The Carb Controversy

Isn’t it strange that the biggest controversy in controlling our diabetes is how much of our diet should be carbohydrate?

Diabetes is, of course, a disease of carbohydrate metabolism. So, isn’t it obvious that the first thing that we should know about controlling diabetes is how much and what type of carbohydrates we need to eat?

We don’t know that. At least many people don’t, because we certainly don’t agree.

Diet is one key to controlling our diabetes. We generally do agree on the other things we need to do.

Exercise helps, and without blood glucose testing and regular A1C tests we wouldn’t have much of an idea how we are doing. The other thing to control our diabetes is our medication – pills or injections. While we have a good choice here and different drugs work differently for individuals, we don’t have any raging controversy around them.

We do have that raging controversy around carbohydrates.

The nearest thing we have in the United States to an official position is that of the American Diabetes Association. The ADA recommends that carbohydrates should be from 45 to 65 percent of our diet.

Dr. Richard K. Bernstein, perhaps the country’s most famous endocrinologist, stands at the other end of the scale, promoting a low carbohydrate diet. His most recent book, The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution, came out last year.

I don’t see that he recommends a certain percentage of carbohydrates in our diet. But he says that people with diabetes should eat about 6 grams of carbohydrates for breakfast and 12 grams each for lunch and dinner. Those carbs will provide only 120 calories, and that is an incredibly small part of a typical diet of 2,000 calories or more.

Between the ADA and Dr. Bernstein is a middle position, the low glycemic diet. The person nowadays most closely associated with the glycemic index is Professor Jennie Brand-Miller of the University of Sydney in Australia. Her book, The New Glucose Revolution, is the best introduction to the subject.

After ignoring or even condemning the glycemic index for years, the ADA has begun to accept that it has some value. “A recent analysis of the randomized controlled trials that have examined the efficacy of the glycemic index (a measure of the effect of type of carbohydrate) on overall blood glucose control indicates that the use of this technique may provide an additional benefit over that observed when total carbohydrate is considered alone,” the ADA says.

While the ADA is coming to accept the glycemic index, Dr. Bernstein certainly isn’t. He thinks that it is flawed, misleading, and too much trouble. The ADA still vigorously rejects a low carbohydrate diet. This organization opposes a diet of less than 130 grams of carbohydrate per day, “because the brain and central nervous system have an absolute requirement for glucose as an energy source.”

Again, Dr. Bernstein dissents from the mainstream view. “You can quite easily survive on a diet in which you would eat no carbohydrate,” he writes in Dr. Bernstein’s Diabetes Solution.

So what’s the best diet? When the experts don’t agree, it is up to us to decide for ourselves. That’s OK, because it is our body and our health. We need to keep an open mind and experiment. We need to keep changing.

This article is based on an earlier version of my article published by HealthCentral.