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

Food
21

I am just so happy to have Franziska around. I get so many messages from so called "experts" telling me that carb restriction doesn't work and as I dug deeply into things I have truly lost faith in the nutrition recommendations. While attending AADE and talking with many RDs and CDEs I came to the realization that many of them have also lost faith but feel unable to change things. I feel like the evidence doesn't support the advice we get on nutrition and nobody listens. But Franziska is on the inside, something most of us as patients cannot do. She is standing up and debating the issues and doing so in a logical and eloquent manner. She wrote an article in the prestigious ADA Spectrum on the evidence for low carb. She wrote an article in the IDF "Diabetes Voice" arguing to the world the evidence for carb restriction.

I am really pleased to have Franziska in my corner. The whole nutrition thing is a mess. And if the evidence truly turns out to establish that low carb diets provide better blood sugar control and achieves better outcomes then these sorts of inside efforts in the belly of the beast will save thousands from harm. As a society, we deserve to have an objective discussion on these matters.

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Jag1, I realize you haven't watched the video, but in the video as well as her blog Franziska says she herself blood sugar issues, although she has a normal fasting blood sugar, she can spike as high as 200 after a carby meal. High carb meals can also produce a reactive hypoglycemic reaction. I don't know how that would be diagnosed.

In my view her approach is more pragmatic than dogmatic. She gradually reduced her carb intake over several years until she could meet her blood sugar goals(keeping < 140 postprandial). To me the point to the blog post you referenced is that she is able to achieve normal blood sugar numbers by restricting her carbs to a very low level and that at the same time she still feels good and her brain is still functioning despite the predictions of the RD mainstream.

In a society that is as lawsuit happy as ours, I consider the disclaimer at the bottom of every page to be more prudent than cop out.

In the blog post you referenced the last sentence is

"Carb restriction may not be appropriate in every case, but I defy anyone to objectively look at the evidence and deny how beneficial it's been for so many, especially those who have struggled with weight and blood sugar issues for years."

In the video, which again I realize you have not seen, she is supportive of whatever level of carb consumption a person uses to meet their blood sugar goals.

I don't know how her previous profession as a court reporter has any bearing on the quality of her dietetic advice. She went to school and passed the tests so she has the right to put the letters after her name. Her blog posts are well researched and footnoted. By your reasoning the fact that I was a carpenter in a past life and know how to cut the rafters for a complex roof somehow means that in my present job in IT I am somehow not qualified to write a complex SQL statement.

I think tuD works best when we speak from personal experience instead of a dogmatic position. Readers can then be exposed to a wide range of views and experience and decide on a path forward. My experience as a T2 not on insulin who has found 30 to 50 grams per day to be essential to meeting my blood sugar goals, in no way negates your experience as a T1 who is able to meet his goals at a higher rate of carb consumption. But the fact that your level of carb consumption wouldn't work for me, or Franziska, and in fact would be a blood sugar disaster, doesn't make either of us a "nut job", just different and determined to meet our condition head on.

In my view diabetics who set ambitious goals and then do whatever it takes to meet those goals should be respected not attacked.

23

Actually, this is a good litmus test for where in the learning curve your HCP might be. Those are the fats recommended. Oversimplifying, fats do not turn into fats in your body. Some other members have mentioned Dr. Peter Attia as a source of information and the book Good Carbs Bad Carbs provides a great insight to the fads and foible that become dietary RULES.

Franziska's video (IMHO) was balanced and appropriate. Skepticism of authorities is a necessary as insulin for a T1. It is a LOT of work to read the primary resources and that sport is clearly not for everyone - however there are people on TuDiabetes (e.g. Holger) that ought to labelled "trusted" sources.

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My last question during the video chat was "Do you deduct all the fiber from a carb count or do you deduct only 1/2 ?" The response was "there is no consensus on that but I deduct it all. Some say to deduct 1/2 if it is more than 5 grams blah blah blah." So if Franziska with all the letters after her name indicating she is CDE and an RD can't give me a definitive answer to the question then where exactly am I supposed to go ? Obviously I have to do what works for me and through a lot of trial and error I try every day to eat what keeps my blood sugar in my target range. There are no hard and fast rules to this. In the UK there is a class held by the NHS entitled DAFNE (dose adjustment for normal eating) for T1's. But how does anyone really define "normal"?

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There is no definite answer. We are all different and all of us need to find our own way. Whether you need to subtract fiber or not, only your meter and you can answer that question.

26

Thanks for sending me back to reread Franziska's ADA Spectrum report entitled, "A Low-Carbohydrate, Whole-Foods Approach to Managing Diabetes and Prediabetes." One sentence she wrote under the heading, "Practical Applications for Clinicians," effectively summarizes my position on low-carb diets for diabetics:

In light of the evidence supporting the benefits of carbohydrate restriction, this eating pattern should be considered as a legitimate option to discuss with patients who have diabetes or prediabetes. A low- carbohydrate eating pattern based on whole foods can meet nutritional needs, promote satiety, and provide a varied, highly palatable meal plan that can be followed indefinitely.

I reject any assertions that a position as summarized above is extreme or that it has no room for other choices along the spectrum of carb consumption amounts for any diabetic. It is not the only way. It's simply one possibility that medical professionals should responsibly offer as one option that they will support.

Thank-you for your comment. I always enjoy reading your take on things.

27

Clare - What have you found with respect to fiber deduction from carb counts? I deduct all fiber, no matter its amount. It seems to work OK for me. As to Franziska's answer, she can't give a definitive answer because the conclusive studies have not been done. In this case there appears to be consensus that some deduction of carb fibers should be calculated for insulin dosing.

As far as defining normal, I believe that we are all humans and our various characteristics fall within a bell curve distribution. The variance does not disprove the central tendency of the group. I don't agree with the sweeping rhetorical conclusion that "we're all different." I believe that we're more similar than different.

28

Thanks for your comment, Shawnmarie. One of the main factors for the absence of a consensus for using low-carb as an effective tactic for BG control is the fact that there are no deep-pockets, like big-pharma, to finance such a study. In the meantime we lurch forward due to inertia alone. Enjoy the video. As Brian mentioned above, we are lucky to have Franziska in our corner.

You are light-years ahead of where I was when I was two years post-diagnosis. I simply accepted that consuming half my calories as carbs was a rational action. Looking back, I'm disappointed that I didn't dig deeper and was more skeptical. Life has a way of distracting.

29

What I have found with regard to fiber is it depends on the food. Raspberries I can only deduct 1/2, whereas Joseph's low carb wraps I can deduct it all. But in all honesty when I am having dinner at a restaurant, it's enough for me to guesstimate the carb count never mind the fiber.

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Elizabeth - Thanks for your comments. I also have never observed any fanatical tyrannical low-carb cabal that ran roughshod over any that disagreed.

I attribute any degree of that perception by some as coming from a place of uncertainty and maybe fear. They may, at some level of consciousness, be wondering if they should invest some energy and fundamentally change their way of eating in order to improve their health. Yet I know that it's simply human to want to cling to the status-quo, especially when it comes to eating.

Congrats on successfully staying off of meds for 7 years. That is simply amazing! I bet it rankles when some "expert" says low-carb eating is not sustainable.

The video is usually posted by Monday or Tuesday of the following week. Enjoy.

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this needs a like button.

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I recently ate a McDonalds egg and sausage muffin sandwich. I guessed that it was 26 carbs. One of my companions found a nutritional poster in the store that showed my sandwich was actually 32 carbs. I quickly added more insulin. In that case I would have been 1.5 units of insulin short and probably had to correct at 2 hours post-meal.

Restaurant meals are just hard. In my earlier diabetic life I would have just over-dosed and added food post meal as needed. That strategy led to excessive weight gain and insulin resistance. Knowing the nutritional composition of meals is such a better way to live.

33

"Eat to your meter" is the best, shortest, most enduring truth about diabetes.

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like!

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I think tuD works best when we speak from personal experience instead of a dogmatic position.
Well said.

Isn't each of our personal experiences with our common struggle why we participate here?

36

OK, I apologize for the "nutcake" reference. If my mind had been clearer (and if bsc hadn't just sarcastically baited me in another thread) I would have said "other low carb extremists" which is what I really believe.

I went back and reread part of the scheiner discussion HERE. He actually said that for a T1 (no mention of T2) that eating 100g carb a day "simplifies control". He was answering the question based on his extensive personal and professional experience managing T1. I'm not sure where the "Nazi-like" reference came from, but I'll note that in that discussion Scheiner was attacked as "a self defined 'expert'", "misinformed", "less than credible", "blatant definite bias", etc. Which I don't think he deserved.

Finally, let me say that I am a T1 and don't pretend to know the best way to manage T2. And I certainly understand that eating ultra-low-carb could be a viable way to minimize or eliminate insulin or other medication for a T2 who still produces enough insulin to cover slow rises in their BG. So if nutritionist Spritzler is talking specifically about managing and minimizing medication for a T2 and not T1, then her advice can make sense. What I don't like is the presumption that because an ultra-low-carb diet may be beneficial to the management of some T2s, therefore it must be the best or only way to also manage all T1s.

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I'm sorry for the nutcake reference (see below). Also, I wasn't trying to make a big deal out of her previous profession and I have no problem with switching careers. I was simply trying to call attention to the dramatic difference in experience that she and Scheiner seem to have.

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Jag nobody ever said an "ultra-low-carb" diet is the best and only way to manage T1. Nobody even knows what an "ultra-low-carb" diet because it is so ill defined. Is it Bernstein low, Paleo low low, or just ultra super low? The basic concept here as Scheiner points out is any kind of D is so ridiculously complicated that if you find something that "simplifies control" and makes it easier for you to live a full, rich, healthy life, then do it. For me cutting back on carbs has simplified my control, allowed me to take less insulin and lose weight. And as a fellow T1 I am sure you can understand how difficult those things can be.

39

Actually she did mention T1's and low carb and referenced Dr. Bernstein's law of small numbers which says that by lowering carbs you also lower the insulin dose and so any errors you make are smaller and hence high's and lows are less dramatic.

I don't see why someone should be labeled an extremest just because they have found something that works for them, especially if they have tried other levels of carb consumption and prefer the low carb approach. Peoples diabetes differs, their body's differ even their ability to do math in their head and estimate portion sizes differs. Also peoples goals differ, while one is satisfied with a mid 6 A1C another is happier with an A1C a full point lower, so it shouldn't surprise anyone that different people arrive at different levels of dietary carbs.

Perhaps the negative characterizations of Scheiner were rooted in the fact that he seemed to be unaware of Bernstein. I guess in the wider world he is not well known, but I would hope that a published diabetes expert would at least have a working knowledge of his theories and if he disagreed, he would have a well reasoned and researched counter argument.

Although the DOC is certainly a subset of the larger population of diabetics too many around here have benefited from reading Bernstein's book for it to be dismissed out of hand.

40

It’s now Friday and I put it on the wrong day on my calendar. So I’ll have to wait until next week when it gets posted with the other videos. My aim is to stay under 80 or so grams of carb per day. Even with that, Type 1 is not easy but it’s much easier than eating 200 grams per day.