My dietician does not recommend low carb diet for small kids, as she says it can stunt growth…do you agree? My little one hates carbs mainly, which is why i think she staved off D for so long (as we saw signs from the early days tbh)…instinctively i think she should not be eating much of the very thing that is damaging her (carbs!) and more of the good fuel (protein, veg, low sugar fruits, nuts, nut milks, eggs etc)…but im already dreading the scolding im going to get from my dietician this week if i dare suggest it
The evidence that proves that this sort of diet would stunt growth seems to based on... what exactly? It seems like this dietician should be paying you for an education.
I don't know much about carbs and kids admittedly and hopefully someone will post who does. I do know that doctors push carbs on kids (even more than on adults!). I personally would suggest going with your instincts about what is right for your daughter and if she is not a big carb enthusiast but eats a healthy diet, thank your lucky parent stars! As for the doctor? Don't tell him! That's what most of us do.
If you force your daughter to eat the Bernstein diet, then she will not be able to eat many of the things you list as being good fuel - Bernstein prohibits many vegetables (no peas or carrots for example), all fruits, any but a few nuts per day, and all nut milks. So if you subject your daughter to the Bernstein diet, then you will be putting her on a very restricted, very abnormal diet.
I feel the same way about an ultra-low-carb Bernstein diet as I do about vegan and other extreme diets. It's fine for a kid to choose them on their own once they are old enough to make their own decisions. But I think it is a very bad idea to coerce your child into eating such a diet when they are too young to make their own decisions. In my opinion it is begging for lifelong eating problems.
You should also not disregard the possibility of stunted growth from such a diet, although I have never studied it and do not pretend to know. You should certainly research it - here's a link to a study on rats that indicates this may be a concern: RatStudy
There are good carbs and bad carbs...as long as she's eating the good carbs it's ok..But I wouldn't be totally cutting out carbs at her age while she's growing. I was in nursing (dropped out due to my deafness) and carbs are still in medicals opinion needed for your body. Some people follow the GI index for carbs ...I don't think it will stunt her growth per se but in my opinion cutting out carbs at her age I don't think is a good idea...but again that's my opinion...
Personally I think the "kids need carbs" is part and parcel of the pushing high carb diets that goes to kids and adults alike. Having said that, I would agree with Jag and think there is a lot of territory in between Bernstein and high carb and I commend your instinct in letting her eat in the way that is natural to her and also happens to be D friendly. (and do the old "smile and nod" when medical personnel tells you she needs four bowls of cereal every morning..lol)
There IS a school of thought, widely espoused by many dietitians and doctors, that a certain daily amount of carbs is "essential" for good health, and that very low-carb diets are therefore dangerous.
HOWEVER: Others are actively encouraged to chime in on this, but I have never seen one single shred of credible, empirical evidence to support that belief. Until someone shows me some, I will remain convinced that this is an urban legend specific to the medical community.
Personally I eat about 40 carbs a day. It works well for me, but that doesn't mean it's right for anyone else. I determined that to be the right amount for me in the only way we can positively determine such personal guidelines: by trial and error. We're all individuals, and no two physiologies behave exactly the same way.
It's also important to remember that a percentage of the protein we consume is converted to carbohydrate. It's only a fraction, but it's enough that it needs to be factored into my bolus calculations in order to determine dosages that are accurate and appropriate.
Since your daughter is not carb-addicted like much of the population, I would try to limit her carb intake to a moderate amount. Try to have her eat a variety of foods. Most of all, let her post-meal BG readings be your guide!
I totally agree with Shawnmarie and Zoe that the important thing to do is to find a reasonable balance. Zoe may have had different experience, but I've found every Nutritionist I've talked to very receptive to the idea of limiting (but not eliminating) carbs to improve health and diabetes control. 100g per day is less than I am comfortable with, but every one needs to find their own level, based on age, height, weight, metabolism, etc.
If I were the parent of a young child with diabetes, I would return the Bernstein book and immediately order the book "Type 1 Diabetes" by Hanas - full name "Type 1 Diabetes: A Guide for Children, Adolescents, Young Adults--and Their Caregivers : Everything You Need to Know to Become an Expert on Your Own Diabetes" by Ragnar Hanas.
It is a truly excellent book and the most complete guide to living with Type 1 diabetes that I have found. Good luck.
Make no mistake, kids that have poorly controlled blood sugars suffer consequences. And having poor blood sugar control can stunt growth. And guess what, overeating carbs can disrupt good blood sugar control. So you are right to be cautious.
The problem with advice from a dietician is that it is without evidence. I have never seen any evidence that carbs are "required" or that a lack of carbs can cause stunted growth. Ask her for a study, even an observational study or case study. Did traditional Eskimo's have stunted growth? No. And they ate primarily a nearly zero carb diet for most of the year.
You need to make your own choice on these matters. If you choose to follow a strict diet like Bernstein that is your choice. If you choose to less aggressively restrict carbs, fine. But eating a high carb diet makes it harder to achieve tight blood sugar control and in my twisted little part of the world having a child have an A1c of 8% is likely to be damaging (although that is what many recommend).
ps. And your dietician is openly in defiance of the current ADA Standards of Care which have a uniform statement about nutrition for diabetes, it should be individualized. Clearly this dietician did not get the memo.
bsc said: "Did tradition Eskimo's have stunted growth? No. And they ate primarily a nearly zero carb diet for most of the year.".
Actually, the Inuit do show stunted growth: "In Greenland, the height of Inuit youth begins to fall behind the general population in their early teens. And decades of work with Canadian adult Inuit populations consistently show they are shorter than adults in the general population." LINK
And of course the Inuit were prone to "rabbit starvation" (protein poisoning) in late winter. Not to mention that their diet included raw caribou liver, raw whale skin, and raw seal brain in order to compensate for the lack of carbohydrates. Good luck convincing your eight year old to eat that :)
Jag1, you are right, when Inuit populations were introduced to western diets, they experienced stunted growth. If you look to the early contacts with these populations they had normal growth and much better health. Weston Price, for example, documented this. Unfortunately, the contact with western civilization has been a health disaster for the Inuit (as it has for many native populations like the Pima).
ps. I hardly think that Inuit or Eskimo ever attempted to obtain carbs from liver, skin and brains. Besides, kids will eat what is normal to them.
Well actually, introduction to Western culture did do catastrophic damage to the Inuit, but decreasing their height was not part of it. As I said before, their height was significantly shorter than the average American when they were eating their traditional meat diet. LINK
Also, I didn't say they were obtaining carb from liver skin and brains. They were obtaining Vitamin C which was otherwise unavailable in their meat diets: "Vitamin C is obtained through sources such as caribou liver, kelp, whale skin, and seal brain; because these foods are typically eaten raw or frozen, the vitamin C they contain, which would be destroyed by cooking, is instead preserved" LINK
Finally, you mentioned the Pima. Surely you are aware that the traditional diet for the Pima was very high in carbohydrate and low in fat: 70-80% carb. But it consisted of high-fiber carbs, not refined carbs. So the introduction of the Western diet that has been so detrimetal to the Pima health has been the dramatic increase in animal fat and protein along with replacing the complex carbs they ate with refined sugar and starch. LINK
You will certainly do your own experimenting, Fiona, but I have to tell you my experience has been that low GI doesn't mean a lot for Type 1's and I think that is the case for many of us. I was hopeful at first because I prefer whole grains anyway, but it made very little difference. Brown rice/white rice, whole grain cereal, whole grain bread - they all punish my blood sugar.
I'd like to add one cautionary note to what has gone before. I don't agree with the attitude that says, "read this book, don't read that one". What makes infinitely more sense, IMHOP, is to read them all. All the good ones, that is.
One size never fits all; no single author will have the approach that is right for everyone -- but more information is always better than less. Learn everything you can! Acquire all the information that's available! From each source, take what you can use and leave the rest.
I do admit to ONE personal bias when it comes to authors: I pay a lot more attention to those who are themselves diabetic; they have "skin in the game" and a personal interest that can't be matched otherwise.
Please excuse the cliche: this is a marathon, not a sprint. Your daughter does deserve a break from all this.
The beauty of “moderate” carb consumption is that it reduces BG variability, thus allowing a lowering of the average BG without the usual hypoglycemia hazard. I leave the definition of “moderate carbs” to you but I know that the carb advice of almost every dietitian would be way too much.
BGs north of 140 mg/dL exact damage. It seems the medical and nutrition professionals are more than happy for us to experience extended hours in the 140-180 range so that we can lessen the chances of hypos. Keep written records and let your daughter eat to her meter.
Testing two hours post meal is the way to see what effect certain foods or certain amounts of foods have on our blood sugar. It's especially important when you are in the early days of figuring out a workable diet as you are. It is also the most reliable way to figure out your I:C ratio (in other words if you start with 1:15 and see you are always high 2 hours PP then you want to try increasing it to 1:13 and see how that works.
But even after this period is past, most of us find it is important to test at two hours after eating to see how high we are spiking in part so we can determine if we need to correct. Since it is significant amount of time spent high, not just a brief spike that causes damage, it's important to correct highs promptly to spend as little time as possible high.
We can eat anything and everything. High carb, low carb, it's all irrelevant. Eating for your meter? eating for your insulin? (which I was doing for over 10 years) is nothing but crazy. Everything comes down simply to the carb value and possibly it's GI value, and us adjusting to it with our doses. A lot of countries are now being taught DAFNE (dose adjustment for normal eating) but I believe this still hasn't caught on in the US. But books such as Carbs and Cals give a simple picture guide to look at a plate, and deal with it approach which makes things simple.
No food is off limits, we just need to do the maths that our pancreas would do and adjust to it is all (heck, I ate a 160g pizza last night and flat lined my BG's through it). If she wanted to just eat carrots fine, if she wanted that McDonald's with the other kids, she could! Don't make the poor kid suffer through being chained down by this condition, she is as capable and able to eat, and do anything anyone else can! (I still get told by my own mother I can't do this and that, and growing up with that did nothing but really get between us).
I am glad that the UK has started to phase in DAFNE. This technique, called a basal/bolus regime was invented in 1972 and by estimating the carbs in a meal, you can adjust the proper dosage of insulin. This technique, usually called "Carb Counting" has been in use in the US since the 1990s. The problem is that while it should in principle work very well, there are major sources of errors which still cause serious problems. Nutrition labels in the US are only required to be accurate within 20% (and that is for an average, a specific product can deviate even more). And there are other sources of error (especially with pizza) as most of us are abundantly aware. So if you eat "anything you want" when you eat your 160g of carbs you might have an error in your carb count of +/- 32g. Since on average your blood sugar will rise 0.28 mmol/L (5 mg/dl) for each gram of carb, your blood sugar will have an error of 8.9 mmol/L (160 mg/dl). If you calculated your target as say 5.5 mmol/L (100 mg/dl) and just bolused you may well end up at 5.5 mmol/L (100 mg/dl), but you could also have a blood sugar of Zero or a blood sugar of 14.5 mmol/L (260 mg/dl). I would never want to take that risk with my child.
And even non-diabetics should try to eat a healthy diet. Nobody can just "eat anything," (well they can, it just may have really bad outcomes). And while I am sorry you don't want to "suffer," I've not heard anything from Fiona except the comment that her daughter likes eating this way. Diets are always controversial here. I'm glad you have able to have a great deal of flexibility, unfortunately, many of us don't. So we each need to find a diet and lifestyle that works for us as an individual.
