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I am a New Zealand registered nurse and nutritionist (Grad Cert Sci: nutrition, Massey Univ). I am a Certified Zone Instructor, and have worked teaching Zone diet principles to hundreds of clients over the last 10 years. More recently after finding that eating Paleo food choices was the "icing on the cake" health wise, I have become a Paleo enthusiast and teacher. Follow me on twitter @juliannejtaylor

"Why I Hate Nutritionists" (by a type 1 diabetic who failed to control blood sugar following diabetes nutritionist advice)

Why I Hate Nutritionists
By Psycho Milt
NO MINISTER blog
(http://nominister.blogspot.com/)

“My wife pointed out to me a bit in the Sunday paper yesterday about cooking for guests with special dietary requirements, among which was diabetes (I’m a type 1 diabetic, ie the insulin-injections one).

Apparently, if you’re cooking for a diabetic, no foods are to be avoided and you should give them plenty of starchy carbohydrates (potatoes, pasta etc) and vegetables. This according to Diabetes UK (article was presumably reprinted from a British paper).

I had hoped that nutritionists would have come to their senses about diabetes in the 10 years since I started ignoring them, but it seems dogma still holds sway. I went and had a look at Diabetes UK and their food recommendations for diabetics are horrifying. Double-checked by having a look a the Diabetes NZ site, and yes it’s the same shit: a food pyramid recommending you eat mostly the stuff that will make your diabetes worse, and cut down on the stuff that won’t.

NZ diabetes food pyramid

Diabetes, whether type 1 or type 2, essentially means the body is no longer able to handle glucose in the blood properly. In type 1 it’s because you’ve stopped producing insulin, and in type 2 it’s because you’ve become insulin-resistant and it takes prodigious amounts of insulin to overcome that resistance. If your blood has high glucose levels over the long term, you can look forward to blindness, impotence, kidney failure, amputated limbs and an early death, so the diabetic’s task is to keep those blood glucose levels down as close to normal as possible.

The body gets glucose from food, and some foods are turned into glucose by the digestive system much more rapidly than others. So it seems clear that nutritionists will be a big help to diabetics, because they can tell diabetics which kinds of foods will quickly raise blood glucose and should be avoided, right? Well, you’d think.

As a quick rule of thumb, here’s what raises blood glucose levels rapidly: starches and sugars (ie, carbohydrates: bread, potatoes, pasta, beans and pulses, rice, fruit, non-leafy vegetables, milk etc).

Here’s what doesn’t: fats, proteins and cellulose (meat, fish, nuts, cheese, eggs, butter, leafy vegetables etc).

You’d think, based on the above, that the diabetic who isn’t keen on a future involving blindness, impotence etc would be following a pretty Atkins-y sort of diet. Well, not if that diabetic is listening to professional nutritional advice, which actively warns them off the foods that won’t raise blood glucose rapidly and actively encourages them to scoff down the foods that will. It burns me up that these imbeciles are encouraging people to sabotage their chances of surviving diabetes.

Here’s the kicker. Why? Why would professional nutritionists instruct diabetics to eat mostly foods that are going to turn them into broken-down pieces of shit? The answer is dogma. Nutritional orthodoxy is that fat is bad and fruit&veg is good. I have in all seriousness been given medical advice that I should eat a high-carb diet that will wreck my blood sugar control because low-carb diets involve lots of fat, and diabetics have an increased risk of heart attack. Why, it could add as much as 5% onto that risk! Uh, right. You know, I don’t think a slightly-elevated risk of heart attack is really my biggest health concern for… let’s see… oh, yes – the rest of my fucking life.

Yeah, I really hate nutritionists.”

So then what does work? What do the Studies Show that nutritionists are ignoring?
Joslin Diabetes Centre attached to Harvard has gone so far as to now recommend a moderate carbohydrate diet, based on a review of clinical studies, for people who are overweight and have type 2 diabetes:
http://www.joslin.org/docs/Nutrition_Guideline_Graded.pdf

It is startling to me that Diabetes New Zealand are not even yet following recommendations of on of the most prestigious diabetes clinics recommend.
However, just because this is recommended – it does not mean this is the best yet. Research continues and recommendations evolve.

When I first started my own nutrition practice I exclusively taught the Zone diet, because this was the plan that radically changed my own health (I’ve since evolved to teaching paleo and lower carb principals).

One of the early studies that Dr Barry Sears did was with type 2 diabetics. In those days Sears recommendations were very paleo and meals usually ended up being lower carb than the 40% calories prescribed.
Here’s the advice that was given:
Eat a portion of protein at each meal – the size and thickness of your palm, this makes a portion approximately 100 – 180 grams depending on palm size.
Add two handfuls of best choice carbohydrates: non starch vegetables
Add a dash of monounsaturated fat: olive oil, avocado, almonds, macadamias were best choice

And here is Sears original food pyramid:

Zone food pyramid, 1997

The results were extremely good:
“A Nutrition Intervention Program to Improve Glycemia, Lipid Profiles, and Hyperinsulinemia in Patients with Type 2 Diabetes”
BARRY SEARS, PAUL KAHL, GEORGE RAPIER, Marblehead, MA and San Antonio, Tx, USA.
This 12 week study with 70 people who had been type 2 diabetic for more than a year
Conclusions:
A protein-adequate, carbohydrate-moderate, low-fat, calorie-restricted diet can be integrated readily into the lifestyle of patients with Type 2 diabetes, providing highly significant clinical improvements within six weeks in hyperinsulinemia, glycemia, and lipid profiles as shown below:
Insulin 23% decrease
HbA1c 7% decrease
TG 14% decrease
TG/HDL 26% decrease
The decrease in each of the risk factors indicates the Zone Nutritional Program has significant potential in reducing the cardiovascular risk that is elevated in Type 2 diabetics.

What other studies show important improvements in diabetes measures?
This one by Steffan Lindeberg
“The original human diet is good for people with diabetes”

“In a clinical study, we compared 14 patients who were advised to consume an ‘ancient’ (Paleolithic, ‘Old stone Age’) diet for three months with 15 patients who were recommended to follow a Mediterranean-like prudent diet with whole-grain cereals, low-fat dairy products, fruit, vegetables and refined fats generally considered healthy. All patients had increased blood sugar after carbohydrate intake (glucose intolerance), and most of them had overt diabetes type 2. In addition, all had been diagnosed with coronary heart disease. Patients in the Paleolithic group were recommended to eat lean meat, fish, fruit, vegetables, root vegetables and nuts, and to avoid grains, dairy foods and salt.

The main result was that the blood sugar rise in response to carbohydrate intake was markedly lower after 12 weeks in the Paleolithic group (–26%), while it barely changed in the Mediterranean group (–7%). At the end of the study, all patients in the Paleolithic group had normal blood glucose.

The improved glucose tolerance in the Paleolithic group was unrelated to changes in weight or waist circumference, although waist decreased slightly more in that group. Hence, the research group concludes that something more than caloric intake and weight loss was responsible for the improved handling of dietary carbohydrate. The main difference between the groups was a much lower intake of grains and dairy products and a higher fruit intake in the Paleolithic group. Bioactive substances in grains (e.g. wheat lectin) and dairy products (e.g. casein) have been shown to interfere with the metabolism of carbohydrates and fat in various studies.

If you want to prevent or treat diabetes type 2, it may be more efficient to avoid some of our modern foods than to count calories or carbohydrate”

And here is an explanation of the the problems caused by grains for those with type 2 diabetes from The Paleo diet researcher Maelán Fontes:
Type 2 Diabetes and Endotoxemia

“In summary, antinutrients introduced with the agricultural revolution 10,000 years ago may be one of the causal factors in the epidemic of obesity, (as well as T2D) in Western countries. Lectins, saponins and gliadin increase intestinal permeability and allow increased passage of gut bacteria from intestinal lumen to peripheral circulation. LPS – an antigen found in gram-negative bacteria cell membranes – interacts with TLR-4, leading to inflammatory cytokine production and low-grade chronic inflammation, which is at the root of insulin resistance. Insulin resistance is recognised to induce the metabolic syndrome, including T2D. Endotoxemia-induced insulin resistance in T2D patients may be exacerbated, in part, by antinutrients.”

What about a low carbohydrate diet? Are there clinical studies showing it reverses the symptoms, or controls type 2 diabetes? YES
The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

Research design and methods
Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A1c.
Results
Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).
Conclusion
Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.”

What about a low carbohydrate diet over the long term?

Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up

Background

Low-carbohydrate diets, due to their potent antihyperglycemic effect, are an intuitively attractive approach to the management of obese patients with type 2 diabetes. We previously reported that a 20% carbohydrate diet was significantly superior to a 55–60% carbohydrate diet with regard to bodyweight and glycemic control in 2 groups of obese diabetes patients observed closely over 6 months (intervention group, n = 16; controls, n = 15) and we reported maintenance of these gains after 22 months.

Results

The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. At 44 months average weight has increased from baseline g to 93.1 ± 14.5 kg. Of the sixteen patients, five have retained or reduced bodyweight since the 22 month point and all but one have lower weight at 44 months than at start. The initial mean HbA1c was 8.0 ± 1.5%. After 6, 12 and 22 months, HbA1c was 6.1 ± 1.0%, 7.0 ± 1.3% and 6.9 ± 1.1% respectively. After 44 months mean HbA1c is 6.8 ± 1.3%.

Of the 23 patients who have used a low-carbohydrate diet and for whom we have long-term data, two have suffered a cardiovascular event while four of the six controls who never changed diet have suffered several cardiovascular events.

Conclusion

Advice to obese patients with type 2 diabetes to follow a 20% carbohydrate diet with some caloric restriction has lasting effects on bodyweight and glycemic control.

So it looks like what works best for type 2 diabetics who wish to control blood glucose and reverse the symptoms diabetes is a low – moderate carbohydrate, paleo eating plan.

And here is a real life result from a type 2 diabetic who did alter the course of his diabetes:
Paleo-Nu Forum: Amazing Type 2 diabetes result

And of course Drew Carey who lost 80 lbs and reversed his type 2 diabetes symptoms on a low Carb diet

What about Type 1 Diabetes?
From the many incredible stories from Robb Wolf’s Paleo Solution Blog – I’ll let you read this one yourself.
http://robbwolf.com/2009/10/19/type-1-diabetes-update-and-progress/

Given the fact that Type 1 diabetes is an auto-immune disease, I recommend that if you have it you follow the paleo diet – Why? It reduces the auto-immune reactions caused by agricultural foods; grains, legumes and dairy. In particular it pays to be strictly gluten free as there is a strong evidence that type 1 diabetics show gluten damage in their gut:
http://robbwolf.com/2009/11/09/type-1-diabetes-the-gut-connection/

And if you haven’t yet read it this book is one of the best using diet to treat diabetes:
DR. BERNSTEIN’S DIABETES SOLUTION; The Complete Guide to Achieving Normal Blood Sugars (Revised edition 2007)

And here are testimonials from Dr Richard Bernstein, diabetes specialist who has type 1 diabetes himself:
http://www.diabetes911.net/testimonials.php

And here is a debate / discussion between various specialists on whether or not a lower carb diet is best for diabetes

Kill or cure? Atkins diet debated in diabetes

Okay, to sum up - Paleo diet, low to moderate carb, (probably lower is better) and some supplements:

Fish oil – read this: Fish oil omega 3 and diabetes – Robb Wolf

It also pays to check you Vitamin D level and supplement to reach 120nmol/L to minimise insulin resistance: Vitamin D supplementation reduces insulin resistance in South Asian women living in New Zealand who are insulin resistant and vitamin D deficient – a randomised, placebo-controlled trial.

Other supplements are also useful; magnesium, chromium and alpha lipoic acid, and of course a very high nutrient, high anti-oxidant diet.

Update June 2011: A type 1 diabetic has reached the age of 90, by eating a low carb diet. http://www.diabetes-warrior.net/2011/06/12/85-years-with-type-1-diabetes/

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11 Responses to “"Why I Hate Nutritionists" (by a type 1 diabetic who failed to control blood sugar following diabetes nutritionist advice)”

  1. C #

    There is NO such thing as “reversing” diabetes. Regardless of what you’re claiming here (which I agree, a low carb/ paleo type diet is best for control).. But that is all it will ever achieve. There is no reversing. There is only control. It’s naive & ignorant to post such claims to get people’s hopes up.

    January 31, 2012 at 9:27 pm Reply
    • Yes, you are right, point taken, reversing the symptoms of type 2 diabetes is more accurate – text has been changed.

      January 31, 2012 at 9:48 pm Reply
    • Julie #

      totally disagree, yes you can reverse type 1 diabetes. read Dr William Davis, cardiologists book, there have been heaps of people put photos/stories of their success on the wheatbelly blog, a couple of them are even off their insulin, so you are wrong. my daughter in law who is a nurse in NZ, said the dieticians at the hospital she works at know the food pyramid is totally upside down but are not allowed to say anything!!! these people are giving incorrect diet advice out, through no fault of there own. basically cut all the grains out and processed food. watched the oiling of america recently, a lot of our calories came from saturated fat – by the way olive oil didnt even exist – no heart disease until we introduced bad oils and processed foods.

      September 18, 2013 at 11:23 pm Reply
      • I imagine their type 2 (I think you meant) would come back in a snap on their old diet. So it may have gone into remission, but the potential for it to come back would probably be a few bad meals away.

        If it was cured it would not come back with eating badly.

        September 19, 2013 at 6:17 pm Reply
  2. I think there are quite a few inaccuracies in this piece. You state:
    As a quick rule of thumb, here’s what raises blood glucose levels rapidly: starches and sugars (ie, carbohydrates: bread, potatoes, pasta, beans and pulses, rice, fruit, non-leafy vegetables, milk etc).

    Dried beans and pulses do not raise BG rapidly. They are low GI and have been show to raise BGs slowly. Same goes for some types of breads. Pasta has a moderate GI as does milk.

    Having said that, as a type 1, I don’t necessarily follow a low GI food plan. Rather, I have learnt to count carbohydrates and dose insulin accordingly. This means I can eat whatever I choose.

    There are reasons that some people with diabetes are advised to avoid high protein food plans (such as Atkins). If they have kidney damage, lots of protein is not recommended.

    Also, I think that scare tactics are nasty, don’t work and, when what is being said is wrong, can be damaging. Threatening impotence and blindness as a by-product of not engaging in an ‘Atkins-y sort of diet’ is a little incorrect. The risk of diabetes complications increase when BGs are elevated over long periods of time. In my opinion, the best information for people with T1 diabetes is to learn to carb count, dose insulin accordingly and eat from a wide variety of foods. Same goes for T2s on insulin.

    And, as C said, diabetes cannot be reversed. Perpetrating myths is damaging too.

    February 26, 2012 at 3:50 pm Reply
    • I personally did not write this piece – Psycho Milt – a man with type 1 diabetes did. This is his experience.

      With regards to carbohydrates and their effects on blood sugar – what you state is true – some raise blood glucose more slowly.

      As a nurse – I saw first hand the effects of uncontrolled blood sugar in people with diabetes (both 1 and 2) – yes blindness, kidney damage, impotence and loss of limbs are all too common.

      An Atkins-y style diet is what worked for Psycho Milt. It also works for others. I have also heard others like yourself say that they can manage their T1 diabetes with a controlled amount of carbs (carb counting) and careful insulin dosage. Each person needs to find what works for them.

      I have personally seen people reverse symptoms of type 2 diabetes and manage it in such a way as to show no measurements of diabetes. One could say it was reversed – but as the previous commenter pointed out – managed is a better description. I myself have auto-immune issues that are 100% symptomless when I eat a paleo diet. So many diseases today are the result of an environment / gene mismatch. In a different environment these diseases are non-existant.

      February 26, 2012 at 4:44 pm Reply
      • Honora #

        >So many diseases today are the result of an environment / gene mismatch. In a different environment these diseases are non-existent.

        Yep, the science of epigenetics. So many people are erroneously being given the message that biology is destiny when they can do something constructive about it e.g. having adequate selenium intake when pregnant to avoid switching on the cystic fibrosis gene in their fetus. But none of these patients know about this stuff.

        March 6, 2012 at 11:04 pm Reply
    • greg white #

      ”Having said that, as a type 1, I don’t necessarily follow a low GI food plan. Rather, I have learnt to count carbohydrates and dose insulin accordingly. This means I can eat whatever I choose”

      I’m a type 1 for over 20 years and know how to carb count and from my personal experience i disagree to eat what you want and learn to carb count as it can create large swings in blood sugar and for me the key is to keep blood sugar within stable range. I also believe hba1c is a poor indicator of your control as it’s an average so your blood sugar can swing low to high, as mine did, but still come out as good hba1c. I’ve eaten what i wanted and dosed correctly for 20 years and over time it’s only made a my control worse. I no longer want to eat a bowl of pasta have my blood sugar go up to 15mmol then back down to 5mmol over period of 3 hours. Plus i realised when i stopped eating grain based food that they are really boring foods. Switching to the primal diet, no wheat/grains, high protein, moderate good fat has greatly improved my control.
      Diabetes is different for each diabetic in it’s detail but i also think nutritionists give out the worst dietary advice for diabetes and the last place i go for advice on diabetes control is diabetes uk, unfortunately those new to diabetes take these websites advise as gospel.

      March 11, 2012 at 10:20 am Reply
    • Julie #

      wheat raises your blood sugar faster than a chocolate bar. watched it on Dr Oz, Dr William Davis (cardiologist) did a test on 5 people, wholewheat (supposedly healthy!!) then a chocolate bar, the wheat increased blood sugar levels in 3 of the 5 higher than the bar, so its unpredictable!! high blood sugar causes your nice big fluffy LDL to shrink to small LDL (the bad one). his book is called wheatbelly, interesting reading if you are interested in what high blood sugar levels do to your health – and it doesnt have to be high all the time to cause the damage.

      September 18, 2013 at 11:30 pm Reply
  3. Sabrina #

    Hi, i’ve had T2 diabetes since 1994. My visit to the eye doc 2 times in a month showed my vision deteriorating at a rapid rate so I bought a meter and tested. My first stick was 289 which shocked me because I had several physicals in the year past and was not told a thing about me being T2 or being in pre-diabetes.

    The best way for any diabetic to know which foods raise their blood sugar numbers is to test 45 minutes to an hour after a food. I did this after being told all the lies by the dietician and low glycemic index food and that low fat is best. I like to killed myself eating bad. I joined a group that eats keto style. Which is atkins but high fat, medium protein and very low carbs. This way of living is much healthier than any I have found so far. My lipids are normal. My A1c is ok and I am not losing more vision or other terrible things that happen to diabetics who have had it as long as me.

    True that each diabetic reacts differently to foods so do test a lot till you find the right foods for yourself. do not go like blind sheep listening to the dieticians who are trained by big pharma and big food.

    God bless all,
    Sabrina

    December 20, 2013 at 7:06 am Reply
  4. Lisa B. #

    I am so sick ‘n tired of stories that start out about Type 1 and then go into a long, long story about research and other stuff for Type 2 diabetics! I thought this article would stick to its title: Type 1. Instead we get “evidence” for type 2 and told to “go look it up” for info about Type 1. It ticked me off.

    I was diagnosed with type 1 almost 7 years ago, and I am convinced there is a cure. I was told “they” don’t know what causes it – I was told a virus; I was told the immune system attacks the Beta-cells as they release insulin, thinking its a bad substance; new research proves the pancreas CAN still produce insulin but gets the shit kicked out of it by our immune system. T-cells are getting the wrong order. With this knowledge, I’m convinced there’s a solution.

    BTW – my numbers are perfect without injecting insulin the first two days of my period – overall hormone issue possibly? I hit my head really bad before diagnosis – possible injury to hypothamus/pituary glands? I also “stupidly” agreed to a booster/vaccine – 6 months later I’m diagnosed – link? So people there’s more to this than meets the eye = oh ya, I needed glasses (blurry in distance), then got A1C back to 6.9 and no longer need them. What happened to you leading up to Type 1 diagnosis?

    One last thing – I’ve found when I am physically active out-of-the-house AND eat much less and less often is when my numbers are the best. (but I still have to carry jelly-beans for when I go low). Only benefit from this diagnosis is that I am now mindful of what I eat/drink/purchase; well, and that I also now love veggies and greens! To conclude: let’s stick to the subject of discussing solutions for Type 1 diabetes. Thank you.

    March 10, 2014 at 8:47 am Reply

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