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.
Franziska Spritzler, RD, CDE