So the diet wars are hotting up again, I have a sense of deja vu… again.
I have had diabetes all my life and soon I will notch up 50 years. I’ve seen the advice chop and change over that time. Firstly it was eat loads of carbs at breakfast, morning tea, lunch, afternoon tea, dinner and supper. The distinction was made between starch and sugar. So it was thought that a piece of fruit would ‘burn up’ in your system more quickly than, say a slice of white bread. Then there was eat a balanced diet, then there was the Glycemic Index diet, then there was the carb counting and insulin dose ratio approach. Now we are learning that protein impacts upon blood sugar, as does eating fats but only if consumed with carbohydrate-so those after tight control are counting and blousing for protein and fats as well as carbs. Lately very low carbohydrate diets have been gaining attention and some very zealous followers.
Back in the olden days, insulins were cruder and tended to peak-there was no such thing as a true basal insulin until about Y2K. For this reason I think carbs were needed until about then. You had to feed the insulin. In order to have sufficient background insulin you needed to withstand the peaks-and the only way to do that was by ingesting a bunch of carbs when the insulins peaked.
Now we have true basal insulins and pumps that deliver variable basal rates over the day we don’t need to match insulin peaks with copious amounts of carbs. It makes sense that if you have a basal regime that works well then, you will reduce the margin of error for both hypos and hypers if you eat fewer carbs. I don’t think you can do away with error all together as protein will impact your blood sugar. There is some observational evidence that low carb diets can be very effective in producing good Hba1cs, all power to those people who can achieve near normal blood sugars. All in all it seems like everyone with type 1 should rethink their eating behaviour in light of emerging evidence.
Does it mean the only responsible thing to do is to cut carbs out of our lives entirely though? I wouldn’t go that far.
Of course people with diabetes can eat anything they like. They just need to put the food in their mouth, chew it and swallow. Simples really. Whether it is wise to eat anything you like is a completely different question. Food choices for anybody are not without consequences and this is particularly true for people with diabetes.
My five decades of diabetes has taught me that what is touted as scientific fact and imposed on patients in one time and place is later debunked, replaced with some more facts that are also subject to review as time goes on. Society changes, food changes (the amount of processed food consumed in western society has skyrocketed in the last 2-3 generations) and so does diabetes drugs and technology. That’s why I hope to see a bit of humility from those touting the latest dietary breakthrough. It’s possible that what works fantastically well for you may not be quite as effective or as achievable for others.
By all means let’s talk about low carb and let’s hear the success stories but let’s not get so carried away by our evangelical fervour for minimising carbohydrate that we attack and drown out other people sharing their experiences. Remember the voice you are shouting down might just have come up with an even better way of managing diabetes.