Ideal diabetic diet?

EGVnurse · Jan 26, 2015

I have my personal opinions on this and ONLY anecdotal evidence to support (using myself as a guinea pig). The best "control"/hgba1c I ever achieved after many years of living with type 1 diabetes was on a low-moderate carb intake (less than 30 grams CHO at meals). Carbs coming from legumes, fruit, vegetables preferred. This meant a high fat intake, which did not deter me, because my weight decreased and I had never seen such beautiful smooth blood sugars. I was not ketotic although I did not check regularly enough (as this was in college before I became a nurse/CDE )

I disagree with the ADA on the amount of carbs recommended for adults. I think we could all benefit from a reduction in carbs, at least from the common sources (grains, cereals, processed grains, etc.)

I think healthy weight children with type 1 diabetes should be able to eat what they please but that they/the parents should know: higher carb intake --> higher insulin dose --> larger margin of error on insulin absorption and more glucose variability (this caused a great deal of frustration for me growing up). So that recommended "diet" is taking into account insulin injections.

I tell my patients with type 2 diabetes and NO other co-morbidities that studies have shown moderate carb intake (30-45 grams per meal or less, depending on gender, activity level and any glucose-lowering medications) is safe/effective when compared to low-fat diets. Both have been shown to be effective, but the new research linking high-carb intake to high cholesterol is pretty compelling!

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I should also mention that I have no other health conditions with the exception of hypothyroidism.

IEDave, ASN, CNA, LVN · Jan 28, 2015

Personally, as a type 1 diabetic, I like Bernstein. He's a type 1 diabetic. I personally get the best control with it. I think physiologically speaking, every persons individual body is different. What works best for my diabetic body doesn't work best for the next persons. It's about the individual, not the overall.

+1 for Bernstein. Having T2, I don't follow his regimen to the letter; rather, I treat it as a collection of "hints & tips" around a core regimen of carb restriction/fat increase. In my case, I do have associated co-morbidities (obesity, HTN, etc. - near-classic Metabolic Syndrome presentation) all of which have benefited greatly by this methodology. My exercise (such as it is) is confined to walking; that said, I can chug out a 6 miler with little trouble these days. When I've put "pedal to the metal" on my walks, I've noted that both BP and BS tend to be better controlled than when I don't; I don't do it as a matter of course because it adversely affects my weight loss (down 70 lbs. (281.2 to 211.2 lbs.) in 6 mos. for those keeping score).

What I tend to find intriguing is that Barnard's vegan diabetic diet appears to have some positive benefit as well; I'd love to see a head-to-head between Barnard's diet and, say, Atkins to see which one gives better BS control.

Overall, I'd have to lean in the direction of at least some level of carb restriction, but that's just me, based on my little n = 1 experiment. YMMV.

----- Dave

*BTW: 'BS' = 'Blood Sugar'; plenty of the other kind of BS flying around regarding diets these days! :saint:

Libby1987 · Jan 28, 2015

Bernstein recommends 30g of carbs? I would have thought 50ish would work.

I'd really like to see the outcome of such low carb diets on IR and type 2. I've heard lots of anecdotal results but would like to see if organ damage could be avoided with strict diet control.

IEDave, ASN, CNA, LVN · Jan 30, 2015

Bernstein recommends 30g of carbs? I would have thought 50ish would work.
I'd really like to see the outcome of such low carb diets on IR and type 2. I've heard lots of anecdotal results but would like to see if organ damage could be avoided with strict diet control.

Likewise, especially given that all of my relatives (both parents & 2 out of 3 sibs) that have passed on died of CV complications. I'd LOVE to find out that I don't have that Sword of Damocles hanging over my head; alas, other than Bernstein's anecdotal revelation (plus a number of online disclosures) nobody really knows for sure.

As far as what level of carb restriction is necessary - it's kind of like throwing darts at a dartboard. Barnard's diet is carb-rich, but restricts refined sugars & starches - appears to work. Atkins - severe carb restriction - appears to work. Bernstein - appears to work. Dr. Wolfgang Lutz's diet (in "Life Without Bread" - 72 grams CHO/day, and you pick the carbs you want to eat) - appears to work. It's all based on clinical observations and large amounts of hearsay up to this point, because a lot of fundamental studies and trials just have never been (or are just being) done. Certainly the fact that pts. are getting better serum glucose control is increasingly well accepted, but there's just a lot of analysis & research to be done on this subject. Oh, to be 25 again - I'd go for a doctorate in Biochem 'cause there's almost certainly a Nobel Prize sitting out there for somebody on this one. Just have to settle for an FNP & hopefully be able to counsel my pts. a bit better on wise dietary choices. Pity. :yes:

----- Dave

p.s. An interesting study out of the Mayo Clinic: Linky

Alisonisayoshi, LVN · Jan 30, 2015

It is all anecdotal, which is ridiculous if diabetic pt's seem to sing it's praises. It's ridiculous to not throughly study it. The straight line on my dexcom and a low A1C are my proof for my body. I need to subsist on fewer carbs. My dietician told me I was wrong and raising my risk of CV issues, even with great cholesterol, perfect triglycerides, and a BP of 110/70. That's the problem, really, that it isn't acknowledged that the right diet is the one that works for the diabetic, not the one out of a book. A book isn't the individual diabetics body. It just isn't. I know we are supposed to use use EBP, but we also need to listen to what is working and what just doesn't. I haven't had a low under 60 in 3 months. Not one. I don't have highs over 150 unless I let cravings for carbs get the best of me either. Yes, I'm a highly motivated pt, but because my endo supports and motivates me like a teammate, if my only motivation was my dietician, who doesn't really listen to me, I'd probably be 'non-compliant'.

kodc · Jan 30, 2015

Not all carbs are created equal. For someone to throw out a certain number w/o qualifying a breakdown may be looking for failure. I agree with Allison, everyone will be different. Having said that you must look at any type of sensitivities (another discussion). This is especially important when including foods that are inherently pro-inflammatory to the general public and especially so with those having difficulties controlling BG. Call the "diet" what you like. A lot of sources are teaching old generalities without taking the newest literature into account. Decrease inflammation and increase quality and longevity of life. Generally speaking

KO

kodc · Jan 30, 2015

It is all anecdotal, which is ridiculous if diabetic pt's seem to sing it's praises. It's ridiculous to not throughly study it. The straight line on my dexcom and a low A1C are my proof for my body. I need to subsist on fewer carbs. My dietician told me I was wrong and raising my risk of CV issues, even with great cholesterol, perfect triglycerides, and a BP of 110/70. That's the problem, really, that it isn't acknowledged that the right diet is the one that works for the diabetic, not the one out of a book. A book isn't the individual diabetics body. It just isn't. I know we are supposed to use use EBP, but we also need to listen to what is working and what just doesn't. I haven't had a low under 60 in 3 months. Not one. I don't have highs over 150 unless I let cravings for carbs get the best of me either. Yes, I'm a highly motivated pt, but because my endo supports and motivates me like a teammate, if my only motivation was my dietician, who doesn't really listen to me, I'd probably be 'non-compliant'.

Archaic advice, in my opinion, is lazy and irresponsible. Your body doesn't read the text. It takes more than a cookie-cutter approach; that takes work. Good on you for keeping yourself in line. I'm glad you also have a supportive endo.

KO