Eat what you want, pretty much. Avoid sugar, salt and fat as much as possible, of course. Don’t scrimp on fresh fruit & veg and eat plenty of starchy carbohydrates such as pasta and potatoes – in fact, half your calorie intake should come from them – but, apart from that, knock yourself out. Over indulge, up your insulin dose. Simple.
That, essentially, is current NHS guidance for anyone living with type-one diabetes in the UK: eat how you would if you weren’t diabetic, within the confines of a balanced diet, and medicate accordingly. I followed that advice for years. And I felt like crap for years. My insulin dose was sky high. My blood sugars were all over the place. Exercise sent them haywire. Hypos were common. Some nearly killed me.
For the past couple of years, I’ve been following a different, high protein and fat, low carb diet. On my current diet, my carb intake is about 60 grams a day. Diabetes UK says I should be consuming 300, give or take. But I feel great. I now have the best blood sugar control of my life. Hypos are few and far between. Yet the experts advise against this diet. Why?
A couple of weeks ago, I phoned Diabetes UK for some advice. See, the charity, the NHS and most other western healthcare bodies warn diabetics against the kind of low carb diet I’m on. A reduction in carbs inevitably results in an increase in saturated fat in a diet, so the thinking goes; this ups the risk of heart disease and kidney problems and leads to poorer blood sugar control.
The Diabetes UK website is pretty clear: “We are aware that some people with type-one diabetes may choose to reduce their carbohydrate intake in order to manage their glycaemic control, reduce their insulin intake or to lose weight. Diabetes UK does not recommend this because there is currently insufficient evidence to show whether this is effective in managing type-one diabetes in the long term.”
This is where it gets confusing. “We don’t officially advise against low carb diets,” the very helpful woman I spoke to at Diabetes UK told me. Of course, she said, there cannot be a one size fits all approach to diet. Any changes to diet should be discussed with a doctor. If it’s decided a low carb diet is appropriate, then so be it.
Now, I’m no fanatic. Diabetes UK is a fantastic charity that provides an essential service to thousands living with this horrible disease. But their advice is contradictory and confusing. I’m not anti-carb. I’ve cut them from my diet for a very practical reason: it’s allowed me to reduce my insulin dose by about two thirds. Studies have shown that when you inject insulin, up to 30% of it is not absorbed by the body. So, the greater the dose, the greater the uncertainty about its effect on blood sugar. By cutting carbs, I’ve achieved much tighter control.
And it’s not just me. The Internet is awash with accounts from type-one diabetics that have transformed their control by following low-carb diets. What’s more, they’ve achieved this without any associated increase in blood cholesterol, one of the biggest concerns of bodies such as Diabetes UK.
Commenting the BMJ website, PhD student Katherine Aull sums it up perfectly: “I eat heroic doses of saturated fat, salt, and cholesterol, with absolutely no whole grains. Yet my blood cholesterol is normal… As a scientist who believes in evidence-based practice, I’m ashamed that much of the critical work on metabolic impacts of low carb/high fat diets is happening on Internet forums. We can do better.”
Things are changing. A recent US Academy of Nutrition and Dietetics report concluded: “Carbohydrate contributes a greater amount to the risk for cardiovascular disease than saturated fat, so the replacement of carbohydrate will necessarily result in a greater improvement in risk… the most effective recommendation for the reduction in cardiovascular disease would be a reduction in carbohydrate intake with replacement by polyunsaturated fat.”
In short, the reduction of carbs allows for tighter control of bloods sugars without increasing the risk of heart complications (my blood cholesterol has remained unchanged since I went low carb). This is why it’s time to rethink diabetic nutritional advice.
I’m not advocating a knee jerk reaction of course; any change should be based on evidence. And if the authorities here in the UK feel they need yet more evidence (not sure why they would; official US guidelines will be changed later this year to advocate the replacement of some carbs with healthy fats) and require subjects for further studies, they know where to find me.
The day I published this Diabetes UK kindly responded on Twitter. In my view, the following transcript illustrates the urgent need for a proper, large scale study into this. Without this, the advice will not change.
@DiabetesUK: @diabeticdadruns And there is currently no strong evidence to say that low carb diets are effective in managing Type 1 diabetes. (3/3)
@diabeticdadruns: Thanks @DiabetesUK In 2008 Nielsen & Joensson reported a 15% fall in HbA1c for low carb #T1D but was small sample. Time for larger study?
@DiabetesUK: @diabeticdadruns Yep, could well be. We always welcome (and try to fund where we can) further research into diabetes and diet.