24 thoughts on “Who gives carbohydrates to diabetics?”

  1. Interesting.
    Well, I have just checked the American and Canadian Diabetics Associations websites:

    ADA

    This is what they say in the section Food/Planning Meals:

    “Focus on filling your plate with non-starchy vegetables and having smaller portions of starchy foods and meats. Creating your plate is an easy way to get started with managing blood glucose levels.
    You don’t need any special tools or have to do any counting. It’s simple and effective—draw an imaginary line on your plate, select your foods, and enjoy your meal! You may have heard of this as the “Plate Method.” Once you’ve changed your portion sizes, you can work on making healthier food choices from each food group.”

    http://www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/

    CDA
    This is what they say in their brochure called Just the Basics:

    “Diabetes is a condition in which your body cannot properly use and store food for energy. The fuel that your body needs is called glucose, a form of sugar. Glucose comes from foods such as fruit, milk, some vegetables, starchy foods and sugar.
    To control your blood glucose you will need to eat healthy foods, be active and you may need to take pills and/or insulin.”

    http://www.diabetes.ca/files/JTB17x_11_CPGO3_1103.pdf

    I would say that Canadian version of dietary advice is even worse than American. On that note, is there any way to change this kind of advice that CDA is giving to diabetics? Can’t Health Canada do anything about this?

    Dr Jay’s Reply:

    In general, both associations support a diabetic diet that doesn’t differ significantly from the general food guide recommendations. As such, the recommended diets are high in carbohydrates, usually 50% or more of total calories. To the credit of the ADA, at least they are now including a low-carb diet option in the weight management section of their guidelines. The CDA has not looked at the literature in support of low-carb at all, as far as I can determine. I have asked why they differ from the ADA in this respect and there is no clear answer. I think it boils down to individuals and the person who writes that section refuses to acknowledge the validity of a low-carb diet for either weight loss or for diabetic management (I know this because I have talked to him about it on more than one occasion). As to Health Canada’s role, they aren’t in the business of producing guidelines apart from the Canada Food Guide. They defer to the disease specific organizations in this area.

  2. I’m in Montreal. A relative was diagnosed type 2 and I saw the officially designed dietary plan for this person, as delivered in person by an officially appointed registered dietician. I can assure everybody that the official dietary advice to diabetics type 2 in Canada is to eat at least 260g of carbohydrates per day, divided into three meals containing at least 60g, and two snacks containing at least 40g. All this without any distinction between refined and whole carbs such as white bread, table sugar, and fruits. Nor with any specific upper limit on those refined carbs.

    The official dietary guidelines for healthy Canadians says to eat at least 300g/carbs/day. Between 300g and 260g, it’s doubtful there’s any difference in the health benefits. This puts serious doubts on the legitimacy of the Canadian Diabetic Association’s advertised goal, which is to help Canadians prevent and manage diabetes. Not to mention the doubts about the official dietary guidelines for the every other Canadian.

  3. Forgot to add.

    I consider diabetes type 2 as merely the symptoms of carbohydrate poisoning. Thus, if that’s how we define diabetes type 2, and we look at what the CDA really says, they’re saying they want to help Canadians prevent and manage the symptoms of carbohydrate poisoning, by telling Canadians to poison themselves by eating carbohydrates, but not to worry because they have a litany of drugs and treatments to deal with all that.

    Call my cynical.

  4. Martin, I’m glad you came back to add that last bit – a very useful way of thinking about it indeed!

  5. Martin, I really like your definition of type-2 diabetes.

    Calling it “ the symptoms of carbohydrate poisoning” forces us to look at it from a different angle. And from that angle the whole type-2 diabetes picture becomes tack sharp.

    Thank you.

  6. I have long refused to acknowledge “Type 2 Diabetes” as a disease and always put the term in quotation marks. That is despite a family history of 3 generations (as far as I know) who have been diagnosed with this “disease.” I have repeatedly stated that I consider so-called “Type 2 Diabetes” to be a symptom of excess carbohydrate consumption in the presence of insulin resistance. I like the idea of calling it “carbohydrate poisoning” even better, so thanks for sharing.
    Dr. Jay – is there a place that one can find this poster in a format that can be shared on Facebook, etc.?

  7. Thanks. It’s just a more pragmatic way of looking at the problem. I just think making things simpler and more tangible makes it easier to find solutions. I think in this case it can’t be simpler than that.

  8. Martin, Excellent!
    PHolloway5, Just copy and paste the address for this entry of Dr. Jay’s blog into your FB status bar. I’m thinking I may do that as well.
    Dr. Jay, it boggles my mind that people can’t see the obvious contradictions in this poster. Are they really that dumb? I fear for this country–and yours. My husband was diagnosed as pre-diabetic by his doctor and handed the AHA pamphlet recommending a low fat high carb diet. I was flabbergasted that a medical professional would tell a prediabetic to eat more of what is surely going to turn him into a diabetic. Needless to say, I put the pamphlet in the circular file immediately. We came home and worked out a way to decrease our CHO intake, not increase it! I do realize it’s the fear of fat that makes them do this–at least I hope so. I would hate to think they are just drumming up more business for all the drug companies. Ah well, thanks for getting the message out. I’m just sad that you are pretty much preaching to the choir! Let’s hope the choir increases it’s membership!

  9. PHolloway5, better yet, click on the poster and copy and paste that address into your status bar. That’s what I did.

  10. Well, “they” have found another way to set people off down a very sad pathway (gastric bypass surgery) :
    http://www.cbc.ca/news/health/story/2012/04/10/obesity-doctor.html
    PeggyC asks – Are they really that dumb? – it seems they are, or else just without any sense of history going back, oh like maybe twenty years. Before you had most of your stomach cut away, wouldn’t you say – Wait a minute, people didn’t use to be this obese, and with complete stomachs! There must be a better answer.
    But here’s a bright spot for you: http://bit.ly/HHUVnf

  11. Carbohydrate poisoning. Brilliant. Indeed, the poison is in the dose.

    Are they really that dumb? I expect they are clever, intelligent people. However, I am continually amazed at the power of people to believe what they have an emotional need to believe in, despite all evidence. All data admits of several interpretations and one must be ever vigilant for confirmation bias, especially one’s own. I expect they see research that shows fatty acids in cells causes damage associated with diabetes and conclude dietary fat must be bad. A nice confirming hypothesis, but one that overlooks that if the cells were not always burning glucose, they would burn off that fat. And perhaps the fat came from liponeogenesis from sugar in the liver, not dietary fats. But the fat-is-evil interpretation is too convenient to consider rivals. Thus, confirmation bias, by otherwise intelligent, well-meaning people. Pity.

  12. Today I was teaching a small group of medical students. The fictional case was an aboriginal man with type 2 diabetes who had developed end stage renal failure. As part of the problem based learning discussion, we were talking about treatments and why there is an epidemic in indigenous peoples around the world. The “thrifty gene” hypothesis was brought up by one of them, and they all agreed that this did not sound likely. I recommended they look this blog up, and when I said your name, Dr. Jay Wortman, one of them knew all about you. He was able to explain your study in Alert Bay, and about ketogenic diets. I was very happily surprised that this student was able to inform his peers, and that the info wasn’t just coming from me. It turns out this student was turned onto ketogenic diets through Crossfit and he has been following the “diet” for a year. The official tutor guide just says “diet modifications” for management, I’m not sure if they get any additional lectures specific to diet and type 2 diabetes, but the professor is Dr. Jenkins, so he would likely not be mentioning a ketogenic diet. At least the students have heard it once from me and their peer. Perhaps one of them will look into it further, and even continue the scientific examinations of the ketogenic diet.

    Did your study get published?

    Keep up the great work. I always enjoy your comments in the G&M.

    Dr Jay’s Reply:

    Thanks for that feedback. It is gratifying to hear that at least some of the med students are clued in. I am sure that Dr Jenkins wouldn’t be promoting a ketogenic diet. I believe he is squarely in the low-fat vegan camp. We haven’t published anything from Alert Bay. We did present some results at conferences, however. I think most people have learned of the study through the documentary which has been broadcast several times now. Thanks for your support, both here and at the G&M.

  13. Dr.Jay

    I’m confused. I see people eating like this, and they are not overweight, and apparently do not have Diabetes 2, although their diet is heavy carb and sugar. Please take a look. I’m seriously asking for an explanation or your best idea:
    http://www.mennonitegirlscancook.ca/

    Then, there’s someone like me, overweight, astronomical cholesterol (10), some atherosclerosis, but no signs of Diabetes 2. 70 yrs. What diet should someone like me follow to lose weight?

  14. Whoops posted before I finished:

    Of course I am being told to lose weight and take medication fo lowering cholesterol, that I must lower it. I also have a “fatty liver”. How can someone like me go on a low-carb diet? Many many post-menopausal women are like me. (Maybe not quite so high a cholesterol). I do see that low-carb will bring about weight loss, but dare I attempt a high fat diet?

  15. Oh my goodness there should be an edit button here:

    How did your diet work on women? I’m really not interested in hearing how men lost weight. No surprise. I’ve never seen a diet where men didn’t lose, lots compared to what women reported on the same diet.

    Women?

    Dr Jay’s Reply:

    That Mennonite coconut cream pie looks delicious! Too bad I can’t tolerate that much carb. I think there are a number of issues to consider. Firstly, it’s not just about weight. It is about metabolic health, cardio-vascular disease risk and the risk of other chronic diseases including arthritis and cancer. IMHO the risk for all these conditions goes up with a diet high in sugar and refined carbs. The high omega-6 oils contribute to this, as well. People who are very active can burn off the carbs and avoid or delay weight gain but they don’t necessarily avoid those other consequences of a high carb diet. Secondly, I think there is a likelihood of an epigenetic effect. We know that dietary practice can influence how genes are expressed and that this can be inherited. It may take a generation or two of eating a high sugar and highly refined carb diet before the full metabolic impact is expressed (I think this may explain why First Nations people started getting type 2 diabetes about 50 years ago while their diet changes started maybe 100 years ago). And thirdly, in your specific situation, you clearly are experiencing metabolic dysfunction due to excess carbs. The fatty liver (unless you are a heavy drinker) is the giveaway. A low-carb high-fat (LCHF) diet will reliably shrink your liver and return your metabolism to a healthier state. It’s not fat in your diet that caused the fatty liver, it’s the fat the liver makes from the excess sugar and carbs you have been eating. Your lipids should also improve with your HDL going up and your triglycerides going down. Your LDL may remain unchanged or may even go up a little but you should rethink the statin medications in either case. Here is a commentary by Dr Mike Eades, someone whose opinion I highly respect, on the merits of statins for women: http://www.youtube.com/watch?v=Qxiu9dpw4MA

    As to how well women do on low-carb vs men. I have seen huge weight loss success for women. One factor that women of your age have to contend with, however, is the effect of estrogen loss as a result of menopause. This can cause weight gain. For some women, this means they have a harder time shedding weight on a low-carb diet (or any other diet, for that matter). Having said that, I recently spoke to a woman, of an age similar to yours, from one of my diet groups who has lost over 70 lbs. I have seen lots of similar success in post-menopausal women.

    All in all, it sounds like you are a good candidate for success on a LCHF diet.

  16. Thank you for your response.

    Very interesting. I’ve read and studied a lot about nutrition and dieting, but “dieted” only once, as a vegetarian. I did lose weight but the cholesterol did not go down. It’s never gone down even on Statins, which I don’t take now.

    You’ve got me on the sugar. While questioning you I ate two brioche stuffed with homemade strawberry jam.

    I’ve requested the book “Art and science of…”.

    I may have more questions later. Thanks again.

  17. I’ve read the JAMA study comparing diets. It seems they all came out about the same for every measurement, including ability to stay with it and liking it. Fair enough. I found this though:

    “The lower carbohydrate diets (Atkins
    and Zone) were more likely to reduce
    triglycerides, diastolic blood pressure,
    and insulin in the short term, although
    the Atkins diet failed to significantly
    reduce mean fasting insulin levels
    at 1 year (P=.26).

    If I was to go on a LCHF diet, which would you recommend? I seriously doubt I’d find any doctor here to help me, but I don’t see any health risk for a two-week trial. My BP is high normal, triglycerides bottomed out, and HDL very high. (Weird pattern). I take no hormones or drugs, and am life-long non-drinker.

    I had been told my fatty liver was from a high fat diet. Since I knew that was impossible (I don’t eat high fat) I couldn’t really figure out what I should do. What you say makes sense. I love sweets. I can eat so much sweet and caffeine and just feel great. Never makes me feel bad. However, I’m willing for the sake of science to give it up for TWO weeks. If I’ve lost any weight on whatever program you suggest, I’ll stay with it.

    I just bought liver, bison, bacon, chicken and cheese. Bring. It. ON.

    Dr Jay’s Reply:

    I assume you are referring to Chris Gardner’s A to Z study which compared Atkins, Zone, Ornish and a conventional diet. Don’t pay too much attention to the results and conclusions of those kinds of studies. They are effectiveness trials which means that a number of factors are bundled together to determine which diet is most effective when applied to a population. It doesn’t tell you how you will do on any particular diet. Usually, those studies botch the low-carb arm by restricting salt and encouraging lots of water consumption. They also allow people to ramp up their carbs rather than staying low. Both those mistakes will make it hard for people to comply and will result in drop-out rates to increase. What they do then is analyze the data as though everyone complied and stayed in the study. That combination will water down the effect of the low-carb diet when compared to other diets.

    Chris Gardner basically gave everyone a diet book and then checked in with them to see how they did. He went on to do a further analysis of this data and found that the women who had insulin resistance did far better on the Atkins diet and might even get worse on a low-fat diet like Ornish. He wasn’t able to get more funding to pursue this and was basically punished for publishing the original findings that showed Atkins in a good light.

    The best studies are those done by my friend Jeff Volek at U of Connecticut. He knows how to properly administer a low-carb diet and gets amazing results. He is co-author, along with my friend, Steve Phinney, of “The Art and Science …”. I recommend it as the best guide to low-carb dieting currently available (until I get around to writing my own book, that is).

    It sounds like you really need to cut out the sweets. I don’t know if you will get over the cravings in a two-week trial. I would encourage you to commit for a longer period, say a month. Don’t be afraid to use artificially sweetened products to help with those cravings. Diet Jello with whipping cream was a favourite at our house until I started making low-carb ice-cream (see recipes above).

    Good luck!

  18. I should say I never use “sugar”. Wouldn’t occur to me. I use Maple Syrup though. By sugar I mean sweets, confections, pies, pastries, cakes, bon bons, truffles: I own shares in Lindt, caramel lattes… like that.

  19. I think the “fatty liver” was caused by Baycol.

    Dr Jay’s Reply:

    Baycol could have caused you to develop fatty liver. However, I would think if that were the case, it should have resolved after you discontinued the drug which I assume would have been several years ago. On the other hand, high fructose consumption will give you fatty liver and by our own account you do eat a lot of sweets. I would expect your fatty liver issues to resolve if you adhere to a LCHF diet.

  21. I had several rather profound incidents on Baycol. I think I would almost use the words stroke-like, and when I heard the expression “transient global amnesia” I knew I had experienced that too. Following Baycol I was on Lipitor then Simvastatin, last Statin in 2004. At ime of taking Baycol, I was very athletic and trim. Very muscular. I lost it all for the pain.

    However, I do agree sugar could be a factor now, and since about 2006. I just kind of gave up. You are the first doctor to tell me that. I have just been hounded to go back on Statins, and told I am not eating low fat enough. Well, I was, but also the other. I am looking at Laura Dolson’s very common sense approach, in lieu of anything else to follow. I think I can manage very well. An egg, two slices of Cdn. bacon in a bit of butter, coffee with a bit of creme this a.m. Thank you.

    Dr Jay’s Reply:

    I have never been a big fan of statins. Your experience with statins is a cautionary tale that is far too common, IMHO.

    Laura Dolson’s advice is not bad. I tend to advise an even lower carb approach for those who have signs of insulin resistance. Another online source is Dr Andreas Eenfeldt’s blog – http://www.dietdoctor.com. Click on the “Weight Loss” tab and go to “LCHF for Beginners”. I also recommend the Volek and Phinney book which you have already ordered. You can also use the latest Atkins book (Phinney was a co-author) if you stay on the “induction” phase indefinitely. It really depends on figuring out what a carb is and avoiding all the foods that contain carbs. LCHF means getting comfortable eating fats (except the high omega-6 oils) and making sure there is enough salt in the diet. A multivitamin and an omega-3 supplement are good. I also recommend taking a slow-release magnesium supplement like mag64 (which is unfortunately available in the US, only. I got some from a Walmart there for $4 a bottle recently). Anyone taking an antihypertensive drug or anything for blood sugar control will need to reduce or discontinue those very soon after they stop eating carbs. Good luck!

  22. Thanks for the link. Site looks great. I have written him with a question, then I can stop spamming you. 🙂

    I take no meds but the usual drug store vitamins recommended to us: D, Calcium, Magnesium, one-a-day, Salmon oil.

    I’ll check in next Wednesday and let you know if there’s been any loss. The only problem I foresee is cost. I am retired on a woman’s pension, however I can just move the Brioche budget over. 😛

    Thanks again.

  23. Hi Dr. Jay.

    One week on low carb:

    Ate only fatty meat, lc vegetables, 2 scant servings fruit daily (frozen Saskatoon berries, and one small apple), and one serving of steel cut oats cooked, daily:

    Gained 2 lbs.

    I will have to modify the diet. I spent more than two weeks grocery budget on this one week’s food. I found a further reduction of the intestinal pain I associate with wheat/grain/dairy. I didn’t like eating so much meat.

    Dr Jay’s Reply:

    I generally recommend using one of the low-carb diet books as guide since I cannot be a diet coach via this blog. The best books are the latest Atkins book where I recommend for people who have insulin resistance to stay on the induction stage indefinitely. Or, you can try the new book by Volek and Phinney, “The Art and Science of Low Carbohydrate Living”. If you do it ad hoc you run the risk of making mistakes like eating too much carb or protein or too little fat.

  24. Hi,

    I read this study that was recently published.

    http://www.nutritionjrnl.com/article/S0899-9007%2812%2900073-1/abstract

    I have been on a ketogenic diet for over 3 years. I needed to lose about 20 pounds, and I did lose that. I was diagnosed with low blood sugar back in the 1980s. In ketosis, I do not get hungry, or weak between meals, and no longer have to snack.
    I also hurt less, have better moods, my blood pressure went down, and I look a lot better. I mostly eat moderate amounts of unprocessed meat with the fat. I eat very low carb vegetables, maybe the juice from a small lemon, and about 3 tbs of butter a day, and about 3 tbs of coconut oil a day.

    Dr Jay’s Reply:

    Dashti and his colleagues have been doing LCHF diet studies in Kuwait for a few years now and have been getting consistently good results. The epidemic of insulin resistance is very severe in the Middle East so I hope his work will be helpful in turning that around.

    Sounds like you are on the right track with your dietary efforts. Keep up the good work!

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