Just Read and Just Visited: Duke Diet and Fitness Center and Management of Type Diabetes With a Very Low–Carbohydrate Diet – More reasons I love this century

The first few sentences of this paper tell the story to those who aren’t aware of the history here:

Before the discovery of insulin, the lives of children with type 1 diabetes mellitus (T1DM) were extended, sometimes for years, by severe carbohydrate restriction.1 After the advent of insulin treatment, the recommended carbohydrate intake was increased without clinical trial proof of superiority. By the 1980s, a low-fat diet containing up to 60% of energy from carbohydrates became the standard of care.2 More recently, the American Diabetes Association (ADA) has emphasized the individualization of diet rather than focusing on macronutrients.Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, et al. Management of Type Diabetes With a Very Low–Carbohydrate Diet

I learned about the paper while visiting one of its authors, Will Yancy, MD (@DrWillYancy) who’s the Director of the Duke Diet and Fitness Center (@DukeDFC), in Durham, North Carolina. This is one of the places in the United States that has been on the forefront of innovating in science-based lifestyle change. Since 1969.

The paper’s authors include many of the leaders of the modern diabetes reversal / therapeutic nutrition movement. All are accomplished clinicians and scientists in the field. I’ve read or am reading several of their books 🙂 .

At Duke Diet and Fitness Center, which sits in the shadow of Duke Health, I saw a maintained environment to support long term lifestyle change. Will’s experience and teaching have been influential in that they demonstrate the individuality of people working toward metabolic health. It is not one size fits all here, and it is combined with science in an intensive program that’s relatively unique in the United States, given the facility and the faculty involved. I grabbed a few photos below of my visit:

TypeOneGrit, Controlling Their Health Destiny

The survey of the people in this Facebook community who are mostly confirmed to have Type 1 Diabetes revealed:

  • Exceptional blood sugar control with a very low carbohydrate diet (average HbA1c of 5.67%)
  • Reported adverse event rate that was low
  • Favorable lipid profiles, indicative of insulin sensitivity, not insulin resistance (a threat to insulin users)

The challenge in #LCHF that I see in #LGBTQ – a world still learning to ❤️ better

I was disappointed to read that while participants reported high levels of satisfaction with their care, 27% did not disclose their self-management to their providers, and only 49% reported agreement or strong agreement that their providers supported their approach.

It was noted that some participants feared being accused of child abuse.

I wrote about this in a previous post: (Why Doctors should meet patients (and each other) where they are: My intersection of #LGBTQ , #LCHF, and #LetPatientsHelp)

What we learned in the care of LGBTQ humans (and are still trying to learn in the are of transgender and gender nonconforming humans) was the devastation that came from not meeting people where they are. Especially in this population, when we found out our patients were right.

A Revolution of Empathy

I’m fortunate that I was able to visit Duke Diet and Fitness Center on the same day I reviewed this research. I can see the future here in the work of doctors, nurses, therapists, and dietitians.

One size doesn’t fit all and therapeutic nutrition will be as valued as any other therapy we’ve been told is the only thing that works.

As I took a walk through the campus of Duke University, in a State that several governments have banned travel to (I will post on that soon), there too, I found a world learning to ❤️ better.


Ted Eytan, MD