Why You Don't Want to Go Low Carb or Vegan

Part 5 of a 5 part feature

Hope Warshaw, MMSc, RD, CDE, BC-ADM, is a diabetes educator and freelance writer. She is the co-author of The Complete Guide to Carbohydrate Counting, 2nd ed. and Practical Carbohydrate Counting: A How-to Teach Guide for Health Professionals, 2nd ed (in press); both books are published by American Diabetes Association.

One You Can Follow Forever!

| Apr 24, 2007

Let’s be realistic and take a long-term perspective in this “which diet is best” debate, rather than wasting time quibbling over extremes—from low-carb to vegan. 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. The major challenge in weight loss, and even more so in weight maintenance, is long-term adherence.

A Team’s No Good If All the Players Quit

A number of 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 (1,2). But studies of low carb diets that last longer than six months do not show significantly more weight loss. They do show that many study subjects drop out of the study and are unable to stick with the diet. (1,2)

Low-carbohydrate diets are not recommended by the American Diabetes Association for two key reasons. First, avoiding carbohydrate, as some low carb diets suggest, does not entirely return blood glucose levels to the normal range after meals.  Second, an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber. (3,4)

Simply put, diets that force people to dramatically change their eating style are not maintained over the long haul. These diets require too dramatic change compared to the common, albeit not healthy, eating habits of the 21st century.

Keep Those Players Coming to the Game

Research from numerous studies, including the Diabetes Prevention Program (5) and the National Weight Control Registry (6), show that people can lose weight and keep it off successfully for three years and five years, respectively, by reducing dietary fat and total calories.

In addition, you need knowledge and skills to make lifestyle changes, as well as help in setting behavioral goals, not to mention ongoing and long-term support. The Diabetes Prevention Program (4) and other studies have demonstrated the need for support, yet our health care system does not reimburse for much education, let alone for support. Keep in mind that Medicare beneficiaries diagnosed with diabetes are eligible for both initial and follow-up care, called Diabetes Self-Management Training and Medical Nutrition Therapy (7,8). These benefits, unfortunately, continue to be woefully underutilized. Many other health plans cover these services as well. Ask your health care provider to refer you to a diabetes education program.

Remember, diabetes lasts the rest of your life. You need to find an eating plan that you can follow that long as well.

1. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill D, Mohammed S, Szapary PO, Rader DJ, Edman JS, Klein S.:  A randomized trial of a low-carbohydrate diet for obesity. NEJM 348(21): 2082-90, 2003.
2. Bravata, DM, Sanders L, Kuang J, Krumholz HM, Olkin I, Gardner CD, Bravata D: Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 289: 1137 – 1850, 2003.
3. Sheard N, Clark N, Brand-Miller JC, Franz MJ, Pi-Sunyer FX, Mayer-Davis E, Kulkarni K, Geil P: Dietary carbohydrate (Amount and Type) in the prevention and management of diabetes. A statement by the American Diabetes Association. Diabetes Care. 27 (9):2266-2271, 2004.
4. American Diabetes Association. Nutrition recommendations and interventions for diabetes—2006. Diabetes Care. 2006;29:2140-2157. 
5. Hamman RF, et al: Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care 29(9), 2102-2107, 2006.
6. Shick, S.M., Wing, R.R., Klem, M.L., McGuire, M.T., Hill, J.O., & Seagle, H. Persons successful at long-term weight loss and maintenance continue to consume a low calorie, low fat diet. Journal of the American Dietetic Association, 1998, 98, 408-413.
7. Medicare coverage of diabetes supplies and services. http://www.medicare.gov/Publications/Pubs/pdf/11022.pdf. Accessed 2/13/07
8. Warshaw HS: Referral to Diabetes Self-Management Training (DSMT) and Medical Nutrition Therapy (MNT). Practical Diabetology. 23 (3), 12 – 19, 2004.

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Posted by TJPJE777 on 15 November 2007

Im a believer as well. "Low Carb" not
"NO Carb" is a great way to keep my BG "NORMAL" or near normal. Dr. Bernstein I tip my meter to you in thanks.

Even though people told me that your "Life Style would not and could not help with my diabetes you have proven them all wrong. Living with Type I for such a long time and being your own test subject, I have a lot of faith in what you say because you have lived it.

I find that if you have a vested interest in finding a better way and follow it yourself you become the greatest example of success.

Diabetes is for life and if you want a better quality of life then you do what will give you that quality of life. Not just for the day, the week, the month or the year... but for your life... after all food is just fuel for you do enjoy your life... not make it more than it acutally is or else you have fallen into the trap of the product salesperson. Eat to live don't live to eat... we make too much of feeding our tastes instead of feeding our body.

Just do it!

Posted by Anonymous on 29 November 2007

My fasting is usually below 100mg/dl, I rarely go higher than 110mg/dl after meals (peak BG NOT 2 hours after.) I'm curious how high your BG is after that oatmeal. I started out eating cheerios and fruit for breakfast and taking the glyburide, too. Now I eat eggs, meat, cheese or some combination for breakfast and meat with salads or veggies at other meals and only take the Metformin. My breakfast can make my BG go down, my last A1c was 5.2% and no more hypos.

Posted by Anonymous on 3 December 2007

To give you an update.

This is Dan again, well, I'm down to 208lbs. I'm still enjoying a bowl of Oatmeal (which now includes a tablespoon of Blueberries) and eating fruit for breakfast. I've join a Fitness club. Which now have double my cardio excersise. My current fasting BG is now 80-90mg/dl.

After experiencing many hypos. My doctor have lower my glyburide from 5MG to 2.5MG. I cut back on the Oatmeal shake and switch to fresh fruits. I've also don't eat Cheerios for breakfast. I have another 2 months before my next A1c.

I cut down on my Subway much. I'm eating more chicken and fish lately. But still I do not allow any red meat in my diet.

I feel positive both physically and mentally. Excercise is indeed the better medicine. You don't have to run a marathon or join a gym. Walking more is indeed a great weapon.

I'm also not having any more alcohol in my life. I'm not a smoker. Please, if you have are smoker just quit.

Posted by Anonymous on 22 December 2007

I have a son who is 7 yrs old and type 1. I am a firm believer of the low carb lifestyle and eat low carb myself. I feel like a big hypocrite because absolutely everyone tells me that it is impossible and unhealthy for a child to eat low carb. I certainly don't believe the unhealthy part but in our society I can almost buy the "impossible" part. I want my kid to be a regular kid and not feel like an alien among his peers. All his freinds eat high carb and all the school lunches are high carb. He eats hgih carb too and his blood sugars are all over the map.

With a kid what am I to do???

Posted by Ladybird on 28 December 2007

I think, you're wanting some praise, Dan! Bravo! I think you're doing well...that is a "low carb" lifestyle, as far as I'm concerned. I'd add some skim milk to the oatmeal and enjoy it even more. I feel,the oatmeal/cereals in the morning with skim milk are healthy. I'm glad you've cut down on the subway sandwich! I also have cereals in the mornings and fruits, not overdoing it, for that something tasty after meals.

I think cutting out processed food, also like all the cookies, cakes etc. has really helped me with weight loss and bringing my A1c to "normal"

Why not add more veggies to you eating style also now? You'll feel even better. Do let us know your new A1c once you do your new tests.

Posted by Anonymous on 9 February 2008

Big Pharma and Big Carb will do anything to keep doctors believeing loow/mo carb is bad. Humans have only been eating grains for a few thousand years in our 2.5 million year evoltuionary history. That's not enough time to evolve to handle it. Skeletons show all sorts of health problems appeared when grain eating did. The sad part is, we are so overpopulated the world absolutely has to consume vast amounts of grain to keep everyone alive.

Posted by Green Lantern on 18 July 2008

It's hard to lose weight and people don't tend to stick to a plan. Well, THERE'S a revelation. From the newest research out of Israel, it's a lot harder to stick to a low fat plan. One like Rosedale, where you get half of your calories from good fats (nuts, avocados, olive and unprocessed coconut oil, salmon, etc.), eat lots of non-starchy vegetables and have moderate amounts of protein and non-tropical fruits helps restore the body's ability to burn fat instead of just sugar for fuel. AND...you don't starve--with all that yummy fat you're full. I lost 19 lbs. in 6 months on this plan, and my blood sugar levels are no longer in the pre-diabetic range.

Telling people who can't process carbs to keep eating them because it's hard to stop is very poor advice.

Posted by volleyball on 30 September 2008

Ms Warshaw, I can see how you may have come to your conclusion. You try to help patients and over time, you find them unmotivated. They want to continue to do what they did and think a magical pill through the miracles of science will compensate. You offer them a healthier meal plan and hope they follow. At least while you are working with them, they can get predictable numbers.
While those people still exist in great numbers, the internet has brought vast information to the masses. People can now make informed choices. They can fuel their motivation. These people and a high percentage of the people here fit this catagory, are not going to impressed by your article. You are preaching to the wrong crowd. And that is why you offer a disservice to people with your credentials, you give us more reason to distrust.

Posted by YODA on 1 February 2009

Nonsense. I have been on a low carb diet for over 15 years, thanks to reading Dr. Bernstein's book "Type 2 Diabetes" soon after being diagnosed. I went from over 200 lb. to under 170 lb., and am still under 170 lb. I use only Metformin and have an A1c of 5.6.

Posted by Anonymous on 9 April 2009

After being diabetic for 10 years I found that over time my sugar was getting harder to control as well as my weight. When my HA1C hit 8.4 while on 2 meds and a nightly insulin shot I knew I had to do something. That's when I heard Dr. Neal Bernard on NPR radio. I purchased his book Reversing Diabetes. After reading and studying the program I decided to try it. I won't say it is easy. But the results are amazing. I started before Thanskgiving. By the end of Feb my A1C was down to 7.4 a whole point. My cholesterol was down from 210 to 140. I do miss cheese and eggs but not the meat. I use some soy substitutes for cheese and milk. I don't like the meat substitutes except for vegie burgers. I had already joined a Jazzercise program and continued with it. I have lost20 lbs something I could never do before. So for me it is worth it.

Posted by Anonymous on 18 September 2009

The title suggests a vegan diet is not a healthy choice for diabetics but then does not address that topic at all in the article. The title should only reflect what is actually written about.

Posted by Anonymous on 1 November 2009

This is just more of the same, "don't do it because you won't be able to." Many diabetics keep their disease managed with low-carb diets. While I am admittedly an otherwise healthy type 1 without weight problems, I was a carb junkie until diagnosis and have had great success since minimizing my carbs to 50 or so grams per day.

There are some of us out there with adequate discipline who would benefit greatly from low-carb diets, but are discouraged by dieticians who take the asinine position that we won't be able to stick with it, and therefore should not bother.

My meals generally consist of a combination of lean meat (chicken, turkey, ham, lean beef), egg whites, vegetables (except for starchy ones), and no more than 1 carb serving (usually low GI fruit or whole grain). I stick to carbs with low glycemic indexes. I snack on things like nuts and have sugar free jello with whipped cream as a treat.

Since diagnosis with an 11% A1c and fasting BG of 340, I am now always within normal range (70-120 BG and low 5's A1c). It is terrifying to think about how many diabetics needlessly suffered complications because their health care providers are more eager to stamp templates on them rather than giving the benefit of the doubt.

Posted by Anonymous on 31 January 2013

This has to be the lamest argument I've ever heard:
"Simply put, diets that force people to dramatically change their eating style are not maintained over the long haul."

I started a low-carb diet a decade ago, when I was diagnosed with diabetes, at the suggestion of my physician. Within 3 months, she took me off medications to control my blood sugar. Now, a decade later, I am still eating a low-carb diet, and without medication to control my blood sugar.
My doctor says I'm healthier than patients she has that are half my age, without diabetes.
(Granted, regular exercise is also part of my regime).

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