By Duane Graveline, M.D., M.P.H.
Even in medical school I doubted many of the concepts of the diabetic diets. While in physiology we learned how rapidly carbohydrates were metabolized to glucose, in medicine we were being told that diabetic diets were to include multiple daily allowances from the bread list of allowable foodstuffs.
Why, I wondered, do they allow so many foods that are rapidly broken down into glucose (high glycemic index), but I never was inclined to ask.
Then during my 23 years of medicine as a family doctor I went about treating my insulin dependent and non-insulin dependent diabetics along the lines I had been taught. It was frustrating business especially with the so-called "brittle diabetics" whose blood glucoses were often all over the place.
I always suspected diet to be a major contributor but the concept of challenging the traditional diabetic diet, quite frankly, never entered my mind. To challenge existing medical concepts is heresy. One simply did not do that unless somewhat suicidal.
Doctors, especially solo family doctors, walk lock step when it comes to the practice of medicine. Innovation was an option perhaps among the University medical school / hospital specialists but not to me.
Now in retirement with time to look back, I find that I was never alone in my thoughts and they were correct. My questions should have been asked.
In today's world remarkable progress is being made in the treatment of diabetes using radical dietary changes but this progress is being made only in small pockets of enlightenment and remain unendorsed by national policy makers.
Meanwhile in these small pockets of "resistance" the protein augmented diet is definitely in and the so-called Paleolithic diet has its advocates. Whether for type 1 or type 2 diabetes there is no doubt that carbohydrate restriction works. And none of this is all that new.
It is now a pleasure for me to read Banting's Letter of corpulence. It would have been of tremendous support to me in medical school. By age 64, on his usual beer, potatoes, bread and sugar diet, he was so overweight that just moving about was a problem.
Coffinmaker Banting lost 46 pounds in the first year on Dr. Harvey's innovative protein/fat diet and went on to live another 20 fulfilling years. Harvey challenged traditional medicine and won in a sense but although he planted a seed, the resistance of his peers was such that it was very slow to grow.
It was almost 100 years before a thoroughly frustrated (now Doctor) Richard Bernstein, an insulin diabetic since childhood, tired of following the advice of the American Heart Association , the American Diabetes Association and the American Dietetic Association, put himself on Banting's life-saving carbo-restrictive diet that immediately brought his diabetes under control. This saved his life and allowed him to promote the proper treatment of diabetes in society today as a medical specialist.
Dr. Staffen Lindeberg of the Department of Medicine, University of Lund, Sweden, was another who threw off contemporary shackles on diabetes control to achieve remarkable success using his "Paleolithic" diet to treat patients with type II diabetes.
He normalized the glucose tolerance of all 14 of his volunteers in 12 weeks. He compared his Palaeolithic ('Old Stone Age') diet based on lean meat, fish, fruits, vegetables, root vegetables, eggs and nuts; with the "Consensus" (Mediterranean-like) diet based on whole grains, low-fat dairy products, vegetables, fruits, fish, oils and margarines.
The literature is now replete with the success stories of others who are now actively promoting carbohydrate-restrictive diets in diabetes treatment.
If I were suddenly back in business as a doctor, all my diabetic patients would be on rigid carbo-restrictive diets. By this I mean at least 75% of daily calories would come from fats and proteins.
Type 2 diabetics are telling us their ability to metabolize carbohydrates is failing. Whether they have concurrent metabolic syndrome as well with excessive girth, elevated blood pressure and elevated triglycerides, carbohydrates are their enemy.
The proper diet will promote weight loss. Diabetes pills do nothing more than give these people the delusion they can eat normally. They cannot. The drug companies are making millions convincing these people they should be taking their pills and following their glucose levels closely. Instead they should follow a tight diet. Once they fail that, their pancreas is exhausted and insulin is mandatory.
Until I read Banting I used to think that weight loss was simply a matter of counting calories. I was wrong. The proper path to weight control is through carbohydrate restriction.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor
Updated August 2011