Rethinking diet advice to prevent diabetes

Physicians and other healthcare professionals often tell their patients with type 2 diabetes to avoid eating too much starch and sugar in order to keep their blood sugar from going too high.

But if the patients follow that advice, they’ll end up eating more fat and more protein, which could increase their risk of cardiovascular and renal complications.

Worse yet, a high fat intake may actually keep the patients diabetic.

It was clear by the early 20th century that diets that include a lot of fat result in impaired glucose tolerance whereas starchy, low-fat diets restore the ability to tolerate glucose. Thus, the low-carbohydrate diet that many patients with type 2 diabetes are told to eat could actually be contributing to their diabetes.

A randomized clinical trial published in 2006 showed that a low-fat diet with carbohydrates based entirely on unrefined plant foods providing 75% of calories outperformed the American Diabetes Association’s standard dietary recommendations for people with type 2 diabetes.

The subjects assigned to the high-carbohydrate diet lost more weight, had better laboratory values (including lower HbA1c and LDL cholesterol), and were more likely to be able to discontinue taking at least one of their prescription medications.

They were also more likely to stick to their diet. Although their food choices were restricted (they could eat nothing but vegetables, fruits, whole grains, and legumes), they could eat as much as they wanted. They didn’t have to count or weigh anything, and they never had to go hungry.

A shift to a low-fat diet based on unrefined starches and vegetables is a promising approach for reversing type 2 diabetes and has also been beneficial in cases of type 1 diabetes.

Not only does this kind of diet promote weight loss, it helps to reverse insulin resistance even before the individual has lost much weight. It also has beneficial effects on blood pressure, cholesterol levels, and other problems that can contribute to the complications of diabetes.

Ponder these points. Maybe you should change your practice.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association. Laurie Endicott Thomas is former medical editor and the author of Where Do Gorillas Get Their Protein?

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