Like many children, a young boy of 13, likes pizza, sandwiches and dessert.
But he 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.
His diet requires careful
planning — he often takes his own meals with him to school. But he and
his parents say it makes it easier to manage his condition and, since
starting the diet, his blood sugar control has markedly improved and he
has not had any diabetes complications requiring trips to the hospital.
“I
do this so that I can be healthy,” he 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 can lead to
dangerously low blood sugar levels, a condition known as hypoglycemia,
and potentially stunt a child’s growth. But a new study published on Monday 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.
“Their blood sugar control seemed almost
too good to be true,” said the lead author of the
study and an instructor in the division of pediatric endocrinology at a Children’s Hospital. “It’s nothing we
typically see in the clinic for Type 1 diabetes.”
The
new study comes with an important caveat. It 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 the co-director of the Diabetes Center, who was not involved in
the study. “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,” the Dr. 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.
“We
think the findings point the way to a potentially exciting new
treatment option,” said a co-author of the study and a
pediatric endocrinologist who has written
popular books about low-carb diets. “However, because our study was
observational, the results should not, by themselves, justify 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. Managing
the condition requires administering insulin throughout the day,
especially when consuming meals high in carbs, which raise blood sugar
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 carb
intake with insulin. But 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.
TypeOneGrit
has about 3,000 members on a social network site who ascribe to a program devised by an 84-year-old physician with Type 1 diabetes.
His book, recommends limiting daily carb intake to about 30 grams, the amount in a
sweet potato, large apple or two slices of whole wheat bread.
Dr. argues that the fewer carbs consumed, the easier it is to
stabilize blood sugar with insulin. He recommends foods like nonstarchy
vegetables, seafood, nuts, meat, yogurt, tofu and recipes made with
soybean flour, sugar substitutes and other low-glycemic ingredients. His
plan emphasizes protein intake, which he says is especially important
for growing children.
An orthopedic surgeon with Type 1 diabetes who follows a
low-carb vegan diet, credits that approach with helping her
keep her blood sugar under control. “It allows me to perform complex
spine surgeries without worrying about my diabetes because my blood
sugar stays relatively stable,” said the Dr., who helped inspire the
new study when researchers learned about her participation in the
TypeOneGrit community.
The most
striking finding of the new report was that A1C levels, on average, fell
from 7.15 percent, in the diabetic range, to 5.67 percent, which is
normal. The rate of diabetes-related hospitalizations also fell, from 8
percent before the diet to 2 percent after, including fewer
hospitalizations for hypoglycemic seizures.
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.
A diabetes
expert who was not involved in the study,
said the findings were impressive and merited further follow-up, and
that patients who wanted to explore a low-carb approach might do so
while being monitored by their health care team. But she also noted that
the patients in the new study were a “highly motivated” group, and that
it would be difficult for many people to adopt the restrictive regimen
they followed.
“The reality is that
it’s really hard to do low-carb, given our cultural norms,” said a professor of pediatrics.
In
an interview, the a co-author on the paper, said it
demonstrates what he sees in his practice: That there are diabetics on
his regimen “who are walking around with normal blood sugars and they
are happy about it, healthy, and growing if they are kids.”
A human resources manager in Alabama, agrees. Both he
and his son, have Type 1 diabetes. He said he
struggled for years to control his blood sugar. But six years ago, he
gave up juice, bread, potatoes and other simple carbs, and made protein
and non-starchy vegetables the focus of his meals.
Since
going low-carb, he said, he has 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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