For more than a quarter century, Dr. Mona Morstein listened to her medical profession colleagues in diabetes talk about new drugs and devices to treat the condition with little to no focus on the effects of food. It seemed clear to her that too many carbs were a big culprit in the "diabetes epidemic," but that wasn't a theme her fellow diabetes doctors appeared interested in addressing.

As a result, she founded the Low Carb Diabetes Association (LCDA) in April 2016, a small non-profit organization that's still in its infancy but hoping to expand greatly by convicing more and more medical professionals to embrace the discussion of low carb eating is an important component of diabetes care.

Certainly, the phenom of whole foods and Paleo and Keto diets have transcended fads over the past few decades, and one can argue the Diabetes Community's been gradually moving in that direction as well. But until recently, there hasn't been a widespread effort aimed at embracing these trends and moving them into medical mainstream.

That's where the LCDA comes in, with the aim to help people manage their diabetes via a more whole body and integrative approach that starts with diet and broadens out into other life facets. And while it's not specifically laid out in their mission statement, a key aspect of the new org is to fill a gap left by larger organizations like the American Diabetes Association (ADA) -- which has long been criticized for recommending a diet too high in carbs.

“The ADA is nearly 80 years old and in many ways their work is very respectable. A lot of laws and civil rights for people with diabetes have been established through their efforts. But in terms of treatment (recommendations), I think it's abysmal," Morstein says.

That's essentially why Morstein decided to do something about it by helping create a new organization.

 

Low Carb Leaders

Since its founding in April 2016, the LCDA has roughly 1,300 members across the United States.

At the helm, there are the eight board members who lead the LCDA's charge, and three of them are living with diabetes themselves.

First, Morstein herself serves as the group's executive director and "a sort of ringleader" for the others. As a naturopathic doctor for 29 years currently with Arizona Integrative Medical Solutions (AIMS) in Tempe, AZ, she's considered a leader in the naturopathic healthcare field and has long practiced and prescribed low carb eating for her patients. She wrote the book, "Managing Your Diabetes: A Comprehensive, Integrative Approach for Both Type 1 and Type 2 Diabetes.

Several of her colleagues on the LCDA board are well-known too:

Zippora Karz: a former professional dancer with the New York Ballet Company, who was diagnosed with type 1 herself more than a decade ago, when she was a 21-year-old aspiring ballerina. She started feeling constantly hungry and thirsty, confused, and losing weight. At first she thought her ailments were the result of stress and a rigorous performance schedule. Blood work said otherwise. It took her two years to be officially and correctly diagnosed with T1D. She was better able to manage her diabetes primarily through rigorous attention to a low-carb diet and by focusing on grooming healthy sleep patterns.

Karz later wrote the “The Sugarless Plum,” a memoir about her struggle to get a proper diagnoses and maintain her ballet career. She now advocates for diabetes management through low carb eating and healthy lifestyle management, along with her work with the LCDA.

“The goal is create a preventative regime,” she says. “For some people, like myself, attention to diet and sleep are central to staying healthy. Other factors might be more impactful to other people.”

Dr. Brian Mowll: a Certified Diabetes Educator (CDE) and founder and medical director of SweetLife Diabetes Health Centers based in Washington, D.C. Many may also recognize his name as host of the annual Diabetes Summit, an annual virtual conference held over five days in May, featuring dozens of speakers on all kinds of diabetes management topics.

“There’s a lot of talk about evidence-based approaches to treating diabetes, but it often only looks at certain evidence,” Mowll says. “I think it’s really important to even look past diet and physical activity, although they are cornerstones. You have to look at sleep and stress and overall body system health. The science supports this integrative approach. ”

Dr. Jody Stanislaw: a longtime type 1 herself who practices in the naturopathic medicine field in Idaho. Her coaching practice services on T1D specifically, and she's managed to make a name for herself as a well-respected diabetes advocate over the years. {We just recently interviewed her about all she does for the Diabetes Community.)

Dr. Helen Hilts is another LCDA board member who's in the D-tribe, as she was diagnosed with type 2 in 2004 and practices very low carb in her own management -- no sugars or starch. On a fascinating note, her background at Stanford University was in string bass and marine biology before she went on to medical school. Growing up in Arizona, she's been a family practicioner there in that state for more than three decades now, focusing also on the science of diabetes and insulin resistence.

The remaining board members are all champions of the low-carb lifestyle in their own approaches as well.

 

"Eight Essentials" to Low Carb Success

As outlined in her book, Morstein believes that by focusing on eight lifestyle essentials (now trademarked by the LCDA), people can be empowered to “overcome the worldwide diabetes crisis and be victors, not victims, of diabetes.” She may be right, and she and her fellow board members are working hard to further and prove their approach.

The “Eight Essentials" combine to form a comprehensive system for managing one’s diabetes:

  • a whole-food, low-carbohydrate diet
  • exercise
  • healthy sleep patterns
  • stress management
  • a healthy gut
  • environmental detoxification
  • dietary supplementation
  • medicines

The LCDA website provides details, and a section of resources such as recipes, handouts, recommended food tracking tools, and more.

Membership is free for PWDs (people with diabetes) so far and includes access to the interview and educational videos on the website, a forum for online discussions, and a monthly newsletter. For physicians who wish to sign up and be listed on in the LCDA directory, there is a $99 annual fee.

 

Growing Evidence on Low Carb Eating in Diabetes

Those who support the LCDA and believe in the foundation of what it stands for are excited that in recent years there has been growing evidence to support the stance that this approach works.

One landmark study was published in the peer-reviewed journal Nutrition in 2015 by Dr. Richard Fienman, Dietary carbohydrate restriction as the first approach in diabetes management.

In the study, Dr. Fienman and 26 medical co-authors lay out a relatively definitive case for low carbohydrate diets for diabetes management. They found that such diets reduce high blood glucose, promote weight reduction, reduce or eliminate the need for medication, and carry none of the side effects seen with pharmacological treatment and management of diabetes.

Morstein sees that study and similar ones as roadmaps for her work at the LCDA, efforts that she believes larger organizations like the ADA are still failing to do.

When she attended the 32nd ADA Clinical Conference in Florida in May 2017, Morstein recalls having enough of the same shortsighted advice she'd been hearing for years. At the conference, she listened to people talk and present for four days without hearing a single mention of low carbohydrate diets.

“It was all just really medicines they were promoting,” she says. “When they started talking about bariatric surgery for treating people with type 2 who were struggling with obesity, I just had to stand up in front of 700 people and say I was shocked that in this day and age we as caregivers were promoting a type of barbaric surgery over low carbohydrate diets and weight loss.”

While the response on stage was uncomfortable silence, Morstein says applause began to break out around her in the audience. That gave her even more motivation to continue on with the LCDA and bring others into the fold.

 

Bucking Old Habits

What the LCDA is doing centers on changing the way food and meal options are thought about in the professional diabetes care world, and how that should be communicated and encouraged among patients living with any type of diabetes.

To understand what a big challenge this is, Morstein says you must look back at the history of the ADA.

In 1971, the ADA started recommending a low-fat diet for those who live with diabetes. The popular rhetoric is that the organization was scared that diets higher in saturated fats would cause heart disease and weight gain in patients. At the time, there was some justification to that view: Americans were starting to gain weight at shocking rates. Processed foods and increasingly sedentary lifestyles were main culprits. And weight gain is anathema to type 2 patients and often at the heart of the onset of the condition to start with.

That low-fat mentality has continued over the decades, though in recent years there has started to be a shift as research has more clearly proved that not all fats are evil, as once thought. In fact, not all fats are unhealthy, and the caloric deliverable that supplanted fats in these diets – carbohydrates – can be even worse for the diabetic body.

“The paradigm has changed, and the ADA is now coming out with newer, less-strict guidelines, telling people to use the best diet for them, for instance, but when it does recommend a specific diet it tends to be their own, which is still very high in carbohydrates,” she says, citing the national Dietary Guidelines for 2015-2020 that recommends 45%-65% of total calories come from carbs, and 130 grams per day in total carbs.

The organization does, on its website and in its dietary publication, now acknowledge several different “eating patterns” that have shown some benefit to some people with diabetes -- vegan and vegetarian, Mediterranean, low fat, DASH, and low carb.

But the LCDA believes we all can do better.

 

What’s in a Number?

In a country at times obsessed with dieting, data, and deliverables, determining how best to eat healthfully can be a stressful and tricky proposition. Even more so, it can be argued, for those with diabetes.

There are a lot of recommended numbers and debate about which number is best: 130 grams of carbs a day. 50 grams of carbs a day. 25 grams of carbs a day. And so on...

Sometimes it’s easier to focus on the science – how food and nutrition work with the body – and how the body ultimately feels and responds at the end of a day.

Morstein says low carbohydrate diets tend to work because most diabetics have lost the hormone that helps deal with carbohydrates, most importantly insulin. “We're trying to inject it in some way that mimics the body, but it's not 100 percent perfect,” she says. “Eating the least amount of carbohydrates is going to put the least stress on your system and reduce either the insulin resistance or the insulin you need to inject. It enables such beautiful control of blood sugars, without highs and lows.”

Morstein also points to a certain cause and effect element with low-carbohydrate diets. Lowering insulin resistance allows for weight loss. And weight loss is the number one way to put type 2 diabetes into remission.

“We can’t cure this of course,” Morstein says, “but here’s the deal. People with type 2 diabetes... can get the weight off. We can get the blood sugar down. There are patients who can get off of their medications, including insulin. But this isn't a cure. We have to be really sure that we're saying this is not a cure, because if they just decide, 'I'm never going to exercise again and go back to burgers and fries, and pizza, and donuts,' it's going to come right back at them. But we can put it into remission, get the blood sugars to such a controlled level that if a new doctor drew blood he or she wouldn’t even diagnose the patient with a diabetic condition."

Morstein points to a type 2 patient from Colorado who came to her with an A1C above 8, BG levels all over the place, and a dosage of 70 units of insulin per day. Together, they went over the eight essentials. They implemented a low carb diet, started regular exercise, and settled on an applicable mix of dietary supplements.

“Four months later she’s down to four units of insulin a day,” Morstein says. “Her blood sugars are between consistently between 80 and 110. It's just outrageous, right? It's just crazy. But it’s possible.”

And the LCDA is helping more people realize it.

 

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Greg Brown is a freelance writer living in western Maine. He has written for Consumer Reports Magazine, Consumer Reports Online, The New York Times, and the Chicago Tribune, among other publications. He can be found online at Yellow Barn Creative.