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The Debate Goes On: Carbs In or Carbs Out?


Dec 27, 2007

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

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.


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



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Comments

Posted by Anonymous on 21 December 2007

Wonderful! And wonderfully written. This could be my diabetes story as well, as I have come to the same conclusions.

Posted by Anonymous on 27 December 2007

OUTSTANDING COLUMN!!!!

Posted by Anonymous on 27 December 2007

Great article! I am sure we would all feel better with less carbs in our diets.

Posted by Anonymous on 28 December 2007

I am printing this out for my type 1 sister! Thanks!

Posted by Anonymous on 28 December 2007

I am a CDE and RD (have been for 5 years). I educate my clients on both low carb and traditional 50%-55% carb diets. I allow them to choose the diet they want and try it (supervised). I myself follow a diet of about 30 grams carb for breakfast and lunch (about 50% of which is fiber) and then 15 grams of carbs from veges at dinner. My cholesterol has changed for the better (HDL, LDL and triglycerides) and my glucose/A1c is great. Since making the change to carb controlled I have lost 15 pounds and my BMI is now 23. I think people should be educated on both diets and given the option to follow what fits their lifestyle. I also think physical activity is essential and understated.

Posted by Anonymous on 28 December 2007

I agree with the low carb approach. When I am taking care of myself well, that's what works for me. Now I just need to develop some discipline to make it more consistent.
By the way, I haven't heard anyone refer to a Singapore Sling in quite some time. It was a favorite indulgence in my youth!

Posted by Anonymous on 28 December 2007

Of course you would need less insulin, but are you well nourished and getting all the required vitamins, minerals and fibre? Not likely when you aren't eating enough whole grains, fruit, and dairy.

Posted by Anonymous on 28 December 2007

Unless you need to reduce calories for weight or other reasons, it would seem that a reduction in carbs would automatically lead to an increase in protein and fat. We all know how good lots of fat is for the body, so that leaves protein. Most Endocrinologists don't want you on a high protein diet because protein is hard on the kidneys, and kidney protection is of significant concern to them, especially for type I's. I think it may be better to cover the carbs with insulin than to risk damage to the kidneys.

This is just my input, but I have been insulin dependent for over 35 years and have participated in several research studies at the University of California at Irvine. Every one of the Doctors that I have dealt with pretty much say the same thing.

Posted by Anonymous on 28 December 2007

I have to say i am not a fan of the Dr Bernstein book, yes, it is easier to control your blood sugars if you only take 1 unit of insulin and then only eat 17g of carbs, but if you are an athlete, then you have to eat more carbs and then therefore take more insulin..but if you match your carbs with your insulin intake then you can eat apples, potato's, etc...all the stuff that Dr Bernstein says you cannot eat. In fact, if you do a test, you can figure out exactly when your insulin starts to work, and when your food comes in, so you don't have those BS's rising to 200 or 250, in fact i just got finished working out for 2hours on the bike, and then when i was finished i wanted to re-fuel, so i gave myself 3units of insulin waited 15minutes and then drank some chocolate milk, and my BS never rose above 140. So it is definitely possible to keep you Blood sugars in good control and still eat as many carbs as you want.
I can say i am definitely not a fan of the Dr Bernstein book which i read and own but when he says that eating baked potato or apples is not recommended, then i disagree with that 12-12-12-6, especially if you are an athlete

Posted by bluesman on 28 December 2007

my problem is im insulin restant and I have to use 80 units of lantus a day to keep balanced not to mention the 40 units of humalog used before meals i also eat low carb.

Posted by Anonymous on 28 December 2007

Good article - I am going to try to cut my carbs so I can lower my insulin. I know I feel better on a low carb day so all the time ought to be great. Thanks for the article.

Posted by Anonymous on 28 December 2007

I believe in moderation and so I disagree with the get rid of all carbs approach just as much as I disagree with the ADA high carb approach. A lower carb approach is what I try to follow. There are a few good points in the article but they are pushed under the high carb vs no carb slants of the article.

The meals discribed in the article would leave me hungry,unsatisfied, and in food/carb prison. I realize and agree with the need to reduce the total carbs(including veggies and fruits) in my meals but I want to enjoy the food I eat and not live in a prison state where eating whole grain bread, brown rice, and whole grain pasta is not allowed. I enjoy bread or rice with my meal and so I limit the portion and type of bread. A salad is a side to be enjoyed with my meal but is inadequate as a meal by itself. I would be hungry 10 minutes after finishing the salad.

And to make a comment to the author since you are into denial of unhealthy food from your diet you had best eliminate the feta from your salads as it is way too high in sodium and fat to be considered healthy.

Posted by Anonymous on 28 December 2007

I'm not radical about cutting the carbs a la Berstein. I do find that if I keep them fairly low most of the time, I can indulge myself occasionally without a lot of consequence (occasional carb hangover.)
However, I have more of a problem with carbs in the morning. There are things I can eat in the evening without a problem that will make my BG spike and then crash if I try eating the same thing for breakfast. (I'm type 2, hyperinsulinemic.)
No oatmeal for me unless it's a bedtime snack with full fat cream and butter.

Posted by Anonymous on 28 December 2007

I've found the low-carb for type-1 diabetics program somewhat puzzling. What if you are an active person (i.e. exercise several times a week for 30-60 minutes)? It was my understanding the body can't convert protein (via gluconeogenesis) quickly enough to replenish glycogen, and may result in hypoglycemia. Thus such a diet may be better for those who are more sedentary, as they would have less variation in blood glucose because of consistent activity. Yes, no? Being a type-1 with hypothyroid, I'd love to know what is the best diet for me.

Posted by Anonymous on 28 December 2007

One issue that was not mentioned is the fact that healthful high carb foods, i.e., whole grains, starchy vegetables, fruits, and low fat dairy products, provide vitamins, minerals, fiber, and a wonderful array of phytonutrients that are important for good health. Populations around the world who consume mostly unrefined carbs have lower incidences of digestive tract diseases, cancer, cardiovascular diseases, etc.

As an RD/CDE, I provide advice tailored to meet the needs of individual patients. I make recommendations, but I respect the patient's right to decide what to consume.

Posted by Anonymous on 28 December 2007

I have diagnosed Type II for 5 years. I failed two glucose tolerance tests. However, I have severely restricted my carbs during the past 5 years; oatmeal in the morning, and, maybe, a half of baked potato in the evening. Ocassionally, a sandwich of high (double) fibre wheat bread. My quarterly A1Cs for the past 5 years have been no higher than 5.8 and, most of the time, 5.5 or lower. I have no diabetes side effects or damage. I am not starving. I have a couple of drinks a day and, generally, a very low carb desert (

Posted by Anonymous on 28 December 2007

My son is 8 and it is obvious that less carbs equal, less insulin. I can't believe this is even a debate. I do allow my son to eat carbs but we do limit them (as well for my other non-d children). But when my son goes to his excercise class he must have carbs pre-class, we have tried to lower his basal rate but that does not work, he must have the carbs.

Posted by Ladybird on 28 December 2007

I'm a type 2, not on any meds, just exercise and a low carb eating style and I totally agree with you. I manage to stay off meds because of my low carbs. I do eat a bit of bread but only 100% whole grains and a bite of desert only. I've lost a whole lot of weight this way also. Feeling great!! My A1c is 6.3 at the moment, it's been as low as 5.9!

Posted by whimsy2 on 28 December 2007

Right on target, Riva! As a type 1, I try to keep my daily meals as lowcarb as possible, to keep my meal insulin dose low. But when I eat out I fantasize that I'm not diabetic and eat pretty much what i want -- judiciously, like you -- sharing a dessert and eating only a small piece of bread --after the main dish.

Like you, I have trouble with the ADA's continuing advocation of eating high glycemic index carbs. It purely doesn't make sense to eat foods that make BGs go up then take meds to bring 'em down again. Why not avoid them in the first place?

Posted by whimsy2 on 28 December 2007

OOps -- I meant the ADA's ADVOCACY, not advocation, of high GI carbs.

Posted by Anonymous on 28 December 2007

When I was first diagnosed with T2 diabetes almost 3 years ago my 12 hour FBG was 300 mg/dl. By simply reducing carbs it dropped to 125 mg/dl in about 6 weeks. I have since systematically progressed in incremental steps to a very low carb diet (less than 30 grams a day) with intermittent fasting. Most days I eat 2 meals with my first being at between 12 noon and 1 PM and my 2nd at around 7 PM. At least one day per week I eat only 1 meal per day.

My 12 hour FBG is now typically well under 100 mg/dl with post prandal readings consistently well within limits for non-diabetics and with little or no rise after meals.

Perhaps the most disturbing aspect of those who continue to promote high carbohydrate diets for anyone, let alone diabetics, is their abject failure to disclose that no requirement exists for carbohydrate in human nutrition and that in view of this, there is not a shred of science to support any recommendation to include carbohydrates in the diet or to suggest that carbohydrates provide any benefit. In my view this omission constitutes negligence on the part of the proponents of carbohydrates in human nutrition.

Posted by Anonymous on 28 December 2007

This crazy but effective idea can easily be checked out by a newly-diagnosed type 2 diabetic whose medical doctor prescribes exercise as his main diabetes medication.

(1) Exercise no less than 1 hour/day or no more than 2 hours/day, divided into several convenient sessions, like walking briskly indoor, making sure that the heartbeat will go high, like between 165% to 180% of the resting heartbeat. Do the sessions immediately before meals (only 3 full meals of heart-healthy foods, nothing between meals but water), and before bed. Do this for one full week. Take sugar readings before and after each exercise session. If the sugar readings are coming down from day 1 to day 7, then the experiment is successful in proving that the exercise suggested is effective.

(2)Continue the exercise experiment for one whole month and then have an A1c reading taken. Compare this A1c level to the one taken before the experiment was started.

If the second A1c is better than the first A1c, then the experiment is really going in the right direction.

What am I saying? For more than 16 years, my only t2d medication has been exercise. My food intake of mostly heart-healthy carbohydrates in unrestricted amounts have never done any harm to my health.

My A1c's have been in the range of 5.3% to 6.3%, the latest one done in October 2007 was 5.6%. No diabetes complications yet. I have been getting healthier, stronger, and feeling younger every day. I was 55 when diagnosed and will soon be 72 and feeling like I am only half my age.

Posted by Anonymous on 28 December 2007

I also have found that if I reduce the carbohydrates I loose weight and have less cravings for sweets. Exercise is also important. After getting my A1c down after diagnosis it has been under 6 with just diet and exercise.

If I go back and increase the carbs i immediately gain weigh.

Posted by volleyball on 29 December 2007

There has been a lot of good discussion. This will rage on because there is no one right answer. The different type of Diabetes, the body type of the person and the environment all play into what is healthiest for them.
I think everyone agrees that enriched flour, starchy potatoes, processed rice and corn syrup are working against us, some people will thrive better with good carbs in moderation.
A person doing heavy work would benefit from more protein while a person doing lengthy light work may want more carbs
They could both maintain good control with different diets

Posted by Anonymous on 29 December 2007

I have had type 1 diabetes for 46 years. For years I have been constantly having to educate people that insulin is not a "medication" per se - it is a hormone that the body normally produces. A hormone is a chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. For example, insulin is a hormone made in the pancreas that tells other cells when to use glucose for energy.

Type 1 diabetes is a condition where the body does not produce any insulin at all. Type 2 diabetes is the result of the body being unable to use the insulin it is actually making.

All carbohydrates are not the same in how they affect blood sugar levels. Managing your blood sugar levels depends on understanding what carbohydrates are and how the body uses them.

I agree completely with reducing refined carbohydrates, such as "sweets," fruit juices and bread that is not made from whole grains. Those types of carbs will send blood sugar levels on a roller coaster ride!

The fact is that carbohydrates are the primary source of energy for the body. Veggies and beans, brown rice (white rice is a refined carbohydrate) and fresh fruit are all major sources of carbohydrate that contain nutrients that are vital to the proper functioning of the body.

My point is that it's unrealistic to say "cut carbs out" or promote "low carb" as a generality without a good understanding of carbohydrates. If you're at all familiar with the glycemic index, you know that some carbohydrates cause blood sugar levels to rise rapidly, while others (including pasta and beans!) cause a slow, gradual rise in blood sugar levels which is ideal.

Balanced nutrition of protein, carbohydrates, fats and water in the right amounts for good health, plus regular physical activity and good rest are the things we must focus on for health and good diabetes management.

My last A1c was 7, down from 11 a few years ago and I have accomplished this improvement by educating myself on these things.

If you are interested in learning more about how different carbohydrates affect blood sugar levels, I highly recommend the book "The New Glucose Revolution."

Oh, and alcohol "lowers blood sugar" by inhibiting the liver from releasing stored glycogen, a form of sugar. So be careful when consuming alcohol as your blood sugar levels can drop too low. I know, been there and done that!

Posted by Anonymous on 29 December 2007

I'm amazed at how many articles and discussions there are regarding diabetics that are on medication or insulin. I was diagnosed a diabetic (type 2) about 5 years ago and have made every effort to stay off ANY madication.

Last year, my doctor decided to prescribe Actos because my A1C's had peaked to 6.8. I went home, did a little soul searching and decided that it was more about what I wasn't doing than what I was. So, I decided to be serious about my health so that I did not end up like my mother (footless, legless and deceased at 62).

At my next appointment, my A1C's were down to 5.8.

Just goes to show that it is all about how well you take care of yourself, both emotionally and physically and if you really want to take less medications, then you need to get SERIOUS about your health and stop expecting a pharmacy to do it for you.

Posted by Anonymous on 30 December 2007

I'm a Type 1 with hypothyroid and gastroparesis. Low carb would be ideal for me, except that with the gastroparesis, I can't rely on low carb fruits and veggies. Bernstein notes that gastroparesis is one of the conditions that makes a low-carb lifestyle extremely difficult. It would be nice if there was another way.

Posted by Ladybird on 30 December 2007

Bravo to the Anonym poster, second above mine...I wish we'd give ourselves some "names"..I totally agree with you and am also trying to do it your way. At 6.8, I also decided there had to be a better way than med with all their side effects. I don't have to tell you how I did it. It's not easy, certainly but we can do it. I'm at 6.3 at the moment after having got to 5.9 and then got back to 6.6, thinking I was fine now.

Certainly, only once in a blue moon can we stray off the path we have chosen for ourselves and it's not an easy one but a doable one for those who make the FIRM decision.

But, ofcourse, not possible for those who're already at very high A1'c, I'm not suggesting it for them. And, there are those who do need help with the meds because of how their individual bodies react to glucose; we have to remember each one of us is different. There are those who are not lucky enough to be able to exercise, be on the road, or do whatever, even a little bit. For them the meds are a necessity, no doubt.

For those who "can", a lot of Will Power and telling ourselves, YES, we can do it, is the "better" way, to stay healthy. Ofcourse, this can only be said for type 2. I'm happy, I am where I am and have lost a lot of weight. A lot of is just common sense and I believe we should not kill ourselves agonizing about what is the "perfect" way. Eat less of whatever, carbs/ no carbs, move more, should be our "mantra". Starving ourselves in not the way, I believe, but yes, "thinner" is healthier for most of us.

Posted by tralea on 30 December 2007

I think the article is good. I've always believed in restricted carbs. I've only been T1 for 8 1/2 yrs but my grandparents were T1's. I have no complications. I have an insulin pump which makes it easier, but I dont think that is an excuse to eat whatever I want all the time. I think that each person has to find a carb limit that works for them. I generally eat 20-40 carbs per meal and never go over 60. To some that's a lot of carbs, but I've kept my a1c's at 5.7 - even when I was pregnant. I think that for instance an Atkin's approach is dangerous because I believe that some carbs are needed to fuel the body. I think it also matters what kind of carbs are being consumed. High sugar/starches I believe aren't a good choice. On the other hand I think that a small portion dessert is ok on occasion. You have to really know and care about what goes in your body and how much of it. I eat a lot nuts and peanut butter which also helps stablize my bg without sending it high. Using less insulin is a plus for many reasons.

Posted by bird54 on 30 December 2007

PS. It's all about "insulin". Gary Taubes explains it very well. If you eat low carbs your insulin production/needs will decrease, preventing complications, diseases, and extending lifespan--another reason you would not want to eat cake all day.

Posted by bird54 on 30 December 2007

Regarding the theory, "eat less, move more..." Read Taubes pp 259-260 "The belief in physical activity as a method of weight control...has long been contradicted by the evidence. When Russel Wilder of the Mayo Clinic lectured on obesity in 1932, be noted that his patients tended to lose more weight with bed rest, 'while usually strenuous physical exercise slows the rate of loss.'"

Posted by bird54 on 30 December 2007

"...we will experience no hunger if we eat nothing at all--zero calories--and our cells are fueled by the protein and fat from our muscle and fat tissue. If we break with our fast with any amount of dietary protein and fat, we'll still feel no hunger. But if we add carbohydrates...we'll be overwhelmed with hunger and will now suffer all the symptoms of food deprivation." Gary Taubes p. 341

Posted by Ladybird on 30 December 2007

"Bird 54", certainly protein and some "good fats" are great for a diabetic. It all depends on what one means by protein, more meat, as the Atkins Diet recommends or just low fat dairy foods, legumes and nuts. I get my protein from basically no meat stuff since am basically a veggie eater, with fish.

Yes, I know Atkins believers swear on the diet, but what about long term? How much red meat is safe? The Cancer Society has come out eating red meat.

You've been completely been bowled over by Mr Taubes, that is clear. I know I could not possibly live on one meal a day. I eat small portions, almost every two/three hours, so that's out for me. Veggies are also low carb
and Dr Bernstein does recommend them.

And I love to exercise, feel great doing it and it HAS helped me tremendously, to both lose weight and lower my A1c.

I will, though, go and have a look at Taubes book but catch me not walking as much as I can. It's good for us in every way!

Posted by Anonymous on 31 December 2007

I agree completely with the position of bird54. Taubes book is both excellent and factual

Up until I adopted a very low carbohydrate diet with little or no grains I was a carboholic with a ravenous appetite. I could and often did eat enormous portions of high carbohydrate foods. A large pizza, a half a loaf of bread or a bag of biscottis were just snacks for me.

After adopting a low carbohydrate diet and eliminating grains my appetite became modest. Even after going for a day without food my sense of hunger is only slight and easily ignored. I can easily get by on 1 or 2 meals per day and still be completely satisfied by modest meals. And contrary to concerns expressed by some that a low carbohydrate diet is high in protein this is not the case. It is adequate in protein whereas a high carbohydrate diet is often low in protein.

Those who argue that we need to eat carbohydrate foods to keep our blood sugar up (it will certainly do that) or obtain valuable nutrients should spend some time researching human nutrition in a medical library. The scientific consensus is that we easily produce all the glucose we need from fats and protein by the process of gluconeogenisis and that our muscles run best on fatty acids, not glucose, and our hearts actually run about 25% more efficiently on ketone bodies.

I concur with those who believe that we are not metabolically designed to need to eat 4 to 6 times a day as many advocate. If this were the case it is highly doubtful that we would be here debating this issue. Nor is there any requirement in human nutrition for carbohydrate. It is not essential. Protein and fat are. This is not speculation or opinion. It is scientific fat. However, the continued purchase and consumption of what I refer to as carbohydrate based edible products is essential to the economic well being and health of a good portion of the food industry.

Posted by bird54 on 1 January 2008

I forgot to mention that Stefansson and the Inuits did not eat "lean" meats. They ate plenty of fat. At one point during his expeditions, there was a shortage of food, so they ate a skinny caribou and got very ill from a deficiency of fat. Years later, at Bellevue Hospital, Stefansson repeated his experiment, eating only lean meat for a few days, and again became very ill. His condition did not improve until he added fat back into his diet. Scientific studies should be based on facts, such as Stefansson's observations, not people's opinions.

Posted by Ladybird on 2 January 2008

I'm sure many of the posters must have read the news that the ADA has just finally come out in support of low carbs but more for weight control, rather than sugar control. Ofcourse, it's all related, but they need to make this clearer for those diabetic patients who follow the ADA guidelines religiously.

Bird 54, I'm totally for low carbs, I'm on a low carbs lifestyle and it's helped me in every way, both loss of weight and a lower A1c but I, personally prefer a green vegetable/low carbs style rather than eating more meat, lean or fatty. I, do think it's a personal choice and I wouldn't advice anybody else on how they should eat, this is just the way I prefer to eat, and I just don't really enjoy red meat.
I do, though, eat fish and believe, it's one of the healthiest things to eat and ofcourse, Eskimos do eat a lot of it.
I do also eat some whole grains but don't over do it and some fruits. I do think it's all very much low carbs.
Keeping our weights down, eating right all the time as well exercising to keep as healthy as we can is not an easy thing to do and we diabetics need to be focused on it all the time, I think but not get obsessive, so that we can lead normal lives. That is the whole point of trying to be healthy.

Yes, I do feel hungrier after exercising, but can eat something "healthy" to help that, not just anything, and not a huge amount. It really means in the end we need to keep an eye on what we eat all the time.

Posted by riva on 4 January 2008

I am buoyed by how many people took the time to comment. Now, as if the carb/fat debate and the exersise/don't exercise debate were not enough - go read the book, The Omnivore's Dilemma. Food, and much of our resulting health, is a political and economic debate.

While the eskimos may have thrived on red meat, today our red meat is nowhere near what they were eating. Our cows are no longer raised grazing in fields of grass but standing in manure eating cheap corn for which they're not built. They end up with ulcers that we end up eating. From meat to dairy to soda to cereal to soup to ketchup and much, much more, high fructose corn syrup has been dropped into our food supply as a cheap grain for animals to fatten up on and cheap shelf preserver, and it is disrupting our bodies food processing functions. Many further believe this corn added to almost half what we eat today is a huge reason Americans are obese. More food for thought.

Posted by Ladybird on 4 January 2008

Good for you Riva! Thank you! Keep it up, let us debate amongst ourselves, make us think and improve our healths! A new book to ponder over now.

A very happy new year to us all, let it be healthier than ever for all of us.

In the end, I really think if we ate low everything, we'd be much better off.

Posted by bird54 on 4 January 2008

Hi Riva,
I agree that our food supply is deplorable, but even so, we do have a choice. We can choose to buy absolutely NO prepared, packaged, or processed foods, including bread. We can prepare everything ourselves from scratch, which is not hard when one eats only fresh vegetables, fruits, and meat (GRASSfed beef, organically raised chicken, turkey, and wild caught salmon, etc.)

Ladybird, you said, "In the end, I think if we ate low everything, we'd be much better off."
A low everything diet is a low calorie diet, the exact diet that is also referred to as a "starvation diet", It is the diet that Keys used when experimenting with the conscieous objectors during wartime. The subjects had all the symptoms of starvation and hunger. However, a low-calorie diet of just meats and fats did not produce any hunger or other negative symptoms. A diet of meat and fat, or a total fast of eating nothing at all, did not produce any symptoms at all because the body prefers meat and fat, whether it gets it from the diet or from its own tissues. So it appears from all the research that carbohydrates are the problem. Therefore it is pointless to decrease "everything" when some foods are absolutely essential for survival (meats and fats) and others are unessential (carbohydrates)because the body can manufacture its own glucose from glucogenesis.
People can debate forever but there is only one question to ask yourself: Do you want your diabetes to control you or do you want to control it (and possibly even reverse it)? Because it the end, we do have a choice.

Posted by bird54 on 4 January 2008

It occurred to me that I may be "preaching to the choir" because most diabetics reading this article do adhere to a low carb diet. So I am not really debating that. It just really bothers me when people say they believe in low carb and then totally contradict themeselves by other statements, such as "eat less, move more" or "eat less of everything". All the research points out that "less" meaning "low calorie" has never caused anyone to lose weight or improve their health. Because it is not the "calories" that matter, but the "type" of calories consumed. So it would not matter if you ate 10,000 calories of meat and fat, if that were possible, or went on a total fast and ate nothing at all. Either way, the body would rely on protein and fat to nourish its cells. It is carbohydrates which raise blood glucose and raise insulin. It is high glucose and high insulin that cause the health problem. Therefore, it is carbohydrates that cause the health problems. How much simpler can that be? Yet, people keep making statements about the evils of fat, and the longterm dangers of eating meat, and how one can eat more carbs if they exercise more, which has absolutely no scientific basis.

Posted by Ladybird on 4 January 2008

I think it's good that you're that interested in spreading the good word about low carbs, and as you said, most of reading this article agree with Riva saying it's a terrific way of eating, INCLUDING me!!

I'm just not a meat eater, that's it and have no intention of going back to it, even if you're right that's it's good for us. As Riva said red meat these days may not be as "healthy" as it used to be, I would agree with her. I have not said, please eat carbs after exercising, not at all and I don't happen to!

I happen to agree with everything you say, but you're not listening at all to anything, since I just don't want to eat meat and I've made that clear. I's not the only way to eat healthy, that's all. I'm sure a lot

I do eat "good fats", fish, add olive oil to almost everything I eat and also enjoy peanut butter. I think that's quite a bit of "good fats". I don't eat any cookies, chip, cakes etc bought form the market, not that I don't make them myself. either, am just off them since have been a type 2 for these last 3 years.

I cook the chicken (and mince for the rest of the family)at home, do not buy frozen food at all.

I think most people do feel hungry after exercising, it's natural, but who said go and eat high carbs after that or nay carbs at all.

My diabetes happens to be well controlled, have not been on meds since have been diagnosed and have lost about 30 lbs in about a year and a half, slowly since I have a majot back problem and cannot go to the gym etc, with basically just walking.

This is not a "quarrel" with you, Bird 54, I only feel that we are all different, as most of us who read this newsletter would agree, we would like to make our lives as "normal" as we can with the limitations we have and would like to eat as close to what we used to before we were diagnosed. I've been a "vegetarian" basically for over ten years now, never stopping the fish, which, I feel is one of the healthiest foods to eat. But, I would def. not tell anyone else, to eat fish, if they don't want to.

If I eat two slices of whole grain bread with peanut butter, I don't think that is "high carbs" at all, but if somebody wants to think that is, there's really nothing I can say, is there, except that is how I'd like to eat!!

Bird 54, I'm so glad you have a "name"!! I hope you'll be a bit happier now that am a bit clearer.

Posted by bird54 on 5 January 2008

Hi Ladybird,
I'm sorry if the tone of my comments gave the impression that I am quarreling with you or anyone else. If my tone appears strong, it is because I am angry at the food industry, the health care professionals, and the pharmaceutical companies that have misled us all, causing us to become diabetic and then keeping us chronically ill. Diabetes does not run in my family, neither does being fat, and yet I got both. Of anyone in my family, I should have been the healthiest, as I have always been athletic and eaten "right". I am angry at doctors who saw my condition coming and yet could not tell me how to prevent it, and then once I got in this condition, all they can offfer me is drugs and medication. My quarrel is not with you. You should be commended for controlling your diabetes so well and keeping off medication. I think it is about time we diabetics revolt against the food industry, the pharmaceutical companies, and the health care professionals.

Posted by Ladybird on 6 January 2008

I think, Bird 54 and other readers, most of us reading this Newsletter (which is really wonderful, giving us the latest news about all sorts of things relating to both Diabetes, both types 1 & 2) would agree that most of us are upset with the authorities, specially the ADA, from which the "rules" filter down from. But it is writing out our thoughts on posts like this on hundreds of blogs all over the net, I think that has helped to finally change the views of ADA to finally publish their new guidelines for a low carbs eating style. So many health studies have been done over many years by prestigious institutes like Harvard advocating this type of eating style.

When so many people write about how they eat and how it's changed their lives, something has to give. One cannot continue to ignore the reality and the fact that diabetics have not been doing great on high carbs.

I do think we need to be open minded and understand that the low carbs style should be tweaked to suit our own particular likes/dislikes.

I would only like to add that we should remember what so many posters have written here, including a couple of CDE's that we need not be too narrow & maybe should be more varied in our styles so as not to miss the vitamins, minerals and fiber available in whole grains veggies, fruits and some low fat dairy products, such as yoghurt. It doesn't have to be high carbs, we can keep it low by controlling and balancing the calories, portions etc to suit each one of ourselves.
So many studies are coming out that many of us diabetics may become this way, because of the nutrients we are missing and eating "better", most health "experts" will probably help us.

I don't claim to be an expert on Diabetes, far from it, I can only speak from experimenting on myself by reading and testing myself all the time.

We could "argue" about exercising till the end of time; I don't think anyone of us can deny how terrific we feel after it! Maybe that feeling alone is worth it!

Posted by bird54 on 6 January 2008

Diabetes is a very emotional issue and very personal for all of us. It is mainly because the authorities want to blame us for the disease by insinuating that diabetes is caused by our own behavior, ie. overeating and being sedentary, which couldn't be farther from the truth. We all feel some guilt as to how we may have contributed to our own illness, and feel resentful that "normal" people can eat whatever they want and never gain weight. That is why I have tried to keep my comments focused on the research of Gary Taubes, (which is how Riva's article began) rather than commenting on people's opinions about how they feel about carbohydrates and exercise. So if it appears that I am not "listening to anything at all" I want you to know that I have read and listened to all the comments, but have chosen to respond by quoting the facts according to Gary Taubes. Anyone can choose to agree or disagree with his research, and that is okay. That is what free speech is all about.

Posted by bird54 on 6 January 2008

On a personal note, I have tried just about every diet known to man, all of them "healthy" according to some expert. The only food I never ate much of was fast foods and soft drinks. I have always exercised to different degrees, from being a competitive athlete and exercising practically all day, to just walking once a day. There is absolutely no rational reason why I should have gained weight or gotten diabetes. My BMI is borderline overweight/obese, although my waist measurement and my hip to waist ratio is normal. I attribute my BMI to muscle mass, not fat, as I am "solid" and not flabby. No doctor ever tested me to determine what type of diabetes I have. They just assume because of my weight and age, that I am the typical sedentary, gluttonous diabetic. I think I am more the "norm" not the exception, and health care professionals should be ashamed of themselves for putting such guilt trips and feelings of hopelessness on us.
Well, I am done with all their "healthy" diets because they have not done me any good at all. I am now going to eat fat and meat. That is the only diet I have not yet tried. So, I choose to be a guinea pig in hope that my diabtes will reverse itself. I will not allow myself to plunge into the category of "most" diabetics that get progressively worse. How depressing and hopeless is my alternative?!

Posted by bird54 on 6 January 2008

One last thought: If I did everything "right" and followed all the "rules", then why did I get diabetes? The obvious conclusion is that their guidelines are WRONG! Now the ADA has changed their guidelines to lower carbohydrates, but still maintain their view on low fat, so they are still WRONG! Fat is essential to health and is ZERO on the glycemic index. So the ADA is talking out of both sides of their mouth again and misleading people as usual. Perhaps they should read Gary Taubes book.

Posted by Anonymous on 14 January 2008

I agree completely with you bird54. The ADA has taken a half step, albeit in the right direction. But their guidelines are still fundamentally wrong.

Thank you to Riva who started this thread and to those who have done their homework and taken the time to post. Knowledge is power and knowledgeable diabetics who communicate their knowledge will drive change while helping themselves and others.

Posted by Anonymous on 9 March 2008

What if you are diabetic and celiac's? No gluten recipes are high in carbs? Help!!

Posted by Anonymous on 21 July 2008

I'm eating 60 carbs for meals, 30 carbs for snacks and my A1C's are at normal levels. My blood sugars range between 90 and 120. When I was first diagnosed a year ago, my blood sugars were at 370 after fasting.

The key for me was exercise and consistency with my carb intake. Instead of 180 carbs for one meal (ridiculous) and 20 for another, I take in the same amount. The carb counting and treadmill helped me lose 50 pounds and brought all numbers down. Thankfully I didn't have to remove carbs. And believe me, 60 is plenty unless you're at a restaurant where even a salad can be 100+.


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