Blog | Friday, December 19, 2008

What's the big deal?


I'm mystified by the attention and press coverage that a new study in JAMA about dietary options for type 2 diabetics has attracted. The Canadian nutrition research found a very small difference in A1c levels resulting from two different diets (a .5% drop in patients who ate low-glycemic-index vs. a .18% decrease in those who ate a high-fiber diet). The results were less than overwhelming, but if these dietary changes are easy, maybe they're worth suggesting, right?

Good luck. The primary distinctions between the two diets are so miniscule that an obsessive-compulsive dieting teenager would have trouble keeping track, let alone your average overweight type 2 patient. To quote from the study, the first group was encouraged to eat "low-glycemic index breads (including pumpernickel, rye pita, and quinoa and flaxseed) and breakfast cereals (including Red River Cereal [hot cereal made of bulgur and flax], large flake oatmeal, oat bran, and Bran Buds [ready-to-eat cereal made of wheat bran and psyllium fiber])" while the other group ate "whole grain breads; whole grain breakfast cereals."

And what do both these dietary plans have in common? Carbs!

There are some potential significant differences hidden in the details of the diets (the low GI list included nuts, while the high-fiber people ate potatoes). Might that have been responsible for the differential in A1cs? We'll never know, because the effects were buried under the details of the cereal aisle.

It's a pet peeve of mine how little attention the relationship between carbs and blood sugar gets in diabetes care recommendations. It's one thing to suggest that obese patients cut the fat, but having people obsess over bread varieties instead of just eating their sandwiches open-faced? Frustrating.