A couple of months ago, a study in the journal Nutrition caught my eye. Titled “Low-carb diet recommended for diabetics,” the study laid out twelve pieces of evidence for why reducing carbs should be the first line of defense for all diabetics, potentially allowing people with type 2 to drop all diabetes medications, and those with type 1 to limit the amount of insulin they take and limit their episodes of high blood sugar. As one of the study’s authors explained to Science Daily:
“Diabetes is a disease of carbohydrate intolerance. Reducing carbohydrates is the obvious treatment. It was the standard approach before insulin was discovered and is, in fact, practiced with good results in many institutions. The resistance of government and private health agencies is very hard to understand.”
I’ve been seeing digital displays of how Bisi reacts to carbs for more than two years now, so this study comes as no surprise to me. When we cook at home and eat in a low-carb way (maybe a turkey cheeseburger with mushrooms and kale for dinner, along with a moderate treat for dessert like frozen blueberries and cream, or a small yogurt popsicle), Bisi’s blood sugar stays in range and is easy to manage. When she goes to a friend’s birthday party and has pizza and cake, we (or the parents who, in a real act of friendship, have miraculously agreed to let her sleep over) are up at least twice that night correcting her blood sugar, and trying to bring it down. When eating these high-carb meals, she is also at greater risk of scary lows, because she’s taking larger amounts of insulin, and, as any parent of someone with diabetes knows, it’s not always easy to get the timing of the dose or the calculation of the carbs exactly right. (I still get a pit in my stomach when I think of the party where I made the big mistake of saying that Bisi should take her insulin for dinner and dessert all at once. By the time all the kids finished decorating their cupcakes, Bisi’s vision had gone blurry and her glucose level was 55 and dropping.)
But, even though the study’s low-carb recommendation makes total sense, it’s completely different from what we were taught in the hospital when Bisi was diagnosed. And what we were taught when visiting nutritionists afterwards. And what we see when we go to events for people with diabetes, where the food usually includes chips, fries, and ice cream (at one event, there were even mashed potato martinis—wrong on many levels). I dug up Bisi’s discharge plan from the hospital, and it recommended that for every meal she have between 45-60 carbs (about the carbs in one large bagel or a cup of rice), and for every snack up to 30 carbs. By contrast, type 1 diabetes pioneer and low-carb guru Dr. Richard Bernstein (one of the co-authors of the Nutrition study) recommends that his patients follow a plan where they eat a total of 30 carbs a day, with the goal of a constant blood sugar of 83. In at least one group on Facebook, parents work together and give tips on how to help their children with type 1 eat well while following a low-carb diet and maintaining an A1C at or near the normal range (A1C is a measure of your average blood sugar over a 3 month period; normal is between 4-5.6%; the American Diabetes Association’s target for children Bisi’s age is 7.5% or below. 4% translates to an average glucose level of 68; 5.6% to 114; 7.5% is an average of 169—a significant difference, and not a healthy blood sugar level over the long term.) As the authors write in the study: “Current knowledge dictates that carbohydrate restriction should be a default treatment for type 2 diabetes and a default adjunct therapy for type 1. Given the superior outcomes of carbohydrate-restricted diets, patients should not be discouraged from adhering to them as is frequently observed. They should, in fact, be encouraged to follow this approach.”
So why isn’t the low-carb approach consistently taught to patients upon diagnosis? Why isn’t it being advocated by nutritionists (at least the three we have met with)? Mark and I had to figure it out for ourselves (helped along by communities we found on the Web). We certainly don’t succeed in getting Bisi to eat low-carb all the time, but it’s a goal we’re working toward, and one we hope she’ll internalize as she grows up and makes her own decisions about what she’s going to eat—and how she’s going to manage this condition.