During March, for National Nutrition Month, I posted a review of gluten-free protein bars, which caught the attention of fellow writer and D-advocate Jessica Apple, co-founder and editor-in-chief of the diabetes magazine ASweetLife. She felt all the nutrition bars were packed with "way too much carb" and was surprised by my emphasis on their fat content. Why? Because many people associate fat in food with weight gain. But this is a fallacy, she says, especially if you're a believer in one Dr. Richard K. Bernstein...
A Guest Post by Jessica Apple
The idea that fat causes weight gain seems to come from that fact that fat has nine calories per gram while carbohydrates have only four calories per gram. If you take that information alone without making other considerations, you conclude that fat contributes more to weight gain than carbohydrates do. And because we've been told since the 1970s that eating fat causes heart disease, and that eating fat makes us fat, we Westerners have come to think of fats as a great threat to our health. So we've stopped eating fat, and instead we eat carbs. And what has happened to us?
You don't need anyone to tell you that the high-carb American diet is a failure. Just look at the people around you. Obesity and diabetes rates are soaring. We all eat as little fat as possible, and yet we get fatter. What's wrong?
"Eating fat will make you fat is about as scientifically logical as saying that eating tomatoes will turn you red," writes Dr. Richard K. Bernstein, author of Dr. Bernstein's Diabetes Solution. Bernstein has type 1 diabetes and his diabetes solution, in a nutshell, is to eat low-carb.
As we with diabetes all know, our bodies need insulin to process carbohydrates and regulate blood sugar. Without insulin, sugar remains in our blood and can't be used by our cells for energy. The more carbohydrate we consume, the more insulin we need, the higher our insulin levels. Insulin's job doesn't end there, though. It also regulates fat metabolism. The more insulin we secrete (or inject), the more fat we store. And elevated insulin levels lead to insulin resistance which is associated with both heart disease and cancer. Bernstein, and others like Peter Attia, author of the blog War on Insulin, believe is that it's not fat, but carbohydrates, that are making us heavy and sick due to elevated insulin levels. Attia writes, "The hypothesis that I currently find most compelling is that chronically elevated levels of insulin — rather than excessive calorie consumption or lack of exercise — is at the heart of the most pervasive chronic diseases afflicting our society."
The logical reasoning then would be to try to avoid carbohydrates so that you'll secrete less insulin, or inject less if you have type 1 diabetes. But that's not what doctors and nutritionists have been telling us.
When I was diagnosed with type 1 diabetes I was told to eat about 40 grams of carbohydrate per meal (the ADA recommends 45-60 grams of carb per meal). That was probably more than I was eating before diabetes! What upset me and confused me was that I was being told to eat something I couldn't metabolize. Over and over again I thought, my body can't process carbohydrates, yet I should eat them at every meal? It made no sense, so I started to do my own research to find out what I could eat at every meal — instead of carbs — that would make me feel full and wouldn't be toxic to my body. The answer: fat.
Metabolizing fat requires little to no insulin. Fat leads to satiation, and it causes a slow (if any) rise in blood sugar. Now let's go back to the four versus nine calories logic: Since the fat calories will make me feel full, I don't need to eat a lot of them. If I eat carbohydrates, I won't feel as full, and, more importantly, I'll need to take insulin, which will lead to fat storage. Moreover, taking insulin is always a gamble. Counting carbs and dosing is imperfect. The more insulin I take the more likely I am to find myself facing hypoglycemia a few hours later. And then the roller coaster begins...
So given these basic facts about what my body is doing with the food I eat, why don't my health care providers tell me to eat a low-carb diet with plenty of fat? Won't it help me manage my blood sugar and help me maintain a normal weight? The answer to this question seems to be that it simply goes against conventional wisdom. In Good Calories, Bad Calories, Gary Taubes' groundbreaking book that shows us almost everything we believe about the nature of a healthy diet is wrong, he cites the 1988 Surgeon General's Report on Nutrition and Health. This report stated that the frequent cardiovascular complications in diabetics were caused by the "traditional restriction of carbohydrate intake in persons with diabetes. If diabetics eat less carbohydrate they will eat more fat, "usually, saturated."
This logic, Taubes says, "led the American Diabetes Association from the early 1970s to recommend that diabetics eat morecarbohydrates rather than less, despite a complete absence of clinical trials that might demonstrate that
the benefits of doing so outweigh the risks, and the decades of clinical experience of establishing carbohydrate restriction as an effective method of controlling blood sugar. "
Dr. Bernstein dates this line of thought to an even earlier time:
"This new [high carbohydrate, low-fat] diet was adopted in the mid-1940s by the American Diabetes Association (ADA), the New York Heart Association, and eventually by the American Heart Association (AHA) and other groups around the world. On the new diet, most of us had much higher serum cholesterol and triglyceride levels, and still developed the grave long-term complications of diabetes. Seemingly unaware of the importance of blood sugar control, the ADA raised the recommended carbohydrate content from 40 to 50 percent of calories, and then more recently to 60 percent. The ADA's most recent guidelines have backed off by vaguely stating that some diabetics may do better with less carbohydrate."
Today's best doctors, like Zachary Bloomgarden (contributor to ASweetLife), Clinical Professor at Mount Sinai Hospital, recognize that fats are better for controlling blood sugar than carbohydrates. When I asked him about the subject he expressed the emerging view that although "a calorie is a calorie," one should also take into account, in understanding dietary choices, the adverse effects of carbohydrates (and the rapidity of their absorption), the types of fat, sodium and other minerals, and a variety of other factors.
Bloomgarden may be on the cutting edge, but supporters of a high-fat diet would even take issue with his suggestion that a calorie is a calorie. If Taubes and other low-carb proponents are right, the whole point is that some calories (carbs) cause the insulin spikes — or require the insulin injections — that make us grow heavy and increase our risk for many diseases, and other calories don't (fats).
I believe that when doctors and nutritionists tell us what to eat and what not to eat, they're taking more than scientific data into account. They're thinking about how we live on a day-to-day basis. Life with diabetes is hard. They want to make it easier for us. For many people, diets aren't sustainable, and a low-carb diet seems to be particularly hard to stick to for some. I'll be the first to agree that it's not easy. I miss carbs on a regular basis, and if there's a pizza in the room, I might have to leave. But that's a momentary discomfort that I can get past. For me, what's not sustainable is the blood sugar roller coaster that comes with a carbohydrate rich diet.
*Jessica adds that if you're interested in taking a very easy step toward a life with less carb, join her for Sugarless Tuesdays, a campaign for one day a week without sugar.*