NYT Article: 'How a Low-Carb Diet Might Aid People with Type 1 Diabetes'

Biggles2 · May 7, 2018

Interesting New York Times article today on a small study - also published today - in the medical journal Pediatrics:
'How a Low-Carb Diet Might Aid People with Type 1 Diabetes'

"It found that children and adults with Type 1 diabetes who followed a very low-carb, high-protein diet for an average of just over two years — combined with the diabetes drug insulin at smaller doses than typically required on a normal diet — had “exceptional” blood sugar control. They had low rates of major complications, and children who followed it for years did not show any signs of impaired growth."

https://www.nytimes.com/2018/05/07/well/live/low-carb-diet-type-1-diabetes.html
Here is the link to the article abstract in Pediatrics:
Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet
Authors: Belinda S. Lennerz, Anna Barton, Richard K. Bernstein, R. David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T. Rhodes, Cara B. Ebbeling, Eric C. Westman, William S. Yancy Jr, David S. Ludwig
http://pediatrics.aappublications.org/content/early/2018/05/03/peds.2017-3349

Alexandra100 · May 7, 2018

Biggles2 said:
Interesting New York Times article today on a small study - also published today - in the medical journal Pediatrics:
'How a Low-Carb Diet Might Aid People with Type 1 Diabetes'

"It found that children and adults with Type 1 diabetes who followed a very low-carb, high-protein diet for an average of just over two years — combined with the diabetes drug insulin at smaller doses than typically required on a normal diet — had “exceptional” blood sugar control. They had low rates of major complications, and children who followed it for years did not show any signs of impaired growth."
https://www.nytimes.com/2018/05/07/well/live/low-carb-diet-type-1-diabetes.html
Here is the link to the article abstract in Pediatrics:
Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet
Authors: Belinda S. Lennerz, Anna Barton, Richard K. Bernstein, R. David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T. Rhodes, Cara B. Ebbeling, Eric C. Westman, William S. Yancy Jr, David S. Ludwig
http://pediatrics.aappublications.org/content/early/2018/05/03/peds.2017-3349

This is what Dr Bernstein has been saying for decades, notably in his book "Diabetes Solution", last revised in 2011. You can read here abut his Law of Small Numbers:
http://www.diabetes-book.com/laws-small-numbers/

Biggles2 · May 7, 2018

Alexandra100 said:
This is what Dr Bernstein has been saying for decades, notably in his book "Diabetes Solution", last revised in 2011. You can read here abut his Law of Small Numbers:
http://www.diabetes-book.com/laws-small-numbers/

Dr. Bernstein was one of the authors of the above study.

Alexandra100 · May 7, 2018

Biggles2 said:
Dr. Bernstein was one of the authors of the above study.

Here is a quote from the article: "The most striking finding of the new report was that A1C levels, on average, fell from 7.15 percent, in the diabetic range, to 5.67 percent, which is normal." No way would Dr B consider an A1c of 5.67% = 38.5mmol/mol as normal. You can read about the targets he sets for his patients, and himself, here: https://www.diabeteshealth.com/qa-with-dr-richard-bernstein-10/
They are discouragingly low! He says, " The A1c target for most people is 4.2% to 4.6%, which is a non-diabetic range." (22.4 - 26.8) Jenny Ruhl, usually rather a disciple of Dr B, disagrees with these targets and sets her recommendations a little higher. For her "A truly normal A1c is between 4.6% and 5.4%". (26.8 - 35.5) She thinks we can avoid or at least postpone most complications by keeping our A1cs under 5.5% (36.6), which equates to a meter reading of 6.2mmol/.

Guzzler · May 7, 2018

Alexandra100 said:
Here is a quote from the article: "The most striking finding of the new report was that A1C levels, on average, fell from 7.15 percent, in the diabetic range, to 5.67 percent, which is normal." No way would Dr B consider an A1c of 5.67% = 38.5mmol/mol as normal. You can read about the targets he sets for his patients, and himself, here: https://www.diabeteshealth.com/qa-with-dr-richard-bernstein-10/
They are discouragingly low! He says, " The A1c target for most people is 4.2% to 4.6%, which is a non-diabetic range." (22.4 - 26.8) Jenny Ruhl, usually rather a disciple of Dr B, disagrees with these targets and sets her recommendations a little higher. For her "A truly normal A1c is between 4.6% and 5.4%". (26.8 - 35.5) She thinks we can avoid or at least postpone most complications by keeping our A1cs under 5.5% (36.6), which equates to a meter reading of 6.2mmol/.

All of those numbers look good on paper. When striving to attain better A1c's in real life your milage may vary.

Alexandra100 · May 7, 2018

Guzzler said:
All of those numbers look good on paper. When striving to attain better A1c's in real life your milage may vary.

I didn't say I was attaining any of these targets. I wish! But I prefer to have them in mind as an ideal. We have to remember that Dr Bernstein prescribes small amounts of insulin to his T2 patients if low carb + Metformin doesn't get them low enough. On the other hand, of course, the poor things have to pay for it, and I read that insulin is very expensive.

ringi · May 7, 2018

Alexandra100 said:
Here is a quote from the article: "The most striking finding of the new report was that A1C levels, on average, fell from 7.15 percent, in the diabetic range, to 5.67 percent, which is normal." No way would Dr B consider an A1c of 5.67% = 38.5mmol/mol as normal. You can read about the targets he sets for his patients, and himself, here: https://www.diabeteshealth.com/qa-with-dr-richard-bernstein-10/
They are discouragingly low! He says, " The A1c target for most people is 4.2% to 4.6%, which is a non-diabetic range." (22.4 - 26.8) Jenny Ruhl, usually rather a disciple of Dr B, disagrees with these targets and sets her recommendations a little higher. For her "A truly normal A1c is between 4.6% and 5.4%". (26.8 - 35.5) She thinks we can avoid or at least postpone most complications by keeping our A1cs under 5.5% (36.6), which equates to a meter reading of 6.2mmol/.

This was a study of people with type1 in a Facebook group who mostly were getting no medical or professional surport with low carb. Hence that they got anywere near to what people get with the personal surport of Dr B shows what could be done on a large scale if the type1 guidance was changed. Also note the low rate of bad hypos.

Guzzler · May 7, 2018

Alexandra100 said:
I didn't say I was attaining any of these targets. I wish! But I prefer to have them in mind as an ideal. We have to remember that Dr Bernstein prescribes small amounts of insulin to his T2 patients if low carb + Metformin doesn't get them low enough. On the other hand, of course, the poor things have to pay for it, and I read that insulin is very expensive.

I didn't mean you personally. Perhaps I should have written '....one's milage may vary'.

By the by, all of those numbers are unattainable for me so setting them as targets means little, personally. All I can do and should strive for is my best.

Alexandra100 · May 7, 2018

ringi said:
This was a study of people with type1 in a Facebook group who mostly were getting no medical or professional surport with low carb. Hence that they got anywere near to what people get with the personal surport of Dr B shows what could be done on a large scale if the type1 guidance was changed. Also note the low rate of bad hypos.

That's encouraging! However the Facebook group is Type One Grit http://typeonegrit.blogspot.co.uk which I think is closely linked to Dr B. Certainly in his phone-ins he often directs people to it. So although the members are not his patients, I imagine they do get some encouragement and guidance. Worth exploring for T1s interested in low carb?

Alexandra100 · May 7, 2018

Here is the actual paper, by Dr David Dykeman:
https://www.dropbox.com/s/a1zr9eb8675hfk1/How to Normalize Blood Sugars for Type 1 Diabetics.pdf?dl=0
IMO very interesting for T2s as well as T1s.

KK123 · May 7, 2018

That certainly was interesting to read, the target being set at 4.6, which is what a 'normal' person's is isn't it? For any diabetic to achieve this I am presuming they would need to go extremely low carb, otherwise a type 1 or 2 trying to lower it to that level with insulin would put you at a massive risk of hypo's. It is fascinating stuff and seems quite obvious, lower your carbs and lower your A1c. I personally am lowish carb (around 50 a day) and I find that fairly easy once you cut out the obvious stuff. My A1c is currently 40 which is still way higher than recommended. Sigh.

Alexandra100 · May 7, 2018

KK123 said:
I personally am lowish carb (around 50 a day) and I find that fairly easy once you cut out the obvious stuff. My A1c is currently 40 which is still way higher than recommended. Sigh.

My heroine (but NOT guru - there is a difference!) Jenny Ruhl says that because we have to treat our diabetes for life, it may be better to follow a slightly more lenient diet with slightly worse bg results, rather than be extremely strict and perfect for a few years and then burn out altogether. She tells how this happened to her, with a year completely uncontrolled in reaction to a keto diet which didn't suit her. Personally I'm a bit on the perfectionist side, it's in my nature, but forewarned by JR I am watching out for trouble. And I do already allow myself the odd indulgence.

kokhongw · May 8, 2018

Alexandra100 said:
Here is the actual paper, by Dr David Dykeman:
https://www.dropbox.com/s/a1zr9eb8675hfk1/How to Normalize Blood Sugars for Type 1 Diabetics.pdf?dl=0
IMO very interesting for T2s as well as T1s.

RD Dikeman is actually a "rocket" scientist...so sometimes you do need a "rocket" scientist to figure things out...
http://www.mendosa.com/blog/?p=3360

When I interviewed Dr. Bernstein for another article a week or two ago, he mentioned to me in passing that his Diabetes University was finally getting off the ground. A few days later when I found it online, I noticed that the producers are R.D. Dikeman and his son David, 11.

R.D., who has a Ph.D. degree in theoretical physics, is chief scientist at Lockheed Martin in Honolulu, Hawaii. David was diagnosed with type 1 diabetes in March 2013. As they documented on David’s journeywith diabetes, he suffered from the high-carbohydrate diet that the doctors at the hospital had him on until the Dikeman family discovered Dr. Bernstein’s Diabetes Solution.

Robinredbreast · May 8, 2018

Some people, especially children/ teenager's, college students etc ( but thinking of my granddaughter here) may find eating' a very low carb high protein diet' difficult.
I like to say 'reduced carb' not low. I had a lovely meal on Sunday, reduced carbs with half a plate of salad too and my BS was 6.8 before dinner, 6.5 at bedtime and woke up on a 4.1 yesterday. The 4.1 was a little low, for me, even with just 1/2 unit of insulin with breakfast, I ran quite low throughout the day and hypoed too, but I was out in the sun for a few hours which does makes me hypo, obviously took less insulin, but it still happened.
I find so many things to think about and to weigh up with type 1 management.

Alexandra100 · May 8, 2018

Robinredbreast said:
Some people, especially children/ teenager's, college students etc ( but thinking of my granddaughter here) may find eating' a very low carb high protein diet' difficult.
I like to say 'reduced carb' not low. I had a lovely meal on Sunday, reduced carbs with half a plate of salad too and my BS was 6.8 before dinner, 6.5 at bedtime and woke up on a 4.1 yesterday. The 4.1 was a little low, for me, even with just 1/2 unit of insulin with breakfast, I ran quite low throughout the day and hypoed too, but I was out in the sun for a few hours which does makes me hypo, obviously took less insulin, but it still happened.
I find so many things to think about and to weigh up with type 1 management.

Indeed, it seems to me that T1s need a PhD at least just to manage their everyday lives. I guess all that brain stimulation must be good for warding off Alzheimers.

Alexandra100 · May 8, 2018

kokhongw said:
RD Dikeman is actually a "rocket" scientist...so sometimes you do need a "rocket" scientist to figure things out...
http://www.mendosa.com/blog/?p=3360

SO interesting! Thanks very much for the link.

bamba · May 8, 2018

Wasn't Dr Bernstein himself originally an engineer ?

Robinredbreast · May 8, 2018

Alexandra100 said:
Indeed, it seems to me that T1s need a PhD at least just to manage their everyday lives. I guess all that brain stimulation must be good for warding off Alzheimers.

Finger's crosses for warding off Alzheimers, which is a very cruel and heartbreaking condition.

Diakat · May 8, 2018

Interesting article. I need to go and read the original paper as I find myself with questions about how low is low in this case.

Robinredbreast · May 8, 2018

Diakat said:
Interesting article. I need to go and read the original paper as I find myself with questions about how low is low in this case.

That's why I refrain from using the word 'Low', but it does say 'Very low carb and a high protein diet'
'Reduced Carb Intake' is what I would change it to as it could make it more manageable and sustainable for the individual's goals or needs.

NYT Article: 'How a Low-Carb Diet Might Aid People with Type 1 Diabetes'

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