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The New York Times Asked Dr. Harlan His Thoughts About Low-Carb Diets with Type 1 Diabetes

Data from a new study was published in Pediatrics

Date Posted: Monday, May 07, 2018
By: Anahad O'Connor - New York Times

Like many children, Andrew Hightower, 13, likes pizza, sandwiches and dessert.

Andrew has type 1 diabetes, and six years ago, in order to control his blood sugar levels, his parents put him on a low-carbohydrate, high-protein diet.  His mother makes him recipes with diabetic-friendly ingredients that won’t spike his blood sugar, like pizza with a low-carb, almond-flour crust; homemade bread with walnut flour instead of white flour; and yogurt topped with blueberries, raspberries and nuts.

Andrew’s diet requires careful planning — he often takes his own meals with him to school.  Since starting the diet, his blood sugar control has improved and he has not experienced any diabetes complications requiring trips to the hospital.

“I do this so that I can be healthy,” Andrew, who lives with his parents in Jacksonville, Fla., said of his diet.  “When I eventually move out and go to college, I’m going to keep up what I’m doing because I’m on the right path.”

Most diabetes experts do not recommend low-carb diets for people with type 1 diabetes, especially children.  Some worry that restricting carbs may lead to dangerously low blood sugar levels, a condition known as hypoglycemia, and potentially stunt a child’s growth. 

A new study published in the journal Pediatrics suggests otherwise.  It found that children and adults with type 1 diabetes who followed a very low-carb, high-protein diet for an average of just over two years — combined with the diabetes drug insulin at smaller doses than typically required on a normal diet — had “exceptional” blood sugar control.  They had low rates of major complications, and children who followed it for years did not show any signs of impaired growth.

The study found that the participants’ average hemoglobin A1C a long-term barometer of blood sugar levels, fell to just 5.67 percent. An A1C under 5.7 is considered normal, and it is well below the threshold for diabetes, which is 6.5 percent.

The study was an observational study, not a randomized trial with a control group.  The researchers recruited 316 people, 130 of them children whose parents gave consent, from a Facebook group dedicated to low-carb diets for diabetes, called TypeOneGrit, then reviewed their medical records and contacted their medical providers.

"While it was not a clinical trial, the study is striking because it highlights a community of patients who have been extraordinarily successful at controlling their diabetes with a very low-carb diet," said Dr. David M. Harlan, co-director of the UMass Diabetes Center of Excellence.  “Perhaps the surprise is that for this large number of patients it is much safer than many experts would have suggested.”

“I’m excited to see this paper,” Dr. Harlan added. “It should reopen the discussion about whether this is something we should be offering our patients as a therapeutic approach.”

The authors of the paper cautioned that the findings should not lead patients to alter their diabetes management without consulting their doctors, and that large clinical trials will be necessary to determine whether this approach should be used more widely.

The standard approach for people with type 1 diabetes is to match carb intake with insulin. The argument for restricting carbs is that it keeps blood sugar more stable and requires less insulin, resulting in fewer highs and lows.  The approach has not been widely studied or embraced for type 1 diabetes, but some patients swear by it.

Those following the diet had increased LDL cholesterol, likely from consuming more saturated fat, which some experts said was potentially concerning and deserved further study.  But other heart disease risk factors appeared favorable: They had high HDL cholesterol, the protective kind, and low triglycerides, a type of fat in the blood linked to heart disease.

Derek Raulerson, 46, a human resources manager in Alabama said he struggled for years to control his blood sugar.  Six years ago, he gave up juice, bread, potatoes and other simple carbs, and made protein and nonstarchy vegetables the focus of his meals.  Since going low-carb, Raulerson said he's lost weight, cut in half the amount of insulin he uses daily, and watched his A1c fall from the diabetic range to normal levels.

“I have normalized, steady blood sugars now,” he said. “I am no longer on the roller coaster.”

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