Low-Carb Ideas vs. Doctor

I recently had lab work done (12 h fast) and here are my numbers:

A1c: 7.1% (ouch)

CHOLESTEROL, TOTAL 179 H 125-170 mg/dL
HDL CHOLESTEROL 45 36-76 mg/dL
TRIGLYCERIDES 88 40-136 mg/dL
LDL-CHOLESTEROL 116 H <110 mg/dL (calc)

(double ouch!)

my doctor recommended low fat diet, see nutritionist, etc… no comment on A1c.

I replied that I do not subscribe to an ADA/AHA recommendation of low fat. I cannot do low fat and lower carb at the same time. I have been thinking about low carb (modification of Atkins diet) for awhile now, so I though why not go for it? My doctor did not like this idea.

I’ve read Dr. Bernstein’s book, my parents were on Atkins for a while (with great results), and I believe in the benefits of a low carb lifestyle.

Does anyone have suggestions? Has anyone gone through this with a endocrinologist?

It is very difficult. All the medical advice that we get harps on low fat and cholesterol, but in fact all the evidence clearly points to the obvious situation that carbs increase your blood sugar. Most doctors feel almost as though their hands are tied forcing them to advice patients to follow a low carb diet and take statins to reduce cholesterol.

You have read Dr. B’s book and you realize he is onto something. You are unlikely to find an endo or other doctor who is going to approve a low carb diet. They will all tell you that your cholesterol will go the wrong way, even though that is not likely to happen. And actually, your cholesterol is actually pretty darn good. If you reduced your blood sugar your triglycerides would probably drop a bit and you would be fine.

I would just make in an informed decision, mention to your doctor that you are controlling carbs and see how it goes. I think you will be pleasantly surprised.

My third endo is more tolerant of low carb than the previous two. He knows that’s what I’m doing,if not exactly encouraging, & can’t argue with success.

The previous endos told me 1) I’d never be able to do it for any length of time (been over 1.5 years now) 2) it’s unhealthy & I’d have no energy (I’ve never felt better) 3) the fat content would kill me (nope) & 4) my brain would starve (I’m still coherent). Also went through this with a CDE & a dietician. All were ADA down the line. By the time I found my third endo, I was direct from the first visit that I followed Dr. Bernstein’s guidelines & was going to continue.

Very good chance that your lipid profile will improve when your BG is lower.

Have confidence in your decision & stick to your guns.

Thank you for your responses, bsc and Gerri. I just feel that it is so backwards for some doctors/CDEs/nutritionists (and nondiabetic friends) to still be preaching this wrong, old-school business, and thinking it’s all backed up by research. I am a well educated, biology student who’s read much information about low carb.

As for your endo telling you that your brain will starve, perhaps he or she ought to go back to biology class and learn that everything we eat (fat and protein too) is converted into glucose (for our brain and cells).

I will be confident in my decision and definitely plan to stick to my guns. Thanks again!

You go, awillie!

You’d be stunned how many times I’ve heard the starving brain scenario from healthcare professionals who should know better. I vainly attempted to tell a CDE & nutritionist exactly that & they shook their heads in disbelief. Don’t know what these people are being taught in school.

Ideas are slow to change. There’s also a vested interest in keeping us high carb with correspondingly high insulin needs. Eat whatever you want & cover it with insulin. Everywhere you turn, it’s ADA recommendations. Say something enough times & it becomes truth.

If you ever get the chance to have a heart-to-heart with a diabetes professional, ask him/her what goals are set for their patients. Sadly, their expectations are low. Many don’t think patients can cut carbs much at all, so patients are given dumb-downed, easy targets. Their concern is that patients will be even less compliant if asked to do too much. It’s a travesty to not be giving people the tools they need based on the assumption they can’t do it. It’s a condescending & disrespectful mindset. Not about education at all.

I think it’s definitely worth a shot to try a low carb diet.

For the last two weeks i’ve been doing low carb (15-50g/day) on the weekdays, and i have felt GREAT. My blood sugars have been amazing, I haven’t had mood swings, and I stopped taking naps.

However, I do tend to have trace amount of ketones (5mg/dL) sometimes, even when blood sugar is in range (120-80). right now i’m trying to eat enough carbs so ketones are not present while staying on the low carb side. However I haven’t talked to my endo about low carb diets yet.

Hope this helps

Hey Paul,

Great you’re doing so well!

It’s normal to have slight ketones with a low carb diet & nothing to worry about. Ketones are a natural by-product of burning fat for energy. The only time to be concerned is if ketones are persistently high when BG is also high. Drinking a good amount of water & correcting the high should bring both ketones & BG down. Diabetic ketoacidosis (DKA) is different than having slight ketones.

Trace amounts of ketones can also be present in the morning due to fasting overnight.

One thing I’ve found with low carb is that it’s good to try to keep the amount of carbs & protein pretty consistent from day to day.

Thanks Paul! I like you attitude that it is definitely worth a shot. It may not be the easiest around the holidays, but I’m up for a challenge! I will keep an eye on the ketones too. Thanks for the info!

Mild ketones are nothing.

I was diagnosed T2 in September. At that time I read a book by Dr. Neal Barnard advocating a vegan diet for diabetes treatment. I started the diet and have lost 50 lbs and brought my A1C down from 6.9 to a 6 at last visit. I am currently taking 2,000 mg Metformin daily. I test 8 times a day and my BG tends to stay pretty stable at 120-130 throughout the day, but my morning fasting readings are always in the 130+ range which is frustrating.

I read information advocating a low carb diet for diabetes and tried it for a week, but my BG levels rocketed up to 140-150 range. Maybe I was doing something wrong, but I am a nutritionist so I do understand what is low carb and what is not. I’m not sure why I had the results that I had. My goal is to continue to lose weight, which I know will be tremendously helpful, and also get off of medications altogether if at all possible. Has anyone else had an experience similar to mine where the low carb diet actually made their readings higher?

Go for the low carb. An A1c of 7% is still quite high. If you go low carb then your BG will improve quite a bit and in tandem so will your lipids. Plus there is indication now that a high fat diet does not generate the bad size of LDL but that fructose does generate the killer cholesterol. NO regular pop whatsoever or any processed foods like ketchup that contain a lot of high fructose corn sirop. Some exercise would improve the HDL and very low carb will lower the triglycerides. Some people now believe that the ratio of HDL to triglycerides is much more indicative of future problems than LDL cholesterol

Dear Tracie.

You could add a little shot of Lantus in the evening to control morning BG. I can see the advantage of a veggan diet is the low calorie density. You can eat a lot of food volume wise whereas fat is high calorie food. The only carbs I can eat now is celery, green beans, lettuce and other non starchy stuff. One though is that there is an induction period for the low carb diet that needs to pass before the body starts burning the fat.

I am glad you had success with the vegan diet. Personally, I am highly dubioous of Barnard, PCRM and the PETA bunch. In the end, everyone has to find their own way. Perhaps others have found success with vegan options. I’ve never found that eating less carbs raises my blood sugar.

I figured that some of my results might have been simply due to the weight loss and when that tapered off I decided to give low carb a try. Maybe I should give it a longer trial than a week, but when my numbers began to climb I got worried and switched back to the vegan diet. Thanks for the feedback everyone. It is tremendously helpful.

I haven’t gone through it with an endo, but with t he CDE nurse that I see. She didn’t believe in the program I had been following, losing over50 lbs, but really wanted to see me on a lo carb diet instead. We went round and round about it, always little jabs about sugars, health, longevity etc. I finally had to be a little more stern and assertive and remind her that I was the patient it was my body and my life…I’d listen to anything she had to say, but in the end I make the decisions. My numbers were good at that time, and my weight loss was great…eventually I did switch over to lo carb…but it was my decision, not hers, and it was my asking her for the help to get there. Can’t say I agree with everything she says, but, I am still the “customer”.

Do I get from the responses , that the above posted chol. results will get better, if a low carb meal plan is being followed ?
My question is there no concern for these results at this moment with 2 of them marked H ? If I recall the comments, only Anthony mentioned the chol levels
I do not eat a low carb diet , as most of you are aware, but a well balanced diet ;my chol. results are within the target range
( and am likely 3 x awillie’s age ??) …I feel like the devils advocate …please just treat me like a pussycat, OK ?

nel- I always enjoy reading your opinions on others’ posts, and I wanted to thank you for commenting on my discussion! And of course, we will be nothing but nice to you. I completely respect others’ choices to take whatever approach in their diets. The goal is to find something that works for the individual and stick to it!

I am concerned with the cholesterol levels… especially with the two marked as High. My doctor mentioned that she wanted the number below 100… and I’m guessing she means the LDL?

I’ve recently not been as active as I usually am… swollen tonsils, constant colds, and finally the tonsillectomy! set me back a bit. Increased exercise should also improve my numbers.

Maybe you hit it right on awillie ( you did treat gently …thanks kiddo ) …movement , movement , movement :wink: …oh, how I loved reading your response …you are soo kind to me …doggie ( ME ) walk next and you know WHY :slight_smile: ( and the total chol is a bit H too )…all the BEST and HUGS from me …living with diabetes for 27 years …you can :wink:

Before you do anything too drastic like Atkins Phase 1. Can you narrow down what foods may be contributing to your LDL? Some Dr’s look at the ratio of HDL/LDL which is low for you. After you get better from your tonsillectomy, excercise is critical to changing the ratio.

I also think the “maintenance” phase of Atkins is just ballanced eating and may help you address the LDL by limiting the short chain fats and gives you a good understanding the GI index. Remember phase 1 of Atkins was created for heart attack victims that needed a rapid significant adjustment. Most docs shy away from “drastic” and I’ve had friends hair actually fall out in clumps on phase 1. If you believe low carb would help you… then read the book and see what you think.

I would echo the previous posts in that low CHO has helped me control BGs and BG variability which should lipids and risks for complications…which is really what the numbers should reflect. I have been playing w/ low CHO for a few months now and A1C is already down from 7.2 to 5.9:)

I am a 30y T1 who aggressively used insulin to control BGs (rollercoaster on high CHO) and gained significant weight as a result. I have been nothing but pleased w/ my numbers and control since the switch…I guess this next set of lipids will tell me more. I am seeing my doc for the second set of numbers end of January…so, cannot say if any have bumped up or not. I suspect not so much, because I have conscientiously kept saturated fat/high fat meat, dairy and cheese intake low and get most of my fat calories from nuts, seeds, and olive oil. Protein is mostly from our chicken eggs, chicken and fish…some beef. Will have to see how my numbers change…but, like yourself…I think this type of intake makes more sense for me and my daily blood glucose numbers show a significant benefit.

Tip of my hat to Nel…yes, we all are different and I am sure different strategies work for different people. By the way…it was my Endo who suggested trying low CHO…and she was elated when she got the news of my 1st HgA1c. I cannot say that any of my previous Endos would have made the same suggestion…she is unique and her research work has kept her more flexible to different types of treatment. I feel great and blood sugars are extremely stable on 1/2 the insulin I was using which should also translate into less risk. Additional benefit has been that I am not hungry all the time like I used to be:) dropped about 15 pounds so far.