Do you think a Low Carb Diet is bad for a Type 1?

I have been thinking about going low carb for a while but my doctor does not think its a good idea. I had to fast for a test over a year ago and it shocked me how stable my blood sugar was on my Continuous glucose monitor. I did talk with my doctor one time a while back and they said that with a low carb diet your body doesn't function properly. I believe what was said is that if you don't take in enough carbs your brain won't function properly. I definitely have problems with my memory as it is. Lol. So I am back and forth on it. I am a brittle diabetic so I just would like to see a steady line on my CGMS all of the time. I mean if my glucose is more stable that would really help me in the long run...right?

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The Low Carb Dietician

I've never seen concrete evidence of brain probems from eating less carbs, other than that if you are used to eating a lot of carbs, it can be sort of odd to stop as you might feel like something is missing. I've always found it less work to eat less carbs and, given how much work diabetes can be, I think that anything you can do to make more time for yourself is a great thing, although I run closer to the 100-140G of carbs and don't mind "excursions" into big food that much either, I might be a bit odd in that.

What do you consider "low carb" and what does your doc consider "enough" carb? There is probably a world of difference between the two. My doc considered me "low" at about 100g of carb per day. The dietitian wanted me to eat about 200g. For me, that would be enough if I was a 250 lb linebacker, not a 5 foot tall petite woman. I considered myself moderate carb and it worked for me.

Why do you want to low carb it? I found that with fewer carbs, there was a smaller margin of error when I bolused. But I was eating enough carbs to satisfy my appetite and I was happy. I included the odd cookie or ice cream in my daily allotment.

Are you really brittle, or are there just things that affect you more easily? Brittle is an old fashioned term that they used to use if you had high blood sugar. I went up sometimes, but I always knew why - be it carbs, weather, stress, exercise or hormones.

Not sure where this brain issue comes from, and I'm no expert, so take this with a grain of salt.

Neural tissue does not need insulin (nor does it have receptors) to absorb glucose. Neurons simply reach homeostasis with whatever BG level is present at the time. Put more simply, if your blood sugar is good, it would seem to take of the brain just fine.

The brain can't tell the difference between a glucose molecule that came from digesting carbohydrate vs. one created from glycogenolysis or gluconeogenesis in the liver. The latter process is what converts protiens into sugar.

I think the concern may be that low carb can lead to more hypos if one is not careful, which is hard on the brain.

You can start reading here...

If you are interested in low carb, I suggest you read a couple of books. Start with “Dr. Bernstein’s Diabetes Solution”. Then read “Why We Get Fat” by Gary Taubes.

I eat relatively low carb. Not as low as Dr. Bernstein’s 30g per day, but way less than any ADA dietician would recommend. I feel great, my highs and lows are greatly reduced, and my A1c’s and standard deviation reflect my improved numbers.

My most recent blog post addresses the issue of low carb. It also has links to two other excellent posts on the subject.

I think there is too much emotion around the term 'low carb diet'.

My approach was more along the lines of 'eat to your meter', which is even easier with the help of CGMS. I started with eliminating 'fast acting' carbs, such as cereals, rice, pasta, breads, etc, because my meter indicated it was too difficult to match the insulin to the BG rise. And I experimented with ways of including small portions of those carbs, mixed with good proportions of 'good' fats and 'good' proteins.

Watching my meter / CGMS, I learned:
1. how long to wait after bolus before eating,
2. to eat a salad first before the higher carb foods,
3. better use of dual and square wave bolus features to match meals
4. better portion control and combinations of carbs/fats/proteins.

This has been working for me and my BG is quite stable. I've maintained an A1C <6.5 for the last 5+ years. I don't follow the Bernstein version of low carb (30c/day), but did learn a lot from his books. I eat the number of carbs that works for me, mostly from vegetables and dairy, small amounts of pasta, beans, grains. I don't eat much meat, but usually have eggs 1/day. I probably average 100-120 carbs/day.

as others have said, i would not worry too much about the exact carb count of the food and rather worry about the type of food you are eating. I eat around 100 c/day, but avoid all processed carbs like grains and packaged food. All of the carbs i eat come from veggies, nuts, and other natural foods and i find bg very easy to control by doing this(not considered 'low carb' by most). If i would eat 100g of carbs in the form of pasta and bread my bg would be out of control like it was the first few months after my dx.
As far as what the brain needs, i dont know medically why they would say the brain cant function on low carb. all i know is, it seems everyone who cuts carbs becomes much healtiher! (myself included)
One other note, i was given alot of eroneous advice from my dr and dietician about what i should eat when i was dx'ed. Conventional wisdom can be misleading at times, and i often wonder if dr's always have the best long term interests of their patients in mind due to legal reasons and such in the short term. so just be cautious about following dietary advice blindly!

I'm on what I consider to be low carb which is 80-100 carbs per meal. The trick is dosing the right amount of insulin for it, and if you start rising above 130s, do correction doses ASAP. Wanting a constant straight line will drive you crazy. Even those without T1 rise up to about 150 very briefly after some meals, so spiking is normal in everyone, just try to keep the spikes under about 150 and for as short of length of time as possible.

IMHO, the ADA guidelines are pretty unhealthy/dangerous. Research hasn't shown any problems with very low carbs (Dr Bernstein) of say less than 40 g per day, My feeling is that it is somewhat of a starvation diet (hence the weight loss) because it requires our body to convert most of its carbs from protein/fat. I'm hesitant to say it is safe and healthy, but there are a lot of healthy people who seem to be doing well on it. Dr Bernstein himself seems to take a very extreme approach, and has lived a long time doing so. He might be right, but it is also a tough diet to maintain.

For me a low carb diet in the 40-100 range seems both very safe and effective at managing BG. The risk of lows and highs are greatly diminished. IMHO, most of the 'slower digesting carbs' like whole wheat don't digest any slower, and there are foods I have cut way back on or avoid completely. I'll eat a piece of bread, but if I eat 2 then I'm crossing a line. I haven't had a glass of milk, juice or soda since I was diagnosed 3 1/2 years ago. Many other carbs I'll eat (chocolate), but in small quantities unless I'm cheating. I do a bit of grazing as well.

As for not being able to tolerate very low carb, I think some of that might be an adjustment thing. It takes a couple of weeks for my body to adjust when carb intake gets lowered.

I agree. I can't say with certainty that we NEED carbs, but I can't say that we don't, either.

I do my best to eat under 100g per day. I add protein to replace carbs, and I seem to eat most of my carbs from chocolate and milk (weird, huh?). I can't handle extremely low carb diets, but as long as my BG isn't high, I'm happy.

You might be interested in reading the blog on the Low Carb Dietician website. Well researched and well written.

Some people think their brain works better on low carb vs the blood sugar roller coaster even normal people experience. I'm a T2 on 30 to 50g/ day. I think it's an easy diet to stay on as long as its giving you good results. You need to like eating lots of veggies.

80-100 a MEAL?!?!

Yes, 80-100 carbs per meal. 300 carbs or less per day. That's as low carb as I could go and my A1C was most recently 5.0% once I added the cgm to the toolkit, so I'm hoping to keep it that way. Before this condition, I was definitely eating double (or more) carbs than that per day which is typical of most Americans.

Just before I got my pump, I figured it would be useful to see a dietitian, as I was still working to lose weight. She rx'ed pretty much 180-270G/ day, although split between snacks and meals.

There are huge controversies over dietary carbs. There are numerous so called "experts" who advocate for a high carb diet, with much of the argument based on the supposed need to have a low fat diet for cardiac health. And it is these "old school" voices which have been drilled into medical education as well as the dietary and nutrition education and guidelines that our health care providers echo to us. And in my opinion, much of that advice is fatally flawed. I have done a lot of research on this topic and when I dig just below the surface, I find that the emperor has no clothes.

So let's look at what the Institute of Medicine says about carbohydrates in their Dietary Reference Intakes (DRI)(IOM is a part of the National Academies and is "credible"). The DRI is supposed to be the basis for the recommended macronutrition guidance doctors and dieticians give out as advice. The DRI says that an adult Recommended Daily Allowance (RDA) and Adequate Intake (AI) is 130g/day of carbs. It says "Allowance," meaning that additional amounts may confer no health benefit. The DRI further says:

"While no defined intake level at which potential adverse effects of total digestible carbohydrate was identified, the upper end of the adequate macronutrient distribution range (AMDR) was based on decreasing risk of chronic disease and providing adequate intake of other nutrients."

The IOM in a disturbing leap of judgment then goes on to say that and AMDR of 45-65% because that is what americans have been eating. It is this crazy logic that then filters down to the silliness we see.

And I then blame the trade organization formerly known as the American Dietetic Association for mucking up the dietary recommendations for those of us with diabetes. For years, a small cabal has controlled the dietary guidance. You can read the latest assessment from Diabetes Care. As someone who has dug through this stuff, I find it an embarrassment. And to follow up on what BadMoonT2 has suggested our fellow member LowCarbDietician who wrote a great article looking at a low carb whole foods approach for Diabetes Spectrum.

I had the opportunity to attend the American Association of Diabetic Educators (AADE) convention and I was surprised at the numbers of educators who personally reject the high carb advice. Diet is a matter of personal choice. If you can control your blood sugar to attain your desired goals, then that is great. But clearly in my case obtaining tight blood sugar control absolutely requires a restriction of carbs. If I attempted to control my blood sugar as tightly as a do with a high carb diet, I would have major ongoing hypos risks (and probably be about 50 lbs heavier).

I'm a very brittle diabetic and I do not see how I could NOT live low carb! My doctor has actually come into agreement with me as he has no other answers and I am such an odd case. I eat about 30 carbs a day including plenty of vegetables, eggs, protein, etc. I will NEVER change my low carb ways. It makes life as a brittle diabetic a little less unpredictable. Less carbs=less insulin=less mistakes (Dr. Bernstein)

I have been low carb for 4 years, including while pregnant.

All emotions aside, the notion that there is no such thing as an essential carb is way overstated as well. You can't build a nucleic acid without ribose for one. For two, we wouldn't have to worry about our Blood Glucose level at all if we could just let it drop to zero. Third, it isn't actually possible for our BG to drop to zero because of any number of process that involve gluconeogenesis.

In addition to being an important building component to an number of essential molecules, carbs serve a valuable function to us as an energy providing molecule. It's the only abundant source of energy that can be utilized anaerobically. Those two functions mean that we can spare much more valuable dietary protein for it's primary purpose of providing amino acids for anabolic processes.

So, yeah, maybe there isn't a single essential carbohydrate, and maybe Humans can "live" without consuming it, but as a group of organic molecules, they are indispensable to us because we have the potential for unbelievably high metabolic rates.

That being said, because they are important to life and because gluconeogenesis can provide much of what we need, how much we actually need to include in our diet depends on any number of factors including, but not limited to, what your daily energy budget actually looks like.

Because carbs come from so many sources, we can be very choosy about how we get them.

Out of hand, no. It's probably going to be good for your diabetes as long as you realize that you are not eliminating carbs completely from the equation even if you go zero carbs. Even in the best of circumstances, you're just delaying the inevitable post-meal spike for some amount of time later, when that big protein load you ate gets partially converted to the glucose you need. If you're not ready for that, it could be just as bad.

As a T1, I still require insulin and the trick will always be to match my glucose load to my insulin load in space and time. It doesn't matter where the glucose load is coming from, or when the glucose load is coming.

I don't know as much about the science as some of the folks who responded. All I can say (jokingly) is I would rather have a bad memory than any of the other complications that come with uncontrolled levels. Someone mentioned Dr. Bernstein and while some of his ideas are ocntroversial its unrefutable how stable and complication free his patients remain well into their 80's. Again, I don't know the science, just my opinion.