Diabetes, What's the truth? Why do Diabetes UK and the ADA Recommend a High Carbohydrate Diet for Diabetics.

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Why do DiabetesUK and the ADA Recommend a High Carbohydrate Diet for Diabetics?

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* Health and Healing *

Friday, April 12, 2002 9:02 AM

Diabetes, What's the truth? Why do Diabetes UK and

the ADA Recommend a High Carbohydrate Diet for Diabetics.

 

 

- http://www.second-opinions.co.uk/diabetes.html -

Why do DiabetesUK and the ADA Recommend a High Carbohydrate Diet for

Diabetics?

 

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There's something very wrong on the diabetes front!

 

 

and both say:

People with diabetes have a greater risk of developing heart disease

and/or hardening of the arteries. Try and cut down on the fat you eat,

particularly saturated (animal) fats. . . Use less butter, margarine, cheese and

fatty meats. Choose low fat dairy foods like skimmed milk and low fat yogurt.

Grill, steam or oven bake instead of frying or cooking with oil or other fats.

 

Choose a diet with plenty of grain products, vegetables, and fruits.

These foods should provide the mainstay of what you eat. Eat regular meals based

on starchy foods such as bread, pasta, chapatis, potatoes, rice and cereals.

Whenever possible, choose high fibre varieties of these foods, like wholemeal

bread and wholemeal cereals.

 

 

In other words, they say that diabetics should eat a

carbohydrate-based, low-fat diet.

 

--

 

BUT THE EVIDENCE ACTUALLY SAYS:

Coulston AM, et al. American Journal of Medicine 1987; 82: 213-220.

'it seems prudent to avoid the use of low-fat, high-carbohydrate diets

containing moderate amounts of sucrose in patients with non-insulin-dependent

diabetes mellitus.'

 

 

Garg A, et. al. New England Journal of Medicine 1988; 319: 829-34.

'As compared with the high-carbohydrate diet, the high-monounsaturated-fat diet

resulted in lower mean plasma glucose levels and reduced insulin requirements,

lower levels of plasma triglycerides and very low-density lipoprotein [LDL - the

'bad'] cholesterol , and higher levels of high-density lipoprotein [HDL - the

'good'] cholesterol. Levels of total cholesterol did not differ significantly in

patients on the two diets.'

 

 

Hays J. Paper presented to the 81st Annual Meeting of the Endocrine

Society, 15 June 1999. " A very high-fat, low-carbohydrate diet has been shown

to have astounding effects in helping type 2 diabetics lose weight and improve

their blood lipid profiles. "

 

Dr. James Hays, an endocrinologist and director of the Limestone

Medical Center in Wilmington, DE, presented the results of three studies of men

and women with type 2 diabetes involving very high-fat, low-carbohydrate diet at

the annual meeting of the Endocrine Society. His study showed an impressive

benefit in body mass index (BMI), triglycerides, HDL, LDL and HbA1c.

Patients were able to eat all the meat and cheese they wanted,

but as for carbohydrates, they are restricted to eating unprocessed foods,

mainly fresh fruit and vegetables. Whereas in a normal diet 60 percent of

calories would come from carbohydrates and 30 percent from fat, patients in this

diet were encouraged to get 50 percent of their caloric intake from fat, and

just 20 percent from carbohydrates.

A whopping 90 percent of the fat content in their diets was

saturated fat, compared with just 10 percent that was monounsaturated fat.

Dr Hays told his audience that:

 

Over the course of one year, the subjects achieved

a.. a mean decline in total cholesterol of between 231 and 190 mg/dl

a.. LDL (the 'bad' cholesterol) fell from 133 to 105 mg/dl,

a.. HDL (the 'good' cholesterol) increased from 44 to 47 mg/dl.

a.. Triglycerides declined from 229 to 182 mg/dl.

a.. HbA1c, which at the start of the study averaged 3.34 percent

above normal, declined to just 0.96 percent above normal

a.. Average weight loss was in the order of 40 pounds.

 

By the end of the one-year study 90 percent of the patients had

achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and

triglycerides.

As for the response from cardiologists who see a high-fat diet

as anathema to what they have been instructing their patients for years now, Dr.

Hays said he has three cardiologist patients who are now on the diet. And

concluded:

" If you have a diet that results in weight loss, lower

cholesterol, and a better lipid profile, eventually, everybody will be eating

that way. "

 

--

 

The Case in Detail

 

Above you have seen some of the evidence that suggests that

DiabetesUK and the American Diabetes Association have got it completely wrong.

This is also my findings from over twenty years of research. Below is the case

for a high-fat, low-carb diet to control both type 1 and type 2 diabetes in much

more detail.

 

Main points

 

a.. Diabetes mellitus, of both types, is a disease of incorrect

nutrition -- too much carbohydrate, and not enough fat.

 

a.. The disease develops as a result of a high intake of

carbohydrates - the 'healthy' diet.

 

a.. Since 'healthy eating', obesity-related type 2 diabetes has

become epidemic to such an extent that it now affects children.

 

a.. This increase at such a time is NOT a coincidence -- it is cause

and effect

 

a.. Drug treatment of diabetes, which is no more than a surrogate

for successful weight loss, often results in further weight gain.

 

a.. Conventional low-fat diets usually lead to control with drugs,

and later, insulin.

 

a.. Both the conventional low-fat diet and diabetic drugs have only

limited, short-term benefits

 

a.. It can be reversed, at least in the early stages, and controlled

easily later by changing this pattern of behaviour.

 

a.. The only strategy that offers the prospect of cure for diabetes

is the one offered in Eat Fat, Get Thin! here for weight loss.

 

You are told one thing - but the evidence says the opposite. What

should you believe?

 

Facts

 

a.. As the epidemic of obesity has spread in the industrialised

world, the numbers of cases of diabetes has risen in tandem.

a.. In the USA the proportion of adults aged 20-74 years with a body

mass index (BMI) greater than 30 kg/m 2 , increased from 12.3 percent in 1976-80

to 22.5 percent in 1988-94. (1)

a.. Similarly, in Britain the proportion more than doubled between

1980 and 1996 from 6 percent to 16 percent in men and from 8 to 17.3 percent in

women .

 

That should come as no surprise - the two diseases are caused by the

same thing - over-consumption of carbohydrates (sugars and starches)

 

Diabetes is not the most sexy of conditions, but it's an important

one. Characterised by raised levels of sugar in the bloodstream, it can

ultimately lead to diverse problems including blindness, gangrene, kidney

disease, nerve damage and impotence, and is the third leading cause of death

after cardiovascular disease and cancer. What is more, diabetes is turning into

a bit of an epidemic in the UK, with the number of sufferers set to double over

the next decade. But it's not all doom and gloom. The good news is that there's

plenty of evidence that making informed dietary choices offers real potential

for the treatment of diabetes.

 

The chief substance in the body responsible for keeping blood-sugar

levels in check is the hormone insulin. In diabetes, insulin simply doesn't do

its job. About one in 10 diabetics has what is known as type 1 diabetes, where

the body fails to make sufficient quantities of insulin. In the more common type

2 diabetes, there is usually plenty of insulin around - the problem is that the

body has become resistant to its effects.

 

Whatever the precise nature of the diabetes, eating a diet that

helps to keep blood-sugar levels on an even keel is of obvious importance. Until

recently, the traditional view has been that sugar, because it causes surges in

blood-sugar levels, should be limited in the diet. On the other hand, starches

such as bread, potato, rice and pasta are recommended by doctors and dieticians

because of the long-held belief that they give slow, sustained releases of sugar

into the bloodstream.

 

And this approach shows better than anything just how little the

diabetes establishment understands about diabetes - because, biochemically, it

makes no sense whatsoever.

 

And I have yet to meet a dietician or a nutritionist who has any

idea what actually happens to foods in the body. So let me give you a short

chemistry lesson.

 

Sugars

 

The first point to make is that all carbohydrates are sugars,

although we do not normally call them that, but differentiate between those that

taste sweet, which we call 'sugar', and those that don't, which we call

'starch'.

 

The simple sugars in foods that are most important to human

nutrition are called sucrose, fructose, lactose, and maltose. But the body wants

the simple sugar called glucose, so these other simple sugars break apart in the

body to become glucose. They do this by coming apart easily at the water

connections.

 

Sucrose is the white granulated stuff we call 'sugar' and put in

bowls on the table. Sucrose is the form of sugar we are most familiar with. It

is obtained from sugar cane, sugar beets, and the syrup from sugar maple trees.

It is also naturally present in some amounts in most fruits and vegetables,

along with higher amounts of other sugars. Whenever the word 'sugar' is used in

common conversation, it is usually sucrose that is being referred to. Sucrose is

a disaccharide which hydrolyses to glucose and fructose.

 

Fructose is the form of sugar found in fruits, honey, and corn

syrup. It is 1.7 times as sweet as sucrose. In recent times fructose, which is

every bit as much a sugar as sucrose, has been added to processed foods so that

the manufacturers can say on the packet that their product 'has no added sugar'.

It's a legal loophole as fructose is a sugar. Fructose is a monosaccharide which

is absorbed intact and changed into glucose by the liver. Diabetics are told

that they can eat fruit so, presumably fructose is thought to be all right.

 

Lactose is the sugar found in milk and cottage cheese. A

disaccharide, it is hydrolysed into glucose and galactose. The galactose is

changed into glucose in the liver

 

Maltose is a disaccharide sugar found in grains. It hydrolyses into

glucose and glucose. Thus, for diabetics it is the worst 'sugar'.

 

Note that all these sugars end in 'ose'. Anything you see on the

label of a product ending with these three letters is almost certain to be a

sugar. Dextrose, for example, is merely another name for glucose. The only

exception is cellulose, which, while it is a complex sugar molecule, is the

material that plant cell walls are made of. Cellulose only has a food value for

a herbivore. It is inedible to a carnivore and as the human digestive system has

no enzyme to digest it, cellulose has no nutritional value and passes straight

through you. It used to be called 'roughage'; we now call it fibre.

 

Is starch better? No - Starch is worse

 

The other source of carbohydrate is starch. In a similar way to the

human body storing surplus energy in the forms of glycogen and fat, vegetables

store energy in the form of starch. For this reason all vegetables contain some

starch. The vegetables that contain the most starch are those that have to

survive a winter before reproducing themselves. This includes the obvious root

vegetables like potatoes, parsnips and carrots, and also cereals such as wheat,

rice and other grains and seeds.

 

When we were talking about sugars above, we talked about

monosaccharides and disaccharides. These are simple sugars. Starches are called

polysaccharides . The 'saccharide' part of this word means sugar, just as it did

before, but the prefix 'poly' means 'many'. This is because starch is really

just another form of sugar. Starch is more complex (in fact, starch is often

called 'complex carbohydrate'), but starch is really nothing more than a chain

of thousands of sugar molecules. And just as sugars are hydrolysed to be turned

into glucose, so are starches.

 

Despite being made entirely of sugar molecules, starches usually

don't taste sweet. So you are unlikely to think of them as sugar, but starch is

quickly broken down into the simple sugar, maltose, and then into glucose.

Although nutritionists talk of 'complex carbohydrates' being better for you than

'sugar', in fact, as far as your digestion is concerned, they are both the same.

 

In fact, starches - the 'complex carbohydrates' we are told to eat

more of - may actually be worse than sugar.

 

For example, the chemical name for sugar - the white granulated

stuff you put in your tea - is sucrose. Sucrose is a disaccharide , which means

two sugars. Its chemical formula, C 12 H 22 O 11 , means that it is made up of

twelve atoms of carbon, twenty-two atoms of hydrogen and eleven atoms of oxygen.

When it is digested, it enters the bloodstream as the blood sugar, glucose,

whose formula is C 6 H 12 O 6 . In this process one molecule of C 12 H 22 O 11

ends up as two molecules of C 6 H 12 O 6 . But you will notice that sucrose has

only twenty-two hydrogen and eleven oxygen atoms, before it can become glucose,

it must gain two hydrogen atoms and one oxygen atom somehow. It does this very

simply by combining with water whose chemical formula is H 2 O (which means it

has two hydrogen atoms and one oxygen atom - exactly what we need). The process

is illustrated thus:

 

 

C 12 H 22 O 11 + H 2 O == 2 C 6 H 12 O 6

 

1 Sucrose + 1 Water == 2 glucose

 

 

The addition of the water molecule to the sugar molecule increases

the total energy content. In this way, 100g of sugar, which you would think

contains 400 kcals, ends up as 105g of glucose or 420 kcals.

 

The situation is similar with starches. Dieticians call starches

'complex carbohydrates' or polysaccharides , which means many sugars. Our

digestion also converts these into glucose but, in this case, the formula is a

little different. Starch is made up of strings of thousands of sugar molecules

fastened together. The formula for each of these individual sugar molecules is C

6 H 10 O 5 so, to make it into C 6 H 12 O 6, it again needs to find two hydrogen

atoms and one oxygen atom. So one molecule of water, H 2 O, is combined with

each of the starch sugars. In this way:

 

C 6 H 10 O 5 + H 2 O == C 6 H 12 O 6

 

Starch + Water == glucose

 

But as the atoms from the water now form a greater proportion of the

total in this equation, 100g of starch actually become 111 g of glucose or 444

calories. That's more than the sugar!

 

So, when a dietician tells you to cut down on calories by eating

less sugar, but tells you at the same time to eat more complex carbohydrates,

she is talking nonsense.

 

Weight for weight, starch is worse than sugar

 

But that is not the whole story -- it gets worse.

 

You will realise just how much worse when I admit to not quite

telling the truth earlier on. You see, the formula C 6 H 12 O 6 , which is the

formula for glucose, is also the formula for fructose. And when sucrose (table

sugar) enters the bloodstream the formula I gave was correct but not the word

'glucose' underneath. Sucrose actually becomes, not two molecules of glucose,

but one molecule of glucose and one molecule of fructose - and you are told that

fruit (whose principle sugar is fructose) is all right?

 

In which case, as half of the sugar becomes fructose, weight for

weight, sugar is less than half as harmful as starch for a diabetic!

 

The sugar that is seems to worst for diabetics is maltose as this

hydrolyses directly into two molecules of glucose -- and as I said above,

maltose is the form of sugar found in grains. Aren't they what you are told you

should eat more of?

 

The question is: why are you told this?

Is it merely ignorance? Or is there some other motive?

 

In my opinion, is it about time that DiabetesUK and the ADA got

their act together -- and started to employ people who know their subject?

 

A growing number of nutritionists and nutritionally oriented doctors

are beginning to question the conventional wisdom behind the standard diabetic

diet.

 

What is Diabetes?

The word 'diabetes' comes from a Greek word meaning a 'flowing

through'. It refers to the increased amount of urea excreted in the disease, a

phenomenon called polyuria. The commonest form is called diabetes mellitus , or

'sweet flowing through', because glucose appears in urine. It is this form of

diabetes in which we are interested here.

 

Diabetes mellitus, is a chronic disorder of carbohydrate metabolism.

It is not contagious; you cannot catch it from someone who has it. Diabetes

impairs the body's ability to use food properly such that blood sugars are not

oxidised to produce energy. This is due to a malfunction of the hormone insulin

which is produced in the beta cells of the pancreas. Insulin is a hormone that

helps to regulate blood sugar levels by taking excess glucose out of the

bloodstream and putting it into body cells, either to be used as fuel or to be

stored as glycogen and fat. An accumulation of sugar in the blood leads to a

build up in the blood called hyperglycaemia and then to its appearance in the

urine. Symptoms include thirst, excessive production of urine and weight loss.

 

In people with diabetes, either the pancreas doesn't make insulin or

the body is unable to use insulin properly.

 

Diabetes can run in families. Researchers are still studying how and

why diabetes occurs in certain children and families.

 

Although diabetes cannot be cured, it can be controlled. And

research has shown that maintaining good control of blood glucose levels can

prevent long-term complications of diabetes.

 

Individuals with diabetes mellitus fall into two broad groups: type

1 and type 2.

 

Type 1 diabetes

 

Type 1 diabetes affects young people, commonly around the ages of 10

or 12, although it can occur as early as one year and as late as forty. The

disease tends to develop rapidly and is severe. In this form of the disease, the

beta cells of the pancreas do not produce sufficient insulin. This type of

diabetes is called either type 1 diabetes or, more technically, insulin

dependent diabetes mellitus (IDDM).

 

Two kinds of problems occur when the body doesn't make insulin:

 

a.. Hyperglycemia occurs when blood glucose levels get too high.

This can occur when the body gets too little insulin or too much glucose in the

bloodstream. Untreated, hyperglycemia may develop into ketoacidosis , a very

serious condition. Treatment is invariably with insulin injections to make up

the shortfall and reduce blood glucose levels.

b.. Hypoglycemia is the exact opposite of hyperglycemia. This

occurs when blood glucose levels get too low, when the body gets too much

insulin or too little food. Hypoglycemia is the most common problem in children

with diabetes. Usually it is mild and is easily treated by giving the child a

sweet food.

Type 1 is generally believed to be an inherited form of the disease,

as it is more likely to occur in people who have close relatives with diabetes.

However, this seems unlikely to be true as type 1 diabetes is not found in the

animal kingdom either in meat or plant eating animals, where those animals live

in their natural habitat. Neither does type 1 diabetes exist amongst peoples who

have not had extensive contact with the industrialised societies: the Inuit,

Maasai, and Hunza, and other indigenous peoples whose diets are typically low in

carbohydrates. (2) While not a single case of type 1 diabetes has been found

among the meat- and fat-eating Inuit population of Alaska, there have been cases

of the maturity onset type of diabetes. (3) These appear to be the result of

increasing carbohydrates in the modern Inuit diet.

 

As diabetes is wholly restricted to peoples of Western

industrialised civilisation, it cannot have a genetic origin, although family

dietary traits and lifestyle can play a major part in its appearance within

families.

 

If a pregnant woman eats too much carbohydrate, this will raise her

insulin levels. It is not thought that insulin itself crosses the placenta from

mother to unborn child. However, insulin produces antibodies that do. (4) Once

in the foetus these increase glycogen and fat deposits resulting in an

abnormally large baby. It may also predispose that baby to type 1 diabetes.

 

The medical profession generally regards type 1 diabetes as

incurable. It is managed conventionally with a 'healthy' low-fat,

carbohydrate-based diet and daily insulin injections to bring the resultant high

levels of glucose in the blood down to normal. This means walking a tightrope

for life as exactly the right amount of insulin must be given or it will either

reduce glucose levels too much, or not enough. And as we will see later, insulin

supplementation is a health hazard

 

But the human body rarely produces no insulin at all. Even in type 1

diabetics, usually five to fifteen percent of the pancreas' beta cells survive

to produce insulin. If these are relieved of the burden of continually having to

reduce excessive levels of blood glucose, they can usually produce sufficient

insulin for the variety of other metabolic processes that need it.

 

A Polish doctor, Jan Kwasniewski, has successfully treated type 1

diabetics for over three decades merely by reducing their carbohydrate intake to

'an amount dictated by the insulin-producing capacity of the sufferer'. (5) This

amount, he says, typically equates to 1.5 grams of carbohydrate per kilogram

body weight for a growing child and between forty and fifty grams for an adult.

With this regime, the main energy source is dietary animal fat. On such a diet,

his type 1 diabetic patients no longer needed to use insulin.

 

Type 2 diabetes

 

The second type of diabetes is more common. This occurs in

middle-aged people, especially if they are overweight. Because it occurs later

in life, this type of diabetes is often called adult- or maturity-onset

diabetes. It is also called type-2 diabetes. As it is usually treated without

the use of insulin, it is known technically as 'non-insulin dependent diabetes

mellitus' or NIDDM. NIDDM is somewhat more common in pregnant women and those

who have had several children. It is also more common in men and women who are

obese. And, in the same way that type 1 diabetes is not found in the animal

kingdom or in primitive man, neither is type 2.

 

That this form of the disease is a result of environmental and

lifestyle factors is demonstrated when people emigrate and adopt the eating

habits of their new country: Populations who migrate to westernized countries

with more sedentary lifestyles have greater risks of type 2 diabetes than their

counterparts who remain in their native countries. (6) But it is not just the

change in exercise patterns that causes the greater susceptibility to diabetes,

populations undergoing westernization in the absence of migration, such as North

American Indians (7) and Western Samoans, (8) also have experienced increases in

obesity and type 2 diabetes.

 

There have been suggestions that particular dietary constituents are

involved in the onset of NIDDM. Excessive fat, sucrose (sugar) and other

carbohydrates, and inadequate dietary fibre are those particularly discussed.

Today, one frequently hears in the medical world, expressions such as 'the

causes of diabetes have not been clearly identified', or 'we do not know what

causes diabetes'. However, this is not so: we have known for almost

three-quarters of a century. In 1935, a Dr H D C Given pointed out the

correlation between carbohydrate intake and diabetes. (9) This has since been

confirmed many times and it is now known beyond doubt that diabetes is caused by

an excessive intake of carbohydrates - just as obesity is.

 

In type 1 diabetes, the pancreas doesn't produce enough insulin.

That is not the case with type 2. In this form of diabetes, the pancreas does

produce insulin but that insulin is ineffective. It is a situation called

insulin resistance.

 

Fortunately Type 2 diabetes is easily treated with a low-carb,

high-fat diet.

 

Insulin resistance

 

Insulin is a hormone, produced in the beta cells of the pancreas. It

carries glucose (blood sugar) from your blood into your body's cells so that it

can be burned for energy or stored as glycogen or fat for future use.

 

Insulin resistance and its role in diabetes is a controversial

topic. The original concept of insulin resistance referred to the clinical

observation that some patients with diabetes required very large doses of

insulin to lower their blood sugars. (10) When Rosalyn Yalow and Solomon Berson

described the technique of radioimmunoassay in 1959, they noticed that

individuals with Type 2 diabetes had high insulin levels and they introduced the

concept of insulin resistance as a laboratory finding.

 

In 1976 Drs. Kahn and Flier described two syndromes of severe

insulin resistance, and research at the time began to focus on the newly

described insulin receptor as the cause of insulin resistance. (11) But further

studies showed that the insulin receptor is usually not the cause of insulin

resistance. (12)

 

More recently, several epidemiologic studies have measured insulin

levels in populations. (13) These noted higher insulin levels in subjects with

high blood pressure and other vascular disease. For this reason, insulin

resistance is now also considered a risk factor for heart disease. These studies

have added a great deal of confusion to the field because many individuals with

insulin resistance do not have diabetes.

 

Diseases of insulin resistance, particularly NIDDM, occur in greater

frequency in populations that have recently changed dietary habits from

hunter-gatherer to Western grain-based regimes, compared to those with long

histories of such diets. This is why obesity and diabetes is so much more common

among Americans of African origin than among those whose ancestry is European.

It has been suggested that insulin resistance in hunter-gatherer populations may

be an asset, as it may facilitate consumption of high-animal-based diets. The

down side of this is that when high-carbohydrate, grain-based diets replace

traditional hunter-gatherer diets, insulin resistance becomes a liability and

promotes NIDDM. (14)

 

The cause of type 2 diabetes via insulin resistance, impaired

glucose tolerance, and pancreatic beta-cell failure, (15) largely explains the

worldwide increase in this disease. (16)

 

Lose weight - lose diabetes

 

If you are overweight, and most diabetics are, weight loss is

normally the first concern for, if maintained, the potential benefits of weight

loss are remarkable. (17) A weight loss of 10 kg can achieve greater reductions

in HbA1c and fasting blood sugar than treatment with the usual anti-diabetic

drug, Metformin. There are also similar reductions in diabetes-related deaths,

and improved control of blood fats and blood pressure without the need for

additional drug treatment. (18)

 

Diet for weight loss - the DiabetesUK way

 

Weight loss should therefore be the main aim of treatment in

overweight diabetics. But with conventional treatment, such sustained weight

loss is rarely achieved. Indeed, weight gain is a major complication of

treatment with drugs: when drugs are used as surrogates for weight loss further

weight gain is the price paid for short-term improvement in glucose

concentrations.

 

Sustained weight loss is also rarely achieved with current dietary

advice. This is hardly surprising as both Diabetes UK and the American Diabetic

Association say:

 

" Choose a diet with plenty of grain products, vegetables, and

fruits. These foods should provide the mainstay of what you eat. Eat regular

meals based on starchy foods such as bread, pasta, chapatis, potatoes, rice and

cereals. Whenever possible, choose high fibre varieties of these foods, like

wholemeal bread and wholemeal cereals. "

But that, of course, is the very diet that gave them the problem in

the first place! Nevertheless, there appears to be a good reason for such

advice.

 

In the last century, diabetics were treated with a low- or

no-carbohydrate diet, which was also high in fat. But that regime was revised

when 'healthy eating' was born. Diabetics are more likely to suffer from heart

disease than people without the diabetes. Under these circumstances, it seemed

unwise to continue to recommend a low-carbohydrate, high-fat diet. And so

Diabetes UK say: 'The healthy diet for people with diabetes is the healthy diet

recommended for everyone'. That is one in which carbohydrates form the major

part of every meal, and fats are restricted. On their website, Diabetes UK make

specific recommendations regarding the constituents of their recommended diet.

(19) In a graphic image of the 'ideal plate' 'for balancing food proportions

correctly' they state: 'Foods can be divided into five main groups. In order for

us to enjoy a balanced diet we need to eat foods from these groups'.

 

These groups are as follows:

 

a.. Sharing first place we have two groups which together should

form two-thirds of your daily intake: 'Base meals and snacks on starchy foods',

and 'Eat at least five portions of fruit and vegetables a day'.

b.. In third place we have 'choose lower fat dairy foods'

c.. Next in size comes 'Choose lean meat, poultry, fish, beans and

alternatives'.

d.. And lastly, the smallest area of the plate: 'Cut down on fatty

and sugary foods'.

The American Diabetes Association reckon only four food groups are

needed. Under the heading: Which Foods Are Healthy?, they say:

 

'No single food will supply all the nutrients your body needs, so

good nutrition means eating a variety of foods.

 

'Food is divided into four main groups. They are:

 

a.. Fruits and vegetables (oranges, apples, bananas, carrots, and

spinach).

b.. Whole grains, cereals, and bread (wheat, rice, oats, bran, and

barley).

c.. Dairy products (whole or skim milk, cream, and yogurt).

d.. Meats, fish, poultry, eggs, dried beans, and nuts.' (20)

Their advice continues thus:

 

'Carbohydrates give you energy. Healthy choices are dried beans,

peas, and lentils; whole grain breads, cereals, and crackers; and fruits and

vegetables. Protein is needed for growth and is a good back-up supply of energy.

Healthy choices include lean meats and low-fat dairy products.

 

'Foods high in fiber are healthy, too. Fiber comes from plants and

may help to lower blood-sugar and blood-fat levels. Foods high in fiber include:

bran cereals, cooked beans and peas, whole-grain bread, fruits, and vegetables.

 

The ADA recommend that you cut down on fat and cholesterol: 'Choose

lean cuts of meat. Remove extra fat.

 

'Eat more fish and poultry (without the skin).

 

'Use diet margarine instead of butter.

 

'Drink low-fat or skim milk.

 

'Limit the number of eggs you eat to three or four a week and choose

liver only now and then.

 

'People with diabetes should eat less sugar. Foods high in sugar

include: desserts such as frosted cake and pie, sugary breakfast foods, table

sugar, honey, and syrup. One 12-ounce can of regular soft drink has nine

teaspoons of sugar.' (Comment - that is the only bit that makes any sense)

 

This conventional approach doesn't work!

 

Diet is the initial mainstay of treatment in overweight patients

with diabetes, and forms the basis for successful drug therapy. Very low calorie

diets achieve rapid weight loss with substantial short-term glycaemic and

metabolic improvement, (21) but the regimen is demanding and relapse is

frequent. With this kind of diet, success is critically dependent on the

commitment and enthusiasm of people who run such programmes, and even when

weight is lost it is almost inevitably regained within 5 years. (22) With

striking but rare exceptions, there is very little evidence that dietary and

behavioural management offers sustained improvement in patients with moderate to

severe obesity.

 

And so drugs are used. But with very little evidence that they are

effective in the long-term.

 

A meta-analysis of eighty-nine studies with 1800 patients testing

strategies for the promotion of weight loss in type 2 diabetes was reported in

1996. (23) Diet alone was the most effective non-surgical intervention, with

mean fall in weight of 9 kg and in HbA 1c of 2.5-3.0%. Patients in studies that

included behavioural therapy, exercise, or drugs to suppress appetite didn't do

so well. Very few studies lasted more than 6 months and there was little to

suggest that conventional approaches to weight loss conferred any lasting

benefit to most moderately to severely obese patients.

 

Diabetes is a disease that progresses over time, and therapies

initially able to control hyperglycemia often prove insufficient over the long

term. (24) Using conventional diet and drug treatments, continued deterioration

of glycaemic control is the norm over time.

 

Insulin increases heart disease risk

 

As diet and drugs fail, and glycaemic control deteriorates, insulin

is prescribed.

 

Our primary evolutionary problem was to maintain a blood sugar level

high enough to ensure an adequate supply for body cells which require glucose:

brain, nerves and red blood cells. Our evolution ensured this supply by giving

us a whole range of hormones to do the job of raising blood sugar: cortisone,

growth hormone, adrenalin and glucagon. It makes evolutionary sense if something

is important to have redundant mechanisms. But we have only one hormone to

reduce blood sugar and that's insulin. The fact that we have only this one

hormone to lower sugar indicates that it was not important in the past. Could

that be because high blood sugar was never a problem in the past?

 

One of the indications that a person has diabetes is the presence of

glucose in their urine. Diabetics regularly measure this so that they can

monitor their disease. Glucose in urine is your body's way of getting rid of the

glucose it doesn't want. If there is glucose in your urine, what you body is

telling you is: 'Whoa! I don't want any more of this'. The last thing you should

do at this stage, therefore is eat carbohydrates. But that is exactly what

conventional wisdom says you should eat. Not surprisingly, many type 2

diabetics, whose bodies are already producing lots of insulin that is having

little effect, are put on a course of even more insulin.

 

This is not without considerable risk.

 

A recent study of subjects in Framingham, Massachusetts demonstrated

that there is more likely to be blood clotting if insulin levels are increased.

This effect was present in individuals who did not have diabetes, and was more

profound in individuals who did have diabetes. (25)

 

Insulin increases breast cancer risk

 

Breast cancer patients with high levels of insulin in their blood

seem to be more likely to die of their disease. Researchers found that insulin

may predict whether a woman's breast cancer recurs after therapy and whether she

will die.

 

In a study of 535 breast cancer patients followed for up to 10

years, those with the highest insulin levels were more than eight times more

likely to die and were almost four times as likely to have their cancer recur at

a distant site. (26)

 

Although many of the women in the study were obese, and obesity is

known to affect both breast cancer prognosis and insulin levels, obesity alone

did not completely explain the link between insulin and poorer cancer survival.

Although insulin normally helps promote cell growth, researchers hypothesize

that in the breast, insulin can spur the growth of both normal and cancerous

cells.

 

Fibre doesn't help either

 

A trial of the effects of adding fibre to the diabetic diet found

that " Fasting plasma triglyceride and VLDL-triglyceride, as well as fasting

plasma cholesterol, LDL-cholesterol, and HDL-cholesterol were also unchanged. In

conclusion, an increase in the fiber content from 11 to 27 g/1000 kcal did not

lead to measurable improvements in overall plasma glucose, insulin, or lipid

metabolism. " (27)

 

So adding 'wholemeal bread and pasta doesn't appear to be much use

either.

 

Diet for weight loss - the correct way: The low-carb, high-fat way

 

The conventional dietary treatment for diabetes has always been

questioned because it makes no sense to give a patient more of the stuff that is

causing his disease. And there is also a considerable body of evidence that the

whole conventional strategy is wrong.

 

The American obsession with fat is harmful

 

Dr Ann Coulston and colleagues at the General Clinical Research

Center, Stanford University Medical Center pointed out that in the United

States, the notion that low-fat, high-carbohydrate diets are essential for

health has grown into an obsession, driven largely by an effort to reduce heart

disease. But they warn that this approach can have serious consequences for

diabetics concluding: 'it seems prudent to avoid the use of low-fat,

high-carbohydrate diets containing moderate amounts of sucrose in patients with

non-insulin-dependent diabetes mellitus'. (28)

 

A high-fat diet is better

 

In 1992, Drs Garg, Grundy and Unger of Veterans Affairs Medical

Center, University of Texas studied the effects in diabetics of diets which had

either sixty percent of energy from carbohydrates or thirty-five percent of

energy from carbohydrates on blood cholesterol levels and insulin sensitivity.

(29) They found that the high-carbohydrate diet had adverse effects in that it

lowered HDL (the 'good' cholesterol) by eleven percent and increased

triglycerides by 27.5 percent.

 

High-fat, low-carb is going to come " Whether we like it or not "

 

In 1999, Dr James Hays, an endocrinologist and director of the

Limestone Medical Center in Wilmington, DE, presented the results of three

studies of men and women with type 2 diabetes involving such a diet at the

annual meeting of the Endocrine Society. (30) His study reported that 'a very

high-fat, low-carbohydrate diet has been shown to have astounding effects in

helping type 2 diabetics lose weight and improve their blood lipid profiles'.

 

Patients were able to eat all the meat and cheese they wanted, but

as for carbohydrates, they were restricted to eating unprocessed foods, mainly

fresh fruit and vegetables. Whereas in a normal diet sixty percent of calories

would come from carbohydrates and thirty percent from fat, patients in this diet

were encouraged to get fifty percent of their caloric intake from fat, and just

twenty percent from carbohydrates.

 

A whopping ninety percent of the fat content in their diets was

saturated fat, compared with just ten percent that was monounsaturated fat. Over

the course of one year, the subjects achieved:

 

a.. a mean decline in total cholesterol of between 231 and 190

mg/dl

b.. LDL (the 'bad' cholesterol) fell from 133 to 105 mg/dl,

c.. HDL (the 'good' cholesterol) increased from 44 to 47 mg/dl.

d.. Triglycerides declined from 229 to 182 mg/dl.

e.. HbA1c, which at the start of the study averaged 3.34 percent

above normal, declined to just 0.96 percent above normal

f.. Average weight loss was in the order of 40 pounds.

 

 

 

a.. By the end of the one-year study 90 percent of the patients had

achieved ADA (American Diabetes Association) targets for HbA1c, HDL, LDL and

triglycerides.

 

As for the response from cardiologists who see a high-fat diet as

anathema to what they have been instructing their patients for years now, Dr.

Hays said he has three cardiologist patients who are now on the diet.

 

Proof that it works!

 

I was in New Zealand in 1999, two months before my book, Eat Fat,

Get Thin! was published. While there I visited a friend's cousin. NL was

seventy-five years old, overweight, with high blood pressure and diabetic.

During the conversation, my book was mentioned and I said I would send her a

copy although, she told me, as it advocated a high-fat diet, she thought her

diabetes would prevent her from using it. Here is an extract from a letter I

received five months after I sent the book:

 

'When your book arrived I read it immediately and gave myself

permission to think it might, just might, work for me, despite the diabetes

factor which I had said to you could possibly complicate blood sugar results.

You assured me that it was more possible that these would improve.

 

'I changed my diet in February and in that and the following

month my weight dropped by eight pounds. It was such a luxury to be eating all

the hitherto " naughty " things that had been such a " no-no " and being rewarded

for my sins. I felt better in all ways and my blood sugars became far more

stable, and lower than they had been for years.

 

'I had meant to write before . . . but as it was getting close

to my annual full diabetic general check-up, I thought I might have medical

evidence to confirm my feelings of improved well-being. Prior to my G.P.'s

appointment I had been for a variety of blood tests and also an

ophthalmologist's examination - retinal photography and pressure measurements.

 

'First major surprise - the pressure behind my eyes which had

for many years been border-line glaucoma, had reduced - " excellent " result.

Cholesterol (total), HDL cholesterol and triglycerides had all improved, my

glycosated haemoglobin was down by 1.5 and blood pressure was down from 160/90

in June last year to 130/74 - the lowest I can ever remember having. Naturally

my G.P. was very confused by my " second coming " and her tut-tutting lacked

conviction when I told her of meeting you, receiving your book and becoming a

convert to and practitioner of what you advocate. So count me as one of your

most loyal disciples.'

 

 

Another case

 

This is from a 51-year-old overweight, British diabetic who has been

on a low-carb, very-high fat diet since May 2000. At that time she was on three

lots of medication:

 

Metformin (Reduces blood glucose levels)

Acarbose (stops the uptake of glucose from the gut)

Glimipiride (stimulates insulin secretion by pancreas)

 

Total Cholesterol

 

a.. 10 August 1999 - 6.2

a.. December 2001 - 4.9

 

Triglycerides

 

a.. 10 August 1999 - 2.0 (very bad)

a.. 9 July 2001 - 1.6 (moderately high)

 

HbA1C

 

a.. 10 August 1999 - 8.2% (poor diabetic control)

a.. 10 March 2000 - 7.8% (borderline control)

a.. 18 August 2000 - 6.3% (good diabetic control)

a.. 6 July 2001 - 5.7% (excellent diabetic control).

 

TSH

 

a.. 10 August 1999 - 8.82 (exceptionally high)

a.. 6 July 2001 - 1.06 (normal)

 

Gamma GT

 

a.. 1996 - 94

a.. December 2000 - 20

 

She has now stopped taking the Acarbose completely and reduced the

glimipiride by half. She displays no symptoms of her diabetes.

 

These letters are typical of my experience with overweight

diabetics. So I ask: Why does DiabetesUK still insist on low-fat, carbohydrate

diets for diabetics?

 

Is a change on the way within the NHS?

 

Although most diabetic clinics and advisers still continue to press

on diabetics the importance of cutting fats and eating more carbs, things may be

changing. JF, a Scottish diabetic, sent me a resumé of a diet he was prescribed

by the Diabetic Clinic of his local NHS Trust. Called the Protein Sparing

Modified Fast, it was developed by the Nutrition Clinic of Grampian University

Hospitals NHS Trust in November 1999.

 

The principles of the diet are as follows:

 

1) You should eat a minimum amount of 12 ounces of meat, poultry,

fish or eggs per day. There is no stated maximum but the diet will be less

effective if much more than 1 lb is eaten.

 

2) Only 40 grams of carbohydrates per day is allowed, broken down

as follows:

 

a.. 200ml/ 1/3 pint of milk == 10 grams

a.. 4 ounces of fruit (excluding bananas or grapes) == 10 grams

a.. 1 slice bread OR 1 small potato OR 1tbsp boiled rice Or 50gr

boiled pasta OR 100gr of cooked porridge == 10 grams

a.. Up to 1lb of green vegetables per day == 10 grams

 

N.B. The l lb of green vegetables can only be taken from the

following; asparagus, aubergine, broccoli, cabbage, cauliflower, celery,

courgettes, cucumber, kale, lettuce, mushrooms, mustard and cress, spinach or

watercress. The amount of vegetables is limited to 4 ounces if it comprises the

following vegetables: Brussels sprouts, leeks, mange tout, onion, runner-beans,

peppers, Swede, sweet corn, tomato or turnip

 

3) You should drink at least 2.5 pints of fluids every day to

ensure the kidneys function properly. This should be water, tea or coffee (using

milk from the daily allowance), diet or low-calorie drinks, Bovril, marmite, oxo

or vegemite. Beer or lager is not allowed but spirits on their own or with diet

mixers are allowed in limited quantities. A glass of dry red wine per day is

also permitted!

 

4) In the fruit category, melon, redcurrants, gooseberries and

grapefruit are lowest in carbohydrates and will allow 8 ounces per day.

Brambles, raspberries and strawberries give a 6-ounce daily allowance, whilst

olives and rhubarb stewed with artificial sweetener can be eaten in unlimited

quantities.

 

5) You must eat a minimum of 2 ounces of cheese per day (or 4

ounces of cottage cheese) to ensure a healthy calcium intake.

 

6) Any soup made should be made from stock cubes and any vegetable

additions should be taken from the daily vegetable allowance. You can have cream

soups but the soup should not be thickened with potato or cornflour.

 

7) Unlimited butter, fried foods, olive oil and vinegar dressings

with salads, sugar-free jellies and any other non-carbohydrate foods.. Double

cream is also allowed but the amount is limited because of lactose content.

 

8) Almost all prepared food products are taboo; packaging should

be checked for carbohydrate content. Be careful with sausages as these very

often are high in cereal or rusks. Most sugars, natural sweeteners and syrups

are forbidden.

 

This diet is not just a low-carbohydrate diet, it is also a high-fat

diet. JF says of it: " I have undertaken a large number of diets over the years

and this is the first that has given me a long-term success and without too much

suffering! "

 

Conclusion

 

It seems clear from the dramatic departure from convention by the

Grampian Hospitals that there is a split appearing in the conventional ranks

away from low-fat, calorie-controlled diets for weight loss in diabetics.

Perhaps this is not surprising for, as Dr. James Hays said at ENDO 99:

 

'If you have a diet that results in weight loss, lower cholesterol,

and a better lipid profile, eventually, everybody will be eating that way. It's

going to come whether we like it or not.'

 

References

 

1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and

obesity in the United States: prevalence and trends, 1960-1994. Int J Obes Relat

Metab Disord 2000; 22: 39-47.

 

2. Yudkin J. Evolutionary and historical changes in dietary

carbohydrates. Am J Clin Nutr. 1967; 20: 108-115.

 

3. JAMA March 27, 1967

 

4. Menon R K, et al . Transplacental passage of insulin in pregnant

women with insulin dependent diabetes mellitus: its role in fetal macrosomia. N

Eng J Med 1990; 323: 309-15

 

5. Kwaniewski. J, Chyliski M. Homo Optimus. Wydawnictwo WGP, Warsaw,

2000. p 163-6.

 

6. Manson JE, Spelsberg A. Primary prevention of

non-insulin-dependent diabetes mellitus. Am J Prev Med. 1994;10:172-184.

 

7. Gohdes D, Kaufman S, Valway S. Diabetes in American Indians: an

overview. Diabetes Care . 1993;16:239-243.

 

8. Collins VR, Dowse GK, Toelupe PM, et al. Increasing prevalence of

NIDDM in the Pacific island population of Western Samoa over a 13-year period.

Diabetes Care . 1994;17:288-296.

 

Hodge AM, Dowse GK, Toelupe P, Collins VR, Imo T, Zimmet PZ.

Dramatic increase in the prevalence of obesity in Western Samoa over the 13 year

period 1978-1991. Int J Obes Relat Metab Disord. 1994;18:419-428. [published

correction appears in Int J Obes Relat Metab Disord . 1995;19:689].

 

9. Given H D C. A New Angle on Health . John Bale, Sons & Danielsson

Ltd. 1935.

 

10. Himsworth HP. Diabetes mellitus: its differentiation into

insulin-sensitive and insulin-insensitive types. Lancet 1936; i: 127-130.

 

11. Kahn CR, Flier JS, Bar RS, et al. The syndromes of insulin

resistance and acanthosis nigricans: insulin receptor disorders in man. N Engl J

Med 1976; 294: 739-745.

 

12. Krook A, O'Rahilly,S. Mutant insulin receptors in syndromes of

insulin resistance. Bailliers Clin Endocrinol Metab 1996;10:97-122.

 

13. Despres JP, Lamarche B, Mauriege P, et al. Hyperinsulinemia as

an independent risk factor for ischemic heart disease. N Engl J Med 1996; 334:

952-957.

 

14. Brand-Miller JC, Colagiuri S. The carnivore connection: dietary

carbohydrate in the evolution of NIDDM. Diabetologia, 1994; 37: 1280-1286.

 

15. DeFronzo RA. The Triumvirate: b-cell, muscle, liver, a collusion

responsible for NIDDM. Diabetes 1987; 37: 667-87.

 

16. Hodge AM, Zimmet P. The epidemiology of obesity. Bailliere's

Clin Endocrinol Metab 1994; 8: 577-99.

 

17. Jung RT. Obesity as a disease. Br Med Bull 1997; 53: 307-21.

 

18. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive

blood-glucose control with metformin on complications in overweight patients

with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854-65.

 

19. http://www.diabetes.org.uk/manage/eatwell/plate.htm, accessed

January 2002

 

20.

http://www.diabetes.org/main/health/nutrition/eating/eating_healthy.jsp,

accessed January 2002

 

21. Wing RR. Use of very low calorie diets in the treatment of obese

persons with non-insulin dependent diabetes mellitus. J Am Diet Assoc 1995; 95:

569-72.

 

22. Wadden TA. Treatment of obesity by moderate and severe caloric

restriction. Ann Int Med 1993; 119: 688-93.

 

23. Brown SA, Upchurch S, Anding R, Winter M, Ramirez G. Promoting

weight loss in type II diabetes. Diabetes Care 1996; 19: 613-24.

 

24. Ratner RE. Innovations in Managing Type 2 Diabetes. Drug Benefit

Trends 2000; 12(supp A):34-43.

 

25. Meigs JB, Mieeleman MA, Nathan DM, et al. Hyperinsulinemia,

hyperglyceima, and impaired hemostasis. The Framingham offspring study. JAMA

2000;283:221-229.

 

26. Annual meeting of American Society of Clinical Oncology, New

Orleans, 23 May 2000

 

27. Hollenbeck CB, Coulston AM, Reaven GM. To what extent does

increased dietary fiber improve glucose and lipid metabolism in patients with

noninsulin-dependent diabetes mellitus (NIDDM)? Am J Clin Nutr 1986;43 (1):16-24

 

28. Coulston AM, Hollenbeck CB, Swislocki AL, Chen YD, Reaven GM.

Deleterious metabolic effects of high-carbohydrate, sucrose-containing diets in

patients with non-insulin-dependent diabetes mellitus. Am J Med 1987

Feb;82(2):213-220

 

29. Garg A, Grundy SM, Unger RH. Comparison of effects of high and

low carbohydrate diets on plasma lipoproteins and insulin sensitivity in

patients with mild NIDDM. Diabetes 1992 41(10):1278-85

 

30. Diabetics Improve Health With Very High-Fat, Low-Carb Diet. ENDO

99: Annual meeting of The Endocrine Society, San Diego, 15 June 1999.

 

 

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Eat Fat, Get Thin! The Cancer Files The Cholesterol Myth

Fluoride -- Health or Politics?

 

The Bottle Boom What's Behind The Screens? Additives --

Look Before You Eat

 

The Healthfood Scam Alternative Medicine -- Your Money and Your

Life? The Naive Vegetarian

 

 

 

[Guest guest]

At 10:26 PM 4/12/2002 -0700, you wrote:

>Why do DiabetesUK and the ADA Recommend a High Carbohydrate Diet for

>Diabetics?

 

I think they mean high complex carb diet, not high simple carbs. There's a

huge difference!

 

Veronica

[Guest guest]

-

" Yummy For Dogs " <dogchef

 

Saturday, April 13, 2002 3:18 PM

Re: Diabetes, What's the truth? Why do Diabetes UK

and the ADA Recommend a High Carbohydrate Diet for Diabetics.

 

 

> At 10:26 PM 4/12/2002 -0700, you wrote:

> >Why do DiabetesUK and the ADA Recommend a High Carbohydrate Diet for

> >Diabetics?

>

> I think they mean high complex carb diet, not high simple carbs. There's a

> huge difference!

>

> Veronica

>

Have you read the long article at the following URL?

http://www.second-opinions.co.uk/diabetes.html

The " huge difference " between sugars starches & grains is not the one the

ADA would like us to believe it is.

 

Alobar