DAA’s views on carbohydrate
DAA supports the inclusion of carbohydrate foods, such as bread, rice, pasta, noodles, breakfast cereal, potato, corn, legumes, fruit, milk and yoghurt, in the diets of the general population, people with diabetes, those who are overweight and people with insulin resistance.
I asked Richard Feinman, Professor of Cell Biology at State University of New York Downstate Medical Center and author of The World Turned Upside Down: The Second Low-Carbohydrate Revolution, to comment on statements made by the DAA.
- DAA on Carbohydrate: “Try to eat carbohydrate-containing foods in every meal to provide the body with energy throughout the day.”
Professor Feinman: “This takes no account of the different ways in which people metabolize carbohydrate-containing foods. Many people find that even moderate amounts of carbohydrates make them fat. It would at least be reasonable to say “if you find that foods containing carbohydrate don’t make you fat…” but that seems not to be their style.”
- DAA on Diabetes: “Foods containing carbohydrate include bread, rice, pasta, noodles, breakfast cereal, potato, corn, legumes, fruit, milk and yoghurt. It is important to include some of these foods with each meal.”
Professor Feinman: Diabetes is a disorder of carbohydrate metabolism. Carbohydrate foods are broken down to sugars, which enter the blood and increase the blood glucose level. People with diabetes cannot clear this sugar from their blood efficiently, resulting in high BGLs that are the hallmark of the condition. It is unreasonable to suggest to a person with this metabolic condition to eat the very foods, incomprehensibly at each meal, that are at the heart of their problem.
- DAA on Insulin resistance: ‘Eat wholegrain foods everyday such as high fibre breakfast cereals, multigrain bread, oats, barley and cracked wheat.’
Professor Feinman: Here it’s just a matter of knowing the science which shows that insulin resistance is best controlled with low-carbohydrate diets and the benefit from grain, where it has been studied at all is very weak compared to reduction in nutrient carbohydrate.
4. DAA on Overweight and obesity: “The following ideas may help those wanting to lose weight.
Try to eat: Lots of vegetables, fruit, whole grain breads and cereals.”
Professor Feinman: To me, this is the nuttiest thing of all. Why you would be counseled to eat “lots” of anything to lose weight is beyond me. DAA is not alone in this bad advice. Among the things whose consumption went up during the epidemics of obesity and diabetes are whole grain breads and cereals. To be fair, consumption of many things went up. The only things that went down significantly as we got fat are eggs and red meat which may tell you something.
- DAA on Pregnancy: “Therefore good nutrition during pregnancy is more about the quality of food eaten than the quantity.
Try to eat: lots of fruit, vegetables, wholegrain breads and cereals”
Professor Feinman: Not my area of expertise but if you have type 1 or type 2 diabetes or develop gestational diabetes and medication is recommended, good nutrition is about taking in as little insulin as possible because of the known effects on the fetus. The DAA recommendation is a good way to do the opposite and seems to be particularly objectionable but, as I say, not my field.
More detail from DAA on carbohydrates comes under the heading: Are carbohydrates fattening?
Foods containing carbohydrate are an important part of a healthy diet. They provide energy for your body and fuel for your brain.
There is no scientific evidence that supports cutting out all carbohydrates from your diet.
Choosing a variety of wholegrain, low GI carbohydrate containing foods will provide you with fibre and help you to feel fuller for longer. There is undisputed evidence that the best way to control body weight and excess fat is to balance energy intake with energy output. The simple key to weight loss is finding an eating pattern that helps you reduce the amount of calories you eat, in combination with physical activity. It is important to consider that weight management is an individual process and an Accredited Practising Dietitian (APD) can assist you to plan a healthy diet that considers weight management techniques that meet your personal health and lifestyle requirements
Professor Feinman says:
“A lot of what’s written here is true. Working backwards, a dietitian can assist you in planning a healthy diet. Jennifer, in fact, is a dietitian with 35 years experience and her book is one of the best introductions for the average person to get control of their diet. I think Jennifer agrees and I agree that weight management is an individual process. One of the individualizations that is established to be very useful for weight loss and especially for people with diabetes, insulin resistance or metabolic syndrome is a very low carbohydrate diet. It is also well established, as in the DAA statement, that low-GI diets can be helpful but only when they follow from the same idea as low-carbohydrate diets (keep the glucose-insulin axis under control), but they are far less reliable. The data in the literature show that a low-GI diet is a very weak form of low-carbohydrate diet and, while generally better than the low-fat diets recommended by many practitioners, it can’t compare in effectiveness to a low-carbohydrate diet.
But, coming back to the carbohydrate statement, “There is no scientific evidence that supports cutting out all carbohydrates from your diet” is probably true but there is also no evidence of any kind suggesting anybody anywhere has ever said that you should cut out all carbohydrates, as if that were possible (even red meat has carbohydrate).
People with diabetes know that the more carbohydrate that they consume, the more drugs they have to take and the worse their blood glucose. The risk of cardiovascular disease is also increased (it is the continued diabetes that is the risk for heart disease not any dietary factor).
So, the statement is correct: “Foods containing carbohydrate are an important part of a healthy diet.” For people with diabetes or even most people trying to lose weight the important part is to make this part of the healthy diet as small as possible. Why? As the statement says “They provide energy for your body…” but energy is exactly what you are trying to reduce if you want to lose weight. People with diabetes store the energy from carbohydrates as fat better than other nutrients. The details require some knowledge of biochemistry but, for most people, yes, carbohydrates are fattening.
“They provide… fuel for your brain” is not strictly true because “they” refers to “Foods containing carbohydrate” in the previous sentence. Fuel for the brain can come from foods containing carbohydrates but also from other sources; stored carbohydrate, from protein via gluconeogenesis or, on a very low carbohydrate diets, ketone bodies from dietary or stored fat.”
DAA says: “All our information has been written by Accredited Practising Dietitians (APDs), and is reviewed regularly.
So you can be sure this is the most up-to-date and credible nutrition info around!”
Professor Feinman: An incredible statement.