The "Diabetic Diet"

What exactly is a “diabetic diet” anyway? 

Was your advice just to “eat healthy”? 

Maybe you met with a nutritionist. If so, that nutritionist may have given you the latest recommendation available on the American Diabetes Association’s website:

“Everyone's body responds differently to different types of foods and diets, so there is no single "magic" diet for diabetes.“(1) 

Well, now...that’s helpful.

Actually, a consensus report was published by the ADA in May of 2019, and that really was their conclusion. 

“Though it might simplify messaging, a 'one-size-fits-all' eating plan is not evident for the prevention or management of diabetes, and it is an unrealistic expectation given the broad spectrum of people affected by diabetes and prediabetes, their cultural backgrounds, personal preferences, co-occurring conditions (often referred to as comorbidities), and socioeconomic settings in which they live.” (2) 

So, because there are so many different kinds of people who are diabetic who eat so many different kinds of things, we can’t really tell you what you should be eating. 

Again, really helpful, right?

And for my friends in the UK, their recommendations are not much different.

"An important part of managing your condition is to eat a healthy, balanced diet. There's no such thing as a 'diabetic' diet or 'diabetic' recipes." (3)  

The ADA report goes on to say that people with diabetes should lose 7-10% of their body weight.

“Well golly gee, I’ve never thought about trying to lose weight before,” you say with just slightly more than a hint of sarcasm.

And one last thing before I get to giving you information that you can really use.

The ADA report also described what you should be doing with macronutrients (proteins, carbohydrates, and fats). (I’m going to give you the quote from the journal article, but if you want to skip the medspeak, just read my summary)

Consensus recommendations 

• Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with or at risk for diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.
• When counseling people with diabetes, a key strategy to achieve glycemic targets should include an assessment of current dietary intake followed by individualized guidance on self-monitoring carbohydrate intake to optimize meal timing and food choices and to guide medication and physical activity recommendations.
• People with diabetes and those at risk for diabetes are encouraged to consume at least the amount of dietary fiber recommended for the general public; increasing fiber intake, preferably through food (vegetables, pulses [beans, peas, and lentils], fruits, and whole intact grains) or through dietary supplement, may help in modestly lowering A1C.

My summary of the above:

• We cannot determine how many carbs, proteins, and fats you should eat each day based on the research. (That’s funny because plenty of docs have determined what macronutrients you should restrict based on the research.)
• Diabetics should be instructed in how to monitor their carbohydrate intake and meal timing so that they can take their medications properly and exercise. (No problem with that.)
• People with diabetes should be encouraged to eat fiber in vegetables, fruits, and whole grains or take a supplement. (Fiber yes. Fruit and whole grains, not so much.)

If the ADA is not going to help you know what to eat with diabetes, what can you possibly do?

 You can do what doctors who are actually able to help their diabetic patients are doing. 

There is ample evidence that the disease called diabetes gets better if you restrict carbohydrates. Period. 

 The only real truth about the above published statements is that exactly how much you need to restrict carbs is indeed an individual recommendation.  

Why doesn’t the ADA or Diabetes UK tell you this stuff? 

That’s hard to say except that the nutrition dogma for the past 50 years has been this:  fat is bad, “healthy” carbs are good, and the only way to lose weight is to “eat less and move more.”

To blindly stick with that dogma is to ignore incredibly valuable and current research, the real life experience of many physicians working with diabetics, and practices that were the medical standard of care before the ridiculous and catastrophic recommendation that we all change our diets to low-fat.

Let’s just take a look at where the low-cal, low-fat, eat less, move more strategy has gotten us since the first national Dietary Guidelines were published in the US in 1980.

• A staggering 42% of American adults are obese. (Data from the CDC)
• If you add the overweight American adults to that bunch, the number comes to 74%. 74% of us are overweight or obese. (Yes, you read that correctly - 74%.)
• In the 1970’s, the incidence of obesity in the US was 15% (4) 
• 10.5% of the US population has diabetes and 34.5% has pre-diabetes. (CDC, National Diabetes Statistics Report, 2020) 
• In 1970, the incidence of diabetes was less than 2% 

Low-fat wasn’t the only change to our diet. We also ate a lot of convenient, low-fat, “healthy”, and highly processed foods (see my blog on the SAD diet).

Clearly, these dietary recommendations that we have been following for decades are lacking in something. In fact, what they are really lacking is any basis in science.

 These national dietary recommendations were based on opinion, not fact. At the time, saturated fats had been (wrongly) accused of causing heart disease. In retrospect, it was far more likely that our consumption of trans fat was the actual culprit causing the epidemic of heart disease. Trans fats were first developed by the food industry to extend the shelf lives of baked goods and improve mouth feel. Later they were used to replace saturated fats (margarine instead of butter). The consumption of saturated fats is actually not related to developing heart disease. The consumption of trans fat dramatically increases the risk of heart disease.

Why hasn’t the recommendation to eat less and move more helped us lose weight? Because low calorie diets don’t work. Research (and probably your own experience) shows us that when we restrict calories, our body slows its metabolism to compensate. Also, we feel miserable - tired, hungry, moody, and we think about food obsessively as in ALL THE TIME. And to make matters worse, when you fail at a low calorie diet by regaining your weight (and you will), you actually regain MORE weight.

 The real problem in recommending that you manage your diabetes with weight loss is that you don’t know how to lose weight! But it’s not for a lack of trying. The underlying problem with diabetes is called insulin resistance. It’s because of this insulin resistance that you can’t lose weight--unless you restrict your carbohydrates. That’s the secret (or at least one of them). 

 In the next post, I am going to talk about why diabetics struggle to lose weight. It has to do with the insulin resistance that I just mentioned. So, stay tuned for more helpful info on managing your diabetes and weight loss.

References:

1. https://www.diabetes.org/healthy-living/recipes-nutrition, accessed 1/21/21

2. https://care.diabetesjournals.org/content/42/5/731, accessed 1/21/21

3. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/healthy-eating, accessed 1/21/21

4. PLoS One. 2016; 11(11): e0167193, accessed 1/21/21