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There came a point in Evelyn Narad's life when she knew it was time to get serious about losing weight. She was 75 years old and had been diagnosed with type II diabetes 22 years ago. A broken shoulder and hand in the summer of 1995 kept her from exercising, and every inactive day she spent inside her house seemed like another pound gained.
She had tried everything-the dietary recommendations of the American Dietetics Association, Dean Ornish's diet, Weight Watchers-but nothing worked. A friend had lent her the audio tapes of Dr. Richard Bernstein, which described a radical method of losing weight by decreasing carbohydrates. When Narad mentioned the Bernstein diet to her doctor, he thought she was crazy. If she should do anything, he told her, she should increase her carbohydrates and decrease her consumption of fat. She tried a version of the low-carb diet anyway, and has been on it ever since. After a year she has lost close to 100 pounds, from a portly 219 pounds to a trim 128. Her doctor doesn't call her crazy anymore.
"I lost a small fifth-grader," Narad says proudly, referring to the amount of weight she's lost.
Narad is one of the lucky few who have found a diet which takes the weight off and keeps it off. But she's not about to proclaim a new "miracle diet" to the world. She attributes her weight loss to finding a diet which caters to her individual body type.
"To thine own self be true," she says. "You have to learn what you're doing to your body and what your body will do back."
Narad is not alone in her opinion. Since the American Dietetics Association (ADA) last revised its diet plan in 1989, the average American has not lost weight but gained it. The ADA diet is based on an individual daily calorie count. Within this calorie count, the diet recommends a limited number of servings from each food group. But this "common denominator" approach has left some people frustrated and still fat.
Dietary gurus have diverged from the generalized approach of the ADA, to branch off in more extreme directions. Doctors such as Julien Whitaker, author of Reversing Diabetes, and Dean Ornish, famous for his success at reversing heart disease, encourage high carbohydrate diets with a minimum of fat. On the other hand, doctors such as Bernstein or Mary and Michael Eades, authors of Protein Power, almost forbid carbohydrates while pushing the benefits of protein.
Low-Carbohydrate, High-Protein Diets
The Bernstein and Eades diets are based upon the body's dynamic of insulin and glucagon. Carbohydrates enter the bloodstream as glucose. If a meal generates more glucose than the body can use, it produces insulin to convert the excess glucose into fat. Later, as blood sugar declines, the hormone glucagon, the same substance used to treat an insulin reaction, converts the stored energy in fat back into the blood. As long as insulin and glucagon remain balanced, the body maintains a healthy weight. But if a person continually overloads the body with carbohydrates, the "fat-producing" hormone insulin overrides the "fat-burning" hormone glucagon. Bernstein and Eades recommend cutting the carbs to halt excessive insulin production and let glucagon get to work on the fat.
Though the protein diet may sound convincing as a concept, it has received criticism from many experts in the nutrition community. "People think that because carbohydrates turn to glucose in the intestines, diabetics should avoid them. This is not only wrong, it's 180 degrees backward. Carbohydrate foods are therapy for diabetics," says Dr. Julien Whitaker.
Chris Kohl, who has had type II diabetes for five years, tried the protein diet around Thanksgiving of 1995, but found it too hard to stick with. He was surprised to find out how difficult it is to avoid carbohydrates. He could eat the turkey, but he couldn't eat the stuffing, the mashed potatoes, the cranberry sauce or the pumpkin pie.
Eating protein and fat in place of carbohydrates didn't seem worth it for Kohl, especially considering the correlation of fat with high cholesterol and heart disease. "I want a diet that will make me a healthier person all around, not one that will just cut my weight. The Bernstein diet just wasn't practical," says Kohl.
Maria Gillen is 30 years old and has had type I diabetes for six years. She became interested in the Bernstein diet when a friend of her mother's told her that Dr. Bernstein claimed to achieve perfect blood sugars on his diet. Gillen was skeptical. Though she was proud of her low blood sugar averages and did not consider herself overweight, she decided to try the diet to see if she could really achieve the "perfect" blood sugars Dr. Bernstein described.
Within a few months on the diet, Gillen lost 20 unneeded pounds. She did not lose any more weight after that, showing that the diet cuts only the excess weight. After six months her HbA1C levels have decreased to 5.8 percent, converting to an average blood glucose level of 132 mg/dl. Gillen's husband also follows the Bernstein diet, though he does not have diabetes. He has always been thin and has not lost a pound on the diet. Gillen says he decided to try the diet to support her, but once he started, he found the diet gave him more energy.
Gillen eats two ounces of protein and eight grams of carbohydrate for breakfast and four ounces of protein and 12 grams of carbohydrate for both lunch and dinner. The diet allows Gillen to eat a couple of eggs along with a low-carbohydrate piece of toast for breakfast. For lunch she might eat a small piece of fish or chicken and a vegetable. She says she likes to have a salad along with whatever protein she has for dinner.
Gillen says the only restaurants she avoids are Thai and Italian- Thai for the sweets in the food, Italian for its propensity for massive quantities of pasta. "But there are so many weird diets out there, staying away from a couple of different kinds of restaurants is not bad," says Gillen. "I was a 'carboholic' before this diet, but I haven't felt deprived."
High-Carbohydrate, Low-Fat Diets
The high-carb, low-fat diet works under the principal that fat rather than carbohydrate causes weight gain, not to mention a host of other complications. At some point in the game, the person with type II diabetes lost his or her sensitivity to insulin, most likely due to already being overweight. As the body reacts by producing more and more insulin, the person gains weight from the increased insulin, becoming more and more insulin resistant. The majority of people with type II diabetes suffer from this vicious cycle.
Dietitians recommending a low-fat diet believe the high-fiber bulk of complex carbohydrates will satisfy a person's appetite with a minimum of calories. Cutting back on simple carbohydrates such as sweets and alcohol and eliminating fat offers a healthy method of losing weight. As a person with type II diabetes loses weight, his or her sensitivity to insulin improves, the body produces less insulin, and the vicious cycle is reversed.
Many people find the high-carb, low-fat diet easy to adopt into a daily meal plan. Ted Czupik took his diagnosis of type II diabetes as a shock, especially when his doctor restricted him to a 1,500 calorie-a-day diet. At 54 years of age, Czupik had never thought twice about a second piece of pie. 1,500-calories-a-day made his new life with diabetes seem almost unmanageable.
"That kind of regimen hurt my psyche. I was going to stay on whatever diet the doctor prescribed, but 1,500 calories felt like I was starving myself," says Czupik.
The doctor referred Czupik to Susan Thom, RD, CDE, who placed him on a diet consisting of 55 percent carbohydrates, 20-25 percent protein and 20-25 percent fat. Much to Czupik's pleasure, she also raised his calorie consumption to 2,000 a day. Czupik lost 15 pounds in six weeks on the diet with relative ease. With the help of a menu planning guide, he had appropriate examples of each meal and a calorie listing of common carbohydrates.
Czupik was happy to find that his cholesterol count decreased from 203 to 163, and that he was able to stop taking his medicine for hypertension. Thom has raised Czupik's calorie count to 2,500 a day, and the weight hasn't returned.
"If there is anything positive to say about being diagnosed with diabetes, I would say that it improved my diet. I pay attention to what I eat now, and I feel like a healthier person," says Czupik.
Though the low-fat diet has been proven to help people lose weight and, as some claim, reverse heart disease, new research has shown that such a diet does not necessarily always lower the risk of a heart attack. Ronald Krauss of the University of California, Berkeley, studied 200 male subjects who reduced their consumption of fat from 30-40 percent of their diets down to 20 percent. The subjects, who were already in danger of a heart attack with triglyceride levels above 200, dramatically improved their cholesterol levels. But "healthy" men with triglyceride levels below 100, actually had their cholesterol levels go up.
"Not everyone is genetically programmed to go on a low-fat diet," says Krauss.
Stick with Whatever Works for You
Thom emphasizes the idea that different diets work for different people. She recommends a person keep an honest record of his or her diet habits and then consult a dietitian. Thom uses a variety of diets including the ADA's "exchange" diet, fat monitoring and carb counting. She does not advise her patients try the low-carb, high-protein diet for more than four months.
"Your body's preferred fuel is carbohydrate," Thom says. "The high protein diet will help you to lose weight, but soon a person will start losing muscle mass rather than fat."
According to Thom, a person must be genuinely ready to lose weight before any work can be done. Most people fail at their diets because they don't really want to be on a diet.
"People will use any excuse not to pay attention to what goes in their mouths," says Thom. "Somebody will break his diet because it was the Fourth of July, then not go back because he thinks it's too late. Before I consult with anyone, I always ask them, 'Are you ready for this?'"
A Way of Life
When Evelyn Narad has some friends over for lunch, she is proud to greet them without crutches, "and more importantly, without medication!" she says. Her guests can't believe their eyes.
She serves grilled chicken breast and a large spinach salad. The only things she doesn't eat in the meal are the rolls with margarine and the ice-cream for dessert. When asked how a diet could cause such a miraculous change in a person she first attributes her success to starting slowly, one day at a time.
"But this isn't a diet," she says. "It's not something I just decided to do for a little while. This is how I've chosen to live my life."
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.