Tuesday, May 17, 2011

When will the Canadian Diabetes Association embrace low-carb?

It's strange that our official diabetic charity has traditionally shunned the diet that was once the cornerstone of diabetic treatment - low carb.

Stranger still that despite reams of evidence that link processed carbohydrates to type 2 diabetes, and the virtually complete exoneration of saturated fat as evil, that the Canadian Diabetes Association still promotes low-fat, high carb diets to diabetics.

Diabetes UK and the American Diabetes Association have both put out official position pieces that, albeit cautiously, support low-carb diets for diabetics.

The Canadian Diabetes Association?

They have a plate broken down into quarters. According to the CDA, one quarter of your plate should be filled with "Starch". Specifically mentioned? Potato, rice or pasta. They recommend eating starchy foods at each and every meal. Why? Because,

"Starchy foods are broken down into glucose that your body needs for energy"
Um, psssst, CDA, ummm, isn't diabetes a disease where the body's not particularly good at handling boluses of glucose? Oh, and have you seen the size of most plates out there? Do you really think that telling people to fill a quarter of their plates with potatoes, pasta or rice is a good idea?

Now I'm not suggesting that the only diet endorsed by the CDA be low-carb. On the other hand, I am suggesting that the CDA make it a top priority to change their dietary recommendations to reflect our current understanding of the impact of diet on diabetes.

Their recommendations need to very clearly and unequivocally reflect the importance of carbohydrate quality, the current thinking on the not-evil status of saturated fat, and the not so scary option of a low carb diet.

If they did that then maybe, just maybe, our hospitals will stop serving white flour pancakes, syrup, Rice Krisipies and fruit juice to diabetics for breakfast.

Sliding scale insulin shouldn't need to be an automatic consideration for every admitted diabetic patient.

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  1. Anonymous8:00 am

    Thank you for posting this. Why why is the CDA continuously putting out dietary recommendations with blinders on? I worked in a hospital diabetes clinic in the late 90's. Little anything has changed!

  2. So, what are your recommendations exactly? What % of carbs in the diet do you recommend? Less than 50%?

    By reading your post, you seem to be disagree with 1 quarter of a plate made of starch; what is your point then? I do not understand why, because 25% of the plate is a small portion of spaghetti or potatoes, promoting low carbs in the form of starch. You also forget to mention that this plate should be also composed by 50% of veggetables. Do you recommend to eliminate potatoes and rice from the plate, which is equivalent to propose Atkins diet for diabetics?

    It is not starch and carbs in itself that are a problem, it is added sugar, fructose as HCSF, and to a certain extend high glycemic index food, and expecially sweet beverages.

    You have a good starting point of discussion, but the wrong target.

  3. Paul - you are completely wrong. It IS "starch in itself" that is the problem! Starchy foods have a HUGE impact on blood sugars and make up a far higher proportion of carbohydrate in most people's diets than sugary foods. Sugary foods are by far NOT the only problem. Have you ever seen a typical portion of pasta for most people? Easily 3-4 cups cooked, taking up a large bowl or plate. That is a HUGE glycemic load, especially for someone with diabetes. And yes, even "whole grain" pasta provides a huge glycemic load in that quantity.

    Also, the glycemic index of many starchy foods is HIGHER than of isolated sugars. For example - the GI of rice krispies, corn flakes, potatoes, short grain rice are all HIGHER than sucrose (table sugar). In fact, the GI of whole wheat bread is higher than sucrose!

    So yes, starchy foods are the problem and they needs to be reduced or eliminated for people with diabetes.

    That being said Yoni, the CDA does understand the affect of carbohydrate on blood glucose and does educate consumers on portion control. The "1/4 plate" concept is the most basic level of education and starch at 1/4 of the plate is likely a reduction in carb for many people when they are first diagnosed with diabetes. After that, there are concepts in counting carb “choices” and counting grams of carb.

    But I do agree with you that their education in carb control / restriction does not go far enough and they should not be so reluctant or ‘scared’ to provide the option of low carb diets.

  4. SAM: Well, this is it, the problem is glycemic LOAD (quantity x index), not glycemic INDEX in itself, something Yoni, like many many others mix up. As you say "3-4 cups cooked, taking up a large bowl or plate. That is a HUGE glycemic load" .

    This quantity represents 8 portions, while 1/4 of a plate represents only half a cup or 1 portion, which is a very resonnable glycemic load for such a high glycemic index for pasta or potatoes.

    Starch may represent a probalem, but sweet beverages are a priority.

  5. Having had diabetes for 20 years now, I have always wonderred about the change in position on carbs, myself. Despite the slight mention that lower carbs may be beneficial, the ADA is pretty into eating all food groups with moderation--even starghy carbs.

    In Pennsylvania, carbs are indeed reccommended. During my last hospital stay (2010), my first meal included mac & cheese (That was the protein!), a slice of white bread, half of a peach from a can, a carton of whole milk and sugar free sherbet.

    Okay, then. I sent the meal back and ordered from the menu.

    Thanks for the info.


  6. Anonymous8:49 pm

    Thanks for posting this.

    Any diabetic with a glucose meter and the will to test themselves 1 and 2 hours after each meal for a period of a couple of months knows exactly how carbs affect their blood sugar levels. My blood sugar readings after a regular-sized bowl of oatmeal were so shockingly high I no longer have any desire to eat it at all.

    After being diagnosed and prescribed the usual nutrition classes based on the CDA nutritional advice (and *not* following that advice), I was the only one in the class low carbing - and the only one losing weight and getting my numbers under control. There was no advice beyond portion control and low fat. The only time low-carb was mentioned was when I told the nutritionist that's what I was doing. My experience was summarily dismissed with 'No one can stick to that'.

    Low carb (and exercise) have allowed me to control my blood sugar without medication, for 5 years.

    Everyone should be provided this information. Whether they follow it or not is up to them, but they at least deserve to hear it.

  7. Here is insight about the diabetes UK statement:
    Previous dietary recommendations have focused on the type of carbohydrate in the diet of people with diabetes said that meals should be based on starchy foods. People with type 2 diabetes are often told that they need to lose weight but struggle to do so on traditional high carbohydrate, low fat diets.

    This new statement makes it clear that the priority for people with Type 2 diabetes wanting to lose weight should be reducing overall energy intake whilst ensuring that the diet still provides all essential nutrients. A number of different diets can achieve this aim, and Diabetes UK recommend that a range of approaches should be considered, because the most appropriate method is different for different people. This statement does not say that low carbohydrate diets are best for all people with Type 2 diabetes, but that it may be suitable for some.

    The evidence that they reviewed suggests that low-carbohydrate diets can reduce weight and lead to improvements in blood glucose control.

    There are many different reasons why people become overweight and it makes sense that there are also different ways to lose weight.

    A sedentary lifestyle and eating too much refined carbohydrate from heavily processed foods is undoubtedly a major cause of weight gain for many people. Reducing these foods that provide excess calories but little quality nutrition is an easy way to lose weight. Carbohydrate foods mainly provide energy for physical activity, so it is sensible to tailor the amount of the foods to how much exercise you do. Few people today get recommended daily minimum amount of physical activity, so it is little wonder that the old advice to eat more starchy foods would lead to weight gain for many.

    This represents a change in that it takes the emphasis away from eating more starchy foods, and less fat. However it is important to realise that this statement does not change the advice that a healthy diet for people with and without diabetes is one that is low in saturated fats and salt, and rich in vegetables and fruits and includes wholegrains and oily fish.

    more: Diabetes UK (2011). Position statement on low carbohydrate diets for people with Type 2 Diabetes. Available here: http://www.diabetes.org.uk/About_us/Our_Views/Position_statements/Low-carbohydrate-diets-for-people-with-Type-2-diabetes/

  8. Low carbs or Low fat? We should rather be talking about decreasing bad carbs like promoting low starch or sweet (especially sweetened beverages) and bad fats like low saturated fat.

    Well guess what? the key point is perhaps High proteins...!!

  9. It's the refined carbs that I think are the problem. 100% whole wheat bread and brown rice are certainly different in terms of health than white bread and white rice.

    Further, when I cut those refined carbs out of my diet, my carb cravings went away, which meant that I lost weight. Less cravings and losing weight definitely would help a diabetic person. :-)


  10. @ Paul - Please can you tell me exactly why saturated fat is so bad?

  11. They could at least recommend a plate size. I've spent a long time looking for smaller 'dinner' plates. Some of them are 11 inches across these days - and buying an 8 inch one is nearly impossible in the UK.


    1. Anonymous12:13 am

      I purchased a child's dinner set consisting of a plate, bowl and cup. The plate is nine inches so it looks fuller if Add about a a tablespoon of food to a heap.It might be silly eating off of a child's plate in private but it works and it has made me more conscience of the right amount of food. I know when I eat out if I have consumed what is probably right and that is verified by the next blood sugar testing.

  12. Anonymous7:40 am

    I think everyone is different, but what remains consistent is that reducing carbs helps to control sugar levels. If slightly reducing them lowers your levels, then slightly reduce them. If eliminating pretty much every carb from your diet does it, then start eliminating. I get frustrated that the leaflets given out all recommend carbohydrates (and brown flour does as much damage to me as white flour) and even suggest that we needn't deny ourselves a small amount of sugar every day. Excuse me? Mind you, high sugar levels followed by low sugar levels would at least be better than the medically recommended method which is to stabilise my levels. Yep, that would be great if the diet didn't whack them up to above 10, and then keep them there all day! And what many people don't take on board is that this is not a diet. This is a lifestyle. So those who lost symptoms after a few months and think that they are cured? Nope, they'll be back on that insulin after a few months. The only thing that works is eating things which keep your levels down, and accepting that this is the rest of your life. Which isn't so bad, I look amazing after a 2 - 3 stone weight loss, and I'm looking forward to needing a weight gain boost from insulin (as opposed to considering suicide from the weight gain that my doctor told me was inevitable).

  13. My sister in law, after being in the hospital for a knee operation, was held because her blood sugar was too high. They used medication to lower it. When she described the wonderful diet they gave her, it really translated into 3 sugars and 1 protein. There really does need to be a change if the health of Canadians is going to improve.