The ADA and The Great Carb Debate

You may have read by now that the American Diabetes Association (ADA) has updated its nutritional guidelines, and the media’s going googly over what appears to be its embrace of low-carb diets, at last. But don’t get too excited. It’s not as if the ADA is admitting any faulty thinking in the past, or even clearly stating that eating low-carb might be the best way to keep blood sugars under control. Personally, I have to agree with Dr. Mary Vernon, who writes, “I’m underwhelmed.”

Check out this very thoughtful piece by David Mendosa on the new ADA position statement, which wasAtkins_burger published in the January issue of Diabetes Care.

David points out the shortcomings of the ADA’s very limited endorsement of low-carb:

* they mention low-carb ONLY as a means to weight loss, not glucose control

* they recommend limiting a low-carb diet to just one year (?)

* they equate low-carb diets to low-fat in terms of weight loss (experts say the effect is NOT the same)

* they imply that low-carb is analogous a high-protein diet, which may be true, but “for most of us it is a high-fat diet” as well, which has different effects on the body (HDL, LDL, etc.)

Nevertheless, David believes we have reason to rejoice. The ADA’s new statement represents “a huge breakthrough,” he writes, because the organization “has finally budged from its single-minded devotion to high-carb diets.” He also lauds the change “because for the first time the leading American diabetes organization broke ranks with the other major health groups like the American Medical Association, the American Heart Association, the U.S. Food and Drug Administration, and the U.S. Department of Agriculture to give any support to low-carb diets.”

This may be true, but is it too little, too late?

In a wonderfully frank article published in Diabetes Health magazine late last month, D-writer and activist Riva Greenberg takes on the great carb debate. She puts it bluntly:

“It’s common sense… that the fewer carbs you eat, the less your blood sugar will rise and the less medication you’ll need. I don’t understand how anyone can argue the logic of that. If we’re still being given diets with substantial carbs in them, it’s probably because the American Diabetes Association (ADA) and other authorities believe that the average diabetic would never stand for cutting carbs so drastically. Along the same lines, the ADA’s A1c recommendation is as high as 7%. That correlates with 170 on your meter, even though we’re advised to stay in a target blood sugar range of 80 to 120 mg/dl. Does something sound fishy?”

I can’t help but agree with her skepticism. The evidence remains: At the ADA web site, the recipe of the day is still pizza — veggie toppings notwithstanding (a recipe sponsored by Splenda, btw).

Also at that site today, I find no mention of the ADA’s supposedly significant new nutritional guidelines, and their food pyramid is still built upon gobs of carbs. Could this mean more bundt cakes on the cover of their monthly magazine? I don’t see any great reason to celebrate that.

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9 Responses

  1. Scott
    Scott January 6, 2008 at 6:49 pm | | Reply

    The fact that the ADA is even acknowledging this issue is miraculous. Just over a year ago, I reported that the December 2006 edition of Men’s Health featured an article entitled “The Cure for Diabetes” which ruffled the feathers of some at the ADA enough so they felt compelled to write a letter to editor of Men’s Health.

    Its ironic that the ADA even bothered responding to the Men’s Health article and noted that “the article glosses over the difference between type 1 and type 2 diabetes …” since the ADA is perhaps the single worst offender of glossing over the differences between the two forms of diabetes.

    The fact that the ADA has reconsidered its position on low-carb diets breaks with decades of dogma by the ADA, who has signed deals with Log Cabin Syrup among the food companies who bear the ADA logo, is quite simply, miraculous.

  2. whimsy2
    whimsy2 January 6, 2008 at 8:31 pm | | Reply

    Good for you, Amy. When I read Mendosa’s newsletter last week about the new ADA recommendations I was quite incensed and left a letter there, too. This is what I posted:

    “Well, okay, goody for the ADA, they now admit that low carbing is good for weight loss. But what about the really IMPORTANT benefit — after all, the ADA is the American DIABETIC Association. So why can’t they just admit that low carbing is an excellent way to help control diabetes???

  3. Anne
    Anne January 6, 2008 at 9:36 pm | | Reply

    When I was first diagnosed with diabetes (back in 1988), my meal plan was based on recommendations by the ADA. My meals contained the majority of calories from carbohydrates (55-60%) and were lower in fat (~25%) and with moderate (~15%) protein. I also had 3 small snacks per day to deal with the R/NPH insulin schedule.I had excellent control and maintained a healthy weight. The big difference I see between then and now is that my idea of what is a serving has changed. I have to constantly remind myself that the default serving that I might get at a restaurant is not normal. Going “low carb” for me is more like just going normal carb for 1988.

  4. Jo
    Jo January 7, 2008 at 3:28 am | | Reply

    I believe the fear in all out endorsing the low-carb diet is that the world equals that to Atkins and most doctors don’t like Atkins. South Beach is actually better for me as a diabetic. Bottom line, we all have to be careful, find out what works for us and stay with it.

  5. Melitta
    Melitta January 7, 2008 at 1:44 pm | | Reply

    In the first paragraph of the Diabetes Care article on MNT by ADA, ADA states, “Since overweight and obesity are closely linked to diabetes…” Typical of ADA, they should state “linked to Type 2 diabetes” since Type 1 is not linked to overweight and obesity. ADA also states that “GDM is a risk factor for Type 2 diabetes after delivery” but neglect to mention that GDM (especially GDM requiring insulin therapy) is a risk factor for subsequent Type 1 diabetes. ADA also makes much of the fact that most weight loss diets don’t work long-term, but I think it would behoove ADA to promote what DOES work for weight loss maintenance (see recommendations out of the National Weight Control Registry). Give people hope!

    For me, I have found that eating whole grains (avoiding White Death, white flour and sugar), eating my veggies, balanced with excellent protein and fats equals improved blood sugar control (and thus better quality of life). Whenever I stray from that food philosophy (such as happened during the recent holidays) I pay.

    I do hope that this Diabetes Care article means that ADA is moving towards a more sensible approach to eating.

  6. Lauren
    Lauren January 7, 2008 at 7:30 pm | | Reply

    I am a pretty healthy (if high-carb) eater — I’m vegetarian and stick to low glycemic index whole grains, etc. YET I find that this is causing trouble. My 2 hour post-prandial sugar is great, usually around 100. But my 4 and 6 hour post-prandials have been high lately! I assume the slow carbs are still digesting 6 hours after my meal, and I don’t have enough insulin to cover it. This is frustrating, to be doing everything “right” and still be running high. Has anyone else had this problem? (I’ve heard it can be helped by programming a dual wave bolus if you’re on the pump, but I’m a multiple daily injector for now.)

  7. AmyT
    AmyT January 8, 2008 at 4:15 pm | | Reply

    Scott,
    That is precisely my point: Why should it seem so “miraculous” that the largest diabetes advocacy group in the US finally acknowledges low-carb diets?

    And more importantly, why do they apparently continue to encourage high-carb eating?

  8. Adam Becker Sr
    Adam Becker Sr January 8, 2008 at 4:36 pm | | Reply

    Yes, I’m disappointed that the ADA didn’t go further. But. Realize that by endorsing low-carb diets (even in the tiniest, most halting way) the ADA has broken ranks with the American Heart Association, the American Acadamy of Clinical Endocrinologists, the National Cholesterol Education Project, the US Dept of Agriculture, the New England Journal of Medicine, JAMA, the NY Times, the American Dietetic Association, the American Association of Diabetes Educators, Center for Science in the Public Interest, the American College of Sports Medicine and my endocrinologist.

    The ADA’s position is not a good one. But they didn’t invent it, and they deserve some praise for taking the step they did. When I realize the forces lined up against low-carb, I conclude that what the ADA did took some real institutional courage.

    Which is why, after disparaging them for more than five years, I’m now sending them a membership check.

    Adam Becker Sr

  9. Trusted.MD Network
    Trusted.MD Network February 29, 2008 at 9:46 pm | | Reply

    Breakthrough on the food-guide front

    Finally, a chink in the armour, a crack in the wall, a miniscule hole in the dike! All the major disease associations collectively have been saying for years that we should be eating lots and lots and lots of grains – that grains are supposedly the most i

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