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Type 2 Diabetes: From Old Dogmas to New Realities - Part 2


Jun 28, 2011

Hope on Diabetes Dogma

In the last decade, dramatic changes have occurred in our understanding of the onset and progression of prediabetes. Lightning speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control. Even with all of this change, however, many old dogmas hang on. It's time to be aware of the new realities. In this article,  I focus on two common old dogmas and the new realities.

Old Dogma: Losing weight will make blood glucose levels plummet no matter how long you have had type 2 diabetes. The message that people continually hear from their providers is "If you'd only lose weight, your blood glucose would go down." And the common reply from people with type 2 is "I'll try harder with my 'diet' over the next few months, but please don't put me on a diabetes medication."

New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis. (Read the Look AHEAD trial results, a study about the effect of weight loss on heart disease in type 2 diabetes.) In fact, the biggest bang for the effort per pound is likely in the prediabetes phase. (The sad fact is that most people don't know that they have prediabetes.)

Large studies have shown that with loss of five to seven percent of body weight (approximately 10 to 20 pounds) and 150 minutes of physical activity (30 minutes five times a week), people can prevent or delay the progression to type 2. Once insulin production is on a dwindling course (particularly after 10 years with type 2), weight loss has less impact on glucose control.

The reality is that if blood glucose is out of control, it's time to progress to blood glucose-lowering medication(s), because it's doubtful that weight loss alone will get and keep blood glucose under control. Today, most experts, including the American Diabetes Association and American Association of Clinical Endocrinologists, agree that people with type 2 should start on a blood glucose-lowering medication that decreases insulin resistance--the core problem in type 2--at diagnosis.

Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet.

New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines (1/31/11) for carbohydrate: about 45 to 65 percent of calories. (Americans currently eat about 45 to 50 percent of calories as carbohydrate--not a "high carb" intake.)

Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they're carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods--all healthy sources of carbohydrate.

Bottom line: The most important new reality for prediabetes and type 2 diabetes is: Take action as early as possible after diagnosis. Don't delay, don't deny. Get and keep your blood glucose, blood pressure, and blood cholesterol into recommended target zones.


Hope Warshaw, MMSc, RD, CDE, is a nutrition and diabetes consultant and the best-selling author of numerous consumer books, including Diabetes Meal Planning Made Easy, Real Life Guide to Diabetes, and Complete Guide to Carb Counting, all published by the American Diabetes Association.


Categories: American Association of Clinical Endocrinologists, American Diabetes Association, Blood Glucose, Blood Pressure, Cholesterol, Diabetes, Diabetes, Food, Losing weight, Low Carb, Pre-Diabetes, Type 2 Issues



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Comments

Posted by Anonymous on 28 June 2011

The idea that a diabetic should NOT eat a low-carbohydrate diet is nonsense. First of all, diabetes is a condition of carbohydrate intolerance (so it makes sense to control carbohydrate intake, no?) Plus, there are studies which show generally good glycaemic control on low carbohydrate diet. Thirdly, my experience in practice as a doctor is that these diets work. Could I ask Ms Warshaw if she uses these diets in her practice? Has she tried them? If my patients took her dietary advice they would, in the main, end up with poorly controlled diabetes and the problems associated with this (blindness, kidney disease, amputation). Would she care to comment?

Posted by SJKurtz on 29 June 2011

I wholeheartedly agree that going on medications at diagnosis is both appropriate and helpful. In my opinion as a layperson and a person with diabetes (Type 2), Metformin is a wonderful drug. However, my experience as a patient is that even on the maximum dose of Metformin, my blood glucose levels did not drop under the ADA diet that my dietitian prescribed. It was not until I started a low carbohydrate diet that my blood glucose numbers fell. They fell rapidly and have been easy to maintain under such a diet. In my quest to avoid diabetic complications by maintaining good blood glucose control, eating a diet of even 40% carbohydrates would make that goal much more difficult and perhaps impossible.

Posted by Judith on 29 June 2011

Respectfully, this column is not helpful to diabetics and probably dangerous. I am going on 6 years of eating 30-35 carbs/day. My A1c has been in the "non-diabetic" range ever since I went this route and I feel better than I have in years. I am not an exception among the many folks I know who live a good life on restricted carb diets.

And guess what--it's a delicious and delightful way to eat. I can even bake yummy sweet treats using nut flours and stevia! What's not to like?!

Posted by Judith on 29 June 2011

My original post didn't seem to go through, so I'll try a briefer version: Going on 6 years of 30-35 carbs/day. It does work for many of us. And I agree with Anonymous.

Posted by Anonymous on 29 June 2011

I am really surprised to read that “Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats.” You obviously have not been looking at studies, because they are out there. I am a T1 so don’t have the same problems as a T2, but I know from participating in the DOC, those T2s that follow low carb have much better results than those that don’t. T2s often have insulin resistance and the best solution for that is low carb. Dr. Bernstein is one of the biggest advocates for low carb diets for diabetics – he is a doctor and living proof that they work.

Posted by Anonymous on 29 June 2011

Low carb and exercise has helped me control my blood glucose numbers. Diabetes is a disease of elevated blood glucose so we should do what is appropriate to lower those numbers.

Ozbuc

Posted by matingara on 29 June 2011

i have to agree with all the comments so far. carbohydrates are a very dangerous and should be consumed with caution and knowledge. i had awful lipids and blood sugar control on a low fat/high carb diet. now that i have switched to a lower carb diet - all my numbers are superb. and the diet is easy to follow and very satisfying!

Posted by Anonymous on 29 June 2011

The first point on weight is rational, though of course reaching and maintaining ideal weight should be the goal every diabetic (actually for everyone).

But where on earth did the comment that low carb diets don't work come from.

The more carbs I eat the more insulin I need to inject or meds I need to take to force my body to handle them. A low carb diet keeps blood sugars more stable (and naturally lower, and makes insulin use lower (and safer) and reduces the need for meds.

I would love to see the references for the 'countless studies' show that low carb diets are not effective or safe long term for diabetics. From my readings and personal experience I've seen exactly the opposite.

Posted by Anonymous on 29 June 2011

Quite honestly after reading this article I am ashamed to call myself an RD. It flies in the face of logic to even suggest that restricting the very thing a person with diabetes has problems metabolizing (e.g. carbohydrates)would not be beneficial. Nope just keep on eating like the rest of America is the "expert" recommendation. Easy for someone not staring complications from diabetes in the face to say keep eating high amounts of carbohydrate and just take more meds. This ends up giving the message to people with diabetes they don't really have to modify their behaviors-just go to the doc and have them tell you to take another pill.

Posted by Karen D. on 29 June 2011

I am another type 2 diabetic who has been on a very low-carbohydrate (30 to 35 grams/day)for the past nine years, and I have maintained normal, non-diabetic blood glucose levels for all that time. My A1Cs have been consistently been in the 4.9 to 5.1 range. My family doctor was very disapproving when I first told him what I was doing, but over the years he has completely changed his mind; he has acknlowledged that I am the only diabetic patient he has ever had who consistently had normal blood sugars. I, too, follow Dr. Richard's recommended diet (See his book, "Dr. Bernstein's Diabetes Solution")

I must admit that I actually feel very, very angry when I read advice such as Hope Warshaw gives in the above article. It is simply untrue that there have been no studies that show the advantage of low-carb eating to diabetes - people like Ms. Warshaw simply ignore them because they have closed their minds to anything that challenges their beliefs. Has she read some of Gary Taubes' work, especially "Why We Get Fat and What To Do About It"? Has she read "Life Without Break"? In fact, has she read Dr. Bernstein's book? I know she once debated him on TV (I think it was on dLife, but I'm not certain of that), but I suspected at the time that she had not even read his book.

A final comment: My endocrinilogist is a strong believer in managing diabetes the way I do. On my first visit, when I showed him my glucose log book, he was amazed and asked how I was able to keep my blood glucose with no insulin or medications. I showed him my Dr. Bernstein book, which he was familiar with, and he said, "Doctors who don't realize that's the way all diabetics should be eating have their headw buried in the sand." I couldn't agree more.

Posted by Anonymous on 30 June 2011

I did not want to go on a low carb diet, so after diagnosis I followed my dietitian's advice and found my blood glucose levels rose and my weight still increased. I changed to low carb and my blood glucose levels are in a good range (5s and low 6s) and I am slowly losing weight. I would also add that before diagnosis I followed the low GI diet my doctor recommended, in fact I had been doing that for several years. So why did I end up diagnosed with Diabetes 2?

Posted by Diet Doctor Pepper on 30 June 2011

Following the advice of Dr. Eades, Dr. Atkins, and Dr. Bernstein, I went on a low carb diet after my fasting blood glucose hit 274 (because my my primary physician told me to eat as much fruit and veggies as possible). It took 6 months of low carb dieting, but finally my FBG went below 100 and has stayed there because I DO NOT eat carbs.

Posted by Black57 on 30 June 2011

I have been low carbing for 10 years. I have been learning and researching my lifestyle the entire time I have been doing it. So, I do not understand why, with such advanced knowledgeable people, would there be no studies on longterm benefits of doing low carb. I do eat fruits and vegetables and find it baffling that so many people do not realize that they are low carb. As a matter of fact nearly 90% of the planet's veggies are indeed low in carbohydrates which makes it easier to absorb the nutrients contained in these items. There are plenty of low sugar fruits that can be consumed on a low carb diet without triggering insulin or glucose spikes. Why? Because the sugar content is very low. TO figure this out it is important to test blood glucose levels, that's why they make the blood glucose meters.I am pre-diabetic and I use my diet to manage my blood glucose and I take supplements that also work with my diet to control my blood glucose. My goal is to stay healthy and to never need meds.

Posted by Black57 on 30 June 2011

Just to add,although my doctor encourages me to continue my low carb lifestyle, I have never been told from my dietitian to go low carb. My doctor told me that from his observations, low carb diets are the best way to manage glucose levels without medication. My point being is that low carb is not at the top of the charts as a recommendation for treating diabetes. Low carb is not common dogma for diabetes treatments. BUT, it should be.

Posted by Anonymous on 30 June 2011

I have had diabetes for over 20 years. When first diagnosed, I was on a low fat, higher carb diet and my blood sugar was very hard to control. My HbA1c was in the 11 range. I was headed for all kinds of complications. I could not gain control of my blood sugar. In 1995 a nutritionist suggested a low carb diet along with a moderate amount of protein and fats, such as nuts, avocados, real butter and lean meats. I now have an HbAlc of 6.2 and feel much better. I also have good cholesterol numbers. This article is not only frightening to read, it is dangerous to anyone who has diabetes.

Posted by Anonymous on 30 June 2011

Respectfully, what makes diabetes such an insidious condition is its varying effect on individuals as well as the appropriate regimen for good control. What works well for one individual may not work well for another. I personally have had great success with a low carb diet and my endo only need to see me twice a year.

Posted by Anonymous on 30 June 2011

Since starting on the Paleo 2.0 diet, I have been feeling better then I have most of my life. I am losing weight and my blood test results are getting better. Not sure why articles like these are even allowed to be posted.

Posted by Dogwatch on 30 June 2011

Daily pills, some weight lifting, and some aerobic exercise several times a week, and a low, low, low carb diets keepd me alive and happy.

If I let any one of those go, up heads the A1C. It takes discipline, but it can be done.

While there's no 'one-size-fits-all' approach, I think the first rule of thumb for anyone in the diabetic range is to follow a low carb diet.

That doesn't mean you don't avoid bread, popcorn, and fruit; just choose wisely. I eat carbs and enjoy them. But I balance it with protein and common sense.

Good luck to all;

Christopher Alexander
Albuquerque, New Mexico

Posted by Anonymous on 30 June 2011

If you're wondering why everyone on here is a low-carb bulldog pushing their ultra-low-carb way of eating, it is because links to this article have been posted on several low-carb websites with instructions to GO GET EM.

Posted by Anonymous on 30 June 2011

After diagnosis I followed the diet Hope Warshaw advocates and it was a total failure in controlling my blood glucose. I started the "eat to your meter" program and eliminated the foods that were causing my sugar to spike. Foods like whole grains fruits and starchy veggies, the article promotes, needed to be eliminated. My A1C went from 13.1 to 5.6 4 months and I was able to eliminate one of the two drugs I was taking.

I consider my diet healthy as it contains plenty of non starch veggies, meat and cheese. I am coming up on 2 years on this diet and have no trouble sticking to it.

I think Diabetes Health should publish an article highlighting the low carb approach to T2 treatment, including references to the numerous peer reviewed studies that show low carbs effectiveness and safety. Readers of your website need to be exposed to the full range of diet options so they can make an educated choice.

Posted by chanson3633 on 30 June 2011

I'm not sure why the "old dogma" is that Type2's should eat a low carb diet. That has never been the dogma as far as the ADA is concerned (unless you go back to pre-insulin days, prior to 1928). The Old Dogma is "Diabetics should eat the same diet as any other healthy person." I think the New Dogma should be: "Go Lo-Carb."

Posted by Anonymous on 30 June 2011

I was diagnosed with type 2 almost 2 years ago. I was not told anything about what to eat or testing my blood sugar.

I came to the ADA site first for diet advice. I followed it for about 2 weeks. My blood sugars were never less than 200.

Then I switched to Dr. Bernstein's low-carb diet. In a matter of a couple of days, my blood sugars were in normal range.

Why on earth would I want to eat more carbs and have high blood sugars? It's clear the ADA approach did not work for me.

Posted by Anonymous on 30 June 2011

Ms. Warshaw, since there are "countless research studies" that have proven low-carb diets do not show benefits on blood glucose, weight, etc., it would have been informative if you would have at least cited one.

Posted by Anonymous on 30 June 2011

So you recommend that diabetics like me eat higher carb diets and then take as much medication as needed to keep blood sugar under control? How can that possibly make sense? I agree Metformin beginning at diagnosis is frequently beneficial but it needs to be combined with exercise and a low carb way of eating - this combination gives me an A1C of 5.1.

The only advice a new diabetic needs on diet is to "Eat to your meter". Anything that raises the blood sugar above the damage level must be limited or eliminated.

Pushing drugs as the best first option is doing a disservice to diabetics. Medications have their place and can be necessary but lifestyle changes including low carb are a better solution when possible.

Posted by Anonymous on 1 July 2011

I am an RNCDE and must say that every time I read/hear about avoiding low carb diets from dietitians I feel like that professional has not done enough research or actually talked to encough people who follow low carb diets! I think the American Dietetic Association must start to update their guidelines to include low carb mealplans. As someone with prediabetes it has helped me and I know from LISTENING to my patients it has helped many people as well. Its time to modernize an old standard!

Posted by cde on 1 July 2011

Diabetes mellitus continues to be the one (and only?) medical condition best treated with SELF-management. Ultimately, each person with the condition must decide what "works" and how "works" is defined. I listened to Ms. Warshaw and the vast majority of health care professionals of her persuasion (most of them, it seems, do NOT have diabetes), and I listened to Dr. Berstein. After trying both, there was no doubt about the "winner," that is, the approach that I wanted to use to prevent DM complications. About 12-13 years ago, after about 30 years of trying to make the kind of diet recommended in this article "work," I happened to figure out that carbs are the fly in the ointment. Dr. Bernstein's book confirmed this observation and provided the missing support and guidance, in concrete terms and numbers, so that I could eventually arrive at an A1c 4.7% - 5.2%. I will say that unless I had tried to self-manage my blood sugars with the kind of advice Ms. Warshaw gives, for many years and with many iterations and permutations, I would never have believed or discovered the effects of carbs on the blood sugar levels of a person with DM (that is, me). The contrast (between the Standard American Diet [SAD, for short] and Dr. Bernstein's approach) was very valuable and convincing to me. Dr. Stan De Loach Certified Diabetes Educator

Posted by Judy Barnes Baker on 1 July 2011

This advice defies logic. Diabetes is a condition of carbohydrate intolerance. Many, many, studies have shown that a low-carbohydrate diet can prevent and reverse the complications of diabetes and more are coming out every day. It is tragic that diabetes "experts" and our health organizations continue to withhold this life-saving knowledge.

Posted by Anonymous on 1 July 2011

Received my initial T2 diagnosis 4 months ago with an A1c of 6.7. I immediately increased the amount of exercize I was doing. After a few weeks of research I started to lower my carb intake, shooting for no more than 50g a day - am now between 35-40g a day. My A1c 3 months after diagnosis was 5.7. Still exercising and shooting for my next A1c test in five months to be below 5.0.

Posted by Anonymous on 1 July 2011

The sad thing about articles like this is that it makes patients think CDEs don't know what they're talking about, so they won't believe anything they say. And other than diet, they do sometimes offer useful advice.

However, apparently Ms Warshaw is unaware of the fact that skim milk increases BG faster than almost anything else. Some type 1s use it when they're low for that reason.

She is also apparently unaware of the more recent studies that carried out LC diet studies to two years. And she seems to be confusing studies concerned with weight control (people tend to regain no matter what diet they're on) with studies concerned with A1c.

There's no question that true LC diets (some people call diets with 45% carb low carb because it's lower than the 60% recommended by ADA) result in lower A1cs. The criticisms used to be that lipid levels would increase.

But recent studies have struck down the "lipid hypothesis" of heart disease too.

Posted by Anonymous on 1 July 2011

When I eat the recommended diet (HIGH carb, grains, high-glycemic fruit, high-glycemic veggies) I have an HbA1C in the 9's or 10's despite injecting insulin -- LOTS of insulin. When I follow a sensible diet (LOW carb, lots of low-glycemic veggies, small amounts of low-glycemic fruits) I have an HbA1C in the 5's with little or no injected insulin. Any questions?

Posted by leolioness on 2 July 2011

I have a long history of seeing patients who have eaten low carb be able to achieve lower blood glucose. Both T2 and T1 profit from keeping to a low carb regimen. I am appalled that low carb diets are dismissed this way. There needs to be a whole new generation of dietitians educated about low carb nutrition but the older generation teaching them must be sadly out of touch.

Posted by Anonymous on 2 July 2011

Ms. Warshaw's bottom line advice: "Get and keep your blood glucose, blood pressure, and blood cholesterol into recommended target zones."

But there's disconnect in there somewhere because then she says low carb diets are not the answer.

This is completely and utterly irrational, since multiple studies have shown that the net health effects of switching to a low carb diet are LOWER blood sugar, LOWER cholesterol and LOWER blood pressure.

Posted by seashore on 2 July 2011

Why do the ADA and most diabetic clinicians recommend a high carb diet, which make the diabetes worse? Let me present my theory.

Diabetics have a high incidence of coronary heart disease (atherosclerosis). The popular dogma is that coronary heart disease (CHD) is caused primarily by excessive fats and cholesterol in the diet. Hence the ADA recommends a low-fat diet, which in turn results in a high-carb diet.

The truth is that fats and cholesterol DO NOT clog arteries, and elevated fats and cholesterol in the blood DO NOT cause CHD. The primary cause of CHD is elevated blood glucose, which seriously damages the arteries. When digested, carbs are converted into glucose. To avoid elevated blood glucose without requiring excessive insulin or diabetic medication, one must minimize the carbs in the diet.

In other words, a low-carb diet is essential if a diabetic is to minimize the incidence of coronary heart disease and other diabetic complications.

Posted by Anonymous on 2 July 2011

This article is ridiculous! I agree that it could even be dangerous to diabetics. Look, the answer to helping diabetics prevent complications and control blood glucose levels does not lie in medications (big pharma wants it this way, period...but that is about the money). It lies in the quality of the foods we eat...and their effects seen in the body. Plain and simple, there is not a benefit to eating high-carb or what this lady calls moderate carb (ha, yeah, whatever). The benefit comes in avoiding grains and products that create inflammation...especially for diabetics! Uggh, when are we going to move past the true dogma that the money-grubbers choose to push? There are plenty of studies showing results QUITE THE OPPOSITE of what is suggested in this weak article!

Posted by Anonymous on 2 July 2011

I was a Type II diabetic for 10 years, thanks to the ADA's recommended high carb meal plan. I was diagnosed with an A1c of 11. I took all those "wonder" drugs which left my blood sugar bouncing from high to low all day long. I even passed out from a few episodes of severe reactive hypoglycemia.

I went low carb and now my BG levels stay in the 70s-80s, even postprandial. I am no longer obese (I could never lose weight before), I don't suffer from low blood sugar and I don't take any medicine.

How can something be old dogma when it was never taught to diabetics in the first place? That doesn't even make sense. The ADA diet is what is truly old dogma and hasn't ever worked, obviously, if you look at how many people still suffer from diabetes.

Posted by Anonymous on 3 July 2011

I beg to differ with these findings. I think there are plenty of studies and Type2 Diabetics that prove that a controlled carbohydrate diet...low in glycemic index help to offset the Type2 diabetes and relieve the sufferer of medications.
I find that most articles are written by someone, professional or not, who has no proven statistics about using medications and using fruits, grains, legumes, vegetables and low fat is helpful to the diabetic. Also articles written are funded by someone or entity pushing their unproven products/agricultural/medications
I have seen proven statistics that show how controlled/low carbohydrate dietary guidelines save diabetics from deteriorating health, control of their blood glucose and early death. They are quickly weaned off medications. Anyone who has lived long-term this way will gladly tell you about their experiences. Plenty of clinical studies prove this out.

Posted by Anonymous on 3 July 2011

I am a type I diabetic and I know for a fact what 45-65% of calories as carbs can do to my BG... This is absurd and border-line dangerous statement from some "best-selling author".
"Countless research studies" would better fit in the article if there was at least one link to such a study showing no long term benefit of low-carb diet on BG.

Posted by Anonymous on 4 July 2011

I am newly diagnosed with type 2 diabetes and was given the standard ADA diet advice. Based on my testing results low carb is the way to go. Carbohydrates cause your blood glucose to rise and in my experience the more carbs I consume the higher my BG readings are (even when eating healthly carbs).

In my opinion, Diabetics should be taught to eat to their meter. I have been eating low carb for almost 1 year now and my diet includes lots of non stachy vegetables, fruits(strawberries, blueberries, raspberries),lean meats,eggs,nuts and some low carb desserts occasionally. My A1C is 5.6 and have accomplished this by diet/exercise alone.

It doesn't make any sense to me to load my body full of carbohyrates and then try and control the BG rise with medications and insulin. Eating low carb has allowed me to control my diabetes with diet/exercise alone, giving me A1C readings and Blood Glucose readings comparable to a non-diabetic. It defys logic to tell a diabetic to consume 45-60% of their calories from carbohydrates the very thing that their body is unable to handle.

Posted by Anonymous on 4 July 2011

I too find this article disappointing and a disservice to all of us living with diabetes. After discovering the Bernstein low carb approach and learning how to happily and deliciously eat this way, I went back to school and am now a Health and Nutrition Coach... a new entrance into the health care mix. Through a 3 or 6 or 12 month program, I teach people HOW to enjoy a life with low carb living... I cook with them, provide recipes, hold them accountable to their goals through small weekly action steps, and provide unconditional support. Change does not happen over night... and it is challenging to eat low carb in a world surrounded by carbs on every street corner. My clients come to me AFTER they have been through the traditional system and cannot understand why they cannot get a grip on their blood sugars... well all the above comments are the proof of the pudding... carbs! Try some delish chia seed pudding tonight... I did...

Posted by Anonymous on 5 July 2011

My earlier comment has not been posted, but I want to agree that controlled carbohydrate with moderate protein and sufficient saturated fat works for me. A1c of 5.6 down from 13 for seventeen years.

Posted by Anonymous on 5 July 2011

Did you know that type 1 diabetics with no active insulin cannot gain weight? It won't matter how much I eat. I could eat every day a whole cow, two pigs, and a truck full of chickens; I would continue to wither away. It is crystal clear to anybody who cares to look: insulin controls adiposity [and much more]. Increase your insulin levels and you will store more nutients as fat and glycogen. Reduce insulin levels and these stores will reduce. I'm not betting my future on "High Carb Hope"

Posted by Anonymous on 5 July 2011

Type 2 diabetes is, at its essence, carbohydrate intolerance.

To suggest that eating carbohydrates is the answer to carbohydrate intolerance is farcical.

Posted by Anonymous on 5 July 2011

This article is downright criminal. It's akin to advocating drinking and driving. It's that dangerous. Advising Type II Diabetics to eat carbohydrates is quite literally putting gasoline on a fire. Nothing good can come from it and frankly I am utterly disgusted that this article was published. The fact that it was published shows that Hope Warshaw and the editors of this website are utterly clueless to both the underlying pathology of diabetes as well as the current research.

Finally, as a side note, my father-in-law treated T2 Diabetes with a low-carb diet 40 years ago because it was widely understood that T2 Diabetes is the result of carbohydrate intolerance. He would blister at this article and the ignorance put forth. The greatest impediment to diabetes treatment are the two ADAs (diabetics and dietitians association). If doctors didn't listen to these two associations, T2 diabetes rates would plummet.

Posted by Lyford on 6 July 2011

This article is misguided. At best.

Anyone with Type 2 diabetes who chooses to follow Ms. Warshaw's advice and carb up is just begging for problems, for retinopathy and neuropathy and dialysis. The most basic fundamental trait of type 2 diabetics is that they cannot process carbohydrates without generating dangerous blood sugar levels. To be recommending that they eat more carbohydrate is just outrageous. Some people are going to have to take some medications, but no one needs grains or fruits to make it through the day, and most, if not all, diabetics are far, far better off without them.

Really, just an outrageous article. If I were to plan to jack up my blood sugar and whine about the consequences, I'd do just what she's recommending.

Posted by Diabetes Health Staff on 6 July 2011

Thank you to everybody for sharing your views. The publisher has appreciated reading everyone's feedback.  
In response to all your comments, she has written to you all in an article titled "Righteously biased about my diabetes diet" that can be read at:   http://www.diabeteshealth.com/read/2011/07/06/7219/righteous-about-a-diabetes-diet/

Posted by Anonymous on 6 July 2011

Hope caters to the lazy, undisciplined people who refuse to make sacrifices for their health.

Posted by Anonymous on 6 July 2011

As a physician with pre-diabetes I am appalled that a high carbohydrate diet continues to be promoted. I am 56 years old. For the past 5 years I have maintained normal fasting blood sugars on a low carb diet. Foods I eat are delicious and easy to prepare. I eat as much as I like, feel energetic and still maintain a normal BMI. I feel satisfied, seldom feel hungry and never feel starved or bored with my food. My dentist is impressed with the health of my teeth and gums as a result of avoiding fermentable carbohydrates. Our bodies have not changed from the times we were obligate hunters and gatherers with no need of dentists or endocrinologists. It makes no sense to insist we remain on an unnatural diet of processed foods that make us sick and rot our teeth. Everyone, diabetic or not, should be educated about delicious and satisfying low carb foods to lower the risk of diabetes and diabetic complications, enhance quality of life and protect oral health.

Posted by Anonymous on 7 July 2011

Good grief! The information in this column is positively antedeluvian! You're calling the USDA guidelines the "new reality" in nutrition advice?? Most of the carbohydrates that people eat are highly refined; low-fat dairy is a fragmented food missing many of its vital nutrients. I hope no one with a serious pre-diabetic condition falls for this nonsense.

Posted by lowcarbhank on 7 July 2011

As someone that sat and watched my father in law die a very long slow and painful death due to diabetes, I set out to find out the truth about treating diabetes with diet. My father in law "managed" his diabetes for years following the advice of CDE's and his doctors, all the while thinking he could follow the prescribed diet and just treat his diabetes with medication. That did not work for him. He eventually lost his leg and finally his life to diabetes. I set out on a low carbohydrate diet and within 6 months had normal blood sugar, normal blood pressure and lost over 100 pounds. People don't need more drugs and bad dietary advice. I think we have all see the rising rates of obesity and diabetes and you are not helping the situation. If you really want to stop the rise, tell people the truth. Low Carbohydrate diets normalize blood sugar. It works every time. Hank Garner

Posted by Anonymous on 7 July 2011

"New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis."

In other words, early intervention is imperative to mitigate damage and so this "honeymoon" period should not be the time to fool around to see if even higher levels of carbohydrates along with medication will work (and it usually doesn't). Rather, stop eating foods that raise blood glucose (lower carb) and use medication if necessary to achieve normal levels.

Posted by Anonymous on 8 July 2011

Sooo.....

high levels of SubstanceX in the blood will cause horrible health problems for a diabetic....

therefore diabetics should make sure that 65% of their calories are from foods that become SubstanceX in the blood...

and then take huge amounts of the antidote to SubstanceX.

They should cut down on foods that are only half SubstanceX....

and make sure they fill their plates up with foods that are entirely SubstanceX....

Plug in 'arsenic' for SubstanceX and that all sounds really, really ridiculous.
And anyone who thinks it is any less ridiculous when you plug in 'glucose' is very dim indeed.

Posted by Anonymous on 8 July 2011

With respect, you might want to go back to school to learn the basics of human biochemistry and physiology. You won't regret it and your advice will be more sound, based on science, not on your own bias. Here's where you can start... search for the work of Mary C. Gannon and/or Frank Q. Nuttall.

Posted by Karn on 8 July 2011

If you are a new diabetic or pre-diabetic, PLEASE DO NOT LISTEN TO THIS VERY POOR ADVICE!

Posted by Anonymous on 9 July 2011

I was diagnosed T2 in Dec 2009. I immediately went low carb (green vegetables + proteins) and lost 40 pounds in 4 months. My doc was surprised and my a1c has basically been 5.6 or so every time tested since 12/09. After a multi-month departure from low carb (boo), I've recently approached it with more knowledge and intention and am now off of (or have drastically reduced) several meds and am again losing weight. Glucose is now *the lowest ever* (to wit, normal 90-110) since 12/09. Daily BP is just a tad higher than "normal," and am confident it will be OK after additional weight loss. These changes were immediate and dramatic simply through adopting low carb.

Posted by Sanskara on 11 July 2011

Most people, including Hope Warshaw do not seem to acknowledge the fact that Type 2 diabetes is like most non-communicable disease a function of Insulin Resistance.

The higher the blood sugar the more insulin you have to produce to either get the energy into the cells or to lower the blood sugar level.

The higher the production of insulin the higher the insulin resistance until the pancreas can no longer produce sufficient insulin. You are then type 2 diabetic- period.

Secondly the more insulin resistant you are the more difficult it is to lose weight by burning fat. Cut the carbs.

Posted by Black57 on 11 July 2011

Fortunately there are some people with some form of insulin resistance who are capable of thinking for themselves. If I had done exactly as Hope Warsaw recommends, I would be in big trouble now. I am glad that I have educated myself in diabetes and various other diseases that are caused or aggravated by the inflammation caused by poison. Poison, carbohydrates are a glorified poison. I just can't help an "expert" who encourages the consumption of poison. People became diabetic from eating exactly the way Hope adheres to.

Posted by Anonymous on 11 July 2011

The ONLY explanation for this BAD advice Regarding carbs is drug company sponsorship.

I challenge her to give specific peer reviewed references to support her claims. Until then, they are BOGUS.

Posted by Anonymous on 12 July 2011

Old Dogma: Diabetics should read Hope Warshaw for dietary advice.

New Dogma: Diabetics should read their blood glucose meters for dietary advice.

Posted by Anonymous on 12 July 2011

Another "Wow, really?" from an RD and diabetes educator. Biochemistry and common sense, not to mention countless success stories and well-designed studies, demonstrate that low carb living is the best way to control blood sugar, as well as support the entire endocrine system. I have seen too many young women put themselves into amenorrhea and even menopause by restricting fats and eating high carb diets (thus maintaining an unnaturally high insulin level and creating total chaos of the endocrine system).
No wonder most RDs and CDEs are disdained by intelligent people--the professions as a whole totally ignore how the body works and what it needs. Sigh...I send my clients to Dana Carpender and Dr Atkins for Truth in biochemistry and low carb living.

Posted by Anonymous on 13 July 2011

A number of relatives of mine have T2 diabetes, one newly diagnosed, and have been given this advice; it is, simply, evil. It is so wrongheaded, and would be laughable if it weren't so tragic.

Posted by Anonymous on 14 July 2011

We are patiently waiting for our scientific proof from you, by the way. Many people are following these comments and are waiting for you to either admit to some wrong in this article or to show us the proof you have. Chances are you don't have sufficient proof. Gary Taubes just showed us that. When you have people's life in your hands, perhaps taking responsibility for your actions is the way to go. I would easily forgive you then.

Posted by Anonymous on 14 July 2011

I was diagnosed in T2 in 2007 with an A1C of 7.2. Went to all the diabetic classes which never said anything about a low carb diet. They stressed finding out what foods I could eat and how much, all the while taking my meds. I was on 4 meds to control my T2 with an A1C of 6.0, consistently. Last year I started a low carb diet to lose weight. I have lost over 103lbs, dropped all the diabetes meds and now register a 5.4 A1C. I am pissed that those diabetes classes I took at the beginning never mentioned the benefits of following low carb diet. It just looks like common sense to me now. They are the ones that are suppose to have the knowledge. I sure didn't.

Posted by Anonymous on 14 July 2011

Please cite some of these "countless studies." All carbohydrates (simple or complex) are processed into sugars and flood the bloodstream. I am not a diabetic, but I am smart enough to know that this is unhealthy for ANYONE. I cannot believe this type of trash advice is promoted towards people who are having trouble with their health. Good luck to all the diabetics out there, limit your carbs and you'll be on the road towards good health. GO LOW CARB!

Posted by Anonymous on 15 July 2011

Even in 2002, when I was diagnosed with T2, the hospital's diabetes educator was recommending a low carbohydrate diet and she showed me how to correlate my meter reading with the carb grams I'd eaten. I'm a lay person, a diabetes patient, and I can obtain gobs of information about treating the disease -- successfully-- with carb restriction.

Do you think that Hope Warshaw's article was peer reviewed, or at least submitted to a medical panel, before it got published? Her advice could kill somebody.

Posted by Anonymous on 15 July 2011

Really? REALLY? This is dangerous advice as anyone with limited biochemistry background understands.

Posted by KShannon on 18 July 2011

Wow. I thought Diabetes Health was supposed to be a reliable source of information for diabetics. Perpetuating this king of nonsense is not only wrong, but dangerous. I was diagnosed with T2 diabetes four years ago. I struggled for 3-1/2 of those years to stick to the real "old dogma" -- high carbs, low fat -- and had no success in controlling my blood sugar. Six months ago my doctor told me to go low carb. It took me awhile to take his advice because I was so mired in the myth of the allegedly healthy higher carb diet. Ever since I finally started restricting my carbohydrates my blood sugar has been remarkably stable, I have had no crazy highs or dizzying lows, and no cravings. My weight is slowly decreasing and my A1c is 6.0. I am so glad I finally stopped listening to "experts" like Hope Warshaw.
Kim Shannon
University Park, MD

Posted by Anonymous on 24 July 2011

I will agree with a number of previous comments, but my blood sugar levels have ONLY gotten under control by restricting the amount of carbohydrates in my diet. At roughly 50% of calories, the "balanced diet" approach recommended by the ADA means I should be eating around 225 grams of carbs a day. There is NO WAY I can maintain a healthy blood glucose level with this amount of carbohydrates. Over the past few months, I have restricted myself to 50-75 grams per day and the results on my blood glucose level have been the best they have ever been since my diagnosis five years ago. I would like to see references to the "countless research studies" that state that we should increase carbohydrate levels to reduce blood glucose levels. It just doesn't work that way.

Posted by Anonymous on 5 August 2011

so, as someone with prediabetes, i should eat MORE carbs? isn't that like telling someone with a peanut allergy that they should eat more peanuts? someone who is lactose intolerant should drink more milk?

and the line about americans not having a high carb intake is laughable. the author obviously does not circulate in the real world. go to any walmart, look at what people fill their carts with, and look at what they look like.

with all the research that is available that's pro LC, why is there such reluctance by the medical community to accept it as a viable option?

Posted by Anonymous on 22 August 2011

what does hope warshaw think will be the benefit of upping your carb consumption if you are a diabetic?

Posted by Feinman on 24 November 2011

Where are the comments from the supporters of the New Reality? Only 1 person out of 69 is not highly critical. Surely, somebody has followed the advice to eat 45 to 65 percent of calories as carbohydrate and had good results?

Posted by Anonymous on 1 March 2012

I used to be a believer in the so-called "Mediterranean Diet" (lots of "healthy" whole grains, only spritzes of PUFAs and tiny bits of protein, oodles of fruits and starchy veg), and the philosophy of "Moderation in All Things" (REALLY??? Moderate radiation? Moderate rat poison? Stupid phrase - often enough it's the extremes that will do the job - like, don't EAT ANY of the rat poison...).

Long and short of it is that these practices made me, and my husband, fat and sick, permanently messed up my gut, and took us both to the edge of diabetes. And I think this prescription was the ultimate cause of my parents' slow declines and premature deaths. So - I am very, very thankful that I stumbled across Gary Taubes' "Good Calories, Bad Calories", and the works of the good Dr.s Eades. We have been low carb for 3 years now, and we will NEVER go back and follow the sort of dangerous and unscientific advice promulgated by the ADA or the AHA.

I just hope we can effectively maintain in spite of years of damage.

The more we study, the more evidence we find that VLC and ketogenic diets are the most effective direct and adjunct treatments for T2 and T1, respectively. More remedies and insights may emerge, but right now, this should be the 1st and base case for almost everybody.


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