Another study attests to the value of a lower GI diet in the management of diabetes

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

12 Responses to Another study attests to the value of a lower GI diet in the management of diabetes

  1. Sue Bedford 2 May 2008 at 9:58 am #

    It just amazes me how ignorant some health practitioners/advisors are. When I was a student nurse back in the 70′s, I distinctly remember being taught that diabetics should restrict their intake of starchy carbohydrate foods.

    After a career break, I returned to nursing and became a Practice Nurse and could not believe my ears when I heard a colleague telling a diabetic patient to eat starchy foods!

    Needless to say, I have left the NHS, did a diploma in nutrition and now offer health screening and up-to-date, evidence-based diet and lifestyle advice.

    I just wish more health professionals would take the time to think and do their own research instead of accepting all that they are told at their drug company-funded study days.

  2. Sue 2 May 2008 at 10:58 am #

    In the early 1900s before the invention of insulin – diabetes was controlled by carbohydrate restriction.
    See this interview with Dr Vernon:
    http://www.diabetesnewsstand.com/vissue/vernon/titlepage.html

  3. Liz 2 May 2008 at 11:22 am #

    Ouch, John , that’s cynical!

    I too wonder at the high carb recommendations for diabetics.

    Does it orginate from an attempt to control type 1 diabetes? As well as not producing insulin they also may not be good at producing glucagon, so it’s useful to encourage them to have easily available sugar all the time. This stops blood sugar going too low and if it goes too high there’s aways insulin!

    This is also why diabetics are “allowed” to have higher blood sugar levels than non-diabetics. I did have one type 1 client who was told at the diabetic clinic that his blood sugar control was “too good” i.e. he was keeping it in the normal range for a non-diabetic. He was also told that low GI carbs weren’t important. I think that the health staff don’t trust the patients to know their own bodies or look after themselves and the staff give advice that errs on the side of caution i.e. has too much sugar in it. Afterall, that can be contolled by drugs!

    I’m not backing this viewpoint – I’ve had very good results advising diabetics to restrict starchy carbs but keeping up the total carb intake up with veg and frut. Blood sugar is well controlled and triglycerides plummet.

    One problem that does crop up is that type 2 diabetics often have a very sweet tooth. A student of mine was recently asked by a firend if she could come up with with a diabetic recipe for a treacle sponge pudding! Perhaps the orthodox advice on starchy carbs is also there to placate the sweet tooth with a starchy sugar alternative. It certainly doesn’t seem to based on any science.

  4. Hilda 2 May 2008 at 11:57 am #

    I was in a hospital waiting room recently and the dieticians room was open . I could see a large poster on the wall showing what diabetics should eat. As a nutritionistI was appalled to see that it was loaded with carbs in a pie chart (can’t remember the exact proportion). When the dietician came back I asked her about it and she said they needed carbs for energy. This is the official line and people do think that the more carbs they eat the more energy they will have. There are definitely two camps here. Nutritionists who are more allied to the health food and naturopathic tradition and dieticians who are allied to the food industry. But, Dr Briffa, is not not going a little far to say that maybe the drug companies want to keep people diabetic. Is it not that no-one (except you ) will rock the boat as their careers depend on it? And secondly that they are just ignorant and have not thought it through enough?

    I also teach science to school children and the official line there is the same. Eat carbs for energy.

    Even as a child it seemed obvious to me that diabetics who do not handle sugar well need a low carb diet (as do most people). Cross cultural studies suggest that cultures with a low sugar intake do not get diabetes.

  5. Katrina 2 May 2008 at 1:44 pm #

    Exactly! Thank you so much for highlighting that carb control with regard to diabetes is the only way. Also for pointing out that Diabetes UK continue to support and advise eating significant amounts of carbohydrates to diabetics. I was very interested in the e-mail communications too.

    I am a type 1 diabetic, and a member of Diabetes UK, and I read their magazine. I was diagnosed diabetic 10 years ago (now in my thirties) and was given advice by a dietician. This advice amounted to more carbohydrates than I was previously used to eating as I am small in weight and build. I put weight on and took large amounts of insulin and lacked energy.

    I started to read nutrition information and was amazed at how this could influence by blood sugar control and my weight. As my insulin allows me to alter amounts I started on a big learning curb. Five years later from being diagnosed, I visited an excellent nutrition consultant, who has given me back a more positive relationship with food. I eat some carbs but restrict them, I have brought my blood sugar readings down to my best ever levels and by reducing the amount of insulin I take to very small amounts. I have the right weight for my size and height and have lots more energy.

    Sadly I have to agree that Diabetes UK, and Balance magazine has far from balanced views to eating carbs. Although it’s important to say here that all diabetics are different and balance with different medications. Diabetics deserve better than an out of date approach to controlling their blood sugar levels with simply carb intake. As for the last paragragrah of your blog John, I couldn’t agree more.

  6. Jenny Ruhl 2 May 2008 at 2:56 pm #

    Dr. Briffa,

    The “Eat your carbs” recommendation seems to stem from several out of date causes.

    1. Confusing Type 1 with Type 2 and then applying advice that was suitable for Type 1s on antiquated insulin regimens that caused hypos to Type 2s using diet alone.

    Put a Type 1 on huge doses of 70/30 insulin or NPH not titrated to their carb intake and yes, they better eat carbs or they’ll hypo and die.

    There is no longer any reason to use those regimens for Type 1s either, but some nutritionists are still being trained that it is dangerous for any diabetic to let their blood sugar go below 5.6!

    2. The mistaken belief that eating fat causes heart disease led to the belief that the only safe diet for a person with diabetes was the low fat diet which is high in carbs. Since protein was believed to be dangerous to the kidneys of a person eating that high carb diet who inevitably had terrible blood sugars, protein needed to be limited, too. Leaving nothing but carbs!

    3. Drug companies do benefit when people with type 2 diabetes eat a lot of carbs because it raises their cholesterol, blood presssure and blood sugar and makes them lifetime consumers of expensive drugs. More than that, though, most of the oral drugs only show significant positive effects in studies done on patients with blood sugars that are extremely high. The drug that drops A1c by .5% when the patient starts out at 8 or 9% might drop it .12 when they have an A1c in the high 5% range which is where most Type 2s will end up if they restrict carbohydrates.

    –Jenny Ruhl

  7. Sara Neill 2 May 2008 at 3:12 pm #

    I am convinced that, in about twenty years’ time, the results of the official advice (to eat a high carbohydrate/low fat diet) will be recognised as one of the greatest ever avoidable public health disasters. We have seen a huge rise in cases of type two diabetes since this became the recommended way of eating.

    I am now positively frightened of going to see either my GP or his diabetic nurse, because, through regularly testing my own blood sugar levels, I know that a low carbohydrate diet keeps my diabetes under control. Diabetes is a very frightening disease, and I am doing my level best to avoid being harmed by it – without any support from my GP! Indeed, his attitude is that I am “non-compliant” and therefore somehow behaving like a child (I am 64)! I am given no credit for my intelligence, for the knowledge I have, nor for my self-discipline in helping myself. Yet I am not only saving myself, I am saving the NHS a small fortune in the cost of drugs.

    I notice, though, that the amount we eat is rarely mentioned in relation to this subject. It is important to eat about six relatively small meals a day, rather than three large ones. This, in conjunction with a (very) low carbohydrate diet, prevents the extreme fluctuations of blood sugar that even the most backward NHS practitioner recognises as a cause of Type 2 diabetes.

  8. Chris 2 May 2008 at 4:08 pm #

    Dr Bernstein’s website is very good on all this.

    He treats diabetes with a low carb diet. His life story is here:

    http://www.diabetes-normalsugars.com/book/mylife.shtml

    It is fascinating how he struggled to control his disease until he went low carb. No one would listen to him in the medical field so he ended up training as a docotor himself.

    He was diagnosed as Type I in 1946 and is still alive which is very unusual!

  9. Ian Watt 2 May 2008 at 5:23 pm #

    Unfortunately for me, a long standing Type 2, I have only been acquainted with Dr Briffa’s views on high carbs quite recently. But now having read his book and having followed his advice for a number of weeks I can attest to both a very significant improvement in the control of my blood sugar throughout the day as well as a welcome reduction in weight. I am now fully converted to the cause!

  10. Sarah 2 May 2008 at 11:34 pm #

    I was lucky enough when I was diagnosed (t1; 2/2007) to quickly stumble across a physician who has a good nutritional background, a healthy skepticism of drug company propaganda, and (most importantly) expectiation that her diabetic patients deserve “normal” blood glucose levels and can achieve those levels by restricting their carbohydrate level. My a1c fluctuates between 5.0% and 5.2% and my carb intake ranges between 50-70 grams per day, avoiding processed foods and all starchy carbs. Carb restriction WORKS. And I don’t even think of it as “carb restriciton” — from where I sit I’m simply avoiding foods that will kill me and eating foods that make me feel good today and tomorrow.

  11. Sue 4 May 2008 at 1:21 am #

    That’s great Sarah and 50-70 grams of carb per day is do-able. I don’t think you would feel deprived of carbs. Also, we’ve got to realise that carb restriction is the best way if you want to try and control your diabetes without medication.

  12. rob clark 11 June 2008 at 1:09 pm #

    ‘Dr Bernstein’s website is very good on all this.’

    Yes, but unfortunately Dr Bernstein is a dangerous nutcase whose advice is impractical for the vast majority of TIs.

    Bernstein aims for an A1c in the non-diabetic range and to achieve this he permanently teeters on the brink of a hypo. For those of us who are trying to raise a family, hold down a job, drive a car (on occasion) and live a relatively normal life, this is neither practical nor safe.

    Dr Briffa’s advice to try to limit carb intake is eminently sensible and something we should all be aiming to do ” no question; Dr Bernstein’s on the other hand is only for the very few who are happy for their entire lives to revolve around their diabetes.

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