How Low Can You Go? Does Lower Carb Translate to Lower Glucose?

Abstract

* Abbreviations: HbA1c — : hemoglobin A1c T1D — : type 1 diabetes VLCD — : very low–carbohydrate diet I once asked the father of 1 of my patients with type 1 diabetes (T1D) to reflect on the advice provided to his family at diagnosis by the diabetes team, and he responded: “You should never have told us that our son can eat anything he wants. It’s just not true.” He was referring to the nutrition education provided, in which we typically tell families that any carbohydrate can simply be matched by insulin. This is reflective of the fact that endocrinologists have traditionally focused on the adjustment of insulin rather than diet as a primary means for controlling glucose levels; for example, the 2018 Standards of Medical Care in Diabetes for children and adolescents does not even address dietary management.1 This gap is partly due to the lack of evidence regarding outcomes of optimal dietary strategies for improving glycemia in T1D. This is why the recent study by Lennerz et al,2 in which they looked at glycemic outcomes of individuals with T1D on a very low–carbohydrate diet (VLCD), is an important contribution to the literature. The authors enrolled 316 participants from a closed Facebook community of adults with T1D and parents of children with T1D who follow recommendations outlined in the book Dr Bernstein’s Diabetes Solution .3 Only participants who self-reported following the recommendation for a VLCD (≤30 g per day from mostly fibrous … Address correspondence to Joyce M. Lee, MD, MPH, Division of Pediatric Endocrinology and Health Services Research, Child Health Evaluation and Research Unit, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456. E-mail: joyclee{at}med.umich.edu