Low-Carb Diets and Diabetes Management

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It might be logical to assume that reducing carbohydrate in the diet would be helpful in a disorder where the body has trouble processing it. Indeed, many people with diabetes find that this is the case, and some doctors are having great success using low-carbohydrate diets to treat diabetes.

There have been times in the history of the American Diabetes Association (ADA) when the organization discouraged people with diabetes from following a low-carb approach to weight loss and blood glucose management. However, this stance has changed and low-carb eating is now considered to be one of the options open to people with diabetes and prediabetes.

Here is what the American Diabetes Association says about low-carb diets and diabetes in their 2017 standards, "A variety of eating patterns are acceptable for the management of type 2 diabetes and prediabetes including Mediterranean, DASH, and plant-based diets. Carbohydrate intake from whole grains, vegetables, fruits, legumes, and dairy products, with an emphasis on foods higher in fiber and lower in glycemic load, should be advised over other sources, especially those containing sugars."

Weight Loss

Weight loss targeting more than 5 percent of body weight is recommended for all who are overweight or obese if they have diabetes or are at high risk for it and a sustained weight loss of 7 percent or more is optimal. This amount of weight reduction has been shown both to help prevent diabetes and to improve the outlook for those who have diabetes.

The American Diabetes Association's "Standards of Medical Care in Diabetes—2017" says "Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss."

Metabolic surgery is also an option for adults who are obese with a BMI of 40 or more and in those with a BMI in lower ranges who have inadequately controlled hyperglycemia. The other weight loss recommendation is that "Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss." A minimum of 150 minutes of moderate-to-vigorous physical activity per week is recommended. The 2017 guidelines added a recommendation to reduce sedentary behavior and to get up and move around every 30 minutes, and two to three sessions per week of resistance training. 

Nutrition and Lifestyle Management

The ADA recommendations on the role of diet in diabetes management include:

  • The mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes.
  • Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control.
  • For good health, carbohydrate intake from vegetables, fruits, whole grains, legumes, and dairy products should be advised over intake from other carbohydrate sources, especially those that contain added fats, sugars, or sodium.
  • People with diabetes should follow the guidelines for the general population for the recommended intakes of saturated fat, dietary cholesterol, and trans fat. Intake of trans fat should be minimized.

No Single Endorsed Diet Approach

There is no standard ADA diet. Many diabetes educators and health care professionals have their own approaches that are not low-carb diets. But the ADA guidelines indicate that a low-carb approach is completely within their recommendations. With carbohydrate monitoring as a "key strategy" for managing diabetes, if a person finds that a low carb diet is optimal for regulating their blood glucose, it could be the individualized approach that works for them.

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