Diabetes Diet War
The nutrition advice given to most diabetics might be killing them
He's not alone. "Diabetes is a disease of `carbohydrate intolerance.' Thus, meal plans should minimize carbohydrates because people with diabetes do not tolerate carbs," says Sansum's Jovanovic. She prescribes food considerably lower in carbohydrates than does the ADA.
Some patients are discovering low-carb benefits for themselves. Nancy Humeniuk, a 70-year-old retiree and Type II diabetic from Monterey, Tenn., was put on the ADA diet under the direction of a diabetes educator. "While I was following the diet, my blood-glucose levels were completely out of control," Humeniuk says. "They told me I was being noncompliant--but I was following the diet exactly. I was scared." After three months, Humeniuk switched to low carb. "Within three days of going low carb, my blood sugars were normal. And they have been for the past six years." Her cholesterol profile is also very good. "My doctor told me that whatever I was doing, I should keep it up," she says.
The ADA, however, remains firm in its stance. "A diet that is very low in carbohydrates is significantly higher in protein and in fat, and there are specific risks to people with diabetes from high-protein diets in regard to kidney disease and from high-fat diets in regard to cardiovascular disease," Clark says. The ADA is far from alone in its position. "We recommend that 45 to 60 percent of calories come from carbs," says Karen Chalmers, director of nutrition services at the Joslin Diabetes Center in Boston.
"Healthy fats." Scientific evidence supporting the low-carb approach has been thin. But some recent studies have refuted the idea that an Atkins-like diet increases cholesterol, or lipid, problems. "Our data would suggest that you don't get a negative lipid pattern with the Atkins diet," says James Hill, director of the Center for Human Nutrition at the University of Colorado, where a recent study compared the Atkins diet with a standard low-fat, high-carb diet. Cholesterol levels in the Atkins dieters were actually better after a year. Frank Hu, associate professor of nutrition and epidemiology at the Harvard School of Public Health, also believes that lower-carb diets are beneficial to some people with diabetes. He is careful to point out, however, that carbohydrates should be replaced with "healthy fats," such as the mono- and polyunsaturated fats found in olive oil, nuts, and avocados.
The kidney-disease claim is also disputed. "There is no evidence that in an otherwise healthy person with diabetes eating protein causes kidney disease," says Frank Vinicor, director of diabetes research at the Centers for Disease Control and Prevention.
Some people hope that the new data will have an impact. "The ADA is responsive to new scientific data and is likely to incorporate this information into new dietary guidelines with a lower proportion of carbohydrates," says ADA board member Barbara Kahn, a physician and diabetes expert at Harvard Medical School. Kahn has seen how difficult it is for people with diabetes to gain control while following current recommendations, so she is pushing for changes. Still, the ADA Web site and all of its literature continue to tell people with diabetes and the thousands of medical professionals who treat them to make starches "the centerpiece of the meal." Revising a bible is never easy, so it may be quite some time before this bit of medical gospel sees real change.
Low-carb Diabetes Solution fare really differs from the standard advice for diabetics.
"DIABETES SOLUTION" DINNER
Steak 4-6 oz.
Cooked broccoli 2/3 cup
Salad w/dressing 1 cup
AMERICAN DIABETES ASSOCIATION DINNER
Pasta w/vinaigrette dressing 1 cup
Fish 3.5 oz.