What Are You Supposed to Eat?

Only adding to the bewilderment of anyone with diabetes or pre-diabetes, both the American Diabetes Association and the American Dietetic Association still refrain from advocating any particular diet or food plan for weight loss and weight maintenance and choose not to formally recognize the importance of restricting certain foods, such as refined grains or added sugars, for optimal prevention or treatment of diabetes.

As a person with diabetes myself, I strongly object to their lack of conviction about the glycemic effect of certain carbohydrates and foods. Although I’m not at all convinced that restricting the amount of carbohydrate in your diet is really that important if you’re eating the right kinds of carbohydrates, I do know from personal and professional experience that what you eat does make a difference to your blood sugar control (as well as your body weight). Nevertheless, just to increase your confusion, for every proponent of a “balanced” meal plan that follows the latest dietary recommendations of 45 to 65 percent of calories from carbohydrates (with the remaining 20 to 35 percent of calories from fats and 10 to 35 percent from protein), you’ll find an equally fervent supporter of a lower-carbohydrate (40 percent of calories or less) plan.

For example, a recent study of obese people with diabetes who went on the Atkins (low- carbohydrate) diet reported that it caused rapid weight loss not because of increased water losses, changes in metabolism, or boredom with allowed foods, but because one consumes fewer calories by cutting carbohydrate intake down to 20 grams or less daily. The researchers concluded that carbohydrate intake drives excessive calorie intake, but that point, in my opinion, is debatable. There is no doubt, however, that the long-term healthiness of extremely low-carbohydrate diets is dubious at best. Furthermore, a high protein intake may have particularly negative health consequences for you as excess protein can lead to the thinning of bones (which are already thinner if you have diabetes) and greater protein excretion by the kidneys (which may damage them long-term), not to mention a higher incidence of kidney stones and gout. If you are on such a diet, you’ll likely need to take calcium supplements.

In contrast to that study, the same researchers reported in another research journal that people with type 2 diabetes lose similar amounts of weight on either of two more moderate diets: a “high-protein diet” (with 40 percent of calories coming from carbohydrates and 30 percent each from protein and fat), or a “high-carbohydrate diet” containing 55 percent carbohydrate, 15 percent protein, and 30 percent fat calories (which, incidentally, meets the current recommended intake of all three nutrients). Even though the high-carbohydrate diet contained 15 percent more carbohydrate calories than the high-protein one (which, incidentally, is not that big of a difference), it actually improved the participants’ insulin sensitivity, fasting blood glucose levels, and overall diabetes control more after eight weeks. Weight loss among the two diets was identical. From that study, you would never conclude that eating the recommended amount of carbohydrate is bad for diabetes control–on the contrary. Once again, it’s the type of carbohydrate you eat that plays a significant role in its metabolic effects.

A more recent study found that weight loss on diets may vary by how much insulin your body secretes in response to the foods that you eat. People who secrete more insulin for the same carb load lose weight more effectively on a low-carb diet. So, it may have to do with how sensitive you are to insulin, particularly if you still make most or all of your own insulin.

Come back next week for more nutrition discussions.

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