Do you agree with Gary Scheiner about Low Carb Diets?

Type 1 and LADA
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Great discussion today in the live interview with Gary Scheiner. I asked a question about low carb diets and T1. Gary's response surprised me, because he basically said that low carb diets are inappropriate for T1. They're more suited to T2, he said. I went back and listened again to his reasoning (13:40-19:50 mins is that portion of the discussion). His theory is that dietary protein, which low carbers rely on, is "meant for" muscle development, bone, etc. But in a low carb diet, protein is instead being used for energy, brain, nervous system, etc - i.e. the things that carbs are supposed to take care of. So Gary recommends at least 100 carbs per day, which he says simplifies your blood sugar control.

Now, this is all fine in theory, but one thing bothers me about it: carbs still make your blood sugar go up too quickly and thus make it harder to control. Yes, protein can raise blood sugar too - Gary recommended a formula whereby you divide the amount of grams of protein by 2 to get an estimated equivalent in carb effect on blood sugar. But the big problem with a moderate carb diet, which using Gary's theory is over 100 grams a day, is that it pushes your blood sugar level up and down a lot. At least that's my experience. So with a low carb diet (and I'm doing about 60 grams a day of carbs, so it's not Bernstein level low), my experience has been that it controls BGL *much better* than on a moderate carb diet. I've also lost weight, which Gary says is what a lot of T1 people want to do.

I'll have to read Gary's new book to find out more about his theory about low carb diet. He seems to be suggesting that longer term it may be better for your body to do a moderate carb diet. That may well be so (nobody really knows the long term impact of a low carb diet), but I'm not convinced that a low carb diet complicates blood sugar mgmt. In my experience, it's the exact opposite: a low carb diet has greatly simplified my approach. I no longer use a short-acting insulin, I've reduced the amount of Lantus (long-acting) I take in morn, and (most importantly) my blood sugar readings have stabilized substantially. If you look at a graph of my readings pre-low carb diet, it is all over the place - up and down like a yoyo, at least one high reading a day. Now, with a low carb diet, it's very stable and I have very few highs (one or two a month!).

So I'm curious what others think of what Gary said, esp those on a low carb diet or who have tried it to manage their T1.

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Yep. He hit it dead on!

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I have the same experience as you do( much more stable BGs), so I don’t agree with him on that one. I didn’t find any referencies on that subject in his last book, he says basically the same he said in this interview. Mixed meal= no need to bother about pros

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I have to give Gary credit. A year ago he helped me gain control over my BGs as I initiated a low carb way of eating. His counsel and advice tweaking my basal rates was invaluable. He's a great asset to our T1D community.

I disagree, however, with Gary on this one. My BGs are much better behaved since I adopted a 50-75 CHO grams/day diet. I've lost 15% of body weight, cut my total daily dose of insulin in half, reduced my A1c from 6.8% to 5.9%, and greatly reduced my BG variability (BG standard deviation reduced from the 60s to 30) and hypos.

Agriculture and the grains it produced has only been around for the last 10,000 years or about 1/4 of one percent of our history. Prior to that man evolved without abundant carbs quite nicely over the previous two million years or so. There's plenty of evidence that a moderate protein and high fat diet can be sustained at healthy levels. Modern North American indigenous people survived just fine on a diet almost exclusively of seal and other marine mammals. In fact these cultures suffer horrible rates of diabetes when they adopted the modern Western carb-laden diet.

I know that we're all unique individuals but I found carb limitation has greatly improved the quality of my life. My experience and my genetics tell me that eating 100, 120, or 200 grams of carbs drives my BGs to sustained hyper levels. What works, works.

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Thanks Terry, great reply. Just curious, how do you know from your genetics that eating over 100 grams of carbs per day makes your blood sugar levels erratic? Did you do a test from e.g. 23andme and it gave you data on that?

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I greatly respect Gary's expertise as a T1 and CDE but disagree that T1s shouldn't eat low carb; in fact, as some of you mentioned, it usually results in improved BG control. I didn't listen to the interview, but it sounds as though Gary's talking about gluconeogenesis when he says protein will be used for energy. However, people who follow a LC diet use ketone bodies as their primary energy source rather than protein, which can continue to be used for maintenance of muscle mass, tissues, enzymes, etc., in addition to a portion being converted to glucose for the few structures that can't use ketones: retina, red blood cells, and portions of the kidney and brain. Dr. Bernstein has demonstrated that following a very-low-carbohydrate diet for 4 decades can greatly improve BG control. And have you seen a recent pic of him? Nice muscles, Dr. B! Pretty impressive for an almost-80-year-old man, along with his ability to keep working at this age!

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Take my views with a grain of salt, I am a T2. I consider Gary to be a devote of ultimate carb counting and bolusing technique. His overall philosophy is that if you count things precisely enough and dose accurately, you should be able to eat "whatever you want." And so he just "accepts" the ADA line that you should eat 45-65% of calories from carbs. That is what he says explicitly in his books and what he communicates. But his explanation above really doesn't hold water since eating some extra protein can readily cover a zero carb diet. And as a self defined "expert" on T1 exercise he didn't even refer to any "benefit" that carbs have for endurance exercise. I just don't think he really has an independent position on what a good diet is. Instead, he is of the belief that you can get "ok" control by eating a high carb diet and just doing a great job of counting carbs and bolusing.

ps. And I have Gary's books on both Using Insulin and Advanced Carb Counting.

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I’ve been diabetic for over 30 years and this is all new to me. Protein raises blood sugers? What do you eat if you are only eating 50 or so carbs a day? Is there somewhere here on tudiabetes that I can find this stuff? My blood sugers have ALWAYS been out of whack and I’m interested in how to fix that.

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Thanks Franziska. btw, everyone should read this excellent article that Franziska, a Clinical Dietitian, wrote for the International Diabetes Federation's Diabetes Voice magazine:

Carbohydrate Restriction for T1 Diabetes: IDF "Diabetes Voice" Debate

http://www.lowcarbdietitian.com/1/post/2013/05/carbohydrate-restriction-for-t1-diabetes-idf-diabetes-voice-debate.html

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I have no problem maintaining good BG control with 100 carefully chosen carbs every day. I just came off a 4000 calorie diet that included 300+ carbs and 10mg dose of prednisone everyday. With a pump and CGM I was able to keep my A!c under 6.0, and my average BG around 120-125 (it was not a easy task) I'm back to a 1500 calorie diet with somewhere around 90-120 carbs per day and my BG is good enough (between 70 and 140, 90% of each day, with a A1c of 5.2.....happy, happy, happy.

Going low carb is not a fix-all for every PWD's BG problems....it does not fix my stability issues...YMMV

Every morning my BG can try to skyrocket carbs are no carbs..food or fasting my BG goes up and down all day like a yo-yo. My CGM is a blessing.

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ricmac - Sorry if my use of the term "genetics" above misled you. What I meant is that some people seem to tolerate/process carbs better than I do. Even people who otherwise share my diabetic profile. It's something that I attribute to genetics.

It's curious that you mention the 23 and me website as I just visited it recently am am tempted to spend the $100 to search into my ancestry.

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Welcome LCD! This is the first time I noticed a comment by you at TuD. Thank you for taking the time to flesh out this discussion with some nutritional science.

I hope you find time to continue to participate here. I too am impressed with Dr. Bernstein's physical appearance. His appearance and energy are that of a man 20 years younger.

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You might be interested in the TAG Group and the Bernstein group here on tuD

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Sam - There's an inactive group here at TuD called TAGgers United. TAG is an acronym for total available glucose. The discussions there center around low carb diets that also count protein and fats when dosing insulin. I've successfully used some of the "tools" talked about on these threads. Like I said, it's not a currently active group but the archive is worth reading.

I eat a diet that's best described as low carb, normal protein, and high fat. The high fat part totally goes against society's belief that "fat makes you fat," and "fat causes heart disease," two beliefs that I don't share.

I eat bacon, chicken, fish, grass-fed beef, low carb vegetables like broccoli, eggs, cheese, and nuts. It's surpisingly easy to follow and I don't feel hungry. You can do a search on "paleo" and find a lot of info.

I wish I could say the three hour CGM trace below is like this all the time but I enjoy a lot more time like this than I ever did consuming 100+ carbs every day.


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Nope. Don't agree with him. Read his books and agree with much of what he says -- but not this. What he said today on this topic runs directly counter to all my experience.

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My personal experience is that I maintain the steadiest blood sugars if I eat somewhere between 45 and 65 net carbs a meal exccept for breakfast when I can eat around 70 net carbs and keep a pretty flat line.

I am comfortable dosing for moderate carb meals and can usually manage the variables, I actually do worse when I low carb.

Maurie

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I missed the interview. can I access it?

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Yes, Nell, it should be posted soon under videos, on the left side of the home page.

I think the biggest thing we can take from this is reinforcement that YDWV. I've tried various levels of carbs, and what works for ME is around 30 carbs a day. Sometimes it's a bit more, but I average around 32 a day. I like having a low standard deviation (variable in bg), and think it's even more important than A1C (though mine is in the high 5s). I do admire Gary, and also own both his books. There are SO many variables, we do have to be our own science experiments.

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Thanks, I will have to check both out. I've read a bit about Bernstein, but I was told as a kid that ketones were VERY bad. I'm not sure I can get over that fear. I gave up most processed foods a year ago and have been eating a lot more healthy. I think I'm eating between 90 and 150 carbs per day. I will pay more attention the next few days to see where I'm really at.

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I think the discussion drifted away from reported Scheiner words:

..dietary protein, which low carbers rely on, is "meant for" muscle development, bone, etc. But in a low carb diet, protein is instead being used for energy, brain, nervous system, etc - i.e. the things that carbs are supposed to take care of. So Gary recommends at least 100 carbs per day, which he says simplifies your blood sugar control.
"simplifies" in respect to higher carbs diets.
He just says diets under 100g CHO are not good NOT for BG control but as an energy source for our body.
That's his thought, you can dissent, but nowhere he said you have better control eating 100g CHO than not eating CHO at all. He was talking about health, not BG.
Don't look anything only "diabetes wise" ;-)
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