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The CDE’s position on low-carb diets for diabetics:

Hi everyone!

So in yesterday’s post I mentioned that the CDE (the Centre for Diabetes and Endocrinology) did not agree with Professor Tim Noakes’ approach to the diabetic diet. Here is their full position on the matter, for anyone who would like it – it’s a very interesting read.

Let us know what you think about this issue, and what questions you would like us to ask on your behalf, by commenting on this blog post, below:

Summary of position:

The CDE recognises the importance of medical nutrition therapy in the management of people with diabetes mellitus. However, the CDE wishes to emphasise the importance of a well-balanced comprehensive dietary strategy that has to be sustainable, cost-effective and individualised for each patient. We also wish to draw attention to the fact that “carb-free”, “low-carb”, “high-protein” and other such diets have shown no long-term benefit over conventionally balanced healthy eating plans. Healthcare professionals and patients should be aware of the scientific merits (or lack thereof) related to nutrition recommendations from various sources. Most importantly, they should receive their guidance from practitioners trained in diabetes rather than from the media.

Introduction

Low-carbohydrate (or high-protein) diets for the treatment of obesity are not new, and have fallen in and out of vogue for many years. They have been promulgated in many forms, from the Atkins Diet to the SureSlim weight loss programme and many more.

Recently, the concept of a low-carbohydrate diet has been revisited in the lay press, the Discovery Health Magazine and on television. These publications make no mention of caloric restriction and it would appear that although carbohydrates need to be severely restricted, calorie / energy intake is unlimited.
Of concern is that the current publicity implies that not only are these diets ideal for patients with both Type 1 and Type 2 diabetes as well as people with pre-diabetes, but that current dietetic principles are outdated. Furthermore, the distinction between Type 1 and Type 2 diabetes is not highlighted.

Nutritional recommendations for patients with Type 2 diabetes

Nutritional therapy is fundamental for the effective management of diabetes, playing a vital role in helping people with diabetes achieve and maintain optimal glycaemic control. This helps to reduce the risk of long-term complications of uncontrolled diabetes. Weight management too remains a key aspect of the treatment of type 2 diabetes. However, the optimal macronutrient distribution for weight loss diets has not been established.

Individuals who have pre-diabetes or diabetes should receive individualised advice. A registered dietician familiar with the components of diabetes therapy best provides this. It is paramount that the cultural, social, ethnic, financial and personal preferences are taken into account when tailoring dietary guidance.

High-protein, high-fat diets are normally associated with a high intake of saturated fat and cholesterol originating primarily from animal sources. In these high-protein diets, initial weight loss is significant due to fluid losses from a reduced carbohydrate intake and lower energy intake. There is also the additive effect of ketosis-induced appetite suppression. The beneficial effect on insulin resistance is due to weight loss, not the change in calorie composition.

The promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets. This therefore provides initial palatability.

Of further concern is that by their very nature, high-protein diets are expensive and not sustainable. In this country where approximately 13 million people live below the breadline and poverty is rife, it is clearly not practical to advise a high-protein diet for all. In addition to the cost considerations, high-protein diets can only be supplied to large populations through highly industrialised methods of production, which are ethically problematic and environmentally unsustainable. Furthermore, a proportion of South Africans adhere to predominantly vegetarian diets for moral, ethical, religious or cultural reasons.

Given that a large number of people with type 2 diabetes have silent or undetected coronary heart disease (CHD), in addition to atherogenic lipid profiles, it seems inappropriate to advocate a diet high in saturated fat. This would only serve to perpetuate their risk continuum. It is therefore inappropriate to opt for a single approach in the management of a complex condition such as diabetes.

Low-Carbohydrate Diets

It is recognised that generally the intake of refined carbohydrates as well as those that are high in fat has increased in recent years. Whilst high-carbohydrate diets are not promoted for people with diabetes, the emphasis should be on portion control and a choice of good-quality high-fibre carbohydrates.

Low-carbohydrate diets have been attractive as a means of losing weight, as well as optimising blood glucose control, especially in people with Type 2 diabetes. There has been much debate about whether this is both safe and effective.
A position statement has been put out from Diabetes UK (DUK). The evidence relating to low-carbohydrate diets from 1998-2009 was reviewed.

It was concluded that:

  • There is evidence that low-carbohydrate diets can lead to reductions in body weight and improvements in HbA1c in the short term (less than 1 year).
  • Weight loss from a low-carbohydrate diet may be due to a reduced energy (calorie) intake and not specifically because of the associated carbohydrate reduction.
  • Although there may be a benefit in the short term, there is no long-term safety data or benefit of following this diet.

It has been recognised by organisations such as Diabetes UK (DUK) and the American Diabetes Association (ADA) that a range of approaches to weight loss should be considered. The overall aim is that energy intake should be less than energy expenditure. The most suitable means of achieving this should be negotiated between the patient and their dietician.

How much carbohydrate is in a low-carbohydrate diet?

Carbohydrate is a component of food that is a source of energy, which is digested into glucose. It is an essential fuel, especially for the brain. If carbohydrate intake is severely restricted and glucose stores are exhausted, fat stores will be broken down and used as energy. During this process, ketones are produced and excreted in the urine – this is the ketosis discussed above. Approximately 50-70 g per day of carbohydrate is required to prevent ketosis.

The ADA recommends at least 130 g of digestible carbohydrate per day. This is based on providing adequate glucose as the fuel for the central nervous system without reliance on glucose production from ingested protein or fat. Although the necessary energy for the brain can be supplied on lower carbohydrate diets, the long-term metabolic effects of very low-carbohydrate diets are not clear.
Due to these restrictions and food eliminations, certain essential micronutrients and fibre may be lost. This may require dietary supplementation.

DUK recommends that for a 2000 kcal (8400 kJ) diet, 45%-60% of the total energy should be supplied by carbohydrate (225-300 g per day).  As there is little evidence for the optimum proportion of carbohydrates for people with diabetes, the DUK 2011 guidelines2 recommend active carbohydrate management in terms of glycaemic control or weight loss rather than prescribing absolute intakes.

Following this, the following definitions have been suggested:

  • Moderate-carbohydrate diet: 130-225 g per day (26-45 % of a 2000 kcal diet);
  • Low-carbohydrate diet: less than 130 g per day (26% of a 2000 kcal diet);
  • Very low-carbohydrate, ketogenic diet: less than 30 g per day (6 % of a 2000 kcal diet).

It is clear that significant weight loss will improve glycaemic control. A pilot study of a Very Low Calorie (VLC) Diet consisting of 600 kcal per day was shown to be effective in reversing hyperglycaemia in newly diagnosed patients.

Acknowledging that VLCD or low-carbohydrate diets may be appropriate for a minority of patients, they must be supervised by an appropriately trained team that should include a registered dietician familiar with the methodology followed by the Newcastle group.

Finally, the acclaimed DASH (Dietary Approaches to Stop Hypertension) study showed that a high-carbohydrate diet including fruit, vegetables, non-fat dairy products and wholegrain reduces blood pressure.

Risks and side effects of a low-carbohydrate diet

One of the main side effects is the risk of hypoglycaemia, which is heightened during physical activity. It is therefore necessary to consider overall control and ensure that blood glucose levels are monitored and medication adjusted accordingly. Other reported side effects include headaches, lack of concentration, fatigue and constipation.

Nutritional recommendations for patients with impaired glucose tolerance (pre-diabetes)

Several large and robust studies, including the Diabetes Prevention Program (DPP), the Finnish Diabetes Prevention Study and the Chinese Da Qing Diabetes Prevention Study have been undertaken in people with impaired glucose tolerance or ‘pre-diabetes’. These studies all had a treatment arm related to amending participant lifestyles to delay or prevent Type 2 diabetes. In summary, the lifestyle intervention arms proved more efficacious than either medication or placebo in terms of the main outcome. Typically, the provision of nutritional guidance was undertaken by and monitored by a team, which included a dietician. None of these studies included a low-carbohydrate diet. In fact, the best outcomes were achieved with careful reduction in total calories and specifically a reduction in fat consumption.

Thus, good evidence exists for low-fat, reduced calorie diets for the prevention of diabetes. These studies have formed part of the annual ADA Clinical Practice Recommendations. The 2012 ADA Standards of Medical Care in Diabetes endorse the fact that it is less costly to offer group intervention than for individuals to participate alone in respect of the lifestyle changes required to prevent diabetes. No evidence base exists to suggest that a low-carbohydrate diet should be used to prevent or delay diabetes. Thus, blanket recommendations for individuals as a means of delaying or preventing their diabetes by pursuing a low-carbohydrate diet alone remain untested, especially in the South African setting.

Due care should be taken in respect of this group of individuals. They must be willing to make durable behavioural changes. They will require the on-going support of a team of suitably qualified professionals and therefore be subjected to a consistent message based on current validated evidence.

Nutritional recommendations for patients with Type 1 diabetes

The majority of patients with Type 1 diabetes are not overweight, and the dietary approach should be to educate these patients on the impact carbohydrate consumption would have on their insulin requirements. This has been well demonstrated through the highly successful and validated DAFNE (Diet Adjustment For Normal Eating) programme, a taught-course for people with Type 1 diabetes, which normalises food intake based on individual preferences and appetite. There is evidence that these programmes do not promote weight gain.

The use of a low-carbohydrate diet in individuals with Type 1 diabetes may well promote ketosis and predispose these individuals to either ketoacidosis or to severe hypoglycaemia following exercise. Not only would a low-carbohydrate diet not be recommended for those with Type 1 diabetes, but also it could be considered to be absolutely contraindicated.

Conclusion

We concur with the findings of the latest Diabetes Excess Weight Loss (DEWL) trial, which was a randomised controlled trial of high-protein versus high-carbohydrate over 2 years in type 2 diabetes. This study does not support the idea that high-protein intakes have any greater benefit on glycaemic control, lipid profile or blood pressure. This study reinforces the need to find ways to achieve sustained reduction in total energy intake as the primary focus to achieve long-term weight loss and supports a flexible approach to dietary composition for individuals with type 2 diabetes.

Future research should focus on reducing the barriers in sustaining the behavioural changes needed to achieve a reduction in energy intake in free-living individuals. Highly controlled dietary studies are unlikely to answer this challenge.

Ultimately total energy intake is the most important determinant of weight loss, regardless of macronutrient composition.

Finally, the degree of adherence will predict outcomes rather than the type of dietary strategy. Intuitively, a diet is more successful if an individual finds it acceptable and enjoyable.

“How skilled are we as healthcare professionals in helping patients to lose weight?” writes the esteemed diabetologist, Hannele Yki-Järvinen. “Did you ever get training in such skills? I didn’t. I learned how to write a prescription and have learned since that what I would need the most is what I know the least: how to help, encourage and support the patient to take control.”

The CDE endorses the notion that there is no one more suitably qualified to offer appropriate dietary guidance than is a registered dietician. Widespread advocacy of only one particular diet in the context of diabetes or pre-diabetes is inappropriate. Unless a comprehensive diet history is taken and the social, personal preferences, cultural sensitivities and economic means of the individual and family are taken into account, dietary guidance is at best unhelpful and at worst potentially harmful.

The Endocrinologists associated with the CDE Network nationwide have reviewed this Position Statement.
Written by: Landau S, Daniels M, Mufamadi V, Grobbelaar L, Brown M and Distiller LA

References
1. Diabetes UK: Position statement: Low-carbohydrate diets for people with Type 2 diabetes. March 2011. Accessed from diabetes.org.uk
2. Dyson PA, Kelly T, Deakin A et al. Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine 2011;28:1281-1434
3. American Diabetes Association. Nutrition recommendations and intervention for diabetes: A position statement of the American Diabetes Association. Diabetes Care 2008; 31: 61-78.
4. Lim EL, Hollingsworth KG, Aribisala BS et al. Reversal of type 2 diabetes: normalisation of beta-cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011; 54: 2204-2207
5. Sacks FM, Svetkey LP, Vollmer Wm et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001;344:3-10
6. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or Type 2 diabetes medication. N Engl J Med 2002;346:393-403
7. Tuomilehto J, Lindstrom J, Eriksonn JG et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344: 1343-1350
8. Li G, Zhang P, Wang J et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20 year follow-up study. Lancet 2008;371:1783-1789
9. American Diabetes Association. Standards of medical care in diabetes-2012. Diabetes Care 2012;35(S1): S11-SS63
10. Krebs JD, Elley CR, Parry-Strong A. The Diabetes Excess Weight Loss (DEWL) Trial: a randomized controlled trial of high-protein versus high-carbohydrate diets over 2 years in type 2 diabetes. Diabetologia 2012; 55:905-914.
11. Yki-Järvinen H. Type 2 diabetes: remission in just a week. Diabetologia 2011; 54: 2477-2479.

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13 Comments

  1. PIETER BRINK PIETER BRINK

    I am 72, diabetic for almost 30 years, overweight, especially after starting to use shortterm Apidra along with longterm, Lantus. With Lantus alone I had better weight control. I also use Glucopharge 3x daily. I believe in high carb diet. I suffer lately from taste promblems even with taking Zink supplements. I can tollerate only a few foods. I cannot take most of my previous favourite foods, salads etc I survive on bread products and fresh fruit. I cannot take most meats, like steaks etc, mostly small amounts. Exept for eggs, I am on a low protein diet. I also suffer from skin rash caused by prescription medicine. Carbs are keeping me alive! Until recenty I could do almost 10000 steps per day, But last year I had a setback because of 6 months of Bronchitus. Currently I do 2500 steps per day. Thanks for the info!

  2. Rene Niemann Rene Niemann

    This is a response to Pieter Brink that left a message regarding low-carb diets! While reading your message a few things jumped out that caused me to worry about your diet and diabetes. I see you are 72, overweight and using short and long acting insulin as well as glucophage 3 times a day!! I am sure your doctor explained to you that insulin causes a bit of weight gain and the more carbs you eat the more insulin you need to inject and then the more weigth you gain.
    I hear you that your taste is affected; has your kidney function,liver function and Vit B12 been tested recently by your doctor? At your age Glucophage 3 times a day should always be monitored in conjunction with your kidney function as we know our kidney function does deteriorate with age and diabetes. Try a “good” vitamin supplementation like Diabion or Diabecinn to assist you. So great hear that you are trying to exercise even though you feel poorly! You are an example to a lot of diabetics. Keep it up!

  3. Guy Meredith Guy Meredith

    What I find fascinating about the above “recommendation” is that it is suggested that one of the main side effects of a low-carb diet is the risk of hypoglycaemia. What drivel – by definition, a low carb diet requires less insulin, and less insulin means less risk of hypoglycaemia. I have been on a low carb eating plan for a year now, I am an insulin-dependent diabetic who has had the condition for 42 years now – and I have had far less hypos since adopting the diet than I ever had whilst following the traditional diet recommended for diabetics. Hence, I would venture that the rest of the recommendations above be taken with a large pinch of salt, as the authors are clearly somewhat misinformed.

  4. Give yourself permission to enjoy an occasional dessert if your diabetes is properly managed and under control.

    Sweets, junk food, and sodas are not allowed on the DASH diet.
    Because the body does not make insulin, the treatment consists of insulin delivered by
    injection or a pump.

  5. Ronel Ronel

    My child is a Type 1 diabetic. We started a low carb diet a year ago and his A1c dropped to 6.2 – he has NEVER had so few hypo events as currently… My child is extremely active and has never been so healthy in his life!

  6. This is a very confusing article. Plan and simple if you are a diabetic, carbohydrate is your enemy. When you eat even small amounts of carbohydrate – say 20g – blood sugar goes up and requires insulin to bring it down. Increasing that load of carb/insulin will bring you into the realm of unpredictability – hypoglycemia is possible, as is hyperglycemia. Large doses of insulin and carbohydrate yield an unpredictable blood sugar. This problem has already been solved for many years – a low carb diet advocated by Dr. Richard K. Bernstein. When you follow his low carb diet, blood sugars are normalized, the threat of hypoglycemia diminishes, complications from elevated blood sugars go away and are even reversed. Depression fades. Your article brings up ketoacidosis – but the data show that the threat of DKA vanishes when you follow a low carb diet. Why? Because DKA is a product of ketones AND high blood sugar. The author of this article does not even understand the basics of fat metabolism, but is offering advice that will do serious damage to diabetics. And an on are the mistakes – hypoglycemia from exercise is ALSO diminished as industrial amounts of insulin are not on board in the body from trying to cover unnecessary carbohydrate. And again you make the mistake that the body needs 130g of carbohydrate. This claim is incorrect and is made over and over again and is causing real damage. The body can make all the glucose it needs via gluconeogenesis. So again you have missed some basic biochemistry. These are not just theoretical mistakes you are making, there are large groups of diabetics thriving – of all ages – with normal blood sugars on a low carb diet. Is Tim Noakes aware that he is associated with an article with so many mistakes?

  7. I am extremely disheartened that the mainstream medical community is still recommending so many carbohydrates for diabetics. As a Type 1 diabetic for the last 13 years, not overweight, I have had a total pancreatic failure, which has caused an inability to process carbohydrates. That is what Type 1 is. As a result, I follow a low carb diet and within the last 3 months, my A1c has been reduced from 7.1% to 4.39% with very few hypoglycemic episodes. I have seen these results with many Type 1 diabetics, children included, who are thriving while following the recommendations of Dr. Richard K. Bernstein in the USA. If my two young daughters were ever diagnosed with Type 1 Diabetes, I would not hesitate to start them immediately on a diet recommended by Dr. Bernstein or Prof. Tim Noakes because I know that their blood glucose levels can be maintained between 70-100 mg/dL, as mine are, despite having Type 1 diabetes.

  8. I have been a type 1 diabetic for 34 of my 35 years and I have been following a low-carb meal plan for the last 5 years. Not only did I lose weight (55lb), but I normalized my blood pressure (from 140/90 to 110/60), my lipids are phenomenal, my kidneys are great, my liver is great, my heart is great. All health markers are wonderful, I cut my insulin use in half, and my a1c stays in the 4.8-5.2 range with minimal hypos.

    Prior to low-carb, I was on a constant blood sugar roller-coaster. I had hypos and hypers on a daily basis even though my a1c was considered, “optimal” in the 6-7 range (even in the 5’s during pregnancy with multiple hypos). At 30 years old I was on 15 prescription medications. I now take 1 prescription in addition to my insulin.

    There are substitutes for every food you can think of, so I never feel deprived. If I want a cookie, I make a low-carb version with almond flour and erythritol, if I want ice cream, I make it with real cream and almond milk and natural flavorings. I can even have pizza with no bg spike! There really is no downside to this other than taking the time to cook and skipping the junk processed foods (which is not a negative in my book).

  9. Mikael Nordström Mikael Nordström

    The CDE recognises the importance of medical nutrition therapy in the management of people with diabetes mellitus.
    -First of all, the code of honor the medical establishment are agreed on are to NOT treat ill people with medication at the first place. But someone seems to have forgot that.
    However, the CDE wishes to emphasise the importance of a well-balanced comprehensive dietary strategy that has to be sustainable, cost-effective and individualised for each patient.
    -Second, the diseases like the sugar diseased type 1 and type 2 diabetics can only live a healthy life when they are on low or nill carb food plans.
    We also wish to draw attention to the fact that “carb-free”, “low-carb”, “high-protein” and other such diets have shown no long-term benefit over conventionally balanced healthy eating plans.
    -And there are no long-term studies for a healthy life on the current high carbohydrate sickening diets either, contrary 60 years of high carb sickening diets have exploded all the metabolic sicknesses. Research now shows how carbs attack cells in the body, destroying receptors that acts on hormones needed for control of the contents coming into the cell. Research have seen how the beta cells and alpha cells in the pancreas are attacked by fructose in combination with vegetable oils and creating inflammations on the cells. We know today that type 2 is due to high over dosage of carbohydrates, research shows how the receptors for insulin get destroyed and when approx. 5.000 receptors are left from the original 20.000 you become a full fledge type 2 diabetic.
    Healthcare professionals and patients should be aware of the scientific merits (or lack thereof) related to nutrition recommendations from various sources. Most importantly, they should receive their guidance from practitioners trained in diabetes rather than from the media.
    -This is a false claim. Most “evidence” you are trying to fool people to trust are just fake research. And the worst one is that lead to this sickening diet advices we are now eating in the world. The worst research was carried out by Ancel Keys in usa. He had a belief based on lack of knowledge that cholesterol was the reason for coronary health issues. But today we know more and we now know that cholesterol is not the reason. As with diabetes it is carbohydrates that are the reason for coronary health issues.
    Introduction
    Low-carbohydrate (or high-protein) diets for the treatment of obesity are not new, and have fallen in and out of vogue for many years. They have been promulgated in many forms, from the Atkins Diet to the SureSlim weight loss programme and many more.
    -The low carb LCHF of today are based on modern knowledge what the body do and how the human body have evolved since we was an ape.
    Recently, the concept of a low-carbohydrate diet has been revisited in the lay press, the Discovery Health Magazine and on television. These publications make no mention of caloric restriction and it would appear that although carbohydrates need to be severely restricted, calorie / energy intake is unlimited.
    -This is a true fact that restriction on carbohydrates is the only way to follow. We humans do not burn fuel as a combustion engine does. That is what the “burning” principle come from when we talk about burning energy. But our body is not a combustion burning chamber, we are a chemical process plant that operated under 37 degree Celsius. As long the body cells are not damaged, they can move the carbohydrates from the blood to the cells and “burn” them. But that fails when your cells get damaged by foremost fructose. Then the “caloric” principle totally fail.

    Of concern is that the current publicity implies that not only are these diets ideal for patients with both Type 1 and Type 2 diabetes as well as people with pre-diabetes, but that current dietetic principles are outdated. Furthermore, the distinction between Type 1 and Type 2 diabetes is not highlighted.
    -The fact are that type 1 and type 2 people get sick when eating carbohydrates, and pre-diabetes is the “pre”-state before they go into a carbohydrate sickening type 2 or in some cases type 1 due to that our immune system is closed because of too high amount of glucose in our blood. And this is what low carb means, to not get sick. It is about preventing the blood glucose from getting into the deadly roller coaster levels as you get with a sickening carbohydrate diet.
    Nutritional recommendations for patients with Type 2 diabetes
    Nutritional therapy is fundamental for the effective management of diabetes, playing a vital role in helping people with diabetes achieve and maintain optimal glycaemic control. This helps to reduce the risk of long-term complications of uncontrolled diabetes. Weight management too remains a key aspect of the treatment of type 2 diabetes. However, the optimal macronutrient distribution for weight loss diets has not been established.
    -And you can never establish an optimal glycemic control or an optimal macronutrient schema if you are eating according to the sickening carbohydrate diet. There are 20% errors in the calculation on carbohydrates, there are 20% error in the calculations on the amount of blood lowering medications you need. And then add up with other factors who creates glucose and activities that lowers the blood sugar depending upon the state your cells. When you mix that in a high carbohydrate diet your blood sugar will go nuts. And for most it does, creating a lot of complications.
    Individuals who have pre-diabetes or diabetes should receive individualised advice. A registered dietician familiar with the components of diabetes therapy best provides this. It is paramount that the cultural, social, ethnic, financial and personal preferences are taken into account when tailoring dietary guidance.
    -The dietician do not have education for threating diabetics. Most dietician are trained by the sugar industry. The dietician organizations are heavily supported from the process food companies that base their sickening food on sugar and genical modified crops that no human have eaten before.
    High-protein, high-fat diets are normally associated with a high intake of saturated fat and cholesterol originating primarily from animal sources. In these high-protein diets, initial weight loss is significant due to fluid losses from a reduced carbohydrate intake and lower energy intake. There is also the additive effect of ketosis-induced appetite suppression. The beneficial effect on insulin resistance is due to weight loss, not the change in calorie composition.
    -Totally false!!! True, for every molecule of carbohydrate you have you bind 10 molecules of water, basic bio-chemistry. By eating saturated fat (not high amount of protein, protein become sugar if eating too much of protein and we shall keep to the amount the body need).
    -When it comes to ketosis, not to be mistaken as ketoacidosis, our body have started to fuel it cells from healthy saturated fat. Saturated fat and carbohydrates are built up of the same atoms, only put together differently, saturated fat does not raise the blood sugar while carbohydrates does. But when the cells are feed from saturated fat (ketons) it allows a signal hormone to start sending out the signal that the cell is full of energy and do not need more. Those leptin signals are suppressed when eating carbohydrates and that’s why we continues to eat even if we are full.
    -Insulin-resistance have nothing to do with weight loose or calorie composition. Insulin-residence is when the cells do not work with the insulin. Basic bio chemistry, insulin is a hormone that acts as a key for letting energy go in and out of the cell. And when it attaches itself to the insulin receptors on the cell it open a channel that the energy can go into the cell. But due to fructose, the receptors are getting destroyed. And when that happen the cell cannot open and let the energy go out to be burned as energy. This is the basics of pre-diabetes, diabetes type 2, diabetes type 3 and also on many diabetes type 1’s when they have been overconsuming of carbohydrates. Sucrose consists of 50% glucose and 50% fructose.
    The promoters of high-protein diets promise successful results by encouraging high-protein food choices that are usually restricted in other diets. This therefore provides initial palatability.
    -No low carb eaters eat high protein. That is like eating sugar itself. Get a grip and educate yourselves.
    Of further concern is that by their very nature, high-protein diets are expensive and not sustainable. In this country where approximately 13 million people live below the breadline and poverty is rife, it is clearly not practical to advise a high-protein diet for all. In addition to the cost considerations, high-protein diets can only be supplied to large populations through highly industrialised methods of production, which are ethically problematic and environmentally unsustainable. Furthermore, a proportion of South Africans adhere to predominantly vegetarian diets for moral, ethical, religious or cultural reasons.
    -The desserts on the earth are mainly because of agriculture of grains. By keeping agriculture kills the soil if there are no animals that fertilize the soil. And this is what happen around the earth now, more and more desserts. In USA you can see wast lands get dead due to poisons from fertilizer based on carbon oils and chemicals that kills ALL organisms and animals that are helping the plants to live.
    -The only way to sustain our land is to let animals nourish on the land. And we will live of those animals and primary from their fat. We will obtain all need macronutrient this way and therefore we need no carbohydrates at all, not even for our brain. That is what our body have evolved to do. Not to eat grass.
    -And if you look at the human body, we do not have the intestines to eat grass. Apes have a longer gut so they can process grass to some extends. But we human have not, we are like lions, cats, hyenas and even dogs, primary fat eaters and then protein eaters.
    Given that a large number of people with type 2 diabetes have silent or undetected coronary heart disease (CHD), in addition to atherogenic lipid profiles, it seems inappropriate to advocate a diet high in saturated fat. This would only serve to perpetuate their risk continuum. It is therefore inappropriate to opt for a single approach in the management of a complex condition such as diabetes.
    -The (CHD) is because of carbohydrates. Not saturated fat. Fructose in combination with vegetable oils creates inflammation in the blood vessels and ends up as CHD (remember now that vegetable oil have not been a human food. It is a human manufactured food. Not natural). The reason vegetable oil emerged was because of the inventor of the electric light. When Edison started to sell those lighst the market for “Burning” oil disappeared. And one company was urged to save their company. The company was Proctor and Gamble. So they asked chemist if they could create something with that toxic vegetarian oil and make it to something for food use. And yes they did, they invented Margarine in 1921. And they sold it through their company Cresco.
    Low-Carbohydrate Diets
    It is recognised that generally the intake of refined carbohydrates as well as those that are high in fat has increased in recent years. Whilst high-carbohydrate diets are not promoted for people with diabetes, the emphasis should be on portion control and a choice of good-quality high-fibre carbohydrates.
    -The raise in fat are from toxic vegetable fats, not saturated fat. The amount of saturated fat have decreased by 24% since 1965 and the amount of sugar have raised 35%. The there are no good carbohydrates, they are all glucose or fructose molecules. Glucose raising the blood glucose and dropping the immune system and by fructose who attacks our cells and destroys them. Does not matter how many, if your body can act on the toxic carbs, you get sick.
    Low-carbohydrate diets have been attractive as a means of losing weight, as well as optimising blood glucose control, especially in people with Type 2 diabetes. There has been much debate about whether this is both safe and effective.
    A position statement has been put out from Diabetes UK (DUK). The evidence relating to low-carbohydrate diets from 1998-2009 was reviewed.
    It was concluded that:
    • There is evidence that low-carbohydrate diets can lead to reductions in body weight and improvements in HbA1c in the short term (less than 1 year).
    -WRONG! Many diabetics are on many years now and still get perfect HbAic’s. Even better than many non diabetics.
    • Weight loss from a low-carbohydrate diet may be due to a reduced energy (calorie) intake and not specifically because of the associated carbohydrate reduction.
    -WRONG! There are research done on low carb people and even if they eat 5000 calories a day they loose weight. As son they let the carbohydrate intake raise they stop loosing weight. Carbohydrates blocking the cells to release the energy.
    • Although there may be a benefit in the short term, there is no long-term safety data or benefit of following this diet.
    -WRONG! many people have been on low carb LCHF for decades and have superb health numbers. As said before, we have 60 years of high carb diets and the result are alarming.
    It has been recognised by organisations such as Diabetes UK (DUK) and the American Diabetes Association (ADA) that a range of approaches to weight loss should be considered. The overall aim is that energy intake should be less than energy expenditure. The most suitable means of achieving this should be negotiated between the patient and their dietician.
    -False and WRONG! As long as your cells work you can set 1 to 1 in energy expenditure. But as soon as carbohydrates have started to destroy your cells that do not count. See previous explanation above.
    How much carbohydrate is in a low-carbohydrate diet?
    Carbohydrate is a component of food that is a source of energy, which is digested into glucose. It is an essential fuel, especially for the brain. If carbohydrate intake is severely restricted and glucose stores are exhausted, fat stores will be broken down and used as energy. During this process, ketones are produced and excreted in the urine – this is the ketosis discussed above. Approximately 50-70 g per day of carbohydrate is required to prevent ketosis.
    -FALSE!!! Carbohydrates are not a essential fuel. We do not need a gram of it. They fuel the cells use is AcCoA, Acetyl coenzyme A. Both saturated fat and carbohydrates are converted in the cell to AcCoA and burned as fuel in the mitochondria. The cell can use both but one is raising the blood sugar and the other one not. What this false claimed text above say and probably mean is ketoacidosis which is due to high amount of carbohydrates and lack of insulin. A common event among high carbohydrates feed diabetics and worst among pump users.
    -When healthy saturated fat are used as fuel it is converted to ketones. And our cells then starts to use that as energy. A clean and non toxic energy.
    The ADA recommends at least 130 g of digestible carbohydrate per day. This is based on providing adequate glucose as the fuel for the central nervous system without reliance on glucose production from ingested protein or fat. Although the necessary energy for the brain can be supplied on lower carbohydrate diets, the long-term metabolic effects of very low-carbohydrate diets are not clear.
    -130 g of carbohydrates are dangerous levels of carbohydrates, even for a non diabetic that starts to get destroyed cells. We know now that all destruction on the nervous system are due to carbohydrates. And many diabetics have damaged nervous system.

    Due to these restrictions and food eliminations, certain essential micronutrients and fibre may be lost. This may require dietary supplementation.
    -FALSE! You get all micronutrient from animals. But from agriculture food you lack many essential vitamins and that cannot be obtain from the vegetable world. Also fibres are not essential for the human gut.
    DUK recommends that for a 2000 kcal (8400 kJ) diet, 45%-60% of the total energy should be supplied by carbohydrate (225-300 g per day). As there is little evidence for the optimum proportion of carbohydrates for people with diabetes, the DUK 2011 guidelines2 recommend active carbohydrate management in terms of glycaemic control or weight loss rather than prescribing absolute intakes.
    -This is deadly level of carbohydrates for a diabetic. This is a level with foot lost, blindness, nervous system damages. Totally madness. Criminal act.

    Following this, the following definitions have been suggested:
    • Moderate-carbohydrate diet: 130-225 g per day (26-45 % of a 2000 kcal diet);
    -Should be removed, dangerous!
    • Low-carbohydrate diet: less than 130 g per day (26% of a 2000 kcal diet);
    -Should be removed, dangerous!
    • Very low-carbohydrate, ketogenic diet: less than 30 g per day (6 % of a 2000 kcal diet).
    -Shall be defined as a moderate low carb diet food plan.
    It is clear that significant weight loss will improve glycaemic control. A pilot study of a Very Low Calorie (VLC) Diet consisting of 600 kcal per day was shown to be effective in reversing hyperglycaemia in newly diagnosed patients.
    -This is starvation! Dangerous!
    Acknowledging that VLCD or low-carbohydrate diets may be appropriate for a minority of patients, they must be supervised by an appropriately trained team that should include a registered dietician familiar with the methodology followed by the Newcastle group.
    -This is starvation! Dangerous!
    Finally, the acclaimed DASH (Dietary Approaches to Stop Hypertension) study showed that a high-carbohydrate diet including fruit, vegetables, non-fat dairy products and wholegrain reduces blood pressure.
    -This study use low carb. And we know now that it is carbohydrates that raises the blood pressure, not salt. But the dangerous with this DASH is that it lack essential fattu acids. The acids our body are built up on. There are a two year research where a guy lived self-sustained in a closed place for two year and he eat a low fat “DASH” diet. And the result are scary and a very big warning sign to go for a low fat diet. Research shows that 85% of all vegans and vegetarians return to a saturated fat diet due to malnourished.
    Risks and side effects of a low-carbohydrate diet
    One of the main side effects is the risk of hypoglycemia, which is heightened during physical activity. It is therefore necessary to consider overall control and ensure that blood glucose levels are monitored and medication adjusted accordingly. Other reported side effects include headaches, lack of concentration, fatigue and constipation.
    -This is totally false!!! This symptom is on people with an unhealthy carbohydrate diet. And the reason is that if you have a lot of insulin or blood sugar lowering medication in your body and you start to remove the carbohydrates you had inside you, you end up in a hypoglycemia. With a healthy low carb LCHF food plan you have no carbohydrates which means you have very little insulin or blood sugar lowering medication inside you so this can effectively prevented. Thousands of type 1 diabetics have started to realize this now when they have moved to the healthy LCHF food plan, their hypoglycemia get minimized. This is the reason so many fight against low carb since the medical industry will have less medications to sell.
    Nutritional recommendations for patients with impaired glucose tolerance (pre-diabetes)
    Several large and robust studies, including the Diabetes Prevention Program (DPP), the Finnish Diabetes Prevention Study and the Chinese Da Qing Diabetes Prevention Study have been undertaken in people with impaired glucose tolerance or ‘pre-diabetes’. These studies all had a treatment arm related to amending participant lifestyles to delay or prevent Type 2 diabetes. In summary, the lifestyle intervention arms proved more efficacious than either medication or placebo in terms of the main outcome. Typically, the provision of nutritional guidance was undertaken by and monitored by a team, which included a dietician. None of these studies included a low-carbohydrate diet. In fact, the best outcomes were achieved with careful reduction in total calories and specifically a reduction in fat consumption.
    -Pre-diabetes is the first stage into type 2 diabetes because of overdose of fructose. Which mean that they start to have destroyed cells. And the only way to prevent this is to remove all carbohydrates and stay away from carbs the rest of the life.
    Thus, good evidence exists for low-fat, reduced calorie diets for the prevention of diabetes. These studies have formed part of the annual ADA Clinical Practice Recommendations. The 2012 ADA Standards of Medical Care in Diabetes endorse the fact that it is less costly to offer group intervention than for individuals to participate alone in respect of the lifestyle changes required to prevent diabetes. No evidence base exists to suggest that a low-carbohydrate diet should be used to prevent or delay diabetes. Thus, blanket recommendations for individuals as a means of delaying or preventing their diabetes by pursuing a low-carbohydrate diet alone remain untested, especially in the South African setting.
    -All metabolic diseases are driven by carbohydrates. So removing them is the first and only choice.
    Due care should be taken in respect of this group of individuals. They must be willing to make durable behavioural changes. They will require the on-going support of a team of suitably qualified professionals and therefore be subjected to a consistent message based on current validated evidence.
    Nutritional recommendations for patients with Type 1 diabetes
    The majority of patients with Type 1 diabetes are not overweight, and the dietary approach should be to educate these patients on the impact carbohydrate consumption would have on their insulin requirements. This has been well demonstrated through the highly successful and validated DAFNE (Diet Adjustment For Normal Eating) programme, a taught-course for people with Type 1 diabetes, which normalises food intake based on individual preferences and appetite. There is evidence that these programmes do not promote weight gain.
    -False! Many type 1 diabetics are fat! Just ask the type 1 doctors. And they have get fat due to become type 12. Both type 1 and type 2 with destroyed receptors on the cells and also because of insulin (THE HORMON FOR FAT STORAGE.)
    The use of a low-carbohydrate diet in individuals with Type 1 diabetes may well promote ketosis and predispose these individuals to either ketoacidosis or to severe hypoglycaemia following exercise. Not only would a low-carbohydrate diet not be recommended for those with Type 1 diabetes, but also it could be considered to be absolutely contraindicated.
    -First of all, you seems to have no clue what you are writing about. Learn what ketosis is and the difference between ketosis and ketoacidosis. And as I wrote, hypoglycemia happens among carbohydrate eating diabetics. Very rare in low carb sugar diseased type 1 diabetics.
    Conclusion
    We concur with the findings of the latest Diabetes Excess Weight Loss (DEWL) trial, which was a randomised controlled trial of high-protein versus high-carbohydrate over 2 years in type 2 diabetes. This study does not support the idea that high-protein intakes have any greater benefit on glycaemic control, lipid profile or blood pressure. This study reinforces the need to find ways to achieve sustained reduction in total energy intake as the primary focus to achieve long-term weight loss and supports a flexible approach to dietary composition for individuals with type 2 diabetes.
    -Low carb are not high protein, that is like eating sugar, Saturated fat are the fuel our cells chooses in the first place, And even the brain choose fat. Fat that our body is built of.
    Future research should focus on reducing the barriers in sustaining the behavioural changes needed to achieve a reduction in energy intake in free-living individuals. Highly controlled dietary studies are unlikely to answer this challenge.
    -Our body need the energy it need, and the only non toxic energy source is saturated fat. A fat that can never be over eaten as carbohydrates can, and if carbohydrates are kept out from our body fat will never make you fat.
    Ultimately total energy intake is the most important determinant of weight loss, regardless of macronutrient composition.
    -Only carbohydrates will make you fat, fat because it destroys the metabolic functionality to burn fat.

  10. My wife is a type 1 diabetic and I am a recovering type 2 / pre-diabetes.

    Our experience has been similar to Guy Meridith’s..

    That is, less carbs -> less insulin -> smaller blood sugar sugars -> increased ability to achieve lower more optimal blood sugars.

  11. Michael Michael

    Hi Guys

    The CDE Position Statement on the Role of Low-Carbohydrate Diets for People with Diabetes Mellitus was published in March 2012 on the available evidence. It is now May 2015… Just a thought…

    • Exactly! That’s why I asked for an updated comment – it’s been a busy few years in the world of carbohydrates and diabetes!

What do you think?