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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Comments
  1. Low Carb is the ‘easy’ way to go with diabetes. I use easy lightly because while it’s nice to have your BS stay in control it’s hard to avoid carbs - they taste so good and are in a lot more products than you realize.

    Posted by Mandy |
  2. Thanks for this blog. It was only when I
    threw out the book given to me during diabetes
    “education class” at a hospital and began my
    low carb diet that I was able bring my BC
    under control. I too take issue with WebMD on this point

    Posted by Bob |
  3. Thank you for writing this. I was thinking very hard myself, but need to let my hostility die before writing about this. You are right on about not changing their dogma when they should know better.

    Posted by Bob Fenton |
  4. I just returned from an appointment with my diabetes nutritionist today. She advised me to cut out the fat. Never mind I had 3 pieces of toast for breakfast this morning, it was that 2 pieces of bacon four days ago that really did me in ;-)

    The high carbohydrate, low fat diet approach is obviously a failure in the general public, with obesity and disease rates climbing more and more. Diabetics, in my nonprofessional but very personal opinion, would do much better to follow a low carbohydrate, good fat diet. Easier said than done, as we all know.

    I’m having terrible trouble getting my blood glucose under control - aiming for “tight” control, I can’t even claim I have “loose” control. As a newly diagnosed type 1 diabetic, I’m struggling… and growing more and more curious about a low carbohydrate approach. Terrific article. I do believe you’re right on.

    Posted by Shannon |
  5. The best advice I got was don’t eat a strach unless you add a protein with it and watch your saturated fats not just trans fat.

    Posted by Lynn |
  6. Y’know, you might like to revisit that wikipedia advice about grains being good for the planet, whilst you’re chucking out perceived wisdom. Lierre Keith’s book The Vegetarian Myth makes interesting reading.

    Nicky (Type 2)
    A1c at diagnosis; 10.3. Prognosis; on insulin within 5 years. 6 years after diagnosis (and a low carb way of life), A1c 5.3; controlling on diet and exercise.

    Posted by Nicky (Type 2) |
  7. Thanks for the posting, David. I did want to point out a couple of things about whole grains: Yes, whole grain foods (brown rice, whole wheat bread, quinoa, etc.) are carbohydrate, which means that they do have an effect on blood glucose. But when eaten in a reasonable amount, say, 1/2–1 cup, along with some protein and fat, they have very definite health benefits, and because they usually have a lower glycemic index, they tend to not cause a steep rise in blood glucose. Besides providing a source of energy, eating whole grains has been shown to reduce the incidence of Type 2 diabetes, and a new study shows that women with Type 2 diabetes who eat whole grains tend to live longer and are less likely to die from heart disease than those who don’t. Eating whole-grain foods can help lower blood pressure, reduce cholesterol, and reduce the risk of some types of cancer. So, while I agree that most of us could certainly cut down on portions and our intake of refined carbohydrate, it’s important not too swing too far the other way and cut out healthful foods altogether (including healthful fats, by the way). Balance is the key!

    Posted by acampbell |
  8. Thanks, Amy. I agree that whole grains can be good food, although perhaps not for highly insulin-resistant people. As I said, people need to find out for themselves what foods work for them.

    Posted by David Spero RN |
  9. my bs went over 1600 march 2008.i started out on 45units 70/30 twice a day. then 30unit twice a day. then after 3 months rehab.i came back to my home state,my dr. gave me metformin 500mg. twice a day .by last summer i was off all meds.winter of 2009/10 my bs was running mid200’s to 300’s.Now hot sweaty summer ,lots of exercise 2 metformins a day and I’m very rarely over 110bs.But if I speak to 100 people i’ll have 100 different answers to diabetic questions.To cut to the chase im still learning.

    Posted by craig mccullough |
  10. I wish I could find more whole grains that are tasty, high in fiber & wheat free due to food allergies. Quinoa is the one I have found and I really like it but do not know how to prepare it myself. But I want to disagree re: brown rice, it is the same calories as white rice and is the same on the gycemic index (does have more fiber & natural nutients) and it tastes like raw dirt even when cooked a long time. Sushi with brown rice-YUCK

    Posted by Liz A |
  11. Thanks for the reminder, David.
    My viewpoint is a lot like yours, every PWD (people with diabetes) reacts differently to food, good, bad, indifferent.
    The more I read your blog, cogitates deep thots thst lead to behavior changes that good for this PWD.

    Posted by miss kitty3 |
  12. Thanks for the article, David. It says exactly what I suspect the last few years. Whole grains may be healthy, but it raises my BG way more than it is supposed to (based on carb grams). I have been so unhappy with ADA that I stopped my membership recently. Recommending a base of grains of any type is not doing diabetics any favor. Our bodies do not metabolize carbohydrates like normal people. If I ate that way, I would need to take twice the insulin, and put on weight, which will make me more insulin resistant. Low carb, good fats, protein, lots of vegetables and limited amount of fruits is the ideal diet for my body.

    Posted by Rita |
  13. Liz A. — Maybe your sushi place doesn’t do the brown rice right somehow. Our favorite place does a great job, and I like the brown rice version a lot!

    To everyone who says low carb, but lots of veggies; please, vegetables have carbs. You mean to eat foods that are low in carbs, particularly starchy foods such as most breads, rice and potatoes.

    Posted by Beverly S. |
  14. I too am T2 since 94 and I learned to stay away from refined white flour. It should be against the law to manufacture it. But the best approach is to test 2 hrs. after eating to see what effect the food you you eat effects your BG.It takes alot of work daily to keep your blood glucose under control.What will work for someone will not work for someone else.Starchy foods are a killer for most type 2s. Thanks for the article Dave.

    Posted by Tom Hargis |
  15. Thanks for your blog, David. This is something I’ve been thinking for a while. Diabetics need our own food pyramid, with (in my opinion) vegetables on the bottom, then proteins, then fruits and grains, then additional fats and sweets. The whole high fiber (i.e. high carb)/low fat plan that’s been pitched to us for the last 35 years or so doesn’t work, at least not for people like me (I’m a 4th generation Type 2 diabetic). Whole grains are better than refined grains, and have certain undisputable health benefits, but once you chew them, the starch comes out and begins affecting your blood sugar. It’s a question of quantity–we each have to figure out what works for our individual metabolisms. Low-carb whole wheat bread works for me, but might not for others. Brown rice is out of the question (a half a cup? I might as well drink real soda pop!) The “recommended” carb limits are WAY too high for me — 30 grams at a meal is my absolute top limit to stay under 140 after 2 hours. I usually aim for half that, with good results.

    Posted by Marcia S. |
  16. Do the people who make up these food requirements ever think about testing diabetics a couple of hours after they eat these high carb foods? I haven’t found an insulin fast or accurate enough to control the swing.

    After 30 years of recommending a low fat, high carbohydrate diet hasn’t anyone noticed the population just keeps getting fatter? I’ll certainly agree that whole grains are better than processed grains, however they certainly put on the lbs… not to mention what it does to your blood triglyceride levels. If you are diabetic it is an invitation to disaster.

    Question: What do they feed cattle to fatten them up before slaughter? Hint: It is not fat.

    BTW David… I still think you are a very smart man.

    Posted by John_C |
  17. I am about double my Metropolitan desired wt. I am not Diabetic, nor do I have elevated numbers in any category except wt. I am 72+. I remain vigilant regarding Diabetes, it does not travel in my family, but at my size, it is an ever present risk. To make matters worse, I am a writer, and my hobby is gourmet cooking, so you can imagine the tousle. I just wanted to comment re: brown rice and flavor. I use a Chinese cooker, when completed, I put real butter on it, and a shake or two of Soy Sauce. I love it, and stopping at a cup is a major problem. That, plus a steak and salad and I call it quits for a meal. comments?

    Posted by Dr Gene E |
  18. My dad had diabetes until he died, so I guess I should have seen this coming and got my act together. Now I have just been diagnosed with diabetes. Thanks for the encouragement to start myself on a healthy low carb diet. but giving up tea butter and bread will be hard for me. It was my favorite. Thanks for the info guys

    Posted by Kevin Powell |

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