October 12, 2021
Monu Khanna, MD,
Over the past few years, there has been a lot of interest in carbohydrate restriction or so called ‘low carbohydrate’ (or ‘low carb’) strategies for specific conditions and populations. Theoretically it makes sense, specially in the context of diabetes which simply put is the intolerance of carbohydrates. So if diabetes refers to one’s inability to manage the glucose load, either due to lack of insulin as in Type 1 diabetics, or Insulin resistance in Type 2 diabetics, it only makes sense to have improvement in sugar levels while restricting carbohydrate intake.
The science of ‘low carb’ diets is based on the carbohydrate -insulin model . Most patients with Type 2 diabetes have insulin resistance and hyperinsulinemia. In a simplistic view that would mean those affected are unable to adequately control their blood sugars because the load of carbohydrates in their diet is in excess of what their body’s insulin level can handle. Hence, they need additional insulin in the form of shots or other medications which help to bring down their sugars. With a ‘low carb’ diet, our goal is to intentionally decrease the burden on the pancreas, which secretes the insulin and eventually leads to improvement in diabetes.
Over the past few years a substantial body of evidence has emerged through various health systems, and it is now evident that a lower carb approach is emerging as a clear winner for diabetes treatment . This does not mean that other diets don’t work; it just means that a ‘low carb’ lifestyle is backed by evidence and hence makes the most sense for our diabetic patients. Most patients with diabetes find this plan much easier to stick to, and it eventually becomes a lifestyle they can adopt and maintain for the rest of their life.
As of April 2019 , even the American Diabetes Association (ADA) published a new Consensus Report: “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia (blood sugar) and may be applied in a variety of eating patterns that meet individual needs and preferences”.
The term ‘low carb’ diets is often used loosely to signify a lesser amount of carbohydrates than what we usually eat in a Standard American Diet (SAD). But generally speaking, it could range anywhere from 20-100 grams of carbohydrates, depending on how strict you need to be . This is not nearly as difficult as it may sound, and here are some simple strategies to help you get started.
Step 1: Elimination
A good place to start will be to try and discard all ultra processed foods around you such as: good old candy, chips, ice cream, cakes, pastries, donuts, jellos, puddings, and even the sweetened yogurts. And yes, the sweetened beverages too, don’t let the empty calories hold you back!
Step 2: Inclusion
Lets bring in the good stuff – filling our plates with the non-starchy vegetables, good quality protein (animal or vegetarian), natural fats, whole fat dairy, seeds, and nuts. Use fruits such as avocados and berries in your smoothies or try some coconut milk for a change
Step 3: Keep Distance / What to Avoid
Stay away from the ‘junk’ or ‘low carb’ versions of cookies and shakes available on the internet. Focus on eating real whole food and don’t fall for the glorified energy bars, which are literally just candy in hiding. You will be surprised how most of them have a high carbohydrate content and hidden sugars. Eat sensibly and try to avoid products sold in the name of packaged food. Remember the saying: if it was not around in your grandma’s time, it probably is not real food.
Step 4: Assess and Recalibrate
Once you have started to focus on real foods and gotten rid of the unhealthy carbohydrates, do a quick self check. Have you noticed anything different, be it good or bad? If all is going well, are you prepared to take it to the next step? This could mean eliminating the refined grains from the diet: white bread, white rice, tortillas, instant oatmeal, pancakes etc. Listen to the cues and always respect your body.
Step 5: Sit Back and Enjoy the Benefits
Did you notice the weight loss and the inches you lost at your waist? Your sugars will get better and you will need lesser amounts of insulin and other medications. A lot of people notice improved mood, better concentration, sleep and energy levels, lesser joint pain. Does your skin look better, is the acne clearing up? Interestingly, a lot of diabetic patients also notice that they don’t feel as hungry and are able to break away from the cycle of incessant cravings and snacking. And that’s not it, long term compliance with a lower carb diet can lead to reversal of prediabetes and even prevent diabetes. You can actually reverse your diabetes and keep it that way. The list does not stop there, research has shown that with a ‘low carb’ diet you significantly lower your risk factors for heart disease, liver dysfunction, and certain cancers.
Step 6: Caution
Most people can easily adopt a ‘low carb’ lifestyle, and if you have diabetes you will see quick results. The amount of diabetes medications you take is tailored to your current eating habits, so if you adopt a ‘low carb’ lifestyle please let your medical provider know right away. That is important because you will need quick modification of your medications, the ones that affect your blood pressure and sugars.
- The carbohydrate-insulin model: a physiological perspective on the obesity pandemic | The American Journal of Clinical Nutrition | Oxford Academic (oup.com)
- JMIR Diabetes – A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- Clinical Guidelines – Society of Metabolic Health Practitioners (thesmhp.org)
- A Low-Carb Diet for Beginners – Diet Doctor