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I regard obvious that the first treatment option for type 1 diabetics should be a carb-restricted diet. In my opinion there is enough scientific evidence that this is the best way for a good control of the disease, using as few drugs as possible (see,see).

Is there any reason not to recommend this type of diets for children and young people?

The arguments that I have found (see) against following a low-carb diet and, instead of that, «eating whatever you want», are preposterous.

In the absence of conclusive evidence of benefit and lack of harm, we would propose a pragmatic solution: achieving and maintaining an appropriate weight, physical activity and a conventionally healthy balanced diet. People with type 1 diabetes can inject the insulin they lack as appropriate for the carbohydrate load and their activity level.

In our (non-expert) opinion, it is better to enable people with diabetes to live a normal life with good control than to promote a difficult-to-achieve, restrictive, expensive and potentially stigmatising diet, which has unclear long-term benefits. This is especially true for young people and adolescents.

In other words, the «pragmatic solution» for diabetic people is irresponsible eating, as if they they hadn’t a problem with carbohydrates, and afterwards trying to fix this nonsensical idea with more medication. But, as I said, there is scientific evidence for the benefits of restricting carbohydrates and just considering that there may be damage from not eating flour and sugar, especially if you are diabetic, goes way beyond surreal.

What kind of medical doctor recommends to live a «normal life» for his/her patients, even when that damages their health, instead of having the patient’s health in mind? Should medical doctors digress into diets being «stigmatizing»? That’s absolutely unacceptable, in my opinion. For me, that’s pseudosociology with no purpose other than justifying the interests of Big Pharma.

In young people, type I diabetes can affect brain development and in consequence effect cognitive disability (see,see,see,see,see,see). This effect may be related to glycemic variations, even in diabetics who keep their blood sugar within the recommended range (see). This is one more reason to advocate for the best possible disease control in people who suffer from diabetes at an early age.

fluctuating glucose levels in children with diabetes may be associated with corresponding fluctuations in brain volume. In addition, measures of hyperglycemia and glycemic variation were significantly negatively correlated with development of surface curvature. These results demonstrate that early-onset type 1 diabetes has widespread effects on the growth of gray and white matter for children whose blood glucose levels are well within the current treatment guidelines for management of diabetes.

With high-carb diets we know that there is no benefit and there is evidence of damage.

It is becoming increasingly clear that tighter management of both mean glucose levels and glycemic fluctuations may be beneficial for brain growth.

 

How long can we as a profession afford to keep our heads in the sand regarding the benefits of low carb diets for diabetics? Katharine Morrison, MD

Obviously, as long as those who make the decisions receive money from Big Pharma.

Further reading:

• “Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit“
• “Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes”
• “Beneficial effects of ketogenic diet in obese diabetic subjects“
• “Dietary Carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base”