![]() ![]() Conversely, it is also possible that for someone who maintains such low average glucose levels as is typical of a very-low-carbohydrate diet, that rises in glucose would alert to impending ketoacidosis sooner than might be the case for someone on a convention diet, for whom substantial hyperglycemia may not be unusual. However, we did not observe evidence of increased rates of ketoacidosis in the study, nor did our review of the literature substantiate this concern. Bistrian, we agree that a very-low-carbohydrate diet, by inducing nutritional ketosis (ketoacids ≤ 5 mEq/L), could theoretically increase risk for ketoacidosis (ketoacids ≥ 7 to 10 mEq/L). (A conventional ketogenic diet typically limits dietary protein to ≤20% of total energy.) Due to the high protein content of this diet, participants may or may not have been in nutritional ketosis, depending on individual differences in metabolism, physical activity level and other variables. For clarify, we would note that our participants consumed an isocaloric diet with an average of 36 grams carbohydrate per day. Relating to terminology, we agree that our acronym for a very-low-carbohydrate diet (VLCD) has been previous used for very-low-calorie diet, and this may cause confusion. Bistrian in his comment of raises two valid points regarding our study. If the media surrounding our study helps stimulate that research, it will have done a public health service.Īdditionally, Dr. It sometimes takes patient activism to stimulate research into neglected treatments, and a very-low-carbohydrate diet for diabetes may be one such area. ![]() Yet to this day, there have been no major government-funded studies of a very-low-carbohydrate diet in the management of diabetes. One hundred years ago, before the discovery of insulin, a very-low-carbohydrate diet was considered the most effective treatment for diabetes, including type 1 (3)(4). On that account, we would note that a relatively high carbohydrate diet is actively promoted to people with type 1 diabetes, despite the lack of any high quality clinical trials demonstrating superiority. However, we should avoid selective enforcement against research that challenges (versus supports) conventional thinking. Scientists, physicians and public health experts are certainly within their rights to correct misleading stories. Of course, media hyperbole can be a problem in any research area of interest to the public. Of special significance, reader comments to the New York Times article included hundreds of testimonials from people with type 1 diabetes who overwhelmingly reported remarkable benefits from a low-carbohydrate diet that were often dismissed by their doctors. In that article, we urged caution, saying “because our study was observational, the results should not, by themselves, justify a change in diabetes management.” The New York Times coverage was balanced, including opinion from two highly regarded diabetes experts with no role in the study (2). The American Diabetes Association considered our study of sufficient merit to publish a “DiabetesPro SmartBrief” (1). In any event, Pediatrics considered the findings of sufficient importance to commission an accompanying commentary. Mayer-Davis, Laffel, and Buse regarding potential selection bias may be exaggerated, as a significant number of members in the social media community were likely not active or did not have type 1 diabetes themselves. But to document a phenomenon not thought possible by many diabetes professionals, this design is an appropriate next step. The study was observational, and we fully acknowledged the limitations of this design in our manuscript. Our study design included extensive review of medical records and survey of diabetes medical care providers to confirm diagnosis and validate reported data. In our study, we document exceptional glycemic control, low rates of complications and high patient satisfaction among a community of children and adults following a very-low-carbohydrate diet. Unfortunately, management of type 1 diabetes remains suboptimal, placing many at increased risk for life-threatening complications. Mayer-Davis and colleagues in their comment of criticize the professional and media attention to our study, but we do not think that suppression of information about a novel treatment for type 1 diabetes is in the public interest.įor decades, the professional diabetes establishment focused almost exclusively on drug and technology development, to the neglect of research into nutritional therapies. ![]()
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