G'day All
X-posted to misc.health.diabetes, alt.support.diabetes
I would appreciate comments on the draft letter below. The
letter is intended for my local Diabetes Australia
quarterly magazine.
I feel a little like Spartacus heading off to the arena; "we
who are about to die salute you". I'm not an expert, so I
know I'm asking to be drawn and quartered here, but I'd
respect informed, civil criticism before I "go to press" :-)
If I'm wrong or uninformed, I'm happy to debate the point or
modify the letter as long as things stay civil.
Letter:
To the editor,
I would hope that you will publish this letter, despite the
obvious disagreement with your standard dietary policy.
I am a type 2 diabetic. I was diagnosed in May 2002 with
high fasting glucose and HbA1c of 8.2. I realise that I
am just another of many thousands, or unfortunately now,
millions, around the world who have stepped out of the
doctor's office finding it hard to come to terms with
this news, and the implications for a significant change
in my life.
From that moment I was determined to learn what I needed to
know to beat
it. One of the first things I learnt was that, at least for
the moment, you can't beat it. It's incurable. But I
also slowly learnt that it is possible to gain a measure
of control. I lost 28 Kg in six months and have
stabilised at a loss of 25 Kg. The net results are that
my blood pressure is great, my lipids are the best
they've ever been, and my HbA1c has dropped from 8.2 to
5.9. My only medication is lipitor 20.
Unfortunately, the stock response to previous writers with
similar results such as ....... in the previous issue, is
that it was achieved because of the weight loss or exercise.
Yes, I lost weight, and yes, I do some exercise (I should do
more). However, the hardest time for control came after the
weight stabilised eighteen months ago. The reason I am in
control is post-prandial self-testing, with analysis of my
results leading to modification of my diet.
How did I do that? I read and listened to everything I could
find on type 2, but as a layman I didn't find much. I didn't
even know what to look for. Of course, I joined Diabetes
Australia, and I later attended a local monthly meeting. The
dietician there recommended his course at the community
health centre, so I went to that. It was good; I learnt
about carbohydrates, and how they lead to blood glucose, and
insulin, fats, food labels etc. Lots of good information.
But it was there that I first came across a contradiction.
In the first lecture, we learnt that eating complex
carbohydrates caused our blood glucose to rise, and eating
more carbs at a meal caused the BGs to rise more. Pretty
basic stuff.
During this time, I had searched the internet for
information and also joined some diabetes newsgroups. I
learnt there some advice which made simple sense to me -
test your blood glucose after you eat to find out what the
effect is from the food you eat. To me, that sounded so
logical. Then if what you eat causes a "spike" modify what
you eat next time. Obvious and logical.
Apparently not as obvious or as logical to the dietician,
Diabetes Australia (DA) or international authorities such as
the American Diabetes Association (ADA). Because in the next
lecture, we were told that we should eat 30-45 gms of
carbohydrate at every meal for our health. In the interim, I
had started testing my blood glucose one hour and two hours
after every meal to see the effects of my diet. When I put
the dietician's advice into practice, I consistently got
very high ( 8, 9 and over 10) readings at one hour.
So we come to the paradox facing Type 2 diabetics around
the world:
1. Dieticians advise high complex carbohydrate consumption,
apparently for heart and vascular health;
2. High complex carbohydrate consumption causes high blood
glucose levels;
3. High blood glucose levels cause diabetic
complications such as retinopathy, neuropathy,
nephropathy and heart disease;
4. DA dieticians promote high complex carbohydrate
consumption, but balance this by recommending medication
to control blood glucose levels. This advice appears to
be in line with the recommendations of the ADA.
I have attached copies of the relevant DA and ADA
recommendations to this letter.
There is an alternative. Follow a healthy diet, and take
diabetes medications or insulin if the diet is inadequate to
maintain safe blood glucose levels. I would define a healthy
diet for a diabetic as one which meets nutritional needs for
general health without raising blood glucose levels above
acceptable limits. That means a much lower carb intake for
most of us than that recommended by the dieticians. My view
is that self-monitoring of blood glucose levels (SMBG) is
necessary to determine the diet for each individual Type 2.
The best method to achieve this that I've seen is at alt-support-alt-support-Open ↗
diabetes.org , under the heading "Newly Diagnosed".
This option, which can lead to a significant reduction in
complex carbohydrates in the diet, is vehemently opposed by
diabetes authorities around the world. The basis for
opposition appears to be that it will lead to a higher
incidence of heart disease, despite a growing body of
evidence that the dietary thinking from the latter half of
the twentieth century was incorrect and simplistic. The
mantra appears to be: "fat is bad, carbs are good, excess
protein gives you kidney disease". Modern research is
starting to discover that the type of fat is critical - some
is good, some is bad, some is neither in moderation; the
type of carbs are critical - low GI, high GI, leafy veg
versus starches etc, the proportion and type of protein is
important, the inclusion of vitamins and minerals such as
calcium, potassium etc is critical; and so on. And most
important: that post-prandial excursions (BG spikes) caused
by high carb consumption are just as dangerous as high
fasting BG levels.
In other words, the more we learn on diet, the less definite
is the reliance on thinking from last century . Thus, there
is less and less foundation for the advice given by
dieticians for diabetics to eat lots of starchy carbs and
balance them with meds.
I had already designed my own diet, a very simple low-fat
low kj diet based on everything I could find on the
subject. Using that, and a lazy man's exercise programme, I
lost about 25 Kg. About half-way through that process I
started intensive testing, up to ten times daily in the
early stages. I discovered exactly what the effect was on
my blood from everything I ate, then went back and changed
the foods that caused spikes - until I didn't get spikes. I
don't eat low-carb deliberately; I eat low-spike, which
tends to be low-carb.
It doesn't mean I'll never use meds. It's a progressive
disease; all I can do is try to delay progress or slow it
down as much as I can. And it's no miracle cure - just the
application of common sense and discipline.
There is a new generation of informed, pro-active e-patients
out there who no longer accept the traditional advice
without backup support, cites to medical papers and logical
analysis. It is no longer acceptable to advise Type 2
diabetics to eat high starch diets unless a rational,
referenced argument can be put to support that case. This
letter is too long already, but I can, on request, provide
many medical research sources on the net for my logic. Can
the dieticians?
And to answer the cynics, no, my diet is not for sale.
Alan Shanley, Pottsville Beach NSW
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.