That statement just blows me away. I just had my 66th birthday and don’t imagine I’m going anywhere. I don’t have any complications, and am healthy as a horse. I also don’t think I’m so special.
BTW, I don’t know personally any T1 diabetics.
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What I meant by this statement was people with T1D from childhood who I know/knew in person (i.e., live in my city and I’ve known offline). Maybe I happen to have just met people skewed to the complications end of the spectrum. My only intent in the statement was to talk about part of what motivated me to adopt a low-carb diet.
I also seem to know a higher number of T1Ds in “real life” (i.e., offline) than many people, both growing up as well as in adulthood.
I tried looking for studies about stunted growth and very low carb diets. I didn’t find much, but I did find the study below. The ketogenic diet can be used as a treatment method for epilepsy. The sample size is small though. Also, I don’t know if the amount of protein they’re suggesting is a lot or not??? Maybe someone else knows?
If it is a lot, then that may not be healthy for PWDs because of the effect a high protein diet can have on kidneys.
"Ketogenic diet is a structured effective treatment for children with intractable epilepsy. Several reports have indicated poor linear growth in children on the diet but the mechanism of poor growth has not been elucidated. We aimed to explore whether the protein to energy ratio plays a role in linear growth of children on ketogenic diet. Data regarding growth and nutrition were, retrospectively, collected from the clinical histories of 35 children who were treated with ketogenic diet for at least 6 months between 2002 and 2010. Patients were stratified into groups according to periods of satisfactory or poor linear growth. Poor linear growth was associated with protein or caloric intake of <80% recommended daily intake, and with a protein-to-energy ratio consistently ≤1.4 g protein/100 kcal even when protein and caloric intakes were adequate." We recommend a protein-to-energy ratio of 1.5 g protein/100 kcal be prescribed to prevent growth retardation.
http://journals.sagepub.com/doi/abs/10.1177/0883073813508222
It also looks like the study might reference a few other studies that looked into this.
http://pediatrics.aappublications.org/content/122/2/e334.short
The above two studies suggest that the ketogenic diet may stunt growth.
There are several things about this paper that I think make it have very questionable value. I’m sure I could come up with more but I’ll leave it at this. But let me start with the fact that this paper was the product of two low-carb diet book authors (Ludwig and Bernstein). My BS radar is already tingling anytime I see that.
First, they recruited participants from a Bernstein VLCD fan-club website. So the people they recruited were all true believers in the value of the keto diet, and were all interested in selling it to the public at large. So clearly there was serious bias in the selection criteria. And there was a very unfortunate incentive for those participants to play up or misrepresent the “good” in their disease, while downplaying or misrepresenting the “bad”.
Second, they didn’t check that most of participants they included in this study even had T1 diabetes or that any of the medical information or other information they provided was valid. They validated only some of the information in less than a third of their participants using medical records, the rest they just decided to “trust”. But remember the first problem - that the people they were trusting were true believers and therefore had an incentive to slant their information.
Third, the average participant in this paper self-reported that they had diabetes for less than a dozen years. From my experience I believe it to be true that diabetes is typically easier to manage and control soon after diagnosis, probably due to the persistence of some Beta cells. This would be especially true for the LADA who were included in this paper due to the often slow onset for LADA individuals. And at no time did the reported results try to separate the data based on the age of onset or years with diabetes, so it is impossible to see how the results reported could have been skewed by the subjects that were selected to participate.
Fourth, the participants self-reported their food intake without any attempt to verify it for any of them - and food intake is widely well known to be incorrectly self-reported. What were they really eating - I think that is hard to say.
Fifth, and probably most important, there was no control group for this paper. Instead, the author of the paper implies in the Discussion section that these participants should be compared to the results of the DCCT, presumably as a control group. But hold on - the DCCT was from 35 years ago, and surely the results of the DCCT should not be expected to be similar to the results attainable today by similarly highly motivated individuals with access to pumps, CGMs, open-loops, not to mention the existence of fast and slow acting insulins none of which existed during the time the DCCT was performed.
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As soon as I read they were all from the same Facebook group, I thought, “I can stop reading now.”
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I am not against low-carb for adults. If it works for them and fits their lifestyle and helps them, that is great.
(And I would not recommend high-carb for anyone, unless they are burning it!)
I know there are a lot of people who are very successful with low-carb. And I understand how it can help with BG, and can also help people with weight loss.
But if the normal recommendations are being done for kids - reducing refined sugar intake, limiting sweetened drinks, limiting processed foods, limiting artificial additives, increased vegetables, eating natural produce, balanced meals, home-cooked meals, reducing saturated fats, eliminating trans-fats, drinking plenty of water - all of that stuff…
If someone is already doing all of that, is there any reputable medical source that recommends less than 50 grams of carbs per day for non-diabetic children who are of a healthy weight?
I know there are diabetes forums where people recommend it, and diabetes groups.
But I am curious, are there sites that recommend less than 50 grams a day for active kids who are not diabetic and are of a healthy weight? <==== Legit question.
And if it isn’t recommended for non-diabetic kids, that is why I question if it would be good for diabetic kids. Because I think there are other ways of winning the BG battle - longer pre-bolus, over-bolus and then basal adjustment, IM injections, exercise, slower complex carbs, all of those things.
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I feel like the discussion is about high carb vs. super low carb. I don’t think that we necessarily need to talk in extremes. My philosophy is that I try to keep my daily carbs under 130g, and I try not to eat more than 30g at a meal. I think that this is a good compromise for my T1D management, and that everyone can make up their own rules about their carb quantities. I fully enjoy my bread, fruit, etc…, and I don’t feel like I deprive myself of carbs at all, but I avoid eating food items that will tally in the 80-100g of carbs for a meal (like pasta). I don’t agree with Dr. Bernstein’s methods, but I do agree with his law of small numbers in that "Big inputs make big mistakes; small inputs make small mistakes.” The more carbs I eat, the more chance that I will be off my estimate, the more likely my insulin won’t absorb fully, the longer it will take to digest etc…
So my main point is that there are many options between super low carb and eating whatever you want. Everyone just needs to find their ‘sweet spot’.
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Ditto for me.
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I impose no carb limits but the daily carb count is usually around 100. More or less. Simply from choice. And not counting correction for lows which on some days could be significant. And when exercising like a full day of kayaking then we very specifically would be adding more carbs in the range of maybe 30 carbs per hour during the vigorous portions.
And if she wants a 100 carb Starbucks mochacrapachinowhatever then we simply have a discussion on how to dose for it. And then correct later when it never works out. But that doesn’t mean she can’t have another one next time she wants it. Which realistically would probably not be for another couple months. It takes awhile to recover from those.
That would be exactly my point. Many of the low-carbers and it seems particularly the parents of low-carber kids, are very specifically discussing extremes here. I try to look at the whole child in the entirety of the situation.
The reality is that T1D is only one slice of a much larger picture.
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This is the key. I’ve been trying eating mostly low carb for the past few weeks, with some exceptions, and it’s way less work for better results. I’ve been doing it the classic Bernstein way too - split dose of Levemir and Regular for meals. I’ve never had nights that are so consistent and I almost forgot I was diabetic while I was at work because I realized how little attention I was paying to diabetes. I almost considered just taking my Dexcom off, but then I ate some carbs and realized how much I needed it! It’s hard to stick to this diet all the time, especially because of social pressures, but it really is easier overall (other than finding interesting things to eat). I also find Levemir works way better with it, there doesn’t seem to be noticeable gaps even if I delay my night or morning doses.
You can always go to the grocery store and just buy low carb alternatives. Groceries are starting to pay a lot more attention to keto wannabes. I can get breakfast, lunch, a candy bar, and some snacks and I haven’t even broken 30g.
Thank you for pointing this out. Reading through I would agree that this discussion in and of itself is skewed to strange ends of the spectrum.
Also, there’s a prevailing force of high or generally heavier carb diet followers on FUD, and for some reason research that gets presented which goes against their beliefs seems to really be an inflammatory thing around here.
@Jen it was clear to me you meant you didn’t personally know unaffected 50+ diabetics from your day-to-day life. Which is so sad, especially because I know FUD is a super group of folks who are working so hard to prevent complications!
I assume those “normal recommendations” are not generally being followed actually. So my take away is that the lower carb diets force the hand, so to speak, of those following them.
Also @ClaudnDaye, there are not necessarily speciality food products required to follow a low carb diet. Veggies and meat are the focus, and it’s hard to get enough carbs to be “high carb diet” that way. It’s easy and tastes good too. I’ll second @Jen’s take that veggies taste better now than before when I was eating more processed foods.
Yeah, I really don’t buy many “specialty foods” for eating low-carb. If I could eat dairy it would pretty much be low-carb veggies, meat, dairy excluding milk, nuts and seeds, and some fruit like berries and avocado. The only specialty items I buy relate to non-dairy things like ice cream, cream cheese, and yogurt. They’re expensive, but if I could eat dairy I’d just buy the normal versions. I used to buy specialty items for baking, but now I often just grind my own nut and seed flours.
I don’t think the guidelines are being followed by most people, diabetes or not. Most of my friends (thirty-somethings) eat out several times a week and eat processed food as staples in their diets and have minimal cooking skills. I also think people who are on this site eating 100 grams of carbs or less are likely actually “low carb” compared to the general population. Many resources I’ve read consider anything under 100 grams of carbs per day to be a low-carb diet.
From what I can tell, most people eating a normal diet are eating around 300 grams of carbs per day or more. At least this fits with what food packages recommend for carb intake. I don’t know what you consider “high carb”, @Eric, but to me 300 grams of carbs per day seems pretty high carb for people who are sedentary or moderately active.
I do agree that extremes don’t really make for a productive conversation, especially if trying to chagne anyone’s mind. And I also agree that many Bernstein followers cause more resistance from people by their insistane on following his strict regimen, when many could benefit from lowering carbs to a leser degree. But I also agree with @TravelingOn that it seems that any time low-carb studies are presented in non-low-carb groups they get such negative reactions (“inflammatory” was a good term!) even when the results of said studies are positive.
In regards to the actual study, I think it was fine even if it could have been stronger. My “BS meter” would be going off if the study authors tried to hide their conflicts of interest, but they didn’t. It would also be going off if the authors had tried to conclude more than warranted, but they didn’t. I have only skimmed the study thus far, but from waht I read their conclusions don’t recommend low-carb diets, don’t recommend people changing their treatment regimens, and discuss the need for more research on low-carb diets and T1D to further examine issues like cholesterol. Given that there’s virtually no research out there about low-carb diets and T1D, I think the study did exactly what its authors set out to do, which was to examine the diabetes control achieved by a group of people with T1D following a very low-carb diet.
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Yeah, I’ve heard this on the site too. I can picture children healthily eating around this amount. When we start talking below 30 grams a day, then I start to wonder about if they’re getting enough that their growth won’t be stunted.
For adults, I think the low carb and very low carb diets should be part of the conversation. I’d want to see quite a bit more research before very low carb diets are considered a treatment option for children. Most of what I’ve found has said that there may be other problems associated with this for children.
I think PWDs who seek out a very low carb way of eating are trying to rigorously manage their diabetes though, so it’s not surprising that the people in this article had well-controlled diabetes and lower rates of complications. I agree that it’d be interesting to see a more in-depth study with a control group (though I’m not entirely sure what that control group would look like).
Thanks for sharing it though! I don’t see a lot of articles or studies with people who have A1cs in this low of a range.
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well he actually does eat some veggies (cauliflower, cucumber, tomato, bell pepper, broccoli, peas, carrots, artichokes and, weirdly, he loves kale).
He’s just super picky about main dishes. In fact most dinners he throws a fit when he finds out it’s, say, a burger, will just eat a few of the veggies, and has basically zero carbs until we let him eat a slice of toast or a glass of milk. I’m not sure a low-carb diet would make him less picky about the veggies he does hate (lettuce, brussel sprouts and asparagus) – but it might make him less likely to recoil at shrimp, eggs or a burger I think.
Then again, I loathed loathed loathed eggs until college, and only using a very, very determined process of exposure over years was I able to eat the things, and that too, only if they’ve been prepared very specific ways.
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But it baffles me sometimes why eating low-carb attracts these types of comments. There has been no research done to show what type of diet is best, including a high-carb diet. So I don’t understand why low-carb gets so many people going “It doesn’t sound healthy…” despite the fact that there is no evidence that high-carb is healthy, either. In fact, any diet can probably be either healthy or unhealthy depending on the foods it’s composed of…
I’m not one of those people who thinks it’s unsafe for kids to eat low carb – I actually find it pretty rude when people shout “stunted growth” or “kids need carbs” at a parent whose child is eating low carb and seems to be happy, healthy, etc.
However, from a scientific perspective I do think the levels Bernstein advocates (<30 g per day) really should warrant more scrutiny than the average diet. Why? Because there is literally no place on Earth where a large community of humans has ever eaten so few carbs for months, or years, on end – even Inuit eat more carbs than that. Ketosis only occurs when the body is running on its backup metabolic pathway. If you were driving on a spare tire, I think it’s fair to be more concerned about how many miles it can go without problems, for instance.
Given that, I think it’s fair to ask more probing questions about the diet than, say, a diet high in carbs.(And to be fair, I think the “modern” highly-processed diet, which humans have never eaten until now, also should be subject to some additional scrutiny, although since so many people eat some facsimile of it, we actually do have good, high quality data on what it does to the body, and it doesn’t seem to stunt children’s growth.)
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Believe it or not, the answer is yes, and it is coming from none other than Bernstein himself. His book has to go through an editorial process, so though it recommends his less than 30g carb per day diet for everyone, including children, that isn’t a focus of his book.
But you get to hear the raw and unedited Bernstein if you listen into his monthly phone calls, and in a recent one of those he made a claim that really blew my mind. He said that his maximum 30g carb per day applies to an adult of 150 pounds or more. But that for children (including toddlers!) of lower weight, that carb amount should be scaled back proportionately. So a woman who called with a 50 pound child was told she should limit her child’s intake of carb per day to less than 10g!!
It is this insanely radical approach being preached by Bernstein that makes me fight so hard against the idea that he is simply teaching moderation. Because he very simply is NOT teaching moderation, he is teaching a very radical approach to diet.
If Bernstein preached what others here have stated, that carb can be hard to balance with insulin, and that therefore everyone needs to determine how much they can eat to achieve balance and health, then I would be his biggest cheerleader. But that is not what he preaches at all, and he is plainly a dangerous old kook in my opinion.
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But that for children (including toddlers!) of lower weight, that carb amount should be scaled back proportionately. So a woman who called with a 50 pound child was told she should limit her child’s intake of carb per day to 10g!!
I don’t even think those children who are on the epileptic keto diet are so low!!! What on Earth can they eat???
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@Jen
I have always been a big proponent of anyone doing what helps them and works. I have never tried to talk anyone out of a low-carb approach (but I have made recommendations to @daisymae about increasing her general carb intake because of how much exercise she was doing).
I think where we get messed up is in applying the terms low-carb and high-carb to specific numbers of carbs, rather than what a person needs.
For a sedentary person, 300 grams could definitely be considered high-carb. But for someone who is intensely training, 300 grams could be on the low-carb side of what they need. I think we are in total agreement there!
So the number by itself is not as applicable as what a person needs.
But I am not trying to be anti-low-carb. I apologize if that is how I came across. What I said in my initial post in this thread was that <50 sounded unhealthy for kids. And I still feel that way. But it was not meant to be against any adult who finds a plan that works for them.
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This makes sense to me. I have read stories of low-carb athletes, but I wasn’t able to find anything on active kids eating a low-carb diet. I know that there there are kids with T1 who are active and eat low-carb. Definitely an area for more research.
I think most people eating 300 grams a day are not intensely active (since most people are not intensely active).
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