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Thursday, November 02, 2006

Diabetes Authorities and Diet

What follows is a copy of a letter I wrote a couple of years ago to the Editor of Conquest, the Diabetes Australia (DA) quarterly magazine. Since then, nothing has changed - so I'll repeat it as sent. Because my opinion hasn't changed either. For accuracy, I will note that I have added 1000mg metformin daily since writing the letter, so I can no longer claim to "take no diabetes medications". But that doesn't change the thrust of my argument.

To be clear, I think that both DA and the American Diabetes Association are marvellous, worthy organisations doing sterling work for diabetics in both countries. My only disagreement is specifically to do with their dietary and testing guidelines. The dietary advice and guidelines promoted by DA is effectively a rubber-stamp of that issued by the ADA; so the same comments apply to both.

I never received a reply.

I am eternally grateful for the work the pioneers at Diabetes Australia did in helping us get the NDSS and the support system that we now have. The organisation continues to do a great job. But I have a basic difficulty with the logic of the dietary advice recommended by your dieticians.

I see their advice like this:

1. Dieticians advise high complex carbohydrate consumption, apparently for heart, kidney and vascular health;
2. High complex carbohydrate consumption causes high blood glucose levels;
3. High blood glucose levels cause diabetic complications such as retinopathy, neuropathy, nephropathy and heart disease;
4. DA dieticians therefore recommend balancing the high complex carbohydrate consumption with medication or insulin to control blood glucose levels.

This advice appears to be in line with the recommendations of overseas organisations such as the American Diabetes Association (ADA).

Specific examples can be found on the DA web-site at http://www.diabetesaustralia.com.au/multilingualdiabetes/healthpros/FoodNut/healthy.htm [Edit 13th August 2008. This link no longer works; the new page on DA is significantly better, although still not great. You will find it at Carbohydrate ]
or the ADA web-site at http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp [Sadly, this link still works in August 2008]
[Both links no longer work in 2010 - excellent!]

My difficulty in understanding this is because no-one seems to be investigating the alternative approaches. I don't mean herbs and supplements, just a better diet for diabetics, together with exercise, to enable minimal medication.

To me, the most obvious alternative is to search for a diet for the diabetic which provides adequate nutrition for good health but does not cause high blood glucose levels. If such a diet is possible it would minimise the need for medication, particularly for type 2, with side
benefits for overall health and health costs. I can attest that it is possible; I've done it, as have many others. However, when diabetics write to give examples, such as K ...... in the Autumn issue, they are dismissed and told that their improvement must be because of exercise, or weight loss, or some other factor.

The method I followed, as a type 2, was simple. I started with a standard, sensible diet to lose weight. Then, as I followed that diet, I tested everything I ate one hour and two hours after I ate it. If I consistently found that something led to high blood glucose, I changed it. Sometimes I changed the food, sometimes the quantity, sometimes the timing, but always the aim was to minimise "spikes". Gradually I found I was eating significantly less carbohydrates, a little more protein and a little more "good" oils. And I did a little "lazy man's" exercise along the way. I also gradually reduced the high level of initial testing as results became predictable.

After attaining a degree of control over my blood glucose, I now progressively review my diet to ensure there are no missing nutritional requirements and to further improve lipids etc. At diagnosis in 2002 my HbA1c was 8.2, now it's 5.9 and I take no diabetes medications. It's a long time since I've seen a "spike" over 8, rarely over 7.5. The improvements continued long after I reached my target weight. And my heart, blood pressure, lipids, kidneys and so on are also in good shape.

Why do your dieticians continue to promote high carbohydrate consumption? What is it I'm missing, apart from complications?

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter


Anonymous said...

Don't reject complex carbs just yet. A vegan diet which is loaded with complex carbs has proven quite effective for treating diabetes, in fact, in many studies most diabetics were able to come off of their meds and is has been said that a vegan diet and exercise is equal to or even better then meds for diabetes control with the all the side effects being good ones.

Alan said...

Hi Anonymous

I don't reject complex carbs - but my meter lets me know what my limits are. So, I suppose, it's my meter advising rejection of excess. Moderation is the key, and the ADA does NOT preach moderation in carb intake.

If Vegan worked for you as a type 2 - great. However, your comment implies belief in other's research rather than personal experience. I have nothing against Vegan diets - I've just never met a type 2 who succeeded on one. And I've met and corresponded with several type 2's who had very significant problems with post-prandial BGs on Vegan diets.

Cheers, Alan

Sue Rafati said...

Hah! Some 2 years later and not much has changed. It's very slowly changing in the UK, and slowly amongst bloggers and forum users. Don't we know best? We live it every day! As a T1 pumper, lower-carb just works for me, as my results bear out.