The most effective diabetes treatment is one which helps people with diabetes lower carbohydrate intake. Eating a large amount of sugar and starch at one time causes blood sugars to spike after the meal. That large blood sugar surge then requires a large insulin response from the pancreas (or in an injection). Too much insulin then crashes blood sugar down. The image below is from a study which looks at blood sugar reactions to high carb meals.
This blood sugar "roller coaster" is rooted in a belief in the mainstream medical community and diabetes organizations that carbohydrates should make up between 45-65% of daily calories. They try to hide this with vague language, but the 2017 medical recommendations from the American Diabetes Association specifically says 15-20% of calories should come from protein, and 20-35% of calories should come from fats. That means the balance of calories (45-65%) come from carbohydrates. See page S36 of this document.
On a daily calorie intake of 2000 calories, that works out to between 225 and 325 grams of carbohydrate. Advising people with diabetes to eat 45-65% of their calories from carbohydrates causes high blood sugar (hyperglycemia) which sticks to or glycates body cells and tissues and guarantees the development of long term complications such as peripheral nerve pain (neuropathy), kidney damage (nephropathy), a loss of eyesight (retinopathy) and other common diabetic complications.
Worse, for those who take insulin injections, the large doses of insulin that have to be given to match high blood sugar spikes can result in low blood sugar (hypoglycemia) episodes which are incredibly dangerous, since hypoglycemia can cause a loss of consciousness or death if the brain runs out of glucose.
I think one reason for this advice is a belief that at least 130 grams of carbohydrates per day are needed to keep the brain functioning. This is only true if one is eating large amounts of carbohydrate on a daily basis. The brain only needs a higher level of carbohydrate intake if the body is carb-adapted, meaning the body is having to process and store sugar and starch continually. This is because insulin levels will be chronically elevated and stored fat will be inaccessible to make ketones when food is unavailable.
If a person is keto-adapted, meaning insulin levels are normal, than the body is able to make ketones to supplement brain fuel stores between meals. If a body is keto-adapted, then the brain only needs about 50 grams of carbohydrate/day, and that can easily come from gluconeogenesis. So the difference is in the primary fuel supply - carbs or fat.
In my opinion, the sensible approach to managing blood sugar safely is to stop eating foods which drive up blood sugar. It's what Dr. Richard K. Bernstein in his book The Diabetes Solution calls the Law of Small Numbers: eating small amounts of carbohydrate results in the need for less insulin. Smaller does of insulin result in fewer episodes of dangerous low blood sugar or hypoglycemia.
People with diabetes have a choice in their diabetes treatment. They can start a low carb, high fat diet, limit carbohydrate intake to more reasonable and healthy amounts, and effectively stop the blood sugar roller coaster. Blood sugars highs will be greatly reduced and having higher blood ketone levels allows the brain to access an alternative fuel when blood sugar is too low. This means freedom from the symptoms of hypoglycemia.
A ketogenic diet treats diabetes at the root cause, and is a much safer, more effective plan than injecting insulin to counteract the consumption of high carb foods. This is true for both type 1 and type 2 diabetics. A recent paper by Feinman et al lays out the science supporting the obvious choice of a low carbohydrate diet for diabetics.
Although type 1 and type 2 diabetes have different causes, limiting carb intake is the key to blood sugar control for both camps. This is especially important for children with type 1 diabetes. The danger of the type 1 diabetes diet recommended by the ADA is compounded by the fact that the ADA tells parents that children must have carbs for growth. This directive has no basis in fact and actually makes achieving blood sugar control impossible.
Let's look at the facts. The primary goals of a diabetes treatment plan are to:
Controlling diabetes and managing blood sugar levels is not an easy task. It involves serious lifestyle and psychological changes, and newly diagnosed diabetics don't always get the correct information they need to make the best decisions.
For example, identifying and switching to the most effective diabetic diet is a challenge because as mentioned, a diet high in carbohydrates makes blood sugar control very difficult. Maybe the ADA recommends a higher carb diet because they don't want to be responsible for deadly hypoglycemic episodes. But over time, high blood sugar condemns those with diabetes to diabetic complications instead.
The solution is really simple. If carb intake is lowered gradually and medications or insulin doses are reduced at the same time, the patient can get off the blood sugar roller coaster.
Implementing the ketogenic solution may take some work, but it is worth it. People who are newly diagnosed with diabetes are probably used to eating higher carb foods and may be used to being to convenience fast foods. After diagnosis, they have to learn how to put together and cook a diabetic meal plan and switch to a way of eating. Hopefully, the learn about and choose to eat a low carb diet. Then they also have to learn to use new tools such as glucometer to track their blood sugar, and learn new terms such as ketosis, ketoacidosis, gluconeogenesis, insulin resistance, dawn phenomenon and a long list of other new concepts that now impact their lives.
Although it may be difficult at first, people with diabetes learn from hard experience that permanently restricting carbohydrate intake by adopting a low carb diet makes life on a diabetes treatment plan easier because:
For more information on using a low carb, high fat diet as a diabetes treatment plan, check out the new book on type 2 diabetes that I've written with Dr. Keith Runyan, a type 1 diabetic himself. We also wrote a book on Type 1 diabetes as well. He uses a ketogenic diet to keep his HbA1c at 5.0, and he has a lot to say about why the diet is the best choice for those with diabetes.
You can also listen to a great podcast conversation I did with the Raphi Sirtoli over at Break Nutrition in which we discussed using a ketogenic diet to treat diabetes and cancer.
Here's a great presentation on how Type 2 diabetes can be reversed with a low carb, high fat diet from Dr. Sarah Hallberg.
Treating Type 1 and Type 2 Diabetes with a Ketogenic Diet: Books Now Available.
Co-authored with Dr. Keith Runyan, a type 1 diabetic who uses a ketogenic diet to treat his diabetes, both books contains valuable information on how to use a ketogenic diet to reduce dependence on medication and insulin, and protect yourself from low blood sugar and complications.
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