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Dietitian dissed low-carb breakfast

Discussion in 'Parents of Children with Type 1' started by njswede, Jun 8, 2015.

  1. njswede

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    I usually trust my health care providers, but I'm questioning what I heard from our dietitian the other day. I've noticed that our son has much better numbers throughout the day if we feed him a very low carb breakfast (eggs and sausages for example). The lack of breakfast spike keeps us from "chasing the numbers" the rest of the day.

    Anyway, our dietitian didn't think it was a good idea. She claimed that he needs carbs with every meal and that he can go into starvation ketosis otherwise. I'm extremely skeptical towards that. If I remember correctly, the liver has enough glycogen to last at least 24 hours. And even if he dips into ketosis for a brief time, that's not dangerous condition, but just a different metabolic pathway. Am I correct?

    It sounds to me like she's going by outdated information, but what do I know? I'm a computer programmer and not a dietitian or doctor...

    Opinions? Comments?
     
  2. nebby3

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    I stopped blindly trusting health care providers long ago. Some win my trust but it's no longer the default. If low carb breakfasts work for you, go for it. You could always test for ketones afterwards for a day or two but I suspect you'll find it's no problem.
     
  3. Theo's dad Joe

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    There is a lot of evidence in modern nutrition that the body is NOT ready to take in carbs in the morning. Also, avoiding carbs at breakfast can keep the liver a little glycogen depleted so that there is a place to put some carbs. Some glucose and much fructose can be moved directly into the liver through the hepatic portal vein without entering circulation if glycogen is a little under-full. Also the liver and muscles will both be more insulin sensitive if they are not glycogen full, however if you start to produce ketones it can reduce insulin sensitivity. This is why non-diabetics who eat less that 150 carb grams of carbs a day can fail a glucose tolerance test. They will have both hepatic and peripheral "physiological" insulin resistance to save glucose for the brain.
     
  4. Melissata

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    Dietitians know what they were taught, all except for a few that think outside the box. Trust your gut and do your own research. There is nothing wrong with what you are doing, and new studies show that lower carb for diabetes means better control.
     
  5. Sarah Maddie's Mom

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    "starvation ketosis" from a low carb meal? That's idiotic.
     
  6. susanlindstrom16

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    You aren't a dietitian or a doctor but you are an expert on your son and what works for him. If you find that a low carb breakfast sets him up for better numbers throughout the day, I say go with it.
     
  7. Mimikins

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    Even if he goes into "starvation ketosis" from a low-carb breakfast, as long as you 100% know he is receiving basal insulin shouldn't there be minimal risk of ketoacidosis? I'm reading Wikipedia (I know, not a good source, but it's easy to read), and there is a big difference in ketone concentration for nutritional (low-carb) ketosis, starvation ketosis, and ketoacidosis. It also came to the consensus that it takes at least 48 hours of very low carb intake for nutritional ketosis to occur.

    I'm tempted to go back to eating low-carb breakfasts. If my endo and CDE disagree, I'll be more than happy to show them how badly my BG spikes with my typical 36g carb breakfast (at least a 80-90mg spike even after attempts to control it by prebolusing and manipulating macros).
     
  8. njswede

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    The diagrams below are enough to convince me I'm right in giving him a no carb/low carb breakfast. There's always the risk of adding too much fat, but he's in excellent shape, so I'm not too worried at this point. I can avoid the spike if I pre-bolus 30 minutes before breakfast, but he's usually starving when he wakes up and it's not easy to do when you're trying to get 7-y/o twins to the bus on time.

    No carbs/low carbs:
    nocarbs.JPG

    Carbs with meal bolus:
    carbs.JPG
     
  9. Christopher

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    Interesting. It looks like he went low before the spike. I wonder if his body reacting to the low contributed to the spike going higher. It was probably mostly the food, but it's possible. At any rate, I am not a big proponent of low/no carb diets for children but you need to do what makes sense for you. Especially dealing with the breakfast spike that many of us struggle with. Nice in range numbers from 2am-8am. Good luck.
     
  10. Sarah Maddie's Mom

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    You can't go into DKA from starvation ketones. Hanas is clear about this. DKA is caused by an absence of insulin, starvation ketones by an absence of carbs. The dietitian doesn't know what she's talking about.
     
  11. njswede

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    I'm not a proponent of a low carb diet either. But we're just talking about breakfast here. I've noticed that if we get a significant breakfast spike, the rest of the day has wild swings. If he's reasonably flat for breakfast, the rest of the day tends to be flat too. He's still getting a fair amount of carbs in his daily diet.
     
  12. njswede

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    Well, that's not exactly what she said. But she claimed that ketosis was a bad thing, which I don't believe it is. At least not for a short time.

    And yes, the way I understand it, DKA is the positive feedback loop when the cells can't absorb glucose due to lack of insulin and the body switches to a ketogenic metabolism. Clearly not the same thing as ketosis due to lack of carbs. And, besides, I've tried a ketogenic diet for weight loss, and it took about a week of no carbs to make me pee any significant amount of ketones. (And it made me feel like **** when the ketosis kicked in, so I stopped...)
     
  13. wilf

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    Exactly right!

    I have a different view on diet, but I as long as your son is happy with this breakfast that is the key thing. What you want to steer clear of is a diabetes-friendly diet that your kid doesn't like..

    I have had no luck with dieticians so far, except in Germany where my daughter was diagnosed. They were so awesome over there! :cwds:
     
  14. dpr

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    Some of the things that come out of supposed medical professionals amaze me. Your dietician doesn't have a clue. Between our endo and most of my mothers cancer team I have pretty much given up on the whole medical community. Their chronic lack of common sense is staggering.
     
  15. Theo's dad Joe

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    In fact the ability to go into mild ketosis with low-ish blood sugars can protect the brain during true lows. The main problem with KA is that the high blood sugar causes extreme dehydration that concentrates ketones to large+ levels.
     
  16. njswede

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    And don't get me started on my pet peeve "Ketones are a poisonous by-product of fat metabolism".
     
  17. suej

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    I just want to add my support for a low carb breakfast, we are on a lower carb journey ( about 100) and I do find that a low carb breakfast prevents that so difficult to moderate post breakfast spike that just starts the sugar rollercoaster for the day. Beloved Ben certainly does not have perfect sugars (except for easter sunday surprisingly) but he is mostly on hills rather than peaks and deep dips. And he loves his bacon and eggs and fried tomato.....
     
  18. quiltinmom

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    If he is "making up for it" later in the day, and it is working for you, which clearly it is, don't change how you do things.

    I would ask how familiar your dietician is with type 1 management. Maybe low carb breakfast isn't great for all kids in general, but we all know type 1 requires adjustments.

    Think of it this way--no general health rule applies to absolutely everyone. We all need to make decisions based on our body's individual needs. Seems like you're doing a great job of that.
     
  19. njswede

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    Well, after a week or so of experimenting, the results are in: It's absolutely stunning what a difference a low carb breakfast makes! If we keep the carb intake below 15g for breakfast, we consistently get a much flatter curve throughout the day. This is true both for a zero carb breakfast with no insulin, as well as a low carb breakfast with a very low dose (0.5U) of insulin. YMMV, but this is a winning formula for us. And since DS has a very good appetite with all his meals, I'm not worried that he's not getting his fair share of carbs throughout the day.
     

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