Friday, November 17, 2017

Diabetes Month Tip of the Day


Question
What about “low carbohydrate diets” like Atkins? Or very low carbohydrate plans like the “ketogenic” diets.
Answer
You might be surprised, but even the American Diabetes Association states that very low and low carbohydrate diets, like the Atkins, are one acceptable plan to follow for people with Type 2 diabetes who are trying to lose weight. (See here:) In short, the plans that limit carbohydrate and make provisions to obtain adequate protein, fat, and vegetables are actually backed up by evidence. Unfortunately there are some problems and/or concerns with the low and very low carbohydrate plans that I have encountered over the years:
1) Some plans (like Atkins) will encourage reliance on a particular company’s products (shakes, bars, special low carb cookies, etc.)   These products are often expensive and usually not very nutritious (and people become bored with the particular products). People who want to follow a plan like Atkins, South Beach, Protein Power, etc. might need encouragement to stick with “regular” food instead of convenience items. That doesn't mean that you can't ever use said items; people who are traveling, who have limited skills/time/facilities for cooking, or who have executive dysfunction problems might need to rely on some of these at first. If you find yourself disliking the taste and/or expense of said products, just remember it's one stepping stone in changing your food journey.   
2) Some people think that on these plans that they can eat whatever they want without paying any attention to portions or calories—and the calories on those “low carb” brownies really add up.  There are many people who have spent years trying to find the perfect diet and the appeal of something "easy" is quite powerful. I noticed this ignoring of the need for a reduction in calories a lot in the early 2000’s, when the South Beach Diet first appeared on the scene and there was a proliferation of low carb stores with low carb pasta, low carb tortillas, etc.  People would spend a lot of money on these products, lose a bunch of weight at first, and then see the weight loss plateau because they forgot that they won’t lose weight if there isn’t some kind of caloric restriction.  If you find a brand of low carb pasta, etc. that you really like, and find that it helps you stay on your plan (and you can afford it) by all means use it.  Just remember the portion will still count. 
3) Some people have other health problems that don’t allow them to follow a very low carb diet. For example, if you have gall bladder disease (or have had it removed) you probably won’t be able to tolerate the amount of fat required for very low carbohydrate plan. Some other people with bowel problems find the lack of fiber and/or resistant starch causes additional problems with constipation and/or and alteration in gut flora that may cause constipation or diarrhea. And of course, if you are a Type 1 diabetic who is not trying to lose weight, you will likely need to eat a  minimum amount of carbohydrate grams each day to keep yourself from forming ketones.
4) Some people also find these type of diets so unlike what they are used to that they can’t keep them up long term.  This problem probably should have been labeled number one on the list. In other words, they might benefit from a plan that emphasizes gradual and consistent reduction of carbohydrate so they can actually stay on their plan. A meal plan, or diet, or whatever you want to call it, is only a good idea IF YOU FIND IT SUSTAINABLE. If you can't keep this up long term you might find yourself discouraged/unmotivated, and faced with health problems that come raging back. (I have also had friends/acquaintances that have used all the forms of low carbohydrate diets as a way of "acting out" their disordered eating. If you think you fit that bill, definitely consult with a mental health professional (if you can) before undertaking a restrictive plan.
Other the other hand, some people do try and find ways to find low carbohydrate eating sustainable. That’s why there are so many blogs, support groups in real life and online, social media groups, etc. for eating for diabetes, eating low carb, eating a ketogenic diet, etc.  Low carbohydrate/carbohydrate controlled plans can be very doable, but not necessarily easy to follow at first, and most of us need a little support and encouragement along the way if we are going to stay with it.  (And if you are in an online support group that is...not so supportive....see if you can find another community before giving up). Keep in mind too that updated versions of books like the Atkin’s diet will give instructions for a more moderate approach  to carbohydrate restriction.  (The newer version of that plan was actually co-authored by a Registered Dietitian).

I also remind people that “low carbohydrate” doesn’t really have a definition.  (“Lower than what?” is my usual snarky question).  I prefer the term “carbohydrate controlled” which implies that the person is aware of what their carbohydrate budget is (as in about how many grams a day, or which foods affect you) and is taking steps to stay within a certain amount.

Want to keep reading about the evidence for carbohydrate controlled plans?

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