Special Workshop and Full-Day Session to Explore Role of Metabolic Therapies including Carbohydrate Reduction in Type 1 Diabetes
The 8th Annual Boca Symposium for Metabolic Health, scheduled for January 12-14, 2024, is generating considerable interest for its upcoming focus on the role of carbohydrate-reduced diets, including ketogenic diets in the management of type 1 diabetes. This year’s symposium will include a special workshop and a full day of presentations on this important topic.
Among the experts contributing to this dialogue is Dr. Jessica Turton, a leading researcher and Accredited Practicing Dietitian (APD) who holds a PhD in nutrition and serves as the Director of Ellipse Health. She will deliver a presentation that focuses on the role and efficacy of low carbohydrate diets specifically in the management of diabetes, particularly type 1. Dr. Turton will also share results from a clinical trial completed last year in Australia, which was part of her PhD thesis.
Clinical Trial: Changing the Paradigm
The trial, which included 20 type 1 patients and had 16 completers, produced encouraging results with respect to therapeutic carbohydrate reduction as an intervention.
Participants reduced their daily carb intake to an average of 63 grams, which led to significant improvements in their HbA1c levels — from a mean of 7.7% to 7.1% in just 12 weeks. This reduction is considered both statistically and clinically significant. Importantly, 44% of participants achieved the trial target HbA1c level of 7% or less. Participants also reduced their daily insulin dosage from 65 to 49 units, which is beneficial given the risks associated with high insulin doses. The study found improvements in other clinical markers like fasting blood sugar levels, BMI, and quality of life, without any adverse events reported. The results support the feasibility, safety, and efficacy of low-carb diets in Type 1 diabetes management.
Bridging the Knowledge Gap: The Role of Reduced-Carb Diets
In our conversation, Dr. Turton illuminated the gaps in public perception and healthcare education concerning the role of reduced-carbohydrate diets in managing type 1 diabetes. She emphasized that much of the existing education about diet and diabetes management is incomplete, often leaving people unaware of low-carb options
“Many patients with type 1 diabetes had this perception that carbohydrates were essential at every meal,” she said. “And they believed that if they didn’t eat carbs, they were going to get hypos or they weren’t going to be able to get energy.”
These beliefs, she said, were often bolstered by general practitioners and endocrinologists, who often discourage low-carb diets, citing insufficient evidence for their efficacy. She also pointed out a double standard in the medical community: while many healthcare professionals claim that there’s not enough evidence to support the use of low-carb diets for type 1 diabetes, there’s also limited evidence to advocate for high-carb diets. Turton revealed that only two randomized controlled trials have directly compared low-carb and high-carb diets for type 1 diabetes, and both favored the low-carb approach.
Addressing Insulin Resistance and Improving Quality of Life
Turton outlined the serious health complications associated with type 1 diabetes, such as a reduced life expectancy by 12 years and a 50% greater risk of cardiovascular disease. She said, “It is predominantly the high blood sugars that contribute to these issues.”
Turton highlighted the importance of personalized nutrition and a supportive healthcare team in managing the condition. She emphasized that a well-managed low-carbohydrate diet can lead to improvements in glycemic control with reduced insulin use, lowering the risks of long-term health issues like heart disease and kidney failure.
“I think being able to improve the control over your health puts you in the driver’s seat, and it allows you to feel more confident about your health outcomes,” she stated. Turton also noted that their study was unique in measuring an improvement in both quality of life and diet satisfaction for those following a low-carbohydrate diet.
Turton emphasized the alarming rise in insulin resistance among people with type 1 diabetes, a development she attributes to the high quantities of insulin they’ve been advised to inject over time. Turton said, “Their whole life and existence is dependent on this insulin that they’re injecting, and they cannot live without it. And they become resistant to it, and it’s not working anymore, that can lead to a spiral of health issues.”
She believes that low-carb diets can have the most significant impact on those with type 1 diabetes who are affected by insulin resistance. Turton anticipates that healthcare professionals will be more open to recommending low-carb diets for this subset of patients, which, according to global data, makes up at least 25% of people with type 1 diabetes. She believes that focusing on such dietary adjustments could have a transformative effect on managing the condition and potentially reversing the sense of hopelessness many feel when conventional treatments fail.
Insulin’s Role: From Historical Context to Present
Turton discussed the historical and evolving treatment of type 1 diabetes, with a particular focus on the role of diet and insulin.
“Before insulin was available, low-carb diets were the only way to treat diabetes,” she explained, highlighting the transformation in treatment methods over time. The introduction of insulin therapy led to a shift in perception, suggesting that people with type 1 diabetes could now consume a “normal diet” by adjusting their insulin doses. However, Turton noted that this shift resulted in a regimented approach due to technological limitations. “It became a rigid routine: take a specific dose of insulin with your main meals and another dose with your snacks, all while consuming a predetermined amount of carbohydrates,” she said..
Turton criticized the current dietary guidelines, which she says were never specifically tested on people with type 1 diabetes: “If you look at the clinical practice guidelines for type one diabetes, they state that there’s not enough evidence to conclusively recommend a specific amount of carbohydrate for people with type 1 diabetes. So therefore, we just default to the guidelines.”
She emphasized that the scarcity of specialized research in this area makes even small studies vitally important: “There’s just such a scarcity of evidence in type one diabetes, so every little study… is really important to help inform practitioners and patients.”
Navigating the Nuances of Low-Carb Diets in Type 1 Diabetes
Turton emphasized the importance of professional support for people with long-standing type 1 diabetes, especially when shifting to a low-carb diet. She pointed out that traditional dietary education often focuses solely on the need for ample carbohydrate intake at every meal, a narrative she finds lacking. “A lot of people really do need professional support, at least at the start, to help them adjust their insulin safely and effectively, and to meet their nutrient requirements on a low-carb diet,” she said.
Turton also noted that the level of carbohydrate restriction can be highly individualized and should be explored further in research. “In my own clinical practice, I work with patients to find what level of carbohydrate per meal, per day, leads to the most optimal results. It’s different for everyone, but generally, some level of restriction compared to their standard diet is beneficial,” she added. This highlights the complexities of managing type 1 diabetes through diet, and the need for a healthcare team that can guide patients through the process.
She also addressed the need for targeted discussions around less commonly explored topics, such as treating hypoglycemia on a low-carb diet. “We need to have strategies in place for these different situations,” she said.
According to Turton, the fear of ketoacidosis in the type 1 diabetes community often deters healthcare practitioners from supporting low-carb diets. “There is a big fear around ketoacidosis, which often gets confused with nutritional ketosis. It’s crucial to distinguish between the two and safely monitor ketones to prevent ketoacidosis,” she added.
Individualizing Glycemic Control: Beyond HbA1c Levels
Turton explained that the main management goal for people with type 1 diabetes is achieving optimal glycemic control, measured by HbA1c levels. “In Australia, the average HbA1c of people with type 1 diabetes is 8.4. The primary target is to get the HbA1c equal to or below 7, which most people, unfortunately, are not hitting,” she said.
Turton further stated that a unique benefit of low-carb diets is their ability to improve glycemic control with less reliance on insulin. “Low-carb diets can lead to a decrease or an improvement in glycemic control without requiring more insulin. This is crucial because higher doses of insulin are associated with metabolic syndrome, which includes obesity and increased risk of hypoglycemia,” she said.
She also mentioned the importance of considering glycemic variability, which is not fully captured by HbA1c measurements. The aim is to minimize both the risk of low blood sugar (hypoglycemia) and rapid spikes in blood sugar, something that continuous glucose monitors can now effectively track.
Symposium Impact: Why it Matters
Turton was enthusiastic about the benefits of devoting a significant portion of the Symposium to this important topic. “Type 1 diabetes management is complex, with so many layers to it. It’s not as if someone with type 1 can just decide to eat a low-carb diet. They need specialized information on adjusting their insulin, counting carbohydrates, and understanding how different macronutrients impact their blood sugar control,” Turton explained.
Turton highlighted the irreplaceable value of attending conferences in person, especially for those dealing with type 1 diabetes. “Being part of a community is incredibly valuable, particularly for people with type 1 diabetes who often feel isolated and misunderstood by their healthcare teams,” she said. Turton also emphasized how important it is for patients to connect with others who share their condition, noting, “No one knows more about type 1 diabetes than someone who is living with it. Sharing experiences is perhaps even more valuable than anything a healthcare practitioner can offer.”
Turton believes that both practitioners and patients benefit immensely from these communal interactions. “We as practitioners learn a great deal from talking to our patients with type 1. Anyone attending the conference with any interest in type 1 will gain invaluable insights from others who are living with the condition,” she concluded. The sense of community that develops at such events not only serves as a supportive network but also functions as a rich resource of shared knowledge and experience.
For practitioners treating patients with type 1 diabetes, as well as those who either have the condition or know someone who does, attending a segment specifically focused on this subject at the symposium would be invaluable. These dedicated sessions promise to tackle the unique complexities of managing type 1 diabetes, offering specialized insights that generic low-carb or obesity talks simply cannot provide.