I’m pretty sure there is no optimum amount of carbs for an adult. What is optimum is to feel good, not develop heart disease, not develop neuropathy, depression, vision problems etc etc as a result of having diabetes. Carbs and blood sugar are some of our best ways of quantifying our efforts towards those goals, but if you could have an A1c of 10 but never developed any complications, then there would be nothing wrong with an A1c of 10. But since the evidence seems strong that lower A1c’s, if achieved w/o additional hypoglycemia, are better for avoiding complications, then that’s what many people try for. The easiest (not the only or even necessarily the best) way to have lower blood sugar w/o a greater risk of hypoglycemia is to reduce carb intake. No doubt there are people people who eat lower carbs/have lower A1c’s than others and develop more complications and vice versa. I think it’s too hard to generalize, and the data isn’t there to prescribe a one-size fits all diet. (ps- i lke carbs too. doesn’t everyone?)
I don’t know what Dr. Bernstein’s recommendations are for children. There isn’t anything specific about this that I remember. Know he has child patients because I’ve heard him say this on his podcasts.
Before insulin, people ate very little. Some ate mostly lettuce. Not the same as 30 carbs a day by a long shot. Actually, low carb is quite calorie dense. I eat a lot of calories & am never hungry. When I was on the ADA diet, I was hungry constantly, tired & it was the first time in my life that I gained weight.
I don’t think my life is a living hell. What was a living hell was being on a BG rollercoaster from swings between highs & lows.
I eat pancakes, waffles, muffins, crackers, cakes & cookies made with low carb ingredients like coconut flour, nuts flours & flaxseed flours. They have fiber & good omega fats. Far better & healthier than wheat flour. I make low carb ice cream that’s healthier than any commercial product that’s filled with chemicals. I entertain frequently & serve friends & family low carb meals, including dessert. No one even knows they are low carb:) I eat lots of vegetables & good proteins. There’s nothing deprived or imbalanced about my diet. I feel better than I have in years. My lipid profile has also greatly improved from low carb.
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You’re surprised? I’m surprised it didn’t take this turn earlier. People on Tu are very passionate about their health and very knowledgeable, and clearly, there are a lot of nutrition facts out that that conflict with one another.
I am impressed, as usual, by the vast amount of knowledge in this group, and by how stinkin’ smart we all are (and have to be). Thank you, everyone, who took the time to respond. -Cindy
First of all I’ll state my own position so you can see where I’m coming from. I eat about 150-200g of carbs a day from fruit, veg, and wholegrains, I exercise regularly though I’m not by anymeans an athlete as I’m a 58 year old grandmother. My weight is stable. I use an insulin pump. My last Hb A1c was 5.5%… Personally I agree with your dietitian,‘No carbs = no energy’ If I am less active then I need fewer carbs. If If I’m more active…for example on a week backpacking, I need far more carbs and also less insulin.
I hate the thought of a child on a Bernstein level of carbs.(and I notice the OPs daughter is not eating a Bernstein diet though he has been brought into the discussion), I think that such a level is too low for proper physical development. I also feel that food is not just a source of nutrients but food eaten shared at meals and celerations is inextricably entwined with being part of society.
As to the number of carbs needed by a child of her age. Surely it would change from day to day (different activities) and will depend whether she was going through a period of growth.
There is evidence to show a very low carb diet for children can cause problems even when well supervised.Children are sometimes placed on a ketogenic diet for epilepsy; (very low carb. adequate protein, very high fat supplemented with minerals including calcium and vitamins.)
These children are rarely kept on the diet for more than 2 years but those on it for longer times have developed high cholesterol, kidney stones, sufferered retarded growth and demineralised bones .
.Long-term use of the ketogenic diet in the treatment of epilepsy.
Groesbeck DK, Bluml RM, Kossoff EH.
Dev Med Child Neurol. 2006 Dec;48(12):978-81.
The diet can certainly be effective but this in itself indicates a relationship between carb intake and brain function, indeed there is a wealth of literature on cognitive function and carbohydrate intake.
Even without being as restrictive as Dr Bernsteins diet rigid, diabetic diets can and have lead to psychological problems, there are far too many young people who end up denying their diabetes. Surely it’s better for them to learn to control their diabetes whilst eating a conventionally healthy diet …and also to be able to cope with the occasionally unhealthy treats at celebrations… Then when they begin to branch out on their own, as inevitably they will, they will have the tools to cope.
Lee Ann wrote a blogpost about her thoughts on a child being put on a Bernstein diet. She writes from personal experience of being a child on a restricted diabetes diet and subsequently developing an eating disorder. She is far more eloquent than I could be. I’m not sure that I should link it here but it is easily found if you google The Butter compartment Bernstein.
Hello BSC - thanks for being my “friend”, I went to the You tube site - checked out the video, filed it in my brain for later reference then went to Gerri (right below your entry) below’s site for Dr. B’s site - found - Hope Warshaw who works in Alexandria VA as a dietitian and who espouses “consistent carbohydrates” - took her test for a CME (classes for credit - unfortunately not one I could use for work) on carbohydrate nutrition - passed it with 80% - did not read the lecture but answered it on my current knowledge of consistent carbs which I am in disagreement over - if I ate as she suggested I would end up killing all of my beta cells - that is assuming I have a few left at all by now - . I know for a fact that my BS screams up high after sugar, jasmine rice (78 grams oc CHO) (my particular brand of slow suicide) dairy milk and fruits. Whew I type dyslexically, and in runon sentences when trying to get my thoughts out fast. The fact that I passed the test without even reading the lecture tells me that I know very well the current viewpoint on a diabetic diet - and I am aware that I am having to read slowly, page by page as I try to process new info from Dr. B. I cannot thank TUdiabetes enough and all the people who have written into this site. I thin your statement that You won’t get certified as a dietician if you espouse Bernstein. is very true.
Are the thursday night meetings with a dietitian? I am going to see if I can make it, checked my schedule - I am working Friday am at 0500, so may drop in briefly for the June meeting.
Since I made the “living hell” comment, I feel I should respond to it. As I said, adults should make their own decisions about what is a healthy diet for them. They are already grown. Many adults have lived on low carb diets for years and it suits their lifestyle. I’m sure there are ways to make sure a low carb diet is healthy for an adult (careful of fats and too much meat, etc). I believe the adults who say low carb diets work well for them and I would not seek to influence their decision. But… There is zero evidence a 30 gram carbohydrate intake per day is healthy for a growing child and I doubt you could find ONE pediatric endocrinologist who says that it is. Dr. Bernstein is not a pediatric endocrinologist. He is completely, dead against the insulin pump. So I would question his other advice as well. Adults should not recommend extremely low carb diets for a growing child. It is not safe. Certainly, it is not necessary for good control. Children will spike postprandially higher than an adult. The younger the child, the higher the spike. Despite this, children must eat a balanced diet, with carbs – and I don’t mean 30 grams – protein, fat, veggies and fruits. Now fruit is a problem on Bernstein… I believe you are allowed some berries. Certain veggies are off limits… he is against tomatoes, I consider his diet way out there, whether or not it works. I doubt there is a child who would consider the Bernstein diet acceptable; they would be miserable on it. There are other diets that could also work that would allow more balanced eating, IMO. Even 100 grams of carbs a day may be too low for a ten year old who is growing at great speed if that is all he/she eats every day. Not positive about that. My endo would say no way, 100 grams is not enough if that is all she eats every day, but if she is not hungry, she could eat 100 grams occasionally… Many adults who have developed Type 1 as an adult have absolutely no experience of caring for or treating a child with diabetes. What is safe for an adult is not necessary safe for a child.
Well, we pretty much lived up to the whole “Can of Worms” thing. These last posts do not warrant a comment.
My recommendation to carb101 is to “close” this discussion.
Just because the last two posts disagree with extremely low carb diets for children does not mean the discussion opens up a “can of worms” and should be closed. I have been caring for a Type 1 child since the age of 8, now 13. A1cs almost always in the low to mid sixes (would like to get it lower, but since she eats the prescribed amount of carbs, not really possible). She started at 180 grams a day, went up to 225 some days even 250 as growing preteens and teens are hungry, they are growing. Now she seems to be eating around 140 to 150 grams. There are days she eats 100 if not hungry. Days she eats 200 if hungry. Am curious if any of the low carb recommendations for a child’s diet are based on personal experience? i.e., are you the Parent of a child with Type 1, caretaker of a child with Type 1 or have you, yourself, been diagnosed as a child and have experience with low carb diets growing up? Children have high energy needs, especially preteens and teens. I have been respectful of the adult choices in eating low carb, and I think lower (not extremely low) carb may be the best choice for many Type 1 adults.
Gerri ,
Reality for me is , that I don’t find the time in my daily routine to prepare cakes, cookies, waffles, ice cream etc. with low carb ingredients …I would have to give up a lot of things I do ( mostly related to diabetes and not including caring for me ) . I don’t think I am alone in this , as are parents of kids living with diabetes and both Mom and Dad holding down jobs . So I learned how to read labels as a for instance .
Not true - you CAN run and finish a marathon on Bernstein’s plan…
When I read Bernstein’s book years ago, he had no recommendations for children; his book is predominately aimed at adults with diabetes (and IMO, the tone is meant for adults with type 2 dm, as so much of the focus is on weight loss/maintenance). In the book Cheating Destiny by James Hirsch, the author describes a meeting he had with Bernstein. Hirsch has a child who was diagnosed as a preschooler with type 1 (as well as being a long-term type 1 himself), and if I am remembering the passage correctly, Hirsch asked Bernstein what he would recommend for children with type 1. Reportedly, Bernstein’s response was that children should also follow his plan, exactly the same as adults. This includes NO snacks, minimal water, and an extremely restricted diet (at least from a 4 year old’s POV, remember!). When Hirsch asked what should be done when other children are chowing down on someone’s birthday cupcakes, or having pretzels (or what not), Bernstein essentially said “Let them eat sugar free Jello – but not too often!” Hmm. If I were a 5 year old and I saw my friends eating cupcakes while I was forced to eat an occassional sugar free Jello, I’d be pretty angry and I would not be a compliant little child. I would probably be a sullen, withdrawn, and, at times, a nasty child even at age 10 if I couldn’t occassionally have a piece of birthday cake! In all honesty, I have to agree with LeeAnn’s opinion that she described in a post on her blog, The Butter Compartment. Her best lines:
“Life as a diabetic is NOT about having near normal BG’s. Most people will drive themselves insane chasing that carrot, and in the process of chasing it, relationships, sense of self and sense of purpose, and quality of life will suffer. Diabetes is about finding balance, learning to love your body despite its flawed pancreas, making the most of every opportunity to live a normal life despite not having normal BG’s, while making every reasonable effort to manage them. If you spend your life chasing a 5-point-something or 4-point-something A1c, chances are, you’ll find that too much of your life is informed by that pursuit, and too little of your life is about living.”
When it comes to children with diabetes and the parents who care for them, I do not think anything could be further from the truth.
Before being diagnosed, I never baked a thing in my life & was the take-out queen for dinner because of my work schedule. I never ate breakfast because of time constraints. I sure don’t do this daily & am not Betty Crocker:) Most things I cook take 10 minutes to put together. Pancakes take 2 minutes & less than 5 minutes to cook. Ice cream is the easiest. Throw a few ingredients in the ice cream maker & freeze. I make large batches & freeze quantities for most recipes.
I got depressed about the things I couldn’t eat, so found alternatives. Most prepared foods are higher carb than I want & are filled with chemicals & soy I can’t eat.
Minimal water? Never heard this from Dr. Bernstein.
I’ve never heard/read anything remotely like that from Dr. B’s books, his podcasts or interviews.
I have heard all these arguments many times. Bernstein is frequently attributed as saying things that he never said. Frequently his critics are just ill informed, but all too often, the criticism eminates from the entrenched establishment. I have read Hirsch’s book, but one must understand he is the brother of noted mainstream endo Irl Hirsch of TCOYD fame and who actually wrote a book suggesting that you don’t need to restrict sugar intake, you can just dose insulin (http://www.amazon.com/Practical-Management-Type-1-Diabetes/dp/1884735940). They “hate” Bernstein because he challenges their core tenants and questions their authority.
Look, Bernstein is no angel. I am happy to discuss the things he recommends. I don’t agree with everything myself. I just find it frustrating that people come out criticize him based on false information and heresay.
Thanks for the shout-out Angela! 
It’s true that a more balanced approach to dietary management is going to support your daughter’s psychosocial health. Diabetes makes kids feel different, and imposing a highly restrictive diet is just going to exponentially exacerbate that since much of the diabetes-related conflict that occurs in families with T1 children can center around food. There have been studies (if you search the Joslin website, look for research by Dr. Gobel-Fabbri) that show 1/3 of girls and women with T1 have manipulated their insulin to control weight which can lead to devastating complications. It can make such a positive difference to instill a more intuitive, moderate approach to eating in children with T1. I know the initial question was more about the physiological effect of carbs, so I’ll also say that good BG control can be achieved on a moderate diet that lets a kid be a kid.
And definitely check out my blog, The Butter Compartment, if you have a chance because I’ve written a lot of posts about my personal experience growing up with diabetes (which I generally offer as a cautionary tale), and my thoughts on parenting diabetic kids with an eye toward supporting their emotional health. If nothing else, it’s a different perspective.
I say, if she’s happy at 105 carbs, and has plenty of energy, and her numbers are good… Then let her be. We are all different, and we all will require different carbohydrate needs. In people who have endocrine illnesses, carbohydrate metabolization becomes… very impaired. I have a lot of other illnesses besides D, and eating a lot of carbs simply bogs me down, takes away my energy, and makes me fat… primarily because my body can’t digest that very well. Some D’s who have Hypothyroidism, or Polycystic Ovarian Syndrome may relate to that… While some D’s may be able to manage larger carbohydrate intakes, without many issues, when kids are chunky, this is something to keep in mind. Her Thyroid levels should be looked at closely, as well as her ovarian health. I haven’t met very many D’s, Type 1 or 2, who were free of other Endocrine disorders (autoimmune, metabolic, or otherwise.) If my day had 40 hours in it, MAYBE, I could eat 200 carbs. lol The problem is… I can only, physically handle about 35-40, in one meal, without further issues, and high blood sugar… and honestly, while I love exercise, I can’t realistically go exercising after every single meal, 4 or 5 times a day. So… 60-100 carbs a day, depending on the day, is enough for me. Let her eat at her pace, what she wants and desires, if that’s 100 carbs, and if she can manage them well, that’s fine. What’s more important is that she doesn’t exceed a certain amount, per meal or snack, that makes it harder to predict and bolus for, therefore needing more insulin, and gaining more weight… know what I mean? The point isn’t protecting a kid from being different… It’s teaching that we are different, indeed, and that we can be creative, and resourceful, and inventive, with those differences, and with food… and the sooner to accept that, the better… I don’t see why we need to pretend we’re just like everyone else, and can prove it by gorging on a bunch of unnecessary carbs. I find that logic rather impaired, and silly, and it will only create more self identity issues down the road when, as adults. Quality of life is being able to live longer years, and enjoy our families, friends and loved ones; not enjoying cake at birthdays, and a bunch of greasy pizza, all the time. 
Although my niece eats a higher carb diet than you advise, I would certainly be interested in low carb, particularly low fat treat (icecreams, cookies, baked goods) etc. that are tasty. I have found she has been refusing these types of snacks, in general, so I don’t have to substitute. But would love to substitute on special occasions (such as Thanksgiving) when the overall carb content is high, so low carb desserts would be welcome.
Honestly, for my niece, we do not restrict her from eating Pizza, Chinese food, icecream or potato chips. This does not mean we offer her these foods on a daily basis. She no longer likes Pizza or Chinese food, rejects ice cream and has been refusing Potato Chips (her favorite) on her own. She has learned to prefer healthy food because that is what we offer her most of the time. But she is not on a carb restricted diet. She eats anywhere from 100 to 225 grams of carbs a day. There are ways to counteract postprandial spikes. Such as mixing lower glycemic foods with fat an protein and observing the spikes cause by differing combinations of foods, overbolusing and then giving more carbs at the 1.5 hour mark, using the fastest insulin (Apidra), prebolusing and for some superbolusing. Carb restriction is one way. Learning how to handle the carbs you eat and cover it with insulin is another. It may be easier for an adult to just restrict carbs. Children do not have this option so parents must learn how to bolus for the food they MUST eat. Bernstein is not an option for children. His recommendations are extreme and ridiculous… for a child. Not saying adults cannot follow him. Remember the person who posed the question is the parent of a child, not an adult. P.S. Using the cgms and observing the effects of a regular fat ice cream such as Friendly’s, her blood sugar never spiked over 140 nor did she drop low later on. Same can be said for Potato chips. We do not offer these products often because of the high fat content which is bad for her heart, not because of adverse high blood sugar effects.