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53 Responses

  1. riva
    riva April 3, 2012 at 7:08 am | | Reply

    I’m right behind you Jessica. After reading Bernstein’s “Diabetes Solution” a decade ago I wiped refined carbs virtually out of my diet. I’ve been doing a low fat, low carb diet these past several years. Just a few months ago I got interesting in Paleo-eating and so have taken a few more carbs out of my diet and put some more fat and protein in. I’ve lost a couple of pounds and feel fit as a fiddle. I totally subscribe to the idea that too many carbs are making us fat, making diabetes worse and leading to many chronic illnesses.

    I also agree health care providers support what they think is doable for the masses, and they don’t think low carb eating is. But people need the information and then need to make their own informed decisions. Thanks for such a good explanation.

  2. Casabby
    Casabby April 3, 2012 at 7:44 am | | Reply

    I revisited Dr. Bernstein’s book a few weeks ago and have been eating low carb since then. My blood glucose levels are much more stable and I’m actually much less hungry than I was on my 120-150 carbs per day. Like many people I could never stop at one cookie or just a few potato chips. So the binges are gone.

    I’m Type 1 and don’t need to lose weight. I am still fine-tuning what I need to eat to get adequate nutrition and maintain a stable weight. This diet is incredibly motivating because the results are so good. Can I do it for life? I don’t know but I hope that I can.

  3. Dave
    Dave April 3, 2012 at 9:17 am | | Reply

    Great article on carbs and fat!! I live a Paleo lifestyle and have given up all gluten, grains, rice and legumes. Why because they all cause gut irritation and raise my blood sugar. They increase inflammation in the body which leads to a whole host of other issues. Another great resource is Robb Wolf’s book “The Paleo Solution” or goto his website http://www.robbwolf.com . This is a great book and more diabetics should read it they might be surprised to learn that low carb, high saturated fat diets fill you up an stabilize your BG and reduce or almost eliminate cravings because your body is no longer on the high carb roller coaster. You will also use less insulin, the list goes on!

    One thing I found interesting while reading a book called “Free the Animal” is who funds both the American Diabetes Association and the American Dietetics Association which I believe is partially to blame for the horrible advice they both give to people about their diets.

    American Dietetics Association:
    Aramark, Coca Cola, Hershey, National Dairy Council, Abbott, CoroWise, General Mills, Kellogs, Mars, Pepsico, Unilever, Soyjoy and more!

    American Diabetes Association:
    Essentially the same list with all the big Drug Companies added in.

    Both associations should get new sources of funding and then we may actually see them embrace low carb diets but as long as the abusers are feeding cash to these Associations they are never truly going to do what is 100% right for the patient.

    Dave

  4. David
    David April 3, 2012 at 9:22 am | | Reply

    Couldn’t agree more with this post. For those who don’t know about Bernstein, you may find his life history very inspiring. He pioneered the low carb approach at a time when the medical community was completely mis-guided. Nowadays we live in pretty good times for being T1 with small bg meters, ultrafine syringe needles, and fast insulins.

  5. Kelly Booth
    Kelly Booth April 3, 2012 at 9:24 am | | Reply

    I wish I had heard of Dr. Bernstein when I was diagnosed 28 years ago – I know my life would be different today. I still like to have some pizza once in awhile, but most days I do low carb and my blood sugars are much better.

  6. Steve
    Steve April 3, 2012 at 10:45 am | | Reply

    I read Bernstein’s book shortly after we brought Lia home from the hospital and knew right away he was right for us and our kind of lifestyle. Two years earlier my entire family gave up all processed sugar for two weeks. Over Valentine’s Day, just to make it interesting. We were amazed at the results, especially in our two young daughter. This happened long before we knew anything about diabetes and pancreases and insulin. It’s not just people with diabetes who can benefit by backing away from the sugar bowl.

    It’s not easy, especially if you don’t grow and produce everything you eat, but it can be done (it helps to stay out of the middle of the grocery store).

    Great post, Jessica!

  7. Noah
    Noah April 3, 2012 at 3:24 pm | | Reply

    I came to a similar conclusion after being diagnosed with T2. None of the doctors even mentioned a need for me to get a glucose monitoring kit, but a friend who has several diabetic family members suggested I might find it useful. Watching the difference in pre and post meal numbers, along with the slower changes in fasting glucose, lead me to a low-carb approach. I discovered Dr Bernstein’s book a little while later, and it proved useful in helping to refine some of my goals and techniques.

  8. Tim
    Tim April 3, 2012 at 4:22 pm | | Reply

    I’m not entirely convinced as a T1. I think my big problem is glucose production that causes the need for more insulin. Because my beta cells have been killed off, I have no insulin production AND no amylin production. I think the lack of amylin production is what’s making me gain weight. I have never ever been able to gain weight my entire life (43 years at time of T1 diagnosis)– until NOW. I’m willing to consider it’s more than just complications of T1 ( I AM also middle-aged now), but my postprandial numbers seem to indicate my body is very quick in its uptake of glucose from foods. As to what is right for others, you have to decide for yourself, but be careful. Don’t assume that what is right for others is right for you.

    1. Ken
      Ken May 21, 2012 at 8:13 am | | Reply

      Tim, you know, I hear this “decide for yourself what is right for you” so often I wonder if somebody has paid you to say it. The evidence for reducing serum insulin levels by lowering dietary carbohydrate intake is without challenge, so the information in this article is spot on.

      Your situation is quite different than that of those this article focuses on–T2′s. If you want to question the applicability of the advice in this article for you and other T1′s (although I’d argue that it is generally good advice for T2′s too), that is entirely appropriate, but to open the door of question by stating that “you have to decide for yourself” if this advice is proper is doing a lot of people a disservice.

      The question of how to reverse the symptoms of T2 are not open to “opinion.” There is clear scientific evidence as to what causes serum glucose and insulin levels to rise. To think you can somehow reduce this destructive process by “deciding for yourself” to follow a different approach is terrible advice.

    2. Ken
      Ken May 21, 2012 at 8:14 am | | Reply

      Correction: meant to say “T1′s” in brackets in second paragraph…

  9. katrina
    katrina April 3, 2012 at 4:29 pm | | Reply

    This was such a great article. It is so important to understand how blood acts when you are diabetic. Your blood and arteries are key to making sure that everything is working properly.

  10. Sysy
    Sysy April 3, 2012 at 5:22 pm | | Reply

    Great stuff, Jessica, thank you!

    I too began to avoid processed food and grains after reading Dr. Bernstein’s book.

    I’ve noticed that some people do really well on a high carb, low fat diet (Example: Pima Indians, Okinawans of Japan) but only if they are not eating any processed foods or extra sugar (those are never going to be considered ok, aside from the special occasion, in my book).

    Metabolically, I’m one of those people that although I’ve tried, I can’t handle much fat. But that doesn’t mean I can’t keep my insulin levels really low. Many vegetables are high in carbs but extremely low glycemic and full of fiber (thus 0 to few net carbs) and so I can eat a green salad with a little fish or chicken and feel full for hours and only give half a unit of insulin. I urge people to experiment with REAL food and see what mix works best.

    Either way, grains, even the non refined ones are very tough on people with diabetes and I’d encourage anyone seeking tighter blood sugar control to try removing them and sticking to low glycemic veggies and fruits, nuts, seeds, poultry, fish, eggs, and beef.

    The carbs that make us unhealthy in this country are not bad because they are high carb, they’re bad because they are full of low quality fat, refined grains, chemicals galore, and loads of sugar. If someone is thinking of starting anywhere, I’d say, start avoiding all that stuff first. Then work your way through low carb experiments and see what works best for you. For low carb to be sustainable you have to figure out the right mix of foods. My husband eats tons of nuts and seafood and organic meats and animal organs. I eat tons of veggies and chicken and low fat fish and that’s what works for each of us. When I’ve tried his diet, I gain weight and feel sick and tired. It’s pretty interesting how different we all are :) I know I reiterate this every chance I get but I think it’s amazing and great for all of us to be aware of.

    1. Ken
      Ken May 21, 2012 at 8:16 am | | Reply

      Appreciate your comments Sysy. I agree.

  11. Scott E
    Scott E April 3, 2012 at 6:20 pm | | Reply

    I’ve been trying to follow (information-wise, not behaviorally) the low-carb logic, and while it seems to make sense to many, I don’t see it working for me. I’m Type-1 and am nowhere near low-carb; I probably consume 160-180 carbs per day, if I’m counting accurately and honestly. 60-65 carbs each for lunch and dinner is not out of the ordinary.

    However, I’m in a position where I’d like to put on a few pounds. I don’t believe I fall under the clinical category of “underweight”, but when I look in the mirror I think I’m a bit scrawny and could use some more meat on my bones. Sure, I could (OK, should!) exercise and build up some muscle, but a little bit of fat on my bones wouldn’t hurt either. I don’t want to appear to be “brittle” like my mom and my grandmother (neither have diabetes) are. I’m just not sure how to do that. Reducing carb intake, though it’s great for blood sugar, doesn’t seem like it would logically help.

  12. Allison
    Allison April 3, 2012 at 7:08 pm | | Reply

    “The answer to this question seems to be that it simply goes against conventional wisdom.”

    Amen… thanks for a great article.

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    maria g April 3, 2012 at 8:03 pm | | Reply

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  14. Tim
    Tim April 3, 2012 at 10:26 pm | | Reply

    The argument that carbs are bad because you can’t process them is like saying Classical music must be bad for deaf people because they can’t hear it. We can’t process fat energy without insulin either.

  15. Mike Ratrie
    Mike Ratrie April 4, 2012 at 6:24 am | | Reply

    While an interesting perspective, I think what doctors are really learning about diet and diabetes is that it is … complicated. Everyone would like to have simple answers to complex problems, but those answers do not exist!

    The quote that really gets me though is this: “I’ll need to take insulin, which will lead to fat storage,” along with the conclusion, therefore, insulin is BAD! Seriously?!?

    OK, if you want simple answers, here are mine. Small portions = GOOD! Exercise = GOOD! Lots of testing = GOOD! The occasional binge = GOOD! Positive attitude = GOOD! Laughter (even forced!) = GOOD!

    1. Ken
      Ken May 21, 2012 at 8:33 am | | Reply

      Simple answers to complex questions do exist for most people. It is the minority that do not fit into the basic structure where things get more complicated, but for most T2′s, low carb will work wonders.

      As to your comments about insulin, if the worst thing insulin did was lead to weight gain and fat storage (which it does) it would be bad enough, but that is far from the most damaging aspect of hyperinsulinemia. Elevated serum insulin levels trigger the inflammatory response mechanism, and this is at the root of most of the “lifestyle diseases” ravaging the Western world. For those T2′s with significant pancreatic failure and unable to produce sufficient insulin, there is arguably a place for exogenous insulin, but for most T2′s with high levels of insulin resistance, more insulin is bad.

  16. Dave
    Dave April 4, 2012 at 7:05 am | | Reply

    What gets me is how people are so easily offended by the notion of low carb eating. What is wrong with keeping your carbs low? Personally I am sick of hearing T1’s complain about their erratic blood sugar spikes and how hard it is to manage their blood sugar. If you eat a couple slices of pizza with cheese and pepperoni and oh and I want to eat some cake your blood sugar is going to be all over the place and I don’t care what type of dual wave bolus you set it is going to be messed up.

    I would really like to hear from people who think the ADA gives great advice by telling diabetics to eat high carb low fat diets. It is like telling a celiac patient to eat bread, it makes no sense. T1’s and T2’s need to own up to what they put in their mouths and the BG results they get after words. Sure everybody’s body is different but if you watch what you eat you can use minimal amounts of insulin which is a good thing and it also helps protect against weight gain and insulin resistance. Not to mention the nasty chemicals that are in insulin as preservatives, do you really want more of that in your body?

    If eating a high carb diet works for you thats great but personally I think more diabetics would be better off with a high fat low carb diet. Because at the end of the day eating fat does not make you fat nor does it raise your cholesterol it actually satiates your appetite and helps get you off the carb roller coaster which will always make you just want to eat more and further messing up your blood sugar.

    1. Ken
      Ken May 21, 2012 at 8:34 am | | Reply

      I’ve talked with thousands of chronic T2′s over the last 13 years, and I can say Dave, your comments are spot on.

  17. Hope Warshaw
    Hope Warshaw April 4, 2012 at 7:14 am | | Reply

    Ah, Mike Ratrie – thanks for your sane response. Couldn’t agree more.

    This blog asks the question Carbs or Fat: What really makes us gain weight. Research (yes, that’s important when addressing the complex topic of nutrition and nutrients!) is CALORIES! If one consumes too many calories they will gain weight. If one reduces calorie intake over time they will lose some weight (and if they have prediabetes or type 2 the minimal weight loss will likely improve their BG, lipids and blood pressure). Keeping those lost pounds at bay, however, remains a challenge. A great resource on this topic is the data collected over years from the National Weight Control Registry. And people don’t follow a low carbohydrate intake over time!

    If you want to know the recent research on this topic I’d suggest people review the very recently: Wheeler M, et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes. A systematic review of the literature, 2010. Diabetes Care, 33, February 2012. It covers the research (I mean well conducted trials that meet criteria) from early 2000′s thru 2010. Then let’s talk some more.

    If Richard Bernstein has done research studies and published them, please provide the references. To the best of my knowledge he has just published consumer books.

    Thanks,
    Hope Warshaw, MMSc, RD, CDE
    hopewarshaw.com

    1. John
      John April 4, 2012 at 5:09 pm | | Reply

      Hope,

      If you haven’t already, please read Good Calories, Bad Calories. It cites many rigorous studies which demonstrate that not all calories are created equal in terms of their effect on metabolism. This is obvious to anyone with diabetes who tests their blood sugar before and after eating: a) a piece of “healthy whole grain” toast, and b) 2 eggs cooked in coconut oil.

    2. Jane Kokernak
      Jane Kokernak April 5, 2012 at 3:00 pm | | Reply

      Hope, thanks for the reference to the lit review. I was able to access it easily from my university library online. (Note a typo: the volume number is 35, and not 33, as you indicated.)

      It’s very helpful to see the numbers, although one must persist in reading through the data (which may explain the appeal of consumer books).

      Here’s an interesting recommendation, for future research, from their conclusion:

      “Moving forward, it is essential to consider that individuals benefit differently from various nutritional approaches. Studies on gene-diet interactions and the impact of various macronutrient compositions across the continuum of dysglycemia/ insulin resistance warrant additional investigation. Related to this tailored approach to MNT, it should be noted that individual adherence to nutrition recommendations is highly variable – and generally suboptimal. Research is needed to develop strategies that enhance adherence and to determine if certain nutritional approaches promote greater adherence than others.” (Wheeler et al., 2012)

      Their point that individuals benefit differently from various nutritional approaches should suggest to us that while some people with diabetes may indeed benefit from a low-carb diet, as some of the commenters here follow, and others may be achieving control with a moderate-carb diet (defined as 40-65% of calories), which is what I follow.

      They also demonstrate that more research on both kinds of diets (among others) is needed, because studies were often small, not randomized, and with subject dropout problems.

      This lit review cites 110 studies since 2002.

      I haven’t yet read the Taubes book, but I am curious so I will, and will also try to read some of the studies he cites as evidence. Hopefully they are valid and treated reasonably.

    3. Ken
      Ken May 21, 2012 at 8:39 am | | Reply

      Gary Taubes destroys the “calories in calories out” theory. Read his “Good Calories Bad Calories” book to understand how this nonsense has been economically and politically motivated. If you don’t want to believe science however, you can always look around you and see how this “low-fat, complex carb” recommendation has been working out. As Dr. Phil asks, “How’s that been working’ for ‘ya?”

  18. Jessica Apple
    Jessica Apple April 4, 2012 at 7:40 am | | Reply

    Thanks for all of the nice feedback!
    @Mike R. and @Tim It’s not insulin that’s bad, but too much insulin. Eating fat rather than carbs is a good way to keep insulin levels or requirements low. It’s still necessary, though, I agree with that :) .

  19. Kelly Booth
    Kelly Booth April 4, 2012 at 8:38 am | | Reply

    @Dave, I agree with what you say about people complaining about their erratic BS but don’t want to give up their carbs. I also wish people could get hooked up to an accurate CGMS for a week so they can see what their beloved carbs do to their BS. I see people commenting all the time about the arrows going straight up after a meal when they get a Dexcom. Unfortunately, most people don’t test enough to truly know what goes on.

    As far as Dr. Bernstein, he has been a T1 diabetic for over 60 years. He became a doctor when he felt the medical community and “science” were letting him down. He had complications and did not want to die so he looked for solutions that would help and was able to reverse his complications. I personally relate better to someone that is walking in my shoes than someone who has no clue what living life as a diabetic is like.

    I followed the ADA garbage crap diet and ended up with complications. Like Dr. Bernstein, I really don’t want to die young. I know for a fact the ADA diet was sending me to my grave early. I have peripheral neuropathy, automatic neuropathy, gastroparesis and retinopathy. I deserve better than that so have no problem following Dr. B’s advice. It is my understanding the studies are out there but my meter tells me I don’t need those studies. My meter also told me the ADA diet didn’t work regardless of what studies claim.

  20. Bruce
    Bruce April 5, 2012 at 2:40 am | | Reply

    A good article but a little behind the times. Tom Naughton at http://www.fathead-movie.com has been advocating Gary Taubes and others advice on this. He has also put together a movie called Fat Head which explains all this in terms even a 10 year old can understand. As a T1 Lada Tom’s advice has changed my life and as evidence my last 5 HbA1C’s have been around 110.

    1. Hermit
      Hermit April 27, 2012 at 2:00 am | | Reply

      Thanks for that spectacularly enlightening comment, Bruce. If you had as you say “A1c’s around 110,” you’d be dead!! Perhaps you meant fasting blood sugar. Still, 110 is hardly good. This should help:
      http://www.phlaunt.com/diabetes/16422495.php

  21. susan f
    susan f April 5, 2012 at 9:56 pm | | Reply

    For me the Paleo diet isn’t correct. The Bernstein diet isn’t right. Nor is the ADA.

    The right diet is the one you can sustain. Pluck elements of diets that work for you and don’t fall victim to hype on any one plan.

    My diet: “low carbish”
    I try to avoid carbs before noon. I try to limit lunch to 20g or less. Dinner is more wide open, but still I aim for 30g unless its something special. I eat lots of fats: olive oil, nuts, cheese, eggs, bacon, red meat.

    Why this diet? Because my peaks are much higher in the morning and get progressively easier during the day. (my morning carb ratio is 3X that of dinner). I value stability because my job is so hectic I don’t have time to lose being weakened by a low.

    My body fat is around 17%, my BMI is low, so clearly the fat isn’t hurting me. I passed a cardiac stress test with flying colors.

    Note: I never was quite as aggressive in restricting carbs until the advent of the CGMS, which I will die if I ever lose.

  22. cj
    cj April 5, 2012 at 10:28 pm | | Reply

    I am all for eliminating processed carbs, but the Paleo diet eliminates legumes. This is ridiculous. Legumes have long been demonstrated to have many health benefits. Soybeans are extremely low carb and high in protein and fiber. As a vegetarian T1 soy beans and tofu have been a godsend. Promoting a diet high in meat consumption has a whole sweet of health and environmental concerns that have nothing to do with blood glucose levels. Its best to replace the carbs with fiber and healthy plant based fats.

  23. Sydney
    Sydney April 6, 2012 at 10:23 am | | Reply

    To offer a different perspective on diet – I’m a T1 diabetic on a insulin pump and I’ve been following a plant-based, whole-foods diet for over 6 months now. This diet is high-carb (80% of calories) with an emphasis on whole, unprocessed foods. I also don’t eat any added fats (oils, butter, nuts), with the exception of 1 TBSP of ground flaxseed per day. All of the food is from plant-based sources. Besides improved A1Cs, I have seen tremendous other health benefits as well.

    As a T1, I would never have believed that I could be successful eating a high-carb, low-fat diet. Initially, my insulin needs nearly doubled. However, after about 3 weeks of eating this way, my insulin needs dropped to about half of what they were before I started the diet and have remained at that level.

    An important factor is that I don’t eat many refined carbohydrates. I think the problem with the Standard American Diet (SAD) is the fact that Americans are eating so many refined carbs. Eating actual whole grains (like a cup of brown rice) is not going to spike my blood sugars like a piece of processed “whole grain” toast. It’s not whole grain if it’s all ground up with 10 or more other ingredients and baked into a loaf, cereal, cracker, or chip.

    One piece that is missing from the article above is that fat blocks the cell’s ability to utilize insulin. For T2 diabetics, this is what causes insulin resistance. Fat is definitely the problem here. A plant-based, whole-foods diet offers tremendous benefits to T2 diabetics as well. My wife is a T2 diabetic and has greatly reduced the amount of insulin she takes.

    For anyone interested in this, I would suggest taking a look at Dr. Neal Barnard’s book “Dr. Neal Barnard’s Program for Reversing Diabetes” (http://www.nealbarnard.org/diabetes_book.htm) and the Physician’s Committee for Responsible Medicine’s “A Vegan Diet How-To Guide for Diabetes” (http://pcrm.org/good-medicine/2006/autumn/a-vegan-diet-how-to-guide-for-diabetes). I’d also recommend the movie “Forks Over Knives”. This movie completely changed my perspective on diet.

    Other resources on plant-based whole-foods diets are: “The Engine 2 Diet” (http://engine2diet.com/), “Prevent and Reverse Heart Disease” (http://www.heartattackproof.com“), and any DVD by Jeff Novick (http://www.jeffnovick.com/RD/Home.html).

    I am a strong believer that a plant-based, whole-foods diet can offer almost anyone huge benefits to their health.

  24. My Svensson
    My Svensson April 7, 2012 at 6:14 am | | Reply

    The key is to eat what your body needs. You can´t eat to much fat, protein or carbs cause then you´ll gain weight. -Simple as that. I´m a vegetarian (called lakto-ovo-vegetarian = eats products with milk and eggs). With this diet I eat more carbs than people normally do AND I´m a type 1 diabetic since 1983! BUT I eat good carbs and I´ve never been overweight. My bloodsugar´s stabile. Have been eaten this diet since 1995 (before I eat carbs and protein). My A1c has stayed between 4,4-5,6% all these years (when I was pregnant I had my A1c as low as 3,7-4,4% without any dangerous lows). My total insulin dose/day lays between 20-25 U/day (depending on “cykle time”), I´m 173 cm tall and weigh 55-57 kg. And another key is to exercise (maintain your weight or loose weight and keep yourself healthy). Ordinary carbs like pasta, potatoes, vegetables and fruit doesn´t make you fat (unless you eat 2-3 times your actual needs) but sitting still and eating fries, candy and drinking soda does. And it also affect your bloodsugar in the wrong way.

  25. Jessica Apple
    Jessica Apple April 7, 2012 at 6:40 am | | Reply

    @Hope, I agree with John that Good Calories Bad Calories is a great source for the data you.

    @Sydney, I think it’s terrific that a plant based diet is working for you. It seems to me, though, that you’re confusing dietary fat and body fat, based on what you said about insulin resistance in your comment.

  26. Susan f
    Susan f April 7, 2012 at 10:37 am | | Reply

    @sydney I am glad you found a diet that works for you. My digestion is different than yours though!

    I have a cgms and love running little experiments on myself. I see about a 5 minute difference in the peak of when my blood sugar spikes if I eat a half cup of white rice versus brown. I wish my body could handle carbs like yours, would be nice.

    I have a coworker just like you… She can forget to bolus and still turn out lower than me! I wonder if some of us type 1′s have more residual beta cell function than others. Your diet would literally kill me ;)

  27. Ruth Deming
    Ruth Deming April 8, 2012 at 3:52 pm | | Reply

    Fantastic post, Jessica! I’m insulin-dependent for only a year. I had a kidney t’plant cuz the drug lithium for bipolar disorder ruined my kidneys. My antirejection meds gave me diabetes. I have a really supportive endo – all my docs must be or I’ll fire them – and I learned early on that my hi-carb diet must go.

    Took me ages before I was willing to forego pasta and desserts, which I now eat in moderation. As a woman who has taught breadmaking, I no longer eat bread. Darn! Pasta? Rarely. I make spaghetti sauce without it.

    When my glucose count is low, I eat Triscuits or Whole Wheat Pretzels. Everything that goes into my body is healthy. Well, nearly everything. Yesterday was Passover and I ate HoneyCake and Sponge Cake. When I came home I went on my exercise bike and dropped 40 points.

  28. Elaine D.
    Elaine D. April 12, 2012 at 9:44 am | | Reply

    I think that encouraging people to eat more fat is irresponsible. Especially diabetics who have a much higher chance of developing heart disease than non-diabetics. Not everything in medicine is “common sense” but eating nutritiously is. If you’re eating more calories than you’re burning you will gain weight! Eating in moderation and exercising are the keys to staying healthy and fit! That includes limiting your carbs, and watching your fat and calorie intake. I completely agree that we as a nation eat too many carbs but encouraging people to eat more fat instead isn’t good either. Have you heard of ketoacidosis? Watch your calories! Eat whole foods, limit your carbs, watch your fat/calories, stay away from processed food, and exercise! We can do it!!

    1. Dave
      Dave April 12, 2012 at 10:39 am | | Reply

      Eating more fat is not irresponsible as long as you are eating good fats like coconut oil, butter and olive oil. The main reason one must include fat in their diet is that when people try to go low to mod carb they end up being hungry which then leads to eating more food. Lots of people still think that eating saturated fat raises your cholesterol which has been proven to be false. Saturated fats actually are better for your cholesterol because they don’t oxidize quickly like vegetable oils which contain chemicals, transfats (yes Canola Oil has transfats even if it doesn’t say it on the label) and high levels of Polyunsaturated Fatty Acids. PUFA’s are the reason these oils oxidize quickly and increase your small (LDL) particle size within your blood.

      Ketoacidosis is the result of uncontrolled high blood sugar and is not the same thing as Ketosis. Ketoacidosis is very serious and not to be messed with but don’t confuse the two as they are different. Ketosis means the body is burning fat for fuel and if it does this regularly it will show up on a urine testing stick.

      I however couldn’t agree more with the eating whole/real foods, exercise and staying away from processed foods. Yes we can do it!

    2. John
      John April 12, 2012 at 11:18 am | | Reply

      Elaine, your comment draws so many questionable cause-and-effect relationships I don’t know where to begin.

      If you want to shake your confidence in the “fat-causes-heart-disease” notion (aka The Lipid Hypothesis), please read: http://www.nytimes.com/2002/07/07/magazine/what-if-it-s-all-been-a-big-fat-lie.html?pagewanted=all&src=pm

      Next, you equate eating fat with eating more calories. In my experience, and that of many others, this is simply not true. Fat satiates you sooner, and you end up naturally consuming fewer calories. Yes, eating more calories than you burn will make you gain more weight. However, many of us argue that the wild up and down blood sugar swings (whether or not you’re diabetic) due to high-carbohydrate diets actually cause you to consume more calories than you naturally would.

      Next, you bring up ketoacidosis after talking about fat. I fail to see the connection. Simplistically, ketoacidosis happens when there is not enough insulin in the bloodstream to metabolize a high level of sugar. Where is the connection to fat in that?

      Finally, you say one should limit their carbs and also watch their fat intake. That leaves only protein as something that shouldn’t be micromanaged. But, in general, people should limit their protein intake to about 20% of calories. So, what macronutrient ratio are you proposing? Low carb, low protein, low fat is a recipe for failure. The answer: increase fat!

    3. Noah
      Noah April 12, 2012 at 11:29 am | | Reply

      Elaine, the modern fear of dietary fat as a cause of heart disease is misplaced. As a personal (and, thus, anecdotal) example, when I was first diagnosed with T2 diabetes, I was eating a moderately low-fat, “complex carbs,” diet, but had triglycerides over 4000 (yes, that’s correct), low-HDL, LDL over 300, and C-Reactive Protein markers just below 5 (which is really high).

      After a little under a year of eating a low-carb, high fat, diet, in addition to dropping my fasting glucose into the 80s/90s, all of those cardiac markers had reversed. HDL over 45, triglycerides under 100, LDL varies between 70-90, c-reactive protein ~1. This is on a diet where ~55% of calories come from saturated fats in coconut oil, ghee (AKA clarified butter) and olive oil, 15-20% come from monounsaturated fats. Most of the rest comes from moderate amounts of protein, along with the small amount of carbs I consume (mostly in the form of greens, cabbage, mushrooms, eggplant and the lower-carbohydrate nuts).

      There’s no doubt a bit of individual variation in the optimal mix of calorie sources for folks. However, I’m far from unique with regards to seeing huge benefits in glucose control, triglycerides (as a direct result of glucose control, something my cardiologist initially pointed out), cholesterol and cardiac markers such as c-reactive protein.

      1. Dave
        Dave April 12, 2012 at 11:42 am | | Reply

        That is an awesome success story!! Kudos to you for going against what all the experts are telling everyone!

    4. Dave
      Dave April 12, 2012 at 12:04 pm | | Reply

      Eating healthy forms of fat is far from irresponsible like coconut oil, butter, Ghee and olive oil. The key is to stay away from eating high amounts of Polyunsaturated fatty Acids or PUFA’s. PUFA’s are less stable and oxidize faster than saturated fats, this oxidation causes a rise in LDL cholesterol. Canola oil which everyone thinks is healthy is not actually healthy. It contains transfats even though the label does not report this because under a certain percentage they are not required to put it on the label. It is also processed with a chemical called Hexane (very nasty stuff), it is high in PUFA’s and when you heat it to a high temp it can increase the amount of transfats by as much as 25%.

      Eating a low fat diet with low to moderate carb intake is a recipe for failure (studies have shown this) because you are going to be hungry all the time. When you eat good fats you get full and stay full which then minimizes snacking and the roller coaster of eating all day long. This is why I eat a high fat diet with low to moderate amounts of carbs. I use 25-50% less insulin and my BG is very stable. That being said there is no one size fits all and this for me isn’t a fad diet. It is a lifestyle of eating real foods, no grains, rice, legumes or gluten. Was it hard? Hell yes but the longer time goes by the better I feel and look.

      You mentioned ketoacidosis which is cause by uncontrolled high blood sugar which is very serious and not to be taken lightly. Ketosis is not the same thing and there is nothing wrong with ketosis. You can test yourself with a urine stick like you would for ketoacidosis but ketosis is the body burning fat for fuel. Again ketosis is not the same thing as ketoacidosis.

      It great to see people try this with success because food can be a very touchy subject but the results speak for themselves!

    5. Ken
      Ken May 21, 2012 at 8:51 am | | Reply

      Elaine, I don’t agree with any of your comment, but the one I must comment on is on ketoacidosis. For most diabetics, this is a non-issue. A daily fast would product about 5 mg/dl of ketones in the bloodstream. A severe carb-restricted diet would produce from 5 – 20 mg/dl of ketones in the bloodstream. Diabetic ketoacidosis is usually ketone readings above 200 mg/dl.

      Dave is absolutely right with his comments on this.

  29. John
    John April 12, 2012 at 11:37 am | | Reply

    Elaine, your comment draws so many questionable cause-and-effect relationships I don’t know where to begin.

    If you want to shake your confidence in the “fat-causes-heart-disease” notion (aka The Lipid Hypothesis), please Google “what if it’s all been a big fat lie” and read the first article.

    Next, you equate eating fat with eating more calories. In my experience, and that of many others, this is simply not true. Fat satiates you sooner, and you end up naturally consuming fewer calories. Yes, eating more calories than you burn will make you gain more weight. However, many of us argue that the wild up and down blood sugar swings (whether or not you’re diabetic) due to high-carbohydrate diets actually cause you to consume more calories than you naturally would.

    Next, you bring up ketoacidosis after talking about fat. I fail to see the connection. Simplistically, ketoacidosis happens when there is not enough insulin in the bloodstream to metabolize a high level of sugar. Where is the connection to fat in that?

    Finally, you say one should limit their carbs and also watch their fat intake. That leaves only protein as something that shouldn’t be micromanaged. But, in general, people should limit their protein intake to about 20% of calories. So, what macronutrient ratio are you proposing? Low carb, low protein, low fat is a recipe for failure. The answer: increase fat!

  30. Elaine D.
    Elaine D. April 12, 2012 at 3:56 pm | | Reply

    Hi John, Thank you for your thoughtful response to my comment. I misspoke and said ketoacidosis when I meant to say ketones. I apologize. I know having some ketones present in our system is fine; however, I have friends who have become very ill and discovered they had toxic levels of ketones in their bodies. At the time they were following the Adkin’s Diet and eating lots of fatty foods, with little or no carbs. I haven’t read the article you suggested yet but i think what you’re saying is that it’s healthier to eat a “healthy” fat tgzn to eat a carb? I’m going to keep an open mind and read the article you suggested and research the subject further. I’m currently non-diabetic and have good cholesterol and blood pressure.. My eight year old son is Type 1 and of course I want to do what is best for him. I have spoken to several nutritionists, diabetes educators and doctors. They have all told me the same thing, moderation and exercise. The patients they have that are the healthiest and have no complications are the ones that exercise daily and eat a balanced diet rich in whole foods and low carbs.

  31. Lynne Marie
    Lynne Marie April 13, 2012 at 5:54 pm | | Reply

    O am am still so confused. When I was born, I hurled EVERYTHING except for protein. Pure protein in powdered form mixed with water. I also had so much diarrhea and projectile vomiting, I went back to a different hospital than I was born, 12 days after I was born, only sadly released to DIE. My mom, then nearly 35, got together with her friends as they perused the library and came up with pure powdered protein somewhere in the U.S. Life went on and I became a really good eater of veges and all meat–never a candy or fruit person–diarrhea, you know… My weight fluxed only a few pounds until I received the dreaded hysterectomy. I began gaining weight fast. In two years, I gained 50 pounds and despite exercise, moderation of food, money to nutritionists and gyms, here I sit. I just don’t know what to do. I increased Lantus and Novolog pen–52 units Lantus and upwards 48 units Novolog per day. Rarely, I can lose up to 14 pounds, but it doesn’t last. I am perplexed. I am now going to a 4th endo…HELP!

  32. cj
    cj May 21, 2012 at 5:59 pm | | Reply

    Consider the flip side- I am 5’7″ and was diagnosed with LADA a few months ago. I am trying to delay going on insulin by eating a restricted carb diet and have gone from 126 pounds to 110, which is too thin for my height. I eat 6 times per day with plenty of fat (including lots of cheese, whole yogurt, avocado, coconut), so calories isn’t the problem. I imagine I will reach a point were my endo will ask me to increase my carb intake and use insulin to control my bs so I don’t wither away. The fact is, your body needs carbs for energy. Low carb diets work really well for sedintary people who want quick weight loss results, but they are unrealistic and unsustainable. I have no doubt that eating a diet heavy in carbs, particularly simple ones, is bad for your health. However, if your an active person of a normal weight (diabetic or not) you will need to eat a healty diet composed of complex carbohydrates, fats, and protein for optimal energy levels (proportions will depend on the individual).

    1. John
      John May 22, 2012 at 7:41 am | | Reply

      Hi cj,

      I’m a fellow LADA, at age 33. But I actually chose to go on insulin as soon as possible so I could give my beta cells a rest. I’m in a research study, and this approach is totally supported by the university researchers. As I’m sure you’re familiar, the longer one can preserve one’s beta cells, the easier the management is in the long run. It’s definitely scary to start on insulin, but it’s something that will eventually happen to all LADAs (due to ongoing autoimmune attack). Why not start now?

      As to your comments about losing weight, how much protein are you getting? The general rule of thumb is you should be getting between 1-2 grams per kilogram of bodyweight to maintain weight. If you want to get back around 120 lb, that would be between 50-100 g of protein per day, probably biasing toward the higher end of that scale. If you find that protein raises your BG too high, that’s another sign you need small amounts of insulin to help your body metabolize the protein.

      If you want inspiration for what’s possible on a very low-carb diet, have a look around Peter Attia’s blog, waroninsulin.com. He’s a very athletic individual, has amazing athletic performance, and doesn’t wither away despite eating around 20 grams of carbs per day. This post, specifically, addresses how low-carb affected his athletic performance via objective measurements (spoiler alert: it’s almost all positive): http://waroninsulin.com/how-a-low-carb-diet-affected-my-athletic-performance

  33. cj
    cj May 22, 2012 at 5:40 pm | | Reply

    @ John-

    Thanks for the information. I am maintaining normal blood sugars with my diet so I see no reason to go on insulin. Why risk the lows or add the cost of medication. If I were to go on insulin I would definately need to increase my carb intake, since I regularely see lows in the 60-70 range without it. Right now I eat 100-150 grams per day, spread out over 6 meals. This was recommended by my endo, whom I trust. I am a runner and a mother of a young child so any less would seem ridiculous. I imagine that people with a less active life style can survive on less carbs.

    With regard to protein I estimate that I get upwards of 50g a day, put haven’t counted since I was pregnant. My protein sources includes beans, tofu, nuts, organic eggs. cottage cheese, and sustainably caught fish. I don’t eat poultry or meat for ethical and environmental reasons. I think encouraging people to eat a high protein diet leads to people being irresponsible about there food choices: eating lots of bacon, sausage, and steak is bad for the environment and has health implication that have nothing to do with bloodsugar. I am a believer that porportions of carbs:protien:fat that are tolerated by an individual has a lot to do with ethnic origin. I am of Scandinavian descent, so I can eat lots of fat from dairy with little weight gain.

    Finally, I think a lot of these studies follow the extremes of a high fat versus a high carb diet, when there are many grey areas. I would like to see how diabetics do that get their carbs from oats, barley, and beans and spread them out throughout the day do for BS control.

  34. Diabetic Diet Therapy | WWW.SHOAIBGARANA.COM

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  35. -
    - November 26, 2012 at 3:41 am | | Reply

    Hey Guys,.. Im a type 1 diabetic.. diagnosed around 16 years ago at the age of 4. For many years till even after i turned 20. i was eating very badly. Lots of carbs.. Not enough Protein..Not enough good fats and definetly not enough exercise. Mainly because i felt that everytime i did exercise i had to eat more. For the last two months i have changed my life completely and i urge all type 1 diabetics to do the same if you have been misinformed by your doctor or nutritionist. Try to eat 40 percent fats, 40 percent protein and 20 percent carbs. Low gi carbs are the best. Fat will help regulate your hormonal levels which include adrenalin. Adrenalin will help your body free up glygoyen that will stop your sugar from going low (just remember to take extra insulin for intense exercise as your sugar will rise). As far as exercise goes, Weight lifting and cardio should be done in total for at least 5 days (30-60 min session). Type 1 diabetics have problems with their metabolism anyway, this will help to make sure you dont get any diabetic related complications. P.s sorry for the late post. I just hope this post can make a difference for anyone reading even if your not a diabetic.

  36. John
    John June 30, 2013 at 11:47 am | | Reply

    I’d rather run 10 miles a day as I do currently and eat whatever I want to maintain 145 pounds than eat the unsustainable diets you people are doing (eating so few carbs). Give it 5 years and I bet you’re worse than you were before the diet.

  37. Pat
    Pat July 14, 2013 at 8:44 pm | | Reply

    Go ahead eat pizza, just throw away the crust. That’s where the carbs are. Especially white floor crusts which have little nutritional value.

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