Diabetes Diet War
The nutrition advice given to most diabetics might be killing them
The bible says "make starches the star." That's the Diabetes Food and Nutrition Bible, published by the American Diabetes Association. "Grains, beans, and starchy vegetables form the foundation of the Diabetes Food Pyramid. The message is to eat more of these foods than of any of the other food groups." For 17 million Americans with diabetes, diet is a crucial part of treatment, And what the ADA bible preaches, many doctors, nutritionists, and patients believe.
But what if the ADA's high-starch diet--another way of saying high-carbohydrate--is not healthy for people with diabetes but harmful to them instead?
This possibility is now the source of heated debate in the diabetes community. It is "the most controversial aspect of diabetes treatment today," says Scott King, editor-in-chief of Diabetes Interview magazine. How controversial? "Malpractice!" is how physician and diabetes specialist Lois Jovanovic, chief scientific officer of the Sansum Medical Research Institute in Santa Barbara, Calif., describes conventional high-carb nutrition advice.
Carb consequences. These arguments are more intense than the nutrition wars over low-carb, Robert Atkins-like diets taking place in mainstream culture. For people with diabetes, the battle is about more than waistlines. As far as bodies are concerned, carbohydrates equal sugar. And complications from Type I and Type II diabetes, which are caused by high blood-sugar levels, include amputation, heart disease, blindness, and kidney failure. Often they are lethal. The illness is not necessarily a disaster, because people with diabetes who maintain close to normal blood sugar can effectively avoid these problems. A number of doctors and people with diabetes, however, believe the high-carb diet is a recipe for trouble.
"There are a number of myths surrounding diet and diabetes, and much of what is still considered sensible nutritional advice for diabetics can over the long run be fatal. I know, because it almost killed me," writes physician Richard Bernstein in his book Diabetes Solution. Bernstein, a Type I, or insulin-dependent, diabetic for the past 57 years, has been at war with the medical establishment since the 1970s. At that time, his failing health caused him to wonder why someone whose body couldn't process carbs--which are chains of sugar molecules--was repeatedly being told to eat a lot of them. Should people with diabetes be eating a diet that is, essentially, 50 percent to 60 percent sugar?
The reason, historically, has been fear of fat and the cardiovascular problems that plague diabetics. As the cholesterol-fat-heart-disease links moved doctors to recommend a low-fat diet, the amount of carbohydrates recommended for diabetics gradually increased to fill the void. In 1994, the ADA stated that people with diabetes could eat anything, including sugar itself. "There is no longer a diabetic diet. People with diabetes eat the exact same foods as anyone else," says Nathaniel Clark, national vice president for clinical affairs at the ADA. "We do not believe there is any harm in eating carbohydrates."
Bernstein does. He prescribes an extremely low carbohydrate diet--approximately 30 grams of carbs over three meals for diabetics to achieve normal blood-glucose readings round-the-clock. "In my experience," he says, "the ADA diet does not work for anyone."
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