Carbs vs. Fats—Who’s to Blame?

Last week, Bluebird commented: "I just got the book [Dr. Richard Bernstein’s book Diabetes Solution] and already what he says makes sense to me. My blood glucose counts…keep inching up. …What is your experience with Dr. Bernstein?"


Thanks, Bluebird. I’ve been meaning to write about this issue since I read this entry from fellow blogger Jan Chait on Aug. 28:

“Hubby stopped by the spaghetti take-out place Thursday evening and brought home a bucket of spaghetti plus a loaf of garlic bread for dinner. I love pasta and I love garlic bread. So I ate pasta with fatty sauce. And I ate uncounted amounts of bread slathered with garlic-infused butter. My blood glucose didn’t totally come back down until Saturday. …[This] emphasized what dietary fat can do to blood glucose control.”

I left this comment on the post: “I don’t see where fats came into this at all. You ate a ton of carbs—pasta and bread. That’s almost certainly what raised your sugars.”

Jan commented back: “It wasn’t that my blood glucose merely soared—it was that it stayed elevated. …Had I eaten the same amount of carbs without the fat, say in a giant fresh fruit salad, my numbers would have come right back down.”

Maybe Jan is reporting the official American Diabetes Association position. The ADA’s document “The Diabetes Food Pyramid” says: “Eat more whole grains! Whole grains and starches are good for you because they have very little fat, saturated fat, or cholesterol. …Yes, foods with carbohydrate—starches, vegetables, fruits, and dairy products—will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you. Your doctor may need to adjust [read “raise” – DS] your medications when you eat more carbohydrates.”

Dietary Malpractice
For my book, Diabetes: Sugar-coated Crisis, I interviewed Drs. Lois Jovanovic and Richard Bernstein about how insane and harmful this advice is. Jovanovic calls it “malpractice.”

Because of insulin resistance and/or lack of insulin, people with diabetes cannot handle carbs well. Eating carbs raises your blood glucose, period. I believe that, in all probability, Jan’s blood glucose didn’t stay up so long because of the fats she ate, but because there were so many refined carbs in her system that her body could not regulate them. (Spaghetti and garlic bread are not whole grains, either.) For a person with diabetes, eating a big pile of spaghetti or several pieces of white bread is one of the most destructive things they can do, in my opinion. Fats are secondary.

Why does the ADA give such potentially lethal dietary advice? About 40 years ago, scientists discovered that most people who died from diabetes died from heart attacks and strokes. They started recommending low-fat diets to reduce blood vessel damage, because that was mainstream thinking at the time. But if you’re not eating fats, you have to get your calories from somewhere. So the ADA recommended lots of carbs.

But since then, the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) conclusively proved that high blood glucose, not fats, is the biggest cause of blood vessel damage. And carbs, not fats, cause high blood glucose. So why hasn’t the ADA changed its tune? Most likely, it doesn’t want to admit a mistake, especially one that has probably killed many thousands of people. Dr. Bernstein told me that the advice “probably wouldn’t change until everyone involved in promoting it has died.”

The ADA’S Response
I asked ADA Science Officer Dr. Richard Kahn about the carb controversy. He said, “We don’t have enough data, and it’s very difficult to study long-term effects of dietary changes in the real world, where people often don’t know exactly what they’re eating.”

But if it’s so hard to do good studies, what is the old advice based on? And if we can’t get reliable studies, how will the ADA’s recommendations ever change?

Of course, there’s more to it than fats vs. carbs. Physical activity also plays a huge role—if you move enough, you can eat more carbs. Whole grains are better than refined grains, and unsaturated fat is usually better than saturated fat (and much better than trans fat, which is found in the “partially hydrogenated” oils). As Dr. Kahn says, individuals are different, and the best diet for each person may be different, too. You have to check and see how different foods affect your own blood glucose levels.

I’ve talked with dozens of people with poorly-controlled diabetes who achieved great control when they went to a low-carb diet. Be aware that you may need to reduce your doses of diabetes drugs if you start eating fewer carbs.

PLEASE, readers—let the community know what you think about this issue. What has been your experience? What have you been told? Comment here or see me at

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  • fmutolo

    What do you eat when you are a diabetic and have coronary problems? Newsprint?

  • Joan :-))

    After 50 years as a Type 1, trying just about every new idea that came along for controlling blood glucose levels I vote for MODERATION on all levels. By this I mean moderate portions of food which means moderate amount of insulin etc etc right through to exercise.
    Our MUSCLES need energy and that comes from carbohydrates,and our BRAIN needs more than it’s share of carbs to work best for us. We need ENERGY to function.
    Control comes from knowing ones own metabolic system inside and out! This info comes from constant testing; keep a Daily Log to review; work closely with our Health Team – AND eating the amount of carbs, protein and fat that works best for each of US as INDIVIDUALS!
    It is important to read the research reports and take out of them what works best for each of us! There is no one best method that fits every person with diabetes!
    If is hurts to cut carbs; don’t do it.
    If carbs works best; then do it!

  • sarah548

    I know that carb restriction and exercise has brought my A1c down from 9.1% to 5.4%. My physician is one of the growing number who takes a truly nutritional position on diabetes: cut the carbs, up the protein and fat (and my lipids are all now in the ideal range; 20+ years on a vegetarian low fat/high carb diet produced higher lipids for me than my current low carb/high protein and fat eating.

    The ADA, in my opinion, should either show properly conducted, double blind, etc., etc. tests to prove its ludicrous position vis a vis high carb/low fat diets or shutter its doors permanently(maybe Schweppes Cadburry, one of its primary underwriters would like to give them all jobs after ADA goes away).

    The Internet has given diabetics from all over the world the capability of exchanging experiences with each other. Overwhelmingly, those experiences have reinforced that low carb eating WORKS for diabetics.

  • HT

    When I was diagnosed with Type 2 about 6 years ago. The most important change was to switch to a low carb diet. I lost 20 pounds in 8 weeks, without any excerise! I tested all the foods I ate to develop a list of things I can tolerate. Now I don’t test at all unless I’m changing my diet. My A1C has been 5.8 or less ever since. Yeah, I’m like everyone else, I cheat but I know I’m cheating and which ones are the lesser evils.
    Now it’s on to excerise. I’m cycling and lost another 5 pounds in 4 weeks.
    Looking forward to a ripe old age 🙂

  • bbeck4x4

    in late January of this year I was diagnosed with diabetes, a1c of 6.3, with a weight of 300+ lbs.

    In mid feburary, I purchased and read Dr burnsteins book, with that info, I am now at a a1c of 5.3 and a weight of 248lbs.(and still dropping) height of 6’3″ It is working for me, no drugs, diet and exercise, with carbs that low not much exercise is needed.(for me at least)

  • Burbot

    And don’t forget the glycemic index! Believe it or not, pasta has a rather moderate glycemic index, so I doubt that the spaghetti was Jan’s main problem either. It was mainly the bread and/or the quantity of food consumed. Fat slows down glycemic absorbtion which is probably why her glucose levels remained high for a while. Basically, the spaghetti raised her glucose levels to a medium high, the bread took it over the top and the fat and food quantity helped keep it there. The ADA doesn’t recognise the glycemic index as important at all, however, practically every other major source of information on diabetes does. Joslin does. The WHO does. The ADA is clearly living in the bottom of a bucket. Check out
    There is a wealth of top quality science, reasearch and just plain good advice there. You might even learn a little Australian!

  • Florian

    I recently started insulin pump therapy after more than 20 years on MDI. The pump settings were not optimal in the begining and my blood sugars were higher than I wanted. I started reducing carbs in my meals (no white bread, pasta, potatoes, and rice) and switching to low glycemic carbs (pumpernickle bread for sandwiches, sweet potatoes for dinner) and fresh fruits (apples and pears) with cinnamon which I like for desert.

    My last A1C on MDI was 5.4% and my first A1C after 2 months on the pump was 5.5% which surprised me because I was expecting a 6 to 6.5%

  • gardening

    After a great deal of study, trial and error and thousands of blood glucose tests, I can only agree that Dr. Berstein is correct! Controlling the rise in blood sugar is our primary task in handling diabetes. I have adult-onset Type 1, so my only treatment is diet and insulin. At the same time, I am trying to find, or devise, a healthy, lower saturated fat diet as free as possible of processed foods and preservatives. Vegetables, lean poultry and fish are the primary foods. Some whole grains and cultured milk products (I love kefir with sunflower seeds) seem to work if I am careful to exercise following the ingestion of some of these higher carb foods.
    My greatest concern is finding the time and energy to accomplish this degree of control – no small task! I wish very much that this program did not take so many of my hours every day and I do find traveling difficult, as a decent salad, fresh vegetables and lean meats in a restaurant are very rare.

  • diet dr pepper girl

    My experiences in the two and a half years I have been diagnosed with diabetes completely support David Spero’s position.I think it is criminally irresponsible for the ADA to recommend high carbohydrate diets for diabetics.
    I don’t think this requires fancy studies to investigate.Any of us with insulin resistance,insulin insufficiency, and a glucometer can test and see that a high carbohydrate meal causes blood glucose to rise sharply, whereas a high fat but low carbohydrate meal does not. Of course we should also watch fat intake, especially of saturated and trans fats. But that’s a general recommendation – not special for diabetics.

  • Donna MacRae

    I got Type 1 Diabetes at age 52.( 2 years ago)
    I struggled with high blood sugars for 1 years while following the dietary advice given here which falls into line with the USA’s ADA advice.
    I bought Dr Bernstein’s book a year ago and applied its advice for about 2 weeks & my blood sugars dropped into the normal ranges very quickly.
    AND..I felt well.
    I took the book to my clinic where I was advised that this was not wise and I should eat about 300 grams of carbs a day.
    I did that and spent 8 months chasing high blood sugar again.
    I returned to my clinic last week to find my HBA1c at 10.6 ..!!
    I returned to Dr Bernstein’s plan 2 days ago and guess what.
    My blood sugars are normalising again.
    AND ..I feel well.
    I am glad someone has written a book about sugar and the dangers of sugar.
    Here in the UK supermarkets are full of ‘low-fat’ products.
    I only recently started looking at labels on these..inevitably crammed with sugar.
    People in the UK are getting more obese by the day.

  • Bluebird

    David, thanks for the column. I have not finished Dr. Bernsteins’ book but I am trying to absorb as much as I can from it. I have already changed my eating habits to fit into his eating plan (not entirely but I’m working on it). My blood glucose count is inching back down. I cannot imagine how good I would feel to register 85-90 each time I tested.

    Thanks again for the article and keep up the good work. Just because the government says so doesn’t make it right!


  • Ephrenia

    Personally, I can’t handle the extremely low carbs of Dr Bernstein’s rwcomendation. if my carb intake drops too low, I know it because my sweat takes on aa ammonia smell. That means i’m burning amino acids (muscle tissue) for energy (dehydration, excessive exercise as in a marathon runner or too low carb intake are the 3 possible causes of ammonia sweat)

    I do eat low carb, but not THAT low. I gnerally intake between 120-150 grams a day. My A1c has ramained below 6.0 since I started eating this way.

    Also, even though I do NOT restrict my fat intake other than to avoid trans fats my overall cholesterol level tests below 150 consistantly, where it used to test in the dangerous levels before lowering my carb and increasing my protein/ fat intake (because I eat more meat than before)

  • Fergus

    It’s a joy to discover that so many other diabetics out there are taking control of their condition for themselves. I’ve had Type 1 diabetes for 26 years, the last 7 of them increasingly low carb. This is still commonly regarded as dietary heresy by health professionals. The dietary advice traditionally given I believe is scientifically illogical, ignorant of our evolutionary history and the cause of great harm to those who are asked to follow it. The ‘complications’ associated with diabetes are entirely due to uncontrolled blood sugar, a consequence of a diet based around starch and carbohydrates. After 7 years, my weight has fallen to a BMI of 22, my HbA1C is 4.6%, my lipids, blood pressure and kidney function that of a healthy non-diabetic. Oh, and I’m not short of energy either, since I completed my first marathon last year! All the best, everyone. Fergus

  • David Spero RN

    Thanks everyone for these valuable stories. I do agree with Joan that everyone is individual, and you have to find what works for you. Also with Burbot that glycemic index is extremely important. Low GI carbs are a lot better than high GI ones, and nobody needs to go to zero carbs. But in general, the ADA’s high-carb advice needs to change. What will it take to make this happen? David

  • acampbell

    Being a dietitian, I’m always interested in hearing different views on nutrition-related topics, and I thought I’d share my two cents (without being too preachy!). I work at Joslin Diabetes Center, which issued a nutrition guideline for people with type 2 diabetes in 2005. The carb recommendation in this guideline is approximately 40% of total kcals, which works well for many of the people with type 2 diabetes in our programs. ADA’s recommendation has traditionally been on the higher side, but I think they realize that a lower amount is beneficial for many, and no longer promote a “high carb diet” for everyone with diabetes. I’m not sure Dr. Bernstein’s approach is necessarily appropriate for all, either. Carbs are not all good, nor are they all bad. The same holds true for fat and protein. And it’s not just carbs that cause prolongued glucose elevations – we know a high fat intake can definitely be a contributor. The key is to learn what works best for you, and not generalize recommendations to an entire population. Some people need more carb, some need less. And, as you all have mentioned, choosing more of the unrefined, low glycemic carbs is the way to go. There are plenty of people who follow a vegetarian diet, for example, who successfully manage their diabetes and their weight. Also, you need to have an eating plan that keeps you healthy and that you can follow long-term. I’ve seen plenty of people (former patients) who struggled with a low carb diet and couldn’t sustain it as it was too restrictive. Anyway, thanks for letting me share my thoughts!

  • Moviejunkie

    When I was diagnosed with Type II five years ago, the high carb literature confused me. I tried to go halfway (125-150 carbs daily)and found the Glycemic Index useful. My A1c began at 13.8 and now is usually around 6. However, bringing my blood sugar levels under control didn’t stop my yo-yo weight. I lost 50lbs with diet and exercise when first diagnosed, but eventually gained it all back. Now I am having gastric band surgery. I’m hoping the band helps me keep the weight off when I lose it this time.

  • dude

    How wondedrful to read this short piece on the value of a low carb approach to glucose intolerance and/or diabetes. Dr. Bernstein makes TOTAL sense and the ADA’s advice seems to border on criminal malpractice! If I keep carbs to 15 gms. per meal, I don’t have high blood sugar. If I followed ADA advice, I’d be insulin dependent. That would be stupid, don’t you think?

  • CalgaryDiabetic

    Fredrick the Great said: “Everyone should be allowed to go to heaven in his own way”. The man who commented that only newsprint is allowed can switch that for sauerkraut. The math in Dr. Bernstein’s book is hard to contracdict. But what do you do if you love carbs? Also cutting them a lot has a negative effect on happiness and may promote depression. The ADA food piramid seems like a way to cure diabetes by killing all the diabetics. Tailor made diets for the individual are probably better than general dogma.

  • Fergus

    I wholeheartedly agree with the sentiments on this site.
    I have had type 1 diabetes for 27 years, but only really got control of it 7 years ago when I adopted a low-carb diet.
    I that time, I have gone from borderline obesity to a BMI of 21, HbA1c’s of 8% to 4.7, and insulin dosages 25% of their former selves!
    The conventional dietary wisdom isn’t simply misguided, it’s criminal!


  • annie

    I think we all have to find what works for us. Low carbs seem to work well for a lot of type 2s, but I’m type 1 and will easily get large ketone levels right away if I try Bernstein’s low carb 6g-12g-12g (30g total)per day, so doesn’t work for me either. I found I need about 90g carb total per day, or I start to see large ketones and blood sugar levels rises, and thus end up taking more insulin just to stay out of ketoacidosis with low carb. Can posters also identify what “low carb” means to them in grams of carbs? I definitely think trying to see if low carb will work for you is a great idea, but it doesn’t work for everyone. If anyone can scientifically explain the metabolic reason why some type 1’s can eat 30g carb/per day and be able to reduce their insulin, and other type 1’s like me and a couple other posters have problems with it I would love to know!!! I’ve been researching this, but haven’t found a reason. I’ve read that low carb may cause trace or small ketone levels, but if blood sugars don’t increase there is no problem with trace or small levels of ketones. I get large ketone levels quickly (within 24 hours) and concurrently large increases in blood sugar levels, so I have to increase my insulin.

  • Valter Martins da Silva

    Well, I am not a diabetic, like my younger sister, and I dont´t suffer from heart disease, living with three by-passes and a stent, taking a lot of drugs for high blood pressure and cholesterol like my older sister, who seems to follow the same path of our parents who died at a relatively early age from stroke and heart disease. Needless to say, I am the only one of the family who have followed a mostly vegetarian diet, where meat, eggs dairy and sofisticated meals have been reserved to very special occasions, once or twice a year,at most. Now, as far as diabetes and heart disease are concerned -just to mention a few chronical diseases, I think fats, all of them, specially refined, high processed fats are the number one vilain, sugar and white flour comming next, as insulin really doesn´t work efficiently in presence of fat, even olive oil. My younger sister´s health improved greatly since she began to follow the advice of her new doctor whose protocols focus on FAT rather than on carbs. Sorry, but I have to emphasize: complex Carbohydrates, like whole grains, fruits and vegetables, leave no residue other than those two harmless ones easily expelled from the body by our lungs and kidneys, complex carbs – to make it short – are the best foods for our overall health.

  • Valter Martins da Silva

    Come on, we are our brain, and our brain feeds on glucose, derived from carbs. So, any doctor or nutritionist who even thinks of excluding carbs – glucose – from our diet is making a big mistake, to say the least. Just don´t buy diesel oil,if your car is designed to move on gasoline.Cut on fats, reducing refined-carbs intake,and insulin will play its role.

    • r92g

      It has been proven that ketogenic diets are neuroprotective on the long run. Look it up, there’s tons of research.