Low Carb Study Appears to Help Type 1 Diabetics


#1

This small study was released today. It was published in Journal Pediatrics. It was conducted out of Boston Cildren’s and Harvard Medical School. The New York Times has a well written article on it.


#2

I am a member of the type one grit group. They follow Dr. Richard Bernstein approach. Many people there are having great success with the approach.


#3

I’ve been following a higher protein diet for over 15 years. It certainly helped me, drop 35 pounds, halve my insulin use, my HbA1C dropped from 7 to 6.4 - this is good for me - and had been in the mid 6’s for 15 years. I read and commented on the article a few days ago, so now considering going further into high-protein. Honestly, I use mostly low-glycemic carbs and focus on protein so need to see what the grit approach is.


#4

I also belong to the Type 1 Grit Facebook group but don’t check in there very often these days. This is the community that the observational study is about. They are a highly motivated and smart community with an adherence and reverence for all-things-Bernstein that can border on religious fervor.

The Type1Grit community is overall friendly and polite. Many of the members are parents of your children T1Ds. Their community wide A1c’s clock in at under 6%. Some of their members have A1c’s in the 4% range.

I think that some people online resent their strict adherence to the Bernstein 30 grams per day limit of carbs. But you just cannot argue with the results.

I had to smile when they quoted 84-year old T1D Dr. Bernstein in the NY Times article. He has faced professional skeptics his entire career. He’s out-lived many of his naysayers. He’s finally getting wider respect for his ground-breaking diabetes treatment regimen.


#5

It is clear that the Bernstein approach works for some (many?) people but a study like this doesn’t show more than that. It is likely that people who try Bernstein’s approach and don’t achieve the results they hope for will simply disappear from the pool. It’s too restrictive a diet for someone to continue with it without success.

Maurie


#6

Hi Maurie –

Although I have to say that my memory of the T1Grit community was of their big emphasis on delicious low-carb recipes. You’re right though, most people would not persist in this way of eating without some success.

I continue my lowish carb (60-75 grams/day) eating going into my seventh year. It continues to add to my quality of life.


#7

There are two things that concern me. First, my understanding is that several members of the TypeOneGrit group have died of hypos recently. Too much “competition” to achieve low A1c’s can have bad results. Second, I have heard too many reports of bullying on the TypeOneGrit site. Not good.


#8

Reports of hypo-deaths concern me. I hope the community is learning something from these tragedies. Bullying is never OK.


#9

I personally followed the story of one of ladies who died. She was a senior neonatal doctor. Her low occurred following a serious illness. She had been having very high blood sugars that she couldn’t get down. Her sugars then dropped very suddenly and she was found unconscious. She was on life support, but unfortunately didn’t make it.

The second I heard of, but don’t know the circumstances. Went to sleep, didn’t wake up.

To put this in context; we have a group of 3000 members, who I would assume are following lower carb eating to some extent (strict or not), and we have had 2 deaths that I am aware of in the past 2+ years since I’ve been a member. I would also be interested to know similar events in a group following standard recommendations.

Sick days throw everything out for people with diabetes. We are still dealing with a disease that is highly challenging and daily using medication that can kill if overdosed. Even with very diligent management things can go wrong. The group emphasie the importance of tight control; avoiding both highs and lows. They also emphasize the importance of close monitoring, especially when unwell. That when ill one must not increase basal insulin, but only do corrections (carefully) with fast acting insulin.

For me the bottom line is still the ‘law of small numbers’. Given how dangerous insulin can be, it is far safer to eat in a way that means I need less insulin than more, and thus my dosing risks drop.

The recent study being discussed did find serious hypo events were less frequent in this population than reported for other type 1 populations.

I believe my risks (and stress levels) are far less when I don’t swing from highs to lows, that need to be corrected.

I haven’t personally seen bullying on that site, though of that’s not to say it hasn’t happened. Mostly I find them very supportive and generous with sharing experience and information.


#10

Grit approach emphasises protein. Low carb of about 30 g/day (for adults, less for kids) - a bit higher than typical keto, and fat that comes with food / energy balance. They also follow eat to your meter approach trying to limit blood sugar swings plus / minus about 10 from that magic target of 83! Realistically that translates to a target range of about 70 - 100, at least for me.

The same eating approach is also followed by the ketogains community - though their carb levels vary based on weight and goals (somewhere between 20 - 50g as far as I’ve seen).

With the recent emphasis on keto, there are now so many great recipes out there for higher carb replacements… so eating low carb becomes less restrictive.


#11

Does anyone know how to find information about the effect of this diet on minimally compromised kidney function?. I also wonder about its impact on heart disease. I have been going lower carb over the last three months. My a1c went from 7.6 to 6.9. Better. But still I do worry re above even tho tighter control is a good thing…


#12

I think the main issue is that there simply is no research saying whether low-carb is safe or dangerous either way. This study is not perfect, it was done on a very specific, self-selected group of people, but it’s at least a start in documenting that a low-carb regimen can work for achieving tight control and calling for further research in the area.

Hopefully more studies will be done in future so that some of the concerns people have with following a low-carb diet (growth in children, effects on cholesterol, risk of hypoglycemia, risk of nutritional deficiencies, psychological impact, impact on kidney disease) can be answered.

For me, following a low-carb diet has had a profoundly positive impact on my diabetes, both physically and psychologically.


#13

There is no research saying low carb is safe. But there are plenty of studies showing high insulin and high blood sugars cause complications. So if low carb lowers my insulin doses and gives me normal stable blood sugars, going a good way towards negating those risks… i know which approach i am following. Addressing known risks, vs leaving those risks as is because of a possible (but honestly i believe an improbable risk from having fairly consistent metabolic ketosis)but undefined risk.


#14

I agree with you for my personal approach to diabetes (I eat low-carb, though for me I still have significant highs/lows daily, so it’s not a perfect solution). But in order to get some people on board (and also to get healthcare professionals to recommend it as a official treatment option), you need long-term research showing that it’s safe for various populations.


#15

I’ve been eating Keto low carb high (healthy) fat. I haven’t felt this good in years. No up/down feelings from high carbs. Steadily losing weight and not hungry between meals. My glucose reading is rarely above 130. Next A1C should be well below 7.0. Also, now that my body is in burn fat mode, I can work in the yard for hours and not go low from the activity. One side affect is carb resistance now that my body is in fat burning mode. Need to use much more insulin to reduce a high BG if I do eat carbs.


#16

I would argue that the evidence on low carb is in. It is safe. The human race has evolved over millions of years and for the most part carbs have been absolutely minimal. Some seasonal wild berries is just about the extent of it. It kind of humours me that the idea of low carb might actually be harmful and requires research. If there was anything about low carb that was detrimental to human development it is questionable if we would even be here to discuss. The agricultural revolution only kicked in some 30 000 years ago, but 1980 is the year when things really went haywire. That so happens to be the year that the US Dietary Guidelines were introduced. If you look at the statistics of health outcomes it is at that exact moment the graph turns. Having said that, it is not only about low carb. It is also about protein and wholesome food.


#17

This article is regarding a very low carb diet- around 30 carbs a day. This is similar to the keto diet, though that contains more fat than protein.

Studies have been done showing that the keto diet can stunt growth in children. These are studies that scientifically compare growth of children on the keto diet to children who are not on a very low carb diet. I’ll paste a couple below. There are more available though. If you have evidence showing that a very low carb diet does not stunt growth, I would very much like to read it. Please post the studies!

http://pediatrics.aappublications.org/content/122/2/e334.short?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A+No+local+token

Many people talk about low carb diets on here, but “low carb” is very relative. Some people consider 80-100 grams to be low carb, and I could see how that diet could be very healthy for children. That’s not what this article is about. This is not a research study either, it is merely an article.


#18

I don’t think that there are any studies that conclusively prove that a very low carb diet does not stunt growth in children. But you are talking about a Ketogenic diet which I am not, and to be honest I don’t know exactly what a Ketogenic diet is as it seems to vary according to goals, and interpretation.
I don’t consider 30 g per day VERY low. Many Ketogenic regimens call for less. 30 g carbs allows for plenty vegetables, berries and low glycemic fruit. Ketogenic diets often (not always) promote low carb and high fat. What is rarely mentioned is the protein. The Bernstein Diet which I follow suggests low carb, adequate protein and whatever fat comes along for the ride. This means that you target protein to energy and growth levels. An athlete or a growing child will need much more than a sedentary person. As I am sure you know protein is the most important building block for humans and is what stimulates growth. Fat is just stored energy with little nutritional value and carbs are just glucose chains that are stored as fat in the body. Nutritionally carbs are worthless.
Carbs and specially refined carbs are a mostly modern invention. There are some seasonal sweet fruits but many of those have been propagated to become what they are today. A ‘natural’ apple or banana is / was very different than what a sugar laden modern version is like. I more or less consider fruit the same as processed food. Ditto most vegetables. Basically I am reiterating my point that for most of human existence there were very few carbs to be had and I have never read research that point to stunted growth in early man. So you are right, there probably are no studies that prove very low carb diets won’t stunt growth. But likewise there are no studies that prove that drinking little water does not do the same. But what we ‘do’ know is that high blood sugars stunt growth and brain development in young children and cause increased cardio vascular events, as well as a host of nasty complications.


#19

If we’re simply talking theory with no basis in research/fact, then sure, theoretically perhaps a very low carb high protein diet could work.

Using early man as evidence for the healthiest way to eat is silly though. We’ve quite literally evolved since that time largely because of agriculture. Of course, there are so many reasons why that happened so you can use that to support all sorts of ideas/theories.

There’s no reason a child should be advised to go very low carb. It reminds me of how restricted my diet was as a child under the whole R/NPH regime. That was awful. Seems like a little bit of research would be a good idea before we decide that an extreme approach is the healthiest way for children to treat this disease. Especially given that research into keto diets shows definitively that there can be problems with growth if carbs are restricted.

Anyway, I don’t expect you to agree with me. I just needed to post an alternate perspective because I don’t want parents coming on the site and deciding very low carb is the only way to go, reading all these posts and an article presented as if it were research.


#20

As I said, keto is different and not a precise thing. The study you refer to was a Ketogenic diet to treat epilepsy. Unfortunately I am not able to read more than the summary. It states that the kids were given adequate nutrition but I don’t know what that means. These were also kids with special medical conditions and as far as I understand the Ketogenic diets used to treat epilepsy are lchf.
The agricultural revolution is relatively recent (30 000 years), and physiologically we have not ‘developed’ in that time. Physiologically we are still the hunter gatherer.