I fear opening up a giant can o' worms here, but I am confused about the purpose of carbs in our diets.
I am specifically concerned with my T1 ten year old, which may result in a different answer than if the PWD was an adult.
I went to advanced Ping training the other day, and the CDE teaching the class is an RD. Between sessions, I asked her about Bernstein, and as often seems to be the case, she was not familiar with his work. Nonetheless, she stated that a person needs to get 30 - 40% of their calories from carbs, which for a person about Clara's size and age, would be between about 150 - 200 carbs/ day.
She was very clear that the purpose of carbs is to give the body energy. No carbs = no energy.
Now, I have not read all of Bernstein's book - it's a biggie, but I quickly realized in dealing with Clara's sugars that fewer carbs = lower margin of error and better results.
She's eating about 105 carbs per day and seems plenty peppy and healthy.
Since her dx, in December, she has grown 1/2" and lost a couple of pounds. (She was a bit chunky before, so she's still in a healthy weight range.)
So my questions are two:
1) Is there some reason that she should eat more carbs?
2) If someone is on a very low carb diet, where is their energy coming from?
No matter what you eat, it can all be converted to energy - proteins get converted to glucose via something called the Cori cycle, and fats get metabolized into energy by a different pathway…but ultimately end up at the Krebs cycle. And of course, glucose is made easily from carbs. All the glucose gets directly into the Glycolysis pathway and then the Krebs cycle, and then further metabolized by the Electron Transport Chain enzymes in the mitochondria to produce ATP. As you know, ATP is the energy currency of life.
So, don’t listen to the ignoramuses who get certified as nutritionists or what not. They never really understood their course material and are essentially regurgitating what they memorized and took as gospel when they passed their required coursework.
I’ll add my voice to the chorus. I have every bit as much energy (probably more) since I switched my diet to low-carb after reading Dr. Bernstein’s book. There was a transition period where adjusting to lower average blood sugars (closer to “normal”) made me feel a little weak and tired overall, but after about a week, I was adjusted and feeling great. That said, for a 10 year old who is running around and using a lot of energy, a few more carbs might not hurt (Bersntein recommends using carbs during exercise, in his case glucose tabs). The other thing I would say is talk to your doctor/cde about adjusting basal rates if you change her carb intake significantly to prevent lows. I had to more than cut mine in half, since before snacking on carbs was masking its effect.
I find your conversation with the RD very frustrating (as do many of the other posters)! Perhaps these misinformed? RDs/Drs/CDEs must conform to what the ADA/other diabetes communities/bodies say in order to be ‘certified’? I’ve never figured that one out.
I COMPLETELY agree with John (and probably would have posted something close to what he did if he hadn’t already beat me to it). As a biology major (now jr in college) I’m wondering why so many ‘experts’ just aren’t quite advocating the right things. Completely frustrated. I’m in agreement that a low(er) carb diet is very beneficial. I am just not sure how many carbs she may need in a day. Perhaps trial and error would be best for determining the delicate balance between control and eating (to an extent) what she wants to eat.
I wish you luck carb101 + daughter. Please keep us updated.
In general carbs are a prefered energy source for the body. It is not as simple as counting and equalizing the amount of energy as if carbs can be replaced without a price. The different pathways to utilize energy from carbs, protein or fat also need different effords and create different forms of residue. The pathway via carbs needs less efford and has a cleaner process with less residue. So I think carbs are an important part of our food. But today we have access to huge amounts of carbs and I think in some food the amount of carbs is just ridiculous: white bread or fast food for example. So I think it is a good idea to reduce carbs BUT not as much as Bernstein recommends. I would reduce it to amounts you can arrange well with your glucose control. The current intake of 105g carbs looks good to me.
Wow. These responses are fascinating. I thought my question would generate a lot of controversy, but everyone who’s responded is on basically the same page.
I have read several pages of Manny’s how many carbs per day post, and it sure got hot, plus it veered off topic a lot. I guess with over 1k responses, that’s to be expected.
I imagine as long as she is growing, not ill or lethargic, and seems to be hitting all her “landmarks” developmentally, I think she’s fine. As near as I can tell, some people need more than others, be it carbs, protein, potassium or medications. She’s lucky to have a mother as caring as you obviously are. Kudos to you.
Am I the one to add some controversy ?? Lets not open a can of worms, unless chocolate coated, ha ha
Possibly without answering your questions …I think others responded well .
I am not on a low carb meal plan , neither does my plan include carbs from junk food .Even before diagnosis I could count on one hand , how often I visited Fast Food joints .My past 31 day intake according to my pump is 175 grams of carbs daily . Daily activity has been slightly less over this time , but I will do a 10 K race in Calgary , May 30 th with Team Diabetes Canada !!..I travelled too much this past month .My weight staying stable under 138 pounds with a 5.7 body frame .
My friend Chris Jarvis, Canadian Olympic Rower , Team Diabetes Marathoner, JDRF’s Cyclebetes Team member , cycling from one part of Canada to other side …( age 30 ???) consumes about 700 grams of carbs daily , when in training . Ofcourse not all of us will become Olympians .My point I am making, is to include regular body movement and one gets to eat more, of one so chooses.
No doubt there will be others who disagree, but add my voice in agreement with the others.
About 58% of protein is converted to glucose & a small percent of fat. Anyone who has spiked after eating a lot of protein can bear evidence to this. Humans could survive eating no carbs, not that this is advisable since we need the nutrients & fiber in vegetables.
I’ve had countless discussions with CDEs, nurses & doctors who’ve all told me that I’d get sick, have no energy & my brain would starve following a very low carb diet. Had one ask me how long I thought I could actually do it. My answer: forever. I’ve stopped discussing it medical professionals & refuse to be lectured by people who don’t know the facts.
Lowering carbs to Dr. Bernstein’s recommendations has had nothing but positive effects for me. I’m not lacking energy & my brain works fine, at least most days:)
They all quote the food pyramid & ADA guidelines. That’s what they’re taught & the same message is repeated to us all. Say something enough times it becomes “truth.” How pushing carbs on diabetics makes sense I’ve never understood. I was reprimanded by nurses when hospitalized because I didn’t eat any of the starch in meals. I was told I needed to eat carbs get my strength back. Yep, I need potatoes, rice & bread while lying in bed. Of course compared to the amount of carbs the average American eats, even the ADA diet is viewed as carb limited.
Pretty simple equation. More carbs=more insulin=weight gain=more insulin=greater chance for BG swings due to miscalculations. Dr. B is right that small doses make for small mistakes that are more easily corrected. Smaller insulin doses also act more predictably because they’re better absorbed.
OMG. I’ve learned that bringing up Bernstein with a CDE and in particular a RD is like going into the Catholic chuch and screaming “I AM SATAN.”
One must realize that Bernstein contradicts central tenants of the teachings of dieticians. You won’t get certified as a dietician if you espouse Bernstein.
Bernstein has been clashing with the “establishment” for probably fourty years. And in basically every case, he ends up being right. He was right about home monitoring of blood sugar, he was right about the basal bolus regime, he was right about counting carbs and I fully expect he will be found to be right with his views on carbs.
For a vivid demonstration of how devisive he is, watch him debate Hope Warshaw, the avowed mouthpiece of the ADA (http://www.youtube.com/watch?v=3PZno7Nkuuw). My favorite part is the bread part, essentially leaving Hope Warshaw speechless.
Oops, I guess I’ve totally exposed my position on the subject.
Many haven’t heard of Dr. B. His name must be banned in classes.
One day, low carb will be taken for granted & people will be shocked that diabetics were told to eat 45-60 carbs per meal plus 15 carb snacks. Of course this will greatly cut into insulin profits, so they’ll raise the price.
Great video.
If anyone is interested, Dr. Bernstein has monthly pod casts through www.diabetesincontrol.com. Sign up through their site. You can email or call in questions for Dr. B. Dr. B is against pumps so be prepared. He believes they allow people to over eat & is concerned about scar tissue effecting insulin absorption.
I think I never had a honeymoon period because of eating the ADA way. When I told my doc about lows, he told me to eat more! Crazed. Fortunately, I found about low carb & Dr. B early on.
Yes, I have read this before , that Dr. Bernstein is against pumping Gerri ,… the possibility of one’s over eating , while on a pump may be so …same can/does happen to people not having diabetes …I choose to do " mindful eating contrary to mindless eating " . This a quote from a RD who had read the book by writer ??? …cannot recall his name …anyone out there knows ??
I have a new CDE who also never heard of Bernstein and who told me I would ‘starve’ my brain if I didn’t get at least 120 g carbs/day. I didn’t buy it.
On the other hand, I think Dr. Bernstein is a fanatic. A smart and lovable fanatic, but a fanatic nonetheless. Really unbending. How does he know that our ancestors primarily ate protein? He’s old, but not THAT old. We have canines, yes. We also have molars. We also invented farming. We’re also omnivores. How did we survive when there was no game around?
Anyway, carbs are certainly not the ONLY source of energy, they are the quickest source of energy. Active people, including children and including diabetics and including diabetic children are able to ‘carb up’ before strenuous activities. See the discussions in the Diabetic Athletes group on this subject.
If your daughter is about to engage in a strenuous activity, like a soccer game, there’s nothing wrong with giving her some extra carbs up front. Yes, even if that means going above whatever magic number Dr. Bernstein prescribes. I think it’s 30 or 45. What is it?
I think one needs to be ‘mindful’ (to borrow a phrase from Nel) of the carbs they’re taking in, both the quantity and the quality. If eating low carb works for someone, they should absolutely eat low carb. I didn’t work for me - not at the levels Bernstein recommended. I was on a constant roller coaster and felt fatigued and deprived. I’m closer to 30 carbs per meal than 30 carbs per day and it’s working for me.
I don’t avoid carbs per se. I avoid food that’s all white or that’s highly processed or has a lot of unknown sauces (goodbye most Chinese take out) or that I know spikes me. I avoid most grains except high fiber grains (my rule is 3 g of fiber per 100 calories) and avoid fruit drinks. (Wine is not a fruit drink, BTW.)
Getting back to the original post -
If she’s not suffering because of the number of carbs she’s eating now, why change? The starve your brain/no energy crowd are parrots.
Who knows where kids get their energy from? I think they have battery packs embedded in the back of their skulls which burn out and disappear when they become high school seniors or there’s a full garbage can nearby.
Only 45-60? I usually eat 80+ for 3 meals and 40 at night. I seem to be doing just fine on a high carb diet and I don’t really see why eating carbs would be a problem for a type one. Once you find out your I:C ratio, you can eat quit a few carbs and still be able to cover it. I could see how a low carb diet could be useful if you are a type 2 not on insulin, but I don’t see how carbs are such a “bad” thing for a T1. If I can achieve decent control on my current diet, why should I restrict what I eat so much that I would never be able to have fruit, doughnuts, or eat birthday cake.
People seem to get so irked when someone tells them they can’t eat a cookie, but when people are on extremely low carb diets that restrict all of that kind of stuff out of their diets, I can see why they would be confused if I get offended when they are trying to help.
and unless you are taking huge amounts of insulin, it rarely results in weight gain
No. I also did a lot of research, read both of Bernstein’s books, listen to podcasts, read blogs, asked questions and then used myself as a test subject. A year ago I cut out starches (bread, potatoes, pasta) and I felt that I have had plenty of energy. I became more active, lost 10-15 lbs and dropped my A1c to a personal low 5.8. I am T2 and control with some meds but mostly diet & exercise.
I eat lots of salads and some friuts so I do not follow Bernstein’s diet to a T. I also get energy from fats and some from proteins. For some reason, starches give me a big spike that lasts a an hour or two but veg & fruit may give me a rise but it is short lived. Fats break down very slowly so do not rise my BS very much.
I suggest eat, test, test, test, repeat. I had to isolate the foods that were causing my spikes. Good luck with her, it sounds like you are doing the right things. Incidentally, I attended classes years ago and they also gave me the same information. I think you just need to figure out what works best for each individual. Cheers, Todd.
