The doctor who wrote this article is a type 1 diabetic. He follows a low carb diet. He wants us to understand why other doctors may not recommend a low carb diet. This is an excellent article. There is much good information here!!
Thanks for posting the link to that article, @Richard157. When I first tried limited carbs as a way to control my BGs and found how profoundly it tamed my glucose levels, I was angry with a whole parade if doctors that I reached out to for help. Being an endo and not knowing how carbs drive blood sugar seemed an obvious truth that must have been willfully ignored.
Over time, my feelings softened as I took into account the insane work load that most doctors labor under in our dysfunctional health care system in the US. As time goes by and more docs witness the data that could only be achieved with carb limiting, I trust that they are at least talking with their peers about this.
I would love to participate in a panel of low carb diabetics presenting their CGM traces at a professional endo meeting.
As with most things like this, attitudes and beliefs in the medical profession change glacially. Bernstein has been promoting the value of low carb diets for years, and in the beginning he would actually get booed at conferences when bringing it up.
But that’s nothing new. The medical profession has always been that way. Pasteur was ridiculed at first, and similar examples could fill a book. I can’t prove, but am thoroughly convinced, that all (or nearly all) professions work pretty much the same way. So as Terry says, there is reason to hope that awareness will slowly permeate the ranks—slowly being the key word. We just need to keep on pushing—and educating.
Terry and David, thanks for your replies! I lowered my carb intake by 40% when I gained a lot of weight in the 1990s. I also used Metformin, even though I am T1, and it helped. I lost the weight, and I am now back to eating an average of 160 relatively healthy carbs each day, with no weight gain. I realize that many diabetics, both T1 and T2, are helped by low carbing, but there are also many of us who have very good control, and no serious diabetes related complication, without limiting our carbs. My endo recognizes this, and she does not suggest I limit my carbs.
There is a group of T1D’s on Facebook who are following Dr. Bernstein, and using a very low carb way of eating. It is a large group, and the participants seem to be very successful and pleased with low carbing. I was invited to join that group, but I declined. The administrator of the group tried to convert me. lol
Not all of us need to limit our carbs that much. I have very good control without any serious complications, after 70+ years of T1D. I do not plan or need to change my diabetes management routine.
Just one more illustration that one-size-fits-all doesn’t apply to diabetes. Congrats on your results and keep fighting the good fight.
I don’t follow Bernstein strictly, but I do follow a LCHF plan with usually less than 100g of carb per day. This has made my BG incredibly easier to manage. It’s not perfect because sometimes my basals don’t cooperate, but it makes the peaks and valleys much less pronounced and results in a much better A1C. I feel that any endo worth their salt would at least support a moderate-carb eating plan, given the obvious benefits.
Lower carb has made my bg control better but I still get plenty of spikes and lows and I did even when I was on 30g per day. I found the super low of bernstein to be too dangerous for me and I felt like I was starving. I still feel that way a lot of the time but not nearly as bad. I also think the restriction of a lot of the foods like fruits and veggies is a bad idea.
Thank you very much for the article! Most of us can understand that doctors aren’t trained about nutrition in medical school and that it probably isn’t a priority to learn about it later. But it was very interesting to read this article from a doctor who explains that reality in detail. Enhances my sympathy for the doctors who are trying to do their best for us!
Thank you, again!
you are doing well on that amount. you need to find the amount that works for you. A lot of people would call 160 low carb, It’s about 600 cal and 30% carb for a 2,000 cal diet
It is out of my scope of practice to give any recommendation on diet or medication. I can only advise on exercise, the self-care behaviors related to diabetes, health education and generally anything pertaining to behavior change.
I work in a medical school teaching premed students a class called the Practice of Medicine II. Included in the curriculum are topics such as lifestyle medicine, social determinates of health, health behavior theories, motivational, some areas of nutrition, diet, exercise, etc., etc. , etc.
My boss is a M.D. who is also dietitian. He is one of the few and has shared a very similar perspective as the author of the article.
In the school of medicine I work at, we are doing all that to create a pipeline of doctors well-versed in areas beyond what is typically covered in from a “biomedical” perspective. We do our best to education the students from a biomedical/biopsychosocial perspective.
Thanks the article.
I have long been concerned that doctors are not sufficiently educated about diabetes. I’m not talking about the biochemical pathways, but rather the day-in day-out management issues. Rather mundane in the academic context but of intense and overriding interest to those who must live with them 24x7x365.
I understand why this was so historically and am not interested in rehashing that. I’m concerned with today’s world. You can’t fix yesterday.
In view of the epidemic proportions diabetes has assumed, a very substantial part of any new doctor’s practice is going to consist of people with diabetes. Education needs to adapt to fit the reality on the ground. There are numerous issues here, but first and foremost, doctors need to fully grasp a couple of key things:
One-size-fits-all rules do not work for diabetes management and control
Failure to achieve expected results does not mean the patient is failing to comply
As I said, there are many points that need to be gotten across. But those two are enormous and cannot be overstated.
@David_dns I would tend to disagree with your statement that the "day-in-day-out management issues associated with managing diabetes is mundane in the academic context.
In the medical context we speak a different language. We look at things from a biopsychosocial perspective which takes into account the day-in-day-out management issues." We try our best to be patient-centered across the board. We try our best to listen and learn from you all.
This is one of the reasons I enjoy being on this portal because I learn how to be a better educator listening to our experiences. It affords me the opportunity to contextualize your day-to-day challenges in managing diabetes from a socioecological perspective as well.
Physicians and other health care providers are far from perfect, but one thing I can say is that we are in the industry because we truly care for people and love what we do.
Thanks for your post.
I think that your message dovetails very nicely with the theme of this thread: Change Comes Slowly.
You speak the language of bio-psychosocial effects, but your predecessors… not so much. Change is coming, generation by generation.
Thanks for being here!
I hope that is true. I really do, and I will cheerfully take your word that it is, in the classroom. Elsewhere—in clinics and consulting rooms on the front lines—I see very little evidence of it.
@Buck I wholeheartedly agree. As the transformation occurs with how clinicians and other deliver diabetes self management education, it is important (at least from my perspective) that the community living with diabetes (type 1, type 2, gestational, LADA, MODY, Flatbush, etc. etc. etc., be open to the POSSIBILITY of collaborating with researchers, like myself. We can’t do it without input from you THE STAKEHOLDERS.
Thanks for allowing me to be part of your lives!
ALL THE VERY BEST!!!
Actually after attending the ADA Scientific Sessions last year, I would tend to agree with David. There was virtually no scientific work looking at beneficial dietary patterns and the few talks that were there were rote repetition of the same old same old trying to get everyone to get back on track with the low fat high carb patterns. That is not to say that there hasn’t been very compelling studies of low carb dietary patterns, but they haven’t been accepted and become a part of the mainstream funded research portfolio.
While it is perhaps true that new medical school graduates today have a better understanding of low carb diet the medical establishment has displayed a consistent inability to change. I’m just glad they got rid of bloodletting.
I think many of us think that collaborating on research is a wonderful opportunity. But it is important to no just simply “utilize” the patient community as a large pool of passive research subjects. It goes both ways. There are important areas where patients want to drive research direction which are basically ignored by the establishment. Research directions are often driven by other stakeholders like pharmaceutical companies not by patients.
Well, I agree that is a good thing, and necessary. But everything has tradeoffs. When they stopped using leeches, the leech market collapsed and has never recovered.
Too bad I invested in leeches instead of Big Pharma!
Wait, I take that back in light of how often pharmaceutical companies get in the way of the availability/affordability of treatments that can lead to better D management.
Oh boy. Yeah.
I’ve used this example before, but I’m nothing if not redundant . . .
In Germany there is a federal law that no prescription med can be sold at more than a 2000% markup. That sounds high, but wait. It means that a vial of insulin that costs, say, $1.50 to produce can never, under any circumstances, be sold for more than $30. Here in the land of the free, that same vial costs close to $200.00.
@Brian, I have read somewhere that doctors are using leeches again in certain circumstances. Perhaps time to re-invest?!