As readers well know, for the last five years, my wife, Nicole, has been following a low-carb diet to make life with type-1 diabetes more tolerable. Following, largely, the recommendations in Dr. Bernstein’s Diabetes Solution, Nicole brought her HgbA1C from the 7.0% to 4.7% in a matter of eight months. Blood sugars were no longer rising so high her glucometer could not read them or so low that she was falling unconscious. Nor did she ever end up as an overnight patient in the hospital (previously, a yearly ritual) for some other issue (ranging from brain seizures to pneumonia). States of deep depression and anger that would last for 3-5 days, now lasted 3-5 hours. We did make many other changes, so it’s hard to know how much the low-carb diet deserves credit for. But life was better, overall. Not great. But plenty better.
As the carbohydrate-deficient years past, however, we started to have our doubts. We tried different variations: low-carb, high-fat, moderate protein; low-carb, moderate-fat, high protein, low-carb, high-protein, high-fat; low-carb, low-fat, high protein. None of these tweaks evaded a few problems that were slowly creeping up:
1. More unreliable blood sugar control: I assume this is what most call insulin resistance (though, sometimes, I suspect, it’s more glucose resistance). I’ve witnessed this amongst other people following low-carb diets. The usual route they take is then to enter into “deep” ketosis with virtually no carbs. Even cauliflower becomes a restricted item, replaced by greens, meat/eggs and butter for breakfast, lunch and dinner.
2. Inability to convert T4 to T3: Nicole had achieved perfectly normal TSH, T4 and T3 levels, taking herself off all thyroid supplementation. Nonetheless, in the last two year, her T3 levels have been dropping below normal. She is still producing enough thyroid hormone, but not converting it to the usable form. This conversion process, according to multiple sources, requires glucose and happens mainly in the liver. Indeed, I know at least one low-carb doctor who admitted he has to put most (if not all) his patients onto T3 supplementation, despite normal T4 and TSH levels.
3. Low hemoglobin: Now, of course, Nicole suffers from kidney failure, so low hemoglobin is no surprise. But, still, the problem seemed to be getting worse, while her kidney function wasn’t. Red blood cells, according to any medical literature I’ve read, rely soley on glucose for energy. This is why they serve cookies and juice at blood donor clinics.
4. Painful Gout: Relying on dead animals for energy seems to have caused very painful gout in Nicole’s fingers. It may also explain inflamation in her back and neck. She was also experiencing uric acid levels so high her breath would smell like ammonia (which initially prompted us to lower her protein intake). Of course, again, the kidney failure would be exacerbating the condition. Still, it made us question the validity of a high-protein foods if the kidneys are expected to dump out a large part of their nutritional contribution.
5. Depression: About a year ago we started to slowly introduce more carbohydrates (mainly in the form of high-carb vegetables and a little fermented whole grains) and found that this relieved a growing depression. This is a big topic, with evidence showing that relying on fat and protein for energy, instead of carbohydrates, leads to a depressed state of mind. For example, a study by Arizona State University, found that “vegetarians reported significantly less negative emotion than omnivores ” despite the fact that the plant eaters were lacking any “major dietary source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), critical regulators of brain cell structure and function.”
So what to do? Go back to a high-carb diet with the out-of-control blood sugars and organ-devastating A1C Nicole suffered before? I assure you, living with someone whose blood sugar routinely went from 2mmol/L to 35mmol/L is about as pleasant as living with a wounded mountain lion who just had its cubs kidnapped. Or do we move north to carb-free Nunuvat and live off fish, caribou thryoid and seal blubber? Or do we try some middleground between the two? Enjoy the best of both worlds, and endure the worst.
Fortunately, we came across another option (indeed, a very deep rabbit hole) that seems to have solved both problems (plus others). Nicole’s now eating a very high-carb diet, but enjoying blood sugar control comparable to what she had on the low-carb diet. So she’s getting all the benefits of glucose without the negatives. Plus, this new approach elminated the problem of gout and other stresses on her kidneys. Of course, like anything, this path doesn’t come without sacrifice – albiet an interesting, rather welcome and unexpected one.
Next post, I’ll fill you in our high-carb experiment and how we are pulling it off.
Thinking outside the T1D Matrix,
–John C. A. Manley
P.S. Even back in 2014, we were already having a confusing mix of benefits and challenges from the low-carb diet. Check out The Dark Side Of A Very Low-Carb Type-1 Diabetic Diet to see what I mean.
P.P.S. If you want to support the Diabetic Dharma blog and see the results of our big $49,800 experiment to turn kidney failure around, you can make a donation (big or small, it’s all appreciated) at KidneyKarma.com.