6 months in from diagnosis, A1C down from 97 to 36, all metrics well within non diabetic range purely through diet and exercise. Low GI primarily which also means fairly low carb, but not very low or keto. Saw the consultant for the first time properly yesterday and he said that's great but a low carb diet is not sustainable long term, and there were no studies on it beyond 5 years. Pretty sure that's b*ll*cks, but anyone been on it long term?
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My consultant said that a low carb diet is not sustainable long term
- Thread starter Vectian
- Start date
Martin.A
Well-Known Member
- Relationship to Diabetes
- Type 2
I've been on what I consider to be sustainable low carb diet since March 2019, usually averaging between 130g & 140g per day, but long term for me is not the same as long term for you, or for anyone even younger, so in that respect the consultant may have a point.
Well done on what you've achieved so far.
He seemed to be saying more than 5 years. I wouldn't say 140g is low carb though, more medium. I have around half that, sometimes less. My blood sugar would be quite a bit higher on 140g. Proper low carb or keto is more like 20g, I wouldn't be able (or want) to go that low.
Jodee
Well-Known Member
- Relationship to Diabetes
- Type 2
I know some have been on low carbs for years and stick with it, but for me your consultant may be right, I started off ok but my body seems to just love carbs 🙂 I think it is / was the conditioning that carbs are needed for energy and they certainly do fill you up. They say protein also fills you up but to me just protein and veg is an unbalanced diet, so I try these days to do a reduced carb diet rather than very low carb. I do think its important to have fibre from grain but then not everyone can tolerate grains, personally I think if your body likes the diet and its working out well for you just keep doing it.
The majority of what I eat is carbs, just complex carbs like vegetables, beans, lentils, quinoa, soya etc. which don't spike blood sugar. Fibre fills you up better than anything, also healthy fats I find simple carbs fill you up the least. Vegetables are full of fibre. The only problem I'm having is a bit of weakness sometimes, he said it was not enough carbs but others say your body can function fine on far less carbs than I eat.
Jodee
Well-Known Member
- Relationship to Diabetes
- Type 2
As I said if your body is responding and likes your diet well, keep doing it. For me my body would not be happy on your diet. I have tried it. I think we are all different in that some diets suit some people well but its not a one diet suits all, because that is just not the case.
Consultant may have read reports about the DiRECT trial and/or the NHS pathway to remission. Year by year some who achieved remission put on weight and their HbA1c rises to diabetic levels again. Same with low carb as any other diet. In other words they did not sustain their lower weight. Others do.
My eating pattern is similar to yours. I have sustained my weight for over a year and see no reason why I should not be able to continue to do so. My recent yearly HbA1c went up a bit more than I expected so I am cutting out the 'extras', like mayo and butter coffee, to get back to my 'racing weight', about 3 kg. 2 kg to go!
Of course I could cut back on healthy fats to eat porridge for breakfast, but I prefer not.
I think there are 2 different sides here - whether it is possible to sustain it from an willpower/motivation point of view, or whether it causes physical issues making it unsustainable regardless of how motivated you are. Most of those whose A1C rises will be due to not sticking to the low carb diet so an issue of willpower, the consultant seemed to be suggesting that you couldn't stay healthy eating low carb long term.
My situation is a bit different as my BMI is 21.7 so not related to weight, I may be LADA but still behaving like T2 so far. I can keep everything well within non diabetic ranges with this diet and no medication, which I'm keen to avoid for as long as possible.
Mayo has minimal effect on blood sugar, oats however give a big spike. Refined carbs and sugar keep the weight and BS up. I wear a CGM so can see exactly what effect different foods have.
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- Type 2
Maybe they were thinking of the VIRTA Health five year results. High profile massively funded US (mainly) low carb program with lots of hand-holding. At the 5 year mark, less than 50% stuck with the program & I think it's not clear how many of the remainder were actually still low carb.
Anyway, it's the same for any "diet" - most people don't adhere to it beyond a few years. Low carb, low fat, calorie counting, whatever.
On the other hand, *some* folks do stick to a disciplined way of eating for the long term & if yr consultant gave you the impression that *nobody* does, they were wrong.
(The new weight loss meds turn that *some* into *many* or *most*.)
... although Weight Watchers has actual RCT's, where Virta just has an observational study "clinical trial" + anecdotes, so it's hard to tell.
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www.virtahealth.com
Anyway, results seem consistent with standard long-term intensive weight interventions like the gold-standard Look AHEAD trial in terms of weight loss and associated clinical markers like HbA1c etc etc. No evidence here that "low carb" is inherently superior long term, in terms of weight loss or anything else.
Virta is a massively...
Virta Health clinical trial patients showed lasting type 2 diabetes reversal and remission at 5 years.
Virta's clinical trial patients reversed type 2 diabetes with many putting it into sustained remission. Patients experienced broad cardiometabolic health improvement, including blood sugar control, weight loss, and medication deprescription.
www.virtahealth.com
Anyway, results seem consistent with standard long-term intensive weight interventions like the gold-standard Look AHEAD trial in terms of weight loss and associated clinical markers like HbA1c etc etc. No evidence here that "low carb" is inherently superior long term, in terms of weight loss or anything else.
Virta is a massively...
Anyway, it's the same for any "diet" - most people don't adhere to it beyond a few years. Low carb, low fat, calorie counting, whatever.
On the other hand, *some* folks do stick to a disciplined way of eating for the long term & if yr consultant gave you the impression that *nobody* does, they were wrong.
(The new weight loss meds turn that *some* into *many* or *most*.)
I get not sticking to a diet when the only reason was to look thinner, it's not enough of a motivation for most. But when it's diabetes and you are putting your health at serious risk I don’t get why the failure rate is so high. I wasn't clear if he meant that it's not sustainable in willpower terms or whether you can't maintain good health long term on a lower carb diet, which seems like rubbish to me.Maybe they were thinking of the VIRTA Health five year results. High profile massively funded US (mainly) low carb program with lots of hand-holding. At the 5 year mark, less than 50% stuck with the program & I think it's not clear how many of the remainder were actually still low carb.
... although Weight Watchers has actual RCT's, where Virta just has an observational study "clinical trial" + anecdotes, so it's hard to tell.
Virta Health clinical trial patients showed lasting type 2 diabetes reversal and remission at 5 years.
Virta's clinical trial patients reversed type 2 diabetes with many putting it into sustained remission. Patients experienced broad cardiometabolic health improvement, including blood sugar control, weight loss, and medication deprescription.
Anyway, results seem consistent with standard long-term intensive weight interventions like the gold-standard Look AHEAD trial in terms of weight loss and associated clinical markers like HbA1c etc etc. No evidence here that "low carb" is inherently superior long term, in terms of weight loss or anything else.
Virta is a massively...
Anyway, it's the same for any "diet" - most people don't adhere to it beyond a few years. Low carb, low fat, calorie counting, whatever.
On the other hand, *some* folks do stick to a disciplined way of eating for the long term & if yr consultant gave you the impression that *nobody* does, they were wrong.
(The new weight loss meds turn that *some* into *many* or *most*.)
Eddy Edson
Well-Known Member
- Relationship to Diabetes
- Type 2
It's the willpower thing. Same thing with DiRECT (ie T2D remission via weight loss). Brilliant results at 2 years, much the same as VIRTA and every other lifestyle intervention at 5 years - ie low adherence and lots of lost remission.
rebrascora
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- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
I think you need to discuss what he feels is "unsustainable" about low carb beyond 5 years as well as defining what he thinks "low carb" actually is....
Is it unsustainable because many people cannot maintain the discipline?
I find it easier the longer I do it and I am 5.5 years down the line. Yes, I have the odd slip or two here and there and I am not terribly strict but mostly about 70g carbs a day. I feel so much better physically when I am low carbing that I want to get back to that healthy feeling after I do slip. Could I maintain keto for even a year, I doubt it, but I don't see a great problem in maintaining this way of eating for as long as I have control over what I eat. If I was admitted to hospital or a nursing home, it would almost certainly not be sustainable.
Is it unsustainable because after 5 years people's bodies are nutritionally or functionally lacking in some way?
Maybe it is because we eat more fats on a low carb diet and your consultant believes that those fats are doing us damage, or that if we don't eat more fat, we will continue to lose weight until we are skeletal.
I am certainly not feeling any detriment and my 6 monthly blood tests are not throwing up anything amiss.
Cholesterol is lower than before diagnosis 5.5 years ago when I started low carb and pretty stable in the mid 4s, despite cream in my coffee and lots of cheese and butter on my veg and creamy natural yoghurt every morning and full fat coleslaw. etc. And I do not take statins or anything else to lower my cholesterol.
Is it not sustainable to manage LADA long term with low carb?
Maybe not.
If it is a genuine slow onset Type 1 LADA, then you can certainly manage it for as long as your remaining beta cells stay alive and your immune system is not stimulated to kill some more. If they are under minimal stress to produce large amounts of insulin to deal with carb rich foods, then they may manage to stay under the radar. An infection or illness could trigger your immune system to take them out regardless though, at any time, but when that will happen is anyone's guess, so if you are LADA, you might be able to sustain your current excellent management with low carb for many more years to come or it could all change tomorrow, if you caught a virus or something.
Any research around diet is very difficult to verify, so I put little store on the results obtained.
I agree with you that fibre is an important factor in lots of respects.
Is it unsustainable because many people cannot maintain the discipline?
I find it easier the longer I do it and I am 5.5 years down the line. Yes, I have the odd slip or two here and there and I am not terribly strict but mostly about 70g carbs a day. I feel so much better physically when I am low carbing that I want to get back to that healthy feeling after I do slip. Could I maintain keto for even a year, I doubt it, but I don't see a great problem in maintaining this way of eating for as long as I have control over what I eat. If I was admitted to hospital or a nursing home, it would almost certainly not be sustainable.
Is it unsustainable because after 5 years people's bodies are nutritionally or functionally lacking in some way?
Maybe it is because we eat more fats on a low carb diet and your consultant believes that those fats are doing us damage, or that if we don't eat more fat, we will continue to lose weight until we are skeletal.
I am certainly not feeling any detriment and my 6 monthly blood tests are not throwing up anything amiss.
Cholesterol is lower than before diagnosis 5.5 years ago when I started low carb and pretty stable in the mid 4s, despite cream in my coffee and lots of cheese and butter on my veg and creamy natural yoghurt every morning and full fat coleslaw. etc. And I do not take statins or anything else to lower my cholesterol.
Is it not sustainable to manage LADA long term with low carb?
Maybe not.
If it is a genuine slow onset Type 1 LADA, then you can certainly manage it for as long as your remaining beta cells stay alive and your immune system is not stimulated to kill some more. If they are under minimal stress to produce large amounts of insulin to deal with carb rich foods, then they may manage to stay under the radar. An infection or illness could trigger your immune system to take them out regardless though, at any time, but when that will happen is anyone's guess, so if you are LADA, you might be able to sustain your current excellent management with low carb for many more years to come or it could all change tomorrow, if you caught a virus or something.
Any research around diet is very difficult to verify, so I put little store on the results obtained.
I agree with you that fibre is an important factor in lots of respects.
Yes, they do when you eat too much of them. Same applies to protein and fat. As the body stores fat due to overnutrition (sugar, carbs, protein and fat combined) liver fat will tend to rise and this will result in higher HbAic values.
No sure how easy it is to spot that with FPs or CGM, but scales are a good guide.
My BMI went up from 20.0 to 21.5. I thought I'd be safe HbA1c-wise at those levels.
It seems that I have decent insulin production (C peptide 1080) but wasn't enough to cope with my previous diet with too much carbs and sweet things. Apparently it's pretty rare for someone to have non diabetic metrics with no medication or insulin at all, so keen to sustain it if I can. I am taking most things they are studying for beta cell preservation, like taurine, vitamin D, GABA, CoQ10. Consultant said this could last for 10 years or more, or 6 months it's impossible to say.
I have about the same carbs as you 70g, the only issue I am having is weakness/fatigue sometimes. Have you had this and did you find a solution? Iron supplements seem to help but I can't take it every day.
My total cholesterol is 5.15, although HDL is OK and triglycerides good. Like you they are recommending statins but I refused just because of some arbitrary targets that don't take individual circumstances into account. You can use the Qrisk calculator they use online and change the numbers to see what difference it makes. For me getting the cholesterol in the target range lowered my overall risk by 1% - hardly worth taking statins for that!
Drummer
Well-Known Member
- Relationship to Diabetes
- Type 2
I am with you on the asterisks there.
These days I stick at under 40 of carbs a day, am just on 8 years from diagnosis and over 7 in normal numbers.
As the low carb diet was first mooted in the 1850s by William Banting Esq. not having data smacks more of carelessness than any lack of information.
He kept saying we don't have enough data on that when I asked him a question he didn't know the answer to, which was quite a few times. He even said low carb is what people did before insulin was invented, our ancestors after all were not eating pastries, Mars bars and drinking coke. Trouble is the number or people who don't stick with it due to willpower issues, which I don't get when there are such serious consequences of not getting it under control. It's not like you will just look a bit podgy at the beach and that's the only consequence!
rebrascora
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- Relationship to Diabetes
- Type 1
- Pronouns
- She/Her
It depends how much exercise and sleep I am getting as regards energy. The more exercise and good sleep I get, the stronger and more alert I feel, but I have had days where I just crash early and whilst I haven't monitored it closely, I suspect it may be related to stress and/or eating more carbs or possibly more gluten rich carbs ie. bread etc which happens from time to time when it would be awkward or rude not to, so it may be a slight gluten intolerance or just my gut microbiome responding to those foods.
At the moment I feel great but I am getting plenty of fresh air and exercise and sticking to my low carb way of eating fairly strictly and going to bed well before midnight.
At the moment I feel great but I am getting plenty of fresh air and exercise and sticking to my low carb way of eating fairly strictly and going to bed well before midnight.
Drummer
Well-Known Member
- Relationship to Diabetes
- Type 2
Sadly, I think that before insulin was discovered, what people did was die.
Even after my getting back to normal I have people insisting that low carb is not healthy or sustainable. These days I just tell them I'll let them know if anything changes.
Over time I have noticed them putting on weight year on year.
I think I'll stick to the steak and mushrooms etc. and see if it kills me in the end.
Cheers just googled that, (Qrisk) never heard of it before, thanx 😎
Also bear in mind with that it's based on averages of large numbers of people, so if you don't follow the average profile then it's less accurate. For example for T1 it includes people who had it since childhood, so for me compared with those that have had 45 years of higher blood sugar and ongoing, whereas mine was high less than a year, now normal range so doesn't correlate very well. It's impossible to work out how much of the increased risk is due to things that often go with diabetes, like being overweight, lack of exercise, bad diet etc. and how much is purely down to the diabetes itself.