Pro Carb or Low Carb?

I must say, the debate is on!  I am not an extremist, as I believe in moderation but a popular topic in the field of diabetes, especially diabetes and weight loss is, as the title depicts, should we eat high carb, low fat, or low carb, high protein, mod fat.  What should we eat?

I am reading a book at the moment called Living Low Carb, great book!  The author Jonny Bowden compares all the low carb diets on the market. His writing style is witty, fun, and makes complicated biochemistry seem interesting, seriously, definitely worth a read! 

The author uses an analogy to clearly display how silly the current stance is for most health care providers, dietitians and associations that place huge emphasis on how carbs are absolutely essential for a healthy diet.


I love Mr Bowden's illustration:

He talks about a time he was lecturing to a large group.  He tells the group that he going to divide them in half. He explains that they are going to be stranded on a deserted island. The first half will be given only carbohydrate to survive on, and the second half will be given protein and fat but zero carbohydrate.  Then, he asks the audience who will be alive in 12 months.

The answer, backed by research  according to his literature review,  is the group that consumed protein and fat . This claim begs the question; are we being told to consume so much bloody carbohydrate when it's not essential for our survival. So I did my own lit search, not a google search but an actual lit search.

I do believe Mr Bowden and the Low Carb crew may be onto something.

The first study article written by Dyson, P and colleagues  in Diabetic Medicine took 13 Type 2 diabetics and 13 non-diabetic subjects. They were randomly placed on a low carb diet (less then 40 gms per day) or the usual diet recommended by the UK diabetes association.  They were assessed monthly for three months.  Guess what the results were?  Those assigned to the low carb eating plan, lost more weight but had minimal changes to lipids and A1C levels.  "The diet was equally effective in those with and without diabetes.
So onto the next study"  Okay good info, interesting.....

Another study done by Shai, Iris R.D and colleagues in the New England Journal of Medicine compared weight loss with three mainstream diets: low-fat, restricted-calorie; Mediterranean, restricted-calorie; or low-carbohydrate, non-restricted-calorie. What did they find?

When they randomly assigned 322 moderately obese subjects to one of the three group they concluded that:
"Mediterranean and low-carbohydrate diets may be effective alternatives to low-fat diets. The more favorable effects on lipids (with the low-carbohydrate diet) and on glycemic control (with the Mediterranean diet) suggest that personal preferences and metabolic considerations might inform individualized tailoring of dietary interventions."

Clear as mud right, so what they are telling us is that a lower Carb higher healthy fat diet may be a good alternative compared to the 60-75 % high carb diets normally recommended to us battling the big D. 
Okay, moving on......

The last study authored by  Brinkworth and colleagues in Diabetologia  randomly assigned 66 obese subjects to either a low carb (40 % carb/30% protein)or high carb(55% carb/15% protein) diet.  The results were "A high-protein weight-reduction diet may in the long term have a more favourable cardiovascular risk profile than a low-protein diet with similar weight reduction in people with Type 2 diabetes."

So you can loose weight, increase the good fat HDL, with no apparent adverse effect?  Sounds good!

After reading the books, doing a bit of a lit review(not an exhaustive one).  I try to remain unbiased, but the evidence is mounting in favour of a reduced carbohydrate way of eating.  I know that the more carb I consume, the more insulin I need, the hungrier I am, the bigger my waist gets and most importantly the sugars are way harder to control. 

Are you pro carb or low carb or somewhere in between?

Trev

Sources:
Dyson, P. A.; Beatty, S.; Matthews, D. R.(2007). A low-carbohydrate diet is more effective in reducing body weight than healthy eating in both diabetic and non-diabetic subjects, Diabetic Medicine. 24(12):1430-1435.

Shai, Iris R.D et al.(2008).  Weight Loss with a Low Carbohydrate, Mediterranean, or Low-Fat Diet,

Brinkworth, G. D. 1; Noakes, M. 1; Parker, B. 1; Foster, P. 1; Clifton, P. M. (2004).
Long-term effects o advice to consume a high-protein, low-fat diet, rather than a conventional weight-loss diet, in obese adults with Type 2 diabetes: one-year follow-up of a randomised trial, Diabetologia. 47(10):1677-1686.New England Journal of Medicine. 359(3):229-241.

The Diabetic Caveman?

I have a bit of an obsession.  Yes I know, it is not good to obsess over any thing, but I do think this is a good one!

I have been on this reading kick, and the theme lately has been low carb eating.  So in the past couple of months I have read three books and I am on my forth book related to this particular topic.

Natures Candy!

I woke up today and the first thing I craved was something sweet.  Tested the sugar and it was 3.9 mmol.  A little bit on the low side but it explained my unusual craving for something sweet.  The first thing I noticed was the beautiful ripe delicious looking orange sitting in the fruit bowl.  Of course I popped 1 dex tab to get me into normal range.  But it got me thinking about one of the books I really enjoyed.  

The "Paleo Diet" written by Loren Cordain, Ph.D.  It is a great read!  The book's premise is based on the fact that since the industrial revolution and agriculture our society no longer eats what we were genetically designed to eat, and as a result we have a huge growing obesity issue in all modern societies.  

It is commonly referred to as the "Cave man diet"  Hence the title.  

If you think about it, our ancestors could only eat what they killed, trapped, plucked, picked, and in rare occasions found in nests (eggs) Basically, berries, leafy greens, seeds, lots of lean animal protein, and the occasional egg when the opportunity presented itself.  

In other words, no processed food, bread, potatoes, anything modern agriculture and manufacturing have placed in our grocery stores. 

The modern diabetic caveman could hunt for lean meat(turkey), pick up a huge bag of frozen berries, find a small bag of unsalted seeds, and one dozen free range eggs.  Notice they are all found on the perimeter of the grocery store. 

The book ranks turkey as the highest source of protein, and nuts the lowest in terms of net protein.  

It discusses the American Food Pyramid and the recommended starch servings, and how they differ dramatically from the way we as a species used to eat.

I have put these principals into practice and feel great while eating loads of lean protein, fresh fruit, and lots of veggies.  

I am not a Diabetic Caveman, but can honestly say this is one diet that is easy to put into practice and satisfies that sweet craving.

Trev

What's up with the Food Guide!

Hello all you wonderful people!

As a nurse educator I am required to teach others with diabetes how to eat properly(well that's not all I do)  Yes, we have dietitian's for that during group programs.  However,  I do a lot of follow up with my diabetic patients.

I am required to cover the basics like, food choices, portions sizes, food types, fiber, etc.

So before every meeting, I must  reluctantly grab the Food Guide.  I say reluctantly for a few reasons.

The original Food Rules was designed and published in the 1940's, yes, the 40's when people were actually needing to gain weight, and suffered from malnourished diseases like scurvy, vitamin deficiencies.

Fast forward to now.  Go to the mall and look around and it is unfortunately obvious that we are no longer malnourished.

So I enter the room to advise my patient on proper eating, using a tool invented in the 40's, although it has been modified over the years.  At least now in Canada the fruits and vegetables are prioritized to the top, not starches like before. Unfortunately protein is on the bottom.

It is let's just say a professional dilemma for me to advise a person with diabetes to consume huge amounts of carbohydrate. Let's just kill the little Islet cells they have left shall we(Sense the sarcasm) Anyhow, I need a job so I have to follow the rules.

So there I am sitting across from an individual who tells me "I have been following the guide as recommended, and I am gaining weight, my blood fats(lipids) keep getting worse, and my diabetes is getting harder to control"
What do I say?  I can tell you what I want to say, which is,  stop eating so much carb, and grill yourself some lean steak and omega three eggs for breakfast instead of the 2 cups of cold cereal loaded with 80 grams of CHO(carbohydrate)

Back to reality. Don't worry, I rely on other tools.

I discuss the fact that obviously the plan is not working, so perhaps try reducing your carb intake by 10-20 grams per meal, add some lower carb vegetables, and increase the leaner proteins. I also explain the concept of glycemic index, fiber, and the role of fat and protein in satiety.

I encourage them to simply explore the literature, trial and error, and to ask themselves if their current method is actually working.

Basically I give them some food for thought, no pun intended.

I am glad that more and more people are considering lower carbohydrate diets as a healthy and legitimate weight loss strategy.  I am also glad that more and more research is being done on the effects of a lower CHO diet.

One final note: I tell them to shop on the perimeter of the grocery store and avoid the inner isles where all the super-carb loaded food is stored.

Trev