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Thursday, July 31, 2008

Carbohydrates or Fats, but not both for Diabetes?

Barnard: low-fat

Bernstein: low-carb
Lately, I've been reading about high-carbohydrate diets that manage or reverse type-II diabetes. But there is another approach -- a low-carbohydrate diet. Both can cite studies that show the diets they've developed help patients much more than the standard ADA-recommended diet. Both diets show dramatic improvements in insulin sensitivity, blood sugar, blood lipids, and weight loss. As far as I can tell, the only thing they agree on is that diabetics should avoid sugar and white bread. How would a person choose between the two programs?

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Diabetes, overstuffed cells, and changing the way you eat.

an over-stuffed couch I've just read Dr. Neal Barnard's Program for Reversing Diabetes. His main argument starts with reasons why your cells start to resist insulin. Insulin is supposed to signal the cells to take in the sugar that is available in the blood. But, if muscle cells already have enough sugar, or are storing a lot of fat, they start to ignore insulin's signal. The blood sugar stays high for some time, (which can be very bad for the body), and then the energy in the sugar gets used to produce fat, which the body will store in case you need it later.

He decided that diabetes sufferers need to

  1. Reduce the fat in their muscle cells to make them more sensitive to insulin's signals and
  2. Reduce the amount of sugar in the blood so you need less insulin in the first place.

His solution is a low-fat, high-fiber diet wherein most of your energy comes from slower-release carbohydrate sources, like sweet potatoes, intact grains, legumes, as well as All-Bran cereal, al-dente pasta, and the like. To keep fats low, the diet is vegan. Fats should be "good" anti-inflammatory mono and poly-unsaturated fats. The diet has performed very well in clinical trials. It reads quite a bit like Dean Ornish's diet for reversing heart disease, at least as it appeared in his earlier Eat More, Weigh Less. Only, Dean Ornish was advocating a vegetarian, not vegan, diet. Both books (and their Amazon reviews) contain testimonials and case histories of people who started the diet because their physical condition was so poor they were frightened, and who had spectacular success.

The thing is, an awful lot of people are not going to renounce steak, eggs, milk, and even wild-caught Pacific salmon unless they are awfully scared. And maybe not even then. And, let's face it, while many women often crave carbs, it seems that many men crave meat. And some of Barnard's substitutes (vegetable broth thickened with cornstarch for olive oil on salads) sound time-consuming and simply hideous.

Studies show Barnard's diet is effective for managing glucose and, even reducing or eliminating insulin dependance in diabetics. And it can probably control and/or reverse heart disease as well. It could be promoted as a gold-standard intervention for diabetic and pre-diabetic patients. But if Barnard's diet were the only choice on the menu, I imagine a lot of patients would head for another restaurant.

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