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Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat


Dec 25, 2008

Richard D. Feinman, PhD, is Professor of Biochemistry at State University of New York Downstate Medical Center, co-editor-in-chief of the journal Nutrition & Metabolism, and Director of the Nutrition and Metabolism Society (www.nmsociety.org).

Diabetes may be described as a disease of glucose intolerance: high blood glucose is both the characteristic indicator and the cause of complications.

The loss of control of glucose metabolism is what makes a low carbohydrate diet a good therapeutic approach, and it's why I'm astonished that experts encourage people with diabetes to eat carbohydrates and then "cover" them with insulin [1].

I am also surprised to hear negative reactions to carbohydrate restriction from people who have actually seen the deleterious effects of high dietary carbohydrate on people with diabetes. On that note, I offer my personal rebuttal to Hope Warshaw's recent article, "Why You Don't Want to Go Low Carb or Vegan," April/May 2007.

Ms. Warshaw's argument is that "avoiding carbohydrate, as some low carb diets suggest, does not entirely return blood glucose levels to the normal range after meals." Well, depending on the patient, sometimes blood glucose does return to normal. In any case, ingesting carbohydrate raises blood glucose.

Ms. Warshaw goes on to say, "Second, an adequate amount of carbohydrate is an important component of a healthy eating plan, providing essential fuel, vitamins, minerals, and fiber." I thought fuel is just what we are trying to reduce. And does anybody think that having to take a vitamin supplement is in the same ballpark as injecting insulin? And how healthy is an eating plan that requires medication?

At the 2004 Brooklyn conference on the Nutritional and Metabolic Effects of Low Carbohydrate Diets, William Yancy, Jr., of Duke University described his research with type 2 patients. After sixteen weeks on a low carbohydrate diet, seven of the 21 patients discontinued their medication and ten of the 21 reduced their medication. During the post-lecture discussion, two physicians "warned" that doctors should not put diabetic patients on a low carbohydrate diet without first reducing their medication.

Of course, if you are taking medication, you should reduce carbohydrates only with medical supervision. In most diseases, however, a reduction in medication is considered a sign of improvement. Why would Ms. Warshaw recommend a diet that requires more medication?

It strikes me as odd that what most experts know about metabolism - diabetes is, after all, a metabolic disease - they learned in medical school from somebody like me [2]. The first thing we teach medical students at Downstate Medical Center 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 thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose.

Figure 1A. Macronutrient consumption during the diabetes epidemic. Data from National Health and Nutrition Examination Survey (NHANES). Absolute caloric consumption from surveys for indicated years. Top of charts: per cent consumption from 1971-74 vs. 1999-2000.
Figure 1B. Incidence of diabetes by year. Data from National Center for Health Statistics.

The second thing we teach medical students is that almost all the increased caloric intake during the ongoing epidemic of obesity and diabetes has been due to an increase in consumption of carbohydrate and a decrease in the consumption of fat (Figures 1A and B). When you look at the foods whose consumption increased during the diabetes epidemic, you see that cereals and grains are among the major ones. (Of course, almost everything increased except red meat and eggs.)

So what is Ms Warshaw's complaint? Well, she points out that "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 ([3]). But studies of low carb diets that last longer than six months do not show significantly more weight loss."

Something's wrong here. Because low carb diets do the same as traditional diets after one year, then you don't want to be on a low carb diet? If they are equal, why doesn't that mean that you don't want to be on a traditional diet? In any case, what is rarely mentioned is that in the study in reference [3], the diets were quite different at six months; as the study proceeded, however, the low carb group added back more carbohydrate. The lesson is clear: the more carbohydrate, the worse the weight control. And the long-term outcomes were not the same. Triglycerides and HDL (healthy cholesterol) were much better on the low carb diet than the low fat diet (Figure 2).

Figure 2. Results at 6 months and 1 year for a multicenter study in which obese men and women were assigned at random to a low-carbohydrate diet or a conventional low-fat diet. Data from reference [3].

Reference [3] is important for showing the general health benefits of low carb diets even when a difference in weight was not maintained, but that study did not include people with diabetes. What happens in those people? Figure 3 shows the results from a controlled ward study of ten diabetic patients before and after three weeks on a strict low-carbohydrate diet [4]. The figure shows the dramatic reduction in insulin fluctuation and, on average, the "return of blood glucose levels to the normal range after meals." Patients were content with the diet, lost weight, had improved lipid profiles, and increased insulin sensitivity by 75 percent.

I don't know of any study on any other diet that shows such good effects on controlling glucose and insulin without increasing drugs. And it's not just the glycemic control. We recently summarized data in the literature showing that all of the features of the so-called metabolic syndrome-high triglycerides, low HDL, hypertension and obesity-are exactly the features that are improved by low carbohydrate diets [5]. If we had been describing a drug, everybody would have rushed out to buy stock in our pharmaceutical company.

Figure 3. Glucose and insulin levels for patients before or after 3 weeks of a low carbohydrate diet. (To convert glucose to mg/dL, multiply by 18). Data from reference [4].

Ms. Warshaw's complaint is that these studies "show that many study subjects drop out of the study and are unable to stick with the diet." She does not mention that the drop-out rate from the low fat diet was the same as from the low carb diet; that's generally true of the many low carbohydrate studies. In any case, wouldn't it be good for diabetes counselors to encourage compliance rather than to dissuade people from a strategy that actually works for the many people who follow it?

You might want to think twice before you let Ms Warshaw tell you what you don't want to do. "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." She seems to be saying that you may as well go ahead and eat candy because it's all hopeless. There are, however, several sites on the Internet that provide a more hopeful look at managing diabetes with carbohydrate restriction; for example, D-solutions (www.dsolve.com) and Dr. Richard Bernstein's forum (http://www.diabetes-book.com).

I am most concerned that if Ms. Warshaw really had something positive to offer, she wouldn't need to dissuade people from making their personal choice. Candy followed by insulin is not good enough.

  1. American Diabetes Association: Nutrition Recommendations and Interventions for Diabetes-2006. Diabetes Care 2006, 29:2141-2157.
  2. RD Feinman, M Makowske: Metabolic Syndrome and Low-Carbohydrate Ketogenic Diets in the Medical School Biochemistry Curriculum. Metabolic Syndrome and Related Disorders 2003, 1:189-198.
  3. GD Foster, HR Wyatt, JO Hill, BG McGuckin, C Brill, BS Mohammed, PO Szapary, DJ Rader, JS Edman, S Klein: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 2003, 348:2082-90.
  4. G Boden, K Sargrad, C Homko, M Mozzoli, TP Stein: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 2005, 142:403-11.
  5. JS Volek, RD Feinman: Carbohydrate restriction improves the features of Metabolic Syndrome. Metabolic Syndrome may be defined by the response to carbohydrate restriction. Nutr Metab (Lond) 2005, 2:31/ Available without subscription at (www.nutritionandmetabolism.com/content/pdf/1743-7075-2-31.pdf)

Categories: Blood Glucose, Diabetes, Diabetes, Food, Insulin, Low Carb, Professional Issues, Type 1 Issues, Type 2 Issues



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Comments

Posted by Anonymous on 22 August 2007

great!

Posted by Anonymous on 23 August 2007

Unbelievable!!! You obviously know nothing about good nutrition.

Posted by Anonymous on 23 August 2007

I totally agree with the low CHO diet for good BS control.

Posted by jackiee on 23 August 2007

Important information for people with diabetes. The ADA's own stats are showing that patients even on meds are not meeting treatment goals. It is way past the time to be open to treatments that show significant promise.

Jacqueline Eberstein, R.N.

Posted by DiabetesDad on 23 August 2007

Thanks to Dr. Feinman for not following the crowd. A lot of us already knew this simply from common sense and experience, but it's great to have an academic confirming our reality.

Posted by Anonymous on 23 August 2007

Absolutely! When I was diagnosed with Type 2,I couldn't drop my weight or blood sugar very much even with metaformin; but after a non professional told me to drop my carb intake to below 100; blood pressure, blood sugar & weight came down 20 lbs. Now I'm in control with low carb diet, exercise & metaformin which I hope can one day stop too.

Posted by Ladybird on 23 August 2007

As DiabetesDad said: Thank you Dr. Feinman! In fact, long ago I stopped looking at special diabetic "advice" coming from supposedly the "experts", because, I saw the advice was not matching what my glucose meter was telling me.

I've lost about 30 lbs over two years, have stopped eating "white" carbs completely. I do eat whole grains/peanut butter sandwiches for lunch and have cereal for breakfast because, I find that is practically the only thing that keeps me "regular"; but have stopped all the "naans"/breads in the Indian/Middle eastern meals that I often have. Otherwise, besides fish, though, I do not eat meat, am a vegetarian. I do tend to add olive oil on to whatever I may be eating, not just the salads. This is the fat, that am eating, and my triglycerides are 72 and HDL 69. When I had cut out a lot of my fat, my trigl were over 240!! My A1c has come down from 6.8 to 5.9. So yes definitely a yes to a low carbs and some fat diet for diabetics.

Dr Feinman, couldn't you please write a short article on how important regular testing of blood glucose is at home. You know a lot of us have been very disappointed with the study done by Dr. Farmer on this topic in England that it's totally useless for Type 2's.

Thank you!

Posted by Virginia on 23 August 2007

We have learned to ignore the ADA and people with diatetic credentials that relate to the ADA.

Posted by whimsy2 on 23 August 2007

Thank you for this refutation of
Ms. Warshaw's misguided advice. Anyone who is diabetic and checks BGs before and after a high-carb meal knows that high glycemic index carbs will make BGs rise. And we know that those high GI carbs are not necessary to make our brains work properly.

When will the ADA finally get it right and stop telling diabetics to follow their high carb recipes then take pills to bring BGs down caused by those very foods? Wouldn't it make more sense to avoid those foods completely??

But then a lot of drug companies wouldn't make so much money off of diabetics.

Posted by Anonymous on 23 August 2007

Bravo, Dr. Feinman! It is time more people like you stood up and spoke truth to power. The lunacy of the current approach to diabetes management serves the interests of no one except, perhaps, the pharmaceutical and medical supply companies who reap enormous profits from this unecessary human suffering.

A Concerned MD.

Posted by Anonymous on 23 August 2007

I was diagnosed with type 2 a year ago. At first I was frustrated and overwhelmed because it was very difficult to control my glucose. I am one of the 20% of type 2's who was not overweight and ate a "great" diet. I was fortunate enough to stumble onto Dr Bernstein's book The Diabetes Solution. Many well meaning individuals cautioned me about the low carb diet. I thanked the well meaning individuals and switched to low carb any way, much to their horror. The diet has made a big difference in my glucose control. Thanks for helping to get the word out.

Posted by Anonymous on 23 August 2007

I am the one that started D-solve (www.dsolve.com) referred to at the end of the article and it is refreshing to see the medical community getting on board with the commonsense approach of not eating as much of the food that causes blood sugar to rise. After reading Dr. Bernstein's book Diabetes Solution my A1C went from 8.0 to 5.0 in 3 months--I have had diabetes for 29 years (since I was 4) and finally feel like it is under control now and I will never go back to a high or even moderate carb diet (which would probably be the healthiest for the general non-diabetic population). There is plenty of research to back-up this way of thinking--hop over to www.dsolve.com to find plenty which I have saved off for reference.

Ryan

Posted by Jamilah on 23 August 2007

A word of caution--I followed Dr. Bernstein's low-carb diet for quite a while w/ increased protein intake. Although it had a stellar effect on my A1C (I'm type 1) I began to spill quite a bit of protein in my urine, and my chol and LDL increased. I still modify my carb intake, but reduced the protein and allow all veges and fruit. Now the proteinuria has resolved. I still require a chol medication however. I hope more unbiased studies will be done looking at risk versus benefit.

Posted by volleyball on 23 August 2007

I thought this to be well written giving a good explanation for the low carb movement. We do have to realize that there are many different iterations of diabetes. So what works for one does not work for all. Just as the world is recognizing that there is no one diet that will work for everyone. A coach does not train a sprinter the same way as a marathoner. We can all see how foolish that would be. A coach could train both if he was knowledgeable and willing to take each runners needs into consideration. As for diabetes management, I gladly explain what works for me but realize it will not work for everyone.

Posted by Anonymous on 23 August 2007

I am an RD, CDE, and I am 100% in agreement with Dr. Feinstein. I cannot for the life of me understand why health professionals continue to recommend a high carb diet when the research is clear. I have asked myself these questions over and over again. Why do I read so many articles on diabetes eating from respected publications that recommend calorie and fat restriction not carb restriction. Some of them don't even mention carbs. No wonder my patients are confused! I tend to recommend a modified lower carb diet, as do the endos I work with.

Posted by Anonymous on 23 August 2007

I would like to see articles of this nature on a regular basis. I am lucky to have read Dr. Bernstein's book and therefore knew to look for a doctor who understood how to work with patients with diabetes.
Kudos to you, Dr. Feinman!

Posted by Peter on 23 August 2007

All of this makes perfect sense eliminate
food that turns to sugar in your system
and your weight will go down and if you
have diabetes you will take less
medication which in the long run is a
good thing.

Posted by Anonymous on 23 August 2007

I can think of no other disease state that rallies so many of those affected by the disease together, to oppose the professional recommendations for treatment! It seems to me that with such support for a "non-recommended" treatment, the medical community would have a huge interest in learning more. Thank you Diabetes Health and Dr. Feinman, for an excellent article. Keep them coming!

Posted by Anonymous on 23 August 2007

This diet of high cholesterol products and not much else doesn't appeal to me.
I am a big pasta eater, bread eater. My fav vegies are potatoes, corn, peas and beans. I am not going to give up a big bowl of pasta and gravy for 2 more years of life.
Life is all about eating not dieting.
By the way my A1c is 9 and my cholesterol is around 260. If I eat a big Pasta meal I just pop a big syringe full of Insulin to cover all of it.
I am happy with it and so is my doctor.

Posted by Anonymous on 23 August 2007

>>>By the way my A1c is 9 and my cholesterol is around 260. If I eat a big Pasta meal I just pop a big syringe full of Insulin to cover all of it.I am happy with it and so is my doctor.

Yeah, fat, dumb, and happy!

Posted by jlnhjm on 23 August 2007

With an A1c of 9 you are courting terrible complications, you would be better off having a sudden heart attack and dying. And you stand a good chance of that happening, unless you get to a doctor who knows how to treat diabetes. Your happy doc obviously doesn't.

It seems as tho the AMA is committed to increasing the profits of the drug companies rather than benefiting diabetic patients. Their advice goes against both common sense and science. Thanks for the article, now to get it printed at the ADA site.

Posted by Anonymous on 23 August 2007

Dr. Feinman deserves all the respect in the world for having the courage to stand for what is right despite the negative fallout from his peers in the medical community. The fact is he is one of the few courageous professionals in the research fields today willing to share the truth as it relates to diet and diabetes control. On behalf of those who stand with you, THANK YOU Dr. Feinman! You are the example for others to follow. Jimmy Moore

Posted by Anonymous on 23 August 2007

THANK YOU!!! Excellent article; I wish that more medical professionals would look at the facts (as you did) instead of following the usual mantra. Bravo.

Posted by Anonymous on 24 August 2007

The only measure of success of any treatment for DM is the set of values on the blood glucose meter. If they (as well as lipids and blood pressure) are in the range that is the goal (mine for glucose is 71-99 mg/dL), I consider the treatment a success. If not, there's a problem. DM is a condition of self-management...no one can or will take care of it except we ourselves, actively in consultation with the endo and certified diabetes educator or passively by failing to carry out this important step. Bernstein's got the approach that works for me (I'm DM1). In Mexico, as a CDE, I present patients with the low-carb option for BG control...most of them use it and find it works better than any other method they are already versed in. Thanks for the excellent article. Dr. Stan De Loach

Posted by swamijie on 24 August 2007

to the anonymous person who said: "Unbelievable!!! You obviously know nothing about good nutrition."
To whom were you referring to? and, please correct the error that you see, i. e., can you please enlighten us about "good nutrition"?

Metabolically speaking, there are essential amino acids and essential fatty acids, along with certain vitamins and minerals without which diseases or metabolic disorders arise, many of which can become life-threatening. However, AFAIK, there are no life threatening effects of carbohydrate restriction, even dietary carbohydrate elimination in the long run. Human metabolism can compensate quite efficiently for any long term lack of carbohydrate intake, but cannot compensate when there is a deficiency in any one of the aforementioned nutrients. The science of nutrition is basically the science of intake and and how ingested foods affect metabolism, that is energy production, anabolism and catabolism. What is termed "good nutrition" is eating for a beneficial and healthy lifestyle, so that ill health is reduced or eliminated. What may be good nutrition for a non-diabetic is not necessarily good nutrition for a diabetic or a prediabetic. Even the US government recognizes that Americans get way too much carbohydrates in their diets and has revised its RDI's for protein and carb intake.

Posted by B. Schatzman RD, CDE on 24 August 2007

This article and these comments by Richard Feinman are outragious and a blatant misrepresentation of what Hope Warshaw said and what Dietitians do. He, first of all, is demeaning in his title when he puts
"Experts" in quotations. Ms. Warshaw would no sooner advise to eat candy over other more healthful carbohydrate choices than any other well trained Dietitian. As Dietitians we work with people, not study subjects. As such, we work with people and their eating behavoirs and choices in their daily lives not for 6 weeks or 6 months but throughout their lives. We don't teach people how they can temporarily change their diets for statistical purposes but for long term health. Carbohydrates, found in their less processed states, have been serving as a food source for a mellennium, long before the obesity and Type 2 epidemics took hold. His intrepretation of the data that he presents is absurd and narrow minded. The increased carbohydrate intake that is demonstrated in NHANES demonstrates increased consumption from increased availability of processed, refined, fast foods, snack foods, sweetened beverages and a world of supersizing. Dietitians counsel on significant reduction of these foods and the overall reduction of carbohydrate portions from all sources. The ADA dropped specific recommendations for carbohydrate many years ago, instead it is recommended that this be individualized based on laboratory paramenters and glucose results. Making long-term healthful behavior and food intake change is hard! In the real world it takes into account familial and cultural influences. Dietitians work in the realm of this reality and not in a research setting.

Posted by deipnosophist on 24 August 2007

I believe our bodies are individual. I hear people reporting good results on low carb -- good for them. As for me my blood sugar was poorly controlled and I always felt like I was starving and my insulin requirements kept snaking upward. Now I'm 100% low glycemic vegan -- see Dr. Neal Bernard's Program for Reversing Diabetes, and I have lost 50 lbs, I rarely suffer from cravings, I am NEVER hungry because I eat all I want, and my daily Lantus injection has dropped from 40 units to 7.

Posted by Anonymous on 24 August 2007

Dr. Feinman has put together an entirely logical and well documented case for Low Carb diets for diabetics and pre-diabetics.

I'd love to see this article expanded -- it is critically important for diabetics to find a pathway to avoid the horrible complications of diabetes, complications which are NOT avoided by the use of standard medication.

And, of course, some bodies do respond differently to different regimens, so those who found a way to tweak a low carb diet in a way that works better for their body are to be congratulated, but are not a refutation of a basic low carb starting point.

Anonymous 2

Posted by Anonymous on 25 August 2007

I generally do not recommend low carb diets for the patients that I see for several reasons, But suggest a balanced diet with a controlled amount of carb.

1. Brain function requires about 135 gms of CHO per day. Yes the body will make gome glucose from gluconeogenesis. but...
2. For patients with chronic kidney disease, on an ultra low carb diet, the calories have to come from somewhere and that generally means protein foods or fats. If protein, then that puts extra load on the kidneys. Do all patients truly know what their kidney status is before they start?? Patients should be under the supervision of their physician if they go to a low carb diet.
3. A high protein diet acidifies the blood making calcium leaching from the bones more likely, hence an increase risk for osteoporosis and if prone, kidney stones.
4. High fat diets, especially the wrong type of fat are bad for cholesterol levels. Meat, any type of meat does contain some fat.
5. The type of carb selected does make some difference. Complex carbs are better choices-whole grains, fruits and vegetables.
Vitamins can't give all of the nutrients found in these items. There are other trace nutrients present in foods that do make a difference in our health. Do those with diabetes truly want to chronically avoid things like fresh strawberries, & fruit?
6. If on insulin or oral hypoglycemic agents and the carb content of the diet is radically altered, hypoglycemia can result.

Posted by Anonymous on 25 August 2007

a high fat carb restricted diet is the only way to go---especially the brain---the brain functions much better on ketones as fuel instead of glucose---that is why a ketogenic diet is recommended for such things as epilepsy, alheimers, parkinsons, and bipolar disorder---
higher fat not higher protein is the answer for diabetics---saturated fat needs to be at least 50% of the fat intake---
unfortunately there are way too many people who would be like the earlier poster---shoot and extra dose of insulin and eat the way they want to--

I agree with the assessment of dietitians---most do nothing about looking into the REAL nutritional science---they spout what we've been hearing for years---and we know how well that has been working....

stick with a traditional whole foods diet like Dr Bernstein recommends---why take medication when you don't have to.

Posted by Ladybird on 25 August 2007

I personally feel that a lot of us, both type 1 and 2 forget that veggies are also carbs - but low- and very healthy for all of us. It's high carbs like pasta and white bread, which are not so good for us and the ADA is not advising diabetics not to eat these foods. When I decided to lose the weight, I didn't to do it by counting either the carbs or the calories but drastically cut proportions as Dr. Bernstein recommends. But,ofcourse, I do understand that someone on insulin does have to do that.

I find it outrageous that B. Schatzman is criticizing Dr Feinman for giving us very sensible advice. Why is he/she sounding so self defensive? Trying to defend the ADA? I haven't yet read anywhere on the ADA website or anywhere that they are asking diabetics to cut portions and spread out their meals over the day, instead of eating three main meals a day. They keep on saying that as long as one has their insulin or meds, they can eat anything they like. Doctors are not doing it any better, as we see from the poster above, who says he and his doc are perfectly happy with his big bowl of pasta and his A1c of 9.

The poster above this one says, he/she does not usually recommend a low carbs diet but a balanced one and then cuts out everything. So is he/she recommending a veggie diet? I think that is great, but why not say it clearly? As posters have written before if doctors are not afraid giving chemotherapy to cancer patients...as Dr. N. Barnard has so clearly written in his book, why are doctors afraid to recommend tough dietary changes to diabetics? It's as much as a killer as cancer is. Dr. Bernstein is, ofcourse, another toughie and needs to be admired. I, myself do not follow his way strictly, but do whatever I can.

Posted by Anonymous on 26 August 2007

To B. Schatzman RD:

I just have to disagree with you on at least some of what you have written. At my Web site, confused diabetics come to me in email and through my forum almost daily. They have tried what their dieticians have told them. They have followed the ADA food guidelines (http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp). Sometimes it worked at first when they were losing weight, but after 6 or 12 months, they got hungry, the weight came back, and their blood glucose rose. Or, the diet never really controlled their BG to begin with. Instead of advising carb cutting, they are advised to take more medication. Somehow they find low carb and my site (lowcarbdiets.about.com). They find they are totally lacking in guidance in controlling their BG through diet. They are left on their own to figure out what works for them in controlling their blood sugar. This has happened time and time and time again.

It really distresses me to hear diabetics not given information about low carb eating because "it's not sustainable". Sure, it's hard to forego a lot of the food we see around us all the time. But would anyone tell a celiac to "go ahead and eat some cake" because it's hard not to? NO - they are told "yes, it's hard, but you MUST eat a gluten-free diet". For the life of me I don't know why diabetics aren't told something similar. There are many ways to make a low carb diet livable - I've been doing it for many years, and so have many diabetics, who are now living happy and healthy lives. We should be helping people to eat the healthiest way they can, instead of this "eat more sugar-take more meds" advice that so many are getting.

Laura Dolson
About.com Guide to Low Carb Diets

Posted by Anonymous on 26 August 2007

When my son was diagonosed with Type I DM we were told by his doctor and the RD at the hospital to give him approximately 350 grams CHO per day between his meals and snacks. His BS ranged 40 -300 daily and his insulin needs were higher than they are now. I worked with a ND who follows Dr. Bernsteins advice and now my son's inulin needs are only 2.5 U Humalog per day and his BS's range 70-110. He is consuming about 80 grams CHO per day. Plenty to avoid ketosis and provide glucose for the brain. His whole personality is brighter, happier, and healthier.

Posted by Anonymous on 26 August 2007

To anonymous with the 1-6 points: If you kept up with the literature you would know that most of 1-5 are myths.

There are plenty of people that have been living and thinking for years on far fewer than 130g carb per day. Heck, some have even written books. Many of the body's processes are able to switch to using ketones so you need much less glucose, some of which may be supplied by gluconeogenesis, depending on the individual's carb tolerance or preference, etc.

If you are diabetic and you don't know your kidney status, it's time to find a new doctor!

Many people switching to low carb don't eat larger amounts of protein or fat than they did before unless they were seriously deficient in the essential amino and fatty acids to begin with. It is incredibly hard to eat too much protein on a regular basis because it is so satiating. People don't feel the need to replace all the calories because the BG swings are no longer driving their appetites. What they usually do is replace some of the volume of the eliminated sugars and starches with low carb vegetables and fruits. A low carb diet may be higher in percentages of fat or protein calories but is not necessarily much higher in actual grams consumed because of a spontaneous reduction in calories many people experience.

Some PWD have reversed their kidney disease and neuropathies by eating low carb. High glucose and insulin levels are harder on the kidneys than protein is. Lowering those levels often improves blood pressure. Acne, reflux, IBS, etc. improve, also.

Most people on low carb diets eat more vegetables than ever before. Who can't eat strawberries? AFAIK only people who are allergic to them. Berries are low in carb. Read a book.

People eating low carb, high fat diets have less fat in their blood than people eating low fat diets. On low carb diets tryglicerides plummet and HDL rises, which has been shown to indicate a change in LDL particle size that is beneficial to heart health and also correlates with an improvement in insulin resistance. Besides, maybe you haven't heard that A1c is a better predictor of heart attack than cholesterol even in nondiabetic people.

As for #6, DUH! that's the point, to reduce medication amounts. Of course people should be changing their diets and medications under their doctor's supervision. If your doctor is against it, fire his @$$ and find one that isn't a dinosaur. Diet can also be changed gradually with your meter as your guide while tapering off the drugs as they are no longer needed. Why should people keep taking higher and higher doses of insulin, ß-cell stimulators, statins, BP meds and other drugs to treat symptoms of complications or side effects, when simple changes in diet can make them healthier? If only most health professionals would tell people the truth and give them the choice of how they want to live with their diabetes instead of perpetuating these lies, diabetes would no longer have to be a slow lingering death for so many.

Maybe you haven't kept up with the work Dr. Feinman has been involved in:
http://www.nutritionandmetabolism.com/content/2/1/31
http://www.ajcn.org/cgi/content/full/86/2/276

Posted by Anonymous on 26 August 2007

Thanks Dr Feinman for a terrific article.

The slaughter of diabetics with the ADA diet benefits only the food and drug companies, and their massive donations to the ADA to keep this crock in place demonstrate just how much profit there is.

Jamilah, there is no high-protein Bernstein diet. Carb calories are replaced with fat, protein stays low. It astonishes me how many try Bernstein's diet without understanding his book.

I presume you're wanting to avoid fats to keep your LDL low. You should be more concerned with keeping the ratio of TGs and HDL

Posted by Anonymous on 27 August 2007

It is only people like you who will be able to change things around and highlight the problems with the ADA recommendations.

GREAT WORK

Posted by Anonymous on 27 August 2007

MY NIECE JUST FORWARDED THIS ARTICLE TO ME. SHE IS A MEDICAL DOCTOR WHO HAS HAD ME ON A LOW CARB DIET FOR YEARS NOW. I'M GLAD TO SEE THAT WORD IS REACHING THE GENERAL PUBLIC THROUGH YOUR MAGAZINE.

Posted by Anonymous on 27 August 2007

As an RD who mostly works with diabetics, I would never recommend a "high carb" diet, but a moderate, balanced diet with consistent carbs, that works with the individuals lifestyle. I would like to know what Dr. Feinman considers "low carb".

Posted by Anonymous on 27 August 2007

God bless you Dr. Feinman!

Posted by Anonymous on 27 August 2007

Fantastic! More medical professionals by the ADA's line of garbage hook, line and sinker. It amazes me that the ADA continues to espouse the line of "live your life normally", but add medicine and eventually insulin. I wonder if the ADA is dedicated to their patients or beholden to the almighty dollar. I mean, it's less sexy and less profitable to tell someone to quit eating carbs.

I was marked as pre-diabetic in 09/06. I flailed around for 3 months following the dietician's diet for diabetics. I gained weight and had no control of blood sugar. In January of 07 I said no more. Coming across the men's health magazine I became a believer. Since January 07 I've gone from 418 pounds to 308. My LDL is 120. My HDL is 42. My Trigs are 101. 10 freaking 1. A1C? 5.1. All this is due to low carb eating, as I maintained my normal exercise routine.

I will always maintain, and there is very little evidence that could convince me otherwise, that the ADA is killing diabetics each day with their outmoded advice.

Posted by Anonymous on 27 August 2007

I just wanted to thank you for saying all the things I wanted to say after reading Ms. Warshaws article. I sat here with my jaw dropped through most of it. I don't have diabetes and plan on keeping it that way. My family history dictates that I will mostly develop this disorder if I do not do something to stop it.
I have seen the effects of the ADA's recommended diet on my own mother. It lead her straight down the path from oral medication to insulin dependance.
This is not a path I chose to follow. I have also witnessed the counter effect a low carb lifestyle have had on her.
The "experts" can argue all they like. I have seen what works and what doesn't.
So again Dr. Feinman I would like to thank you for saying all the things I would have liked to have said.
V

Posted by Anonymous on 28 August 2007

I am writing to you from the Nutrition and Metabolism Society to thank you for publishing Dr. Feinman's article in Diabetes Health Magazine. The website address listed for NMS (Dr. Feinman) is incorrect. The correct address is www.nmsociety.org I'm sure you agree it is wonderful to see such interest among your readers (42 comments!). Due to the interest, I am requesting that the article remain on page 1 with our correct web address through the end of this week. I appreciate your consideration and I thank you again! Best, Lauri Cagnassola Associate Director Nutrition and Metabolism Society

Posted by Richard Feinman on 28 August 2007

I am grateful for the many responses to my article especially those that shared personal experience. I wanted to answer a couple of the these.

With regard to deipnosophist’s comment on low glycemic vegan diets. I think everybody agrees that the data show that this is one of the effective nutritional approaches for those who are comfortable with it. It is a big lifestyle change for many but one can go back to Aristotle for the idea that we may be more comfortable with extremes than with moderation.

In any case, my article was only in response to those who want to stop people from using a different approach, an approach that, in fact, has numerous success stories, some in this list of comments, and one that is grounded in biochemistry. Similarly, I don’t know whether anonymous’s doctor is really happy with an A1c is 9 or he is just exaggerating the reasonable idea that many people prefer drugs to lifestyle change. My only point is that all the options should be on the table.

On B, Schatzman’s comments, it is not true “The ADA dropped specific recommendations for carbohydrate many years ago...” Whereas the 2007 ADA nutritional statement is very vague on what it recommends -- I don’t think it suggests even moderate reduction in carbohydrate -- it is very specific about what it doesn’t recommend. The phrase “Low-carbohydrate diets, restricting total carbohydrate to 130 g/day, are not recommended” appears at least six times. Forgive my original exaggeration but the ADA does say "Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications."

As for anonymous who does not recommend low carb diets, it seems that it is the fact that he does not recommend them that is taken as justification. The points he mentions have been raised and answered a hundred times in the literature. It is not for me to say that I am an expert on that literature but I thought I presented sufficient data so that he might ask (not tell): Isn’t there a “but…” on no requirement for CHO? Are low carb diets really high protein? And is there really evidence for risk of kidney stones? Does Figure 2 mean that there is no risk even for saturated fat? Do you think the type of carb makes a difference? Are there other trace nutrients that would over-ride the benefits of carb reduction?

I have no doubt that anonymous and Hope Warshaw are considerate and show real compassion in interactions with their patient but I think they would be able to offer more opportunities if they tried to ask what might be valuable in carbohydrate restriction rather than trying to dismiss it out of hand.

Posted by Susan Enzer on 28 August 2007

Thank you for challenging "Conventional Wisdom." As the widow of a Type II diabetic and the mother of a Type I diabetic we have spent years trying to find the right balance for managing BS and staying healthy. The JDF/ADA recommended diet has always included at least 40% carbohydrates. The more carbs, the more insulin! The more insulin, the hungrier you are.... It's time to challenge current practice and change protocol.

Posted by Anonymous on 29 August 2007

I am a RN and went to school over 30 yrs ago. We were taught then that carbs were to be avoided or minimized when a diagnosis of diabetes was made. I guess my school was behind the times as we continued to treat diabetics as they had been treated prior to the discovery of oral meds.....restrict carbohydrates! ALL carbs should be restricted and the ones that are eaten should only be from whole natural foods like dairy, fruits and veggies.

I can't understand why they push carbs on diabetics. Like Laura stated in her post....we tell those with gluten intolerance to avoid gluten....so why do we encourage carbohydrates when someone has a carbohydrate intolerance?

Re weight....weight gain is a SYMPTOM of impaired glucose tolerance, it is not the cause. We knew these things 30 yrs ago, why don't we know it now?

Re "sugar" vs "complex carbs". ALL non-fiber carbs are absorbed, but complex are absorbed slower. So if you eat 100grams of sugar vs the equivalent of 100grams of grains you will still get the same amount of glucose in your blood....but the glucose will rise a bit slower in when taken as grains....big whoop, it's slower, but it still causes a rise in blood sugar.

Thank you Dr Feinman. Eventually the truth will come out. Personally I believe the medical industry (which includes the AMA, AHA, and ADA) are afraid to give the OK to low carb diets as they will be forced to admit that fat isn't bad for us and is in fact essential for good health. Can you imagine the lawsuits?

Saturated fat is good for us. It increases HDL (good) cholesterol. Low carb is good for us. It increases the size of LDL particles (and makes them less dangerous), lowers triglycerides, blood sugar and insulin levels, blood pressure. High protein is relative, but essentially also good for us. Higher protein levels lead to higher albumin levels, which is directly related to survivability of serious illness or injury.

Cindy Moore

Posted by Abuela on 29 August 2007

Just what I was looking for. I find that carbs make me feel week and somewhat sick

Posted by Anonymous on 30 August 2007

EXCELLENT article. On a low carb diet, I have loads of energy, require less sleep cause my sleep is so deep and uninterrupted, I am happier, and don't have mood swings!

Posted by Anonymous on 30 August 2007

As a health care professional, I would love to see my patients with diabetes eat low-carb, and it's wonderful to see so many of you who have responded are willing to take responsibility for your health and make significant long-term lifestyle change. However, in over 20 years of diabetes health care, I have seen very few people who are willing to make a lifelong commitment to living healthy. Bravo to those of you who do. Please don't blast health care professionals who say that in general it's not realistic - it ISN'T for most people, regardless of how much we encourage, insist, cajole, negotiate, educate. As frustrated as many of your are with your providers, imagine how we providers feel when we can't even get someone to try a new vegetable, eat pasta as a side dish instead of as an entree, or stop eating french fries.

I agree that health care professionals are often too prescription-happy. ( After all,trends in health care is largely run by pharmaceutical companies). In fact, many people with Type 2 diabetes complain to me about the big list of meds that they are on. If I say that they could get off all of them if they eat a whole foods, plant-based diet and get active, rarely do I see anybody get excited and decide to do just that.

I'm glad the ADA includes foods with sugar as acceptable in small amounts, not because it's healthy, but because it gets people with diabetes off the shame/blame cycle that ruled diabetes care for decades.

Instead of blaming each other, what can we do to make 21st century life more conducive to healthy living for the common person? How do we make fresh healthy foods easily available and affordable? What can we do to make being active a part of our culture?

Posted by Anonymous on 30 August 2007

I blame the ADA for my carbohydrate addiction as a Type II. Following their high CHO diet got me where I am today....knowing that low carb is best for me, but unable to stay away from the carbs that I should not eat. I learned by researching myself that what they were recommending was wrong. As for most dieticians, they are as bright as the ADA when it comes to CHOs and diabetes. Bravo Dr. Feinman.

Sign me a Registered Nurse who ignores dieticians and the ADA.

Posted by Anonymous on 31 August 2007

i know following a low carb diet helps diebetes. My husband was on three shots a day for years and when he lowered carbs has been off shots for over five years now. keep encouraging people to lower carbs thanks for this article

Posted by bjk on 31 August 2007

How ignorant can you be? You would tell me that you would rather have a patient feeding off their own protein stores to supply the essential glucose our bodies need, rather than getting an adequate amount through diet? A person needs at least 150 g of carbohydrates on a daily basis to help maintain energy, utilize protein metabolism, and keep the body out of ketoacidosis. I really think instead of reading into Ms. Walshaw's statements and interjecting your own misinformations, expand on them in a way that is more helpful. Emphasize whole grains, fruits, and vegetables that do offer fiber, vitamins, and minerals that are essential to maintain optimal health.

Posted by Anonymous on 2 September 2007

Could someone please acknowledge the differences between type 1 and type 2 diabetes, 'cause I think that's a big factor in this discussion. A different thing happens to your body, and it's treated differently most of the time. I have type 1 diabetes. I'm 20 years old and not overweight at all, and I HATE it when people talk about the "obesity epidemic" that leads to unprecedented numbers of newly-diagnosed diabetic each year. My disease has nothing to do with my weight!

Posted by Anonymous on 3 September 2007

As an RD, CDE with 30+ years of experience in diabetes management, I find that I am in general agreement with Dr Fienman. I have read most of the research comparing a low carb diet to a low fat, high carb diet. The science speaks loudly that as carbohydrates are reduced blood sugars, HDL, triglycerides and insulin sensitivity improve. I give my patients the education and data on the benefits of a lower carb diet and encourage them to experiment. I use a health coaching approach helping patients to set goals, develope low carb menu plans. Many of my RD counterparts are advising low carb diets in keeping with the new science. Don't give up on all dietitians!

Posted by KABS on 5 September 2007

There are arguments to support both the low carb and the ADA recommendations. As a responsible educator I need to assess each person and come up with a solution to good blood glucose control that will work for that individual. Removing an entire macro nutrient group from someone's diet doesn't always translate into long term sustainable control. If our goal is to move each person out of the category--high blood sugars = possible complications...Then creating a life style that the person can live with and maintain is the way to go.
Look at where pump therapy has taken us--kids with type 1 on pumps with appropriate carb to insulin ratios are eating carbs and keeping their blood sugars in good control and hopefully living long healthy lives. Let's not take a giant step back to where we were a mere twenty or so years ago: NO SUGAR. That produced generations of people who couldn't or wouldn't comply and lived miserable lives and died of horrible complications.
Let's try to remember what the body does when it works well--it releases more insulin in response to carb intake and keeps the blood sugar where it's supposed to be. What the fat cells do in response to the extra calories is another chapter, but let's not be so short sighted as to create that kind of closed approach again. We've come to far for that.

Posted by Anonymous on 5 September 2007

To Richard D. Feinman, PhD:

It is great to see that low carb movement is making headway. Please keep the articles coming.

Although I don't have any medical issues since following the Atkins Nutritional Approach I have never felt or looked better. My blood work is also excellent.

Posted by mjensentulsa on 7 September 2007

There is another significant advantage to a low- or reduced-carb diet that hasn't been mentioned. It provides a more predictable correlation between food intake and dosages for insulin-dependent diabetics. This leads to a dampening of BG "swings" that lead to additional correction dosages, which are frequently followed by low-BGs, followed by more carbs, etc.

In my house, we refer to this as "the rollercoaster." And yes, the whole house knows about it, because it affects my mood, as well as my ability to join in meals, the need to seek out something -- anything -- containing carbs (man does not live by glucose tablets alone).

Here's how that works. Even a pump user like myself who is able to adjust fast-acting dosages to a tenth of a unit or less is basing those dosages on criteria that are estimates at best. First, you have to estimate the carbs themselves, then you have the varying uptake of the insulin dose. This, in turn, is affected by exercise (before during or after), time of day, previous carb/insulin intake that hasn't fully resolved, etc.

My pump has some software built in that helps somewhat, but that's not entirely a reliable control. Instead, think of this: Let's say the variations net out to 20% plus or minus. If I eat a meal with 10 carbs, and dose "properly" then my body's response might be like I ate 8 carbs (and thus the insulin dosage was an equivalent proportion "too high") or like I at 12 carbs (and the dosage was proportionally "too low").

That will cause a swing in my BG, but not a big one.

If instead I eat a 50 carb meal (really not hard, if you are familiar with counting carbs), and dose "properly" for that, the 20% swing can mean you "underdosed" by 10 carbs (20% of 50), or you "overdosed" by 10 carbs.

You didn't do anything wrong -- your actual dose was what your meter, your pump, and your doctor said was right, in both instances.

But in the second instance, you could have an upward or downward swing like you took a shot of insulin that was equivalent to the low-carb adjustment without eating anything -- or like you at 10 carbs without any dose at all. What would your BG look like in either of those cases?

Sadly, many Type 1's will not know the answer to this question, because they simply chase the BGs up and down with insulin and food, without any sense of control. Or worse, they avoid the meter altogether and simply try to maintain a high enough BG that they don't end up in the ER with hypoglycemia. That's why so many diabetics have A1cs of 9 and above. They're trying to stay out of the hospital, and their medical advice doesn't give them the tools for proper control.

As for the educators who wonder how to get people to make long term changes? You do that by getting them to change habits. You get them to change habits by focusing on the extremely short term. Test-eat-dose-wait-test -- now, how do you feel? Repeat.

The feedback I get from my meter, and the way it improves my moods is enough to keep me on a reduced carb diet. My control is better, I feel better, I actually get to eat a lot of foods I like that other advice eliminated from my diet, and I simply reduce the portions or make other choices. Nobody has to lecture me to convince me that it is good for me -- I feel it every day, minute by minute, hour by hour.

Posted by Anonymous on 10 September 2007

Eating low carb has changed my life. I had a BS level of 128 and after four weeks on Atkins, it was 96. I have lost 120 pounds and have maintained the weight loss now for over six years and have had a consistent BS reading of 94!!
Thank you for your most encouraging artical.

Posted by Anonymous on 12 September 2007

I don’t think people should be condemning RDs so much or the recommendations they provide. There’s a reason much of the info has been “spouted” for years. It’s because it does work. For those it hasn’t worked for, it’s most likely because they didn’t follow the recommendations 100%. Similar to what will happen if you don’t follow a low-carb diet 100%...you start gaining the weight back. You have to be very strict about whatever diet plan you choose, otherwise you will not succeed.

Many people say, “I followed the ADA diet, or a dietitian’s advice and it didn’t help me.” My question to them…how much of it did you follow? Many of my patients come back to me and say “I followed everything you said, but I still didn’t lose any weight or my sugars are still high.” So I start asking questions; are you sticking to 45-60 grams of carbs per meal?....”well I had 1 cup of rice and 1 cup of potatoes for dinner, so I did what you said!”…when in fact they hadn’t done what I recommended.

Maybe carb counting is too difficult for some patients, and I agree it can be a bit confusing especially for those with limited education. So maybe RDs have to come up with more simplified ways of explaining things. Thus I don’t think it’s the information that should be criticized but they way it is delivered.

All these arguments against dietitians and for “low-carb” diets seem to ignore the people who have had success following a dietitian’s plan. There are many people who eat carbs in moderation, eat more whole foods, fruits, veggies, eat healthy fats, etc, who are also healthy, fit, have “good numbers,” and are able to keep their diabetes in control. I as a dietitian follow this way of eating now, even though I was raised on a typical American diet of junk foods, fast food, sweets, and sodas. So I have also been encouraging my diabetic patients to reduce their carbs but not go completely low-carb. I usually recommend 45-60 grams per but to also include pro & fat.

Now the patients who actually follow this…they do very well. Those who don’t follow this, don’t want to or know how to count carbs or reduce their portions. Therein lays the problem. It’s almost easier to tell people to eat all they want as long as it’s just fat & protein, rather than tell them to moderate their carb intake. People prefer an all-or-nothing approach. Also by eating in “moderation” you end up eating less, and God-forbid people in this country eat less! So of course a “low” carb approach works because it lets us Americans eat all the fat & meat we want! How lovely!

I’m going to stick by what I teach…whole, natural foods in moderation & less processed junk foods, and of course an active lifestyle

Ultimately, I think diabetics should find a plan that works for them and gives positive results. If that means low-carb, hey that’s fine. If it means moderate carbs, that should also be fine.

For all of you who criticize dietitians, you are also criticizing the people who come to us for help & who benefit from our help. It’s like, not liking “shrinks” or psychiatrists and thus criticizing people who seek mental health counseling.

Just b/c you didn’t have success with an RD, doesn’t mean we are all incompetent. You’re then just being as narrow & close-minded as you claim us to be! For those who have never met a dietitian or worked with one, where are you drawing your conclusions from...or are you just going along with the crowd?

Of course I don’t agree with everything ADA says nor do I encourage all patients to be on meds…in fact, I would prefer if all patients could get off meds & treat their illnesses with a healthy lifestyle instead. I agree the drug companies enjoy making a profit and will do whatever they can to keep patients on meds. In fact, I sometimes find them to be pure “evil.” I also know that many RDs & RNs, & MDs can be “influenced” by these drug companies (whether it’s through free samples, meds, money grants, etc) and I should hope that we do not let these companies influence our counseling or care-giving.

Posted by mjensentulsa on 13 September 2007

In response to the previous comment....

"For those it hasn’t worked for, it’s most likely because they didn’t follow the recommendations 100%." Any recommendation that requires a patient to comply "100%" for effectivenes is the wrong recommendation. That's not therapy, that's shame and blame, and I'll bet it's pretty close to 100% ineffective.

"I usually recommend 45-60 grams per but to also include pro & fat."

You're recommending an amount of carbs that will cause your patients to be unable to predict their postprandial BG to the tune of a 200 point swing (based on insulin sensitivity of 100, carb ratio of 10g/unit, and a 20 percent variance in the conversion rate).

When that patient comes back in a month and says that they are still riding the roller coaster, do you accuse them of not following your advice 100%?

"For all of you who criticize dietitians, you are also criticizing the people who come to us for help & who benefit from our help."

No. Actually I am criticizing dieticians who do not understand the impact of their advice on BG control, and who wash their hands of the outcome based on unrealistic expectations of the patients they see.

Posted by Anonymous on 13 September 2007

As evidenced by some of the people who have posted their successes in the comments to this story, many people can, and do, comply to a low carb diet 100%. It's a choice one makes.
I don't think Dr. Feinman is trying to make anyone's choices for them, he is simply showing us that there is an alternative. We each have the perogative to do what ever we want with our bodies and manage our health however we like. A low carb diet is one way that does indeed work for many people, and all people should be afforded the option. Dr. Feinman is simply providing the research and the public has a right to be made aware of it. And we each still have the right to choose if it's the path we want to follow.
Thank you Diabetes Health for providing the information.
Ivan C.

Posted by Anonymous on 14 September 2007

To Dr. Feinman:
It is actually NOT true that the 2007 ADA Clinical Practice Recommendations state that "low carb diets restricting total carbohydrate to 130 grams/day is not recommended" - the CORRECT statement is "...restricting low total carbohydrates to LESS THAN 130 gm/day is not recommended".

Posted by Anonymous on 14 September 2007

"Ladybird" expressed exactly my path and it works for me to the point that 7 years after diagnosis with Type 2 I am back to a normal person's profile with excellent HDL and A1c 5.1 and Dr Feinman's propostion makes perfect sense to me as one strategy.

Posted by Anonymous on 16 September 2007

Let the dietitians eat my share of carbs. I will not be eating 130g, it is too much for me. I feel like crap when I eat like that, I feel much better at ~60-80g total. The professionals that tell people not to cut carbs to what they can tolerate should be the ones having to experience the BG rollercoaster for themselves.

Posted by Anonymous on 20 September 2007

I agree with this article.
It's just common sense.
Why do some people seem to think it's a good idea to maintain a high-level carbo intake? Once I reduced my carbs (a year ago) I had a lot better control over glucose levels and I've lost thirty pounds. My Dr. says I'm practicly normal (although I'm type 2). But I don't tell him I'm doing a low-carb diet because I know he'll tell me to stop. Why would he tell me to stop? Because that's what HE's been told.

Posted by Anonymous on 23 September 2007

To 'anonymous' (Sept. 20) Don't be sure that your Dr. is opposed. Dr. Feinman published a survey of the low-carber's forum which found that most Dr.'s were supportive of low carb diets. Also, most of the other Dr.s were supportive after the patient showed good results! I think that most Dr.s want to help their patients. The experts on the ADA panels seem to be self-serving (not to mention self-appointed) and don't speak for many MD's. Take a look at the survey. It's very interesting and shows how many stereotypes of low carb diets are not consistent with what people actually do. Ivan C

Posted by Anonymous on 29 September 2007

If the doctor has any brains left in his head he can tell from the change in your triglyceride:HDL ratio what type of diet you eat now.

Posted by Anonymous on 4 October 2007

"How ignorant can you be? You would tell me that you would rather have a patient feeding off their own protein stores to supply the essential glucose our bodies need, rather than getting an adequate amount through diet? A person needs at least 150 g of carbohydrates on a daily basis to help maintain energy, utilize protein metabolism, and keep the body out of ketoacidosis." You have no clue about human metabolism.

Posted by Anonymous on 17 October 2007

To the poster named bjk

No one is ignorant here, especially not Dr. Feinman. The problem is that you are misinformed on the subject of basic human biology.

You are confusing ketosis with ketoacidisis. They are two entirely different processes. Ketogenic metabolism uses fat stores not protein for glucose. Ketosis is a harmless and possibly preferential fat burning metabolism. It's too bad that so many people still believe the myth that it is dangerous and it's ironic that these same misinformed people often throw insults and call others ignorant.

Your claim that "a person needs at least 150 g of carbohydrates on a daily basis to help maintain energy etc." is completely false. The human body has no specific carbohydrate needs. None. A diabetic person certainly should not be getting even half that amount on a daily basis. I am under 30 g carbs from vegetables only. No fruit. No grains. I am one of the healthiest diabetics you will ever meet and I do not need more than 30 g. I could easily do with less than that.

Posted by Anonymous on 19 November 2007

I walked into a medclinic 3 weeks ago because I had been experiencing pain (comes and goes)up and down both arms. The doctor said I looked fine and was confused, but suggested blood tests. The next day, he called to tell me I had a bg reading of 366 and that I'd probably had diabetes for a while and didn't know it...the pain may be neuropathy. He prescribed metformin. I bought a monitor and tested myself. But, even with the meds, I couldn't control the bg and the readings which ranged from 296 to an alarming 393! (The doctor had said at 400, we put you in the hospital).

So, I was determined to go on the Atkins Induction. One day later, the bg reading was 179 (with metformin 2/day). The second week of induction, the average was 150 with some as low as 143. The pains in my arms are gone! I am so happy to have stumbled across this blog, because I was starting to crave cake and I was doubting the intelligence of this low carb lifestyle.

Thank you Doctor for this article. I am now confident that this is the way to continue. I am praying that soon, I can eliminate taking the metformin. I have also noticed that I have no acid reflux or gas.

I'm eating many more vegetables than I have ever eatin in my life! And I substitute my cravings for cake with sugar-free jello and whipped cream or sugar-free candy. I also have nuts like almonds & macadamia, seeds like sunflower and pumpkin, and many different cheeses to help with snacks. Low carb does not mean ONLY meat! My motivation and prize are my lower bg readings!

Posted by Anonymous on 29 November 2007

(anonymous on 19 November 2007,)
Watch out for those sugar free candies, some of the sugar alcohols they contain do raise your BG almost as much as sugar. There are other sweets you can make yourself that are extremely low carb.

Posted by lmy on 10 December 2007

i have a hba1c of 6.5. i am on no meds , exercise regularly , low carb diet , eat mainly fish and vegetables. i also take my bld glucose @ home upon arising ,pre and post prandial. My 1-2 hours post prandial are below 120. they then decrease to 100 or below. My morning numbers are usually in the 100-125 range and then go down after eating to below 100.

what i don't understand is having an HBA1C of 6.5 correlates to an average bld glucose of 154. i have never had a reading of anything even close to that high of a reading. I don't want to take any meds , and would rather continue to eat and exercise properly. any comments would be helpfull.

Posted by Ladybird on 28 December 2007

To Imy, I'm also puzzled by the co-relation of my A1c numbers and average bld glucose. This time my A1c of 6.3 came to 129, higher than most of the figures on my meter, last time my A1c of 6.6 came to average of 139, I can't remember ever being that high. My A1c in May was 5.9 and my average was 117. The number I see is to divide the average by about 20 in all my A1c's, yours is almost 24, I do feel your average should be closer to 130, although, that may be higher than your actual numbers.

I often feel the numbers on our meters are much lower than than what is obtained in the labs. I'm like you, a type 2 not on meds and hope never to be, on a low carb lifestyle, I refuse to call it a "diet", this is for the rest of my life, not temporary, on veggies, whole grains but not much and low fat, but putting olive oil on everything I eat. I eat no red meat and chicken once in a while only, but do eat fish and nuts and cheese like another poster. My trigs are very low!!

I exercise religiously, I feel it's the most important thing to do for all of us, luckily, I can do so will continue to do so. I do feel using our common sense in choosing what we choose to eat. Extreme "diets" don't work in the long run, unless, that's what you really want to do. But let's not insist on having that cake also and then wondering what went wrong!

Posted by anonymous8888 on 5 January 2008

I was just recenlty diagnosed with type 1 diabetes and am becoming very frustrated. Can you tell me what the normal blood sugar level should be before and after meals? It seems that no matter what I eat, example, salad with no dressing and dry chicken breast, for dinner, my sugar levels are always in the upper 200's....Help

Posted by Anonymous on 16 January 2008

Is oat bran an ground flax seed harmful or benefical for diabetics?

Posted by btoth on 16 January 2008

Is oat bran and gorund flax seed benefical or harmful to blood sugar levels. Also is olive oil benefical or harmful? Thank you!

Posted by Anonymous on 23 January 2008

" Posted by anonymous8888 on 5 January 2008
I was just recenlty diagnosed with type 1 diabetes and am becoming very frustrated. Can you tell me what the normal blood sugar level should be before and after meals? It seems that no matter what I eat, example, salad with no dressing and dry chicken breast, for dinner, my sugar levels are always in the upper 200's....Help"

If you are on a low carb diet, you need fat. Dry chicken breast? Where's the skin? Salad with no dressing, Have your choice of low carb dressing.

Check out proteinpower.com or any other low carb website. There's tons of advice for diabetics and none of it includes leaving fat out of your diet.

Read Good Calories, Bad Calories by Gary Taubes.

Too much protein and not enough fat can cause higher BG levels.

Good Luck.

Posted by Anonymous on 5 February 2008

perfect. brilliant!

Posted by Anonymous on 10 February 2008

to lmy and ladybird. Take a blood sugar reading every 15 minutes from the time you eat a meal until 2 hours afterward. By only measuring at 1 and 2 hours you are missing the peak reading, which is probably going way over 200.

To anonymous8888, if you are a Type I then you are on Insulin. In the short term you need to be taking larger doses of insulin. In the longer term you need to buy Dr. Bernstein's Diabets Solution book and see how to save your life.

Posted by Anonymous on 10 February 2008

I am a low-carb advocate. I am a diabetic who keeps my HgbA1c = 4.5 - 4.8 through low-carb eating and exercise.

There are many misconceptions in people's comments.

1) Yes, you do require a certain amount of carbs per day. However, you body can make all of them from other foods that you eat. It's called gluconeogenesis.

2) It's true that not everyone would stick with a low-carb diet. People who give advice to diabetics should at least offer them the option. Right now it's suppressed information.

3) Your body will only break down its own muscle tissue to make glucose if you don't eat enough protein.

4) Eating a lot of protein is not harmful to you unless you have very very bad kidneys. Only a very small percentage of diabetics are so far gone kidney-wise that they should not eat a lot of protein.

5) You shouldn't argue with your glucometer. If you have any food and you want to see its effect on blood sugar then just take a baseline reading, then eat the food, then test every 20 minutes for two hours. See how the food affects your blood sugar.

6) Let's cut the RDs some slack. They are only technicians. They aren't paid, and aren't allowed to think. They have to do as they were taught or they could be guilty of malpractice. When the textbooks and their classes change then they will change. You really wouldn't want it any other way.

7) Doctors, on the other hand, are allowed and even encouraged to think. If you have a doctor who is stronly against low-carb then that doctor is not working in your best interest. Time to move on.

8) If you haven't tried low-carb for your diabetes, you really should. Ask yourself would you rather keep on eating flour, sugar, etc and eventually end up having your body parts cut off a little bit at a time, or would you rather just give up the bread, cake, and potatos, and keep your body intact. It's your choice.

Posted by Anonymous on 14 February 2008

Bravo Dr. Feinman! I noticed many of the same bizarre contradictions in the conventional, text-book thinking on diabetes and diet that you have skewered here.

I couldn't believe it when I found out that my cousin was told by his doctor to feed his diabetic child a high carb diet and then offset that with high doses of insulin. Some day medical historians will look back on that thinking as one of the stranger dogmas in medical history, akin to bleeding patients and other odd treatments of the past that were not based on scientific evidence.

Posted by Anonymous on 29 February 2008

I have been researching alot since being diagnosed 3 months ago and this is one of the best articles I have seen to date.
Great.

Posted by Anonymous on 6 April 2008

My father was diagnosed a diabetic in the early '70s. He started out on tablets (sorry, don't know which ones) and controlled his carbohydrate intake. Once the initial scare wore off, he started increasing his intake. He rollercoasted over the next few years, having to go into hospital every so often to be "stabilised". The diabetes got worse until he had to start injecting insulin. He then started "contolling" his disease by eating and drinking what he liked and just injecting the appropriate amount of insulin to sort out the blood sugar levels. Maybe this was OK, all I know is that he died early as a result, about 10 years later. Diabetes runs in my family, and having looked at the "low-carb" arguments, I try and keep to a low level myself, certainly not the vast amounts of pasta/potatoes etc recommended at the moment. It strikes me that if you don't allow the blood sugars to leap around all over the place, less damage will be done. So far I am not diabetic, and I am hoping to stay that way.

Posted by Anonymous on 7 July 2008

Hi -
What happenwd to the rest of the comments that were here?

Posted by Green Lantern on 18 July 2008

Excellent, excellent article. I'm so glad to hear someone say that there is NO carbohydrate requirement (the body can make what it needs) and that less is more when it comes to carbs and diabetes. Now if we could get the grain lobbyists out of Washington, maybe the food pyramid could reflect what we really should be eating: Good fats, LOTS of vegetables, moderate amounts of protein and non-tropical fruits, and only very limited, occasional servings of low-carb grain-based foods...

Posted by Anonymous on 1 August 2008

I was looking for the rest of the comments as well. I even wrote to Scott King twice to find out. I have received no response. Can you please let us know?
Thanks,
Laurie C

Posted by Diabetes Health Webmaster on 4 August 2008

Hi Laurie,

It seems that most of the comments were disabled. They're back now.

Posted by Anonymous on 11 August 2008

Isn't gluconeogenesis or a high protein diet harmful for the kidneys? As a thin Type II on insulin with proteinurea, I've read that carbs are healthier fuel than protein.

Posted by Anonymous on 14 August 2008

Quote "Life is all about eating not dieting."

Surely, you jest!

Life is about living.

Posted by rumford on 15 August 2008

Gluconeogenesis (GNG) is a normal process. When you wake up in the morning about 50 % of your blood glucose comes from GNG (more or less depending on your diet). High protein diets may be harmful for people with kidney disease but it has been impossible to show that they have any effect on people with normal kidneys and researchers have tried very hard over the years. There is, however, no requirement that you increase protein when switching to low carbohydrate diets. Most people increase vegetables and don't substantially change fat or protein. On the other hand, it is clear that substitution of fat (even saturated fat) for carbohydrate is beneficial -- carbohydrate (directly and via insulin) controls what you do with the fat. Low fat diets continue to be shown to be inferior to low carbohydrate diets and the scandal in the promotion of low fat has been described by many authors, most recently by Gary Taubes.

In the end, though, low carbohydrate diets have been around for thirty years and the medical establishment has varied between "concerned" and "alarmed" yet they have not come up with any patients who are harmed by the diet. At the same time, they have been unwilling to accept any responsibility for the epidemic of obesity and diabetes and instead blame the patient, the fast food companies, television, whatever and continue to be critical of any alternative.

Posted by catman on 15 August 2008

It's been some time since I have read through this thread. Great comments by Dr. Feinman. Good to have you out here with the rest of us low carb proponents.

Good one Cindy Moore when you said;
"Re "sugar" vs "complex carbs". ALL non-fiber carbs are absorbed, but complex are absorbed slower. So if you eat 100grams of sugar vs the equivalent of 100grams of grains you will still get the same amount of glucose in your blood....but the glucose will rise a bit slower in when taken as grains....big whoop, it's slower, but it still causes a rise in blood sugar."
And with the complex carb the BG will come down slower and later than the BG from a simple carb. But in the end, glucose is glucose and a carb is a carb is a carb.
A big problem with the concept of good carbs, bad carbs theory is that it assumes that slow digestion makes a difference. Not really. The sugar gets into your blood a bit slower with a good carb. But the amount of sugar and the associated amount of insulin required is the same as the same amount of bad carb.
The real issue is that of the 3 macro nutrients (protein, fat and carbohydrate)only protein and fat are essential in human nutrition. Any perception that may have been created that carbs are an important nutrient is a grand illusion.

Posted by Anonymous on 21 August 2008

Very interesting article and comments. I have recently been diagnosed Type II and have not yet gone through the diabetes education program at local hospital. Will begin these in 2 weeks so should be fascinating to hear what is said about low carb eating plans! However, having been overweight all my life, I am more than familiar with South Beach, Atkins, Weight Watchers. After being diagnosed, I immediately switched to low carb eating! I had always eaten sweets, white flour, white rice, pastapastapasta, rolls,pies,etc., and red meat 2 or 3 times a week in different guises. No more! I am eating loads of fresh veggies, chicken, salmon, sardines. I do eat some carbs such as Wasa Bread or low carb whole wheat bread once a day but prefer getting carbs from the veggies. I loathe fruit so no cravings there but DO love the sugar free gelatin. Also, a few walnuts and almonds, salad dressings low carb. I have lost 8 pounds of pure bloat and realize how crummy I always felt after consuming pasta, pie, cookies, potatoes and cake! I test alot as a newbie to learn what the food is doing to me. Numbers pretty good as taking Lantus at bedtime. I have friends who are Type I who do the "eat anything and take more meds" routine....I find this scary as heck. At this stage, I just want to learn, learn, learn but low carb sounds like the way to go.............................

Posted by Anonymous on 21 August 2008

Every one of you needs to read the China Study by Dr. Campbell. I'd like to see your comments after that.

Posted by Anonymous on 22 August 2008

I don't think we still have the data to support a high fat, high protein diet long term. Even protein raises insulin levels. Protein in excess can be hard on the kidneys of many diabetics, esp with microalbuminurea and can be hard on livers. High protein & high fat diets are usually high in saturated fats, which we know promote heart disease. I agree in individualing treatment and offering all options. But, I think long term we will find that unless we lead the lives of cavemen, we cannot propose eating like cavemen.

Posted by Anonymous on 22 August 2008

Very interesting posts. I am type 1 diabetic (41 years)and I have tried low to no carb diets for varying times. No support for this from my medical team, so I had to really test and experiment to try to get my reduced insulin intake in line with my reduced carb intake. And I found it very difficult not to eat dairy or ANY fruits or milk at all as on Dr. Bernstein's program. I did find that the protein filled me up. However, I returned to a moderately low carb intake (about 90-100 grams per day) and found it was more sustainable. I still crave salty processed food ( like crackers) I will admit, but the roller coaster blood glucose effect is greatly reduced, and my numbers look good.
I also want to say that low carb diabetes management IS very difficult for those of limited education and economic means. Many of the most ill diabetics have not been able to get access to higher qulity low carb food, have been raised on a eat what you want because it is one of the ways you can entertain yourself( due to limited means or opportunities to do otherwise. I am not sitgmatizing, just pointing out what I have seen as an educator in the public schools and in many communities. Hey the whole country has this viewpoint:How do you change a mindset of America at large that says "EAT,Drink and be merry?" Many people, regardless of soioeconomic standing, feel that a life of "FOOD denial" is not a life worth living. That is beyond the scope of most diabetes researchers, CDE's, or doctors can change.

Posted by Anonymous on 3 September 2008

>>Ms. Warshaw would no sooner advise to eat candy over other more healthful carbohydrate choices than any other well trained Dietitian.

You are funny.

I tell my diabetic friends that chocolate candy bars would be a better choice than pasta, rice, potatoes, etc.

It gets their attention - Everybody instinctively knows that chocolate candy bars are a very bad choice for diabetics!

But calorie for calorie chocolate candy bars will not raise blood sugar nearly as much as bread or rice will.

SO:
Why do CDE push "healthy" carbohydrate foods onto diabetics, when those foods are worse for us than even chocolate candy bars??

This is not a conspiracy to kill us diabetics, it only seems that way.

Nor is it a conspiracy to push drug sales up.

I am struggling to understand why CDEs push a diet that raises BG and makes triglycerides much worse and skews the HDL/LDL ratios in a bad way.

My guess is that it is the "Fear of Fat"
Is that correct?

Posted by Anonymous on 3 September 2008

>>1. Brain function requires about 135 gms of CHO per day.

If that were true, I would be dead.
My brain is functioning fine on 20 to 30 gms.


>>2. For patients with chronic kidney disease, on an ultra low carb diet, the calories have to come from somewhere and that generally means protein foods or fats. If protein, then that puts extra load on the kidneys.

I was spilling protein in urine until I went low carb. A good friend who has more advanced diabetic kidney disease has also seen symptoms reverse on low carb. Maybe elevated BG is worse for the kidneys than is a little more protein?

>>3. A high protein diet acidifies the blood making calcium leaching from the bones more likely, hence an increase risk for osteoporosis and if prone, kidney stones.

I had kidney stones shortly after diagnosis.
The stones have not returned after several years of low carb. Again, I would guess that the elevated blood sugar has a lot to do with it.

>>4. High fat diets, especially the wrong type of fat are bad for cholesterol levels. Meat, any type of meat does contain some fat.

This is a common stereotype.
It is not supported by facts.
Low carb diets usually greatly reduce serum triglyceride levels and raise HDL a bit.


>>5. The type of carb selected does make some difference. Complex carbs are better choices-whole grains, fruits and vegetables.

"Complex Carbs" are starch.

If the starch is geletanized as it must be to make bread rise, then it is rapidly digested and turned to glucose.

White bread is turned into blood glucose more rapidly than even table sugar.

Diluting the wheat starch with bran to slow down absorption makes no sense.

If the bread rises, it means the starch was liberated from the kernel and geletanized and is available for instant digestion and rapid rise in blood glucose.

>>Vitamins can't give all of the nutrients found in these items. There are other trace nutrients present in foods that do make a difference in our health. Do those with diabetes truly want to chronically avoid things like fresh strawberries, & fruit?

What nutrients are found in fruit that are not found in non-starchy vegetables?

>>6. If on insulin or oral hypoglycemic agents and the carb content of the diet is radically altered, hypoglycemia can result.

DUH.
The point is to reduce the usage of dangerous hypoglycemic drugs.

Balancing high carb intake with hypoglycemic drugs is mistake prone.

Less carbs + less drugs = less deadly mistakes.

Posted by type1pete on 4 September 2008

My biggest complaint with Mr Feinman's article, from the start and throughout, is that he doesn't distinguish between Type 1 and Type 2 diabetes. Although there are just two references to "type 2" deep in the article, most of the comments are about "people with diabetes", rather than "people with type 1 AND type 2", or "such-and-such applies more to type 2 than type 1", etc. This vagueness invalidates most of the information for me, although in general, some level of carbohydrate intake reduction & control/monitoring IS advisable for both types. I STRONGLY suspect that Mr Feinman doesn't have Type 1 diabetes, and probably doesn't have Type 2 either, so most of his info is from an academic and theoretical point of view.
The terms "diabetes"/"diabetes mellitus" originated long before insulin was known about, and what its specific functions are, so just less than 100 years ago even most educated people did not realize the differences between these two main types of diabetes. Sadly, many "educated" people today do not either. The fact is, Type 1 (formerly called "juvenile diabetes") and Type 2 (formerly called "adult-onset" diabetes) are two distinctively different conditions/diseases, with different origins, causes and dynamics. They are not just variations of one disease.
As a person who became a Type 1 diabetic at age 43, I've found that many people who should know better, including doctors and nurses, confuse the information about the two types, probably because they don't truly understand the differences. And they often assume that because my onset occurred as an adult (when I "got" diabetes), that I am Type 2, even when I make it clear that I have Type 1. I have had doctors (not my own above-average internal medicine doc) and nurses say things like, "you look like you're in pretty good shape, are you able to control it with exercise and diet, or do you have to take some pills, too?", and "do you think you'll be able to get off the insulin and control it with diet and/or exercise?", often repeating this same line of comments and questions after I repeat that I'm Type 1.
Most articles I see in the news, magazines, drug store pamphlets, etc., have this same kind of generalized, group-both-types-together info.
The two best things I did to educate myself shortly after my onset over 10 years ago was to get the "white paper" booklet on diabetes from Johns Hopkins University, and to attend the TCOYD (Taking Control of Your Diabetes) conferences, started by Type 1 - Dr. Steve Edelman (of San Diego, CA).

Posted by type1pete on 4 September 2008

As follow-up and clarification to my previous comment(s), I would like to add that I do not disagree with Mr Feinman's general assertions that most people consume too many or too high of a dietary percentage of carbohydrates. My main complaint is that the article does not differentiate between Type 1 and Type 2.
Among many other things, high carb intake is usually a significant factor in a person developing Type 2 (which is an insulin-resistance condition, which generally develops over a 7 - 10 year period), while it has nothing to do with Type 1 onset (which is an auto-immune disease [some exceptions], which develops over a 3-4 month period as the person's immune system is attacking and destroying its own insulin-producing cells).

Posted by ndocroth on 18 September 2008

Excellent and very accurate representation of the destructive effect of carbs in persons at risk of diabetes. Thank you, Professor Feinman!

Allow me to point to an additional distinction.
It appears that many of the low-carb opponents fail to make the distinction between grain carbs and vegetable carbs...
Grains are not natural to our hunter-gatherer metabolism.

Carbs from grain sources are the ones diabetics want to eliminate; particularly the wheat family should be avoided.
Obviously starchy vegetabls too, fruit juices and fruit like bananas and apples bring to the scale an unacceptably high sugar=carbohydrate count--and keep the body on a blood sugar roller coaster.

Braking the sugar roller coaster by eating sensibly (non-starchy vegetables, no more than one or two daily servings of high-antioxidant, low-sugar fruit such as berries, protein not in excess of the size of your palm, fresh water) brings results and postpones or prevents cell damage.

Keep up the good work and keep avoiding a future with diabetes!

Rivkah Roth DO DNM
author of "At Risk? Avoid Diabetes by Recognizing Early Risk - A Natural Medicine View" and the DIABETES-Series Little Books.

Posted by Anonymous on 23 September 2008

Two people have posted comments that said they were thin Type 2's, or "among the 20% of think Type 2's." As a late onset Type 1, I would like to suggest that these folks see an endocrinologist and find out if they are really a Type 1. I was misdiagnosed as a Type 2 because my onset was slow, my age was 50, and I am always a little heavy. Years later, after I convinced my internist to put me on insulin, an endocrinologist correctly diagnosed me. I have all 2 antibodies and am not at all insulin-resistant. I suspect that many of the "20%" are really Type 1's who got it in their middle years. People think Type 1 is a disease exclusively starting in childhood, but many young adults get it and a few old people such as myself get it. My brother and daughter are both Type 1's. My endocrinologist said there is always a genetic component with Type 2's, and about 30% with Type 1's. I strongly agree with Type1pete, who is frustrated by the widespread non-separation of these 2 diseases.

Posted by Anonymous on 23 September 2008

I do know of another diet that shows such good effects on controlling glucose and insulin without increasing drugs, without any of the potential dangers of a high meat diet. Read "Eat to Live" by Joel Fuhrman (www.drfuhrman.com). The issue isn't limiting "carbs" as a category, but rather eating nutrient-rich whole foods - lots of vegetables and beans, and moderate amounts of fruit and nuts/seeds. That is, eating food the way it actually comes in nature. This way of eating shows substantial benefit not just for diabetes, but also for heart disease, autoimmune disease, headaches, and many other medical conditions.

Posted by Anonymous on 23 September 2008

After being on a low carb diet for a year, I ended up with very painful kidney stones. The surgical removal caused bladder spasms for 6 months after. A horrible ordeal. So please be very careful with your protein intake and oxlate intake.
I now keep my carbs around 125mg a day with protein around 70 and am doing well. My a1c is around 6.5 with no meds.

Posted by Anonymous on 23 September 2008

I have been low carbing for almost a year. I've dropped from 227 to 191 & am continuing to lose a pound or 2 a week. My A1c is 5.3 and has been there since starting Atkins. I have more energy, my triglycerides dropped 107 points & my HDL is 105. No meds, which is the most important to me. This is how I eat for life.

Posted by Anonymous on 23 September 2008

Very good discussions, which side am i on? I dont know!. I am a type 2 insulin dependant. I have dropped my HBA1c to below 6 by going low carb. It is an execeptional method of blood sugar control. But....
On low Carb, i have no energy, very sore and then my kidneys started passing protien. So I changed to ""moderate"" carbs, between 100-200/day, energy is better but Kidneys still an an issue.
My question is to control my kidneys i need carbs, why I dont know, about 200+ a day. To control my sugar ideally I need less than 100/day of carbs. A happy medium is 150/day, ie a balance, but that still does make ideal blood sugar or protien control. But it is a balance.

keep the discussion going

Posted by Anonymous on 24 September 2008

Bravo, bravo to Dr Feinman!!! I totally agree with her. I am a RD, LD, CDE and I have teaching moderate consumption of Carbs for quite some time.

Posted by Anonymous on 25 September 2008

Ed from Columbus, OH, here. Information such as that presented in this article is worth its weight in gold, so to speak. I'm a Type II who has been a long-term practitioner of the low carb diet (I don't consider it a diet now; just my particular eating style), and my A1C over the past year dropped from 8.something to 7.1, and my doctor has recently decreased my glucophage prescription from two per day to one per day because of my good control statistics. I'm 66 and still going strong.

I thank the author for this fine article and look forward to more of the same.

Posted by Anonymous on 19 October 2008

I am 57 and was diagnosed with type II 2 years ago. I was not overwight or had HBP. Diabetes runs in my family and I believe how I handled stress caused it to become active. I understand the seriousness of this disorder. I found I was very carb sensitive and could only eat 1/4 of recommended ADA carbs. diet. My doctors argued me with constantly telling me I needed to eat more carbs to keep my brain functioning. I gave up most carbs and learned how to be creative example using almond meal instead of flour to bake. I have maintained this diet for 2 years and have kept my numbers well under control. My problem is I went down to 89lbs. I am now on glyset which allows me to eat some carbs, however I make sure they are complex ones. What I am saying, you have to pay attention to your body, and not just what the doctor's tell you. Just because they are doctors they are not always right. You know your body best.

Posted by Anonymous on 2 November 2008

I was heading for a Diabetes diagnosis, having a family history of it, and just 25 lbs. above my ideal weight (BMI 24). That wake-up call, and some due diligence brought my weight down 25 lbs, my BMI to 19, and I feel so much better. Sensible Low Carb eating (WOE way of eating) has changed my life.

My mother's BS was 752, when she was admitted to ICU in a Diabetic Coma. While in there, my father died. BS, is nothing to ignore. Thank you all for sharing your experiences and facts.

Posted by Anonymous on 4 November 2008

It is my pleasure to comment on this article. First I would like to wish everyone to educate yourself on food. It can be your friend or your enemy.

For myself, I had been taking metformin twice a day for almost 2 years and my fasting sugar increased to 189 in January of 2008. I decided to educate myself and heal at a cellular level. I tested several times a day and got my fasting sugar to 150. This was still not low enough, so I still continued on my search to lower my fasting sugar. During this time I had lost about 20 lbs.

I then read an article and they had interviewed Dr. Rosedale, at that point came more research. I decided to give his diet a try, which is low carb. In following the diet, within one week my fasting sugar was normal. It is a medium protien diet that is based on the individual and not the same amount for everyone. I have lost a total of 55 lbs and just got all of my test results back from my Dr. (who asked my how I did it)

My A1c dropped from 7.0 to 5.9. My cholesterol dropped to normal. My triglycerides dropped from 157 to 110. All of these results were without the sugar medications or cholesterol medication for 6 months.

I feel better than I have felt in years. One other thing I would like to mention is concerning grains. It has come to my attention, they can also be a culprit of many other diseases, along with being careful of GMO foods. I do try and eat organic as much as possible. In this eating plan, he explains the reasons along with nutritional supplement reccomendations that I have also followed.

This is about changing your eating habits for the rest of your life. It makes it easier if you prepare snacks ahead of time, and you can grab them quickly if needed and if you will be away from home. My husband decided to change his eating habits too and he had lost 50 lbs. and feels great as well. To those that want to commit to help themselves, all I can say is YOU CAN DO IT!!!

Posted by Anonymous on 8 November 2008

I've been diagnosed diabetic for 7 years -- and read Sugar Busters and Adkins and studied ADA and have been low-carb ever since. I'm 49 years old. My A1c is 5.9 but my tryglicerides are terrible - sometimes as high as 600+ -- how can I avoid cholesterol lowering meds? I do occasionally like to drink - is this the problem? Also, my bg reading will be 160 in the a.m. after a good diet of low carb the day before ??! Is this due to gluconeogenisis? And is that acceptable if my a1c is around 6? I also have elevated blood pressure -- I weigh 150 lbs. and am 5'6" so a little heavy for my frame. I exercise 5 x per week. What else should I do??? I take fish oil and diabetic vitamins.

Posted by SKYFROG on 15 November 2008

At last the truth!
This diet saved me from the drug industry killing me!

Posted by doyanna on 23 November 2008

Nick i know you do not take drugs and iknow you you eat healthy food and that is good bacause that what you suppose to eat to keep your body strong not weak

Posted by Anonymous on 6 December 2008

Geez, more overwhelming and conflicting information!
Understand that I no longer get so involved in my glucose numbers. I test and deal with WHAT IS! And, I also rely alot on fats since Im a vegetarian: Lacto-Ovo-vegetarian.

And, since I have a flawed kidney, I need to limit PROTEIN, so rely alot on Taco Bell for the missing vitamins as well on the cheaper and easy to enhance (with lettuce, onions, pickles, etc) Jack in the Box BreakfastJacks.

Like another ANON: "I am not going to give up ...for 2 more years of life.
Life is all about eating not dieting.

And not fussing so much about kitcheneering.

Ive even found a food that reduces my cravings and is only 80 calories:KROGER brand PRIVATE RESERVE Strawberry Fruit Juice Bars.

As a victim of NO GOOD DEED GOES UNPUNISHED and finding myself living on Soc Sec Disability ($1240/mo) with insulin costs nearing $1500 in the black DONUT HOLE, I dont foresee living that much longer anyways.

Im screwed and tired of the stress that managing my path on a road that is surely becoming a DEAD END.

Viva Thelma & Louise solution.

SIGH/Alex the Ogre

Posted by Anonymous on 8 December 2008

I've been paying attention to what works and what doesn't for me (I can't speak for anyone else) for a long time now. (Almost 21 years as a type 1 diabetic) and I *know* this article speaks truth. When I cut carbs to near zero (not absolute, cause its not sustainable) I do *so* much better. When I want to eat more carbs, I combine that with increased activity. (50 mi bike ride anyone?) And that burns the excess right off. I still use insulin and active monitoring, but I find I have to make only small corrections, instead of huge ones. And I generally *feel* better. Anyway, I've gotten to the point where I tell my doctor what he wants to hear, in such a way that he recommends what I want to do anyway -- cause when he thinks its his idea, he's happy, but if I suggest it -- he'll come up with something else, inevitably more stupid. Endo's can't save me. Only I can.

Posted by Anonymous on 27 December 2008

Hello, I am in the UK and was diagnosed Type 1 Feb 08, here. When I was first diagnosed I was told not to change anything straight away as they wanted me to first work on how my body processes the insulin. After my first A1C (5.8 and no diet changes) I said I needed to change something as I had gained 10 pounds. At that point, I was advised to back off the insulin a bit and see what happens. I did do that and took out all white carbs except 4 servings a week (I HATE whole grain pasta and MUST have white potatoes from time to time). When I went for my next check up my A1C was 7.0 and I had lost the 10 lbs I had gained. The endo then gave me a child's pen, as my rapid insulin ratio is 20:1 and I was running just a little higher than I wanted (my self goal is 6, docs are happy between 4&7).

I again spoke with the dietician who was quite pleased I cut carbs to no more than 120 each day (and this is a high day, typically only have 70-90 carbs each day) and have increased my intake of complex carbs exponetially. She advised against too much protein and we worked out what I should be puttin in my body to (1) keep insulin use low and (2) LOSE WEIGHT!

So far, BG levels are wonderful with being able to administer a half unit. I have averaged 6.2 over the past 30 days (this is how long I have been using the new pen) and even through Christmas, my levels have been stable as I have changed the menu to only having white potatoes for simple carbs (all other carbs served were complex).

I believe a "watched carb" diet is the best. It allows you to live a "normal" life as a diabetic. Too low carb diet would feel like an additional punishment... it's bad enough I have to test BG at least 6 times a day and take 4 TINY shots (1 - 3.5 units each time on average, except Lantus which is 6).

I need to also add that we can argue this back and forth all day long, but the reality is that diabetes is an INDIVIDUALIZED disease, treatment is different for everyone. Also, to argue type 1 and type 2 as though they are the same is insane. Although they are both "fruit" they are like apples in oranges in both origin and treatment. Yes, the same treatments affect all diabetics, but they do affect type 1 and type 2 differently.

For example, if a Type 2 totally cuts carbs odds are that they may be able to stop using antidiabetic drugs. Even when a Type 1 cuts carbs (which must be done under a Dr's care to ensure the person does not have a deadly hypo), odds are they will need to continue taking some insulin... the body WILL continue to increase BG levels, even without carb intake, meaning that the type 1 will still need to use insulin to keep it in check.

I believe that we should do our best to use as little insulin as possible; however, I also think the med community believes (as do I) that the less stressful everyday life is the better a diabetic will care for themselves. I believe this is the reason why the "base advice" is to continue doing what you're doing until you get your routines and then make small life-time changes a few at a time.

I don't know about type 2's but I do know that Type 1's have an extreme life-altering experience when first diagnosed. I was fortunate enough to know I was ill before I went into a coma... most Type 1's do not find out until they are hospitalized. It's like this: you wake up in the hospital to be notified that the drip is insulin and that you'll be spending a lot of time learning a whole new lifestyle. You then immediately learn how to check you BG levels, how to check for ketones and what to do daily, weekly, monthly, quarterly and for the rest of your life to ensure you have a long, happy, healthy life DESPITE the ignorance of others.

It's a trip, it's been 10 months and I have become an expert on Type 1. My health care providers all give me a "well done" when I visit with them. When I ask why they seem impressed, they tell me that I am the first to be so successful from the start. I'm not sure how to respond to this, but I do know it's my body and I know how hard I was on it my first 34 years, the best thing I can do is try to take very good care of it the next 34.

Posted by Nitpicker on 29 December 2008

My reference is Gary Taubes book "Good Calories, Bad Calories" or in England "The Diet Delusion". It has more pages and more citations, but is in strong agreement with Dr, Feinman on every point I read here.

What a clearly written, easy to understand, and scientifically accurate article on a really important topic. It is a joy to read. I hope you keep it at the current URL for a very long time.

We have a whole lot of physicians who currently do not agree and yet should. They seem convinced that obesity is due to sloth and gluttony which is very badly wrong.

I wish this were in a wiki so that the comments could be inserted at the appropriate places and the redundancies removed.

Many kudos to the author. And thanks as well.

Posted by Nitpicker on 30 December 2008

Since type 1 diabetes is less common and so different, we should give it a different name. Perhaps we could call it beta cell allergy or insulin deficiency instead.

Posted by Anonymous on 24 January 2009

Good on you, Dr Feinman!

It is a breath of fresh air to read of someone who lets the data speak for itself rather than dismissing it because it does not sit well with outdate and incomplete models of metabolic systems.

One has to start questioning the role of multinational food and drug companies in all this.

I went on the Aitkins Diet to lose weight. To my doctor's astonishment, apart from the weight loss my blood chemistry returned to normal despite higher than recommended protein and fat intakes. My lipids were better than normal. In essence, I was no longer diabetic.

I was frightened off Aitkens with the claim it will damage my kidneys -- a common result of diabetes!

I can not understand why diabetics are steered towards medication when the obvious reason for the plague of diabetes is the overabundance of refined carbohydrate.

Please keep getting the message out there.

David (Australia)

Posted by Anonymous on 22 February 2009

3 months ago...I wad diagnosed with type 2. I am 54, 5.5 224 lbs. at the time. Metaformin ex 500 was prescribed. I have been eating low carb...whole grains...lean meat, veggies and fruit. I occasionally spluge and have a treat.
I drink red wine also. I have lost 24 lbs. I fit into a 14 now where as my 18's were getting tight.
Use common sense, white stuff turns to sugar...forget about it. Barilla Pasta is the best as it is so high in protein! A light sauce, salad and some grainy bread in olive oil..you have feasted like a queen! Don't take more med's so you can eat crappy food...go for the good stuff. Meds do not cure....they just cover up the symptoms.

Posted by Anonymous on 12 March 2009

Does anyone know if diet pop has an impact on blood sugar levels?

Posted by deonMype on 19 May 2012

Performing memory may be the capability in the human brain to hold and manipulate detaills in abbreviation time frames generic for ambien Cushioning was adopted to reduce movements


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