The Debate Goes On: Carbs In or Carbs Out?

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Recently on "Good Morning America," a friend of mine (and fellow A1c champion)watched author Gary Taubes talk about his new book, Good Calories, Bad Calories.My friend sent this email around: "Taubes says that exercise makes us hungryfor carbohydrates and that carbohydrates cause insulin secretion, which createsfat."

One of her email recipients, a PhD medical specialist, wrote back: "Thereis still a lot that we don't know, but for me, eating less and moving more hasled to my weight reduction. I could have dieted on birthday cake as long as Idid not eat more cake calories than I spent."

It's a constant debate in this country: What's the magic formula for fast andeasy weight loss? The second question, especially for us d-people, is whethercarbs are good or bad. To me, the answer to both is simple: eat less and movemore. And, since carbs raise blood glucose, eat fewer carbs if you want to loweryour blood sugar. Why is that such a difficult notion? Seems crystal clear to meand, trust me, I'm no rocket scientist.

Carbs Arouse Fierce Debate

Around the same time that my friend's email went around, a wicked debate wasplaying out on the Diabetes Health website. Diabetes educator Hope Warshaw,MMSc, RD, CDE, BC-ADM, wrote a piece called "Why You Don't Want to Go Low Carbor Vegan" that garnered more comments than I've ever seen in response to anarticle, as well as a rebuttal article by Richard D. Feinman, PhD, Professor ofBiochemistry and Director of the Nutrition and Metabolism at State University ofNew York Downstate Medical Center ("Low Carbohydrate Diets: Why You Don't Want the "Experts" to Tell You What to Eat").

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

"It strikes me as odd," said Feinman, "that what most experts know aboutmetabolism – diabetes is, after all, a metabolic disease – they learned inmedical school from somebody like me. The first thing we teach medical studentsis that there is no biological requirement for carbohydrate. It is true thatyour brain needs glucose, but glucose can be supplied by the process ofgluconeogenesis; that is, glucose can be made from other things, notablyprotein. This is a normal process: when you wake up in the morning, between 30and 70 percent of your blood glucose comes from gluconeogenesis. There is norequirement for dietary glucose. And all of the metabolic syndrome ills – hightriglycerides, low HDL, hypertension and obesity – are improved by lowcarbohydrate diets. If we had been describing a drug," Feinman went on to say,"everybody would have rushed out to buy stock in our pharmaceutical company."

My Low-Carb Experiences

I can't comment on such metabolic complexities, but I can share with you what Iexperienced when I changed my diet to low carb. It was five years ago, after Iread Dr. Richard Bernstein's book, Diabetes Solution. For the first time, Iencountered someone advocating getting rid of carbs to control blood sugar.

Dr. Bernstein advises next to no carbs in a diabetic diet. Himself a diabeticfor more than 50 years, Bernstein claims he has reversed many of his earlycomplications and gotten his blood sugar under tight control by virtuallyeliminating carbs. Fewer carbs means you'll be taking less insulin. By takingless insulin, Bernstein claims, there'll be less variability in its absorptiontime and efficacy, as well as greater predictability with your blood sugars.

After I read his book, I was so encouraged and inspired that I pretty muchvacuumed the carbs out of my diet. I essentially eliminated refined carbs, suchas white bread, white potatoes, rice, pasta, sweets, muffins, and starchyveggies. The result? My sugars indeed dropped. They were consistently lower, andmy insulin doses dropped. Maybe best of all, I was no longer chasing high bloodsugars – you know, the ones that come from refined carbs, where you just can'tseem to knock them down all day. My Lantus dose went from 20 to 12.5 units, andmy pre-meal Humalog was all but cut in half. The results were so dramatic andmade my life so much easier that I never went back to my old ways. (I do have toadd the caveat that we're all different, and your body may not respond likemine.)

It's common sense, though, that the fewer carbs you eat, the less your bloodsugar will rise and the less medication you'll need. I don't understand howanyone can argue the logic of that. If we're still being given diets withsubstantial carbs in them, it's probably because the American DiabetesAssociation (ADA) and other authorities believe that the average diabetic wouldnever stand for cutting carbs so drastically. Along the same lines, the ADA'sA1c recommendation is as high as 7%. That correlates with 170 on your meter,even though we're advised to stay in a target blood sugar range of 80 to 120mg/dl. Does something sound fishy?

A Typical Low-Carb Day

For those interested, here's the routine that keeps my sugars low. My one carbmeal is breakfast. I figure it's healthy, high fiber, and satisfying, and sinceI walk in the morning, the blood sugar rise gets leveled out. Every morning Imake a bowl of slow-cooked steelcut oatmeal. I know many people who make a batchevery week and freeze daily portions, but I like the morning ritual. I actuallyeat less than a whole serving, making up the difference with a dollop of low fatplain yogurt or cottage cheese and a tablespoon of peanut or almond butter. Ialso add flax seed and cinnamon. For this treat (like Jerry on Seinfeld, I couldeat breakfast for any meal), I need 3.5 units of Humalog, or only 3 units if I'mtaking my usual hour-long walk around my local park.

Lunch is generally a spinach salad with feta cheese, tomatoes, beans andleftover veggies, or a spinach/feta omelet. For that, I need 0.5 to 1 unit. Dinner is typically fish or chicken, vegetables, and beans. If I'm having aglass or two of wine with dinner, I don't need any insulin (Alcohol lowers bloodsugar for most people, unless they're drinking strawberry margaritas orSingapore slings.)

A few months ago I interviewed a fellow type 1 who had received an islet celltransplant (two, actually). For 18 months afterward, she was insulin-free.Unfortunately, as is the case for most, if not all, islet cell transplantrecipients, her new cells began to fail and she had to add some insulin back tokeep her blood sugars in range. She told me, though, that she's still on a verysmall dose – 14 units total daily. My daily dose is only about 18 units, and noneof my beta cells work. Seems enough evidence for me that you can keep yourinsulin, or meds, to a minimum by sweeping most of the carbs out of your diet.

In the interest of full disclosure, I should tell you in that my diet is notpuritanically carb-free. Alas, I am not perfect. When out to dinner, I oftennibble on the bread, and I love it dripping with olive oil. (Thank God, someonedecided that olive oil is healthy.) I indulge in an order of fried calamari orcrab cakes from time to time, and if dessert comes to the table, I'll stick myfork in like everyone else for a taste. But without question, the fewer carbs Ieat, the less insulin I need. For me, the control I get and the way I feel areworth it.

If you're curious about a lower carb diet, give it a try. First, hook up aHoover to your pantry and suck out all the chips, pretzels, rice, and muffinmixes. Second, while experimenting, test, test and test. Third, see if yourblood sugars and meds drop. Fourth, reward yourself with some high cocoa darkchocolate. (Lindt's 85 percent Excellence chocolate bar has only eight carbsper serving!) Good luck.

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