Diabetes Self-Management Blog

Two opposing writers make their case

Low-carb diets are one of the most contentious issues within the diabetes community today. Here, two well-known bloggers explain why people with diabetes should — or shouldn’t — slam the bread box shut for good.

Low-Carb: Not For Everyone — Allison Blass
Why I Low-Carb — David Mendosa

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Comments
  1. I follow a low-carb diet, but MY way. My way is also Low-Fat and Moderate Protein. In fact, some days, I have to add Fat, it is SO Low-Fat! I don’t eat ANY slice bread, but instead eat Whole Wheat Pita Bread and Whole Wheat Bagels. I very seldom have any white potatoes and if I do, I limit myselft to 1/2 cup. I have been doing this since I was diagnosed in July with Diabetes and have managed to lose over 30 pounds already and have my sugar so under control the Dr is considering me not testing my sugar 2 times per day any more. The key for me is writing EVERYTHING I eat down in a journal and keeping track of ALL of the nutrients, not just the Carbs, so that I maintain a Daily Balanced Diet of all the needed Nutrients.

    Posted by carolivy |
  2. Low carb is a way that works for me to control high blood sugars. Knowing what will spike and keep your sugars high helps. My blood sugars are high when I eat items made with white flour. I have switched to whole wheat. My sugar goes up when I am stressed. It also goes up when I travel. So I make sure I have protein drinks available. Best practice is to just check your sugars and keep notes on not only what you have eaten but what was going on around you at the same time. It does get easier over time.

    Posted by Airborne mom |
  3. I can see why David uses a low carb diet…he can control his diabetes with it…I assume he is type 2. Type 1’s do not have this option, so the reasons to eat a low carb diet are different. It seems to me that the comparison used for the “Carb Battle” point/counter point is one of apples and oranges.

    Posted by phome |
  4. My b-in-law has type 2 and constantly avoids carbs. He also has frequent low-sugar ‘events’. These events are dangerous from what I know. My Doc says carbs are Ok in moderation and to test after dinner to check any spiking. I haven’t had a low sugar event in 3 years and very few spikes. Everyone is different but I think his Doc is giving him bad information.

    Posted by lincolnlover |
  5. I don’t keep a journal anymore.I do eat a very low-carb diet.I also eat the red potatoes the very small ones that fit right in your hand skin to.I like the receipt for cauliflower mashed potatoes.I look for the words whole grain before i buy anything.I test my blood sugar three times a week.I don’t know how good this is, but my readings aren’t over 127

    Posted by dud |
  6. I don’t see the articles as opposing views. They are 2 examples of diabetes, one is young, the other not so. One is Type 1 while the other is Type 2.
    Your diet needs to be the one that works best for you. The amount and type of nutrients that make up your diet should be what works for you. Carbs are the wild card in all diabetics meal plans. How those carbs affect you on that day is the question. And how you deal with it, a change in insulin dosage or activity to help regulate.
    What is low carb, what is a Mediterranean diet? These are ambiguous terms. And I have not found any study of the Med. diet. I have only heard of test of people from that region. So unless you live the lifestyle, your mileage will vary. 50 miles can have a profound effect on what makes up a diet for native people is these less industrialized areas.
    Someone here made a comment that they eat low carb, moderate protein and low fat. That could be called a high protein diet.
    I myself use the low carb term as my description but others would not consider that low carb. I am waiting for a generally recognizable term for lower carb, quality carb diet which bridge the two viewpoints. I consume way more animal fat/protein than the Med. diet but do try to use the best part of the Med. diet that people overlook, it is a limited calorie diet. I found that if you can eat where your calories are at max your consumption and hopefully a slight deficit, you will have the best control you can. The losing weight to help your diabetes really should be the process of losing weight helps control your diabetes, so losing 5 lbs over 2 -3 months is better than losing 10 lbs in a week and trying to maintain that and maybe gaining back a pound or two.

    Posted by Volleyball |
  7. I try not to eat more than 15-20 carbs for breakfast, due to large blood sugar spikes in the am. I am currently taking 500mg Metformin after breakfast and 500mg after supper. This, in combination with low carbs for breakfast, keeps my fasting BGS under 110, instead of 200. I usually take in about 40 carbs for lunch, 10-20 carbs for snacks, and about 40 for supper. So far, I have lost 15 lbs, with no low episodes. I also read every label and write down everything that I put in my mouth..keeps me accountable.

    Posted by glynnsmom |
  8. I agree with a former commenter that we use these terms “low-carb,” “high protein,” etc. without any real measurements or qualifications. I have been following Dr. Bernstein’s diet loosely since I read his book almost 10 years ago. I don’t restrict my carbs to the degree he advocates but I did vacuum almost all the white/refined carbs out of my diet and my insulin dose reduced by 1/3 (I am a type 1) and my A1cs dropped into the 5s and have remained there since. I also walk daily one hour, which helps.

    But even I who will tell you I am on a very low carb diet, am inaccurate. Yes, I no longer eat rice, white potatoes, corn, beets, white flour products like muffins, bagels and scones, and I eat mostly protein, beans and non-starchy vegetables at lunch and dinner. But non starchy vegetables (like broccoli and brussels sprouts) are 1/2 carbodhydrate. Beans are carbohydrate. So, I think Mendoza and Blass are not really on opposite sides, but every time we broach this topic our terminology is sloppy.

    I do believe you have to find what works for you: carbs make your blood sugar go up, you want it to go up less, eat less carbs; you don’t have to replace carbs with fats as everyone always says you will, eat more healthy carbs like non-starchy veggies, and, fat is not the enemy as Taub has told us. Lastly, don’t forget how important exercise is and test, test, test and correct.

    Posted by riva |
  9. Diabetes is an intolerance of carbs–so don’t eat carbs. If everyone followed a low carb diet we wouldn’t have this epidemic of obesity and diabetes.

    Posted by LoC |
  10. i am too a type 2 diabetic. i,ve had it for about five years. its been a struggle for me as a woman is with my weight. i,m 49 and i,m going into my third of being in menopause, which i know doesnt help as far as trying to lose weight. i went to diabetes education classes for the second time since i,ve had type 2.iwas doing well with watching what i ate. i was told to aviod potatoes, rice, pasta, bread, and i did good. i tried to walk every day with my boyfriend whom i live with. i lost 18 pounds, but now i know i,ve gained some weight back. he likes all the things, like i do which are sweets, bread, and pasta. but, its hard trying to tell someone thatyou,re not on aspecial diet, that you,re a diabetic. my doctor used to take care of him when he got sick or something. hes 57 and he could stand to lose some weight. but, he says, he wants to eat just subway subs , he thinks he can lose the weight just by eating subway. i,ve tried to tell him that i know whole grains are good for you, but you cant just eat bread and meat. but how can i get through this weight ups and downs? i want to get to a healthy weight. please help me with some ideas to quit this weight yo- yo. thank you , alice allman

    Posted by allmanrebel |
  11. I have lost 65lbs while eating up to 6 slices of heavy 100% sliced whole wheat bread a day. This happened. The weight came off within 6 months of me stopping eating sugar, liquer and walking a lot. All bread I eat is high is fiber and low in fat with a tiny bit of sugar (under 4 gr.) Bread gets a bad rap. My sugar levels are always in the 90 range everyday and I feel better then I ever had - I’m 63 years old.
    I really don’t have to closly watch my calorie intake as long as I eat right and get some walking done each day.

    Posted by Nanci |
  12. I’m a practicing Type 1 who was diagnosed in 1967. I use an Animas 2020 pump with Novolog.
    I follow a modified low carb meal plan. I’ve eliminated all white carbs from my meals that have a high glycemic index. I substitute low glycemic index carbs where ever I can, sweet potatoes for white potatoes, pumpernickel bread for white breads, and brown rice for white rice. The benefit for me, better blood sugar control and lower post prandial spikes in blood sugar.

    Posted by Florian |
  13. I beleive that diabetes is a collection of like diseases and that no one size fits all. If low carb works for you and you can stay healthy on it and function/feel well that is all well and good; but it is not the magic bullet and not everyone can do so.

    I have kidney issues (congenital disease) that pre-existed my diabetes(T1). High protein does not work for me. Moderate-high (depending on who is defining) Carb (170-200g/day)takes only about 4 more units of unsulin a day for me than a low carb (<70g);and at low carb I feel like crap...so whatever works for a particular person is the way it should be.

    Everyones body/diabetes is different,so treatment regimines must also be.

    Posted by denise |
  14. Two things –

    From the posts so far, it sounds as though most people aren’t necessarily following a low carb diet but are using some of the glycemic index principles in choosing which carbs they eat. This — plus other low-glycemic index/load “tips” — has worked excellently for me with type 2 diabetes. My 2hr PP readings are often under 110 and A1c’s have been in the low 5’s for several years.

    To LoC: Your comment doesn’t take into consideration many of the known causes and influences related to type 2 diabetes - and in many cases obesity. Number one is genetics. Others include poor sleep, exposure to organic phosphates and other toxins, chronic stress, certain common medications, and inflammation.

    It would be wonderful if the solution to type 2 were more easily addressed, but at this point in scientific knowledge, that’s just not the case.

    Posted by marcie |
  15. The things I read repeatedly is that low carb diets are HIGH FAT, not high protein. Bernstein spends a good deal of time why diabetics need to watch their protein as well as their carbs. Essentially it is because upwards of 60% of protein can (not necessarily does) be convered to glucose.

    Posted by RobLL |
  16. I have committed my life to teaching people how to eat properly, lose weight and get off diabetes medications. However, I am not a dietitian, I am a nurse. After spending futile hours with patients teaching them a system that clearly did not work, I turned to the HMR diet [a commercial weight-loss program]. This diet is high (65%) in complex carbs (no bread), appropriate in protein (25%) and very low in fat (usually much less than 20%)and physical activity is not optional. Amazingly when followed people get off a multitude of meds including those for cholesterol and blood pressure. It seems sadly that our diets have been developed by the food industry, those out to create a false sense of need..if they can create yet another flour based product, people will eat it. It doesn’t seem to matter whether its needed as a fuel source-people eat for pleasure, not necessity-unfortunately that is not why we should eat. Yes we should enjoy our food, and it should taste great, and it should be satisfying. But we need to learn what is right for our body, not what satisfies other non-nutrient needs. The system HMR created actually becomes a process for re-educating people how to eat. To my surprise, its one of the best kept secrets-unfortunately for those struggling with weight and living the poly-pharmacy medical paradigm for diabetes management. Our clients eat up to 100 servings (1cup that is) a week of any fruit or vegetable they want-not less that 5 a day. Unlike refined wheat based products complex carbs are a superior source of nutrients, vitamins, minerals, etc. So, save your money from Ketosticks, bacon, and meat and invest in fruits and veggies, a good scale and some walking shoes, eat low calorie proteins sparingly and enjoy the sweet life of better blood sugars through healthier eating.

    Posted by McKinneyDiabetes |
  17. I’m a type II diabetic. My family has a history of diabetes — I’m the third generation with it and was diagnosed in my early 30s.

    When I was first diagnosed in in 2001, it so happened that one of the doctors in my family practice was Mary Vernon, a long-standing advocate of the Atkins diet who has also co-authored a book about using Atkins as an effective therapy for type II diabetics. We started an agressive therapy of medication and Atkins and in six weeks my glucose went from 220 to 130.

    I’ve been following a modified Atkins diet for almost eight years, go to the gym 3-4 times per week doing mostly cardio, and take small amounts of metformin and lovastatin. As a result, I’ve kept my A1c in the 5.5-5.7 range for about five years, have kept my cholesterol under control (with help from the medication), and have normal triglyceride readings.

    When my blood work numbers fluctuate, I have a pretty good idea what’s causing the problem (usually straying too far from the diet reservation) and can fix it pretty easily.

    However, I also know from conversations with Dr Vernon that low-carb diets such as Atkins aren’t always the best choice for type I diabetics. We’ve done ketone monitoring to ensure that protein isn’t being dumped through the kidneys, for instance. If you already have some diabetic complications, a low-carb diet might not work for you. But if you’re type II, it could be worth trying for six months.

    Posted by Edward |
  18. What really matters is the type of carb. I check the fiber content on everything. Eating a high fiber diet has brought my blood sugar levels under control and lowered my cholesterol from 269 to 158. Cutting out those useless carbs and eating those which are beneficial makes a real difference.

    Posted by Kufta |
  19. Re: low carb diets for diabetics: I lost 25 pounds on Atkins and though I have leveled off the loss has made my diabetes and blood pressure much more manageable. I did it with my doctor’s approval.

    Posted by hometimes |
  20. My nearly 20 year experience with Type II diabetes mirrors that of David’s. Doctor Bernstein’s approach follows a simple principle: “small inputs” enable a system to produce predictable outputs. With this approach, the relevant inputs (carbs, insulin, as well as protein) are kept small. In my experience this results in an sustainable ability to achieve nearly normal blood sugars as well as normal weight.

    I’ve tried every approach to managing my diabetes and the only effective AND sustainable one has been a small inputs approach. The base of this approach is a low carb, high fat diet. Like David, Gary Taube’s incredible book “Good Calories, Bad Calories” all but eliminated any concern I had about heart disease being caused by high fat diets. I believe high simple carb diets are the problem.

    IMHO, Allison repeats many myths regarding the “dangers” of low-carb diets. In my personal experience, all of my labs, including kidney function and lipid profile, are terrible on a high-carb diet and very good on a high fat diet.

    I encourage anyone who is struggling to normalize their blood sugars to do some research (David’s site is a great place to start). I also encourage you to experiment with your own body. Try this simple experiment: First thing in the morning, eat a tablespoon of oil and test your blood sugars in an hour. Then eat whole wheat bread or cereal and repeat the blood test an hour later. The result is predictable. The carbs will elevate your blood sugars. The oil is a small input and the bread is a large input.

    A “small inputs” approach to managing diabetes truly works. I see it as an upward spiral. For type II diabetics I believe it works this way:

    Small inputs = low carb diet
    Low carb diet = high fat diet
    High fat diet = low insulin
    Low insulin = low hunger
    Low hunger = normal BMI
    Normal BMI = low insulin resistance
    Low insulin resistance = normal blood sugars
    Normal blood sugars = small inputs

    I dare anyone to construct a similar model that starts with “large inputs”. In my experience, the result for Type II’s will eventually be a downward spiral leading to obesity and high insulin resistance.

    Posted by BarryC |
  21. My story is not unusal for a type II diabetic…

    The right medication, a low carb diet utilizing all the new food products and some exercise (not as much as is recommended) has kept my A1c below 6.0 since the 6th month after being diagnosed (my A1c when diagnosed in 2003 was 11.6). I’m still fat and probably always will be; but, my blood sugar is under control and I feel good.

    There’s nothing better for me than a good low carb diet, exercise and all things in moderation. As per my doctor’s instructions I take 1000mg of Metforim per day; but, my absolute best defense is a healthy low carb diet and exercise.

    I still test 2 to 3 times per day. I’m sure this help’s me stay on track.

    Posted by J. Nap |
  22. My experience with carbs is the opposite of what logic dictates it should be. If I eat a very low carb diet, my glucose levels short term and over time raise. If I splurge on carbs, my glucose drops to dangerous levels. I find that if I simply eat what my body asks for -the foods I’m craving, in amounts that are satisfying- everything evens out. I suspect that just as starvation diets make it harder for one to lose weight over time, it may turn out that very low carb diets aggravate diabetes as well.

    Posted by r.woodward |

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