T1D Nutrition and Low CarbMD: Revolutionizing T1D Care: The Benefits of Therapeutic Carbohydrate Reduction with Beth McNally and Dr. Tro Kalayjian

The journey of managing Type 1 Diabetes (T1D) is fraught with challenges, both for individuals living with the condition and their families. This was the central focus of a recent episode of the Low CarbMD podcast featuring Beth McNally, MS, MA, CNS®, LDN, CKNS®, a leading global advocate and expert in T1D management, and Dr. Tro Kalayjian. Together, they explored how Therapeutic Carbohydrate Reduction (TCR) has transformed T1D care and highlighted the significant breakthroughs in this space, including the publication of two groundbreaking documents: the IPTN’s Therapeutic Carbohydrate Reduction in Type 1 Diabetes: A Guide for Dietitians and Nutritionists, and the Society of Metabolic Health Practitioners (SMHP) Position Statement on Therapeutic Carbohydrate Reduction in Type 1 Diabetes.

This blog delves into the powerful insights shared during the episode and offers a comprehensive exploration of the transformative potential of TCR in T1D care.

The Turning Point: A Mother’s Journey to Revolutionizing T1D Care

Beth McNally’s journey into T1D advocacy began on September 7, 2015—a date etched in her memory as the day her nine-year-old son, Lachlan, was diagnosed with T1D. Like many parents, she and her husband faced a steep learning curve as they grappled with the implications of their son’s diagnosis. Initially, they followed conventional dietary and insulin-management strategies, which led to fluctuating blood glucose levels and constant stress.

“The first two months were a roller coaster,” Beth recounted during the podcast. Desperate for a solution, her husband discovered a YouTube video by Dr. Troy Stapleton, an Australian radiologist diagnosed with T1D, who shared his success with a low-carbohydrate diet. Inspired by Dr. Stapleton’s experience, Beth and her husband decided to implement TCR for their son.

“It was like magic,” Beth said, describing the dramatic stabilization in Lachlan’s blood sugar levels. This marked the beginning of a transformative journey that would eventually lead Beth to become one of the most influential voices in the T1D community.

Why Every T1D Patient Should Know About Therapeutic Carbohydrate Reduction

TCR is a dietary approach that focuses on reducing carbohydrate intake to minimize blood sugar spikes and stabilize insulin requirements. For individuals with T1D, whose bodies cannot produce insulin, managing blood glucose levels is a critical component of care. Conventional medical advice for the management of Type 1 diabetes typically involves high-carb diets which often necessitate large insulin doses, which leads to blood glucose variability and unpredictability due to the inherent instability of exogenous insulin increasing the risk of both hyperglycemia and hypoglycemia, resulting in the blood glucose roller coaster.

Beth emphasized during the podcast that TCR isn’t just a dietary option—it’s a tool that can fundamentally improve quality of life for T1D patients. By lowering carbohydrate intake, you decrease the spike in blood glucose levels as a result, and require a smaller dose of insulin, leading those diagnosed with Type 1 diabetes to experience more stable blood glucose levels, fewer episodes of hypoglycemia, and reduced risk of long-term complications.

“We’re not saying everyone has to adopt this approach, but everyone deserves to know it’s an option,” Beth explained. Empowering patients with knowledge is at the heart of her advocacy and her clinical practice.

The Lived Experience: Understanding the Burden of T1D

Dr. Tro and Beth dedicated significant time during the podcast to unpacking the psychological and physical toll of T1D on patients and families. Beth described the fear and exhaustion that accompany constant blood sugar monitoring and insulin dosing, particularly for parents of young children with T1D.

“It’s a 24/7 job,” she said. “You’re watching the continuous glucose monitor (CGM) all day, worrying about highs and lows, and constantly texting your child to ensure they’re safe.”

The unpredictability of blood sugar levels not only affects physical health but also emotional well-being. Prior to adopting TCR to help manage her son's Type 1 diabetes, Beth shared how high blood sugar would make Lachlan moody and irritable, while low blood sugar episodes induced panic and fear.

For Beth, the adoption of TCR brought relief from this relentless cycle. By stabilizing blood sugar levels, TCR reduced the psychological burden on both her and Lachlan, allowing them to focus on living life rather than merely managing the condition.

Transformative Breakthroughs in the T1D Community

The past year has been a watershed moment for the T1D community, marked by groundbreaking advancements in TCR advocacy and education:

1. Low CarbUSA Boca Raton Symposium

In January 2024, the Low Carb USA Boca Raton Symposium dedicated an entire day to the application of TCR in T1D management. This event brought together leading experts, including Dr. Ian Lake and Dr. Suzanne Schneider, Allison Herschede, and Beth herself, to share cutting-edge research and practical strategies. For many attendees, including healthcare professionals, the symposium was a revelation, offering insights that challenged conventional approaches.

The entire Type 1 diabetes workshop is available via the Low Carb USA YouTube Channel: https://www.youtube.com/playlist?list=PLZubf5aqlDTJxfV_zOycm55uRUCNqycw6

2. IPTN’s TCR Guide for Dietitians and Nutritionists

On World Diabetes Day 2024, the Institute for Personalized Therapeutic Nutrition (IPTN) released the Therapeutic Carbohydrate Reduction in Type 1 Diabetes: A Guide for Dietitians and Nutritionists. This comprehensive guide provides evidence-based strategies for implementing TCR safely and effectively. Written by a multidisciplinary team, including team leader Beth, the guide addresses common concerns about insulin management and nutrient intake, making it an invaluable resource for healthcare providers.

Therapeutic Carbohydrate Reduction in Type 1 Diabetes: A Guide for Dietitians and Nutritionists: https://www.therapeuticnutrition.org/tcr-type-1-diabetes-guide

3. SMHP’s Position Statement on TCR in T1D

In December 2024, the SMHP published its Position Statement on Therapeutic Carbohydrate Reduction in Type 1 Diabetes, a landmark document advocating for TCR as a standard option in T1D care. Dr. Tro praised the statement’s impact, emphasizing that it empowers patients to demand better care and equips clinicians with the knowledge to support TCR safely.

The SMHP™ position statement on therapeutic carbohydrate reduction for type 1 diabetes: https://journalofmetabolichealth.org/index.php/jmh/article/view/100

Behind the Scenes: The Creation of Two Landmark Documents

Beth shared the immense effort that went into producing the IPTN guide and the SMHP position statement. Both documents were the culmination of years of research, collaboration, and advocacy by dedicated volunteers.

“These papers represent a decade of work,” Beth said. She recounted the challenges of coordinating diverse teams, balancing differing perspectives, and ensuring the final products were accessible and actionable.

The impact of these documents has been profound. The IPTN guide has been downloaded over 6,000 times, with translations underway in multiple languages. The SMHP position statement has garnered significant attention, providing a critical counterpoint to outdated guidelines and biases against low-carb diets.

The Role of Community in Driving Change

One of the most inspiring themes of the podcast was the power of community in advancing T1D care. Beth credited organizations like Low Carb USA, the SMHP, and the IPTN for creating platforms where patients, caregivers, and healthcare professionals can come together to share knowledge and advocate for change.

Beth also highlighted the role of grassroots movements, such as the TypeOneGrit Facebook group, which connects families navigating T1D with TCR. “When you find your community, you find strength,” she said.

Overcoming Barriers to TCR Adoption

Despite its benefits, TCR faces resistance from some corners of the healthcare community. Dr. Tro expressed frustration at the reluctance of organizations like the American Diabetes Association (ADA) to embrace TCR, describing it as a failure to prioritize patient well-being.

“How do they not get embarrassed?” Dr. Tro asked, pointing to research demonstrating the effectiveness of TCR in achieving normal HbA1c levels and reducing complications.

Beth acknowledged these challenges but remained optimistic. She urged patients to take the initiative by educating themselves and advocating for TCR with their healthcare providers. “If the system won’t change, we’ll change it from the ground up,” she said.

A Vision for the Future

The podcast concluded with a call to action for patients, caregivers, and clinicians to embrace TCR as a viable option in T1D care. Beth and Dr. Tro emphasized the need for continued advocacy, education, and research to ensure that every T1D patient has access to tools that can improve their quality of life.

“We must not settle for the status quo,” Beth declared. “Every person with T1D deserves the opportunity to thrive, not just survive.”

Conclusion

The conversation between Beth McNally and Dr. Tro Kalayjian underscores the transformative potential of Therapeutic Carbohydrate Reduction in T1D care. From stabilizing blood glucose levels to reducing psychological stress, TCR offers a pathway to better health and a brighter future for individuals with T1D.

With groundbreaking resources like the IPTN guide and SMHP position statement now available, the T1D community is better equipped than ever to challenge outdated paradigms and advocate for change. By empowering patients and clinicians with evidence-based tools, we can revolutionize T1D care and create a world where every individual with T1D has the chance to thrive.

For more information, visit T1D Nutrition and explore the resources offered by Low Carb USA and the Society of Metabolic Health Practitioners.