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I've been reading a lot of the threads here and see a lot about a low carb diet. However, I have a question or series of questions. First let me start out on this premise: Let's say I am a type 1 diabetic (how about that, I am!) and I know my I:C ratio is 1:20 as an example. As long as I give myself proper insulin for the carbs I don't have a problem with my BG being out of control after meals regardless of whether I have 200 carbs a meal or 60. In this type of situation, what is the benefit to me as a diabetic, not just general health benefits anyone could get, from being on a low-carb diet? In essence, I'm doing what my pancreas would normally do and dose for the meal (although my pancreas was much more efficient and precise of course).
If this is a hot-button issue here then forgive me, I don't intend to open up a can of worms. My books from Dr. Bernstein and 'Think Like a Pancreas' are still on their way, so maybe they will answer this question. I've just seen a few people here who seem to feel very guilty that they were still "living like they didn't have diabetes and dosing for the meal." If you're BG's are in check and your otherwise healthy and doing okay, why is this a problem? Again, we're discounting the benefits anyone could get, and focusing on why it's beneficial specifically for diabetics.
NOTE: I DO count my carbs religiously (I don't see how that could be optional as a T1) and try, in general, to eat fewer than I did before I was diagnosed. Also, the ratios and scenario above do not fit me, they are just setting the stage for the discussion.
Honestly, I have found that going full fat, full flavour and having a smaller size and having it less often is the best option with things like chocolate and icecream. I'm luckly that Whittakers Chocolate is nice and close to me - good, dark mass produced choc, hopefully their peanut butter choc that has just been released is great. Reeses is hard to get here, and I love it!
I find a lot of the low fat/low sugar options have other stuff that screws me over, so instead of getting a large I get a small, and enjoy it.
2 squares of Lindt 70% chocolate is very friendly to my blood sugar. I usually eat it with some almonds or pecans. I think the fat in the nuts and the fat in the chocolate slows down the absorption of the sugar to where my T2 pancreas can handle it. It might have a different effect on T1s
Works for my LADA pancreas too ;) Thank goodness! With almonds please.
I think some of the guilt may stem from the 'not being a 'perfect' diabetic, which I think is silly. Every one has good and bad days, if you eat like crap one day, just don't do it every day, or you will start to see poor results.
For me, I used to be able to get away with 2 Mrs Macs chilli beef and cheese pies and a cookie time (about 150g carbs) for lunch, and still be losing weight and have good numbers. I was however working as a farm hand, and doing a lot of manual labour. If I tried to eat that much now I'd feel really, really ill!!
I too have really bad insulin resistance in the mornings, so keep breakfast to about 10-15g, I also feel really nauseaous in the early morning if I eat too much, so it's not hard to have a light breakfast. I do however find that if I only have protein, my bg goes up, more than it does with a small amount of CHO. With other meals I find that if I have a large amount of carb, and I haven't been 'working' it off, I just feel blah, the same as I'd feel if it was a massive feed of protein too. I don't "low carb' as such as I don't have a high fat/high protein diet in the classic sense either. I just find that there is an amount of carbs, that under normal daily 'use' of my body, works best. I do find that I have to up that rate if I'm doing something like skiing or tramping (hiking)for multi days as even with a lowered basal rate I was struggling.
When I look at what I eat now, as a person working in a sedentary job, compared to a friend of a similar height that works as a glacier guide, (the girl can eat an entire chocolate cake for morning tea and says if she ever stops walking for a living, she will have to learn to make what she eats for 'second breakfast' last all day!), I think with the sedentary lives/jobs that most of us now have, we just don't need the carbs/energy.
As diabetics we have to pay more attention to what our food does to us than 'joe public' so I think most are more aware.
I can't get the really low carb (30g/day) to work, but I'm normally around 15/20-40/20-40 for each meal max.
With isnulin resistance, for me it only becomes a problem when I get fat... hence why I'm trying to get back to my old weight.
I low carb as a T1. But I don't follow Bernstein per se. I make my own low carb rules that I know work for ME. During the first year I definitely limited my carb intake but I still ate regular bread, potatoes on occasion, ice cream etc. Once my pancreas went kaput and my insulin needs increased, I was concerned about the amount of insulin I intake daily. I am not weight obsessed but I have been thin all my life and I like the way I feel and look. But that is really not the main reason I low carb. I do it because for ME I have found that my blood sugars are very consistent when I eat this way. I pretty much make all my own food and I love the things I make and eat. I have had a blast learning to bake and cook this way. I read many different food blogs and have found that the food I make and eat is delicious and really satisfying. Plus, I feel like I eat more healthfully this way. When I go to the market I pretty much shop the periphery...fruits, veggies, dairy, meat and cheese. I just don't eat things out of a box anymore. When I read the ingredients it seems they invariably slip things in that for ME raise my sugars.
So in the end I think it's a personal choice of what you like,can tolerate and feel the best in doing for you overall health. There is no right way only YOUR way.
You'll learn a great deal from Dr. Bernstein's book whether you choose to follow his approach or not. And in case you haven't seen references to it already, I also learned a lot from Jenny Ruhl's book, Blood Sugar 101, and website http://www.phlaunt.com/diabetes/ I would recommend her book as a great place to start for anyone new to diabetes.
Thanks for the resource, Marty. I'll take all the information I can get. If what Zoe is saying about Dr. Bernstein (anyone else always think Berenstain when they see that name or is it just me?) and keeping carbs to 30 or so a day is true then I don't think I'll be following that to the letter. Going that low begs the question as to what side effects there would be to that diet. I read an article where they talk about the common side effects from low carb dieting. Short excerpt on side effects:
"The most frequent complaints with low-carb diets are constipation and headache, which are readily explained by the lack of fruit, vegetables and whole grains, Astrup said.
Also, bad breath, muscle cramps, diarrhea, general weakness and rashes are more often reported on low-carb diets than on low-fat diets, Astrup found.
"The majority had some of these side effects in the Atkins group. In the control group, almost nothing," he said.
These side effects are consistent with carbohydrate deficiency, because the brain and muscle do not get enough sugar from carbohydrates to maintain their normal function, Astrup said." (Full Text Here)
None of that sounds too fun either! Now, that is a news article and not a medical article/journal, so take it as you will.
I've been low carb eating 30-35 carbs for over 3.5 years. I've never experienced any of negatives on that list. Sorry, but have to eye roll at that article. Plenty of fiber on low carb diets from vegetables, nuts & nut flours. Grains are believed to be high fiber because that's what the marketing & cereal commercials promote. For example, two slices of whole wheat bread has 24 grams carbs & 3.8 grams fiber. A cup of rolled oats has 55.4 grams carbs & only 8.3 grams fiber. One avocado 17 grams carbs & 13.59 carbs fiber. Guess which one has more vitamins, minerals & healthy fats:)
There's not a carb deficiency on low carb because about 58% of protein is converted to glucose & a small percentage of fat. Other biochemical processes also contribute glucose, such as cells dying.
I have more energy eating low carb & feel much better than I did on my former high carb diet.
If there is not a CHO deficiency why does the brain then convert to working off ketones? Although not as readily the rest of the body will convert to ketone use as well. Unless there is a CHO deficiency the body would have no need for ketones unless of course there is an insulin deficiency.
Ketones are a consequence of burning fat. The more fat you burn, the more ketones you produce.
You're right, there is a minimum amount of CHO that your body requires. However, if done correctly, low-carbing balances minimal carb intake with gluconeogenesis from protein intake to meet your body's minimum requirement, as Gerri says. Gluconeogenesis from protein is the reason why people lose muscle mass if they just cut calories accross the board when they diet. With no extra source of dietary protein to turn to, your liver will call on your muscle to be broken down for gluconeogenesis. Gerri quotes a 58% conversion from protein to glucose, but that number varies a lot from study to study. 58% is near the upper limit, but given that carbs are restricted, I'd imagine that number is attainable.
Really, the point is just to provide enough protein to fuel gluconeogenesis.
Higher fat is required because gluconeogenesis actually requires energy to run, so with lower carb, your body turns to fat to produce the energy needed for running both gluconeogenesis and daily activity. That's where the ketones come in.
Burning ketones is really just a stop-gap measure once liver glycogen is significantly reduced enough to affect bloodglucose balance. Once gluconeogenesis kicks in, there's plenty of glucose being produced to maintain BG levels and run your brain and heart.
So, technically, even though you are cutting dietart carbs significantly, there really isn't a CHO deficeiency.
Ive been trying to cut carbs too, ive lost like 20 pounds, my carb ratio is I:C is 1:4, I go threw 300 units in about 2 1/2 days. I wish my body didnt require so much insulin. Im a type one but i didnt carb count before the pump now i do, I would just do 25 units for breakfeast, lunch, 30 to 35 for dinner. For stuff like the chinese buffet i would do like 45 to 50 units.
"As long as I give myself proper insulin for the carbs I don't have a problem with my BG being out of control after meals regardless of whether I have 200 carbs a meal or 60."
1. I'm going to postulate that this is true. That you have *good control* and do not have any difference in control no matter how big a meal you eat. (This is definitely not the case for me.)
Here's my take/understanding/not a doctor/I could be wrong:
Given (1) there is very little benefit other than the benefit that any person might derive. Type 1 is primarily the loss of an automatic mechanism that you must replace with a manual one. If you were theoretically able to maintain exactly the same glucose profile as the automatic mechanism, you would have no symptoms and be in the same boat as everyone else. The DCCT trial effectively established this. Having diabetes does not cause the complications. Diabetes causes loss of the automatic mechanism to regulate blood sugar. The resulting high blood sugar causes the complications.
However, even diabetics with "good control" can often have cumulative damage at some point that will affect them adversely. The degree of good control will essentially push that damage farther into the future. At this point, many of the things that affect other people (such as heart disease/etc...) are much more common in diabetics. So, the healthy things in life that reduce heart disease, etc..., will be that much more important for you (us). So, in this manner, even though your control was unaffected by your carb choice, it could be that a poor carb choice will still affect you disproportionately because of your diabetes.
Ultimately, you need to do what is right for you. If you are healthy and can maintain good A1c's with consistently low variance in daily blood sugar (not a lot of highs and lows that average out), don't sweat the low carb diet. The low carb diet can be a great tool for some of us. Same as insulin pumps. If it helps your control and you find it more convenient, fine. If you are doing great without it, more power to you. If someone is proselytizing low-carb, ignore it. But make sure you are honest to yourself about what good control is!
When I go on a low-carb diet, and it has amazingly great impact on my BG.
Here's one reason why:
My I:C is 1:5 and my ISF is 20.
Let's say i eat a 15 carb meal and my starting BG is 100. Even if I FORGET TO TAKE A SHOT, my after meal BG will be 160. The largest expected error to the high end is still within a postprandial range. Nice.