What Diabetes Teaches Us About the “Right” Diet


A week or two ago, Mark Bittman’s column in the New York Times caught my eye. Titled “Which Diet Works?” it was a summary of a recent study, published in the prestigious Journal of the American Medical Association, that evaluated the effects of three different types of diet on people’s ability to maintain weight loss. The point of the study (titled “Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance”) was to highlight the supposedly surprising conclusion that when it comes to weight management, not all calories are the same. But what I found surprising, from a diabetic perspective, was how unsurprising the ultimate conclusion seemed. 

Here’s how the study worked: researchers assigned three groups of dieters — that is, people who had recently managed to lose 10 to 15 percent of their body weight — to three different diets, each of which contained exactly the same number of calories. To quote Bittman’s description:

“One was a standard low-fat diet: 60 percent carbohydrates — with an emphasis on fruits, vegetables and whole grains (but not unprocessed ones) — 20 percent from protein and 20 percent from fat. This is the low-fat diet that has been reigning “wisdom” for the last 30 years or more.

“Another was an ultra-low-carb diet (for convenience, we’ll call this ‘Atkins’), of 10 percent of calories from carbs, 60 percent from fat and 30 percent from protein. And the third was a low glycemic diet, with 40 percent carbs — minimally processed grains, fruit, vegetables and legumes — 40 percent fat and 20 percent protein.”

At the four-week study’s end, the results were quite interesting: people on the Atkins diet burned 350 more calories per day than people on the low-fat diet (the equivalent, says Bittman, of an hour’s worth of moderate exercise). People on the low glycemic diet burned 150 calories a day more than the people on the low-fat diet. It would seem, therefore, that Atkins is best. But people on Atkins also had increases in levels of cortisol (a hormone that mediates stress) and c-reactive protein (a measure of chronic inflammation), Bittman points out. According to Bittman, David Ludwig, who’s one of the study’s authors and the director of the  New Balance Foundation Obesity Prevention Center  of Boston Children’s Hospital where the study was conducted,  says that both of these are “tightly linked to long-term heart risk and mortality.” 

Bittman quotes Ludwig as concluding that “It’s time to reacquaint ourselves with minimally processed carbs. If you take three servings of refined carbohydrates and substitute one of fruit, one of beans and one of nuts, you could eliminate 50 percent of diet-related disease in the United States. These relatively modest changes can provide great benefit.”

Here’s what I do find surprising: that eating fewer carbs actually encourages your body to burn more calories. That’s very interesting from a weight loss perspective. (And it makes me feel like, because of the diet-caused change in my metabolism, I can sit in this chair and write a blog post instead of going for a walk — which is probably not exactly what the researchers are arguing.)

What I don’t find surprising in the slightest is that we would benefit from eating fewer processed carbs. This is slowly seeping into conventional wisdom, but I’m surprised that so much research money seems to be being devoted to a conclusion people with diabetes reach every single time they eat. Honestly, what person with diabetes who pays even the slightest bit of attention to blood glucose levels would not be able to tell you that a donut or a soda is going to have a different effect on  blood sugar than those same calories/carbs as, say, wild rice? Or, despite the ADA’s protestations, that a relatively low-carb diet is going to result in fewer, more gradual blood glucose swings than one that is high in processed carbs?

It made me realize — and not for the first time — that a “diabetic diet” is actually what everyone should be eating, regardless of their body’s ability to produce insulin. Highly processed carbohydrates are not good for anyone — and the world could learn from our experiences. It’s not often that diabetes makes me feel healthier than other people, but this is one of them. 

I finished the article, therefore, feeling both empowered and frustrated. Frustrated because I don’t understand why anyone is still arguing that a traditional low-fat, high-carb diet is best for health (let alone weight loss) — not to mention that there are people out there who could get off the train to triggering Type 2 diabetes if they changed what they eat. And empowered because,  you know what? I eat really, really well. I may not always have perfect glucose numbers afterwards, but it’s nice to know that I am doing all I can, diet-wise, to take care of my health. It’s sounds ironic, but it’s true: the more people we can get to eat like diabetics, the healthier society will be. 

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Tony Butler
Tony Butler
10 years ago

Have you read Dr Richard Bernstein’s book  Diabetes Solution? If not, then it may help a great deal to bring about a lower usage of insulin and a reduction in complications.

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