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Weighing in Carbohydrates

    Abdulaziz Sobh
    By Abdulaziz Sobh

    Categories: Health


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    Habitual advice and why: Most diabetes experts do not recommend low-carbohydrate diets for people with type 1 diabetes, especially children. Some worry that restricting carbohydrates can lead to dangerously low levels of blood sugar, a condition known as hypoglycemia that could hamper a child's growth. But a new study published in the journal Pediatrics suggests otherwise. recommendations He found that children and adults with type 1 diabetes who followed a diet low in carbohydrates and high in protein for an average of just over two years, combined with insulin for diabetes in doses smaller than those required in a normal diet, they had "exceptional" blood sugar control. "They had lower rates of major complications, and the children who followed it for years did not show any signs of growth decline. The study found that the average A1C hemoglobin of the participants, a long-term barometer of blood sugar levels, fell to only 5.67%. An A1C below 5.7 is considered normal and is well below the threshold of diabetes, which is 6.5%. "His blood sugar control seemed almost too good to be true," said Belinda Lennerz, lead author of the study and instructor in the division of pediatric endocrinology at Boston Children's Hospital and Harvard Medical School, USA. UU "It's not typical of us." in the clinic for type 1 diabetes. " The new study comes with an important warning. 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 their 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 surprising because it highlights a community of patients who have had "extraordinary success" in controlling their diabetes with a low-carbohydrate diet, says Dr. David M. Harlan, co-director. of the Center of Excellence for Diabetes at UMass Memorial Medical Center, USA. UU., That did not participate 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 work," adds Dr. Harlan. "I should reopen the discussion on whether this is something we should offer our patients as a therapeutic approach." The authors caution that the findings should not lead patients to alter diabetes control without consulting their doctors and that large clinical trials would be needed to determine if this approach should be used more widely. "We believe the findings point the way to a potentially exciting new treatment option," says Dr. David Ludwig, co-author of the study and pediatric endocrinologist at Boston Children's Hospital, who has written popular books on low-carbohydrate diets. "However, because our study was observational, the results should not, by themselves, justify a change in the control of diabetes."

    Standard Focus: About 1.25 million Americans have type 1 diabetes, which occurs when the pancreas does not produce enough insulin to regulate blood sugar levels. The management of the condition requires the administration of insulin throughout the day, especially when consuming foods high in carbohydrates, which increase blood sugar more than other nutrients. Over time, chronically elevated blood sugar can cause nerve and kidney damage and cardiovascular disease. The standard approach for people with type 1 diabetes is to match the intake of carbohydrates with insulin. But the argument for restricting carbohydrates is that it keeps blood sugar more stable and requires less insulin, which results in fewer highs and lows. The approach has not been widely studied or adopted for type 1 diabetes, but some patients swear it. ToneOneGrit has around 3,000 Facebook members who subscribe to a program devised by Dr. Richard Bernstein, an 84-year-old physician with Type 1 diabetes. Her book, Diabetes Solution by Dr. Bernstein, recommends limiting your daily carbohydrate intake to about 30 grams, the amount in a sweet potato or about four or five cups of cooked broccoli. Dr. Bernstein argues that the fewer carbohydrates are consumed, the easier it is to stabilize blood sugar with insulin. He recommends foods such as non-starchy vegetables, shellfish, nuts, meat, yogurt, tofu and recipes made with almond flour, sugar substitutes, and other low-glycemic ingredients. His plan emphasizes protein intake, which he says is especially important for growing children. Dr. Carrie Diulus, an orthopedic surgeon with type 1 diabetes who follows a low-carbohydrate vegan diet, credits Bernstein's approach with helping to keep her blood sugar under control. "It allows me to perform complex spine surgeries without worrying about my diabetes because my blood sugar level remains relatively stable," said Dr. Diulus, who helped inspire the new study when researchers learned of his involvement in the community. TypeOneGrit. The most surprising finding of the new report was that A1C levels, on average, fell from 7.15% in the diabetic range to 5.67%, which is normal. The rate of hospitalizations related to diabetes also decreased, from 8% before the diet to 2% thereafter, including the lowest hospitalizations for hypoglycemic seizures. Those who followed the diet had increased LDL cholesterol, probably by consuming more saturated fat, which some experts said was potentially worrisome and deserved further study. But other risk factors for heart disease seemed favorable: they had a high level of HDL cholesterol, protective type, and low levels of triglycerides, a type of blood fat related to heart disease. Dr. Joyce Lee, a diabetes expert at the University of Michigan who was not involved in the study, said the findings were impressive and deserved further follow-up, and that patients who wanted to explore a low-carbohydrate approach could do so at the same time. . supervised by your healthcare team. But he 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 is very difficult to do it with low carbohydrate content, given our cultural norms," said Dr. Lee, a professor of pediatrics at the University of Michigan. In an interview, Dr. Bernstein, co-author of the article, said he demonstrates what he sees in his practice: that there are diabetics in his regimen "who walk with normal blood sugar levels and are happy with that, healthy and growing if They are children ". Derek Raulerson, 46, a human resources manager in Alabama, agrees. Both he and his son, Connor, age 13, have type 1 diabetes. Mr. Raulerson said he had problems for years to control his blood sugar level. But six years ago, he abandoned juice, bread, potatoes and other simple carbohydrates, and made proteins and vegetables without starch the center of his meals. Since she started using low amounts of carbohydrates, she said, she has lost weight, has reduced the amount of insulin she uses daily and has observed that her A1C falls from the diabetic range to normal levels. "Now I have normal levels of blood sugar," he says. "I'm not on the roller coaster anymore." NY TIMES