Diabetes Self-Management Blog

I don’t usually write about diet issues. Everyone talks about food too much already. But a recent article on WebMD, “Diabetic Food List: Best and Worst Choices,” upset me. It tells people to eat lots of carbohydrate and little fat, advice that has been damaging people with diabetes for decades.

WebMD follows the American Diabetes Association’s food pyramid. Here’s what they say:

The Diabetes Food Pyramid starts with breads, grains, and other starches at the base and rises to fats, oils, and sweets at the top. Here’s the full list of categories from bottom up:

• Breads, grains, and other starches
• Vegetables
• Fruits
• Meat, meat substitutes, and other protein
• Dairy
• Fats, oils, and sweets

Your goal for shopping and preparing meals is to choose more food from the base of the pyramid and less as you move toward the top.

What is wrong with this picture? I mean, it’s essentially the same as the food pyramid for the general public. It’s nice in a green-living, easy-on-the-planet kind of way.

But does it work for people with diabetes? Diabetes is a disease of carbohydrate metabolism. Because of problems with insulin production or insulin resistance, people with diabetes tend to have trouble using carbohydrates. And grains are the most concentrated sources of carbohydrates. So why do the ADA and WebMD tell us to eat so much of them?

Thirty-Eight Foods Not to Eat
“Best and Worst Foods” then lists 38 “bad” foods and their “good” alternatives. I seriously question how bad or good some of these foods are. Under “Breads or Grains,” they list “best choices” as whole grains and “worst choices” as processed grains and fried foods. Well, whole grains are definitely better than refined grains for most people, but they’re all grains. They’ll all raise your blood glucose — I hardly think they can be classed as “best” and “worst.”

Under “Vegetables,” they rate fresh, raw, or lightly cooked vegetables “best,” and canned or heavily sauced or buttered ones are “worst.” OK, can’t argue that fresh is better, but from here on, the whole list is all about reducing fats. This is questionable advice, isn’t it? Fats have been demonized by health promoters for years, but the evidence isn’t very strong. You have to get your calories somewhere, and if you are going to reduce carbohydrate, you will need to eat more fat and protein.

But then, they are not advising anyone to reduce carbohydrate. Their advice is all about reducing fats, and also about eating less processed, more natural food, which I am all for. I also like the idea of eating less meat, or no meat, but not because of the health benefits, which are unclear. I just don’t like abusing or killing animals or wasting resources. And eating animals uses many times the resources of plant-based diets, and contributes to global warming as well.

But health experts like those at ADA and WebMD don’t just advise eating less meat; they want you to reduce all kinds of fats and oils, and anything fried. To me, it’s clear that more calories from protein, fats and oils, and less from carbohydrate makes sense for many people with diabetes. And among carbohydrate, more fruits and vegetables and less grains is likely to be healthier.

Of course, all those nongrain sources of calories tend to be more expensive. Grains are subsidized, which is why breads and grain-fed meat are relatively cheap. Let’s face it; the food environment is unhealthy, and it takes some work to eat well here. But advice like WebMD’s does not help.

I don’t claim to know what the right diet is. As I’ve written before, the best diet varies from person to person, and you should find out what’s right for you. Pay attention to how you feel after eating (not just one minute later, but hours later.) Check blood glucose levels after eating until you know how different foods affect you. (Once you know, you don’t need to keep doing it.)

In researching my book on diabetes, I interviewed four people who told me they could not get their blood glucose under control with the ADA’s guidelines. They got better when they tried low-carbohydrate approaches. I’m not saying that’s right for everyone. But I wish the ADA and WebMD would stop calling grains “best” and fats “worst” for diabetes. They know that’s not right, but they keep saying it. How can we get them to stop?

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