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• August 28, 2009 3:43 p.m.

  I've got to say that this article cost the Mayo Clinic all credibility in my mind as a reliable source of information on diabetes. As many have pointed out, a diet with 45% carbohydrate is not "low carb"--yet you're eager to take anything you can cling to put out the brushfire of diabetics taking charge of their own health by going on low-carb diets despite the "pooh-pooh" attitude of the professional diabetes establishment. Even a cursory search of the literature will reveal a multitude of controlled, peer-reviewed studies showing that true low-carb diets are associated with better outcomes for diabetics--yet your article ignores this. Foul!

  - Patrick

• March 25, 2009 11:14 a.m.

  I must repeat what others have pointed out, "A diet containing 45% of total calories from carbohydrates SHOULD NOT BE LABELED LOW-CARB!" On my low-carb diet, I'm consuming around 8% of total calories from carbohydrates (40 grams for me, many folks do 20 grams), 22% from protein, and 70% from fat (mostly saturated). This article provides a more balanced view of studies like the first one mentioned above: http://www.fathead-movie.com/?p=6

  - Kait

• March 18, 2009 7:40 p.m.

  I am a biochemist and was a researcher in metabolism and carbohydrate restriction before being diagnosed with type 1. So I know about low-carb results from the literature AND from my own experience AND from quizzing countless successful and unsuccessful diabetics. Guess what? The successful diabetics (whether type 1 or type 2) all eat low-carb and they don't worry about fats. In addition, the positive effects of carb restriction are strongly supported in the literature AND there is a biochemical basis for this. When I consider science, I think about mechanisms and whether or not there is a biochemical basis for something. The problem with dietiican training is that there is too little understanding of biochemistry and too little research experience to understand the literature.

  - Wendy

• March 16, 2009 10:41 a.m.

  you forgot to mention one thing from the egg study, that the higher mortality rate was NOT form heart problems (they actually had less heart attacks and less strokes), they were from all cause mortality. it;s like saying: if you eat more eggs you are more likely to die from a car accident! Another addition you forgot to emtnion: "One would assume that the overall lifestyle of subjects with higher egg consumption would have predicted more CVD. That is, the physicians with higher egg intake were older, smoked more cigarettes, were less physically active, ate breakfast cereal less often, and had a higher prevalence of hypertension and diabetes than did those with lower egg intake."

  - Rabbi Hirsch Meisels

• March 14, 2009 8:33 p.m.

  With all due respect, are you sticking your heads in the sand? more and more well-documented, scientifically sound studies are PROVING that low-carbohydrate is the healthiest way to eat, particularly for diabetics! How you can recommend a diet high in carbohydrates for people with diabetes is beyond me. You may as well suggest that cigarette smokers switch to cigars because they're so much better for you. The high-carb, low-fat diets of yesteryear are continually proven to be a surefire way to RAISE YOUR INSULIN. And isn't that just what you DO NOT want for diabetics? As someone who has had blood sugar issues as a direct result of low-fat, high-carb diets, this article is downright offensive. You should be deeply, deeply ashamed of yourselves.

  - Vicki

• March 14, 2009 8:19 a.m.

  Shame on you both! As "health professionals" you have a supposed intent to help your clients become healthier. What you recommend here will lead your diabetic clients down the road to worsening BG levels and all that come with them! There have been plenty of references cited here, GO READ THEM! You are obligated to do so! Again I say: Shame, Shame, Shame!

  - Chris

• March 13, 2009 7:58 p.m.

  I've been a type II diabetic for 20 years. For over half this time, I followed the traditional dietary advise like that offered in this article. It never worked, despite my best efforts. 9 years ago I decided to follow Dr. Bernstein's advise and eliminate most carbs from my diet. It works as advertised. In fact, my endo kicked me out and said I didn't need to come back any more. Don't listen to professional Nutritionist scare tactics like I did for way too long. Instead, listen to diabetics that have conquered the beast, like Dr Bernstein. I personally can testify that low carb is the most effective diabetes therapy I've ever tried. Prior to low carb my A1C peaked over 10 and my lipids were a total mess. After eliminating carbs, I rarely see blood glucose readings over 100 and my lipids are vastly improved. IMO, carbs kill diabetics not fat. Like Gary Taubes author of the book "Good Calories, Bad Calories" says: What if it's all been a big FAT lie? I dare my fellow diabetics to try low carb for 3 months and see what happens for themselves. I thank God that I did.

  - Barry

• March 13, 2009 6:51 p.m.

  I'm a type-2 using diet and exercise only to control my diabetes. I eat less than 20g of carbs per day. My average BS is 96. My cholesterol has never been better, and I eat plenty of meat and eggs.

  - Craig

• February 24, 2009 10:09 a.m.

  I do not think that this article is the best tool to a nutrition plan,it isnt the best way to go about controling diabetes..

  - marisa

• February 23, 2009 9:58 a.m.

  what is the biggest killer of diabetics who do not control their blood sugar effectively—oh yes...HEART DISEASE.... Wouldn't we all like to eat more fruit, crusty bread and the odd slice of dare I say it , pizza? Would I if I could make it work with good bg control? YES! We low carb because we want to live a long time and in good health.. and 5 years in it is still working, low insulin usage and non diabetic lbs...I might add including good lipids and I eat whatever saturated fat comes my way...

  - jillian

• February 23, 2009 6:58 a.m.

  The authors of this article don't have a clue what it is like to live the life of a diabetic person.

  - Anne

• February 10, 2009 11:22 a.m.

  Perhaps the authors of this post (and the Mayo Clinic) have experienced some more "aha" moments since reading the 3 pages of (mostly) astute comments from readers who clearly understand diabetes and biochemistry better than this pair.

  - Anna

• February 10, 2009 7:45 a.m.

  My advice, use a glucose meter to see how different foods affect blood glucose. I did and discovered that sugar & starch raise my blood glucose, while fat doesn't. My common sense tells me to avoid foods that raise my blood glucose or eat them in very small quantities. Therefore, I consider the advice in this article to be nonsense.

  - Dan Clem

• February 9, 2009 4:43 p.m.

  1- As noted by the authors, a 45% carb diet is not in any way a low carb diet. 2- As noted by them in the comments, the reduction of carbs from 55% to 45% resulted in a growth in fat consumption, as a percentage of calories. 3- What fails to track is that this increase in dietary fat led to the result, reduced control over blood glucose. 4- Why this fails to track: dietary fat really has no impact on blood sugar. We're really interested in carbs, protein and alcohol when we talk about blood sugar, no? 5- The multicenter study cited has people getting 18% of the calories from protein and alcohol on their lower carb diet. This seems lacking in general. If you were following any sort of carbohydrate restriction, you would be eating more protein. It is hard to do otherwise. 6- If they were getting 45% of their cals from carbs, we're talking 675-900 kcal from carb. That works to 169 to 225 grams. This feels like an amount that would drive blood sugar wild in a T-1 diabetic. 7- Why do most people worry about T-1 diabetes. Since T-2 is most of the population, shouldn't we worry about effects on that particular flavor? 8- I find this post to be intellectually dishonest. The authors are (or should be) able to decide that a reduction from 55% to 45% of total calories from carbs is really shuffling deck chairs, not a firm commitment to health and change. One can only conclude that they are not bright or are dogmatic soldiers. We weep for the Mayo Clinic, either way.

  - ML Harris

• February 9, 2009 10:36 a.m.

  This is the sort of article which helps reinforce the truth of the comment my son frequently makes: "If you want to understand human nutrition *never* ask a dietician or a nutritionist, ask a biochemist". I'm a T2 diabetic and thank God I'm pretty internet-savvy. Thus I know full well that a diet that is 45% carbs is a true "killer" diet for diabetics. Any diabetic who researches the issue knows that a real low carb diet is the best hope for longevity. I try to keep carbs at about 5% of my total caloric intake, sometimes up to 10% but *never* higher than that! Higher would send my blood sugars spiraling out of control. But my numbers are all good. I eat plenty of saturated fats too, since I feel quite sure it is not a demon. Not that I eat fat indiscriminately. I avoid trans fats, and polyunsaturated vegetable fats. But I eat my share of dairy fat, animal fat, coconut oil, and monos like olive oil. My typical diet is 70% fat, 5% carb, 25% protein. It's easy to maintain, makes me feel incredible. So far I've lost 70 pounds, and all my numbers are much better. But I pity the poor diabetic who does not have access to the internet. They are the ones likely to lose their limbs, their eyesight, etc. I used to respect the Mayo Clinic as a dispenser of medical information, but after reading this I realize I can't trust a word written here either!

  - Debbie

• February 8, 2009 7:10 p.m.

  Go easy on the egg yolks? Have you not kept up on the research that shows their danger to your health is bunk? If people keep following the low fat, high carb recommendations, we'll continue to watch our population get worse...

  - Tom

• February 8, 2009 7:06 p.m.

  45% is low carb? What are you talking about? I cannot believe this is coming from the Mayo. You completely mislead people by calling 45% carbs "low-carb." When RDs usually recommend 50-55% carbs, you're talking about a study that reduces carbs by about 10%. That is NOT low carb!

  - No name given

• February 8, 2009 6:01 p.m.

  All blather no science... If diabetics keep taking advise like this we're screwed. Low carb is a lifestyle, not a fad, it is backed up by sound science and is safe.

  - Trevor

• February 8, 2009 4:59 p.m.

  > Jennifer, why is this suprising? You were giving diabetics a diet made up of 45% sugar. How much sugar is that, a cup or two or three? Why on earth would that be a good idea? And how exactly did you decide that it was the saturated fat that required the insulin? Do you think maybe that for diabetes, a disease involving the body's ability to manage blood sugar, that perhaps it was all that SUGAR causing the problem? Cut the carbs way closer to zero, and then tell us about insulin requirements.

  - mrfreddy

• February 8, 2009 8:31 a.m.

  He who will not reason is a bigot; he who cannot is a fool; and he who dares not is a slave. - Sir William Drummond You must take a broader view of the evidence before making any sort of health recommendations. Weigh the two studies above against the rest of the evidence, and then you might have something to talk about. By the way, what they told you in your R.D. training does not constitute scientific evidence. Here's a good place to start: http://nutritionandmetabolism.com/content/2/1/31 Dare not to be a slave.

  - Dave

• February 4, 2009 9:03 a.m.

  To those who noted that 45% of calories from carbohydrates is not the definition of a low-carb diet, I agree. You'll notice that we've changed the title of the blogs to reflect this. However, the surprising thing in this study was that the mild reduction in carbs resulted in people eating diets that had enough total and saturated fat to require more insulin. See part 2 (posted February 3) for further information about this study.

  - Jennifer Nelson (blog host)

• February 3, 2009 8:33 p.m.

  Try reviewing the literature before commenting on low carb diets for diabetes: Nutrition & Metabolism 2005, 2:34 doi:10.1186/1743-7075-2-34 A low-carbohydrate, ketogenic diet to treat type 2 diabetes [LCKD] William S Yancy Jr, Marjorie Foy, Allison M Chalecki, Mary C Vernon and Eric C Westman "Hemoglobin A1c decreased by 16% from 7.5 ± 1.4% to 6.3 ± 1.0% (p >>>> "Fasting serum triglyceride decreased 42% from 2.69 ± 2.87 mmol/L to 1.57 ± 1.38 mmol/L (p = 0.001)" >>>> "Conclusion: The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants." J Nutr. 2005 Jun;135(6):1339-42. Modification of Lipoproteins by Very Low-Carbohydrate Diets [VLCDs] Jeff S. Volek, Matthew J. Sharman,and Cassandra E. Forsythe "VLCDs consistently improve postabsorptive and postprandial triacylglycerols (TAGs), HDL cholesterol (HDL-C), and the distribution of LDL-C subfractions to a greater extent than low-fat diets. VLCDs also improve proinflammatory markers when associated with weight loss."

  - Ben Fury

• February 3, 2009 8:32 p.m.

  Next time you decide to run a blog post about low carbohydrate diets for diabetics, I would respectfully suggest you ask for a contribution from authors who actually know the field. 45% carbohydrate is NOT a low carbohydrate diet. Less than 25% carbohydrate is the beginnings of a low carbohydrate diet. The kind of Very Low Carbohydrate Ketogenic Diet (VLCKD) that Dr. Bernstein recommends for diabetics is in the neighborhood of 5% carbohydrate. Nelson and Zeratsky describe 45% carbohydrate as a low carbohydrate diet? Preposterous! They don't know what it is by definition, much less know enough about it to comment on it. Do you have any peer review of your nutrition blog? If not, perhaps it's time to start.

  - Ben Fury

• February 3, 2009 12:35 p.m.

  Lets not overlook the central problem here. Diet is at the root of the problem. If you're old enough you'll remember that 50 years ago type two diabetes was so rare it had not yet been discovered; now its growing in epidemic proportions. We know at its base is the development of insulin resistance due to abuse of the insulin system through diet. If you want to know how to avoid the problem ask Grandma what her diet was when she was growing up and then compare it to your diet. What you will find is that fish and animal fat and protein consumption has declined and sugar and simple and processed carbohydrate consumption has increased. You have a choice and Mom and Dad will not make it for you.

  - David Boothman

• February 3, 2009 10:31 a.m.

  The conclusions of one study are quite simply the conclusions of one study. Typically due to cost and time, studies do not include enough participants over enough time to provide statistical relevance. For example, to predict the eventual outcome for Vioxx would have taken a study of approximately eighty thousand individuals and such a study would still have been unable to accurately predict age, sex, drug interaction and co-existing health factors. The statistically accurate study came after the drug was approved and prescribed to many hundred thousand individuals. Consequently the reliable studies involve the type referred to by a previous contributor, such as The Women’s Health Initiative. Aha moments following the reading of small studies are based upon unwarranted faith in suggestions rather than facts. This is not the fault of the researchers, they publish the data they have found and careful reading will usually show they cautiously avoid words such as ‘fact’ and instead use words like ‘indication’. The studies of the efficacy of post-menopausal hormone replacement should have provided a lesson for all. The studies continually contradicted each other and even meta-studies failed to establish the reality. Statistics is hard and unforgiving and the only way around this is to collect a lot of data over a long period of time. Once that is done, accurate statistical analysis is a difficult, long and tedious process. Science is slowly becoming discredited by concl

  - David Boothman