When working with nutritionally-based medicine, one gets a feel over the years for what tends to work and what doesn’t. One thing I’ve learned to be fairly certain of is that when an diabetic individual who is eating the mounds of carb so often recommended to them switches to a diet with less carb in it, their blood sugar control improves. Oh, and they’re usually able to reduce their medications. Some of them can even stop that medication altogether. Lo and behold: when a diabetic eats less of the types of food they have difficulty handling in their body, they are better off for it!
As I have pointed out before, the idea of restricting carbohydrate makes sense (for all but the most blinkered) and happens to be supported by the science too. One recent review I blogged about outlined the myriad of benefits for diabetics to be had by simply eating less carb.
More evidence for the benefits of carb-consciousness emerged this week on the publication of a study in which higher and lower glycaemic index (GI) diets were tested in a group of individuals with type 1 diabetes aged 7-16 years. As s quite predictable, when eating a lower glycaemic index diet individuals enjoyed significantly better blood sugar control compared to that following higher GI meals. When consuming the low GI diet, blood sugar levels were in the target range 66 per cent of the time, compared to 47 percent of the time when consuming the high GI diet. It should be noted that the diet were tested for only one day each. A longer study would, I think, have yielded even more meaningful results.
In this study, carbohydrate was not restricted, just the type of carbohydrate was. Nevertheless, it’s another example of the evidence which shows the importance of limiting the consumption of foods that tend to disrupt blood sugar levels.
When I wrote about the recent review detailing the benefits of carb-control in diabetics, I prefaced it by saying that day I had had in the post a photocopy of what looked like a page from a book indicating the usual guff that diabetics should eat plenty of carb. This individual emailed the Observer Food Monthly magazine, questioning some lower-carb recommendations I’d made for those wishing to avoid getting diabetes. In her email, she stated that she knew she was ‘supposed to’ make up a third of her diet with carbs, and eat carbs with every meal.
I responded with the following email:
Hello XXXXXX
Do see my blog post today:
http://www.drbriffa.com/blog/2008/04/14/doctors-details-the-benefits-of-carbohydrate-restriction-in-diabetics/
The idea that diabetic should find a third of their diet in the form of starchy carbs is not scientifically based. Personally, I think it’s nonsense too.
Thanks for sending in the photocopy because it reminded me how woefully inadequate dietary advice for diabetics often is.
Regards
John Briffa
This lady then forward my email to Diabetes UK (the leading diabetes charity in the UK) with the following note:
I’m sending a copy of my emails to/from John Briffa of the Observer, plus his blog reference. What do you think?
Best wishes
XXXXXXX
Here’s the response she got:
Dear XXXXXX
Many thanks for your email which has been forwarded to the Care Advisor Team at Diabetes UK.
Diabetes UK’s dietary recommendations are based on the recommendations published in 2003. You can find these by following this link. http://www.diabetes.org.uk/About_us/Our_Views/Care_recommendations/Nutritional_guidelines_in_diabetes_care/ The carbohydrate recommendation is that Total Carbohydrate should make up 45 – 60 per cent of total daily energy intake. Based on the guideline daily amounts for the general population this equates to between 300 – 400 g carbohydrate for a man and 240 – 320g for women. Of course this is a general recommendation and does not take into account individual requirements and where one is aiming to reduce weight.
We are aware that there is emerging evidence that a lower carbohydrate diet may be of benefit for some people with Type 2 diabetes and we will be reviewing our recommendation on the basis of this. Any change in recommendation will always be disseminated through our website and publications.
Can I also suggest that you discuss your own individual carbohydrate requirements with your healthcare team? You can ask them for a referral to a registered dietitian.
I do hope this information is helpful.
With best wishes,
Care Advisor
Healthcare and Policy team
Diabetes UK
Rather disappointingly, the ‘Care Advisor’ (who remains nameless, for some reason) for Diabetes UK trots out the all-too-familiar line that diabetics should eat a carb-based diet, despite the fact (if it needs repeating) that carb is explicitly what diabetics don’t handle too well. Hey, and check out those carb limits for men and women: they equate to 60-80 teaspoons of sugar for women and 75-100 teaspoons of sugar for men.
What is it about Diabetes UK that stops this organisation doing a proper job of being a true advocate for diabetics? It’s speculation on my part, but I think the fact that this organisation receives funding from drug companies who have a vested interest in diabetics NOT achieving control through diet might have some thing to do with it (for more on this, click here). And now if you put this in the context of those ridiculous recommended carb intakes for diabetics, it’s easy to see how a spoonful of sugar really does help the medicine go down after all.
References:
1. Nansel TR, et al. Effect of Varying Glycemic Index Meals on Blood Glucose Control Assessed With Continuous Glucose Monitoring in Youth With Type 1 Diabetes on Basal-Bolus Insulin Regimens. Diabetes Care 2008;31:695-697
