Diabetes Forecast

What to Eat?

The Evolution of the Diabetes Diet

By Sue Robbins, RD, CDE , ,

Starvation, high-fat, low-fat, high-carb, low-carb, no sugar, low glycemic index: The diabetes diet has certainly evolved over the years. Before the discovery of insulin in 1921, for example, patients were placed on a severely restricted regimen. Take this excerpt from 1917's Starvation Treatment of Diabetes:

"Forty-eight hours after admission to the hospital the patient is kept on ordinary diet, to determine the severity of his diabetes. Then he is starved, and no food allowed save whiskey and black coffee. [W]hiskey is given in the coffee: 1 ounce of whiskey every two hours, from 7 a.m. until 7 p.m. This furnishes roughly about 800 calories. The whiskey is not an essential part of the treatment: it merely furnishes a few calories and keeps the patient more comfortable while he is being starved."

Believe it or not, the starvation diet actually prolonged some patients' lives, because it prevented diabetic ketoacidosis. Fourteen-year-old Leonard Thompson, for one, was kept on a 450-calorie, very-low- carbohydrate diet and was literally reduced to skin and bones. He was at death's doorstep when he received the world's first dose of insulin, in 1922. He lived thirteen more years, eventually dying from pneumonia.

Early on, it was recognized that carbohydrate had the largest impact on blood glucose levels. Between 1921 and 1950, diabetic diets generally limited carbohydrate to about 20 percent of calories (fat was about 60 percent). For a 1,500-calorie diet this would provide about 75 grams of carbohydrate and 100 grams of fat. The "weighed" diets were based on the amount of carbohydrate per ounce of food. They were very complicated, which made them impractical for most people.

In the 1950s, experts recommended that the amount of carbohydrate be increased to about 40 percent. Around this time, the exchange system was developed by the American Diabetes Association and the American Dietetic Association. Foods were organized in lists by the amount of carbohydrate, protein, fat, and calories they contained. People were encouraged to eat complex carbohydrates and to limit added sugar. The new system was much easier to use, and after many revisions, it is still popular today.

In the 1980s the glycemic index was developed to compare how quickly carbohydrates in food are broken down in the body, converted to glucose, and released in the bloodstream. Surprisingly, it was found that sugar had less glycemic effect than white bread. The advice to avoid sugar was rethought, and the concept of counting carbohydrates became popular. Because experts were beginning to understand that fat may be linked to cardiovascular disease, the new recommendation for carbohydrate became about 50 to 60 percent of one's diet, which in turn decreased the recommended percentage of fat to about 30 percent.

Research continues on how to find the best mix of nutrients and calories to maintain target glucose levels and overall health. The current recommendation is to individualize a patient's meal plan to meet with his or her lifestyle and current medical needs. This is why I encourage you to make an appointment to see a dietitian. He or she is trained to assess your current eating and will help you come up with the meal plan that works best for you.



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