Does low carbing cause Insulin resistance?

[PattiEvans]

So Inka and I were having a discussion in another thread, but I felt we were in danger of hijacking the OPs subject, so I suggested we discuss it elsewhere.

I was rather surprised when Inka said that low carbing caused insulin resistance as it goes against everything I have read. So I decided to do some research and I have to apologise to Inka as there is indeed evidence for that theory. However, it would appear that it is a physiological change that is triggered by a very low carb diet where the body has gone into ketosis.

The following quote comes from Marks Daily Apple - https://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/

However, going very low carb – to around or below 10% of calories, or full-blown ketogenic – can induce “physiological” insulin resistance. Physiological insulin resistance is an adaptation, a normal biological reaction to a lack of dietary glucose. As I’ve said in the past, the brain must have glucose. It can use ketones and lactate quite effectively, thus reducing the glucose requirement, but at the end of the day it still requires a portion of glucose. Now, in a low-glucose state, where the body senses that dietary glucose might not be coming anytime soon, peripheral insulin resistance is triggered. This prevents the muscles from taking up “precious” glucose that the brain requires. The brain’s sensitivity to insulin is preserved, allowing it to grab what glucose it needs from the paltry – but sufficient – levels available to it.

So what do we mean by "low carb" when talking to T1? Do we mean a very low carb diet as advocated by Bernstein? Or the TypeOneGrit group on FB (incidentally I did mention that I am a member, but it doesn't mean I follow it for anything other than the odd low carb recipe for a sweet treat). The article here https://www.diabetes.co.uk/news/201...ptional-type-1-diabetes-control-91241367.html discusses a study showing the exceptional control experienced by the type ones who adhere to this type of diet.

Or do we mean just moderating carbs and avoiding high carb meals? What is a high carb meal and what is a "normal" amount of carbs? To me, growing up in the 50s and 60s, we ate meat, fish, bread, potatoes and vegetables. Our diets did not consist of lots of pasta nor rice. Rice was for rice puddings, usually only after Sunday dinner. I well remember working with an Italian girl in the late 60s who gave me her recipe for Spaghetti Bolognaise. I decided to cook it for my parents. I had to scour the shops for spaghetti, eventually finding it in a specialist shop in a long long purple paper packet. The general public were largely unaware what a pizza or a curry was (except for Vesta curries which were dehydrated) In the 70s the majority of people were slim and an obese person stood out. It was in the 70s and 80s that carb creep crept in, takeaways became more available and between then and now people started to feel that if you don't have a huge pile of carbs on your plate it's not a meal. In part I do feel that the "Eatwell plate" which started to be touted in the 70s as "heart healthy" has a lot to blame with it's insistence that grains should be a large part of people's diets. That all goes back to a very flawed 7 countries study that Ancel Keys thrust upon the world and that the American grain industry latched on to. He omitted to mention that the study had started with 22 countries and that he had thrown out the results from the countries that contradicted his theory.

Sorry to hark back to DSF, but there we advised T2s to "eat to your meter" and frankly I do not think that's bad advice for T1s either. I know that if I have a couple of days where I overdo the carbs that I am going to suffer for several days afterwards, struggling to get back to over 70% Time in Target on the Libre. So where do I stand? I prefer to stick to 70g(ish) carb per day with the relevant insulin boluses. I would not consider 70g as normal carb in one meal. I'm more insulin resistant in the mornings, so I usually don't bother with breakfast. This week though I have a series of appointments in the late morning which means my lunch is later than usual and so I have been having a small breakfast, a single piece of Burgen (12g carb) with butter and marmite spikes me up into the 10s and 12s. This morning instead I had 100g greek yoghurt with strawberries. It was quite filling and I bolussed for 10g. I had barely a blip in BG. Anyway I digress, the thing is if a T1 eats something, pre-bolusses and counts carbs correctly then it spikes them, then I am likely to mention it might be better avoided in future. Just because we have insulin doesn't mean we can eat everything with impunity.

As we so frequently say, we are all different.

 

[Deleted member 21371]

We have eaten carbs throughout time.
High carb was a staple diet.
Rarely was meat the predominant part.
Bread was always used to finish off a meal, semolina puddings, potatoes were a bulk of the meal.
We evolved to process carbs.

It is true that cutting carbs out of your diet causes high blood glucose, but only until the body readjusts. (for a normal, healthy person).
Whether it's insulin resistance, or the pancreas becoming slow to respond for a type 2, or both, we adapt to the diet we are on.

For a type 2, taking an oral glucose tolerance test, it is recommended to eat a normal carby diet for at least three days before to let the body re-adjust.

 

[Pumper_Sue]

I have always found it's the amount of fat in the diet that causes the problems.

 

[Inka]

Apology accepted @Pattidevans 🙂 I explained what I was referring to in that thread - a biological response. I used to like Mark Sissons because he was pretty balanced about carbs but now he’s jumped on the keto wagon so his explanation downplays it a bit IMO. It’s not something I’d want to encourage longterm. I have excellent insulin sensitivity and I’d like to keep it that way.

There are Type 2s I know who have been very low carb for ages and I don’t think it’s done them any favours, and it does Type 1s no favours either. The keto forums are full of cult-like rubbish and women (mainly) with eating disorders. The ones inflicting keto on their children are...well, I can’t think of a polite description.

You said that we should start a thread and I purposely didn’t - because I’m so sick of the obsessives going on and on about keto and I’ve said what I think a thousand times over. I have no desire to go over it all again, It’s not a secret way to better control for Type 1s. It’s a haven for people with disturbed eating, and hypo unawareness. Obviously that’s not you or others here, but the amount of utter garbage out there is shocking. You mention Bernstein. He has zero hypo awareness. That’s dangerous.

No, you’re not “over-doing the carbs” - you’ve messed up your sensitivity. That’s what happens. A T1 friend used to bolus 4 units for a sandwich. They then decided keto was the answer and now if they want to eat a sandwich they have to bolus 12 or more units. That’s solely because they effed up their sensitivity. It’s stupid.

No, I don’t expect people in the U.K. ate much rice and pasta in the 60s but that’s because we tended to eat British traditional foods like your meat, potatoes and veg example. We still ate plenty of carbs though. I’m significantly younger than you but as a child I ate cereal and toast for lunch, crisps or an apple for snack, a sandwich, choc wafer fruit and yoghurt for lunch, and roast potatoes, meat, veg and fruit crumble and custard.

I am SO sick of carbs being blamed the whole time. It’s not carbs per se - it’s c**p, processed nothing foods and too many takeaways and snack options. It’s also lifestyle like watching TV and playing inside rather than outside. Look at that BBC programme a while back where they fed teens on a 1940s or 50s diet. They were all astounded at having bread and butter with their meals, and stodgy puddings, etc yet they all lost weight because they weren’t surrounded by rubbishy foods.

Obesity was also far less decades ago. Even when I was at school, you rarely saw a fat child. There was literally one of each sex in my school of approx 150 children, and they were seen as unusual. Now walk down any high street and look around you. That’s not because people are eating rice and pasta but because they’re eating too much rubbish and not exercising enough.

My HbA1C is (and has always been) lower than yours. I achieve that by using my insulin. I don’t sit and eat vast amounts of carbs each day. I eat normally - ie what I’d have eaten without Type 1. I don’t keep a tally. I count for my bolus then forget them. My insulin sensitivity is good but I know it could be improved if I lowered my fat. That’s how Barbaro and others did it - ate very low fat. It’s fat that’s associated with IR.

Sorry if this sounds rude and abrupt. That’s not aimed at you. I left one forum because it was ruined by very low carb cultists and my tone is informed by that not by my feelings about you @Pattidevans I won’t be writing any more in this thread. I would just add that I tried very low carb myself twice. It doesn’t work. It just swapped one set of problems for another. I also don’t believe it’s healthy.

I wish you well.

 

[Deleted member 21371]

I was curious, so I read the other thread

"then how do you explain that a low carb diet works well for Type 2s in reducing their insulin resistance? In fact if the body perceives a lack of carbs it will easily switch to making energy from protein and fat."

It is actually the opposite.
Low carb doesn't reduce insulin resistance, the same as non diabetics, the body tries to conserve BG, and also the pancreas needs kick-starting later. BG is simply kept low, as there is nothing apart from the liver to increase it. Many end up with "dawn phenomenon" and find workarounds, like a snack before they get up, or ways to measure before the liver kicks in, such as measuring in bed.
The body doesn't often switch easily, many suffer from "low carb flu" as the body tries to switch to burning fat and protein. It has quite a lengthy list of symptoms, and is often mentioned on here.
It is a process the body normally rarely uses, there is a price to pay for making it work differently.

Interestingly, as an aside, as fat has been mentioned, it does seem low carb, high protein is now becoming an alternative, low carb, high fat may have had it's day, and a change is coming?

 

[trophywench]

I'm not ever likely to give myself insulin resistance since I certainly don't eat very low carb much at all but OTOH I've never ever eaten actually high carb.. Gobsmacked at the amount that people eat - average 250g of carb a day? How on earth do their bellies cope with that!

 

[trophywench]

It never should have been termed HIGH fat - it was only ever intended to be normal fat - not 'fat with absolutely everything'.

 

[Stuvart]

I'm not ever likely to give myself insulin resistance since I certainly don't eat very low carb much at all but OTOH I've never ever eaten actually high carb.. Gobsmacked at the amount that people eat - average 250g of carb a day? How on earth do their bellies cope with that!

I did a Google on something today and 250g-350g a day of carbs is recommended for a 2k calorie intake seems wierd now, but half of that could come from 4 medium spuds (roughly 36g per spud) then add a bowl of cereal for breakfast plus the carbs in everything else it seems entirely possible.

 

[Deleted member 21371]

It never should have been termed HIGH fat - it was only ever intended to be normal fat - not 'fat with absolutely everything'.

It does seem many feel the need to add saturated fat to every meal though.

250g of carbs is 1000 calories.
Around half the average food intake.
By the time you include the carbs in all food types, like veg, fruit, milk, it's quite easy to hit 50% of energy from carbs.
If memory serves, that's about the target advised for most people.

 

[trophywench]

Yes - I don't know how it would be possible to consume 2000 calories a day though. I'd still be there tomorrow if I had to eat that much. Plus I'd be like a barrel. I do not wish to look like that. So I try not to.

 

[SB2015]

An interesting article @Pattidevans. As you say we are all different.

I am of a similar age and remember the newness of pasta when I when to uni. Food was what was available and in season. Many years later when I was diagnosed with T1 (or LADA if you want to be picky) I took the message from my DSN of eat what you want and match the insulin.

A few years later and I then have the Libre output. Now I saw the spikes I was getting, and started to time my bolus, modify my diet and portion sizes to get flatter lines. I chose to stick to about 30g of carbs per meal and that seems to work for me for what I want to achieve.

like others have said it is the access to processed pre-prepared meals that seems to be an issue around carb loading. I do not think of myself as being ‘on a diet’ I simply eat what I choose to in order to manage my levels in a way that I am happy with, and to avoid developing hypo unawareness.

so much that we now know through the use of tech.

 

[pm133]

@Inka,

I said on another thread that the food and diet world is choc-full of snake-oil salesmen with their latest fad complete with evangelical disciples out there spreading the word.
Sadly diabetes is no different.

I ended up just switching off from all of it and going with what worked for me.

I only hope that newly diagnosed people don't get side-tracked into dangerous and inappropriate fads which can lead to serious consequences or avoidable eating disorders but the snake-oil salesmen know that desperate people will take desperate measures and are quick to cash in on that. The worst type of disciple is the one for whom an approach worked personally and maybe for a few mates and now they are out there saying it'll work for everyone. Low Carb is absolutely rife with those people but it's not alone in that regard. Like I said, eventually I just switched off from all of them. I have an approach which works for me and am happy with that.

It doesn't matter whether your approach is blunt or not. I think it needed said and it'll need said again and again.

 

[Deleted member 21371]

I just read the article in the link above.

The findings of the survey showed that the group, of over 300 patients......The data was taken from an online survey of a social media group for young people with type 1 diabetes...Those that took part in the survey were generally children or young adults, with parents completing the survey for their children.

Now, I may be cynical, but as a parent, I know full well what my kids eat, and what they tell me are two completely different things. And I know full well, that as a parent, I tend to present my parenting in the best light, so I wonder how reliable I'd be filling in an on line survey on behalf of my kids? Particularly on a forum where poor results would be a "failure", considering the website the survey was on. I may just scroll by, and think I'd fill it in next time around, when we'd got the hang of it properly.
A sample of 300 seems very small. But maybe not in that context.

I wonder what results he got from the controlled study, or if indeed it's been done in the three years since the online survey was published?

 

[pm133]

I just read the article in the link above.

The findings of the survey showed that the group, of over 300 patients......The data was taken from an online survey of a social media group for young people with type 1 diabetes...Those that took part in the survey were generally children or young adults, with parents completing the survey for their children.

Now, I may be cynical, but as a parent, I know full well what my kids eat, and what they tell me are two completely different things. And I know full well, that as a parent, I tend to present my parenting in the best light, so I wonder how reliable I'd be filling in an on line survey on behalf of my kids? Particularly on a forum where poor results would be a "failure", considering the website the survey was on. I may just scroll by, and think I'd fill it in next time around, when we'd got the hang of it properly.
A sample of 300 seems very small. But maybe not in that context.

I wonder what results he got from the controlled study, or if indeed it's been done in the three years since the online survey was published?

At an HBA1c of just 39 in a Type 1, I'd be very worried about the disappearance of hypo awareness.

 

[AndBreathe]

So Inka and I were having a discussion in another thread, but I felt we were in danger of hijacking the OPs subject, so I suggested we discuss it elsewhere.

I was rather surprised when Inka said that low carbing caused insulin resistance as it goes against everything I have read. So I decided to do some research and I have to apologise to Inka as there is indeed evidence for that theory. However, it would appear that it is a physiological change that is triggered by a very low carb diet where the body has gone into ketosis.

The following quote comes from Marks Daily Apple - https://www.marksdailyapple.com/does-eating-low-carb-cause-insulin-resistance/

So what do we mean by "low carb" when talking to T1? Do we mean a very low carb diet as advocated by Bernstein? Or the TypeOneGrit group on FB (incidentally I did mention that I am a member, but it doesn't mean I follow it for anything other than the odd low carb recipe for a sweet treat). The article here https://www.diabetes.co.uk/news/201...ptional-type-1-diabetes-control-91241367.html discusses a study showing the exceptional control experienced by the type ones who adhere to this type of diet.

Or do we mean just moderating carbs and avoiding high carb meals? What is a high carb meal and what is a "normal" amount of carbs? To me, growing up in the 50s and 60s, we ate meat, fish, bread, potatoes and vegetables. Our diets did not consist of lots of pasta nor rice. Rice was for rice puddings, usually only after Sunday dinner. I well remember working with an Italian girl in the late 60s who gave me her recipe for Spaghetti Bolognaise. I decided to cook it for my parents. I had to scour the shops for spaghetti, eventually finding it in a specialist shop in a long long purple paper packet. The general public were largely unaware what a pizza or a curry was (except for Vesta curries which were dehydrated) In the 70s the majority of people were slim and an obese person stood out. It was in the 70s and 80s that carb creep crept in, takeaways became more available and between then and now people started to feel that if you don't have a huge pile of carbs on your plate it's not a meal. In part I do feel that the "Eatwell plate" which started to be touted in the 70s as "heart healthy" has a lot to blame with it's insistence that grains should be a large part of people's diets. That all goes back to a very flawed 7 countries study that Ancel Keys thrust upon the world and that the American grain industry latched on to. He omitted to mention that the study had started with 22 countries and that he had thrown out the results from the countries that contradicted his theory.

Sorry to hark back to DSF, but there we advised T2s to "eat to your meter" and frankly I do not think that's bad advice for T1s either. I know that if I have a couple of days where I overdo the carbs that I am going to suffer for several days afterwards, struggling to get back to over 70% Time in Target on the Libre. So where do I stand? I prefer to stick to 70g(ish) carb per day with the relevant insulin boluses. I would not consider 70g as normal carb in one meal. I'm more insulin resistant in the mornings, so I usually don't bother with breakfast. This week though I have a series of appointments in the late morning which means my lunch is later than usual and so I have been having a small breakfast, a single piece of Burgen (12g carb) with butter and marmite spikes me up into the 10s and 12s. This morning instead I had 100g greek yoghurt with strawberries. It was quite filling and I bolussed for 10g. I had barely a blip in BG. Anyway I digress, the thing is if a T1 eats something, pre-bolusses and counts carbs correctly then it spikes them, then I am likely to mention it might be better avoided in future. Just because we have insulin doesn't mean we can eat everything with impunity.

As we so frequently say, we are all different.

Patti - As I understand things, one way to manage physiological insulin resistance is to periodically eat a few extra carbs, which appears to almost rest the clock. Allegedly, it doesn't usually have to be much of a carb "booster".

Not being T1 or an insulin user I have no experienced this myself.

As a a T2 in remission (or other word of your choice) for over 6 years now, I can't say I have noticed any increase in insulin resistance, but then I rarely eat keto for any prolonged period, which I believe is where physiological insulin resistance is most likely to rear its head.

 

[Ljc]

As an insulin user I find that that the less carbs I eat the less rapid insulin I need to inject

 

[PattiEvans]

@Inka

No, you’re not “over-doing the carbs” - you’ve messed up your sensitivity. That’s what happens. A T1 friend used to bolus 4 units for a sandwich. They then decided keto was the answer and now if they want to eat a sandwich they have to bolus 12 or more units. That’s solely because they effed up their sensitivity. It’s stupid.

I haven't messed up my sensitivity - I have always had a higher ratio of insulin to carb in the mornings. It hasn't changed. Just to set the record straight, I don't champion the very low carb or keto diet. Never have and never will. I just wanted to hear from others what carb level they consider "normal". Some people have responded to that and I am happy with those replies. So you learn something new every day.

 

[PattiEvans]

@SB2015

I am of a similar age and remember the newness of pasta when I when to uni. Food was what was available and in season. Many years later when I was diagnosed with T1 (or LADA if you want to be picky) I took the message from my DSN of eat what you want and match the insulin.

A few years later and I then have the Libre output. Now I saw the spikes I was getting, and started to time my bolus, modify my diet and portion sizes to get flatter lines. I chose to stick to about 30g of carbs per meal and that seems to work for me for what I want to achieve.

That's exactly what happened when I first started to use the Libre (self funded) shortly after it came out so, like you, I modified my diet and portion sizes. Yes, it works for me too.

It's a normal diet to me as it's more or less the sort of thing I ate before diagnosis and that visit to the dietitian where she told me to base my diet around carbs and that made me gain 3 stone, most of which is now gone. We never eat processed food. I cook everything from scratch and always have. I've been shocked in the past at what some of my colleagues considered "normal eating".

For example yesterday I had:
100g greek yoghurt with strawberries. OK I don't normally bother with breakfast.
Lunch: 2 poached eggs on one slice of Morrison's Spelt, wheat and rye bread with 2 rashers of bacon.
Dinner: Roast fillet of Pork with a sauce made with apple, thyme and garlic, minted new potatoes, braised fennel topped with Parmesan, some leftover roasted butternut squash and roast beetroot. Fruit platter with raspberries, strawberries, blueberries and a couple of small slices of Mango.

I would say that was moderate low carb. Only 20g carb at lunch but nearly 50 for dinner. This diet hasn't caused any insulin resistance as far as I know, as my ratios have stayed the same for years.

 

[SB2015]

Dinner: Roast fillet of Pork with a sauce made with apple, thyme and garlic, minted new potatoes, braised fennel topped with Parmesan, some leftover roasted butternut squash and roast beetroot. Fruit platter with raspberries, strawberries, blueberries and a couple of small slices of Mango

I like the sound of your menu. It is my week to cook so I am feeling inspired.

We didn’t change much, as we cooked from scratch, but with the Libre we just dropped the portions and did a few swaps for spikes foods.

 

[rebrascora]

I am 2 years down the line with my low carbing. I probably have 50-70g carbs a day.
I have openly spoken about my poor relationship with food, comfort eating and sugar addiction prediagnosis and for me cutting the carbs has given me back a lot of control because I no longer crave the carbs/sugar anymore and I feel so much fitter and healthier eating this way. I have no interest in going keto. It is too restrictive for me and I am not organized enough, but avoiding high carb foods or keeping portion size of them to a minimum is simple enough that I don't have to do much planning or thinking for it. I would only very rarely have a meal containing as much as 50g carbs but I am pretty good at timing my bolus to prevent spikes now that I have Libre. Protein tends to be the complication for me as my levels drift upwards 2 hours after a meal so I have to remember to jab for that later.

I have not noticed any increase in insulin resistance during that time and nothing else so far which would discourage me from continuing to eat this way because it feels right for me and has given me back control over my eating disorder, even if others might consider that my low carb diet may itself be an eating disorder. I guess I am an all or nothing girl!