Low Carbohydrate Diet Controversy
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, March 24, 2006 |
Q: "I have type 2 diabetes diagnosed 3 months ago, I have gone to 3 of the classes at the hospital. The dietitian told me I was to have 225 grams of carbs in a day evenly spread out through the day, but the only way I can keep my blood sugar down in normal range is to consume only 100-125 grams a day. I'm not on any meds—diet and exercise control only. My question is: by lowering my carb intake am I taking any chances of any other medical problems? Also when first diagnosed, my weight was 279 pounds and now, 3 months later, it’s 249 pounds due to exercise, and avoiding junk food."
A: First, congratulations on your successful weight loss! Your question is both a common one as well as a challenging one. There are several issues involved:
- Although it is great that you lost weight through diet and exercise, I can't determine your ideal weight--since weight goal is somewhat determined by height, as well as age, body fat, etc., and this determination is best done by your doctor and dietitian.
- You could get to your normal weight, but due to the nature of diabetes, you may still be in need of medication. For more about this, please read the related questions noted at the end of this answer.
- Then there's the issue of low carb vs. moderate-to-high carb with low-fat,
and guess what--no one can agree on this. Previously, I posted an answer in
regards to the Low Carbohydrate Diet. In this answer, I stated what is still
considered the official opinion of the American Diabetes Association: they do
not recommend low carb diets. However, I'm sure you're aware that there has
been increased interest lately in the very low carb diet (popularly called the
Atkins Diet, although that is a more extreme low carb diet). There have been
recent studies showing that lower carb diets do work and do not seem to have
any harmful effects, but it still remains unclear whether any one diet is
superior to the other. Here’s a summary:
- In May, 2003, The New England Journal of Medicine reported the
results of two studies.
- In one study, 63 healthy obese men and women were randomly assigned to either the Atkins Diet or a low-fat weight loss program for a year on their own. At 3 months, the Atkins group had lost an average of 15 pounds, compared with 5 pounds for the low-fat group. At 6 months, the Atkins group averaged 15.4 pounds, while the low-fat group had lost 7 pounds. But at the one-year follow-up, the Atkins group had regained more weight--about 5 pounds while the low-fat group had regained about 2 pounds. The researchers noted that this difference was not statistically significant. Although there has always been concern that the consumption of high fat foods would increase the risk of heart disease, in this study, by 3 months, there were no differences in the cholesterol or LDL for either group. It was speculated that the weight loss may over-ride the effect of the high fat high cholesterol diet.
- In the second study, 132 severely obese men and women were randomly assigned for 6 months to either the Atkins or the low-fat diet. Most participants had other health problems, including diabetes. In this study, the Atkins group lost more weight—an average of 12 pounds compared to four pounds in the low-fat group. The Atkins group also had greater decreases in triglycerides and showed improvements in insulin sensitivity. However it was stated that these results needed to be interpreted with caution: considering the severe obesity of the participants, the weight loss was small for both groups, and 40% dropped out before finishing the study.
- The National Vice President of Clinical Affairs for the American Diabetes Association commented: "The key to obesity treatment is not simply weight loss but maintenance of the weight lost over time. For people with diabetes, a low carbohydrate (and therefore higher protein and fat) diet poses potential risks due to concerns regarding kidney and heart disease…Based on the current data to date, the ADA continues to recommend an individualized, balanced calorie-reduced diet for weight reduction."
- In May, 2003, The New England Journal of Medicine reported the
results of two studies.
- Temple University researchers reported in the March 15, 2005 Annals of Internal Medicine that people on low-carbohydrate regimens spontaneously reduced their calories by 30%, and on average, cut 1000 calories per day from their intake. The researchers concluded that the carbohydrates had previously stimulated excessive appetite. So by reducing the carbohydrates, these subjects improved glucose levels, insulin sensitivity, triglycerides, and cholesterol.
Conclusion:
- Experts have agreed on certain things:
- Calories do count, and the success of these diets was attributed to caloric reduction.
- All of these studies were relatively short-term, with small numbers of participants; NIH plans to study low-carb vs. low fat diets over a 5- year period to see if weight loss can be maintained, which is the ultimate goal of any healthy diet.
- There is inadequate evidence to support or refute the claims that low carb diets are beneficial.
- So I would recommend you discuss the above issues with your doctor and your dietitian. If you still have some weight to lose, your diabetes team may feel it is reasonable to continue on your current diet.
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Related Links
Partnership for Essential Nutrition
http://www.essentialnutrition.org
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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