This week we’re looking at the third of four things diabetic heart patients have to watch in their food lifestyle: starchy carbs. Of our four foods to limit, refined and starchy carbs are the most harmful, and contribute to both diabetes and heart disease. When push comes to shove, if we cannot limit all four categories, we believe limiting this one should be our highest priority.
What are starchy carbs? On a broad level, they include the sugars we talked about last week, but we are primarily singling out most breads, rice, pasta and potatoes, as well as all the chips, cereals and other snack products made from these foods. Unfortunately, starchy carbs include a multitude of tempting foods that constitute nearly all of our snack options. If you doubt this, walk into any roadside convenience store when you stop for gas on a trip, and try to find a snack that does not contain refined wheat, rice, corn, or sugars. You will be left mainly with beef jerky, nuts, and maybe some fresh fruit. And that’s to say nothing of restaurants where the primary menu ingredients are pasta, bread or rice.
The traditional approach to diabetes care relies on a balanced diet that includes a limited amount of carbohydrates (about 250 grams a day). This approach urges diabetic patients to limit their carbs to healthy, unprocessed foods, like whole grains, vegetables and fresh fruits.
There is an entirely different school of thought in diabetes treatment that suggests limiting carbohydrates much more drastically to about 50 grams per day, and replacing those foods primarily with fats, even saturated fats. Several studies have documented very significant blood glucose reductions and even a reduced need for medications for Type 2 diabetes with a so-called “LCHF” (low carb high fat) approach. This approach has some similarities to a very strict Keto diet. For diabetes alone, there is research to support its great effectiveness in controlling blood glucose. This approach does have its proponents, though it hasn’t found widespread mainstream support as of yet.
The issue with an LCHF diet is that those carbs have to be replaced with something, and the name says it all: high fat. These plans typically allow saturated fat foods, like cheese, bacon, meats with saturated fat, butter, heavy cream, and other high fat products. Coconut oil and cream, which are particularly high in saturated fat, are included in many recipes. If we knew that these foods were healthy for heart patients, we would embrace it and recommend it enthusiastically, because those foods are delicious!
So, what is a diabetic heart patient to do? As far as we can determine, the appropriateness of a LCHF diet for heart patients is less clear. There is support from a few cardiologists here and there that can be found online, but others express caution. For many years, it was believed that saturated fat was the major contributor to heart disease. Research in more recent years has suggested that refined carbs (the sugars and starchy carbs we were just talking about) might be much more of a factor in heart disease than saturated fat is, but we personally approach saturated fat with great caution, especially since traditional heart patient advice still warns patients to limit it.
Are we leaving you with more questions than answers? Here are some action steps we suggest:
- Talk to your doctors (probably both cardiologist and primary care physician, or other diabetes health professional) about their recommended limits for your carb intake, particularly in light of the dual conditions of diabetes and heart disease. Discuss the fact that if you remove carbs, you have to replace them with something. At the very least, perhaps your new strategies can at least minimize the impact of the most unhealthy, starchy, refined carbs in your daily life.
- Expand your resources to include more information on the LCHF approach to Type 2 diabetes, and continue to discuss these with both your diabetes and heart doctors.
- To the extent that you do choose to follow a more traditional approach to carbs, consider relying on whole grain, high fiber, and minimally processed products as much as possible and avoid highly processed, refined carbs.
- If you include potatoes in a meal, use small portions and choose dishes and recipes that allow you to minimize sodium and saturated fat. Avoid avoid potatoes in highly processed forms.
- As much as possible, eliminate junk food and refined carbs from your daily routine. If you focus on very healthy core meals and healthy snacks, the temptation to indulge in junk will be reduced.
Our Resources page provides links to several studies and authoritative articles on these issues. We are not here to tell you which approach is best for you. We try to limit our use of grains, and trying to avoid starchy/refined carbs. This and other nutritional issues on which the professional community appears divided will be the subject of future blog posts as we learn more.