I agree. The current diet recommendation for Type 2, or pre-Type 2 diabetics that they replace sugar with other types of high carb food is illogical and unscientific. If you want to reduce blood sugar levels, you need to cut out foods that your body easily converts into glucose - carbs (grains, sugars, starchy foods). You can have a healthy and sustainable diet cutting out sugar and (high glycaemic load) starchy foods from your diet completely.

A ketogenic diet can help reduce weight, hypertension and blood sugar levels. See /r/keto for more details.

The only issue with Ketogenic diets for diabetics is the increased risk for going into ketoacidosis. I'd recommend seeing a nutritionist or registered dietitian.

Also, as a Personal Trainer, I do agree that the average American eats way too many carbs, but the real devil is processed and GMO 'foods.' It's pretty much barely edible garbage.

Please give me evidence for GMO's being horrible for the health of a person, I really want to see why people are so against them.

if you really wanted it you'd go looking yourself. You clearly know how to use the Internet

Dodging my request by telling me to do my own research. Good shit.

I don't answer patronixing questions

Especially ones that you have no evidence to disprove

K.

Gimme a few days, I'm a busy man.

Just checking to see if you have those sources yet. .... .... And you don't.

Sorry that I have a job.

Well, you said a few days, a few usually refers to 2+, and two days is certainly enough to quickly find a source. In fact, in the time it took you to reply to my comment, you could have found one of you sources condemning GMO's.

That is, unless no credible ones exist.

Good, I think we can reach a compromise here. So genetic mutation isn't causing the health issues? Wonderful! But the herbicides are? Well, I can certainly see how that would be possible. However, even with the residues going into the plant roots, the majority would still be the film on the exterior, I feel we can both agree to that.

With that in mind, rinsing or peeling the fruit/vegetable in question should get rid of most of the offending possible-carcinogens. Also, just because it is a probable/possible-carcinogen, does not mean that everyone will die from eating produce sprayed with it. We need to know the toxicity levels, and gauge our action from there. Jumping to conclusions at this point is foolhardy at best.

But why? If GMO's don't cause any adverse health effects, what's the point of labeling them? It would just add an extra cost to the businesses and serve no purpose. You want to stay away from GMO's? Buy organic, since you know its not GMO, and leave the rest of the produce alone.

I said genetic engineering wasn't causing the problems, because it's not, but herbicides of course can cause problems if the produce is not washed properly. The genetic mutation itself doesn't cause the potential problem. But then again, any produce can use herbicides and pesticides, GMO or otherwise.

And if organic producers have the time and money to put labels about organic food having more nutrients than GMO food (which is bullshit), than they keep on doing that, and people who want to avoid GMO can just use those products.

First, I said that most of the herbicide would be gone with a good washing, I never said all of it would go away. So no, you assumed I said none was taken up, which is false.

Second, I was using that as an example of why it is already unnecessary for GMO labeling, as organic companies already label their products as organic. Why add another level of idiocy?

Third, I'm not gonna drink Roundup because that's retarded, and would most certainly be toxic. You seem to think that because something is a probable carcinogen (read: not a known carcinogen, but a probable one) that it is toxic in any amount. This is simply untrue, as anything could be toxic given enough of it. I'm not going to tell you to drink Roundup, because that is basically like telling you to kill yourself, and that would be a very immature thing to do on a discussion on GMO's, isn't it?

Respectfully I believe this is far more nuanced than is being portrayed above. I'm not in Family Medicine but metabolism and endocrinology are huge components of medical education and I've rotated through many primary care practices... and any first year medical student is well aware of how starch is processed and the impact on various proteins, molecules, etc. including blood sugar.

Regarding the implication that we're tricking patients into having poor control, the majority of diet counselling we're taught and also the guidelines (at least in Canada and US where I've trained) are based on carbohydrate counting and glycemic index. This means your starch / whole grains are being examined in terms of raw carbohydrate and also the ease at which those carbohydrates are accessed (glycemic index). Also, the guidelines don't recommend consuming copious amounts of anything, they frequently cite the "size of your palm" shortcut to gauge the size of a serving of carbohydrate. Finally, thee major emphasis in initial planning for most people with new onset T2DM is on exercise and calorie restriction and balanced diet.

Regarding reporting back with high glucose - this shouldn't be a surprise to any patient. They should be tracking their sugars throughout the day and by doing so learning about the impact of food intake on blood sugar. If they did go home and eat a large serving of whole grain carbs they'd notice their blood sugar going high after. There should never be a case of "Oh how is my HbA1C so high?? I mean I've been hyperglycemic after all-you-can-eat pasta every day but still!"

Of course there's the question of whether patients should be recommended whole grains at all - if you review the articles cited in the most recent Health Canada guidelines (similar to USA) the intention is realistic diet goals. We're starting with a population that is statically likely to be largely overweight with poor diet history to begin with. There are commonly multiple comorbidities affecting metabolism and exercise capacity. Commonly from lower socioeconomic backgrounds which have a myriad of associated barriers from education, cooking skills, free time for grocery shopping and meal preparation, geographic and financial barriers to healthy foods, neighbourhoods not conducive to exercise, etc. and often addictive relationships with consumables like food, cigarettes, alcohol. Now you have to get this person to change their diet - a task that is most likely going to fail over the long-term in even the best-supported patients.

So what do you go with? Though keto-type or paleo-type diets have been shown to have slightly better long-term efficacy (edit: I posted this in r/keto several years ago)in multiple studies, they have abysmal long-term compliance rates and they generally aren't accessible to most people. Thus guidelines err on the side of realistic harm reduction as high fiber diets do lower glycemic spikes and are associated with less hunger. The goal is to prevent OP's scenario through multiple checks including self-monitoring, carb counting, glycemic index awareness, etc.

That's just the guidelines though. Anecdotal of course but the vast majority of family docs I rotated with in medical school supported almost every diet a patient brought up so long as they were receiving adequate nutrients. Its SO hard to get someone to change ANYTHING that most docs will happily support whatever small amount of motivation a person can muster.

This leads to the final point about trying to snare yourself some poorly-managed diabetic patients because its somehow helpful for your practice - this couldn't be less true. Managing these scenarios is one of the main reasons why people don't go into primary care. Ask any primary care doc and they LOVE the patient that comes in with beautiful meal tracking, carb counting, HbA1c right in the sweet spot, no complicated adjustments of meds needed just keep eating healthy and exercising - that's what people go into medicine for. The poorly managed diabetic is a personal loss. If you're looking at monetary motivation its a big financial loss - you don't get paid per pill you prescribe and these patients take more time and follow up if only for due diligence.

Note that some people with T2DM will struggle to find a doctor who will take them on, tragically, because it is volunteering to do unpaid work, which we generally do anyways but there has to be limits in some instances.

Edit:Apologies that was longer than I intended. It sometimes feels like we're banging our heads on a wall hoping to prevent these situations and this implies they're actually the intended outcome... I see so many colleagues coming to hate their practice because of stuff like poorly managed T2DM and even if you go the greedy route its definitely a net loss

See the research on the power of expectations

Yes this is covered in medical school as well and also several other interesting outcomes related to how we relate to one another resulting in particular outcomes. That said there are well-described reasons for why diets fail - as I listed the factors are completely stacked against even the best-prepared patients from the most beneficial bio-psycho-social backgrounds. We have to be realistic and defer to the evidence whenever reasonably possible.

See this study

I don't think this is the forum to discuss diet efficacy in detail as I was more concerned about the perception of conspiracy, but keto diets consistently put up great short-term numbers. The referenced paper has some issues with the presentation of the data but even if they had leaned less on p-values they still only looked at 24 weeks as a primary outcome. My comment referenced long-term outcomes however which unfortunately are pretty similar across all diets.

There's a separate discussion to be had about the guidelines not being intended to be a "diet" at all. I have patients on long-term keto for epilepsy control and most struggle significantly even without a prior history of poor eating / obesity / etc. Our culture and the momentum of our development is greatly biased towards eating grain products. The fact that this is acknowledged through various guidelines doesn't mean there's a cabal of Family Doctors trying to raise people's blood sugar.

Consider the fact that those who are trying to be compliant are swimming upstream

Absolutely, which is why they should discuss this with everyone and be active in their healthcare. Again guidelines are just that - if a patient comes in wanting to try a sufficiently nutritious diet then their doctor will most likely support it. They won't think, "oh no this will control their blood sugar and relieve me of having to treat this frustrating and devastating condition"

I suspect you are trying to say it's too expensive

Not just expensive though some high protein diets do cost more if people plan on getting all the nutrition they need. Accessible invokes the social and psychological barriers we study (because they help us to help people overcome them) which makes eating properly (regardless of diet) difficult.

While you don't get paid per pill you prescribe...

The easiest way to address this relative to the OP is to show how many people with T2DM struggle to find primary care providers. If you look on any medical forum you'll see the major bane of primary care is influx of complex chronic diseases like DM. If they were actually making money on it (lets assume they only care about money) they wouldn't be complaining. You'll never see Ophthalmologists complaining about cataracts because as mundane as they are you can increase people's quality of life and make good money doing it.

Regarding pay, you generally get paid the same for the healthy / minor complaint patient or the patient who is obese with hypertension, neuropathy, nephropathy, retinopathy, and cardiac problems. That's so much more work - questions, charting, follow-ups, coordination with other doctors, filing, dictating etc. just to do your due diligence and stay licensed and protect yourself legally (again assuming docs don't do it because at some level they care). All of that PLUS you have to book this person more time AND more frequency because they're not doing well. And you get paid the same. In the province I practice in we actually have financial incentives to get people to make objective improvements based on lifestyle changes (i.e. getting a blood sugar in control through diet, getting a smoker to quit, etc.) but I don't know if this holds true across the US - that said we have extremely similar training, board certification, etc. so its not like our culture is that different.

A final point on "return business" - primary care is generally understaffed meaning most docs don't struggle to fill up their schedule. The usual complaint is wait-times being too long. A callous doctor would much rather see healthy minor complaints from patients who manage their own health as much as possible. Again its just so much more work even in paperwork and lab reviews and filing...

So there's no incentive to let patients get sick and there's no benefit to having a polypharmacy patient coming in with side effects that need more medications again because you get paid the same (again assuming you're evil and you are OK with making people suffer for literally a few extra bucks per person).

Keep in mind, as well, that in addition to their base salary, and irrespective of their denials[5] , these doctors do have lucrative relationships with the drug manufacturers[6] .

This is another long discussion - its certainly a problem in some instances. Its heavily regulated (banned in most instances) in Canada but we read the same things as you guys and we're often the ones studying our own patients and sharing evidence to make sure care is never subverted by financial interests.

The fact that it happens though doesn't mean its happening in this instance. All along for the sake of argument we've painted doctors as evil or money hungry or oblivious to show even if this were the case there's still no incentive to have sick patients. We could go into the burden on public healthcare systems and talk about how the biggest funders of research have the most to gain by creating a healthy non-medicated (because they pay for meds and hospital care) population.

Of course I'd argue that I'd be ecstatic if my patients went on keto, or paleo, or restricted calories, or quit smoking, or did yoga or running, and meditated, etc. and they just popped in for non-complicated non-chronic diseases... or chronic diseases they had no control over like epilepsy but are actively engaged in managing. That'd be great from a purely selfish perspective but that's not realistic and I like working with people's real-life problems.

Anyways I'm off to bed.

Dont you see? Do you see the corruption here? Do you know that youre enabling it? You get programmed with all this bullshit information and you go around repeating it to people as if its simple science we have trouble comprehending. Bro, whole grains are horrible for us. That's your first mistake. Secondly, No one should be monitoring their sugar levels all day because they shouldnt be thinking about sugar to begin with. Where the hell in nature, if you and your synthetic and processed loving friends were removed from it, is one supposed to find all of this sugar? Fruit? He'd be shitting himself before he came close to eating the equivalent of a soda or baked goods. Wheat is the number one enemy in our food supply. And its EVERYWHERE. Have fun getting healthy with wheat in your diet. Also, if you really cared about people and patients you'd have mentioned HFCS and to stay away from it. Instead, I see coke machines at the goddamned clinics and hospitals. You people arent necessary and yet the only reason you are around is because to make yourself necessary. That's the scam. It is the worst scam and anyone who participates in it should be the first ones to line up blindfolded with a cigarette. You say you cant recommend a diet change because our lifestyles cant afford home cooked meals anymore, no time for it. Well how do you like that? Our lives have turned into overtime and shitty processed food resulting in visits to the doctor. It's as if there was a plan or something.

Hey guys, its plain and simple. Dont want 'diabetes' and a protruding stomach? Dont eat sugar, replace your beverages with water, get drunk on wine if you have to and eat plenty of produce with a little meat thrown into the mix. Too much meat will make you acidic. If the ocean wasnt a wasteland Id say eat fish and youll be alright but. Anything on that food pyramid that required a dude to make happen you shouldnt eat. Im looking at you, bread and cheese. Have cracked teeth? Stay away from whole grains and nuts/seeds until it is healed. Take in a lot of readily available calcium. And if you find a good source please let me know. Good luck with that one. You need sodium for the electricity in your body to flow through you, dont listen to those people telling you not to eat it. You wont have trouble in a diet like this anyway. Anything fun like pizza, beer or candy or whatever should be to celebrate only. Eating how your body wants you to eat is pprobaby the hardest thing to do but it beats dying early at the hands of a doctor.

Keep these things in your diet;

organic eggs (all the proteins)

avocado (best fats)

celery (calcium/fiber)

potatoes (energy/vitamin c)

fish(oil) (Omega fats/vitamins A and D)

cucumbers (B vitamins/folic acid)

Saurkraut (Vitamin K)

Spinach (Iron)

Regarding whole grains - whether they're horrible or not that's what patients are going to have access to. I can barely get someone to quit smoking and they KNOW about the dangers of smoking.

Regarding sugar monitoring - we were talking about blood glucose in diagnosed diabetics. They should monitor it throughout the day because it helps them see where they stand. This is important because if they let it get bad, they develop huge problems like nerve damage, eye damage, kidney damage, cardiac damage... so yes they need to monitor their sugar if they want to prevent that stuff. As someone who cares about them - a doc doesn't want them to get that stuff. Doesn't matter what they're eating - their body will convert something into blood sugar because your brain needs it and you need to keep in balance if you're diabetic.

Further we're talking about T2DM which generally means these people have long-lasting unhealthy lifestyles that lead to metabolic collapse so yes regardless of what I say they ARE thinking of sugar and now that their metabolism is changed they need to monitor it regardless of what they put in their body.

Also yes did you check the diet guidelines I linked? Explicitly states most of what you said - avoiding all that crap. You're on this soap box about stuff that everyone knows. Find me one diabetic guideline recommending HFCS or cola or baked goods. The authors of that paper didn't put McDonalds everywhere before publishing it.

It is the worst scam and anyone who participates in it should be the first ones to line up blindfolded with a cigarette.

Seriously that's an awful thing to say about another human who is helping people with devastating disease. A primary care doc didn't give anyone diabetes - to my knowledge there are no medical guidelines supporting obesity, caloric excesss, lack of exercise, or high glycemic index foods... but they're there to help people from a myriad of consequences including death once they do get sick. If you disagree with the guidelines or a particular paper why not just critique it or do a study to replicate or disprove it? Why default on firing squad? Geez.

You say you cant recommend a diet change because our lifestyles cant afford home cooked meals anymore, no time for it.

Didn't say that. Said guideline recommendations need to be reasonable based on evidence-informed expectations. Data shows the vast majority of people who try major diet changes fail. The more extreme the change the more likely they are to fail. Long term data on paleo and keto supports this. Isn't my opinion - I don't have a horse in this race and like you saw I was posting support of keto several years ago - whatever the evidence says I try to support. Ultimately we try to work with whatever our patients bring us - if they want to go vegan we discuss the research on it and make sure they do it right (i.e. check b12 levels when appropriate). If they think they can do South Beach or Paleo or DASH or whatever we say "OK this is what the research shows" and try to support that.

If you disagree with the guidelines or a particular paper why not just critique it or do a study to replicate or disprove it? Why default on firing squad?

Because you people never tell patients the right answer. You promote dependence and ignorance. You do it in the name of profit. Life and death shouldnt be left up to profit. You're kidding yourself if you think the food suppliers and medical industry arent in the same bed. The reality is if HFCS and wheat werent 98 percent of the food supply you wouldnt have a job. You shouldve studied something else for a living. Instead, you were told there was a lot of money to be made in this field so you chose it. 'Helping people' was a nice excuse for it but you know damned well it was the money. Then, when you undoubtedly figured out why there was so much money to be made, you chose to disregard it because of the money. You drive past new Mc Donalds and Dairy Queens and you smile inside because its more business at the end of the day. That's why.

That's a ton of unfounded accusations considering you don't even know what I do, how I do it, or to what degree I'm paid, or why I went into it. For someone who seems to have it all worked out you're not a fan of the objective perspective. Further, if I only cared about profit I wouldn't waste time explaining anything online. Like I said I have no horse in this race I just understand the process and the data through my training.

The guidelines in question go completely against this tirade you're on (they recommend against HFCS, fast food, etc. which flies in the face of your theory there) to the extent that its like you haven't read anything posted or linked. Also regarding healthy life choices - again its like you read nothing. You're massively simplifying a complex issue and you're underselling the degree to which people knowingly routinely make poor life choices. Again I'm not a Family Doc but I sure as hell wouldn't want to be because its nearly impossible to help people change these things.

You're massively simplifying a complex issue and you're underselling the degree to which people knowingly routinely make poor life choices. Again I'm not a Family Doc but I sure as hell wouldn't want to be because its nearly impossible to help people change these things.

And youre massively complicating it. You assume they are life choices when in reality it's not a choice. In the low income areas the only choice is fat sugar and salt. I saw the demise of nutrition happen. It's gradually getting worse while more low income areas pop up. A vicious cycle on a massive scale. Many people simply cant afford to eat the required amount of proper calories and now the only thing within their reach when their stomachs hurt and theyre off work is taco bell. The grocery sells the same garbage now. There is no organic produce, hell there is hardly any produce at all. We all know what the center of the grocery stores contain. So what are they to do? They get 8 dollars an hour and theyre supposed to somehow pay rent, pay electric bills(which come to find out theyve been overcharging their customers and threatened to raise the rate if presented with a lawsuit) and then go to 'the fancy grocery' and pay a premium just so they have a shot at a decent meal. Theres no way they can maintain that. My problem with you, and Ill admit, the previous post wasnt entirely directed at you, is that youre not placing the blame where it ought to be placed and where you are placing it is offensive and insulting. Human beings arent inherently self destructive contrary to this new popular belief. We are being destroyed. The people who work in this pharmaceutical and food supply game are enabling it. Top to bottom, there is no innocence, just varied responsibility.

I've literally stated each of those points already, hence the feeling you haven't read any of my posts.

He's not debating guidelines. He's looking for a solution. Guidelines are not the solution.

You seem to be part of the problem, so you have nothing to offer.

Never said they were. He just reiterated all of my points which I'd argue offered more solutions than anyone else i.e. lets address social contributors to disease like food cost and neighbourhood set up and education about food preparation - how are these not solutions? Don't answer I don't actually care, though I hope anyone reading can glean some insight into social effectors of health outcomes.

The bottom of the food pyramid should be fats, meats and cheeses and the grains should be stuffed into the peak with the sugars because that's what it is anyway.

cheeses. Come on bruh.

Chromium and vanadium deficiency.

[deleted]

Type 2 diabetes, otherwise known as: being fat.

Diabetes is why we have mandatory autopsies. They harvest the fat liver for foie gras.

Please give me evidence for GMO's being horrible for the health of a person, I really want to see why people are so against them.