A reader of this blog wrote to Hope Warshaw, author of the “eat your carbs and take your drugs” article in Diabetes Health that was the subject of my last post. I didn’t see his original email to her, but he did forward me her response. Here’s the opening:
Rather than throwing stones and continually citing Richard Bernstein, MD, who as far as I know has only written consumer books and not published one research paper on his recommendations, or discussing your own experience of one, how about providing/discussing citations of well conducted long term research studies in people with type 1 and type 2 diabetes (or even prevention trials) who more successfully manage glycemia, lipids and blood pressure and eat healthfully on an intake of carbohydrate below 40% of total calories.
I see … the reader has successfully managed his diabetes with diet, but we can simply dismiss that evidence because it’s an “experience of one.” Ms. Warshaw apparently is convinced the reader is the only diabetic in the world who found a low-carb diet beneficial. Therefore her advice to eat a high-carb diet is still correct.
Riiiight … except we already know it’s not an “experience of one.” I quoted some comments diabetics posted on the Diabetes Health site regarding Ms. Warshaw’s article in my previous post. Here are a few more:
I set out on a low carbohydrate diet and within 6 months had normal blood sugar, normal blood pressure and lost over 100 pounds. People don’t need more drugs and bad dietary advice. I think we have all see the rising rates of obesity and diabetes and you are not helping the situation. If you really want to stop the rise, tell people the truth. Low Carbohydrate diets normalize blood sugar.
As a physician with pre-diabetes I am appalled that a high carbohydrate diet continues to be promoted. I am 56 years old. For the past 5 years I have maintained normal fasting blood sugars on a low carb diet.
I have been eating low carb for almost 1 year now and my diet includes lots of non stachy vegetables, fruits(strawberries, blueberries, raspberries), lean meats, eggs, nuts and some low carb desserts occasionally. My A1C is 5.6 and I have accomplished this by diet/exercise alone.
I am a type I diabetic and I know for a fact what 45-65% of calories as carbs can do to my BG… This is absurd and border-line dangerous statement from some “best-selling author.”
On Facebook and in other corners of the blogosphere, a lot of people are complaining that they also left comments on the article, but those comments never showed up. Perhaps Diabetes Health isn’t interested in letting the world see how many diabetics disagree with their house expert. Whatever the explanation for the blocked comments, it’s clear that many, many people have successfully managed their diabetes by doing the opposite of what Ms. Warshaw recommends. It’s not an “experience of one.”
Ms. Warshaw continued in her reply:
And instead of reading top line messages in resources like myplate.gov, dig into the research based information in the Dietary Guidelines Advisory Committee Report, 2010. Here’s the link: http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm
A couple of quotes from the Carbohydrate Chapter:
The Institute of Medicine (IOM) (2002) set an acceptable macronutrient distribution range (AMDR) for carbohydrates of 45 to 65 percent of total calories. Thus, current dietary guidance recommends consumption of carbohydrate-containing foods, including vegetables, fruits, grains, nuts and seeds, and milk products. Carbohydrate foods are an important source of fiber and other nutrients.
Well, there you have it: Ms. Warshaw’s dietary recommendations for diabetics must be correct because the USDA and other experts say so. No other proof needed — which is a rather odd position for her to take, considering how she ended her reply:
No need to write back unless you’ve got well conducted published research studies to share.
So we’ve got someone who is supposedly interested in helping diabetics, but arrogantly dismisses comments from actual diabetics who’ve achieved normal blood sugar through a low-carb diet. You’d think she would find all those “experience of one” stories intriguing and look into the matter a little more.
Banging my head on my desk didn’t diminish my annoyance with Ms. Warshaw’s reply to the reader, so this morning I wrote to her myself:
Dear Ms. Warshaw –
I’ve been following your responses to people who questioned your advice to diabetics to consume a high-carbohydrate diet. Those responses boil down to two arguments:
1. I’m right because the USDA Dietary Guidelines say I’m right.
2. Show me the long-term clinical studies proving carbohydrate restriction is effective for diabetics, or shut up and leave me alone.
Appealing to the authority of the USDA — whose mission is to sell the grains our government subsidizes — isn’t proof of anything. As you may already know, one member of the committee that wrote those guidelines has already stated publicly that the guidelines aren’t based on good science. I read the entire, mind-numbingly dense, stupefying, often-contradictory report myself, and I agree: the guidelines aren’t based on anything resembling solid science. So let’s set those aside and deal with actual science.
Here are links to just a few of the clinical studies that demonstrated the effectiveness of low-carbohydrate diets for managing diabetes:
Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The Low-Carbohydrate Ketogenic Diet group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).
The Low-Carbohydrate Ketogenic Diet improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.
Compared to baseline diet, after 8 weeks of a 25% carbohydrate diet, subjects showed significantly improved glycemia as evidenced by fasting blood glucose values (p<0.005) and hemoglobin A1c levels (p<0.05). Those previously treated with oral hypoglycemic agents showed, in addition, a significant decrease in weight and diastolic blood pressure despite the discontinuation of the oral agent. When then placed on a 55% carbohydrate diet, the hemoglobin A1c rose significantly over the ensuing next 12 weeks (p<0.05).
Yes, I know: you asked for long-term studies. As far as I can tell from my online research, there are few if any controlled clinical studies of dietary interventions that have lasted more than a year or perhaps two at most. So you appear to be asking your critics to quote the results of studies that have never been conducted.
But I’m clearly mistaken about that. You obviously have access to a long list of multi-year clinical studies on carbohydrate-restricted diets. I know this because of what you wrote in your article in Diabetes Health:
“Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control, or blood fats.”
Since you’ve examined countless such studies, could you please provide me a list of, say, a dozen references to clinical studies in which subjects adhered to a carbohydrate-restricted diet for more than a year, but failed to achieve improved glucose control compared to a control group? If you could point me to studies matching that description that lasted five or ten years, that would be super. I’d like to share them with my readers. Then we’ll all understand exactly how countless studies failed to show any long-term superiority of carbohydrate restriction for glucose control.
Also, given that you don’t like anyone to promote dietary advice that isn’t backed up by long-term clinical studies, could you please provide a list of multi-year clinical studies in which a diet of 45-65% carbohydrates produced superior glucose control and lower A1c when compared to a control group, or – better yet – when compared to a group in which carbohydrate was restricted to less than 40%? The diabetics among my readership especially would love to see the scientific basis for your advice — after all, their lives depend on it.
Writer/Director “Fat Head: you’ve been fed a load of bologna”
I haven’t received a reply.