August 1, 2007

Who ya gonna trust?

If you have just found out you have diabetes, you will almost certainly be told that part of the treatment for diabetes is "diet." The problem arises when you ask which diet.

It will take about 5 minutes of web research to learn that there is no agreement on what is the right diet for a person with diabetes. People with impressive medical credentials argue, often convincingly, for every possible diet a human could eat and some that very few humans would ever want to eat.

It is not my intention to debate diets in this blog entry. Instead, I'd just like to share a couple thoughts with you that might help you sort through the torrent of conflicting advice you're about to receive.

Most Dietary Research So Poorly Conducted the Results are Not to be Trusted.

Almost all research conducted by dietitians relies on having participants fill in a standard questionnaire about what they ate in the recent past.

I participated in one such study during a period when I was carefully weighing and logging every single bite I ate using LifeForm software because I wanted to really understand the impact of my food input on my weight and blood sugar.

After submitting my survey, the people conducting the study kindly sent me a print out they said showed what I'd been eating during the time period covered by the questionnaire.

Since I also had LifeForm's report that broke out exactly what I'd been eating over the identical period, I was surprised to see that the dietitians report was about 500 calories higher per day than what I had actually eaten, and that the percentages of Carb/Fat/Protein the dietitian's survey claimed I'd eaten bore no relationship to what analysis of my actual food logs showed I'd actually eaten.

I emailed the dietitian about this and offered to send a copy of my own computerized log and records to the dietitian but was told there was no need for it. They had confidence in their survey which used a standard form that was universal in dietetic studies.

So much for the accuracy of dietetic studies!

Beyond that, most dietary studies fail to control for many other factors than the one they are studying. Reading the actual study you see cited in the news often shows that strong conclusions are being drawn from the thinnest bits of data.

Even worse, most dietary research is funded by someone who profits from the food the research investigates. I've already discussed the deceptive studies that have touted the healing properties of chocolate and soy yogurt in this blog. But there are thousands of other such studies, all highly promoted in the press because the companies who sell these foods have active PR departments.

Bottom line: Treat all dietary studies with caution. Over the 9 years I've been following diabetes-related research I've seen just about every dietary research conclusion published contradicted by another equally poorly designed study. It's jungle out there!

Dietitians Do Not Keep Up With Research

No matter how much research comes out in mainstream journals showing that low fat diets have none of the positive health effects they were expected to have, a large proportion of dietitians continue to chant the religious mantra "fat is bad."

Even worse, many give out highly erroneous information such as the idea that the brain can't function on less than 130 grams of carb a day--which is more carb than I've eaten daily for the past 9 years, a period during which, apparently, brain-free, I've published several successful nonfiction books and designed some very complex software!

Dietitians continue to suggest people eat soy--though it is known to be poisonous to iffy thyroids. They suggest "low glycemic" diets to people with Type 1 diabetes who have no second phase insulin response which is what makes slow carbs useful to people with normal second phase insulin response--i.e. normal people and people with very early Type 2.

Don't Take Advice about Diabetes Diets from anyone who is NOT a Person who has Your Kind of Diabetes with Great Control

It was interesting to read the blog postings a couple years ago describing the diabetes journey of Dr. Bill, founder of the diabetes blog, who was an endocrinologist for years before he himself developed Type 1 diabetes. It was only when he started testing his own blood sugar after meals that he discovered that following the dietary advice he'd been giving patients for years raised his own blood sugar unacceptably.

This does not surprise me. Anyone who has tried to make insulin work with a nutritionist-recommended 300 grams of carbs a day or even a diet that is 1/3 carbs--and hence 55-70 grams of carbs per meal knows that this level of carb intake combined with unpredictable insulins makes it very tough to avoid hypos unless you let your blood sugar run high enough to cause complications.

This is one reason that so many of us people with diabetes have so much respect for Dr. Richard Bernstein, who was the very first diabetes patient in the world to use a blood sugar meter, with dramatic results. You may not agree with everything he writes (I don't) but Bernstein has forgotten more about diabetes than most of us will ever know, and everything he writes is worth checking out, if only because he's lived it.

It's that simple: The people whose advice is worth checking out are those who have the kind of diabetes you have, who have been able to maintain excellent control over a period of at least five years and who have not developed serious complications after adopting the diet they are advising you to try.

You'll get different and even conflicting advice from these people, too, because our bodies are different. If you are diagnosed with Type 2, there may be a huge difference in how much your diabetes is caused by insulin resistance and how much by insulin deficiency. People who are mostly diabetic from insulin resistance will get very good results from diets that won't work if your problem is insulin deficiency.

But the advice of someone who has your kind of diabetes and has made their diet work for them, is a good place to start. And the emphasis here is on the word "start".

No advice is good advice if your meter shows you getting blood sugars consistently over the level known to cause complications.

The AACE (American College of Clinical Endocrinology) says this level is 140 mg/dl (7.7 mmol/L) at 2 hours after eating. The ADA says it is 180 mg/dl at the same interval (though there is no current research that supports this level and a lot that supports the lower level.) But whatever your target is, if your diet is raising your blood sugar over that target, it's a bad diet.

Try out the ideas people share with you, but check them against what your meter tells you.

The best diabetes diet for you is the one that keeps your blood sugars in the safe zone!


Anna said...


Have you ever considered writing a book on diabetes? I'd buy it in a NY minute! At the very least, a compilation of your blog posts? With your publishing experience and your vast, common sense knowledge of the diabetes world, it would be fantastic!


Jenny said...



I've queried just such a book to a bunch of agents and one editor who publishes this kind of thing, but so far, no joy.

The lack of the letters "M.D." after my name is a major problem, as is the fact that health books as a category are not doing well anymore except for the blockbuster "Cure everything with one simpleminded idea" books written to appeal to credulous idiots.

One editor told me my book proposal was pitched to too intelligent a reader and that his experience has been that health books sell mostly to people who are frightened by big words and by references to scientific journals.

A recent visit to Borders and Barnes & Noble found that the only books displayed on the incredible shrinking Diabetes Shelf are the stupid ones. No Bernstein, No Becker.

That's why my stuff is posted on the web in all its overeducated, footnoted glory.

I suspect the other issue is that there is so much health information and support available online nowadays that there isn't much reason for most people to buy a book. They can find the information they need online fast and free. And they can ask questions, too.

I'm glad I entered nonfiction publishing back in the days when any intelligent person started out researching anything they were interested in by buying a book, but I'm also glad I got out of publishing a few years ago when the spread of the web made selling books became so much more difficult and the book industry responded by carrying fewer books in stores and demanding publishers give up a larger cut of profits to even get on those shelves.

Nasty business, nonfiction publishing, in the age of the web!

Khürt Williams said...

I will continue to read your blog and educate myself about my disease and will challenge my endo to stay on top of what actually works and what is crap.

Keep up the good word.

Kathy said...

I recently spoke to a nurse who told me there are 2 kinds of sugar: "good" sugar and "bad" sugar. Bananas are fruit, so they are good sugar and I should go ahead and eat them. I protested that bananas would not be good for my blood sugar level. She told me not to worry, and go ahead.

I explained this to my meter, had a small banana with my normal lunch, but the meter stubbornly refuses to listen. I went over 140 after 2 hours.

I decided my meter knows best, although it has not been to medical school. No more bananas for me.

Dietary advice is so confusing, they tell me things are ok but the meter disagrees.

Whole wheat bread tests badly. Can't have a sandwich and stay under 140. Put the same meat & cheese on a salad, the meter is happy. So much for healthy whole grains.

Unknown said...

how does all of this tie into a person(myself) with type 2 and still experiencing reactive hypoglycemia, of course I am eating low carb, and slow carb to the best of my ability's, but it is like my pancreas is just spitting and sputtering and I am along for the joyride.


aurora said...

Jenny..just found out about you...I find your writing and information interesting and easy to understand..I have be to two endos...and both have firmly declared NO LOW CARBS...and that was before I found out about L/C..I follow Dr.Berstein..(with a little tweaking)..Thanks so much!!!

Anna said...

What about if you teamed up with someone else? For instance, Fred Hahn of Slow Burn strength training temed up with the Drs. Eades (Protein Power) to write the Sow Burn exercise book. IMO, the exercise info is better with the Eade's info. I probably would have never even looked at the book without the Eades name connected to it.

Dr. Mike Eades' blog has an interesting preview of Gary Taube's upcoming book Good Calories, Bad Calories. In some of the reader comments there is a bit of a discussion on why Taubes (not an MD or diet guru) has the credibility to pull this off and get people thinking rationally again about fat/carbs. Hmmm, can you get to know Gary Taubes? As an author team, you two would ROCK!!!!


Unknown said...

I just finished Dr Bernstein's book on Diabetes, and thought it was superb. It would have saved my mother-in-law much grief and suffering if we had been able to find it while she was still alive.

I found the book on amazon by reading reviews, and wondered what you thought of it, glad to see you consider him a true expert.

Can I ask which of his opinions you disagree with?

Jenny said...


I was extremely lucky to find Dr. Bernstein's book the day I was diagnosed in 1998. Without it, I would have believed my doctor's assurance that blood sugars in the middle 200s after meals were "nothing to worry about" and would not have cut out the carbs that were poisoning me.

I disagree with Bernstein's definition of "normal" blood sugar, because it is not supported by the evidence of CGMS studies performed in populations of normal people. The text in the 3rd edition carries over from earlier editions and is out of date.

I also believe that his claim that the 4.2% A1c is normal is flawed, and that attaining the low 5% range will keep people in good health.

I think his experience is colored by treating people with severe control problems, and it is not necessary for everyone to eat at the very low carb level he suggests. The approach suggested by the A.S.D. Newly Diagnosed page seems like a better approach to me because it is more doable. I know so many people who have regained health using it. I think that Bernstein's extremism keeps people from trying a slightly less rigid approach that could save their health.

I think he is wrong that the thyroid function drop caused by prolonged low carbing is autoimmune in nature. I think it is an adaptation to what the body interprets as starvation and a major reason I no longer eat a ketogenic diet.

Finally, I think he is a bit confused about the Incretin drugs. They do have blood sugar effects he hasn't seen in his patients, probably because only someone with very severe diabetes would pay the $10,000 or so it costs to consult him. For some people with milder diabetes these drugs may have significant effects on insulin secretion.

That said, I think everyone with diabetes of any kind should read his book a few times, because they will learn things there they will see nowhere else. And anyone using insulin should also read him again.