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Weigh the carbohydrates



Like many kids, Andrew Hightower likes 13, pizza, sandwiches, and dessert. But Andrew has Type 1 diabetes, and six years ago, his parents put him on a low-carbohydrate, high-protein diet to control his blood sugar levels.

His mother makes him recipes with diabetic-friendly ingredients that do not raise his blood sugar levels, such as pizza with a low-carbohydrate almond flour crust; homemade bread with walnut flour instead of white flour; and yogurt with blueberries, raspberries and nuts.

Andrew's diet requires careful planning – he often takes his own meals to school with him. But he and his parents say it's easier to control his condition, and since the beginning of the diet, his blood glucose control has improved significantly and he had no diabetes complications requiring a trip to the hospital.

"I do that so I can be healthy," said Andrew, who lives with his parents in Jacksonville, Florida, USA, about his diet. "When I finally move out and go to college, I'll keep doing what I do because I'm on the right path."

Usual advice and why

Most diabetes experts do not recommend being low-carb diets for people with type 1

diabetes, especially children. Some fear that limiting carbohydrates can lead to dangerously low blood sugar levels, a condition known as hypoglycaemia, which may inhibit a child's growth. However, a new study published in the journal Pediatrics suggests otherwise.

Findings

They found that on average children and adults with type 1 diabetes consumed a very low carbohydrate, protein-rich diet for just over two years – in combination with the diabetes drug insulin in smaller doses than normally required for a normal diet – had "exceptional" blood glucose control. They had low rates of serious complications, and children who had been following for years showed no signs of impaired growth.

The study found that the participants' average hemoglobin A1C, a long-term barometer of blood sugar, dropped only 5.67%. An A1C below 5.7 is considered normal and well below the diabetes threshold of 6.5%.

"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, USA "It's not something we see in the clinic for type 1 diabetes."

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 dedicated to the low-carbohydrate diet diet called TypeOneGrit, and 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 The control of their diabetes with a very low-carbohydrate diet David M. Harlan, co-director of the Diabetes Center of Excellence at UMass Memorial Medical Center, USA, 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," adds dr. Harlan added. "It should revive the discussion of whether we should offer our patients this therapeutic approach."

The authors of the paper warn that the findings should not induce patients to 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," says Dr. 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 justify a change in diabetes management."

Standard Approach

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. TypOneGrit has about 3000 members on Facebook who attribute to a program written by Dr. med. Richard Bernstein, an 84-year-old type 1 physician, developed diabetes. His book Bernstein's Diabetes Solution recommends limiting daily carbohydrate intake to about 30 grams, the amount in a sweet potato, or about four or five cups of boiled broccoli. 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 almond flour, sugar substitutes, and other glycemic ingredients. His plan emphasizes protein intake, which he considers particularly important for children's cultivation.

Dr. Carrie Diulus, a Type 1 diabetes orthopedic surgeon who follows a low-carbohydrate vegan diet, attributes the Bernstein approach to keeping her blood sugar under control. "It allows me to perform complex spinal surgery without having to worry about my diabetes because 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 of the A1C values ​​fell from 7.15% in the diabetic area to 5.67%, which is normal. The rate of diabetes-related hospitalization also fell from 8% before diet to 2%, 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 related to 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 hard to reach low levels – carb, given our cultural norms," ​​Dr. Lee, a professor of pediatrics at the University of Michigan.

In an interview, Dr. Bernstein, a co-author of the article that he shows what he sees His practice: That there are diabetics on his program, "who walk around with normal blood sugar and look forward to being healthy and growing when they are kids."

Derek Raulerson, 46, a human resources manager in Alabama, agrees. Both he and his son Connor, 13, have type 1 diabetes. Mr. Raulerson said he fought for years to control his blood sugar. But six years ago, he gave up juice, bread, potatoes, and other simple carbohydrates, focusing on protein and non-starchy vegetables.

Since he low-carb, he said, he has lost weight, cut In half the amount of insulin he consumes daily, he observed how his A1C dropped from the diabetic range to normal levels.

"I now have normalized, steady blood glucose levels," he says. "I'm not on the roller coaster anymore." NY TIMES


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