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Thursday, November 27, 2008

The Diabetes Diet Wars

So, you’re a type 2 diabetic and you want to know what to eat? It seems such a simple question. After all, scientists all around the world have been studying the subject for nearly a century. How long does it take to discover which foods are good and bad for a type 2 to eat?

Going by the results, a very long time.

Welcome to the diet wars.

Which camp are you in? Do you follow the low-fat dietary guidelines of the ADA, AHA and USDA? Those guidelines usually start with something like "People with diabetes have the same nutritional needs as anyone else". That is technically accurate, but it implies that we must meet those needs in the same way as everyone else; and that is simply not true. Somehow they blithely ignore the fact that everyone else doesn’t have insulin resistance and a struggling or defunct pancreas. They will often follow with something like "The message today: Eat more whole grains! Whole grains and starches are good for you". But we all know that will raise our blood glucose levels, don’t we? No problem – they have a solution for that too: "Your doctor may need to adjust your medications when you eat more carbohydrates". In fact, despite the "same as anyone else" preamble the recommended diet is very low-fat and high-carb. It leads, in my opinion, inevitably to over-medication and progression.

I did the approved training with the dietician, but I kept having this radical thought as I saw my numbers go into the stratosphere and realised I would have to ask the doctor for lots of medications if I ate as the dietician recommended – what if there was a way of eating that gave all of the benefits of those grains and starches without doing that to my blood glucose? Much later I have started to read the book "Good Calories, Bad Calories" by Gary Taubes. I'm so glad he wrote it because he supports with science many of the decisions I made using logic and my meter some years ago.

Or are you in the low-carbohydrate camp, following weight-loss diets such as Atkins or South Beach and similar, or ultra-low-carb diabetes control diets such as that recommended by Dr Richard Bernstein? Or are you following something less radical such as Gannon and Nuttall’s LoBAG (Low Biologically Available Glucose) diet?

If I had to choose one of those it would be Gannon and Nuttall; but I don’t belong to any of those warring camps. I know my signature of "Everything in Moderation – Except Laughter" seems rather boring, but I chose it with care. The more I read about diabetes, the more I realised that extremes can kill us. In blood glucose terms both hypo- and hyper- are to be avoided; normal numbers are my aim. The same applies to lipids (cholesterol, especially triglycerides), weight, blood pressure and all of the various medical indicators we have to be aware of. I am honestly mystified as to why the experts keep urging us to go to extremes of low-this and high-that.

Another part of the problem is the word "diet"; it implies a short-term restriction to meet a goal such as weight loss. Diets do not work for us. As diabetics we have a chronic, life-long, life-threatening condition that is directly affected, more than most other conditions, by the food we eat at every meal. We do not need a short-term quick-fix diet. Instead we need to each discover for ourselves a "way of eating" that is delicious and enjoyable to ensure that we can happily follow that way for the rest of our lives, but which also meets our nutrition needs while aiding, rather than exacerbating, our diabetes control or other health problems.

But people like labels so I call my way of eating "low-spike" because that is my aim: to minimise blood glucose spikes after I eat. Compared to the ADA guidelines I eat low-carb, but I don’t count carbs because that is not my aim; instead I read my meter after I eat, review what I ate, and adjust the menu next time if the result was unacceptable. It’s pretty simple really. Occasionally I check to be sure nothing vital is missing, but the only thing I seem to be missing after six years of eating low-spike is complications.

So I’ll keep doing what I’m doing and let the others keep fighting the diet wars.

Cheers, Alan
Everything in Moderation - Except Laughter

PS That was my third and final dLIfe column.


Margie's Musings said...

Last night we went out to eat, Alan, and Bob had brisket, coleslaw and baked beans. His after dinner sugar was 255. Was it the baked beans or the coleslaw or both?

Alan said...

Hard to say without recipe details. But it could have been either or both.

Some restaurant coleslaws have a lot of sugar, and possibly some starch, in the dressing. Here is just one example: http://caloriecount.about.com/calories-kfc-coleslaw-i72970

With the baked beans there are two possibilities; the beans have some carbs but the sauce can be loaded with sugar and starch too. Here is a classic "healthy" example from the Mayo Clinic, with 57gms carb to the cup (who eats 1/3 cup?): http://www.mayoclinic.com/health/baked-beans/NU00308

Cheers, Alan

Mark said...

Does drinking Chinese green tea help to control T2 diabetes?

medical training

Alan said...

I have seen claims concerning green tea or EGCG and some cancers, although there is still controversy on that subject, but I have never seen any well-supported claims concerning either the tea or it's extract for diabetes of any type.

There are a few non-definitive studies from Asia, but nothing I would place much value on at this time.

I drink tea, including green tea, occasionally but not a lot and for flavour, not really for health.