Diabetes-friendly Diet Wars

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Diet has been inextricably linked with diabetes treatment since ancient times. Before the discovery of insulin, starvation diets were the only way of prolonging a wretched life. Since the discovery of insulin the diet fads advice has waxed and waned. It’s all butter and fatty meat one decade and white bread and potatoes the next.

Carbohydrate “exchanges” or “portions”, high carb, low carb, ultra-low carb, low GI, low glyceamic load, plant-based, whole grains, low protein, low fat, low saturated fat… The list seems almost endless and of course you can combine many of these to create some kind of Frankenstein diet. Do you fancy plant-based paleo, low GI/high carb/vegetarian, no red meat/high protein and then there’s the eat anything so long as you bolus school of thought? If you spend more than a few minutes surfing the net you can find any number of staunch advocates for one position or the other. There are some dubious claims from unqualified people but there is plenty of controversy amongst experts too.

Plant based w diary & a dash of highly processed!
Vegetable curry, lowish carb, partially plant based, defn not paleo though!.

I’ve been experimenting with low-carb, a move my endo is enthusiastic about. I searched academic journals, clinical guidelines and professional position statements looking for scientific evidence about diet and diabetes. Instead of science and evidence though, I’ve found something more akin to faith, there’s dogma and lots of entrenched opinion but as I look for evidence the results are so scant it seems as though nutrition “science” is a case of the Emperor’s New Clothes. There are professionals who have studied and know a lot about food and nutrition but there’s a gaping chasm between knowing about elements of food and what actually works. There are plenty of qualified and unqualified experts claiming to have “the answer” but proof is scarcer than cronuts at a dietitian’s conference.

The American Diabetes Association published a position statement in 2013 that admits “There is no standard meal plan or eating pattern that works universally for all people with diabetes.”. I’ve blogged about some of the problems with their ‘we have no position other than what you’re doing is wrong ‘ diet position statement before.

The Australian National Evidence-Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults review a lot of evidence but the recommendations are alarmingly scant;

“Matching of mealtime insulin dose to carbohydrate intake should be considered for patients using multiple daily injection therapy.”

“Individuals with type 1 diabetes should be educated on low-GI diets.”

There is insufficient evidence to make a recommendation on high protein diets.

“Diets high in monounsaturated fats should not be used routinely in type 1 diabetes.”

Hardly compelling is it? How many vague qualifiers like “routinely” and “should be considered” before you feel they’re  just not trying with this whole diet advice thing?

As with so much in diabetes, I guess it’s a case of personal trial and error as you try to find what works for you. If you’ve succeeded with the trial and error to find the ultimate t1 diabetes diet let me know. Just don’t mention cinnamon or ochra!

High glycemic load, "street" food. How much to bolus for just that bite?
High glycemic load, “street” food. How much to bolus for just that bite?

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