i have read soo much now on the advantages of eating low carb, but there are some issues that I am still insecure about and it would be great to get some direct answers: I am a fairly newly diagnosed late onset diabetic (GAD antibodies positive) but must be in my honeymoon period because my fasting numbers range between 80-110 and I need very little bolus when I eat a low carb meal.I do however spike significantly when having a fair amount of carbs.
My management has been pretty good as long as I stick to low carb, often I don't inject at all.
BUT when I went back to the hospital a few weeks ago for a routine check up the doctor there interviewed me about my diet (after she looked at my many "low" numbers in my diary) and as I told her about my carb intake her face grew darker and darker and she told me in this almost threatening tone that if I keep doing what I m doing I might seriously endanger myself as I might slowly "over-acid" my system which might lead to ketoacidosis.
Now I am confused. I thought ketoacidosis could only happen if my body was not receiving ANY insulin, therefore my BG would rise extremely high and start breaking down my own body fat in such large amount that THAT would lead to the keto. Could that happen to me? Is it dangerous not to inject external insulin because my honeymoon phase could abruptly end and all of a sudden my body is all out of insulin??
If I measured my ketone level right now it would probably be elevated since my main glucose is being made from the fats and proteins I eat, is that correct? But if so, I thought that as long as my BG levels were ok at the same time, those ketones werent harmful?
And my second concern would be: How dangerous is the issue of malnutrition on a LC diet? Is it really true that I am consuming way to many fats and proteins for my own good, increasing my risk of heart and kidney damage?
I would really appreciate some insight from people both in favor and against a LC diet. Unfortunately during this course at my hospital every question about or interest in LC by me or others was immediately shot down (like an automatic response) either through saying "it just cant be done properly" or "it might be dangerous or just plain silly", but all I know is that I am on low carb anyway because it makes control so easy and I have been feeling great since I started. I just dont want to oversee something and put myself in actual danger...
You have encountered something many of us have dealt with. It is not uncommon for a nutritionist or dietician to be totally uneducated about low carb diets. I know it seems strange, but the whole profession has made a special effort to make sure that everyone is "stupid."
Ketosis is natural, it happens to everyone everyday. As you sleep, your body burns fat, you are in ketosis every night. But you don't build up large levels of ketones and you don't get ketoacidosis. You are right, DKA only occurs when you don't have circulating insulin and your blood sugar goes high. Being in ketosis doesn't lead to DKA. In fact, doing a low carb diet and having a low blood sugar and ketones is protective against DKA.
I also find the issue of malnutrition laughable. Again, I've heard all this before. There are no nutrients in grains, starchy veggies and fruit that cannot be obtained from other sources. About the only thing I've ever heard is vitamin C which is actually available from low carb sources and easily supplemented. Any claims that there are unknown micronutrients that are important is what I call "woo." If there were really important micronutrients it would have shown up in the millions of people who low carb. How many of them got sick?
New studies also suggest that a low carb diet actually improves lipid levels and is protective of your heart. And as to kidney damage, there is evidence that when you have kidney failure, high levels of protein can accelerate decline. But there is no evidence that normal kidneys have any trouble with even "epic" levels of protein. And besides that, diets like Bernstein or Atkins are not high protein, they are low carb, high fat and moderate protein.
Sometimes, it can be really hard to fight "stupid." I just don't bother to tell most nutritionists or dieticians what I eat.
I am an LADA diabetic who has positive GAD Antibodies, as well. I began eating a low carb diet a couple of years ago. At the same time, I began to investigate a pump. I really noticed the difference in both blood sugar levels and blood sugar levels after beginning to use the pump. It was one of my better life decisions.
My endo was skeptical as to the effectiveness of the pump for me. He told me that he thought it wouldn't work. In deed, it had to work hard when I was eating pretty much what I wanted to. Low carb, high protein diet choices have done wonders to control both insulin usage and blood sugar levels. My last A1-c was 5.3! His only concern is the condition of my kidneys, which weren't the healthiest from prior to the start of this thing, probably from long uncontrolled diabetes.
I have no doubt that low carb has greatly helped my diabetes control. I think it is worth a try for anyone who wants to work at good control.
The first question I would ask is how much carb per day you are actually eating. Are you talking strict Bernstein, 30g per day, never any fruit or milk products or varied vegetables (aka ultra low-carb)? Or are you doing a more moderate approach?
I am personally not a fan of ultra low-carb diets for T1's, but it is primarily because I can't imagine finding such a diet enjoyable or satisfying. That said, I do not believe that even the ultra-low carb diet is dangerous or unhealthy in the short-term. As you say, if you are checking your BG, and maintaining your BG in a normal range, then you should not have any trouble with keto-acidosis.
If you have found a diet that is satifying to you, and if eating that diet means you can maintain normal BG without injecting insulin, then it sounds perfectly reasonable to continue (assuming you don't want to try to preserve beta cells by taking some supplemental insulin - you should discuss that with your doctor). But make sure you are really maintaining your BG in a normal range - because if you aren't, or if you stop testing, then as a T1 you are at risk for ketoacidosis (just about all of us T1's who got it when we were young decades ago were admitted to the hospital with ketoacidosis and it isn't fun).
As to your second question, I don't think there is a definitive answer to how good or bad for you ANY life-long diet is. Unlike caged rats, people eat whatever they want, and it is therefore very hard to know what the people you are studying have actually eaten. This uncertainty is what keeps the diet charletans selling their books.
Personally I believe in the numerous studies that have found a correlation between heart disease and eating a large amount of saturated animal fat and protein. And the studies that indicate that eating vegetables, fruits and whole-grains are good for your long-term health. Some people call that "stupid" - OK fine, whatever, but it seems smart to me. And that's something that everyone needs to decide for themselves.
There is a lot of great information on this website - including quite a few links Youtube interviews of several experts in this area of nutrition, and to peer reviewed literature about low carb / high fat diets: http://www.dietdoctor.com/lchf
I've been doing LC/HF for 5 months now. I've lost 22 pounds and have an A1C of 5.4 (it was 12 when I started). My total cholesterol dropped from 225 to 189. My triglycerides went from 255 to 108. My cardiovascular risk ratio improved from 7 to 6.
No nutritional issues here, and while there is a dearth of long term clinical data, there is alot of short term research indicating that LC diets are beneficial for both blood glucose control and cardiovascular health - although I am type II and not on insulin, I don't think you have anything to worry about!
Are you aware of the 2010 meta analysis of the highest quality studies on the subject led by Ron Krauss (former chair of the AHA nutrition committee) that found "no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD." I think it is time to actually say that the emperor is wearing no clothes.
Everyone should make their own choices, but I think we all have a right to be informed about our decisions. If you have information on studies that show that low carb is actually dangerous, I do hope you will share it.
I have been doing 'moderate' carb, and think more about choosing whole foods/less processed foods, with high nutrient value. I learned a lot from the book 'Eat to Live', and changed the way I evaluate which foods to eat. I think the other key factor is to 'eat to your meter'. Everyone is different, and only you and your meter will show what are the foods that help you attain the best blood sugar levels.
What is common for many here, is that most cereals, breads, pasta, rice, etc. are very hard to balance BG with the 'right' dose and timing of bolus insulin. I think those that are more active seem to handle them better, which makes sense to me.
I eat fruits and small servings of some grains, others find it doesn't work for them.
Although my doctors did not recommend this to me, they have not objected to my choices, especially after seeing improvements in A1C and other lab results.
My suggestion is to find what you think is a healthy diet, and fits your lifestyle. And if you need supplemental insulin, and attain your BG goals, without lows, perfect !. Some have suggested that using external insulin helps preserve the pancreas/beta cells, and prolongs the ability to produce insulin.
No, but I also know that there are many studies reaching the opposite conclusion that you have not read. As I noted, there are studies on both sides - please read what I already wrote: "I don't think there is a definitive answer to how good or bad for you ANY life-long diet is."
So no, one study is not enough for me to conclude that eating sticks of butter instead of mixed vegetables every day is going to be more healthy for me. And perhaps you could point out where I stated that low carb is actually dangerous? What I said is that a diet that excludes all fruits and whole grains and most vegetables (as the Bernstein diet does), does not sound like a very satisfying or healthy diet to me. But maybe that's because I'm just plain "stupid".
Hi Julez: For me, going lower carb has been a really positive move. Reading about the success of TuD members helped me move in that direction, and I personally think it is both healthy and makes blood sugar control so much easier. I am a lower carb advocate, not low carb a al Bernstein, as I find Bernstein not conducive with my active life. I would suggest you experiment and see what works best for you! And let us know how it goes.
You entered this conversation. You claimed that you had studies showing saturated fat caused heart problems. I gave a reference to what is called a meta-study, a quantitative look at all the highest quality studies (randomized controlled intervention trials) that had been done to date (presumably including any you would quote). And the conclusion, in total, we still don't have any evidence that saturated fat causes heart problems.
And I would agree with you in a lots of cases, we don't know "definitively" what is good for you. This cuts both ways. We also have studies which seem to point to grains such as wheat as particularly unhealthy. Dr. William Davis has a book on this subject "Wheat Belly." But we have spend much more time and resources trying to prove saturated fat is bad and despite all that effort, the studies don't show it.
And yes, I think it is stupid for a dietician or nutritionist, whose profession is diet, to be so willfully ignorant of low carb diets. This isn't about Bernstein (we are painfully aware you don't like his diet). My comment about stupidity is about knowing the basics of your profession.
I don't think many of us low carb types are "eating sticks of butter instead of mixed vegetables". Personally I do eat lots of mixed vegetables(low carb) with perhaps a pat or two of butter on top, or raw in the form a salad sans the butter.
I recall a specific guy I used to work with, eggs, bacon, pork rinds, (large) microwaved container of ground beef for lunch. I was like "I know there's something wrong with that..." without knowing what it was.
I don't ever eat much fruit but have been aiming at veggies as I feel healthier and stronger recovering from longish runs when I've made the effort to toss more veggies down the hatch. Even if it's psychosomatic, I'll take what I can get. Re "diet", I'm not one to say "I can't eat that..." about anything.
I noticed decades before my diagnosis that I felt better if I ate a salad that included lots of raw vegetables, in addition to lettuce, everyday. I have missed very few days since then without eating one. Luckily a salad like this fits in nicely with a low carb diet. I am restricted to what fruit I can eat without unacceptable spikes but strawberries and blueberries seem to work fine.
Eating any kind of diet can be dangerous for you as a T1 D. But it isn't necessarily the kind of diet it is the effect that the kind of diet you have has on your blood sugar. If you can find a diet you can live with and avoid blood glucose "excursions" whether high or low then great. The doctor is programmed to avoid lows at any cost. These can lead to accidents, neuroglycopenia, and death, all of which would add up to a large law suit if you were following their advice. So in an effort to avoid litigation endo's, CDE's, and dieticians are all taught that T1 D's cannot maintain euglycemic control without having too many hypos. It is probably why the ADA says the A1C range for a well controlled T1 D is 6.5-7.0 % if you do the math a 6.5% A1C equates to an average blood sugar of 140. Not sure that is the range I would be aiming for, and I challenged my PCP the other day to find me a single scientific reference paper using a T1 population where an A1C of 6.5% was better than one of less than 6.0%. Naturally she could not find one. And until she can I will stick with my plan to get my numbers down as far as I can provided I can avoid hypos. I have found since I have cut down on carbs my blood sugar control is a lot easier. I am not LC by any stretch of the imagination, but I can't find anything wrong with it if you can avoid lows.
Well, this is silly. I don't believe you really think there have been no studies that indicate saturated fat is associated with cardiovascular risk. Do you REALLY think the AHA and nutritionists conspired together to secretly foist an unhealthy diet upon the American people because they are all willfully "stupid"?
Let me remind you of what a meta-study is - it doesn't necessarily choose "highest quality studies" - in fact it chooses whichever studies it wants to, based on the selection criteria the researchers define. And let me also point out that the researcher who did this study is being funded by the National Dairy Council - you know, the lobbyists for butter and cheese.
I entered this conversation because julez specifically asked for input "from people both in favor and against a LC diet". Several people including you supplied the pro-LC diet point of view, so I think it was perfectly reasonable for me to throw in a comment from the other point of view. I'm not sure what this has to do with "Wheat Belly", but I do recall there was a spirited debate here about the book in an earlier thread LINK HERE. I guess things haven't changed much.
I think that they foist an unhealthy diet on us because they are corrupted by agribusiness subsidies.
It's interesting that the food threads here seem to be pretty much oriented towards lower carb solutions but there aren't a lot of people saying "I eat 300G of carbs/ day and my A1C rocks" convincingly. Although I will say I eat (*checks pump*) 150ish G of carbs/ day (this incl 20G or so of flussigkeitbrot or liquid bread heh heh heh...) and my A1C is ok. I am perhaps overly hyper about my BG but I would be overly hyper about my BG if I didn't pay any attention to the numbers too (cf. 2004...) and I feel much better with it on a leash.
I think we can go back and forth on the whole dietary fat, cholesterol heart disease debate. It has been endlessly debated. In the end, I will tell you what I decided. You just need to look at the numbers. Type 1 diabetics have a ten fold higher risk of CVD than non-diabetics and it is attributed to high blood sugars, NOT cholesterol. The DCCT showed that a decrease in A1c of 1% reduced CVD by 47% and risk of heart attack or stroke by 57%.
The risks shown in even the most alarming studies of dietary saturated fat? An increased risk of 35%. By any measure you should feel very safe that controlling your blood sugars is the best way of decreasing your risk of CVD, even if you believe all the worst studies about dietary saturated fat.
In the end, there seemed no other conclusion, "It's the carbs that are the clear and present danger."
ps. Another thing to remember about these studies is that if there was "big effect" it would show up. The DCCT only had 1,441 participants and showed such a big effect that the trial was stopped, it seemed unethical to deny the particpants the opportunity to improve blood sugar control. The study I cited looked at over 300,000 patients and found no evidence. If studes with 1000 times more resolving power can't find a clear effect, it just isn't a "big effect."
I agree to some extend. Most endos would argue that they see little benefits to aim below 6% for the A1c. In contrast they focus on the likelyhood of lows and their potential negative side effects like: nightly lows with impaired sleep, traffic accidents and cardiovascular stress. I write that just for the sake of a more balanced view on "low blood glucosing".
Like the studies of low carb dieting, I don't think there's a lot of studies aiming at A1Cs in the 5s or studying the effects since only dangerous lunatics do that. Maybe there's enough people at Tu to give it a whirl however I abandoned anything other than a dilletant's interest in science about 30 years ago, right about the same time as I got diabetes as I flunked advanced chemistry since I was sleeping through it every day. I still hate that teacher a lot, although she's probably pretty old by now.
I haven't had any traffic accidents for a while, haven't had the nighttime sweats since I've had a pump and my heart was cleared after my wierd incident during one of my last hypos. I read somewhere that the thing that kills runners isn't the same thing that kills people with diabetes and I think that I've run enough to exclude the thing that kills runners. I'm a very small sample size though?
