zoodler" or other device intended for this purpose -- I'm not wild about the results. Although I rarely crave pasta the way I imagine some people on low-carb diets do, occasionally I enjoy making low-carb noodle entrees like Thai Chicken and Noodles and Beef Stroganoff. In my opinion, Miracle Noodles are ideal for these dishes and many others. Shirataki (also called glucomannan) comes from the konjac plant, which is native to Japan. It's essentially all fiber and contributes less than 5 calories and 1 carb per serving, yet provides a lot of volume. There's some evidence it may promote weight loss and reduce high cholesterol levels. Maybe it would actually be Paleo approved because it's not really processed other than being ground up and formed into strands before being packed in liquid. At any rate, I enjoy eating these sometimes.
Tip: Rinse Miracle Noodles really well and pan-fry them without oil or other liquid in order to remove as much water as possible. The less water that remains, the better the texture will be.
I use mayo on beef patties.
Conventional mayonnaise is made with soybean oil and a little bit of sugar, although the amount of carbs in a tablespoon is less than zero. Yes, this is the type of oil that's made from GMO soybeans and is high in omega-6 polyunsaturated fatty acids (PUFAs). I'm not saying it's healthy and I don't eat it that often, but if I'm getting a protein-style burger and there's no guacamole around (which is usually the case), I'll top it with mayonnaise without a second thought.
Sometimes I eat nuts roasted in peanut oil, cottonseed oil, etc.
Peanut and seed oils are high in omega-6 PUFAs as well. I usually have raw almonds, macadamias, hazelnuts, and pecans on hand at home. But my husband likes the roasted type, and let's face it: They do taste better. So sometimes I'll grab a few from his stash and eat them instead of the raw nuts. I eat a lot of sardines and salmon -- usually about four fish meals per week -- so I'm definitely getting plenty of omega-3s for balance.
I'm not a fan of Cross-Fit.
In all honesty, I'm about as far from a Cross-Fitter as you can get. I realize not everyone who follows a Paleo diet does Cross-Fit, but enough do to mention it here. I prefer walking and doing Ellen Barrett's Pilates, yoga, and light resistance routines to stay fit and energized. From my understanding of what Cross-Fit entails and online reports of people (particularly women) developing problems when combining it with carbohydrate restriction, it appears that the two aren't compatible.
I reheat food and beverages in the microwave.
I've read articles online cautioning people about the dangers of microwaving food, and at least a few have been from members of the Ancestral community. I need to see convincing evidence for the assertion that microwaving alters food in a different way than occurs in other cooking methods. This article is one of several that explains why microwaving is safe for cooking and reheating foods and beverages when guidelines are followed (i.e., no metal, plastic tubs, etc.).
So now you see the way I truly eat and live. Particularly in the context of my balanced, very-low-carbohydrate diet, I really don't think any of these behaviors will do me any harm. In fact, I hope you can relate to a few of them.
Ketogenic diets (aka keto diets, nutritional ketosis or NK) are currently all the rage, and for good reason. As I wrote in a previous post a few weeks ago, very-low-carbohydrate, ketogenic diets (VLCKDs) are extremely effective for weight loss and diabetes, among other things. There's also emerging evidence suggesting they may be beneficial for certain cancers and neurological conditions like Parkinson's disease and ALS (also known as Lou Gehrig's disease). Having previously worked in a clinical setting with several patients who had the misfortune of contracting these diseases, I find it very encouraging that following a ketogenic might offer some improvement for them, as well as others in the same boat.
I follow a VLCKD and receive a lot of great feedback from others who have also experienced overwhelmingly positive results with this way of eating. I love hearing these success stories, so please keep them coming. However, one reader named Michelle had this to say in the comments section of my recent article:
"I don't do well on a very low carb diet; I have to have around 50-70 g's of carbs a day to feel well and function. I guess this is still low carb when compared to the standard diet, but find so much prejudice against me because people say 'If you just stuck to eating VLC you would eventually lose weight and feel better'. This just is not the case with me. I've adapted the LC diet for me and I feel great and I am losing weight steadily. Please folks, stop thinking that one size fits all, it does not!
Great site. Thank you for all your efforts."
I was disappointed to hear that this woman -- who is most definitely following a low-carb diet and having success doing so -- feels that others are judging her for not restricting carbs to ketogenic levels (generally defined as <50 grams/day, although some require <30 grams/day to enter and remain in ketosis). She clearly is losing weight and feeling well, so if I were her nutritionist, I'd recommend she keep going with what she's doing now. This is exactly what I do with my clients: find the level of carbohydrate intake that works best for them, whether or not that means NK. In my own case, I started restricting carbs for blood glucose management and ate around 100 grams total carbs (70-80 grams net carbs) for over a year before discovering that limiting carbs to <40 grams net carb was the only way I could achieve truly normal postprandial blood sugar.
While there's a lot of compelling research supporting ketogenic diets for weight loss and diabetes, there are also studies that have demonstrated benefits at carbohydrate intakes between 60-100 grams per day. In fact, many studies that initially provide <20 grams of carb daily gradually increase the amount over the course of the trial, based on individual tolerance. This was Dr. Atkins's approach as well, and many people have maintained large losses using the Atkins "Carb Ladder." In addition, it's very possible to be in ketosis yet not lose weight if calories are too high.
For diabetes control, I believe everyone can achieve good control using Dr. Bernstein's plan: very-low-carbohydrate intake consisting of 6 grams at breakfast and 12 grams at lunch and dinner. Many Type 1's and Type 2's have written to me about their success with Dr. Bernstein's approach, and I have a very good Type 1 friend who maintains fantastic control by following his plan to the letter. But some people may find this too restrictive and instead find success at higher -- although still fairly low -- carb intakes. Two long-term studies from Sweden found significant improvements in blood glucose control (including a substantial decrease in hypoglycemic episodes) when total carbohydrates were restricted to 70-90 grams per day.
As someone who lost 30 pounds and maintained that loss for over 25 years on around 150 grams of carbs a day (an estimate, as I never counted them), I know that being in ketosis isn't always necessary to induce weight loss. There are people with experiences similar to mine, many others who find that a VLCKD is the only way that works for them, and still others like Michelle and my husband who do best somewhere in between. We're all so unique in our responses to carbs, calories, protein, and food in general. In my own experience, I honestly never felt pressure from anyone to lower my carb intake when I was eating around 80 grams net per day, but perhaps things are a little different now given the popularity of NK. As passionate as I am about ketogenic diets and their potential benefits beyond weight loss, I really want people who follow any level of carb restriction to feel supported by the low-carb community. Remember n=1, YMMV, etc., so do what works best for you. And to all my readers -- from the zero carbers to the 100-plus-grams folks -- thanks for your continued support of my work.
1. Foster GD, et al. Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial. Ann Intern Med 2010 Aug 3;153(3):147-57
2. Boden G, et al. Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with Type 2 diabetes. Ann Intern Med. 2005 142:403-411
3. Nielsen JV, et al: A low carbohydrate diet in type 1 diabetes: clinical experience: a brief report. Upsala J Med Sci 2005 110:267–273, 2005
4. Nielsen JV, et al: Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: a clinical audit. Diabetol Metab Syndr 2012; 4:23
Hope you're all doing well and enjoying the holidays. Is Christmas really only a week away now? This month's kind of been a blur for me!
Holiday Eating, Low-Carb Style
I've read a few stories on other blogs about staying low carb over the holidays. To be honest, I don't find it too hard since I love LCHF foods more than anything and know what my blood sugar will do (and how awful I'll feel) if I indulge in holiday cookies, candy or pies. I realize that using sugar substitute is controversial and many are vehemently against it, but for people who want something sweet this time of year, it's definitely preferable to eating the real thing for anyone on a carb-restricted diet. The one holiday treat I could never resist were my own gingerbread cookies, which I stopped baking a few years ago when I started low-carbing. However, I'm thinking about making a low-carb version of gingerbread men Carolyn shared on her All Day I Dream About Food blog. At only 2 grams of net carb per serving, I'm very tempted! I'd love to hear reviews from anyone who's tried it.
I'm going through a range of emotions about leaving my position as an outpatient dietitian at the veterans hospital at the end of next week in order to go into private practice. Yes, I'm definitely excited about getting to educate and counsel people using a low-carb approach, but I'm truly going to miss my patients. I care about them very much, and although I wasn't free to make as "radical" dietary recommendations as I would have liked, I hope that my advice to cut back on carbs and replace margarine with butter will have at least a small positive impact on their health.
I've updated my website with information on the services I'll be offering as of January 2. I decided to offer a couple of low-carb classes in addition to one-on-one counseling. I may add other nutrition-related services as well at some point in the future if there's a demand. I've also updated the Links section with my favorite low-carb books and cookbooks, and I finally updated and reorganized the Research page that I don't think I've even looked at in over a year! That page is finally starting to look the way I envisioned it.
Low Carb Cruise
Looking ahead to the spring of 2014, I'll be speaking on the Low Carb Cruise in May. I'm thrilled to get to meet Dr. Eric Westman, Dr. Andreas Eenfeldt, Jackie Eberstein, Emily Maguire, Tom Naughton, all the other speakers, and of course Jimmy Moore. Sounds like a fantastic adventure with a balance of learning, socializing, and relaxing. If you like cruising, definitely consider it. I'd love to meet my long-time followers as well as my newer readers!
Best wishes for safe and happy holidays to you and your families, and thanks for your continued support.
First off, I hope all of you and your families had a wonderful Thanksgiving. Mine was really nice: delicious food and great conversation with family and dear friends.
I've been wanting to write a post like this for some time now. My intention is not to criticize other people's beliefs but rather to explain my own and why I hold them. Looking over a number of "Paleo Thanksgiving" menus prompted me to finally address my ambivalence about Paleo, Primal, Weston A. Price Foundation, and other "real food" ways of eating. I know that several people who read this blog identify with one or more of these ways of eating. Please keep in mind that I strongly favor a whole foods approach over a diet containing processed foods. I'm a proud member of Real Food Dietitians, and I recently became a Primal Docs featured member. However, I think carbohydrate restriction is ultimately more important for people trying to manage diabetes, prediabetes, obesity, metabolic syndrome, and PCOS.
Diabetes, Hyperinsulinemia, and Insulin Resistance
There's a lot of convincing research supporting very-low-carbohydrate diets for people with Type 2 diabetes, metabolic syndrome, and polycystic ovarian syndrome. I'm planning a blog post on insulin resistance and hyperinsulinemia in the near future, but suffice it to say that many, if not most, overweight people have impaired insulin sensitivity, resulting in elevated blood sugar and insulin levels that cause hunger, damage blood vessels and nerves throughout the body, and promote fat storage. Keeping carb intake very low (less than 50 grams per day) will have a beneficial effect on insulin resistance and hyperinsulinemia in virtually everyone, whereas a diet containing twice or three times as much carbohydrate may work for a portion of this population, but most will need to restrict carbohydrates further to lose weight and achieve healthy blood sugar and insulin ranges. In general, the works of Drs. Steve Phinney, Jeff Volek, Eric Westman, Richard Feinman, Michael Eades, Richard K. Bernstein, and other low-carbohydrate researchers are more exciting and convincing to me than authors who classify themselves as Paleo or Primal.
People with Type 1 diabetes or normal weight individuals with blood sugar issues (I'd place myself in the latter category) will also benefit from keeping carbohydrate levels very low. I followed a Primal, moderately low-carb (100 grams or so per day) diet for a while but continued to have postprandial blood sugars over 160 and sometimes as high as 200. Only when I began restricting carbohydrates to 15 or fewer grams per meal did my blood sugar response normalize, and it's remained this way for the past year and a half.
I realize dairy is controversial in the Paleo and Primal community due to its lactose content, insulin-stimulating properties, and potential for allergies, but I personally consume quite a bit of it without any problems. In fact, I have Greek yogurt, cheese, sour cream, and/or cream every day and maintain a healthy weight. While there are certainly people with legitimate reasons to avoid dairy (such as true allergies or hypercalcemia), I think many others will do okay with it. If you have other symptoms that clear up when you eliminate dairy, then obviously you shouldn't eat it.
I understand the WAPF's position on the benefits of raw milk, but I disagree that pasteurized, homogenized dairy products are inherently bad. My parents are from Switzerland and grew up on pasteurized milk products, as did their parents, and continued consuming them throughout their lives. They're now in their 70s, active, and in excellent health, and I know there are many others like them. While raw milk may contain more nutrients and allow for better absorption of fat-soluble vitamins, I think pasteurized milk provides benefits as well.
Here's where I may lose some of my readers (if I haven't lost you already). There was recently a very successful Gluten Summit, and two intelligent MDs, Drs. Davis and Perlmutter, have written books detailing the devastating effects gluten can have on susceptible individuals. But not everyone is gluten sensitive! I avoid grains because of their carb content and I don't really mind not eating them, but there are other low-carbers who consume low-carb bread, wraps, etc., without any problems. Dr. Steve Parker's Low Carbohydrate Mediterranean Diet allows grains for those who tolerate them. The Paleo Thanksgiving yam and sweet potato recipes I saw online contain a lot of carbohydrates. Eating a small amount would be fine, but many people tend to eat larger portions of foods they're told are healthy. I'm not saying that grains are good for you, but to be honest, I'd rather someone with diabetes eat a forkful of stuffing (about 3 grams of carb) than a cup of sweet potatoes (37 grams of carb if plain).
Another controversial area among Paleo/Primal/WAPF devotees is sweeteners. Honey or pure maple syrup is often recommended as an alternative to table sugar. However, these items contain more carbohydrate per serving than sugar does, so they're not a good choice for people with diabetes or insulin resistance. Green leaf stevia is recommended as an option for those who need to limit carbohydrates. But have you tasted stevia? It's got an interesting flavor (reminiscent of anise, in my opinion), but it really doesn't work well as a sweetener for all types of food. I rarely use any sweetener at all, but when I do bake occasionally, I use erythritol, a sugar alcohol that isn't absorbed by the body and tastes very similar to sugar. Some have argued that erythritol is a processed product made from corn, but I think people with issues related to glucose intolerance would be better off consuming it -- or even saccharin -- instead of "natural" sweeteners, including fruit juice. Again, it's best to avoid all types of sweeteners except in limited amounts. I do eat a square of 85-90% cacao dark chocolate a few times a week. It's sweetened with sugar but only has about 2 grams of net carb.
Pastured and/or Organic
As a former vegetarian for ethical reasons, I strongly support raising animals as naturally and humanely as possible. I would prefer to always eat pastured, organic, or naturally raised meat, dairy, and eggs, and most of the time I do, at least at home. But there are many people who can't afford to eat this way on a daily basis. I've written about this before, but I feel even more strongly now that people on limited budgets shouldn't be made to feel that they're jeopardizing their health if they can't buy organic food. I've seen individuals on low-carb forums say that they have to quit eating low carb because it's too expensive. But there are lots of ways to eat low carb without spending a lot of money (also Google "low carb on a budget"). Replacing higher-carb items with conventionally raised animals, eggs, and cheese can have a profound positive effect on blood glucose and insulin levels, as well as weight. And at the end of the day, that's the most important thing.
I hope I didn't offend any of the people I respect yet differ with on this issue, but I wanted to make clear where I stand. If folks with diabetes or weight issues can combine "real food" and low carbohydrate intake, this is ideal. But I'll always place carb restriction as the top priority for them because I truly believe it's the key to improving their health.
1. Volek JS, Feinman RD.Carbohydrate restriction improves features of the Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005 ;2:31
2. Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal. Nutr Metab (Lond) 2008; 5: 9
3. Westman EC, et al. Low Carbohydrate Nutrition and Metabolism. Am J Clin Nutr 2007; 86(2):276-284
4. Mavropolous JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond) 2005: 2:35
The latest guidelines on treatment of diabetes, prediabetes, and cardiovascular disease published by the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) are extremely comprehensive (48 pages) and contain over 500 references. Much of the discussion focuses on cardiovaascular risk factors and treatment, although a fair amount of time is spent on diabetes management itself. I'll confess that I didn't have time to read the entire document and certainly don't expect you to, but I did read the short section entitled "Prevention of cardiovasclar disease in patients with diabetes," paying particular attention to the "Diet" section. To say that I was disappointed with the recommendations would be an understatement.
A few quotes from the paper:
"Carbohydrates may range from 45-60% of total energy. Metabolic characteristics suggest thta the most appropriate intakes for individuals with DM are within this range. There is no justfication for the recommendation of very-low-carbohydrate diets in DM."
On the contrary, there are many studies (cited in previous blog posts, most recently this one), along with anecdotal evidence from thousands of people with diabetes, demonstrating that VLCKDs can dramatically improve glycemic control to the point that diabetes medication can be significantly reduced or even eliminated in the case of T2 diabetes.
"Total fat intake should not exceed 35% of energy. For those who are overweight, <30% may facilitate weight loss."
Restricting fat to these levels guarantees that the diet will be high in carbohydrate, which does not benefit people with diabetes regardless of their weight.
"Saturated and trans-fatty acids combined should be <10% of total daily energy intake. A lower intake of <8% may be beneficial if LDL-C is elevated."
Grouping saturated and trans fats together is extremely misguided. One is highly processed and has been shown to cause a number of health problems, while the other is a healthy, natural fat that people have been consuming for thousands of years.
"Vegetables, legumes, fruits, and whole-grain cereals should be part of the diet."
I agree with vegetables and certain fruits being appropriate for people with diabetes, but there is no reason to consume legumes or whole-grain cereals, as they don't contain any nutrients that can't be found in other foods.
Last week I did an interview on TuDiabetes about carbohydrate restriction for people with diabetes where I discussed these issues in more detail, among others, in response to questions from the audience. Feel free to give me any feedback, positive or negative, if you're able to watch. I apologize for sitting so close to the camera that my face pretty much takes up the whole screen and really looks pretty strange, but I'm new to this videotaped live interview thing.
Also, here's a link to my most recent Answers.com articles on a few low-carb breakfast ideas I discussed in the interview.
A recent study by Kaiser Permanente and Yale Medical Center found that severe hypoglycemia is quite common in people with Type 2 diabetes who take insulin-stimulating medications. This was true regardless of level of control, meaning those with elevated blood sugar and A1c levels experienced low blood sugar as well as those who were within or below their A1c goal. Severe hypoglycemia is defined as a blood glucose level less than 50 mg/dL and is associated with increased risk for heart attack, stroke, loss of consciousness, and death, particularly when it occurs during sleep. Its symptoms can be frightening and include sweating, shaking, dizziness, unsteadiness, and heart palpitations.
Although having tight control (A1c <6%) is considered dangerous by many diabetes specialists because it suggests frequent low blood glucose levels, it's evident that anyone taking medications which cause the pancreas to secrete insulin is at risk for hypoglycemia as well. (For the record, I think having a lower A1c is good, provided it's not due to frequent lows). According to Dr. Kasia Lipska, an endocrinologist at Yale Medical Center, "It's important to note that it's not the HbA1c that directly causes hypoglycemia; it's the therapies we use to lower it." Exactly.
Insulin-stimulating medications cause unpredictable blood glucose response in several ways. Typically prescribed to be taken twice a day at meals in fixed dosages, they are unable to make the pancreas produce the precise amount of insulin needed to cover the carbohydrate ingested at a meal, nor do they start working at exactly the right time to match the digestion of carbohydrate. In the poorly controlled overweight person with diabetes, taking this type of medication practically guarantees at least occasional episodes of low blood sugar leading to overtreating with juice, soda, or candy, resulting in hyperglycemia and weight gain. It also places a burden on the beta cells of the pancreas by causing them to secrete large amounts of insulin, thereby increasing progression of the disease. Precisely the problems diabetes management is supposed to avoid.
I feel that carbohydrate restriction should be offered as an alternative to taking these types of medications, and I outline the basis for why this way of eating is ideal for diabetes management in my recent Answers.com article. I have heard about or spoken with many people -- including Type 2 bloggers Dan Brown, Steve Cooksey, and Eddie Mitchell, as well as Dr. Jay Wortman -- who have been able to stop their insulin-stimulating diabetes meds and improve their blood glucose control by following a very-low-carbohydrate ketogenic diet (VLCKD). In most cases, those who adopt a VLCKD require only metformin, an insulin sensitizer that does not place a person at risk for hypoglycemic events.
The message given by many of my fellow dietitians and CDEs is, "You can eat the same foods everyone else does as long as you take your diabetes medication." I don't feel comfortable naming names, but the vast majority of articles by RDs and CDEs that I've read advise individuals with diabetes to eat low-fat, high-carb meals and snacks and take whatever meds are needed to keep blood glucose in check. I realize many people may not want to change their eating habits, and that is of course their choice. But I think they should be told about the risks of these medications, including the strong likelihood that they will periodically experience low blood sugar when taking them. Some will want to assume the risk, but others may be interested in an alternative way of eating that involves less medication and no risk of low blood sugar. Every patient I talk to who has ever experienced severe hypoglycemia would prefer to avoid it all costs.
I'm not saying that there isn't a need for diabetes medication in some people. People with Type 1 diabetes obviously require long-acting and mealtime insulin, although considerably less of the latter when on a carbohydrate-restricted diet (Hypoglycemia is also minimized with this approach). Those with Type 2 who adopt a VLCKD may only need metformin and possibly a long-acting insulin, depending on how much beta cell function they have remaining. Dr. William Yancy and Dr. Eric Westman have demonstrated that insulin and oral diabetes medications can be reduced and in some cases eliminated in people following a VLCKD, and that blood sugar control improves across the board with this method. Why not encourage and support those who are interested in trying it?
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I also want to let you know that I'm going to be participating in a live video interview with TuDiabetes on Thursday, September 26, at 1:00 pm Pacific time. I'm sure many of you won't be able to listen live -- I'm taking the day off of work for it --- but it will be available on their archives. Hope you can watch :)
1. Kaiser Permanente. Severe low blood sugar occurs often in patients with Type 2 diabetes. Science Daily. July 30, 2013.
I wanted to share my most recent Answers.com articles with all of my readers. Please take a moment to click on them, and if you have time to read them and give feedback, that would be even better!
Using Sugar Substitutes on a Low-Carb Diet: Pros and Cons
Thai Ginger Scallops with "Rice"
How Does Alcohol Fit Into a Low-Carb Diet?
Tips for Eating Low Carb on a Budget
As I mentioned previously, my contract with Answers.com states that I'm required to write 10 articles a month for the next year. So 15 articles down, 105 left to go :)
This is what I'd love to get from any of you (via Facebook, Twitter, blog post comments, or using my website Contact page):
If you're able to help me by providing any of the above, I'd greatly appreciate it! Thank you all again so much for continuing to share my website and message with others. I'm not a natural at self-promotion but recognize that it's necessary to some extent. Since I'll be going into private practice at the end of the year, I'm doing my best to figure out how to do it in a way I'll be comfortable with.
While doing research for one of my Answers.com articles, Defending Your Low-Carb Diet, I found an interesting article on WebMD. I know that much of the information found online is critical of carb restriction, but I was unprepared for the claims made on this website, which is extremely popular and considered a trusted source by many Americans.
First of all, the article discusses "high-protein, low-carbohydrate diets" and defines "high protein" as 30-50% of caloric intake. Aside from the Stillman diet and perhaps the diets of a few bodybuilders, I don't know of any other popular low-carb plans that recommend more than 30% of calories from protein. On a 2000-calorie diet, 30% is 150 grams of protein, and 50% is 250 grams. Most low-carb diets are moderate in protein, although some people may consume higher amounts. This article purports to talk about the risks vs. benefits of high-protein, low-carbohydrate diets, but the "benefits" are glossed over, and several of the statements seem to denigrate carb restriction in particular.
According to Web MD, high-protein, low-carb diets can cause many health problems:
In the summary, "Is Low Carb Right for Me?" the writer states that carb restriction is dangerous, particularly for those with heart disease, and that low-carb diets don't allow a high intake of fruits and vegetables. I strongly disagree. I believe this way of eating is beneficial for people with heart disease for the reasons listed above, as well as improvements in hyperinsulinemia, hyperglycemia, and hypertension. And there are plenty of plant foods allowed on a low-carb diet. I eat vegetables at every meal, a few servings of nuts a day, berries once a day, and avocado just about every day on my VLC diet. I probably get more vegetables than most people do, along with more fiber and antioxidants.
Although I guess I shouldn't be surprised, it concerns me that such a highly critical and inaccurate article was published on WebMD. Perhaps there are even worse articles written on medical sites considered reputable? In my opinion, using scare tactics to discourage people from adopting a carbohydrate-restricted diet is troubling, particularly since this way of eating has had such a positive impact on a significant number of people and has the potential to improve the lives of so many others.
* Although low-carbohydrate diets are safe and healthy for most people, it's important to speak with your doctor prior to adopting a low-carb diet or making other dietary changes.
1. Friedman AN, et al. Comparative effects of low-carbohydrate, high-protein vs. low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012 Jul;7(7):1103-11
2. Kritchevsky SB, et al. Serum cholesterol and cancer risk: an epidemiologic perspective. Annu Rev Nutr. 1992; 12:391-416.
3. Strohmaier S, et al. Total serum cholesterol and caner incidence in the metabolic syndrome and cancer project (ME-CAN).J Epidemiol Community Health 2011;
4. Barzel US, et al. Excessive dietary protein can adversely affect bone. J Nutr 128:1051-1053, 1988
5. Sampath A, et al. Kidney stones and the ketogenic diet: risk factors and prevention. J Child Neurol. 2007 April:22(4):375-378
6. Poplawski MM, et al. Reversal of nephropathy by a ketogenic diet. PLoS One 6:1–9, 2011
I published six more low-carb articles on the Answers.com site, so I've fulfilled my quota of 10 for August. (I didn't link to the Cinnamon Almonds one because there's already a blog post on that recipe available on this site). Please check out the others if you have time:
Saturated Fat Intake on a Low-Carb Diet
Five Terrific Low-Carb Recipe Websites
Beyond Atkins: Low-Carbohydrate Diet Books
Tips for Staying Low Carb When Dining Out
Best Dairy Choices for Low-Carb Diets
I should also make it clear that there are a lot of third-party articles on the site that I didn't write; only the ones with my name at the top are mine. However, I encourage you to read the others as well if it's convenient, and let me know what you think of them.
Mostly, though, I'd really appreciate hearing what topics you'd like me to write on! I enjoy writing, but these articles are a little different than my blog posts, where I just write about whatever moves me at the time. There are only a few formats to choose from (Do's and Don'ts, Briefing, Lists, etc.), and while I've got a few in the works for next month on diabetes, eating on a budget, and artificial sweeteners, I'd love it if you'd give me some more ideas. You can either use the "Contact" page on this site or the "Comments" section, write on my Facebook page, or send me a tweet. Thanks so much!
Franziska Spritzler, RD, CDE