Why are people eating specific and low carb diets?

[tim2000s]

However, at the levels that are present in nutritional ketosis, ketoacidosis does not occur. Higher levels of ketones cause acidosis, as does dehydration. As long as you have insulin, ketones are regulated. This statement about Ketosis being dangerous due to acidification of the blood is a common confusion with DKA.

Most of the side effects you have listed are caused by deficiencies in the types of food eaten and prolonged acidosis rather than ketogenic diet per se. As a result, longer term use of the diet is not an issue. Have a look at this paper:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

This study shows the lack of bone loss issues with long term ketogenic diets (this time looking at those with glucose transportation issues):

http://www.nutritionjrnl.com/article/S0899-9007(14)00044-6/abstract

 

[pinewood]

@sammyc123 - I agree with a lot of what you're saying. Obviously everyone is different; everyone has different variations/tolerances etc. I think we all agree on that. But a lot of people seem to spread the word that some of kind of "special" or low-carb diet is required to effectively manage T1 diabetes. I mentioned on another thread previously that this was a myth and got criticised. However, you have proven the point and I know many other T1s who also eat a completely "normal" diet and maintain excellent HbA1c results. My latest HbA1c was 5.8, which is higher than I want, but I eat whatever I want, whenever I want and haven't changed or restricted myself at all. I do exercise regularly and hopefully with some tightening of my carb ratio I can bring this down any more. I expect I inject more than average - often both before and after meals to catch the later stages of digestion.

 

[phoenix]

No, you certainly don't have to eat a very low carb diet to manage diabetes in spite of some peoples attempts to imply this.
I'm T1, probably LADA
I would say I eat a moderate carb diet and have kept my own HbA1c at around 5.8% for several years It contains about 40-50% carbohydrates but as I'm a 62 year old woman with a relatively low calorie requirement that ends up at 140-180 g carbs a day. (sometimes a lot less, sometimes more)
180 g carb is what my dietitian prescribed 10 years ago; I probably need less on non active days now. My insulin requirement is still not high taking well under the 0.5-0.8 U per kg per day often suggested as a norm.
I do a fair amount of exercise but I'm not competitive ie hill walking or very slow running (5 hour plus marathons) . On a walk in the mountains or hills , I eat a lot more carbs and have to reduce insulin. This is particularly the case carrying a backpack, but even on local walks, it's either up 100m or down 150m in the first Km so I rarely walk on the flat.#
I require far less insulin during this sort of exercise because of course glucose does not require insulin to get into muscle cells during exercise. In the case of anaerobic activity, it's absolute nonsense to suggest that more carbs requires more insulin . (indeed the problem is getting the balance right because the body still needs some insulin for all it's other functions).
I do think that food quality is important,so often it's implied by some individuals that someone who eats carbohydrates must per se be eating lots of junk foods, pies, pastries , cakes and biscuit..I certainly don't.

re competitive exercise

Ketosis doesn't seem optimal for a competitive cyclist . Even Phinney admits that the cyclists in his famous trial of low carbing and exercise had no reserves ,they could not sprint
http://www.nutritionandmetabolism.com/content/1/1/2

Therapeutic use of ketogenic diets should not require constraint of most forms of physical labor or recreational activity, with the one caveat that anaerobic (ie, weight lifting or sprint) performance is limited by the low muscle glycogen levels induced by a ketogenic diet, and this would strongly discourage its use under most conditions of competitive athletics.

Perhaps that's why the elite Kenyans diet is so heavy in ugali (maize porridge)
Interestingly, Phinney's co-author Volek in the art and Science of low Carb performance endorses modified form of starch for sportspeople (ucan).He calls it a 'healthier' carbohydrate but it's still a carbohydrate albeit very low GI.

This thread is in the T1 section but as lots of T2s have replied, how about this diet used in several recent trials
It contained very high carbs, it wasn't particularly low calorie.

40–50% whole-grain (rice, millet and barley); 30–40% vegetables (carrots,savoy cabbage, chicory, red radish, onions, parsley, cabbage and, because of the local lack of some vegetables, other varieties not included in the original Ma-Pi 2 diet were used such as kale, broccoli, lettuce and chive); and 8–10% legumes (adzuki beans, chickpeas, lentils and black beans);plus gomashio (roasted ground sesame seeds with unrefined sea salt); fermented products (miso, tamari and umeboshi); seaweeds (kombu, wakame and nori); and Bancha tea (caffeine-free green tea). Daily average energy intake was 2000 kcal (12% protein, 18% fat and 70% carbohydrate).

It has produced excellent results including in Ghana and in Cuba, the type of countries where T2 is increasing at far higher rates than Europe and where solutions are needed. I suggest that this sort of diet is more sustainable than a diet high in animal products
Personally, I doubt there is anything magical about some of the particular ingredients of this very specific diet. but the paper discusses possible mechanisms . (fibre +effects on micro biome, anti-oxidants are among mechanisms discussed) http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2519/pdf

and lastly, (TBH, I've put this in and edited it out twice, )
re ketosis

I'm sure some people will hate this. It's the first part so she may have other points to make. I'm sure it is a blog that will produce some strong reactions (note she is not saying that keto diets will have all these effects in everyone and it is the first of several intended blogs)
http://www.thepaleomom.com/2015/05/adverse-reactions-to-ketogenic-diets-caution-advised.html

 

[sammyc123]

No, you certainly don't have to eat a very low carb diet to manage diabetes in spite of some peoples attempts to imply this.
I'm T1, probably LADA
I would say I eat a moderate carb diet and have kept my own HbA1c at around 5.8% for several years It contains about 40-50% carbohydrates but as I'm a 62 year old woman with a relatively low calorie requirement that ends up at 140-180 g carbs a day. (sometimes a lot less, sometimes more)
180 g carb is what my dietitian prescribed 10 years ago; I probably need less on non active days now. My insulin requirement is still not high taking well under the 0.5-0.8 U per kg per day often suggested as a norm.
I do a fair amount of exercise but I'm not competitive ie hill walking or very slow running (5 hour plus marathons) . On a walk in the mountains or hills , I eat a lot more carbs and have to reduce insulin. This is particularly the case carrying a backpack, but even on local walks, it's either up 100m or down 150m in the first Km so I rarely walk on the flat.#
I require far less insulin during this sort of exercise because of course glucose does not require insulin to get into muscle cells during exercise. In the case of anaerobic activity, it's absolute nonsense to suggest that more carbs requires more insulin . (indeed the problem is getting the balance right because the body still needs some insulin for all it's other functions).
I do think that food quality is important,so often it's implied by some individuals that someone who eats carbohydrates must per se be eating lots of junk foods, pies, pastries , cakes and biscuit..I certainly don't.

re competitive exercise

Ketosis doesn't seem optimal for a competitive cyclist . Even Phinney admits that the cyclists in his famous trial of low carbing and exercise had no reserves ,they could not sprint
http://www.nutritionandmetabolism.com/content/1/1/2


Perhaps that's why the elite Kenyans diet is so heavy in ugali (maize porridge)
Interestingly, Phinney's co-author Volek in the art and Science of low Carb performance endorses modified form of starch for sportspeople (ucan).He calls it a 'healthier' carbohydrate but it's still a carbohydrate albeit very low GI.

This thread is in the T1 section but as lots of T2s have replied, how about this diet used in several recent trials
It contained very high carbs, it wasn't particularly low calorie.


It has produced excellent results including in Ghana and in Cuba, the type of countries where T2 is increasing at far higher rates than Europe and where solutions are needed. I suggest that this sort of diet is more sustainable than a diet high in animal products
Personally, I doubt there is anything magical about some of the particular ingredients of this very specific diet. but the paper discusses possible mechanisms . (fibre +effects on micro biome, anti-oxidants are among mechanisms discussed) http://onlinelibrary.wiley.com/doi/10.1002/dmrr.2519/pdf

and lastly, (TBH, I've put this in and edited it out twice, )
re ketosis

I'm sure some people will hate this. It's the first part so she may have other points to make. I'm sure it is a blog that will produce some strong reactions (note she is not saying that keto diets will have all these effects in everyone and it is the first of several intended blogs)
http://www.thepaleomom.com/2015/05/adverse-reactions-to-ketogenic-diets-caution-advised.html

On mobile device so it is difficult to read and respond to everything you have written...but from what I have read and digested of your very detailed post I agree completely!! Thank you for the post and I look forward to reviewing some of the links that you have offered when on a computer!

Cannot emphasise enough how impressed I am with your post!

 

[LucySW]

Thanks for posting that @phoenix. The ketosis post is very interesting and will chew over. Two initial thoughts: it depends on the degree perhaps of ketosis (is carb intake 35g or 10g, or nil), and you can probably tell quite quickly whether ketosis suits the individual person. This is what Peter Attia (I th highly of him because he's such a stickler for checking and getting things right - because he's a pedant, basically) says: check the biomarkers. Some of his patients have got on very well with carb restriction/ LCHF, and some clearly did not, and they stopped, or adjusted in some way. I think it's responsible to monitor, and adjust accordingly.

I'm impressed by her argumentation.

I am not swayed very much tho by those who haven't even read Phinney and Volek, let alone read properly around the subject. There's a lot of ignorance around about ketosis.

 

[LucySW]

Perhaps the OP has done some research on insulin toxicity.

 

[Spiker]

It's common for doctors to state at diagnosis that all insulin production is gone, without actually checking for evidence. Yet people are still showing measurable insulin production decades later. Unless you have had a C peptide test it's a reasonable assumption you have insulin production of some kind. HBa1c deteriorates from the onset of diabetes, year by year, regardless of the level of control. In the first year of diagnosis I had an excellent HBa1c and what I did then to manage T1 was frankly clueless. I was probably honeymooning and my residual insulin was smoothing out the bumps. I will never know as they didn't test C peptide. I suspect the same is happening in you and in most T1s - residual insulin production means HBa1c is good in the early years, regardless of treatment method, and deteriorates thereafter. In the later years control becomes more difficult to achieve and more concerted methods are needed.

 

[sammyc123]

It's common for doctors to state at diagnosis that all insulin production is gone, without actually checking for evidence. Yet people are still showing measurable insulin production decades later. Unless you have had a C peptide test it's a reasonable assumption you have insulin production of some kind. HBa1c deteriorates from the onset of diabetes, year by year, regardless of the level of control. In the first year of diagnosis I had an excellent HBa1c and what I did then to manage T1 was frankly clueless. I was probably honeymooning and my residual insulin was smoothing out the bumps. I will never know as they didn't test C peptide. I suspect the same is happening in you and in most T1s - residual insulin production means HBa1c is good in the early years, regardless of treatment method, and deteriorates thereafter. In the later years control becomes more difficult to achieve and more concerted methods are needed.

I requested for the C peptide test to be carried out and they completed it twice...2months apart. The consultant stated something along the lines of 'you pancreas does not have the capacity to produce any insulin and if it is producing any the amount is negligible and will have very little to no affect on BG control'.

 

[Robinredbreast]

I wonder if I could get mu C peptide test done? I would love to know, but a couple of decades down the line, they would probably say no, not necessary

 

[tim2000s]

An interesting set of data @phoenix. That blog article is going to polarize people. I think it's key point about lack of good evidence is a valid one though.

 

[AndBreathe]

@sammyc123 - I'm coming to this thread late, and firstly will sign post myself as not T1, but was diagnosed T2, which I seem to have wrestled to submission, for now at least, using diet and exercise.

Your HbA1c of 4.4% (or 24.6) is extremely impressive. At level, do you suffer many hypos, or marginal hypos? Do you drive? And if so, does that get tricky, bearing in mind I understand the recommendation is 5 for driving?

As I say, I'm not too close to these rules/guidelines.

 

[azure]

It's common for doctors to state at diagnosis that all insulin production is gone, without actually checking for evidence. Yet people are still showing measurable insulin production decades later. Unless you have had a C peptide test it's a reasonable assumption you have insulin production of some kind. HBa1c deteriorates from the onset of diabetes, year by year, regardless of the level of control. In the first year of diagnosis I had an excellent HBa1c and what I did then to manage T1 was frankly clueless. I was probably honeymooning and my residual insulin was smoothing out the bumps. I will never know as they didn't test C peptide. I suspect the same is happening in you and in most T1s - residual insulin production means HBa1c is good in the early years, regardless of treatment method, and deteriorates thereafter. In the later years control becomes more difficult to achieve and more concerted methods are needed.

There was a study, wasn't there? I read about it in Balance. A number of people who'd had Type 1 long term were still producing tiny amounts of insulin. I found that encouraging as I hoped they could somehow make people produce enough to control sugars. I think they will one day.

I also found it reassuring as I've had diabetes for more than 20 years and it was nice to be able to hope my islets weren't completely knackered!

I don't remember all my HbA1Cs over the years, but they've stayed between 4.7 and 5.5. The average is probably between those two figures. I've never had a C peptide test. I'd have been interested to have one, but the attitude seemed to be ""Well, you've got diabetes, here's how you treat it, there's no cure - off you go!".

 

[Heathenlass]

My answer to your question is that you may find the answer yourself. I would suggest printing out this thread, and coming back and reviewing it some time on the future, perhaps when you have stopped cycling at the level you are now ( and trust me, that comes to us all ) . Or else next year, or the year after, definitely at some time in the future.

The reason that I say this is because the status that suits us at the moment can and will change. Insulin to carb ratios change more frequently than you think, sometimes for no apparent reason. Basal rates change. Tolerances change. Someone who is comparatively newly diagnosed may find that their bolus will cover X amount of carbs within a certain food, but later find that that food spirals their BG unacceptably upwards . Or even that something that had that effect in the first few years , they can tolerate later on. The nature of the D beast is that it is never static for most people.

Yes, it's been mentioned that Type 1's exist that can eat a heavy carb load, bolus for it, and apparently have a good HbA1c and are generally none the worse for it. That is probably true of some, because of the diversity of the condition, some will be very fortunate in this regard, and I hope that for them, it continues They are, however, the minority, and for the rest of us it requires experimentation and constant change to maintain good, level, BG levels and avoid complications. So for many of us, it's an act of empowerment to experiment with lowering the carbs and thus the insulin requirements, usually because they have already tried the carb heavy route and found it doesn't work for them

If this works for you at the moment, then great. But consider the possibility of change in the future, and that the given advice of eating whatever you want and bolusing for it doesn't work for everyone, all of the time. There are just too many variables for that to remain consistent, and that's where flexibility and the willingness to adapt comes in to it.

Signy

 

[Picci]

My answer to your question is that you may find the answer yourself. I would suggest printing out this thread, and coming back and reviewing it some time on the future, perhaps when you have stopped cycling at the level you are now ( and trust me, that comes to us all ) . Or else next year, or the year after, definitely at some time in the future.

The reason that I say this is because the status that suits us at the moment can and will change. Insulin to carb ratios change more frequently than you think, sometimes for no apparent reason. Basal rates change. Tolerances change. Someone who is comparatively newly diagnosed may find that their bolus will cover X amount of carbs within a certain food, but later find that that food spirals their BG unacceptably upwards . Or even that something that had that effect in the first few years , they can tolerate later on. The nature of the D beast is that it is never static for most people.

Yes, it's been mentioned that Type 1's exist that can eat a heavy carb load, bolus for it, and apparently have a good HbA1c and are generally none the worse for it. That is probably true of some, because of the diversity of the condition, some will be very fortunate in this regard, and I hope that for them, it continues They are, however, the minority, and for the rest of us it requires experimentation and constant change to maintain good, level, BG levels and avoid complications. So for many of us, it's an act of empowerment to experiment with lowering the carbs and thus the insulin requirements, usually because they have already tried the carb heavy route and found it doesn't work for them

If this works for you at the moment, then great. But consider the possibility of change in the future, and that the given advice of eating whatever you want and bolusing for it doesn't work for everyone, all of the time. There are just too many variables for that to remain consistent, and that's where flexibility and the willingness to adapt comes in to it.

Signy

Well said Signy, I like you have been type 1 for 36+ years. For a number of years after diagnosis I was able to achieve great hba1c results while eating huge amounts of carbs. (I was told my pancreas was not producing any insulin too after the pep c test).
Over the years things do change and many will have to change their regime to achieve tight control. I fee great low carbing and living with permanent ketosis and have eliminated damaging spikes post meals. It is very easy for folk to question this way of living but one day the poster who started this thread may consider it when things become more difficult to control.

 

[Spiker]

I requested for the C peptide test to be carried out and they completed it twice...2months apart. The consultant stated something along the lines of 'you pancreas does not have the capacity to produce any insulin and if it is producing any the amount is negligible and will have very little to no affect on BG control'.

I can't believe how cooperative your consultant was. Most T1s I have heard of are refused C peptide even if they ask for it, let alone the vast majority who never ask and are never asked. And you had two tests two months apart? Sounds like a very good consultant.

Anyway, good luck with your excellent results and long may they continue. It's a shame that more of us don't find it a simple matter of applying a carb ratio.

Out of interest what is your carb ratio and how fine grained do you calculate it?

 

[ann34+]

I can't believe how cooperative your consultant was. Most T1s I have heard of are refused C peptide even if they ask for it, let alone the vast majority who never ask and are never asked. And you had two tests two months apart? Sounds like a very good consultant.

Anyway, good luck with your excellent results and long may they continue. It's a shame that more of don't find it a simple matter of applying a carb ratio.

Out of interest what is your carb ratio and how fine grained do you calculate it?

Sometimes consultants will do tests, but as part of their own research. If anyone does have one in such circumstances, ask for a copy of the actual results! i had the then test - it was called the glucagon stimulation test - and I was told - or thought i was told - that my insulin production was 'negligible"., it was in a crowed clinic and was said quickly with no explanation. I imagine i mis-heard. Years later, for other reasons, i obtained a copy of all my hospital notes, and was idly looking through them and came across the results of the test - it said it had found that 'insulin production was appreciable" !! I know i had another test sometime, but cant find the result of that. It would be nice to have one now. I thought things were difficult then, but i knew nothing - things are far more difficult now. I have had had to lower CHO, and eat no fast absorbing carbs, there is a link between insulin and carbs, but not a clear one that allows precision. The only way does seem to be limiting CHO, and this site has been very helpful re this, though i am in no way yet low carbing. i would agree with all the comments re everyone is very different. And also that things also change with age, or other illness etc. Ann

 

[SweetEnoughToo]

That's fair enough - I understand everyone is different. My situation - training for competitive cycling so I need to eat a lot and I inject between 5-7 times a day...2 basal and 3-5 bolus depending on how much I eat. But I have to do this as my body needs fuel. I wouldn't eat unhealthy carbs every day...peak of season I might only consume unhealthy carbs once a month but I do need dense carbohydrate meals to ensure that my muscles have the fuel.

Hi Sammy, great to see all your posts on this subject and i've got a number of questions. I've been diabetic for over 20 years but only in the last few years have i actually worked out what diabetes is and i'm still learning! To see your HBA1C of 4.4% is amazing and very impressive, i've never been anywhere near that, but as i say, i've only really started thinking more about it in the last few years.

From this post you're clearly on injections rather than a pump. In order to keep in such tight control how many BMs do you do and how do they relate to your exercise? Do you see a drop of in level after finishing exercise - for me it comes around 6 hours afterwards.

Also what insulin are you on?

In another of your posts on this thread you mention that you only eat out at three resaurants, which have provided you with the full nutritional info for the dishes. My thought here is that you must watch absolutely everything that passes your lips and take account of it. That must be so much work and something that i've not done to any great level of detail (although that is now changing)

 

[NoCrbs4Me]

Why are people eating specific and low carb diets? You can achieve an hba1c as low as 4.4% (my current result 4 weeks ago) and eat as many carbs as you want...provided you bolus for it. Just ensure you are exercising or you may gain weight...but thankfully due to the amount of activity I am doing I eat whatever I want...had my dinner this evening and then went to coffee shop for cinnamon scone and hot chocolate fudge cake with ice cream an hour later.

From what I've learned in the last couple of years after being diagnosed as type 2, there's more to good health than good blood glucose levels. Eating lots of high carb/nutrient deficient/factory processed food is not healthy for anyone. I would also think that for type 1 diabetics there could be a concern about becoming insulin resistant.

 

[Dillinger]

..that combined with exercise and the confidence to experiment and I think many people could drastically improve their results.

It's also handy to be in the honeymoon period which you undoubtedly are.

Something like 7% of Type 1 diabetics achieve HbA1c's of less than 6.5% every year.

What you are really asking is "why aren't more people me?"

I don't think that's a very useful question for a thread.

Regards

Dillinger

 

[sammyc123]

It's also handy to be in the honeymoon period which you undoubtedly are.

Something like 7% of Type 1 diabetics achieve HbA1c's of less than 6.5% every year.

What you are really asking is "why aren't more people me?"

I don't think that's a very useful question for a thread.

Regards

Dillinger

Read the above posts. I have had two C peptide tests carried out.