The last time I rented a car at the Stockholm airport, I felt a little nervous filling up the gas tank. The brand new Volvo was a flex-fuel car and the Swedish gas pumps had more choices than I was used to. After fretting about it for a few moments, I still chose the familiar unleaded gasoline over the E85 ethanol, which I had heard of but not run into in my rural home state in America.
Our bodies are even more adaptable than modern car engines. Yet, there is a lot of controversy about which fuel is best in certain situations. Not long ago there was a new official edict, replacing the latest version of the food pyramid with an image of a properly stacked dinner plate.
Last week, my mother in Sweden asked me if I had heard that you could lose weight by eating bacon and eggs for breakfast. I reminded her that when I was a vegetarian, between the ages of twenty and thirty-five, my weight climbed steadily as I filled up on oatmeal (I should write more about the oatmeal fallacy some day), cheese sandwiches, rice and pasta. She remembered that my weight dropped when I reintroduced some more protein in my diet.
My mother was recently diagnosed with Type 2 diabetes. She, like many of my patients over here, hears from her diabetes nurse that she needs to take in a steady dose of carbohydrates, because “her body needs them as fuel”.
It seems that many Swedish and American dietitians share the same idealistic view of what diabetics should eat.
The trouble is that some people’s bodies aren’t flex-fuel bodies anymore. Their Type 2 diabetes makes their carbohydrate burning terribly inefficient, so they actually run better on protein and fat. The dietitian community gets the heebie-jeebies about this, because they prefer to prescribe a “balanced diet”.
If the manual of that rented Volvo said to fill it up with gasoline every other time and E85 every other, and the car sputtered and stalled every time I filled it up with gasoline, I would ignore the manual and drive it on E85 all the time.
I tell my diabetic patients that I agree with the notion that a balanced diet is generally best, but that their diet so far has probably been unbalanced enough to stress their carbohydrate burning system. It is as if they have already had their lifetime supply of carbohydrates and they now need to correct that imbalance.
If a diet that works well for non-diabetics sends Type 2 diabetics’ blood sugar through the roof, it can’t be the right diet for them. This is where my patients get to practice their own evidence-based medicine; I ask them to check their blood sugar two hours after their most common foods and to start modifying their meal choices according to their blood sugar results. Then we check their weight, long-term blood sugar and cholesterol profiles. When every single parameter looks better, we know that together we have taken a step in the right direction.
In reality, even Type 2 diabetics have some remaining flex-fuel capability. The challenge is not to use up this ability, but to maintain it as long as possible by limiting carbohydrate intake enough to keep blood sugars reasonably low without relying on drugs, which never work as well as the right kind of diet.
Food pyramids and popular diets come and go, and the theories behind them may seem confusing. But every patient with Type 2 diabetes has the tools (their lancet, glucometer, pencil and paper) to see what type of diet actually works when the “usual” way of eating just continues to make things worse.
A Country Doctor Writes: 
I can remember being at a relative’s house where they battled Type II diabetes. In their cookbooks was an ADA approved one entitled “The Low Fat Cookbook for Diabetics.” I just shook my head at how slow the ADA is to at least reconsider their notion about what is appropriate with respect to macronutrients. It’s a shame.
Good advice, doctor. When I was told a few years back that I was “pre-diabetic” and was headed straight for “metabolic syndrome” (overweight, middle-aged female with a fat abdomen and high sugar and cholesterol levels) it scared me. My doctor offered a cholesterol-lowering medication, but I asked her to let me try lowering it myself. She agreed. I put myself on a low-carb, high protein diet. When I saw her again six months later, I’d lost 25 pounds and my cholesterol and blood sugar levels were normal. I’ve stayed on that diet–made it my “lifestyle” diet–and I’ve lost 35 more pounds. I still have 30 to go to reach a healthy weight for my age, height and bone structure. I still eat carbs, but I stick to the “good” carbs–whole grain bread, pasta, and brown rice. I eat a lot more vegetables than I have at any other time in my life. I feel better, and I feel like I’ve dodged a dangerous bullet. Sometimes I miss those old bad carbs, but not that much.
All that said, it’s hard to maintain this low-carb, high-protein and tons of veggies lifestyle. Dinners out are rare. But it’s worth it. It really is.