“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.
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:
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:
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
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.
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).
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 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.
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.
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
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.
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:
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:
And here is a debate / discussion between various specialists on whether or not a lower carb diet is best for 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/