In my last post, I commented on a reply from Hope Warshaw — the diabetes educator (ahem, ahem) — to a reader of this blog in which she pooh-poohed his “experience of one” with using a low-carb diet to manage diabetes.
The same reader emailed me that he conducted an “experiment of one” in recent days to compare his blood sugar after drinking a 12-ounce Pepsi versus eating some of the foods Hope Warshaw recommends for diabetics. Take a look:
|Food||Carbs||BG before||BG at 60 mins|
|12-ounce Pepsi||42 g||89||156|
|Oatmeal, milk||40 g||113||163|
|Whole wheat bread||48 g||93||141|
|Whole wheat toast, milk||36 g||103||173|
Perhaps those numbers don’t look scary to you, but they do to me. Here’s what Chris Kresser of The Healthy Skeptic wrote about post-meal glucose levels awhile back:
Even the American Association of Clinical Endocrinologists is now recommending that post-meal blood sugars never be allowed to rise above 140 mg/dL. Unfortunately, less informed groups like the ADA haven’t caught up with the science.
The consequences of this are severe. Nerve damage occurs as blood sugar rises above 140 mg/dL. Prolonged exposure to blood sugars above 140 mg/dL causes irreversible beta cell loss (the beta cells produce insulin). 1 in 2 “pre-diabetics” get retinopathy, a serious diabetic complication. Cancer rates increase as post-meal blood sugars rise above 160 mg/dL.
Every one of the high-carb meals produced a glucose level above 140 in my reader’s one-man experiment. The biggest spike (173 mg/dL) was produced by two pieces of whole wheat toast and a glass of milk – a normal breakfast for a lot of people.
With those results in mind, let’s look at the advice Hope Warshaw doled out to diabetics in a Q & A article for Health.com:
Q: Do I need to pay attention to the sugars on the nutrition facts label?
A: No. Pay attention to the total carbohydrates. The sugars content includes the amount of added and natural sugar in a serving. The amount of sugars are included within the total carbohydrate count, which is the key piece of information you need for planning meals and snacks.
Well, so far so good. She’s telling diabetics to watch their carbs. Perhaps I misjudged the woman. Let’s skip ahead.
Q: Are nutrition recommendations different for people who have just been diagnosed with type 2 diabetes than they are for those who’ve had diabetes for years and take insulin injections?
A: No, the Dietary Guidelines for Americans, which are supported by the American Diabetes Association, are appropriate for pretty much everyone, including most people with type 1 and type 2 diabetes: Eat more whole grains, low-fat and fat-free dairy foods, fruits, and vegetables; limit consumption of high sodium processed foods and saturated and trans fats; get more of your protein from seafood and poultry and nonmeat sources, like beans (legumes); and eat all sources of protein in portions no larger than three ounces cooked. The Dietary Guidelines for Americans also recommend getting 45% to 65% of your calories from carbohydrates (with less than 25% of your total carbohydrates from added sugar); 20% to 35% from fat; and 10% to 35% from protein.
Nope, turns out I judged her correctly after all. We need to eat lots of carbohydrates because the USDA says so. Never mind what happens to blood-sugar levels in living, breathing (for now) diabetics who consume the high-carb meals the USDA recommends. Brilliant. And can someone please explain to me why beans — which are full of carbohydrates — are better for diabetics than meats?
Q: I’ve heard there are healthy and unhealthy carbohydrates. What should I eat more of, and what do I need to limit?
A: Foods that contain carbohydrates are starches, grains, fruit, vegetables, and dairy foods. The healthiest sources of carbohydrates provide plenty of vitamins and minerals per calorie—they are nutrient-dense. Everyone should eat more fiber-rich carbohydrates, such as whole grains, fruits, vegetables, and beans (legumes). You should try to eat at least three servings or half your servings of starches as whole grains each day. Less healthy carbohydrates like candy, sweetened beverages, and ice cream pack little nutritional punch but contain plenty of calories; keep them to a minimum.
Yes, grains are more nutrient dense than a Pepsi. But as my reader discovered in his one-man experiment, they can jack up your blood sugar just as high or higher.
Q: Is it OK for people with prediabetes and diabetes to eat some sugar and sweets?
A: Yes. People with diabetes can enjoy sugary foods and sweets in moderation.
And then take a moderate shot of insulin.
However, the amount of sweets you eat should be balanced with your diabetes nutrition goals, such as weight loss, blood glucose, and blood lipid control.
Yes, balance your diet with your goals for blood glucose. Then eat your grains. Then watch your blood sugar shoot up. Then take your drugs so you can meet your blood glucose goals.
Be aware that some desserts and sweets, for example ice cream and cheesecake, are also high in fat and the fat may be the unhealthy saturated type.
You know, for a woman who told the reader not to bother her anymore unless he could quote some controlled clinical studies, Ms. Warshaw doesn’t seem to apply the same intellectual rigor to her own advice. Can she point to any long-term clinical studies that prove saturated fat is bad for us? Has she simply ignored all the recent studies showing that low-carb/high-fat diets produce better lipid profiles than high-carb diets?
Q: How many carbohydrates should an adult man or woman who is trying to lose weight eat each day?
A: Aim to get roughly half of your calories from carbohydrates.
Yes, be sure to do that. Then take insulin to bring your blood sugar back down.
Head. Bang. On. Desk.
For example, a sedentary woman who wants to lose weight should limit her calories to 1,400 to 1,600 a day, so she should consume 700 to 800 calories from carbohydrates daily.
Bang. On. Desk. Again.
Following is a sample meal plan that would meet this guideline, along with examples of serving sizes.
- Seven starch servings (one serving is a slice of whole wheat bread, or half a medium baked potato)
- Two servings of milk and yogurt (one serving is eight ounces of fat-free milk, 2/3 cup of fat-free yogurt)
- Four servings of vegetables (one serving is one cup of salad or a half-cup of cauliflower or carrots)
- Five ounces of meat (cooked)
- Three servings of fruit (one serving is a cup of cantaloupe, 2 small tangerines, a small banana, or a small apple)
- Six servings of fat (one serving is a teaspoon of olive oil, two tablespoons of avocado, four pecan halves, or a tablespoon of reduced-fat mayonnaise)
Seven servings of starch per day, eh? Two servings of whole-grain starch plus a cup of milk pushed my reader’s blood sugar to over 170 mg/dL. (Thank goodness he didn’t add a banana to that meal, as Ms. Warshaw would recommend.) So for many diabetics out there, Ms. Warshaw’s diet is an invitation to walk around with jacked-up blood sugar all day. But of course she’s a big fan of Metformin and other drugs that lower blood sugar, so it all balances out.
Q: Since I have diabetes, do I need to prepare my food separately from my family?
A: No. The foods that are healthy choices for you will also be healthy choices for your family members who don’t have diabetes.
That’s true. Too bad Ms. Warshaw and the ADA have no flippin’ idea which choices are actually the healthy ones.