In recognition of November as Diabetes Awareness Month, we’re publishing a series of Editorials that will bring real "awareness" to this very serious health problem which now affects 25% of the world’s population. The story of how this easy-to-beat lifestyle condition has been allowed to become a global pandemic is nothing short of scandalous. I find it appalling that the food, drug, and medical industries — along with our government — are allowing diabetes to rage out of control because it represents a new source of tremendous revenue.
Thanksgiving is America’s biggest food holiday. But for people with diabetes, prediabetes or other metabolic problems, it’s one of the biggest food traps of the year.
Why? Because so many traditional Turkey Day dishes and desserts can wreak havoc on your blood sugar.
But my jaw really dropped when I looked at the website of the American Diabetes Association (ADA) and saw its "diabetes friendly" Thanksgiving menu. Yikes! It’s truly a recipe for blood sugar disaster, featuring some decidedly "diabetes UNfriendly" dishes like mashed potatoes, maple syrup sweet potatoes, cranberry sauce, and gooey desserts including Pumpkin Pie with Maple Ginger Crust and Frozen Double Fudge Peanut Butter Pie.
These menu items will shoot up your blood sugar higher than fireworks on the Fourth of July. What were they thinking?
Pass the Diabetes, Please
I can tell you what the ADA wasn’t thinking about: The Glycemic Index (GI). Their Thanksgiving side dishes and desserts rank high on the GI scale, a measure of how fast a food digests into blood sugar (also known as glucose). Developed by Dr. David J Jenkins in 1981, the GI scale determines which foods are good and bad for people with diabetes and other blood sugar problems.
You can be sure that chowing down on these ADA Thanksgiving goodies will send a diabetic rushing for the metformin or insulin syringe because they’ll push blood sugar into the stratosphere. (Yet given the ADA’s close ties with the diabetes drug industry, I sometimes wonder if this isn’t their plan. More about this in a moment.)
Let the GI Be Your Guide
The GI Rating Scale goes from 1 to 100, with faster-digesting carbs showing higher numbers (white bread has a score of 100), and slower carbs coming in at 55 and under. The higher the score, the faster the food pushes up your blood sugar.
Whether a carbohydrate is "fast" or "slow" largely depends upon the amount of fiber it contains, because fiber slows its breakdown into glucose.
Slow-digesting carbohydrates (fiber-rich natural foods such as vegetables, beans, and whole grains) provide a steady supply of blood sugar to the body. Fast carbs (refined grains, processed food products, and "white" foods) launch a tidal wave of blood glucose, creating a kind of "sugar high" followed by sleepiness and more carbohydrate-cravings as glucose is cleared from the bloodstream.
High-GI Foods Make Diabetes Worse
Research clearly shows that eating low-GI foods significantly lowers your risk for developing both Type 2 diabetes and heart disease (the number one complication of diabetes). On the other hand, consuming high-GI foods that trigger repeated glycemic "spikes" actually encourage these health problems.
Based on this research, you’d think the ADA and its current Stop Diabetes® campaign would be telling everyone and his brother to eat more low-GI carb foods — while cutting back on the high-GI refined carbs that send blood sugar skyrocketing, like mashed potatoes and pumpkin pie. But that’s certainly not their message here.
"Why?" you might ask. Well, keep reading because I think I found the answer.
Fat Is Their Demon, Not Carbs
Despite the evidence (and there’s a considerable amount of it), the ADA doesn’t believe high-GI carbs cause or worsen diabetes. In fact, they don’t even differentiate between a fast carb (high-GI) and a slow-carb (low-GI). To them "a carb is a carb." An apple is the same as table sugar.
And carbs aren’t the enemy to ADA anyway. Dietary fat is the real bad guy, or so they believe, because it causes heart disease, the number one fatal complication of diabetes. So their solution is a low-fat diet.
What the ADA is really saying is that diabetes won’t kill you, but heart disease will. Yet this completely disregards how diabetes — even when blood sugar is controlled at levels doctors recommend — slowly wastes and destroys the body, causing blindness … nerve damage … amputations … and slow death. Not a pretty way to go.
Current research has moved way beyond this "fat causes heart disease" superstition. More than a dozen peer-reviewed studies published since 2003 show that a low-carb, high-fat diet is more effective at reducing overall heart disease risk than a high-carb, low-fat regimen.
The scientific explanation is that high levels of blood sugar and insulin are extremely inflammatory and damage artery linings, initiating the plaque-building process. Sugar, not dietary fat, is the real cause of heart disease.
In fact, consumption of dietary fat has decreased in the US since the 1960s, while heart disease has been steadily on the rise. What has kept pace with heart disease is our consumption of sugar (now up to 150 pounds per American per year!) and refined carbohydrates.
According to Jeff Volek, Ph.D., R.D., a nutrition researcher at the University of Connecticut. "Research shows that replacing carbohydrates with saturated fat has a beneficial effect on cardiovascular health (because) a low-carbohydrate diet … increases (the body’s) ability to burn the incoming dietary fat."
Dietary Fat Actually Fights Diabetes
Here’s more proof: Before the discovery of insulin, the leading treatment for diabetes was a high-fat, low-carb diet. Dr. Elliott Proctor Joslin, M.D., a Harvard- and Yale-educated physician, relied on it more than a century ago to successfully sustain dozens of diabetic patients — including his own mother. His treatment? A diet made of 70% fat and just 10% carbohydrates.
And then there are the Greenland Eskimos, who before the introduction of the Western-style high-carb diet, had the lowest incidence of heart disease and diabetes on earth. They ate fat and protein almost exclusively — and only about three percent carbohydrates. So much for dietary fat causing heart disease. So much for dietary fat causing heart disease.
The problem is, if you’re cutting back on fat, you have to make up the calorie difference somewhere else. And in the ADA’s view, that "somewhere else" should be carbohydrate foods. Hence, its official pro-carb, anti-fat position.
But we’ve already seen how mistaken this approach is dating back the 1980s, the decade of "low-fat mania." Then, food manufacturers cranked out thousands of low-fat foods, replacing their fat content with sugar and other sweeteners such as high fructose corn syrup. That fad diet started our current obesity/diabetes boom.
Apparently, the ADA was asleep for the whole decade, because they still maintain that our diabetes and obesity woes stem from consuming too much dietary fat — even though fat consumption declined significantly over the past 30 years. But carbohydrate consumption (and I’m not talking about fruit, vegetables, and whole grains) has been steadily increasing.
Why The ADA Favors a High-Carb Diet
Reflecting their fat phobia, the ADA recommends that up to 65% of a diabetic’s daily calories come from carbohydrates. And they don’t differentiate between a slow-carb the fast-carb. Instead, they want you to simply "count carbs" no matter what kind of carbs they are.
You see, in the ADA universe, a 1/2 cup of oatmeal or black beans counts the same as two cookies or 1/4 serving of French fries — even though these foods have very different effects on your blood sugar as indicated by their GI ratings. Cookies and French fries will spike your blood glucose, while oatmeal and beans will stabilize it.
If you have diabetes or prediabetes, eating high-GI foods (like those on the ADA Thanksgiving dinner menu, for example) will send you running for your medications. Low-GI foods, on the other hand, usually allow your doctor to lower your dose — or withdraw them completely.
Reducing High GI Carbs Reverses Type 2 Diabetes
When my diabetes patients reduce the high-GI carbs in their diet and replace them with fiber-rich carbs such as vegetables, beans, and whole grains, we see significant reductions in their blood sugar and insulin levels — so much so that we’re able to completely discontinue their medications.
Not only does this type of eating normalize blood sugar, but replacing refined carbs with protein, fiber, and healthy fats, usually results in a reduction of overall calories which translates into weight loss without any "dieting" whatsoever. A
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Terrific editorial.
I submitted a comment on the ADA holiday menu site pointing out that a single serving of the four sides they show add up to 106 gm carbohydrate (48 gm of it sugar!). I noted what eating this much poison at one meal would do to me as a T2 diabetic.
Since comments are reviewed before posting, my ADA comment probably will not be posted even though I tried to be diplomatic – I avoided using the word “malpractice”.
What is with Registered Dieticians and their love of graham crackers? I am a nutritionist and every client I have with diabetes and who has been to a registered dietician was told to eat graham crackers as a snack before bed. Scary stuff! (This article has them using these crackers as a pie crust). Needless to say, their were off their graham crackers when they walked out of my office! I don’t even want to vent my opinion here about their other love of sugar substitutes.
Thanks for the link. I am an RD, CDE, and actually their new standards of care published in January acknowledge the benefits of low carb in weight loss and also acknowledge a slight improvement of glycemic index over just counting carbs. How interesting that these recipes don’t suggest that. I have gone right to the link letting them know that I would never recommend such a meal to my patients.
The advantage of slow digesting carbs has been known for some time. So why the ADA does not make it the “top” recommendation is quite puzzling. There is growing (but non-scientific) belief that processed foods are “pre-digested” and are even more likely to rush sugars to the blood.
Whole grain carbs, a primarily vegetarian diet will surely help.
For those looking for help with sugar cravings and for natural sugar support, an herb called Gymnema sylvestre has been found to help. Check out clinical studies on PubMed (Natl. Library of Medicine). Here is a link to a company that manufactures this supplement in the USA in FDA inspected facilities:
http://www.naturesformulary.com/Products/52-gymnema.aspx
wow this was a great article!
I still think the “whole grains” thing needs to be re-thought. Basing a diet on whole grains first, before protein and fats, will just serve to perpetuate the whole diabetic thing. Grains we eat should be soaked/sprouted for optimum digestion. This way they become more like vegetables, and their ranking plummets on the glycemic index. We really need to be eating whole, real fats (low-fat dairy products are not “real” food), healthy proteins, lots of cooked vegetables, small amounts of fruit, and ditch the cereals, pastas, etc., even if they are “whole grain”.
I hope everyone had a Happy Thanksgiving! I want to apologize if I delivered the message that people with diabetes should “splurge” and “binge” on Thanksgiving. That was not my intention. I simply meant to try and take some of the pressure off of those with diabetes. Thanksgiving can be an overwhelming and guilt-filled holiday. Further, people in different areas of the country and at different income levels may have difficulty supplying all of the foods you recommend. I simply meant to imply that all people should enjoy the holidays with family and friends, including those with diabetes.
I certainly do agree with various parts of the article including focusing on high fiber carbohydrate foods to provide the majority of carbohydrates. I also love the mention of incorporating exercise – stroll after dinner, walk in the am. I believe exercise is a critical part of diabetes management – especially type 2. I always tell my patients that a proper diet and exercise is an essential part of diabetes management. And I also appreciate that these changes take time.
One last thing to mention, I do not appreciate the idea that ADA is conspiring to keep diabetes a problem and is not providing accurate up-to-date information. The ADA is the public representative and supporter of people with diabetes and I have faith in that organization.
While I do wish sincerely that there was a cure to diabetes, I am aware that there is not one now and believe they are working to find a cure. (FYI – cure in my opinion is defined by completely “fixing” the body so that it operates like “normal,” not making lifestyle changes to decrease or come off of medications like in Type 2 – which is certainly possible in some).
Again, I apologize if I sent the wrong message the first post, but I have a soft spot in my heart for people with diabetes and want to do everything I can to support them while promoting a healthy lifestyle.
What about glycemic load? I did not see that mentioned in the article. According to Harvard School of Public Health:
A food’s glycemic load is determined by multiplying its glycemic index by the amount of carbohydrate it contains.
Further, while I do appreciate that basing a diet on whole grains, fruit, vegetables, low fat dairy, and lean proteins is definitely recommended the majority of the time – Thanksgiving is a holiday! It is one day a year! For my patients that work hard balancing their diet to the best of their ability the majority of the time if they have some favorites they would like to indulge in on a special holiday, I think it is okay to do so within reason. A significant part of diabetes management in my opinion is also quality of life – to enjoy family, friends, and yes even food!
While I completely agree with the importance of education, prevention, diet and exercise, I also appreciate how difficulty diabetes management can be. I believe many things should be considered when determining the best way for an individual with diabetes because every individual is different.
I wish everyone a Happy Thanksgiving! Enjoy the holiday!