Why This Former Army Captain with Type 1 Diabetes Eats Low-Carb

Dr. Ryan Attar was diagnosed with type 1 diabetes a decade ago while serving as a captain in the U.S. Army. After his diagnosis, he received a medical discharge. medically discharged. He made the most of his unexpected career change by getting a doctorate in naturopathic medicine and a master's degree in nutrition. Dr. Attar opened his practice in 2019.

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There is a small population of people with type 1 diabetes who follow the very low-carb diet Dr. Richard Bernstein recommends as a way purpose of “normalizing” their blood sugar levels. Dr. Attar shadowed Dr. Bernstein at his office and wrote about his three days with Richard Bernstein on Diabetes Daily. You can read the article here.

 

According to his C-Peptide tests, Dr. Attar makes no insulin endogenously, and yet his A1c level is consistently normal—in the high 4s. He points to his low-carb diet. Recently, Dr. Attar answered my questions about his nutrition plan.

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DD: Why do you follow a low-carb diet?

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RA: I want to live complication-free. The complications of diabetes all stem from the damage that occurs during hyperglycemia.  A normal, healthy, insulin-sensitive person is almost always between 80 to 99 mg/dL. Many people with diabetes regularly spike above 120 after meals. Damage from elevated blood sugars happens at lower levels than most think. Link linked nowhere.

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DD: How many grams of carbohydrates per day do you eat?

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RA: I don’t count carbs because I just try to avoid them altogether, but 30 grams or lower. Protein is always the bulk of my meals. I also eat lots of non-starchy vegetables to ensure I have all the nutrients I need, such as Vitamin C. For example, a serving of cauliflower has the same amount of vitamin C as an orange. Additionally, Vitamin C uses glucose transporters to enter cells and glucose is competitive with vitamin C. So ultimately, you get less Vitamin C from the orange.

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I’ve found there is almost no recipe that can’t be low-carb. I make a delicious pizza with almond or coconut flour crust, cheese, and ground chicken. And it doesn’t “spike” me. A great resource for low-carb recipes is the Type One Grit Pinterest page. You’ll find a community of people with diabetes or families with a child with diabetes here all of whom follow low-carb diets.

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DD: Do you think physicians should recommend this way of eating to their diabetic patients?

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RA: Absolutely!  Sadly, most physicians, even endocrinologists who see many people with diabetes don’t. Most doctors are still stuck in the old low-fat, high-carb paradigm. Physicians who keep up with the latest research and see the outcomes of a low-carb diet understand the benefits. Many see my A1c and equate a low A1c to hypoglycemia, but this is just not the case. When you eat low-carb, you use very small doses of insulin and have very shallow spikes. Even moderate amounts of carbs are difficult to properly cover with insulin resulting in a spike either up or down after meals. Bernstein stresses this with his “Law of Small Numbers,” small inputs (of insulin and carbs) equal small mistakes; large inputs lead to large mistakes. Once physicians understand this, they are usually on board with low-carb diets.

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DD: Do you use a pump or CGM?

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RA: I do use a CGM, and I love it. I think everyone with diabetes should wear one. They’re not perfect, and finger sticks are sometimes needed to verify the numbers, but the technology is getting better and better.

 

DD: Why do you think some people don’t follow or know about low-carb eating for diabetes?

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RA: Their physicians and dieticians don’t know about the option. High-carb foods are also very addictive. But once someone weans themselves from the habit and starts feeling better without the roller-coaster of rising and falling blood sugars, they do great with the diet. Lately, low-carb eating is becoming popular for non-diabetics, which is terrific. Almost everyone can realize the health benefits of low-carb, especially because it’s easy to maintain a lean weight.

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DD: What do you think of the ADA’s recommendation of an A1c below 7% for people with diabetes?

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RA: It's far too high! We should shoot for non-diabetic blood sugars and A1cs. Someone with an A1c of 7% means their average blood sugars are between 123 to 185 mg/dL. Even an A1c of 7% is an average of 154 mg/dL. These numbers are well into the range where tissues and organs are damaged by glycation, which is the root of all diabetic complications. Here’s a chart that translates A1c into blood sugar levels.

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DD: Is low-carb eating challenging for you?

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RA: Not at all. I love the food I eat! For example, for breakfast today I had a veggie omelet. Lunch was a chipotle chorizo salad (hold the rice and beans), and dinner will be salmon, steamed veggies with butter, and cauliflower “rice.” Delicious, healthy food and my numbers will be in the 80s all day. With each meal, I take small doses of R Insulin (an older, gentler insulin that covers protein perfectly).

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DD: Anything else you’d like to say including reasons for or against low-carb eating that you’ve heard from others?

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RA: For anyone who wants to adopt a low-carb lifestyle, I’d recommend joining a supportive community like Type One Grit on Pinterest or Facebook. 

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DD: And I recommend calling you for a 20-minute complimentary consultation: (203) 307-5291

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