I found a response to this article at this link - gotbeer.
July 08, 2003
Carb Scare Tactics
U.S. News and World Report has an article in their upcoming issue (7/14/03) entitled: "The Diabetes Diet Wars: The nutrition advice given to most diabetics might be killing them" that discusses the great carb debate - again. Headlines like this really rub me the wrong way, especially for those who are newly diagnosed and may read this piece. The article does touch on some interesting points in the ADA nutrition guidelines vs. low-carb debate, but unfortunately leaves out critical information. Begin rant here...
Here's the letter I wrote to the U.S. News editor in response to the piece:
To the Editor:
I found the headline "The nutrition advice given to most diabetics might be killing them" on your "Diabetes Diet Wars" piece to be irresponsible and alarmist. While I agree that the current dietary recommendations from the ADA deserve re-evaluation in light of the recent NEJM studies on low-carb diets and weight loss in type 2 diabetes (which were vaguely referenced in your article), the current guidelines are a far cry from killing anybody. Given that the consumers who are actively digging for diabetes information online and in their bookstores are often those who are newly diagnosed as type 2 and completely overwhelmed (I know, I get email from hundreds each month), this type of fear-mongering headline is uncalled for and designed not to inform but to cause panic.
Diabetes is very much an individual disease, and I believe the ADA emphatically recognizes that when they state in their technical review on the subject that a primary goal of medical nutritional therapy should be: "To address individual nutritional needs, taking into consideration personal and cultural preferences and lifestyle while respecting the individual’s wishes and willingness to change." In other words, while the ADA does issue evidence-based clinical practice recommendations for carbohydrate intake (and the key phrase is *evidence-based* - meaning based on the current body of knowledge from controlled scientific studies and subject to future change as knowledge evolves), these are only guidelines.
Your article also fails to address several critical points of the debate. You quote Frank Vinicor of the CDC speaking to how high protein intake (a feature of popular low-carb diets) cannot harm anyone with healthy kidneys. This is absolutely correct, but your reporter fails to mention that diabetes is the number one cause of chronic kidney failure in America. Many people with diabetes *do* have existing renal impairment, and forcing their kidneys to process extra protein makes the problem worse.
There's also the matter of carb quality versus carb quantity (otherwise known as the glycemic index, or GI), which should play a necessary role in this debate. A baked potato, for example, will raise blood glucose levels much higher and faster than a portion of fiber dense whole grain bread, even if the portions given have equal amounts of carbohydrates gram for gram. If anything, there should be a push towards including GI basics on smart carb choices in diabetes medical nutrition therapy. The ADA currently acknowledges the possible utility of the GI, but stops well short of endorsing it, citing a lack of current scientific evidence on long-term success, plus the supposed complexity of the method. In a world of exchange lists, carb counting, and blood glucose testing, however, the GI seems to be just a little more math for a much larger reward.
Finally, exercise is an absolutely essential component of any treatment plan for type 2 diabetes. Exercise lowers blood glucose levels, improves heart health (cardiovascular disease is a major complication of diabetes), and improves overall well being. Inactivity is sometimes, though not always, the cause for a seemingly ineffective diet plan.
Respectfully,
Paula Ford-Martin
*****************
About Diabetes
Editor and Content Producer
diabetes.guide~about.com
http://diabetes.about.com
End of rant.