Type 2 Diabetes: From Old Dogmas to New Realities – Part 2

In the last decade, dramatic changes have occurred in our understanding of the onset and progression of prediabetes. Lightning speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control. Even with all of this change, however, many old dogmas hang on. It’s time to be aware of the new realities. In this article,  I focus on two common old dogmas and the new realities.

Old Dogma: Losing weight will make blood glucose levels plummet no matter how long you have had type 2 diabetes. The message that people continually hear from their providers is “If you’d only lose weight, your blood glucose would go down.” And the common reply from people with type 2 is “I’ll try harder with my ‘diet’ over the next few months, but please don’t put me on a diabetes medication.”

New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis. (Read the Look AHEAD trial results, a study about the effect of weight loss on heart disease in type 2 diabetes.) In fact, the biggest bang for the effort per pound is likely in the prediabetes phase. (The sad fact is that most people don’t know that they have prediabetes.)

Large studies have shown that with loss of five to seven percent of body weight (approximately 10 to 20 pounds) and 150 minutes of physical activity (30 minutes five times a week), people can prevent or delay the progression to type 2. Once insulin production is on a dwindling course (particularly after 10 years with type 2), weight loss has less impact on glucose control.

The reality is that if blood glucose is out of control, it’s time to progress to blood glucose-lowering medication(s), because it’s doubtful that weight loss alone will get and keep blood glucose under control. Today, most experts, including the American Diabetes Association and American Association of Clinical Endocrinologists, agree that people with type 2 should start on a blood glucose-lowering medication that decreases insulin resistance–the core problem in type 2–at diagnosis.

Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet.

New Reality: Nutrition recommendations for people with type 2 diabetes from the American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines (1/31/11) for carbohydrate: about 45 to 65 percent of calories. (Americans currently eat about 45 to 50 percent of calories as carbohydrate–not a “high carb” intake.)

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. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they’re carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains, and low fat dairy foods–all healthy sources of carbohydrate.

Bottom line: The most important new reality for prediabetes and type 2 diabetes is: Take action as early as possible after diagnosis. Don’t delay, don’t deny. Get and keep your blood glucose, blood pressure, and blood cholesterol into recommended target zones.

Hope Warshaw, MMSc, RD, CDE, is a nutrition and diabetes consultant and the best-selling author of numerous consumer books, including Diabetes Meal Planning Made Easy, Real Life Guide to Diabetes, and Complete Guide to Carb Counting, all published by the American Diabetes Association.

0 thoughts on “Type 2 Diabetes: From Old Dogmas to New Realities – Part 2

  • John Smith

    Yea, if I had followed the US dietary guidelines, I’d still be somewhere north of 295LBS, diabetic, and probably on my way to getting a triple bypass by now.

    Seven months ago I started a ketogenic diet (Low Carb High Fat), and have lost approximately 75 LBS. Oh, and ALL of my numbers (HDL, LDL, TG, hbA1C, etc…) are WAY better now.

    If the “so called” studies you sight say otherwise, then my only conclusion is that the idiot(s) running the studies were doing it wrong. Lowish carbs, and/or high protein, is not LCHF (Low Carb High Fat), and WILL NOT have the same effect on ones metabolism. If the carbohydrate intake is too high, no ketosis, if the protein intake is too high, again no ketosis (via gluconeogenesis). If the carbs are low enough (5% or less), and protein is 20% or less, and fat calories are 75%+, but yet the carbs that you are eating are high glycemic in nature (like wheat bread), again NO F&*KING KETOSIS. If you keep spiking the BG, the insulin kicks in, and your body goes into fat storage mode again. After which, it takes at least 4~7 days for your body to even think about becoming keto adapted again. And it can take upwards of 6 weeks for your body to become fully ketogenically adapted.

    Like any other diet, if the subject doesn’t actually follow the diet properly, it doesn’t work (DUH). LCHF diets work (when followed CORRECTLY) and are popular because the subject is NOT constantly hungry (like pretty much all other diets). This is because fat and protein are much more filling, for longer, as they take longer to digest than even high fiber carbohydrates. And I can attest from personal experience, that once fat adapted, it is like your hunger switch has been turned off.

    Yep, keep throwing carbs at the problem. Oh, it was the wrong kind of carbs? They weren’t “complex” enough? ALL carbohydrates break down to monosaccharides (SUGAR) minus the fiber.

    The fact that our modern diet consists of so much sugar in various forms (even HFCS in “healthy” whole wheat bread), that is is no wonder diabetes, obesity, and heart disease have been on the rise since the ADA’s disastrous diet recommendations that have been followed since in the early 1980’s. And food companies have been more than happy to replace expensive fats with cheap sugar, wheat, & corn, and then charge even more as it was a special “diet” version.


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