Scientists: A Low-Carbohydrate Diet Should Be First Approach for Diabetics!

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A new scientific review article from a large group of scientists put forward the argument that a low-carbohydrate diet should be the first approach in managing both type 2 and type 1 diabetes.

Nutrition: Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base

Behind the article is a large group of scientists who have long focused on low-carb diets. But the name that stands out to me is Arne Astrup, the influential Danish professor and nutrition researcher who in recent years became convinced and changed sides in the debate. And dared to admit it! A scientist with integrity.

The article in Nutrition is excellent for printing and hand out to curious physicians and diabetes nurses. Recommended!

In the media

Diabetes.co.uk: Researchers recommend carb restriction as primary method of diabetes control

More

Diabetes – How to Normalize Your Blood Sugar

Reversing Diabetes After a Visit to the Emergency Room

Yet Another Study Showing Better Blood Sugar for Diabetics on a Lower-Carb Diet

Why You Should NOT Listen to Your Dietitian

39 comments

Top comment

  1. Galina L
    Darius,
    What you described in your comment is just a bona fide first step for a person who used to live on industrial foods, but decided to get healthier. Eating non processed food is not enough for everyone, and if you can ignore how much carbohydrates/proteins/fats you eat, it doesn't mean the rest of commenters are in your situation. I have been reading testimonials of newbies for a while who , for example, started to walk regularly after many years of being a coach potato or stopped drinking soda, and they were amazed by improvements in their health. Many live a healthy life style already and don't have an option to drop junk or start walking , next step for them would be to look into macro nutrients and add interval training /weight lifting/intermittent fasting to their routine.

    Frank,
    I also think that there is no global conspiracy to make people unhealthy, just usual global economy forces at work . We can contribute only in the form of creating demand for food we agree to concume and avoiding sertain products (low fat yogurt, bread, sugary drinks, statines, Nexium...) and sertain services .

    Read more →

All comments

  1. erdoke
    Finally we are getting close to being back to the 1930's with regard to diabetes care? It is really time to restart, otherwise the financial consequences will be unbearable. And I'm not talking about 20-30 years time, rather a 5-10 years timeline.
  2. Tyrannocaster
    Excellent reference! Thanks for posting that.
  3. Eddie Mitchell
    Diabetes is now a run away train. It’s out of control, around the world hundreds of millions of people have joined the club, no one wants to join. The epidemics of type two diabetes and it’s often linked obesity are going to get far worse the experts tell us. Big pharma knows this, big pharma can hear the big cash register ringing. My opinion on big pharma and many of it’s drugs is well known. Many have proved to be useless and others banned for killing people. There was a time when no drugs were available for the control of diabetes, and many type two diabetics lived long and active lives. Many feel Dr. Atkins was the start of the lowcarb diet, but lowcarbing for improved health goes back to the days of William Banting.

    The link below will take you to a free of charge read on line digitalized book, on the best diet for diabetics before big pharma loaded the dice, and diet and exercise kept people healthy and in control of their diabetes. I urge you to take a look. I have left the book open at pages 12 and 13, foods of great value and foods to avoid. Many will not be surprised to see, nothing has changed in almost a hundred years, in the best way to control diabetes. Diet and exercise and nil/minimal medication.

    Check this link out, a fantastic read and well worth your time.

    http://archive.org/stream/diabeticcookeryr00oppeiala#page/12/mode/2up

    Diabetic Cookery Recipes And Menus by Rebecca W Oppenheimer printed 1917

    Kind regards Eddie

    Reply: #36
  4. Tyrannocaster
    Eddie, that link is very interesting. We always think we are the first to discover something but those two pages read like something out of Wheatbelly or Dr. Bernstein. I wonder what "Aleuronaut flour" (p. 5) was! The basic "flour" in the book is almond flour; plus ça change, plus c'est la même chose, LOL.

    I did note that the book allows Crisco, which most of us would avoid like the plague now. But 95% of it is right on the mark.

  5. Karen
    Andreas, do you count total or net carbs? I've noticed some other low-carb fans (including Peter Attia in response to a comment on his post about the myths around ketosis) says he counts total carbs, not net. I am finding personally that I need to consider total carbs too. What are your thoughts? Thanks!
    Reply: #8
  6. Karen
    "Aleuronat" flour is made from "aleurone": a granular protein found in the endosperm of many seeds or forming the outermost layer in cereal grains, and also found in some tubers.
  7. Nate
    thanks for posting that article. To see a summary of all of the science behind the use of low carb for diabetics was awesome. However, I'm not going to hold my breath that the numbskulls at the ADA are going to agree to a discussion of low carb for diabetics.
  8. London Lady
    Everyone counts net carbs surely? In the UK (and Australia amongst other places) all food labelling shows only the net carbs anyway. I am aware that in the US it's different and this is a mistake that some British low carbers make - they take the carb info from the packaging and then deduct the fibre, which in the UK has already been accounted for so they end up deducting it twice. The concept of 'net carbs' seems to apply principally to the US.
    Reply: #9
  9. FrankG
    Among diabetics I understand it is common to count total carbs (or at least a percentage of them)... yes in theory we should not be able to digest fibre/cellulose but when you see it increasing your Blood Glucose, theory goes out the window.

    Food labeling has become little more than yet another marketing tool; so as a rule, I choose real whole food which does not require a label to explain the contents :-)

    ---

    I just found this...
    http://www.webmd.com/women/features/net-carb-debate

    In an effort to cash in on the low-carb craze, food manufacturers have invented a new category of carbohydrates known as "net carbs," which promises to let dieters eat the sweet and creamy foods they crave without suffering the carb consequences.

    But the problem is that there is no legal definition of the "net," "active," or "impact" carbs popping up on food labels and advertisements. The only carbohydrate information regulated by the FDA is provided in the Nutrition Facts label, which lists total carbohydrates and breaks them down into dietary fiber and sugars.

    Reply: #10
  10. London Lady
    It's that kind of thinking that allows Atkins bars to speak of 'net carbs' even though they're nutritional garbage :D On that basis food labellers get to make the rules up as they go along, but if the nutritional data simply shows the carb count as being total carbs minus fibre there is no room for bogus claims. I too eat 'real' food without labels - but nonetheless in the UK the published data on those real foods will show a breakdown of protein, fat and net carbs.
  11. Eddie Mitchell
    Nate said "However, I'm not going to hold my breath that the numbskulls at the ADA are going to agree to a discussion of low carb for diabetics."

    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" Upton Sinclair

    Why do some medical professionals refuse to learn ?

    Anyone here ever heard of a man called Ignacio Ponseti ? Please let me tell you about this genius. He devised a method of correcting clubfoot in children. His idea was to use manipulation and plaster casts to correct clubfoot. All around him were naysayers from the medical establishment, surgery was the only way they said and Ponseti was wrong. Well Ponesti was right, very right ! Let's move forward a bit.

    From Wiki.

    Clubfoot (talipes equinovarus) affects almost 150,000 children annually. Almost 80% of these children live in developing nations. Dr Ponseti's technique is painless, fast, cost-effective and successful in almost 100% of all congenital clubfoot cases. The Ponseti method is endorsed and supported by World Health Organization[3][4] National Institutes of Health,[5] American Academy of Orthopedic Surgeons,[6] Pediatric Orthopedic Society of North America,[7] European Pediatric Orthopedic Society,[8] CURE,[9] STEPS Charity UK,[10] STEPS Charity South Africa,[11] A Leg to Stand On (India)[12] and others.

    At the 2007 International Clubfoot Symposium attended by 200 doctors from 44 countries, papers were presented for an estimated 10,000 children successfully treated with the technique around the world in the past few years.

    The Ponseti International Association for the Advancement of Clubfoot Treatment was founded in 2006 at the University of Iowa. The Ponseti International Association aims to improve the treatment of children born with clubfoot through education, research and improved access to care.

    Now here is the $64,000 question, when did the great man come up with this idea ? Again from Wiki.

    The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Dr. Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, USA in the 1950s, and was repopularized in 2000 by Dr. John Herzenberg in the USA and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard for the treatment of clubfoot.

    How many years will it take the medics to realise, treating type two diabetes with a high carb diet and a bag full of drugs is not the way to go ? 10, 20, 30, 40, 50 years.

    Kind regards Eddie

    Reply: #12
  12. erdoke
    Well, scientists prefer to get their funds for overcomplicated studies like this:
    http://dx.doi.org/10.1038/nn.3737
    Eric D Berglund, Tiemin Liu, Xingxing Kong, Jong-Woo Sohn, Linh Vong, Zhuo Deng, Charlotte E Lee, Syann Lee, Kevin W Williams, David P Olson, Philipp E Scherer, Bradford B Lowell, Joel K Elmquist
    Melanocortin 4 receptors in autonomic neurons regulate thermogenesis and glycemia. Nature Neuroscience, 2014; 17 (7): 911
  13. FrankG
    ...this is where the marketing comes in:

    "The only carbohydrate information regulated by the FDA is provided in the Nutrition Facts label, which lists total carbohydrates and breaks them down into dietary fiber and sugars."

    The nutritional breakdown is not provided by a unbiased independent agency but by the "food" manufacturers themselves

    There is no government watchdog agency which regularly checks the validity of these labels -- heck, even the safety of our food has become marginalised by recent policies!

    There is an acceptable "margin of error".. perhaps as much as 20%

    If the ingredient falls below a certain threshold they are able to claim "zero" -- hence foods which shout "trans fat free" and yet if you check the ingredients list you'll find "partially hydrogenated..."

    Total Carbohydrates (in North America) are broken down into "Sugars" and "Fibre" but if you sum up those two values you'll often see they are less than the "Total"...

    "Sugars" usually refer to simple mono- and di-saccharides (carbohydrates) such as Glucose, Fructose, Sucrose, Lactose...

    What is not accounted for is "Starch" which is considered "complex carbohydrates" but nowadays includes such things as Maltodextrin -- a man-made starch which is digested to Glucose just as readily as if you ate Glucose

    The Ingredients list is from "most to least", so if there was a great deal of a single sweet carbohydrate it would appear high on the list BUT by using smaller amounts of multiple sweet carbohydrates -- preferably with obscure names that don't scream "sugar" -- it is easier to scatter and hide them in amongst all the other chemical-sounding names, much lower in the list

    Big food manufacturing companies have their own nutritional labs (some also sponsor big-name University nutritional labs) so they can (and do) manipulate their recipes and labels to the fullest extent allowed by the law... anything to give them a competitive edge

    Like I said, I generally avoid labeled food... especially anything making an health claim :-P

  14. Eddie Mitchell
    To Tyrannocaster

    "We always think we are the first to discover something but those two pages read like something out of Wheatbelly or Dr. Bernstein"

    A low carb higher fat diet or lifestyle for diabetics has one massive drawback, very little if any money to be made. If all the diabetics around the world, followed the method, junk food and big pharma would lose $billions. Countless dietitians, diabetes nurses and Doctors would be out of a job.

    Last time I checked, over two hundred type two medications were in the research pipeline, big pharma's biggest pay day will be treating type two diabetics and obesity. If the drugs work as per the current available, they will achieve very little for the diabetic, but never mind the quality, it's profit that counts. Most drugs do not work FACT. Not my opinion.

    "A senior executive with Britain's biggest drugs company has admitted that most prescription medicines do not work on most people who take them.

    Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them.

    It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public."

    http://www.independent.co.uk/news/science/glaxo-chief-our-drugs-do-no...

    Kind regards Eddie

    Reply: #15
  15. FrankG
    I think that is the first thing to recognise in this situation Eddie: food and drug manufacturers are in business to make a profit.

    They do NOT have our best interests at heart, except for when that helps them market more of their products

    There is no great conspiracy to keep us unhealthy -- although it doesn't hurt profits, so at some level there is the question of immoral practice and accountability.

    The idea of white-coated scientists labouring altruistically in drug labs, to cure the World of its ills is just that, a nice idea. That doesn't make them bad people, they have bills to pay, the same as the rest of us.

    It's all about the bottom line

  16. Darius Wright
    NO! A Natural food diet, is the way to go! Just eat the foods provided by the earth, in as close to their Natural form as possible, and watch the change in health! Never waste time talking about carbs, fats, proteins, just eat a majority "Living foods", and learn about the other Natural substances such as the herbs, the superfoods, and other Natural substances that were provided to give us maximum life!
    Reply: #18
  17. FrankG
    On a lighter note...

    That Mitchell and Webb Look - The Garnier Laboratoire

    http://www.youtube.com/watch?v=hdHFmc9oiKY

  18. Galina L
    Darius,
    What you described in your comment is just a bona fide first step for a person who used to live on industrial foods, but decided to get healthier. Eating non processed food is not enough for everyone, and if you can ignore how much carbohydrates/proteins/fats you eat, it doesn't mean the rest of commenters are in your situation. I have been reading testimonials of newbies for a while who , for example, started to walk regularly after many years of being a coach potato or stopped drinking soda, and they were amazed by improvements in their health. Many live a healthy life style already and don't have an option to drop junk or start walking , next step for them would be to look into macro nutrients and add interval training /weight lifting/intermittent fasting to their routine.

    Frank,
    I also think that there is no global conspiracy to make people unhealthy, just usual global economy forces at work . We can contribute only in the form of creating demand for food we agree to concume and avoiding sertain products (low fat yogurt, bread, sugary drinks, statines, Nexium...) and sertain services .

  19. Andrew
    Many people these days are now telling me olive oil is bad for my health :(
    Replies: #20, #22
  20. erdoke
    Monounsaturated fats in olive oil are more stable than PUFAs in vegetable oils, but it is still not perfect for cooking and especially not for frying. The rule of thumb is that the more solid a natural fat is at room temperature, the more suitable it is for heating.
    The only science I've seen which involved some evidence about the ratios of different fat types in a so called "balanced" diet was a well explained and referenced recommendation of 1:1.3:1 for SFA:MUFA:PUFA. This would make olive oil – being high in MUFA – the champion of all. On the other hand I don't think this recommendation is fully valid when somebody is on LCHF. Also, some animal fats are high in MUFA.
  21. FrankG
    Also there is no single product known as "olive oil"... check the source, check to see how it was processed

    ...but most importantly, do some resarch for yourself and make up your own mind, rather than relying on what other people are telling you :-)

  22. Zepp
    I guess its the same people that tell you that steel cut oats is the healtyest breakfast?
    Reply: #25
  23. Jo tB
    Andrew, you said:

    "Many people these days are now telling me olive oil is bad for my health"

    They should also tell you why Most cheap olive oils aren't pure, but have been mixed with manufactured seed oils.

    I should have known that you can't buy extra virgin olive oil for 3 Euros at my local supermarket!!!!

    I now buy my EVOO at a farmer's market for 15 Euros a litre. The stall holder assures me that it is pure unadulterated olive oil.

  24. Nate
    Complex carbohydrates (starch) are simply long strings of glucose molecules strung together. As most readers here know, the strings of glucose must be cut into individual glucose molecules to be able to pass thorough the intestinal wall and enter our bodies. The cutting process begins in the mouth with the chewing and interaction with saliva. Saliva is able to separate one glucose molecule from another. Thus, by the time the mouthful of starch/glucose hits your stomach it is already mostly pure glucose.

    Dr. Richard Bernstein, author of Diabetes Solutions, has a great video on dLife. He takes a bite of bread and chews it for a few seconds. Then he spits it out onto a strip of litmus paper that changes color depending on how much glucose is in the saliva. The paper turns the darkest color indicating the highest amount of glucose the paper can accurately measure. (I think that is around 150 mg/dl).

    STARCH IS SUGAR. And should be labeled that way, especially if it is Amylopectin A.

    Replies: #26, #33
  25. Andrew
    Yes for the most part :)
  26. erdoke
    Of course starch is sugar, but there seems to be something wrong with the interpretation of Dr. Bernstein's demonstration.
    As far as I know saliva only contains alpha-amylase (ptyalin) which primarily cleaves 1,4 glucosidic bonds between glucose molecules inside starch, having higher activity on amylopectin. This means that the enzyme initially creates a mix of soluble dextrins and does not build up significant amounts of glucose or maltose (DP1 and DP2). If the reaction left to go on for a longer period of time – which does not normally happen during chewing starchy food – there will be indeed some maltose and maltotriose (DP3) cleaved. This you can easily verify by chewing white bread for a while and waiting until your saliva gets mildly sweet. It will never turn really sweet which would be the case if a lot of glucose were generated during the enzymatic reaction.
    There are pancreatic amylases that finish the job down to DP2-3 in the small intestine.

    Also, the litmus test is normally used to check pH and not glucose in a solution. Mono- and oligosaccharides do not alter pH to a degree that involves a nice color change on the litmus paper (4.3 and 8.5 respectively).

    Replies: #27, #29, #32
  27. FrankG
    I believe this is the clip being referenced...

    http://www.youtube.com/watch?v=3PZno7Nkuuw

    My views of Hope Warshaw aside (aaaargghhh!) it looks to me like Dr Richard K. Bernstein is putting his bread and saliva sample on a urine glucose test strip

    Urine testing for glucose is much less accurate (blood glcusoe management is so overwhelmed that glucose spills from the kidneys) and not so often done these days; since home blood glucose meters are readily avaialbe -- thanks in part to one of their early pioneers Dr Richard K. Bernstein, who met resistance from the establishment when he promoted their use.

    Regarding an earlier conversation: Richard K. Bernstein also comes from an engineering background but went back to college and became an MD in his 40's to try and gain some professional acceptance of what is basically an LCHF approach. An approach which has allowed him -- a Type 1 Diabetic (diagnosed aged 12) -- to ignore the established advice -- which in those days was basically an early death due to complications -- to stop and reverse the progression of his complications, which were becoming severe into his early 20's, living productively and healthily into what is now his 81st year.

  28. Eddie Mitchell
    To Frank

    "My views of Hope Warshaw aside (aaaargghhh!)" Jeez I was having a good day until I read that. I have bad dreams about that woman and wake up screaming in the night.

    As for Dr. Richard Bernstein, the worlds number one diabetes expert in my opinion. He has saved countless people all over the world from grim diabetes complications. He deserves a Nobel prize I reckon.

    Kind regards Eddie

  29. FrankG
    I agree Eddie.. he is a great unsung hero and deserves much more credit than he has received... one of the many pitfalls of sticking your neck out against the establishment.

    Just an observation on Glucose and "sweetness" erdoke: glucose by itself is surprisingly unsweet. Among the diabetic supplies you may find at a pharmacy, are pure glucose tablets -- to be carried at all times to fend off the evil hypoglycaemia! -- they taste like chalk :-)

    Reply: #30
  30. erdoke
    Some decades back I spent 6 hours per week in organic chemistry labs. If I remember correctly on a relative sweetness scale where sucrose is 100, glucose comes up at 70-80 and fructose is at 140. Maltose on the other hand is only around 35 while honey and xylitol are very close to 100. Also, it used to be common around here to sell glucose pills claiming that it improves cognitive performance, so I clearly recall how sweet high purity glucose is. It is not as sweet as sucrose, but sweet enough and definitely does not taste like chalk.
    I still doubt that there is a significant amount of glucose in saliva after chewing on bread for a few seconds. Maybe not much even after chewing for minutes... It should mainly be maltose and longer dextrins, the former providing 90+ % of the sweet(ish) taste.
    Reply: #31
  31. FrankG
    Not arguing with you :-) Perhaps they use some binding agents in the glucose they sell at pharmacies?

    I guess it goes to show why real whole food rarely contains just glucose or just fructose.

    The urine test strips would show the presence of glucose (should be none in healthy urine) but I'm not sure how accurate they would be otherwise.

    I think Dr Bernstein was simply demonstrating that: even so-called healthy complex carbs like "whole grain bread" still readily translate to glucose and how quickly

  32. Nate
    erdoke,

    Thanks for the clarification. Nutrition is always more complex than I want it to be.

    BTW, do you know the name of the test strips that test glucose in solution. Is it Diastix or something like that?

  33. Mark
    What we call "starch" is a mixture of two polysaccharides. Amylose is around 300 glucose molecules, as either a chain or in a spiral. Amylopectin is around 3,000 glucose molecules in complex branched structure. Even though Amylopectin is more "complex" than Amylose it is digested more quickly because it is more water soluable. In also comprises at least 75% of any "starch". (So called "resistant starch" is amylose in certain configurations.)
    Sugars don't just stick together they form what are called "glycosidic bonds". In order to break such a bond a molecure of water is required. What this means in practice is that 100g of Amylopectin (or Amylose) actually equates to 111.1g of glucose.
    Reply: #34
  34. Nate
    "Sugars don't just stick together they form what are called "glycosidic bonds". In order to break such a bond a molecure of water is required. What this means in practice is that 100g of Amylopectin (or Amylose) actually equates to 111.1g of glucose."

    That last sentence is confusing. I'm guessing that it takes 11.1g of water to break up 100g of Amylopectin. Am I close?

  35. Don
    I am confused. do we count total carbs or net carbs.
  36. Kathy
    That is a fascinating book! Thank you for sharing it.
    It can be added to your kindle library, for anyone who would like a copy, or downloaded as various file types. Just click the title link on the top left and go to the info page. The options are on the right.
  37. Corey
    It makes sense, diabetes is caused by thousands of recurring surges in blood sugar which have over time deprived your pancreas of the ability to secrete insulin effectively due to the overload of carbohydrates. Food which doesn't cause spikes in insulin could naturally only help diabetes. I laught when I hear these doctors recommending to they're diabetic patients to eat 'slow burning carbs' instead. That's just giving tents to the protestors, even when doing that blood sugar levels will still be changing and the damaged pancreas won't be able to handle that.
  38. 1 comment removed
  39. bryan fenn
    My husband is type 1 insulin diabetic for 21 years started Lchf diet 3 weeks ago and hasn't lost any weight first week lost 2 lb now nothing also hus sugar readings were really good but now have started to creep up again. What's wrong.
    Reply: #40
  40. Zepp
    Mayby you dont doing anything wrong.. it takes time.

    First of all read about it.. its a new way of thinking.. and Dr Bernstein is the best expert on Type1 and low carb.

    http://www.diabetes-book.com/read-online/

    http://www.dietdoctor.com/type-1-diabetes-and-lchf-a-great-combination

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