DAA vs. Science – DAA’s views on carbohydrate

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.

  1. 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.”

  1. 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.

  1. 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.

  1. 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?

DAA says:
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.

 

 

 

6 thoughts on “DAA vs. Science – DAA’s views on carbohydrate”

  1. If you go to Diabetes Australia seeking nutritional advice they give you the outlines of a high carb low fat diet (they even say a modest amount of sugar is fine) – and for evidence they refer you to the DAA. They won’t change until the DAA change.

    If you go to the DAA seeing advice they will (as Jennifer points out) give you the same story and for evidence refer you to the Australian Dietary Guidelines 2013 ( http://www.eatforhealth.gov.au/guidelines/about-australian-dietary-guidelines ) from the Dept of Health and the National health and medical research council. The DAA are digging in and won’t change until the NHMRC does.

    That 2013 guidelines document includes their reference studies they used to concoct their recommendations, but also included extensive public consultation. I suggest contacting the NHMRC to find out when the next standard is due and presenting to that committee the significant evidence against a high carbohydrate diet for diabetics during the public consultation period.

    The sad thing is it will probably be a decade until the next update and between now and then there will be a lot of unnecessary amputations, and blindings, and deaths. And then the DAA will change their stance, and they will be a little embarrassed, and then they will start helping sick people eat themselves healthy – which we all know is exactly what they wanted to do all along.

  2. Good clear concise overview which I’ve shared on Facebook (for what it’s worth). Sorry to hear the crap you’ve had to take from the DAA. I hope you take comfort from knowing that there’s a lot of us out here who agree with you.

  3. I am SO sick of diabetic associations , clinics , educators who arrogantly refuse to read the literature or do the research. Their dietary recommendations exacerbate their patients disease ! I recently was forwarded a brochure circulated by a local RD in which he states that diabetics can even eat sweets occasionally as long as their insulin regime is adjusted accordingly!
    Jennifer there are increasing numbers globally who are disgusted at your dismissal ! We salute you and support you !

  4. lets get this debate on Q and A or Sixty Minutes.
    Current guidelines are criminal.
    Literally killing people.
    As a medical professional i am disgusted!

  5. Here is my letter to the Hon. Jillian Skinner:

    Dear Hon. Jillian Skinner –

    I have been using low sugar/carb diets for all my diabetic clients (for ALL my clients in fact) for the past fifteen years. The results they have achieved are nothing short of astounding.

    Most of my T2 diabetic clients have completely reversed their disease and ALL have experienced dramatically positive results. Not one has experienced a negative response.

    The science behind low sugar/carb diets is undeniable. It should be the go to diet for any diabetic – both T1 and T2. In fact, is it so potent for helping diabetics, that the person’s doctor must be informed beforehand because they will need to lower their meds in the very first few days. This alone tells you how beneficial this approach is.

    I humbly suggest you revise your dietary guidelines to reflect what the research and clinical evidence reveals – that low sugar/carbohydrate diets are a healthful and potent means to end type 2 diabetes.

    The dieticians who understand the value of this approach and implement it with their patients should be praised. Those who don’t need to read the research and begin adopting this nutritional approach before their next T2D patient loses their foot or their eyesight needlessly.

    Sincerely,

    Fredrick Hahn, ACE,
    Owner of Serious Strength Personal Training Studios,
    Author of The Slow Burn Fitness Revolution and Strong Kids, Healthy Kids

  6. Dear Jillian Skinner, MP.

    Concerning the shameful sacking of the dietician Jillian Elliot for giving correct advice to diabetics. Australian advice to diabetics can be summed up as: “You can’t deal with carbs, so eat carbs and take insulin and get progressively worse.” Carbohydrates are quickly converted into glucose and telling someone who can’t control their blood to eat glucose is medieval in its stupidity. Is Australia completely ignorant of the science on this subject?

    A century ago in France and the UK we called type 2 diabetes ‘carbohydrate intolerance’ and treated it highly successfully with a very low carbohydrate diet. Now it’s regarded as a progressive disease that needs insulin. The Australian position follows the damaging idiocy of the British and American systems and all three health systems should be ashamed of the harm they are doing. Yet the US and UK systems both accept that a low carb diet is a valid option. Reseach has clearly shown it should be the first option, but your system sacks a dietician who gives advice in line with the science.

    The leading researcher in low carb diets and diabetes is Wendy Pogozelski, a professor of biochemistry and type 1 diabetic. She is one of the authors of a research paper called ‘Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and base’. The paper is dated January 2015.

    (http://www.nutritionjrnl.com/article/S0899-9007(14)00332-3/fulltext)

    If you put Wendy Pogozelski’s name into YouTube and you’ll see her Ted talk and her own struggle with ‘official’ and totally unscientific advice. See also the work in the UK of Dr Unwin and Dr Sarah Hallberg in America? The latter has an excellent Ted talk describing her successful obesity and diabetes clinic.

    Jennifer Eliot is a hero and did the right and logical thing for her patients in Australia. Sacking her is an utter disgrace and perpetuates bad practice. An inquiry should be launched and this brave and sane practitioner reinstated.

    What can explain this astonishing situation where a major problem has such an obvious and well-tested cure, yet you persist with failed advice that makes no sense? You spend millions to make people fat and their condition worse. Do you know how many limbs you amputate a week as a result? It’s 130 a week in the UK and ten times that figure in Mexico.

    The only winners from the current stupidity are the suppliers of insulin and maker of artificial limbs.

    I suppose the ancient excuse that your system will trot out for this foolishness is that diabetics can’t eat a diet high in fat or they’ll get heart disease. This science is utterly discredited and has been so for many years. Please see the attached independent review of the science released this week by the outstanding research arm of Credit Suisse. Meta-analysis by both Harvard and Cambridge Universities both showed there is no link between saturated fat and heart disease.

    Jennifer Eliot is right. I have attached more than enough evidence to show that and there is so much more out there for anyone interested in looking. I ask you to hold a genuine inquiry into the reprehensible action taken by the DAA against Jennifer Eliot. They have moved the goal posts onto several new pitches and their case is transparently weak. They have no case to deregister this dietician.

    Please think again and help Australian diabetics. The politician who finally ends this scandal will be long remembered and not just in Australia.

    https://doc.research-and-analytics.csfb.com/docView?language=ENG&source=ulg&format=PDF&document_id=1053247551&serialid=MFT6JQWS%2b4FvvuMDBUQ7v9g4cGa84%2fgpv8mURvaRWdQ%3d

    Regards.

    Stephen Town, Bradford, England

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