Article for the IDF’s Diabetes Voice
“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.
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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!
I look forward to reading this debate on the Diabetes Voice pages. Your RD credential combined with your living a low carb lifestyle gives you a unique perspective.
As a person with long-term Type 1 diabetes, I’ve often wondered about the aggregate RN-MD-RD-CDE community’s blind spot when it comes to actually living with T1 diabetes. They have no idea as to the never ending minute-by-minute, hour-by-hour, day-by-day, year-after-year relentless demands. If they did, I’m sure they would back off their endorsement of consuming 50-60% of daily calories as carbs. That’s a position that causes metabolic chaos in many T1D’s, including myself. When finally, after 28 years as a T1D, I adopted a lowered carb diet (50-70 grams per day), it restored some metabolic sanity and peace that I had forgotten existed. Their lack of empathy for the reality of our lives amazes me! I’m sure a few in this community are also people with T1 diabetes but I see no effect of that minority on their policy.
People often resist change and apparently so do organizations. The trouble with the medical/nutritional establishment’s reluctance to see the value that low-carb diets represent to the T1D community is that their reluctance translates to lives lost and unnecessary suffering from diabetic complications.
I admire your defense of the value of a low carb diet in such a public and professional fashion. Your actions generate hope that future generations of people with diabetes will not suffer the allusions peddled by today’s low-fat, high-carb medical professionals. Thank-you.
Hi Terry,
Thank you so much for your heartfelt words and support. I agree very strongly that people who do not live with diabetes should try to be more open-minded about carb restriction and the health benefits it concurs.Yes, there are diabetes specialists who have T1D, but only a portion follow a low-carb diet. I personally know of several other T1s who’ve seen huge improvements in blood sugar control, energy, and overall sense of well being after adopting a low-carb diet. This needs to be seen as a viable option by healthcare providers as soon as possible.
Thanks so much again for your comments.
Way to go Franziska! You are the perfect spokesperson to be selected for this ‘debate.’ And you’re on a roll now, having been propelled into the spotlight by your first venture. Congratulations!
PS: I love the reference to our ‘underground movement.’ I wonder when they will give it little more legitimacy by calling it an ‘alternative hypothesis,’ or would that just expose and demote the low fat (high carb) diet to just hypothesis status, which it also clearly is. Anyway, go get ‘im.
Thanks so much, Dan! Your continued support means a lot 🙂
Congratulations on being selected to voice an alternate viewpoint in the sometimes heated carb debate. You are eminently qualified both because of your professional credentials and experience and because you are utilizing a low carb diet to treat your own blood sugar issues. I’m very much looking forward to reading the debate.
I think the tide is slowly turning and one day, perhaps soon, carb restriction will be seen as a viable treatment option for both types of diabetes. The scientific evidence is mounting that low carb is not unhealthy, and although anecdotal, there are too many success stories in the diabetes online community to ignore.
Thank you so much for your kind words and continued support, Tim. Very much appreciated.
I agree that things are looking up for low carb, and although we’ve still got a long way to go, I’m very optimistic about the future. I know we’ve both seen dramatic improvement in blood sugar control with LC, and there are countless others who’ve had the same experience. Dietitians, CDEs, and other health professionals need to hear these stories and rethink their standard dietary recommendations, which in most cases do not result in achieving optimal control.