Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat

[lowcarb0rbustmypants]

Another great article on the Diabetes Health website.

Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat - Diabetes Health
Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat

Richard D. Feinman, PhD, is Professor of Biochemistry at State University of New York Downstate Medical Center, co-editor-in-chief of the journal Nutrition & Metabolism, and Director of the Nutrition and Metabolism Society (Nutrition & Metabolism Society - Home).

Diabetes may be described as a disease of glucose intolerance: high blood glucose is both the characteristic indicator and the cause of complications.

The loss of control of glucose metabolism is what makes a low carbohydrate diet a good therapeutic approach, and it's why I'm astonished that experts encourage people with diabetes to eat carbohydrates and then "cover" them with insulin [1].

I am also surprised to hear negative reactions to carbohydrate restriction from people who have actually seen the deleterious effects of high dietary carbohydrate on people with diabetes. On that note, I offer my personal rebuttal to Hope Warshaw's recent article, "Why You Don't Want to Go Low Carb or Vegan," April/May 2007.

Ms. Warshaw's argument is that "avoiding carbohydrate, as some low carb diets suggest, does not entirely return blood glucose levels to the normal range after meals." Well, depending on the patient, sometimes blood glucose does return to normal. In any case, ingesting carbohydrate raises blood glucose.

Ms. Warshaw goes on to say, "Second, an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber." I thought fuel is just what we are trying to reduce. And does anybody think that having to take a vitamin supplement is in the same ballpark as injecting insulin? And how healthy is an eating plan that requires medication?

At the 2004 Brooklyn conference on the Nutritional and Metabolic Effects of Low Carbohydrate Diets, William Yancy, Jr., of Duke University described his research with type 2 patients. After sixteen weeks on a low carbohydrate diet, seven of the 21 patients discontinued their medication and ten of the 21 reduced their medication. During the post-lecture discussion, two physicians "warned" that doctors should not put diabetic patients on a low carbohydrate diet without first reducing their medication.

Of course, if you are taking medication, you should reduce carbohydrates only with medical supervision. In most diseases, however, a reduction in medication is considered a sign of improvement. Why would Ms. Warshaw recommend a diet that requires more medication?

It strikes me as odd that what most experts know about metabolism - diabetes is, after all, a metabolic disease - they learned in medical school from somebody like me [2]. The first thing we teach medical students at Downstate Medical Center is that there is no biological requirement for carbohydrate.

It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose.


Figure 1A. Macronutrient consumption during the diabetes epidemic. Data from National Health and Nutrition Examination Survey (NHANES). Absolute caloric consumption from surveys for indicated years. Top of charts: per cent consumption from 1971-74 vs. 1999-2000.
Figure 1B. Incidence of diabetes by year. Data from National Center for Health Statistics.The second thing we teach medical students is that almost all the increased caloric intake during the ongoing epidemic of obesity and diabetes has been due to an increase in consumption of carbohydrate and a decrease in the consumption of fat (Figures 1A and B). When you look at the foods whose consumption increased during the diabetes epidemic, you see that cereals and grains are among the major ones. (Of course, almost everything increased except red meat and eggs.)

So what is Ms Warshaw's complaint? Well, she points out that "studies that compare low carb diets to conventional diets demonstrate early initial weight loss and improvement in other health parameters, such as blood glucose control ([3]). But studies of low carb diets that last longer than six months do not show significantly more weight loss."

Something's wrong here. Because low carb diets do the same as traditional diets after one year, then you don't want to be on a low carb diet? If they are equal, why doesn't that mean that you don't want to be on a traditional diet? In any case, what is rarely mentioned is that in the study in reference [3], the diets were quite different at six months; as the study proceeded, however, the low carb group added back more carbohydrate. The lesson is clear: the more carbohydrate, the worse the weight control. And the long-term outcomes were not the same. Triglycerides and HDL (healthy cholesterol) were much better on the low carb diet than the low fat diet (Figure 2).


Figure 2. Results at 6 months and 1 year for a multicenter study in which obese men and women were assigned at random to a low-carbohydrate diet or a conventional low-fat diet. Data from reference [3].
Reference [3] is important for showing the general health benefits of low carb diets even when a difference in weight was not maintained, but that study did not include people with diabetes. What happens in those people? Figure 3 shows the results from a controlled ward study of ten diabetic patients before and after three weeks on a strict low-carbohydrate diet [4]. The figure shows the dramatic reduction in insulin fluctuation and, on average, the "return of blood glucose levels to the normal range after meals." Patients were content with the diet, lost weight, had improved lipid profiles, and increased insulin sensitivity by 75 percent.

I don't know of any study on any other diet that shows such good effects on controlling glucose and insulin without increasing drugs. And it's not just the glycemic control. We recently summarized data in the literature showing that all of the features of the so-called metabolic syndrome-high triglycerides, low HDL, hypertension and obesity-are exactly the features that are improved by low carbohydrate diets [5]. If we had been describing a drug, everybody would have rushed out to buy stock in our pharmaceutical company.


Figure 3. Glucose and insulin levels for patients before or after 3 weeks of a low carbohydrate diet. (To convert glucose to mg/dL, multiply by 18). Data from reference [4].
Ms. Warshaw's complaint is that these studies "show that many study subjects drop out of the study and are unable to stick with the diet." She does not mention that the drop-out rate from the low fat diet was the same as from the low carb diet; that's generally true of the many low carbohydrate studies. In any case, wouldn't it be good for diabetes counselors to encourage compliance rather than to dissuade people from a strategy that actually works for the many people who follow it?

You might want to think twice before you let Ms Warshaw tell you what you don't want to do. "You'll have type 2 diabetes for the rest of your life, and you'll likely struggle with weight management throughout your life as well." She seems to be saying that you may as well go ahead and eat candy because it's all hopeless. There are, however, several sites on the Internet that provide a more hopeful look at managing diabetes with carbohydrate restriction; for example, D-solutions (D-solve -- low carb and low insulin diabetes management) and Dr. Richard Bernstein's forum (Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars. Official Web Site).

I am most concerned that if Ms. Warshaw really had something positive to offer, she wouldn't need to dissuade people from making their personal choice. Candy followed by insulin is not good enough.

Even though this article is mainly about diabetes, it also helps explain why low carb works and can be applied to anyone.

[maizenbluebabe]

Thanks for posting this, LCOBMP. Finally a doctor who knows the truth about diabetes and tells it like it is! There is a lot of dangerous information out there from so-called "medical experts."

Case in point: I ran into an old acquaintance I hadnt seen in years and she had been DX'd with Diabetes about 5 months before--is taking a couple of meds for it and is on a " great diet for diabetes" where she can eat 60-70 Gms of "healthy carbs per day" like whole wheat pasta and whole wheat bread, cereals, and a small baked potato, etc etc. You get the pic. She is at least 100 pounds overweight and said she hasnt lost any weight yet but figures that someday soon she will start to lose after her body gets used to this sensible diet.

I tentatively mentioned the value of low-carb and she got all bristly right away and asked if I was a doctor. Poor girl. . She will probably have to continue these poisonous meds the rest of her life and it will be shorter than it needs to be and probably not very healthy, but she is convinced her doctor is right and said "I have all the faith in the world in Doctor So and So, but not in those dangerous low carb fad diets"

I am not gong to get into a p*ssing contest with anyone over this. Suggested she read Atkins and Eades and dropped the subject. But it made me feel sad and frustrated to see how she is continuing to wreck her already-fragile health.

[KlingonBabe]

If you get healthy, neither doctors nor drug companies will make any money off you.

This is why they push a diet that just makes you sicker.

[chantyl03]

Originally Posted by KlingonBabe

If you get healthy, neither doctors nor drug companies will make any money off you.

This is why they push a diet that just makes you sicker.

I completely agree with this statement. I swear my sisters doctor's want to keep just well enough to where they can continue to collect. No one wants to see her get better IMO. And she's so dependent on the medical profession, she won't even consider lifestyle changes.

[Ted_Hutchinson]

What Feinman is telling us in this article is confirmed by this scientist on the Jimmy Moore blog.
Study: Equal Glucose And Energy Production On Low-Carb Or Low-Calorie Diet

It's easy for those with a beginners understanding of low carbohydrate eating to think that it's either burning carbs for glucose or burning fat for ketones. But life isn't quite that simple and the truth is as Feinman points out we naturally go from supper to breakfast without running out of brain fuel and without burning ketones but through the natural process of gluconeogenesis and Browning is showing that the amount of glucose we can generate this way is much greater than we thought. I'm not particularly surprised as I could never get much colour on my ketostix and yet I lost weight at 5 ounces daily and never counted carbs or calories or added exercise.

[Valleydachs]

Here's my daddy's meaning of an "expert" an HAS BEEN (ex) DRIP UNDER PRESSURE (spurt). Nice to see this may talks sense!


SandiH

[Margot 65]

Great article!!

I do want to add though that there is an entire population that enjoys being under a Doctor's care.

I know a few diabetics who prefer to eat candy and then inject themselves (or their kids because well, kids want to eat cake... were her words)

I know a lot of people who know how they should be eating for better health. They see myself and my hubby who eat this way and their words are 'I just can't.. there is no way I could do that' (so I will just stay fat and sick... and probably get fatter and sicker)

[maizenbluebabe]

Originally Posted by Prozak

Great article!!

I do want to add though that there is an entire population that enjoys being under a Doctor's care.

I know a few diabetics who prefer to eat candy and then inject themselves (or their kids because well, kids want to eat cake... were her words)

I know a lot of people who know how they should be eating for better health. They see myself and my hubby who eat this way and their words are 'I just can't.. there is no way I could do that' (so I will just stay fat and sick... and probably get fatter and sicker)

YES!

havent we all known people who said, "No, I dont want any special diet or exercise plan to control my (fill in the blank) I told my doc, just gimme a pill or a shot.."

[KlingonBabe]

Originally Posted by maizenbluebabe

YES!

havent we all known people who said, "No, I dont want any special diet or exercise plan to control my (fill in the blank) I told my doc, just gimme a pill or a shot.."

I am totally the opposite. I want the preventive lifestyle measures (diet, exercise, rest, stress management) so that I can AVOID taking medications.

[Margot 65]

It absolutely takes determination and gumption to get on board with low carb.. not to mention the mind set to go against the grain of everything we have been told.

It is to bad that most of us find out only when we ARE sick and fat.

This is why my kids are learning how to eat now, and not wait until it is too late.

[sugarless4life]

Originally Posted by KlingonBabe

If you get healthy, neither doctors nor drug companies will make any money off you.

This is why they push a diet that just makes you sicker.

Exactly. And I for one would like to be the first to put both out of business.

Betty

[BamaGal]

Originally Posted by Prozak

Great article!!

I do want to add though that there is an entire population that enjoys being under a Doctor's care.

I know a few diabetics who prefer to eat candy and then inject themselves (or their kids because well, kids want to eat cake... were her words)

I know a lot of people who know how they should be eating for better health. They see myself and my hubby who eat this way and their words are 'I just can't.. there is no way I could do that' (so I will just stay fat and sick... and probably get fatter and sicker)

my mom and my sis are both on meds for diabetes---both have told me they would rather take meds for the rest of their lives than give up potatoes, rice and pasta

[juliebean]

[QUOTE=Prozak;11041338]It absolutely takes determination and gumption to get on board with low carb.. not to mention the mind set to go against the grain of everything we have been told. QUOTE]

I am getting to re-start and I am trying to wrap my mind around low carb because there is so much "stuff" I have been told my whole life that I am sometimes afraid it is true.

[rottinluv]

"The first thing we teach medical students at Downstate Medical Center is that there is no biological requirement for carbohydrate."

It's too bad they don't teach this to all medical students!