New 2008 ADA Recommendations Partially Acknowledge Low-Carb Diets

Has the American Diabetes Association endorsed the Atkins diet?

We've heard a growing undercurrent of rumblings over the past month or so that the all-powerful American Diabetes Association (ADA) is FINALLY beginning to consider giving credence to low-carb diets as a means for diabetics to control their health. Much anticipation has been steadily building among supporters of livin' la vida low-carb that perhaps maybe, just maybe, a major breakthrough could be happening within one of the most influential health institutions in the United States upon the release of their new dietary recommendations scheduled for Friday, December 28, 2007.

Well, the answer is a sorta yes and a little bit of no, too, as we learn in this Atlanta Journal-Constitution column. As Veronica Atkins, widow of the late great Dr. Robert C. Atkins, told me in my interview with her this year, the ADA still "has their head in the sand" about low-carb living!

First to the good news. After years of failing to even acknowledge that low-carb diets like Atkins were an option for people with diabetes to consider, the ADA released their 2008 Clinical Practice Recommendations used by diabetes health providers in helping their patients adequately treat their disease and stated that low-carb diets are now indeed a strategic method for producing weight loss. This comes after years of pushing a monopolistic high-carb, low-fat diet as the ONLY nutritional approach for diabetics to follow in order to control their weight and health despite the fact that carbohydrates have been known to raise blood sugar levels and spike insulin production--two things you try to avoid when treating diabetes.

Now, as I suggested earlier this year, low-carb diets will be promoted alongside low-fat ones to give people a choice about which one will work best for them. The one-size-fits-all mode of thinking within the ADA is now history and now diabetics who have not yet been exposed to the joy of the low-carb lifestyle could very well find this way of eating suits them perfectly.

This is pretty huge news not just for diabetics, but for anyone who needed to know that low-carb is not the dangerous "fad" diet that it has been made out to be! While the preponderance of the evidence from the research community has continued to pour in over the past few years in support of controlled-carbohydrate diets (we'll examine some of it in just a moment), it's a major announcement that a group like the ADA would step outside the conventional wisdom of the day and make these kinds of changes within the language of their recommendations--much to the chagrin of the other self-appointed dietary gods telling us how to eat for our health.

Don't you know the powers that be over at the American Medical Association (AMA), American Heart Association (AHA), Food & Drug Administration (FDA), and the U.S. Department of Agriculture (USDA) have got to be beside themselves today because the ADA has basically chopped off the legs on their crumbling low-fat diet scheme that has lasted untouched for the past three decades? If a health organization like the ADA gives ANY credence to livin' la vida low-carb, then it forces the hand of those other groups to follow suit in like manner.

If the AMA, AHA, FDA, and USDA do not fall into line with these same recommendations themselves, then the American people will begin to question exactly who is lying to them. As long as they were all on the same page touting the same old low-fat mantra, then everything was hunky dory and the bamboozle could continue. But obesity has gotten worse, Type 2 diabetes is way out of control, and preventable disease is all around us despite the heavy promotion of the great and mighty low-fat diet.

I want to publicly applaud the ADA for being the first to break ranks with the establishment and realizing that the health of diabetics is much more important than preserving a failing dietary philosophy that has been a decisive abomination for the vast majority of people who have tried it. The time is ripe as we enter a new year for another alternative to be given an opportunity and low-carb fits the bill perfectly.

But...

As much as I'd like to be overjoyed by the ADA's decision to add low-carb diets to their recommendations for diabetics, I cannot. Why? Because rather than looking at all the studies that have come out, especially in the past year or so, showing the vast improvements in insulin control, A1c levels, blood sugar stabilization, lipid profile, and other key health indicators with a low-carb diet, the ADA has made this change based solely on weight loss over the short term.

They have taken the very small handful of studies showing low-carb is as effective as low-fat for shedding pounds over a one-year span like this one published in JAMA out of Stanford University in March 2007. And because some people can stick with a low-carb diet better than they can a low-fat one (AMEN!), the ADA says diabetics should pick the one that suits them best to bring about the same weight loss result. Sounds logical, right? Not exactly because they still don't acknowledge an important part of livin' la vida low-carb--the health improvements that happen exclusive of weight loss.

Wanna see some of these studies for yourself? Check them out:

- Atkins produces weight loss and improves glucose tolerance
- Low-carb controls Type 2 diabetes without weight loss or insulin
- Ketogenic diet produced significant improvements in HgbA1c levels
- Low-carb stabilizes blood sugars and reduces medications
- Lower insulin levels from low-carb reduces acne

This doesn't even count all the research that shows how unhealthy eating the traditional high-carb, low-fat diet can be for your health. Here are just a few examples of this:

- High-carb, low-fat diet ineffective against high insulin levels
- High-carb diet raises insulin levels, blood pressure
- High-carb diet leads to age-related macular degeneration
- High-carb diet lowers HDL, increases triglycerides
- High-carb diet leads to the development of Type 2 diabetes
- High-carb, low-fat diet produces negligible weight loss

There's plenty more research I could present in favor of low-carb diets for improving health as well as how high-carb, low-fat diets can be detrimental to your health. But it's out there for anyone willing to open their eyes and see it. Livin' la vida low-carb is about so much more than just weight loss. It is indeed the healthiest way to eat which is my primary reason for supporting it today.

Yes, I lost 180 pounds on the Atkins diet and it has done a wonderful job of helping me maintain that triple-digit weight loss for the past four years. But more than that, my health did a complete turnaround and I shudder to think what it would look like today had I not started on the low-carb lifestyle. Heart attack, stroke, Type 2 diabetes, or even death was probably in the cards for me and low-carb REVERSED that trend completely. I'm healthy and that's all that matters!

And for people who already have diabetes, livin' la vida low-carb gives them a chance to not only shed a few pounds but to find a diet that would allow them to control their blood sugars and insulin levels naturally with little to no use of diabetes drugs or insulin. Why would you want to continue taking drugs and insulin when you could quite possibly eliminate them from your life by eating a low-carb diet? Why indeed!


Albright supports low-carb for weight loss, not health

Dr. Ann Albright, president of Health Care & Education at the ADA and a Type 1 diabetic herself, said they now realize that people need "realistic ways to lose weight" and livin' la vida low-carb is certainly part of that equation.

"The evidence is clear that both low-carbohydrate and low-fat calorie restricted diets result in similar weight loss at one year. We’re not endorsing either of these weight-loss plans over any other method of losing weight," she said in a statement. "What we want health care providers to know is that it’s important for patients to choose a plan that works for them, and that the health care team support their patients’ weight loss efforts and provide appropriate monitoring of patients’ health."

All I can say is WELL IT'S ABOUT TIME! This is precisely the message I've been sharing with people for nearly three years since I've been blogging and I'm glad the ADA understands that individualization of a diet program that works is what low-carb supporters want. We're not trying to eradicate the low-fat diet if that way of eating is helping someone bring their weight and health under control. On the contrary, we've been supportive of people finding what works for them and then doing it.

If that means a low-carb diet, then so be it. There shouldn't be any judgment placed on those of us who choose to eat this way. Irresponsible comments about low-carb describing it as a "dangerous" diet that can "kill you" needs to stop because that is simply hyperbolized conjecture in a civilized discussion of proper nutrition. This open dialog begun by the ADA today needs to trickle down not just to the health care providers, but also to government officials in charge of health policy, journalists who wield influence through the use of their public platform, and all the so-called health "experts" who have been railing against livin' la vida low-carb for years.

Of course, Dr. Albright continues the scaremongering hyperbole that has run rampant about low-carb living by warning any diabetics who use a low-carb diet about their cholesterol going up. Um, hello, I'd be willing to bet that people who follow an organized low-carb plan like the Atkins diet will see their triglycerides fall below 100 and their HDL "good" cholesterol rise to above 50. It's the tell-tale sign that someone is on a low-carb diet and studies have shown these are better markers for cardiovascular health than LDL and total cholesterol.

She also adds that since "high protein diets may also worsen kidney problems," anyone with kidney disease should talk to their doctor about watching their protein intake. Again, what's this all about? How many people actually have a kidney issue, Dr. Albright, hmmmm? Obviously anyone making ANY dietary changes should talk to their doctor first to make sure there are underlying problems they need to be aware of.

And that includes going on a low-fat diet. Are we worried about people who produce high levels of insulin going on a high-carb, low-fat diet in the same manner that we show concern over people with kidney issues going on a low-carb diet? Not hardly. And yet I would argue there's more concern over the former than there is the latter, so let's keep our priorities straight, shall we?

Additionally, a low-carb diet need not be high in protein as is often claimed by those who oppose this way of eating. In fact, my own diet is very heavy in fat, even saturated fat, with nearly 65-70 percent of my calorie consumption coming from this macronutrient. Protein has been around 20-25 percent up until the past few weeks when I began resistance training and upped it to around 30-35 percent. Carbs are kept to a minimum around single digits.

Like clockwork, Dr. Albright also cautions about weight loss being sustainable by stating that "what is most important for health is keeping the weight off long-term." ABSOLUTELY, Dr. Albright, I couldn't agree with you more which is why I have chosen to continue with my low-carb diet for the past four years and counting to improve my health. It's the best thing I could have ever done for my weight and health and I'll never regret it!

Stuck in the sound bytes that seem to pervade most health leaders these days, Dr. Albright makes sure we don't forsake the need for getting proper exercise while eating a low-calorie diet.

"We also want to continue to emphasize the importance of regular physical activity, both to aid weight loss from calorie-restricted diets, and also for the positive health gains associated with exercise that are independent of weight loss," she exclaimed.

True enough, exercise is important, but there should be more specific instructions provided for what this means. What kind of physical activity, how vigorous should the workouts be, how often should you do it, how long does it need to be in order to produce results, and what ratio of cardio/resistance training is necessary? None of these are addressed by the ADA or most other health organizations when they put out these recommendations. They just assume people inherently KNOW what to do.

It's like the silly notion that we always hear from the "experts" to just eat a healthy diet and exercise. WHAT THE HECK DOES THAT MEAN?! People need to be educated with specifics about what constitutes a healthy diet and what kind of exercise is beneficial for various aspects of weight and health management. Obviously anything is better than nothing, but people need to be guided about what to do.

To see the ADA's 2008 Clinical Practice Recommendations for yourself, it will be published on the Diabetes.org web site in January 2008 (or you can pay to see them right now at Diabetes Care). You can also request a copy by e-mailing the ADA at AskADA@diabetes.org or by calling 1-800-DIABETES (1-800-342-2383). Regardless, let them hear from you about what you think of their new recommendations for diabetics. And feel free to share your reaction to their focus on weight loss rather than health with livin' la vida low-carb. Are they still missing the boat?

Leave it to low-carb diabetes expert Dr. Mary C. Vernon to put this news from the ADA in the proper perspective at her blog today for people who are advocates of low-carb.

"Carbohydrate restriction and the resulting control of insulin secretion is much more than weight loss," she wrote. "It’s not the weight-it’s the metabolic state your body is in, that generates disease or well-being. I suppose we'll have to wait another 5-10 years before the ADA catches up with the rest of the science."

Maybe not, Dr. Vernon, if enough of us voice our sincere concerns and opinions to the ADA, our representatives at both the state and federal level, our doctors, and in letters to the editor at our local newspapers. We have a unified voice with a message backed up by the data, but the question remains whether we will choose to use it or not. Our silence has long been interpreted that we accept what we've been told is true. Is that the message you want to be making?

Diabetes Health Leaders Finally Realizing Low-Carb Diet Has Merit

When I asked Dr. Richard D. Feinman, professor of biochemistry at SUNY Downstate Medical Center in Brooklyn, New York and renowned low-carb researcher, about when he thought diabetes health leaders--including the American Diabetes Association (ADA)--would start realizing livin' la vida low-carb has merit during my interview with him in June 2006, his answer was hopeful.

"With diabetes, carbohydrate restriction has been a traditional treatment and because the underlying physiology is obvious and accepted. Since low carbohydrates stabilize glucose and insulin excursions, we can expect progress pretty soon. Even the ADA is probably trying to back into carbohydrate restriction with a minimum of losing face."

Well, it's about to happen and none too soon.

According to my friend and fellow low-carb blogger Laura Dolson from the About Low-Carb Diets web site, there are "potential changes in ADA recommendations" to be announced in January 2008. It seems they are FINALLY listened to those of us who advocate carbohydrate restriction and are are going to abandon their high-carb recommendations. So much for people like Hope Warshaw dictating what diabetes policy looks like in the United States and it's about time.

Coming in January 2008, the ADA is expected to publish new dietary guidelines for people suffering with diabetes where livin' la vida low-carb will be acknowledged and promoted as one way to improve the symptoms of this awful disease. A talking head from the ADA states "there is growing recognition that a variety of diets including low carbohydrate diets, can achieve weight loss [and] improve postprandial blood glucose." We'll definitely be looking forward to the new ADA dietary guidelines coming in the January 2008 issue of Diabetes Care and report to you any positive changes they are expected to make. Stay tuned!

In the meantime, the paradigm shift is also happening in the grassroots among those who are passionate about helping people with diabetes. Take Jackie Eberstein, co-author of Atkins Diabetes Revolution and who worked directly with the late great Dr. Robert C. Atkins for three decades, for example. In celebration of National Diabetes Month in November, she wrote an outstanding positive message on carb control for diabetics.

Her overall message is one of prevention--knowing the warning signs BEFORE you are diagnosed with diabetes, changing your lifestyle to put yourself in a better position to avoid it, and take the subject of diabetes health as serious as your heart health. Essentially, diabetes has become a rampant disease of modern society because of our poor dietary habits and over 1 in 5 have no idea they have it (a dangerous place to be in considering carbohydrates--poison for diabetics--are the primary macronutrient in most American households).

Untreated diabetes leaves a haunting trail of obvious symptoms:

"Once the disease has progressed common symptoms such as extreme thirst, extreme hunger, frequent urination, unexplained weight loss, unusual fatigue, blurred vision and the slow healing of cuts and bruises makes the diagnosis easier," Eberstein explained. "But by the time these symptoms are apparent, blood sugar levels have been elevated for a long time causing silent damage to every cell in the body."

These are merely precursors to the even worse damage that can happen to your body, including cancer and Alzheimer's disease--something neurologist Dr. Larry McCleary describes in his book The Brain Trust Program as "Type 3 diabetes."

Eberstein expresses her concern that the ADA has traditionally recommended a low-fat, low-calorie diet that includes too many carbohydrates for a diabetic causing them to rely on upwards of 3-6 medications to keep their disease moderately controlled. She is deeply disturbed by the potential and known side effects of these drugs while the ADA has turned a blind eye to the negative impact extra sugars and refined flour have had on this. I know she will be anxious to see the new changes in the ADA recommendations come January.

Be sure to check out all the diabetes risk factors that Eberstein notes for people with Type 2 diabetes in her column. It very well could save your life or the life of your loved one.

Another exciting development regarding the embracing of the low-carb message for diabetics comes from the top diabetes blogger online today--Amy Tenderich from Diabetes Mine. Although I was less than impressed by her lack of even a single acknowledgment of livin' la vida low-carb for people with diabetes in her 2007 book release Know Your Numbers, Outlive Your Diabetes, I was blown away to see Tenderich was willing to at least hear what actual low-carbers have to say about what they eat to control their diabetes with the low-carb lifestyle when she requested recipes from the members of my new "Livin' La Vida Low-Carb Discussion" forum.

She was so moved by my readers that she reprinted the column "Low-Carb Favorites, from the Devotees" at MyDiabetesCentral.com. THANKS Amy and I'm happy to see your openness to new ideas that go against everything you've ever known to be true in the past. That takes courage and strength beyond the scope of modern journalism to do and I applaud you for it.

But Tenderich didn't stop there. Check out her recent guest post at Diet-Blog where she lists "10 Ways to Treat Diabetes With Diet." She particularly points out that diabetics need to watch their carbs to control their A1c levels, be aware of the carb content in the foods they eat, avoid "carb-heavy choices," watch out for corn syrup on nutritional labels, not equate sugar-free with carb-free, and the best one of them all--CURB THE CARBS (go straight to #7 for this one!). Sure, she still sticks with the low-fat mantra that has been what she's known for years, but at least Tenderich is moving in the right direction.

Her conclusion regarding past ADA recommendations is spot on:

"There’s a lot of controversy over the ADA's food pyramid for people with diabetes, because they recommend more breads, grains, and starches (carb-heavy foods) than anything else," Tenderich stated. "We have to side with the patients-in-the-know: keep the carbs low for better control of blood sugar."

And that, my low-carb friends, is what I call progress in this effort to bring legitimacy and practicality to the world of diabetes health. This is merely the beginning of a major change in health policy that could very well cascade into the general dietary recommendations at some point in the future. First things first, though. Let's get diabetics eating this way and vastly improving their health and then the turnaround will speak for itself.

If The Atkins Diet Works As Well As Low-Fat, Then Why Not Recommend It?

Boy, we've got the low-fatties beside themselves today!

After the release of this JAMA study on Tuesday that is making tons of positive headlines for livin' la vida low-carb, you would think those who support low-fat diets were just told the government was no longer going to actively recommend that way of eating as the publicly-endorsed nutritional approach for getting healthy.

Of course, you know that wouldn't be such a bad idea if it happened. GASP! LOL! More about that in a moment.

I was privileged to be invited to join a teleconference debate last night sponsored by RevolutionHealth.com, a new web site dedicated to helping people take action to manage their health care, conditions and healthy living goals by bringing together a blend of the best health information, tools, communities and services all in one place. It's a free site that is worthy of your attention if you are like me and care about the subject of health.

The debate itself was between Dr. Michael Dansinger, MD who authored this JAMA study comparing various popular diets in 2005 and Dr. James Hill, PhD. from the National Weight Control Registry (NWCR). Neither one of these men are what I would call enthusiastic supporters of livin' la vida low-carb, but Dr. Dansinger is at least respectful of the diet. Dr. Hill, on the other hand, has his doubts about the Atkins diet beyond short-term weight loss. I'll explain why I think he believes this way shortly.

Jason Rosenberg, who hosted the call, asked me to invite people to the call since my "Livin' La Vida Low-Carb" blog was one of the more prominent ones in the low-carb community. So, I e-mailed a handful of low-carb supporters across the various fields of academia, research, advocacy, and blogging and came up with people who I thought could join me and the other low-fat diet bloggers and advocates as we hash out the the details of this study.

But when I called just minutes before the teleconference began at 7:30pm, imagine my surprise when every single one of the people participating in the call was in some way connected to the low-carb community. What?! Where were the low-fat diet bloggers and supporters? Were they simply unwilling to engage in a little spirited debate surrounding these newfound facts about the Atkins diet? Surely you jest?!

Nope! It was true. Not one single person beside Dr. Hill was there to defend low-fat, despite the fact that Jason invited them just like he did me. In a way I felt bad for Dr. Hill because I didn't want him to think all of us low-carbers were ganging up on him like a bunch of blood-thirsty savage wolves seeking to devour some freshly-caught prey. I'm sure that may be how he felt once we all started asking our questions and making our comments.

So, who was on the call with me? Here's the list:

- Dr. Mary C. Vernon from the University of Kansas
- Dr. Eric Westman from Duke University Medical Center
- Laura Dolson from About Low-Carb Diets
- Kate Welch from The Steaks Are High
- Dr. Gil Wilshire from The Carbohydate Awareness Council
- Regina Wilshire from Weight Of The Evidence
- Dana Carpender from Lowcarbezine!
- Marilyn Turnbow from Atkins YAHOO! Group

It was quite a distinguished panel and I was honored to be a part of it. After some formal introductions of the speakers and an informal roll call of everyone who was participating, both Dr. Dansinger and Dr. Hill gave their assessment of what they thought about the Gardner study that released on Tuesday.

Interestingly, both men agreed that there is very clear evidence from the body of research that has come out in the past few years about low-carb diets that they should not be dismissed altogether. But what irritated me the most was when Dr. Hill kept insisting on giving the caveat "in the short-term" whenever he discussed low-carb diets. Oh, they're great for weight loss "in the short-term" and I wouldn't have any problem with someone wanting to try that diet "in the short term."

UGH!

As you can imagine, I was chomping at the bit to ask my question and Jason gave me the first shot. So I asked Dr. Hill point blank if low-carb is only good for the short-term, then how am I supposed to eat long-term? He responded by stating that if it's working for me then keep doing it, but it does not work well for everyone. Thankfully, he did admit the same thing about low-fat diets, but the same scrutiny does not exist for that diet.

One interesting statement made by Dr. Hill that quite frankly floored me was when he said low-carb diets are as equally ineffective after a year just as low-fat diets are. Did you catch that apparent slip of the tongue? He just said low-fat diets are INEFFECTIVE after a year. If that's true, Dr. Hill, then why do we keep having what you admit is a FAILED message hammered down our throats year in and year out? Isn't the low-fat, low-calorie diet what your National Weight Control Registry recommends as the long-term way to lose weight?

Taking his thesis that low-carb is equal to low-fat in bringing about weight loss and improved health (or not) a little further, I asked a follow-up question for Dr. Hill a few minutes later asking if the Atkins diet works just as well as the low-fat diets, then why aren't government and health entities recommending both alongside each other? Dr. Hill said that was an important question to ask, but never really said if he believed it could, should, or would ever happen. There's a reason he ducked at that question.

Dr. Hill's answer was not at all surprising considering his obvious conflict of interests I blogged about previously with his ties to the food industry. Dr. Hill is on the advisory board for the Grain Foods Foundation and has consulting ties to PepsiCo, McDonald's, HealtheTech, Johnson & Johnson, Procter & Gamble, and Coca-Cola. He has also received speaker fees from Abbott Laboratories, Roche Laboratories, and Kraft Foods as well as research funding from M&Ms/Mars. The Sugar Association has also funded his research on the role of carbohydrates in weight management.

And this is the same man, along with Dr. Rena Wing from Brown University/Miriam Hospital, who supposedly speaks for what works for people to bring about weight loss over the long-term according to the much-heralded NWCR. Ever since I joined the NWCR in 2005, I have been concerned about their apparent bias against low-carb while the low-fat, low-calorie diet is so heavily endorsed. Frankly I'm surprised nobody outside the low-carb community is as concerned about this as I am.

This conversation about developing long-term weight and health strategies is an important one to discuss as Dr. Vernon so eloquently mentioned regarding providing individuals with the support they need to be successful. Before that happens, though, we must all agree that if low-carb diets are as effective as low-fat diets (and that's what the evidence has shown in multiple studies now), then they deserve equal footing, equal treatment, and equal endorsement by our leaders.

The time for talking about this is over. We've seen the research and it shows that low-carb is as good or better than low-fat diets for at least one year. With this knowledge under our belt, when are we going to stop pandering to the special interests in the food industry and finally do the right thing--PROMOTE LOW-CARB AND LOW-FAT AS EQUALS! This is a public charge to health leaders like Dr. Hill and the like to stand up and do the right thing.

Kate from "The Steaks Are High" blog summarized it well in her post about the teleconference call echoing my message of equal treatment for low-carb diets.

"All low carbers are asking for is that the low-carb approach be recommended as an option alongside low fat, since the medical safety of Atkins has been proven by this and many other studies. Oh yeah, and that the American Heart Association and the American Diabetes Association read some of the latest research for a change."

That really is all we are asking for. Livin' la vida low-carb doesn't have to be advocated (although it could be argued that low-fat diets HAVE been for decades), but simply put on the table as a viable option for people to try if they need to lose weight and get healthy. What harm will come if people are given a choice, hmmm?

E-mail Dr. James Hill and urge him to use his powerful position in the realm of health and nutrition to push government and health leaders to promote low-carb alongside low-fat in national dietary recommendations at CHN@uchsc.edu.

3-7-07 UPDATE: You can now listen to the audio of this nearly one-hour teleconference call I blogged about. ENJOY!