The education of Type 1 Diabetes in the two day hospital stay was all about Carbohydrates. This disease runs on the stability of carbs. Insulin - Carbs. Carbs - Insulin. So you can understand the fears as the Endo yells, "You can not carb Restrict" DKA! DKA!
So it is this confusion as well as my lack of knowledge at this time that is holding me back.
I have more reading to do and will continue to ask questions to this group.
Thank you!
Good luck finding a doctor who is on board with this. I have resorted to lying to my doctor because it proved impossible to find one who didn't completely freak out at the idea that I was eating fewer than 30 grams of carbs per day.
I hope you have better luck than I have.
Interesting. Are their alternative endocrinologists out there? I heard that CA has great endo's. I've googled around, but I have not found anything.
Great idea for a new Post!
There is no such thing as "essential carbohydrates" so don't worry that you will be depriving him of good nutrition by restricting carbs. Get a good multi-vitamin for him.
So it's safe to go by feel. There may be a level at which he doesn't feel as good if you go below. Or a level that has diminishing returns in the difficulty vs. results equation. But there is no fundamental physiological requirement for carbohydrates the way there is a fundamental physiological requirement for sleep.
As the American Dietetic Association Screams - Eat your carbs! Eat your grains! It's all about your Macro Nutrients!
Because we receive so much conflicting advice about the "dangers" of low carb I think it's useful to self educate as much as possible. In addition to Dr. B's book I found The Art and Science of Low Carbohydrate Living by Phinney and Volek to be very useful. It explains what is going on in your body using the results of published studies as well as the authors own experience. As type1VT says the evidence for the necessity of eating a high carb low fat diet simply isn't there.
Thanks to type1VT, Hana Rous and FHS among others, who have a scientific education and are willing to share their knowledge when the discussion gets too deep into the weeds for us laymen.
Thank you. I was not aware of the book. I will order it.
Came late to this discussion, but all of the advice here is excellent. I have been following Bernstein for well over a year and my experience mirrors type1VT's: A1c down, LDL down, HDL up, trigs negligible. As for DKA, nothing even remotely near. I just don't think about it. No need to.
One small caveat: as with everything related to D, each individual is . . . well, an individual. What works perfectly for me may be useless for the next person, and vice versa. The key is to determine (empirically, there is no other reliable way) what works for you. For me, the magic number seems to be about 35 carbs a day. Your results may vary. Probably will, in fact.
Oh, and when it comes to counting carbs, two more things that may prove useful. First, an intelligent scale, i.e., one with a builtin database that will automatically tell you the carb content of a particular food. This is an enormous time- and work-saver. There are several out there.
Second, this book:
Gary Scheiner, The Ultimate Guide To Accurate Carb Counting (Boston: Da Capo Press, 2006)
This is where it is important to be very clear about what is "essential" and what is "not essential".
The glycolysis pathway and products from glycolysis are absolutely essential to cell function. This is why, even in the complete absence of carbohydrate intake, your body will go to great lengths to convert other substrates, like amino acids, into glucose, breakdown glycogen to glucose, and even digest it's own protein sources into amino acids to maintain blood glucose levels and a consistent supply of substrates for glycolysis.
If we think of Type I diabetes, we see what happens when glycolysis is, for all intents and purposes, removed from metabolic consideration. In the complete absence of glucose entering the cell to enter glycolysis because of the lack of insulin, your body will continue to, even accelerate, it's own natural production of glucose, even as blood glucose levels and blood acidity reach critically high levels.
Maybe KTV can clarify this, but it seem that tt that point, the effective signal is not high blood glucose or even low pH, it's the zero glucose entering glycolysis. Basically, all hell breaks loose and just about every physiololic system is going into disaster control.
Increasing protein and fat intake due to a low carb diet is not just about making sure there is enough energy production. It's also making sure that you have enough gluconeogenesis from protein to maintain BG levels. At extremely low carb intake, enough to produce ketosis, you've already depressed or depleted glycogen stores to the point where they are insufficient to maintain BG levels. It is essential to have enough protein and fat intake to supply both catabolic and anabolic pathways and you have to do so by accounting for the decrease in dietary carbohydrates.
Glucose is a carbohydrate but, really, all carbohydrates are broken down into simple sugars that become subsrates for glycolysis. Products from glycolysis are absolutely essential, but the need for dietary carbs that enter glycolysis is what is being questioned here.
That's a very individual thing because it depends on a lot of other variables. Researchers like Dr Phinney are finding out that even though carbs can be restricted to extremely low levels even in highly trained athletes, the need for dietary supplementation also increases dramatically, so the decrease in dietary carbs appears to be setting up a situation where cells have to rob Peter to pay Paul at some point. As long as you can make for deficit through supplementation, you are fine.
Anyway, interesting stuff.
Perhaps this is why Bernstein came up with 6 12 12. SOME. Just Some
amount of carbohydrates have to be in the system.
And more confusing for the athlete.
Thank you. There is a lot to learn here. The body is intricate.
Actually, the explanation that Dr. B has for 6-12-12 rather than zero is that he hypothesized that there were unidentified micronutrients that were in vegetables. If the diet had zero carbs, that would exclude virtually all veggies. He recently has identified lycopene as a microelectronic that has been shown to be important. Lycopene is only available from veggies sources (like tomatoes, although tomatoes are nominally on the no list for Dr. B).
I eat tomatoes nearly every day. I simply weigh them to make sure the total carb load stays within my limit.
I´ve learned that total need for glucose is 30-40 gr a day. The body will easily make this itself from amino acids and glycerol (from fat). It means there´s no need to eat carbs in any form but it´s beneficial to eat something like 40-60 gr a day to "spare the body" from producing it itself. Maybe this is why Dr Bernstein has ended on 30 gr a day?
So, this means that meals contained of mostly vegetable, animal and or fish protein and fats and seeds? A truly Paleolithic diet?
Well, I've never specifically studied the Paleo diet as such, but I do eat veggies and protein almost exclusively. (Plus a few specifically targeted supplements such as Vitamin D3, which I am chronically low in.) Since making that change (about a year ago) everything has improved -- A1c, lipids, everything. And when i say improved, I mean drastically.
$0.02
The definition of Paleo diet varies, in a way the definition is somewhat arbitrary. We don't really know what are ancestors ate. In fact, one of the things that allowed our ancestors to live in such diverse climates is the ability to tolerate different diets.
One difference between Dr. B and paleo is the absence of dairy in a paleo. Also foods like sweet potato are considered acceptable in paleo. I for one cannot eat sweet potato without an unacceptable spike.
As diabetics our condition manifests differently in each of us. Ultimately our meters are the best guide to what is an appropriate diet. For me Dr. B's book accurately predicted what foods I can eat and what foods I need to avoid.
You're welcome.
I'd just strongly emphasize that we are all individuals and there isn't a single number for anything that really represents any of our requirements.
Like I said, the main requirement for putting yourself in ketosis is to do what it takes to deplete, or chronically depress, your glycogen stores. For some people, that means eating extremely low amounts of carbs like Dr B, or Atkins before him, suggested. If you're an athlete in training, or a growing child, or doing any one of a thousand other things that makes you different from somebody else, you may have different requirements.
I think one of the things I asked when I first came to this forum was if it was even necessary to be in ketosis to get the benefits of Dr B's philosophy. The consensus, here, seemed to be no. Ketosis definitely helps burn massive amounts of fat and can help you shed pounds very efficiently. I have the opposite issue. Maintaining weight, specifically muscle mass, has always been a problem for me.
What I have been able to do, however, is gradually lower my carb intake from something like 300-400 g/day to roughly 100-150 g/day. I'll top off at 250g on very active days where I'd be near 500g before changing my diet. That's defintely nowhere near what people here would consider low-carb, but it's certainly a significant decrease for me and about as low as I can go while still maintaining my activity level and, more importantly for me, my lean muscle mass.
Way more importantly, my diabetes associated numbers accross the board have improved.
Find what works for your family, as long as you are reaching your management goals. It is defintely a journey, not a destination.
I've seen that number quoted somewhere, I want to say Mendosa's blog, but from what I recall, those are minimal requirements at basal metabolic rate. So, that would be the activity level where you are waking up in the morning.
From other research, it's not exactly clear where the line is. Some folks will insist it's zero. I would think you'd have to have a pretty clear idea of what your daily energy budget is and know how much is specifically required to spare protein, either already incorporated into muscle or any you are intending on building, before you can determine a minimum for you.
On the flip side, I'm reading more biochemistry out there that suggests the trigylcerides from fat, not just the glycerol, can be actually be converted into glucose under certain conditions. Currently, the only data for humans are for diabetics in DKA which actually traces the carbons in the ketones and finds that they are incorporated into some of the glucose that is spilled in the urine. Not conclusive, but certainly suggestive.
And to offer additional anecdotal evidence of our individual differences, 30 grams is too high to put me in ketosis. My body clings on to every bit of fat it can and the only times I’ve gotten my body weight below 200 pounds (I am 66 inches tall) is when I’ve been eating 0 to 5 grams of carbs per day. Anything above 10 grams and I lose ketosis and stop losing unwanted fat.
Do you keep track with ketone strips?