Carbohydrate Restriction for T1 Diabetes: IDF “Diabetes Voice” Debate
I just learned that my piece on low-carbohydrate diets for management of T1 diabetes has been published in the International Diabetes Federation’s Diabetes Voice magazine. My pro-carbohydrate restriction article is published below, followed by my opponent’s. It’s interesting that she argues that restricting carbohydrates to less than 100 grams per day will make blood glucose control more difficult when research and the anecdotal experiences of thousands of people with T1 diabetes have demonstrated otherwise. I’m interested to hear thoughts from everyone, especially T1’s.
“My pro-carbohydrate restriction article is published below, followed by my opponent’s. It’s interesting that she argues that restricting carbohydrates to less than 100 grams per day will make blood glucose control more difficult”
Don’t tell Dr. Richard K Bernstein that, he might give you one hell of an argument. Bernstein was the first diabetic to test BG numbers at home. The inventor of the basal/bolus insulin regime and arguably the worlds foremost expert on blood glucose control. Bernstein has many detractors, as does his 30 carbs per day diet. They forget to say he has been a type one diabetic for over 60 years, and still fit, active and working at close to 80 years of age. I’m a type two, a lowcarbing type one taught me most of what I know about diabetes control. He is a Bernstein fan and after around thirty years of diabetes, is still running marathons and competing in 100 mile bike races. In the UK the standard diabetes dietary advice has failed totally. The high carb low fat diet has resulted in 93% of type one diabetics failing to get to a target HbA1c of 6.5%. Need I say more ?
Keep up your great work Eddie
Link to the NHS diabetes audit for type one HbA1c control.
https://catalogue.ic.nhs.uk/publications/clinical/diabetes/nati-diab-audi-10-11/nati-diab-audi-10-11-care-proc-rep-V4.pdf
Thanks so much for your comments, Eddie! Dr. B is definitely a pioneer in using a very-low-carb diet for management of diabetes and has had amazing success personally, with his patients, and the many people who have read his books. I was very happy to include him in this article and pleased that the editorial staff did not modify or ask me to change one word. Fantastic that you and all the others at the Low Carb Diabetic website have achieved such wonderful results with LC.
Thanks very much for the link to the NHS diabetes audit. Sobering statistics indeed.
I feel as if I fell down the rabbit hole reading pro-carb views regarding diabetes management. As a T1 doing VLC for going on five years, there’s no problem relying on gluconeogenesis. Nada, zip. There’s nothing unpredictable about eating LC for blood sugar control & I take issue with Carolyn’s statement this leads to instability. Absurd. Of course, gluconeogenesis is a slower process, but one that’s relatively easy to calculate. What’s far more unpredictable is attempting to cover high carb meals with correspondingly high insulin doses. High carb is the more frustrating option, despite her claims to the contrary. If this as straightforward as Carolyn states, “Though challenging, the required insulin dose can be estimated to achieve near normal glucose levels after a meal,” millions wouldn’t be struggling. I’d like to inform her that all insulin dosing is proactive, regardless of dietary plan. It angers me that healthcare professionals invariably assume LC is something people cannot do or maintain. LC is cloaked in patronizing negativity instead of offered as a positive, healthy option.
Thanks so much for your comments, Gerri. Greatly appreciate your excellent rebuttal. I doubt Carolyn has ever spoken with any T1s who employ carb restriction. Wish she could read your comments and those of so many other T1 low-carbers who have achieved optimal A1c’s and experience fewer hypoglycemic incidents than those eating a higher-carb diet.
Your article is great. Thank you for being the voice of reason & standing firm against the mainstream. The low fat/high carb emperor has no clothes on.
I have to admit, I was unaware of the danger of weight-gain from low-carb diets.
Wait…what?
I know, right? I get e-mail from a lot of T1s, and not unsurprisingly every single one has lost weight after adopting a VLCKD. It seems that Carolyn has a strong bias against carbohydrate restriction and erroneously believes it leads to weight gain and poor blood sugar control, which is contrary to all the research I’ve read, not to mention the personal experiences of many PWDs.
Gluconeogenesis “releasing glucose into the blood stream in a totally unpredictable manner” … huh? it seems like Carolyn equates low carb dieting with going rogue – abandoning glucometers & insulin treatment. And I’ve heard a lot of things about hepatic glucose production, but “erratic” isn’t one of them (regardless of what you’re eating). But yeah, I might agree with her final conclusion that LC is “difficult to follow” – it’s a lifestyle change, I don’t doubt that it’s difficult [in the beginning].
Thanks for your comments, Bill! I’ve heard other CDE’s make similar statements about gluconeogenesis complicating insulin dosing, but PWDs report that this isn’t problematic, as Gerri stated above. Although she’s board certified in Advanced Diabetes Management, Carolyn seems to misunderstand how Type 1’s respond to carb restriction in the real world. Of course changing to a LC diet can be difficult at first, but the payoff in improved glucometer readings and lower insulin requirements can really help with motivation. And you and I both know how satisfying a LCHF diet can be in the long run 🙂
My husband had a total pancreatectomy and autoislet transplant due to a hereditary sphincter of oddi disfunction that caused chronic pancreatits. We were mis led by uninformed or diabetic councelors who hadn’t been updated or taught other methods. We decided to try an atkins diet type change and slowly removed carbs until we had him at a constant in range bg reading. We found at 30carbs per meal (eats every 2hrs) that he has great control. For several reasons we have left several endocrinology practices and have had so much bg problems trying to follow yhier methods. We once again revert to our own method and bgs normalized. (He’s also had an unrelated massive stroke-family coronary artery disease)and has a sedentary lifestyle. We obviously would have to increase carbs upon his activity level. Carb restriction is the only way we have been able to manage his diabetes. He also takes lantus and if needed , when he has a treat; he has humalog on a carb counting method.
Thank you so much for sharing your husband’s experience, Celeste. Glad you’ve found a method of carb restriction that works for you. So sorry you’ve had difficulty with endocrinologists and that he’s had to deal with several setbacks. I hope better days for him lie ahead.
Congratulations again, Franziska!
Published in an international diabetes journal, as an expert on equal standing, and without editing. You, and all of us who share your beliefs and passions, have taken another giant step forward. And they (the editors) say that this will be the first in a series. I would say that is a strong foothold, or beachhead, as we approach D-day.
PS: I think your opponents piece is confusing to read. It perhaps refelects as much her confused thinking as her frustration. I don’t mean this to sound mean. It’s just an observation of my takeaway from trying to understand the reasoning of her argument.
Thank you very much, Dan!
I was so flattered and honored when the IDF editor contacted me about debating the benefits of carb-restriction for T1 as an “expert” on the topic. I hope it gets people talking! Definitely a big step forward, yes 🙂
Agree that Carolyn’s remarks are confusing. In a way, I wish this had been a true debate, where we would respond and counter each other’s arguments with our own. Neither of us saw the other’s piece until yesterday, when we received a PDF of the next issue.
Carolyn says “A number of tissues—mainly the brain, red blood cells and nerves – depend solely on glucose as fuel.” This is one of the main arguments frequently quoted by the high carb advocates. Low carb advocates claim the brain is quite happy using ketones as fuel. Do you know if this has been studied? Anecdotally my brain functions much better since I switched to a low carb diet (30 to 50 grams) in response to T2 high blood sugars, which caused a brain fog.
I find it interesting that you are able to quote studies and actual experience while Carolyn argues from a more theoretical viewpoint that low carb causes unpredictable blood sugar levels without any supporting evidence.
I often feel I’ve fallen down a rabbit hole when reading the arguments of the eat high carb or die crowd. Thanks for the breathe of fresh air your well reasoned and scientifically based articles provide.
Thanks for your comments, Tim! There is some research on ketogenic diets and mood, although some indicate that the effect is short-lived. I like this one, which compared a VLCKD with a LF diet:
http://onlinelibrary.wiley.com/doi/10.1038/oby.2007.516/full
Thank you for your kind words and continued support, Tim. Greatly appreciated 🙂
You did a great job of presenting the case for Type 1 diabetics using low carb as a nutritionally reasonable tactic to control blood glucose without compromising their health. I only wish there was a way for people like Carolyn could see and feel first-hand the the consequence of following their recommendations.
From my perspective as a T1D, when I experience the moment to moment benefits of feeling energetic, alert, and relieved of the hypo and hyper-glycemic roller-coaster that a low carb diet gives me, I know which argument persuades me. Your activism on this topic generates hope that the tide may have turned and doctors and dietitions in the not-too-distant future will see low carb as another legitimate option to keep BGs in range and promote health. Thank-you!
Thanks so much for your kind words and sharing your perspective as a T1 following a carbohydrate-restricted diet. I’m disappointed that many doctors, nurses, and dietitians who specialize in diabetes management discount the positive reports by their patients who choose a LC way of eating and instead encourage them to eat more carbs with arguments like Carolyn made above. But, like you, I’m really hoping this changes soon, and I’ll continue writing articles, doing interviews, and speaking out on my blog until it does! 🙂
Ms. Robertson makes an error in her second sentence when she implies that the brain is solely dependent on circulating blood glucose as an energy source. The brain can utilize systemic lactate, for example (reference: http://www.ncbi.nlm.nih.gov/pubmed/19337275). As you mentioned, Franziska, ketone bodies can also be used by the brain as an energy source (ref: http://cdn.intechopen.com/pdfs/32399/InTech-Brain_energy_metabolism_in_health_and_disease.pdf.)
Yes, glucose is an essential energy source for the brain. But it’s not the SOLE source. Admittedly, if your blood sugar drops to 10-20 mg/dl, you will lose consciousness; if it stays there long enough, you’ll get brain damage and die.
FWIW, I was on a ketogenic diet (30 g of carb/day) for four months with little difficulty. My muscles didn’t waste away to provide bloodstream glucose via gluconeogenesis. (I don’t have diabetes.)
So she got off on the wrong foot with me.
Her other major point is that the body’s production of blood sugar is highly erratic and unpredictable in the setting of very-low-carb eating. I have not found that to be the case in clinical settings. I’m not familiar with that idea in a purely research setting either.
Good job, Franziska.
-Steve
Thanks so much for your feedback, Steve. It seems that many CDEs don’t even consider that lactate and ketones can safely be used as an energy source by the brain, even people with T1 diabetes. It’s 130 grams carbohydrate minimum, period. I’ve rarely heard of VLC causing issues with glycemic control; in fact, people usually report just the opposite, including the PWDs who’ve responded here.
My son has type 1 diabetes , aged 13. We all eat a low carb diet. No processed food. Only my cooking. I can make almost anything low carb: cookies, cakes, waffles, brownies, pasta from zucchini, rice from cauliflower, cheesecake, chocolate mousse. It is so delicious, and best of all
tasty because it contains healthy fats.
HIS BG’S are always normal if he eats my cooking, His HbA1c is 5.5, and apparently the ONLY patient his paediatrician has with these numbers. He also exercises regularly and spends time in the sun to synthesise vitamin D. I research every week about true nutrition and physiology. The health benefits from eating low carb are substantial and it is honestly very easy to keep my son healthy this way. And yes, I was told NOT to put my son on a low carb diet by his diabetes educator. BUt, as a mother, I will do what every I can to stop my child from developing diabetic complications, and I believe I have found the “magic secret” to diabetes control, except that it is not magic and it is just so simple.
Hello Suzy,
Thank you so much for sharing your son’s experience. It’s always encouraging to hear Type 1 low carb success stories. He has a fantastic A1c, particularly for a young teen. I’m so glad you investigated the benefits of carb restriction and decided to implement this way of eating rather than following the diabetes educator’s advice. Thank you again, and best of luck to you and your family.