Discussion Board

Dr. Barnard places a lot of emphasis on the glycemic index in his treatment of diabetes. While I do not want my blood sugar to be high if I can help it, I am somewhat puzzled by his logic. He says in his book, Reversing Type 2 Diabetes, that people in countries where diabetes was uncommon were not following anything like a diabetic diet. They did not avoid carbohydrates, they ate starchy foods every day. In Asia and Africa, rice and other grains, starchy vegetables, bean dishes and noodles are staples. Researchers found that people in these countries ate considerably more carbs than North Americans or Europeans eat yet diabetes is relatively rare.

However, he seems to have ignored whole south american indigenous populations whose diets are based on many different varieties of potatoes. Not only do they eat potatoes fresh, but process them by a freeze drying method to eat later. And these populations do not have high rates of diabetes. He says that white potatoes have a high glycemic index so avoid them. Yet the Asian population he uses as an example consume white rice almost exclusively and according to Dr. Barnard, diabetes is practically unknown in these populations. So I am wondering why he eschews white potatoes for diabetics on the basis of glycemic index when they are a part of a healthy, diabetes free diet in some parts of the world. If potatoes are a healthful food in the Andes, why not here?

Didi

Didi, I am also puzzled by this and wonder if it is related to the difference between prevention and treatment. In other words, the traditional diets are quite effective in preventing DM but for those who have DM, he may think the GI is an issue and that one should choose the lower GI foods.

If one is actually on the way to reversing the disease--not just living with it--I wonder if it makes any difference in the long run. See

http://www.drmcdougall.com/misc/2006nl/ ... 0700gi.pdf

My guess is that most with T2 could reverse the disease by following the MWL program. After achieving a low BMI (<21) and and steady normal BG levels, perhaps Dr. Barnard would consider the disease reversed and the GI irrelevant if one is eating unrefined plant foods....?

I second what Pinkrose said. If you eat a relatively low-fat high-starch and vegetable-based diet your whole life it probably won't matter what the glycemic index or load of your food is. You're trim and your pancreas and insulin will be working just fine. But a person who HAS eaten SAD for 40 or 50 years is going to be in a compromised state. The insulin won't be able to 'unlock' the fat-laden cells to let glucose in. In those cases, foods with a high glycemic load might be better off avoided in order to prevent blood sugar spikes. Once the person has lost sufficient weight and the insulin starts working properly again, they should be able to eat freely of potatoes, white rice or bread without issue. If I were a type-2 diabetic and overweight, I would follow Dr. Barnard's advice for a month or two, then start introducing Yukon gold or baby red potatoes and monitoring my blood sugar afterwards. If they tested OK, I'd try russett potatoes and bread. Eventually, you should be able to eat any starch you want - so long as you remain trim and get some daily exercise to use up stored glycogen. Remember it's not the fault of the food, it's the fault of the fat.
Kate

But you can't have it both ways. If it is true that those without diabetes can eat potatoes and those with should not, then either Dr. Mcdougall is mistaken or Dr. Barnard is mistaken. Maybe it is a matter of quantity. Too many carbs at one meal might spike blood sugars. But diet and diabetes are tricky things to coordinate because I have found that one day a certain quantity of food will raise my blood sugar so high and the next day the same quantity will make it go higher.

My blood sugars have always been in the normal range but evidently something was happening to my arteries. Witness the heart attack.

I am reading Dr. Barnard's book on diabetes now. I do not recall that he did experiments showing why white potatoes, specifically, should be eliminated from a diabetic's diet but I will continue reading and maybe come up with the answer.

Didi

Don't forget those indigenous potatoes are a whole different vegetable from our GMO giant mutant Russets!

The Asians eating a lot of white rice do/did get by with it because they were lean and physically very active. They had zero insulin resistance so even if they ate relatively high glycemic diet, their after postprandial spikes were not very high and came down quickly. Once you accumulate visceral fat (and are living a fairly sedentary lifestyle) you will have insulin resistance. Then the downward spiral begins. Sort of off the plateau and on to the slippery slope. You need serious traction to get back up off that slope i.e. lower glycemic load on your system + weight loss + muscle building/using exercise.

Also, as we find in western populations, there are genetic differences in sensitivity to glycemic impact, body fat accumulation caused IR, etc. So it could be that Asian populations as a whole are a bit more blood sugar stable. But now we are seeing that when that white rice is added to McDonald's grease and fat, diabetes rates soar.

It's one thing to look at the diet of people who have never suffered from a particular disease and conclude that their diet helps prevent that particular disease. It's an entirely different subject applying that same diet to people who haven't eaten it their whole lives and are diseased because of it. When we've abused ourselves to the point of being diseased, issues aren't as clear and what works for one person might have minimal affect on another. We're really only just discovering what is the best diet to prevent disease. Applying that knowledge to those who already are diseased is difficult and going to cause disagreement even among people I admire and respect, like Dr. McDougall and Dr. Barnard.
I love and respect them both. Dr. McDougall, for giving freely of his program and his passion for starches which has given me my life back! Dr. Barnard, because it was watching one of his videos in December of 2010 that first sparked my interest in the dietary changes that have brought me to where I am today. While I agree with Dr. McDougall about the overall retarded nature of the glycemic index, I wouldn't hesitate at all to steer people with uncontrolled or poorly controlled diabetes towards Dr. Barnard, and in fact, have done just that before.
They're both mostly on the same team. Pick and choose between them and find what works for you, then offer feedback to help enlighten us all!

-Norm

One thing that Jeff Novick has mentioned is that when he worked at the Pritikin Longevity Center, they took thousands of diabetics off of their diabetes medications using diet and exercise and they never used the glycemic index.

Dr. McDougall's program for getting diabetics off of their medications is similar to (and if anything, stronger than) Pritikin's program.

Here's my question: Has their ever been a controlled trial in which 100 diabetics followed the McDougall (don't worry about the glycemic index) diet and 100 diabetics followed an alternative diet that did concern itself with the glycemic index?

Until I see a head to head matchup like that, I don't think diabetics should be overly concerned about the glycemic index. That said, I am not currently diabetic and I am not a doctor. So, what do I know?

Oh, one more question.....

At the McDougall programs, do they test postprandial blood sugars in order to guard against spikes in blood sugar given that they serve some high glycemic food there?

If they don't and they have great success in getting diabetics off of their meds, what problem are we trying to solve with this glycemic index?

As a practical matter, if you eat the way those at the live in center eat--that is salads and soups and cooked and raw vegetables then the main starch dish,--you would probably not be eating very large quantities of the starch. Which is very much in line with the MWL plan. Which is probably the best plan for diabetics.

Geoffrey, I believe I read that Asians on a primarily rice as the main staple diet actually become more insulin resistant when switching to the SAD. And they get diabetes at much lower weights than those of us raised on the SAD. Some have suggested that they are actually more susceptible genetically to insulin resistance than westerners. Which would make one think twice about a diet of white rice. But, despite their greater genetic tendency to insulin resistance, they remain thin and diabetes free on rice which has the same glycemic index as new potatoes. (Russets are about 20 points higher). And while it is true that being more active can keep high blood sugars and artery disease at bay on a starch diet, Jim Fixx and others bear witness that on the SAD, all bets are off.

And evidently for someone with diabetes, normal blood sugars don't always protect you from the complication of artery disease.

Didi

When Dr Barnard spoke at the Advanced Study Weekend a few years ago he said the GI was "controversial" and that "you didn't have to use it" even though he used it in his diabetes studies. He conducted those studies with the creator of the GI which is perhaps why it was used.

Well said Norm. Just thinking that my type 2 husband lost all his weight on the MWL program with no BG testing and it was only afterwards that I realized that all the potatoes and oats he was eating were spiking him 200+ consistently. Still, he lost the weight and brought his ac1 from and 8.9 with 2 meds to a 6.8 with no meds while eating those spiking foods.

At the moment I have him completely avoiding bread (flour, fruit, sugar) and oats, and have had some encouraging results with organic potatoes. What bothers me is the fact that after many of our meals featuring various starches i.e. the other night sweet potatoes and red lentils, he will go to 165 one hour pp. The fact that he's back to 120 after two hours encourages me and I try not to worry about him going over 140 on a regular basis. It's still early days in terms of reversing his diabetes as he's only reached his final weight loss goal a month and a half ago after being overweight for 15 years. Rome wasn't built in a day!

I'm curious why oats? I can understand flour & sugar.

Barnard uses oats in a diabetes diet (http://www.nealbarnard.org/pdfs/Diabetes_Recipes.pdf).

He also allows (at least limited) fruit (http://www.nealbarnard.org/diabetes_qa.htm).

Because they put him at 220 1 hour post pp. I'd love to know why. He does have a disease after all, and his BG responses are not normal. He also doesn't handle fruit well at all, so I'm just avoiding it for the time being. Baby steps...

I'd also like to add that I'm a non-diabetic who has endured a lot of blood testing along with husband for comparison purposes, and sometimes it's very frustrating to see our different BG responses. I just keep reminding myself that diabetes is a disease, and that explains why I can eat all the things that spike him with hardly a blip in my BG.

Oats work great for some w/ diabetes or pre-diabetes but for sure not all. I used to get over 200 from a moderate serving of oats. Now they still put me much higher than I get from same calories of beans, much higher, but barely acceptable for the rare treat.

Re: Oats -- Appreciate the responses. I find the variability a bit surprising.

While a starch-centered diet is a good thing, Dr. McD doesn't discuss whether Caloric Restriction via selecting foods for low calorie density is still a good thing on a VLF plant-based diet. There is no guidance for making more optimal choices within his general guidelines.

Fuhrman certainly makes that point and Jeff Novick has discussed CRON on the McD forums.

From a practical (and cost) basis, the MWL WOE may actually be pretty near optimal for many of us. I know that at least one Star McDougaller has made that her permanent lifestyle choice.

Fuhrman's approach costs too much, takes too much time, and relies too much on blended foods, IMO. Nuts are another possible issue.

Novick's SNAP meals and the MWL recipes are probably the "sweet spot" for a lot of us. Most calories come from starches, but high proportions of non-starchy veg gives relatively low caloric density, as well as lower glycemic load and high nutrient density.

This is an interesting discussion about blood sugar spikes from a few years ago.

pasta

If you replace "pasta" with "potatoes" in this conversation, this conversation is very similar to ours.