Part 2 – Can Diabetes Educators and Dietitians Teach Low Carb?

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In the past, when providing nutrition education to those with diabetes, it was customary to give standard advice (see above) to all people with diabetes to eat a set number of carbs per meal.  Why was this advice ineffective?

  1. Not all those with diabetes have the same ability to process a set amount of carbohydrates.  This advice, therefore, led most to have wildly uncontrolled blood glucose (requiring increased medication.)
  2. The percentage of macronutrients assigned to each patient was the same, not allowing room for personal preferences, cultural considerations or individual carbohydrate tolerance.
  3. Too much emphasis was placed on the consumption of simple, processed, refined carbohydrates (bread, pasta, rice, starches) that are devoid of nutritional content and, in fact, are the very foods that people with diabetes are unable to effectively process.

The guidelines for Medical Nutrition Therapy now acknowledge the need to “individualize” every  person’s care.  If so, why are many Dietitians and Educators still giving the same, standard, one-size-fits-all approach?  What does “individualization” really mean?  If giving blanket recommendations to ALL people with diabetes, is that really “individualization?”  The guidelines mention focusing on “nutrient dense foods” and away from a set number of carbohydrates or set percentages of macronutrients.

In my opinion, individualization means that there should be no more blanket recommendations to all people with diabetes, rather each person requires a customized plan.  The plan begins with listening to the patient.  What you will most often find, is that most patients want:

  • Better glucose control
    • Less hyperglycemia, which makes them feel terrible, and
    • Less hypoglycemia, which can be life threatening
  • Less medications, which often carry undesirable side effects
  • Lowered risk of long-term complications
  • Lowered risks for other diabetes induced disease processes
  • Improved quality of life
  • Weight loss (which often is difficult or nearly impossible to achieve on many medications)

The current recommendations typically being given will NOT help people reach these goals.

Excerpts from the ADA position statement for Medical Nutrition Therapy…

“Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.”

“Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes. Therefore, collaborative goals should be developed with the individual with diabetes.”

“Monitoring carbohydrate intake, whether by carbohydrate counting or experienced based estimation, remains a key strategy in achieving glycemic control.”

“Published studies comparing lower levels of carbohydrate intake (ranging from 21g daily up to 40% of daily energy intake) to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes.”

“Studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels revealed improvements in serum lipid/lipoprotein measures, including improved triglycerides, VLDL triglyceride and VLDL cholesterol, total cholesterol and HDL cholesterol levels.”

“In a systematic review and in four studies and in a meta analysis published since the systematic review, lowering total fat intake did not consistently improve glycemic control or CVD risk factors.”

Therefore, individualization would include the option for one of the most effective tools for nutrition-based management of diabetes and lowering of cardiovascular risk factors.  That being, a low carbohydrate, whole food approach.  Why would anyone in the business of educating those with diabetes NOT want to promote the very diet that has the best effect on blood glucose and cardiovascular markers?

In the 2015 ADA Standards of Care, the following guidelines are suggested as the focus of medical nutrition therapy:

“To promote and support healthful eating patterns, emphasizing a variety of NUTRIENT DENSE foods in appropriate portion sizes, in order to improve overall health and specifically to:

  • Attain individualized glycemic, blood pressure and lipid goals,
  • Achieve and maintain body weight goals
  • Delay or prevent complications of diabetes.”

So let’s compare those goals with what studies have CONSISTENTLY PROVEN about low carb, whole food lifestyles.  A low carb way of eating has been shown to:

  • Normalize blood glucose
  • Improve blood pressure
  • Improve cardiovascular markers including:
    • Lowering small, dense LDL
    • Raise HDL
    • Lower triglycerides
  • Cause significant weight loss
  • Lower insulin levels, which:
    • Decreases insulin resistance
    • Increases insulin sensitivity

All of the factors improve BG, A1c, cardiovascular markers and significantly reduce the risks of diabetes related complications.

Here are some resources from Dietitians and Nutritionists using a low carb approach with excellent success.

Today’s Dietitian: Low-Carb Diets — Research Shows They May Be More Beneficial Than Other Dietary Patterns: Aglaée Jacob, MS, RD, CDE  HERE

A Low-Carbohydrate, Whole-Foods Approach to Managing Diabetes and Prediabetes, American Diabetes Association’s Diabetes Spectrum, November 2012, Fransizka Spritzler, RD, CDE  HERE

Carbohydrate Restriction: An Option for Diabetes Management (PDF), Diabetes Self-Management Magazine, March/April 2014, Fransizka Spritzler, RD, CDE  HERE

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Dietitian Websites

Low Carb Dietitian HERE

Dietitian Cassie HERE

Valerie’s Voice HERE

Low Carb Caryn HERE

Mikki Wiliden, Nutritionist HERE

Vicky Kuriel, Dietitian HERE

Academy of Nutrition and Dietetics 2015 Guideline Recommendations  HERE

Video: Franziska Spritzler, RD: “Carbohydrate Restriction: The Key To Optimal Blood Sugar” HERE

Video: Vicky Kuriel, RD: “Case Reports From an LCHF Dietitian” HERE

Video: Caryn Zinn, RD: “A Low Carb Dietitian’s Perspective” HERE

Video: Dr. Trudi Deakin, RD: “Is the Eatwell Plate Healthy?” HERE

Ten Myths About Low Carb Diets HERE

Understanding Low Carb Diets HERE