![]() 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.
14 Comments
Judi
10/3/2013 07:39:44 am
Just when you think progress is being made there is this nonsense. Newly diagnosed people just have no hope! Your work in this area is so valuable and very much appreciated. Thanks!
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10/3/2013 07:48:11 am
Thanks so much for your comments and support, Judi!
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Ann
10/3/2013 08:10:06 am
I wish that someone would do a careful analysis of the connections between the EASD, the American Diabetes Association, the Canadian Diabetes Association and the manufacturers of drugs and processed foods. The levels of dietary carbohydrate and fat recommended by the diabetes organizations guarantee that the overwhelming majority of people with diabetes will struggle with increased blood glucose levels and a significantly higher risk of serious complications than those who follow a low-carbohydrate diet and manage to keep their blood glucose levels in the 5% range or lower. Many diabetics who follow these organizations' dietary guidelines will be blamed for their high blood glucose levels because they will be presumed not to be complying with dietary recommendations. Everyone who eats as much carbohydrate and as little fat as these guidelines recommend will also need to take medications with well-documented serious side-effects to lower their blood glucose and, even then, will be unlikely to achieve "normal" blood glucose levels. Their risk of serious complications will remain dangerously high. This is all great for the pharmaceutical industry and for any company that sells cereals, breads, legumes and other supposedly "healthy" carbohydrate products. It's not good for diabetics, however. Also, notice that there are no people with any type of diabetes on these organizations' Boards of Directors!
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10/3/2013 08:24:20 am
Thank you very much for your insightful comments, Ann. I'm in 100% agreement with all of them, of course.
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Gerri
10/3/2013 02:03:50 pm
Arrrgh, here we go again. Can't believe transfats are included. What decade are these organizations living in? I'd like to see their references for transfats. So very discouraging that guidelines continue to put health at risk. Any info on who funded this project? Hoping we'll be freed one day from low fat, grain based, high carb authoritative recommendations.
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10/3/2013 09:43:59 pm
Thanks so much for your comments, Gerri. These recommendations don't make any sense to me either. And as Ann pointed out, people with diabetes aren't on the board of directors of the organizations that publish these guidelines, nor are successful PWDs consulted about what type of diet they follow.
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PhilT
10/3/2013 05:56:39 pm
Cardiologists should not be allowed within a country mile of dietary advice to the public. They should stick to their discipline and work with dietitians etc to formulate appropriate dietary recommendations which should then be owned and promoted by the latter.
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10/3/2013 09:46:30 pm
I'm not religious, but I have to say "Amen" to that, Phil! Thanks for your comments and support.
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Anna
10/3/2013 11:21:05 pm
Hi Franziska, I really enjoyed your online Q&A session and just wanted to remark on how uncannily similar our experiences seem to be. I am also mid-40s, normal FBS, problem with post-prandial BS into the 200s, now eating LC, Paleo-like + dairy (~50g carb) and rarely a BS over 120. I owe it all to resources like yours, Jenny Ruhl and Dr. Bernstein. Thanks for sharing all of your helpful information.
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10/4/2013 12:09:16 am
Hi Anna,
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10/4/2013 02:51:20 am
Hi Franziska
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10/4/2013 04:47:44 am
Hi Eddie,
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10/9/2013 02:55:53 pm
I saw that European document and immediately objected to the allegation that no studies support carbohydrate restriction in diabetes. A couple years ago, I put together this list of supportive scientific articles:
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10/9/2013 10:24:22 pm
Thanks so much, Steve! I remember this impressive list from one of your blog posts. I believe there are several more now, including a few looking at Type 1 diabetes.
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