From time to time, I get a real die hard carb-avoider to the detriment of the overall diet, including a scary amount of saturated and trans fats. I like to use real research to make my point. I have a few articles in my files, but I just found this one today. It's a few years old, but I still want to share.

G Riccardi, R Giacco, A.A Rivellese Dietary fat, insulin sensitivity and the metabolic syndrome

Clinical Nutrition - August 2004 (Vol. 23, Issue 4, Pages 447-456, DOI: 10.1016/j.clnu.2004.02.006)

You can find it here: http://www.clinicalnutritionjournal.com/article/S0261-5614(04)00026-3/abstract

Thanks Jill,

Great article, but I have a question for you.  Are you talking to your patients about total calories vs. only focusing on one nutrient ?  I'm trying to get folks to focus on switch to the healthier fats, but that all calories count.

Just curious?!

Joan

Thanks for sharing the article Jill. I talk with my clients about insulin resistance, and how they can improve insulin sensitiviey, primiarily with weight loss and increased exercise/activity. In fact, when I see people newly diagnosed with T2 I've been telling them that activity/healthy weight is just as important as paying attention to carbohydrate intake. We always talk about using healthier types of fats and also decreasing total fat intake.

I thought that everyone realized any product with the word 'oil' is a fat, but I've been proved wrong. Last week my husband told me that olive oil wasn't a fat, because it's healthy. You would think that the husband of a dietitian, as well as a reasonably intelligent person, would know that any food with the word 'oil' is, in fact, a fat. I had to pull out nutrition labels to demonstrate to him that olive oil contains just as many calories as other sources of fat. He was amazed.

I find this article unimpressive.  There may well be some real effect that increased fat intake can result in insulin resistance.  But the same thing can be said about high carbohydrate intake.  As a patient, my real problem was that I have felt "let down" by my medical team being unable to advise me on following a low carb diet.  Because of the strict positions related to low carb, none of my nutritionists or CDEs were ever able to provide me with good advice particularly as it relates to fat in my diet.  It was always "Don't DO IT!"  It is simply not true that fats are bad for you.  As a patient, I am just so tired of this low fat mantra.

Patients are going to find out about low carb diets anyway.  If a patient chooses a low carb diet, they will by definition be eating a higher fat diet.  And knowing how to make good choices about the types and sources of fats is confusing.  Perhaps we are all clear about trans fats, but many patients do not recognize that many products "lie" about transfats and call them partially hydrogenated oils.

And then we get to the controversy about saturated fats, the research is just not clear.  Patients are told that saturated fats are a CVD risk, but the evidence is not really there.  A recent meta analysis of gold standard CVD and mortality studies found no evidence that dietary saturated fat increased CVD risks.  And I regularly use coconut oil, which is mostly saturated fat.

Then there now seems to some evidence that many of the fats that we are encouraged to use (the Omega-6s) may not actually be all that great.  I really try hard to limit my Omega-6s and keep them balanced against my Omega-3s.

Patients are going to eat fat and many of them will likely choose a low carb diet and eat more fats than the current dogma wants.  The medical community needs to be prepared to support that choice and help patients make informed choices on fats in their diet.

I'd be interested in what advice this community provides on the types and sources of fat they recommend.

ps. And I bet that most of you don't see soluble fiber and think "fat," but in fact soluble dietary fiber is digested in the lower part of the GI and absorbed as short chain fatty acids.

Joan, I usually focus on the total diet, calories, fats, and everything else. When I work one on one, it's much easier to show people how to trade one food for another and where to cut back on portions to trim calories. It's typical though for patients to want to talk only about carbohydrates. Lynn, I agree that teaching about ways to increase insulin sensitivity is important. That's why I was so pleased to add this article to my files.

Only research covering up to 2003-pretty old considering the breakthrus since. Here is the complete text:

http://www.edulife.com.br/dados%5CArtigos%5CNutricao%5CObesidade%20e%20Sindrome%20Metabolica%5CFat,%20insulin%20and%20syndrome%20X.pdf

  (You'll need to copy and paste the whole thing to get there-link is broken for some reason dropping at the comma)

This group also did interesting research of interest: http://www.ajcn.org/content/87/1/269S.full

Lynn,

This is just TOO funny. It never ceases to amaze me. The other day my husband said "I don't really understand what you mean when you say 15 grams of carbs". We've been cooking together for almost 40 years and I think he knows more about diabetes than the average nurse (he's a good listener) but still does not understand carbs. This should be a lesson to us to keep probing, asking questions, ask for feedback... so we can evaluate understanding of the topic.

Roxy