How Low Can You Go?

Does Lower
Carb Translate to Lower Glucose?
Carly Runge, BS,​a,​b Joyce M. Lee, MD, MPHa,​b,​c

I once asked the father of 1 of my ensure confidence of a true diabetes

patients with type 1 diabetes (T1D) diagnosis based on age at diagnosis,
to reflect on the advice provided BMI, positive results for diabetes
to his family at diagnosis by the antibodies, and insulin requirements
diabetes team, and he responded: immediately after diagnosis. Adult
“You should never have told us that participants reported following the
our son can eat anything he wants. VLCD for a mean of 2.7 ± 3.6 years,
It’s just not true.” He was referring with a mean daily carbohydrate intake
to the nutrition education provided, of 36 ± 16 g. In the pediatric group,
in which we typically tell families the mean VLCD duration was 1.4 ± 1.2
that any carbohydrate can simply be years, and the mean daily carbohydrate
matched by insulin. This is reflective intake was 36 ± 14 g.
aChild Health Evaluation and Research Center, cDivision of
of the fact that endocrinologists have Before the initiation of the VLCD, the Pediatric Endocrinology, and bDepartment of Nutritional
traditionally focused on the adjustment mean hemoglobin A1c (HbA1c) for all Sciences, School of Public Health, University of Michigan,
of insulin rather than diet as a primary participants was 7.15% ± 1.15%. At
Ann Arbor, Michigan
means for controlling glucose levels; the time of data collection, the mean Opinions expressed in these commentaries are
for example, the 2018 Standards of reported HbA1c for all participants those of the authors and not necessarily those
Medical Care in Diabetes for children was 5.67% ± 0.66%, and it was of the American Academy of Pediatrics or its
and adolescents does not even address committees.
5.71% ± 0.58% for the 131 pediatric
dietary management.‍1 This gap is participants, which is an exquisite DOI: https://​doi.​org/​10.​1542/​peds.​2018-​0957
partly due to the lack of evidence level of control. Among a subset of Accepted for publication Apr 2, 2018
regarding outcomes of optimal dietary patients who used continuous glucose Address correspondence to Joyce M. Lee, MD, MPH,
strategies for improving glycemia in monitoring, the mean reported blood Division of Pediatric Endocrinology and Health
T1D. This is why the recent study by glucose value was 102 ± 17 mg/dL Services Research, Child Health Evaluation and
Lennerz et al,​‍2 in which they looked at with an SD of 26 ± 12 mg/dL for
Research Unit, University of Michigan, 300 NIB,
Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-
glycemic outcomes of individuals with adults (n = 64) and 107 ± 15 mg/dL 5456. E-mail: [email protected]
T1D on a very low–carbohydrate diet with an SD of 29 ± 12 mg/dL for kids PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online,
(VLCD), is an important contribution to (n = 51). Authors of previous studies 1098-4275).
the literature. of the VLCD have found comparable Copyright © 2018 by the American Academy of
The authors enrolled 316 participants decreases in HbA1c, albeit not as Pediatrics
from a closed Facebook community dramatic. Researchers of 1 study FINANCIAL DISCLOSURE: The authors have
of adults with T1D and parents investigated the change in HbA1c 4 indicated they have no financial relationships
of children with T1D who follow years after attending an educational relevant to this article to disclose.
recommendations outlined in the course that recommended dietary FUNDING: No external funding.
book Dr Bernstein’s Diabetes Solution.‍3 carbohydrate reduction to ≤75 g POTENTIAL CONFLICT OF INTEREST: The authors
Only participants who self-reported per day, with an HbA1c decrease have indicated they have no potential conflicts of
following the recommendation for from 7.8% ± 1.0% to 6.0% ± 0.6%.‍4 interest to disclose.
a VLCD (≤30 g per day from mostly However, this study was small, with COMPANION PAPER: A companion to this article
fibrous vegetables and nuts) for at only 13 adherent participants. Authors can be found online at www.​pediatrics.​org/​cgi/​doi/​
least 3 months before the study were of another study of individuals who 10.​1542/​peds.​2017-​3349.
enrolled. Data collected from patient were on a carbohydrate-restricted
surveys were validated with medical diet of 30 g per day for 8 months to To cite: Runge C and Lee JM. How Low Can You
Go? Does Lower Carb Translate to Lower Glucose?.
records and provider surveys, and the 61 months reported a mean change in
Pediatrics. 2018;141(6):e20180957
authors took a rigorous approach to HbA1c from 6.8% ± 1.1% to 5.5% ± 0.8%,

PEDIATRICS Volume 141, number 6, June 2018:e20180957

Downloaded from http://pediatrics.aappublications.org/ by guest on May 7, 2018 COMMENTARY
but this also was a small study of unknown. Furthermore, the VLCD REFERENCES
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2 Downloaded from http://pediatrics.aappublications.org/ by guest on May 7, 2018 RUNGE and LEE

 How Low Can You Go? Does Lower Carb Translate to Lower Glucose?
Carly Runge and Joyce M. Lee
Pediatrics originally published online May 7, 2018;

Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2018/05/03/peds.2
018-0957
References This article cites 9 articles, 3 of which you can access for free at:
http://pediatrics.aappublications.org/content/early/2018/05/03/peds.2
018-0957.full#ref-list-1
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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2018 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.

Downloaded from http://pediatrics.aappublications.org/ by guest on May 7, 2018

 How Low Can You Go? Does Lower Carb Translate to Lower Glucose?
Carly Runge and Joyce M. Lee
Pediatrics originally published online May 7, 2018;

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2018/05/03/peds.2018-0957

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2018 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.

Downloaded from http://pediatrics.aappublications.org/ by guest on May 7, 2018