Low Carb & Hypothyroid ~ Healthy?

It is very difficult to find peer review studies on thyroid function and the effects of a low carbohydrate diet.  I've found a few short term studies, but nothing long term.  It would be nice to have longer term studies on VLC, but there's just not a lot of people going to be willing to follow such a diet for a matter of years in a study.  So if anyone is aware of any studies that might be relevant, please do provide links in comments.  What I'm particularly interested in is the second half of the first year - e.g. months 7-12 - and beyond.  Because anecdotally, this is the time frame when hypothyroids seem to react rather poorly to a VLC diet.  Far more material is available on health and nutrition related sites.  While I prefer not to rely on such sources, I think the information available from reasonably reliable sources demonstrate that carbohydrate restriction reduces T3, reduces T4-to-T3 conversion and increases reverse T3 (rT3).  The latter happens with all diets but the T4-to-T3 conversion differences I've seen reported are reductions in the 25-35% range with VLC diets.

I've been somewhat befuddled with the number of hypothyroids who go on long term VLC diets to begin with knowing this - or perhaps they don't know.   Lots of threads with lots of hypothyroids on Low Carb Friends for example.    I'm even more befuddled when I read that their thyroid goes out of whack as time progresses, yet they continue with the diet and increase their thyroid meds.

I don't think you'll find a higher concentration of thumb-your-nose at conventional wisdom and medical establishment types than in LC circles.  Especially where diabetics are concerned, because Bernstein says it, so many will avoid insulin or other available meds at all costs.  Metformin is acceptable, though.  Now obviously a diabetic of either type should not be mainlining Coke and trying to "cover it" with insulin.   But too many will have raging hyperglycemia eating the smallest amount of carb but will not use insulin.  And yet diabetes is ultimately an insulin insufficiency disease at some point - so why wouldn't you consider supplementing insulin secretion?  Folks seem to have no issue with supplementing an underperforming thyroid with hormones.  Why not the underperforming pancreas?

So I went off on a little tangent there, but my main point being hypothyroid low carbers do not apply the same standard to their thyroid treatment.  Part of my issue with the "low carb is inherently healthy" mantra is that I see a lot of people report on discussion forums, and contact me via email or in the comments here, some serious health complications.  The hypothyroids will report having symptoms of low thyroid and run to the doctor to get their meds increased.

To me this seems like the wrong approach.  It is certainly evidence of what folks often complain about going into too much of the science or looking at this stuff at the academic level rather than "in practice".  If I've heard once, I've heard it a thousand times, that who cares if Atkins was wrong, his diet works so it doesn't matter that his original ketone theories held up to the test of time.  I'm fine with that, just don't perpetuate the gimmickry.  If something works for you who really cares how or why, right?

I'm not in the business of giving out medical advice here, but on a personal level I would only encourage those with thyroid issues who experience worsening of those issues with low carb dieting to consider this:  Is the diet working for you?  There's more to diet than weight loss.  If you are having worsening symptoms or needing to increase medications, I would suggest not.  I'd even go so far as to suggest that the diet is not a healthy one for you.

And I would give the same advice as regards the trends of intermittent or longer term fasting, and, what I consider a very dangerous trend of using those HCG injections in conjunction with a very-low-calorie diet for rapid weight loss.  I'm sure there are others doing this that aren't low carbers, but it's disturbing to me the degree to which I'm seeing, mostly women who've hit the plateau on LC, go that route.


MM said…
Just a quick search. I don't have a lot of time this morning. I know you were looking for long-term studies, and like you said there don't seem to be many. I unfortunately can't get full text on this one. :( This study was more calorie restriction than low carb. However, on the lower calorie, lower carb diet the thyroid definitely dropped after only three days.

It almost gives credence to Matt Stone's theories.
Melchior Meijer said…
"Especially where diabetics are concerned, because Bernstein says it, so many will avoid insulin or other available meds at all costs."

CarbSane, this is not entirely fair. Dr Richard Bernstein is extremely clear about the paramount importance of insulin and he promotes the use of exogenous insulin whenever it is reasonably plausible that it helps the patient. The man has saved and improved many lifes and deserves respect, me thinks.
gregory barton said…
I saw this comment by Chris Masterjohn:

"One thing to look out for is that extended low-carbing can decrease thyroid function, which will cause a *bad* increase in LDL-C, and be bad in itself. So be careful not to go to extremes, or if you do, to monitor thyroid function carefully."


What are extremes? After being on 100g per day with 'normal' cholesterol for a few months, I found my LDL starting to increase. I decided to further reduce carbs to 30g per day, following Protein Power. Cholesterol went up even further (including HDL for that matter). One of the low carb gurus suggested that 30g was still too much. I should go even further to 20g per day. I tried that for a couple of weeks but the LDL went still higher.

Dr Eades describes the phenomenon as 'transient hyperlipidemia' which should clear after a while. On the other hand, a respected thyroid patient looked at my lab numbers and concluded, without hesitation, that my soaring cholesterol is a result of RT3 and that the only way to bring the cholesterol down is by a course of T3.

So which is it? Transient hyperlipidemia or RT3?
If the former, how long should one wait. Here's the story of a person who waited three years till her cholesterol reached 400!


Hmmmm...I don't think I will wait that long.
Mario Iwakura said…
Some considerations.

First, hytpothyroidism is basically caused by Hashimoto's, an autoimmune disease. What does low carb have to do with autoimmunity?

Even if thyroid hormones are lowered somewhat in long term VLCD, how can you be sure this phenomenon is due to carb restriction, calorie restriction, protein increase (Broda Barnes warned about a high protein diet increasing hypothyroid symptoms), malnutrition (aggravated by a low calorie diet) or food toxins (specially if such a diet is high in omega 6, http://wholehealthsource.blogspot.com/2008/12/omega-6-linoleic-acid-suppresses.html)? Or even expected?

I think that at least some of those cases of low thyroid could be the reason of high LDL seen in some people doing VLC. So, Paul's considerations could apply to low thyroid cases too (http://perfecthealthdiet.com/?p=2547).

Having said that, my n=1 experience, as someone with Hashimoto's and subclinical hypothyroidism, doing VLC (but without calorie restriction, since I'm not obese) for around a year, was that thyroid hormones or cholesterol (total or LDL) did not correlated with carbs consumption.
CarbSane said…
@Melchior: I am not knocking Bernstein here, I'm knocking the reflexive interpretation/implementation of his views. As far as I can tell, the limitation on protein and shunning of diabetes meds except for Metformin can pretty much be traced to a bit of guru worship of this man coupled with a fear of the actions of insulin. His carb limits appear to be developed in a time when various longer acting insulin and insulin pumps were not yet available.

Personally, I've questioned for a long time how best to manage T1 is anyway relevant to how best to manage T2. They are such wholly different animals. I would love to see the two diseases called two entirely different things at this point. Insulin Resistance Syndrome and/or Impaired Beta-cell Function come to mind.
Melchior Meijer said…
Okay CS, then I did not say anything.

Bernstein is very much aware of the differences between the countless forms and individual manifestations of ‘diabetes’. Do I hear you flirting with the conventional treatment for type 1 DM: eat what and whenever you want and compensate with (the different types of) insulin? From what I see around me, this seldom works. Large ajustments, large mistakes, scary highs, dangerous lows. Quite ugly. Pumps? However sophisticated modern divices might be, they are not artificial pancreases, if only because the insulin is delivered subcutaneously. If I were a type 1 diabetic, I would definitively go for the low carb approach. Bernstein himself is a living example of the superiority of his management. Did you hear about the guy who developed type 1 DM at age 5 who recently turned 90? He must have been eating pretty low carb, following the sound advise they gave to juvenile diabetics back then. Otherwise he would have been dead long ago. Or?
Margaret said…
Of course reverse T3 is known as the "hibernation hormone" because it's an evolutionary response to food scarcity. T4 is converted preferentially to rT3 instead of T3 as a way of slowing down metabolism in preparation for hibernation, so it seems to me that this would happen naturally as carbohydrate foods (particularly fruits) become scarcer with the onset of winter, so that hibernating animals who rely on these food sources naturally go into hibernation. I'm not saying that we are all squirrels or bears but it kind of makes sense that we have some similar adaptations to a loss of carbohydrate in the diet, throwing the body into a food-conserving mode with a suppression of thyroid activity via increased rT3.
Margaret said…
In response to Maria Renato, hypothyroidism is not only a result of autoimmunity. Subclinical hypothyroidism has been estimated to occur in around 10% of the population, especially women as they get older. There are many causes - mineral deficiencies that can slow down T4 to T3 conversion, stress, other hormone imbalances, insufficient iodine (needed to make T4), etc. It is linked to obesity and high cholesterol.
j said…
What is critical is a reminder that people in general are poor historians, very often mis-reporting how much carbs they actually eat.

I am surrounded by morbidly obese women in my office who constantly boast about how they only eat a salad for lunch and a slice of toast for breakfast, followed by a low fat dinner but somehow they still are obese... until "treat day" friday's come along and they scarf down a plate full of brownies while proclaiming they ate a few...

this doesn't apply to all, but its a significant issue when it comes to the level of shame that overeating causes for many obese people. its no surprise to see folks under report what they eat to the point where they may actually believe they are being accurate.

in general on message boards and the like you will encounter people who report a host of symptom resolution or arrival on the adoption or removal of any type of food or supplement. just look up any benign food like "sweet potato" and you will find people claiming their depression, and arthritis went away when they began eating one in the morning alongside another person who had to stop eating them because it was making them dizzy....

should i change my handle to "Mr. Grain of Salt"?
Anonymous said…
@ Jeff Borsato,

I recently read a back issue of 'Men's Health' magazine. In it, an actor explained that, to get ready for a role that required him to bare his torso, he got his abs in 'washboard shape' by eating nothing but baked sweet potatoes for 3 days. His little bit of tummy flab went away eating sweet potatoes! I'll bet he wasn't depressed!
CarbSane said…
@Melchior: Yes, he's living proof and I don't disparage or knock him. And I'd agree with Nigel that there is reason to be wary of some of the other diabetes meds that came down the line for Type II's. I'm also quite sure he's aware of the differences. What I don't see is a different approach. I've not read his books so will gladly stand corrected if what his T2 readers implement, but the focus for a T2 should be to restore beta cell function and insulin sensitivity if possible. I again go back to the results with gastric bypass. Byetta shows a lot of promise. If I were T2 I would take it, and I hope it gets approved for weight loss as I think it could well be helpful in assisting the IR obese in losing weight and restoring normal metabolism.
Anonymous said…
Quick question: What is the metric for "very low carb"? 0/day? 10/day? 100/day?
Kindke said…
if anyone is interested, the only negative(??) effect I have noticed on a ketogenic diet is much less frequent Nocturnal penile tumescence.

Ahem, if anyone has a theory to put forward on this im listening .... ;o
Anonymous said…
Just saw this: http://www.healthkey.com/os-islet-cell-transplant-20110606,0,5387638.story
CarbSane said…
@rk: I think a semi-ketogenic line is drawn around 50g carb/day but many seem to be striving for less. Induction level 20g seems like a common benchmark or just a few more from nuts and stuff not normally included in induction. Basically VLC is starch and sugar free except for "incidental" amounts in whole foods like berries and nuts. That would probably be a good working definition.
CarbSane said…
I'll let the male bloggers ... erm ... handle that one Kindke!
Anonymous said…
I've been cruising along and losing weight at a steady but not insane pace with 70-110 g/day, which I guess isn't classified as VLC. I'm essentially following Taubes' advice of no refined sugars and grains, and no starches. I part company from him on fruits, which I consume more than before.
Sanjeev said…
Mario Renato wrote ...
First, hytpothyroidism is basically caused by Hashimoto's, an autoimmune disease. What does low carb have to do with autoimmunity?
answering the direct question: parts of the immune system could be carb dependent. based on one thing that we probably do know, Paul Jaminet's point about mucus, if mucus helps the immune system, low carb will clobber immunity. Just as one example, if one has H. Pylori in the stomach but it's not causing ulcers on high carb, low carb could easily bork the immune system (the system that protects against bacteria, in this case mucus) enough to give you ulcers. This doesn't speak to auto-immunity, just pointing to a link between carbs & the immune system.

(pure guesswork): I wonder ... does the body use carbohydrate to make "self versus non-self" indicators on cell walls? And if it does, at what level of carb deficiency would it stop making those?

Answering the pre supposition in the question:

there are a lot of reasons thyroid can be low besides autoimmune disorders.

iodine deficiency

iron deficiency

lots of medications interfere with proper thyroid function.

more causes
Sanjeev said…
Until low carb became popular I rarely read about the types of symptoms I had. Certainly I never read about Pritikin or Ornish or McDougall being correlated with Raynaud's type symptoms.

Very low calorie by itself is also known to reduce thyroid, I don't know that it's been proven beyond doubt that low carb goes any further than low calorie.

It could be that the low carb's other effects (increased sympathomimetic amines as one example) magnify hypothyroid's effects
Mario Iwakura said…

Yes, reduced mucus can be detrimental to immune system. But if it could worsen thyroid autoimmunity in a relatively short time it's just a guess. In my case, I can attest that one year on VLC did not increased my thyroid autoantibodies.

The second point: yes, there are a lot of reasons thyroid can be low, besides autoimmune, but how many VLC eaters have acquired iron or iodine deficiency or started taking medications AFTER they started low carb? Not many, I suppose.
I had symptoms of hypothyroid and autoimmune wackiness since 1989, which I see in retrospect (had to stop donating blood due to antibody titer being positive, lethargy, then sleeping up to 20 hours a day, steady weight gain, dry hair, dry skin, falling out hair), but because I had other chronic conditions since infancy, I wasn't clearly diagnosed until 1997. Yeah, I suffered THAT long and had to quit work even. Sucked butt.

I ate superhigh carb. As a depressive in a depressive state due to BEING FRICKEN SICKLY (acute bronchitis 6 to 7 x a year, at 3 to 5 weeks at a pop), exhaustion, dead sex drive, I fed the emotions. Superhigh carb, lots fat (pizza, burgers, rice and beans, pasta with cheese, comfort foods like meat loaf and mashies, subs). My mom never did low carb in her life and got Hashimoto's, too. But she got it in her 70s and i got it at 30.

I've never done VLC. I lasted 1 week on South Beach and 1 week on a sorta Atkins. I hated the Frankenfoods.

But I love moderate carb (60 to 120 carbs, usually 90 to 100ish. I can't give up fruit. I like avocado sushi and kappa rolls, so rice has to fit in somewhere. :D

I hope this is not going to make my T3 issues worse. I suspected I had them. Last June, I asked my endo to put me on Cytomel (T3), cause I was clinically beautiful (the labs were under 1), but still felt "not right". Depression lingered without cause. Dry hair, Itchy skin, sleeping 10 to 12 hours.

Within 3 weeks of being on Cytomel, I started perking up. I have not had a depressive episode since. I have been able to stick to a low cal eating plan. I have energy to walk and do fun stuff.

Will even moderate carb affect me? Hope not, cause it's the only diet type that keeps my hunger issues/appetite issues in check. Tried ovo-lacto vegetarian, tried raw vegan (briefly, cause, hell, I missed cheese), went organic (and pretty much still am as budget allows), upped fruits and veggies, tried low fat and high carb last year (briefly, as it made me feel worse and stall).

I don't know the connection, but if it does make issues worse for us Hashimoto's peops, they need to get the endos together on this. I know I had to FIGHT to get Cytomel (endo reluctance, and she admitted some wouldn't give it to me, even with my research print-outs in hand).

To me, this is a critical issue. Scared me enough that I had rice and beans yesterday. Scale went up 1.6 pounds. No more rice and beans. Fruit doesn't do that to me, so I'll stick to those carbs....

Please keep discussing this. I sure as hell am interested!
gregory barton said…
Paul's post, cited by Mario Renato, above, makes this claim:

"Copper deficiency is, I believe, the single most likely cause of elevated LDL on low-carb Paleo diets. The solution is to eat beef liver or supplement."

One of the commenters on Paul's article claims to have dropped TC by 200 points after supplementing iodine.

Margaret, above, agrees that mineral or iodine deficiency could slow down T3 conversion.

So now we have four contenders for elevated LDL on low carb diet:

i. hybernation via RT3
ii. transient hyperlipidemia
iii. copper deficiency, and
iv. iodine deficiency

Although according to Margaret, iii and iv work by the same mechanism as i - slowing T3 conversion.

My question: If iodine or mineral supplement can stimulate T3 conversion, might not increasing the carbs have a similar effect on hibernation?

This week I'm increasing carbs from 20-30g per day to 50-60 g per day. I'll test next week. See if I come out of hibernation naturally.
Margaret said…
Sounds like a plan!
Dawn said…
Bernstein supports the use of Byetta and related drugs, especially for people that need to lose weight. He also doesn't hesitate to put type 2's on insulin as well as Glucophage (metformin). I think his approach is pretty sound even for type 2 diabetes and that his low-carb diet does make insulin dosing more easily controllable and less error-prone for people that follow it. I've also noticed that he does expect people to eat a few carbs with each meal (including grains, usually in the form of crackers), so he's not going for zero carb and it would seem he thinks there are good reasons not to.

I think people's fear of insulin keeps them from using it early enough in the game, but it's not because Bernstein is telling them not to. In fact his most recent webcast made some waves because he apparently said that in his experience nearly everyone needs drugs to manage diabetes, and this surprised a lot of people who think that his approach is intended for management with diet only.

My forum reading suggests that very few people are able to manage with diet only, but that a few are successful at this. I suspect this has much to do with how early their diabetes is caught, the underlying reasons for it, their fitness and exercise levels, and other variables.
Mario Iwakura said…
Here's an example of what a moderate carbohydrate (35%), apparently not calorie restricted diet (the abstract is not clear), could do to T3 levels of healthy young adults if high in protein or polyunsaturated fat after seven days:


T3 basal: 198 ug/dL
T3 in a diet high in protein (35%): 113 ug/dL
T3 in a diet hign in polyunsaturated fat (35%): 138 ug/dL
CarbSane said…
Thanks for that input Dawn. I guess my comments, then, are indicative of second generation morphing of the take-home message. When one reads blogs and forums and folks cite Bernstein, the takeaway message it appears that many take from him is that metformin is the only acceptable diabetes drug. His diabetes diet, is pretty low carb 6g + 12g + 12g = 30g/day though. Perhaps with some of the newer drugs he's modified his position. That's great about Byetta, because so many seem so reluctant to take on any meds. It seems, almost, that if someone goes on insulin they think that will progress their diabetes or that's endstage. Byetta has the potential to actually cure diabetes in some, perhaps many.

And of course they presume they'll just gain weight because the insulin will now be locking their fat away in their fat cells.

There's almost a holier-than-thou attitude in LC circles that they are able to manage hyperglycemia through diet - for a time. Look ma, no meds!
CarbSane said…
Re Bernstein Diet Dawn:

Unless Dolson got this wrong, no fruit or starches.
CarbSane said…
This is a very interesting discussion we have going on here. Lots of thoughts to share but kinda busy finishing off other blog stuff. Big changes coming to the Asylum too ... {tease}
Anonymous said…
{{Big changes coming...}}

Wouldn't be an acronym decoder, would it?
CarbSane said…
Nope rk, but check out my labels. Just for you (well, not really just because others have asked) I started an ACRONYM's post. Please feel free to list acronyms you want decoded in the comments as those were just a few that came to mind.
OnePointFive said…
To Melchior
I don't think you have to reduce your carbs to Bernstein levels to manage type 1 well. I have an HbA1c in the 5s and eat a moderate carb diet. (150-180g a day)and am active. I doubt I'd be able to have the lifestyle I do (running/hill walking, maintaining a large garden) on 30g carbs a day.
Nor do I think that many long term diabetics have needed to stick to those levels. In the UK the main regime for many years was the Lawrence lines diet. Dr R Lawrence was himself a T1, one of the first to receive insulin. The first incarnation of the diet (1925) was quite low, in carbs. It contained 25 calories per Kg of bodyweight, divided into 0.66g carbs, 1g protein and 2g of fat. By 1929 though T2s (ie those not on insulin) started with a 'ration' of 100g of carbs, (1500 calories) those on insulin started with 150g carbs. The amounts in the diet were was raised or lowered according to results. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2196673/
According to the stories told in a set of oral histories.Those who have survived have varied lives and diets. Some, like the man you referred to stuck rigidly to a diet for years. Others were less rigid. Not all those who have lived long lives have had flawless control. Indeed with the tools available, that was impossible.
Sue said…
Cheat meals are meant to counter low thyroid from low calorie dieting.
Melchior Meijer said…
Hi OnePointFive,

Thanks for sharing your own experience and the interesting info. And congratulations with your excellent control! Indeed, there must be more to it than just bg control. I know a long time type 1 with a consistently bad HbA1c (>8) who simply 'refuses' to get complications. His eye doctor is puzzled by his 'completely normal' retinal vasculature. He also has a health Heart Rate Variability. On the other hand I also know some type 1's who reversed complications by severely reducing carbs a la Bernstein. I guess I myself would 'play it safe', I think. And like you point out, <200 g/day is pretty moderate, isn't it?

I am a healthy (I hope) recreational athlete (swim/bike/run, very dangerous behaviour, I know) and like you I cannot do that on 30 g of carbs per day. I don't think there is any difference between a type 1 diabetic and a 'healthy' individual wiht respect to adaptation. Maybe I haven't tried hard enough (according to Phinney). No problems at all with vigorous (endurance) exercise in the fasted state though.

Sanjeev said…
This comment has been removed by the author.
Sanjeev said…
Sanjeev said...

> Maybe I haven't tried hard enough
> (according to Phinney)

In the famous cyclists on high fat study most of them never adapted much at all and remained low-performing for the duration. The few (it may have been one) that adopted very very well threw off the averages.
Sanjeev said…
low carb, high fat for endurance athletes :

Lyle's take

... subjects who got the best performance on carb-based diets showed the biggest decrease on the fat adaptation diet. But subjects who did relatively poorer on high-carbs usually got a performance boost on the with fat adaptation.
Melchior Meijer said…
Thanks for that link, Sanjeev!

Ten years ago I basically fueled myself with cake, cookies and pastries during longer bicycle trips (between 110 and 180 km/day with heavy camping gear). After eating I could ride very fast, but after only 30 km I would be empty. After switching to 'paleo' I don't feel this explosive energy rush after eating, but I can easily ride 60 to 80 km (depending on wind and elevation) without bonking. I have no idea about the amounts of carbs I consume. It must be a lot less than back in the cake days.
Debbie Cusick said…
I actually did try out Byetta a few years ago. It did squat for me - useless for either glucose control or weight management. But from what I understand this is not uncommon. I've read that for those it helps Byetta is a spectacular drug, but it only helps about a third of the people who try it. For the other two thirds (like me) it does squat.

Don't know why people think Bernstein is anti-drug. I've read his book and I was actually turned off by *how many* drugs he recommended and used for his patients, including some now coming out with reports of very bad health outcomes for other things, like Actos.
CarbSane said…
I don't know either unless this is based on an older book? It just goes to show you people read what they want to sometimes because if I've heard it once, I've heard it 1000 times that Metformin is the only "acceptable" diabetes drug.

Sorry Byetta didn't work for you. There are several folks on LC forums who "broke down" and went on Byetta with good results. Why should someone be made to feel like a failure if there's a pharmaceutical intervention that can help them and near-zero carb is impossible for them to adhere to? I don't get that.

I guess there's the fatalism that taking insulin means you've progressed from NIDMM to full blown diabetes. There's no going back. But injecting insulin doesn't impact remaining beta cell function that I'm aware. There's also evidence that Byetta can increase beta cell mass and preserve function.
Russell Moris said…
I suffered my worst depression 3 years ago. The main cause was my thyroid disease, it was a nightmare. I suffered aches, pains, tiredness and depression. I had overactive thyroid and got mood swings. I'm glad, I tried herbal thyroid supplements 8 weeks ago cos I can feel some improvement to my health.
Amh79 said…
I agree. I also have to chime in here. I am a type 1 diabetic, hashimoto's, with awful food and seasonal allergies. In short, a bunch of autoimmune issues. I followed a paleo diet for years with great results, but the thyroid and t3 conversion does have to be watched while following lc. I did the 30 grams per day for years but after the birth of my son was having issues. I am finding that I now need to eat between 50 to 75 carbs a day to keep the t3 conversion up. I also added a few brazil nuts because selenium also promotes t3 conversion. If you deal with auto immune disease you have a lot more pieces to th puzzle and cannot expect an easy path. I will say that with diabetes, the lower the carb the better, but you must look at the whole picture and make changes as needed. Oh, I upped my carbs with berries, peaches, plums, carrots, peppers and kept it to no more than 15grams of carb per hr. I am not gaining weight just an FYI for those wondering. I feel like I am eating all day, but when you do not eat grains or dairy you have to to keep the carbs up.
CarbSane said…
Welcome Amh! Thanks for bringing this back up! I recall responding to this at the time but don't see my comment here. Maybe it was on a different post where Bernstein's recommendations were discussed.

I now realize that Bernstein is not an insulin-phobe, he just subscribes to minimalizing the need by limiting carbs. Unfortunately the take home message most LC'ers get is that insulin is bad, and with all due respect to Bernstein, he developed his protocols early on in the development of pharmaceutical insulin when immune responses and hypoglycemia was more deadly than mild hyperglycemia (well, it still is, but nowadays there are far more tools available to prevent it). In my opinion, diet and insulin therapy would ideally mimic what the functioning pancreas in the usual human diet. Short of islet transplantations the "ideal" would be an implant capable of sensing glucose (AND free fatty acid and amino acid levels) and mimicking pulsatile insulin delivery to the portal vein.

But we have much better tools at our disposal. I don't see minimizing dietary carb to minimize insulin needs as being the best way for a T1 to approximate a healthy person with a functioning pancreas. Insulin is a hormone of life -- the hormone of life. You KO insulin receptors in an animal and they die in days. You KO receptors in target tissues and they exhibit a variety of phenotypes that elucidate cross talk and an intricate dance. I find focusing on just glycemic levels within certain levels by any means being a desired end as hugely myopic.
rodeo said…
You got those wrong, it's the other way around. Read the abstract again.
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