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Managing type 2 diabetes with a low-carbohydrate diet

Simply Good Foods
April 21, 2021
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A low-carb diet may be a popular weight-loss method, but it’s also a well-established way to manage type 2 diabetes. In fact, carb restriction, in conjunction with moderate protein and healthy fats, has been used since the 1700s to manage the condition, although it has received less attention since the proliferation of insulin treatment.1

Management of type 2 diabetes is a critical public health imperative, as it accounts for up to 95% of cases of diabetes — a disease responsible for 11% of deaths each year. Although risk factors such as family history, age and race can play a role in developing type 2 diabetes, obesity is the most common predictor.2 A physician may choose to treat diabetes through medication management, but a dietary approach can also help control the condition at a lower cost — and it might even push patients into remission.

A recent meta-analysis in The BMJ suggests that patients who kept a low-carb diet for six months were more likely to experience remission than other people with type 2 diabetes.2 Type 2 diabetes develops when cells become insulin-resistant and high levels of sugar build up in the blood, causing hyperglycemia.3 Because carbohydrates are mostly absorbed as glucose or fructose, limiting their intake helps with blood glucose control.2

This type of eating plan typically emphasizes non-starchy vegetables, such as spinach and cauliflower, as well as protein such as poultry, fish, eggs, meat, and nuts. It also focuses on fat consumption with butter, olive oil and full-fat dairy products, while restricting grains or starches, high glycemic fruits and high-carbohydrate dairy products such as milk or added-sugar yogurt.4

In addition to achieving diabetes remission, the BMJ meta-analysis—which reviewed 23 studies involving more than 1,300 participants—found that low-carb diets led to weight loss, reduced medication usage and improved triglyceride concentrations at six months.2

Participants in the studies examined by the meta-analysis followed varying degrees of low-carbohydrate diets, with carbs making up:

  • less than 10% of a 2,000-calories-per-day diet (< 50 grams per day), often referred to as “ketogenic;”
  • less than 26% of a 2,000-calorie diet (130 grams).

While the review specifically looked at diets containing less than 130 grams of carbohydrates per day, one study, published in Frontiers of Endocrinology, found that ketogenic diets had a beneficial outcome on glycemic control and weight.5 Popular low-carb plans, such as the Atkins Diet, also promote varying levels of carb restriction that can offer benefits for patients with diabetes.

Specifically, low-carbohydrate and very-low carbohydrate diets have been found to reduce A1C and the need for antihyperglycemic medications in people with type 2 diabetes.6

Health care providers can help their patients manage type 2 diabetes by providing information and resources on low-carbohydrate diets. Recommending specific low-carbohydrate products to patients can help with adherence to a healthy eating plan. Patients may also benefit from nutrition counseling with a registered dietitian. With the right diet and medical support, patients can more effectively manage their condition to live a happier, healthier life.

References:

1. Lennerz, Belinda S., et al (2021). Carbohydrate Restriction for Diabetes: Rediscovering Centuries-Old Wisdom. The Journal of Clinical Investigation. Available at https://www.jci.org/articles/view/142246/pdf.

2. Goldenberg, Joshua z., et al (2021). Efficacy and Safety of Low and Very Low Carbohydrate Diets for Type 2 Diabetes Remission: Systematic Review and Meta-Analysis of Published and Unpublished Randomized Trial Data. Available at https://www.bmj.com/content/372/bmj.m4743.

3. Type 2 Diabetes. U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/article/000313.htm.

4. Cucuzzella, Mark, et al. (2019) A Clinician’s Guide to Inpatient Low Carbohydrate Diets for Remission of Type 2 Diabetes: Toward a Standard of Care Protocol. Diabetes Management. Available at https://www.hsc.wvu.edu/media/14874/lc-pathway-paper-diab-mngt-2019.pdf.

5. Athinarayanan, Saminie J., et al. (2019) Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial. Available at https://pubmed.ncbi.nlm.nih.gov/31231311.

6. Facilitating behavior change and well-being to improve health outcomes: Standards of medical care in diabetes — 2021. American Diabetes Association. Diabetes Care 2021 Jan; 44(Supplement 1): S53-S72. https://doi.org/10.2337/dc21-S005