It all depends on your definition of decent control, and your tolerance for lows. One of Bernstein’s main arguments is that the more carbs you eat, the more insulin you need, and the more potential for error (highs/lows). For him, decent control is an A1c of between 4.3 and 4.8 (average blood sugar of 83-90), the same as a non-diabetic. For most people, to achieve those kinds of numbers on a high or moderate carb diet without a significant amount of hypoglycemia (which would defeat the purpose) is not possible. Obviously, if you can achieve your target numbers and an acceptable lifestyle, it doesn’t matter how you do it, you have won! Keep doing it! Management is all about your own goals and what you’re willing to do to reach them. Most people whose goal is to have blood sugar levels comparable to non diabetics, and to do so without fears of low blood sugar, find that a low-carb diet is an essential part of the equation. It doesn’t mean carbs are “bad”. It only means that’s what works for some people. The whole point of diabetes management is to meet your own health goals. We should all do so however best meets our needs/aspirations.
Stick with Bernstein and you can count on a pretty sedentary life. If you manage your insulin very carefully you can consume high levels of carbs. It takes careful planning and using a pump.
Just anecdotally - I went on Bernstein’s diet for 9 months and had a great A1C, but had little energy, lost weight and muscle mass. I probably didn’t manage my diet perfectly. But my choice now is to put all my energy and time into managing a higher carb diet - with a super active, high energy lifestyle.
I’m not saying this is appropriate for a child. Or for those who don’t want lots of activity and exercise. But you cannot climb a mountain, swim an ocean, or race a bicycle 200 miles on Bernstein’s diet.If you want fewer limits on your life, you can learn alternatives to Bernstein.
PS - Go Team Type 1! Currently racing in the Tour of California. (www.teamtype1.org
Interesting. I guess people are different. I never had an energy problem. I gained 30 lbs of lean body mass and got to 15% bodyfat on a Bernstein style diet. I always thought I was ectomorph, destined to be skinny. But it turned out it was the way I was eating and training.
He’s a fanatic, but he’s OUR fanatic.
I’m glad his plan is working out for you, Judith. Not for me though. I try to follow the Law of Small Numbers, which is easy because I’m very sensitive to insulin, but the low carb plan just didn’t cut it. For me.
Terry
Stop using the fact that fat converts to energy as an argument. No doctor or dietician is going to deny this. It is the way it converts that matters (more slowly and with some bad residue).
It all depends on how active you are and secondary to that; how accustommed you are to converting fat.
The speed at which you convert fat depends on how accustommed you are, but no one with an active lifestyle (training/competition) can cut on carbs. For aerobe exercise and replenish glycogen you need fast energy (normal exercise at least 30 gr/ hour).
“Humans could survive eating no carbs, not that this is advisable since we need the nutrients & fiber in vegetables.”
There’s a not so subtle difference between “no carb” and “low carb”. Yes, there are alternative metabolic pathways that allow proteins and fats to be converted to glucose, but they are not sufficient to allow the complete replacement of carbohydrates with either fats or proteins indefinitely. Humans cannot survive for long without carbohydrates and it has everything to do with how glucose is made available for catabolism.
Remember, Bernstein is a “low carb” diet not a “no carb diet”.
“Pretty simple equation. More carbs=more insulin=weight gain=more insulin=greater chance for BG swings due to miscalculations.”
Not that simple, especially if you happen to be a competitive athlete or extremely active.
In general, I agree that carb control is key to good BG control, but there are ways to control carbohydrate metabolism to fit a particular lifestyle without having to eliminate or even lower carbohydrate intake. Personally, it’s always been more inportant to me to consider the type of carbohydrate I’m eating moreso than the amount.
Check that link to the Cori Cycle.
The Cori Cycle does not allow proteins to be converted to glucose. It’s a metabolic pathway that allows the lactate produced in the muscles during anaerobic exercise to be converted back to glucose in the liver.
Hi,
Rather than arguing about the merits of a low carb diet, which obviously works great for a lot of people, I’ll just try to answer your questions directly.
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As mentioned, you can get energy from carbohydrates, fats, and protein. Fats have the highest energy content, carbohydrates have the next highest, and proteins the least. Fats are used to store energy so they have the highest calories, and proteins are used primarily as building blocks for growth, repair, and enzymes, so they have the least amount of usable energy. That leaves carbohydrates as the fastest and most effiecient energy source.
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If you are extremely active, you may need to eat more carbohydrates.
As a competitive athlete and type 1 diabetic in college, and for a couple years in a track club, I ate between 4000 and 6000 calories a day to maintain my 160 lb body weight and workout schedule. I ate between 60-70 % carbs, 20-30% protein, 10% fat. There is no possible way to eat that many calories with a higher protein and fat percentage and hope to have any kind of effective workout and competition schedule. Your muscles depend upon maintaining their carb stores to work properly. It’s just too inefficient for your body to depend upon protein and fat to sustain that kind of calorie and activity requirement.
For the first 7 years after being diagnosed. I maintained an a1c between 4.4 and 5.0 on this diet and workout schedule.
Now, 20 years later, I probably eat half the amount of calories and have dropped my carbohydrate content considerably. I’ve actually raised my fat intake a bit rather than my protein content. More importantly, I pay attention to the type of carbs I eat morseo than the amount. I certainly can’t carb load on pasta like I used too.
I’m still active and work out consistently and I just feel better with a moderate amount of carbs in my diet versus a low amount. I would certainly never eliminate carbs completely from my diet. I maintain an a1c between 6.0 and 6.5 now, hoping to dip into the 5s again at some point.
Oh, and my insulin requirements have changed very little over the years. My base amount of Novolog is 7 units per meal, and I take between 9 and 12 units of Lantus. That’s up 2 units from 20 years ago when I was on Humulin reg and NPH, I believe.
The best to you and your daughter!!
I don’t believe anyone suggested removing all carbs from any diet.
Fair enough, but you said Humans can survive without carbohydrates. To be completely fair, I suppose that does depend upon what you mean by survive and if there’s any time requirement for survival.
Yes, survive being the operative word, & I also said this wasn’t advisable. I didn’t say this was healthy, desirable, nor was I advocating a no-carb diet. The point was that carbs aren’t necessary for survival the way protein & fats are.
We all know that Dr. Bernstein’s isn’t a no-carb plan.
Most people aren’t competitive athletes or consistently active enough to require high carb diets.
Hey Andy,
I was a Track and Field sprinter and I couldn’t even sustain my highly anaerobic speed training schedule on even a moderate amount of carbs. I imagine you are absolutely right about your glycogen stores. You are just blowing through them too fast. As a conseqence you end up splitting your high protein diet between glycogen storage after depleting your reserves, muscle growth and maintenance after trashing your muscle protein for energy once your glycogen stores are gone, and straightforward energy usage just to maintain your baseline activity level. That’s on top of your protein requirement just to maintain muscle density after the normal amount of breakdown expected after a workout.
As far as breaking down fat, do you even have any body fat to convert to energy at this point? =P
I really don’t want to give you the impression that I’m argumentative but i guess I’m trying to work my brain around what you’re trying to say about carbohydrates.
It’s true that carbs aren’t necessay for survival the way proteins or fats are but that’s because your body uses each of those carbon compounds for primarily different purposes, not because one is more necessary than another. You cannot survive, live, draw breath, whatever, for “very long” without consuming some type of carbohydrate. It’s not a question of how healthy or desireable it is to do so. It can’t be done.
If you’re saying being alive can be accomplished in any way shape or form without carbs, then that’s our point of contention.
And, I never said that anybody other than a competitive athlete or somebody who’s very active might require a high carb diet. I acknowledge that many people do quite well on low carb diets.
The OP asked specifically under what circumstances someone might require “more” carbs. Clearly, being a competitive athlete or very active are both cases where “more” or even 'high" carbs might be required.
The OP was asking about her 10 year old daughter.
Yup. No worries, I think it has a lot to do with the topic.
10 year olds do compete in sports too.
I realize that things are different today, with the internet, video games, text messaging and all, but in my mind I still think of 10 year olds as being fairly active. =).
Well, there are studies that show that there are definitely negative affects associated with diets that are severely carb restricted. Even though the body can use protein and fats as energy sources, that’s not their primary function so there are metabolic consequences. An overreliance on fat and protein catabolism for energy requirements is abnormal.
Acidosis from protein catabolism, for example, is a concern.
I actually found this review:
http://www.ajcn.org/cgi/content/full/75/5/951-a
To summarize, there are entire populations out there who have extremely carbohydrate restricted diets and do quite well. Nobody has carbohydrate free diets.
There are no Human studies to show that carbohydrate free diets can kill you, although, apparently, there are animal studies where the subjects have “survived” without carbohydrates, but nobody’s recommending you try for good reason. The key seems to be in healthy fat catabolism to make up for carb deficiency.
And yes, Bernstein’s is far from “carb free” and the carb guidelines seem to be well within safe limits, so I don’t see an issue with it specifically.
Not having read his book ,what is Dr. Bernstein’s take on carb intake specifically for ( physically active) children ?
Is his recommendation same as for adults. ?
I don’t recall a specific mention for children, but for exercise in general, he advocates regular intake of glucose tablets over the duration of the workout, at a rate determined by testing to find out individual need.
I don’t remember reading anything specific to children either, other than what sisiay mentioned about exercise/physical activity. Dr. B states that non-diabetic kids tend to have lower BG than adults, so highs in diabetic children are relatively higher than they would be for adults. Consistently high BG in kids effects growth & development.