Something interesting came in the post today, though I’m not sure who it has come from because the person who sent it marked it with their email address only. The item is a photocopy from what I think is a book, that seems to be called ‘Diabetes for Beginners’. The page (page 36) has a diagram of a wheel split into segments of various sizes, each of which is ‘filled’ with pictures of certain foods. A full one-third of the circle is devoted to starchy carbs including bread, potatoes, rice, pasta, breakfast cereals and even some instant mashed potato too.
The person who has sent it to me has added the following words: Note that the recommended daily diet includes 1/3 carbohydrate.� It is not clear at this stage whether this individual is:
1. Making the point that because I don’t recommend much in the way of starchy carbs for diabetics, then I am out-of-step with conventional ‘wisdom’ and need to smarten up my act.
2. Saying ‘look at the ridiculous dietary advice diabetics are getting. Shouldn’t something be done?!’
Pondering which of these points is being made is pointless, I reckon, because the only one that has any merit is number 2.
Variously on this site, I have cited a considerable body of evidence which shows that controlling carbohydrate has the potential for significant health benefits, especially for diabetics. Not only is the science strong in this area, it is certainly supported by common sense: diabetics chiefly have a problem controlling blood sugar levels, so it makes sense to limit foods that tend to disrupt blood sugar levels including many starchy carbs such as bread, potatoes, rice, pasta and breakfast cereals.
The landing of this ‘food wheel’ on my doormat this morning is very timely, because just this week a group of scientists and doctors published on-line a review of the evidence for carbohydrate restriction in diabetics. You can see it here (click on ‘provisional pdf’ in the box).
The authors of this review make five basic assertions, which they then go on to validate by citing published evidence in the area.
These assertions are:
1. Carbohydrate restriction improves glycaemic control, the primary target of nutritional therapy and reduces insulin fluctuations.
2. Carbohydrate restricted diets are at least as effective for weight loss as low-fat diets.
3. Substitution of fat for carbohydrate is generally beneficial for markers for and incidence of CVD (cardiovascular disease).
4. Carbohydrate restriction improves the features of metabolic syndrome.
5. Beneficial effects of carbohydrate restriction do not require weight loss.
One point that the authors makes in this review is that while carbohydrate restriction is not for everyone, medical care is sometimes about choices. And one choice that physicians and their clients should be aware of the role of carbohydrate restriction in the management of diabetes, and the evidence for it.
If you have an interest in the management of diabetes, either from a sufferer’s perspective or as a health professional, I urge you read this article. Some lives may be saved and a lot of suffering prevented as a result.
Accurso A, et al. Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal.Nutr Metab (Lond). 2008 Apr 8;5(1):9 [Epub ahead of print]