Very-Low-Carbohydrate Diet vs. Oral Diabetes Medication
Although having tight control (A1c <6%) is considered dangerous by many diabetes specialists because it suggests frequent low blood glucose levels, it’s evident that anyone taking medications which cause the pancreas to secrete insulin is at risk for hypoglycemia as well. (For the record, I think having a lower A1c is good, provided it’s not due to frequent lows). According to Dr. Kasia Lipska, an endocrinologist at Yale Medical Center, “It’s important to note that it’s not the HbA1c that directly causes hypoglycemia; it’s the therapies we use to lower it.” Exactly.
Insulin-stimulating medications cause unpredictable blood glucose response in several ways. Typically prescribed to be taken twice a day at meals in fixed dosages, they are unable to make the pancreas produce the precise amount of insulin needed to cover the carbohydrate ingested at a meal, nor do they start working at exactly the right time to match the digestion of carbohydrate. In the poorly controlled overweight person with diabetes, taking this type of medication practically guarantees at least occasional episodes of low blood sugar leading to overtreating with juice, soda, or candy, resulting in hyperglycemia and weight gain. It also places a burden on the beta cells of the pancreas by causing them to secrete large amounts of insulin, thereby increasing progression of the disease. Precisely the problems diabetes management is supposed to avoid.
I feel that carbohydrate restriction should be offered as an alternative to taking these types of medications, and I outline the basis for why this way of eating is ideal for diabetes management in my recent Answers.com article. I have heard about or spoken with many people — including Type 2 bloggers Dan Brown, Steve Cooksey, and Eddie Mitchell, as well as Dr. Jay Wortman — who have been able to stop their insulin-stimulating diabetes meds and improve their blood glucose control by following a very-low-carbohydrate ketogenic diet (VLCKD). In most cases, those who adopt a VLCKD require only metformin, an insulin sensitizer that does not place a person at risk for hypoglycemic events.
The message given by many of my fellow dietitians and CDEs is, “You can eat the same foods everyone else does as long as you take your diabetes medication.” I don’t feel comfortable naming names, but the vast majority of articles by RDs and CDEs that I’ve read advise individuals with diabetes to eat low-fat, high-carb meals and snacks and take whatever meds are needed to keep blood glucose in check. I realize many people may not want to change their eating habits, and that is of course their choice. But I think they should be told about the risks of these medications, including the strong likelihood that they will periodically experience low blood sugar when taking them. Some will want to assume the risk, but others may be interested in an alternative way of eating that involves less medication and no risk of low blood sugar. Every patient I talk to who has ever experienced severe hypoglycemia would prefer to avoid it all costs.
I’m not saying that there isn’t a need for diabetes medication in some people. People with Type 1 diabetes obviously require long-acting and mealtime insulin, although considerably less of the latter when on a carbohydrate-restricted diet (Hypoglycemia is also minimized with this approach). Those with Type 2 who adopt a VLCKD may only need metformin and possibly a long-acting insulin, depending on how much beta cell function they have remaining. Dr. William Yancy and Dr. Eric Westman have demonstrated that insulin and oral diabetes medications can be reduced and in some cases eliminated in people following a VLCKD, and that blood sugar control improves across the board with this method. Why not encourage and support those who are interested in trying it?
References:
1. Kaiser Permanente. Severe low blood sugar occurs often in patients with Type 2 diabetes. Science Daily. July 30, 2013.
2. Westman EC, et al.A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab 2:34, 2005
3. Yancy WS, et al. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab 5:36, 2008.
Loved it. Beautiful piece that I will promote. Next, how about a piece on the dangers of excess insulin caused by the meds. Dr. Ron Rosedale believes that high insulin is worse than high blood sugar. I would love to talk to you about it.
Thanks so much, Andre! Agree 100% that hyperinsulinemia is extremely dangerous for overall health, particularly cardiovascular. Thanks for the idea for a future post. I’d be happy to talk to you about this, and truly appreciate your support.
Hi Franziska, yet again a stunning article and as always you hit the nail firmly on the head. So many myths and lies surround and are perpetuated about the lowcarb lifestyle. So many type two diabetes medications are not only useless, they actually cause far more harm than good. Big pharma so often proudly boasts about HbA1c reductions that are pitiful, and most they tell us can reduce HbA1c by less than two full points, but some, only when used with Metformin. A cheap well proven drug that can reduce HbA1c by 1.5 points. Can there be a more ludicrous scenario ? A patient can increase the risk grim complications such as heart attack and stomach cancer for a reduction in HbA1c of an extra half a point. This was proved with now banned drugs such as Avandia and Actos. Other high selling type two diabetes medications are under the FDA spotlight for suspected serious side effects. The terribly sad fact about these drugs is they are not only expensive, for many highly dangerous, and do nothing to improve long term outcomes for most diabetics. There are over two hundred type two diabetes drugs in the pipe line, most will be useless, many will be highly dangerous and some will no doubt be banned. If this was my opinion it would be worthless, but this lamentable situation is a fact ! A man who also knows the facts is Allen Roses, who around ten years ago said this.
“A senior executive with Britain’s biggest drugs company has admitted that most prescription medicines do not work on most people who take them. Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK), said fewer than half of the patients prescribed some of the most expensive drugs actually derived any benefit from them. It is an open secret within the drugs industry that most of its products are ineffective in most patients but this is the first time that such a senior drugs boss has gone public.” http://www.commondreams.org/headlines03/1208-01.htm
I see no evidence the situation has improved. What Allan Roses did not say is even more important. Check out the deaths caused by pharmaceutical drugs, the numbers are grim in the extreme. Your post and link exposes another great diabetes myth. That running dangerously high blood glucose numbers will be more effective in warding off dangerous and life threatening hypoglycemia. Bad diabetes control is bad diabetes control full stop. For so many diabetics this is very often the cycle of decline and an early death. They follow the dietary advice from the NHS, ADA and most dietitians, and eat starchy foods with every meal advice. Chasing highly elevated blood glucose numbers, with ever increasing medication, becomes a full time job. It does not work and will never work.
There has never been a large well run trial on the effects of a low carb diet in the long term, there probably never will be. I believe the trial would prove the low carb lifestyle to be safe. The cost to junk food and big pharma would be monumental, certainly many $billions per year. One thing we do know, and has been proved countless times, ramming down highly elevated blood glucose numbers with multi drug regimes does not work. Steve Cooksey knows the truth and look how hard the establishment has tried to shut him up. You know the truth Franziska and I know how lucky your clients will be when you start your private practice. I know if they follow your advice they will be in safe hands. You may have battles ahead with the establishment, things could get tough, one thing is sure, your patients will be the winners.
Hello Eddie,
Thanks so much for sharing this sobering information, along with your insight. I truly appreciate your very kind words of continued support.
Hi Franziska !
Great article indeed,I’m a 37 year old Type 1 diabetic who has been following a low carb regime for around 18 months now and during this time I have reduced my A1c from 14.1% down to 5.1% eating fresh meat,vegetables,berries,nuts and dairy,I currently consume around 30 grams of carbohydrate per day and although I use insulin-I only need around 10 units a day of a Basal insulin to hold good BG levels.
My lipid panels have improved too as well as my weight and blood pressure.
Here in the UK we are battling ludicrous dietary advice for diabetics so I want to offer my sincere thanks to you as a professional for speaking out about all the benefits a low carb lifestyle.
Great blog BTW !
Best regards
Paul
Hi Paul,
Welcome, and thanks so much for sharing your incredible success story! It mirrors that of many T1s I’ve heard from, although I must say your results are even more dramatic than most. I’m so glad you’re doing so well on a VLC regimen. Thanks also for your kind and supportive words. Hearing from people like you, Eddie, and others who have experienced the benefits of carb restriction solidify my commitment to making sure this is becomes an option for all people with diabetes.
Big Pharma continues to race getting new T2 drugs to market with millions of eager potential customers & always will. No one dares say the emperor has no clothes on. Difficult beating down the behemoths of pharma & intentional widespread misinformation. Your voice of reason is greatly needed & appreciated.
I become militant repeatedly hearing eat what you want & cover with meds &/or insulin. A prescription for disaster. PWD essentially are being told be in denial about their disease.
Everyone I know following VLC has reaped benefits. As you advocate, people should be presented with a choice.
Thanks so much for your insightful comments and continued support, Gerri.
Thank you for the great post
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