Low-Carb Diet Recommended For Diabetics

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Low-carb diet recommended for diabetics

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.

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sueOnooshRichard David FeinmanMary DexterAdele Recent comment authors
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sue
sue

my daughter was diagnosed with DT1 three weeks ago, and though we were pretty low carbs before – no sugar, occasional bread – having researched just a little, we are trying to go gluten free, sugar free and low carb – my daughter gets about 20-30g a meal, maybe 5-10g for snack. however, she is 2 and 4months and is basically living off of nuts, broccoli, eggs, avocados and chicken, with the occasional other. Being still in shock, I am going back and forth with how much carbs to include given the insulin shot before the meal. I worry she… Read more »

Onoosh
Onoosh

Thank you, Dr. Feinman, and to your colleagues on the paper, for casting a strong light on this problem. I think you’re right about the “stubbornness of the medical establishment” (and government) and the dangers that presents to both diagnosed and pre-diagnosis diabetics. Diabetics need to do their part in educating both themselves and their physicians. My poor doctor is used to me sending him, in advance of my visits, information he has probably just not had time to look for, or leisure to read—until I pressured him—which have made him say more than once “I didn’t know that!” I… Read more »

Richard David Feinman

I was the lead author on the paper that you cite. I am grateful for your calling attention to our work. I think, in the end, your compelling description of the problem is the kind of thing that will over-power the stubbornness of the medical establishment. I think that you have a right to ask for an explanation and you can write to the ADA and ask why your experience is so out of line with their position. Let us know what they say.

Mary Dexter
Mary Dexter

Dr. Frederick Allen’s Starvation Diet was low-carb, high protein. Then Joslin was worried the fat and protein might contribute to kidney failure, heart attacks and stroke. For years, the ADA advocated a high-carb, low fat diet.  Only recently, have they modified that position.  Dr. Bernstein’s diet is too extreme for me to follow.  I would have to give up cooking for and eating with my family, which would affect my mental health and my support system.  I average somewhere between 35-60g/meal, which is high according to Bernstein, but a tiny fraction of what others are eating when I venture out of my home.

Onoosh
Onoosh

Adele: No, that DOESN’T make any sense…but corresponds to the experience I had in the hospital when I had cervical disc surgery last year. I had HAD the conversation with the dietician prior to admission, had made it clear that I was both a Type 1diabetic and a vegetarian (not vegan), it was IN my chart…and what do they bring me right after the surgery, when the incision in my throat was very raw anyway? A heaping plate of huge chunks of fruit, which would probably have measured out (conservatively) at maybe 500 carbs. ???? Fortunately (I suppose) since I… Read more »

Adele
Adele

So nice to hear others in the diabetic community that think as we do. Our 8-year old’s meals are typically UNDER 45 Cho, while the recommendation from doctors and nutritionists is 45-60. We also questioned why in the hospital as he was being diagnosed with Type 1, he was being given tater tots for breakfast and graham crackers for snacks. Didn’t exactly make sense then and certainly doesn’t make sense now.

Onoosh
Onoosh

P.S.: Best wishes to all if you who are fighting your own, or a family member’s, good fight!

Onoosh
Onoosh

Yes, Kerry! I think you’ve hit the nail right on the head! Thinking of carbs like they were any other allergen is an excellent way of addressing the problem. We wouldn’t be in denial, whining about what we couldn’t eat, if the culprit were shellfish, or chocolate, or peanuts, or anything else that caused severe, if perhaps more immediately noticeable, adverse reactions: we just wouldn’t ingest the offender. Gluten gets a lot of press, but not carbs for diabetics, even though high blood sugars–mine fluctuate in direct relation to carbs–can cause neuropathies, amputations, vision loss, and a host of other… Read more »

Lori Leigh
Lori Leigh

After being diagnosed with Type 2 in June 2010 I have been on a low carb diet. My A1c went from 6.3 to 5.4 and has stabilized there. I credit my success with having the good fortune of finding Jenny Ruhl’s website: Blood Sugar 101. She spells it out clearly and backs up her information with scientific studies. The only time I need to take Metformin is when I’m sick with a cold or flu and just can’t get my numbers down.

Ahmed

It is a huge business and closed circle ..if u eat low carb then there is no cereal, bread, baked goods and then u will reduce almost more than half of insulin ….it is a mafia kind of thing i guess

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