by Wesley W. Wilson, MD
NOTE: If you have any questions for "Ask the Doctor," please send them to the VOICE editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I've heard a lot about low-carb, high-fat diets like the Atkins diet, by
people who tell me they are the ideal way to lose weight and keep it off. Are
such diets safe for a diabetic like me? Are they the best choice?
A: Low-carbohydrate, high-fat diets can lead to weight loss. It's also true that any diet that provides fewer calories than a person uses will lead to weight loss. A standard diabetic diet can help achieve significant weight loss, especially if it's coupled with a mild daily exercise routine. By that, I mean parking your car an extra block away from work, using the stairs rather than the elevator, and going for an evening walk with your spouse.
It seems the Atkins diet has one major benefit -- foods high in fat provide a sense of satiety and "fullness," so that hunger is less troublesome than with low-fat diets. But, over the years I've seen a wide variety of diets help with weight loss. The problem is after a burst of enthusiasm, too frequently there is a lag in enthusiasm, and, with that, a tendency to regain the weight lost in the diet's "success." It is surprising how few extra calories it takes to regain those lost pounds.
Use of insulin does complicate diet choice, as insulin needs to be balanced against the carbohydrate consumed, and a dramatic reduction in carbohydrate (a "low-carb" diet) will certainly require a change in insulin dose. By checking blood sugars frequently, the new, correct dose of insulin can be figured. If you choose such a diet, be prepared to test more often, and to re-figure your insulin dosages.
I'm more concerned about the high-fat part of such diets, since type 2 diabetes (90 percent of all diabetes) has a number of components: Insulin resistance, tendency to gain weight, higher than normal blood pressure, and lipid (blood fats) abnormalities. All are part of the type 2 diabetes package. The lipid abnormalities include low HDL and high triglycerides. I'm still unsure of the effect of a high-fat diet on those lipids. The question is important, since diabetes is associated with a greatly increased risk of vascular disease such as stroke and heart attack. Certainly, if I were to undertake such a diet, I'd want to watch my lipids very carefully.
I don't think the low-carbohydrate, high-fat diet is magic, and I'm not sure
of its safety. It seems the old fashioned diabetic diet may be safer for diabetics.
Plus, it will work if a person can stick with it. Note: A diet, any "diet"
should not be seen as something to be used for a bit and then discarded. Rather
it should be a "lifestyle change," a new way of life that will be
continued indefinitely.