New diabetes study: nutritional researchers still divided on diet-based approaches (Part 1 of 2)
Paleo dieters often wonder when the rest of the world will catch up.
Most of all, they wonder when mainstream nutritional science will finally validate what they experience every day: safe and natural weight loss; freedom from chronic illness; vibrant energy all day long.
But mainstream nutritional researchers remain divided on basic diet and health issues and many factors inhibit progress—especially toward understanding non-conventional approaches like Paleo.
Freighted with years of conventional wisdom, torn by conflicting agendas, and (like scientists in all disciplines) too frequently impervious to new ideas, these savants often run in place. Covering new ground sometimes only moves a few inches a year.
A new study by Professor Nita G. Forouhi and colleagues provides some understanding of the lack of consensus when it comes to diabetes, and what drives it.
The study itself is an overview or meta-analysis of several current dietary therapies for type 2 diabetes (T2D).
The authors discuss several interventions, including pros and cons from different camps within the nutritional field. Forouhi is not afraid to show both sides of each debate, especially regarding low-carbohydrate diets.
The analysis acknowledges that dietary interventions can mitigate or even reverse T2D — but admits up front that these interventions are both “controversial and difficult.”
Paleo readers will quickly note how conventional Western dietary wisdom underlies much of the “controversy”.
Questions about data and dietary guidelines
Intriguingly, the study notes that basic scientific nutritional data is subject to manipulation:
Moreover, lack of transparency in the development of guidelines and bias in the primary nutritional studies can undermine the development of reliable dietary guidelines; recommendations for their improvement must be heeded.
The study continues further down “…more investment is needed in good quality research with a greater focus on overcoming the limitations of existing research.”
This frank admission is important in the context of what follows—including the discussions of unconventional therapies like low-carb and ultra-low calorie diets.
And bear in mind that entrenched conventional ideas do bias the analysis throughout including the diet-heart hypothesis (bias against saturated fat), and the traditional low-fat-high fiber agenda including a strong bias in favor of whole grains.
Unexpected disagreement on foods
Participants agree that patients should avoid processed meats, sodium, trans fats, refined grains and sugars, as well as sugary drinks.
Surprisingly, fruits and vegetables are dismissed by some as desirable but too expensive for low- to middle- income populations. Other researchers recommend them, but only in the context of weight loss.
Diets that rely on vegetables for fiber (instead of whole grains) are discarded as “difficult” without further discussion.
As an aside, the study stops short of endorsing unprocessed red meat (and even fish) claiming more research is needed.
The low carbohydrate conundrum
Low carbohydrate diets are discussed extensively, but not all researchers endorse them—even though the study admits that they work.
Macronutrient ratios (fat to carbohydrates to protein) are acknowledged as important, but no consensus exists on therapeutic ratios. The American Heart Association is cited as insisting that no population-wide recommendations can be made and that all advice should be individualized.
The research cited by Forouhi shows no real agreement on what constitutes “low-carb,” or what type of carbs are best. Reducing grains and legumes appears broadly acceptable but different factions disagree on fruit consumption. “Refined” carbs are discouraged, but most researchers insist on including whole grains.
Carbohydrate percentages in the analysis vary from ketogenic levels to 40% of calories, or more.
Some researchers think low-carb diets aren’t sustainable (or desirable) because they think people will eat too much protein, or too much saturated fat.
Others claim that low-carb diets have no affect at all on diabetes—directly contradicting the study’s premise that such diets are recognized as therapeutic.
The study concludes that low-carb is controversial, but candidly admits it deserves further study.
The study emphasizes weight loss as therapeutic, endorsing it as a “cornerstone” of diabetes treatment.
The study emphasizes the success that bariatric surgery patients have with T2D due to caloric reduction and the resulting normalization of glucose levels. It explores ultra-low calorie diets that mimic this sudden, dramatic drop in total calories.
However, these diets are acknowledged as hard to sustain over time, and often include heavily processed, high sugar, liquid meal-replacements. The study notes and accepts the high sugar component as a tradeoff for the overall reduction in calories.
Note: The drug industry has also taken note of this “bariatric surgery effect” and is developing a new pill that coats the intestines to prevent caloric uptake. The goal is to mimic the surgery’s blood glucose results for T2D patients.
Looking beyond weight loss
Something the Forouhi seems to miss is that while sudden weight loss improves blood glucose markers, this may not be the whole story. Focusing on weight loss alone ignores the central issue that whole grains affect blood glucose levels the same way “refined” grains do. 
Even if a whole grain-based diet promotes overall weight loss, with all its acknowledged positive effects, the grains themselves will still promote insulin resistance, intestinal permeability, overall systemic inflammation…and diabetes.
Most diabetics are unlikely to choose drastic surgery, with its likelihood of complications, or highly processed, unsatisfying sugar-based liquid diets. Instead, they should consider an inexpensive, low-impact, health-promoting low-carb diet — like Paleo.
Paleo: the original low-carb, weight loss diet
Following a sustainable, satiating Paleo Diet is easy (compared to surgery) and addresses the study’s major concerns:
- High fiber: anyone on the Paleo Diet for over 30 days knows that vegetables provide MORE fiber than any type of grains.
- Lower calories: well-planned Paleo Diets (approximately 2/3 vegetables by volume) provide satiety from protein and healthy fats (like coconut, avocado, and olive oils) without exceeding sensible caloric guidelines. (Anyone can overeat on any diet, but Paleo makes this far less likely.)
- Low carbohydrates: Paleo carb calories come from healthy, low-glycemic sources like sweet potatoes, squash, and non-starchy colorful vegetables.
Properly followed, Paleo is by definition a sustainable, low carb, high-fiber diet. Exactly what Forouhi’s analysis recommends and it has been demonstrated as therapeutic for Type 2 Diabetes many times .
- Dietary and nutritional approaches for prevention and management of type 2 diabetes, 6/13/2018, published in The BMJ by professors Nita G. Forouhi, Anoop Misra, Viswanathan Mohan, Roy Taylor, and director William Yancy, retrieved here
- The Paleo Diet, Revised, by Loren Cordain, Ph.D., Professor Emeritus, copyright 2002, 2011, published by John Wiley & Sons, Hoboken, NJ; electronic edition, page 48
- “The Paleolithic Diet is the best bet for diabetes and other diseases” by Loren Cordain, Ph.D., Professor Emeritus, published in The Insider, Vol. 5, Issue 12, retrieved here