A doctor has finally come out and made the case for addressing diabetes through a low-carb diet. I say it’s about time, but apparently she’s getting shit for it.

This is something I’ve been thinking about for years. I’m not a diabetic (yet), but the risk factors are certainly there in my family. My personal interest started in the 90s when I was trying to lose weight and got the American Diabetes Association materials from my doctor. I tried it, but the intense combination of calorie restriction and blood sugar spikes (from all the bread and sweet fruit) meant I was constantly hungry and would nearly pass out at the gym from low blood sugar.

Then when I started doing the research on low-carb diets around 2000, I at some point had the epiphany–if this diet suppresses blood sugar spikes (at the time this was a question, but in the intervening years more science has been done to back it up), why the hell aren’t they using it for diabetics? There are, in fact, some secondary health issues in play, but if you’re mainly addressing poisonously high blood sugar levels with potentially dangerous insulin injections it seems like keeping blood sugar spikes to a minimum might be a good idea.

I think the initial popularity and media over-simplification of the Atkins Diet contributed to the low-carb equals high-fat reputation (such that many people automatically equate low-carb with greater heart disease risk), but in reality it’s possible to take a more reasonable approach. When I’m serious about it, I usually follow something between South Beach and Atkins–a high-protein, moderate-fat, “good carbs” approach. I have no interest in fruit, and I’ve trained myself to distrust anything that’s available in white (principally bread, rice and potatoes*). For me, what remains in terms of dietary staples is a lot of chicken and eggs (skewing as much as possible toward the whites), some beef, occasional fish, with spinach, green beans and asparagus as the main greenery. Lesser amounts of squash, mushrooms, tomatoes and bell peppers hopefully fill in the antioxidant gaps. My pet avoidance, and where I diverge with what many people think of when they think “low-carb,” is cured meats. Even though it’s technically allowed under Atkins, I try to stay away from bacon, sausage and the entire deli case. I’d like to cut the beef too, but for the sake of expedience and variety, it sticks around. Of course there are also items like cheese, sour cream and salsa used in reasonable amounts for flavor and texture. But we are most definitely not talking about a recipe for a heart attack here.

Here’s the thing: done properly, you’re not consuming any more meat or fat than you would regularly (that is, on anything but the ADA diet, which is skewed toward starches). As this article states, many people actually eat more vegetables on a low-carb diet (it’s amazing how much spinach you can consume once you’ve made it a staple and not a garnish). So here’s my question: if you’re a type-2 diabetic, or especially someone at risk, why wouldn’t you try low carb as a first line of defense? I guess for the same reason that if you’re diagnosed with high blood pressure you don’t “just” lose 50 pounds—it’s hard, a lot harder than taking a pill (or an injection? That’s, maybe, a weightier choice).

I’m not willing to knock the medial establishment too hard on this one. Statistically speaking, insulin injection is probably the solution for most people. Most people, even if their life is threatened, are going to be overweight and are not going to have the discipline to control their diet 100% of the time. On the other hand, the reason these are forgone conclusions could very well be the primacy of white foods. Processed starches are the true evil here. They’re quite literally what the American diet is based on (look at the pyramid), partly due to overwhelming availability and cost efficiency, party because we’re told they’re good for us (what has a more wholesome image than white bread?). I think it’s here that maybe doctors and the nutritional establishment start to become culpable. Shouldn’t they at least be trying to get the “white food = bad” message out? I don’t know. Maybe it’s the New York problem—ban the trans fat and where are you sending people, back to lard? Ban bread, rice and potatoes and do people make a beeline for triple meat patties with bacon and cheese? I’m not willing to kid myself about the average American‘s interest in spinach, green beans and squash (and if you won’t eat these thing, then yes, a low-carb diet might kill you). But then again the average American is 50 pounds overweight, has high blood pressure, is at risk for diabetes and takes 3.7 pills per day just to maintain their current poor level of health. I just made those numbers up, but I’m sure it’s close, or wildly worse. So maybe a heightened level of interest in shifting the dietary spectrum toward green from stark, starchy, comforting, processed white is in order.

* There’s another white food worth mentioning: milk. Having consumed my own weight per month of the luscious white stuff as a kid, it’s hard to come down too hard on it. But as an adult I find it doesn’t agree with me. From a low-carb perspective, lactose isn’t the worst of the carbs, but it’s not great either. On the other hand, most lactose-free milk is just disgustingly sweet. Here in Austin, at least, we have a really good option: HEB’s Mootopia—a lactose-free, high-protein, low-carb milk that actually tastes like milk. Yum!