Response to How Low (Carb) Should You Go?

Yesterday I learned of a recent blog post by  the Joslin Diabetes Center regarding my ADA Diabetes Spectrum article on the benefits of a whole-foods-based, low-carbohydrate diet for people with diabetes.  (It's still not accessible to the public, but it should be within the next couple of months). While I appreciated the few positive remarks, I was disappointed by the overall message that we need grains and starchy vegetables in order to have a balanced, nutritious diet that people can follow indefinitely. 

First of all, the recommendations I made were for a carbohydrate amount considerably higher than I currently follow or think is necessary for many people. While I don't have the time or inclination to go point by point over every statement made, there are a few things I'd like to address:

1. Grains and/or starchy vegetables are not necessary to ensure adequate micronutrient intake. 
The post included my table containing a sample day's menus and nutrient analysis for select vitamins and minerals. Space considerations did not permit me to list additional nutrients or calorie counts (I originally submitted four tables with different menus and calorie counts but was told I could choose only one).

Fortunately, I still had the complete nutritional analysis for this day on FitDay (impressive, as this was a whole year ago) and found that it exceeded or came close to the RDA for the micronutrients in question:

Thiamin: 81%
Riboflavin: 164%
Niacin:  173%

Yes, the day was a little low on thiamin. Pork is the best source of thiamin, but I'm not necessarily suggesting people eat it every day. However, by slightly  increasing the amount of nuts or animal protein, a person would easily meet the RDA . Also, consider the 10 Best Sources of Thiamin.  Not a grain or starchy vegetable among them! 

2. The fat content of this menu may be "elevated beyond the culinary comfort of most Americans," but that doesn't mean it is unhealthy or that a higher-fat diet would be difficult to adapt to.

I've discussed the issue of dietary fat in a previous blog post, and I have several references in my Diabetes Spectrum article regarding the lack of evidence that a high-fat diet contributes to heart disease or has other detrimental effects on health; on the contrary, such a diet may have a beneficial effect on lipid profiles and markers of inflammation. I  believe a person with diabetes or metabolic syndrome following a "healthy, low-fat diet" that includes a breakfast such as a bowl of cereal with a banana and skim milk would achieve better blood sugar control and experience increased satiety by switching to the breakfast in the menu above and eating similar high-fat, moderate-protein, low-carb meals on a daily basis.  This can be a very luxurious and satisfying way of eating.

3. Some people may find low carb difficult to stick to, but that doesn't mean it shouldn't be offered as an option for those who are interested in following it.

There is a well-known study indicating that a carb-restricted diet can be sustained over two years, but most studies are of much shorter duration.  Unfortunately, the most difficult part of low carb is often at the beginning, when a person becomes adapted to using fat rather than glucose as a primary fuel source. There are many examples online of low-carb adherents -- including doctors, nurses, dietitians, and other healthcare professionals -- who have experienced great improvements in glycemic control and/or weight and find this way of eating enjoyable, energizing, and sustainable.  I am one of them, and I will continue to advocate carbohydrate restriction as an alternative to the low-fat diet, higher-carbohydrate diets currently promoted by the majority of nutrition professionals.