If low carb diets work so well why are we still recommended high carb diets?

From a personal point of view @ElizabethMcCallister I'm at a loss to explain why high carbs are still recommended because a low carb diet is far better but what surprises me is the attitude of your Diabetes Educator.As a T1D herself she should really know better than to treat you like that.
 
ElizabethMcCallister said:
My diabetic educator literally treats me like I'm starving myself when I'm technically considered overweight just because I shy away from eating so many carbs *-* she is also a T1D
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What may be suitable for those who are Type 1 and able to use their insulin appropriately for the carbs they eat is not necessarily so for those who are Type 2 managing their condition by diet and /or oral medication.
What happens in the USA is often different from the UK.
As an aside the units used in the UK are not the same as the USA so it would be useful if you put units on your numbers when you post to avoid confusion.
 
Are "high carbs" recommended or is it a fear of "low carb"?

I did not change my diet when I was diagnosed with Type 1 and there has been little change since.
I do not eat a low carb diet as it was too much upheaval to my lifestyle compared to learning insulin dosage and timing.
Plus it came with the added complication of having to calculate insulin dosage and timing for protein.
Twenty years later with the occasional pizza and frequent pasta plus almost daily bread, my HBA1c is 40, I have no diabetes complications and I am still not overweight.

I think it is important to recognise that we all manage our diabetes differently as we all live differently.
What is important is being able to make the choice and not being forced down one route only.
 
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I follow a low carb way of eating but it isn't necessarily easy as a Type 1. I have to inject for protein release about 2 hours after meals as well as insulin up front for the carbs I have.
I certainly don't starve myself and there is plenty of flesh on my bones.
I started low carbing because I was initially assumed to be Type 2 and wanted to do all I could to aim for remission but I found there were many health benefits from this way of eating for me and increasing fat intake made it sustainable long term, so I stuck with it long term. I was encourage to eat "normally" when I started on insulin and I tried for a week or two, but went back to low carb because it made more sense to me, there were as I mentioned health benefits and it helps me manage by disordered/comfort eating.

I think it is wrong to discourage Type 1 patients from this dietary route if they want to try it, but I don't necessarily think it is easier and I think it is important for the individual to consider why they are taking this route and the challenges they may face with it, so that they can weigh up the pros and cons so to speak.
 
Just at the moment I am, literally, starving myself - using shakes and very small meals, but I am doing what I want to achieve - maintaining fat burning for energy, but using body fat rather than what I am eating.
It is not a dangerous situation - Humans probably experienced it quite frequently for millennia, and we adapted to cope with it.
I still have coffee with cream - just minimising the amount, still have meat or fish. Good quality foods are sustaining and although I am thinking about foods more frequently than usual I am not feeling hungry.
The way HCPs are willing to deny the evidence is quite frankly astonishing, and not a little alarming.
The diabetes type shouldn't matter - we are all working with Human 0.1 equipment after all.
 
ElizabethMcCallister said:
My diabetic educator literally treats me like I'm starving myself when I'm technically considered overweight just because I shy away from eating so many carbs *-* she is also a T1D
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How many grams of carbs do you eat a day @ElizabethMcCallister ?

I think these are two separate things: if you need to lose weight, then you can reduce your carbs if you choose, but Type 1s in the U.K. just eat a normal healthy diet. That is, pretty much what they’d have eaten if they didn’t have Type 1. Type 1 isn’t a food/diet problem, it’s an insulin problem.

How do your other disabilities affect your diet?

Who told you that low carb diets “work so well” for Type 1? I eat a normal amount of carbs and my TIR is excellent. You’ve said your blood sugar is usually high so it doesn’t sound like low carb is working very well for you.
 
Tried low carb for few months about 12 years ago, insulin doses didn't go down but they didn't really go up either. Just found it frustrating having to inject up to 3 times for each meal & having to monitor bg all the time, so it was taking up a lot of head space which I didn't like at all, back then no cgm so was using way to many bg strips.

Think like all things in life it's about finding right balance when it comes to diet, restricting food unnecessarily leads to fewer options, besides like my food so a normal diet suits me fine.
 
I believe the resistance to low-carb diets is mostly down to lack of evidence about long-term health effects. It's very difficult to gather evidence about the long-term effects of diet. It's mostly done by asking people to fill out questionnaires about what they typically eat and then track their health over very many years. To the best of my knowledge no study has been completed which tracked the health of people who stuck with a low-carb diet consistently over a very long period of time, so nobody knows which varieties of low-carb diet are any better, or worse, for long-term health. There is however plenty of evidence about common types of diet composition which are known to be quite healthy - for example the Mediterranean diet.

I believe when done for the purposes of losing weight the potential and unproven negative health implications are outweighed by the obvious health benefits that come from losing weight. In the long term - nobody has hard evidence about the ideal diet options for diabetics, and without that evidence the advice will always be to eat a diet that similar to those that large populations of healthy people have been eating for a long time. That approach has evidence to back it up as a recommendation for the general population, but not for diabetics specifically. For Type 2s at least I believe there are big flaws with that approach to advice about diet.
 
ElizabethMcCallister said:
My diabetic educator literally treats me like I'm starving myself when I'm technically considered overweight just because I shy away from eating so many carbs *-* she is also a T1D
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Hello, I’m sorry to read about your less than positive experience with a DE. Try not to take it personal, some times you will get a “round peg” insisting other shapes can fit the same hole. Best wishes.
 
PerSpinasAdAstra said:
I believe when done for the purposes of losing weight the potential and unproven negative health implications are outweighed by the obvious health benefits that come from losing weight. In the long term - nobody has hard evidence about the ideal diet options for diabetics, and without that evidence the advice will always be to eat a diet that similar to those that large populations of healthy people have been eating for a long time. That approach has evidence to back it up as a recommendation for the general population, but not for diabetics specifically. For Type 2s at least I believe there are big flaws with that approach to advice about diet.
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As I understand it, in comparative trials there are no clear winners in terms of dietary approaches for weight loss, neither in terms of what is sustainable, nor in terms of what is more effective (low calorie vs low carb). Low carb do tend to do slightly better in terms of BG response. If I remember rightly @Eddy Edson has posted some links/studies about this?

In T1 there are question marks over potential increase in insulin resistance with low or very low carb menus (we have members who have direct experience of this).

Personally I suspect it’s all very individual, and boils down to what works for you as a person. What it sustainable, flexible, enjoyable, affordable, and what gives you the results you are looking for.

I’ve found “just eat whatever you want and bolus for it” doesn’t quite work for me. But I don’t avoid carbs, and aim to have the, as part of every meal, in appropriate portion sizes and types that seem to suit my metabolism. A varied normal healthy diet with appropriate doses and timings is what I aim for.

Diabetes Educator isn’t a common term in the UK @ElizabethMcCallister , are you based in the US?
 
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everydayupsanddowns said:
I suspect it’s all very individual, and boils down to what works for you as a person. What it sustainable, flexible, enjoyable, affordable, and what gives you the results you are looking for.
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This!...and only this.

Doctors should be giving options, not recommendations. Each patient must be given ALL the information, an be guided to choose a protocol that feels the least restrictive to them, such that they would feel happy to continue to follow it for the rest of their lives.Tweaks can of course be made along the way.
 
everydayupsanddowns said:
As I understand it, in comparative trials there are no clear winners in terms of dietary approaches for weight loss, neither in terms of what is sustainable, nor in terms of what is more effective (low calorie vs low carb). Low carb do tend to do slightly better in terms of BG response.
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When it comes to weight-loss I think whatever works for a person is the right approach. Consistency, being able to stick with it until the weight loss is done is the most important thing. Low-carb diets do have obvious benefits for lowering BG levels and they work weight-loss miracles for many people.

What I meant about long-term evidence relates to the best approach after the weight-loss is done. I haven't gone through the Diabetes UK materials in detail though a Diabetes Ireland Type 2 booklet I read soon after diagnosis, and again recently after they revised it, recommends eating a substantial amount of carbs with every meal in the form of wholegrain foods and keeping saturated fat intake very low due to cholesterol issues and the implied heart disease risk. That's probably good advice for the general population, but in a Type 2 that strikes me as heavily prioritising one risk factor over another. Take breakfast - wholegrain toast with eggs or full-fat Greek yogurt with berries. One high in carbs, the other high in saturated fat. In a Type 2 who is taking a statin and thus greatly reducing the risks associated with saturated fat, which is the better long-term option? If eaten every morning for decades, which might yield a good chance at leading to the best possible health outcomes?

In my own very specific case I'm moderating my carb intake, not extremely low but no two slices of wholegrain toast every morning for me, and eating significantly more saturated fat than is generally recommended, mostly in the form of cheese, full-fat yogurt and dark chocolate. I'm taking a low dose of Atorvastatin (10mg). My last lipid panel says my LDL is at 1.24 mmol/L and my non-HDL cholesterol level is at 1.73 mmol/L. These levels are associated with extremely low risk of heart disease - the likely result of weight loss, the statin, and perhaps genetic factors. My overall fat intake is very high, though I've never seen a study which shows that the fat in nuts for example has any negative effect on health. On a typical day I achieve 100% 'Time in Tight Range', or that's how I've seen it described - levels between 3.9 and 7.8 mmol/L - patterns similar to a non-diabetic. I'm ignoring the advice from Diabetes Ireland about eating plenty of carbs while, apparently, avoiding increased risk on both the blood glucose side and the cholesterol side. Are they right? Am I doing the wrong thing? Should I eat more carbs and stop eating so much Greek yogurt?

There's no evidence that my approach is a good one, which is why the Diabetes Ireland booklet and the advice from many or most nutritionists is the way it is, or at least so I believe. Saturated fat bad (along with fat in general), carbs good, being diabetic makes no difference when it comes to diet. It would take a very long-term study of diet in diabetics specifically to identify the best long-term approaches to diet. I personally believe the optimal approach for a Type 2 lies somewhere between the 'carbs are fine so long as they're wholegrain' approach and extreme low-carbs diets like Keto, which may be too extreme for a typical statin dose to compensate for. Somewhere in the middle there might be a sweet spot, keeping eyes and feet healthy without increasing risk of heart attacks and strokes. Guidance on what that looks like might never come from official sources unless a long-term diet study in diabetics is done, and I can't see anyone funding a 20 year study of that kind any time soon :(
 
Please please please please
Stop referring to no low carb diets as High carb.
There is a big range between keto and pizza everyday which many people follow.

I find it is disappointing that an any non low carb diet keeps being referred to as high carb.
 
helli said:
Please please please please
Stop referring to no low carb diets as High carb.
There is a big range between keto and pizza everyday which many people follow.

I find it is disappointing that an any non low carb diet keeps being referred to as high carb.
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You're right, my apologies. I've found my own use of these terms changing in past months. A few days looking at CGM graphs and suddenly what I thought of as moderate became high, and what I thought of as quite low became moderate. Now what I think of as a high-carb meal differs between breakfast, lunch and dinner depending on what the graph looks like due to the second meal phenomenon, and the graphs are specific to me and nobody else. I'll try to find better language.
 
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