Mortality and carbohydrate intake in a cross-sectional, multi-country study

Since we don’t do low-carb, I cannot speak from experience. But my understanding is that Bernstein dieters are, in general keeping their insulin doses very low. Possibly someone he follows Bernstein will correct me? @walkingthedragon88 had a really interesting thread about her experience: Sharing my story

It only takes a couple of days before your body switches to a different sensitivity though.

I do think, though, that Bernstein is not for everyone (not for us right now for instance).

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I think different people need different diets, maybe based on genetics or other factors. That’s the only explanation I can think of for why some people love low-carb and some people hate it, and it would fit in with the general theme of diabetes where MDI works for some people while pumps work for others and so on. I’ve found my insulin sensitivity has increased a lot since going low-carb. I haven’t, however, lost any weight, which was part of my reason for trying it. Other people talk of weight literally falling off. I’ve been stuck at the same weight for months now. So clearly low-carb has different effects for different people, and for some it may just not work for their body.


My sense is that people who have good success with this approach keep it up, but that some fraction of people who try it find it doesn’t work or maybe initially it does but they find the BG benefits start getting less predictable and wane over time. And they have to progressively limit more and more carbs to achieve the same results. Then they go back to carbs and find a rough patch and then find they can maintain decent control with more carbs. At least, I’ve heard quite a few stories like that.

One way to ask the question is to look at the average doses of people who are Bernstein versus those who are on a regular diet – are the people who are, long-term, eating almost no carbs using closer to 50% of the insulin of people who eat a normal diet? Or is it more like 75% or 80%? If it’s the latter, that’s a sign that the long-term, steady state condition at this low-carb intake is to be more resistant to insulin for them.

Or, to put it another way, more carb-sensitive. Ultimately, the food you eat needs to be converted into energy for your body – the metabolic process for converting fat into ATP for your cells is the same exact metabolic process used for converting glucose into ATP, but just with just a few extra steps tacked on. And your body needs a certain amount of energy to function. Once you’re at that threshold, you can’t really go much lower on insulin use, which is why low-carb diets didn’t work in the first place, when people slowly wasted away before Dr. Banting.

Also, I’m convinced a lot of the sharp rise in BG is due not simply to the direct conversion of food-based glucose into blood sugar, but also to the release of glycogen from the liver. And that process is way more complicated, and fat mediates that release in lots of complicated ways.

Plus, I just can’t discount the fact that almost every large study of T1Ds that’s looked at carb intake has not found a correlation with better control. They have found a correlation with higher fruit and veggie intake and lower processed food intake, though.

Clearly, this diet does work for many people. But I am not convinced it’s the majority.


I don’t think this would necessarily be a fair test, because you are testing two different cohorts. I suspect a lot of people who end up eating low-carb do it because they can’t achieve their desired control whle eating carbohydrates, maybe because they are insulin resistant to begin with. I think you would have to find two groups who were taking the same amount of insulin beforehand, and then compare them again after one group goes low-carb and the control group just continues on with thier normal diet.

I definitely think spikes after eating are more complicated than just glucose from food. But the main reason people go low-carb is that food does play a big role in control. There are lots of times we’ll go high or low and not know why and just can’t control it and can only get back in range as soon as possible and move on. But if we can eliminate after-meal spikes and/or lows by eating low-carb, that’s one factor affecting blood sugar that we can control. Others find they can control it by pre-bolusing or by doing complicated combination boluses. But some people just like eliminating that variable completely.

Do you have links to these studies? I’d be interested in reading them. I wonder, in part, what they use as a criteria of “low carb”.


There are lots of times we’ll go high or low and not know why and just can’t control it and can only get back in range as soon as possible and move on. But if we can eliminate after-meal spikes and/or lows by eating low-carb, that’s one factor affecting blood sugar that we can control.

yes, that definitely makes sense. I’m just saying that I suspect that many after-meal spikes are mediated by what we eat, but not necessarily in that straightforward way where the glucose into the stomach = glucose in BG. My (admittedly totally speculative theory) is that it has to do with whether the liver’s storage and release of glucose is more dysregulated by high carb intake or high fat intake, or some combination of both, which I suspect is mediated by genetics. That’s supported also by the notion that T2D is temporarily improved (I wouldn’t say cured) when you strip fat from the liver through near-starvation diets.

HEre’s an interesting talk I watched about Diasome, a company that’s trying to “insulinize” the liver. Whether that pans out or not, I think it’s interesting and a sign that we’re missing something important when we try to explain why low-carb works, or why it doesn’t, for some people.


Thanks for the shout out, Michel! Yes, low carb has worked fantastically for me. I never thought I could achieve such great results. I agree that if one consumes a lot of fat and almost no carb, IR can ensue. I do well eating about 50g a day, most of them from plants (mainly vegetables). I do not limit protein or fat. My basal doses have stayed the same for many years. I did increase my bolus ever so slightly in the am, but I can’t say if that is due tonjust more diligent control, or the extra 10 lbs I’ve kept on since being pregnant!


Also, I want to add that of course everyone is different. The metabolism is complicated and individual. However, in general, most of the people that I have personally conversed with who have switched to low carb (be it 3 months or 30 years ago) are using less insulin then before and achieving better stability and control. As far as medical professionals disagreeing with the benefits of or questioning the safety of low carb (especially for people with diabetes), I feel strongly that they are wrong. As they say Nutritionists do not study medicine, medical doctors do not study nutrition, and neither study science. This is a somewhat of an inaccurate generalization, but there is a lot of truth to it! The nutritional recommendations are absolutely shocking! Some doctors don’t remember basic biochemistry (ketones in the context of metabolism as opposed to acidosis, for one). I avoid such individuals or try to educate them. Luckily, many of my Endos during grad school and postdoc experience were researchers as well as clinicians, who not only untertood basic science but were in fervent support or my management techniques. Rant over!


Well said, Jen!!

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I’ve done ketogenic levels of low carb, and I’ve found it useful in some ways and highly challenging in some. Besides the obvious challenge of it being very difficult to eat out and eat meals prepared by people not on that kind of diet, I have dysautonomia which means even with a normal diet, I need to consume more fluids and electrolytes than typical to keep myself feeling normal. On a keto diet, it becaomes incredibly easy to become out of whack. Even from talking to my friends who have done keto without my issue, it’s shocking how much additional salt they needed to not feel really off while doing keto. On the flip side, I’ve never seen flat CGM lines like I have when I’ve eaten keto, I think because of a combo of minimal carb intake and liver depletion. I think ideally for diabetes control, I would do this all the time, but since diabetes isn’t the only factor in my life, between my dysautonomia and the joy I get out of at least sometimes eating out and eating things that don’t fit in that diet, I don’t.


Perhaps this is part of the reason that some people are using more insulin and some people are using less. Dr. Bernstein doesn’t recommend a LCHF diet, he recommends a LCHP diet. I eat fat, of course, but I can’t say I’ve necessarily increased my fat intake a lot. I’ve mostly just replaced carbs I used to eat with veggies and low-carb baking.