Last week I received an e-mail from the editor of Diabetes Voice, a publication of the International Diabetes Federation, the organization comprised of diabetes associations around the world, including our own ADA. I've been asked to participate in a friendly written debate regarding low-carbohydrate diets in the Type 1 adult population and have gladly accepted! The debate will be published in late spring, just in time for the annual ADA conference in June. The opposing voice is an RN CDE, and we will each write a short (800 words or less) piece addressing the following:
"Debate: How low can you go?
The low-down on the low carbohydrate debate in Type 1 diabetes nutrition
As a means of representing relevant issues to the diabetes community, Diabetes Voice will be providing a forum in which experts can examine controversial issues and provide an argument supporting their point of view. The low carbohydrate debate marks the first in our series.
Since the advocacy of intensive insulin therapy following the Diabetes Control and Complications Trial, people living with Type 1 diabetes have been subjected to broad nutrition and dietary advice, with varying opinions on the recommended total daily intake of carbohydrate. Current American Diabetes Association (ADA) guidelines suggest a flexible range of carbohydrate, protein, and fat tailored to meet individual preferences, emphasizing the need to monitor and match insulin to carbohydrate intake as a means for achieving glycemic control below or around an HbA1c of 7%. More rigorous goals (<6.5%) are recommended for healthy younger people who have been recently diagnosed.
While low carbohydrate diets are recommended for weight loss as an effective short-term (up to 2 years) measure, there is less clarity regarding the utilisation of very low (>30 g/day), or low carbohydrate (30-105 g/day) intake. According to the ADA guidelines, the moderately low recommended daily allowance (RDA) for carbohydrate intake (130 g/day) is “an average minimum requirement.” Many people complain that maintaining even a moderately low carbohydrate diet is counterproductive, making glycemic control difficult to achieve, especially when considering the targets for post-prandial excursion (1-h postmeal: ≤140 mg/dL (7.8 mmol/L) or 2-h postmeal: ≤120 mg/dL (6.7 mmol/L)). Many patients, especially those on insulin pump therapy, have opted out of a diet based on 50%-60% carbohydrate intake, and an ‘underground movement’ has prompted some endocrinologists with large numbers of Type 1 patients to support their efforts.
We have asked our experts to weigh in and answer the question:
Can a nutritional regimen based on low carbohydrate intake provide safe and more effective glycemic control for a healthy Type 1 diabetes patient?"
Needless to say, I'm very excited about this opportunity. It's very encouraging that such a large and respected organization is providing a platform for a pro-low-carborbohydrate viewpoint. Definitely cause for celebration!
Franziska Spritzler, RD, CDE