Is a low-carbohydrate diet really the best way to go? Maybe for a small percentage of people.
Researchers have been debating the benefits of using low-carbohydrate diets to control blood glucose levels in people with diabetes for decades. Starvation-level minimal carbohydrate, high fat diets were used previous to the discovery of insulin to keep people alive, and variations of lower carbohydrate diets were in vogue up to the late 1960s/early 70s when concerns about heart disease predicated the move to a more fat-restricted, higher-carbohydrate meal plan.
The pendulum has been swinging back to the use of moderately restricted carb intake in the range of 35 to 45 percent of calories over the past decade. This level of carbohydrate intake allows a variety of foods with choices among all the food groups. However, a recent article appearing in the Fall, 2012 Diabetes Spectrum by Franziska Spritzler, a registered dietitian and certified diabetes educator, challenges the wisdom or need for balance and discusses the benefits to glycemic control of following very low-carbohydrate diets in the order of 20 percent of calories or less. She also reviews and effectively rebuts some of the arguments against them, namely that they are nutritionally inadequate, overwhelmingly lead to heart disease because of elevated fat and saturated fat content and may affect thyroid levels.
It is easy to dismiss calls for the use of these type of diets when made by those outside of the scientific community but less so when the evidence in their favor are cogently presented by a member of your own trade. Ms. Spritzler does something medical researchers almost never do—she gives an example of a real world meal based on a carbohydrate load of approximately 20% of calories.
Ms. Spritzler makes some cogent arguments and there are people for whom the diet could be beneficial. However, many Americans would have profound difficulty adjusting to its requirements. In order to follow this type of diet a severe, and in the sample meal, total elimination of an entire food group occurs. No grains or starchy vegetables appear at all and the fat content of the diet is elevated beyond the culinary comfort of most Americans.
Now, it is almost a truism that most patients with type 2 diabetes need to reduce their reliance on grains and starchy vegetables, but these foods play an important role in the diet; they provide several of the B vitamins: thiamin, niacin and riboflavin. They also form the backbone of the American food culture. Presenting a mealplan devoid of starches is akin to asking Italians to stop using tomatoes.
In addition, the sample menu presented is based on a 2,000 calorie diet. Many people with diabetes need to lose weight, and calorie levels for women, for example, would fall more into the 1200 to 1500 range.
While it is certainly feasible to reach the Recommended Daily Requirement Dietary Allowance (RDA) for the nutrients such as calcium without the diet’s use of dairy products, it requires a good deal more planning, and the diet may require calcium supplementation for the average American with diabetes.