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Response to What if It's All Been A Big Fat Lie?
Published in The New York Times, Sunday July 7, 2002

It is my observation, from attendance at the annual American Diabetes Association meeting and from other venues, that the volume on this debate is getting louder. To me this article puts this discussion out in front of millions of consumers to digest. Unfortunately (and I will use this word a few times), the article really only represented one side of the discussion. Unfortunately, the article, as is so common with the mass media, goes for the hype and the sensational. In the end the article does more to confuse people than help them.

In addition, Americans are still, unfortunately, looking for a panacea when it comes to weight loss. They want the magic bullet. The reality is there isn't one. Neither the New York Times or many other mainstream magazines would publish an article about the 20 relatively easy steps you can take to improve your eating habits. Yet, that is what I believe people need to read-how do I do this and integrate it into real life.

I believe the article leaves people with the feeling that they must make a choice between a low-fat and high- carbohydrate intake, (which I don't believe are the correct terms for the current recommendations from ADA) and high-protein and low carbohydrate (the Atkin's approach). This polarization turns people off! People are so confused and don't know what they should eat. They continue to throw up their hands in despair.

No such choice needs to be made! There is middle ground! Based on the strong message of individualization, people can apply what we know today makes up a healthy eating plan while finding the right balance of nutrients for them to achieve their desired metabolic goals. This plan must be meshed with their real life! But to do all this people need help. Help that is often unavailable because the education and support of a knowledgeable dietitian/diabetes educator is not sought or they aren't referred for it.

Yes, I think there may be some value to some people, ie those with pre-diabetes who typically have relatively high levels of insulin and abnormal lipids or those with early onset type 2 diabetes, to eating a lower carbohydrate and higher protein intake. Note the accent on lower and higher. Does this mean get the carbohydrates down to nearly nothing, don't eat fruit and eat as much steak and bacon as one desires? Absolutely not! It means eating less total carbohydrate and choosing healthy non-refined sources of carbohydrate, eating fruit and vegetables that offer lots of vitamins and minerals. It means that maybe some people do better with a bit higher intake of protein. But that protein should be from lean sources to keep the saturated fat and total fat intake down. And it means people might want to eat more fat (greater than 30% of calories) if the fat is from healthier sources, higher in monounsaturated fats), such as olives, olive oil, some nuts, canola oil and avocado; and higher in omega- fats such as some fatty fish, some nuts and flax.

It all comes down to what is the person's situation and they are willing to do to achieve their goals. For many Americans the first thing they need to do is EAT LESS and EXERCISE MORE. After that goal, then they can zero in on making additional changes. Clearly Americans are eating too much and too much of the unhealthy foods. Plus, we are just not burning the calories we need to be to eat the way we are. But we do need to keep in mind that what help people most in the long run is making a number of small changes that can add up to a big difference. These changes need to be actions that people can do for the rest of their life. Going on a diet to lose 10 or 20 pounds only to gain it back again is of no value in the long run.

-- Hope Warshaw, MMSc, RD, CDE
Diabetes Educator and Freelance Writer

July 11, 2002

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