A Diabetic Doctor's Take on Carb Cravings

I’ve mentioned Dr. Richard Bernstein here before. Bernstein is the 78-year-old Long Island-based doctor who for years has been a thorn in the side of the American Diabetes Association. That’s because of his advocacy of a low-carb approach to both type 1 and type 2 diabetes.

(Over the years the ADA has reluctantly come around to recognizing that high-protein/low-carb diets can work as well as high-carb/low-fat diets at achieving blood sugar control. Even so, the association’s grudging approval of what was once considered a radical approach comes slathered in all sorts of hemming and hawing.)

In his practice, Bernstein, who was diagnosed with type 1 diabetes 64 years ago, only treats patients who are diabetic or have metabolic syndrome.

One of the bedrock things he teaches them is that the daily levels of carb intake recommended by advocates like the ADA are way too high. They invite the overuse of insulin to compensate—a practice that almost always has long-term bad effects on health.

We all know, whether we have diabetes or not, that carbohydrates taste awfully good. A world without pasta, pastries, bread, tortillas, potato dishes, corn on the cob, and other carb-rich foods would be a dismal place.

So it seems like a small mercy when experts tell us type 2s that we can have way more than 100 grams of carbs a day. (The ADA recommends 45 grams to 60 grams per major meal, or at least 135 to 180 grams per day.)

After all, we can get around any potential danger by eating low-glycemic carbs or, if we take insulin, “covering” them with a bigger bolus hit.

But Bernstein says there’s another danger lurking in carbs for us type 2s. According to an interview he gives here, carb craving gets ramped up with diabetes because our loss of insulin-producing beta cells also leads to the loss of the production of amylin.

Amylin is a hormone that signals food satiety to the brain. Reduced or non-existent amylin produces a feeling of constant hunger, which often leads to bingeing on carbs to get a sense of fullness and satisfaction.

Like so much else that comes with diabetes, this means we have to make some decisions that aren’t always easy. I don’t think there’s anywhere near a one-size-fits-all piece of advice here.

If you start with the notion that carbs are enjoyable and bring tasty variety to a diet, the question becomes how to consume them in a way that takes into account your own strengths and weaknesses.

If you’re somebody who can consume carbs and not be tempted to overdo it, more power to you. It should be fairly easy to set up a routine where you eat a set number of them daily, including the occasional “naughty” carbs from a sweet treat.

But if going beyond a certain number of grams of carbs tempts you too much, it may be best to develop a low-carb habit you can stick to without going nuts.

That involves finding the tastiest possible low-carb recipes (there are many out there) and creating a list of “safe” low-glycemic carbs you can indulge in without feeling like you’re sliding down a slippery slope.