A low-carb discussion without the emotional noise ***Update*** with video link

Food
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Here's the link to the video discussed below. Several people expressed an interest in viewing it and it just posted yesterday, 10-3-13.

I just finished watching Franziska Spritzler, the Low Carb Dietitian, participate in the weekly TuD video chat. What a breath of fresh air! She was informative, non-judgemental, empathic, and has also shared some personal BG challenges with us. Her expressive face added an extra channel of bandwidth!

I can't remember any post here about using a low-carb diet that was not marred by at least some emotional discontent. Many people, including me, have discovered the benefits of using low-carb as an effective tactic to control BGs, yet our enthusiasm seems to elicit a predictable backlash.

It's probably just human nature. I know when I hear someone who is very excited and enthusiastic about something, I often get skeptical. Some personalities just work that way.

Franziska seems to genuinely convey that she simply wants what's best for each diabetic. She said that if you can eat a higher carb diet and you get good BG results and it fits in your life, then by all means go for it. She also says that she's aware of many diabetics who use low-carb with great success.

I guess it was nice for me hearing Franziska because her training as a registered dietitian naturally elevates her as an "expert" in our eyes. More important than that, though, is that she has struggled with her own BG issues and found low-carb to be an effective tool to return her to good health. (This session is the opposite of the Gary Scheiner video last spring when he panned low-carb eating and caused a stir here.)

It was a very good and enjoyable video. I highly recommend viewing it when it posts sometime early next week (9/30/13 through 10/4/13).

For those who watched the Low Carb Dietitian's video chat, what did you think?

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I too enjoyed it Terry. This is a part of an email I sent to my CDE. "It would seem to me that especially for diabetics the dietary emphasis should be on consuming the smallest amount of carbohydrates as possible, and those should be the more complex ones. Unfortunately that is not the advice I have been given. Heck learning how to carb count enables me to eat virtually anything I want provided I take enough insulin to cover it. The more I read the more disillusioned I become." Here is what my CDE said about a low carb diet. "Yes that is why I consider diabetes to be a form of heart disease. The CRP inflammatory marker is very often elevated in people who have diabetes or heart disease. Carb counting improves the way you "cover" the carbs ingested but the meal plan as we teach it is to a heart healthy one. You are looking at complex carbs as well as the fat intake. To do one without the other would be a disservice to your cardiovascular health. So I usually say to people to look at your meal and if a person with heart disease shouldn't it eat then either should you. This is why we have an epidemic of obesity type 2 diabetes and metabolic syndrome including hypercholesterolemia and hypertension. So consider your meal plan a heart healthy one with good fats and saturated fats less than 7% of it. And keep carbs under 45 gm/ meal so there isn't excess that gets stored as fat."
This is the only time anyone has said a word about how many carbs/meal I should eat. While 45 per meal would be 135 a day, I keep it lower than that at around 100 per day, which works for me. D, Diets, and Low Carb/High Carbs will always create a firestorm of debate. What works for one doesn't work for another. But that is no different than any other topic we discuss here, whether it's this pump is better than that pump, this insulin is faster, better, cheaper..... In the long run (and let's be honest, D is a marathon not a sprint), find what works for you and stick with it. It's nice on TuD that there is a forum to discuss stuff like this and a place to learn and teach.

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It's confusing to me when doctors and other medical professionals use terms like "a heart healthy diet." I consider that a diet with high fats, medium protein, and low carbs. And not one low in saturated fats! As your CDE advises, limit saturated fats to < 7% of calories.

I don't think that fats, including saturated fats are to blame when it comes to heart disease. As Franziska said, it's the combination of high carb and high fat that constitute a diet bad for your heart. I'm amazed that the medical and nutritional establishment has only focused on fats and let high carbs completely off the hook!

I see progress when any medical professional recommends a daily diet with carbs limited to only 135/day. That's down from the 300/day @ 60% of 2000 calories. There probably are diabetics that can consume 135 carbs/day and really benefit. Unfortunately, the 45 grams/meal advice is often followed up with adding at least a few 25 gram snacks.

Most mainstream nutrition advice also recommends "good fats." What does that mean??? I'm pretty sure they're not thinking about butter, coconut oil, and bacon fat (it is pork!). What they probably have in mind are the inflammatory omega-6 seed-oil fats like safflower, sunflower, and canola oils.

I'm not a diabetic that can manage good BGs on 135 grams carbs/day, however. I would respect the medico advice if it was phrased along the lines that each person needs to find their daily carb threshold that will balance good BG control with lifestyle wishes. Instead most of them just feed our unhealthy desire to carb-out and chase it with insulin.

You're right about the firestorm of debate that often ensues any low-carb discussion. People can be very sensitive about their way of eating, me included!

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There's always emotional noise in these threads. Civilization/ Culture is totally carb oriented. I'm horrible in that I've read some of the low carb "manuals" and tried it out and agree it works but can't be bothered committing to it. I do lower carb a couple days/ week (I had a 33G day recently, I had some meat lying around or something...) and it works great but I don't have a breakdown and seem to be able to do OK with higher "doses" of carbs either. I loathe saying "I can't eat a burrito" because I'm pretty sure I can blast away at one but I have to run for a week to burn it off and don't bother.

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"I consider diabetes to be a form of heart disease" I have never heard anyone say that- I find it kind of odd since many people have cvd and no diabetes and many pwd have no cvd.

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Hi Terry,

I will watch this, it sounds interesting, thanks for posting this. My view on low carb: I was told to do that by my former gp. The hospital then tried to overdose me on carbs and I thought, are these people trying to kill me? lol. I thought they were crazy, they also didn't want to give me any insulin for meals until I was 140!

I agree, we should all just do what works for us, although I do think carb restriction should be suggested to pwd as a good option for part of your treatment. If you can do higher carb and your bg is ok that is great. If not, then try low carb.

For me I feel since I'm so insulin sensitive a lot of the time I don't want to start taking large doses to try to control more carbs all the time and I don't think I can do enough exercise to help out due to chronic pain and not being a marathoner etc. And I saw what the carbs did to my bg so that was what made me go lower.

I do miss the carbs though a lot at times.. and I plan to make a low carb birthday cake this year. Hopefully it will be good :)

I'm going to forward that link to a friend whose brother was just diagnosed type 2- he has had cvd for a long time also, so I think that diet will help both if he can do it.

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AR - The reason I started this thread was to draw attention to the video chat today featuring Franziska Spritzler. The way she handled the issue was very sensitive. She said at one point that she held no judgment as to what level of carb consumption a diabetic chooses.

She seems totally on our side and supports our struggle with this disease. She only thinks that its fair that a spectrum of choices be available to us and that low carb be one of those choices. The medical community's general reluctance (there are exceptions) to support low carb has hurt us. I wasn't even aware of low carb as a BG control tactic until I started showing up here. I had been seeing an endocrinologist four times a year for decades. Never once did one of them take a minute to let me know that carb restriction might benefit me.

I was impressed with how she handled herself on a topic that often produces friction here. If you have the time to view the video, I believe it would be worthwhile.

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Franziska cited a Swedish study where the hypo incidents were reduced by a large percentage, like 85%, in the study arm that limited their daily carb amount to about 75 grams. The safety aspect alone makes a low carb way of eating attractive to anyone that needs insulin to live.

It's interesting that your GP recommended low carb to you. I guess the word is getting out.

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Well let's see. Would I rather participate in a video chat with Scheiner, the author of four diabetes books including one of the most helpful diabetes books written (Think Like a Pancreas), who runs a consulting group designed to help diabetics, and who is a fellow T1 for 30 years who knows first hand what it is like to manage this disease?

Or would I rather participate in a video chat with Spritzler, who has never had diabetes (though she seems not to admit that) and whose training was as a court reporter before becoming a dietitian? And whose dietary advice pages all contain a disclaimer stating that you really shouldn't try anything she recommends. Particularly now that she has gone from preaching what I consider a reasonable approach to diet similar to what Clare was given HERE to jumping off the deep end with Bernstein and the other nutcakes HERE

I guess you know what my answer is. And no, I didn't watch the video chat (and I won't be able to until it posts), so maybe she came off as much more reasonable than she appears to be in her more recent blog posts. I hope so.

p.s. The only reason the Scheiner video caused "quite a stir" isn't that he said anything wrong or that he raised any emotional noise - it's that the low-carb community here doesn't like anyone questioning their strict ultra-low-carb or nothing point of view. At least that's the way I see it.

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Yes meee it struck me as kind of a strange comment too, but it was in response to an article I had sent to my CDE http://www.sott.net/article/242516-Heart-surgeon-speaks-out-on-what-really-causes-heart-disease
This made perfect sense to me, inflammation caused by blood sugar swings contributes to heart disease. What I copied was her response to my email.

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yes I agree it does make sense in a way, but I don't think cvd/inflammation is the cause of beta cell attack in type 1 probably?

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No it doesn't have any impact on T1 beta cell destruction, but after that has happened, the blood sugar swings can create cdv problems.

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Thank you for your reply.

I don't see Fanziska Spritzler's position of choices along the carb spectrum as "jumping off the deep end." She said today that she fully supports whatever works for her diabetic patients.

The thing that irritated some here about Gary Scheiner's video chat was his dismissing the low carb way of eating as not viable. He said, if I remember correctly, that he felt the brain required a minimum level of glucose that could only be provided by a minimum level of carb consumption.

I respect Gary Scheiner and have read his books. In fact, I hired him to help me last year. His advice produced good results that I enjoy to this day. I do disagree with his take on low carb as a sustainable viable tactic to control BGs.
But that's OK.

I consume about 50-75 grams of carbs/day but I don't consider the people who limit their carb intake to 30 grams/day as extreme. Nor do I consider a diabetic that can eat 300 grams or carbs/day and still control their BGs as extreme. What I would call them is lucky; I would love to have that freedom in my diet. We each have to take care of our health as best as we see fit.

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yes I know that, so in type 1 I think it doesn't make sense to say diabetes is a form of cvd.. or in type 2 either prolly I think it is the other way round, the diabetes causes the cvd maybe.. although it could be some reverse effect in some cases for all we know.

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"We each have to take care of our health as best as we see fit."

I agree, and I also think we should refrain from calling people who promote lo carb quacks and nutcakes etc. If you don't want to eat low carb, and you can manage your bg well with higher carb, just say no to low carb, it's pretty simple. I would consider them lucky too, wish I could eat more carbs per day and per meal, but since my bg can go to 250 from 15-20g juice I don't think it would be a great idea for me

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That is good... I do still have too many lows but I was having them whatever my carb content was, but I think I would be much worse on higher doses of insulin. Some of them may be from my own insulin production at times still.
He told me to just eat protein, raw veggies and some fruit, unfortunately I was in dka already at that time. And he was the one who told me about Dr. Bernstein, but he was confused about the whole basal bolus meanings. I don't think he is the norm though, because my endo didn't seem to know about him- My endo didn't say anything about my diet, just that D didn't mean I can't ever have a piece of cake etc.

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"As Franziska said, it's the combination of high carb and high fat that constitute a diet bad for your heart." I am pleasantly surprised to see a registered dietician thinking outside of her training as a dietician. You get enough clinical studies and enough doctors whose education in diabetes is more than a few minutes one day in the 3rd year of medical school, then we might see some change in the common attitudes against low carbing.

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I had already heard about this before having or knowing I had D and I sort of thought it was the mainstream thought, but have now learned it isn't maybe? I guess it depends who you're talking to.

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I am hopeful that Franziska's reasoned take on this represents the leading edge of a significant shift in mainstream medicine's thought on nutrition, diabetes, and heart disease.

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Terry---Jag likes stir things up and that's okay. He often offers more than that.

However, I have never found this site to have some kind of Nazi-like lo-carb element. Mostly, folks here say---whatever helps you do well, do it. Though most of us say you need to re-shape your life around analyzing your carb-intake in relation to your BG #s at least until you do figure out what works for you.

I do Bernstein's approach and it has kept me off meds as a T2 for over 7 years, though I never expect that to last. I would never say anybody else needs to do that....Eat to your meter is my mantra...

Now I will go listen to the interview and check back in tomorrow...Blessings on us all...