What to Eat? ADA Speakers Disagree

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Diabetes-care professionals don’t seem to share their patients’ vigilance about food. Out of about 1,000 presentations at the American Diabetes Association’s (ADA) Scientific Sessions in San Francisco, only 20 or so concerned diet. And those presenters mostly disagreed with each other.

I went to session called “Carbohydrates: Are They All Created Equal When it Comes to Glycemic Control?” Julie Miller Jones, Ph.D., of the University of Minnesota says they’re not. She’s a leading activist for whole grains. She presented studies indicating that eating more whole grains is one of the best things you can do to prevent or manage diabetes.

Janine Higgins, Ph.D., of University of Colorado Children’s Hospital, sang the praises of cold carbs, what she calls “resistant starch.” Starches that might not be that good for you hot, like white rice or potatoes, can be great diet tools if served cold. They fill you up and aren’t easily absorbed. Then when they get to the large intestine, they ferment.

For some reason, this fermenting causes the liver to burn fat as fuel, instead of carbs. Higgins recommends increasing your starch intake and eating it cold. Both of these speakers, as well as dietitian Hope Warshaw, were advocating smart carbs, possibly even more carbs.

What About Protein?
Two M.D.’s, Osama Hamdy and Joel Kopple, slugged it out for 90 minutes on the question of how much protein people with diabetes should eat. Hamdy, of the Joslin Diabetes Center, gave a talk called “High Intake of Protein Is Good.” He framed the debate as between endocrinologists, who advocate low carbs to prevent weight gain and obesity, and nephrologists, who want low protein intake to protect kidneys.

Dr. Hamdy says that studies support eating moderately low protein if you have Type 1 diabetes and albumin in your urine, but that no studies exist to show protein intake is a problem in Type 2 diabetes. It’s also not a problem if you have normal kidney function, he said. He cited research showing that high fat intake is associated with kidney problems but high protein intake is not. You can see the slides of his presentation here.

When it comes to protecting the kidneys, controlling blood pressure is much more important than controlling protein intake, Hamdy reported. For people with Type 1 diabetes who have some renal symptoms already, it is probably good to limit protein, especially animal protein. Vegetable protein had a much weaker association with kidney symptoms.

Dr. Kopple took a harder view on protein. He thinks the vast majority of people with diabetes either have some kidney disease or are on the way to it. So in his view, they should be eating less protein. He has written a book on nutritional management of kidney disease which spells out the low-protein case.

When Experts Disagree
At this point, I turned to the doctor next to me, a woman from India, and asked, “So it sounds like nobody really knows anything, is that it?” She said that to her, the disagreement might mean that different people should eat different things. She was looking into the genetic differences between people of East Indian and Chinese descent in the way different foods affected them. She said they were finding some significant differences.

So my takeaway message from these debates was to eat healthy carbs and healthy proteins, and even some healthy fats and oils, and not trip about it too much. Find out what works for you. Obsessing about food doesn’t do you any good, unless you are competing on Top Chef.

One other thing people agreed on: Watch portion sizes, particularly with fruits. They’ve gotten so big that one fruit may be two, three, or even four servings.

Enter the Vegans
In the exhibit area afterward, a young doctor came up to me. She noticed my Diabetes Self-Management name tag. She handed me a copy of a study her group had published in Diabetes Care (“A Low-Fat Vegan Diet Improves Glycemic Control And Cardiovascular Risk Factors In A Randomized Clinical Trial In Individuals With Type 2 Diabetes”) and said, “Tell your readers about this.”

Her group’s study showed dramatic reductions in HbA1c and LDL (“bad”) cholesterol with a strict vegan (no animal products) diet. The main pathway to the lower HbA1c seemed to be that the vegan dieters lost a lot more weight.

In turn, the weight loss seems to have been due to the fact that the group eating vegan stayed on their diet better than the other group, which was eating a low-calorie ADA diet (15% to 20 % protein, less than 7% saturated fat, 60% to 70% carbohydrate and unsaturated fats). The researchers (apparently all vegans themselves) suggest that vegan diets might be easier to stay on. The high fiber content and larger quantities you eat may make you feel full and satisfied with less intake in calories. More about this next week.

What do you think about the protein debate? What about the cold carbs? Would you try, or have you tried a vegan diet? Let us know by commenting here.

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