G'day All X-posted to misc.health.diabetes, alt.support.diabetes I would appreciate comments on the draft letter below. The letter is intended for my local Diabetes Australia quarterly magazine. I feel a little like Spartacus heading off to the arena; "we who are about to die salute you". I'm not an expert, so I know I'm asking to be drawn and quartered here, but I'd respect informed, civil criticism before I "go to press" If I'm wrong or uninformed, I'm happy to debate the point or modify the letter as long as things stay civil. Letter: To the editor, I would hope that you will publish this letter, despite the obvious disagreement with your standard dietary policy. I am a type 2 diabetic. I was diagnosed in May 2002 with high fasting glucose and HbA1c of 8.2. I realise that I am just another of many thousands, or unfortunately now, millions, around the world who have stepped out of the doctor's office finding it hard to come to terms with this news, and the implications for a significant change in my life. From that moment I was determined to learn what I needed to know to beat it. One of the first things I learnt was that, at least for the moment, you can't beat it. It's incurable. But I also slowly learnt that it is possible to gain a measure of control. I lost 28 Kg in six months and have stabilised at a loss of 25 Kg. The net results are that my blood pressure is great, my lipids are the best they've ever been, and my HbA1c has dropped from 8.2 to 5.9. My only medication is lipitor 20. Unfortunately, the stock response to previous writers with similar results such as ....... in the previous issue, is that it was achieved because of the weight loss or exercise. Yes, I lost weight, and yes, I do some exercise (I should do more). However, the hardest time for control came after the weight stabilised eighteen months ago. The reason I am in control is post-prandial self-testing, with analysis of my results leading to modification of my diet. How did I do that? I read and listened to everything I could find on type 2, but as a layman I didn't find much. I didn't even know what to look for. Of course, I joined Diabetes Australia, and I later attended a local monthly meeting. The dietician there recommended his course at the community health centre, so I went to that. It was good; I learnt about carbohydrates, and how they lead to blood glucose, and insulin, fats, food labels etc. Lots of good information. But it was there that I first came across a contradiction. In the first lecture, we learnt that eating complex carbohydrates caused our blood glucose to rise, and eating more carbs at a meal caused the BGs to rise more. Pretty basic stuff. During this time, I had searched the internet for information and also joined some diabetes newsgroups. I learnt there some advice which made simple sense to me - test your blood glucose after you eat to find out what the effect is from the food you eat. To me, that sounded so logical. Then if what you eat causes a "spike" modify what you eat next time. Obvious and logical. Apparently not as obvious or as logical to the dietician, Diabetes Australia (DA) or international authorities such as the American Diabetes Association (ADA). Because in the next lecture, we were told that we should eat 30-45 gms of carbohydrate at every meal for our health. In the interim, I had started testing my blood glucose one hour and two hours after every meal to see the effects of my diet. When I put the dietician's advice into practice, I consistently got very high ( 8, 9 and over 10) readings at one hour. So we come to the paradox facing Type 2 diabetics around the world: 1. Dieticians advise high complex carbohydrate consumption, apparently for heart and vascular health; 2. High complex carbohydrate consumption causes high blood glucose levels; 3. High blood glucose levels cause diabetic complications such as retinopathy, neuropathy, nephropathy and heart disease; 4. DA dieticians promote high complex carbohydrate consumption, but balance this by recommending medication to control blood glucose levels. This advice appears to be in line with the recommendations of the ADA. I have attached copies of the relevant DA and ADA recommendations to this letter. There is an alternative. Follow a healthy diet, and take diabetes medications or insulin if the diet is inadequate to maintain safe blood glucose levels. I would define a healthy diet for a diabetic as one which meets nutritional needs for general health without raising blood glucose levels above acceptable limits. That means a much lower carb intake for most of us than that recommended by the dieticians. My view is that self-monitoring of blood glucose levels (SMBG) is necessary to determine the diet for each individual Type 2. The best method to achieve this that I've seen is at http://www.alt-support- diabetes.org , under the heading "Newly Diagnosed". This option, which can lead to a significant reduction in complex carbohydrates in the diet, is vehemently opposed by diabetes authorities around the world. The basis for opposition appears to be that it will lead to a higher incidence of heart disease, despite a growing body of evidence that the dietary thinking from the latter half of the twentieth century was incorrect and simplistic. The mantra appears to be: "fat is bad, carbs are good, excess protein gives you kidney disease". Modern research is starting to discover that the type of fat is critical - some is good, some is bad, some is neither in moderation; the type of carbs are critical - low GI, high GI, leafy veg versus starches etc, the proportion and type of protein is important, the inclusion of vitamins and minerals such as calcium, potassium etc is critical; and so on. And most important: that post-prandial excursions (BG spikes) caused by high carb consumption are just as dangerous as high fasting BG levels. In other words, the more we learn on diet, the less definite is the reliance on thinking from last century . Thus, there is less and less foundation for the advice given by dieticians for diabetics to eat lots of starchy carbs and balance them with meds. I had already designed my own diet, a very simple low-fat low kj diet based on everything I could find on the subject. Using that, and a lazy man's exercise programme, I lost about 25 Kg. About half-way through that process I started intensive testing, up to ten times daily in the early stages. I discovered exactly what the effect was on my blood from everything I ate, then went back and changed the foods that caused spikes - until I didn't get spikes. I don't eat low-carb deliberately; I eat low-spike, which tends to be low-carb. It doesn't mean I'll never use meds. It's a progressive disease; all I can do is try to delay progress or slow it down as much as I can. And it's no miracle cure - just the application of common sense and discipline. There is a new generation of informed, pro-active e-patients out there who no longer accept the traditional advice without backup support, cites to medical papers and logical analysis. It is no longer acceptable to advise Type 2 diabetics to eat high starch diets unless a rational, referenced argument can be put to support that case. This letter is too long already, but I can, on request, provide many medical research sources on the net for my logic. Can the dieticians? And to answer the cynics, no, my diet is not for sale. Alan Shanley, Pottsville Beach NSW Cheers, Alan, T2 d&e, Australia. Remove weight and carbs to email. -- Everything in Moderation - Except Laughter.