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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.
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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