My reading of the studies is that it's high carb coupled with high fat that is the dangerous combination. Low carb high fat and low fat high carb yield similar results in regards to blood lipids, so a study of saturated fat in the diet is only valid if carb consumption is taken into consideration.
I agree with Brian, "It's the carbs that are the clear and present danger." If carbs are causing spikes in blood sugar they must be controlled by whatever means an individual finds works, and just as importantly, is sustainable. For me low carb is the answer, I have just started year 4 of low carb and find it a sustainable way of eating, for me, and so far I have been able to avoid unacceptable spikes.
I don't have the answer to your question julez, however I know living with diabetes for almost 30 years what has and what is working for me ..my weight has been stable , I exercise regularly , I do believe in " mindful eating /variety of foods " and consume daily approx 150 grams of carbs ( require less than 20 u of insulin daily ) ..plan to eat more when I start my " training for my Amsterdam run , October 2013 " . As an example: presently our home grown spuds , beets, etc.for supper, hubbies prepared steel cut oats for breakfast , plums from the neighbour's tree . We are all different...
Jag1 mentioned one issue that hasn't really been picked up on. There is some evidence that starting insulin early is a way to maintain beta cell function which helps your control over the long run. Eating a diet which allows you to skip insulin entirely may not be the optimum strategy for the long run.
I was diagnosed almost 6 years ago at the age of 57, have averaged around 150-165 net carbs per day, maintained a good A1c and probably some - although declining - beta cell function to this day.
I think it's clear that one can be healthy on a low carb diet and one can be healthy on a moderate carb diet. If you want to eat more carbs you can reduce your chance of errors by weighing your food and sticking to foods you know.
Good luck and remember you can always change your mind if one strategy or the other doesn't work.
good point about starting insulin and continuing Maurie ( and Jag1 mentioning same ...which I missed ) ...when I was diagnosed in 1983 none of this information seemed to be av. to me ...yet my instinct told me : use insulin !!!..and I was only using 2 u a day ..maybe it saved me and as a 72 year old person and looking ahead of many more years living with D !
While there is evidence that early insulin use leads to better outcomes, I think it is all related to preventing glucotoxicity. Glucotoxicity is when high blood sugars damage your beta cells. There is some evidence the damage starts occuring at 140 mg/dl. I've not heard of any other mechanism by which insulin helps. So I think glucotoxicity is why early insulin, certain intensive oral treatments and why low carb diets all work. They keep your blood sugar stable and well controlled avoiding excursions above 140 mg/dl and damage to your pancreas. So yes, I agree, think certain intensive treatments, early insulin use and low carb diets can all help a T1 or T2 (both) preserve beta cells.
We have had extended discussions about Cousens before. I consider him a dangerous charlatan and a purveyor of science woo. He advocates a raw vegan diet as a cure for both T1 and T2 a position I consider potentially harmful. Don't be mistaken, I am all for eating whole foods and lots of veggies. But I don't think a raw vegan diet is going to lead to good blood sugar control. If you believe strongly that you cannot ethically eat meat, seafood and dairy products and are willing to make the tradeoff against your health, that is your choice. Just not one I would make. In the end, we all should seek to get the best information on these issues and make our own choices.
I don't believe there is a "once and for all" regarding the best diets for individual diabetics. Good research with good methodology can tell us a lot but even the best research generates conclusions based on statistical probability. To find out what's best for us, as individuals, it is important to have as much accurate information as possible and to be able to look inside the numbers to see where we, as individuals, lie.
There is plenty of misinformation on all sides of the argument, whether you believe that dietary fat is the enemy or that dietary carbs are the enemy or that anything less than vegan is the enemy. The truth of the matter is, despite the propaganda from all camps, you require some amount of carbs, fats, and protein in order for your body to function properly. How much of each you require can be generalized based on what research tells us but it has to be individualized based on your individual needs.
As diabetics, what brings us all together in a common cause is trying to control our Blood Glucose levels and maybe even the idea that our BGs should be normal for as much of the day as possible. Beyond that, however, we can only seek out advice that benefits us if we understand our indivudual demands. Yes, your cells convert protein to carbs, carbs to fat, and all sources to energy but if you're training to be Mr/Ms Olympia the next Usain Bolt/Alyson Felix, or just trying to maintain a steady BG throughout the day without having to take insane amounts of insulin, you will have to tailor your intake of fats, carbs, and protein to your needs.
Do your research. Find reliable sources of information that, above all else, do not promise a silver bullet to the demands of managing our conditions.
We can help here, but remember that when it comes to controlling BG, no matter how much information you can find, each of us only has our own experiences to truly rely on for the affects of any one diet on BG levels.
I actually did not mean the "once and for all" in regards to the right or wrong diet, as I wrote in my post I was referring to the possible DANGER involved on going low carb as a type 1. All in relation to the ketoacidosis subject. It was only through the cause of the replies that the focus shifted towards this fat/protein/carb debate...
Ketones cause the blood to be more acidic, period. That's the nature of ketones. Ketones are a by-product of burning fat. That's not a reason to fear ketones though.
Really, as others have stated, it's the level of ketones that build up in the blood, dropping pH to dangerously low levels, that is a danger. It typically will take something as extreme as the complete lack of insulin and complete reliance on fat to result in high enough levels of ketones to drop pH to dangerously low levels.
Can this happen on a low carb diet? Sure. Going low carb doesn't protect you from building up ketones to dangerously high levels.
Does going low-carb increase your risk of ketoacidosis? There's no reason to think so. As long as you maintain the appropriate insulin regime to keep your cells burning any carbs resulting from conversion of protein, or any carbs you do eat in your diet, you will not have a 100% reliance on fats and shouldn't see a build-up of ketones to dangerous levels.
As others have stated, on a Low-carb diet, there is also a shift to using ketones, themselves, as an energy source which probably works to help keep ketones from building up, but I have seen no quantifiable evidence to how much this helps to actually provide needed energy, or stop ketones from building up versus the conversion of protein to glucose that also happens with a low-carb diet.
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?
This is the questions I was answering, really. To be more specific, it is impossible to say without looking at your individual needs. Needless to say, there is a lot of controversy regarding this issue which is why I replied the way I did.
I miss carbs, I hate carbs, I love carbs. I'm absolutely starving. Sometimes when I ate seriously low carb I didn't need to inject either, but it didn't last long. Just little and often, that's what I do, its so much easier to control.
god josephine, i know what you mean about loving and hating carbs!!! i love to hate them, i hate to love them. wouldnt it be great if we werent able to process brussel sprouts or cinnamon sticks...
Well, I am not a T1 -- I'm a T2 (for approx. 10 years?) on Novolog and Levemir. I recently discovered that I could achieve excellent control on a vegan diet. If I eat mostly low-glycemic (non-starchy) vegetables and a little fruit, my insulin requirements drop from approx. 100 IU per day (with poor control) to 20 IU per day (with good control.) My understanding is that vegetables/fruits have anti-inflammatory qualities which improve my insulin sensitivity.
I'm still trying to figure out which protein sources and which essential fatty-acid sources work best in my body. I do fairly well with nuts; beans are more difficult.
I am not advocating this diet for anyone else. I'm just reporting what seems to work best for me. I think our bodies vary enough that it makes sense to customize your own way of eating based on your body, your tastes, your exercise regimen, your results (BG's, A1C, etc.)
I think Dr. Cousins research has a lot to teach us about the human body and how it works.
I think a big puzzle-piece still remains on insulin resistance, and that a diet rich in organically-grown, lower-glycemic, high-micronutrient vegetables and fruits (of which Dr. Cousins would approve) really does help some people become more insulin sensitive -- often to the point of no longer needing to inject insulin.
The devil is always in the details with these ways of eating.
Some so-called "healthy" vegans are subsisting on packaged, processed foods with very questionable ingredients.
For example, chocolate Tofutti is vegan, but is eating a pint of it before bed really the best choice for a diabetic? Ummm...I'm thinking, no.
On the other hand, some very-low-carb eaters completely avoid fruit. Is living without the phytonutrients in blueberries, strawberries, and blackberries the best idea? Some say yes. For me? I don't think so. On the other other hand, should a diabetic be eating four bananas and two cups of white grapes per day, washed down with several cups of high-sugar fruit juice? I'm thinking that would spell big trouble, but if I were a marathoner or competitive bike racer, I might need that level of quick carbs in order to keep from digesting my own muscles for fuel.
(Note: Home-juiced, perfectly fresh veggie juice -- carrot, cucumber, kale, celery, parsley, etc. -- works fine in my body, but not high-sugar fruits.)
