This is so obvious. Why didn’t I think of it? Type 1 diabetics (T1DM) make no insulin and need replacement of insulin to keep them alive. Before the discovery of insulin and it’s availability to treat this disease, very low carbohydrate diets (VLCD) could keep type 1 diabetics alive for years. After the use of insulin became available and especially during the era of the evil of eating fats, we told type 1 diabetics they could eat as many carbs as they wanted to as long as they chased it with enough insulin.
A recent study used a volunteer sample of 316 children and adults recruited from TypeOneGrit, an online Facebook community for people with T1DM who follow a VLCD and a diabetes management method recommended in the book “Dr Bernstein’s Diabetes Solution” to examine this strategy. (1,2,3) They also got the medical records and a doctor survey of a proportion of this sample. The success of the low carb diet was remarkable. Hemoglobin A1c (HBA1c) that many of you who know is a long term measure of sugar control, went from 7.2% to 5.7%. That is an exquisite level of control. This was accomplished with an actual decrease in the rate of adverse events like hospitalizations and dangerously low blood sugars that you might worry about with this impressively improved level of sugar control.
The low carb diet has been much in the news as a weight-loss strategy but for this, it is not as great as advertised. Type 1 diabetics, for instance, didn’t lose weight. If they had, this would have been a worry for kids who are still growing. One of the biggest problems with the low carb diet for weight loss as we’ve written about multiple times is that it is too painful to follow – no beer, etc… But maybe it is easier to follow if you haven’t lost weight and you’re not hungry that makes you crave yummy carbs. Among the type 1 diabetic followers of very low-carb diets in this study, there was very high satisfaction with health and health care and diabetes control. But that is not exactly the same as happiness with the rules and restrictions of the diet. Interestingly 27% of participants reported not discussing their low carb diet with their diabetes care providers. And of those who did discuss their diet, only half agreed or strongly agreed that their diabetes care providers were supportive of the idea. Finally, Dr. Bernstein himself was one of the authors of this study report and might be construed as biased and this was a group selected by being true believers.
But it’s hard to argue with the results so there’s some good news for some of us in this dire world of coronavirus.
1. Lennerz BS et al. Management of type 1 diabetes with a very low-carbohydrate diet. Pediatrics. 2018;141(6):e20173349
2. Runge C, Lee JM. How low can you go? Does lower carb translate to lower glucose? 2018;141(6):e20180957
3. Bernstein RK. Dr. Bernstein’s Diabetes Solution:A complete Guide to Achieving Normal Blood Sugars. New York NY:Little, Brown and Company:2011
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.