![]() While most of my recent posts have focused on the problems with studies, recommendations, and guidelines, I'm happy to say that there has been some very good news on the low-carb front over the past few weeks. The American Diabetes Association's position paper on nutrition recommendations for people with diabetes When I initially read this document, I was disappointed by the statement, “Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.” It was hard to reconcile that first sentence with my knowledge of carb restriction's dramatic effect on blood glucose response. However, upon further reflection, I now view the statements made in this paper as being far more permissive of low carb than in the past. The ADA no longer says that a minimum of 130 grams of carbohydrate daily are required to meet the brain’s energy demands; in fact, they seem to accept the possibility of even very-low-carbohydrate intake, as evidenced by the sentence, “Some published studies comparing lower levels of carbohydrate intake (ranging from 21 grams daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes.” So while the ADA also approves vegan, Mediterranean, and low-fat diets for diabetes management, carbohydrate restriction is now considered just as valid an option, which is very encouraging for the doctors, dietitians, and other healthcare providers who take this approach. Positive portrayal of saturated fat in the British Medical Journal Although not about carb restriction per se, in this article Dr. Asseem Malhotra explains that the blame for obesity, heart disease, and other health problems has been unfairly placed on saturated fat rather than excessive carbohydrate -- particularly sugar -- intake. Unfortunately, it looks like the full text is no longer available free of charge, so I hope you were able to read it in its entirety last week. It may be available again at some point. If anyone has a link to the full text elsewhere, feel free to leave it in the Comments section. Diet article in The Consultant A recent article by John Whyte, MD, in The Consultant comparing various diets is encouraging on several fronts. First, the author correctly describes the Atkins diet as low in carbohydrates and high in fat rather than high in protein. The many benefits of low-carbohydrate diets are discussed, including dramatic weight loss, particularly in the initial phases, improvements in lipid profiles and blood glucose levels, and lower blood pressure. On the downside, low-carb diets are characterized as “fad diets,” and a study linking lower carbohydrate intake to greater all-cause mortality is cited (Of course, that study was observational, the reported carbohydrate intake was fairly high at more than 30% of calories, and there were several limitations of the study, including the use of food frequency questionnaires to assess intake and misinterpretation of data regarding fat intake from animal vs. plant sources). However, the last sentence of the low-carb section sums up Dr. Whyte's overall feelings nicely: “With these findings, in addition to the benefits of low-carbohydrate diets (not high protein, high fat content) on markers of cardiovascular risk, it is evident that low-carbohydrate diets could be considered in the lifestyle modifications of patients with diabetes.” SUCCEED study comparing VLCKD vs. low fat diet in people with Type 2 diabetes Researchers at the Osher Center for Integrative Medicine at the University of California San Francisco are recruiting people across the nation for the SUCCEED study, which will examine the effects of a very-low-carbohydrate ketogenic diet vs. a low-fat, conventional ADA diet on overweight people with Type 2 diabetes. Participants will take classes, have blood pressure checked and labs drawn to measure changes in biomarkers, and receive ongoing support and compensation over an eight-month period of time. You can contact the researchers if you're interested and meet the criteria; however, be prepared for the possibility that you end up being randomized to the low fat rather than low carb group. I've heard that there will also be further studies investigating the effects of ketogenic diets on cardiovascular disease, cancer, and neurological diseases like Parkinson's and ALS based on favorable early research. All in all, I’m feeling optimistic about carbohydrate restriction becoming more accepted by doctors and other healthcare providers, governmental organizations, and society in general. However, there's still a lot of work to be done, not the least of which is changing the perception of low carb as a “fad” diet. As we well know, carbohydrate restriction is a way of life that offers long-term blood sugar and weight management via appetite regulation and hormonal control. Nothing faddish about that.
13 Comments
10/31/2013 10:34:27 pm
My initial impression of the new ADA guidelines on diet was similar to your initial impression. Guess I need to scan them again. Or the ADA's paper was poorly written.
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10/31/2013 11:49:59 pm
Oh, there are several things I don't like about the new ADA dietary guidelines as well. They're still very anti-saturated fat, for one thing. But the fact that they're now endorsing carb restriction as an option without a limit on time (as opposed to their previous statement that LC can be used for up to two years) or amount (as low as 21 grams per day) is a really big move for them. I feel I'm in a much better position to start my private practice using a VLC approach now that the ADA has given their approval.
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Paul
11/1/2013 12:26:16 am
There's much more ground to break still but it's a very positive step in the right direction from the ADA.
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I think the ADA Position Paper is a break-through document, a watershed. They've 'made the turn,' although not with dietary fats. But this Postion Paper was prepared by the RDs and CDEs, not the Medical doctors in the ADA. I address this in my column #155 published last Saturday, and follow up with 2 more columns last Wednesday and tomorrow morning. Take a look, if you have time.
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11/1/2013 02:10:11 pm
Thanks so much for your comments and for alerting me to your blog posts, Dan. I'm going to try to read all three this weekend.
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Tim
11/1/2013 10:34:30 pm
Loved your analysis of the implications of this paper in your blog Dan, highly recommended!
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Tim
11/1/2013 10:28:50 pm
In the past the ADA started with diet and then adjusted blood sugar goals to match the results of eating higher amounts of carbs. The result was goals that led to complications.
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11/2/2013 06:52:28 am
Thanks so much for your excellent comments and insight, Tim. I'm very encouraged by the ADA's acceptance of LC and excited about where this will lead. And of course I greatly appreciate your continued support/
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11/2/2013 06:54:33 am
Thanks as always for your comments, Jan! Salmon with cream sauce is one of the best food combos around, in my opinion :)
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Terry O'Rourke
11/2/2013 06:50:28 am
Thank-you for bringing this ADA position paper to my attention. I believe your second thoughts on the ADA's take on low-carb eating as a viable alternative for diabetics as closer to the truth. Large organizations also contain human characteristics; they are, after all, made up of people.
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11/2/2013 07:54:54 am
It's great to hear from you, Terry. Thank you very much for sharing your thoughts and providing further insight on this topic.
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Franziska Spritzler, RD, CDE Categories
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