So many comments came in to my blog post on Paula Deen’s diabetes announcement, “weighing in on Paula Deen,” that I thought it was worth revisiting in my monthly (first Sunday) column in the San Francisco Chronicle. The question (edited) came from a blog reader:
Q: I have been diagnosed with type 2 diabetes and am very confused about insulin resistance, and what carbohydrates I can and cannot eat. So much of what I read is contradictory.
A: The first line of defense against type 2 diabetes is weight loss, but you would never know it from listening to Paula Deen, the celebrity Southern cook who recently announced that she has this disease, or even to the American Diabetes Association.
Having diabetes is no joke. It is a leading cause of blindness, kidney failure, leg and foot amputations, and premature death.
The disease comes in two forms – type 1 and type 2 – but type 2 accounts for 95 percent of cases. In both, levels of blood sugar are too high as a result of problems with insulin, a hormone that enables the body to use blood sugar for energy. But the reasons differ.
Type 1 is an autoimmune disease. It causes the pancreas to stop making insulin or not make enough. Type 1 is not yet preventable and requires insulin treatment.
In type 2, insulin may be available, but body tissues resist its use.
Being overweight is the key factor in type 2. Most people can prevent it by not gaining weight. And most people with the type 2 disease can eliminate symptoms by losing some weight.
Genetics is certainly a factor – many overweight people never develop the disease – but 85 percent or more of people diagnosed with type 2 diabetes are overweight or obese.
In genetically predisposed people, being overweight causes insulin resistance. Metabolism does not handle excess calories very well, and this means calories from any source, not just carbohydrates.
Fast food, soft drinks
Children and adults who habitually consume fast food as well as soft drinks tend to take in more calories and weigh more and are more likely to develop symptoms than people who eat healthier diets and are more active.
This makes healthy eating and physical activity the most important approaches. The vast majority of overweight people at risk of type 2 diabetes can prevent symptoms by losing a few percent of their body weight and doing a couple of hours a week of moderate – not necessarily vigorous – physical activity. The same works for treatment. Some people will still need medications, but the drugs work better with diet and physical activity.
As the Centers for Disease Control puts it, “all diabetes-care programs should make healthy weight a priority.”
Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits and whole grains, and don’t consume too much junk food or too many sugary beverages.
Scientists may argue endlessly about the relative importance of calories, sugars and refined carbohydrates in the diets of people with type 2 diabetes, but everyone agrees that eating less of all three would help resolve symptoms.
Why isn’t weight loss better recognized as a treatment strategy? Paula Deen’s announcement said nothing about losing weight.
The ADA does talk about weight loss on its website ( www.diabetes.org), but you must search hard through several complicated screens before you find, “Losing just a few pounds through exercise and eating well can help with your diabetes control and can reduce your risk for other health problems.”
Pharmaceuticals
I can’t help wondering if the lack of prominence given to weight loss might have something to do with the influence of pharmaceutical companies.
A few years ago, I gave a talk on the importance of weight loss in control of type 2 diabetes at an ADA annual meeting. Although many conference talks dealt with drug treatment, mine was the only one on diet – except for a session on sugars sponsored by Coca-Cola.
The exhibit hall was packed with drug company representatives dispensing free pens, writing pads, books, lab coats and stethoscopes – all with corporate logos.
The influence of drug companies on diabetes advice is worth attention. Deen represents a drug that costs hundreds of dollars a month. Drug companies give the ADA millions every year.
Eating less and being active make no money for anyone (unless people can be induced to join commercial weight-loss programs).
Losing weight is a losing battle for many people. It’s hard to lose weight in today’s “eat more” food marketing environment.
Teachable moment
But a diagnosis of type 2 diabetes should be a teachable moment. Shouldn’t the ADA more strongly urge people with the disease to eat less, eat better and move more, and help everyone find ways to cope with “eat more” messages?
The health and economic costs of type 2 diabetes, and its preventability, are reason enough to demand changes in the food environment. The ADA should be working hard to make it easier for everyone to eat more healthfully, be more active and avoid the need for a lifetime of diabetes medications.
Marion Nestle is the author of “Food Politics” and “What to Eat,” among other books, and is a professor in the nutrition, food studies and public health department at New York University. She blogs at www.foodpolitics.com. E-mail comments to food@sfchronicle.com.
This article appeared on page G – 4 of the San Francisco Chronicle
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Sign in nowWhen I found out I was Type II diabetic it was a real wake up call for me. I lost heaps of weight and stopped eating portion sizes that would suit someone of average height. I’m really short and don’t need anywhere near the same calories.
No more problems. Paul Deen needs to learn that anyone can manage this disease without drugs. It’s not easy but weight loss and portion control DO work.
Check out the book Wheat Belly. By giving up wheat (99%; nobody’s perfect) I’ve finally lost a bit of weight (probably because most junk has wheat in some form in it) and my fasting and postprandial glucose is vastly improved.
You should follow a low fat diet with complex carbs – they are vegetables, unrefined grains and legumes.The grains must be unrefined otherwise certain minerals that are required are removed in the refining process.
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Contrary to popular and scientific opinion, it’s not the weight loss that improves diabetes. There is nothing magic about being 10 pounds lighter. After all, when someone with diabetes is gaining weight, they are no less diabetic at 180 pounds after gaining ten pounds than they are at 190 pounds after gaining twenty.
Smart people need to stop focusing on the number. The scale is a very crude tool. We need to pay attention to the real issue: metabolic health.
When someone eats in a way that allows their body to lose weight, many if not all metabolic signs and symptoms of diabetes quiet down. The problem is that the many of the bio markers of disease quiet regardless if one is starving or just eating much less of junky foods.
Just because someone loses weight doesn’t necessarily mean they are eating better. And what about people who are not overweight but still are diagnosed with diabetes (cardiovascular disease, cancer, gout, hypertension, and many other inflammatory states)?
Focusing on weight is short sighted and reinforces a destructive bias. Isn’t it time to redirect our energy to encourage health at every size?
“You should follow a low fat diet with complex carbs – they are vegetables, unrefined grains and legumes.The grains must be unrefined otherwise certain minerals that are required are removed in the refining process.”
C’mon, diabetes is an inability of your body to deal with blood sugar and yet you suggest ridiculously that people eat foods that will in fact raise blood sugar levels. Grains, even unrefined grains are nothing but sugar by the time they are digested.
Eat sugar and take drugs all the while avoiding fat are not a solution to the problem.
Ridiculous.
@Steve
“C’mon, diabetes is an inability of your body to deal with blood sugar and yet you suggest ridiculously that people eat foods that will in fact raise blood sugar levels. Grains, even unrefined grains are nothing but sugar by the time they are digested.”
Steve, your body *needs* carbs. Being diabetic forces people to regulate their intake of carbs, not cut them out completely.
@MarionNestle:
Good to see you refocus the discussion on diet and exercise.
Paula Dean is a pointless distraction – and her paid endorsement for the drug of the moment is just another symptom of our culture’s need to distill complex problems down until a simple fix can be offered up.
There is no miracle pill. There is no single-gimmick diet. There’s nutritional education, careful attention to diet, regular exercise, and a range of medical treatments.
Then you evaluate how effective your choices are by testing your blood sugar levels – and adjust.
Over time, you can expect treatment levels to change. What worked before is likely to need additional effort or treatment because your system will degrade as you age.
Two things are right in this article:
1) I agree that Pharmaceutical companies are influencing the message–it’s possible to treat T2 without drugs, and they naturally don’t want that, so mute the message. Very sad.
2)Yes, it’s possible losing weight may alleviate symptoms (of Type 2), particularly in newly diagnosed, overweight diabetics. However, as you said, at least 15% of people with T2D are not overweight and some people who are overweight are not diabetic. So being overweight or obese is most likely secondary to the disease. Eating less of everything will, perhaps, help but also leave one, particularly a T2 diabetic, hungry all the time. That is not the answer, at least long term, and diabetes, whether it is T1 or T2, is for life.
3) Physical activity is important, though not so much for losing weight as for increasing sensitivity to insulin.
What’s seriously wrong in the post:
1) “Metabolism does not handle excess calories very well, and this means calories from any source, not just carbohydrates.” Please, Dr. Nestle, explain this to me–as one biochemist to another. Fat has no effect on blood glucose and protein only minimal. The issue at hand is blood glucose, not calories, so how can foods that have little or no effect on blood glucose be involved in development of this disease?
2) “Dietary advice for type 2 diabetes is the same as advice for everyone else: Eat a wide variety of relatively unprocessed foods, especially vegetables, fruits and whole grains…” People who have type 2 diabetes are not like everyone else, so the dietary advice CANNOT be the same. Sure, they should not be eating processed foods, which tend to contain a lot of carbohydrates of all types. But, the disease is one of a broken ability to handle blood glucose, so ANYTHING which raises blood glucose should be avoided/eaten sparingly, including fruits, starchy vegetables, and grains, whole or not. There are doctors out there who know this and are successfully treating their diabetic patients with a low carbohydrate, high fat diet. Dr. Mary Vernon, Dr. Jay Wortman, Dr. Andreas Eenfeldt (and others in Sweden), Dr. Robert K. Su, Dr. Stephen Phinney, and Dr. Steve Parker, to name a few. Some of these doctors are themselves T2 diabetics, so they have a vested interest finding out the facts about the disease and how best to treat it. Google any one of them to find out more.
Sorry, I meant 3 things are (sort of) right.
@murph, I have nothing against good carbs, for a diabetic as well as a healthy person, and it’s true that diabetics don’t need to eliminate carbs, just regulate them. However, it’s a myth that the body “needs” carbs. There are essential fatty acids and essential amino acids, but no essential carbohydrates. Our bodies are quite capable of making enough glucose for the few tissues that require it as an energy source and can’t use anything else. It’s called gluconeogenesis and protein (hopefully from the diet, not muscles) is the substrate. Just saying…
@Margeretrc
“There are doctors out there who know this and are successfully treating their diabetic patients with a low carbohydrate, high fat diet. ”
The same doctors, RNs and dieticians who told me that glucose is essential to only a few tissues in the body (like the brain) are the same people who have repeatedly told me that “your body needs carbs.”
They have also pointed out that diabetics are between two to four times as likely to have a heart attack or stroke – and have more severe consequences for eating a diet high in fats.
I am confident that you can find doctors who advocate a different approach, but I would be very interested to see longitudinal studies comparing low carb, high fat diets to low carb, low fat diets.
Over and above that, the idea that people at greater risk for heart disease and stroke should eat more fat just seems – to be polite – counter-intuitive.
@murph, “They have also pointed out that diabetics are between two to four times as likely to have a heart attack or stroke…” Or perhaps the increased risk of heart attack is related to the elevated glucose levels in a diabetic’s blood. http://www.jhsph.edu/publichealthnews/press_releases/2012/selvin_hyperglycemia.html I’m not disputing that diabetics have a higher incidence and risk of heart attack and stroke, but it has yet to be proven that it is a result of the fat in their diet. In fact, there is considerable evidence that, in the absence of excess carbohydrates, fat, including sat fat, can be used for fuel and does not raise risk factors for heart disease. Sat fat in particular raises HDL while lower carbohydrate intake results in lower triglyceride levels and those two factors go a long way toward reducing risk of CVD. For a complete, referenced, scientific treatise on this I recommend “The Art and Science of Low Carbohydrate Living” by Jeff S. Volek, PhD, RD and Stephen D. Phinney, M.D., PhD They know much more about it than I.
“…and have more severe consequences for eating a diet high in fats.” More severe than neuropathy, kidney failure, blindness, amputation of limbs, for just a few of the complications of unregulated blood sugar? I am not a diabetic, but if I were, I’d take my chances on the risk heart attack. (There are many who have taken just such a risk and found their lipid levels actually improve as a result, so it might not be much of a chance.)
“I would be very interested to see longitudinal studies comparing low carb, high fat diets to low carb, low fat diets.” I’m sorry, but low carb, low fat diets are not sustainable long term. The body doesn’t need carbohydrates, but it does need energy and that has to come from somewhere–either fat or carb. Protein is neither an efficient source of energy nor safe to eat in the quantities necessary as primary source of energy. That’s why a low carb diet has to be a high fat diet. http://www.second-opinions.co.uk/fat-not-protein.html There are studies comparing low fat high carb diets with high fat low carb. Here’s one: http://jama.ama-assn.org/content/297/9/969.full
@Margeretrc
I said low carb when perhaps the proper term is controlled carb (at least from my perspective). My pre-diagnosis carb intake was uncontrolled and quite high.
After consulting with a my doctor, a nurse and multiple dieticians – I was advised to keep my carb intake to a set amount over the course of a typical day.
This is the “low” that I was referring to. Given the extremely low levels of cab in diets like Atkins, I should probably used a term like “controlled.”
As part of this diet – a lower intake of fat was stressed over and over by all of the health care professionals I’ve consulted. I’ve read similar admonitions in the ADA’s complete guide to diabetes (http://goo.gl/cPtB9) as well as on the NIH website (http://goo.gl/8Zpbd).
While I’m defining terms – I should also point out that a longitudinal study I would consider credible would assess the overall health and longevity of diabetics on a controlled carb, low fat diet vs a low carb, high fat diet over several years.
The study you link to is none of those things.
It is assessing weight loss in “nondiabetic, premenopausal women” for 1 year.
While low carb diets have no shortage of proponents, they have have many skeptics (http://goo.gl/9KqPA and http://goo.gl/Dk3HW) as well.
I’m not interested in belief, I’m interested in proof over the long haul for my specific disease.
Show me that.
I take issue with much of what is said in this article. I do not believe that being overweight causes “Type II Diabetes” (which I do not even acknowledge to be a disease and which should be called something else perhaps just chronic high blood sugar). People who are overweight are more likely to have high blood sugar because both situations are caused by the genetic insulin resistance. Those of us with insulin resistance (yes I am extremely insulin resistant as is everyone in my family; my father and grandfather died of complications of “Type II Diabetes” and I am completely qualified to talk about this condition) can avoid both being overweight and having abnormal blood sugar levels by restricting dietary carbohydrate, the food class that requires insulin to metabolize, which the article rightly says is the definition of insulin resistance/Type II Diabetes. It is outrageous (even criminal) that the ADA and medical establishment continue to promote a low-calorie, low-fat, high carbohydrate diet (healhtywholegrains, you know) for people with blood sugar disorders. This is due to hanging on to the debunked “lipid hypothesis” which posits that fat makes us fat, being fat makes us “diabetic,” and calorie deficit is the way to lose the weight that is making us “diabetic.” This is poppycock and complete ignores the role of insulin which is the major player in this potentially devastating condition. Happily it can be completely prevented and even reversed as I have witnessed with my own situation and many family members. We are all following low-carb, high fat diets and have seen major improvements in all the conditions associated with insulin resistance including weight issues, GI distress, chronic fatigue, depression, insomnia, eating disorders, anxiety disorders, ADHD, and of course high blood sugar and insulin levels. The medical establishment needs to start paying attention to science. I highly recommend a book written specifically for doctors, etc. “The Art and Science of Low-Carbohydrate Living” by Phinney and Volek.
Believe me, I am not interested in belief, either. The proof you are looking for is available, if you look for it. Stephen
Phinney and Jeff Volek’s book might be a good place to start. “Both of them have done a large part of the hardcore research on low-carb dieting that is in the medical literature today. Go to PubMed and enter Volek JS or Phinney SD in the search window, hit ‘Search,’ and you will be rewarded with more peer-reviewed scientific papers on low-carb dieting than you will have time to read.” Dr. Michael Eades. Others involved in extensive research of diet and diabetes: Dr. Richard K. Su and Dr. Richard Bernstein.
Dr. Jay Wortman conducted a study involving the First Nation people of Canada. You can read about it and his experiences at http://www.drjaywortman.com/blog/wordpress/about/ I don’t know if the results have been published yet and his documentary is not available in this country yet, but…
That fat/sat fat is a problem, whether you are diabetic or not, is itself a belief, with little scientific evidence to support it. http://www.awlr.org/saturated-fat-and-heart-disease-clinical-trials.html
Far be it from me to counter what works for you. If you are satisfied, that’s all that counts for you. Are you type 1 or 2? One of the links you provided is about type 1, so I was just wondering. My son is type 1 and follows a low carbohohydrate, high fat diet (his own decision, based on his own research and advice from his own doctor) and has great control of his BG. Sure there are skeptics of the low carbohydrate diet–for weight loss. But really, can anyone logically argue that a diabetic, whether type 1 or type 2, shouldn’t be restricting (that’s the word I would use) carbohydrate intake?
Sorry, my last comment is addressed to @murph. I couldn’t see Peggy
Holloway’s comment until after I posted.
I don’t understand how it is whole grains are so much healthier than refined grains. I have stood in the grocery isle and compared brown rice to white rice, 100% whole wheat bread to white bread, 100% whole wheat pasta to refined pasta, etc. ALL those products are filler with mininal nutrients to calories. There is nothing in a “healthy” whole grain you can’t get with less calories in a vegetable.
So I quit eating grains, ate more vegtables, meat and fruit, lost 30 pounds in 4 months. I’m 46 and weigh what I did in high school. Likewise my husband lost 40 pounds in 5 months. We no longer crave any food.
We will always be told to eat whole grains by the USDA, ADA or any other “expert” lettered group. Why? Well it’s good for business. My husband and I were able to discontinue all medications due to our vastly improved health.
Grains are used to fatten livestock and sadly people, too.
@Margeretrc
I certainly am not suggesting that a diabetic shouldn’t watch their carbs. It is something I personally am doing – on the advice of my health care team. What I question is this: Why would a diabetic – any diabetic – increase their intake of fats when diabetics are more prone to heart disease and stroke?
The effects of high fat diets are (like anything) subject to question – but I’d certainly like to see the study that undoes the correlation between saturated fats and elevated risk of heart disease.
Absent a finding that diabetics respond differently to diets high in fat and cholesterol than everyone else – it’s very hard to see a reason for diabetics to voluntarily eat more fat.
I did go to PubMed, and I did enter “Volek JS” into their search engine. And yes, I did get lots of peer reviewed studies. But since most of them have titles like “The Effects of a Customized Over-the-Counter Mouth Guard on Neuromuscular Force and Power Production in Trained Men and Women.” or “Waist circumference is positively correlated with markers of inflammation and negatively with adiponectin in women with metabolic syndrome,” it would save us all a lot of time if you could link to the study or studies that establish the health benefits (or even the benign nature) of a high fat diet.
I added “carbohydrate” to my search terms and came up with a few studies that sounded promising – until I found their test samples were underwhelming (8 men for 6 weeks – http://goo.gl/We7FV, or worse 20 guinea pigs for 12 weeks).
The blog you link to is of questionable relevance since it discloses no methodology or results. If you haven’t read published results – what is it about this blog that you find convincing?
And it certainly isn’t about whether or not I’m satisfied or not. I miss bacon. A lot.
It has to do with what science tells me is the best path for me to meet my grand kids with all my parts. Because that’s what I’m going to do – be it eating Quinoa and popping pills or whatever.
I would be thrilled beyond words if there were a long term study on human diabetics that said eating more fat was a good idea. But since one never seems to show up on demand – I’m inclined to go with the recommendations of my heath care team, the ADA book on diabetes and general guidelines from groups like the CDC (http://goo.gl/3fncm).
@Ginger, All grains, whole or not, eventually become glucose in the blood–some faster than others, but all pretty fast. As you’ve learned, you are better off without them, particularly if you are diabetic.
Good post which I actually agree with. A basic regimen of a well balanced diet and being active is good for everyone. Based on the comments though it appears that a “well balanced diet” is subjective as many avenues seem to lead to the same destination.
In my career as an RD I too have noticed that drugs and the financing behind them seem to have the upper hand to simply eating right and exercising. Common sense doesn’t come in a pill and a good many that I have worked with over the years would rather take the easy road paved with pills.
GIven this fact I am neither dismayed or deterred because what I believe and have taught for years is vindicated by positive results. There will always be someone with more money and a bigger platform but I have the truth and in that I will be content and press on.
One of the best ways to balance meals and blood sugar while managing weight is through carbohydrate counting.
The American Diabetes Association, Mayo Clinic and Academy of Nutrition and Dietetics (formerly American Dietetic Association) all recommend this for people with diabetes, for those at risk and as a healthy eating plan for just about anyone. It is really how we should all eat.
Carbohydrate counting is not a low carbohydrate diet, but is more about keeping your carbohydrate grams within a certain range at each meal based on your lifestyle. There is still plenty of flexibility for choosing foods and no food is off limits.
Carbohydrate counting is realistic and sustainable which cannot be said for crash or restrictive diets.
The way I understand it is that fat cells release hormones that make diabetes and insulin resistance worse. I also understand that insulin resistance and the various hormone balances in someone genetically prone to diabetes will cause them to store more fat than the average person, especially when their blood sugar is high or when circulating insulin is high.
Although it helps to lose weight, and weight loss should be a goal of anyone overweight with diabetes, once you have diabetes, controlling glucose levels should be your number one priority. High glucose levels cause all sorts of problems in the body and can be very dangerous.
All diabetics are different, and their are many root causes of the disease. Some diabetics can control their blood sugar by following the same healthy diet recommended for all people, but other diabetics may need quite a bit of medicine AND many foods may still be completely off limits.
I have a hard time imagining ANY diabetic controlling their blood sugar and drinking even ONE sugar soda, EVER. But some diabetics may be able to, I don’t know.
I am a Type II Diabetic diagnosed in 2004. I’m thin, exercise at high intensity including strength training 4-5 days a week. I have cut my carbs to the point that I have to track leafy greens and non-starchy vegetables to keep my blood glucose stable. I take 2000 mg of Metformin per day. Losing 10% of my body weight didn’t help a bit (10% is the target of common wisdom). I lost significantly more. Aggressive, consistent application of a very low carb, high fat, sufficient protein diet is the only treatment that allows me to keep my blood glucose in control. I am aided in control of my “metabolic derangement” by high intensity exercise and Metformin. I continue the Metformin to address other aspects of my Metabolic Syndrome including managing triglycerides levels and insulin resistance. -Zero- information about how to eat for managing glucose was provided by my general practitioner, Diabetes Educator, Registered Dietician, or Endocrinologist. I read every research study, web site, and chat room I could find about how to treat Diabetes. Complete and utter disconnect between the medical field and the lay people and scientists advocating for low carb nutrition.
Whoever said people need to eat carbs to keep their bodies functioning probably doesn’t know that protein can be converted to glucose by the body when needed for essential functions. I eat lots of vegetables and an occasional handful of berries now and then because i enjoy them, but my metabolic profile would be better if I didn’t. I use saturated fat (animal fat) to cook with and season, followed by EVOO and minimally processed coconut oil. I lost a significant amount of weight (80 pounds) four years ago and have had no trouble keeping the weight off. If weight loss were all it took, I would no longer manifest symptoms of Diabetes. This is not the case.
@margaretrc
“I’m just saying you might want to at least consider investigating other–independent of drug companies and grain lobbies!–sources, like Dr. Steve Parker, Dr. Richard Bernstein, Dr. Robert K. Su, and so on, just to see what they have to say and how they back it up.”
I would consider those options – and take them seriously – if they had the kind of long term study results I’m looking for.
But they don’t.
Science isn’t about picking a champion before the results are in.
I’ll go with the data that exists, (http://goo.gl/lVcDT) not the data I hope will one day show up. If the science shows a better option later, I can always change. But if I pick an unproven plan that doesn’t pan out – then I’ve needlessly done myself damage.
I get that taking charge of your personal diet can be cathartic, but it doesn’t make a person right – it just means you are responsible for the outcome.
And listen to the conspiratorial notions coming out of the woodwork here. I should look for plans that are “independent of drug companies and grain lobbies!”
Heavens, “Big Bread” is coming to get you…!
As if proteins or vegetables (or diets for that matter) are somehow free of commercial interests.
Or that advice free of commercial interest is inherently more correct.
Like this:
“All grains, whole or not, eventually become glucose in the blood–some faster than others, but all pretty fast. As you’ve learned, you are better off without them, particularly if you are diabetic.”
That’s free, noncommercial advice – but it’s suggesting you need to be worried about foods that turn into glucose. Except that your body needs glucose – its the primary fuel for your brain.
There are studies with a quarter million participants showing that 2 and a half daily servings of whole grains was associated with over a 20% reduction in cardiovascular disease (http://goo.gl/OcMWR). What evidence is there that this benefit should be ignored in favor of low carb, high fat?
No one study is going to have all the answers, and the human body is complex beast – but I would hope we could rely on sound science to inform our choices.
@murph
I would really like to know how many carbs you are being encouraged to eat daily by your medical team, and what target blood glucose numbers you are being encouraged to shoot for. Don’t believe the hype that 180 is “good enough”.
@murph
You might want to consider finding your own n=1 proof. Take regular glucose readings at the same time each day for two weeks, following your ADA-approved, doctor recommended diet.
Next, for two weeks, follow Atkins Induction, or follow the diet excerpted in the book “Why We Get Fat” by Gary Taubes. The eating plan contained in the book is the Duke University Lifestyle Medical Clinic Diet. They are essentially the same. Keep taking the glucose readings at the same times each day.
Review your findings. I guarantee – you will be VERY pleasantly surprised at Week 4.
I know it feels scary and risky to buck common wisdom. I’m advocating this because I know what I went through to get where I am now, and I don’t want to see other people struggle and stumble when the information and solutions are available now. Think about it?
@ murph
I have 8 years of lipid profile results and A1C readings. The more proficient I became at fine tuning my low carb high fat nutrition plan, the lower my LDL and tri-glycerides dropped, and the higher my HDL increased. My doctor believes my number are indistinguishable from a “non-diabetic”, but I know I can do even better. I have a much higher standard for myself than the “anything under 7.0 A1C is doing great” mantra. I’m shooting for a 5.5 A1C, trying to keep my blood glucose in the 70-90 range as often as possible.
It’s a really important question to think about – what are your standards for Diabetes Management? What results do you want? What your doctor is likely recommending as a target is going to lead to diabetic complications. What was really helpful to me what the site, Blood Sugar 101, by Jenny Ruhl. A real eye-opener!
@Suzanne
I appreciate that you’re trying to help. I do.
But a two week trial with a sample size of 1 is exactly the kind of data that can lead people into the weeds.
I might feel great for two weeks – but after a year, who knows? That article I linked to (http://goo.gl/kZ9wx) shows more weight loss using Atkins in the first six months – but no difference after 12 compared to the control.
There’s strength in large sample sizes and long durations.
Mike Janavel said:
“Check out the book Wheat Belly.”
That book is atrocious. Please reconsider where you procure your nutritional information.
Mike Janavel said:
“I’ve finally lost a bit of weight (probably because most junk has wheat in some form in it) and my fasting and postprandial glucose is vastly improved.”
There’s your answer as to why it works. You’ve reduced junk food in your diet. It has little to do with Dr. Davis’s gobbledygook.
Bonnie Modugno, MS, RD said:
“Contrary to popular and scientific opinion, it’s not the weight loss that improves diabetes.”
Not exclusively, no. But in most cases it does significantly help.
Bonnie Modugno, MS, RD said:
“There is nothing magic about being 10 pounds lighter.”
Fat, especially belly fat is metabolically active and does indeed impede insulin. We know this, it’s metabolic syndrome 101.
Tricia said:
“The way I understand it is that fat cells release hormones that make diabetes and insulin resistance worse.”
Basically (more or less), yes.
Bonnie Modugno, MS, RD said:
Smart people need to stop focusing on the number. The scale is a very crude tool.
Which is why waist circumference is taken into account as well. Marion Nestle is describing one of the larger factors from controlling diabetes, not every factor.
Bonnie Modugno, MS, RD said:
“Just because someone loses weight doesn’t necessarily mean they are eating better.”
Better doesn’t matter so much, Eating less, does.
Bonnie Modugno, MS, RD said:
“And what about people who are not overweight but still are diagnosed with diabetes (cardiovascular disease, cancer, gout, hypertension, and many other inflammatory states)?”
It’s a matter of risk factors, there are no absolutes. The 85% Marion Nestle cited is a very high risk factor to consider.
Steve said:
“C”’mon, diabetes is an inability of your body to deal with blood sugar and yet you suggest ridiculously that people eat foods that will in fact raise blood sugar levels. “
While carbohydrates spike insulin levels, saturated fat elevates levels as well but for for longer periods.
http://www.ajcn.org/content/66/5/1264.full.pdf+html
Check out the Insulin Index of Food graph on page 1273 in the PDF file. This of course isn’t news and is why diabetics are urged by every major nutritional organization inside and outside the United States to limit saturated fat in their diet.
Steve said:
“Grains, even unrefined grains are nothing but sugar by the time they are digested.”
No. Stop reading Internet nonsense and regurgitating it here.
Margeretrc said:
“Eating less of everything will, perhaps, help but also leave one, particularly a T2 diabetic, hungry all the time.”
I agree with this to a certain extend. People accustomed to overeating, ostensibly experience feelings hunger when trying to control weight. It’s a problem, and why weight loss/control is so difficult for many people.
Margeretrc said:
“Fat has no effect on blood glucose and protein only minimal.”
See the PDF I linked to. Again, not news.
Margeretrc said:
“so ANYTHING which raises blood glucose should be avoided/eaten sparingly”
Referring to that chart in the PDF, following your own conclusion, one would be advised not to consume beef.
Margeretrc said:
“There are doctors out there who know this and are successfully treating their diabetic patients with a low carbohydrate, high fat diet.”
Personally, I think low-carb diets may be reasonable alternatives for certain people. I’m not opposed to the appproach, there’s more than one path to any destination. What I cannot tolerate is some of the really poor arguments bandied about as facts by many low-carb advocates.
Even the late Atkins appreciated, to paraphrase him, “there are two ways to get to Fuji.” He was nowhere near as mistakenly dogmatic as the current crop of low-carb anti-grain zadvocates.
Peggy Holloway said:
“I do not believe that being overweight causes ‘Type II Diabetes”
Causes? No. An important risk factor? Yes.
Peggy Holloway said:
“We are all following low-carb, high fat diets and have seen major improvements in all the conditions associated with insulin resistance including weight issues, GI distress, chronic fatigue, depression, insomnia, eating disorders, anxiety disorders, ADHD, and of course high blood sugar and insulin levels.”
I, and many people like myself follow what would be described as a high carb diet, and I don’t have these problems, nor are that as prevalent in many high carbohydrate diets outside of the West. I’m very glad low-carb is working for people here that they want to share their success stories, but realize that there are plenty of people who went about it the way Marion Nestle describes. It’s not an either or proposition and you don’t have to rely on faulty low-carb nutritional ideas to bolster your claims. Sure, offer good information, I think low-carb may be an option for some people. But rethink parroting some of the more outrageous low-carb claims even a layperson as myself can spot as blatantly incorrect or rampant hyperbole.
Ginger said:
“I don’t understand how it is whole grains are so much healthier than refined grains.”
It’s not altogether clear, but it seems like the finer processing lends to faster absorption and the removal of the other parts of the grain add to this absorption issue along with removing the beneficial parts of the seed.
Ginger said:
“I have stood in the grocery isle and compared brown rice to white rice, 100% whole wheat bread to white bread, 100% whole wheat pasta to refined pasta, etc. ALL those products are filler with minimal nutrients to calories.”
Filler? Are you joking? Grains are not “just sugar” or “filler” They are plant seeds, the suns energy and along with soil nutrients, concentrated as to begin a new plant life. Grains, legumes, nuts, seeds, contain protein, fats , macronutrients, photochemicals, and fiber along with carbohydrates. There’s a reason humanity has depended on cereals so strongly for the past few thousand years.
If the retort is to bring up paleo hominids, please note I said humanity, beings like us who live and thrive in civilization and have evidence of writing and parallel social culture. Paleo hominids were around for millions of years, not very interesting if you consider that every species alive today accomplished the same level of survival. Oddly enough, the interesting things with humanity began with civilization and widespread cultivation of cereals. The people of the fertile crescent were a lot like us; paleo homonids, not so much; may as well be aliens.
Ginger said:
“So I quit eating grains, ate more vegtables, meat and fruit, lost 30 pounds in 4 months. I’m 46 and weigh what I did in high school. Likewise my husband lost 40 pounds in 5 months. We no longer crave any food.”
Congratulations. I’m genuinely glad you found a plan that works for you and I’m not trying to be patronizing. But “grains are filler” isn’t a serious statement.
Ginger said:
“Grains are used to fatten livestock and sadly people, too.”
Are you seriously comparing livestock physiology to people? Which livestock? Cattle? Pigs? Chickens? None of them are big meat eaters, certainly don’t eat beef. Should we up our insect and worm consumption to be on par with chickens? Please refrain from making these sorts of statements. You would have a much better chance of being taken seriously.
Suzanne said:
“I’m thin, exercise at high intensity including strength training 4-5 days a week.”
…
“If weight loss were all it took, I would no longer manifest symptoms of Diabetes.”
You are in the 15% difference of the 85% that Marion Nestle quoted. Nothing contradictory there.
I mentioned a two week sample of each eating approach to show you how to lower your blood glucose levels without any additional intervention. What you can achieve is stunning. Managing insulin/glucose levels is an excellent way to diminish cardiovascular risk, which I believe you are concerned about.
At some point in time if your blood glucose levels are not stabilizing at an acceptable level, you might recall the conversation here and research to your satisfaction. Best of luck.
I agree with your conclusion that drug companies have a vested interest in keeping the focus on diabetes drugs instead of dietary and lifestyle changes, but I take issue with your approach.
Specifically two things:
1. What makes you think that every obese person hasn’t tried eating less and moving more??? To claim that the solution is that simple is to imply that every obese person is too lazy and stupid to do the obvious.
Nobody wants to be obese, and scratching the surface of any obese person will reveal a person who has tried numerous “eat less move more” schemes that worked temprorarily if at all and caused the body weight set point to be reset ever higher in the body’s attempt to avoid starvation at the molecular level. News Flash–Eat less, move more DOES NOT WORK in the long term.
2. What came first, the chicken or the egg? Did obesity cause insulin resistance, or did insulin resistance cause obesity? Gary Taubes and many others believe that the insulin resistance comes first, and simply losing weight, without correcting the underlying metabolic issue, will not cure insulin resistance. Dr. Mary Vernon states that she sees many thin people who are “metabolically obese” because of severe insulin resistance despite a lean body type.
My own personal experience is nothing but an anecdotal, N=1 story, but nevertheless is illustrative. I have PCOS. I was a thin adolescent and young adult with very severe PCOS. I was not obese when I married and we started trying to conceive–5’3″ and 110 pounds. Yet I had very few non-ovulatory periods and other symptoms of severe PCOS. It took 3 years of fertility treatments and 2 IVF cycles to conceive my first child.
I rapidly gained weight from the fertility hormone treatments and in the years after my first child was born. When research finally began to show that PCOS is more of a metabolic issue than a reproductive one, I adopted a low carb diet and went on Metformin. Within a month of starting this regimen, BEFORE any appreciable weight loss, I had my first ovulatory period EVER. Weight came off more rapidly than it ever had in all my previous failed attempts on WW and other “eat less, move more” schemes. I wasn’t even exercising much at that time because I was working 2 jobs and attending night school (aren’t I the picture of a lazy, fat slob!). 6 months later, to my utter surprise, I was pregnant.
In my case, there is NO question that insulin resistance came first and contributed to the obesity (I’m not rejecting my own responsibility for what I put in my mouth, but insulin resistance was a huge driving force in that as well). Within 1 month of reducing insulin resistance, symptoms were dramatically improved. Weight loss was secondary.
You do a grave disservice to suggest that weight loss alone will improve insulin resistance. Weight loss with a high carb, low fat diet will not have the desired effect–in fact higher carbs can make insulin resistance worse and require an individual to need MORE medication, regardless of any weight lost.
Weight loss is always a positive thing, but people need more tools than “eat less, move more” to assure long term success.
Thank you for sharing your story, Janknitz. We are fighting an uphill battle, as we are many, many N=1′s. I agree with you 100% that “eat less move more” is not the answer to metabolic disturbance!
@Hylin,
Ok, what I meant was anything which raises blood glucose significantly and reasonably fast should be avoided or eaten sparingly. Everything except pure fat (I saw no values for fat alone in the PDF you linked) does cause some insulin response–true enough, and I did not say otherwise. But people have to eat. Even diabetics. Choosing foods that raise BG less (meats, non starchy vegetables), rather than more (grains, starchy vegetables, legumes, sweets) seems like a reasonable strategy to me. Or one could choose to eat whatever one wishes and take meds. I know people like that.
Actually, pigs, in particular, are anatomically and physiologically not as dissimilar to people as you would think and you cannot completely discount that similarity. Pigs, like people, are omnivores and would happily eat meat and thrive on it if given the chance. But we don’t give them that chance because a) we don’t want trichinosis and b) we want fat pigs–they do indeed grow fat on a diet of grains–ask any farmer. If you think people don’t, take a look at the obesity statistics and the typical American diet, which is also high in grains (as recommended by the USDA). Think that’s a coincidence?
Sorry. Hylton.
Gary Taubes’s landmark book “Good Calories, Bad Calories” includes exhaustive references to studies that either debunk the “lipid hypothesis” of fat,saturated fat in particular, causing heart disease or show the poor quality of science used in all of those studies. The book is about 1/3 references, so Murph could be busy for quite a while.
I’m so surprised that anyone still buys the fat fallacy when the science is absolutely clear and easily available.
I do not pay any attention to epidemiological “studies” which are self-reported diaries submitted by individuals and are notoriously unreliable. The other problem with this sort of “research,” is that the “scientists” comb through mountains of this self-reported data looking for correlations, usually looking for anything that supports their pre-existing hypotheses. Then, their reports, especially as published by the media, mistakes correlation for causation. That’s exactly how we got 50 years of the “lipid hypothesis” foisted on us by Ancel Keys and his 7 Nations Study that has destroyed the health of much of Western society. I’m surprised Murph has never heard of Ancel Keys, George McGovern, and the bad science that spawned the promotion of lowfat diets and the epidemics of obesity and “diabetes” that ensued. So, read Gary Taubes, who tells the story. Or for better entertainment, watch the documentary “Fathead” by Tom Naughton. He also does a good job of describing the folly of the fat fallacy.
Again read the Phinney/Volek book which is full of good science, written for medical professionals, but easy to understand. The book cites exactly the sort of research (real, lab studies) that Murph is seeking. The difficulty is that true double-blind, controlled studies of human behavior are very hard to conduct. Perhaps all of the n=1 experiments described by the commentators here add up to one big study. You can add me to the list. Is 12 years long enough to prove the efficacy of a low-carb, high-fat diet? That’s how long my brother and I have been low-carbing. With our family history, it’s proof enough to me that low-carb normalizes weight and blood sugar in people with genetic insulin resistance.
Hylton: “That book [Wheatbelly] is atrocious. Please reconsider where you procure your nutritional information.”
Hylton, if you had read any Jane Austen you would know that a jibe is not a rebuttal.
Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 2004;140:769–77.
This is just one of the studies conducted by Eric Westman, et. al.
There was also the Krauss Study, a meta-analysis of countless nutrition studies over the years that concluded that there is no correlation between saturated fat consumption and heart disease and the the nutrition class that is most closely associated with risk for heart disease is dietary carbohydrate. I don’t have the link but Jimmy Moore’s blog has a major discussion of this study in its archives.
@Peggy Holloway, here are links to the studies you mention.
http://www.ajcn.org/content/86/2/276.full is the link to the first study, which I’m sure won’t be satisfactory to @murph et al due to the short length of the study and the fact that there were additional variables–supplement, for example, given only to the low carbohydrate group.
http://www.ajcn.org/content/86/2/276.full is the link to the second study–the meta-analysis. This article, as far as I’m concerned, says it all: The conclusion of the study: “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.” Since it is epidemiological studies that implicated sat fat in the first place, it is valid to use epidemiological studies to vindicate it.
@Hylton, “What I cannot tolerate is some of the really poor arguments bandied about as facts by many low-carb advocates.” such as?
@murph, “Science isn’t about picking a champion before the results are in.” It’s funny you should say that, because it was decided that sat fat is the villain before the results were in, yet you (and millions of others, including your doctors), have no problem accepting that.
“I’d certainly like to see the study that undoes the correlation between saturated fats and elevated risk of heart disease.” Here’s one, which is actually more than one as it is a meta-analysis. (I linked it already in a previous post, but it doesn’t hurt to repeat.) http://www.ajcn.org/content/86/2/276.full Conclusion: “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.”
Can I offer a correction to your excellent post?
Diabetes is not the leading cause of the problems you list, poorly-controlled diabetes can lead to these. As a person with type 1 diabetes for 40 years, I’m doing just fine.
DAMN skippy! And I’ll add that the traditional Japanese diet, based on rice (or, in times of bad rice harvests, millet), fish, relatively unprocessed soy, and lots of vegetables, has long been considered one of the planet’s healthiest.
Hello,
I have a 6-year old son who is grossly overweight and I am kind of worried for him. Can you recommend some weight loss tips for him? Almost all the weight loss solutions I found online are meant either for teens or adults! Many thanks for your help!
@Jasmine, Feed your son real food: meat, eggs, fish if he’ll eat it, full fat dairy, vegetables (mostly non starchy ones), nuts and nut butters, and low sugar fruits like berries. Stay away from processed foods–the cereals, breads, cookies. Ditch the fruit juice, soda, and any other sugared beverages (flavored milk, for example.) Lots of people eating Paleo or Primal are feeding their kids of all ages this way, too. Here’s a link to the blog of a brand new doctor who (I think) is going to specialize in Pediatrics, has a kid, and has made it her business to learn way more about nutrition than most doctors: primalmeded.com Good luck. You are right to be worried, but there really is a solution.
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