Re: ADA on Low-Carbohydrate Food Facts And Fallacies

[Guest guest]

I didn't make it through the entire article but yes, like I've always stated,

net carbs is deceiving and should not be followed by diabetics... always go with

the total carbs on the label and forget net carbs... exactly what this article

seemed to be implying.

Regards,

ADA on " Low-Carbohydrate " Food Facts And Fallacies

For those of us counting carbs I have copied what the ADA American Diabetes

Association has to say about carbs in their latest newsletter below

***I have surrounded this editorial comment by me with stars, See how they

dance and give you a lot of mumbo jumbo. This is important information, but

obvious obfuscation on the part of ADA as to the real meaning of carb

consumption for diabetics like me. Obfuscation is a word derived from the

root word obfuscate, which means to make dark, unclear, to confuse in case

you want to know the meaning of the word used here.***:

23-SEP-2004

" Low-Carbohydrate " Food Facts And Fallacies

Originally Published:20040701.

Ten years ago, weight-conscious Americans jumped on the fat-free bandwagon.

Supermarket shelves were replete with products touting " reduced-fat " and

" fat-free "

labels, which implied that these products were healthier and lower-calorie

alternatives to standard " high-fat " fare. Yet, in the same 10-year time

interval,

Americans have continued to struggle with ever-expanding waistlines, gaining

an average of 1 lb/year.1 The prevalence of type 2 diabetes has risen

simultaneously.2

Thirty-eight percent of our population is currently attempting to lose

weight.3 The latest trend in the highly lucrative, yet often fickle, diet

industry

is a resurgence of low-carbohydrate, high-protein, high-fat diets. Findings

of a February 2004 survey by A.C. Nielsen, a leading market information

company,

revealed that 17.2% of households included someone on a low-carbohydrate

diet. Slightly more, 19.2%, included someone who had tried a low-carb diet

but

had quit.4 This current diet trend directly counters the decade-old focus on

low-fat diets and implicates carbohydrates as the culprit in America's

obesity

problem.

In response to the low-carb resurgence, food manufacturers have rapidly

revised food products and package claims to seemingly reduce the

carbohydrate content

of their products and increase consumer demand for them. Restaurant menus

have incorporated purportedly low-carb entrees to accommodate demand for

low-carb

meals away from home. Aggressive marketing schemes imply that these products

are healthier alternatives to standard high-carb fare and that they promote

weight loss. For individuals with diabetes who are counting carbohydrates or

attempting to lose weight, the current marketplace can be a source of a

great

deal of misinformation, cause considerable confusion, and possibly affect

glycemic control.

Confusing Labeling Terminology

Many food manufacturers have created their own terminology for carbohydrate

content that they claim has minimal effect on blood glucose. They suggest

that

consumers subtract carbohydrate contributed from sugar alcohols, fiber, and

glycerin from the total carbohydrate value on the Nutrition Facts panel of

packaged foods to determine the " net carbs, " " impact carbs, " " effective

carbs, " or " net effective carbs " of these foods. While these terms sound

slightly

different, they are used by manufacturers to mean essentially the same

thing.

However, this calculation can substantially underestimate the actual

carbohydrate value in many products and may result in insulin errors for

people using

carbohydrate counting to determine their insulin dosages. In addition,

individuals with type 2 diabetes following a low-carb regimen for weight

loss may

erroneously interpret these " disappearing carbs " to mean " disappearing

calories, " as well.

Currently, there are no Food and Drug Administration (FDA) regulations for

the use of carbohydrate claims on food package labels, as there are for

claims

about fat, such as " low-fat, " " reduced-fat, " and " fat-free. " Several

organizations, including the Grocery Manufacturers of America, have

petitioned the

FDA to establish regulations for carbohydrate content claims. The FDA is

working on guidelines for defining " low, " " reduced, " or " free " carbohydrates

and

for the use of the term " net " in relation to carbohydrate content of food,

based on recent recommendations by its Obesity Working Group.

The U.S. Department of Agriculture (USDA) Food Safety and Inspection Service

has implemented an interim policy that provides guidelines for the use of

such

labels on products within its jurisdiction, such as meat and poultry. The

USDA permits manufacturers to use the terms " net carbs, " " impact carbs, " and

" net effective carbs, " provided such claims are truthful, not misleading,

and supported by calculations shown on the label.5

The net effect of this labeling lingo is confusion and a host of inquiries

to which health care professionals must respond.

How Do Manufacturers Lower the Carbohydrate Content of Foods?

A few creative chefs have replaced some naturally occurring carbohydrate

with healthy lower-carbohydrate alternatives, such as making

low-carbohydrate mashed

" potatoes " with pureed cauliflower. But for the most part, food

manufacturers are lowering the grams of carbohydrate in processed foods by

altering the

portion size or replacing naturally occurring carbohydrate with ingredients

that are higher in protein, fat, or other types of carbohydrate. Examples

include:

* substituting soy flour, soy protein, or wheat protein for refined flour

* adding fiber from wheat bran, oat bran, corn bran, inulin, or polydextrose

as a bulking agent

* adding high-fat ingredients, such as nuts and oils

* replacing sugar with sugar alcohols, such as maltitol, lactitol, or

sorbitol, or nonnutritive sweeteners, such as sucralose or acesulfame

potassium

Are the Terms " Net Carbs, " " Impact Carbs, " and " Net Effective Carbs "

Truthful?

Fiber and sugar alcohols (including glycerin) currently must be included in

the total carbohydrate value shown in foods' Nutrition Facts panel. To

appeal

to the low-carb market, food manufacturers are subtracting these values from

the total carbohydrate grams to yield a lower-carbohydrate value termed " net

carbs, " " impact carbs, " " effective carbs, " or " net effective carbs " (Figure

1). The intent of these claims is to convince consumers that the products

are

beneficial to a low-carb diet because with their minimal effect on blood

glucose, increases in insulin levels and consequent weight gain will not

occur.

But is this labeling misleading? Do these alternative carbohydrate values

have a minimal impact on glycemia?

Sugar alcohols/polyols

Sugar alcohols, or polyols, are hydrogenated carbohydrates that are used in

foods primarily as sweeteners and bulking agents. Table 1 provides a list of

commonly used sugar alcohols or polyols and their caloric values. Sugar

alcohols provide 0.2-3.0 kcal/g, rather than the usual 4 kcal/g from

completely

absorbed carbohydrate, because they are incompletely absorbed in the small

intestine. FDA regulations require that food manufacturers count polyols as

2 kcal/g or use the specific kcal/g value determined by the FDA for a

single-sugar alcohol.6 Because of their incomplete absorption, consumption

of polyols

can cause flatulence or a laxative effect in varying degrees in some

individuals.

Despite claims by many food manufacturers, sugar alcohols do affect the

postprandial blood glucose response in individuals both with and without

diabetes.7

In some studies, specific sugar alcohols elicited a lower glycemic response

than glucose, fructose, and/or sucrose.7,8 In addition, a recent study

showed

maltitol syrup to have a significantly greater glycemic effect than other

sugar alcohols.9

The glycemic effect of sugar alcohols may vary because of the type and

amount of sugar alcohol consumed or because of individual responses. The

American

Diabetes Association nutrition recommendations state: " There is no evidence

that the amounts likely to be consumed in a meal or day will result in

significant

reduction in total daily energy intake or improvement in long-term

glycemia. " 10 The following general guidelines11-14 are frequently used for

counseling

individuals with diabetes in carbohydrate counting (Figure 2):

* Subtract half of the grams of total sugar alcohols (polyols) listed from

the total carbohydrate value.

* Many sugar-free products that contain sugar alcohols, such as sugar-free

hard candy and gum, would fall into the " free foods " category, with < 5 g of

carbohydrate or < 20 kcal/serving, making it unnecessary to count the

carbohydrate from the sugar alcohol.

Individuals with diabetes who adjust their insulin based on carbohydrate

intake would be most likely to benefit from this information. However, many

educators

are finding the need to address the topic with other patients who have type

2 diabetes simply because of their interest in the carbohydrate information

on food packages.

Glycerin(e)/glycerol

Glycerin (sometimes spelled glycerine), or glycerol, is a sweet, syrupy

liquid that is about 75% as sweet as sucrose. It is chemically categorized

as a

polyol with 4.32 kcal/g. The FDA classifies glycerin as a Generally

Recognized as Safe food additive. As a food additive, glycerin is used in a

variety

of products, including nutrition or energy bars, because of its ability to

retain moisture, and reduced-fat frozen desserts, to prevent formation of

ice

crystals. Many nutrition bars have > 9 g of glycerin in a single-serving

bar.

According to the FDA, synthetic glycerin is produced by the hydrogenolysis

of carbohydrates15 and must be included in the grams of total carbohydrate

listed

in the Nutrition Facts panel. If the label has a statement regarding sugars,

the FDA requires the glycerin content per serving to be declared as sugar

alcohol.16 Some food manufacturers disagree with the classification of

glycerin as a carbohydrate and have been omitting it from their

calculations.

The metabolic fate of glycerin has yet to be determined, but it is believed

to be converted into glucose primarily via gluconeogenesis.17 The effect of

glycerin on blood glucose levels in individuals with diabetes is unknown.

Dietary fiber

The term dietary fiber includes a wide variety of food components, each

having different physiological effects. Dietary fiber is not digested and

absorbed

in the small intestine like glucose. Fiber is fermented in the large

intestine to produce fatty acids, which are then absorbed and used as

energy. Foods

rich in hemicelluloses and pectins (generally known as soluble fiber), such

as fruits and vegetables, are more completely fermentable than foods rich in

celluloses (insoluble fiber), such as cereals.18 Although the energy derived

from fermented fiber varies among individuals, the estimated energy yield

from fiber is between 1.5 and 2.5 kcal/g.18

Although fiber does contribute to calories, its effect on blood glucose is

likely minimal. For individuals with diabetes who desire this level of

detail,

practitioners may suggest subtracting the total grams of dietary fiber from

the grams of total carbohydrate on the Nutrition Facts panel. The effect is

probably insignificant if the amount of dietary fiber is < 5 g.13,14

Do Products Billed as " Low-Carb " Support a Healthy Weight Loss Regimen?

Food products, whether manufactured or naturally occurring, must be

evaluated within the context of the dietary goals they are intended to

support. Therefore,

it is essential to evaluate products advertised as " low-carb " with regard to

the contribution they make to weight loss or maintenance and overall health.

Table 2 compares a purportedly low-carb meal to a more traditional meal

advocated by many professional organizations that promote health. Neither

menu was

devised with the intent to restrict calories, because caloric restriction is

not a point of focus for many popular low-carb diets. Controlled-carb

processed

products were added to the low-carb meal as allowable deviations. When

comparing the two meals, the following legitimate reasons for concern about

the

low-carb claim become apparent:

* The low-carb meal contains less food volume and potentially less satiety

value than the traditional meal.

* The low-carb meal provides ~ 520 more calories and ~ 51 more grams of fat

than the traditional meal.

* Total carbohydrate contained in the low-carb meal is 52 g compared with 83

g in the traditional meal-a difference of 31 g.

* Of the 52 g of total carbohydrate in the low-carb meal, 17 g are claimed

to be " net carbs. " The other 35 g (27 of which are from the controlled-carb

products)

seem to be negated.

Individuals with diabetes should be advised that use of low-carb products

does not necessarily lead to weight loss or improvements in metabolic

measures.

Implications of the Low-Carb Diet Trend

History tells us that popular diets, like fashion trends, tend to cycle. The

currently fashionable low-carbohydrate diet trend has experienced periods of

more and less popularity during the past 40 years. Unfortunately, this diet

trend promotes misconceptions about carbohydrates and can cause people to

restrict

health-promoting nutrients while guiding them to consume liberal amount of

nutrients, especially saturated fat and cholesterol, that can negatively

affect

health.

Perhaps the greatest risk of this diet trend is the impact it may have on

eating behaviors of those individuals who have been unable to establish

sensible

relationships with food. Manipulations in food manufacturing and terminology

that seemingly allow undesirable nutrients and, by association, their

calories

to magically disappear are psychologically appealing to dieters who are

rationalizing how to eat more without having it count.

Individuals with diabetes should be offered sound guidance about how to

interpret truths and mistruths of any diet trend. This is crucial within the

context

of the low-carb trend because claims about the glycemic effects of

carbohydrate foods and their contribution to insulin

resistance/hyperinsulinemia and

weight gain tend to be a central philosophical feature. Confusing labeling

lingo that has been contrived and printed on packages of manufactured foods

can create unique challenges for individuals with diabetes who must

accurately count grams of carbohydrate to achieve glycemic control,

particularly individuals

on intensive insulin therapy.

In truth, the rise in prevalence of overweight and obesity can largely be

attributed to energy imbalance resulting from an increase in energy intake

and

decrease in energy expenditure-not to the excessive intake of any single

nutrient.19 Diets that support severely restricting or omitting any single

nutrient

without offering psychosocial support and monitoring of metabolic parameters

should be considered suspect. Severely restricting or omitting carbohydrates

can have potential negative long-term health consequences, especially if

healthful carbohydrate sources, such as fruits, vegetables, whole grains,

and

dairy foods, are severely restricted.

Thus, not only amounts, but also sources of carbohydrate should be a focus

of any discussion about meal planning.7 Highly processed grains, cereals,

and

sugars should be replaced with minimally processed whole grains, fruits,

vegetables, and dairy foods for optimal nutritional benefits. Sweets and

sugars

should be used with moderation, especially for those who need to lose

weight. When these sensible, but not headline news-making, guidelines are

applied,

use of highly processed and manufactured foods that manipulate carbohydrates

becomes unnecessary.

[Guest guest]

,

You got that right! The key word here is " implying " . All diabetics only

need to know the total amount of carbs, since your body converts all carbs

into glucose, and the unused portion of glucose in the blood stream not used

for present body functioning is converted into fat via insulin, the storage

hormone, and the excess glucose is converted to fat, a reserve energy

source for the body.

ADA on " Low-Carbohydrate " Food Facts And

> Fallacies

>

>

> For those of us counting carbs I have copied what the ADA American

> Diabetes

> Association has to say about carbs in their latest newsletter below

> ***I have surrounded this editorial comment by me with stars, See how

> they

> dance and give you a lot of mumbo jumbo. This is important information,

> but

> obvious obfuscation on the part of ADA as to the real meaning of carb

> consumption for diabetics like me. Obfuscation is a word derived from

> the

> root word obfuscate, which means to make dark, unclear, to confuse in

> case

> you want to know the meaning of the word used here.***:

> 23-SEP-2004

>

> " Low-Carbohydrate " Food Facts And Fallacies

>

> Originally Published:20040701.

>

> Ten years ago, weight-conscious Americans jumped on the fat-free

> bandwagon.

> Supermarket shelves were replete with products touting " reduced-fat " and

> " fat-free "

> labels, which implied that these products were healthier and

> lower-calorie

> alternatives to standard " high-fat " fare. Yet, in the same 10-year time

> interval,

> Americans have continued to struggle with ever-expanding waistlines,

> gaining

> an average of 1 lb/year.1 The prevalence of type 2 diabetes has risen

> simultaneously.2

>

> Thirty-eight percent of our population is currently attempting to lose

> weight.3 The latest trend in the highly lucrative, yet often fickle, diet

> industry

> is a resurgence of low-carbohydrate, high-protein, high-fat diets.

> Findings

> of a February 2004 survey by A.C. Nielsen, a leading market information

> company,

> revealed that 17.2% of households included someone on a low-carbohydrate

> diet. Slightly more, 19.2%, included someone who had tried a low-carb

> diet

> but

> had quit.4 This current diet trend directly counters the decade-old focus

> on

> low-fat diets and implicates carbohydrates as the culprit in America's

> obesity

> problem.

>

> In response to the low-carb resurgence, food manufacturers have rapidly

> revised food products and package claims to seemingly reduce the

> carbohydrate content

> of their products and increase consumer demand for them. Restaurant menus

> have incorporated purportedly low-carb entrees to accommodate demand for

> low-carb

> meals away from home. Aggressive marketing schemes imply that these

> products

> are healthier alternatives to standard high-carb fare and that they

> promote

> weight loss. For individuals with diabetes who are counting carbohydrates

> or

> attempting to lose weight, the current marketplace can be a source of a

> great

> deal of misinformation, cause considerable confusion, and possibly affect

> glycemic control.

>

> Confusing Labeling Terminology

>

> Many food manufacturers have created their own terminology for

> carbohydrate

> content that they claim has minimal effect on blood glucose. They suggest

> that

> consumers subtract carbohydrate contributed from sugar alcohols, fiber,

> and

> glycerin from the total carbohydrate value on the Nutrition Facts panel

> of

> packaged foods to determine the " net carbs, " " impact carbs, " " effective

> carbs, " or " net effective carbs " of these foods. While these terms sound

> slightly

> different, they are used by manufacturers to mean essentially the same

> thing.

>

> However, this calculation can substantially underestimate the actual

> carbohydrate value in many products and may result in insulin errors for

> people using

> carbohydrate counting to determine their insulin dosages. In addition,

> individuals with type 2 diabetes following a low-carb regimen for weight

> loss may

> erroneously interpret these " disappearing carbs " to mean " disappearing

> calories, " as well.

>

> Currently, there are no Food and Drug Administration (FDA) regulations

> for

> the use of carbohydrate claims on food package labels, as there are for

> claims

> about fat, such as " low-fat, " " reduced-fat, " and " fat-free. " Several

> organizations, including the Grocery Manufacturers of America, have

> petitioned the

> FDA to establish regulations for carbohydrate content claims. The FDA is

> working on guidelines for defining " low, " " reduced, " or " free "

> carbohydrates

> and

> for the use of the term " net " in relation to carbohydrate content of

> food,

> based on recent recommendations by its Obesity Working Group.

>

> The U.S. Department of Agriculture (USDA) Food Safety and Inspection

> Service

> has implemented an interim policy that provides guidelines for the use of

> such

> labels on products within its jurisdiction, such as meat and poultry. The

> USDA permits manufacturers to use the terms " net carbs, " " impact carbs, "

> and

> " net effective carbs, " provided such claims are truthful, not misleading,

> and supported by calculations shown on the label.5

>

> The net effect of this labeling lingo is confusion and a host of

> inquiries

> to which health care professionals must respond.

>

> How Do Manufacturers Lower the Carbohydrate Content of Foods?

>

> A few creative chefs have replaced some naturally occurring carbohydrate

> with healthy lower-carbohydrate alternatives, such as making

> low-carbohydrate mashed

> " potatoes " with pureed cauliflower. But for the most part, food

> manufacturers are lowering the grams of carbohydrate in processed foods

> by

> altering the

> portion size or replacing naturally occurring carbohydrate with

> ingredients

> that are higher in protein, fat, or other types of carbohydrate. Examples

> include:

>

> * substituting soy flour, soy protein, or wheat protein for refined flour

>

> * adding fiber from wheat bran, oat bran, corn bran, inulin, or

> polydextrose

> as a bulking agent

>

> * adding high-fat ingredients, such as nuts and oils

>

> * replacing sugar with sugar alcohols, such as maltitol, lactitol, or

> sorbitol, or nonnutritive sweeteners, such as sucralose or acesulfame

> potassium

>

> Are the Terms " Net Carbs, " " Impact Carbs, " and " Net Effective Carbs "

> Truthful?

>

> Fiber and sugar alcohols (including glycerin) currently must be included

> in

> the total carbohydrate value shown in foods' Nutrition Facts panel. To

> appeal

> to the low-carb market, food manufacturers are subtracting these values

> from

> the total carbohydrate grams to yield a lower-carbohydrate value termed

> " net

> carbs, " " impact carbs, " " effective carbs, " or " net effective carbs "

> (Figure

> 1). The intent of these claims is to convince consumers that the products

> are

> beneficial to a low-carb diet because with their minimal effect on blood

> glucose, increases in insulin levels and consequent weight gain will not

> occur.

>

> But is this labeling misleading? Do these alternative carbohydrate values

> have a minimal impact on glycemia?

>

> Sugar alcohols/polyols

>

> Sugar alcohols, or polyols, are hydrogenated carbohydrates that are used

> in

> foods primarily as sweeteners and bulking agents. Table 1 provides a list

> of

> commonly used sugar alcohols or polyols and their caloric values. Sugar

> alcohols provide 0.2-3.0 kcal/g, rather than the usual 4 kcal/g from

> completely

> absorbed carbohydrate, because they are incompletely absorbed in the

> small

> intestine. FDA regulations require that food manufacturers count polyols

> as

> 2 kcal/g or use the specific kcal/g value determined by the FDA for a

> single-sugar alcohol.6 Because of their incomplete absorption,

> consumption

> of polyols

> can cause flatulence or a laxative effect in varying degrees in some

> individuals.

>

> Despite claims by many food manufacturers, sugar alcohols do affect the

> postprandial blood glucose response in individuals both with and without

> diabetes.7

> In some studies, specific sugar alcohols elicited a lower glycemic

> response

> than glucose, fructose, and/or sucrose.7,8 In addition, a recent study

> showed

> maltitol syrup to have a significantly greater glycemic effect than other

> sugar alcohols.9

>

> The glycemic effect of sugar alcohols may vary because of the type and

> amount of sugar alcohol consumed or because of individual responses. The

> American

> Diabetes Association nutrition recommendations state: " There is no

> evidence

> that the amounts likely to be consumed in a meal or day will result in

> significant

> reduction in total daily energy intake or improvement in long-term

> glycemia. " 10 The following general guidelines11-14 are frequently used

> for

> counseling

> individuals with diabetes in carbohydrate counting (Figure 2):

>

> * Subtract half of the grams of total sugar alcohols (polyols) listed

> from

> the total carbohydrate value.

>

> * Many sugar-free products that contain sugar alcohols, such as

> sugar-free

> hard candy and gum, would fall into the " free foods " category, with < 5 g

> of

> carbohydrate or < 20 kcal/serving, making it unnecessary to count the

> carbohydrate from the sugar alcohol.

>

> Individuals with diabetes who adjust their insulin based on carbohydrate

> intake would be most likely to benefit from this information. However,

> many

> educators

> are finding the need to address the topic with other patients who have

> type

> 2 diabetes simply because of their interest in the carbohydrate

> information

> on food packages.

>

> Glycerin(e)/glycerol

>

> Glycerin (sometimes spelled glycerine), or glycerol, is a sweet, syrupy

> liquid that is about 75% as sweet as sucrose. It is chemically

> categorized

> as a

> polyol with 4.32 kcal/g. The FDA classifies glycerin as a Generally

> Recognized as Safe food additive. As a food additive, glycerin is used in

> a

> variety

> of products, including nutrition or energy bars, because of its ability

> to

> retain moisture, and reduced-fat frozen desserts, to prevent formation of

> ice

> crystals. Many nutrition bars have > 9 g of glycerin in a single-serving

> bar.

>

> According to the FDA, synthetic glycerin is produced by the

> hydrogenolysis

> of carbohydrates15 and must be included in the grams of total

> carbohydrate

> listed

> in the Nutrition Facts panel. If the label has a statement regarding

> sugars,

> the FDA requires the glycerin content per serving to be declared as sugar

> alcohol.16 Some food manufacturers disagree with the classification of

> glycerin as a carbohydrate and have been omitting it from their

> calculations.

>

> The metabolic fate of glycerin has yet to be determined, but it is

> believed

> to be converted into glucose primarily via gluconeogenesis.17 The effect

> of

> glycerin on blood glucose levels in individuals with diabetes is unknown.

>

> Dietary fiber

>

> The term dietary fiber includes a wide variety of food components, each

> having different physiological effects. Dietary fiber is not digested and

> absorbed

> in the small intestine like glucose. Fiber is fermented in the large

> intestine to produce fatty acids, which are then absorbed and used as

> energy. Foods

> rich in hemicelluloses and pectins (generally known as soluble fiber),

> such

> as fruits and vegetables, are more completely fermentable than foods rich

> in

> celluloses (insoluble fiber), such as cereals.18 Although the energy

> derived

> from fermented fiber varies among individuals, the estimated energy yield

> from fiber is between 1.5 and 2.5 kcal/g.18

>

> Although fiber does contribute to calories, its effect on blood glucose

> is

> likely minimal. For individuals with diabetes who desire this level of

> detail,

> practitioners may suggest subtracting the total grams of dietary fiber

> from

> the grams of total carbohydrate on the Nutrition Facts panel. The effect

> is

> probably insignificant if the amount of dietary fiber is < 5 g.13,14

>

> Do Products Billed as " Low-Carb " Support a Healthy Weight Loss Regimen?

>

> Food products, whether manufactured or naturally occurring, must be

> evaluated within the context of the dietary goals they are intended to

> support. Therefore,

> it is essential to evaluate products advertised as " low-carb " with regard

> to

> the contribution they make to weight loss or maintenance and overall

> health.

>

> Table 2 compares a purportedly low-carb meal to a more traditional meal

> advocated by many professional organizations that promote health. Neither

> menu was

> devised with the intent to restrict calories, because caloric restriction

> is

> not a point of focus for many popular low-carb diets. Controlled-carb

> processed

> products were added to the low-carb meal as allowable deviations. When

> comparing the two meals, the following legitimate reasons for concern

> about

> the

> low-carb claim become apparent:

>

> * The low-carb meal contains less food volume and potentially less

> satiety

> value than the traditional meal.

>

> * The low-carb meal provides ~ 520 more calories and ~ 51 more grams of

> fat

> than the traditional meal.

>

> * Total carbohydrate contained in the low-carb meal is 52 g compared with

> 83

> g in the traditional meal-a difference of 31 g.

>

> * Of the 52 g of total carbohydrate in the low-carb meal, 17 g are

> claimed

> to be " net carbs. " The other 35 g (27 of which are from the

> controlled-carb

> products)

> seem to be negated.

>

> Individuals with diabetes should be advised that use of low-carb products

> does not necessarily lead to weight loss or improvements in metabolic

> measures.

>

> Implications of the Low-Carb Diet Trend

>

> History tells us that popular diets, like fashion trends, tend to cycle.

> The

> currently fashionable low-carbohydrate diet trend has experienced periods

> of

> more and less popularity during the past 40 years. Unfortunately, this

> diet

> trend promotes misconceptions about carbohydrates and can cause people to

> restrict

> health-promoting nutrients while guiding them to consume liberal amount

> of

> nutrients, especially saturated fat and cholesterol, that can negatively

> affect

> health.

>

> Perhaps the greatest risk of this diet trend is the impact it may have on

> eating behaviors of those individuals who have been unable to establish

> sensible

> relationships with food. Manipulations in food manufacturing and

> terminology

> that seemingly allow undesirable nutrients and, by association, their

> calories

> to magically disappear are psychologically appealing to dieters who are

> rationalizing how to eat more without having it count.

>

> Individuals with diabetes should be offered sound guidance about how to

> interpret truths and mistruths of any diet trend. This is crucial within

> the

> context

> of the low-carb trend because claims about the glycemic effects of

> carbohydrate foods and their contribution to insulin

> resistance/hyperinsulinemia and

> weight gain tend to be a central philosophical feature. Confusing

> labeling

> lingo that has been contrived and printed on packages of manufactured

> foods

> can create unique challenges for individuals with diabetes who must

> accurately count grams of carbohydrate to achieve glycemic control,

> particularly individuals

> on intensive insulin therapy.

>

> In truth, the rise in prevalence of overweight and obesity can largely be

> attributed to energy imbalance resulting from an increase in energy

> intake

> and

> decrease in energy expenditure-not to the excessive intake of any single

> nutrient.19 Diets that support severely restricting or omitting any

> single

> nutrient

> without offering psychosocial support and monitoring of metabolic

> parameters

> should be considered suspect. Severely restricting or omitting

> carbohydrates

> can have potential negative long-term health consequences, especially if

> healthful carbohydrate sources, such as fruits, vegetables, whole grains,

> and

> dairy foods, are severely restricted.

>

> Thus, not only amounts, but also sources of carbohydrate should be a

> focus

> of any discussion about meal planning.7 Highly processed grains, cereals,

> and

> sugars should be replaced with minimally processed whole grains, fruits,

> vegetables, and dairy foods for optimal nutritional benefits. Sweets and

> sugars

> should be used with moderation, especially for those who need to lose

> weight. When these sensible, but not headline news-making, guidelines are

> applied,

> use of highly processed and manufactured foods that manipulate

> carbohydrates

> becomes unnecessary.

>

>

>

>