Carbohydrate Restriction: An Option for Diabetes Management

4/1/2014

I'm very happy to share the article I recently wrote for Diabetes Self-Management magazine. Like many dietitians and CDEs, I read this publication regularly and think it's a great source of information for people with diabetes. However, I often don't agree with the nutrition articles written by the RDs, as they generally recommend using MyPlate as a foundation for meal planning. I contacted the editor to ask about writing a piece on carbohydrate restriction as an alternative to MyPlate, and somewhat to my surprise, she invited me to write this article. Even better, she made only a few minor changes prior to publishing it, so it's very similar to what I submitted. One thing that wasn't included, though, was a sidebar I created that had a list of resources for people with diabetes, including websites like Blood Sugar 101 and The Low Carb Diabetic and books like The Art and Science of Low Carbohydrate Living and The Rosedale Diet. I think this was likely due to lack of space. But overall, I'm pleased with the way the article turned out, and I hope that many people with diabetes -- as well as dietitians, nurses, CDEs, and doctors -- get a chance to read it and discover that a low-carbohydrate diet can be very safe, effective, and sustainable.

(The document below contains the cover of the March/April issue and my article. If you're interested in the other articles listed on the cover, you'll have to order the magazine from the publisher).

Copyright (c) 2014 Madavor Media
www.DiabetesSelfManagement.com

29 Comments

Axel F link

4/1/2014 07:48:18 am

Great article Franziska. A very good overview of this very important issue.

I've seen many patients with type 2 diabetes who have been able to reduce insulin dosage and oral medication on low carb. A concern for Big Pharma though I guess. Hopefully we'll be seeing more studies in the nearest future confirming that low carb is an option in type-2 diabetes.

I've been more skeptical for type 1 diabetes, but there are certainly case reports where low carb has worked there as well. Of course converting to low carb for type 1 diabetics has to be done carefully and under supervision because there are important issues to consider for these patients.

Franziska Spritzler link

4/1/2014 08:00:17 am

Thanks so much for your kind words and comments, Axel! Indeed many people with Type 2 diabetes have been able to reduce and in some cases eliminate diabetes medication by following a very-low-carbohydrate diet. And there are many Type 1's who are doing very well on VLC, in some cases achieving optimal glycemic control for the first time since diagnosis. Agree that for people with Type 1 switching to low carb requires careful titration of insulin and monitoring of blood glucose levels.

Thank you for being a doctor supportive of carbohydrate restriction.

Lisa link

4/1/2014 09:35:40 pm

My child is type 1 and on a low carb high fat diet, due to my own research and not from the advice of his healthcare team. He is the ONLY kid in the clinic to have ever achieved normal blood glucose,blood lipids and HbA1c results. He uses half the amount of insulin other kids use. He is fit and healthy. He does rowing training and gym work 5 times a week. He competes in rowing competitions and wins gold medals. There is absolutely no way a diabetic can be healthy on a high carb diet. As soon as you start using large amounts of insulin, blood glucose instability and hypos occur. And I love low carb cooking!

4/1/2014 10:20:59 pm

Thanks so much for sharing your son's experience, Lisa. It's great that he's getting off to such a healthy start with your guidance and support. So inspiring!

Ted link

4/1/2014 10:34:34 am

Excellent article, nice work! I have been recommending extremely LCHF diets for ALL of my diabetics (insulin-resistant, insulin-deficient, or both) for over a decade now with amazing results. Unfortunately however the nutritionists I work with do not agree with me at all and the feeling is mutual! Can we clone you? ;)

[if you happen to have an iPad check out my free app and you can see why they might not like my advice!]

https://itunes.apple.com/us/app/diet-and-exercise-2.0/id836080709?mt=8

4/1/2014 10:46:11 am

Thanks so much, Ted! I'm always happy to hear from MD's who advocate VLCHF diets for their patients with diabetes. Unfortunately, none of you seem to live in my area, so cloning would need to work both ways :)

Thanks for the link to your app -- will check download it and check it out!

Andre Chimene link

4/1/2014 10:42:15 am

Great article it's about time.
I passed the hat tip to Dr. Rosedale On to him. Sure he'll love the article as well. You are a treasure

4/1/2014 10:51:46 am

Thanks so much for your kind word and continued support, Andre! It means a lot to me. I really wanted to interview Dr. Rosedale for the article, but he wasn't available when I was writing it. I wish the editors had included the sidebar I submitted because I think his book is excellent and very helpful for PWDs, as are his website and blog.

Janknitz

4/1/2014 11:12:39 am

Great Job! I'm interested in what type of feedback you get from readers and professionals.

4/1/2014 11:31:27 am

Thanks, Janknitz! So far it's all been good, but I wouldn't be surprised if I get negative comments as well. I have a feeling many RD's who read the article in print weren't too happy with it, but others seem to like it.

Jenn

4/1/2014 12:05:23 pm

Great article! I'm happy you were able to reach the diabetic audience with information about low-carb. My grandfather was T2, followed the "standard' T2 diabetic nutrition advice and ended up with both legs amputated. I wish low-carb had been written about a decade ago, I'm sure it could have helped him.

4/1/2014 12:31:25 pm

Thank you very much, Jenn. I'm so sorry to hear about your poor grandfather losing his legs because of uncontrolled diabetes. My Type 2 grandfather died of diabetes-related complications as well. Low-carb has been around for many years, but unfortunately many diabetes specialists haven't been recommending it to their patients. On a positive note, support for carb restriction is growing among doctors and other healthcare providers, and I'm very optimistic that it will soon be viewed as a legitimate option for people with diabetes.

Eric Westman

4/2/2014 04:21:09 am

Thanks for this informative and up-to-date article. I'm sending referrals your way!
Eric Westman, MD MHS
Duke Lifestyle Medicine Clinic

4/2/2014 07:38:09 am

Thank you so much, Dr. Westman! And thanks for all of your research on carbohydrate restriction, the support you provide to your patients who adopt this way of eating, and your continued advocacy of
very-low-carb living!

Eddie Mitchell link

4/2/2014 06:07:18 am

Hi Franziska

Yet again a great post and a great article, and so good to see an ever growing acceptance for what we stand for. It’s easy for me, I am an average Joe. You as a healthcare professional are sticking your head above the parapet of lies and greed. But, every week more are joining you and the cause, the cause for eating whole foods and the relegation of junk food. The turning our backs on highly processed non foods and trying to stay healthy with ever increasing big pharma medication.

Low carb works for me, my non diabetic wife and my diabetic friends. Having said that, if I could go back to eating, Italian food with lots of pasta, Chinese and Indian food with lots of rice. All the stuff I used to eat, it would be very tempting proposition. Back in the real world I cannot.

This food is poison to me. The high carb highly processed foods lead to my obesity, and may well have contributed to my diagnosis of type two diabetes. I have a choice. Change my diet and lifestyle, or make meds taking a full time job. Trouble is so many type two meds have been proved to be dangerous, and some have been banned for killing people. For most, type two diabetes drugs do not work. My HbA1c at diagnosis was close to twelve, after three months into low carb, in the fives, the highest in almost six years since low carbing 6.1.

The bottom line. If I want to check out with four limbs, sighted and not spending a big part of the time I have left on kidney dialysis. I have no choice. I have to commit to a lifestyle change that has reduced my BG numbers, over almost six years to non diabetic, on only two metformin pills per day.

Dr Richard Bernstein once said "some say I am too strict regarding blood glucose numbers, I have no choice, nothing else works" Bernstein is still working at around eighty years of age, a diabetic for over sixty years, and holds non diabetic BG numbers, on a low carb diet, that will do for me.

Kind regards Eddie

4/2/2014 07:44:03 am

Thanks very much for your insight and honesty in sharing your experience, Eddie. Your story is inspirational and a powerful testament to the benefits of following a very-low-carb diet. Keep up the great work over in the UK.

lily link

4/2/2014 10:05:30 am

Fantastic article, Franziska! As a fellow RDN, CDE, I'm very pleased to see your work in such a widely circulated publication. You are truly a gem in this field. Thank you for your well-researched and well-written articles.

4/2/2014 11:18:01 am

Thank you so much for your very kind words and support, Lily! So appreciative of RDN, CDE's like you.

Rick

4/3/2014 03:10:16 am

Excellent article Franziska!
I am not diabetic and never have been, however, fourteen years ago I had a heart attack at forty years old. My wife and I followed the low fat/high carb diet recommended by the hospital dietician for years (in fact we went strict Ornish diet). We lost weight and maintained a healthy weight for years………..but I have been on multiple medications because blood work and vitals never improved without it.

When my wife started gaining weight (and kept gaining) after a hysterectomy, we decided to go low carb because we knew someone that had lost weight using it in a similar situation. We were both about twenty pounds over where we wanted to be. We did it to lose that weight not even thinking about the health aspects. Only after losing the weight and then reading books and blogs did we start to understand the real implications of diet. Period.

We never had any idea of what the modern diet is doing. All we knew is that there is something about modern life that is literally killing us. Obesity, heart disease, metabolic syndrome, diabetes, etc, etc. Neurologist David Perlmutter explains that humans did not evolve to eat the carbohydrate diet of modern times. Even fruits were just part of a cycle. Coming at the end of summer, they were eaten, because we liked the taste of sweet, and allowed humans to plump up a bit for the coming fall and winter. Sugar was an uncommon household ingredient until the nineteenth century. Consuming grains only became part of our diet with the development of farming in the last ten thousand years………..a tiny fraction of time in the evolutionary development of humans. Now we eat grains and fruit and sugar with abandon year round. And except for the huge amounts of sugar, it is recommended by the experts we rely on for good health.

As a high school art teacher, I get to see young humans in their native environment. They are busy socializing, working (part of the time), and often, snacking. Knowing what I know now, I cringe. Yesterday, I watched a group of about ten students passing around an enormous bag of gummy worms. They followed handfuls of gummy worms with swigs of soda from a two liter bottle. They then chased the whole thing with a handful of flaming hot cheetos. I cringe.

A major supermarket chain in California is having a prize game of monopoly. You get a certain number of game pieces based upon……….not how much you spend………but based upon “what” you buy. The game is sponsored by big food so the more cereal and processed food you buy the more you get. I spent eighty dollars at the store yesterday and received one whole game piece………because they give everyone at least one. The person in front of me received thirty-one game pieces and spent less money than I did.

We are poisoning ourselves and we don’t even know it.

4/3/2014 05:36:42 am

Welcome, Rick! Thanks so much for the nice feedback and sharing your story and experiences. I'm so glad you and your wife have seen improvement in your health after adopting a low-carb, whole foods diet.

That description of your students' snacking party yesterday made me cringe as well.

I know which store you're talking about :) Yes, we only receive one monopoly game piece as well, even when purchasing a week's worth of groceries. But I guess you and I should consider ourselves fortunate, given that the more game pieces received, the lower the nutritional quality of the food purchased.

Tim

4/4/2014 06:08:03 am

Great article, well written and informative as always. I am heartened by the number of medical professionals who are reading and commenting favorably on your blog as well as using carb restriction in the treatment of their patients. The tide is turning!

4/4/2014 06:20:09 am

Thanks so much for your kind words and continued support, Tim. Agree that it's an exciting time for low carb :)

charles grashow

4/6/2014 01:01:42 am

What are your thoughts on these studies on the effects of a high carbohydrate diet on type 2 diabetes?

Vast improvement was shown by all participants

http://onlinelibrary.wiley.com/enhanced/doi/10.1002/dmrr.2519#Survey

http://www.medicc.org/mediccreview/articles/mr_119.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3477773/

http://arab-board.org/sites/default/files/Vol.11%20No.4.pdf#page=8

4/6/2014 01:21:53 am

Hi Charles,

Thanks for sharing these studies. I have no doubt that many people with diabetes can achieve better glycemic control by switching from a diet high in processed carbohydrates to a macrobiotic diet based on whole grains and vegetables, particularly overweight T2s. However, macrobiotic diets aren't very palatable or satiating (I tried one 20+ years ago for a week or so), nor are they easy to follow in social situations like dining out or at the homes of families or friends. They also may not achieve optimal glycemic control in all PWDs. In my opinion, carbohydrate restriction is a much more satisfying, practical, and easily sustainable way of eating for people with diabetes and improves blood glucose control in both Type 1 and Type 2. I personally know dozens of people who've achieved significant improvement in diabetes control by adopting a VLC diet. I've followed a VLCKD for almost two years and honestly feel better than ever before -- and as a dietitian, my previous diet was very balanced, high in whole grains, vegetables, etc.

However, I realize not everyone with diabetes is interested in going low carb, which is of course their choice. If people want to give macrobiotic eating a try, that's fine with me. Note at the end of the article, I say "Having a number of dietary options, including carbohydrate restriction, gives you the opportunity to try different approaches and find out what works well for you."

4/6/2014 01:56:55 am

The final study just opened up (had a computer glitch), and I see that it was conducted on children with Type 1, who did see improvement on a macrobiotic diet. However, the control diet was very high in refined carbs, including soda and jam.

Ahmed Afifi link

4/28/2014 11:14:40 pm

I find this article the best simple, targeted, easy going, less enemy creating, kind of article I have ever read about the low carb issue, I gave it to a friend who hates even hear about LC diets and I was amazed that he completed all and said to me if you talk to me simply like that I was gonna listen to you but you are aggressive (he meant me). great work, thank you and again I am honoured to know you Franziska

5/2/2014 10:22:52 pm

Wow, thank you so much for your very kind words, Ahmed. I'm so happy to hear about your friend. Going against mainstream recommendations is difficult, but reading messages like yours makes speaking out in favor of carb restriction worth with the risk. Thanks again, and all the best to you and your friend.

Joan Geohegan, RN, BSN, CDE link

11/3/2016 05:25:55 am

I agree wholeheartedly with the LCHF approach to diabetes management! THANK you for taking a stand. Where I work, we have RDs teaching the OLD ADA recommendations, and I have pretty much been told to refer all diet teaching to our diabetes RD, who STARTS with 45-60g per meal for women and 60-75 for men. Talk about sending people down a road of medications and side effects! State staff have told me that LCHF is not evidence based and they have to follow EBP in their curriculum. I asked where the evidence for HCLF can be found and that was met with some anger and resentment.
I have had type 1 for 49 years. I have complications to show it. If I had been taught LCHF decades ago, (I was diagnosed in the 60s when the ADA was 'bought' by the sugar industry), I may have full use of my feet (Charcot) and not worry so much about the potential for dialysis. My A1c was >13, and now rests around 5.9. I have witnessed other PWDs following LCHF and reversing complications as well as eliminating the need for ANY D meds (type 2s), and number of T1s who are normoglycemic. WHY can we not get this information to our people?????
OFF soapbox now. The choir is tired of me.

11/3/2016 06:45:49 am

Thank you so much for your supportive words and for share your own story, Joan. Congratulations on the dramatic improvement in your A1c! I understand your frustration and am glad to hear that you're doing everything you can to change minds at your facility. I'm so sorry that you're experiencing diabetes complications and wish you the very best going forward.

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Carbohydrate Restriction: An Option for Diabetes Management

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