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Saturday, December 29, 2007

American Diabetes Association's 18-degree turn on carb restriction

The 2008 recommendations by the American Diabetes Association have been released. In regards to carbohydrate restriction, they've done an astounding 18 degree turn -- which is to say, they've gone a tenth as far as they ought to.

ADA Issues New Clinical Practice Recommendations: New Advice for Doctors About Low-Fat, Low-Carb Restricted Diets For Short-Term Weight Loss

(Note that the press release is incorrectly titled. The body of the press release concerns the ADA's new advice about fat-and-total-calorie-restricted diets and carbohydrate-restricted diets .)

The ADA now says -- oh, so grudgingly, it seems -- that low-carb can have a place in the weight loss efforts of a person with diabetes. Specifically, they now admit that low-carb reducing diets, when used over a short term, have the potential to be at least as effective (for weight loss) as a low-fat, calorie-restricted diet.

Unfortunately, in this faint praise, they completely miss the larger benefit of carb restriction as it relates to diabetes: insulin control. Insulin! Insulin! How long will this organization, one ostensibly dedicated to helping the diabetic, continue to ignore the role of diet in the management of blood glucose and insulin?

Speaking of weight loss, here's a sentence that's completely off-base: "[T]here is now evidence that the most important determinant of weight loss is not the composition of the diet, but whether the person can stick with it, and that some individuals are more likely to adhere to a low carbohydrate diet while others may find a low fat calorie-restricted diet easier to follow."

Wrong. The evidence suggests that macronutrient composition is indeed the most important determinant of weight loss. It's more important than total amount of calories. Which, by the way, is the real other choice in the standard debate, not whether a person can stick to it. Framing the debate as one between composition and ease of adherence is what's known in informal logic as a "false dilemma."

At any rate, the evidence -- as well as common sense -- suggests that a low-fat, calorie restricted diet is more difficult to stick to than a diet that sticks to your ribs. Low-fat meals leave you hungry, especially if they're also low in protein. Low-carb meals might leave you a little dizzy, but only until you've broken the addiction. It takes a couple of days for the body to adjust once you stop shooting it up with the glucose from your starchy, sugary food.

Here's a good article by Jimmy Moore: New 2008 ADA Recommendations Partially Acknowledge Low-Carb Diets -- it gets better, more informative, and more thought provoking as it goes along, so be sure to keep going past the first few grafs. He has great info about and links to discussions of many diabetes-related benefits of carbohydrate restriction. Also good commentary on what the ADA spokesperson has said about the new recommendations.

Here's the Men's Health online article by Adam Campbell, "Apparently, Hell just froze over," which discusses the ADA's change in recommendation.

The Atlanta-Journal Constitution overstated with this headline: "Diabetes Group Back Low-Carb Diets."


David Brown said...

Good discussion here. I think you meant to say "Framing the debate..." in the below (7th paragraph) sentence.

Phrasing the debate as one between composition and ease of adherence is what's known in informal logic as a "false dilemma."

lowcarbarama said...

Indeed! I took the liberty of editing the above post to read "Framing" rather than "Phrasing."

Thanks for the comment!