The study found that the participants' average hemoglobin A1C, a long-term blood glucose barometer, was only 5.67 percent. An A1C below 5.7 is considered normal and well below the diabetes threshold of 6.5 percent.
"Your blood glucose control seemed almost too good to be true," said Belinda Lennerz, lead author of the study and an instructor in the Department of Pediatric Endocrinology at Boston Children's Hospital and Harvard Medical School. "It's not something we typically see in the clinic for type 1
The new study comes with an important caveat. It was an observational study, not a randomized study with a control group. The researchers recruited 316 people, 130 of whom were children whose parents gave their consent, from a Facebook group that was on the low-carbohydrate diet diet called TypeOneGrit, then reviewed their medical records and contacted their healthcare providers. The study is striking because it highlights a community of patients who are "extremely successful" who were controlling their diabetes with a very low carbohydrate diet, Dr. David M. Harlan, the co-director of the Diabetes Center of Excellence at the UMass Memorial Medical Center, who was not involved in the study. "Perhaps the surprise is that it is much safer for this large number of patients than many experts have suggested."
"I'm thrilled to see this paper," Dr. Harlan added. , "It should reopen the debate about whether to offer this therapeutic approach to our patients."
The authors of the article warned that the findings should not make patients change their diabetes management without consulting their doctors that large clinical trials will be needed to determine whether this approach should be used more widely.
"We believe the results point the way to a potentially exciting new treatment option," said Drs. David Ludwig, co-author of the study and a pediatric endocrinologist at Boston Children's Hospital, has written popular books on low-carbohydrate diets. "However, since our study was observational, the results alone should not warrant a change in diabetes management."
About 1.25 million Americans have type 1 diabetes, which occurs when the pancreas does not produce enough insulin to regulate blood sugar levels. Treatment of the condition requires administration of insulin throughout the day, especially when high carbohydrate meals are taken, which increase blood sugar levels more than other nutrients. Over time, chronically elevated blood sugar can lead to nerve and kidney damage and cardiovascular disease.
The standard approach for people with type 1 diabetes is to match carbohydrate intake with insulin. But the argument for limiting carbohydrates is that it keeps blood sugar more stable and uses less insulin, resulting in fewer highs and lows. The approach has not been extensively studied or accepted for type 1 diabetes, but some patients swear by it.
TypeOneGrit has about 3,000 members on Facebook who use a program by Dr. Ing. Richard Bernstein, an 84-year-old physician, attributed to Type 1 diabetes. His book "Dr. Bernstein's Diabetes Solution" recommends limiting the daily carbohydrate intake to about 30 grams, the amount in a sweet potato, a large apple, or two slices of whole wheat bread.
Dr. Bernstein argues that the fewer carbohydrates are consumed, the easier it is to stabilize blood sugar with insulin. He recommends foods such as non-starchy vegetables, seafood, nuts, meat, yogurt, tofu, and recipes made with soybean meal, sugar substitutes, and other glycemic ingredients. His plan emphasizes protein intake, which he considers particularly important.
Dr. Carrie Diulus, a type 1 diabetes orthopedic surgeon who follows a low-carbohydrate vegan diet, appreciates the Bernstein approach by helping her keep her blood sugar under control. "It allows me to perform complex spinal surgery without worrying about my diabetes, as my blood sugar remains relatively stable," Dr. Diulus, who inspired the new study when researchers learned of their participation in the TypeOneGrit community.
A striking finding of the new report was that the average A1C level dropped from 7.15 percent in the diabetic area to 5.67 percent, which is normal. The rate of diabetes-related hospitalization also declined 2 percent from 8 percent before diet, including fewer hospitalizations for hypoglycemic seizures.
Those who had raised LDL cholesterol after the diet were likely to consume more saturated fat, which some experts said was potentially important and deserved further study. But other risk factors for heart disease seemed favorable: they had high levels of HDL cholesterol, the protective type, and low levels of triglycerides, a type of blood fat associated with heart disease.
Dr. Joyce Lee, a University of Michigan diabetes expert who was not involved in the study, said the results were impressive and deserved further follow-up, and patients wishing to explore a low-carb approach could do so while They are monitored by their health team. However, she also found that the patients in the new study were a "highly motivated" group and that many would find it difficult to accept the restrictive treatment that followed them.
"The reality is that it's really difficult to reach low levels – carb, given our cultural norms," said Dr. Lee, a professor of pediatrics at the University of Michigan.
In an interview, Dr. Bernstein, a co-author on paper, shows what he sees in his practice: That there are diabetics in his regime who walk around with normal blood sugar and are happy about it. They are healthy and grow when they are children.
Derek Raulerson, 46, a human resources manager in Alabama, agrees: both he and his son Connor, 13, have Type 1 diabetes, and Mr. Raulerson said he has spent years fighting to control his blood sugar. But six years ago, he gave up juice, bread, potatoes, and other simple carbohydrates and put protein and non-starchy vegetables at the center of his meals.
Since he took low-carb, he said, he had lost, halved the The amount of insulin he consumes daily, and how his A1C declined from the diabetic range to normal levels.
"I now have normalized, steady blood glucose levels," he said, "I'm not on the roller coaster anymore."
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