Study by 24 Doctors and Researchers Lobs Rebuttal At the ADA and EASD for Their Stance on Low-Carb

Jun 26, 2008

Twenty-four diabetes doctors and researchers from the United States, Canada, the United Kingdom, Finland, Sweden and Portugal have published a study criticizing the American Diabetes Association (ADA) assertion that diabetics should consume no fewer than 130 mg of carbohydrates daily and the European Association for the Study of Diabetes (EASD) statement that low-carb diets are “not justified.”

“Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal” (read the original study) proposes that the time has come to rethink the current approach to treating type 2 diabetes and metabolic syndrome through low-fat diets.

In the study, the authors propose that there is now enough clinical evidence that low-carb diets improve glycemic control and reduce insulin fluctuations and that they are at least as effective as low-fat diets in helping weight loss (see abstract below). They further state that carbohydrates, not fat, put people with diabetes at increased risk of cardiovascular disease.

The authors suggest that greater acceptance of low-carb diets as an effective, justifiable treatment for some people with diabetes will give doctors and other healthcare providers greater flexibility in helping patients manage the disease.

Abstract of the Study:

Current nutritional approaches to metabolic syndrome and type 2 diabetes generally rely on reductions in dietary fat. The success of such approaches has been limited, and therapy more generally relies on pharmacology.

The argument is made that a re-evaluation of the role of carbohydrate restriction, the historical and intuitive approach to the problem, may provide an alternative and possibly superior dietary strategy. The rationale is that carbohydrate restriction improves glycemic control and reduces insulin fluctuations, which are primary targets.

Experiments are summarized showing that carbohydrate-restricted diets are at least as effective for weight loss as low-fat diets and that substitution of fat for carbohydrate is generally beneficial for risk of cardiovascular disease. These beneficial effects of carbohydrate restriction do not require weight loss.

Finally, the point is reiterated that carbohydrate restriction improves all of the features of metabolic syndrome.

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Categories: Diabetes, Diabetes, Insulin, Low Carb, New Cure Research, Nutrition Advice, Nutrition Research, The Cure, Type 2 Issues

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Posted by cathyjwoofter on 27 June 2008

Hoorah!! Finally, researchers standing up to the ADA and saying enough is enough! I have always thought 130mg of carbs was too much for me. For 15 years I held fast to the ADA recommendations, but in the last 10 years, I tossed those ideas out the window for less carbs and greater control of my blood glucose levels. The glycemix index is another tool I use along with daily exercise. I hope this study will go a long way with the ADA and help pave a new road towards acceptance of a low-carb lifestyle for diabetics within the ADA recommendations.

Posted by Anonymous on 27 June 2008

We are seeing good results in our population with the low-carb diets. The patients are not as hungry and the lose of weight has a good affect on the BG levels.

Posted by Anonymous on 28 June 2008

Personally, I think there is no 'right' way to do things. It's whatever works for the diabetic in question. If you exercise a lot, then you CAN eat a few more carbs than those who don't. It depends on lifestyle as well.

Posted by HOFIII on 30 June 2008

I have definitely greater control of blood glucose readings by adherring to a low carb diet and the added benefit of weight loss. Lots of vegies, some fruit and minimal protein from lean boneless skinless grilled chicken work for me. No meds and 5.7 A1C on average. Never been higher than 5.8 and as low as 5.6. Pre-Diabetic and staying that way!

Posted by RDMelinda on 30 June 2008

It strikes me as funny that this argument lingers on. In my experience most RDs and CDEs customize plans to the individual. That's why we have meters! If I do my job right a patient can basically titrate his/her carbs based on blood sugar results. However, and this is where I stand with the ADA, if a woman cannot eat at least 45g carbs at a meal or a man cannot eat at least 60g carbs at a meal without a 2-hour blood sugar out of target range, that would be a signal that the person needs an advancement in medication to the next level. There has to be a point where we decide that it's not in our brains' best interest to run on ketones (which is what happens when you cut back too far on carbs). Furthermore, doctors need to refer their patients to dietitians who can do more than just say "eat less sugar" or "don't eat carbs". And I'm sorry, it would be irresponsible not to teach people to choose less saturated fat, so all of us out in the trenches are going to continue preaching carb management, whole grains, fruits and vegetables, adequate lean protein and heart-healthy fat intake.

Posted by Anonymous on 30 June 2008

I love carbohydrates too much. With many medical setbacks, I have been on many other restricutions besides carbos, and wouldn't be able to give them up.

Though I do have many vegetables and healthy things, I love rice cakes and lots of cereal in big amounts. :o(

Posted by Anonymous on 30 June 2008

Saturated fats aren't the BAD fats. Yes, we need to limit saturated fats, but the BAD fats are hydrogenated fats and transfats (notice these are the fats invented by man)

have you ever notice that you can leave margarine out at room temp for a month, even in summer and NO mold will grow on it? try that with BUTTER

Posted by Anonymous on 30 June 2008

RD Melinda - I know not where you are but I for one am very very pleased you have nothing to do with MY treatment of MY diabetes.

because it IS mine, and I DO treat it - with help from medically qualified personnel.

Neither my GP, Consultant or any number of nurses and dieticians treat it, only assist me.

I listen to advice from professionals and similar to when I seek investment or other advice, then consider that advice and choose whether or no to accept it. If what I choose to do doesn't work I will look at the previous advice again.

I am an (otherwise healthy) 58 yr old working woman taking an average amount of exercise - nothing particularly for exercise sake, just going for walks, sometimes a mile or 2, sometimes 5-6 miles. If I ate 45g of carb at every meal well OK my BS would be OK as I'm T1 as it happens - but I'd be as fat as a pig and waddling instead of 'just right'.

Posted by Anonymous on 30 June 2008

Well, well, well, looks like Dr. Atkins, may God rest his soul, is vindicated again! I've blasted the ADA and the highly educated dieticians and doctors on pushing their high carb diet on me and my diabetic siblings, and how they bad mouthed Dr. Atkins. I knew they were wrong, wrong, wrong! Some diabetic people will defend eating high carbs till they are left with no feet and blind. They are the ones always complaining that they can't get their blood sugar in control. And when you tell them it's the carbs you're consuming they have a sh*t fit and try to demoralize you. Great article! Thanks!

Posted by jayeS on 30 June 2008

RD Melinda said: However, and this is where I stand with the ADA, if a woman cannot eat at least 45g carbs at a meal or a man cannot eat at least 60g carbs at a meal without a 2-hour blood sugar out of target range, that would be a signal that the person needs an advancement in medication to the next level.

My response: Why medicate yourself when you can do it with diet? Why take more meds just so you can stuff yourself with more carbs which turns into glucose? When does it end? Shoot more insulin to dsatisfy the sweet tooth? No thanks. I'd rather control it by eating fewer carbs and exercising everyday than shoving pills down my throat and suffering the nasty side effects from them.

Posted by Ivan C on 30 June 2008

My suggestion is that RD Melinda come out of the trenches and talk to peole who have experience with low carbohydrate diets instead of spouting the party line.

Posted by yksin on 30 June 2008

RDMelinda wrote: "There has to be a point where we decide that it's not in our brains' best interest to run on ketones (which is what happens when you cut back too far on carbs)."

Why do you feel that "it's not in our brains' best interest to run on ketones"? Do you have any scientific basis for this assessment, or is this based on mere prejudice and hearsay? -- which seem to be the main source of "information" about ketosis, even among doctors and nutritionists. Having read much of the scientific literature about how ketosis actually works, I doubt your conclusion.

Posted by rumford on 1 July 2008

To RDMelinda:Did you read the article? C'mon, tell the truth.
To Others: The paper only asked that we reappraise the current position. It laid out the positive features and suggested alternatives instead of blindly following the recommendations that have failed to stop the epidemic of diabetes. The article did say that treatment should be individualized and not based on arbitrary numbers like 45 g of CHO or 60 g of CHO.

In the end, is there any other disease where practitioners make the disease worse so they can give more drugs.

Posted by phishery on 1 July 2008

This is a very informative study and it is good to see that we are starting to look at hard data once again. With pushing carbs on diabetics and the entire cholesterol hypothesis it started to feel like we were going to just "go with the crowd" instead of really scrutinize the data and come to an objective and rational conclusion. The comment about ketones not being in our brains "best interest" is only an example of how we make assertions but fail to use an objective means to come to those conclusions. I have been trying to centralize as much low-carb/low-insulin diabetes informatin, research, articles, and news on as possible for those that want to explore the topic further. Thanks to all those that authored this study for taking a stand, going against "the flow", and seeking to be both objective and rational in our pursuit of knowledge. Knowledge which just so happens will have an enormous positive impact on billions of people as the standard of living continues to increase in the world.

Posted by jayeS on 1 July 2008

Doctor Atkins has been vindicated. He started his lo-carb approach back in the early 70's and never gave up his stand on the effects of carbohydrates on the human body. There will always be naysayers spewing misinformation, for what reasons I don't know. Anyone who is a diabetic can and should take charge of their own health and destiny with this disease. I'm thankful for these doctors and researchers who have dispelled the ADA party line. Take a look at the ADA recipe site--far from being anything a diabetic should be eating. They are a hindrance to poor souls trying to get control of their diabetes.

Posted by Anonymous on 1 July 2008

What is bizarre about RDMelinda is she is talking as we have this all under control, that people with diabetes will be fine if they keep fitting their meds to fluctuating meter readings. The authors of the article in question seem to be from wide variety of fields --one I know is the head of a major endocrinology center -- and they seem to think there is a real problem and the same old stuff isn't cutting it. They lay out a scientific case. Might be worth evaluating it.

Posted by Anonymous on 1 July 2008

I am not a diabetic, but there are a few T2s in the family. To support family members, went on the Bernstein Diabetes Diet for 2 months (30g carb/day). After I lost the belly fat, I went up to 50-70g of carb/day. I am doing just fine, thank you! Eating lots and lots of leafy grean veg. Read Life without Bread and Going against the Grain and see how to meet your nutritional needs in a much lower carb way.

Posted by Anonymous on 1 July 2008

RDMelinda - I am a physician and a type 1.5 diabetic on a low carb (Less than 30 gm/day) for the last 4 years with a A1c of 5. I have not noted any brain disfunction with my ketogenic diet and would like to see where you get the DATA for this.

Posted by Anonymous on 2 July 2008

I am not a diabetic, but there are a few T2s in the family. To support family members, went on the Bernstein Diabetes Diet for 2 months (30g carb/day). After I lost the belly fat, I went up to 50-70g of carb/day. I am doing just fine, thank you! Eating lots and lots of leafy grean veg. Read Life without Bread and Going against the Grain and see how to meet your nutritional needs in a much lower carb way.

Posted by Pattidevans on 2 July 2008

Regarding RD Melinda's comments on it being "time for more medication" has she really studied the results of the ACCORD trials where lowering Hba1cs by means of increased drug therapy increased deaths. Whereas the ADVANCE study proved that lower Hba1cs achieved by other means such as diet actually lessened the incidence of diabetes?

RD Melinda needs to educate herself, not only on current thinking, but also on how one descends into ketosis! Eat lots of carbs and get high BGs, then get ketosis! Diabetic ketosis is a completely different scenario than the Atkins type ketones.

Posted by Pattidevans on 2 July 2008

Sorry... cannot edit... should have said "actually lessened the incidence of complications", not diabetes.

Posted by Anonymous on 3 July 2008

Well, I only started achieving better Hba1c's after I started low carbing. I don't adhere to any specific type, ie Dr A or Dr B, you all know who I mean. I just low carb, average around 30 CHO a day, and have been doing this for a year now. Am on no meds, and last Hba1c was 5.2, before that was 5.4. Am hoping the next will be lower.

Come on, low carb is so much better for us, especially a T2 like me. I don't want to have a higher carb intake and end up with high bg's and be put on any meds.

D&E has to be so much more preferable than resorting to meds.

Methinks RD Melinda needs to go on another and updated course of education, or just listen to those D's who have educated themselves and taken control, and who because of that have far better results.

Posted by Anonymous on 4 July 2008

Over the years I have actually met about two diabetics who have had success with a high carb low fat diet. For the other hundreds it has been an unmitigated disaster.

As a result of following this protocol

I have an A1c in the fives, lipids to die for (previously they were to die *from* and became significantly worse on the Healthy High Carb Low Fat nightmare diet I was prescribed - so much worse that I was accused of not following it) and normalised BP.

I eat around 60 - 100g carbs/day and restrict them most in the morning when I am most insulin resistant.

Apart from the measured numbers I have an order of magnitude more energy, concentrate better - and lost 30 lbs.

These results are very much along the lines of what happens to most every T2 and not a few T1s who go against official dietary advice. It's long past time that the Diabetes Authorities are awakened to this fact.

Posted by catman on 4 July 2008

RD Melinda should dust off her college text books if she still has them or perhaps enroll in a some basic night school courses on physiology and human nutrition and improve her knowledge. The last time I checked no requirement for carbohydrate has been established in human nutrition. So while RD Melinda may be of the opinion (that is all it is) that women need 45 grams of carbs per meal and men need 60 grams the scientific reality is that humans need zero grams of carbs. RD Melinda, like most registered dietitians and nutritionists, also seems to be blatantly unaware of the existence of the process whereby glycogen and thus glucose can be synthesized in the human body through gluconeogenesis.

Posted by Anonymous on 7 July 2008

Since RDMelinda has been willing to set herself up as a spokesperson for standard treatment, in the spirit of the times, I challenge her to a townhall meeting style debate. I am one of the authors of the 24-author paper.

Posted by Anonymous on 12 September 2008

I am late, I know, but as a CDE I know that lower carb diets lower blood sugar. Not extreme low carbs, but even 100-120 gms per day. Insteasd of the 400 gms of carbs per day you would get from some of these "party line recipes." Why add more meds if you can do it with diet??? Unless the ADA is taking so much money from drug companies that that IS the reason why they won't look at the low carb diet?? Maybe they want more people to use more meds! I cannot think of any other reason!

Posted by Anonymous on 17 November 2008

Why don't you try one approach for 3 months,
get a A1c test, if it is too high, or just right, react accordingly. If it is too high, obviously you are eating too many carbs for your medication level.(or no meds), less carbs, substitute low glycemic veggies & fruits ie..veggie slices for tortila chips, low carb cereal etc. until you get an acceptable reading.

Posted by Anonymous on 24 January 2009

It is absolutely clear to me that a low low carb diet is the best tool I have in keeping my blood sugar near normal levels. The ADA and many other so called experts do not seem to have a clue. My wife recently bought the mayo clinic guide to diabetes for me, but when I saw that two of the four suggested "ideal meals" for diabetics were pasta dishes I quickly threw it in the trash. Low carb is the best diet for diabetics, and try to get the carbs you do eat from mainly green vegetables (broccoli, grean beans, cabbage, brussels, etc). NOT from fruit (except maybe avocado).

Also alcohol appears NOT to be a problem, so enjoy some red wine.

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