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.
If you enjoy my posts, please consider a small donation to the Fat Head Kids GoFundMe campaign.
Isn’t it amazing that the vegans and vegetarians, who see their way of life as a sort of spiritual and religious experience, are the ones who seem to fight the issue? It’s the Crusades all over again.
I certainly don’t see paleo dieters trolling vegan blogs and preaching to them.
Laura’s post quoting the person on the diabetic forum : “double check how much fat you’re eating. The lower you can get the fat intake, the better for bringing blood sugars down”
Can they explain how fat is causing blood sugars to rise? What the heck? Since when does that make a lick of sense?
It doesn’t make sense.
Sheesh. I see she keeps stressing that “Fat-free dairy”. I went to the supermarket the other day. I wanted some full-fat yogurt, but the store didn’t carry any. None of them even carry my beloved full-fat Fage anymore, they only carry the 0% fat and occasionally the 2% fat Fage. So I bought me a carton of my beloved full-fat Daisy-brand sour cream. It’s ingredient list reads “Grade A cultured cream” and that’s it!
Sitting next to it on the shelf was the store brand fat-free sour cream, the sort Ms. Warshaw would want you to buy undoubtedly, so I took a look at ITS ingredient list, which read: “cultured pasturized skim milk, food starch – modified (corn), whey, cream, artificial color, propylene glycol monoester, sodium phosphate, agar, xanthan gum, cellulose, propionic acid, acetic acid, citric acid, natural and artificial flavor, vitamin A palmitate enzyme”.
Hmm, sorry Ms. Warshaw. I sure know which one of those *I* would rather eat!
I’m glad we can find full-fat yogurt where we are. It’s delicious.
Hi Tom.
I think that the advice regarding the 140 limit is good, but I don’t think the evidence that levels higher than 140 lead to beta cell loss.
What seems to happen is the reverse: beta cell loss leads to high glucose levels.
Typically if you consume a certain amount of carbohydrates, you’ll get a proportional AUC (area under the curve) glucose response. Most people, but not all, can reduce the peak glucose level by consuming either protein or fat together with the carbs.
Thank you for the clarification.
Isn’t it amazing that the vegans and vegetarians, who see their way of life as a sort of spiritual and religious experience, are the ones who seem to fight the issue? It’s the Crusades all over again.
I certainly don’t see paleo dieters trolling vegan blogs and preaching to them.
Laura’s post quoting the person on the diabetic forum : “double check how much fat you’re eating. The lower you can get the fat intake, the better for bringing blood sugars down”
Can they explain how fat is causing blood sugars to rise? What the heck? Since when does that make a lick of sense?
It doesn’t make sense.
Sheesh. I see she keeps stressing that “Fat-free dairy”. I went to the supermarket the other day. I wanted some full-fat yogurt, but the store didn’t carry any. None of them even carry my beloved full-fat Fage anymore, they only carry the 0% fat and occasionally the 2% fat Fage. So I bought me a carton of my beloved full-fat Daisy-brand sour cream. It’s ingredient list reads “Grade A cultured cream” and that’s it!
Sitting next to it on the shelf was the store brand fat-free sour cream, the sort Ms. Warshaw would want you to buy undoubtedly, so I took a look at ITS ingredient list, which read: “cultured pasturized skim milk, food starch – modified (corn), whey, cream, artificial color, propylene glycol monoester, sodium phosphate, agar, xanthan gum, cellulose, propionic acid, acetic acid, citric acid, natural and artificial flavor, vitamin A palmitate enzyme”.
Hmm, sorry Ms. Warshaw. I sure know which one of those *I* would rather eat!
I’m glad we can find full-fat yogurt where we are. It’s delicious.
Re: towncryer’s comment, it’s more realistic to compare results from one diet to results from another diet rather than comparing them to perfection. Take Jimmy Moore, for instance: he’s still a big guy, buy he’s kept off over 100 pounds on a LC diet, takes no medications, and has a heart calcium score of 0 (meaning his arteries aren’t hardened).
It’s not all about weight. It’s also about controlling diabetes or high blood sugar levels that cause organ and tissue damage (and make some people feel like crap), eliminating acid reflux (the original reason I started LC), avoiding food allergies, eliminating arthritis and joint pain, and even healing cavities. It’s the success so many of us have achieved in these areas with a LC diet, not indoctrination, that keeps us away (for the most part) from starchy, sugary foods.
But if it really is all about the weight for you, I’m a low carber and I weigh 118 pounds at 5′-4″–same weight I was in high school. Before LC, I was 140 and gaining. Angelina Jolie said that her biggest beauty secret was a steak–that veganism didn’t do her any good. And a vegan troll mistook 51-year-old Junianne Taylor for 40. (Click the link and scroll down to the comment from “Jason.”)
http://paleozonenutrition.wordpress.com/2011/03/05/30-bananas-a-day-durianrider-an-analysis-of-his-paleo-vegan-diet/
This low-carber looks pretty good, too.
http://samipaju.com/the-how-and-why-of-weight-loss/
@townCryer, “I couldn’t help but notice that…..very few people that follow a low carb diet actually look good.” Wow! I don’t know what to say. That is so not nice. Aside from the fact that you purposely selected certain pictures (8 people out of…how many on the cruise as well as elsewhere that you don’t even know?), who cares what people look like? Beauty is only skin deep. What matters is their health–mental and physical. Perhaps you are healthy on a vegetarian lifestyle–good for you. Like Tom, I tried it and was a lot less healthy–and fatter–than ever before or since. I realize he’s prejudiced, but my husband tells me I look younger and better now than I did then (20 years ago) and better than many who are much younger than I. That may or may not be, but I know I’m healthier. more active, and more energetic than I was then. I can still hike all day, play tennis (singles) or swing dance for a couple of hours at a stretch. And I’m 64.
Re: towncryer’s comment, it’s more realistic to compare results from one diet to results from another diet rather than comparing them to perfection. Take Jimmy Moore, for instance: he’s still a big guy, buy he’s kept off over 100 pounds on a LC diet, takes no medications, and has a heart calcium score of 0 (meaning his arteries aren’t hardened).
It’s not all about weight. It’s also about controlling diabetes or high blood sugar levels that cause organ and tissue damage (and make some people feel like crap), eliminating acid reflux (the original reason I started LC), avoiding food allergies, eliminating arthritis and joint pain, and even healing cavities. It’s the success so many of us have achieved in these areas with a LC diet, not indoctrination, that keeps us away (for the most part) from starchy, sugary foods.
But if it really is all about the weight for you, I’m a low carber and I weigh 118 pounds at 5′-4″–same weight I was in high school. Before LC, I was 140 and gaining. Angelina Jolie said that her biggest beauty secret was a steak–that veganism didn’t do her any good. And a vegan troll mistook 51-year-old Junianne Taylor for 40. (Click the link and scroll down to the comment from “Jason.”)
http://paleozonenutrition.wordpress.com/2011/03/05/30-bananas-a-day-durianrider-an-analysis-of-his-paleo-vegan-diet/
This low-carber looks pretty good, too.
http://samipaju.com/the-how-and-why-of-weight-loss/
@townCryer, “I couldn’t help but notice that…..very few people that follow a low carb diet actually look good.” Wow! I don’t know what to say. That is so not nice. Aside from the fact that you purposely selected certain pictures (8 people out of…how many on the cruise as well as elsewhere that you don’t even know?), who cares what people look like? Beauty is only skin deep. What matters is their health–mental and physical. Perhaps you are healthy on a vegetarian lifestyle–good for you. Like Tom, I tried it and was a lot less healthy–and fatter–than ever before or since. I realize he’s prejudiced, but my husband tells me I look younger and better now than I did then (20 years ago) and better than many who are much younger than I. That may or may not be, but I know I’m healthier. more active, and more energetic than I was then. I can still hike all day, play tennis (singles) or swing dance for a couple of hours at a stretch. And I’m 64.
I watched Bill Maher last night and he had on T. Colin Campbell, Jacob Gould Schurman Professor Emeritus of Nutritional Biochemistry at Cornell University. He’s pushing a movie called, “Forks over Knives”, in which he states a plant based diet, with no meat or dairy, can save lives much more effectively than modern medicine.
He states that meat and dairy cause cancer, with no research to support it. Maher, an active member of PETA, proclaimed that we are eating a bucket of lard in the morning. I sent a reply to his Twitter account that I would rather eat that than a bowl of Froot Loops, glass of OJ with toast and butter, and explained to him that lard has as much of the good fats as olive oil and better nutritional content.
Maybe Mr. Maher and Dr. Campbell could do with a complimentary copy of “Fat Head” and “Big Fat Fiasco”.
I watched Bill Maher last night and he had on T. Colin Campbell, Jacob Gould Schurman Professor Emeritus of Nutritional Biochemistry at Cornell University. He’s pushing a movie called, “Forks over Knives”, in which he states a plant based diet, with no meat or dairy, can save lives much more effectively than modern medicine.
He states that meat and dairy cause cancer, with no research to support it. Maher, an active member of PETA, proclaimed that we are eating a bucket of lard in the morning. I sent a reply to his Twitter account that I would rather eat that than a bowl of Froot Loops, glass of OJ with toast and butter, and explained to him that lard has as much of the good fats as olive oil and better nutritional content.
Maybe Mr. Maher and Dr. Campbell could do with a complimentary copy of “Fat Head” and “Big Fat Fiasco”.
@townCryer We are a happy group here, I am sorry to see that you seem grouchy.. have you thought that maybe your diet, which is known to lack many vital nutrients, might be the cause? Without a change in diet, I am concerned that you will become terminally grumpy… That, my friend is what makes a person Not Good Looking.
@townCryer We are a happy group here, I am sorry to see that you seem grouchy.. have you thought that maybe your diet, which is known to lack many vital nutrients, might be the cause? Without a change in diet, I am concerned that you will become terminally grumpy… That, my friend is what makes a person Not Good Looking.
@townCryer –
You found photos of overweight people who are on a weightloss diet? I’m shocked! Shocked, I tell you!
Yes, normally only naturally skinny people go on weight-loss diets.
@townCryer –
You found photos of overweight people who are on a weightloss diet? I’m shocked! Shocked, I tell you!
Yes, normally only naturally skinny people go on weight-loss diets.
I think Dana Carpender may have misunderstood the term “nutrient dense.” I tried to explain using an analogy with an anecdote from Darwin that the term, like Hope Warshaw’s myths and realities, doesn’t mean anything at all.
http://rdfeinman.wordpress.com/2011/03/24/darwin-and-the-usda-dietary-guidelines-nutrient-dense-or-just-dense/
I think Dana Carpender may have misunderstood the term “nutrient dense.” I tried to explain using an analogy with an anecdote from Darwin that the term, like Hope Warshaw’s myths and realities, doesn’t mean anything at all.
http://rdfeinman.wordpress.com/2011/03/24/darwin-and-the-usda-dietary-guidelines-nutrient-dense-or-just-dense/
Wow… a friend recommended this post to me and I love it! As a registered nurse who works with many diabetics (and the daughter of a diabetic and wife of a diabetic) and I have always thought the advice handed out by most “diabetic educators” was pretty much crap!
I let the doc talk my husband into one meeting with the diabetic educator after we moved to a new community and he came home totally confused.
Of course, the doc also thought that because I carry a bit of extra weight that I was unhealthy. (I work night shift and have had seven healthy babies over the past 18 years. I’m also very, very muscular and stronger than many men, which is a requirement of my very physical work load in ER and Trauma nursing).
Well, I told him to do a full set of bloodwork on me and also pointed out that I have a strong family history of diabetes and yet managed with seven pregnancies to never ONCE have gestational diabetes. Not even close… I can do the glucose challenge they require and end up with a blood sugar in the 90s.
Sure enough, my bloodwork came back perfect. In fact, my numbers are what most cardiologists would consider better than perfect. And I do it low carb. (Low carb also keeps me from having horrible migraines and gives me more energy, too.)
I hope you’re allowed to give advice to diabetics about diet.
Wow… a friend recommended this post to me and I love it! As a registered nurse who works with many diabetics (and the daughter of a diabetic and wife of a diabetic) and I have always thought the advice handed out by most “diabetic educators” was pretty much crap!
I let the doc talk my husband into one meeting with the diabetic educator after we moved to a new community and he came home totally confused.
Of course, the doc also thought that because I carry a bit of extra weight that I was unhealthy. (I work night shift and have had seven healthy babies over the past 18 years. I’m also very, very muscular and stronger than many men, which is a requirement of my very physical work load in ER and Trauma nursing).
Well, I told him to do a full set of bloodwork on me and also pointed out that I have a strong family history of diabetes and yet managed with seven pregnancies to never ONCE have gestational diabetes. Not even close… I can do the glucose challenge they require and end up with a blood sugar in the 90s.
Sure enough, my bloodwork came back perfect. In fact, my numbers are what most cardiologists would consider better than perfect. And I do it low carb. (Low carb also keeps me from having horrible migraines and gives me more energy, too.)
I hope you’re allowed to give advice to diabetics about diet.
I love this exchange:
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.
We eat. People with diabetes enjoy.
I love this exchange:
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.
We eat. People with diabetes enjoy.
The ADA recommendations for people with diabetes are criminal.
The sad thing is that those of us who took a few minutes to look over the scientific literature, to consider for a moment the connection between carbohydrates, insulin and diabetes/obesity/heart disease are the ones who have to provide evidence/justification.
People like Hope Warshaw and the entire nutritional establishment that seem intent on forcing a deadly and scientifically unsound way of eating upon even the most vulnerable members of our society.
This same issue came up 100 years ago when Viljhalmur Stefansson (a Canadian explorer) reported how well he and his men did on the traditional Eskimo diet of “meat and cold water” (meat at the time meant both the “fat” and the “lean” portions). I’m currently running a multi-part write up of his story (you can read part one here http://www.fitnessinanevolutionarydirection.com/2011/07/viljhalmur-stefansson-and-foodways-of.html) to bring awareness to this fact.
The ADA recommendations for people with diabetes are criminal.
The sad thing is that those of us who took a few minutes to look over the scientific literature, to consider for a moment the connection between carbohydrates, insulin and diabetes/obesity/heart disease are the ones who have to provide evidence/justification.
People like Hope Warshaw and the entire nutritional establishment that seem intent on forcing a deadly and scientifically unsound way of eating upon even the most vulnerable members of our society.
This same issue came up 100 years ago when Viljhalmur Stefansson (a Canadian explorer) reported how well he and his men did on the traditional Eskimo diet of “meat and cold water” (meat at the time meant both the “fat” and the “lean” portions). I’m currently running a multi-part write up of his story (you can read part one here http://www.fitnessinanevolutionarydirection.com/2011/07/viljhalmur-stefansson-and-foodways-of.html) to bring awareness to this fact.
“Isn’t it amazing that the vegans and vegetarians, who see their way of life as a sort of spiritual and religious experience, are the ones who seem to fight the issue? It’s the Crusades all over again.
I certainly don’t see paleo dieters trolling vegan blogs and preaching to them.”
I’m almost positive the paleo dieters aren’t out trolling because they’re actually satisfied and happy after a meal instead of sitting there wanting something else. 🙂 Love this blog Tom!
I certainly have no desire to visit vegan blogs and preach to them. It would be like attending a meeting of Hezbollah and attempting to convert them to Mormonism.
“Isn’t it amazing that the vegans and vegetarians, who see their way of life as a sort of spiritual and religious experience, are the ones who seem to fight the issue? It’s the Crusades all over again.
I certainly don’t see paleo dieters trolling vegan blogs and preaching to them.”
I’m almost positive the paleo dieters aren’t out trolling because they’re actually satisfied and happy after a meal instead of sitting there wanting something else. 🙂 Love this blog Tom!
I certainly have no desire to visit vegan blogs and preach to them. It would be like attending a meeting of Hezbollah and attempting to convert them to Mormonism.
About Hope Warshaw…I can think of a few scenarios.
1) As Upton Sinclair, author, so aptly commented, “it’s difficult for a person to understand something when their very salary depends on them NOT understanding it
2) She’s a Liar.
3) As others said, she’s a “front”, for the American Diabetes Ass. (sic) in order to insure an ever increasing population dependant of the services offered, and my guess is that the ADA is a “Front” for big Pharma, and possibly even the AMA. (Brilliant marketing move).
5)The American Dietetic Ass.(sic) gives out certifications when you send five box tops to them (from Kellogs or General Mills cereals) along with a $100.00 registration fee.
6) She’s an idiot.
You choose the best fitting scenario!
7) All of the above.
About Hope Warshaw…I can think of a few scenarios.
1) As Upton Sinclair, author, so aptly commented, “it’s difficult for a person to understand something when their very salary depends on them NOT understanding it
2) She’s a Liar.
3) As others said, she’s a “front”, for the American Diabetes Ass. (sic) in order to insure an ever increasing population dependant of the services offered, and my guess is that the ADA is a “Front” for big Pharma, and possibly even the AMA. (Brilliant marketing move).
5)The American Dietetic Ass.(sic) gives out certifications when you send five box tops to them (from Kellogs or General Mills cereals) along with a $100.00 registration fee.
6) She’s an idiot.
You choose the best fitting scenario!
7) All of the above.