Should the Bee Suck Honey or Lard?: That is the question

Of all the nonpharmacologic endeavors available to diabetic patients to mitigate the complications of diabetes, none has as profound an effect as nutritional manipulation. There has, however, continued to be a great CHO versus fat controversy. The Papyrus Ebers, written around 1500 BC, advocated a high-CHO diet consisting of wheat grains, fruit, and sweet beer ‘to drive away the passing of too much urine.’ Araetus the Cappadocian coined the term diabetes (to flow through), and prescribed starches, fruit, and sweet wines (1). These sentiments were echoed by the ADA in their consensus statement Nutritional Recommendations and Principles for Individuals with Diabetes Mellitus (2), first published in 1986. This statement recommended liberalizing CHO intake, not so much to replace the lost CHO, but to fill the void derived from a restriction in protein intake, to protect the kidney, and to reduce total fat intake to reduce morbidity and mortality from macrovascular disease. The recommendations of ADA were extremely similar to those being promoted by the AHA and the American Cancer Association, which are concerned with the possible relationship between fat intake, heart disease, and bowel and breast cancer. Other researchers, however, disagree with the liberalization of CHO intake. They argue that a high-CHO intake might worsen glycemic control, and suggest that a high-fat diet is much more palatable to the American public than a high-CHO diet. There is no doubt that meals for ‘fat teeth’ will always suit the hedonistic tendencies of our population. Nonetheless, considerable recent evidence strongly supports the 30% dietary-fat guideline recommended by ADA.