Cause of Death: American Diabetes Association Recommendations

I was diagnosed with type 1 diabetes (LADA) when I was pregnant with my third son. I had been previously misdiagnosed with gestational and type 2 diabetes, and my husband had been living with type 1 for seven years at the time of my diagnosis. You could say I knew a few things about diabetes by the time I received my proper diagnosis. For example, I knew that Insulatard, the insulin I was taking, was not a great name for a product, and I knew that diabetes was a disease of carbohydrate intolerance. And the latter is where I kept getting stuck. Why, I asked the pallid dietician I saw every three weeks in the high-risk pregnancy clinic, are you so adamant about pregnant women with diabetes eating bran flakes?  

“Fiber,” she said.

For a short while, I bought into the bran flakes-fiber theory. Except there was one undeniable problem: bran flakes made my blood sugar soar. So did the whole wheat bread I was supposed to eat as a snack at 11:00 a.m., even if I wasn’t hungry. So did the portions of fruit that had been assigned to my diet. 

About halfway through my pregnancy, the dietician and I had a falling out.

“I’m not eating bran flakes,” I said.

“Then have corn flakes ,” she replied. “Less fiber, but still good.”

I looked at her, feeling the same sense of bewilderment that overcomes me when the president tweets.

“Why should I eat something that makes my blood sugar go up so much?” I asked. “It doesn’t make sense.”

“That’s why you take insulin,” she said. “To bring your blood sugar down.” 

Right. More Insulatard, the medication I’d begun to pretend was named after a prince in a Nordic fairy tale. I stared at the food pyramid diagram she was showing me for the third time.

Back then, I didn’t really comprehend what eating low carb entailed. I don’t think I’d ever heard of the ketogenic diet. And the only thing I understood for certain was that just as 1+1=2, carbs+diabetes=significant rise in blood sugar. So, although when it comes to following my health care professionals’ instructions, I’m normally, compliant, adherent, obedient, strict, and straight-laced, when a recommendation is illogical, I question it.

I asked my endocrinologist if I needed to eat bran flakes. He told me the dietician at the clinic was great. I asked my obstetrician about the bran flakes. “As long as they aren’t sweetened, it should be fine,” he said. My GP told me carbs were important for happiness. He dismissed my argument that I didn’t feel happy when my blood sugar was high. In fact, nothing stressed me out more than the realization that with every vapid bite of bran, I was harming my baby. When I turned to the American Diabetes Association for guidance, the recommendations were the same as my doctors’. Eat whole grains and take your medication. And still today, nine years after my pregnancy, the American Diabetes Association is preaching a low fat diet rich in whole grains and fruit. Click through their website and you will find recommendations like this, “Dried fruit and 100% fruit juice are also nutritious choices.” 

Excuse my language, but WTF?

Those are good choices only if your goal is high blood sugar, diabetes complications, and early death. The Association is lying to people with diabetes, and the health care professionals who subscribe to its guidelines are complicit in the lie. The argument that a low carb diet is not sustainable is not an argument. Of course, it’s a given that not everyone is capable of sticking with a low carb diet. I’m guilty of the occasional slice of pizza or piece of fruit, too. But at least I know the truth: the only reason a person with diabetes should ever have fruit juice or dried fruit is when they are experiencing hypoglycemia. It’s time for the Association to own up to the truth that people with diabetes should not be encouraged to eat carbohydrates. And yesterday, in a way, it did. The Association sent out a fundraising email with the subject line: Cause of Death: Diabetes. It’s a punchline of sorts, and loaded with irony, because if you live according to its recommendations, death by diabetes may very well be the case.

Finally, a truth.

Here’s another one. A low carb diet isn’t all that difficult. It does take some thought and planning ahead. But there is a wealth of good content online to help people with diabetes get started on a low carb diet. There are recipes for low carb versions of almost every meal and dessert. Sometimes it’s hard to say no to the things our bodies can’t tolerate. But good health requires realism.

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)