I’m working on an aging & longevity post and I found this article on low-carb diets finally being recommended for type 2 diabetes.
At first I was excited that FINALLY the diabetes associations of Canada & the US were finally acknowledging what many of us have known for years, that a low-carb diet is the best choice for managing diabetes & that the “eat what you want & medicate accordingly” model should be defunct! However, my excitement dwindled when I see the names of the co-authors. Not because I feel that this research is any less valid, quite the contrary, this group of researchers are, in my humble opinion the leaders in low-carb research & their recommendations should be taken quite seriously. I was just disappointed because I realized that my profession is still lagging behind the research by about 20 years and that there is still a lot of fighting & representing of this worthy cause left to do. It’s extremely FRUSTRATING!
Anyway, let’s take a quick look at the study!
Essentially, it was a review of the current state of the literature on low-carb diets and the authors conclude with very nicely summarized 12 points of evidence for the use of low-carb diets as the first approach to treating type 2 diabetes and as the most effective adjunct to medications in type 1.
The 12 points are well written & researched thoroughly. The authors do a great job laying out the evidence for each point & subsequently explaining them in the discussion section., so I’m not going to redo that. However, I’ve re-written the 12 points below & added a quick personal comment to each.
1) Hyperglycemia is the most salient feature of diabetes. Dietary carbohydrate restriction has the greatest effects on decreasing blood glucose levels.
2) During the epidemics of obesity & type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrate.
3) Benefits of dietary carbohydrate restriction do not require weight loss.
4) Although weight loss is not required for benefit, no dietary intervention is better than carbohydrate restriction for weight loss.
5) Adherence to low-carbohydrate diets in people with type 2 diabetes is at least as good asa adherence to any other dietary intervention & is frequently significantly better.
6) Replacement of carbohydrate with protein is generally beneficial.
7) Dietary total & saturated fat do not correlate with risk of CVD.
8) Plasma saturated fatty acids are controlled by dietary carbohydrate more than by dietary lipids.
9) The best predictor of micro-vascular &, to a lesser extent, macro-vascular complications in patients with type 2 diabetes, is glycemic control (HbA1c).
10) Dietary carbohydrate restriction is the most effective method (other than starvation) of reducing serum triglycerides & increasing high-density lipoprotein (HDL).
11) Patients with type 2 Diabetes on carbohydrate-restricted diets reduce & frequently eliminate medication. People with type 1 usually require lower insulin amounts.
12) Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacological treatment.
These points are laid out and quite self-explanatory. As I mentioned, the authors do a great job laying out the evidence for each & explaining them in their discussion section.
All that I can add is that in my experience counselling clients on weight management (more to the point fat management) in diabetes (both type 2 and type 1, but most commonly type 2) I’ve seen hundreds of people with diabetes who have been better able to control their blood sugars (both with & without meds) using a low-carb approach.
Furthermore, whenever clients had excess fat to lose, especially in the abdominal (visceral) region then even more benefits were observed, especially improving the criteria for diagnosis for metabolic syndrome including reducing body weight (by BMI – don’t get me started on this), reducing waist circumference, reducing blood pressure, increasing HDL cholesterol levels, reducing triglyceride levels and improving blood sugar regulation.
Importantly, the benefits I mentioned above were seen, not necessarily on a full blown ketogenic approach (20-50 g carbs/day), but simply on a low carbohydrate diet (less than 130 g/day). This further supports the suggestion that we evolved to consume less carbohydrates than we currently are and that this increase in carbohydrate consumption due to abundance of refined carbs is likely contributing to the overweight/obesity & metabolic dysregulation epidemic that we are currently facing.
Gary Taubes has been talking about this for over a decade & with the increasing popularity of the paleo diet over the last 5 years and the recent success of the book Grain Brain by Dr. Perlmutter, a lower carbohydrate approach is becoming more prevalent in the popular media. Recently, even Dr. Oz has started to reverse his position on this topic, as can be witnessed by his new dietary advice for the 2-week diet, which starts to resemble a low-carb paleo diet (with a few exceptions), ostensibly even Dr. Oz has to bend in the face of overwhelmingly positive evidence.
If you have diabetes, I implore you to print this article out & take it to your health professional & discuss a low-carbohydrate strategy that you are willing to try and then see how you do. Be sure to include your health professional so that a) they can help you adjust medications (i.e. wean down) properly to decrease your risk of encountering problems & b) they become more aware that this is a good first option for treatment of diabetes.
If you are a health professional reading this, as I am writing it, then I implore you to research this topic fully so that you see how valid it is as a treatment & prevention option and furthermore, that you become comfortable teaching your clients how to do it safely & effectively!
I hope you enjoy this post. More coming in the near future.
Have an awesome day!