Righteous About a Diabetes Diet

Nadia Al-Samarrie

| Jul 6, 2011

Recently, we published an article by Hope Warshaw, MMSc, RD, CDE, titled "From Old Dogmas to New Realities. "In the article, Hope voiced the opinion that a low carb diet is not the only dietary option for people with diabetes, and that, in fact, such thinking is an "old dogma." In response, we received a number of strongly worded comments advocating the low carb diet as the only way to go.

I am delighted that such a passionate, vocal group of low carbers follows Diabetes Health, but I take issue with their implication that Diabetes Health does not support low carb, and I disagree with their conviction that low carb is the one true path for people with diabetes. 

Twenty years ago, when Drs. Bernstein and Atkins were ridiculed and black-listed in the medical community, Diabetes Health was one of the few voices that applauded and echoed their philosophy. As a result, we received many hate letters voicing disdain for our publication and questioning the reliability of our information.

But it is our culture to venture into new territory and take stands. Years ago, in fact, one of the ADA's managing editors told us that the ADA could not write about controversial topics unless we broke the story first. We are Californians, out in the Wild West where new ideas don't scare us.

Oddly enough, writing about Dr. Bernstein when he was unpopular earned us the same diatribes that we are getting today for Hope Warshaw's article. We published the Warshaw article for the same reason that we published the Bernstein diet: because we believe that people could benefit from it. It's ironic that many of you who disparaged Hope's article found out about Dr. Bernstein by reading Diabetes Health. In fact, you are proof of our low carb editorial vision.

Different diets work for different people. Each person's success is based on how well he or she can realistically integrate a diet into daily life. Because you swim for exercise, does that mean that swimming is the only successful program for everyone who has diabetes? What about your community of diabetic friends, family, coworkers, and acquaintances? Are you sure that your way is the only way for their success?

Despite the well documented merits of a low carb diet, the reality is that it's not successful for everyone. I chose to print Hope's opinion because I feel that she offers another path for people who cannot embrace a low carb diet, but can successfully manage their disease by eating whole foods and exercising. I would hope that you would support them in exploring other venues to achieve a normal A1C. Isn't this what you would wish for anyone who has diabetes?

We will soon publish an article about a type 1 who diligently tried the low carb diet and still suffered from a high A1C. Low carb did not work for her. It wasn't until she persuaded her physician to prescribe metformin for her (which is generally prescribed for people with type 2, not type 1) that she achieved success. After going on metformin, she finally realized normal blood sugar. What works for one may not work for another.

I would like to ask you to be tolerant of other opinions and support whatever modalities allow your peers with diabetes to achieve the success that rewards you. It should not matter what diet people are on, as long as they achieve an A1C that offers them the quality of life that we all want for one another?
Personally, I have not been successful on a low-carb diet, and that's true of many other people with whom I am familiar. A low carb diet is difficult to stick to. Saying that everyone should be on the low carb diets is like saying that everyone should go to Jenny Craig. Do the people who go there achieve the success they hope for? Yes and no. It's the same with low carb.

To those of you who are so passionate about low carb, I get it. You have defied conventional wisdom in pursuit of a normal A1C. But there are many, many ways to keep an A1C in the normal range. No one argues the merits of low carb, but it is not for everyone. And giving a stage to one diet does not exclude the merits of the other.

In any case, the real issue about food, one that is not being addressed, is why we eat what we eat. It is a topic that deserved much more exploration. That's why I plan to publish an interview soon with Carol Normandi, who has written a well-known book titled "It's Not About Food."

 

Best regards,

Nadia Al-Samarrie
Publisher/Editor in Chief/Founder

Diabetes Health Magazine

Click Here To View Or Post Comments

Categories: A1C, American Diabetes Association, Blood Sugar, Carol Normandi, CDE, Diabetes, Diabetes, Diabetic, Diets, Food, Hope Warshaw RD CDE, Low Carb, Metformin, Nadia Al-Samarrie, Type 1 Issues, Type 2 Issues


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Comments

Posted by Lyford on 6 July 2011

Thank you for responding.

Unfortunately, you do not appear to have fully appreciated the problem with Ms. Warshaw's article. It is true that everyone is different, and different people tolerate different diets with differing degrees of success. But Ms. Warshaw's article doesn't say that. It says that "People with type 2 diabetes...should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods--all healthy sources of carbohydrate." It echoes the ADA and US guidelines that people should eat "about 45 to 65 percent of calories" from carbohydrate.

That's what's outrageous. The average type 2 diabetic shouldn't be anywhere near 45% of their calories from carbohydrates. She doesn't say that "some people can handle that level, but you should always eat to your meter" - she says that people should be eating that level of carbs.

And she says 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." Well, how many research studies actually have gone "greater than six months to a year"? The evidence is overwhelming that a) the fat-phobia that leads to the low-fat (i.e., high-carbohydrate) diet is wrong - fat is not bad, fat does not cause heart disease. The evidence is overwhelming that most people with type 2 diabetes can manage their condition best with limited carbohydrates.

That's what people are upset about.

And while this - "a low carb diet is difficult to stick to" - may be true for you, it certainly is not true for everyone. It's not a categoric fact, as you stated it. I, for one, have zero difficulty on a diet with less than 3% of my energy from carbohydrates, and in the year since I started it, all of my blood values have normalized, and I've stopped all of the medications I was on. Everyone's different, but there are a lot of people like me.

And Ms. Warshaw gives no indication that that's the case. You say that "no one argues the merits of low carb, but it is not for everyone," but that's what the piece you're talking about does. It's one thing to present a piece which says that, "hey, here's another way that might work for you," but what's actually written there is completely different. It's "this is what works, so don't do that other thing."

It's wrong. It's misguided. And it's going to do damage to many people who follow it.

That's why people are outraged.

Posted by bsc on 6 July 2011

Thanks for taking the time to discuss the reasons behind providing alternate views. I think many in the diabetic community also believe that there are different dietary paths to success. The difficulty I have with the article from Hope Warshaw is that it presents an outwardly authoritative article that is unbalanced and distinctly against the tolerance you speak about. Ms. Warshaw makes sweeping generalizations, does not recognize the validity of other views and does not provide credible sources. The last time Hope Warshaw presented her views here in 2007, a follow up from Richard Feinman provided an overall balance to the coverage (http://www.diabeteshealth.com/read/2008/12/25/5383/low-carbohydrate-diets-why-you-dont-want-the-experts-to-tell-you-what-to-eat/).

The greatest concern is that a casual reader coming to this publication can be left with the serious misconceptions. That is not the balanced coverage that we so coveted in this publication.

Posted by Anonymous on 6 July 2011

imo success would be a diet that allows individuals to function as a healthy person without the need for medications. now that is my definition. i'll speculate that would be considered a success by just about any health care practitioner. why shouldn't that be any persons goal? to be medication free.
it seemed hope's article was advocating a lifelong reliance on medication. why would that be needed and why would that be deemed a success?

Posted by Anonymous on 6 July 2011

You are certainly correct that most of the comments concerning Hope Warshaw's article were as dogmatic as the article itself was. The basic mistake is believing all of us are the same and that a one size diet fits all.

Having said that, I believe only a tiny minority of T2's are going to do well eating as many carbs as she recommends. She says "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." but she does not quote research that shows a benefit of the diet she recommends that ran over a year.

I commend you on your desire to be even handed, but in light of that, I don't think a statement concerning lack of long term studies for low carb should have been allowed without quoting long term studies supporting the high carb alternative. Without the supporting evidence her statement proves nothing.

I am most concerned about the newly diagnosed who might read the article and follow the advice contained in it thinking they are doing the right thing. For all too many T2's it's clearly the wrong thing.

Posted by Anonymous on 6 July 2011

Thank you for explaining that some diets work better than others for people. I understand that some diabetics are okay with taking meds and/or insulin injections to keep a diet that is satisfactory for them. I also understand that some diabetics can’t avoid the meds/insulin due to the state of their health. I will be one of those if/when my disease progresses to that point.

I agree with Ms. Warshaw’s view that weight loss has less impact when insulin production is insufficient. I also agree with her advice to “Get and keep your blood glucose, blood pressure, and blood cholesterol into recommended target zones.”.

What I would not do is ENCOURAGE new and pre-diabetics to consume foods that have a direct impact on the very blood glucose they are being told to “manage” as if it will not have consequences.

Posted by Anonymous on 6 July 2011

imo success would be a diet that allows individuals to function as a healthy person without the need for medications. now that is my definition. i'll speculate that would be considered a success by just about any health care practitioner. why shouldn't that be any persons goal? to be medication free.
it seemed hope's article was advocating a lifelong reliance on medication. why would that be needed and why would that be deemed a success?

Posted by Anonymous on 6 July 2011

I have noticed on diabetes forums that evangelical low carbers feign superiority over their chosen path. Statements like, it is the only way forward are not true. They never take into account the personal medical history of anyone and base their mantra on their personal experience but forget that there are other ways. They tolerate other ways of managing diabetes but find it hard to accept.
Whatever works for the individual is the way forward.

Posted by Anonymous on 6 July 2011

I write at thegirlsguidetodiabetes.com and I just want to say that I agree wholeheartedly with previous commentors "Lyford" and "bsc".

I acknowledge that Hope wants to emphasize whole foods in place of processed ones. She wants people to realize that they might need medications to control glucose. The problem is when she doesn't acknowledge the startling amount of feedback from people who find success on a low carb diet. She makes no mention of there being more than one path to healthy eating and perhaps this is because she does not agree that there is. When many people out there are passionately recounting their successes with low carb diets, I would expect someone so influential as she to acknowledge that and pay attention to it. Ignoring it is irresponsible.

Posted by Anonymous on 6 July 2011

Your argument is absolutly right: Low carb does not work for everyone, it only works for 90% of the T2 population.

Also, metformin is not an alternative of Low carb, 90% of T2 go low carb + metformin, or low carb alone.

Posted by margaretrc on 6 July 2011

While I applaud your willingness to publish articles by forward thinkers like Drs. Atkins and Bernstein, I agree with Lyford and bsc above and all the people who took issue with Ms. Warshaw's article. And unlike you, I honestly don't see how anyone with diabetes, especially type 2, could benefit from the type of diet Ms. Warshaw put forth as best--or any other diet that doesn't restrict carbohydrates, for that matter. I said benefit from. It is possible that some may manage okay on it with medication (which will probably need to be increased as time goes on), but that is not benefiting. It is just treading water and not the optimal condition. The only way to achieve optimal control of a disease is to reduce or eliminate the disease causing agent--in this case starchy carbohydrates and sugar. Nothing else makes sense. And if (if) people have trouble sticking to a low carbohydrate diet, I suspect it's because they are not including enough fats to meet energy needs. There is plenty to eat in a low carbohydrate diet if you are not afraid of natural fats like cream, butter, lard, tallow, olive oil, coconut oil and palm oil and there is absolutely no reason to be. Now it's possible that there are those who would rather have their grains/sweets and control their A1c with meds, but to suggest that doing so is on a par with consuming a diet that reduces the amount of glucose that enters the blood stream and the need for meds, is tantamount to saying that it's fine to expose oneself to some bacterial infection and then take antibiotics to treat it. Who would do that?

Posted by Anonymous on 6 July 2011

Can you imagine the effect on a newly diagonsed diabetic if they acted only on the biased article you published by Hope Warshaw? I think you owe it to your readers to present another view, or at least a disclaimer to the effect that this is her opinion and that there are other opinions that diabetices need to research before embracing one approach.

Posted by Anonymous on 6 July 2011

I've read the comments to Ms. Warshaw's article and I believe that you have missed the point of the commenters entirely. I did not get the impression that the commenters were advocating that diabetics go on low carb diets without the aid of any medication. The overall thrust of their arguments was that with a low carb approach, they were able to manage their BG levels with much less, or eventually no medication. Many were unsuccessful on the diet that Ms. Warshaw is promoting. Of course people should be free to choose whatever diet works for them, but the key word is "works." In this regard, many diabetics have had to discover on their own, with no support from the medical community, that the 45-65% of carbohydrate method is disastrous to their health and well-being. As I'm sure you know, the ADA has an "informative" bulleted list about diabetes. It's a prime example of cognitive dissonance:

*Your digestive system turns carbohydrates into sugar quickly and easily [true]

*Carbohydrate is the food that most influences blood glucose levels [true]

*The more carbs you eat, the higher your blood glucose goes [true]

*The higher your blood glucose, the more insulin you need to move the sugar into your cells [true]

*The Food Pyramid (or now, the Plate) is an easy way to remember the healthiest way to eat. [subjective opinion]

*At the bottom of the pyramid are bread, cereal, rice and pasta. These foods contain mostly carbohydrates. [true]

*You need six to eight servings of these foods per day [subjective opinion]

WHY? If you stepped on a nail, would you take pain medication and leave the nail in your foot? Would you continue to step on even more nails and increase the amount of pain pills in an attempt to eliminate the inevitable pain? Most likely not. How is this scenario any different than a diabetic eating more carbs and taking meds to make the resulting high BG go down?

Posted by Anonymous on 6 July 2011

90& failure rate. That's how well diabetics are treated in North America. The real science points to carbohydrates as our enemy. There's mountains of evidence. There is zero proof that saturated fat or cholesterol cause any problems. We the liberated prove every day that insulin controls adiposity, and carbs control insulin. Lose the fat phobia and start practicing what you claim to be preaching!

Posted by Anonymous on 6 July 2011

This article still doesn't understand the fundamental problem of diabetes.

40 years ago, the way T2 Diabetes was controlled was by a low-carb diet because metformin and other T2 diabetes drugs did not exist. These patients were controlled in their glucose levels because in the absence of glucose, T2 diabetes simply doesn't exist. It is a fundamental condition of carbohydrate intolerance.

Hope's logic would equally apply to injecting strychnine. Some people can tolerate and possibly thrive on it due to natural genetic variance but the vast majority of people will suffer through it. The ADA's recommendations are equivalent to advocating the injection of strychnine. The best way (and frankly the only way) to control T2 diabetes is through carbohydrate restriction.

Posted by Anonymous on 7 July 2011

If you read the comments after Hope's article you will see that low carbers were directed here to contest the article. That is how a few of them behave throughout the diabetes websites, blogs and forums. They cannot accept that there are other ways to manage diabetes.
Something I agree with is to manage your carbohydrates to a level that suits you. If I am managing my carbs then am I a low carber or is there a magic number of carbs that enables me to be called a low carber? Nobody who screams about low carbing as the only option seems to be able to answer my question.

Posted by chanson3633 on 7 July 2011



Thank you for your response regarding Hope Warshaw's article. I think the reason the article received such a vehement response is that most of use rely upon experts (like Ms. Warshw) in making decisions about our health. It is very disconcerting when it seems like the "expert" is uninformed. I think the opinion that the ADA guidelines are appropriate for diabetics is not supported by good science. It reminds me of the issue with eggs and cholesterol years ago. Eggs contain cholesterol. Studies showed that elevated levels of cholesterol in the blood increased the risk of heart disease. Therefore (it was said) stop eating eggs and you will decrease your risk of heart disease. HOWEVER when studies were done comparing cholesterol levels, heart disease and egg consumption, they showed there was no increased risk from eating eggs. I wonder how many egg farmers went out of business because of the mistaken assumption that eating eggs was bad for your heart health?

Posted by Anonymous on 7 July 2011

I think it's sad and telling that you've decided to censor or suppress comments under the guise that they're "diatribes." Who's dogmatic now? Who's trying to sway the agenda here? People are starting to realize that they've been duped by so-called "educators" and the pharmaceutical companies, not to mention the department of agriculture, as they become sicker and fatter following the advice that's presented in Ms. Warshaw's article and by the ADA.

Posted by Anonymous on 7 July 2011

Hope is definitely advocating a high carb diet. Wew've been there and we know it's at least 20 years out of date. She is like my niece, recently graduated as a nutritionist, who exclaims: you NEED carbohydrates! you NEED sugar! Like all the others who wrote, I always see a high glucose reading after eating rice, or potatoes or whole wheat pasta etc. So we keep the carbs as low as possible and exercise 30 minutes a day and lo and behold glucose and A1C go and stay down (and so does the weight). It is the best way for us.

Posted by Anonymous on 7 July 2011

Greetings

I am Type II and have a larger chronic issue which requires a CBC every 6 weeks for the rest of my life, so when I 'became' diabetic it was caught right away (5 years ago).

I have always controlled my BS levels by diet (all meds are for my other condition), my endo at the time was a firm believer in low carb lifestyle and I loosely followed his recommendations and paid attention to my carb intake, not necessarily what the food was. My a1c's have been consistently in the mid 5's.

As I have now passed 50, I noticed my BS was getting a little unruly and my research pointed to the LCHF diet and so I have started to eat that way and everything went back under control within two weeks.

My next CBC(s) will show if this is right path for me, that’s for me and my Dr. to determine.

Posted by seashore on 7 July 2011

Dr. Bernstein recommends that carbs be restricted to 30 grams (about one ounce) per day, whereas the American Diabetes Association (ADA) recommends six times this amount. I will admit that restricting the diet to 30 grams per day is difficult to follow, but every diabetic (type 1 and type 2) should strive to be close to Dr. Bernstein’s recommendation. The ADA recommendation is dangerously high.

Why does the ADA recommend such a high level of carbs? The reason is that they insist that diabetics eat a low-fat diet in order to reduce coronary heart disease. (The incidence of coronary heart disease is high among diabetics.) One cannot eat a low-carb diet along with a low fat diet without starving oneself. Hence the ADA recommends a carb level that is much too high.

The answer to this dilemma is that a low fat diet does not reduce heart disease, regardless of the enormous propaganda claiming that it does. Elevated blood sugar is the main cause of coronary heart disease, not elevated fat.

Diabetics who follow the ADA dietary recommendations on carbs usually cannot maintain healthy blood glucose levels. Hence the ADA gives very lax guidelines for blood glucose control. They recommend a peak blood sugar level of 180 mg/dl as a goal, and imply that a significantly higher level may be acceptable. Nevertheless, there is strong evidence that a peak blood glucose level greater than 140 mg/dl produces diabetic complications.

Posted by carbohydratescankill on 7 July 2011

I respectfully ask Ms. Warsaw, Ms. Al-Samarrie, and those diabetes experts with USDA, American Diabetes Association, American Dietetic Associations, American Heart Associations a few questions below that are related to biochemistry you all and I have taken and passed its examination.

(1) What do dietary carbohydrates, other than indigestible fibers, become after they are absorbed into my blood circulation?
(2) Whatever the metabolites are converted from carbohydrates, isn't it true the more carbohydrates I consume the higher level of these metabolites are?
(3) If I want to keep a lower level of these metabolites, isn't it logical for me to restrict the consumption of carbohydrates and avoid the need of medication?
Robert Su, Pharm.B., M.D.

Posted by Anonymous on 7 July 2011

Nadia What a wonderful response! You are so right! Different diets work for different people and we all need tonsupportmand acknowledge that fact. Thank you for providing us with a full perspective. You are the best! A CDE who has followed your publication for 20 yrs!

Posted by cde on 8 July 2011

D Health has, from the beginning in the printed issues, been my favorite DM magazine because it has presented various current and breaking viewpoints and done so with honesty. The latest uproar caused by people with DM who are "passionate," is fantastic. To actually THINK about what we as persons with DM do with self-treatment or medical treatment of the condition is the most basic, essential step, which all too often is missing in doctors' visits, private moments, and family dialogue. The focus, more frequent nowadays than ever before, on doing "what works" for the individual and the class (people with DM) is also a huge advance, made possible by 30 years of getting to know the marvelous blood glucose meter. This article and the comments thereon have produced thought...a great accomplishment. That the thought is about or directed to understanding "what works" on an individual and collective level is even more admirable. In matters regarding any aspect of DM care, the voice of experience is, for me, more valid than ADA proclamations and clinical recommendations or registered dietitians or certified diabetes educators who espouse a treatment modality whose effects or results they themselves NEVER have to experience. A person without DM has no concrete personal knowledge of the effects of a diet with 45 - 65% as CHO, because his or her pancreas manages whatever CHO load to keep BG normal. The authorities without DM have an idea of "what works" (an A1c of less than 7 - 7.5%) that is distinct from my own (an A1c of 5% or less). It is not stated or clear whether Ms. Warshaw actually is managing her own case of DM or not. But, assuming that she is not, perhaps we should search for an article in DM Health by a person with DM2 or DM1 who eats as the ADA and she suggest AND has made it "work," however the person defines "works." Are there really people with DM who can eat 45 - 65% of their calories in the form of CHO and still have a safe or normal A1c (even as commonly defined by the laboratories as 4 - 6%)? I have never met one, and the myriad research articles in the professional journal Diabetes Care (representing the ADA) never have reported cases of anyone achieving that kind of results, but maybe they exist. Ultimately, each individual affected has to think, consider, monitor BG results, and commit to some form of management or self-management of DM, according to the goals he or she sets with respect to prevention or acceptance of diabetic complications. No matter what treatment or self-treatment is accepted, utilized, recommended, or successful, the nature of the condition (defective CHO metabolism) is NOT CHANGED. Even insulin, which is the most powerful self-treatment tool available, does not cure or alter the underlying defects that produce DM. Acceptable treatment or self-treatment to meet one's goals thus also needs be chronic. Congratulations to DM Health on provoking thought and commitment and interest by providing a vibrant and vital forum for those who have DM. Dr. Stan De Loach México, Distrito Federal

Posted by Anonymous on 8 July 2011

For years I struggled with up and down A1Cs and finally started eating whole grain breads, pasta, brown rice, etc. as advocated by Ms. Warshaw and many other diabetes experts, with no significant difference. At an A1C of 7.3 in Feb. 2011 I was put on 4mg of glimiperide and also continued my metformin. At the time I started the glimiperide I also decided to cut out all grains and eat protein, fats, nonstarchy vegetables, and fruits such as apples and berries sparingly. At my three month checkup my A1C was down to 6.1. Because I had been experiencing lows that frightened me and made me feel shaky and ill I cut my glimiperide pills in half to a two milligram dose and now feel much better. My next A1C will be in early August and I hope that it will still be a good reading and that I can further reduce my meds. After the first couple of weeks on my diet I lost my intense, relentless cravings for carbohydrates and hope to be able to stay with my new habits because I realize that regarding most carbs I act like an addict. It is not easy but neither are any of the diets that deprive us of the foods we love and crave. We diabetics have to find what will work for us.

Posted by Anonymous on 8 July 2011

I agree that what works for you may not work for me. But having said that, I have battled to avoid highs and lows for years (I am a type 1) until I started limiting carbs. Make no mistake I still eat them but I have learnt that the only way to avoid the horrible lows, is to reduce the insulin I use and therefore the carbs I eat at one sitting. And now I no longer have my family calling out the paramedics in desperation. This has a context. I have a normal HBA1C, my BMI is 21,5 and I have no health problems other than diabetes. I really think that my problem was caused by the amount of insulin I had to use to cover the amount of carbs I was consuming. And that is what always started the roller coast ride for me.

Posted by Anonymous on 8 July 2011

I get so tire of "A low carbohydrate diet is difficult." It will be 16 years this September that I have been low carbing, and I have NEVER been forced to eat anything I didn't want to, even when on the road. There is virtually *always* low carbohydrate food available; it is simply a matter of choosing it.

I suspect what you actually mean is "Breaking addictions is difficult," and it is certainly true that many, if not most, people find it so. That doesn't change the fact that breaking the addiction to the substance causing the damage is the only logical choice. Quitting smoking is legendarily difficult, but I know of no one who says, "Well, it's hard for a lot of people to quit smoking, so they need an alternative to treat emphysema. They can just cut down a bit, and switch to organic tobacco, and keep their oxygen tank on hand."

Carbohydrates raise blood sugar. That's a simple and true statement. The more carbohydrate a diabetic eats, the higher their blood sugar will go, and the more medication will be needed to reduce it. Simple, inescapable logic.

That some people continue to need some medication is a red herring. Do they need less medication on a low carbohydrate diet? Do they achieve tighter glucose control? Virtually invariably, the answer to these questions will be less, just as those who quit smoking will suffer less lung damage, and be less likely to need that oxygen tank.

Posted by margaretrc on 8 July 2011

This is for Anonymous, who posted on July 7. "They cannot accept that there are other ways to manage diabetes." That's because there ARE no other ways that don't involve medication. Diabetics do not have the metabolic means to control blood sugar properly, so they have to do it with diet and/or medication. Most people would prefer, if possible, to manage it without medication rather than risk the long term effects of taking drugs.
"Something I agree with is to manage your carbohydrates to a level that suits you. If I am managing my carbs then am I a low carber or is there a magic number of carbs that enables me to be called a low carber? Nobody who screams about low carbing as the only option seems to be able to answer my question." I'll do my best. If managing your carbohydrates means you are eating 60 or fewer grams of carbohydrates a day, most people would consider you a low carber. That is certainly way lower than the standard American diet! If you eat a large amount of carbs (45-60% of calories, as recommended by Ms Warshaw, the ADA and the USDA) and don't need medication or insulin to control your blood glucose, you are not a low carber, but you are also probably not diabetic--not yet, anyway.

Posted by Anonymous on 8 July 2011

Geez, I am reading all the comments and what I find lacking are the words: unique and the individualized meal plan. I have DM2 and eat approximately 50% of my foods in carbs, most high fiber and nonprocessed; I am DM2 and medication-free with an A1c of 6% after ten years. I am considering getting medications because that is up from the usual 5's. Oh, by the way, I am also a CDE. The secret is activity and food balancing until the pancreas says one needs medications.

Posted by Anonymous on 9 July 2011

Why is it when people don't continue a low-carb diet it is because it is "...difficult to stick to..." but when people don't continue a low-fat diet it is because they have no willpower and aren't committed to getting healthy? Yes, it takes a while for the cravings for carbs to pass, but they do pass and pretty soon it becomes second nature to avoid the breads and rice and potatoes.

Posted by Anonymous on 9 July 2011

We have a method that advocates for individual to take control of their disease by limiting what exacerbates it. Yet that approach is discouraged. Instead people are told to eat the food that is making them sicker and compensate with medication. The people who are making this recommendation are subsidized heavily by the company who sells those drugs. I don't subscribe to conspiracy theories. But I'm having a real hard time with that one.

Posted by Anonymous on 9 July 2011

When they say that they are doing low what they really mean is 50 or more grams of carbs per day. A diabetic should never go over 20 grams per day.

Mike Scott

Posted by Anonymous on 9 July 2011

Eating a low-carb diet lowers blood sugar. What's so hard to understand about that? Seems pretty simple to me. Either keep your blood sugar low or pay the medical and pharmaceutical giants--then die early with horrendous complications. Simple.

Posted by Anonymous on 9 July 2011

I think it's poor logic to say that just because low-carb diabetics are reading blogs disputing Hope's article that they've been somehow instructed to come here to see for themselves. If there are thousands of diabetics and pre-diabetics that manage their blood sugar by eating low-carb and higher fat HOW can this publication dismiss them so easily? I haven't come across many testimonials from commenters singing the praises of a low-fat high-carb approach, which stands to reason because they are few and far between. I've had two grand-mothers die from following the exact guidelines Hope recommends for diabetics, and if I'd known then what I know now about managing diabetes with a low-carb diet you better believe I'd be pointing my grand-mothers in this direction and away from the destructive diet responsible for their early deaths. Dismissing low-carb eating the way that this publication has is not only irresponsible but very telling of where it's loyalties lie.

Posted by Anonymous on 9 July 2011

Type 2 diabetes is, at its basic level, a disease of carbohydrate intolerance. Suggesting that people who have carbohydrate intolerance should eat carbohydrates, spike their blood sugar, and then shoot insulin to control that blood sugar is simply crazy.

Posted by Anonymous on 10 July 2011

Honestly, I was one of those people who thought low-carb didn't work for me. But when I first tried low-carb I did it low-carb AND low-fat, being paranoid of fat due to conventional wisdom. No wonder I was miserable. I bet the majority of people who try low-carb and fail likely give up for the same reason. Or another reason - it takes about 2 weeks for you body to adjust to burning fat instead of carbs. I was never told that, either. Had I known both these things, I would have started and been successful living low-carb a lot sooner. All I can say, is when I finally overcame these issues and went low-carb, my severe reactive hypoglycemia finally went away for good. Out of all the diets I tried, it was the only one that was successful in eliminating it.(My blood stats are excellent now too.)

-Ailu (didn't want to register to comment)

Posted by Anonymous on 11 July 2011

Dear Nadia, I just would like to tell you how much I appreciate your sharing other views on such a complex subject, leaving space for an open and (although not always the case) "civilized" discussion. It is interesting to see low-carb fundamentalists accusing other approaches of being... fundamentalist!

Posted by Anonymous on 13 July 2011

Hello All, I am a Type 1 diabetic for 54 years! WOW, what a ride so far!

I suspect that since we are informed that there is approximately 26 million known diabetics that there may also be 26 million ways for each of us to find what method of control works the best

It seems to me that it is important to have as a goal a comfortable lifestyle which includes enjoying tasty meals, some excise, a career we enjoy, having some fun every day or so, using a pump or MDI and/or medications to control whatever kind of diabetes we may have.

Some days I am ravenous and have quite a few carbs per meal and some days I am not hungry at all so consume very little food. I select a meal plan based on how I feel any particular day, and what my BG level is and go from there. I use an insulin pump but for years used MDI method. My control is pretty good: A1c of between 6.5 - 6.8 most of the time. Always some not so great days to get through.

I read many articles and some I do not necessarily agree with but they are informative either way! I also find that those articles that I tend to disagree with - I also find some truths to face or some new ideas to try.

Let's all relax and allow our BG to not rise to high over any issue or written article.

Tomorrow is another day.

Posted by Anonymous on 14 July 2011

I am a Type2, follow a low GI diet, consume between 90-120 carbs per day. I have had an HBA1c in the 5's since diagnosis ten years ago and take no medication. I do not have any complications, no weight problems and live a full and active life.
What am I doing wrong?

Posted by Anonymous on 14 July 2011

Kudos to those who can consume higher levels of carbs and maintain control of their BG levels, but one of the points of Ms. Warshaw's article was to tell us that a low carb diet was "old dogma" and that people, including diabetics, should eat over half of their daily calories in the form of carbs! She didn't advocate finding what works for the individual, or acknowledge that a low carb diet could prove to be most helpful and healthful for diabetics, or advise that if a low carb diet doesn't completely normalize your BG levels that medication might be needed too. She was not offering "options." Please stop trying to rewrite her article.

Posted by Anonymous on 16 July 2011

I am a DM1 and using insulin. I was eating a hc/lf diet until June 1st. my a1c was 11.3, cholesterol and triglycerides all way too high and my blood sugars were up and down all the time with no real control. i had to make constant correction doses to offset the highs and then eat more carbohydrate to offset the corresponding lows. going lc/hf took the guess work out of insulin usage for me and i now stay between 90-120 bg most days. i went lc/hf because it was way too taxing for me to have to constantly figure out how much insulin/exercise/food i would need. I have lost 20 lbs in 45 days and feel great. the carb cravings went away within 10 days. i still eat plenty of veggies and i have a serving per day of either strawberries or blueberries because i did not want to give up fruit. eat w/e you want to eat. if you can manage with hc/lf cool. if you can manage with lc/hf cool. I suspect the people posting here have found what works best for them. i also suspect the only diabetics posting here are the one's who actively follow some plan and work at it everyday. let's all stay healthy however we need to and respect each other.

Posted by Anonymous on 17 July 2011

Low carb diet is what works for me. Diabetes is a very individualized disorder and people have to figure out what works for them. I exercise,keep my wight down, and use Glycet to help eliminate carbs in the stomach. But I still have to be very careful what I eat.

Posted by Anonymous on 17 July 2011

According to your site's Submission Guidelines, you expect feature article submissions to have at least three to five outside sources. Unfortunately, Hope only cited one source (Look AHEAD trial) in the combined part 1 and 2 of her article. I appreciate that you strive to include various approaches to diabetes control, but I would love to see the approaches within the same article or next to each other so we can choose the approach that best works for us. Her generalizations about what experts say are no longer accurate, as the science and applications of that science are leading to conclusions that contradict not only her idea of old dogmas, but also her supposed new realities. The old dogma that "People with type 2 diabetes should follow a low carbohydrate diet" was dropped after World War 2 and replaced with the current dogma "Eat according to ADA guidelines (mostly carbohydrates)and use expensive pills and insulin to avoid hypoglycemia and malpractice suits" The low carbohydrate diet has never been considered old dogma since the invention of insulin and only after incontrovertible evidence of its effectiveness for fifty years did the ADA give tentatively support for it for those wishing to lose weight.
I'm one example that losing weight after 8 years of following the ADA guidelines and multiple meds can help with my glucose control and improve my markers for heart disease. Three years ago, I replaced my ADA diet with a low carb diet and lost over 50 pounds, with improvement of HbA1c and lipids. If low carbohydrate diets are the old dogma proven effective for a great many people, maybe the new reality should be that it should be given as a good alternative right away when diagnosed so the weight loss and blood improvements can show up even sooner, thereby delaying the health and monetary costs associated with my disease.

Posted by Anonymous on 18 July 2011

"To those of you who are so passionate about low carb, I get it. You have defied conventional wisdom in pursuit of a normal A1C."

But it seems you don't get the science of metabolism.

Posted by Anonymous on 21 July 2011

I know you won't print this, but I don't know how you can sleep at night. Hope Warshaw's article was clearly dismissive of the low carb approach - which works for many people. The very "spirit" of this magazine, of looking at all sides of the issue, was clearly violated by Hope's assertion that diabetics should stick with a high carb diet.
I am not comfortable being so abrupt but it is what it is.

Posted by Anonymous on 5 August 2011

It's not about food; it's about big pharma. Of course, some people actually need medicines; there's no denying that. but from what i understand, the prediabetes phase is the phase where you can really determine the course of the disease. so why shovel more carbs into a system that is beginning to show signs of carb intolerance?

Posted by Anonymous on 7 August 2011

Would you walk into a den of rattlesnakes? Why not, there's a shot of antidote nearby for when you get bitten. Would you walk into a bee hive? Why not, we have an epi pen handy if you go into anaphylactic shock?

That is essentially what the ADA and people like Hope Warshaw are doing: urging people to do something that it's pretty clear has a high risk of harm, and telling them it's safe because there is medication available with the ability to counter the body's adverse reaction to the poison being introduced.

Yes, some people will survive without adverse affects. But why take that risk in the first place?

Posted by Anonymous on 12 August 2011

Who is funding Hope Warshaw?what big pharma is it?.

Posted by Anonymous on 22 November 2011

Ms Al-Samarrie, when you wrote that Ms Warshaw voiced the opinion that a low carb diet is not the only dietary option for people with diabetes,


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