The ADA has always believed that obesity was the cause of type 2 diabetes and that weight loss was the primary tool to battle it. (Type 2 diabetes was formally called "adult onset" diabetes but due to the "obesity epidemic" it was showing up in kids as young as 10 years old.) The ADA called for a reduction in total caloric intake via a low fat diet and increased activity levels. Here is what they have added for their 2008 guidelines:
Until now, the ADA did not recommend low carbohydrate diets because of lack of sufficient scientific evidence supporting their safety and effectiveness. The 2008 Recommendations include a statement recognizing the increasing evidence that weight-loss plans that restrict carbohydrate or fat calorie intake are equally effective for reducing weight in the short term (up to one year).This sounds like good news to us low carbers, but why only 1 year? Let's read on:
Because people following low carbohydrate diets may replace calories from carbohydrate with fat or protein, the recommendations also include monitoring the lipid profile (blood fats, including cholesterol and triglycerides) of patients on such diets.Interesting... In the first quote they are "recognizing the increasing evidence," which makes me think they might have read a scientific paper or 2. But any paper that found weight loss was about equal on either diet also found that lipid profiles improved more on a LOW CARB diet then on a low fat diet. (A link to the most recent paper showing this can be found here.) So they seem to be cherry picking the info they want and hiding or denying anything else. After all, the ADA has spent decades promoting the low fat diet with out any evidence, why admit they were wrong all that time? Not only have they been promoting low fat, they have been vilifying low carb. They go onto to say this:
High protein diets may also worsen kidney problems. Therefore, it is also recommended that patients with kidney disease be counseled about appropriate intake of protein and that their kidney functions be monitored carefully.But there is no eveidence of this nor any physiological mechanism that confirms this. Still, they attack low carb with out any scientific evidence.
Recently, Adam Campbell of Men's Health magazine wrote an article criticizing the ADA's nutritional recommendations (more on that later). The ADA wrote him a letter saying,
"...your publication printed dangerous information that could potentially jeopardize the lives of millions of Americans with diabetes or at risk for diabetes."That doesn't sound like an endorsement, but a year later they now tell the medical community that low carb can be useful for weight loss.
Many people in the low carb community see this is a partial victory, as do I, but there is still a lot of work to do. The ADA isn't recognizing all the other health benefits of a low carb life style, like curing the disease the ADA is organized to cure. Huh, cure diabetes? Yes, at least type 2 that is.
Let's briefly look at how low carb and low fat affect blood sugar and insulin and how elevated insulin causes type 2 diabetes. Type 2 diabetes is caused by the body's inability to use insulin properly. In normal individuals elevated blood glucose will cause an insulin release. Insulin bonds with the cells and allows the blood sugar into the cells to be used as energy. If the blood sugar is constantly elevated and the insulin is also, then over time the cells become desensitized to insulin. This results in an even higher blood sugar, more insulin is released and the cells become more desensitized. This starts a downward spiral that ends with type 2 diabetes.
Until December 28, 2007, the ADA recommended a low fat diet exclusively to prevent people at risk for diabetes to become diabetics. Let's see how that works out. There are 3 macro nutrients that the body can use to make energy: fat, protein and sugar (carbohydrate). When we reduce fat we naturally reduce protein since the 2 are closely linked. This leaves carbs as our primary source of energy. Carbs break down into blood sugar and we start the previous mentioned downward spiral. What makes this worse is when we remove fat from our naturally occurring foods. This makes previously yummy foods taste crappy so we do one of 2 things: 1. Replace the natural fat with a fat that is thought to be less unhealthy (that's were we get transfats from), or 2. We add sugar. Now we have taken someone at risk of getting diabetes and told them to increase their sugar intake. BRILLIANT!
Low carb will have the same calorie reducing effect as a low fat diet but allows us to burn fat for energy (This is called "ketosis" and I will dedicate a whole other blog entry to it). It has no effect on blood sugar or insulin and in a type 2 diabetic it will normalize blood sugar and insulin. Which method do you want to try?
Amendment for 1/2: Click here for a list if links to research articles showing the many health benefits of low carb AND articles showing how low fat is NOT a healthy choice.
