This article is a rebuttal to the last article I sent. Written by a 
Times reporter.

http://www.nytimes.com/2016/09/16/health/type-2-diabetes-low-carb-diet.html

Diabetes and Your Diet: The Low-Carb Debate
By GINA KOLATA    SEPT. 15, 2016

A few years ago, Richard Kahn, the now-retired chief scientific and 
medical officer of the American Diabetes Association, was charged 
with organizing a committee to prescribe a diet plan for people with 
diabetes. He began by looking at the evidence for different diets, 
asking which, if any, best controlled diabetes.

"When you look at the literature, whoa is it weak. It is so weak," 
Dr. Kahn said in a recent interview.

Studies tended to be short term, diets unsustainable, differences 
between them clinically insignificant. The only thing that really 
seemed to help people with diabetes was weight loss - and for weight 
loss there is no magic diet.

But people want diet advice, Dr. Kahn reasoned, and the association 
really should say something about diets. So it, like the National 
Institutes of Health, went with the Department of Agriculture's food pyramid.

Why? "It's a diet for all America," Dr. Kahn said. "It has lots of 
fruits and vegetables and a reasonable amount of fat."

That advice, though, recently came under attack in a New York Times 
commentary written by Sarah Hallberg, an osteopath at a weight loss 
clinic in Indiana, and Osama Hamdy, the medical director of the 
obesity weight loss program at the Joslin Diabetes Center at Harvard 
Medical School.

There is a diet that helps with diabetes, the two doctors said, one 
that restricts - or according to Dr. Hallberg, severely restricts - 
carbohydrates.

"If the goal is to get patients off their medications, including 
insulin, and resolve rather than just control their diabetes, 
significant carb restriction is by far the best nutrition plan," Dr. 
Hallberg said in an email. "This would include elimination of grains, 
potatoes and sugars and all processed foods. There is a significant 
and ever growing body of literature that supports this method." She 
is in private practice at Indiana University Health Arnett Hospital 
and is medical director of a startup developing nutrition-based 
medical interventions.

But there are no large and rigorous studies showing that low 
carbohydrate diets offer an advantage and, in fact, there is not even 
a consensus on the definition of a low-carbohydrate diet - it can 
vary from doctor to doctor.

"There have been debates for literally the whole history of diabetes 
about which kind of diet is best," said Dr. C. Ronald Kahn, chief 
academic officer at Joslin, and no relation to Dr. Richard Kahn. But, 
he said, "the answer isn't so straightforward."

In support of a diet like Dr. Hallberg's, there is one recent short 
term study by Kevin Hall of the National Institute of Diabetes and 
Digestive and Kidney Diseases and his colleagues involving 17 
overweight and obese men, none of whom had diabetes. They stayed in a 
clinical center where they ate carefully controlled diets. The 
researchers asked what would happen if calories in the diet were kept 
constant but the carbohydrate composition of a diet varied from high 
to very low. The answer was that insulin secretion dropped by 50 
percent with the very low carbohydrate diet, meaning that much less 
insulin was required to maintain normal blood glucose levels. "Since 
diabetes results when the body can't produce enough insulin, perhaps 
it is a good idea to reduce the amount of insulin it needs by eating 
very low carbohydrate diets," Dr. Hall said.

Some longer term studies, though, failed to show that low 
carbohydrate diets benefited glucose control.

Even if diets are effective in the short term, Dr. Hall said, "the 
difficulty is adhering to the diet over the long term."

In an analysis of weight loss diets (not specifically for diabetics) 
published this summer, he and Yoni Freedhoff of the University of 
Ottawa wrote: "Diet adherence is so challenging that it is poor even 
in short-term studies where all food is provided. When diets are 
prescribed, adherence is likely to diminish over the long term 
despite self-reports to the contrary."

But short term studies of just a few weeks - which constitute the 
bulk of the diet studies - can be misleading, said Dr. C. Ronald Kahn.

"In the short term, the low carbohydrate diet sometimes does better 
on glycemic control," he said. "But as time progresses the difference 
mostly disappears. What counts is which diet helps most with long 
term weight loss. "

The reason the advantage that is sometimes seen with a low 
carbohydrate diets tends to vanish, Dr. C. Ronald Kahn added, is 
probably a mixture of people failing to adhere to the diets and their 
bodies adjusting to them.

Another issue with low carbohydrate diets, researchers said, is the 
question of what will happen to overall health if diabetics actually 
follow the diet for years or decades. (Heart attacks are the major 
killer of people with diabetes.) Insulin levels may be better but, 
said Dr. Rudolph Leibel, co-director of Columbia University's Naomi 
Berrie Diabetes Center, "effects of a low carbohydrate diet on 
lipoproteins and vascular biology could offset such a 'benefit.'" In 
other words, it is not clear if a lower insulin level would translate 
into fewer heart attacks.

Dr. Hamdy, whose recommended low carbohydrate diet is less 
restrictive than the one Dr. Halberg suggests, reports that many 
patients in his clinic have been able to stay with the diet for as 
long as five years, losing weight and keeping it off. He presented 
his study at the 2015 annual conference of the American Diabetes 
Association and has submitted it for publication. It involved 129 
patients. Half were able to lose weight and keep it off, and those 
who did maintained an average weight loss of 9.5 percent. Their 
diabetes was much improved.

It is impossible, Dr. Hamdy said, to separate weight loss from the 
diet's effects on diabetes because people following such a diet - 
which limits but does not forbid limits things like breads and pasta 
and rice - also lose weight.

But multiple studies have found that when it comes to weight loss - 
the only proven way to help with blood sugar control over the long 
term - there is no difference between diets that restrict calories, 
or fat, or carbohydrates.

Experts like Dr. David Nathan, director of the diabetes center and 
clinical research center at Massachusetts General Hospital and a 
professor of medicine at Harvard Medical School, advise dieting for 
people with diabetes. But, he said, "when we advise people to be on 
diets, the major goal is to lose weight."

What matters the most for controlling diabetes, Dr. Nathan said, "is 
how much weight you lose."