Part 1 took a look at a Systematic Review of this subject.
A new study (May 2018) on the subject of Low Carb and Type 1 Diabetes (Leow ZZX1, Guelfi KJ1, Davis EA2,3,4, Jones TW2,3,4, Fournier PA1. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with Type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med. 2018 May 8. doi: 10.1111/dme.13663.).
To investigate whether very-low-carbohydrate high-fat diets, typical of ketogenic diets, can improve glycaemic control without causing any ill health effects in adults with Type 1 diabetes.
In this observational study, 11 adults with Type 1 diabetes (seven men, four women, mean ± sd age 36.1± 6.8 years, mean ± sd duration of diabetes 12.8 ± 10.3 years), who followed a ketogenic diet (< 55 g carbohydrate per day) for a mean ± sd of 2.6 ± 3.3 years (β-hydroxybutyrate 1.6 ± 1.3 mmol/l), underwent sampling and analysis of fasting blood, and were fitted with a blinded continuous glucose monitor for 7 days to measure glycaemic variability.
The mean ± sd HbA1c levels were 35±4 mmol/mol (5.3±0.4%), and participants spent 74±20 and 3±8% of their time in the euglycaemic (4-8 mmol/l) and hyperglycaemic (>10 mmol/l) ranges, respectively, with little daily glycaemic variability (sd 1.5±0.7 mmol/l; coefficient of variation 26±8%). Blood glucose levels were <3.0 mmol/l for 3.6% of the time, and participants experienced a median (range) of 0.9 (0.0-2.0) daily episodes of hypoglycaemia.
Total cholesterol, LDL cholesterol, total cholesterol/HDL cholesterol ratio, and triglycerides were above the recommended range in 82%, 82%, 64% and 27% of participants, respectively; however, HDL cholesterol levels were within the recommended range for all participants. Participants displayed no or little evidence of hepatic or renal dysfunction.
This study provides the first evidence that, ketogenic diets in adults with Type 1 diabetes are associated with excellent HbA1clevels and little glycaemic variability, but may also be associated with dyslipidaemia and a high number of hypoglycaemic episodes.
A failure of this abstract is that it was an observational study which didn’t have a control group. Hence, the objection about hypoglycemia lacks a comparison.
Yes, there is a chance of going too low but the very fact that the participants had “little glycaemic variability” reduces the chance of hypoglycemia rather than increases the chance. How were these participants trained? When the details of the study are released we may find out more.
Also, as I have noted on many occasions it is not unusual to have low blood sugar levels while on the ketogenic diet with no ill effects. The presence of ketone bodies as fuel reduces the dependence on blood glucose.
The other complication was the cholesterol numbers. The total cholesterol and total cholesterol to HDL ratio is a function of the LDL cholesterol so this is really one issue not two particularly since this was the value most affected. This BLOG has numerous articles about LDL cholesterol on the ketogenic diet. This is a well understood subject.
Overall, this is an encouraging study for Type 1 Diabetics who want to control their HbA1c values more closely.