You may be surprised to know that for the past couple of decades, the American Diabetes Association has been sort of a cheerleader for carbs. Yes, I'm talking about the organization who's mission it is to promote education and research in ways aimed at preventing diabetes and alleviating the suffering of diabetics. What is diabetes? It is essentially a disorder of the body's ability to process carbohydrates. This includes Type 1 and Type 2 diabetes, pre-diabetes, metabolic syndrome, insulin resistance, and all the other points on the diabetes spectrum. (The Endocrine Society suggests that anyone with a fasting blood glucose of 89 or above is at risk for damage to their health.)In light of this, you'd think that limiting carbohydrate intake would be a priority in educating people about handling these disorders. And yet, the ADA jumped right onto the Food Pyramid bandwagon and began to advise people to get at least 55% of their calories from carbohydrate, such as in this Food Pyramid for Diabetes. In 2008, they made one exception: diabetics trying to lose weight could follow a low-carb diet for up to one year; this was later loosened further to two years. But still they did not recommend a low-carb diet for health, blood sugar control, or preventing progression of the diabetes.
Now, in the March 2011 edition of the ADA magazine "Diabetes Forecast" are three rather remarkable articles. The first is called The "ADA Diet" Myth, which claims that there is no such thing as the ADA Diet! (Who else was having this hallucination?) Instead, Stephanie Duncare, director of nutrition and medical affairs for the ADA says, "For more than 15 years now, ADA has recognized that people with diabetes should eat in a way that helps them reach their blood glucose, cholesterol, blood pressure, and weight goals. For some, this means a relatively higher-carbohydrate diet, and for others, the diet may be lower in carbohydrate". Well, hallelujah to that, especially if the goal is "normal blood glucose" (normal meaning "a blood glucose level that will not cause further damage in the pancreas").
Even more bold is an article called, "Are Carbs the Enemy?" which attempts to cover the debate. They first present a sort of wimpy pro-carb stance. This section of the article has a notable absence of anything to do with science, instead relying on statements such as "Gone are the days of 'diabetic diets' that were meager and confining" and "as long as people eat less or cover their carb intake with medications, they can keep blood glucose levels in check with a healthy diet" ("healthy" in this case meaning "high-carb").
The article then goes on to describe a low-carb approach, citing Dr. Richard Bernstein. This section cites actual evidence, and makes what I think is a much stronger case for controlling blood glucose by limiting carbohydrates. The article goes on to a section on saturated fats which is much more balanced than usual, and then the normal "we don't have the long-term studies". The article concludes with the statement: "In the end, the best diet is the healthy one you're able to follow." The only thing I would add is that people need support in making those changes, and as far as I can tell they are still leaving an awful lot up to the individual to figure it out for themselves. There has been quite a defeatist attitude coming from the organization that is supposed to be helpful - along the lines that it is asking just too much of people to cut carbs in any significant way. Are dietitians now actually going to support people in finding a diet that achieves as close to a normal blood glucose as possible? It would be a very big change if this happened any time soon.
But wait, there's more! A follow-on short piece called "Eating With Diabetes: 3 Approaches" lists the low-carb approach first, and then follows with "Moderate-Carb" and "Vegan/High-Carb". The weird thing is that the three approaches are described as "less than 10% carb", "40-50% carb" and "75% carb". What about people who normalize their blood glucose with 20% carb or 30% carb? Why not just say, "it's a spectrum disease, with a spectrum of carb that will treat it effectively"? In any case, I don't want to complain too loudly, because this is SO great to see in an ADA publication!
Now, to be sure, the ADA is not yet changing their basic stance. Nowhere on the latest update of the diabetes.org Web site is it stated that diabetics should follow a low-carb diet. On the other hand, there is no longer anything I can find that says to eat over half of calories from carbohydrate, either. The former food pyramid, as far as I can tell, has vanished, and there are several hints that low-carb eating is becoming a bona-fide option. There are statements such as, "Understanding the effect of carbohydrate on blood glucose levels is key to managing diabetes. The carbohydrate in food makes blood glucose levels go up." Although diabetics are still advised that "a place to start is at about 45-60 grams of carbohydrate at a meal.", (yikes) it goes on to say to adjust from there. Even though this is not what most of us would call a low-carb diet, for most people it is a reduction from their previous advice.
[Side note: I also notice it doesn't actually say 45-60 g/meal is a good place to start. If that actually controls someone's blood glucose, that's great, but I would think that in the cases where it doesn't, it would be more disheartening to subsequently take more carb away. Why not start lower, and then add? Also, most likely, the person for whom this works is losing weight - a phase which doesn't last forever.]
To me this looks like the beginnings of a real change in approach from the ADA. The Titantic may actually be turning around! This could make a difference to the health of millions of people, and nothing could make me smile more than that.
Photo of Cereal and Insulin © villiers at IStockphoto
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The diabetes association in Stockholm seem to be shifting their diet advice too
http://translate.google.com/translate?hl=en&sl=sv&tl=en&u=http%3A%2F%2Fwww.kostdoktorn.se%2F
Thanks for this very important info, Laura. It does indeed sound like the ADA is changing its stance regarding carb consumption. The extension of low-carb dieting for weight-loss from one to two years was done without fanfare, and I’m sure was unnoticed by many.
A key point for me is that we don’t know the long-term effects of many of the 11 classes of drugs we use to treat diabetes – it’s the adverse effects I worry about. To eat lots of carbs and take more drugs to “cover” the carbs is a roll of the dice in many cases. Why not just limit the macronutrient that diabetics can’t handle: carbs?
-Steve
I know that the hospitals in Southern Maryland are giving their diabetic patients a low carb diet because my mother-in-law was in for a week and fussed about them giving her the wrong diet. The hospital and I keep trying to explain it to her but she is from the old school and until the day she went home, was still fussing about it. I thought it was great that the hospital was on board with lower carbs.
I don’t even look at the ADA site anymore because it has consistently given such high amounts of carbs and such low fat and protein foods. Tried it at first and so bad for my blood sugar. Got same advice at our local hospital diabetes class and own doctor. So I just go low carb and yadda yadda them just like they do me.
I am very glad that, after struggling for such a long decades, American Diabetes Association finally began to get IT.
Most hospitals now do not use 5% dextrose in the operating room. We also have had more studies that show keeping a low, normal blood glucose level is the best for speedy and uneventful recovery from illnesses including traumas.
Wow, this is what I said about a year or more ago and got FLAMED BIG TIME, on this site. Love this site and all it has to offer. Glad you noted that the ADA is shifting albet, ever so slightly. OF COURSE most of us need to go above and beyond what the ADA recommends. (or less and below, LOL)
If we all ate what the ADA tells us to, while still ‘normal’ with BS, then MAYBE we wouldn’t become diabetic…MAYBE…but to eat this way AFTER there are problems…not gonna work. WITH MEDS, maybe…and docs count on meds because a lot of patients don’t work the program.
Thanks for letting me comment. I am going to hide under the covers again…and be quiet!
I don’t know about anyone suggesting that Diabetics should eat Carbs-I have been borderline diabetic for several years now and my Dr. is very strict about me eating a lot of Carbs-I’m careful to keep carbs @ 45g for Breakfast,Lunch and Dinner-with a 25g snacks in between and at bedtime-Maybe this is not what you are implying-but just thought I would write this-keep SMILING !!
There is not as much new in the ADA article as the author here implies. Quoting Bernstein as an authority is obviously new; disappointing that there was real discussion of how well people, including virtually all of the regulars on the ADA Discussion groups, where I have posted for years, do with 20-35% calories from carbs.
But there is nothing new about the ADA not recommending a specific diet–since I was diagnosed in 2003, their consistent refrain has always been to consult with your doctor or dietitian. And they have always recommended lowering carbs as a first step over that period. Not lowering as much as some of us would like, but with the average American eating 464 grams of carbs per day, and the USDA Nutrition Facts labels based on 312 grams of carbs in a 2000 calorie diet, even 45-60 grams at meals with 15g snacks represents a substantial reduction in carbs for most people.
Which is not meant to excuse the ADA for not leading on this issue. They should be out front for lower carb and will be a lot more effective in helping people manage blood glucose levels when they go there. But so many people in the past, and currently, see only the negative and condemn the ADA to a degree much harsher than makes real sense–which confuses the heck out of the newly diagnosed.
Perhaps where I agree most with the author here is the idea of low-carb as a continuum, starting somewhere around Bernstein, but extending up to include however many carbs an individual can consume while maintaining normal blood glucose levels. People newly diagnosed always want to know an exact number, however. On the ADA Discussion groups they are consistently advised by pretty much everyone there to listen closely to what their meters tell them rather than follow any one-size-fits all approach.
Which, fittingly, was precisely the advice in the first reply to the first question ever on the ADA message boards, and was also the advice the dietitian gave me in my diabetes education class.
At last some sensible advice.
Big question is now what do you replace the carbs with?
Only 2 alternatives fat or protein.
Wonder if the medical community is going to change their stance on saturated fats which mankind has been eating for thousands of generations!
I was diagnosed with D2 2 years ago…..after one year I realized what a joke the ADA was! I control my blood sugar with diet alone, low carb, and, no, it isn’t perfect..there are days when I mess up, however, had I listened to the ADA, I would be in extremely bad shape today! The ADA has a very loving relationship with the drug manufacturers, pushing all kinds of pills and insulin….they are NOT helping diabetics! And, their recipes are pathetic..white flour, sugar, dried fruit…ARE THEY KIDDING???
A diabetic will get more help and advise from heathcentral.com..david mendosa, than he/she will ever get from the ADA…sad but true!
Michelle, you really hit this nail on the head when you said:
“At last some sensible advice.
Big question is now what do you replace the carbs with?
Only 2 alternatives fat or protein.”
This is the real issue. It is the Lipid Myth and rampant lipophobia induced by 50 years of intense (and baseless) propaganda which forces this skewed dietary advice. One diabetic in the UK came across a publication from the British version of the ADA from 1970. I said the first step was to reduce carbs “to at least less than 100g per day”!!
Today, they sound just like the ADA at its worst. Profit motive and drug companies? Maybe. But, even without that as you pointed out they can’t really tell people to get serious about carbs because that would necessitate either high protein – pretty much known to be bad for you – or high fat which just sticks in their throats.
I’m at about month 18 since a dx with A1C of 10.7. Last A1C was 5.1. I’m using diet alone – LC/HF of course. Currently, as percentage of calories approximately C:10;P:15;F:75.
Great information, and a very well-written article! Well, as someone’s already said, I’ll believe it when I see it…
Thanks for the link to the Endocrine Society suggestions. The big question I have is WHY DO THE ENDOCRINOLOGISTS KEEP THE UPPER LIMIT FOR “NORMAL” AT 100 INSTEAD OF LOWERING IT TO 90? I have had fasting blood glucose levels in the 90s for years, and even above 100, and my doctors called it “normal”. My advice to all is to get your fasting blood checked at least once a year, and if it is above 90, get a hemoglobin A1C test. And if you have no medical care or insurance that covers testing, consider buying a cheap meter and a few test strips and doing the job yourself-although be forewarned, those store-bought glucose meters can be off about 20% plus or minus, which is pretty inaccurate. My other suggestion is to check out the website Blood Sugars 101.
I’m a 30 yr. nurse who is old school. The old “norms” for blood sugars were 60-120 and we taught people about their diets and
calories and limiting carbs and increasing protein (and exercise). After being out of hospital nursing for a number of years, I returned to find that patients are now being taught in their diabetic education classes that they can eat whatever they want and just use sliding scale insulin based on their carb count. I am having a hard time with this.