The Debate Goes On: Carbs In or Carbs Out?

This article has been reproduced by kind permission of the author, Riva Greenberg, on whose website,", it first appeared.

| Dec 27, 2007

Recently on "Good Morning America," a friend of mine (and fellow A1c champion) watched author Gary Taubes talk about his new book, Good Calories, Bad Calories. My friend sent this email around: "Taubes says that exercise makes us hungry for carbohydrates and that carbohydrates cause insulin secretion, which creates fat."

One of her email recipients, a PhD medical specialist, wrote back: "There is still a lot that we don't know, but for me, eating less and moving more has led to my weight reduction. I could have dieted on birthday cake as long as I did not eat more cake calories than I spent."

It's a constant debate in this country: What's the magic formula for fast and easy weight loss? The second question, especially for us d-people, is whether carbs are good or bad. To me, the answer to both is simple: eat less and move more. And, since carbs raise blood glucose, eat fewer carbs if you want to lower your blood sugar. Why is that such a difficult notion? Seems crystal clear to me and, trust me, I'm no rocket scientist.

Carbs Arouse Fierce Debate

Around the same time that my friend's email went around, a wicked debate was playing out on the Diabetes Health website. Diabetes educator Hope Warshaw, MMSc, RD, CDE, BC-ADM, wrote a piece called "Why You Don't Want to Go Low Carb or Vegan" that garnered more comments than I've ever seen in response to an article, as well as a rebuttal article by Richard D. Feinman, PhD, Professor of Biochemistry and Director of the Nutrition and Metabolism at State University of New York Downstate Medical Center ("Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat").

In a big nutshell, Feinman said, "I'm astonished that experts encourage people with diabetes to eat carbohydrates and then 'cover' them with insulin. Why would anyone (let alone doctors, who advocate it every day) recommend a diet that requires more medication?" Are they all in bed with pharma companies? (Sorry, that last question is my own.)

"It strikes me as odd," said Feinman, "that what most experts know about metabolism - diabetes is, after all, a metabolic disease - they learned in medical school from somebody like me. The first thing we teach medical students 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 30 and 70 percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose. And all of the metabolic syndrome ills - high triglycerides, low HDL, hypertension and obesity - are improved by low carbohydrate diets. If we had been describing a drug," Feinman went on to say, "everybody would have rushed out to buy stock in our pharmaceutical company."

My Low-Carb Experiences

I can't comment on such metabolic complexities, but I can share with you what I experienced when I changed my diet to low carb. It was five years ago, after I read Dr. Richard Bernstein's book, Diabetes Solution. For the first time, I encountered someone advocating getting rid of carbs to control blood sugar.

Dr. Bernstein advises next to no carbs in a diabetic diet. Himself a diabetic for more than 50 years, Bernstein claims he has reversed many of his early complications and gotten his blood sugar under tight control by virtually eliminating carbs. Fewer carbs means you'll be taking less insulin. By taking less insulin, Bernstein claims, there'll be less variability in its absorption time and efficacy, as well as greater predictability with your blood sugars.

After I read his book, I was so encouraged and inspired that I pretty much vacuumed the carbs out of my diet. I essentially eliminated refined carbs, such as white bread, white potatoes, rice, pasta, sweets, muffins, and starchy veggies. The result? My sugars indeed dropped. They were consistently lower, and my insulin doses dropped. Maybe best of all, I was no longer chasing high blood sugars - you know, the ones that come from refined carbs, where you just can't seem to knock them down all day. My Lantus dose went from 20 to 12.5 units, and my pre-meal Humalog was all but cut in half. The results were so dramatic and made my life so much easier that I never went back to my old ways. (I do have to add the caveat that we're all different, and your body may not respond like mine.)

It's common sense, though, that the fewer carbs you eat, the less your blood sugar will rise and the less medication you'll need. I don't understand how anyone can argue the logic of that. If we're still being given diets with substantial carbs in them, it's probably because the American Diabetes Association (ADA) and other authorities believe that the average diabetic would never stand for cutting carbs so drastically. Along the same lines, the ADA's A1c recommendation is as high as 7%. That correlates with 170 on your meter, even though we're advised to stay in a target blood sugar range of 80 to 120 mg/dl. Does something sound fishy?

A Typical Low-Carb Day

For those interested, here's the routine that keeps my sugars low. My one carb meal is breakfast. I figure it's healthy, high fiber, and satisfying, and since I walk in the morning, the blood sugar rise gets leveled out. Every morning I make a bowl of slow-cooked steelcut oatmeal. I know many people who make a batch every week and freeze daily portions, but I like the morning ritual. I actually eat less than a whole serving, making up the difference with a dollop of low fat plain yogurt or cottage cheese and a tablespoon of peanut or almond butter. I also add flax seed and cinnamon. For this treat (like Jerry on Seinfeld, I could eat breakfast for any meal), I need 3.5 units of Humalog, or only 3 units if I'm taking my usual hour-long walk around my local park.

Lunch is generally a spinach salad with feta cheese, tomatoes, beans and leftover veggies, or a spinach/feta omelet. For that, I need 0.5 to 1 unit. Dinner is typically fish or chicken, vegetables, and beans. If I'm having a glass or two of wine with dinner, I don't need any insulin (Alcohol lowers blood sugar for most people, unless they're drinking strawberry margaritas or Singapore slings.)

A few months ago I interviewed a fellow type 1 who had received an islet cell transplant (two, actually). For 18 months afterward, she was insulin-free. Unfortunately, as is the case for most, if not all, islet cell transplant recipients, her new cells began to fail and she had to add some insulin back to keep her blood sugars in range. She told me, though, that she's still on a very small dose - 14 units total daily. My daily dose is only about 18 units, and none of my beta cells work. Seems enough evidence for me that you can keep your insulin, or meds, to a minimum by sweeping most of the carbs out of your diet.

In the interest of full disclosure, I should tell you in that my diet is not puritanically carb-free. Alas, I am not perfect. When out to dinner, I often nibble on the bread, and I love it dripping with olive oil. (Thank God, someone decided that olive oil is healthy.) I indulge in an order of fried calamari or crab cakes from time to time, and if dessert comes to the table, I'll stick my fork in like everyone else for a taste. But without question, the fewer carbs I eat, the less insulin I need. For me, the control I get and the way I feel are worth it.

If you're curious about a lower carb diet, give it a try. First, hook up a Hoover to your pantry and suck out all the chips, pretzels, rice, and muffin mixes. Second, while experimenting, test, test and test. Third, see if your blood sugars and meds drop. Fourth, reward yourself with some high cocoa dark chocolate. (Lindt's 85 percent Excellence chocolate bar has only eight carbs per serving!) Good luck.

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Categories: A1c Test, Blood Glucose, Blood Sugar, Diabetes, Diabetes, Insulin, Lantus, Low Carb

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Dec 27, 2007

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