The debate goes on: carbs in or carbs out?

Screen Shot 2015-02-08 at 4.09.19 PMTreat carbs like special treats

A friend, and fellow A1c Champion, saw author, Gary Taubes, talk about his new book Good Calories, Bad Calories, a month ago on Good Morning America and sent this email around, “Taubes says that exercise makes us hungry for carbohydrates, not lean, and that carbohydrates cause insulin secretion which creates fat.”  One of her email recipients, who is a Ph.D and medical specialist, wrote back: ‘There is still a lot that we don’t know but for me eating less and moving more has led to my weight reduction. I could have dieted on birthday cake as long as I did not eat more cake calories than I spent.’

It’s a constant debate in this country: What’s the magic formula for losing weight, fast – and easy. The second battle ground, and especially for us d-people, is are carbs good or bad? To me, the answer to both is simple: eat less, move more and since carbs raise your blood sugar, if you want to lower it eat less carbs. Why is that such a difficult notion? Seems crystal clear to me and trust me I’m no rocket scientist.

Around the same time my friend’s email went around, a wicked debate was playing out on DiabetesHealth’s web site. Hope Warshaw, MMSc, RD, CDE, BC-ADM, and diabetes educator, wrote five articles on carbs, Don’t Want to Go Low Carb or Vegan, that garnered more comments than I’ve ever seen in response to an article, and a rebuttal article by Richard D. Feinman, PhD, Professor of Biochemistry and Director of the Nutrition and Metabolism at State University of New York Downstate Medical Center.

In a big nutshell Feinman said, “I’m astonished that experts encourage people with diabetes to eat carbohydrates and then “cover” them with insulin. Why would anyone, (let alone doctors who advocate it every day), recommend a diet that requires more medication?” Are they all in bed with pharma companies? Sorry, that last question is my own.

“It strikes me as odd that what most experts know about metabolism – diabetes is, after all, a metabolic disease,” said Feinman, “they learned in medical school from somebody like me. The first thing we teach medical students is that there is no biological requirement for carbohydrate. It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose. And, all of the metabolic syndrome ills – high triglycerides, low HDL, hypertension and obesity – are improved by low carbohydrate diets. If we had been describing a drug,” Feinman goes on to say, “everybody would have rushed out to buy stock in our pharmaceutical company.”

I can’t comment on the metabolic workings, but being like most diabetics I can share with you what I experienced when I changed my diet several years ago to low carb. I read Dr. Richard Bernstein’s book, Diabetes Solution, and for the first time read someone advocating getting rid of carbs to control blood sugar. Dr. Bernstein advocates next to no carbs in a diabetic diet.

Himself a diabetic for more than 50 years, Bernstein claims he has reversed many of his early complications and gotten his blood sugar under tight control by virtually eliminating carbs. Less carbs means you’ll be taking less insulin and by taking less insulin, Bernstein claims, your insulin will be better absorbed, there’ll be less variability in its time and efficacy and greater predictability with your blood sugars. Let’s just say after I read his book, I was encouraged and inspired to try his “solution,” so I pretty much vacuumed the carbs out of my diet. “Vacuumed” in the sense that I cut way, way back. I essentially eliminated refined carbs: white bread, white potatoes, rice, pasta, sweets, muffins, starchy veggies. The result? My sugars indeed dropped, were consistently lower, my insulin doses dropped, and maybe best of all I was no longer chasing high blood sugars. You know the ones that come from refined carbs where you just can’t seem to knock them down all day. My Lantus dose went from 20 to 12.5 units and my mealtime Humalog was all but cut in half before each meal. The results were so dramatic and made life so much easier, I have not in five years gone back to my old ways. I do have to add the caveat that we’re all different and your body may not respond the same as mine.

It’s common sense, though, that the less carbs you eat the less your blood sugar will rise and the less medication you’ll need. I don’t understand how anyone can argue the logic in that. If we’re still being given diets with substantial carbs in them it’s probably because the American Diabetes Association (ADA) and powers that be think the average diabetic will never stand for, and won’t be able to, cut the carbs. Not unlike why the ADA’s A1c recommendation is as high as 7 – which correlates with 170 on your meter – even though we’re advised to stay in a target range of 80 – 120. Something sound fishy?

For those interested, here’s my routine that keeps my sugars low. My one carb meal is breakfast. I figure it’s healthy, high fiber, it’s satisfying, and since I walk in the morning, the blood sugar rise gets leveled out. Every morning I make a bowl of slow-cooked, steel cut oatmeal. I know many people who make a batch a week and freeze portions, but I like the morning ritual. I actually eat less than a whole serving and make up the difference with a dollop of low fat plain yogurt or cottage cheese and a tablespoon of peanut or almond butter. Also I add flax seed and cinnamon. For this treat, and like Jerry on Seinfeld I could eat breakfast for any meal, I need 3.5 units of Humalog or 3 if I’m taking my hour walk around my local park. Lunch is generally a spinach salad with feta cheese, tomatoes, beans, left over veggies, or a spinach/feta omelet. For that I need .5 – 1 unit, and dinner is typically fish or chicken, vegetables and beans. If I’m having a glass or two of wine with this dinner I don’t need any insulin – alcohol for most people lowers their blood sugar, unless you’re drinking Strawberry Margaritas and Singapore Slings.

A few months ago I interviewed a fellow type 1 who had had an islet cell transplant, two actually. For 18 months afterward she was insulin-free. Unfortunately, as for most islet cell transplant recipients, if not all, her new cells began to fail and she had to add some insulin back to keep her blood sugars in range. She told me, though, she’s on a very small dose — 14 units total daily. My daily dose is about 18 units and none of my beta cells work. Seems argument enough for me that you can keep your insulin, or meds, at a minimum by sweeping most of the carbs out of your diet.

I should tell you in full disclosure my diet is not carb-free – and alas, I am not perfect. When out to dinner I often nibble on the bread and love it dripping with olive oil. Thank God someone decided that’s healthy. I indulge in an order of fried calamari or crab cakes from time to time, and if dessert comes to the table I’ll stick my fork in like everyone else for a taste. But without question, the less carbs I eat the less insulin I need, and for me the control I get and the way I feel is worth it.

If you’re curious about a lower carb diet, give it a try. First hook up a hoover to your pantry and suck out all the chips, pretzels, rice and muffin mixes. Second, while experimenting, test, test, test. Third, see if your blood sugars and meds don’t drop. Fourth, reward yourself with some high cocoa dark chocolate — Lindt’s 85% Excellence chocolate bar has only 8 carbs per serving! Good luck.

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