Why Doctors May Not Approve Low Carb

Treatment
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@Brian, I try my best not to judge the motivations of researchers. I don’t share your perspective that researchers view the “patient community as a large pool of passive research subjects” nor will I try to convince those who believe that about all those who participate in research whether or not they are patients.

I belive there are many who want to volunteer their time or organs to contribute to research. Participating in research is voluntary if (across the board) the perspective is that patient/participants are passive participants, then my academic preparation tells me to meet people where they are. I have no intention of trying to convince those who are convinced of whatever they are convinced of. What I will say is that no one ever asked my how I view potential participants in my research and to have someone paint a global portrait of their perception of researchers that is thoroughly inconsistent with my value system really sucks. However, I am happy to meet you where you are with your perception.

It’s is always great learning from you and others. It truly broadens my perspective and assists me in becoming a more empathetic clinical exercise physiologist/certified diabetes educator/certified health educator/wellness coach/ adjunct associate professor and researcher.

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I have made this comment before, and was curious why us t1s don’t look at it. when we don’t eat carbs , our gas tanks still need fuel to burn for the engine to go. Anyway, this has to do with ketones. Ketones are your bodies storage of unused carbs (fuel). For most people, ketones are not bad, but for us (diabetics), they are acidic, which is a known fact. How many of us have had ketoacidosis? Very low carbs does this. Ketones are not something that happens when we’re high. Sorry, but I am just curious why this isn’t looked at.

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scott I’m afraid you have the wrong end of the stick, there are lots of T1’s with dietary ketones on low carb and normal BG. healthy as can be. dietary ketones are in the 0.5 and 4 with normal BG range…

High BG and ketones above 1 need more insulin…ketoacidosis ketones are above 10, you should be on a drip
you use the sick day rules for low carb,
https://c.ymcdn.com/sites/www.ispad.org/resource/resmgr/Docs/CPCG_2014_CHAP_13.pdf

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Great article and great replies.

Jojeegirl, it is great to hear your perspective and the things you are doing at your job. I read down through those entire thread and found most of it to be informative and accurate to my experience.

There is one thing though, that I don’t see here and in fact rarely see mentioned at all. And that’s the fact that no matter how well trained or educated health provider might be, no matter whether they understand and support a low carbohydrate diet or not, the doctor, CDE or any other care provider has a very limited influence on those day-to-day “mundane” management issues. They are not with us 24 seven, at every meal, in the morning, at night. They don’t have our lifestyle, habits, traditions and customs or anything else that makes up the life of the patient.

Every single one of us, doctors included, is different. It is up to the patient to figure out what best works for them. Unfortunately what is really missing in the typical doctor-patient relationship regarding diabetes is accurate information. Without accurate information how is the patient supposed to figure out what they should do or how they should do it. I was told by a CDE that maintaining a low-carb diet is impossible. She actually said that it is impossible. For the most part the information I got from medical professionals was brief, canned and delivered in what felt like a condescending manner. Not all but most.

That’s my heartburn with the whole issue. I spent literally hundreds of hours (beginning right here at TU) studying everything I could and reading forms everywhere I could find them just so I could dig deeper to understand what I was facing. The more I learned the more I realized that my best source of information was NOT from my doctors. I don’t know how we as PWD would go about correcting that problem. You are doing your part where you work, but that is just literally a drop in the ocean.

There are as many approaches to good diabetes management as there are diabetics. We just need to find a better way to get complete and accurate information when people are diagnosed (or when they finally decide they want to take control of this) so that they can make an informed choice as to how they want to approach their treatment. In the long run this would make them much better patients and more successful at living with their disease.

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@Randy Thank you for your thorough response.

Please understand that I don’t claim to have all the answers. I am a work in progress as are people with diabetes as you all traverse through the continuum of living with the condition. The human body is dynamic and as a consequence of the complexity of human biology and metabolism the manner in which anyone manages any chronic illness changes from one minute to the next as a consequence of the aging continuum.

I agree with you that I can’t possibly know the intimate intricacies of an individual’s life, whether or not he/she has diabetes. The only way I would know it isif I were your Siamese twin and we shared a brain. Other than that it is not possible.

Randy5, I reiterate I do not have all the answer. And my my master’s degree in diabetes education management is insignificant with the day-to-day management issues you live with as a person with diabetes. However, as a professional who has invested over 25 years in the health, wellness and fitness arena and who, like many on this portal, is academically prepared and passionate about helping people living with diabetes in addition to other chronic illnesses there are skills that I use that really help people become more aware of their "lifestyle, habits, traditions and customs [and] anything else that makes up the life of the patient. That is where I am different.

It pains me to know that many of you are not being heard and I agree that much must be done so that your voices are heard. Particularly, within academia. If I have understood what you have expressed in your post, (please clarify if I have not), it pains me to know that those to whom you entrust your health are not truly listening to you. That really sucks.

I wholeheartedly agree with you that for many the "best source of information [is] NOT from doctors. I am a huge advocate for all to do whatever they need to do increase their health literacy. It is so very important.

Regarding, how PWDs go about correcting the “problem” of clinicians being generally unaware of how to “treat” persons living with diabetes (or for that matter any clinical condition), it boils down to the curriculum that is taught at the colleges and universities and medical schools the students attend.

Without being judgmental, even if a person has a specialized medical degree in endocrinology, from what I understand the curriculum doesn’t focus on what you operationalize as the “heartburn with this whole issue.” I wish I could change it too. However, right now medicine is taught according to a “biomedical” model not a “biopsychosocial” model that takes the entire person and his/her environment into consideration.

The backbone of medicine is in the natural sciences which is heavily focused on causation.

What we are doing at the Sophie Davis School of Biomedical Education is teaching the prospective primary care providers how to “treat” people from the biopsychosocial" perspective before all the “biomedical” stuff so that learn early to deliver medicine that is truly patient-centered.

Randy5, it’s just the beginning. Please know that there are clinicians who hear your voices and bring your voices to the classroom.

I thank you so very much or sharing yourself with me. I wish you success as you traverse managing your condition through the aging continuum and look forward to continued interaction with you on this portal.

Be well.

Jo

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jack16 Hi Jack ketones are an indication that the body is using “fat” as a fuel source as opposed to stored glycogen.

The human body prefers to use glycogen/glucose as a primary fuel source as opposed to "fat."
I think you would find learning about RER (if you don’t already know) the resting exchange ratio and it’s connection to fat and carbohydrate metabolism.

Thanks so much for your post!

Jo

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sorry jo, can you google ketogenic, I think that will tell you all you need to know.

also I think the body can use fats, muscle and organs to fuel life when through lack of insulin, glucose isn’t possible, leading to DKA, coma and death without intervention.

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It is more of a habit, in 1978 when I was diagnosed, all they did was check ketones. Also because of a digestive problem I have. So for me they aren’t there, or boy they are. And as I said, it is just a comment

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if you aren’t on very low carbs, you wont have ketones above 0.6. normally. Unless you lack insulin as a T1. with high BG…then as you say, you have them and it’s all men on deck, It’s a major drama. It can easily lead to a hospital trip. I gave the sick day rules link, as an example of good and bad

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@Jack16 Thank you for your response and if I offended you at all apologize.

The purpose of self disclosure. I have not been diagnosed with diabetes. But I am thoroughly invested in helping those who diagnosed by it and how love and support those with diabetes.

I thought I would share the definition of words associated with “ketones” as they are defined by Taber’s Cyclopedic Medical Dictionary. May rationale for doing so is not to argue or to “be right” but simply to live according to my professional values as “health educator” among other professional titles that I hold and to to whatever I can to help all sorts of people continually build upon their health literacy as we are our own health advocates! 8))

I’ll start out by saying that most thinks we eat have carbohydrates in them. Even green vegetable. If the sun had any contact with it in its original form, then it contains carbohydrates. Human are carbon-based. Carbon forms the key component to all life on earth. Hence, it makes sense that ketones contain a form of carbohydrates when it goes the the process of beta-oxidation. It’s a carbonyl group.

Beta-oxidation according to Google: In biochemistry and metabolism, beta-oxidation is the catabolic process by which fatty acid molecules are broken down in the mitochondria to generate acetyl-CoA, which enters the citric acid cycle, and NADH and FADH2, which are co-enzymes used in the electron transport chain. It is named as such because the beta carbon of the fatty acid undergoes oxidation to a carbonyl group. Various mechanisms have evolved to handle the large variety of fatty acids.

According to Tabers Medical Dictionary though:

Ketoacidosos: Acidosis due to excess ketone bodies. It occurs in individuals who do not produce adequate insulin to sustain normal metabolism>

Ketoaciduria: The presence of keto acids in the urine.

Ketogenesis: The production of acetone or other ketones.

Ketolysis: The dissolution of acetone or ketone bodies.

Ketone: A substance containing the carbonyl group. Acetone, C3H60 is an example of a simple ketone.

Ketone threshold: The leve of ketone in the blood above which ketone bodies appear in the urine.

Ketone body: One of the number of substances that increase in the blood as a result of faulty carbohydrate metabolism. Among them are beta-hydroxybutyric acid, acetoacetic acid, and acetone. They increase in persons with untreated or inadequately controlled diabetes mellitus and are the primary cause of acidosis.

Ketosis: Ketosis results from the incomplete metabolism of fatty acids, usually from carbohydrate deficiency or inadequate use, and is commonly observed in starvation, high-fat diet, and pregnancy, following either anaesthesia; and most significantly in inadequately controlled diabetes mellitus. Large bodies may be eliminated in the urine. Ketosis is easily determined by testing for the presence of ketone in blood specimens.

Jack16, I agree with you that “the body can use fats, muscle and organs to fuel lack of insulin, glucose isn’t possible, leading to DKA, come and death without intervention.” The same is true for populations living with type 2 diabetes. It is called HHS (hyperglycemic hyperosmolar syndrome).

The common thread with both DKA/HHS is the utilization of FFA (free fatty acids) as a fuel source to create ATP (adenosine triphosphate). ATP is what the body uses so that voluntary and involuntary muscle contraction occur. Without ATP we die. Highlighting the importance of carbohydrates in our diets. In the realm of nutrition it is considered the master food.

One of the things that I tell fitness professionals (I am also a clinical exercise physiologist) to do if they have desires to work with populations living with diabetes is to gain a thorough understanding of the Krebs Cycle aka know as the TCA cycle. It is important to understand normal glucose metabolism first before one truly understand compromised glucose metabolism.

All in all, it is not possible to be ketogenic or follow a ketogenic diet with/ the body using free fatty acids as a fuel source.

Jack, I thank you for the exchange. I truly hope this post is “insightful” and not “inciteful” in a negative for this is not my purpose.

FYI, I don’t advocate any diets as it is outside of my scope of practice to do such.

Be well. 8))

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“All in all, it is not possible to be ketogenic or follow a ketogenic diet with/ the body using free fatty acids as a fuel source.”

jo, why would I be offended because you have the wrong end of the stick? you thought you didn’t need to google because you are educted and have no need to

simply, you are wrong, you didn’t google or didn’t understand what your read when you googled ketogenic

lets keep it simple for a start

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@jack16 I genuinely apologize. I am not here to argue. Have a nice day.

Jo

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I’m at a misunderstanding, I thought I was sharing with you the fact that the ketogenic low carb, 10-50g a day is standard practise, used by Dr’s to treat epilepsy kids,

I don’t know why you see this as an argument, unless you wish you argue you previously held wrong opinion?
“All in all, it is not possible to be ketogenic or follow a ketogenic diet with/ the body using free fatty acids as a fuel source.”

I thought you came here to learn and share?

here is a bunch of T1 kids on keto under 50g having a wonderful life

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@Jack16, once again, I apologize. As a consequence of my imperfection I made a typographical error. You will notice that after the “w” there is an oblique. I intended to put an “o” after the oblique. Abbreviation for without. #Mybad. 8((

Yes. You are correct, I am here to learn and to share. As I mentioned in an earlier post, I don’t exchange information on diets. That is not within my professional scope.

I do though, genuinely, wish you a very pleasant day.

Jack, I do feel the need to express “my feelings” regarding you quoting my objective of being a member of TuDiabetes as a person who is not living with diabetes is to “learn and share.” I became a member to TuDiabetes when I was pursuing my second masters at Teachers College, Columbia University in diabetes self-management and education.

As a student in that program we were required to deliver a videochat to the TuDiabetes community as part of our course work. It was then that I met the most pleasant Emily Cole. That was in 2014, the very year I completed the program. This year I was subsequently invited back to deliver another video on the same topic. T2DM and exercise. I really enjoy this group.

I have been a member of several diabetes support group and at times the tone from some of the participants (from my perspective) has been less than supportive. When I begin to perceive this I remove myself from circumistances that I feel are unhealthy to me. I am beginning to feel that as a consequence of the tenor of your response it feels to me that this discussion is heading in a direction that I am uncomfortable with. May I say, if my response to you is perceived as being unkind, I genuinely apologize. That is not my intent. I am into feeling good. Please know that I am simply responding to you questioning my motivations for being a member of this group.

However, for now I am going to pull back because it’s beginning to feel uncomfortable to me.

Jack, although we are unfamiliar with one another, I, genuinely, wish you a most pleasant day.

All the very best.

Jo

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ok, I accept it was a typo and I had the wrong end of the stick and it wasn’t your claim. at least you got some links to add to your library :slight_smile:

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Hi Jojeegirl,

Very glad that you are here at TuD!

It is always useful to so many of us to have someone with a professional perspective on diabetes here!

Over the years that I have been here, we have had R.D.s, doctors and nurses here for a period of time. It helps so many of us–especially those of us new to diabetes! It’s great to be able to share knowledge and experience back and forth. It enriches everyone.

Good, caring, hardworking people in the medical profession can’t know everything–there are just so many complexities in the human body! And every human being is different! I greatly admire everyone in the field of medicine and health who is trying to do their best for their patients!

Unfortunately, many people who have diabetes have had difficult experiences with the medical world. It’s happens so often.

That’s why someone like yourself, with knowledge and good intent is so valuable here!

To everyone: I’m not meaning to cast any negativity in any direction! I believe that we are here to support each other and to share our experiences. Everyone’s experience is educational and valuable to the rest of us. And, surely, we can communicate in a way that values and supports each other–whether we see things the same way or not!

Very best wishes to all!

marty1492

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I’ve read that MOST of the body can use ketones as its source of energy, after the liver has converted fats to ketones. However, part of the brain cannot. For this part, the liver also converts proteins into glucose. Some doctors haven’t kept up enough the recognize that ketone detection can now detect the normal ketone level as the body burns fats, and not just the very high level found in DKA.