4 Myths about Carbohydrates and Diabetes

Cookie to Kale Ratio

Since the turn of this century, Carbophobia – the fear of carbohydrates – has rooted itself in American food and nutrition culture. With the rise of type 2 diabetes, some people will swear that carbs are the food equivalent of Satan himself. And of course an entire cottage industry of low carb diets with billions of dollars in revenue has sprung up, perpetuating some irresponsible myths.

But not only is this carbo-fear mongering unbased, it can lead to worse outcomes for people with prediabetes and diabetes. In an excellent piece published on Present Diabetes’ Nutrizine, Registered Dietitian and Diabetes expert Hope Warshaw outlines the reasons. You should read the entire article, but if you don’t have time, here is a summary of 4 carb myths:

Myth #1: People with diabetes need to drastically reduce their carb intake.

WRONG! In healthy adults, carbs should account for 45-65% of total calorie intake. People with diabetes should be in the lower range, but not below the 40% mark.

Our bodies need carbohydrates to survive: they provide the fuel for our body and brain, and they provide essential nutrients. America’s problem is the TYPE of carbohydrates we consumes are the wrong ones. We eat too many simple carbs, and not enough nutrient dense carbohydrates. Our cookie to kale ratio is the problem, not carbs.

Reducing carb intake while on a low calorie diet (less than 1500 calories daily) may lead to deficiencies in many nutrients provided by carbs such as dietary fiber, potassium, calcium, magnesium and vitamin A,C,D.

Additionally, less carbs in the diet means more fat and protein. Often these choices lead to higher levels of saturated fat consumption. Saturated fat has been demonstrated to be a cause of insulin resistance, one of the key symptoms of diabetes and prediabetes.

Myth #2: Reducing carb intake improves blood glucose levels

In studies comparing cohorts of people with diabetes, those with regular carb consumption (above 50%) had slightly BETTER blood sugar levels than those on very low carb consumption (less than 40%).

Myth #3: Carb restriction eliminates the need for medication

A proper, balanced diet, with a focus on calorie reduction, may help people with prediabetes stave off type 2 diabetes. But once a person is diagnosed with Type 2 diabetes, medication is just a matter of time. Studies have shown that only a small fraction of people at the onset of type 2 diabetes were able to postpone any type of medication through intensive lifestyle changes.

Myth #4: A low carb diet decreases chances of other diseases as well.

One of the complications of diabetes is co-morbidity. Diabetes increases the chances for heart disease, kidney disease, and a host of other complications. People on ultra low carb diets consume more fats (and saturated fats) which are a risk factor for heart disease. They also consume more protein, which above safe levels can be problematic for overburdened kidneys.

In summary, carbs are not evil. People should choose foods that have nutrient rich carbohydrates such as fruits, vegetables, and whole grains while limiting low quality carbs (read: sugars) from soft drinks, candy, and refined flours.

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  • DrTroy

    “But once a person is diagnosed with Type 2 diabetes, medication is just a matter of time. Studies have shown that only a small fraction of people at the onset of type 2 diabetes were able to postpone any type of medication through intensive lifestyle changes.” Weak science. Sure the studies show that. Poor dietary habits are what got them there in the first place. Intensive lifestyle changes are what can reverse Type 2 and only a small fraction of the people were able to achieve that. So instead you could have said “Almost everyone who adapts intensive lifestyle changes were able to postpone medication for type 2 diabetes”.

  • The Candid RD

    GREAT post! I’m starting a 6-week diabetes class in April and will be sharing this with the group :)

  • laura

    Here we go, more posting with the merry go round of nutrition. Saturated fats do not increase risk for heart diseases, the wrong kind of saturated fats do. Read Hartwig’s “It Starts With Food”, first time in 9 years that I’m actually reducing the inflammation in my body!

  • Rajneesh Verma

    Nice post. is there a way to share post via email?

  • Rachel

    Then why is it that I read again and again and again stories of people who have switched to a paleo diet after years of following conventional wisdom (see above) and reduced or given up medication? This is in addition to feeling better and losing weight!

    These are people who stray from these recommendations and have MEASURABLE improvements.

    The proof is in the pudding (sorry, not the best metaphor for a diabetic).

    The kicker is, after their blood sugar levels improve, their dieticians / doctors / diabetes experts see what they’re eating and think, oh, no… how can you be eating so few of those wonderful whole grains!!

    If I were a diabetic, I’d try both methods for a month or two, measure carefully and compare.
    And if I were diabetic, I’d want to read this blog. http://www.diabetes-warrior.net/

    • Devyn

      Rachel, I have often wondered this myself. I have gone on the paleo diet and my blood sugar levels have dropped, my waist-to-hip ratio is in the healthy range now, I have boundless energy, I’ve lost 45lbs and 5 sizes and my skin has cleared up! I have cut out grains (even whole grains) and have increased fat (including saturated fats) in my diet. I would love to hear more about the long-term effects of the paleo diet and perhaps some real debate on it, but I have yet to see any solid evidence that the paleo diet is actually a bad thing. I’d be interested to know what knowledgeable people have to say on this issue.

      • Rachel

        Devyn, if I had a nickel for every time I’ve heard something like
        “I have gone on the paleo diet and my blood sugar levels have dropped, my waist-to-hip ratio is in the healthy range now, I have boundless energy”
        I could retire, buy a house with a garden and raise chickens. :)
        In my opinion, “solid evidence” when you are talking about diet is impossible. There are simply too many variables.
        If you really want to know what works, you have to do long term studies – i.e. years. If you truly want to control all the relevant varibles, you’d basically have to lock people up and feed them to know exactly what they are eating. And you’d need large numbers of subject to be statistically significant.
        This ain’t gonna happen.

    • http://www.fooducate.com/ Fooducate

      If paleo works for you, how can we argue with that.
      The thing is, that when reviewing literature on entire populations, its the “conventional wisdom” approach that provides the best outcome for a majority people.

      • Rachel

        Don’t buy it. There too much politics involved.
        * Research is almost always funded by interested parties.
        * All the various national associations of dieticians, the diabetes assocition, the heart association.. (sorry… didn’t take the time to look up the exact names) they all get lots of money from food companies. You have written about this yourself on fooducate.

        I don’t think individual dieticians and certainly not the author of the article, are trying to deceive the public. But much as I’d like to trust research, I can’t.

        But like I said, I think each individual should try for him or herself. Try one diet seriously for a month or two (but educate yourself about it). How do you feel? How are your glucose levels. Try another. How’s that working?
        It’s really the only way to know.

      • Brian Klein

        Is the literature based on double blind studies or is it based on epidemiological studies. Epidemiological studies have been steering us the wrong way for years now.

      • MarieM

        Why do you say that the conventional approach provides the best outcome, when you noted in the article the increasing medications and comorbidities are a matter of course with the conventional treatment?

        • http://www.fooducate.com/ Fooducate

          Because diabetes is a degenerative disease.

          • Chroi23

            Diabetes is a degenerative disease if you continue following the conventional medical “wisdom” of the day… that does not have to be the case. I have to disagree with almost every point in this article…from personal experience…and 2nd hand information from diabetic friends and family…we have found every one of those supposed “myths” to be actual truths. I personally have been totally med free for over a year and all of my lab values for possible co-morbidities are in the healthy range.

  • Brian Klein

    We don’t really *need* carbs. We could all eat very low carb diets and we’d get by just fine. It’s not necessarily the healthiest way to live, though, and if you are active at all, you probably want to have carbs. Each person is different, and their level of carbs should be different. Applying a rule of 40% or 30% or whatever is not a good way to go about nutrition. There’s no denying that the standard american diet is way too high in carb consumption.

    Your point about saturated fat is just as much as a myth as the point you are making about carbs. Americans have been scared of fat for years now, and look where it got them? There are old studies that are resurfacing now where they hid the fact that people on diets higher in saturated fats actually lived longer lives, and died of less diseases than those on low saturated fat diets. All in the name of selling vegetable oil, and promoting the cholesterol myth. So believe all the studies if you want, but know that there is usually a reason why they are being done. It usually isn’t to find good health. It’s to sell more product, or to feed a scientists ego.

    http://www.bmj.com/content/346/bmj.e8707

  • Tonya

    Have you read or heard about Dr.Liponis (sp?) Hunter / Farmer Diet solution? I heard him lecture and it was a very interesting solution based on body shape. I’d like to hear your opinions on this.

  • Brad

    It’s not the amount of carbohydrates that really matters, it’s the type of carbs. When people significantly reduce or even eliminate flour based products and foods high in sugars such as most fruit juices and all sodas they almost always see a decrease in weight and better glycemic control. Insulin is a fat promoting hormone, consistent spikes in insulin lead to weight gain and diabetes. The old concept of a calorie is a calorie, in other words, all calories are the same is false. 100 calories from carbs in that cookie is going to react very differently in the body compared to 100 calories of carbs from a non-starchy vegetable. It’s time we stop sticking up for refined processed junk foods

    • Robert

      Sorry Brad – I’m a Type I Diabetic on a 24/7 continuous blood glucose machine (monitors my BG’s all day long) and I have to tell you – a carb is a carb. It doesn’t matter whether it is a cookie or a sweet potato I have to take the same amount of insulin bolus and they both raise my blood sugar equally.

      Since I pump insulin I can see the direct result of lowering carbs and eating paleo – I went from greater than 40 units of insulin (manufactured syntheitcally by the way) eating an ADA carb-rich diet to under 20 units with an a1c under 6 and very few hypo’s – meaning I am no longer a victim of wild blood sugar swings.

      • Brad

        the example you mentioned, a sweet potato, is a starchy vegetable, so yes it would likely raise your blood sugars rapidly. However most all of the non-starchy vegetables do not. those are the carbohydrate foods I am referring to, not potatoes.

    • HawkJRL

      Actually the amount of carbs do matter. Nonstarchy vegetables tend to have very high water content. 100 calories of broccoli, cauliflower, or cabbage is more than one would eat in a typical meal…those would be very large servings.
      So unless someone actually eats that much in one sitting and then test their blood sugar, you wouldn’t know what sort of response your body would have.

      Even if nonstarchy vegetables are one of the better carb sources, Warshaw suggests one consumes at least 40% of their calories from carbohydrates. It would be unrealistic to think that the average person would consume that many calories from nonstarchy vegetables. Fruit and whole grains would be consumed and will elevate blood glucose.

  • http://www.facebook.com/covaelite Trey Bandemir

    Ummm…where the heck are the sources? The human body processes every macro nutrient into a sugar if it needs to and so long as your nutrient intake is well over 200 grams of anything, your brain is getting adequate fuel. Take a cold food processed multi, you will get more nutrients in your body than with food intake. Proteins and fats convert to sugar puts the body into a state of lipolysis if carb intake is low enough. Simple or complex, carbs still antagonize yeast infections such as candida and too much fiber can continue the cycle of symptoms of IBS, colitis, compacted stools therefore potential micro hemorrhaging of the intestinal tract…ect…Seeing how you are giving examples of kale vs a cookie…a cookie is going to be macro nutrient dense but lack actual nutrients when kale will fill the body with vitamins and minerals depending slightly on where it was grown and the soil consistency…kind of a poor comparison because kale isn’t going to really contribute to heightened or lowered blood sugar however…when ingested with a simple sugar, could potentially increase the time it takes to digest the sugars therefore making the bad sugars less likely to cause an imbalance than say on an empty stomach. So how do we pull calories out of a nutrient dense calorie poor item…you don’t…where does the calorie come from then? healthy grains? rice? sweet potatoes? legumes? low GI foods or high GI if you just worked out? Now we are going back to excessive fiber is excessive. Should really check out sites like http://www.gutsense.org and http://carbsanity.blogspot.com/2011/08/why-insulin-levels-lipolysis-do-not.html for starters.

    To address people who are actually diabetic…the only way you can be safe is to either get your pancreas working again or continue to take the insulin…that’s obvious. Lowering your carb amount can reduce the need for insulin to a certain degree but like I said, every food product can be converted to sugar regardless of the macro nutrient. If you are concerned about the onset stages of diabetes or are a few years into it, check out herbals like essiac tea, known to stimulate a failed pancreas…if you are diabetic and taking this tea, you may have to watch your numbers closely because it can antagonize the pancreas to start working on its own again, therefore reducing the amount of medication needed regularly.

    There are risk factors for excesses in any macro nutrient if the body doesn’t put it to good use. Keep it simple stupid mindset comes to play…just start lifting weights…lift hard…count the reps slowly…do some sprints…go on a hike…burn off the excesses regularly and you shouldn’t have much to worry about. Stick to the outside of the grocery stores regardless of how your body might crave those boxed, nutrient dead foods…they are pretty much dead despite their listings of any nutrients in them with few exceptions.

    Stop hating on saturated fats…consume grass fed organic meats as much as you can and stop eating naturally fatty meats or fatty parts of an animal. MCTs from coconut oil and milk aren’t going to destroy your heart and will contribute to a variety of health benefits…not faults. Conjugated linoleic acid and other sat fats derived from things like grass-fed beef and pasture butter will have positive benefits to various processes in the body. I cook my spaghetti with quinoa noodles and grass fed beef, leaving the fats off the beef in the sauce rather than down the drain.

    Keep it simple, progress of the mind, body and soul (however you interpret that last part) does not include stagnation…what you don’t use you lose. Find ways to work the brain regularly for memory and to reduce age/chemical induced degradation, exercise beyond a simple but almost useless walk with your dog, lift weights, go swimming if you enjoy it, meditate, imagine, keep a child-like enthusiasm about life.

    A paleo type caveman diet isn’t unhealthy the way this article kind of portrays it. The food pyramid is a complete sham minus the desserts being on the top…they shouldn’t even be acknowledged.

  • http://www.facebook.com/trainer.dave.fitness Trainer Dave

    This discussion does not include the complexities of grain induced inflammation & the lurking dangers of GMOs. Sweet & Starchy “Carbs” should be ingested post workout …. other ingestion should be with great moderation. The complexities of diabetes is one thing, but for the average person your non-starchy vegetables should over half your diet & will give you all the “carbs” you need.

  • HawkJRL

    Well anyone with a blood sugar meter can experiment with foods and see what effect they have on blood glucose.

    Just like a cookie, a banana and a bowl of oatmeal can raise your blood sugar. I think it is assumed that only “bad” carbs raise blood sugar, which is not true.

    Why no talk about eating carbs in smaller portions in more frequent meals? The amount of carbs eaten at any one time definitely influences blood sugar.

    Certainly being vigilant with carbs can delay the need to take medication. Why don’t “conventional wisdom” people like Hope Warshaw want to find ways to assist those sorts of people who would like to delay taking medication.

    I would take Hope Warshaw more seriously if her “nutrizine” didn’t have a bunch of drug company logos at the end of the page. There was no way for this information to be presented without the drug company advertising?

    • Rachel

      Nutrizine is sponsered by Merck, Abbott, Pamlab, Sechrist, KCI Clinical Advantage, and Sanofi Diabetes.

      Surely we can trust the drug companies to provide excellent information on which forms of nutrition will lower their sales. I, for one, am convinced.

  • Mscott

    Reducing carb intake while on a low calorie diet might lead to a vitamin D deficiency? Uhhh what carb food naturally contains vitamin D again? (hint: the answer is none of them).

    • http://www.facebook.com/covaelite Trey Bandemir

      You can also leave the house and stand under the sun which is pretty easy to do for most people. Most people don’t realize we synthesize sun light for various processes in our bodies. Most people on a high carb diet are still deficient in vitamin D. If you don’t supplement it in this age, you are probably deficient in more than just D, which is a lot less serious than other vitamin and mineral depletion.

  • Carol H.

    Thanks for posting this. The myths are so old and entrenched that even many physicians believe them. From the looks of the comments, there are plenty of confused/misled consumers as well. Example: paleo is not a carb-free diet (berries and even nuts have carbs), nor did “cavemen” eat carb-free diets… they actually ate lots of roots, grasses, berries, etc., because they needed to eat whatever they could find. Remnants of such foods have been widely found in archeological sites. Diet/health/bio-anthropology are not black and white. We need carbs — the whole-foods ones are packed with nutrients we couldn’t survive/thrive without.

    • Brian Klein

      No, we don’t need to ingest carbs at high levels, especially at the levels discussed in this article. Our body will make them in the form of ketone bodies for us if we don’t consume enough of them. That’s not saying you shouldn’t eat carbs. You definitely should. Just be judicious where you get them from. And if you are eating any variety in your diet, it’ll be hard to avoid them.

      I’m not sure where you read in the comments that people were saying Paleo is carb-free, but one of the biggest myths about the paleo diet is that it is a low carb diet, which you allude to. It’s not. It can be, but most don’t practice it that way. But it’s generally lower in carbs than SAD. And individualism is key here. Some people will do well with low carb intake, and some won’t.

  • Dra Maru

    I love your articles and I had written about your webpage. But I don’t agree with you with this article. I’m a doctor and I work mainly with nutrition in diabetes. Restricting carbs is very helpful in diabetes and indeed may quite cure patients with this illness. If you read Dr. Mark Hyman, you would find similar results. The problem is we cannot classify all carbs as similar since they aren’t. Besides, I have patients that were on diabetic medication that went on a restricted carbs diet and ended with no medication at all, even one patient with a record of 10 years on medication, with blood sugar in 400 when she began reprogramming her diet & lifestyle. The carb restriction applied to high and medium glycemic index &load. I suppressed fruit juices, rice, potatoes, whole wheat breads, and counseled her to use barley, whole fruits, beans, good sources of proteins and fats. She is doing fine 4 years after with no medication at all. Please don’t allow conventional “nutritionism” deceive your terrific work with food.

    • http://www.fooducate.com/ Fooducate

      Sounds like you restricted all the refined and simple carbs. But what was the daily carb intake from whole sources?

  • tabletalk

    Ack!

  • Amanda

    It’s definitely hard to argue when you hear a paleo success story (lost 50 lb, lab values great, etc.). But one big thing a lot of people don’t think about is that by committing to a paleo diet, they’re cutting out the high calorie processed carbs they usually eat on a daily basis. If I cut out cookies, I’d probably lose weight too! So while it’s great to rid your diet of some of the processed junk, I think the paleo diet goes a step too far.